DDX3X
Advice, resources and practical strategies for parents and carers of children and young people with DDX3X
SENSORY INTEGRATION
Sensory integration is a term that refers to processes in the brain that allow us to take the information we receive from our senses, organise the information and respond appropriately to be able to carry out daily living activities. Some children have problems processing sensory information, which means that the sensory messages go into the brain but are not organised into appropriate responses. These difficulties can result in fight, flight or freeze responses. Furthermore, children with sensory processing issues experience functional challenges with activities of daily living and difficulties with participation in everyday home and school life. A strong sensory foundation is really important as daily living skills, learning, behaviour and communication all grow from it.
One aspect of sensory integration is sensory reactivity, which is the ability to filter out unwanted sensation from any sensory system (e.g. certain noises) and be able to continue to function in daily life, in a calm and organised manner. We are bombarded with sensory sensation throughout the day and we are designed to not always be aware of some sensation. If we were continually aware of every single sensation without the capacity to filter out anything unneeded, our nervous systems would be overwhelmed (over responsive). Equally if we were not able to pick up sufficient clues from sensory sensation within our environments our nervous systems would not have enough input in order to respond (under responsive) and we may be seeking to additional sensory input. Both these problems are termed reactivity difficulties.
Another aspect of sensory integration is sensory perception. If we have difficulties making sense of sensory information and organising it in our brains, then we can either struggle with activities or find them effortful and fatiguing. Activities people sometimes struggle with include sitting to write, using a knife and fork together, catching a ball, using scissors and tying shoelaces.
In school we are usually taught that we have 5 senses, however, we actually have 8! Below is an introduction to these senses. If you believe your child has difficulties in these areas then you may benefit from support from an occupational therapist who has training in sensory integration. Please click here to find an occupational therapist in your area.
The tactile system
The tactile system is the largest sensory system and is highly complex. It plays a role in how we experience different forms of touch (light, firm, vibration, texture etc) but also pain and body temperature. Temple Grandin (autistic author, speaker and academic) says:
“Imagine trying to pay attention in a classroom… but you can’t, because the tags on your sweater feel like sandpaper scratching your neck… the seams on your socks feel like someone digging their fingernails into your feet... the routine jostling from a peer feels like someone punching your arm. How can you possibly concentrate?”
It is important to understand that tactile over-responsivity isn't simply 'discomfort'; for many children it is experienced as real pain. Many children will have difficulties with tactile activities such as tooth brushing, haircutting and nail cutting. A key strategy to dampen down over responsivity to tactile input is ensuring the child engages in lots of activities that involve proprioceptive input (muscle resistance activities). For example before an activity such as a hair cut, you could encourage your child to do some star jumps or bounce on a trampoline or therapy ball, then whilst they are getting their haircut you can encourage them to chew or suck something (giving them calming muscle resistance to the mouth and jaw) and after the activity, if they like tight hugs this can help them calm down.
Other children can be under-responsive to tactile input and they may engage in seeking behaviours such as getting involved in anything messy, touching everything in sight and perhaps even biting or pulling at their own skin or hair. These children need lots of extra tactile input to feel good in their bodies. Have a look at recommended sensory equipment by clicking here.
The vestibular system
The vestibular system plays a role in our balance, spatial orientation, coordination of our eye control and head movement, posture, motion perception and more!
Some children are over responsive to vestibular input. They get dizzy easily and may be fearful of movement and balance activities. They may have difficulty tipping their head back for example when you are washing their hair, they may get car sick and they may dislike it when their feet leave the ground for example on a swing.
Other children are seeking to vestibular input. They can't sit still, are always on the go and love movement activities. There are some sensory movement equipment suggestions on this page.
The proprioceptive system
The receptors for our proprioceptive system are located in the joints and muscles. This sensory system allows us to know where our body parts are without looking at them, it aids motor planning and coordinating movements, it helps the brain regulate arousal states (helping us feel calm, alert etc) and it helps inhibit other sensations by having a dampening down effect. It is such a powerful sense and we would all benefit from more proprioceptive activity! Hanna's YouTube channel has lots of sensory activity demonstrations on it and most of these involve proprioception. Activities in daily life that involve proprioception are activities such as climbing, jumping, swimming, bike riding, carrying things, pushing and pulling things.
The auditory system
Auditory sensitivity and auditory processing are two key aspects of our ability to perceive and interpret sounds. These processes are essential for our ability to communicate, navigate our environment, and enjoy music and other auditory experiences.
Auditory sensitivity refers to our ability to detect and perceive sounds. It encompasses our capacity to hear a wide range of sound frequencies and detect sounds at varying levels of intensity. Several factors influence auditory sensitivity including frequency range, intensity and auditory thresholds. It is common for children with sensory processing difficulties to be over responsive to auditory input; they have a low auditory threshold.
Auditory processing involves the brain's ability to make sense of the sounds we perceive. It includes a series of complex cognitive and neurological processes that allow us to discriminate sounds, localise sounds, remember sounds, comprehend/make sense of sounds and integrate sounds from both ears.
Auditory processing disorders can occur when there are difficulties in these processes and they can affect an individual's ability to understand spoken language, follow instructions, or process complex auditory information. It is important to recognise whether a child is simply over/under responsive to auditory input or whether they have an auditory processing disorder that may require input from an audiologist.
In terms of strategies, traditional ear defenders can be useful for children to wear at school and in shops/busy places etc. A popular make to search for is 'Silverline' and these are usually around £15. For a more discreet in ear option Loop do a range of options depending on the level of noise sensitivity. Usually it is recommended to take ear defenders or ear plugs on and off throughout the day, only wearing them when noise increases e.g. busy class time and assembly, otherwise children can find it even harder to tolerate noise.
The visual system
The visual sensory system is a complex biological system that allows us to perceive and interpret the world around us through the sense of sight. It is a critical aspect of our sensory perception and provides us with information about the shape, colour, distance, movement, and depth of objects in our environment.
Heightened sensitivity to visual stimuli can lead to discomfort, anxiety and sometimes sensory overload. Some key strategies are:
- Work out what type of lighting is difficult for the child and turning lights off or down if possible. Dimmer switches and using blinds can be helpful.
- Wearing polarized sunglasses or tinted lenses work for some children. Or wearing a cap or wide brimmed hat.
- Adjust brightness levels on screens.
- Keep walls and decor plain and minimal.
- Understand that visually stimulating environments such as shops and school can be a lot to tolerate and the child may need a low stimuli break afterwards and some regulating vestibular, deep tactile and/or proprioceptive activity to regulate.
Some children seek additional visual input to feel good in their bodies. You can get toys that spin and flash that can be stimulating for them. Combining visual input with vestibular input can enhance their experience, for example giving your child a colourful ribbon on a stick that they run around with or having something stimulating to look at whilst bouncing on a trampoline. Children who seek visual input can often get distracted as they are constantly scanning the environment for more input. At school it is about getting the balance right - giving the child the visual input they need but also limiting distractions when they need to focus on a piece of work.
Occupational therapists consider whether a child's visual processing is a barrier to them learning in school and to playing and participating in home life. Visual processing difficulties can affect reading, writing, comprehension, spelling, note taking, maths, problem solving and hand eye coordination. Of all the systems, the visual system is the most crucial for learning as 80% of learning occurs through the visual system.
The olfactory system
Also known as the sense of smell, this is the sensory system responsible for detecting and processing odours or scents in the environment. Some children can be over responsive to smell and find the school environment difficult as there are so many different smells in the various rooms of a school. Toilets are particularly difficult places to visit if you are over responsive to smell and some children who are sensitive will try to avoid the toilet which can lead to accidents or constipation difficulties. The smell of school lunch and the dinner hall can be a significant issue and this can impact on a child's willingness to eat.
One of the main strategies for over responsivity to smell is to find a scent that the child does like and to make sure they always have access to that smell, especially when in a room where they find the smell difficult tolerate. Please follow precautions if you use essential oils and do not place them directly onto skin. You can buy refillable essential oil inhalers. Another key strategy is ensuring good ventilation and at school the child might need to sit by an open window. If the difficulty is severe then the child might need to eat lunch in a classroom rather than in the dinner hall.
For many children their over responsivity to smell does not prevent them doing things but it does add to the demands of school. All sensory sensitivities no matter how small do add up and then this takes away spoons from the child (learn about spoon theory here).
The gustatory system
The gustatory system, commonly referred to as the sense of taste, is the sensory system responsible for detecting and interpreting the chemical properties of substances we put in our mouths. It plays a crucial role in our ability to perceive different flavours and it is closely linked with the sense of smell, playing a central role in our enjoyment of food and our dietary choices.
When children have difficulties with eating it can be due to taste but more often than not, it is in fact a difficulty with the tactile system. If your child dislikes strong flavours they are likely over responsive to taste and if they have difficulty telling the difference between flavours they are likely under responsive. If however, they struggle with different textures it is probably a tactile processing difficulty. Foods like spaghetti bolognaise that include a mixture of textures in the same mouthful can be particularly challenging for children with tactile processing difficulties.
For more information on difficulties related to eating, including helpful strategies, please click here.
The interoceptive system
Interoception is the ability to sense and perceive the internal physiological signals and sensations of the body. It involves being aware of bodily sensations related to functions like heartbeat, respiration, digestion, temperature regulation, pain, tiredness, emotions and more. Essentially, interoception allows us to sense what's happening inside of our bodies and to recognise and interpret these sensations. We then take action based on these signals.
Kelly Mahler is an American occupational therapist who offers a wide range of helpful information and resources related to interoception. You can click here to visit her website.