Case Study: Sensory Integration Dysfunction Underlying Most Learning Disabilities


Stephen was a bright but severely learning-disabled child growing up in the 1960’s. Stephen was blessed with a mother who was a special education teacher determined to find the best resources available for him at that time. He was delayed in developing fine motor skills for using scissors, pencil tasks, or building with Lego-type™ blocks. His gross motor skills for ball play, riding a bicycle, swimming, climbing ladders on playground equipment or swinging on monkey bars were also affected. Reading and writing were laboriously acquired through attending Scottish Rite’s Dean Learning Center with their Alphabetic Phonics strategy. As an adult, Stephen, through much courage and perseverance with supportive academic modifications, graduated from a state university with a bachelor’s degree and went on to acquiring a master’s level degree from a private seminary. As an adult, his job required supportive skills of learning a second language, multi-tasking, and basic gross motor coordination and balance skills, which he found extremely challenging. It was dealing with these secondary job requirements that brought him to language therapy for memory processing and recall where his severe deficits in sensory integration and motor planning were identified. The roots of his earlier learning difficulties and current life-skill obstacles were found to lie in the processing areas of auditory-visual memory, visual-motor coordination, motor planning, picking out the important message from a background of noise or visual field, balance, spatial awareness and orientation, sensory defensiveness, sequencing and timing for all sensory-motor areas. These issues had roots in the dysfunction of the proprioception (body muscle and joint awareness), tactile, visual, auditory and vestibular (movement/gravity) systems. After a year of occupational therapy using a sensory integration model, Stephen was able to return to a comparable overseas occupation and performed successfully in not only his trained field but also the secondary, supportive job requirements which had been impossible two years prior.

The founder of Sensory Integration, A. Jean Ayres, Ph.D., OTR, did all of her original research on the learning disabled population. Even to this day, the Sensory Integration and Praxis Test, which is the diagnostic tool she developed and modified in 1988, is only appropriate for children that can sit through a three hour test, i.e. children of normal intelligence with learning differences. Her research of evaluating and treating school age children with learning disabilities from a sensory integration perspective, laid the groundwork for treating the dysfunctions of neurological processing systems that are foundational to acquiring academic skills.

Academic learning is dependent upon high-level sequencing and memory skills with multi-tasking using ongoing sustained focus and attention. These areas use abstract symbols based on body and spatial awareness and orientation in both oral and visual arenas. Skills are developed with increasing complexity based on the assumptions that the child already has a foundational set of motor and processing abilities that allow letter and number matching, recognition, and duplication, as well as sound symbol correlation to merge those symbols with the auditory system. It is also assumed the child has the ability to translate these coded messages into mental pictures that added together become a story of events, procedures or list of instructions.

Everyone receives information about the world around us through our sensory systems. The processing of these systems takes place within the nervous system at an unconscious level. The familiar systems of taste, smell, sight, and sound are integrated with the lesser-known systems of gravitational awareness and body position at the level of the inner ear in the vestibular system. It is this organization of the senses for functional use that is termed sensory integration. For most children sensory integration develops as a natural course of childhood activities.

But for some children something hinders the natural development of sensory integration and a learning difference or disability occurs. If the child has dysfunction of the vestibular system which integrates all the sensory modalities, they may have difficulties with one or more of these areas: following directions, learning to read, understanding what they read, memorizing math facts, understanding math word problems, playing sports, sitting in their chair, paying attention or focusing especially when there is distracting movement or sound around them, or completing tasks of daily living. These difficulties may fluctuate from day to day with varying degrees of occurrence or severity. These highly impact the child’s emotional development as these disruptions cause unclear messages to be perceived which can sometimes cause a fear reaction that is not relative to the level of the triggering incident. This is sometimes known as a “melt down.” The child that lives in a constant state of fight or flight due to his oversensitive body’s nervous system has little mental energy left for learning capabilities or developing skills for emotional maturity. The amount of systems that are dysfunctional along with the severity of the dysfunction determines the extent of the disruption in the acquisition of learning.

Sensory Integration therapy takes the child through a process of movement and gross motor experiences to increase overall awareness of where they are in space and how their body connects to the information it is receiving to enable it to respond with appropriate sequential patterns. Abigail was an intelligent five-year child who was at risk for learning disabilities. She had a genetic predisposition for being dyslexic from both sides of her family. She entered kindergarten unable to recognize letters or numerals, could not say the ABC’s, was uncoordinated in gross and fine motor skills, had difficulty following two part directions, and could not draw a person or a house. After nine months of intensive therapy for sensory integration which included auditory and visual processing as well as sequential movement (for vestibular function) and strength and coordination training (for proprioceptive input), she moved from the bottom of her kindergarten to the top half of her parochial class in reading single words and simple sentences using a phonetic approach, writing words and numerals with precision with a mature handwriting style, playing the piano with two hands combined, and was successful in a gymnastics class. She previously had severe separation anxiety reactions, but now loves school and is able to play at other friend’s houses with inner comfort. Without sensory integration therapy, Abigail would probably been unsuccessful in a regular school setting, would have needed to repeat kindergarten, and would have possibly been a candidate for a school specializing in children with learning differences. Sensory Integration therapy gave her a more hopeful future to develop her full potential.

Written By: Elizabeth “Betty” McBride, OTR and Jane S. Shook, M.S., CCC, SLP
Names of individuals have been changed to protect their privacy.