I would like to share the exciting changes in Thomas's behaviour since I have been treating him with Sensory Integration Therapy along with Therapeutic Listening techniques.

Sensory Integration Dysfunction is a common but misunderstood problem affecting many children. Often it is the cause of conditions with names such as dyspraxia, developmental co-ordination disorder, attention deficit hyperactivity disorder and so on. If untreated children will grow into adults who may demonstrate eccentric or controlling behaviours, difficulty with learning or accepting new ideas, severe emotional problems and lack of self esteem. Sensory Integration Therapy was pioneered by Dr Jean Ayres in the sixties and today Occupational, Speech and Language and Physiotherapists take post graduate training using her revolutionary techniques.

My first impressions of Thomas were his anxiety, poor spatial awareness and expressive language difficulties. He spoke with a high, light voice, which demonstrates poor breath control, using two or three words without personal pronouns. This shows a lack of awareness of self. He was small for his seven years although sturdily built, with noticeable lax ligaments and low muscle tone around his fingers, wrists and elbows. When crawling he would place the back of his hands on the floor. He found most manipulative tasks hard, had very poor pencil control and it was not easy for him to use two hands together. Thomas tested as having very poor tactile (the sense of touch) discrimination. He would quickly move from one activity to another, charged with energy, sometimes climbing as high as he could on my suspended equipment or throw himself onto a soft, low sofa pressing his front repeatedly on the cushions. Often he would run to his mother for a hug.

This is all very typical sensory seeking behaviour. Thomas was seeking touch and pressure to his hands and body by stimulating the tactile and proprioceptive (the unconscious awareness of sensations coming from one's joints, muscles, tendons, and ligaments) receptors which enabled him to be more aware of where his body was in relation to its surroundings. Deep pressure (which activates receptors in the discriminative system) is also comforting and reassuring. However, Thomas disliked unexpected light touch which he perceived as threatening, throwing him into an anxious and fearful state. Light touch activates receptors in the protective system- this is called sensory defensiveness.

Thomas was unable to stand still, or move slowly and had difficulty with his balance. He also showed signs of gravitational insecurity (extreme anxiety and fear that one will fall when one's head position changes). He had poor eye contact and poor eye- teaming skills, although, with a quick glance, he was able to take in enough visual information for his needs. This demonstrated poor vestibular integration (the sensory system that responds to changes in head position, body movements through space, and that co-ordinates movements of the eyes, head, and body).

Thomas had complex needs. My treatment aims were to improve his vestibular, proprioception, tactile, visual and auditory sensory processing, gradually through play, in order to improve Thomas's balance, body awareness, self confidence, organisational ability. Also, to improve listening and visual attention, breath and speech control so he could participate in and learn from school activities, after-school clubs and his home environment.

There was no doubt that Thomas was clever but, imprisoned by his brain and body as a result of sensory overload and severe modulation difficulties (the brain's regulation of its own activity), his brain was not free to learn. Both Thomas and his mother needed good support. They had relocated to England to find the correct therapy input having already had various therapies-Auditory Integration Therapy, deep pressure and massage techniques in France.

Thomas was on a strict diet, his mother was trying to clear his gut of candida, detox his system of heavy metals, and, at the same time, doing her best to find the correct school which would give him the support he needed. This entailed a lengthy process of assessment by private professionals and those suitable to the local education authorities and, possibly, going to tribunal in order to get state funding for the school with the right level of teaching and therapy input. Tess is the perfect mother for Thomas-determined, aware of his needs, open minded and very capable of carrying out a daily routine at home.

Thomas quickly began to enjoy coming to my clinic where we started Therapeutic Listening combined with Sensory Integration Therapy. We used deep pressure techniques, crawling through tunnels, bouncing on his tummy on tyres and over soft balls. I noticed that Thomas did not use his hands; they appeared not to be part of him-no wonder his pencil control was immature. The activity he enjoyed most of all was climbing high on my suspension frame and hanging by his hands. In his way he was giving himself deep tactile and proprioceptive feedback and strengthening his arm, hand and shoulder muscles. We played games with him lying over the soft ball, palms flat on the mat. He enjoyed the visual and mental challenges. It took time to encourage Thomas to play on the suspended platform swing. Every time this moved, Thomas became fearful (gravitational insecurity). I explained that the fear of being off balance meant that Thomas had never learned dynamic balance skills and carried out all movements at speed.

Slowly, Thomas worked through this fear. Soon he was happily climbing on and falling off onto the soft mats enabling me to suspend the platform by one point – different planes of movement activating different parts of the vestibular system. At home Tess practised daily rolling, spinning and compression and used the soft brush over Thomas' arms legs and back. When Thomas became over aroused, Tess learned to calm him with deep pressure. We began to notice changes in his behaviour -Thomas became more organised, he appeared happier, he showed less self stimulating behaviour and slept better. Tess enroled him at an after school gymnastic club.

We started blowing and sucking techniques using a big collection of whistles, kazoos and other blowing toys to improve breath control (by strengthening diaphragm and intercostal muscles and those of the cheeks, lips and tongue). Thomas had not been able to blow his own nose-this improved. He was encouraged to suck up ice drinks before eating. We put lemon on the tip of his tongue (stimulating the mouth); he ate popcorn and chewy foodstuffs and finally began to chew gum. We used natural gum without additives. At first, he found this impossible - spitting it out straightaway. Slowly he began to keep the gum in his mouth for longer periods. I taught Tess to massage his gums, the roof of his mouth and to stretch the muscles of his cheeks. Tooth cleaning became easier, his eating skills improved and his tongue became stronger.

With improved breath control his voice deepened, taking on more resonance. Thomas began to use his tongue to play with his own mouth and became less defensive to our touch. His use of language improved. I visited his school after he had been there a few weeks to see how he reacted. Most noticeable was his defensiveness to sounds and touch. At playtime he walked on his own, keeping to the fringes of the play area. In class he kept himself away from the other children, observing what was going on. His pencil control was very poor.

Tess and I continued to work with his hands and vision. Together, we devised exercises he could practise at home. Every day he listened to an increasing variety of specialised CD's for up to an hour a day. Before school, they would stimulate his listening abilities, helping to improve spatial awareness, focus and attention and, after school, calm him down. His vocabulary was increasing dramatically with Thomas expressing emotions and using personal pronouns clearly demonstrating an awakened sense of self. He was becoming more able to modulate his response to sensory stimuli. This was demonstrated by his improved eye contact, greater ability to listen to instruction, better organised in his movements, with less hyperactivity, impulsiveness and less defensiveness to unexpected touch.

All this progress has been made in four months and there is still plenty to do. Thomas has settled into school for a full day and is learning to integrate with the other children. At school there is a need for extra therapy to help with his fine motor and language skills. Tess has taken advice from a behavioural analyst and we are working to encourage him to carry out a task at the first request. But Tess and I continue to be excited by the continuing changes and progress we see in Thomas' abilities.

Judy Sommer March 2003