Navigating sensory integration theories: How can we reconcile points of confusion?
“The map is not the thing. It is just a map of the thing.” -unknown
A reflection on Sensory Integration models and the development of understanding
Models are things that people come up with to explain what they are seeing. But they are just models. The model is not the thing…it is just a map of the thing.
The models used to explain Sensory Integration are not the whole of Sensory Integration.
Imagine that the models are like a map of a city. I’m going to imagine my city, Charleston, SC. As a visitor to town, you might have a map of the city that depicts only the businesses. No residential buildings. Does it give you information about Charleston? Yes. Does it give you a complete picture of the city? No. A map of downtown Charleston would need to have the residential and commercial information.
So, imagine you have a map that has residential and commercial and when you click on the map it tells you if the restaurant you’re considering is one, two, or three $ signs. You will know more about the restaurant when you see that $$$, but it still doesn’t tell you everything. To be able to describe that restaurant accurately, you need to have read the menu, and preferably you would have actually been there, felt the atmosphere, and eaten the food. Then you can accurately describe your perception of the restaurant.
And still, what you describe will be based on what you know and how you experience things. A food critic who can taste nuances of flavor is going to describe the restaurant in a different way than someone who doesn’t have a developed palate.
In this analogy, the models that explain Sensory Integration theory are like maps. They aren’t the thing, they are just representations of the thing, from a particular person or set of people’s perspective. They don’t teach us all the nuanced information we need to know to really understand sensory integrative processing.
There are a lot of models (maps) to explain the concept of sensory integrative processing. It is a very complicated concept, so to provide a basic level of understanding people have come up with ways to simplify (and sometimes oversimplify) the concepts. The models are not complete; they are limited.
But they can be valuable, if they are representing things as they are. When we evaluate a model, we must go back to what we know to be true.
In the case of sensory integration and the models of function/dysfunction it is important to go back to the underlying functions and neuroscience that that the models are trying to explain. Understanding the theory neutral information is going to better equip us to understand the models, and more importantly, the child in front of us.
Pediatric occupational therapist Tracy Stackhouse is one clinician who presents sensory integration from a theory neutral perspective. She identifies the two ways that we, as humans, use sensory information. We have modulatory brain circuitry that processes sensory information, and we have discriminative brain circuitry that processes sensory information.
“Sensory Modulation is for the purposes of regulation.” says Tracy. The circuitry involved is primarily found in lower brain structures, responsible for things like homeostatic functions, unconscious attention regulation, and our emotional experience.
“Sensory Discrimination is for the purposes of skill.” Sensory discrimination happens primarily in higher brain structures, specifically the cortex (by way of the thalamus). The cortical structures hold detailed sensory and motor maps that allow us to be precise in the way we understand sensory information coming in and have precision in motor commands going out. “Sensory discrimination allows us to perceive details contained in the sensory information and use it for producing skillful actions.”
Both of these processes (of modulation and discrimination) are important, and they are happening simultaneously. Knowing when to address sensory integrative challenges from a modulation or discrimination perspective is both critical and confusing.
I recommend Tracy’s work for building that understanding from a theory neutral perspective. I will also list others I recommend, whose teaching is grounded in neuroscience, at the bottom of this blog.
I recently taught an introduction to Sensory Integration to OT students. Historically, I’ve heard people teach Sensory Integration (SI) Theory by starting with the history and evolution of SI theory, followed by the different models that people have created to explain SI. Instead of the normal progression, I structured the lectures around starting with theory neutral information. We looked at the brain and how it processes sensory information: through sensory modulation circuitry and sensory discrimination circuitry. And then, by the time we got to the different models, the students were able to make sense of how the models compared and contrasted. They could better reason through what a particular model does or does not tell us. And that, I hope, will prepare them to be therapists that can build a solid understanding of sensory integrative processing.
As OTs treating from an SI perspective, we need to able to explain how sensory integrative processing is contributing to function and meaningful participation. We need to make our language relatable and user friendly. But the ability to do that does not come from simplifying our understanding. Rather, we must have precision and a depth of knowledge that allows us communicate clearly.
The models can create points of confusion, and without the theory neutral perspective, they can create an oversimplification that prevents rather than enhances understanding.
You might be someone who is working from a particular model or understanding of SI theory, without a solid background in the theory neutral, neurally grounded perspective. That is common, as most of us under the age of 55 learned SI theory from the models. My mentors, however, learned SI theory from a neurally grounded perspective because that is what Jean Ayres taught. Their understanding of SI theory has led them to precision in practice that creates greater change than is possible for someone who is relying on a simplified understanding of the complicated process we call sensory integration.
When we don’t fully understand Sensory Integration theory there is a temptation to oversimplify, to say that the challenge that the child is facing “isn’t a sensory issue”, or to blame the child and family for not being willing to do the work.
It is harder to say “I don’t understand.”
“I don’t understand” requires us to have self-awareness. It requires us to be able to regulate ourselves and our emotional experience. And most importantly it requires us to have compassion for ourselves.
That work of building our awareness, our capacity for self-regulation, and our ability to have self-compassion is the most important work we can do for our clients, and ourselves.
If we go back to our map of Charleston analogy, and think about the food critic who has actually been to the restaurant versus the person who has a map with $$$ describing the restaurant, we can imagine how different their review of the restaurant would likely be. In most cases, the food critic is going to give us information that is going to be more helpful and guide us to make choices that provide the best experiences.
As a therapist learning the concepts of sensory integration you are not going to start with a well-developed palate…it takes time to build observation skills and clinical reasoning. But just because you can’t see the nuances doesn’t mean they don’t exist. A food critic can taste that there’s a pinch of nutmeg that some people wouldn’t taste at all, and others might taste but be unable to describe. It takes time, patience, and practice to develop our understanding.
Beyond working on ourselves, the most incredible gifts we can give to our clients are:
Building our understanding of what is happening in the brain as a part of this sensory integrative processing
Putting in the work to develop our eyes to see and support the many aspects of sensory integrative processing that are affecting their life
And learning to communicate that information clearly with anyone who needs to understand.
This sensory integrative processing information is complicated and much of it is theory. Finding a solid base in theory neutral information is a good place to start. It gives us a solid foundation on which to build our understanding.
And as we grow and learn, the science is also progressing and the thing we thought we knew to be true may shift over time. New models will come along, and with them our understanding will evolve. We must find ways to be comfortable with that change. Jean Ayres, as always, said it best:
“Truth, like infinity, is to be forever approached but never reached.”
-A. Jean Ayres (1972)
Other recommendations of teachers I have learned from, whose work is grounded in neuroscience. (This is not an exhaustive list and there are many I have not had the opportunity to learn from yet):
Tracy Stackhouse through her Learning Journeys platform
Kim Barthel through her Relationship Matters platform
Sheila Frick through Vital Links
Teresa May Benson through TMB Educational Enterprises