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Sensory Integration Problems in International Adoption

By Lindsey Biel, co-author of Raising a Sensory Smart Child

Katie is an adorable 7-year-old who was adopted from China. She's an affectionate child with a great sense of humor who loves to draw and go to the playground. However, socks really bother her. After she puts them on, Katie feels her socks for hours, and if they have seams or little pills on them, they annoy her all day long. Katie also cannot tune out the casual touch sensations that are an everyday part of life. The breeze outside gently blowing on her arms feels like little insects. And while Katie is a gentle, kind child who loves her classmates, a child might accidentally brush against her, so she avoids sitting right next to other children and pushes them away if they get too close. Better to sit a bit on the sidelines than be worried about getting in trouble for pushing. Katie loves reading, but is comfortable handling only certain types of paper. Some types of paper send chills up her spine. She hates getting glue on her skin and refuses to finger-paint. She can hear a dog bark outside from the 28th floor of her apartment building. She is terrified of fire drills-and was hugely relieved when her school agreed to having the classroom aide take her outside before to the alarm rings. With all of these bothersome sights, sounds, and touches all day, it's no wonder Katie gets so cranky in the evening. When it's finally bedtime and lights out, her body just doesn't feel right. Most nights, she thrashes around in her bed for 30 minutes or so until she finally falls asleep.

What is going on with Katie? She shows signs of sensory integration issues.

What is Sensory Integration?

All of us learn about and comprehend the world through our senses. We see things, we hear things, we touch things, we experience gravity, and we use our bodies to move around in it. All of the sensory input from the environment and from inside our bodies works together seamlessly so we know what's going on and what to do.

Sensory integration is something most of us do automatically. Usually, sensory input registers well, gets processed in the central nervous system and then hooks up seamlessly with all of the other senses. This lets us think and behave appropriately in response to what's going on.

Kids with sensory integration (SI) dysfunction experience the world differently. They don't take in and use sensory information the same way. Their central nervous system responds to sensory input differently, so they're not always getting an accurate, reliable picture of their bodies and the environment.

Think of sensory integration like an orchestra. You need the woodwinds section, the strings section, the percussion, the piano to all be in tune, playing in key at the right volume, all perfectly coordinated with each other. With SI dysfunction, the conductor isn't controlling the music well. Different sections in the orchestra are out of tune and out of sync so it doesn't sound right.

For a child with severe sensory issues, walking into the supermarket can feel like walking into a rock and roll concert. Such a child may be able to see and hear the fluorescent lighting flicker, a squeaky shopping cart may sound like thunder, the meat department may smell like a garbage dump, and navigating the aisles and other shoppers may feel like being on a bumper car ride.

What seems normal to us can easily overwhelm a child with sensory problems.

Common Signs of Sensory Integration Dysfunction

• Out of proportion reactions: over or undersensitivity to touch, sounds, sights,
movement, tastes, or smells
• Problems with vestibular (movement) and proprioceptive senses (body awareness)
• Bothered by particular clothing fabrics, labels, waistbands, etc.
• Avoids or excessively craves intense movement — slides, swings, bouncing, jumping
• Resists grooming activities such as brushing teeth and washing hair
• Avoids foods most children enjoy
• Gets dizzy easily-or never at all
• Seems clumsy or careless
• Often “tunes out” or “acts up”
• Poor attention and focus
• Uncomfortable in group settings
• Very high or very low pain threshold
• Squints, blinks, or rubs eyes frequently (may have an undiagnosed vision problem)

What causes sensory problems?

Sensory problems result from neurological differences, and new research is being done to confirm this. It's a difference in how the brain and nervous system are wired. Sensory problems are quite often seen in children born prematurely (especially the smallest and the youngest), those adopted from overseas, children who have experienced birth trauma or prolonged hospitalization, and those exposed to heavy metals. Sensory problems are a common symptom of other special needs diagnoses. However, a child can have sensory problems and nothing else.

What about sensory integration in children adopted from overseas?

Children who have been adopted are at increased risk for sensory problems, with those adopted from overseas orphanages at significantly higher risk. The conditions in these orphanages vary greatly, but all too often facilities have limited resources, poor nutrition, lack of sensory stimulation, and limited social interactions that can lead to developmental delays, medical problems, emotional difficulties, and yes-sensory issues. Many children placed in overseas orphanages may have been born prematurely or with low birth weight to begin with. So it's a double whammy to be predisposed to problems and then be placed in an institutional environment. What's more, the biological mother may have been malnourished and had limited or no access to prenatal care. So much-but certainly not all-depends on prenatal factors, birth, and environment.

Sensory problems make adjusting to a new family and a new culture even harder. Katie lived in a Chinese orphanage for eight months, where she had limited sensory experiences: a monotonous daily routine, and rarely being held, rocked, cuddled, feeling different clothing, being carried around in someone's arms or moving in a stroller or car, rarely being outdoors, being bottled propped, and looking at the same bare walls and toys month after month.

She certainly wasn't used to being hugged and smothered with kisses by her adoring new parents, getting bounced on someone's lap, being pushed around the park on a sunny day looking at animals at the petting zoo with the sound of a fire truck in the background and lots of people laughing and talking and brightly colored toys dangling from her stroller. Her brain and body never had that kind of exposure, and she hadn't yet built the neural connections for that kind of thing.

The Good New: There is help for sensory integration problems!

With appropriate interventions and time, most children develop needed central nervous system connections and sensory input starts getting more familiar and more comfortable. Not always, but most of the time, children can overcome their sensory problems, especially with parents who develop their own "sensory smarts."

If you are concerned about whether your child has sensory integration issues, the first step is to get an evaluation from a qualified health care professional. This may be a developmental pediatrician or an occupational therapist who has special training and experience in this area. If your child is under age 3, you can get a multidisciplinary evaluation through your state's Early Intervention program (see for a link to your state's EI program). If your child is over age 3, you can request an occupational therapy evaluation from your school district. You also have the option of hiring an OT privately, which may be covered by your health insurance.

Lindsey Biel, OTR/L is the co-author of Raising A Sensory Smart Child... For more information on sensory integration issues, practical solutions, finding professional help, advocating with schools, and more, see Raising A Sensory Smart
The Definitive Handbook for Helping Your Child with Sensory Integration Issues, by Lindsey Biel, OTR/L and Nancy Peske (foreword by Temple Grandin). Also visit
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