Note this recent research study: A Controlled Pilot-Outcome Study of Sensory Integration (SI) in the Treatment of Complex Adaptation to Traumatic Stress

Sensory processing disorder (also known as sensory integration dysfunction, SID, or DSI) occurs when a person fails to process sensory messages coming from the environment in a smooth and efficient manner. Children with sensory processing problems often feel confused, afraid, oblivious, assaulted or angry when confronted with sensations that other children their age take in stride. These emotions may in turn play out in their behaviors.

Carol Stock Kranowitz, author of The Out-of-Sync Child and The Out-of-Sync Child has Fun, notes that the main hallmarks of sensory processing disorders are unusual (and often extreme) responses to “tactile, vestibular, and proprioceptive sensations – the sensations of touching and being touched, of moving and being moved.” The other senses – hearing, seeing, and tasting may also be involved.

Sensory processing disorder looks different from person to person. One child may be tactile defensive and so avoid touch, and tantrum at the feel of tags in her clothing. Another child may be completely unaware that his diaper is wet or his hands are cold. Some children are “sensory seekers” who crash, spin, swing and tumble. Others may refuse to use playground equipment at all, because even one swing would make them feel dizzy.

Sensory processing disorder can be sub-divided into several patterns. First are problems with sensory modulation, in which the child fluctuates between under-reaction and over-reaction to sensory messages because her central nervous system cannot accurately organize or regulate them. This child might scream – because her brother is talking too loudly! With disorders of sensory discrimination, the child may not be able to differentiate between different stimuli, so he misunderstands and misjudges the relative significance and value of the things in his world. He may overfill his cup while pouring milk, trip on the stairs, hug a friend with too much force. In dysfunctions of praxis, (dyspraxia), the child cannot plan and organize a sequence of unfamiliar actions. She will struggle to keep up with other children as they open their desks or lockers, write in their books, get changed for gym, etc.

How does all this relate to attachment and attachment disorders?

The relationship between sensory processing disorders and attachment is complicated and not completely understood. However, common sense suggests that children who have failed to complete and repeat the bonding cycle in their first two years of life or who have suffered neglect or abuse will be at increased risk for developing sensory processing disorders, just as they will be at increased risk for developing RAD.

Throughout the attachment cycle the mother (or primary caregiver) acts to regulate the child; eventually, over many repetitions of the cycle, the child internalizes the mother’s messages and learns to modulate her responses to fit the situation. This capacity for modulation grows, in part because throughout the cycle, the mother is providing the infant with physiological experiences (rocking, swinging, sucking, touch) that are foundational for all future development. A child who has been institutionalized or otherwise neglected has been short-changed of these fundamental experiences. As a result, she is neurologically disadvantaged. No wonder she has difficulty processing sensory messages from the environment in as efficient a manner as her more “typical” peers. Moreover, in a developing child, sensory experience helps to shape neural connections and to prime the areas of the brain having to do with emotional regulation. If those connections are absent or minimal, the child may struggle to feel genuine trust or love. Instead, she relies on more primitive areas of the brain and shows an exaggerated fight or flight response to stress.

It is not surprising, then, to find that while it is possible for a child to be diagnosed with sensory processing disorder alone, or with RAD alone, many children coming from backgrounds of neglect suffer from both attachment disorders and sensory integration dysfunction. In practice, it can sometimes be difficult to distinguish the two, since the symptoms can overlap. For example, children with sensory processing disorder may avoid eye contact, just as some children with RAD do. Children with sensory processing issues can be extremely controlling – just like children with RAD. Children with sensory processing disorders often show extreme and inappropriate reactions – just like children with RAD or PTSD. So it is confusing for even an experienced professional to distinguish the two.

Despite the problems of differential diagnosis, the good news is that treatments for attachment can help a child to overcome or respond more adaptively to sensory processing problems , and – when undertaken with professionals who are sensitive (not necessarily educated) about a parent’s attachment concerns – treatments for sensory processing disorder can help to secure attachment. The most common therapies for sensory processing disorder include occupational and physical therapy, “listening programs,” vision therapy, and cranio-sacral therapy.


Kranowitz, Carol Stock. The Out of Sync Child and The Out of Sync Child Has Fun. Carol Stock Kranowitz is a pre-school teacher who has recently popularized the foundational work of A. Jean Ayres and others on sensory integration. Her explanations are clear and comprehensive and her tone is positive and parent and kid friendly. The suggested activities are terrific, inexpensive (for the most part) and fun for all children, not just those with SID.

Answers to Questions Teachers Ask About Sensory Integration. This is a book of forms, checklists, and classroom advice.

Williams, Mary Sue, and Sherry Shellenberger.

How Does Your Engine Run: A Leader’s Guide to The Alert Program for Self-Regulation. The Alert Program was designed by two occupational therapists to help kids learn to “read” their bodies’ signals and to give them the tools they need to modulate their own responses.

Kurcinka, Mary Sheedy.

Raising Your Spirited Child, Raising Your Spirited Child Workbook, Kids, Parents & Power Struggles. Kurcinka is best known for her popularizations of recent work on temperament and its role, but her suggestions are also helpful for parents and children affected by SID.

Greenspan, Stanley, I.

The Child with Special Needs, The Challenging Child, Building Healthy Minds. Greenspan, a proponent of “floor-time” (special one-on-one parent and child play time, on the child’s terms), is one of the few physicians who gives much attention to the role of sensory integration in temperament and development.

Hannaford, Carla.

Smart Moves: Why Learning is Not All in Your Head. Includes directions for several “Brain Gym” movements that parents and children can try at home to improve brain function.

DeGangi, Dr Georgia, Ph.D

Pediatric Disorders of Regulation in Affect and Behaviour. Is a therapist’s guide to assessment and treatment od sensory integration disorders in Children. DeGangi is one of America’s experts in treating SID. This book presents the state of the art in theory, research and treatment strategies for infants and children with regulatory problems. Complete with comprehensive case studies, references and index, this wonderful book is replete with photographs, screening tools, detailed assessment procedures and integrated treatment approaches.

When the Brain Can’t Hear : Unraveling the Mystery of Auditory Processing Disorder by Teri James Bellis

Like Sound Through Water, A Mother’s Journey Through Auditory Processing Disorder by Karen J. Foli (2002).

Language Processing Problems, A Guide for Parents and Teachers by Cindy Gaulin (available from

Web Resources:

A sampling. There is much available and following any one of these should lead to further information.

Carol Kranowitz: The Out-of-Sync Child

Auditory Processing Links: (capd links and more links- just keep clicking away)
ASHA (American Speech-Language-Hearing Assoc.)
American Academy of Audiology
Fast ForWord
Earobics Step 1 and 2
Lindamood-Bell Learning Processes (including LiPS and V/V)


Support Groups
Some communities apparently have in-person support groups available to parents. Not mine! E-lists include one at and several on Yahoo, including SIDCHINA2 @ yahoogroups. Com

Occupational Therapy for Sensory Processing Disorders

Occupational therapists use purposeful activity to increase a client’s ability to function in his or her day to day life. For a child suffering from sensory processing disorder, “purposeful activity” might include jumping, drawing, swinging, rocking, buttoning, and listening exercises. The therapist plans a program to address each child’s specific deficits, so treatment sessions for one child will not be identical to those for another child. But in all cases, the therapist will be helping the child to achieve greater balance and control over her responses to movement, touch, or the other senses.

Occupational therapy may be obtained through EI programs or through the schools, or privately. It may or may not be paid for through insurance. In working with an occupational therapist, it is important for a parent of an attachment disordered child to mention her concerns about attachment. If performed sensitively in the right environment, occupational therapy can look (and can work) a lot like Theraplay. The therapist (and/or the parent) are always in control of the sequence of activities. The activities are fun and are (or can be) designed to facilitate physical closeness and emotional connection between parent and child. Many of the activities described in Carol Stock Kranowitz’s book, The Out-of-Sync Child has Fun, are similarly suited to attachment work at home. So while you are addressing sensory processing problems, you can also be addressing attachment.

The above information was provided by Susan Olding, an ATN Member and parent of a child with Sensory Integration Disorder. As with all the descriptions on this website, we strive to present the most current information on all the disorders, issues and treatments related to attachment disorder and to focus on information our members have found useful. ATN does not recommend diagnoses or assumptions based on the information on this website and we make no claims as to the effectiveness of any treatment option. Please consult with a qualified medical professional and/or therapist for your individual situation.