Richard Shircore M.Sc. FRSPH, Director of the Burnham Health Promotion Trust with his own Health Promotion Consultancy, explains the importance of Sensory Integration as a public health determinant.

Having worked in NHS Health Promotion for most of my professional life I felt I had a good grounding in social and biological determinants. For me Health Promotion practice is all about “…the study of, and the study of the responses to, the modifiable determinants of health and disease” [1].  

Yet there is one set of determinants I only came to appreciate after retirement from the NHS and when engaged in my own research specialism of child Mental and Behavioural health.  

Sensory Integration (SI) as a Public Health Determinant 

SI refers to how an individual’s five senses:-Sight (visual), Hearing (Aural), Touch, Smell and Taste, operate. SI can have a profound impact on population mental health, social inequality and consequently, the health divide.  

The origins of SI. 

In the 1970’s Jean Ayers defined her understanding of SI as “the process by which people register, modulate, and discriminate sensations received through the sensory systems to produce purposeful, adaptive behaviours in response to the environment." [2]  A contemporary of Ayres, Alfred Tomatis, focused on hearing, speech and cognition. [3]  

SI seems to be little understood as a significant Health Determinant. Yet it is central to everyone’s personal development and modifiable if shortcomings are identified.  

If SI is functioning efficiently and effectively the individual will have excellent comprehension of their world and will be able to interact with it to maximum advantage. Imagine a school pupil with A1, SI functioning. They will be able to see what is on the white-board and printed page with excellent visual comprehension. As an example of visual comprehension, completing a Code Word puzzle in a newspaper would be impossible without being able to recognise the “pattern” of letters and words. As is an electrical wiring diagram or reading a map. 

They will be able to hear and process all that the teacher and other pupils say: excellent aural comprehension. When writing about “comprehension” I am not talking about the capacity just to see accurately and to understand what is seen (or heard) but to accurately infer the correct meaning.  

They will have mastery of their gross and fine motor skills meaning they can write/draw with accuracy. When writing about the Romans, for example, they can use a pen or laptop using only 5% of the brain to carry out writing tasks leaving 95% of brain to be creative and fluent. For others it is the opposite. 95% of their brain goes on controlling the writing and only 5% left for creativity. 

If SI is delayed or under developed then there are significant consequences for the individual whether as a child or an adult. Everyday tasks may become insurmountable hurdles where the child can never fully comprehend what they are seeing nor hearing. Under such conditions success at school impossible and subsequent life style choices are limited. SI is not related to IQ. 

SI as a Public Health Issue

As stated earlier SI is a Public Health Issue. It is a Public Health issue in that all children need to maximise their SI to be successful at school and any career.  

Child growth and maturity.

There is an assumption that children simply grow and master sensory skills simply by passage of time. This is to over simplify a complex process. SI development can get stuck. Here are a few examples 

  1. Glue ear or other ear infections in a toddler can interrupt the brain capacity to recognise sound pitch. Thus children develop partial deafness at certain frequencies. This plays havoc with their aural comprehension. 
  2. Visual acuity (i.e. both eyes tracking together), we assume this occurs automatically. It does not. Visual play is essential for the developing child to gain this special skill in comprehension.  
  3. Fine and Gross Motor Skills, again specific sorts of exercises and play are critical in allowing the brain to co-ordinate these functions. In the UK children are often encouraged to do the “daily mile” which might be great for aerobic functioning but is of little value in developing brain/hand/eye/muscle integration.   

The issue of school absence and Youth Offending is easy to comprehend if the pupil cannot engage with the curriculum. 

One of my correspondents reported that he failed to learn to read at Primary School, thus Secondary School was a nightmare. He could not understand why. He considered himself as bright as the other kids in the class. 

He truanted and got involved in drugs and crime. It was only when imprisoned and on completion of his medical did the doctor say, "you can't see black on white can you?" No wonder learning to read was so difficult. 

In this case he had Irlen Syndrome. Easy to correct if known. 

If we want to improve children’s chances of school and life success we need to ensure they can engage fully with and comprehend their environment.  

Public Health Policy must ensure that:  

  1. Child Mental Health. All children exhibiting anxiety, depression and failure to make social or educational progress should be assessed for SI before referral the CAMHS. 
  2. New parents are aware of the importance of “developmental play” that stretches co-ordination via brain and motor sensory integration. 
  3. Parents and child health professionals follow up children with glue ear or other ear related infections over time to ensure there are no residual aural deficiencies 
  4. School’s Physical Education must develop programmes of SI which are monitored regarding child development.  
  5. Parks and public spaces must support development of SI. 

Looking back on my time with socially and educationally excluded children and teenagers I now ponder whether how many had SI issues rather than the “default” reasoning given at the time, such as failure of “parental bonding”, “attachment issues”, or “inability to accept boundaries”.  

We do not have to keep repeating the same mistakes when it comes to misinterpreting behavioural patterns and associated affective disorders. 


[1] Wylie, A. and Holt T. Health Promotion in Medical Education,   (2010) Radcliffe Publishing. 

[2] Ayres A. et al, Sensory integration and the child: Understanding hidden sensory challenges – 2005, WPS 

[3] Tomatis A. The Ear and the Language (1997), Stoddart Press 

Postscript.  Richard’s presentation to RCN conference of how SI can be part of a child mental health assessment can be viewed here.