Sensory Integration Therapy

Sensory Integration Therapy for sensory
processing disorders and Dyslexia

Sensory integration therapy is designed to help kids with sensory processing issues. This type of therapy aims to adjust the way children respond to physical sensations. It is based on the idea that some kids experience ‘sensory over load’ and are oversensitive to certain types of stimulation. When children have sensory overload, their brain have trouble processing or filtering many sensation at once. Meanwhile, other kids are under sensitive to some kinds of stimulation. Kids who are under sensitive don’t process sensory messages quickly or efficiently. These children may seem disconnected from their environment. Sensory integration therapy exposes children to sensory stimulation in a structured, repetitive manner. The theory behind this treatment approach is that, over time, the brain will adapt and allow them to process and react to sensation more efficiently.

Sensory integrationis a subconscious and automatic neurological process that occurs in every person at all stages of life. Our brains take in information thorough our senses and organize. It so that we are able to respond appropriately to particular situations and environmental demands. Sensory experiences include touch, movement, body position, vision, smell, taste, sound and the pull of gravity.
Sensory integration therapy uses repetitive exercise to help a child experience other sensations more accurately. An intervention study involves observing the child in the class room and while at play. Parents are interviewed and an assessment is done. Based on that, recommendations are made which best suits the child and a plan of action is charted.


Autism’s symptoms often include difficulty processing sensory information such as textures, sounds, smells, tastes, brightness and movement. These difficulties can make ordinary situations feel overwhelming. As such, they can interfere with daily function and even isolate individuals and their families.

Sensory integration therapy, as practiced by occupational therapists, uses play activities in ways designed to change how the brain reacts to touch, sound, sight and movement. While the therapy is not new, it has remained somewhat controversial. “Part of the problem has been the many different techniques that have been used under the name sensory integration.

"The rationale is that by changing how sensations are processed by the brain, we help children with autism make better sense of the information they receive and use it to better participate in everyday tasks

For most people sensory integration develops in the course of ordinary childhood activities. When a person has good sensory integration then they are able to process information automatically and efficiently. But for some people, sensory integration does not develop as efficiently as it should and can affect activities of daily living, academic achievement, behavior or social participation.

Children can present with different types of sensory integration difficulties (also known as sensory processing processing difficulties). These include:

Hyper (over) sensitive
  • Fear of heights
  • Dislike of touch experiences eg nail cutting, messy play, hair cutting
  • Dislike of loud and sudden sounds
  • Avoidance of playground equipment (swing and slides)
Hypo (under) sensitive
  • appears to have no fear or doesn’t feel pain
  • Seeks movement or touch opportunities’ (fidgets, rocks, run about, leans on peers)
  • mouth or chew things
  • poor attention to the environment or people around
Motor Planning (praxis)
  • Appears clumsy
  • Difficulty creating movements ideas
  • Difficulty planning and executing new movements
Poor posture
  • Slouches at desk
  • Fidgets/difficulty sitting in one position for extend period of time
  • Impact on fine motor coordination & ball skills
  • Impact on fine motor coordination & ball skills
  • Poor Balance
  • Sensory integration provides occupational therapists with a frame work for assessing and treating children who present with difficulties outlined above.

Different ways an occupational therapist may use an sensory integration approach:
  • Direct 1:1 therapy using specialised equipment
  • Provision of a sensory diet and sensory based therapeutic activities for home and school (see “calming and altering activities activity ideas” information sheet-coming soon)
  • Environmental adaptations at home and school (see ‘coping with classroom environment strategies’ information sheet – coming soon).
  • Consultation & education with careers and school.
Some areas of involvement are:
  • Balance and posture
  • Muscle tone and strength
  • Environmental adaptations at home and school (see ‘coping with classroom environment strategies’ information sheet – coming soon).
  • Body awareness
  • Fine motor abilities (pinching and grasping, manipulative skills, pencil and scissors use, hand writing)
  • Gross motor abilities (running, jumping, climbing)
  • Motor planning (ability to plan, initiate and execute a motor act)
  • Visual perception (shape recognition, visual memory)
  • Visual motor integration (copying shapes, copying block design)
  • Sensory integration (response to sensory stimuli, discrimination of sensory input)
  • Behaviour Modification (arousal level, attention, problem solving skills)
  • Self-care skills (eating , toilet habits, bathing)
  • Community living skills (management of money, shopping)
  • Pre academic skills (identify letters, sounds, shapes, colours and numbers)
  • Play skills are used as a tool to enhance life skills.
  • Social skills.

Standardized Assessments are conducted on a regular basis. These Assessments are for motor proficiency, visual perception, hand writing skills and sensory processing. These skills are evaluated and progress reports are sent to the parents along with their academic reports. Parents are trained at school so that they can continue the therapy at home to maintain continuity and regularity.

Some areas of involvement are:

Sensory process (or sensory integration) is the way in which the central nervous system of the body receives messages from the senses of the body and uses that information to act in appropriate motor or behavioral responses. Sensory processing disorder (SPD, also known as sensory integration dysfunction) is a condition in which the sensory signals received by the central nervous system do not become organized into an appropriate response. A child who has SPD may find it challenging to process and act appropriately his or her central nervous system receives sensory information which causes problems with carrying out activities of daily living. SPD can cause tremendous challenges for a child if it is not treated or managed appropriately.

Sensory processing disorder may affect only one sense – such as sight or hearing – or it can impact multiple senses and impacts each child in a different way. One child may react strongly to different textures of clothing while another may over-respond to loud sounds. Children with SPD may also have impairments of the joints and muscles, impacting posture and motor skills. Many children who have SPD are not immediately diagnosed with the condition as the disorder can be mistaken for ADHD. While this disorder is commonly diagnosed in childhood, many people reach adulthood without a proper diagnosis and may struggle with the symptoms of the disorder.

Children who have sensory processing disorder are effectively treated by a combination of physical and occupational therapy that focuses upon activities that strengthen a child’s ability to handle sensory stimuli appropriately. Over time, a child will learn to appropriately respond to sensory stimuli so that they are able to behave in a more positive manner in therapy, in school, and at home.

Types of Sensory Processing Disorders

There are certain subtypes of sensory processing disorder that may alter the course of treatment and diagnosis. The subtypes of SPD include:

Sensory Modulation Disorder: Children who have sensory modulation disorder have problems regulating the intensity and nature of responses to sensory input. The responses may be emotional or behavioral, negative responses to stimuli not averse to others, and the problems are exacerbated by stress. Common symptoms include:

  • Withdrawing from light and unexpected touch
  • Gagging and refusal to eat textured foods
  • Dislike of teeth-brushing, hair washing, or nail cutting
  • Avoidance of messy textures such as dirt or lotion
  • Avoidance of messy textures such as dirt or lotion
  • Strong preferences to certain types of clothing, including textures and fit
  • Oversensitivity to sounds or visual stimuli

Sensory Discrimination Disorder: Children who have sensory discrimination disorder have problems discerning and assigning proper meaning to qualities of particular sensory stimuli. These children may struggle with recognition and interpretation of characteristics of sensory stimuli, have poor detection of difference or similarities in the stimuli, and often occurs with dyspraxia and poor skill performance. Symptoms may include:

  • Difficulty manipulating an object when out of sight
  • Difficulties following directions
  • Challenges distinguishing between similar sounds
  • Problems finding an image in a cluttered background
  • Uses too much or too little force
  • Poor balance
  • Poor sense of movement speed

Postural-Ocular Disorder: Children with postural-ocular disorder have problems controlling or stabilizing the body during movements or at rest. Muscles may be hypo or hypertonic and joints may be unstable. Poor usage of vision and coulomotor control. Symptoms may include:

  • Poor posture control or strength
  • Poor equilibrium and balance
  • Difficulty isolating head-eye movements
  • Poor tracking of visual stimuli
  • Avoidance of upper extremity weight bearing
  • Discomfort climbing or fear of heights
  • Tires easily
  • Challenges establishing dominant hand (right or left handedness)

Dyspraxia: Children with dyspraxia have a deficit in their abilities to plan, sequence, or execute unfamiliar actions. Motor skills and movement may be awkward; these children may have poor ability to generalize learned skills to apply to other tasks, and may have poor timing, sequencing, and action of motor skills. Symptoms may include:

  • Trouble performing activities of daily living
  • Accident-prone and clumsiness
  • Resists new activities
  • Poor playing skills
  • Poor fine motor coordination
  • Poor articulation
  • Co-Occurring Disorders

    Sensory processing disorder may occur with other types of disorders. The most common co-occurring disorders include:

    • Autism
    • Asperger syndrome
    • Attention-deficit hyperactivity disorder
    • Language disorders
    • Learning disabilities
    • Post-traumatic stress disorder
    • Fragile X syndrome
    Causes of Sensory Processing Disorder

    The precise cause for SPD is still unknown, although researchers are spending much time learning more about the condition. Some of the potential causes for SPD may include:

    Genetic: Children born to adults who have autism spectrum disorders may be at higher risk for developing sensory processing disorder. Additionally, children with Asperger syndrome or autism are at a higher risk for developing SPD. Boys are more likely than girls to have SPD.

    Sensory Modulation Disorder: Children who have sensory modulation disorder have problems regulating the intensity and nature of responses to sensory input. The responses may be emotional or behavioral, negative responses to stimuli not averse to others, and the problems are exacerbated by stress. Common symptoms include:

    Symptoms of Sensory Processing Disorder

    Children who have sensory processing disorder cannot properly process the sensory stimuli from the outside world and may have trouble interpreting information from one or more senses. As no two children with SPD have the same type of sensory dysfunction, the symptoms will vary tremendously from child to child and may include:

    Behavioral Symptoms:

    • Withdraw when touched
    • Behavioural problems
    • Difficulties calming oneself after exercise or being upset
    • Refuse to eat certain foods due to the textures of the foods
    • Be hypersensitive to certain fabrics
    • Only wear soft clothes or clothes without tags
    • Dislike dirtying his or her hands
    • Do not engage in creative play
    • Lack variety in play – may watch the same television program over and over
    • Oversensitivity to sounds, especially hair dryers, washing machines, or sirens
    • Be oversensitive to odours – strong or mild
    • Have challenges with certain movements, such as swinging, sliding, or going down stairs
    • Notice or hear background noises that others cannot
    • May harm others during play accidentally
    • Physical Symptoms:

    • Have odd posture
    • Clumsiness
    • Poor balance
    • Delayed fine motor control, such as handwriting challenges
    • Delayed gross motor development
    • Impairments in sleep, eating, and elimination patterns
    • Be in constant motion
    • Jump, swing, spin excessively
    • Fatigue easily
    • Alternate between constant motion and fatigue
    • Poor coordination
    • May fall often
    • High tolerance to pain
    • Psychosocial Symptoms:

    • Decreased ability to interact with peers
    • May stand too closely to others
    • Social isolation
    • Depression
    • Anxiety
    • Aggression
    • Fearful of crowds
    • Avoidance of standing in large groups
    • Fearful of surprise touch
    Effects of Sensory Processing Disorder

    As SPD may be undiagnosed, especially in older people, and left untreated for years, the long-term effects of living with SPD can cause significant impairment in their daily lives. Many healthcare professionals are not trained to recognize the symptoms of this disorder and as a result, diagnosis may be delayed for years.

    The long-term effects of SPD may include:

    • Trouble maintaining a mainstream job
    • Challenges with interpersonal relationships
    • Inability to find pleasure in recreational activities that over stimulate the senses
    • Depression
    • Underachievement
    • Social isolation
    • Poor self-confidence
    • Decreased friendships
    • Low self-esteem
What is dyslexia?

In a person with dyslexia, the brain processes written material differently. This makes it hard to recognize, spell, and decode words.
People with dyslexia have problems understanding what they read. Dyslexia is a neurological and often genetic condition, and not the result of poor teaching, instruction, or upbringing. Between 5 and 15 percent of people in the United States have dyslexia.

Symptoms
  • Dyslexia commonly causes difficulties in word recognition, spelling, and decoding.
  • Dyslexia is different from delayed reading development, which may reflect mental disability or cultural deprivation.
  • The most common signs and symptoms associated with dyslexia can be displayed at any age, but they normally present in childhood.
Childhood symptoms of dyslexia include:

Difficulty in learning to read
Many children with dyslexia have normal intelligence and receive proper teaching and parental support, but they have difficulty learning to read.

Milestones reached later
Children with dyslexia may learn to crawl, walk, talk, and ride a bicycle later than the majority of others.

Delayed speech development
A child with dyslexia may take longer to learn to speak, and they may mispronounce words, find rhyming challenging, and appear not to distinguish between different word sounds.

Slow at learning sets of data
At school, children with dyslexia may take longer to learn the letters of the alphabet and how they are pronounced. There may be problems remembering the days of the week, months of the year, colors, and some arithmetic tables.

Coordination
The child may seem clumsier than their peers. Catching a ball may be difficult. Poorer eye-hand coordination may be a symptom of other similar neurological conditions, including dyspraxia

Left and right
The child may confuse "left" and "right."

Reversal
They may reverse numbers and letters without realizing.

Spelling
Some children with dyslexia might not follow a pattern of progression seen in other children. They may learn how to spell a word and completely forget the next day.

Speech problems
If a word has more than two syllables, phonological processing becomes much more challenging. For example, with the word "unfortunately" a person with dyslexia may be able to process the sounds "un" and "ly," but not the ones in between.

Concentration span
Children with dyslexia commonly find it hard to concentrate. Many adults with dyslexia say this is because, after a few minutes of non-stop struggling, the child is mentally exhausted. A higher number of children with dyslexia also have attention deficit hyperactivity disorder (ADHD), compared with the rest of the population.

Sequencing ideas
When a person with dyslexia expresses a sequence of ideas, they may seem illogical or unconnected.

Types

Dyslexia can be broken down into different subtypes, but there is no official list of dyslexia types because they can be classified in different ways.
However, the following categories are sometimes used:

Phonological dyslexia:
The person has difficulty breaking down words into smaller units, making it hard to match sounds with their written form. This is also known as dysphonetic dyslexia or auditory dyslexia.

Surface dyslexia:
The person cannot recognize a word by sight, making words hard to remember and learn. This is sometimes called dyseidectic dyslexia or visual dyslexia.

Rapid naming deficit:
The person cannot quickly name a letter or number when they see it.

Double deficit dyslexia:
The person finds it hard to isolate sounds also to name letters and numbers.

Visual dyslexia:
The person has an unusual visual experience when looking at words, although this can overlap with surface dyslexia. Sometimes people refer to "directional dyslexia," meaning it is difficult to tell left from right. This is a common feature of dyslexia, but it is not a type.
If a person has difficulty with math learning, the correct term for this is dyscalculia. It is not dyslexia.

Phonological Deficit:
Difficulty decording or assembling words based on their sounds. Note that phonemic awareness is not a reading deficit per se since it involves only sounds and not letters.

Speed Naming Deficit:
Slow reading: poor use of sight. A sight word is a word that is instantly recognized by the reader: is not sounded out, and requires almost no effort to understand.

Comprehension Deficit
Poor understanding of what was just read.

By Sensory System

Auditory Dyslexia
Auditory Dyslexia involves difficulty processing sounds of letters or groups of letters. Multiple sounds may be fused as a singular sound. For Examples the word ‘back’ will be heard as a single sound rather than something made up of the sounds /b/ - /aa/ - /ck/. Single syllable words are especially prone to this problem.

Visual Dyslexia
Visual dyslexia is defined as reading difficulty resulting from vision related problems. Though the term is a misnomer, visual problems can definitely lead to reading and learning problems.

Attentional Dyslexia
Attentional Dyslexia in which children identify letters correctly, but the letters jump between words on the page. “kind wing” would be read as “wind king”. The substitutions are not caused by an inability letters or convert them to sounds, but instead result from the migration of letters between words-the first letters of one word switches place with the first letter of another word.

By Deficit

Phonological Dyslexia
Phonological dyslexia is extreme difficulty reading that is a result of phonological impairment, meaning the ability to manipulate the basic sounds of language. The individual sounds of language become ‘sticky’, unable to be broken apart and manipulated easily.

Surface Dyslexia
A type of dyslexia characterised by difficulty with whole word recognition and spelling, especially when the words have irregular spelling sound correspondences”.

Deep Dyslexia
Deep dyslexia is an acquired form of dyslexia, meaning it does not typically result from genetic, hereditary (developmental) cause. It represents a loss of existing capacity to read, often because of head trauma or stroke that affects the left side of the brain. It is distinguished by two things: semantic errors and difficulty reading non-words.

By Time of Onset:

Developmental Dyslexia
Developmental dyslexia is not so much a type of dyslexia, it is dyslexia. In fact our definition of it would be the same as our definition of dyslexia generally: Extreme difficulty reading caused by a hereditary, brain based, Phonologic disability. So why do people use the term instead of just saying dyslexia? The simple answer is they are trying to be more specific, distinguishing ‘regular’ dyslexia from the other types of dyslexia. In particular, distinguishing it from acquired forms of dyslexia that result from stroke or head trauma for example, which often present very differently. For more on developmental dyslexia.

Acquired Dyslexia
This type results from trauma or injury to that part of the brain that controls reading and writing. Late in life this can be the result of a tumor or stroke.

Other Dyslexia Types:

Directional Dyslexia
Directional dyslexia is distinguished by left-right confusion and tendency to become disoriented or lost. The term is also occasionally used to mean confusion with letters such as P and b or d and b, where there is confusion over the ‘direction’ of the letter. Generally, problems with direction are a symptom of dyslexia more than a sub type. Not all dyslexics have this problem.

Math Dyslexia (Dyscalculia)
Math dyslexia or dyscalculia is not, in fact, a type of dyslexia, but we included it here because the term is frequently used. According to the U.S National Center for Learning Disabilities, math dyslexia, or dyscalculia, refers to wide range of lifelong learning disabilities involving math, varies from person to person and affects people differently at different stages of life

As with reading, when basic math skills are not mastered early, more advanced math becomes extremely difficult. Approximately half of people with dyslexia also have dyscalculia, though far less research has been conducted regarding testing, assessment and remediation.

Language Disorder group, Articulary and Dyscoordination Group and a Visual spatial Perceptual Disorder group

They divided the children into three groups: (I) those with brain damage who could read, (II) those with brain damage who were dyslexic and (III) those without brain damage who were dyslexic. Interestingly enough they found a similarity between those with developmental dyslexia and those with brain-damage dyslexia. On the basis of these results and a battery of neuropsychological examinations, they divided dyslexia into three syndromes.

  • Syndrome I Language Disorder- This syndrome is characterized with anomia, comprehension deficits, confused imitative speech and speech- sound discrimination. Vision and motor coordination is normal.
  • Syndrome II Articulatory and Graphomotor Dyscoordination- Children with this syndrome have gross and fine motor coordination disorders. They have poor speech and graphomotor coordination.
  • Syndrome III: Visuospatial Perceptual Disorder- These children score 10 points more on verbal IQ than performance IQ. Their visuospatial perception is very poor, as is their ability to store and retrieve visual stimuli.
What is dyspraxia?

Dyspraxia is a neurological disorder that impacts an individual's ability to plan and process motor tasks.

Individuals with dyspraxia often have language problems, and sometimes a degree of difficulty with thought and perception. Dyspraxia, however, does not affect the person's intelligence, although it can cause learning problems in children.

Developmental dyspraxia is an immaturity of the organization of movement. The brain does not process information in a way that allows for a full transmission of neural messages.A person with dyspraxia finds it difficult to plan what to do, and how to do it.

The National Institute of Neurological Disorders and Stroke (NINDS) describes people with dyspraxia as being "out of sync" with their environment.

Experts say that about 10 percent of people have some degree of dyspraxia, while approximately 2 percent have it severely. Four out of every 5 children with evident dyspraxia are boys, although there is some debate as to whether dyspraxia might be under-diagnosed in girls.

According to the National Health Service, United Kingdom, many children with dyspraxia also have attention deficit hyperactivity disorder (ADHD).

Symptoms of dyspraxia

Symptoms tend to vary depending on the age of the individual. Later, we will look at each age group in more detail. Some of the general symptoms of dyspraxia include:

  • poor balance
  • poor posture
  • fatigue
  • clumsiness
  • differences in speech
  • perception problems
  • poor hand-eye coordination/li>
Diagnosis of dyspraxia

A diagnosis of dyspraxia can be made by a clinical psychologist, an educational psychologist, a pediatrician, or an occupational therapist. Any parent who suspects their child may have dyspraxia should see their doctor.

When carrying out an assessment, details will be required regarding the child's developmental history, intellectual ability, and gross and fine motor skills:

  • Gross motor skills - how well the child uses large muscles that coordinate body movement, including jumping, throwing, walking, running, and maintaining balance.
  • Fine motor skills - how well the child can use smaller muscles, including tying shoelaces, doing up buttons, cutting out shapes with a pair of scissors, and writing.
    The evaluator will need to know when and how developmental milestones, such as walking, crawling, and speaking were reached. The child will be evaluated for balance, touch sensitivity, and variations on walking activities.
  • Dyspraxia in children
    Dyspraxia symptoms may vary depending on age. With that in mind, we will look at each age individually. Not every individual will have all of the symptoms outlined below:

    Very early childhood
    The child may take longer than other children to:

    • Sit.
    • Crawl -the Dyspraxia Foundation says that many never go through the crawling stage.
    • Walk.
    • Speak -according to the Children's Hospital at West mead, Australia, the child may be slower in answering questions, find it hard to make sounds, or repeat sequences of sounds or words; they may also have difficulty in sustaining normal intonation patterns, have a very limited automatic vocabulary, speak more slowly than other children, and use fewer words with more pauses
    • Stand.
    • Become potty trained (get out of diapers).
    • Build up vocabulary.
    • Early childhood
    Tying shoelaces can be a difficult task for children suffering with dyspraxia.

    Later on, the following difficulties may become apparent:

    • Problems performing subtle movements, such as tying shoelaces, doing up buttons and zips, using cutlery, and handwriting.
    • Many will have difficulties getting dressed.
    • Problems carrying out playground movements, such as jumping, playing hopscotch, catching a ball, kicking a ball, hopping, and skipping.
    • Problems with classroom movements, such as using scissors, coloring, drawing, playing jigsaw games.
    • Problems processing thoughts.
    • Difficulties with concentration. Children with dyspraxia commonly find it hard to focus on one thing for long.
    • The child finds it harder than other kids to join in playground games.
    • The child will fidget more than other children.
    • Some find it hard to go up and down stairs.
    • A higher tendency to bump into things, to fall over, and to drop things.
    • Difficulty in learning new skills - while other children may do this automatically, a child with dyspraxia takes longer. Encouragement and practice help enormously.
    • Writing stories can be much more challenging for a child with dyspraxia, as can copying from a blackboard.

    The following are also common at pre-school age:

    • Finds it hard to keep friends
    • Behaviour when in the company of others may seem unusual.
    • Hesitates in most actions, seems slow.
    • Does not hold a pencil with a good grip.
    • Such concepts as 'in', 'out', 'in front of' are hard to handle automatically.

    Later on in childhood

    • Many of the challenges listed above do not improve or only improve slightly.
    • Tries to avoid sports.
    • Learns well on a one-on-one basis, but nowhere near as well in class with other children around.
    • Reacts to all stimuli equally (not filtering out irrelevant stimuli automatically)
    • Mathematics and writing are difficult.
    • Spends a long time getting writing done.
    • Does not follow instructions.
    • Does not remember instructions.
    • Is badly organized.

    Dyspraxia in adults In adults, symptoms include:

    • Poor posture and fatigue.
    • Trouble completing normal chores.
    • Less close control - writing and drawing are difficult.
    • Difficulty coordinating both sides of the body.
    • Unclear speech, often word order can be jumbled.
    • Clumsy movement and tendency to trip over.
    • Grooming and dressing more challenging - shaving, applying makeup, fastening clothes, tying shoelaces.
    • Poor hand-eye coordination.
    • Difficulty planning and organizing thoughts and tasks.
    • Easily frustrated.
    • Less sensitive to non-verbal signals.
    • Low self-esteem.
    • Difficulty sleeping.
    • Difficulty distinguishing sounds from background noise.
    • Notable lack of rhythm when dancing or exercising.

    Social and sensory - individuals with dyspraxia may be extremely sensitive to taste, light, touch, and/or noise. There may also be a lack of awareness of potential dangers. Many experience moods swings and display erratic behavior.

    How does one determine which sensory perception areas should be trained?

    If the child displays more than one deficiency in the following areas, then these areas of sensory perception should be trained:

    Visual recognition
    • Basic essentials cannot be understood from what is seen
    • Visually similar things are not recognized as different
    • Distinguishing important information from a multitude of stimuli is unsuccessful
    • The ability to filter something out of the background is lacking
    • The child must touch/handle everything in order to understand it
    • Difficulties with distinguishing between colours and shapes
    • Writing and recognition of letters is difficult
    • Handwriting is untidy and difficult to read
    • Lack of uniformity in the size of the letters
    • Uneven reproduction of letters and numbers
    • Confusion between letters which are different in placement (d/b, u/n)
    • The ability to distinguish between visually similar letters, arithmetical symbols, and numbers (h-k, a-o, 7-4, 6-5) is severely lacking
    • Inverted (left to right or right to left) reading or writing of numbers, for example 6 and 9
    • Increasingly occurring copy errors
    • Difficulties grasping amounts
    • Omission of letters or numbers
    • Difficulties with quantities over ten
    • Difficulties with compound arithmetic problems
    • Difficulties with structuring text exercises
    Visual memory
    • Visual information is not retrained
    • Difficulties in recognizing colours, shapes, images, patterns, and objects
    • Memorization of word images does not succeed: words are often written properly ten times, then incorrectly again
    • Difficulties with drawing patterns from memory
    • Transposition of letters a-e-o, h-k, f-t, m-n
    • The child cannot find his place in the text when reading
    • Frequently checking the pattern while copying
    • The writing is angular, curvatures and lengths are different
    • The letters a-e-o appear the same
      • Visual sequencing
        • Visual sequences cannot be perceived properly
        • Difficulties with grasping the succession of letters when reading together
        • Reversing the sequence of letters when reading and writing
        • Letters or syllables are missing, they are transposed or added
        • Halting, slow reading
        • Assistance articulating, prompting of a given text
        • Switching the word order when writing
        • Omission of letters, endings or words when writing
        • Duplication of letters
        • Frequent subsequent additions of missing letters in a word
        • Uneven line spacing and spaces of the letters within a word as well as between the words
        • Reversal of the sequence of a story (for instance, while writing compositions)
        • Distraction by small details and losing the place in the story
        • Incorrect sequencing of numbers, omission of digits
        • Difficulties counting and counting off
        • Difficulties grasping amounts
        • Slow learning of basic arithmetic skills
        • Omission of intermediate steps when doing arithmetic
          • Acoustical recognition
            • The basics of the sounds heard cannot be grasped
            • The ability to distinguish whether sounds are the same or not is severely lacking
            • A sound is matched with the wrong letter
            • Removing a letter from a word does not work
            • Inability to distinguish between or transposition of similarly sounding noises, words or numbers
            • Ability to distinguish between vocalized and non-vocalized consonants is severely lacking: g-k, b-p, d-t, s-z, f-v
            • Ability to distinguish between diphthongs is severely lacking: ei-eu, eu-au
            • Transposition of elongation and sharpening
            • Difficulties distinguishing between m and n, for example between 3. and 4. case
            • Difficulties repeating the same or similar words
            • Difficulties repeating unfamiliar words
            • Difficulties transcribing a series of spoken words
              • Acoustical memory
                • Cannot remember and repeat what was heard
                • Frequent questions when reciting
                • Omissions or additions of letters, syllables or words
                • Failure to complete recitations
                • Severe difficulty understanding what was heard
                • Errors with b/p, d/t, g/k
                • Poor vocabulary, frequent repetitions of words
                • Short compositions with poor content
                • Prompting of sentences
                • Omission of parts of verbally assigned arithmetic problems
                • Assistance articulating, prompting of a given text or arithmetic problem
                  • Acoustical sequencing
                    • Acoustical sequences are not perceived correctly
                    • Muddled explanations, loses the thread easily
                    • Difficulties with verbally presenting sentences with the correct word order and placed correctly in the thought process
                    • Difficulties avoiding becoming distracted by minor details when telling a story
                    • Halting, broken speech with inharmonious breathing
                      • Spatial orientation
                        • Spatial perception is not judged correctly
                        • Ability to judge spatial and temporal measures (distances, amounts, and units) is severely lacking
                        • Difficulties orienting oneself in an unfamiliar environment
                        • Memorizing a specified route is tiring
                        • Building to a pattern or blueprint (building games) is unsuccessful
                        • Difficulties learning to tell time
                        • Very slow learning to dress oneself
                        • Riding a bicycle and swimming are learned much later
                        • Ability to imitate rhythmic movements is severely lacking
                        • Problems with singing and movement games
                        • Ignoring given spatial instructions
                        • Uneven line spacing
                        • Cannot arrange the lines properly, writing outside the margins
                        • Losing the line when reading
                        • Inverted writing (right to left instead of left to right)
                        • Transposition of letters when distinguishing their position: b-d, b-p
                        • Numbers are transposed: 6-9, 36-63
                          • Body perception
                            • Difficulties orienting oneself to one’s own body
                            • Confusion between right-left, above-below, behind-before (in back of-in front of)