Paediatrica Indonesiana

VOLUME 53 July ‡ NUMBER 4

Original Article

Prevalence of dysfunction in sensory integration in

kindergarten children
Sem S. Surja1, Hendry Irawan1, Theresia Ilyan1, Jessica Fedriani1,
Satyadharma M. Winata1, Irene2

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Abstract HQVRU\ LQWHJUDWLRQ 6, LV WKH RUJDQL]DWLRQ RI
Background Children with dysfunction in sensory integration VHQVDWLRQ,QRWKHUZRUGV6,LVWKHQHXURORJLFDO
'6,KDYHGLIILFXOW\HIIHFWLYHO\DQGHIILFLHQWO\LQWHUDFWLQJZLWK
WKHLUHQYLURQPHQW,WKDVEHHQHVWLPDWHGWKDWWRRIFKLOGUHQ
ZLWKRXWGLVDELOLWLHVKDYH'6,/DWHDVVHVVPHQWDQGLQWHUYHQWLRQ
in children with this problem may significantly impact further
GHYHORSPHQW7RGDWHWKHUHLVQRDYDLODEOHGDWDRQ'6,SUHYDOHQFH
LQ,QGRQHVLDQFKLOGUHQZKLFKLVFUXFLDOIRUEHWWHUXQGHUVWDQGLQJ
RIWKH'6,EXUGHQLQWKHFRPPXQLW\
Objective7RHVWLPDWHWKHSUHYDOHQFHRI'6,LQ1RUWK-DNDUWD
children using standardized screening tools.
Methods Parents of kindergarten children from two private
VFKRROV LQ 1RUWK -DNDUWD ZHUH JLYHQ TXHVWLRQQDLUH SDFNHWV
including the Family Information Questionnaire and Winnie Dunn’s
Short Sensory Profile (SSP) to assess demographic data and parents’
SHUFHSWLRQVRIWKHLUFKLOGUHQZLWKUHJDUGVWR'6,
Results2ITXHVWLRQQDLUHSDFNHWVGLVWULEXWHGSDFNHWV
process that organizes sensory input from the
body and the environment so that one can sense the
body and effectively interact with the environment.
Sensory input in this regard includes stimuli to
the five basic senses (visual, auditory, gustatory,
olfactory, and tactile), vestibular senses (related to
the earth’s gravity and balance), proprioceptive senses
(position and movement), and visceral senses. This
integration is a sustainable process that consists of
reception, integration, and customization of obtained
information which can determine the appropriate
reaction to a situation. Sensory processing in humans
involves reception of a physical stimulus, transduction
ZHUHUHWXUQHG0RVWFKLOGUHQZHUHRI&KLQHVHHWKQLFLW\
DQGDJHGWR\HDUV2IWKHFKLOGUHQFKLOGUHQ of the stimulus into a neural impulse, and perception
PHWWKHFULWHULDIRU'6,GHILQLWHGLIIHUHQFHFKLOGUHQ RUWKHFRQVFLRXVH[SHULHQFHRIVHQVDWLRQ A child
ZHUHLQWKHSUREDEOHGLIIHUHQFHFDWHJRU\IRU'6,DQGFKLOGUHQ with good sensory processing will be adaptive to their
ZHUHLQWKHFDWHJRU\RIW\SLFDOSHUIRUPDQFH7KHVFRUHVIRU environment. These processes are foundational for
WKHSDUDPHWHUVRIXQGHUUHVSRQVLYHDQGYLVXDODXGLWRU\VHQVLWLYLW\
were the most commonly observed in subjects in the definite
learning, perception, and action.
GLIIHUHQFH FDWHJRU\ )URP DOO TXHVWLRQQDLUH SDFNHWV D WRWDO RI ,PSDLUPHQWRIWKHLQWHJUDWLRQSURFHVVPD\RFFXU
 RI FKLOGUHQ LQ VHOHFWHG NLQGHUJDUWHQV LQ 1RUWK -DNDUWD in some or all sensory systems, including the tactile,
PHW WKH VFUHHQLQJ FULWHULD IRU '6, ZKLOH DQ DGGLWLRQDO  auditory, visual, gustatory, olfactory, proprioceptive,
were likely to have the disorder.
Conclusion%DVHGRQSDUHQWDOUHSRUWVZHILQGWKDWRI
children from two private kindergartens in North Jakarta had
'6,ZKLOHDQDGGLWLRQDODUHOLNHO\WRKDYHWKHGLVRUGHU From Atma Jaya Catholic University Medical School, and the Department
[Paediatr Indones. 2013;53:223-7.]. of Child Health,$WPD-D\D&DWKROLF8QLYHUVLW\-DNDUWD,QGRQHVLD

Reprint requests to: Sem S. Surja, Atma Jaya Catholic University

Keywords: dysfunction in sensory integration, short 0HGLFDO6FKRRO7DPDQ$ULHV$:HVW-DNDUWD,QGRQHVLD7HO
sensory profile, screening, parents’ report (PDLOVDPXHOBVHP#KRWPDLOFRm.

Paediatr Indones, Vol. 53, No. 4, July 2013‡223

 Sem S. Surja et al: Prevalence of dysfunction in sensory integration in kindergarten children

and vestibular systems. Such impairment is called using the Family Information Questionnaire and Short
G\VIXQFWLRQLQVHQVRU\LQWHJUDWLRQ'6,DQGFDXVHV
difficulty in modulating, discriminating, coordinating,
or organizing sensations in an adaptive manner. ,W
KDVEHHQHVWLPDWHGWKDWRIFKLOGUHQZLWKRXW
GLVDELOLWLHV KDYH '6, An American study showed
WKDWRIVWXGHQWVHQUROOHGLQNLQGHUJDUWHQPHW
WKH VFUHHQLQJ FULWHULD IRU '6, &KLOGUHQ ZLWK '6,
DUHPDODGDSWLYHDVVKRZQE\H[FHVVLYHUHVSRQVHVWR
normal sensory input or even ignoring of the incoming
LQSXW ,W LV GLIILFXOW IRU VXFK FKLOGUHQ WR HIIHFWLYHO\
and efficiently interact with their surrounding
Sensory Profile 663 D VWDQGDUGL]HG VHOIUHSRUW
TXHVWLRQQDLUHILOOHGE\SDUHQWVWRDVVHVVWKHLUFKLOGUHQ·V
behavioral responsiveness to sensation. Written
informed consent was obtained from subjects’ parents
prior to the study.
Subjects were kindergarten children from
the Tarakanita Kindergarten 4 or BPK Penabur
.LQGHUJDUWHQ  (YHU\ SDUHQW ZKR KDG DFWLYH
NLQGHUJDUWHQ FKLOGUHQ ILOOHG WKH TXHVWLRQQDLUHV
completely. Questionnaires were collected from
 VXEMHFWV ZKLFK UHSUHVHQWHG  RI SDUHQWV
environment because they cannot process, integrate,
or properly respond to incoming sensory stimuli.
These sensory disorders may negatively affect a
child’s developmental and functional abilities in
the behavioral, emotional, motor, and cognitive
domains.,PSDLUPHQWVLQIXQFWLRQDODELOLW\XVXDOO\
become apparent when children enter school and may
persist through adulthood.
To date, there has been no available data on
'6,SUHYDOHQFHLQ,QGRQHVLDQFKLOGUHQ7KLVGDWDLV
FUXFLDOLQRUGHUWRHOXFLGDWHWKH'6,EXUGHQLQWKH
community. Therefore, the objective of this study
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in children. We chose two kindergartens in North
-DNDUWDEHFDXVHRIWKHLUSUR[LPLW\WRRXULQVWLWXWLRQ
This study may be considered to be a pilot study to
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Methods
This prospective study was performed at two private
kindergartens in North Jakarta from May to June
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HQUROOPHQWQ LQWKHVHOHFWHGNLQGHUJDUWHQV
The Family Information Questionnaire was used to
assess the children’s demographic data (e.g., age and
birth date), parental information (e.g., education),
and parents’ perception of their children with regards
WR'6,
7KH 663 LV D VFUHHQLQJ TXHVWLRQQDLUH XVHG WR
DVVHVV'6,LQFKLOGUHQ,WZDVGHYHORSHGDVDVKRUWIRUP
of the Sensory Profile Questionnaire7KH663LVDLWHP
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EHKDYLRUVUHODWHGWR'6,7KLVTXHVWLRQQDLUHFRQVLVWV
RI VHYHQ FDWHJRULHV WDFWLOH VHQVLWLYLW\ WDVWHVPHOO
VHQVLWLYLW\ PRYHPHQW VHQVLWLYLW\ XQGHUUHVSRQVLYH
VHHNV VHQVDWLRQ DXGLWRU\ ILOWHULQJ ORZ HQHUJ\ZHDN
DQGYLVXDODXGLWRU\VHQVLWLYLW\3DUHQWVPDGHVXEMHFWLYH
global ratings of their children for each item, using a
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responds in this manner every time, and 5 representing
never, as the child never responds in this fashion. Higher
scores represented better functional performance in
seven sensory profile’s categories. Finally, the data
was analyzed using Winnie Dunn’s SSP classification
(Table 1).
Definite difference was defined as the child
responds to stimuli definitely more or less than others.
Probable difference was defined as the child responds

Table 1. Winnie Dunn’s 5JQTV5GPUQT[2TQſNGENCUUKſECVKQP10

5GPUQT[RTQſNGU Typical performance Probable difference &GſPKVGFKHHGTGPEG
Tactile sensitivity 35-30 29-27 26-7
Taste/smell sensitivity 20-15 14-12 11-4
Movement sensitivity 15-13 12-11 10-3
Under-responsive/seeks sensation 35-27 26-24 23-7
Auditory Filtering 30-23 22-20 19-6
Low energy/ weak 30-26 25-24 23-6
Visual/auditory sensitivity 25-19 18-16 15-5
Total score 190-155 154-142 141-38

224‡Paediatr Indones, Vol. 53, No. 4, July 2013

 Sem S. Surja et al: Prevalence of dysfunction in sensory integration in kindergarten children

Table 2. Demographic characteristics of subjects compared to the general population of Indonesia

Characteristics Children in study Children in Indonesia
n=117 n=40,796,467
Gender, n (%)
Males 59 (50.43) 20,729,566 (50.81)* 12
Females 58 (49.57) 20,066,901 (49.19)* 12
Children’s age, n (%)
2 years 3 (2.56) n/a
3 years 39 (33.33) n/a
4 years 54 (46.16) n/a
5 years 18 (15.39) n/a
6 years 3 (2.56) n/a
Religion, n (%)
Moslem 1 (0.9) (88.58)13
Christian 45 (38.5) (5.79)13
Roman Catholic 24 (20.5) (3.07)13
Buddhist 30 (25.6) (0.61)13
Hindu n/a (1.73)13
Others 17 (14.5) (0.22) 13
Ethnicity, n (%)
Chinese 55 (47) (0.86)14
Javanese 2 (1.7) (41.71)14
Betawi 2 (1.7) (2.51)14
Bangka 1 (0.9) n/a
Batak 1 (0.9) (3.72)14
Bugis 2 (1.7) (2.49)14
Minahasa 3 (2.6) (0.33)14
Others 51 (43.6) (48.38)14
*0-9 years old; n/a=not available

to stimuli probably more or less than others. Typical Results

performance was defined as the child responds to
stimuli just like their peers. Scores were interpreted 2ITXHVWLRQQDLUHSDFNHWVVHQWWRVXEMHFWVIURP
as follows: a definite difference was indicated by WZRNLQGHUJDUWHQVLQ1RUWK-DNDUWDZHUHUHWXUQHG
scores greater than two standard deviations from (Figure 1UHSUHVHQWLQJDQHQUROOPHQWRIRI
the mean for children who were developing typically all parents. Family Information Surveys were used to
LQWKHQRUPDOSRSXODWLRQDSUREDEOHGLIIHUHQFHZDV summarize characteristics of subjects. Most children
indicated by scores greater than one and less than assessed in this study were Chinese and aged 4 years.
WZRVWDQGDUGGHYLDWLRQVDW\SLFDOSHUIRUPDQFHZDV 7KHUHZHUHPDOHVDQGIHPDOHVTable 2).
indicated by scores that fell within one standard 3DUHQWVRIVXEMHFWVUDQJHGLQDJHIURPWR\HDUV
deviation of the mean. Most parents were university graduates (Table 3).
Prior to the beginning of the survey, permission
letters were sent to the principals of selected Table 3 'FWECVKQP NGXGNU QH UWDLGEVUŏ RCTGPVU YJQ ſNNGF
NLQGHUJDUWHQV ,I SULQFLSDOV JUDQWHG SHUPLVVLRQ WKH\ the questionnaires
ZHUHVHQWTXHVWLRQQDLUHSDFNHWVLQFOXGLQJWKHFamily Educational level attained Subjects’ parents
Information Questionnaire, the SSP and an informed n %
consent form, to be distributed to the parents. Packages Junior high school or below 1 0.85
were distributed to the children at school to be passed Senior high school 17 14.53
to their parents. Parents were given one week to fill and University or above 82 70.09
UHWXUQWKHTXHVWLRQQDLUHVWRWKHVFKRROV Unknown 17 14.53

Paediatr Indones, Vol. 53, No. 4, July 2013‡225

 Sem S. Surja et al: Prevalence of dysfunction in sensory integration in kindergarten children

Table 4. 5JQTVUGPUQT[RTQſNGUTGUWNVU
5GPUQT[RTQſNGU Typical performance Probable difference &GſPKVGFKHHGTGPEG
(%) (%) (%)
Tactile sensitivity 42.7 25.6 31.6
Taste/smell sensitivity 47.0 23.1 29.9
Movement sensitivity 41.9 31.6 26.5
Under-responsive/seeks sensation 34.2 25.6 40.2
#WFKVQT[ſNVGTKPI 38.5 29.1 32.5
Low energy/ weak 70.9 13.7 15.4
Visual/auditory sensitivity 35.0 29.9 35.0
Total score 29.9 28.2 41.9

Discussion
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packets sent EXUGHQRI'6,SUREOHPVLQ,QGRQHVLD%DVHGRQSDUHQWV·
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in two selected private kindergartens met the definite
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Tarakanita BPK Penabur E\DVVXPLQJWKDWDOOQRQVXEMHFWVZHUHLQWKHW\SLFDO
Kindergarten 4: .LQGHUJDUWHQ
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SDFNDJHVVHQW SDFNDJHVVHQW
LIDOOQRQVXEMHFWVZHUHH[FOXGHG
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TOTAL: E\ $\UHV ZKLFK ZDV  WR  RI FKLOGUHQ ZLWKRXW
SDFNDJHV disabilities. Another previous study also had a result
returned
RI  SUHYDOHQFH suggesting a relatively high
'6, SUHYDOHQFH LQ VHOHFWHG NLQGHUJDUWHQV LQ 1RUWK
Figure 15VWF[RTQſNG Jakarta. However, further studies involving many more
subjects from representative kindergartens should be
FRQGXFWHGLQRUGHUWRDGHTXDWHO\HVWDEOLVKWKH'6,
prevalence rate.
)URP  TXHVWLRQQDLUH SDFNHWV UHWXUQHG ZH Several limitations should be noted in our
IRXQGWKDWFKLOGUHQPHWWKHFULWHULDIRU study. First, our results cannot be used to generalize
'6,GHILQLWHGLIIHUHQFHEDVHGXSRQSDUHQWV·UHSRUWV WKURXJKRXW ,QGRQHVLD QRU HYHQ LQ 1RUWK -DNDUWD
FKLOGUHQZHUHLQWKHSUREDEOHGLIIHUHQFH DV  RI VXEMHFWV ZHUH &KLQHVH ZKLOH  RI
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in the typical performance category of the general subjects’ parents had attained a relatively high
population (Table 4). The most commonly observed educational level (mostly university graduates or
parameters of subjects in the definite difference DERYH  ZKLOH PRVW SDUHQWV LQ ,QGRQHVLD
FDWHJRU\ ZHUH XQGHUUHVSRQVLYH DQG YLVXDODXGLWRU\ attained less education (mostly senior high school
sensitivity. Because the parental response rate was low, RU EHORZ  :HOOHGXFDWHG SDUHQWV PD\
ZHFDOFXODWHIURPDOOTXHVWLRQQDLUHSDFNHWVDWRWDORI have better perception in reporting and rating their
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LQ1RUWK-DNDUWDPHWWKHVFUHHQLQJFULWHULDIRU'6, Also, the small number of kindergartens (only two
ZKLOH DQ DGGLWLRQDO   ZHUH OLNHO\ WR kindergartens agreed to enroll) and the specific type
have the disorder. of kindergartens (only private kindergartens enrolled)

226‡Paediatr Indones, Vol. 53, No. 4, July 2013

 Sem S. Surja et al: Prevalence of dysfunction in sensory integration in kindergarten children
were leading causes of this population skew.
Second, the assessments were a screening method
based only on parents’ perceptions. Although SSP is a
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studies involving a larger population and more intensive
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prevalence in children.
Third, the low survey response rate by parents
contributed to several problems in data analysis. Of
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4. Miller LJ, Lane SJ. Toward a consensus in terminology in
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of neurophysiological processes. Sensory integration special
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and attention as important substrate for the process of sensory
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children would have been estimated to be as high as
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a method similar to that of an earlier study Hence,
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persist until later in life and affect a child’s future.
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terminology in sensory integration theory and practice: Part
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of parents’ perceptions of sensory processing disorders among
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parents, teachers, and care providers, at least in the two
private kindergartens enrolled in this study.
The limitations of our study suggest a need for
further, more rigorous, epidemiological studies to
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