Bilateral Integration Difficulties

Bilateral integration difficulties are commonly seen as a set of symptoms associated with Sensory Processing Disorder, also called Sensory Integration Disorder. Children who experience bilateral integration difficulties can be impacted in a variety of ways. Fortunately, there are evidence-based therapies that can help your child navigate tasks and situations with confidence.

Sensory Integration Disorders

There are several subtypes of sensory integration disorders that describe dysfunction in one or more sensory systems. On the whole, difficulties with processing sensory information arise because of a kind of “traffic jam” of information in the nervous system. Information coming in from the outside world or information from the brain that directs bodily movements is not organized in the same way that it usually is for others. A child with Sensory Integration Disorder has difficulty sorting and interpreting sensory information- sight, sound, touch, smell, taste, and two often-forgotten senses, proprioception and interoception.

Bilateral Integration

Difficulty with bilateral integration, that is- coordinating both sides of the body to perform sequenced or otherwise complex tasks, falls partly under the Sensory-Based Motor Disorder (SBMD) subtype of Sensory Integration Disorder. In people without symptoms of SBMD, tasks like tying their shoes, following a simple dance routine, and planning a series of actions, comes relatively easily. This process of taking in information, organizing it in the brain, and then directing the body to carry out a response, is known as “praxis”.


In the context of sensory-motor disorders, dyspraxia is defined as “difficulty thinking of, planning, and/or executing skilled movements, especially novel movement patterns”. Bilateral integration challenges can contribute to a child’s dyspraxia, potentially resulting in developmental delays.


Tasks that require coordination of both sides of the body are everywhere. We likely forget just how many times a day we complete these tasks until a loved one is experiencing difficulty. If your child struggles with bilateral integration, you may notice some or all of the following symptoms.

  • Clumsiness

  • Poor posture

  • Difficulty skipping, riding a bike

  • Trouble learning dexterous tasks like using a fork and knife or tying shoes

  • Difficulty choosing a dominant hand or foot

  • Reluctant to “cross the midline” (e.g., reach across the body to grab an item)

  • Poor hand-eye coordination, difficulty playing sports

  • Difficulty planning a series of steps

  • Accident-prone

  • May prefer fantasy play and sedentary activities

Effects of Bilateral Integration Difficulties

Sensory challenges are a complex neurological issue. When a child is struggling, it may be difficult for them to verbalize what they are feeling or why they’re having a hard time. In many cases, children with Sensory Integration Disorder also experience difficulty in other areas of functioning such as social development, communication, focus, and mood regulation. These secondary effects can sometimes lead to a misdiagnosis that overlooks the underlying sensory issues.


Children (and adults) with bilateral integration challenges can see a dramatic improvement in symptoms and quality of life through occupational therapy. Treatment usually follows a sensory integration approach, which seeks to teach the nervous system how to handle sensory information properly. A typical occupational therapy session will look different for each child’s specific needs, but will likely include fun, play-based activities like obstacle courses, puzzles, drawing, swinging, and balance activities. With practice, your child can “re-wire” their brain to handle sensory input in their daily lives.

If your child has an additional diagnosis like Autism Spectrum Disorder, ADHD, or OCD, treatment in the form of talk therapy, Exposure and Response Prevention (ERP), or medication may be needed. Co-occurring diagnoses can make it more difficult for a child to make sense of the world around them when their nervous system is already over or under-responsive.

Bilateral integration difficulties and Sensory Processing Disorder can be successfully treated. With occupational therapy, you and your little one can learn strategies to help them feel safe and confident, and, over time, to minimize their symptoms. At Novomed, our psychiatry and psychology department treats children with bilateral integration difficulties. Our team of psychologists, psychiatrists, and occupational therapists provide personalized care to ensure the treatment needs of every child are met. To learn more about our services in Dubai and how we can support you and your child, contact us today.