1. Is there an analogy to describe SPD?
Thinking of the brain as a “traffic director” for sensory input can be helpful when trying to understand SPD. In those with intact sensory processing, the brain acts as a traffic director and is able to take the incoming sensory information from all the senses, process it, and then send it to the appropriate location in an orderly and accurate fashion; this allows people to respond to all of the sensory information in an accurate, efficient, and functional manner, and supports their ability to move, learn, and engage socially. In individuals with SPD, however, the sensory information is not processed and sent off to the appropriate location in that expected orderly fashion, causing what you could say is a “neurological traffic jam” (a term pioneered by OT, educational psychologist, and neuroscientist Dr. A. Jean Ayres in her amazing book “Sensory Integration and the Child“). This means certain parts of the brain do not receive the correct information needed in order to interpret and respond to the sensory input, making it difficult to process and act upon the information received from the senses in an accurate, efficient, and functional manner.
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2. What does Sensory Processing Disorder look like in everyday life?
I think one of the simplest ways to describe this is to say that, with SPD, the body can respond to sensory input in one of three ways. It can:
- Under-respond to sensory input
- Over-respond to sensory input
- Seek/Crave sensory input
When a sensory system is under-responsive to sensory input, this means it does not notice and respond to certain stimuli that an intact sensory system would normally notice and respond to. These sensory systems require a greater intensity of stimulation in order to notice and respond. OTs also call this “low registration” of sensory input. A few examples of what this might look like in real life include the child who does not seem aware of his body and is constantly bumping into people and objects even though vision is totally fine (under-responsive proprioception), the child who drags her hand along a fence and doesn’t notice the splinters in her fingers (under-responsive tactile), or the child who can spin and spin but never seems to get dizzy (under-responsive vestibular).
When a sensory system is over-responsive to sensory input, this means it is overly sensitive to certain stimuli that an intact sensory system would think is not that big a deal. An over-responsive sensory system can cause kids to be sensitive to, bothered by, fearful or, or totally avoidant of certain types of sensory experiences. Talk about an emotional rollercoaster! A few examples of what this might look like in real life include the child who screams and cries because the seam in the sock or the tag in the shirt is so annoying or painful (over-responsive tactile), the child who is a “picky eater” or who gags at the smell or taste of a variety of foods (over-responsive olfactory or oral-tactile), the child who defiantly refuses to enter or participate in noisy environments (over-responsive auditory), or the child who is so sensitive to movement experiences that he or she is fearful of being on unsteady surfaces (such as an escalator) or of being out of a totally upright position (over-responsive vestibular).
When a sensory system seeks or craves sensory input, this means it drives the child to actively gain access to certain types of sensory input. Similar to under-responsive systems, these sensory systems need a lot more input than typical in order to feel satisfied or “regulated”. Sensory seekers CRAVE this type of input and do whatever they can to get it. This can often cause them to appear impulsive, fidgety, inattentive, or “naughty”. A few examples of what this might look like in real life include the child who chews on everything (seeking oral-proprioception), the child who touches everything (seeking tactile), the child who leans on everything (seeking proprioception), or the child who just can’t sit still (seeking vestibular).
3. Do all the senses respond in the same way (under-responding, over-responding, or seeking/craving)? Or can different senses respond in different ways?
Sensory Processing Disorder can (and often does) occur in relation to more than one sensory system, however, each sensory system responds to sensory input in its own way. So a child (or grown-up) with SPD may be over-responsive in one or more senses while simultaneously being under-responsive or sensory seeking in other senses. Additionally, a person’s ability to process and respond to particular types of sensory input can vary from day to day, hour to hour, even minute to minute.
This can be extremely frustrating for parents, teachers, therapists, medical professionals, and even the children themselves. One day (or one minute) they may be fine with the hum of the air conditioning or the fluorescent lights in the room, and then the next…it is unbearable to them. One day they may be okay eating a food of a certain texture or wearing a particular pair of socks, and then the next…the sight or thought of them makes them scream and cry. The body is constantly working to filter out what is necessary and focus on what is important, and then trying to respond to all of that input in a functional way. For a person with disordered sensory processing, the brain and body need extra help to be able to balance all of this incoming sensory input and appropriately respond to it (often referred to as “modulation”).
As you can probably tell, Sensory Processing Disorder is very complex, and very tricky!
4. What causes Sensory Processing Disorder?
At this point in time, the exact cause of Sensory Processing Disorder is unknown. But we do know from research that SPD is neurologically based; the brains of individuals with SPD are actually different than those of individuals who do not have SPD. In Chapter 13 of “Sensational Kids”, Dr. Lucy Jane Miller notes that current research suggests three “leading contenders” that contribute to Sensory Processing Disorder – heredity, prenatal and birth complications (such as prematurity or labor and delivery difficulties), and environmental factors (such as sensory deprivation, trauma, or abuse). However, like many conditions, more research is needed to in order to truly be able to identify the causes of SPD.
5. Who diagnoses Sensory Processing Disorder?
At this point in time, Sensory Processing Disorder is not a formal medical diagnosis. That is, it is not listed as its own category in the most current version of the handbook used for diagnosing neurologically-based disorders such as Autism, ADHD, OCD, and Depression. That being said, in my experience, children with sensory challenges who are referred for occupational therapy evaluation and/or treatment often come in with a referring diagnosis code (ICD-9 code) such as “Sensory Integration Dysfunction.” So it does “exist” in that sense. Unfortunately, there is no blood test, DNA test, or other medical test that will come back “positive” for SPD. However, as any parent of a child with SPD will tell you, this does not mean Sensory Processing Disorder is not real. It just means there is still millions of dollars of research that needs to be done in order to demonstrate that SPD is a condition that is separate from the other neurological disorders.
As pediatric occupational therapists, we do not treat the diagnosis; we treat the whole child. So, to be honest, to us it doesn’t really matter what “diagnosis” a child has when they are referred to OT. We look at what the child’s strengths are, what occupations they are struggling with, what skills or abilities are needed to be able to perform those occupations, and then we set goals and create a treatment plan to help them be able to more fully engage, participate in, and enjoy life. This can include addressing sensory processing difficulties and their impact on daily life. That being said, having SPD added to the list of “official” medical diagnoses has the potential to positively impact the lives of so many families as it can open doors to more easily access therapies and resources needed to be able to overcome the symptoms of SPD and improve the child’s ability to participate and THRIVE in daily life.
7. Can SPD occur on its own, apart from other diagnoses, or does it only come with other disorders? What other disorders does it co-occur with?
Research has already shown that the brains of children with SPD are different (and respond differently to sensory input) than those diagnosed with disorders such as Autism and ADHD. Yes, Sensory Processing Disorder can and does absolutely occur on its own. However, it also can and does occur alongside many other diagnoses such as Autism (at least 75% of individuals with Autism also have SPD), ADHD (approximately half of those with ADHD also have SPD), OCD, Depression, PTSD, Prematurity, Developmental Delays, Learning Disorders, and more.
10. How early can SPD be identified and what are some red flags to look out for?
Sensory processing difficulties can often (but not always) be identified during the first year of life, though it is not usually until late in the child’s first year or beyond that parents or medical professionals suspect a child’s behavioral or developmental difficulties might be related to sensory processing.
As I mentioned previously, kids may either over-respond, under-respond, or seek/crave certain types of sensory input. Dr. Lucy Jane Miller’s book, “Sensational Kids”, has some great checklists in Chapter 2 to help parents identify whether their child might be exhibiting signs of SPD. Below are some examples from those checklists, all of which are commonly known to OTs who are trained to work with children with SPD. For an online checklist, check out this SPD checklist/guide from the SPD Foundation.
Some red flags related to over-responsive sensory systems can include avoiding or being extremely bothered by certain textures, fabrics, messy substances on hands or face, grooming tasks (tooth or hair brushing, nail clipping), smells, sounds, lights, or movements (particularly not wanting to be laid down for diaper changes as a baby or not wanting to be out of an upright position as a child). Children with over-responsive sensory systems may appear to be irritable (babies often express an over-responsive tactile system by arching), aggressive, impulsive, overly cautious, or overly rigid in their desire for structure and predictability.
Some red flags related to under-responsive sensory systems can include appearing to not “register” the sensation or pain caused by minor injuries (such as splinters or sprains), seeming to not sense typical body sensations such as hunger/temperature/full bladder or bowel, preferring sedentary activities over physical play, seeming oblivious to what’s going on in the environment, and generally demonstrating a lack of body and spatial awareness. Children with under-responsive sensory systems may appear passive, lethargic, slow, unmotivated, uncoordinated, or disinterested in social interactions.
Some red flags related to sensory seeking/craving can include excessive movement, fidgeting, wiggling, spinning/jumping/rolling/climbing, touching everything, non-stop talking, seeking out vibration (such as washing machine, dishwasher, vibrating toothbrush or toys), licking/mouthing/chewing non-food objects, consistently smelling objects, seeking out certain noises, seeking out visual input, and preferring strong foods and textures (lemons, hot sauce, pickles, ice cubes, crunchy foods, etc.). This can cause children to behave as if they are impulsive, angry, difficult to calm down, disobedient, or difficult to control.
8 What should parents do if they suspect their child is demonstrating red flags or symptoms of Sensory Processing Disorder?
If you are a parent and you suspect your child may be demonstrating significant sensory processing difficulties, mention it to your child’s primary care provider (usually the pediatrician) and be an advocate for your child!Unfortunately, it is not uncommon for pediatricians to brush off parental concerns regarding sensory processing difficulties. I have heard many examples from parents where the pediatrician either disregarded the concern altogether (saying something to the effect of, “He’ll grow out it, he’s just active because he’s a boy”, or, “She’ll grow out of it, all toddlers and preschoolers are picky eaters.”), or completely overlooked the sensory issues and labeled them as something else entirely (such as Oppositional Defiance Disorder or ADHD) when, in fact, it was the sensory issues that were driving the defiance or the hyperactivity. So, as both a parent and a professional, I strongly feel that parents need to be advocates for their kids. I’m not saying you need to be hostile toward your child’s doctor. Please don’t! But you know your child best. You know how they have been since the day they were born (and before), and you know how significantly their daily life is impacted by their difficulties. Speak up, and keep a record of when you brought up these concerns so you can refer to it later when working with other medical professionals if needed.
If and when you do talk to the pediatrician about your concerns, emphasize how these sensory processing difficulties are impacting your child’s ability to perform activities of daily living such as bathing, grooming, dressing, eating, self-feeding, sleeping, or playing. You can also emphasize any safety concerns you have, such as your 4-year-old unsafely seeking movement by climbing onto countertops or fences and then jumping off, or becoming so overstimulated in noisy environments that she begins crashing her body into walls, banging her head, or punching and hitting people. Once you have shared your concerns with the pediatrician, he or she can then put in a referral for an occupational therapy evaluation and, depending on the results, OT treatment sessions can then begin in order to address the areas of concern and goals that are written as part of the evaluation process.
9. How can occupational therapy help kids with sensory processing difficulties?
As you can imagine, sensory processing difficulties can make completing everyday childhood activities quite…well…difficult. They can impact a child’s ability to perform self-care tasks (such as bathing and washing their face, brushing their hair or teeth, going to the bathroom, being able to dress or feed themselves), participate in mealtimes and receive adequate nutrition, go out into and participate in the community (grocery store, birthday parties, restaurants), or develop the motor and social skills needed to participate and make progress in school.
Occupational therapists help kids with sensory processing difficulties in a few different ways:
- Identifying what the big-picture problems or concerns are as it relates to daily function (such as being able to bathe, eat, or play with friends).
- Identifying what specific patterns of sensory processing patterns are contributing to these big-picture problems. This can be done through a combination of standardized assessment, parent interview, a review of previous medical or developmental records, and clinical observation of the child.
- Identifying other factors in addition to sensory processing (such as low muscle tone, poor motor coordination, difficulties with emotional control or short attention span, etc.) that may be contributing to the child’s difficulties in the big-picture problem areas.
- Identifying measurable goals that will support the child’s progress in the big-picture problem areas.
- Creating a treatment plan to help the child work on specific skill areas in order to make progress on their goals.
- Implementing treatment activities to target the specific skill areas needed to meet the goals.
- Monitoring the child’s progress in an ongoing manner in order to determine whether the goals are still appropriate or if they need to be changed.
- Continually communicating and collaborating with the family members who are involved with the child’s OT treatment and follow-through at home, including monitoring of the child’s individualized home program, often referred to as a SENSORY DIET (what’s that?).
- Collaboration with other professionals who work with the child, as appropriate (such as educational staff, Behavior, Speech, PT, Counseling, Psych, or other medical professionals).
ACCOMMODATIONS AND MODIFICATIONS
- This usually goes hand-in-hand with collaboration, but helping family members and other professionals figure out how to accommodate for the child’s sensory needs (e.g., having an “escape plan” or noise-reducing headphones in a noisy environment, allowing them to sit on an exercise ball while reading or taking a test) or modify the actual environment to improve their ability to participate (e.g., reducing clutter in a visually distracting room, hanging a swing in the room to provide more targeted opportunities for vestibular input, converting a garage into a sensory/home therapy room).
This combination of evaluation, treatment, collaboration, and accommodations or modifications tends to create a holistic, powerful approach to help kids who struggle with sensory processing difficulties.