Sensory Processing Disorder
Catharine Critz, PhD, CPNP, APRN & Kiegan Blake, OTR
Meet Sarah. She is a blond, curly haired, two year old who is creating quite a fuss in the grocery store. Her mother is trying to get her to put on her sunglasses because the bright lights are bothering her but she whips them off and throws them on the floor. She is squirming in the cold, hard shopping cart seat and complaining that “it’s hurting” her bottom. Sarah is clearly miserable and her mother is doing her best to keep her calm. Sarah and her mom make it to the checkout line. Barely. When they get there, the clerk reaches out to touch Sarah’s beautiful curls and she starts crying and pushes the clerks hand away. The clerk thinks Sarah needs a nap or is just plain spoiled.
Most adults have met “Sarah” at one time or another and formed conclusions about the child’s behavior. Unfortunately, the conclusions may be far from accurate. Sarah is not spoiled, nor does she need a nap. Rather, she is doing the best she can trying to cope with the sensory input from her environment but is unable to do it effectively. Sarah has Sensory Processing Disorder (SPD).
Sensory Processing Disorder is a neurologically based problem stemming from the brain’s inability to integrate the sensory input it receives from the sensory systems. Sights, smells, sounds, touch, body position and movement may be affected individually or in combination. Often the child is extra sensitive or under sensitive to these sensations. A young child’s ability or inability to integrate these sensory inputs can have a profound effect on the child’s comfort in the world, the way the child behaves, learns, moves and relates to others. The child tends to have out of proportion reactions and the parents of these children often feel at a loss as typical disciplinary strategies do not consistently work. Kids with sensory processing challenges are often average to above average intelligence and the gross estimate is that it impacts approximately 1 in 20 children (Miller, 2006). Sensory processing and integration challenges are also associated with children who have other developmental disorders such as autism spectrum disorders, attention deficit hyperactivity disorder, cognitive disability, or genetic disorders such as fragile X.
Typically developing children are able to integrate their sensory input and respond to it in coordinated, smooth, responses. Children with SPD respond inappropriately to certain sensory input and cannot organize a response in an automatic, fluent, and appropriate way. Some children are over reactive to stimuli while other children are under reactive to sensory input. For example, when the school bell rings, the child with an over reactive response may cover his ears, cower, and complain about the noise because he registers the sound as much louder. The child with an under reactive response may not respond to the sound. Neither response is appropriate. When children cannot make a smooth response to sensory input, they cannot adapt appropriately. Kids that are extra sensitive like Sara, tend to have out of proportion “fight or flight” reactions. To those around the child, these responses often look like “bad” behavior.
There are a wide range of sensory processing challenges and each child will present differently. Some of the common characteristics of SPD include:
Poor self regulation
Over or under reactive to sights, sounds, and movement
Hypersensitive to certain textures and will only wear certain, specific clothing
Does not like face washed, hair washed, hair cut, tooth brushing
Seeking of intense movement experiences (spinning, running, ‘crashing’, climbing, jumping, acceleration) or avoiding certain movements
Difficulty transitioning between activities & settings; the child asks what is coming up a lot
Difficulty calming down for seated activities & falling asleep
Refuse to eat certain foods because the texture or the way the food looks
Lacks creativity and spontaneity in play activities
Appearing clumsy, having poor endurance or having poor balance
If you suspect your child may have SPD, speak with your nurse practitioner or physician and request an evaluation conducted by a qualified professional or contact the professional directly. The assessment may be done by an occupational therapist who has specialized training in evaluating and treating children with SPD. You can search the SPD Resource Directory at www.SPDnetwork.org/directory, call your local hospital’s OT department, contact an OT program at a local university, seek local contacts through the American Occupational Therapy Association (AOTA), call your local school or local organizations offering pediatric OT services.
Once the diagnosis is made, an individualized treatment program should be developed. The goal of Sensory integration therapy is to
Help the child’s body process sensory information more accurately
Educate caregivers on their child’s form of SPD, effective therapy activities at home, accommodations and parenting strategies
Support the child to develop coping and problem solving abilities to replace ‘fight and flight’ reactions; intact self-esteem
Therapy is customized to address the specific sensory needs of the child and can include an array of specialized therapy strategies that may include:
Physically resistive “heavy work” & movement activities
Motor coordination, strengthening and balance activities
A “sensory diet” of activities to do at home & school
Auditory therapies
Self-regulation & coping strategies
Parent education
For additional information on Sensory Processing Disorder see www.spdnetwork.org.