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Sensory Processing Disorder: Ambiguous but Real

A child screams violently when her grandmother tries to squeeze and kiss her goodbye.

A little girl smacks her playmates in the head, without concern for consequences.

Another child zones out in the corner of a loud room.

A little boy wails because his feet are wet, and he is inconsolable.

Sensory disorders can cause children to act out or zone out.
Sensory disorders can cause children to act out or zone out.

These incidents look like bad behavior. We often quickly conclude that children who do these things are  spoiled, bossy or disrespectful.

And that is what makes understanding sensory processing disorder (SPD) so challenging. Behavior resulting from SPD can look like a tantrum or discipline problem. And the remedies for dealing with the behavior tend to be counterintuitive. Which is why it’s a disorder often undiagnosed and untreated. Sensory disorders, like many autism spectrum disorders, remain somewhat obscure to most people.

Sensory Profiles: Sensory Input Preferences

We all have individual sensory profiles, preferences for different types and amounts of stimuli.

Ruth Goldeen, an occupational therapist at UVA Children’s Hospital, explains:

“We all have a unique nervous system with preferences and distastes for sensory input. One person might prefer to spend free time in an arcade with plenty of noise and hustle and bustle; another might want to sit in a quiet space and read a book. Both are ‘normal’ but definitely opposite extremes. And certainly some people may know they don’t like loud noises or crowds and find ways to adjust their environments accordingly.”

The Kinds of SPD

People can have two basic kinds of sensory processing disorder.

Sensory defensiveness: A child who is sensory defensive doesn’t like touch, sound or input they don’t create themselves. It sends them into “fight or flight” mode, an acute stress response triggered by real or perceived threat that causes the release of hormones and increases heart, breath and blood pressure rates.

Example: A 3-year-old spends the day in daycare, which often means a chaotic, noisy atmosphere filled with unpredictable children. By the end of the day, the child, having spent 8 or 9 hours in a state of heightened anxiety, reacts to normal interactions as if to a threat, by running away, hiding or punching.

Sensory seeking: A child seeking sensory input will bang into everything, literally bounce off the walls, even chew things.

Example: “They don’t seem reactive to the environment. The child will be finger painting and suddenly the paint covers their whole body. Or the child will walk right off the edge of the playset. And they don’t react at all. It’s a hyporeaction, an underresponsive reaction.” Goldeen explains that sensory seekers often end up in long-term hobbies that involve a great deal of physical stimulation, like rugby, football and horseback riding.

Other things to note:

  • You can also have a mix of sensory defensiveness and sensory seeking. A child might be hyperresponsive to some things, or hyporesponsive to others.
  • SPD can impact any one sense or a combination of several. It can affect the auditory, visual, tactile, vestibular (movement), proprioception (awareness of joint/body position).

Sensory Disorder: Is This Autism?

No. That is, SPD is not autism. Children who have a diagnosis of autism spectrum disorder more often than not also have sensory processing challenges. However, children who have a sensory disorder don’t necessarily qualify for an autism diagnosis.

The Trick of Diagnosis

Diagnosing a child for SPD is tricky. The individual nature of sense preference and the fact that children, especially young children, can’t always identify and articulate their preferences results in a great deal of ambiguity.

Goldeen says that an additional challenge is that “the local pediatrician may not see your child for long enough or in varied situations. Much of the findings come from parent report and experiences in daycare or school.”

Which puts the burden of recognition on the parents and also underscores Goldeen’s recommendation that concerned parents get a referral from their pediatrician to have an evaluation at a specialized facility like UVA.

What symptoms should you look for? Pay attention if your child is:

  • Triggered by environmental sounds — they cause your child to get upset or become very active — like weeping every time the vacuum cleaner turns on
  • Hyperreative or hyporeactive (more or less than expected norm) in response to daily events
  • Experiencing extreme difficulty with transitions
  • Exceptionally bossy
  • Unusually inflexible
  • Rigid
  • Controlling
  • Needs things to be predictable
  • Extremely aversive to certain textures with food, hands, or feet — some kids won’t touch anything that looks wet, or eat anything with soft texture or food items mixed together

None of these symptoms in isolation means your child has SPD. All of these characteristics and preferences may be completely normal, especially in young children whose nervous symptoms are in the process of development.

SPD Resources for Parents

  • Get support: A sensory processing disorder support group meets the last Tuesday of every month at 7 p.m, at the Fontana Clubhouse in Charlottesville. All are welcome to come once or regularly. Email for more information.
  • Read: Check out one of the most popular and helpful books on the subject, Out of Sync Child, by Carol Kranowitz
  • See your pediatrician: Get a referral for an evaluation. Though it’s never too late, Goldeen says, it’s always better to get intervention early, while a child is still developing, to increase their quality of life. Need a pediatrician?

“When these preferences become a concern is when the child’s sensory tolerance or need (whether seeking sensation or avoiding it) interferes with functioning in the environments of family, school or the playground,” explains Goldeen. “For instance, if a family has stopped going anywhere because it’s too difficult, or a 3-year-old child has been kicked out of several preschools, then we’re talking about quirks that have become dysfunctional.”

Nature Deprivation: The Environmental Impact?

Goldeen, who has worked at KCRC for 24 years, says she’s seen the patient population shift from most patients having motor-related issues like cerebral palsy to more on the autism spectrum, with psychological diagnoses, anxiety disorders, obesity, autism disorders and sensory processing disorders.

“Seeing how it’s changed, I have to think something’s different.” Goldeen contrasts her childhood experiences of riding her bike outdoors all day unsupervised to the ultra-structured, oversanitized, indoor, supervised activities that make up most kids’ experiences today.

“In the old days, you’d catch grasshoppers, get gooey stuff on your hands. You didn’t have cell phones, there was no checking in. Kids today have less spontaneous exposure to sensory input.”

The problem? “All children are kinesthetic learners. They learn through their bodies; first they touch it, then they label it.”

And without the chance to get their hands dirty and engage in free play, young nervous systems don’t develop a tolerance. Some call it nature deprivation syndrome.

While the causes of sensory processing disorder remain unknown (possibilities include the usual suspects of genetics and environmental influence), without access to sensory experiences that satisfy and inform a child’s nervous system, occupational therapists like Goldeen and the children’s families have to supply them.

Therapy for the Senses

Which is where occupational therapy comes in.

For example, the Wilbarger Deep Touch Pressure protocol uses a sequence of deep, rhythmic pressure with surgical brushes and compression to send input into the joints. The protocol is performed first by the caregiver and then actively by the child, for 3 minutes every 1 ½ – 2 hours to stimulate the nerves through the tactile and proprioceptive receptors. Over time, this approach actually changes the nervous system. Goldeen explains: “The goal is to help the child more successfully tolerate sensory input.”

Other therapies allow children to play in a nonthreatening space while pushing their tolerance levels. “The safe environment helps them be open to trying new things,” Goldeen says.

Experiential, hands-on activities that prove helpful include:

  • Finger painting with pudding or shaving cream
  • Working with play dough, dried beans and rice
  • Gardening
  • Baking and cooking (great also for teaching sequencing, following directions, math, making a mess and cleaning it up, using taste, touch and smell)
  • Yoga (helps with body awareness)
  • Swimming
  • Swinging
  • Horseback riding, which includes movement, touch and smell

Over a 12-week period of routine visits and parent education, the occupational therapist tries to accomplish two main goals:

  • Intervene with the nervous system’s tolerance levels
  • Find socially acceptable ways for sensitive kids to meet their extreme sensory needs in the short and long run

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