What is Sensory Processing Disorder?
‘Sensation’ is the process by which our brain takes in the sensory information from the seven senses, i.e., vision, hearing, touch, taste, smell, vestibular (movement and balance) and proprioception (body awareness and position). Perception is the process by which our brain organizes, interprets and or experiences the sensation it receives. And Sensory Processing Disorder or SPD means the disruption to the perception of the sensory information our brain receives. Appropriate reception, interpretation, and response to the sensory stimuli, in short, good sensory integration, is essential to our daily lives.
Why is it important to know about SPD?
Sensory integration affects how we move, learn, work, and socialize. For a young child, sensory integration is a normal part of development. Sensory integration is usually automatic and an accurate process in most children. However, children with SPD struggle to filter, analyze, organize, and integrate the sensory information they are receiving. SPD may affect the processing of a single or multiple sensations. Children with SPD could be either oversensitive or under-responsive to any of the seven sensations. When even one aspect of sensory integration doesn’t work the way it should, this may impact the child’s attention, coordination, learning, leisure, diet, or play.
What causes Sensory Processing Disorder?
Unfortunately, no one knows what exactly causes SPD. But, the genes likely have a significant role to play in the varied manifestation of this condition. Our midbrain and the brainstem are involved in the early processing of sensory information. Since the very same regions are also involved in processing coordination, attention, and arousal, it should be no wonder that SPD is more commonly associated with attention difficulties, coordination difficulties, neurodiversity and anxiety
What is the difference between sensory processing difficulty vs SPD?
In my practice, in keeping with other experts, I tend to use the term ‘sensory processing difficulty/ies’ when there is no clear evidence of impact on the child’s functioning. Conversely, I use the term’ sensory processing disorder’ when there is clear evidence of these difficulties impacting the child’s functioning, e.g., affecting the child’s attention, emotional regulation, play, learning or leisure.
Will SPD get better with age?
Sensory Processing Disorder is more evident in children with neurodevelopmental disorders. Since I am a paediatrician, I cannot say much about adults. Still, in my opinion, SPD is less visible in adults as either they have developed a better ability to cope with these difficulties or developed ways to circumvent or avoid these difficulties by their better communication abilities. Neuroplasticity may also have a role to play, and hence these difficulties are likely to get better with age.
Which neurodevelopmental conditions is SPD associated with?
Sensory Processing Difficulties/Disorder is more commonly present in a child with the following neurodevelopmental disorders:
- Autism Spectrum Disorder
- Attention Deficit Hyperactivity Disorder
- Cerebral Palsy
- Genetic conditions, e.g., Fragile X syndrome, Down syndrome
- Developmental Delay
- Visual Impairment
- Hearing Impairment
- Learning Disabilities
- Traumatic Brain Injury
What are the symptoms or indicators of SPD?
With sensory hypersensitivity, “a little feels like a lot”. This can happen in response to all sensory input, or it may be related to information coming from only one or a few of the sensory systems that send information. An over-responsive child may get overwhelmed by standard sensory input and react strongly and negatively to this. They may try to avoid sensations, be fearful, become distressed, cautious, or aggressive.
Hence, sensory hypersensitivity may appear in a child as:
- Avoiding non-harmful touch (e.g., craft materials, food, clothing, washing)
- Fear of movement that is usually not threatening (e.g., swinging, being picked up, etc.)
- An over-reaction to certain lights, sounds, odours, and tastes
With hyposensitivity, “a lot feels like a little”. A hyposensitive child may seem oblivious to sensory information from the senses, such as certain sights, tastes, smells, sounds, touch, pain, or movement.
Therefore, sensory hyposensitivity in a child can appear as:
- A tendency to withdraw and be difficult to engage
- Conversely, they may be “constantly on the go, to try and find more robust sensory input (e.g., jumping dangerously, or preferring very strong flavours)
- Difficulty with postural control or movement (e.g., dyspraxia)
Why is Sensory Processing Disorder not a recognized medical condition?
SPD is neither clearly defined nor quantifiable nor predictable nor testable, unlike many other medical conditions. Thus, there is a lack of widely agreed valid diagnostic criteria. There is no universally accepted diagnostic tool. And since the perception of sensation varies with each individual and sometimes within a given individual based on other factors, it has not been possible to define the boundaries of the disorder. Consequently, neither the tests nor the therapy given for this condition is reproducible and comparable.
Therefore, SPD is not recognized as a disorder by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) or the ICD-11 (International Classification of Diseases-11th edition), the global and widely accepted standards for diagnostic health information.
Consequently, it is a standard practice not to diagnose SPD or Sensory Processing Disorder as a standalone diagnosis or condition. However, SPD can be named a separate diagnosis in conjunction with any of the above-mentioned neurodevelopmental disorders.
So, how is Sensory Processing Disorder diagnosed, and what can be done to address this?
Sensory Processing Disorder is usually identified or diagnosed by Occupational Therapists (OT) and or Neurodevelopmental Paediatricians. The diagnostic process may involve either carrying out sensory integration and praxis tests by an OT or assessments that include reports from the child’s setting, parental reports, questionnaires, and observation findings.
Even though there is no medication to treat SPD, a lot can be done to address a given child’s sensory difficulties and prevent its impact on the child’s functioning and enhance their activities of daily living. Once an assessment has diagnosed your child’s SPD, occupational therapy is used to help manage this condition.
How is occupational therapy used to treat SPD?
An occupational therapist (OT) will help the child, parents, and teachers understand how SPD affects the child’s everyday life. The OT would then provide strategies to help the child achieve a more optimal level of alertness, which will help the child more effectively engage at home, in school, and their extracurricular activities.
Addressing the child’s sensory difficulties in this way will improve your child’s self-esteem by empowering the child and family with strategies to manage the condition, decrease frustration and stress levels, and improve engagement and participation in everyday activities.
The occupational therapist should recommend specific strategies tailored to your child’s sensory profile. The OT may call this a ‘sensory diet‘ or ‘sensory lifestyle’. They contain a list of activities and adaptations that need to engage your child in a fun way. Parents and teachers can practice/carry out these activities daily. The OT would also recommend any aids, adaptations, equipment, or sense toys a child may need to help regulate their sensory processing. Then, allow your child to do the activity in a fun way, build upon the activities your child chooses, and stop if they become distressed.
What strategies and activities are there to address SPD?
Before you read any further, I would like you to note this disclaimer that ‘I strongly recommend you seek a professional opinion from an occupational therapist before you implement any of the strategies listed in this article’. With that in mind, you can read the below-mentioned sensory integrating strategies that have been collated over the years in working with two very experienced occupational therapists, Clare Wallace and Nicole Bigler, while we all worked here in Oxford. Then, you may consider trying some of the below-mentioned strategies that suit your child’s needs while you consider an assessment by an OT or while waiting to see an OT. Nevertheless, please consider seeking an opinion from an occupational therapist if you have any doubts, difficulties, or queries about any of the below-mentioned sensory strategies.
I have listed the strategies under each sensory category and tried to record some ideas for ‘hypersensitive’ and ‘hyposensitive’ for each sensation. Here they are:
If your child is hypersensitive to visual stimuli:
- Make sure spaces are uncluttered
- The lighting is soft, not fluorescent
- Try and allow sunglasses, even indoors
If your child is hyposensitive to visual stimuli:
- Make the environment is visually exciting with bright colours, posters, mobiles, and flashing toys
- Play games that encourage visual discrimination and hand-eye coordination such as throwing bean bags into a basket, popping bubbles, fishing games, and treasure hunts
If your child is hypersensitive to auditory stimuli:
- Use quiet voices. Try to avoid loud, unexpected voices wherever possible
- Have a quiet space your child can retreat to at home and school
- Give your child ear-defenders to block out noise when needed, e.g., at the shopping centre or hoovering
- Carry laminated out-of-order signs to stick onto public hand-dryers if necessary while your child is using the toilet.
If your child is hyposensitive to auditory stimuli:
- Vary your tone of voice when you’re speaking
- Use lots of music, singing, and nursery rhymes
- Please encourage them to experiment with noisy toys and musical instruments
If your child is hypersensitive to olfactory stimuli:
- Avoid perfumes, strongly scented lotions, and laundry powder
- Turn on the kitchen fan to minimize strong cooking smells
If your child is hyposensitive to olfactory stimuli:
- Use scented playdough or pens
- Encourage your child to smell the different foods when you’re cooking
If your child is hypersensitive to gustatory stimuli:
- Oversensitivity is generally due to the texture rather than the taste, e.g., lumpy foods may cause them to gag
- Encourage chewing, sucking, blowing, which help develop the oral motor skills
- Don’t pressure your child into eating foods they find uncomfortable
- Instead, have non-preferred foods available throughout the day for your child to experience on their terms by playing with it messily or helping to cook with it, rather than pressuring them to eat and causing stress
- Provide a wide range of foods, at different temperatures and with different textures
- Consider referring to a dietitian if you are concerned about your child’s nutritional intake
- Consider referring to a speech and language therapist if you are concerned about chewing, swallowing, or drooling.
If your child is hyposensitive to gustatory stimuli:
- Give crunchy and chewy foods with intense flavours, e.g., peppers, grapefruit juice, spices
- Use a vibrating toothbrush
If your child is hypersensitive to contact or touch:
- Use firm touch (avoid light or sudden touch)
- Give firm “bear hugs.”
- Give your child choices for clothing, bedding, and towels, and cut out tags if requested
- Give a firm head massage or a tight-fitting hat before washing or cutting hair
- Slowly introduce messy play or new textures.
If your child is hyposensitive to contact or touch:
- Use touch to get your child’s attention before speaking to them
- Give opportunities for messy playing with different textures, e.g., play dough, fidget toys.
If your child is hypersensitive to the sense of balance and spatial orientation:
- Encourage ‘heavy work’ activities before and after movement activities
- Provide opportunities for slow, steady movements (e.g., a gentle back and forth) over fast, jerky, or rotatory movements.
If your child is hyposensitive to the sense of balance and spatial orientation:
- Encourage regular movement breaks throughout the day, e.g., rough and tumble play, playground, exercise ball
Hypersensitiveness to proprioception, i.e., awareness of position and movement of the body, is not encountered in routine clinical practice.
However, if your child is hyposensitive to proprioception, i.e., poor awareness of position and movement of the body, then you may consider:
- Doing lots of ‘heavy work’ activities where the muscles and joints are pushed and pulled (e.g., jumping on a trampoline, digging, an obstacle course)
- Give your child a chewy necklace or bracelet
- Use a heavier blanket or sleeping bag for sleeping
Where to next?
I hope you have found the above article helpful. While you wait to see an occupational therapist, using these strategies can help your child process sensory information better, allowing them to engage more happily and effectively with family, school, and others. At the bottom of this article, I have given sources where you can get more information on strategies and support you can access.
As always, early intervention is crucial for better outcomes. Moreover, seeking help earlier can prevent secondary psychosocial problems of low self-esteem, reduced confidence, avoidance of learning activities, school refusal, low mood, anxiety and behavioural issues. But, on the other hand, identifying your child’s difficulties earlier can lead to effective interventions that enable their learning and emotional well-being.
Sensory integrating and sensory modulating strategies (such as above) given by an occupational therapist should improve the behaviour and functioning of your child and enhance their ability to perform daily activities.
If your child looks like they struggle with processing sensory information, then I would recommend seeking an assessment by an occupational therapist in the first instance. However, if you have concerns regarding aspects of your child’s behaviour or development (such as attention, communication, learning or coordination) in addition to their sensory processing difficulties, then a neurodevelopmental assessment (NDA) is recommended. An NDA conducted by an experienced paediatrician would be vital in identifying and addressing these comprehensively.
- Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.
- ‘The Out of Sync Child’: Recognizing & Coping with Sensory Processing Disorder. Carol Stock Kranowitz. ISBN-13: 978-0399531651
- Sensational Kids: Hope and Help for Children with Sensory Processing Disorder by Lucy Jane Miller (2006)
- The Out-of-Sync Child Has Fun: Activities for Kids with Sensory Processing Disorder by Carol Stock Kranowitz (2006)
- The Ultimate Guide to Sensory Processing Disorder: Easy, Everyday Solutions to Sensory Challenges by Roya Ostovar (2010)
- Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues by Lindsey Biel and Nancy Peske (2009)