SPD – What is it and how does it affect an individual?

 

Ask parents of children with learning and behavioural disorders if their children experience problems with sensory processing, and many of them will answer with a resounding "yes". While it is widely accepted that most children with Autism Spectrum Disorders have trouble integrating sensory input, the fact that children who aren’t on the spectrum also experience these issues to varying degrees is now being examined more closely by the special needs community.  While all children can seem quirky or particular about their likes and dislikes, children with Sensory Processing Disorder (also called Sensory Integration Dysfunction) will be so severely affected by their sensory preferences that it interferes with their normal, everyday functioning. Sensory issues are usually defined as either hypersensitivity (over-responsiveness) or hyposensitivity (under-responsiveness) to sensory stimuli. What exactly is Sensory Processing Disorder (SPD)?

 

Definition of SPD

Sensory Processing Disorder or SPD (originally called Sensory Integration Dysfunction) is a neurological disorder in which the sensory information that the individual perceives results in abnormal responses.

 

Sensory processing refers to the way the nervous system receives messages from the senses and turns them into responses. For those with Sensory Processing Disorder, sensory information goes into the brain but does not get organized into appropriate responses. Those with SPD perceive and/or respond to sensory information differently than most other people. Unlike people who have impaired sight or hearing, those with Sensory Processing Disorder do detect the sensory information; however, the sensory information gets “mixed up” in their brain and therefore the responses are inappropriate in the context in which they find themselves.

 

A more formal definition is: SPD is a neurophysiologic condition in which sensory input either from the environment or from one’s body is poorly detected, modulated, or interpreted and/or to which atypical responses are observed. Pioneering occupational therapist and psychologist A. Jean Ayres, Ph.D., likened SPD to a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly.

 

Some people, with sensory processing disorder are oversensitive to things in their environment. Common sounds may be painful or overwhelming. The light touch of a shirt may chafe the skin.

Others with sensory processing disorder may:

·         Be uncoordinated

·         Bump into things

·         Be unable to tell where their limbs are in space

·         Be hard to engage in conversation or play

 

Sensory processing problems are usually identified in children. But they can also affect adults. Sensory processing problems are commonly seen in developmental conditions like autism spectrum disorder. Sensory processing disorder is not recognized as a stand-alone disorder.  But many experts think that should change.

 

Ten Fundamental Facts About SPD.  When extended family, teachers, neighbours, other parents, and service providers ask you what Sensory Processing Disorder is, the following are research-supported statements you can make.

1.       Sensory Processing Disorder is a complex disorder of the brain that affects developing children and adults.

2.       Parent surveys, clinical assessments, and laboratory protocols exist to identify children with SPD.

3.       At least one in twenty people in the general population may be affected by SPD.

4.       In children who are gifted and those with ADHD, Autism, and fragile X syndrome, the prevalence of SPD is much higher than in the general population.

5.       Studies have found a significant difference between the physiology of children with SPD and children who are typically developing.

6.       Studies have found a significant difference between the physiology of children with SPD and children with ADHD.

7.       Sensory Processing Disorder has unique sensory symptoms that are not explained by other known disorders.

8.       Heredity may be one cause of the disorder.

9.       Laboratory studies suggest that the sympathetic and parasympathetic nervous systems are not functioning typically in children with SPD.

10.   Preliminary research data support decades of anecdotal evidence that occupational therapy is an effective intervention for treating the symptoms of SPD.

 

What are the sensory systems that provide stimuli to the brain?

 

The Eight Sensory Systems

Most people are surprised to find out that we actually have eight sensory systems rather than five. Learn more about these eight systems in detail.

·         Visual – Using our eyes to see what is far or close to us. A typical person is able to use smooth and precise eye movements to scan and visually assess their environment.

·         Auditory – This includes hearing, listening, and being able to filter and selectively attend to auditory stimuli.

·         Tactile – This is often the most commonly recognized sensory system of the body and the one most people notice if they have an overactive or under-active tactile system. Anything you touch or feel is part of the tactile sensory system.

·         Olfactory – The olfactory system, or sense of smell, is the part of the sensory system used for smelling (olfaction). 

·         Gustatory – The gustatory system is the sensory system responsible for the perception of taste and flavour.

·         Vestibular – The vestibular system is located in the inner ear and helps you to detect changes in regards to gravity. Are you sitting, standing, lying down, upside down, spinning, standing still etc? It is often referred to as the internal GPS system of your body.

·         Proprioception This is one of the internal senses of the body that comes from the joints, muscles, ligaments, and other connective tissue. The proprioception system allows you to know where your body parts are and what they are doing without necessarily looking at them.

·         Interoception This sense is all about the physiological condition of your body. Are you hungry, thirsty? Do you need to use the bathroom? Is your heart racing or at a normal pace?

 

Hypersensitivities to sensory input may include:

·         Extreme response to or fear of sudden, high-pitched, loud, or metallic noises like flushing toilets, clanking silverware, or other noises that seem unoffensive to others

·         May notice and/or be distracted by background noises that others don’t seem to hear

·         Fearful of surprise touch, avoids hugs and cuddling even with familiar adults

·         Seems fearful of crowds or avoids standing in close proximity to others

·         Doesn’t enjoy a game of tag and/or is overly fearful of swings and playground equipment

·         Extremely fearful of climbing or falling, even when there is no real danger i.e. doesn't like his or her feet to be off the ground

·         Has poor balance, may fall often

 

Hyposensitivity to sensory input may include:

·         A constant need to touch people or textures, even when it’s inappropriate to do so

·         Doesn’t understand personal space even when same-age peers are old enough to understand it

·         Clumsy and uncoordinated movements

·         An extremely high tolerance for or indifference to pain

·         Often harms other children and/or pets when playing, i.e. doesn't understand his or her own strength

·         May be very fidgety and unable to sit still, enjoys movement-based play like spinning, jumping, etc.

·         Seems to be a "thrill seeker" and can be dangerous at times

 

Causes of SPD

The exact cause of Sensory Processing Disorder has not yet been identified. Preliminary studies and research suggest that SPD is often inherited. Prenatal and birth complications have also been implicated as causal in SPD, as well as certain environmental factors.  A 2006 study of twins found that hypersensitivity to light and sound may have a strong genetic component.  Other experiments have shown that children with sensory processing problems have abnormal brain activity when they are simultaneously exposed to light and sound.  Still other experiments have shown that children with sensory processing problems will continue to respond strongly to a stroke on the hand or a loud sound, while other children quickly get used to the sensations.

 

Symptoms of Sensory Processing Disorder

Sensory processing disorder may affect one sense, like hearing, touch, or taste. Or it may affect multiple senses. People can also be over- or under-responsive to the things they have difficulties with.  Like many illnesses, the symptoms of sensory processing disorder exist on a spectrum.  In some children, for example, the sound of a leaf blower outside the window may cause them to vomit or dive under the table.  They may scream when touched. They may recoil from the textures of certain foods.  But others seem unresponsive to anything around them. They may fail to respond to extreme heat or cold or even pain.

 

Here are some sensory avoiding signs you might see in a child:

·         Is easily overwhelmed by people and places.

·         Seeks out quiet spots in noisy, crowded environments.

·         Is easily startled by sudden noises.

·         Is bothered by bright light.

·         Refuses to wear itchy or otherwise uncomfortable clothing.

·         Avoids touching people or hugging them.

·         Has a strong reaction to the texture or smell of certain foods.

·         Refuses to try new foods and has a very limited diet of preferred foods.

·         Gets upset about small changes in routine or environment and avoids trying new things.

 

Here are some sensory seeking signs you might see in a child at different ages:

·         Constantly touches objects.

·         Plays roughly and takes physical risks.

·         Has a high tolerance for pain.

·         Often squirms and fidgets.

·         Is constantly on the move.

·         Invades other people’s personal space.

·         Often gets distracted or feels anxious.

·         Is clumsy and uncoordinated.

 

Many children with sensory processing disorder start out as fussy babies who become anxious as they grow older. These children often don't handle change well. They may frequently throw tantrums or have meltdowns. 

 

A tantrum is an outburst that happens when a child is trying to get something he wants or needs. Some kids with learning and attention issues are more prone to tantrums. For instance, some can be impulsive and have trouble keeping their emotions in check. They may get angry or frustrated quickly.  A child may have a tantrum if he didn’t get to go first in a game of kickball. Or he might get upset when you pay attention to his sister and he wants your attention. Yelling, crying or lashing out isn’t an appropriate way for him to express his feelings, but he’s doing it for a reason. And he has some control over his behaviour.  Your child may even stop in the middle of a tantrum to make sure you’re looking at him. When he sees that you’re watching him, he may pick up where he left off. His tantrum is likely to stop when he gets what he wants—or when he realizes he won’t get what he wants by acting out.

 

A meltdown is a reaction to feeling overwhelmed.  For some kids, it happens when there’s too much sensory information to process. The commotion of an amusement park might set them off, for instance. For other kids, it can be a reaction to having too many things to think about. A back-to-school shopping trip could cause a tantrum that triggers a meltdown.  Here’s one way to think about too much sensory input. Imagine filling a small water pitcher. Most of the time, you can control the flow of water and fill the pitcher a little at a time. But sometimes the water flow is too strong and the pitcher overflows before you can turn the water off.  That’s how a sensory meltdown works. The noise at the amusement park or the stack of clothes to try on in the dressing room at the mall is sensory input that floods your child’s brain. Once that happens, some experts think your child’s fight-or-flight response kicks in. That excess input overflows in the form of yelling, crying, lashing out or running away.

 

Many children have symptoms like these from time to time. But therapists consider a diagnosis of sensory processing disorder when the symptoms become severe enough to affect normal functioning and disrupt everyday life.

 

Treatment for Sensory Processing Disorder

Many families with an affected child find that it is hard to get help.  That's because sensory processing disorder isn't a recognized medical diagnosis at this time.  Despite the lack of widely accepted diagnostic criteria, occupational therapists commonly see and treat children and adults with sensory processing problems.

 

Treatment depends on a child's individual needs.  But in general, it involves helping children do better at activities they're normally not good at and helping them get used to things they can't tolerate.  Treatment for sensory processing problems is called sensory integration. The goal of sensory integration is to challenge a child in a fun, playful way so he or she can learn to respond appropriately and function more normally.

 

One type of therapy is called the Developmental, Individual Difference, Relationship-based (DIR) model.  The therapy was developed by Stanley Greenspan, MD, and Serena Wieder, PhD.  A major part of this therapy is the "floor-time" method. The method involves multiple sessions of play with the child and parent. The play sessions last about 20 minutes.  During the sessions, parents are first asked to follow the child's lead, even if the playtime behaviour isn't typical. For example, if a child is rubbing the same spot on the floor over and over, the parent does the same. These actions allow the parent to "enter" into the child's world.

 

This is followed by a second phase, where parents use the play sessions to create challenges for the child. The challenges help pull the child into what Greenspan calls a "shared" world with the parent. And the challenges create opportunities for the child to master important skills in areas such as:

·         Relating

·         Communicating

·         Thinking

 

The sessions are tailored to the child's needs. For instance, if the child tends to under-react to touch and sound, the parent needs to be very energetic during the second phase of the play sessions. If the child tends to overreact to touch and sound, the parent will need to be more soothing. These interactions will help the child move forward and, DIR therapists believe, help with sensory issues as well.

 

Ways to help

·         Pay attention to your child’s cues and ask them to explain what sensations bother them.  Look for patterns and take notes to help you find effective solutions.

·         Help your child learn how to self-advocate. For example, let them know it’s OK to say, “I don’t like feeling squished, so I’d prefer to be at the back of the line.”

·         Develop routines that help your child feel more comfortable. Be flexible about clothing and food choices.

·         Teach under sensitive children to pay attention to and tell an adult about situations that are typically painful, such as a bumped head.

·         Help oversensitive children practice how to respond when classmates accidentally bump into them and how to react to unexpected sounds like fire drills.

·         Talk with our child’s school about classroom accommodations, behaviour plans or informal supports that can help your child control their reactions to sensory input.

·         Talk with an occupational therapist or read about “sensory diets” and other activities you may want to try at home.

 

Strategies for Tantrums and Meltdowns:  The causes of tantrums and meltdowns are different, and so are the strategies that can help stop them. It’s important to remember that the key difference between the two types of outbursts is that tantrums usually have a purpose. Kids are looking for a certain response. Meltdowns are a reaction to something and are usually beyond a child’s control.

 

A child can often stop a tantrum if he gets what he wants. Or if he’s rewarded for using a more appropriate behaviour. But a meltdown isn’t likely to stop when a child gets what he wants. In fact, he may not even know what he wants.

 

Meltdowns tend to end in one of two ways.

·         One is fatigue—kids wear themselves out.

·         The other way a change in the amount of sensory input. This can help kids feel less overwhelmed. For example, your child may start to feel calmer when you step outside the store and leave the mall.

 

So how can you handle tantrums and meltdowns differently?

·         To tame tantrums, acknowledge what your child needs without giving in. Make it clear that you understand what he’s after. “I see that you want my attention. When your sister is done talking, it’ll be your turn.” Then help him see there’s a more appropriate behaviour that will work. “When you’re done yelling, tell me calmly that you’re ready for my time.”

·         To manage a meltdown, help your child find a safe, quiet place to de-escalate. “Let’s leave the mall and sit in the car for a few minutes.” Then provide a calm, reassuring presence without talking too much to your child. The goal is to reduce the input coming at him.

 

Knowing the difference between tantrums and meltdowns is the key to helping your child through them. It may also help to get a better idea of the kinds of situations that can be challenging for your child. You can also explore tips on how to deal with noise and other sensitivities.

 

 

Day in the life of a child with SPD

Children with sensory issues are often misunderstood by teachers and family members.  To see how sensory processing issues can affect primary school children both in an out of school, take a look at a typical day in the live of a child with sensory processing issues.

 

Sensory processing issues may include:

·         Being over sensitive to sights, sounds textures, flavours, smells or other sensory input.  This is sometimes called hypersensitivity.

·         Being under sensitive to some sensory input, like not noticing a skinned knee after falling down. This is sometimes called hyposensitivity.

·         Having trouble knowing how your body is orientated in space. This is called body awareness or proprioception.

·         Seeking or avoiding certain kinds of movement. This involves the vestibular system, which contributes to your sense of balance.  It can also impact motor control and safety awareness.

·         Having trouble with emotional regulation.  This can be triggered by sensory overload and may lead to meltdowns.

 

6:14am    The sunlight coming through the curtains wakes the child before the alarm.  The light is bright and irritating thus the child hides under the blankets.  But due to worrying about falling asleep and the loud beeping of the alarm will wake them with a surprise the child is anxious.  The child waits and turns off the alarm a minute before it was set to go of so as to avoid dealing with the noise.
Sensory related issues: Sensitivity to sight and sound

7:00am    The child puts on the clothes they picked out the night before but the tags are too itchy.  Thus, the child insists on wearing their favourite soft t-shift and leggings even though they’re dirty.  At breakfast the child wants milk in a cup so that they can pour the milk on their cereal a little at a time otherwise the flakes get soggy and feel gross in their mouth. 
Sensory related issues: Sensitivity to clothing and food textures.

7:30am    The child needs to get to the bus stop on time, but is struggling to put on a coat and to tie their shoes.  Secretly though, the child hopes to miss the bus as it is always so loud and crowded.  It is hard for the child to find a seat where they will not feel squished by other children.
Sensory related issues: Trouble with motor control, sensitivity to touch.

10am      The child loves writing stories while at school but keeps getting distracted when other children walk down the hallway.  The child is also not feeling well and this makes it difficult to stay in her seat.  The child requests to move to a desk away from the classroom door and grabs a wiggle cushion for the chair.
Sensory related issues: Sensitivity to sight, sensory-seeking

12pm      At lunchtime, the teacher doesn’t understand why the child will not go into the cafeteria.  The odour of meatball sandwiches doesn’t bother the teacher or the other children but it is overwhelming to the child.  By trying to explain why they cannot go in the child has a meltdown and ends up eating in the school office after calming down.
Sensory related issues: Sensitivity to smell, emotional regulation

4pm        At the playground the child has fun climbing and jumping of the equipment and running around with her friends.  They also love doing somersaults on the grass and somehow all the tumbling makes her feel calmer.  When someone points out that the child’s knee is scraped and bleeding, they remember falling down but it didn’t hurt so they kept playing.
Sensory related issues: Sensory-seeking, under sensitivity to pain

6pm        It’s taco night but the chid doesn’t like mixing all those textures and tasted so their favourite ingredients are kept in different sections of the place so they can be eaten separately.  When refried beans are added to the plate the child refuses to eat them as mushy food makes them gag.
Sensory related issues: Sensitivity to taste and food textures.

7:30pm    The child keeps standing outside the shower because the water temperature isn’t right.  Although they are told the temperature is fine it feels too hot to the child.  Another reason for the hesitance is that today is hair-washing day, that means slimy shampoo and painful combing afterwards!  The child starts getting upset, but calms down when informed that hair washing will be skipped for today. A fluffy towel and toothpaste that is not “too spicy” helps bedtime go more smoothly.
Sensory related issues: Sensitivity to touch (including gauging temperature), emotional regulation.

 

 

It is abundantly clear that diagnosing SPD is still complicated and treatment perhaps even more so.  But that it is real and that it affects people is beyond any doubt.  Individuals diagnosed with this disorder have a significant battle in their everyday lives but there is help and strategies available to assist.

 

 

 

 

References:

Star Institute – Understanding Sensory Processing Disorder

Brain Balance Achievement Centres – Signs and Symptoms of SPD

WebMD – Sensory Processing Disorder

Understood.org – A Day in the Life of a Child with Sensory Processing Issues