What Parents Should Know About Sensory Processing Disorders
Information and Resources for Parents
"Why on earth would you put your brother's dirty shoe in your mouth?" I asked my 4-year-old son.
"I want to feel it with the inside of my mouth," he explained.
My son is a sensation seeker. He loves tight bear hugs, anything wet and messy, Texas Pete on his eggs, and the louder the music, the better. Most of the time, he is a delight. These sensory preferences become a problem, however, when he hugs his friends at school too tight or refuses to put his clothing on in the morning, because he would rather go without.
We all have sensory issues at times. Some of us are distracted by noise and need absolute quiet to work. Others find leftover food on dishes repugnant and wear dishwashing gloves to avoid touching it.
You probably also know your children's sensory quirks, such as refusing to eat mushy foods or not falling asleep without a silk-bordered blanket in hand. Most children are able to find acceptable ways to handle these sensory challenges. For some children, however, sensory issues interfere with their daily lives in consistent and considerable ways. These children would be diagnosed with Sensory Processing Disorder (SPD).
Barbara Chandler, Ph.D., a registered and licensed occupational therapist (OTR/L) specializing in pediatrics and associate professor at Winston-Salem State University, gives the example of a child who cannot pay attention in class because of a preoccupation with how the waistband on his pants feels against his skin. "We usually habituate to those kind of irritations, but kids who have sensory processing disorder get stuck," Chandler says.
SPD can affect any combination of the seven sensory systems. These systems are sight; hearing; smell; taste; and touch; the vestibular sense, which gives information about movement and balance; and the proprioceptive sense, which through muscles and joints gives information about the body's position in space. Sensory processing involves organizing this flow of sensory information to produce an adaptive response, e.g., the stove is hot, pull your hand away.
When sensory information is misinterpreted or jumbled somewhere along the way, problems with learning, paying attention and behavior result.
SPD causes a broad array of symptoms more comparable to allergies than to a broken bone. Allergies can cause people to sneeze when exposed to pollen, break out in a rash after touching an animal or get a stomach ache when eating certain foods. Likewise, the symptoms of SPD appear in different patterns, and children with sensory issues can look very different from one another.
Several categories of SPD have been identified, and a child's symptoms will often fall into a combination of these.
Sensory Modulation Disorder: Reactions to sensory messages are not typical because of difficult organizing sensory information
Over-responsive children react too quickly to relatively slight intensity.
Under-responsive children need sensory messages of greater intensity to become aware of them.
Sensory seeking children crave and excessively seek sensory input.
Take for example an alarm clock. An over-responsive child may wake to this sound startled and cover his ears, while the under-responsive child may not wake at all. A sensory-seeking child may seek out this intense sound by setting off the alarm repeatedly.
Sensory-Based Motor Disorder: Motor skills are affected by sensory difficulties.
Dyspraxic children have trouble planning movement and may appear clumsy and uncoordinated.
Children with Postural Disorder have problems stabilizing themselves and may be appear sluggish and unmotivated.
Sensory Discrimination Disorder: Difficulty figuring out what is being perceived, such as the source of a siren or the temperature of food.
Pamela Smith* first learned about SPD when her daughter began preschool last year at age 3. Midway through the year, her daughter's teachers gave Smith a copy of Carol Stock Kranowitz's popular book "The Out-of-Sync Child." The teachers described behaviors such as chewing furniture, making excessive messes and crashing into classmates. Smith had observed these behaviors at home, but had not seen them as a problem until they were happening in the context of school.
Smith's daughter has since been evaluated for sensory issues, and the family is working with an occupational therapist to learn to meet their daughter's sensory needs in ways that are more adaptive to school and other social environments.
If sensory issues seem to be causing problems for your child, Chandler suggests starting with your pediatrician to rule out a medical basis for the behaviors. A pediatrician can make a referral for an OT evaluation
Inattention, clumsiness, aggressive behavior, withdrawal, and increased or decreased activity level are the most common reasons that children are referred for a sensory-processing evaluation, Chandler said.
Most experts emphasize the importance of early intervention. For children under the age of 3, North Carolina provides free evaluations through the state's early intervention program. After age 3, local school systems provide OT evaluations as part of a multidisciplinary approach to developmental delays.
Once a child has been diagnosed with SPD, occupational therapy will be recommended to correct or compensate for sensory issues. Pediatric therapy offices have sensory gyms that include equipment and toys designed to give appropriate sensory experiences. The OT will also work with family members and teachers to design a sensory diet. This personalized schedule of sensory activities gives the child beneficial sensory input at regular intervals throughout each day.
Smith was initially concerned about getting occupational therapy services for her daughter. A friend whose own children had received therapy for sensory issues compared the experience to getting a tutor for a child who needs extra help in math. "Addressing these issues early can only increase her successes later," Smith says.
"We build a program around the child's strengths in occupational therapy," Chandler says. She advises parents to make sure children know what they are good at doing.
She also suggests giving children "words to help them explain themselves to others" so they are better able to advocate for their unique preferences and needs.
My own son will not convince me to let him chew his brother's shoe, but he can ask for an acceptable substitute. Chewy fruit ropes or soft pretzels give him what he needs, without the dirt.
* We used a different name to protect the family's privacy.
STAR Institute for Sensory Processing Disorder
Information about SPD including a list of red flags, advice on evaluation and treatment.
North Carolina Division of Child Development and Early Education
919-527-6335 | 1-800-859-0829 (In State Only)
Information about early intervention programs offered by the state of North Carolina.
Personal stories of SPD children and their families, networking and support.
Jan Campbell Wharton is a freelance writer from Winston-Salem.