Sensory Processing Disorder
Sensory processing disorder is a generic term used to describe a child’s inability to integrate sensory stimuli from the environment in order to make an appropriate response. Sensory processing disorder may also be referred to as sensory integration dysfunction.
The sensory integration theory was developed by Jean Ayers and is referred to as having both neurological and behavioral components. When a child has a well integrated sensory system, he/she is able to take in the information from the environment (sights, sounds, smells, tastes, touch, and movement), interpret the information and respond to the information in ways that are appropriate for the situation. Children with SPD lack the ability to “make sense” out of the stimuli around them, thus are unable to make necessary responses that are appropriate.
Types of Sensory Processing/Integration Disorders
There are many types of sensory processing disorders. Major categories that fall under the umbrella of SPD include: Modulation, Sensory Defensiveness, and Apraxia.
Modulation refers to the ability to be able to maintain a level of attention and arousal to learn and respond to the demands of a task effectively. Children with modulation difficulties may exhibit behaviors that appear to be overactive and distractible, lethargic and passive, or fluctuating between these two extremes throughout the day.
Sensory Defensiveness is a disorder in which the child’s body may perceive non-noxious stimuli as irritating or noxious. Sensory defensiveness can be experienced in one or more of the sensory systems. Sensory defensiveness can also have a range of severity. One of the most common types of sensory defensiveness is touch defensiveness. A child with mild touch defensiveness may complain of the tags in the back of the shirt being scratchy or irritating, desire to not wear clothes, or wants his/her socks worn a certain way. A child with severe touch defensiveness may resist affection from caregivers, cry when presented with the anticipation of having to touch things that do not feel good to him/her such as glue, lotion, bathing or getting a haircut.
Other types of sensory defensiveness may include a discomfort or fear of movement, an anxiety to or over-attentiveness to loud or common everyday noises such as a dog barking or hairdryer blowing, a dislike of various textures or temperatures of foods, or aversions to the sunlight or fluorescent lighting. Children with defensiveness issues may become easily upset and hard to calm down. Their emotions may appear to be unpredictable.
Praxis is the ability to motor plan. Motor planning involves thinking of the idea or task, sequencing the actions and executing the actions with smooth, coordinated movements. Most things we do are automatic and do not require thinking of all the steps involved. For example, when walking, we do not have think about where to place our feet, look at our feet when we are stepping or remember to swing our arms. Children with apraxia (inability to motor plan) have a breakdown in one or more of the components to create the idea, sequence, or execute the idea. These types of children may have problems organizing tasks, coordinating their bodies, following directions, learning new tasks, or producing written or expressive language in correct sequence or word order.
Evaluation of the child with suspected SPD requires an extensive look at the whole child and his/her behaviors and how the behaviors impact the roles of the child in everyday functioning. Standardized tests help to identify specific areas of sensory dysfunction, while clinical observations and family/child interview help to link evaluation findings to how the identified areas of dysfunction are affecting the child’s functioning day to day.
Sensory integration therapy is a very specialized type of treatment, which requires extensive training in the sensory integration theory and frame of reference. Therapists who acquire this extensive training are certified in the Sensory Integration Praxis Test, which requires over 90 hours of training in research, theory, evaluation, interpretation, and treatment of sensory integration dysfunction.
Treatment for the child with sensory processing/integration dysfunction is individualized for the specific needs of the child. Therapeutic activities are carefully chosen to elicit physiological responses so that the body can learn to make appropriate responses to the various sensory stimuli. Behavioral and body responses are carefully monitored and activities adjusted to allow the child to learn new neurological “mapping” which aids in learning new ways of coping, modulating activity level to attend and learn, coordinate body movements, and respond more appropriately to sensory stimuli.
Although therapeutic sensory activities are chosen very intentionally, the treatment is child driven, meaning that typical play activities of the child’s interest are incorporated. SI therapists guide the intensity and type of movement or tools used in conjunction with the child-led play activity to give the child the correct challenge needed for optimal learning. Sensory integration treatment works best when behavioral methods are applied and consistently done in all of the child’s environments.
Another key factor to treating children with sensory integration dysfunction is to teach self-regulation skills. Child and caregiver education is vital to help the child understand his/her reactions to stimuli so that the child can begin to understand and apply strategies to:
- Decrease or diminish undesired behaviors
- Minimize the frequency of undesired behaviors associated with SPD
- Increase awareness of the child’s unique design so that the child and family can gain a fresh perspective why the child is responding with undesired behaviors
- Empower the child in all types of environments with a variety of people so that the child can be more independent
- Integrate socially with peers
- Increase the child’s ability to try new things
- Decrease anxiety
- Improve the child’s overall quality of life in everyday tasks
Sensory diet is a common term associated with treating children with SPD. A sensory diet is simply providing the right types and frequency of sensory stimuli throughout the day to help the child with SPD self-regulate. Sensory diets are often times recommended in the classroom settings to help with attention and arousal. At home they are often times recommended to help the child adapt better to daily routines such as getting ready for school, or in preparation for stressful activities such as getting a haircut, going to family gatherings, or going out in the community. Each sensory diet should be individualized and planned according to the ability of the school or caregivers to be able to carry out the plan.
Sensory Stimulation Versus Sensory Integration
Common treatment tools to see in therapy clinics treating children with sensory integration disorders include various moveable equipment such as swings and scooter boards or weighted equipment such as vests, blankets or tactile tools such as a ball pit. Although these things are very useful tools to use in the treatment of children with SPD,how andwhy they are used make the difference as to whether the child is only being stimulated or if integration is taking place.
Sensory stimulation isusing sensory input for the pure sake of using sensory input. No demand is placed on the individual therefore no “integration” is needed within the brain (Paris & Murray-Slutsky, 2005).
Sensory integration therapy usesa child-centered approach of purposeful and meaningful activities to help organize sensory input. The SI theory applies neuroscience to give insight into observed behavioral patterns (Parham & Blanche, 2000).
There are a wide variety of tools used in treating a child with sensory processing disorder. These tools should be carefully chosen to elicit the appropriate responses, and the individual needs of the child should be considered. In a classroom setting, various tools such as a weighted blanket or vest may be used to help calm a child. Alternate seating such as a beanbag chair, pillow, or air cushion to sit on may help a child sit more attentively at his/her desk.
At home, typical play toys such as swings, bicycles, trampolines, and couch cushions can aid in carrying out various types of input the child with SPD may need throughout the day.
Since the behaviors of children with SPD must be addressed, behavioral tools are often times also needed. Such tools may include timers, small dry erase boards, visual charts, or social stories.
Treatment methods used in treating the child with SPD will vary between therapists. However, it is important to note that the intention of sensory integration therapy is to provide purposeful and meaning activities, which can have an impact on the neurological level. It is important the activities for the child are presented at a level in which the child is challenged and can be successful at the task.
Things to look for in your child’s treatment goals and sessions:
- A variety of movements are used during treatment, using a variety of moveable surfaces (the same activities are not done repetitively)
- Behavioral tools and strategies are applied
- Education for the child and/or parent are given for self-regulation
- Treatment tools to use at home are reasonable to use at home and fits within the family’s schedule
- The therapist treating has a knowledge for discerning behaviors associated with SPD versus other causes for behaviors
- The therapist is able assist the child with SPD using other types of supports such as language boards, visual schedules, graphic organizers or charts, etc. to aid in communication and organizational skills