Sensory Processing Disorder
“SPD” is an often-misunderstood disorder of the central nervous system. You have 8 senses. The basic 5: vision, hearing, touch, taste, smell, and 3 lesser known: vestibular (movement and balance), proprioception (sense of position), and interoception (sensation related to internal organs). When these senses don’t work properly or don’t work together, it can result in difficulty doing things, learning things, or getting along with others in work, home or school. Our expertly-trained therapists are here to help!
What is Sensory Processing Disorder (SPD)?
SPD is an umbrella category that describes a complex neurological condition that exists when sensory signals either get disrupted or don’t get organized into accurate responses. SPD is the most widely-researched area of occupational therapy.
“Sensory processing (originally called sensory integration dysfunction or SID) refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses…A person with SPD finds it difficult to process and act upon information received through the senses, which creates challenges in performing countless everyday tasks. Motor clumsiness, behavioral problems, anxiety, depression, school failure, and many other problems may impact those who do not have effective treatment.”
STAR Institute for SPD
SPD is often mis-diagnosed or under-diagnosed and may, but does not necessarily, accompany other existing diagnoses. Current research suggests that 1 in every 6 children experiences sensory symptoms that may be significant enough to affect aspects of everyday life functions (Ben-Sasson, Carter, Briggs-Gowen, 2009). Sensory challenges were recently added as a diagnostic criterion of autism spectrum disorders (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V; American Psychiatric Association, 2013).
Sensory symptoms can be broken down into three patterns: hyper-responsiveness, hypo-responsiveness, and sensory-seeking (Miller et al., 2007). This means that a person with SPD may be highly sensitive or be over-responding to specific sensory input(s), they may take longer to respond or be under-responsive to sensory input(s), and/or they may actively seek out certain sensory input(s) throughout the course of daily activities. Some people with SPD show all three patterns of response.
Signs and Symptoms
These checklists (compiled by the STAR Institute) are not diagnostic tools and should not replace the advice and guidance of a trained professional. When completing the checklist please consider the child’s behavior over the past 6 months.
____ My infant/toddler has problems eating.
____ My infant/toddler refuses to go to anyone but me.
____ My infant/toddler has trouble falling asleep or staying asleep.
____ My infant/toddler is extremely irritable when I dress him/her; seems to be uncomfortable in clothes.
____ My infant/toddler rarely plays with toys, especially those requiring dexterity.
____ My infant/toddler has difficulty shifting focus from one object/activity to another.
____ My infant/toddler does not notice pain or is slow to respond when hurt.
____ My infant/toddler resists cuddling, arches back away from the person holding him.
____ My infant/toddler cannot calm self by sucking on a pacifier, looking at toys, or listening to my voice.
____ My infant/toddler has a floppy body, bumps into things and has poor balance.
____ My infant/toddler does little or no babbling, vocalizing.
____ My infant/toddler is easily startled.
____ My infant/toddler is extremely active and is constantly moving body/limbs or runs endlessly.
____ My infant/toddler seems to be delayed in crawling, standing, walking or running.
____ My child has difficulty being toilet trained.
____ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
____ My child is unaware of being touched/bumped unless done with extreme force/intensity.
____ My child has difficulty learning and/or avoids performing fine motor tasks such as using crayons and fasteners on clothing.
____ My child seems unsure how to move his/her body in space, is clumsy and awkward.
____ My child has difficulty learning new motor tasks.
____ My child is in constant motion.
____ My child gets in everyone else’s space and/or touches everything around him.
____ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
____ My child is intense, demanding or hard to calm and has difficulty with transitions.
____ My child has sudden mood changes and temper tantrums that are unexpected.
____ My child seems weak, slumps when sitting/standing; prefers sedentary activities.
____ It is hard to understand my child’s speech.
____ My child does not seem to understand verbal instructions.
___ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
___ My child is easily distracted in the classroom, often out of his/her seat, fidgety.
___ My child is easily overwhelmed at the playground, during recess and in class.
___ My child is slow to perform tasks.
___ My child has difficulty performing or avoids fine motor tasks such as handwriting.
___ My child appears clumsy and stumbles often, slouches in chair.
___ My child craves rough housing, tackling/wrestling games.
___ My child is slow to learn new activities.
___ My child is in constant motion.
___ My child has difficulty learning new motor tasks and prefers sedentary activities.
___ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
___ My child ‘gets stuck’ on tasks and has difficulty changing to another task.
___ My child confuses similar sounding words, misinterprets questions or requests.
___ My child has difficulty reading, especially aloud.
___ My child stumbles over words; speech lacks fluency, and rhythm is hesitant.
___ I am over-sensitive to environmental stimulation: I do not like being touched.
___ I avoid visually stimulating environments and/or I am sensitive to sounds.
___ I often feel lethargic and slow in starting my day.
___ I often begin new tasks simultaneously and leave many of them uncompleted.
___ I use an inappropriate amount of force when handling objects.
___ I often bump into things or develop bruises that I cannot recall.
___ I have difficulty learning new motor tasks, or sequencing steps of a task.
___ I need physical activities to help me maintain my focus throughout the day.
___ I have difficulty staying focused at work and in meetings.
___ I misinterpret questions and requests, requiring more clarification than usual.
___ I have difficulty reading, especially aloud.
___ My speech lacks fluency, I stumble over words.
___ I must read material several times to absorb the content.
___ I have trouble forming thoughts and ideas in oral presentations.
___ I have trouble thinking up ideas for essays or written tasks at school.
Many parents report relief when finding out their child has SPD because it gives them a way to describe and understand what they’ve seen their child live with and it gives them hope there may be solutions available in the not too distant future.
What Causes SPD?
Research is just beginning to identify known causes of SPD. Additionally, many people who experience sensory symptoms may benefit from sensory strategies because we are all sensory beings. However, having sensory symptoms and liking the way sensory strategies feel, does not mean you have SPD.
“Preliminary research suggests that SPD is often inherited. If so, the causes of SPD are coded into the child’s genetic material. Prenatal and birth complications have also been implicated, and environmental factors may be involved. For example, children who are adopted often experience SPD, due perhaps to restrictions in their early lives or poor prenatal care. Birth risk factors may also cause SPD (low birth weight, prematurity, etc). Of course, as with any developmental and/or behavioral disorder, the causes of SPD are likely to be the result of factors that are both genetic and environmental. Only with more research will it be possible to identify the role of each. A preliminary summary of research into causation and prevalence is contained in Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (New York: Perigee, 2014, 2nd Edition).” – STAR Institute for SPD
Sensory processing disorder (SPD) is identified by an occupational therapist who has advanced training in identification and treatment of SPD and sensory integration. An evaluation for SPD typically involves some standardized testing, detailed clinical but non-standardized observations, and parent-report measures. Often other disciplines are involved as well, to offer clinical insights and information about other categories of function.
When identifying SPD, the therapist completing the evaluation will consider factors such as intensity, duration and frequency of symptoms, i.e. how severe are the symptoms, how long do they last, and how often they occur? Some people may experience sensory symptoms but they are not disrupting to the person’s daily routine or activities. Thus an accurate diagnosis of SPD must take into account the level of disruption to daily routines and activities as a result of the sensory symptoms, in what environment the challenges occur, and how the person experiencing the symptoms is functioning, relative to other people the same age.
A diagnosis of SPD does not guarantee potential to benefit from treatment and does not guarantee access to services, however it offers information that may be valuable in helping family members learn to interact with and support their loved one and it may also help to shape decisions that are made about other things such as school or work, living environment, and daily routines and even what hobbies could be most helpful or enjoyable.
Many parents report relief when finding out their child has SPD because it gives them a way to describe and understand what they’ve seen their child live with and it gives them hope there may be solutions available in the not-too-distant future.
Assessment and Evaluation
At OTC, we view assessment as the cornerstone of effective treatment. We require all clients to participate in an assessment unless they have recently participated in a prior occupational therapy assessment within the past year; even then sometimes re-assessment is indicated in order to get the most accurate and current results to guide treatment.
Assessments take place over the first 1-2 sessions and will typically involve standardized testing and non-standardized activities. Some standardized assessments we use at OTC include:
- Sensory Processing Measure
- Miller Function and Participation Scales
- Beery Developmental Test of Visual Motor Integration
- GOAL-Oriented Assessment of Life Skills
- SCAN-3:C Tests for Auditory Processing Disorders in Children
- Test of Visual Perceptual Skills
- Developmental Eye-Movement Test
- BASC-3 Behavior Assessment System Children
Following assessment all parents and adult clients receive a written summary of the evaluation results and recommendations. Therapists meet with families face-to-face to provide verbal summaries and to answer questions that parents/clients may have about how to move forward.
Occupational Therapy with a sensory integration approach (OT-SI) is the most indicated form of treatment for sensory processing disorder. OT-SI is one type of treatment that may only be provided by therapists with advanced training in sensory integration. Other types of treatment also used to effectively treat SPD include: sensory-motor or sensory-based treatment, rote skills training, and neuro-developmental treatment (NDT) strategies. Integrated Listening Therapy and the SOS Approach to Eating are other specialized treatment programs that may be used at OTC during treatment sessions. Therapists at OTC are trained to use one or all of the aforementioned therapeutic approaches and the type of treatment selected will depend on which therapist is selected to work with your child, what the presenting challenges are and what assessment results indicate may be the most suited for you or your child.
Treatment at OTC looks a lot like play! This is because children are motivated by play, they learn through play, and it is meaningful to your child. Treatment for adults may be playful because we often incorporate use of some of the specialized equipment in our therapy gym. All sessions regardless of age, will provide meaningful activities that are graded to provide specific sensory inputs but that are balanced so that the experience is tolerable and encourages continued interaction and success, at whatever the task may be.
For example, a child struggling with touch sensitivities may be encouraged to play or draw pictures in shaving cream with their hands. If that is too stimulating or averse, the therapist may start by offering dry kinetic sand or hide enticing toys such as zoo animals in a bin full of beans and rice. A young child may play in a tub of warm soapy water where they “give the zoo animals a bath” and progress to stickier bubbles on a table where the animals “march through the swamp,” moving then to sticky slime where they get stuck in the mud. This kind of graded experience signals to the brain that these inputs are good and because they are self-directed and not imposed, the child’s nervous system gradually learns to form new more positive associations.
An adult struggling with touch sensitivity who is thus struggling to shower before work in the morning, may be encouraged to shift their routines so they shower less often and do so at night and/or on weekends so time constraints are less of a stressor. They may also be encouraged to use a weighted blanket, sit in certain body positions and use a bath scrunchy instead of a washcloth to provide deep touch pressure throughout the day, and they may also be taught ways of applying deep pressure while drying off after the shower, while getting dressed, and intermittently at their desk throughout the day at work. These are just a couple of examples of what treatment for SPD may look like at OTC.
Touch sensitivities and many other types of SPD, are often paired with anxiety or other social emotional or behavioral challenges and our Collaborative Counseling Services means that parents may meet with our mental health counselor, while their child participates in therapy. For adult clients, it means they may schedule intermittent counseling sessions or alternate counseling and OT sessions. The collaborative approach is one way that treatment at OTC may be more effective than pure SPD treatment alone.
Research on use of OT-SI and best practice models are finding that children benefit from frequent repetitive sessions per week, thus to treat SPD, we use an intensive model of service that includes 3-5 sessions per week for a duration of approximately 2-3 months. Parents are involved and work with the therapist in every session to learn more about their child’s sensory challenges and methods for engaging their children in therapeutic activities. At OTC we do not do therapy “to” your child and your child does not “receive” therapy. Parents and children participate in therapy together and regularly scheduled parent-only sessions, ensure that parents have ample focused time with their child’s therapist to review treatment plans and learn about their child’s specific type of SPD.
A Typical Appointment
A typical OT session lasts 60 minutes. For clients receiving once weekly services, once you are assigned a treatment slot and you come to OT sessions at the same day and time each week, throughout your course of treatment. Clients are asked to commit to an initial block of treatment that lasts 8 weeks and the treatment plan will be reviewed just prior to the end of the initial 8 week period. At the initial 8 week review of treatment, the therapist and parent will meet to discuss the child’s progress and remaining goals and objectives for treatment. You will also decide together how long the next block of treatment will be and when. For clients participating in an intensive block of treatment (more than once weekly), you will be assigned a schedule of possibly varying times each week and are asked to commit to a block of 12-16 weeks, depending on your frequency of service. The more frequently you attend OT, the shorter your block of treatment will be. For all clients, regardless of intensity, parent consultations to review the treatment plan take place at 8 weeks and then at the time of discharge or every 12 weeks thereafter, whichever comes first. If your child still needs further intervention at the end of the initial block of treatment, continued treatment will be contingent on availability in the treatment schedule and other factors to be discussed at the time of your parent review meeting. Parent meetings typically last for 60 minutes but if cost is an issues, please let your therapist know and we can attempt to limit the time and thereby limit the expense to you.
OTC uses a parent partnership model of service, meaning parents are welcome and often needed in the treatment sessions and therapists require parent involvement and input at some level during treatment. Parents know their child better than anyone, and by including parents in treatment, therapists are able to gain valuable feedback about the child’s level of function and are also able to model and share strategies that may be helpful at home. All clients receive “OT Homework” and when parents are active in sessions, it is much easier for parents to support carryover of whatever is assigned in between sessions.
Of course, there are times that having parents in treatment sessions is not beneficial to the child. Parents may also have busy schedules or siblings to manage, therefore this will be discussed with each client on an as-needed basis and in cases where parents are not able to attend or it is deemed more beneficial for the parent to wait outside the session, time will be reserved from each session to talk with parents about observations and progress or information that will be helpful for home. We have many active grandparents who play a key role in transporting their grandchildren to therapy when parents can’t be at therapy consistently. In these instances, therapists may require parent consultation meetings to review the progress happening in session and at home.
Most children with SPD enjoy coming to therapy. They feel supported and successful, and are able to engage, interact and relate at a level they have typically found challenging in other environments.
Thank you for giving us our little boy back.
-Mom to 3-year-old boy with brain injury
He started seeing you and our whole lives changed.
-Mom to 5-year-old boy with autism
We love the services we receive at OTC. You and Erin care very much about the families you work with and it shows in all of our interactions. You both are quite knowledgeable in sensory processing disorder and are the first people to understand Ethan and actually “get” what he struggles with. Many other practices we tried didn’t seem to know what to do with him and quickly discharged him. You both weren’t afraid to tackle the many issues he struggles with and continue to strategize and work with us on new techniques to help meet his needs. Shane and I really like the ongoing educational classes you offer as well as the social classes you have for the kids to attend. You offer a comprehensive approach and even going out into society and helping the kids manage their sensory needs is very helpful and most places do not offer that.
-Mom to 6-year-old boy with autism
If someone had told me our lives could be like this, I wouldn’t have believed them. I see a 180 degree difference in [our daughter], since we started therapy. I can’t thank Kelly enough for what she has given our family.
-Mom to a 7-year-old girl, post international adoption
You are the first person who has given us some answers and told us what to do.
-Dad to 7-year-old boy with learning disability
[My daughter] said yesterday that working with you was the best day of her life.
-Mom of 8-year-old girl with poor motor coordination
You helped me to “understand” [my son]. As a parent we may look at therapy as a way to fix our children. I’m sure that is why we originally came, but along the way I realized that understanding and learning how to support [our son] were more important than just a “fix.”
-Mom to an 8-year-old boy with a learning disability
I have noticed that she has been doing better recently socially. She just seems more present when we are talking. Her teacher let me know that she has been doing better at school as well, playing well with the other kids. [She] also has been helping another girl in her class… when she feels upset. That was really nice to hear.
-Mom of 7-year-old girl with autism
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