September Specialty Series with Mama OT: All about Sensory Processing Disorder Part I

Today I'm thrilled to introduce Christie from MamaOT!  Hi Christie!  I'm a faithful follower of your blog and find your activities so easy, fun and practical to do at home!  For my readers who don't know you though, tell us a little bit about yourself, your background as an OT, and your family.

I’m a pediatric occupational therapist who works with children and their families to help improve their ability to participate in daily living activities (known as “occupations”) such as eating, sleeping, self-care, playing, socializing, and learning. This is done by addressing underlying difficulties such as fine motor, hand-eye coordination, problem solving, attention, and sensory processing skills (to name a few), while also taking into account the effect of a task’s difficulty on the child’s performance, as well as the impact the physical and social environment has on their ability to participate. OT's get to do such amazing work! I have worked as a pediatric OT in a variety of settings, including in-home early intervention, clinic-based therapy, and school-based therapy. I have loved working with kids ever since I myself was a kid and, once I discovered the field of occupational therapy after I graduated college, I realized I was born to be an OT.

I am a wife and a mom to two sweet boys, currently ages 3 and 1. The thing I love about being both a mama and an OT is that nearly everything I learn in one role teaches me how to do a better job in the other. The things I learn from being an OT make me a better parent. And the things I learn from being a parent make me a better pediatric therapist. It’s awesome!

So today I wanted to talk about Sensory Processing Processing Disorder.  SPD gets a lot of buzz lately, but was is it really?

In order to talk about Sensory Processing Disorder, we need to first understand what typical sensory processing is.

“Sensory processing” refers to the nervous system’s ability to take in sensory input from all the different sensory systems, organize it in the brain for functional use, and then send out signals to activate the appropriate motor, behavior, or emotional responses (known as an “adaptive response”). In individuals with intact sensory processing, this happens automatically, unconsciously, and nearly instantaneously.

When occupational therapists talk about sensory processing (also referred to as “sensory integration”), we are typically referencing seven sensory systems. 

Most people have heard of the classic five senses but never knew there are two additional “hidden” sensory systems that play a powerful role in our body’s ability to function on a day-to-day basis. Without going into too much detail (I don’t want to bore you!), the seven sensory systems OT's typically refer to are:

 Vestibular: Sense of balance and motion, located in the middle ear, tells us where we are in space.

 Proprioception: Sense of body awareness, located in sensory receptors in our muscles and joints, activated any time we push or pull on objects, as well as any time the joints are compressed together or stretched apart (such as jumping up and down or hanging on monkey bars). Proprioceptive input tends to have a calming and organizing effect on the body. 

  Tactile: Sense of touch, located in sensory receptors in our skin and mouth. Tells us when we’ve touched something (sensation) and what it is we’ve touched (discrimination, such as texture, size, temperature).

   Visual: Sense of vision, but it’s more than just about being able to see clearly. Our visual system also helps us see what we need to see and filter out what we don’t need to focus on.

   Auditory: Sense of hearing but, again, it’s more than just able to hear accurately. When we process auditory information, our brain has to be able to determine what sounds are important and what sounds can be “tuned out”.

   Olfactory: Sense of smell, influences sense of taste, and is the only sense that is directly tied to the part of the brain responsible for emotional memories (think of the emotions you feel when you smell a familiar smell, whether a positive one like grandma’s cookies baking in the oven, or a negative one like the smell of cologne/perfume that a previous boyfriend/girlfriend used to wear).

   Gustatory: Sense of taste, responsible for detecting all the different flavors that come in the mouth.  

Sensory Processing Disorder occurs when the nervous system struggles to adequately process the incoming sensory information and organize it (or “integrate” it) in order to produce the expected motor, behavioral, or emotional responses. 

While all of us struggle with processing certain types of sensory input to some degree on occasion, disordered sensory processing occurs in approximately 1 out of every 20 individuals, and it significantly impacts individuals’ ability to participate and succeed in the important tasks, activities, and roles of daily life (aka – “occupations”). I want to be clear that SPD is more than just being sensitive to certain types of textures, scents, movements, or sounds. As occupational therapist Dr. Lucy Jane Miller describes in her book “Sensational Kids”, the difficulties resulting from Sensory Processing Disorder are chronic and they disrupt everyday life. It doesn’t matter how hard you try to positively reinforce good behavior, or how firmly you set your behavioral expectations for wearing certain clothing textures, eating certain foods, not wiggling or fidgeting while seated, or keeping hands to self. It just doesn’t work, because those kiddos’ brains are just wired differently than those without SPD.

Thinking of the brain as a “traffic cop” for sensory input can be helpful when trying to understand SPD. In those with intact sensory processing, the brain acts as a traffic cop and is able to take the incoming sensory information from all the senses, process it, and then send it to the appropriate location in an orderly and accurate fashion; this allows people to respond to all of the information in an accurate, efficient, and functional manner. In individuals with SPD, however, the sensory information is not processed and sent off to the appropriate location in that expected orderly fashion, causing what you could say is a “neurological traffic jam” (a term pioneered by OT, educational psychologist, and neuroscientist Dr. A. Jean Ayres). This means certain parts of the brain do not receive the correct information needed in order to interpret and respond to the sensory input, making it difficult to process and act upon the information received from the senses in an accurate, efficient, and functional manner.

Sensory Processing Disorder can (and often does) occur in relation to more than one sensory system. So a child (or grown-up) with SPD may be over-responsive in one or more senses while simultaneously being under-responsive or sensory seeking in other senses. Additionally, a person’s ability to process and respond to particular types of sensory input can vary from day to day, hour to hour, even minute to minute. This can be extremely frustrating for parents, teachers, therapists, medical professionals, and even the children themselves. One day (or one minute) they may be fine with the hum of the air conditioning or the fluorescent lights in the room, and then the next…it is unbearable to them. One day they may be okay eating a food of a certain texture or wearing a particular pair of socks, and then the next…the sight or thought of them makes them scream and cry. The body is constantly working to filter out what is unnecessary and focus on what is important, and then trying to respond to all of that input in a functional way. For a person with disordered sensory processing, the brain and body need extra help to be able to balance all of this incoming sensory input and appropriately respond to it (often referred to as “modulation”).

As you can probably tell, Sensory Processing Disorder is very complex, and very tricky! 

So do we know what causes Sensory Processing Disorder?

At this point in time, the exact cause of Sensory Processing Disorder is unknown. But we do know from research that SPD is neurologically based; the brains of individuals with SPD are actually different than those of individuals who do not have SPD. In Chapter 13 of  “Sensational Kids”, Dr. Lucy Jane Miller notes that current research suggests three “leading contenders” that contribute to Sensory Processing Disorder – heredity, prenatal and birth complications (such as prematurity or labor and delivery difficulties), and environmental factors (such as sensory deprivation, trauma, or abuse). However, like many conditions, more research is needed to in order to truly be able to identify the causes of SPD.

Who diagnoses Sensory Processing Disorder?

At this point in time, Sensory Processing Disorder is not an “official” medical diagnosis. That is, it is not listed as its own category in the most current version of the handbook used for diagnosing neurologically-based disorders such as Autism, ADHD, OCD, and Depression. However, as any parent of a child with SPD will tell you, this does not mean Sensory Processing Disorder is not real. It just means there is still millions of dollars of research that needs to be done in order to demonstrate that SPD is a condition that is separate from the other neurological disorders.

As pediatric occupational therapists, we do not treat the diagnosis; we treat the whole child. So, to be honest, it doesn’t really matter what “diagnosis” a child has when they are referred to OT. We look at what the child’s strengths are, what occupations they are struggling with, what skills or abilities are needed to be able to perform those occupations, and then we set goals and create a treatment plan to help them be able to more fully engage, participate in, and enjoy life. This can include addressing sensory processing difficulties and their impact on daily life.

Can SPD occur in isolation or only with other disorders? What other disorders does it occur with?

Research has already shown that the brains of children with SPD are different (and respond differently to sensory input) than those diagnosed with disorders such as Autism and ADHD. Yes, Sensory Processing Disorder can and does absolutely occur on its own, but it also can and does occur alongside many other diagnoses such as Autism (over half of individuals with Autism also have SPD), ADHD (approximately half of those with ADHD also have SPD),CAS (Childhood Apraxia of Speech),  OCD, Depression, PTSD, Prematurity, Developmental Delays, Learning Disorders, and more.

How early can SPD be diagnosed, and what are some early warning signs? 

Sensory processing difficulties can be identified from birth, though it is not usually until later in the child’s first year or beyond that parents or medical professionals suspect that a child’s behavioral or developmental difficulties might be related to sensory processing.

As I mentioned previously, kids may either over-respond, under-respond, or seek/crave certain types of sensory input. Dr. Lucy Jane Miller’s book, “Sensational Kids”, has some great checklists in Chapter 2 to help parents identify whether their child might be exhibiting signs of SPD. Below are some examples from those checklists, all of which are commonly known to OTs who are trained to work with children with SPD.

Some red flags related to over-responsive sensory systems can include avoiding or being extremely bothered by or avoidant of certain textures, fabrics, messy substances on hands or face, grooming tasks (tooth or hair brushing, nail clipping), smells, sounds, lights, or movements (particularly not wanting to be laid down for diaper changes as a baby or not wanting to be out of an upright position as a child). Children with over-responsive sensory systems may appear to be irritable (babies often express an over-responsive tactile system by arching), aggressive, impulsive, overly cautious, or overly rigid in their desire for structure and predictability.

Some red flags related to under-responsive sensory systems can include appearing to not “register” the sensation or pain caused by minor injuries (such as splinters or sprains), seeming to not sense typical body sensations such as hunger/temperature/full bladder or bowel, preferring sedentary activities over physical play, seeming oblivious to what’s going on in the environment, and generally demonstrating a lack of body and spatial awareness. Children with under-responsive sensory systems may appear passive, lethargic, slow, unmotivated, uncoordinated, or disinterested in social interactions.

Some red flags related to sensory seeking/craving can include excessive movement, fidgeting, wiggling, spinning/jumping/rolling/climbing, touching everything, non-stop talking, seeking out vibration (such as washing machine, dishwasher, vibrating toothbrush or toys), licking/mouthing/chewing non-food objects, consistently smelling objects, seeking out certain noises, seeking out visual input, and preferring strong foods and textures (lemons, hot sauce, pickles, ice cubes, crunchy foods, etc.). This can cause children to behave as if they are impulsive, angry, difficult to calm down, disobedient, or difficult to control.

Wow Christie!  Thank you so much!  

Stay tuned for Part II when Christie discusses treatments, what parents can do, and why sensory play isn't just a Pinterest trend!  

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