Sensory Processing Disorder

What is sensory processing disorder? Sensory processing disorder (SPD) is a neurodevelopmental disorder that is characterized by difficulties with organizing and using sensory information from the body and environment. This sensory information includes vision, hearing, taste, smell, tactile (touch), vestibular (perception of movement) and proprioception (perception of body position). The inability to organize and use this information may interfere with development and activities of daily life.

Typically, children are able to receive, manage, process and integrate all kinds of sensory information through their central nervous system helping them learn, respond, and adapt to their environment. Every child has preferences of how much or how little sensory information he or she can tolerate or use to calm, concentrate or wake up. Winnie Dunn, an occupational therapist, has identified four sensory processing patterns or styles (See Dunn’s Model of Sensory Processing Characteristics).

Children with SPD have problems with receiving, organizing, integrating and responding to sensory information. The severity and symptoms vary by child, but generally children over respond, under respond or have altered perception or discrimination of this sensory information. Because children with SPD do not interpret and organize sensory information adequately, their response to the information often results in poor self regulation, arousal, attention and motor skills which affect their emotional, social, physical, and learning abilities. Children with other developmental disorders such as autism spectrum disorders (ASD), attention deficit/ hyperactivity disorder (ADHD), learning disabilities, fetal alcohol spectrum disorders (FASD), and developmental coordination disorders (DCD) may also have sensory processing disorders.

How many children have a Sensory Processing Disorder? The number of children with a SPD is not well documented. Approximately 5% of children in early school age (kindergarten) were found to have a sensory processing disorder according to a parental perception survey (Ahn, Miller, Milberger & McIntosh, 2004). Other sources estimate the prevalence is as high as 10-13% in early school age children without other developmental disabilities (Anzalone, 2004). The number of children with a SPD under the age of 5 is not known. The prevalence of SPD in children with other developmental disabilities is thought to be higher than for children without disabilities.

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Dunn’s Model of Sensory Processing Characteristics (Dunn, 1997)

Neurologic Threshold High Explanation Low Explanation

Behavioral Response

Low Inadequate neural Sensory Sensitive Overactive Registration activation to • Aware of neural system Passive • Appear support surroundings and uninterested, appropriate stimulation Difficulty disconnected responses to • Distractible habituating • Dull or flat environmental • May be affect cues hyperactive • Low energy • Difficulty levels Brain is not maintaining • Self-absorbed receiving attention adequate sensory stimulation to respond appropriately

Sensory Inadequate neural Sensory Avoiding Sensory Seeking activation • Limit sensory sensations • Active, input uncomfortable, Active engaging, Driven to activate • Unfamiliar input irritating, disruptive neural system distressing frightening • Require through sensory • Disruptive novelty seeking behaviors • Tend to have Overly active • Fidget, rituals, routines, neural system explore rules that is highly objects • Rigid sensitive to stimulation • Constantly • Avoid or increasing withdraw from sensory input new, unfamiliar activities

What are the causes of Sensory Processing Disorder? The cause of SPD has not yet been identified but it is believed to be a distinct neurodevelopment disorder.

www.teachingei.org p. 2 What are the developmental complications of Sensory Processing Disorder? There are differences in the physiologic response to sensory stimuli and an altered ability to habituate, or reduce reaction over time. A wide range of social, emotional, behavioral, and functional difficulties can be seen in children with SPD. These difficulties disrupt daily life and affect participation in home, educational and community environments.

Domain Areas of difficulty Social-emotional Play skills Self-confidence Social interaction Withdrawal Self-esteem Behavioral Attention Self-regulation Fear Tantrums Anxiety Feeding problems Avoidance/Intolerance Functional Motor skills Coordination Balance Motor planning Daily living activities

What affect does SPD have on learning in young children? Sensory processing disorders effect the way a child interacts with their environment and their opportunities for learning. Depending on the nature of the disorder in the individual child, they may avoid learning opportunities or be too distracted to learn from their environment. Dunn and others have described the impact of SPD on learning according to their sensory threshold and response.

Profile Characteristics Effect on Learning Low Disinterested, unengaged, underactive • Need increased external Registration structure and support • Provide cues to maintain engagement Sensory Hyperactive, distractible • Reduce distractions Sensitivity Difficulty with sustaining attention • Organization • Routines • Clear expectations Sensory Distractible, hyperactive • Need increased external Seeking Fidget, disruptive structure and support Impulsive • Embed needed sensory input Disorganized into tasks, routines Sensory Disruptive • Reduce unnecessary input Avoiding Ritualistic • Introduce sensory Routines experiences carefully Habitual • Controlled environment Narrow interests and experiences • Provide clear expectations • Avoid power struggles • Acknowledge cues

www.teachingei.org p. 3 Screening and assessment tools used to help identify young children with Sensory Processing Disorder There are several screening and assessment tools designed to measure the response and integration of sensory information from infants through adults.

Sensory Integration and Praxis Test (SIPT): school aged children http://portal.wpspublish.com/portal/page?_pageid=53,123039&_dad=portal&_schema=P ORTAL

Sensory Profile and Short Sensory Profile: versions for infants, children, adolescents/adults. http://pearsonassess.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=076-1638-008

Sensory Processing Measure (SPM): school aged children www.wpspublish.com/spm

What are the interventions used with Sensory Processing Disorder? An early intervention or school age related service provider familiar with SPD designs a program for children based on their severity and symptoms. Interventions include increasing the tolerance threshold to the unwanted sensory stimuli, increasing awareness to sensory information, improving the perception and discrimination of the information and support for motor, balance, coordination and motor planning skill development. Interventions are also specific to a child’s educational needs. Interventions that match a child’s sensory profile are also incorporated into everyday activities and routines. The following chart provides simple suggestions that correspond to each of Dunn’s four profiles.

References Ahn, R.R., Miller L.J., Milberger, S. & McIntosh, D.N.(2004). Prevalence of parents' perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy. 58(3) 287-293

Anzalone, M. E. (2004). Sensory integration disorder. In Parker, S. Zuckerman, B.S. & Augustyn, M. C.(Eds.) Developmental and Behavioral Pediatrics: a Handbook for Primary Care Edition: 2. Lippincott Williams & Wilkins.

Dunn, W. (2007). Supporting children to participate successfully in everyday life using sensory processing knowledge. Infants and Young Children, 20(2)84-101.

Dunn, W. (2001). The sensations of everyday life: Theoretical, conceptual, and pragmatic considerations. American Journal of Occupational Therapy. 55(6) 608-620.

Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants & Young Children. 9(4), 23-35.

Jirkikowic, T., Olsen, H.C. & Kartin, D. (2008). Sensory processing, school performance, and adaptive behavior of young school-aged children with fetal alcohol spectrum disorders. Physical & Occupational Therapy in Pediatrics. 28(20, 117-136.

www.teachingei.org p. 4 Miller, L.J., Anzalone, M.E., Lane, S. J., Cermack, S.A., & Osten, E. (2007). Special Issue: Cenceptualizing and identifying sensory processing issues. American Journal of Occupational Therapy, 61 (2). 135-259.

Willimason, G. G. & Anzalone, M.E. (2001). Sensory Integration and Self- Regulation in Infants and Toddlers: Helping Very Young Children Interact with Their Environment. Washington, DC: Zero to Three: National Center for Infants, Toddlers and Families.

Resources Dunn, W. (2008). Living Sensationally: Understanding Your Senses. London and Philadelphia: Jessica Kingsley Publishers.

Kranowitz, C. S. (2005). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder 2nd Edition. New York: Perigee. http://www.out-of-sync-child.com/

Miller, L.J. & Fuller, D.A. (2006). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD). New York: Penguin Group Inc.

Sensory Processing Disorder Foundation (SPD) http://www.spdfoundation.net/index.html

Sensory Processing Disorder Resource Center http://www.sensory-processing- disorder.com/

Cite As: Georgetown University Center for Child and Human Development. Contemporary Practices in Early Intervention: Sensory Processing Disorder Primer. 2011. Available online at http://www.teachingei.org.

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