Sensory Processing Issues Explained
Tantrums, clumsiness, 'immaturity' all could point to problems taking in the world
Child Mind Institute
When Jill went hunting for new shoes for her 6-year-old daughter, Katie, it wasn't a simple question of finding the cutest pair in her size. While the second-grader doesn't have wide feet, Jill learned the hard way that Katie needs a really wide toe box because "if she feels things are constricting at all, we're done." And because her daughter has balance issues that make her prone to tripping and falling, Jill looks for soles that aren't too smooth, thick or clunky, with a rubber toe that won't wear out quickly.
Not long ago, mothers in Jill's shoes might have been frustrated by what they'd likely have perceived as a "difficult, clumsy" little girl. But that wasn't the case. Instead, Jill posted a distress signal on Facebook: "help! kid with sensory issues!" She also enlisted a friend who blogs about special needs and her 8-year-old son. The pair got a total of 43 responses. When Jill made her final online purchase, she shared her triumph as if it she'd snagged the Golden Fleece.
All the moms who answered Jill's call are well-versed in sensory issues like Katie's, which often are recognized during the toddler years, as parents observe an unusual aversion to noise, light, shoes that are deemed too tight and clothes that are irritating. They may notice clumsiness and trouble climbing stairs; and difficulty with fine motor skills like wielding a pencil and fastening buttons.
More baffling—and alarming—to parents are children who exhibit extreme behaviors: screaming if their faces get wet, throwing violent tantrums whenever you try to get them dressed, having an unusually high or low pain threshold, crashing into walls and even people, and putting inedible things, including rocks and paint, into their mouths. These and myriad other atypical behaviors may reflect sensory processing issues—children who are overwhelmed because of their difficulty integrating information from their senses. It's often called Sensory Processing Disorder, or SPD, although it's not recognized by the psychiatrists' bible, the Diagnostic and Statistical Manual.
Sensory issues received widespread attention earlier this month with the autism- and sensory-friendly staging of Broadway's The Lion King, in which potentially over-stimulating and distressing lights were dimmed and noise subdued. As one mom noted, after her son froze at the door to the theater—even though he'd been preparing for weeks—"My husband equates it to excitement times 100, so that it is no longer exciting but becomes incredibly overwhelming to the point of being a nightmare for him."
In fact, SPD and autism spectrum disorder are often thought of in tandem because the majority of children and adults on the autism spectrum also have significant sensory issues. However, most children with SPD are not on the spectrum. It can also be found in those with ADHD, OCD and other developmental delays—or with no other diagnosis at all. In fact, a 2009 research study suggests that 1 in every 6 children has sensory issues that impede their daily functioning, socialization and learning. It isn't hard to see how these types of challenges could lead to a child feeling anxious and depressed.
"It's like a traffic jam in your head, with conflicting signals quickly coming from all directions, so that you don't know how to make sense of it all."
A toddler who covers her ears at the sound of a fire truck's siren or a second-grader who insists that all the tags be cut out of his clothes may have auditory or tactile sensitivities. But unless these sensitivities seriously interfere with their lives, they don't have SPD.
What parents often notice first is odd behaviors and wild mood swings, strange at best, upsetting at worst. Often it's an outsized reaction to a change in environment—a radical, inexplicable shift in the child's behavior. For instance, a first-grader may do fine in a quiet setting with a calm adult. But place that child in a grocery store filled with an overload of visual and auditory stimulation and you might have the makings of an extreme tantrum, one that's terrifying for both the child and parent.
"These kids' tantrums are so intense, so prolonged, so impossible to stop once they've started, you just can't ignore it," notes Nancy Peske, whose son Cole, now 12, was diagnosed at 3 with SPD and developmental delays. Peske is coauthor with occupational therapist Lindsey Biel, who worked with Cole, of Raising a Sensory Smart Child.
Another response to being overwhelmed is to flee. If a child dashes out across the playground or parking lot, oblivious to the danger, Peske says that's a big red flag that he may be heading away from something upsetting, which may not be apparent to the rest of us, or toward an environment or sensation that will calm his system. This "fight-or-flight response is why someone with SPD will shut down, escape the situation quickly, or become aggressive when in sensory overload," she says. "They're actually having a neurological 'panic' response to everyday sensations the rest of us take for granted."
There are some theories that kids on the spectrum who wander are often attracted to water because it offers input they crave, too often with deadly results. "Not all sensory kids do this," Peske says, "but most gravitate toward the sensations and environments they find calming or stimulating. Their self-regulation is not great, so safety takes a back seat to their need to get that input or that calming experience of being in water."
Children, teens and adults with SPD experience either over-sensitivity (hypersensitivity) or under-sensitivity (hyposensitivity) to an impairing or overwhelming degree. The theory behind SPD is based on the work of occupational therapist Dr. A. Jean Ayres. In the 1970s, Dr. Ayres introduced the idea that certain people's brains can't do what most people take for granted: process all the information coming in through seven—not the traditional five—senses to provide a clear picture of what's happening both internally and externally.
Along with touch, hearing, taste, smell and sight, Dr. Ayres added the "internal" senses of body awareness (proprioception) and movement (vestibular). When the brain can't synthesize all this information coming in simultaneously, "It's like a traffic jam in your head," Peske says, "with conflicting signals quickly coming from all directions, so that you don't know how to make sense of it all."
What are these two "extra" senses in Dr. Ayres' work?
Proprioceptive receptors are located in the joints and ligaments, allowing for motor control and posture. The proprioceptive system tells the brain where the body is in relation to other objects and how to move. Those who are hyposensitive crave input; they love jumping, bumping and crashing activities, as well as deep pressure such as that provided by tight bear hugs. If they're hypersensitive, they have difficulty understanding where their body is in relation to other objects and may bump into things and appear clumsy; because they have trouble sensing the amount of force they're applying, they may rip the paper when erasing, pinch too hard or slam objects down.
The vestibular receptors, located in the inner ear; tell the brain where the body is in space by providing the information related to movement and head position. These are key elements of balance and coordination, among other things. Those with hyposensitivity are in constant motion; crave fast, spinning and/or intense movement, and love being tossed in the air and jumping on furniture and trampolines. Those who are hypersensitive may be fearful of activities that require good balance, including climbing on playground equipment, riding a bike, or balancing on one foot, especially with eyes closed. They, too, may appear clumsy.
To help parents determine if their child's behavior indicates possible SPD, Peske and Biel have created a detailed sensory checklist that covers responses to all types of input, from walking barefoot to smelling objects that aren't food, as well as questions involving fine and gross motor function, such as using scissors (fine) and catching a ball (gross). The SPD Foundation also offers a litany of "red flags." The list for infants and toddlers includes a resistance to cuddling, to the point of arching away when held, which may be attributed to feeling actual pain when being touched. By preschool, over-stimulated children's anxiety may lead to frequent or long temper tantrums. Grade-schoolers who are hyposensitive may display "negative behaviors" including what looks like hyperactivity, when in fact they're seeking input.
At first, SPD parent blogger Hartley Steiner couldn't understand why her son Gabriel's psychologist suggested that he had SPD; after all, he didn't fit the avoidance profile most people think of when they hear "sensory issues"—kids who cover their ears or won't try new foods. As she wrote in her blog, Gabriel was "fine with loud noises, loved water, mud, hot salsa," Steiner says. "He would climb to the tippity top of a play structure—and stand on top of it. No, my kid was not at all adverse to sensory stimuli—as a matter of fact, he couldn't get enough."
It took a year, and reading Carol Stock Kranowitz's seminal book, The Out-of-Sync Child, for Steiner to realize there are two types of kids with SPD: sensory seekers and sensory avoiders. Those like Gabriel, who seek input, "are often considered 'behavior problems,' 'hyperactive,' 'difficult,' 'stubborn,' 'coddled.' Many of us parents have been blamed, told our kids need more discipline, or that they are 'in need of a good spanking.'" Those who perceive things too intensely are avoiders; this can translate into refusing to brush their teeth or have their faces painted. To make things even more complicated, kids can be both seekers and avoiders and have both proprioceptive and vestibular challenges, along with issues relating to the traditional five senses.
Peske sums up the way sensory issues can affect kids this way: "If you're a child who is oversensitive to certain sensations, you are not only likely to be anxious or irritable, even angry or fearful, you're likely to be called 'picky' and 'oversensitive.' If you rush away because you're anxious or you're over-stimulated and not using your executive function well because your body has such a powerful need to get away, you're 'impulsive.' If you have trouble with planning and executing your movements due to poor body awareness and poor organization in the motor areas of the brain, you're 'clumsy.' Because you're distracted by your sensory issues and trying to make sense of it all, you may be developmentally delayed in some ways, making you a bit 'immature' or young for your age."
Amid this confusion, there may be relief for more than a few parents in recognizing what maybe causing otherwise inexplicable behavior. "When I describe sensory issues to parents whose kids have it," Peske says, "the usual reaction is 'Oh, my gosh, that's it!' They've been trying to put a finger on 'it' for many months, even years! The sense of relief that they finally know what 'it' is is humongous."
Published: October 26, 2011
This is part I in a three-part series on sensory issues. Read part II in the series details specialized treatment for sensory processing issues. Part III explores controversies surrounding sensory processing, how big a role it plays in behaviors attributed to diagnoses like ASD and ADHD, and what evidence there is for the effectiveness of treatment.
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