I’m Sensitive, Don’t Touch Me! (Sensory Processing Disorder)

Image courtesy of sheknows.com. Exploring using all senses (sight, smell, taste, hearing, touch) is fun for most of us, but not all.

As children, we love to explore the world around us using all our senses (sight, smell, taste, hearing, touch, and sometimes sixth sense ^_^). We play with mud, louden or soften radio volume, wear all kinds of clothes, etc. But not all children can do that. Sometimes, you can see some kids (and adults too) who resist to wear clothes with tags or let their hair cut, are intolerant to loud noises and dust, glare easily in low light or don’t want to be touched. You can tell they are weird or sensitive. Some really are, but others are not. What you thought about their sensitivity is actually a disorder called sensory processing disorder.

What is Sensory Processing Disorder?

First, let’s define sensory processing. Sensory processing (or sensory integration) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or “sensory integration.”[1] It’s the input from the observation of the 5 senses and processing them in the brain for interpretation. It’s comparable to the input you enter into a computer and then the CPU processes it to be displayed by the monitor.

While most of us are doing fine with sensory processing, some people do experience intolerance to sensory processing. It’s as if your stereo volume is up to 10 or maximum that all that you sense is very extreme. For example, wearing a shirt with a tag at the collar is fine with me, while for you it’s like a knife cutting through your neck. Others feel irritated when touching dust. It’s not hyperbole. It’s sensory processing disorder. Now, let’s define sensory processing disorder. Sensory Processing Disorder (or SPD, formerly known as sensory integration dysfunction) is a condition that exists when sensory signals don’t get organized into appropriate responses.[1] With this condition, a person becomes very sensitive with what he or she senses in his or her surroundings just like the example I gave above. Pioneering occupational therapist and neuroscientist A. Jean Ayres, PhD, likened SPD to a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly. 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 other impacts may result if the disorder is not treated effectively.[1]

How Common is Sensory Processing Disorder?

One study (Ahn, Miller, Milberger, McIntosh, 2004) shows that at least 1 in 20 children’s daily lives is affected by SPD. Another research study by the Sensory Processing Disorder Scientific Work Group (Ben-Sasson, Carter, Briggs-Gowen, 2009) suggests that 1 in every 6 children experiences sensory symptoms that may be significant enough to affect aspects of everyday life functions. Symptoms of Sensory Processing Disorder, like those of most disorders, occur within a broad spectrum of severity. While most of us have occasional difficulties processing sensory information, for children and adults with SPD, these difficulties are chronic, and they disrupt everyday life.[1]

What Causes Sensory Processing Disorder?

The exact cause of SPD is unknown. It is generally genetic. Brain composition may have some fault in developing SPD. Experiments have shown that children with sensory processing problems have abnormal brain activity when they are simultaneously exposed to light and sound. Still other experiments have shown that children with sensory processing problems will continue to respond strongly to a stroke on the hand or a loud sound, while other children quickly get used to the sensations.[2]

Another cause is an abnormal white matter microstructure in children with SPD, compared to typical children and those with other neurological disorders such as autism and ADHD.[3][4][5]

What are the signs and symptoms of SPD?

SPD has a lot of signs and symptoms but all of these symptoms may or may not appear altogether. SPD symptoms are grouped into the following:

People suffering from over-responsivity might[3]:

  • Dislike textures such as those found in fabrics, foods, grooming products or other materials found in daily living, to which most people would not react. This dislike interferes with normal function.
  • Avoid crowds and noisy places
  • Motion sickness (not related to other medical explanations)
  • Refuse normal skin contact interactions (kissing, cuddling or hugging) due to negative experience of touch sensation (not to be confused with shyness or social difficulties)
  • Feel seriously discomforted, sick or threatened by normal sounds, lights, movements, smells, tastes, or even inner sensations such as heartbeat.
  • Be picky eaters
  • Have sleep disorders (waking up to minor sounds, problems getting sleep because of sensory overload)
  • Find it difficult to self calm, feel constantly under stress

People suffering from under-responsivity[3]:

  • Show extreme difficulties waking up
  • Appear unreactive and slow
  • Be unaware of pain and/or other people
  • Might appear deaf even when auditory function has been tested
  • Child might be difficult being toilet trained, unaware of being wet or soiled

People suffering from sensory craving might[3]:

  • Fidget excessively
  • Seek or make loud, disturbing noises
  • Climb, jump and crash constantly
  • Seek “extreme” sensations
  • Suck on or bite clothing, fingers, pencils, etc.
  • Appear impulsive

People suffering from sensory motor based problems might[3]:

  • Appear slow and uncoordinated
  • Feel clumsy, slow, poor motor skills or handwriting
  • Have poor posture
  • Children might be delayed in crawling, standing, walking or running
  • Become verbose to avoid motor tasks

People suffering from sensory discrimination problems might[3]:

  • Drop things constantly Have poor handwriting
  • Difficulty dressing and eating Use inappropriate force to handle objects

Other signs and symptoms[3]:

  • Poorly integrated balance and rightening reflexes
  • Low muscle tone patterns
  • Poor core tone
  • Low postural control (may appear hunchback)
  • Poor nystagmus (or involuntary eye movement)
  • Presence of non integrated reflexes
  • Jerky eye tracking
  • Poor tactile astereognosis (inability to identify an object by active touch of the hands without other sensory input) Inadequate motor, ideational or constructional praxis
  • Difficulties with planning movement using feedback information
  • Difficulties with planning movement using feedforward information
  • Poor motor coordination

Image courtesy of rockinmomsworld.wordpress.com. Diagram of SPD symptoms

How is SPD diagnosed?

Unfortunately, SPD is not yet recognized by the International Codes of Diseases (ICD-10 ) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But SPD is currently accepted in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R)[3]. Diagnosis is primarily arrived at by the use of standardized tests, standardized questionnaires, expert observational scales, and free play observation at an occupational therapy gym. Observation of functional activities might be carried at school and home as well. Some scales that are not exclusively used in SPD evaluations are used to measure visual perception, function, neurology and motor skills.[3][6]

Tests include[3]:

Standardized tests:

  • Sensory Integration and Praxis Test. (SIPT)
  • DeGangi-Berk Test of Sensory Integration (TSI)
  • Test of Sensory Functions in Infants (TSFI)[7]

Standardized questionnaires:

  • Sensory Profile, (SP)[8]
  • Infant/Toddler Sensory Profile[7]
  • Adolescent/Adult Sensory Profile Sensory Profile School Companion Sensory Processing Measure (SPM)[9]
  • Sensory Processing Measure Preeschool (SPM-P)[10]

Other tests used:

  • Clinical Observations of Motor and Postural Skills (COMPS)[11]
  • Developmental Test of Visual Perception: Second Edition (DTVP-2)[12]
  • Beery–Buktenica Developmental Test of Visual-Motor Integration, 6th Edition (BEERY VMI) Miller Function & Participation Scales
  • Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)[13] Behavior Rating Inventory of Executive Function (BRIEF)[14][15]

How is SPD treated?

Therapies are used to treat SPD[3]:

Sensory integration therapy – in this therapy, the therapist works closely with the child to provide a level of sensory stimulation that the child can cope with, and encourage movement within the room. Sensory integration therapy is driven by four main principles:

  • Just right challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
  • Adaptive response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
  • Active engagement (the child will want to participate because the activities are fun)
  • Child directed (the child’s preferences are used to initiate therapeutic experiences within the session)

Sensory processing therapy – the same as sensory integration therapy but adds the following[16]: Intensity (person attends therapy daily for a prolonged period of time) Developmental approach (therapist adapts to the developmental age of the person, against actual age) Test-retest systematic evaluation (all clients are evaluated before and after) Process driven vs. activity driven (therapist focuses on the “Just right” emotional connection and the process the reinforces the relationship) Parent education (parent education sessions are scheduled into the therapy process) “joie de vivre” (happiness of life is therapy’s main goal, attained through social participation, self-regulation, and self-esteem) Combination of best practice interventions (is often accompanied by integrated listening system therapy, floor time, and electronic media such as Xbox Kinect, Nintendo Wii, Makoto II machine training and others) Developmental, Individual

Difference, Relationship-based (DIR) model – developed by Stanley Greenspan, MD, and Serena Wieder, PhD, where parents are first asked to follow the child’s lead, even if the playtime behavior isn’t typical. For example, if a child is rubbing the same spot on the floor over and over, the parent does the same. These actions allow the parent to “enter” into the child’s world.[17] This is followed by a second phase, where parents use the play sessions to create challenges for the child. The challenges help pull the child into what Greenspan calls a “shared” world with the parent. And the challenges create opportunities for the child to master important skills in areas such as[17]: Relating Communicating Thinking

A major part of this therapy is the “floortime” method. The method involves multiple sessions of play with the child and parent. The play sessions last about 20 minutes.[17]

Image courtesy of speechified.com. This is how a child with SPD feels. Actually, he wants to explore the world. His brain and senses just cannot cope with the stimuli

These therapies are aimed to minimize, if not totally eliminate all the symptoms of SPD, as this does not easily go away.

Without these interventions, significant losses or hardships may happen to the individual with SPD as he or she will struggle to navigate the world, including education, employment, and social environments which may deeply affect his or her self-esteem and may develop depression, anxiety obsessive-compulsive disorder, or phobias.

Sensory Processing Disorder Brain

Still, a lot of people see people with SPD as “sensitive” and “very moody” or “picky” and just thought this is their character. On the contrary, it’s not. In fact, SPD is biological in nature.

Image courtesy of ucsf.edu. Scan showing the brain of a person with SPD

A study done at University of California, San Francisco where researchers used an advanced form of MRI called diffusion tensor imaging (DTI), which measures the microscopic movement of water molecules within the brain in order to give information about the brain’s white matter tracts. DTI shows the direction of the white matter fibers and the integrity of the white matter. The brain’s white matter is essential for perceiving, thinking and learning. The imaging detected abnormal white matter tracts in the SPD subjects, primarily involving areas in the back of the brain, that serve as connections for the auditory, visual and somatosensory (tactile) systems involved in sensory processing, including their connections between the left and right halves of the brain.[18]

Image courtesy of ucsf.edu. Brain scan of a child with SPD. Abnormal white matter is seen at the occipital (back) part of the brain.

Hope this study will make sensory processing disorder a legit disorder included in the world’s list of disorders. Much recognition is needed to give support and understanding to people with SPD.

References:

  1. http://www.spdfoundation.net/about-sensory-processing-disorder/
  2. http://www.webmd.com/parenting/sensory-processing-disorder
  3. http://en.m.wikipedia.org/wiki/Sensory_processing_disorder
  4. Owen, Julia P.; Marco, Elysa J.; Desai, Shivani; Fourie, Emily; Harris, Julia; Hill, Susanna S.; Arnett, Anne B.; Mukherjee, Pratik (2013). “Abnormal white matter microstructure in children with sensory processing disorders”. NeuroImage: Clinical 2: 844–853. doi:10.1016/j.nicl.2013.06.009. ISSN 2213-1582
  5. Chang, Yi-Shin; Owen, Julia P.; Desai, Shivani; Hill, Susanna S.; Arnett, Anne B.; Harris, Julia; Marco, Elysa J.; Mukherjee, Pratik (2014). “Autism and Sensory Processing Disorders: Shared White Matter Disruption in Sensory Pathways but Divergent Connectivity”. Plosone. doi:10.1371/journal.pone.0103038.
  6. Kinnealey, Moya; Miller, Lucy J (1993). Helen L Hopkins; Helen D Smith; Helen S Willard; Clare S Spackman, ed. Sensory integration and learning disabilities (PDF). Willard and Spackman’s occupational therapy (8 ed.) (Philadelphia: Lippincott, cop.). pp. 474–489. ISBN 9780397548774. OCLC 438843342. Retrieved 2013-07-23.
  7. Eeles AL, Spittle AJ, Anderson PJ et al. (April 2013). “Assessments of sensory processing in infants: a systematic review”. Dev Med Child Neurol 55 (4): 314–26. doi:10.1111/j.1469-8749.2012.04434.x. PMID 23157488.
  8. 8. Ermer J, Dunn W (April 1998). “The sensory profile: a discriminant analysis of children with and without disabilities”. Am J Occup Ther 52 (4): 283–90. doi:10.5014/ajot.52.4.283. PMID 9544354
  9. 9. Miller-Kuhaneck H, Henry DA, Glennon TJ, Mu K (2007). “Development of the Sensory Processing Measure-School: initial studies of reliability and validity” (PDF). Am J Occup Ther 61 (2): 170–5. doi:10.5014/ajot.61.2.170. PMID 17436839.
  10. Glennon, Tara J.; Miller Kuhaneck, Heather; Herzberg, David (2011). “The Sensory Processing Measure–Preschool (SPM-P)—Part One: Description of the Tool and Its Use in the Preschool Environment”. Journal of Occupational Therapy, Schools, & Early Intervention 4 (1): 42–52. doi:10.1080/19411243.2011.573245. ISSN 1941-1243.
  11. Wilson B1, Pollock N, Kaplan BJ, Law M, Faris P (September 1992). “Reliability and construct validity of the Clinical Observations of Motor and Postural Skills.”. Am J Occup Ther 46 (9): 775–83. doi:10.5014/ajot.46.9.775. PMID 1514563
  12. Brown T, Hockey SC (January 2013). “The Validity and Reliability of Developmental Test of Visual Perception-2nd Edition (DTVP-2)”. Phys Occup Ther Pediatr 33 (4): 426–39. doi:10.3109/01942638.2012.757573. PMID 23356245
  13. Deitz JC, Kartin D, Kopp K (2007). “Review of the Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)”. Phys Occup Ther Pediatr 27 (4): 87–102. doi:10.1080/j006v27n04_06. PMID 18032151
  14. Gioia GA, Isquith PK, Guy SC, Kenworthy L (September 2000). “Behavior rating inventory of executive function”. Child Neuropsychol 6 (3): 235–8. doi:10.1076/chin.6.3.235.3152. PMID 11419452
  15. Gioia GA, Isquith PK, Retzlaff PD, Espy KA (December 2002). “Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample”. Child Neuropsychol 8 (4): 249–57. doi:10.1076/chin.8.4.249.13513. PMID 12759822.
  16. “The “So What?” of Sensory Intergration Therapy : Joie de Vivre” (PDF). spdfoundation.
  17. http://www.webmd.com/parenting/sensory-processing-disorder?page=2
  18. http://www.ucsf.edu/news/2013/07/107316/breakthrough-study-reveals-biological-basis-sensory-processing-disorders-kidsi
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2 thoughts on “I’m Sensitive, Don’t Touch Me! (Sensory Processing Disorder)

  1. Pingback: Little Professors (Asperger Syndrome) | Aegyo Kawaii's Neurodiversity Blog

  2. Pingback: Giftedness | Aegyo Kawaii's Neurodiversity Blog

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