Every day, we are bombarded with millions and millions of pieces of sensory input. Sights, sounds, smells, tastes and touches are ever-present. The technologies that we have surrounded ourselves with have not lessened the burden – indeed, in many ways they have removed the last remaining respites we had. An ever expanding array of cordless devices, internet connections and cell phone towers have effectively done away with the concept of “being out of range,” much less the notion of completely unplugging. Frankly speaking, this is the new normal.
And for most of us, this is not a problem. Our brains are wired to effectively receive and interpret this incredible amount of data and formulate appropriate responses to it, all in fractions of a second. Unfortunately, many children lack or struggle with this ability. And while this blog has discussed and counseled parents regarding established, recognized disorders such as autism and developmental delays, less discussed – and often less understood – are general sensory processing issues in children.
Let’s start with some definitions. “Sensory processing” (sometimes called “sensory integration”) refers to the way the nervous system takes in information through the senses (touch, movement, smell, taste, vision, and hearing), combines it with prior information such as memories and knowledge stored in the brain, and creates appropriate motor and behavioral responses.
“Sensory Processing Disorder” (“SPD” also referred to as “sensory integration dysfunction”) is a condition that exists when sensory information doesn’t get organized into appropriate responses. Oftentimes, compared to a neurological “traffic jam,” people with SPD cannot process and act upon information received through the senses, which ultimately creates challenges in performing everyday tasks (self-care, work and leisure activities). SPD can also cause behavioral problems, anxiety, depression and clumsiness if not treated. Children with extreme sensitivity to sensory input may result in extreme avoidance of activities, agitation, distress, fear or confusion.
Generally speaking, there are two types of SPD: hyposensitivity and hypersensitivity. When children have trouble modulating the sensory input around them, it can lead to over-sensitivity (or “hypersensitivity”), where a child is withdrawn and puts their hands over their ears because the auditory information is too much for them. Attending to a task can be difficult for children with hypersensitivity because there’s too much stimuli around them. Conversely, a child who presents with under-sensitivity (or “hyposensitivity”) may be referred to as a “sensory seeker” and will constantly move, run, spin and crash in order to receive the sensory input they crave.
SPD is a very common disorder. Recent studies show that at least 1 in 20 children are affected by SPD. Another study suggests that 1 in every 6 children experience sensory symptoms significant enough to affect aspects of everyday life functions. Many people have occasional difficulties processing sensory information (consider the foods you avoid because of the texture), while individuals with SPD have chronic difficulties, and disrupt everyday life.
This diagnosis is not without controversy, particularly as to whether or not sensory processing disorder is a distinct diagnosis or a symptom of some other diagnosis. The American Academy of Pediatrics, advises against a diagnosis of SPD unless it is a symptom due to autism spectrum disorder, attention-deficit/hyperactivity disorder, developmental coordination disorder or childhood anxiety disorder. The American Psychiatric Association also recently rejected SPD as a diagnosis to be included in the recently updated DSM-5 that requests additional studies be conducted before the disorder can be recognized. On the other hand, SPD is in Stanley Greenspan’s Diagnostic Manual for Infancy and Early Childhood and as Regulation Disorders of Sensory Processing part of The Zero to Three’s Diagnostic Classification.
While the controversy continues over whether SPD is its own disorder, one thing is certain – children with difficulty processing sensory information face extreme challenges in daily life; therefore, proper treatment is vital. As a pediatric physical therapist for over a decade and an owner of two sensory gyms in Manhattan, New York, I have witnessed hundreds of children who have SPD, some whom also have another disorder (such as Autism or developmental coordination disorder) and others who seem to have a “Regulation Disorder of Sensory Processing,” as defined by Dr. Greenspan. While the distinction between a mere symptom or an independent disorder may seem academic, it can actually be life-changing for parents trying to seek reimbursement for their child’s therapy.
For example, my own one-year-old daughter has feeding issues. At first, it appeared that her difficulties were localized to just feeding. However, a more thorough evaluation of her sensory system revealed that her issues were not limited to feeding, but actually demonstrated global sensory processing difficulties. Once a sensory diet was implemented, immediate changes were noted. She was able to tolerate tactile input in and around her mouth with greater ease. Had she not had a feeding issue, however, her therapy would not have been reimbursed; most insurance companies do not currently cover SPD as an independent diagnosis.
Ultimately, proper individualized evaluation and assessment is vital to determining each child’s unique sensory needs. After assessment, the right space, equipment and knowledgeable therapists can partner with parents and caretakers to work toward improving the condition. But parents and caretakers should recognize that specific sensory-related symptoms may be indications of a broader sensory processing disorder which, if not effectively treated early on, can manifest itself in future complications. Parents who have such concerns should contact a licensed physical, occupational or speech language therapist for an individualized evaluation.
Shirael Pollack is a pediatric physical therapist and owner of Watch Me Grow Sensory Gym and Speech Language Center in Manhattan, New York. She is devoted to helping children with a wide variety of physical and developmental challenges by providing therapy that is both fun and effective. In addition to her practice at Watch Me Grow, Shirael is an active member of the National Autism Association NY Metro Chapter where she currently serves as the Chairperson of the Fundraising Committee.
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