Understanding Sensory Processing Disorders (SPD) is complex because there are three primary diagnostic groups, and children may have more than one type. These three primary types are:
1) sensory modulation disorders (see 3 subtypes below)
2) sensory-based motor disorders(postural disorders and dyspraxia)
3) sensory discrimination disorders
There are a total of six recognized sub-types of SPD. This article describes the 3 types of sensory modulation disorders and how they differ from Attention Deficit Hyperactivity Disorders (ADHD). Please keep in mind that children may have more than one subtype as well as ADHD.
Sensory Modulation Disorders
Sensory over-responding: These children are extra-sensitive to sensations, often picky eaters, and easily over-stimulated by sensations. They are sometimes called hyper-reactive or avoiders.
Sensory under-responding: These children need a lot of stimulation to respond; for example, they can spin intensely without getting dizzy. They are sometimes called hypo-responsive, under-reactive, or seekers
Sensory craving: These children never seem to get enough stimulation, touching and chewing on everything. They may also be called seekers.
The Impact of Sensory Modulation Disorders
Many children on the autism spectrum (ASD) have challenges with sensory modulation. However, SPD may affect children who do not demonstrate the social/communication and behavioral features of ASD. Note: like many individuals with SPD, the little girl in the photo benefits from wearing a weighted vest while pushing a heavy shopping cart. The sensory stimulation helps her to focus on her task, be aware of how her body is moving and tolerate overwhelming sensations from people and noise at a store.
Children with SMD may be described as having difficulty with self-regulation. Self-regulation is the ability to control one’s behavior, emotions, or thoughts and adapt to the demands of a situation. Children with a sensory modulation disorder may be impulsive, overly and easily stressed, difficult to soothe, or highly distractible. On the other extreme, they may seem lethargic, apathetic, or day-dreamy. Some children have behaviors associated with both seekers and avoiders! Let’s take a closer look at the three subtypes of sensory modulation disorders. I describe the following 3 fictional children in my book From Flapping to Function: A Parent's Guide to autism and Hand Skills.
Sensory over-responding, or super-sensitive: Four-year-old George is easily overwhelmed by sounds, smells, movements, and things he sees, to the point where he frequently “shuts down” and cries. He hates to touch food, bubble bath, or fur, and often strips naked at home. George’s favorite “toys” are rocks and blocks of wood, which he lines up in the basement. Repetitive body movements—such as rocking, flapping his arms, or flicking objects—seem to calm him. George will give familiar people a “high five”—but it had better be a firm one. His mom calls him “the Naked Curious Avoider.”
Sensory under-responding:Ten-year-old Dorothy frequently daydreams and slumps in her chair at school. She finds it easier to do her homework while bouncing on a ball seat, listening to music, and chewing gum. Even with all this sensory stimulation, Dorothy’s hand gets tired after writing a couple of sentences and she struggles to organize her sentences into a paragraph.
Sensory craving:Twelve-year-old twins, James and Errol, are home-schooled. They both love to make funny sounds, stand on their heads, and have pillow fights. Their parents converted the basement into a small gym with a suspended swing, trampoline, and crash pad made out of pillows on a mattress. James and Errol follow a schedule that includes weight lifting, jogging, cooking—the spicier the better, according to the boys—making bread, and creating pottery between their academic lessons and weekly visits to volunteer at a farm. These boys never seem to get enough stimulation. These children may mistakenly be diagnosed with ADHD or they may have both disorders.
Researchers have documented that sensory modulation disorders interfere with developing functional skills. Both sensory “seekers” and “avoiders” frequently have fine-motor delays because they have avoided and therefore, lack experience and practice in common childhood activities, such as building with construction toys, coloring or cutting out paper dolls. These children may prefer to be on the move!
Researchers disagree on which of the three types of sensory modulation disorders are most associated with ASD. In fact, many children appear to fluctuate between hypersensitivity and hyposensitivity.
Strategies for Sensory Modulation Disorders
The Brain is like an Engine
Occupational therapists strive to provide the type of sensory stimulation that helps an individual reach an optimal state of engagement, focus and ability to function. The Alert Program compares the brain to engine, the goal is to have the engine running "just right".
Sometimes a visual chart is helpful in explaining that their brains need the right type of sensory stimulation so that its not running too high or low. For example, if Joe's "engine" is running super high- his dad may ask him to spend time on a trampoline followed by stacking wood. Movement and heavy pressure activities often help to bring the engine to an optimal level.
Individuals must have the cognitive abilities to understand these concepts in order to benefit from this type of program. Check out the following books to learn more about The Alert Program
Creating a Sensory Diet
Therapists may create a sensory diet that can be implemented throughout the day (such as jumping jacks and dance music) to rev up the engine, as well as at night (such as a weighted blanket, soft music and white noise) to slow down the engine. Strategies may address
4) Activities that provide deep pressure and movement sensory stimulation such pressing hands or a vibrating cushion against the wall (shown in photo at top).
The Difference between ADHD and Sensory Craving
Attention Deficit Hyperactivity Disorder (ADHD) may present with similar symptoms observed in children with a sensory craving subtype of modulation disorders. ADD and ADHD are typically diagnosed by a psychologist, pediatrician or psychiatrist and may be treated with medication and/or a behavior plan. Diagnosis assesses behaviors related to
The child with ADHD may not demonstrate sensitivities to touch, sound, lights and other sensory stimuli unless the child has both disorders. Sometimes ADHD and SPD coexist. However, it is important to distinguish one from the other because their treatments are different. Sensory craving individuals seem to never get enough sensory input, especially movement (vestibular) and heavy pressure (proprioception). Children with ADHD may be more impulsive than children with sensory craving SPD. Children with ADHD may have a large initial response (i.e. yell or run away) to a stimuli such as a buzzing fan but will habituate to it over time. The child with SPD may continue to overrespond to the fan regardless of exposure, medication or a behavior plan.
More Therapeutic Strategies
1.Create ORGANIZED, goal-directed, purposeful movement experiences.
2.Pair up with an under-responsive child
3.Movement that stops and stars unexpectedly, games with intermittent movement such as
a)“duck duck goose”
c) “red light/green light”
4. Vary head position while playing games such as “Mother May I?” with brief jumping, spinning, swinging, inclines
5. Teach to use stop signs, stop lights, flash cards to control behavior
6. Heavy work, weight lifting is organizing
7. Use environmental boundaries
8. Create personal space using tape, hoola hoops or mats on the floor, bean bag chairs, enclosed spaces
In addition, social stories, chart reminders and behavior plans that incorporate rewards may be helpful (i.e. stickers, stars on a chart etc.)
The occupational therapists in the following video do a beautiful job of explaining the differences between ADHD and SPD.