Does your child crash into walls? Does she throw a tantrum when you try to brush her teeth? Does he cover his ears in a crowded amusement park or shy away from birthday parties? Does she seem insensitive to pain, or overly sensitive to sound or light?
If so, your child may be one of many children who have difficulty processing the information that they take in through their senses. When children have difficulty processing or making sense of the sensory information they take in, they may have difficulty responding appropriately in a given situation or environment. When this difficulty is so severe that it impedes daily functioning, the child may be said to have a Sensory Processing Disorder (an “SPD”).
An SPD may affect a child’s ability to access his school education in numerous ways. For example, an SPD may affect a child’s ability to focus, to write, to perform motor activities or to participate in school social situations, such as lunch or recess. These difficulties may cause a child’s self-esteem may suffer, and depression and anxiety may result. The good news is that much can be done to help children with SPD succeed in school and in life.
Recognizing SPD
Estimates of the prevalence of SPD among children range from one in six children to one in twenty children. SPD can have many different presentations. A child may have an SPD that affects one or more of the five main senses: visual, auditory, tactile, smell, and taste. For example, a child who seems to “mishear” words may have an auditory sensory processing disorder. A child who puts non-edible objects in his mouth may have a sensory processing disorder relating to his sense of taste.
In addition to the five main senses, two additional sensory systems are often implicated in a SPD: the vestibular sensory system and the proprioception system. Vestibular input is key to balance and coordination. Vestibular receptors in the brain help the child know where his body is in space by providing information related to movement and head position. Children with hyposensitivity crave constant motion and may jump on furniture or love being tossed into the air.
Proprioceptive input tells the brain where the body is in relation other objects and how to move. Proprioception receptors in the joints and ligaments allow for a child’s motor control and posture. When the brain misinterprets signals from the joints and ligaments, a child may appear to lack coordination. If a child is hypersensitive, that child may have difficulty sensing how much pressure she is using when holding a pencil, and may have difficulty writing. If a child is hypersensitive, he may crave input and enjoy crashing into objects or receiving tight bear hugs.
In most children, a sensory processing disorder describes over-sensitivity or under-sensitivity to stimuli. A child who is overwhelmed by noise or visual input may shut down. On the other hand, a child who is under-sensitive and does not register tactile input in a typical fashion may seek out input by, for instance, taking risks or crashing into walls. Both children may have an SPD.
A Sensory Processing Disorder is Not a Behavior Issue
Parents and teachers need to know that an SPD is not the same as a behavior problem. When parents hear a report about a possible “behavior problem” it may be appropriate to investigate whether the child’s behavior is simply a manifestation of a hidden sensory processing disorder. For example, a child who is overwhelmed by tactile input may push another child in line if that other child pokes or touches him. What might look like aggressiveness might actually be a child with an SLP who is simply reacting to sensory overload and trying to control his environment?
In fact, it has been suggested that children with sensory processing disorders are often misdiagnosed with behavior problems or as children who have Attention-Deficit/Hyperactivity Disorder. While Sensory Processing Disorder is not listed in the Diagnostic and Statistical Manual, it is commonly assessed by neurologists and occupational therapists who can help address it.
Parents should also know that SPD is neurological impairment, but it is not a cognitive impairment. Children with SPD have normal intelligence and often are gifted intellectually.
Treatment for SPD
Many occupational therapists are “sensory smart” meaning that they are skilled at helping children with SPD overcome challenges in responding to sensory input in their environment. Treatment usually consists of occupational therapy that is sensory based. Children with SPD misinterpret sensory information such as movement, sound, and touch; sensory based occupational therapy aims to foster appropriate responses to sensations in an active, meaningful and fun way so that the child is able to behave in a more functional way. The goal is to generalize the appropriate responses to environments that are outside of the therapy gym, such as home and school. Occupational therapy has helped children with SPD take part in daily activities that other children take for granted such as enjoying school, sleeping, eating, and playing.
Helping Children with SPD in School
Parents can help their children by educating school personnel about SPD. Parents can explain to teachers what SPD looks like in their child so that a teacher is less likely to consider a child’s reactions to evidence a “behavior problem.” Parents can also advocate for their children to receive services and accommodations in school to address their child’s SPD through either an Individualized Education Plan (IEP) or a 504 Plan.
An IEP entitles a child to special education and related services when a child has a disability that impedes his or her educational performance. A 504 Plan provides accommodations to students with a disability that impedes a major life activity when the child requires special accommodations in order to access his education. SPD can impede a child from many activities such as listening and attending that are essential for a child to access the school learning environment.
Parents who are concerned that problems in school may relate to an underlying SPD may request a child study team evaluation which may lead to development of an IEP or 504 Plan. The child study team evaluation would need to evaluate the child in all areas of suspected disability. The parent would have the right to ask the school to perform an occupational therapy evaluation that focuses on the child’s sensory needs.
The Role of a School Occupational Therapist
An occupational therapist can work with a child in school both outside the classroom (often called “pull-out”), or in the classroom environment (often called “push-in”). Occupational therapy in school but outside the classroom enables the therapist to help the child develop skills before the child generalizes those skills to the classroom and other settings.
Push-in occupational services can be useful to the therapist in assessing how the child’s SPD impacts her ability to perform in class. Push-in services also allow the therapist to assess the classroom environment. The therapist can help restructure the classroom environment to be more friendly for the child. Push-in services can also help a child learn to use strategies within the classroom environment.
A school occupational therapist can also help the school implement a “sensory diet” throughout the child’s day, to help the child maintain a state of self-regulation or alertness that is optimal for learning. A sensory diet may consist of series of accommodations for that child designed to help the child manage the sensory input he will encounter throughout the school day. Such a sensory diet can become a part of a child’s 504 Plan of IEP accommodations.
Accommodations for Children with Sensory Processing Disorders
In addition to providing sensory-based occupational therapy services, a school child study team or 504 team can provide numerous accommodations to enable children with SPD to function in the school environment. The following list contains only a sample of the accommodations that have been put in place for students with SPD. Parents should know that creativity can also lead to inexpensive solutions that respond to their individual child’s sensory needs.
- Allow the child to take tests in a quiet space so the child is not distracted by classroom noise.
- Prepare the child for intense sensory experiences such as fire drills.
- Appropriately prepare the child in advance for transitions or changes in the schedule so that the child can process the information and plan accordingly.
- Allow the child who needs to move to take movement breaks in order to increase the ability to attend.
- Allow the child who is overwhelmed by noisy environments to eat lunch in a quiet space instead of in the lunchroom cafeteria.
- Allow a child to sit near the front of the class in order to hear the teacher better and be shielded from noise from peers or the hallway.
- Allow a child to sit away from the window to avoid visual distractions from outside.
- Allow a child to use a special chair cushion or seat to allow for movement while seated and provide increased vestibular input.
- Allow a child to play with hand fidgets or chew gum in class to address sensory needs to that the child can focus on learning.
- For a child who becomes overwhelmed by visual stimuli, tape off portions of written work so that visual input is limited.
- Allow a child to wear a weighted vest or other clothing that provides sensory input.
- Allow a child to perform coursework in various positions, such as reading on a rug on the floor with a blanket on top of the child for pressure.
- Teach the child using methodology that incorporates the senses through which the child interprets information best. Or, use a multi-sensory teaching approach–for instance a multi-sensory reading methodology.
Who Are Children With SPD?
Children with SPD may be children with Autism or other neurological or developmental disorders. They may also have no other disorders. In either case, parents can help assess their own child’s needs and the possible existence of a sensory processing disorder by taking note of their child’s reactions or behavior in response to various environments and various stimuli, and by asking questions. For children with SPD, more information and understanding is available now than ever before.