This episode comes to us courtesy of my friend Jess, whose daughter has Sensory Processing Disorder (SPD) and who is on a mission to make sure that as many parents as possible learn about it. She says that every time she describes it to a parent they realize that they know someone who exhibits behavior that looks like SPD that warrants following up.
I have to say that I was highly ambivalent about doing this episode, because I don’t usually deal with topics that result in medical diagnoses as I’m (obviously) not a doctor. But the more I looked into this the more I realized that helping parents to understand the mess of research on this topic is exactly the kind of thing that I usually do on this show, and that an episode on this topic could probably be useful to a number of you.
And here’s the love letter to John McPhee that I mention in the episode
Hello and welcome to the Your Parenting Mojo podcast. Today’s episode on Sensory Processing Disorder comes to you courtesy of my friend Jess, and I’m going to tell you a little about Jess and her daughter as a way to introduce the topic. Jess told me that her daughter likely had a mini-stroke either in utero or during birth that affected the left side of her body, and Jess figured this out around the time her daughter was 10 months old. So her daughter started physical therapy for that, but Jess still felt as though something wasn’t quite right, and while she already had a pediatrician, physical therapist, and neurologist, six months or so of Jess being (in her words) “a crazy parent,” along with the support of her mother who happens to be a pediatric physical therapist, to convince her daughter’s support team that something wasn’t right, and finally her daughter was evaluated for sensory processing disorder. Her daughter received occupational therapy treatment and is now doing very well.
Jess realized that if she hadn’t been especially vocal, and if she hadn’t had her own mother’s expert support, then it’s possible that her daughter’s issues would have gone undiagnosed. Jess told me she has started talking with anyone who will listen about this topic and whenever she mentions it a lightbulb goes off with whomever she is talking with about either a child in their lie or a friend of a friend who is having similar issues, so she asked me to do an episode on it so more people could learn about it.
Now I have to say that as much as I love Jess I did hesitate before taking this on. I don’t usually deal with topics that result in medical diagnoses because I’m obviously not a doctor or a psychiatrist. But the more I looked into this the more I realized that helping parents to understand the mess of research on this topic is exactly the kind of thing that I usually do on this show, and that an episode on this topic could probably be useful to a number of you. So, to reiterate, I am not a doctor or a psychiatrist, and this episode is not intended to diagnose, treat, cure, or prevent any disease. In fact, for reasons we’ll get into in the episode, it’s actually kind of difficult for a doctor to diagnose as well. So we’ll talk about diagnoses, and about the efficacy of treatment for SPD, and finally about how to chart a path forward if you suspect that your child may have difficulties processing sensory information.
So let’s get into it! For those of you who haven’t heard of it before, what is sensory processing disorder, and where did it come from? The research in this field was pioneered by Dr. A. Jean Ayres, who was an occupational therapist active from the 1960s to the 1980s. Dr. Ayres’ classic book is called Sensory Integration and the Child, and was re-released in 2005 in a 25th anniversary edition. In the book, Dr. Ayres describes sensory integration, which is the organization of our senses, which give us information about the physical conditions of our body and the environment around us. She says that the brain has to organize all of these sensations if a person is to move and learn and behave in a productive way – for example, by making your eyes, nose, mouth, skin, muscles, and joints work together to peel and eat an orange, and that an adaptive response to a sensory experience is a purposeful and goal-directed one. When we have an adaptive response we master a challenge and learn something new. Until the child is about 7, they are primarily a sensory processing machine – they sense things and respond, without having many abstract thoughts and ideas. Dr. Ayres says that the brain’s mental and social functions in the later years are based on this foundation of sensorimotor processes, and if sensorimotor processes are well organized in the first 7 years, the child will have an easier time learning mental and social skills later on.
Dr. Ayres died in 1989, and Dr. Lucy Jane Miller has carried the flag on this work. Dr. Miller is the director of the Sensory Therapies and Research Center in Denver, Colorado, and has written her own book called Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. In Dr. Miller’s book she shifts Dr. Ayres’ original six syndromes of sensory integration dysfunction into three main “pattern types” with a number of subtypes.
Pattern Type 1 is Sensory Modulation Disorder (SMD), and results when a person has difficulty responding to sensory input with behavior that is appropriate to the degree, nature, or intensity of the sensory information. Dr. Miller’s book describes SMD as having three main subtypes, although her own peer-reviewed research has only found support for two of these – sensory seeking, and sensory underresponsivity.
In Subtype 1, Sensory Overresponsivity (so the one that doesn’t have peer-reviewed research support), people respond faster, with more intensity, or for a longer duration than people with typical sensory responsivity. It may occur in only one sensory system (like not wanting to be touched) or in multiple systems. Difficulties are most often seen in new situations and during transitions, and the responses may appear as willful behavior, seemingly logical, and inconsistent. For example, a child with this subtype may not be able to tolerate being jostled as coats are being put on at preschool for the transition to outdoor play, and may lash out at another child in response. Behavior may also result from cumulative stresses, so the jostle while putting coats on might just trigger the response that has built up as a result of a whole morning of being jostled and touched through normal interactions.
People with Subtype 2, Sensory Underresponsivity, disregard or do not respond to sensory stimuli. A child may seem apathetic, lethargic, and lacking an inner drive to socialize and explore. They might not notice bumps, falls, or cuts, or extreme eat or cold, and may be labeled ‘lazy’ or ‘unmotivated.’ As an infant, the child might have been considered a ‘good baby’ or an ‘easy child’ but when they become older they may not be able to maintain enough arousal to participate in family or school life.
People with Subtype 3, Sensory Seeking/Craving, crave an unusual amount or type of sensory input, possibly including spicy food, loud noises, visual stimulation, and constant spinning, which can lead to socially unacceptable or unsafe behavior and can be perceived as demanding or attention-seeking. They may become explosive or aggressive when they are unable to meet their sensory needs – for example, when they are asked to sit still and be quiet at school. This subtype can be confused with, and even co-occur with, attention deficit hyperactivity disorder, or ADHD.
People with Pattern 2, Sensory Discrimination Disorder, have trouble interpreting qualities of sensory stimuli and tell how they are similar and different; this characteristic may be present in just one or more than one sense. SDD in the tactile, vestibular, and proprioceptive systems, which tell you where your body is in the world, results in awkward motor abilities. SDD in the visual or auditory systems can lead to learning or language disabilities.
There are two sub-types to Pattern 3, which is Sensory-Based Motor Disorder. In Subtype 1, Postural Disorder, the person has difficulty stabilizing the body during movement or at rest. The child may have low muscle tone, inadequate control of muscles and movement, and poor balance.
In Subtype 2, Dyspraxia, the person has difficulty conceiving of, planning, sequencing, and executing actions. They may appear awkward and poorly coordinated in their gross motor skills like running and jumping, fine motor skills like drawing and painting, or oral-motor skills like chewing and swallowing. They seem unsure where their body is in space, have trouble with ball sports, and any actions involving coordinated timing.
Where does SPD come from? Dr. Ayres herself acknowledged that we don’t really know what causes SPD, but she goes on to make quite a variety of speculations. She says “Many people think that the increase in environmental toxins, such as air contaminants, destructive viruses, and other chemicals that we take into our bodies may contribute to the dysfunction,” without offering a shred of supportive evidence from these “many people.” She hypothesizes that hereditary and chemical factors may be combined in some children, and that genetic factors in certain children may allow environmental toxins to interfere with sensory integrative development. Some babies do not get enough oxygen at birth, which may affect brain function, and that children who lead very deprived lives – like the children in the Romanian orphanages from the 1980s who had very little human contact – don’t develop adequate sensory, motor, or intellectual functions. But lest you start...
