Sensory processing disorder (SPD), formerly called sensory integration disorder, occurs when the brain has difficulty interpreting the information it receives through the senses. The term “sensory processing disorder” can refer to three subtypes: Sensory-based motor disorder, Sensory discrimination disorder, and Sensory modulation disorder.
Each of these disorders will look different in every child, as no two individuals interpret sensory input in the exact same way. Understanding how your daughter responds to her senses will help her feel understood, teach her how to cope with sensory issues, and facilitate progress in her treatment. Anna Jean Ayres, a California-born occupational therapist and clinical psychologist, first defined sensory integration in 1972. Since that time, sensory processing disorder has continued to be studied for causes, impacts, and treatment.
There are three main types of Sensory Processing Disorders: Sensor-based Motor Disorder, Sensory Discrimination Disorder, and Sensory Modulation Disorder.
A child with dyspraxia will have difficulty planning and execute motor tasks. She may accidentally break things and struggle with activities such as sports. She is seen as awkward and clumsy and therefore may try to hide her poor motor skills with verbalization or sedentary activities.
A person with good postural control is able to use her body to push, pull, and resist force. These basic skills are—on some level—necessary in most motor tasks. A person with postural disorder will have hard time stabilizing her body for certain activities, including sports, taking a box off a high shelf, or bracing for the impact of a wind gust.
Sensory discrimination is the ability to understand pieces of the world around you based on one sense. This allows you to reach into your bag and find your phone by touch alone, or guess what flavors of skittles you are eating without looking at the colors. An individual with sensory discrimination disorder has difficulty understanding what is seen, heard, felt, tasted, and smelled using input from only the one sense. She will need to take extra time to process her experience, or use another sense to help her. A child with sensory discrimination disorder will have a difficult time with many things that others can do with ease, which may cause poor self-esteem as she grows older.
Sensory modulation is our brain's ability to regulate our sensory system input. Our brain is able to take in the things we see, feel, hear, smell, and taste, and then decide what’s important and what’s not. When sensory modulation is working correctly, we are able to maintain eye contact with a friend while people pass by on the street, tune out the feeling of tags and seams in our clothing throughout the day, and ignore the sound of our coworkers chatting in the background while we write a report. Sometimes, the brain doesn’t process these senses in the same way that others do. Sensory modulation disorder is when the brain over responds to sensory input, under responds to sensory input, or seeks out sensory stimulation.
A young woman enrolled in our program is dealing with difficult emotional challenges. When these problems are compounded by an SPD, this student has likely experienced years of feeling “different” and misunderstood. By working with sensory processing disorders, we are able to help her tackle these struggles from every angle.
Margaret* first started going to therapy for severe anxiety and depression. Her parents felt that she was closed off. Their attempts to get her to talk to them resulted in her pulling back further. “Stop talking about it,” she’d say. “There is nothing wrong.” As a child, she had been fairly shy. She was kind and
As a child, she had been fairly shy. She was kind and thoughtful but guarded. She kept to herself at family functions, had one or two close friends, and she had never been the type of kid who liked a lot of hugs. In fact, she often got irritated or angry when people close to her tried to touch her or hug her when she was working on something else. Her family began to joke, “Margaret only likes hugs if she is the one to give them.”
She often got irritated or angry when people close to her tried to touch her or hug her when she was working on something else.
Once therapy started, it was obvious that something was keeping Margaret from being emotionally vulnerable. She would not open up. It was hard for her to express what she was feeling. She was fine to interact in a fun way with her therapist, but when she was asked to share her feelings she closed up. She did not like people to sit close to her, and she often flinched when someone touched her unexpectedly.
Her therapist felt sure that they were missing something. Her reactions to physical touch and her unwillingness to share her feelings seemed like symptoms of past trauma. Something must have happened to her to make her react this way. Her therapist began gently broaching the subject of past abuse. Had anything ever happened to her? Had anyone ever touched her inappropriately? Had she ever had a bad accident that her parents didn’t know about?
Margaret's answers continued to be “no”. She began to feel frustrated. If nothing bad has ever happened to me, then why do I feel defensive? Why do I feel anxious all the time? Where is my depression coming from? There seemed to be no reason for what she was feeling. She felt like something was inherently wrong with her. Her therapist and parents went back to the drawing board. Maybe Margaret’s problems weren’t related to trauma.
Her therapist and parents went back to the drawing board. Maybe Margaret’s problems weren’t related to trauma. Certainly, someone can feel depressed or anxious without a stimulus. Chemical changes in the brain can cause these symptoms on their own. But what about her continual flinching away from people? It was then that her parents began to research her symptoms on the Internet and they came across an article about Sensory Defensiveness. The issues that the article described almost mirrored what was happening for Margaret.
There seemed to be no reason for what she was feeling. She felt like something was inherently wrong with her.
Margaret’s parents cautiously brought the article to her. They worried that once again she’d reject their offer to help. But her reaction was the opposite. As she read through the article, she saw that other people felt the same way that she did. She began to feel understood, and no longer alone. More importantly, she began to see that there was a reason for how she had felt all her life. She wasn’t “just broken”. She felt relieved. For most of her life she had alternately felt angry or guilty for not liking it when her mom gave her physical affection. She loved her mother. She liked spending time with her. So the irritation that she felt when her mom tried to rub her back or give her a hug was frustrating and conflicting.
This new information was also eye-opening. Margaret had heard about people who experienced Sensory Integration Disorder, but that was something that only happened to people who had more serious diagnoses, like Autism. Right? She took the article that her parents had given her to her therapist. It felt like a weight was lifting as they discussed together what it meant for her.
She learned later that people with anxiety and depression can also have Sensory issues. She learned that the updated term for her type of Sensory issue was “Sensory Over-Responsiveness”. In some ways, her nervous system became easily over-stimulated. When she felt unexpected touch, or faced a room full of people, the over-stimulation increased her anxiety. She now understood why she often felt defensive.
Margaret and her therapist began working together on a plan for how to deal with this issue. One of the strategies was for Margaret to meet with an Occupational Therapist to get ideas of how to “calm” her responses down. She learned that if she was going to go to a party with a lot of people, it helped her to do some physical exercise beforehand. She began using a weighted blanket in therapy. She learned how to do deep-breathing exercises when she felt anxious. She learned that for her, wearing long-sleeves sometimes helped to cut down on how defensive she got when someone else touched her.
She learned that the updated term for her type of Sensory issue was ‘Sensory Over- Responsiveness’.
She also learned that sometimes she needed to be aware of what others needed. Her mother needed to be able to show that she loved Margaret in some kind of physical way. Just like Margaret didn’t like physical touch, her mother did like it. The two of them had to work out a way for each of their needs to be met. It wasn’t enough for Margaret to learn that she had Sensory Over-Responsiveness. She then had to make accommodations so that she could have fulfilling relationships.
Discovering her Sensory issues did not solve all of Margaret’s problems. She continued to work in therapy to learn coping skills. But understanding how her body worked, and therefore the best way for her to learn, made the work she needed to do easier.
*name has been changed
Sensory modulation disorder looks different for every child, which makes it difficult for parents to recognize. Symptoms depend on whether your daughter is an over responder, under responder, or sensory seeker, and with which sensory input system she struggles. Each child's brain will respond differently to certain senses. The same child may be an over responder to auditory and visual senses, an under responder to smell and taste, and a tactile sensory seeker.
Parents may not recognize her symptoms and become frustrated that their daughter is not listening, or is irritating, or lazy. In turn, the child may feel increasingly misunderstood by those around her. This feeling can grow to depression, anxiety, and wondering why she can't be "normal" like those around her.
To a person with sensory defensiveness, an everyday sensory stimulus feels like an attack. A light touch on the shoulder or the noise of a restaurant can feel overwhelming to an over responsive child. She may not like foods with a lot of flavor or become nauseous at mild smells. Don’t even think about taking her to a demolition derby.
A child who is an under responder may appear lazy. She is hard to motivate and needs external stimulation. However, once she is up and engaged in an activity, she enjoys herself. If she is under responsive in taste, she may think all food is bland. Although she tests within a normal hearing range, she will ask “what?” a lot and may not respond to her name.
Sensory-seeking tendencies will often come across as irritating to those around her. In her attempt to receive enough tactile sensory stimulation, she will lay on you, sit right next to you, intentionally run into walls; fall down; or run, skip, or jump everywhere she goes. An auditory sensory-seeker will make random noises, silly voices, or turn the TV up obnoxiously loud. These children are also impulsive and prone to take risks in an effort to get her “sensory needs” met.
A sensory issue can be a sign of different disorders such as Attention-Deficit Hyperactivity Disorder (ADHD) and obsessive-compulsive disorder. Sensory defensiveness is well-known as a symptom of the Autism spectrum. A child's behavior or covering her ears during loud noises or running away from someone trying to give her a hug can be a tell-tale sign of Autism. However, not every child displaying this behavior will be on the Autism spectrum. While there is not a decisive cause for SPD, potential causes include genetics and environmental factors.
One of the most frustrating experiences for a clinician is to feel that there is a key piece missing from the mental health puzzle, to know they don’t have the complete picture. At New Haven, we’ve put together a comprehensive treatment team to ensure that doesn’t happen. We have:
One of the biggest problems we run into is when the missing piece isn’t mental or emotional, but biological. Sensory processing issues have been one of those missing biological pieces. For example, in trying to ease a student’s anxiety, we may give her a hug without understanding that the fear of being touched is what causes her anxiety. Being in a touchy/feely environment literally increases her anxiety.
To make sure we never again miss this piece, we now screen every student admitted to New Haven in order to identify what her sensory “preferences.” Even if a student doesn’t have preferences that fall into the category of a Sensory Processing Disorder, understanding these preferences allows us to better individualize every student’s treatment. Here’s how it works:
When a student enrolls at New Haven she will complete various diagnostic tests, which include a Sensory Modulation Disorder screening. For some students, this will be the first time she has heard of sensory modulation disorder. If testing shows that she may struggle as an over responder, under responder, or sensory-seeker, we will teach her what that means and what it may look like. Struggling with sensory modulation does not mean that something is wrong with her. It is simply the way her brain processes certain sensory inputs. This experience can be incredibly validating for a young woman who has spent much of her life wondering, “What’s wrong with me?”
We know that each one of our students is unique and won’t thrive in a one size fits all treatment approach. That is why we have such a robust system for providing individualized treatment. Here are some ways we can improve treatment for students struggling with sensory modulation:
Identify major sensory modulation differences in the family system and pinpoint how those differences translate into family dynamics. It can be incredibly validating for a sensory-seeking mother to know that her over-responsive daughter isn’t refusing physical affection out of spite or hatred. Education around your daughter’s specific sensory issues encourages patience and empathy. And once we identify the differences, we can plan specific tactics for everyone in the family to get their needs met.
Therapist and staff can identify the best interventions: Many years ago, we had a student who was an extreme sensory seeker. She felt like her skin was crawling unless she soothed it by scratching or washing her hands. Every day was a struggle until we discovered that the body movement of running and immersive feeling of swimming met her sensory seeking needs. We began to make accommodations for her to have extra time running and swimming, and she was then able to start progressing in therapy. Our high staff-to-student ratio allows us to implement specific accommodations/interventions for our students who are sensory seekers and over/under responsive.
Academic Accommodations: Knowing each student’s sensory preferences helps our teachers cater the lessons to each student’s needs. If a student is an over-responder, then we might assign her to a much smaller class and set up a quiet room for her to study in. If a student is an under responder or a sensory seeker, we might ask her to sit in the front row and have the teacher prepare more experiential and interactive lessons. We would then find a place where she could play music while studying and schedule frequent breaks for her to get up and run around the house.
Children with severe sensory processing disorders, including sensory modulation disorder, may need treatment from an occupational therapist. Occupational therapy will help treat concerns of these disorders directly. New Haven’s focus is on mental health therapy with an ability to accommodate and work with sensory processing disorders.
If your daughter has emotional or behavioral struggles and you think she might have mild to moderate sensory processing issues, please call us at 888.317.3958 and learn more about how New Haven can help your daughter and your family.
This quiz is intended to help you better understand the way you process sensory input. It is not intended to be a diagnostic tool. If you believe you have a sensory processing disorder, contact an occupational therapist for a diagnosis and treatment.