What Is Sensory Processing Disorder? – NYT Parenting

CreditOri Toor

Its no surprise that young children can be extra sensitive about new and different experiences. The market for bathtub visors to keep water out of kids eyes or the prolific memes about the horrors of a broken granola bar show just how seemingly unreasonable our little people can be when their senses are overloaded. But even as adults, we have different sensory preferences: Some people cannot stand the feel of wool, while others abhor the squishy texture of cooked mushrooms.

We develop preferences based on how our bodies interpret the world, and some of us are more sensitive than others. This is normal, but when do differences in how kids process sensory information become problematic? I spoke with experts in the fields of psychology, occupational therapy and developmental behavioral pediatrics, as well as children with sensory processing difficulties and their parents, to find out exactly how these issues affect their lives.

We all have different thresholds that we can tolerate the key is that it is not a problem until the sensory issues begin to interfere with their everyday lives, said Jamie Fleming, an occupational therapist focusing on sensory issues who has been practicing in the Pittsburgh area for almost 20 years.

Sensory processing disorder, or S.P.D., is a condition in which the brain receives and reacts to certain stimuli such as smells, sensations, sounds and tastes in a dysfunctional way. According to a 2013 study, as many as 5 to 16 percent of school-age children are affected by differences in how they process sensory information. Some might feel disgust at the way their clothes rub against their skin, or at the pitch of someones voice. Others might be triggered by a foods smell, texture or taste.

Other triggers may be more nuanced and less obvious to an outside observer. Some children feel a rush from certain movements related to balance or the orientation of the body in space from swinging or a roller coaster or car ride, for example. Children with S.P.D. might seek out strong feelings associated with joint and muscle movement such as they experience from running, lifting, pulling or jumping. Some struggle with patterns of sleep, overawareness of their heart rate, or excessive or diminished hunger and thirst.

Dr. Heather Ufberg, a psychologist in Pittsburgh for Allegheny Health Network and Jewish Family and Community Services, has seen a greater range of sensory differences as a practitioner than as a mom. We could all point out a few sensitivities our kid has, such as not liking the sound of others chewing or being scared of the hair dryer, but these typically arent the kids I am seeing in my office, Dr. Ufberg noted. Medical and therapeutic help are warranted when childrens sensory issues limit their function or have a big impact on their everyday life.

S.P.D. is recognized in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, but not in the latest editions of the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Disease, which are the two most widely accepted diagnostic tools in the medical world. Some experts argue that so-called sensory integration difficulties arent a single condition, but are always part of a larger diagnosis such as autism, attention deficit hyperactivity disorder or brain injury, but there has been a recent push for new research to classify S.P.D. as a standalone diagnosis.

Dr. Ufberg said she has seen standalone sensory issues, but more often the children who require treatment have other developmental concerns. While the specific cause of S.P.D. is unknown, researchers have found that several risk factors increase ones chance of developing the condition. Low birth weight and prematurity; prenatal and delivery complications; and maternal stress, illness and use of certain medications can increase the prevalence of S.P.D. in kids. Environmentally, children from poorer households, those in single-parent homes and ethnic minorities are more likely to struggle with sensory issues.

Kids with S.P.D. who are underresponsive to certain stimuli those who hold a finger to a hot light bulb for longer than it would take most people to realize its hot, for instance are often called seekers. Such a child might develop a penchant for sour or spicy foods at a very young age or might crave heavy work, like lifting or pulling weighty items. Or he might prefer spinning and swinging.

None of these behaviors are typically problematic on their own, but they can become worrisome if you notice that theyre beginning to affect your childs daily life. Many kids like swinging, for instance, but if your child must go to the backyard to swing for an hour before she is calm enough to go to bed, and its disrupting your household routine, you should bring it up with your childs pediatrician at your next visit.

Children who crave specific kinds of touch might want to wear seemingly inappropriate clothing, such as heavy boots or a tight skull cap in the summer. Kristina, mom of 2-year-old Zachary in Victoria, Tex., said that her son loves to wear many layers of clothing. His record is 21 socks on one foot, Kristina said. (The parents I spoke with preferred to not be identified by their last names because of privacy concerns.) Zachary does not have many words yet, but he uses Ouch! to describe anything that makes him feel out of sync. His mom thinks this is his way of telling adults that what they are doing is not working for his needs.

When Zachary craves certain sensations, Kristina said that she dresses him in snug or layered clothing, or provides other opportunities for him to get those same feelings his body is seeking. This could mean giving him tight hugs or letting him snuggle under a weighted blanket. Other families use weighted vests or compression clothing. If children worry about what their friends might think of their clothing, Fleming noted that weights can be sewn into the lining of a regular zip-up hoodie to give a child the same effect.

Kids can also be overresponsive, or hypersensitive, to sensory input. They are often called avoiders. Many youngsters, for example, eat a limited diet. This is common, and is not necessarily indicative of the childs becoming a picky adult nor always indicative of S.P.D. It can become problematic, however, if they gag or vomit when encountering a new food, or if they throw a fit when you offer them a different brand of a favorite food. Many children with food-related S.P.D. go on to develop anxiety around food and eat extremely limited diets, often limited to specific textures. Many kids with sensory issues avoid pureed foods such as applesauce, while others cannot tolerate crunchy foods at all. It is not uncommon for a child with S.P.D. to eat the same few foods every day.

Karl, a 6-year-old in Pittsburgh, for instance, ate only four things until he was 4: plain yogurt, milk, crackers and cheese. He has expanded his palate slightly to include pancakes and even fried shrimp. But seeing or smelling a food he cannot tolerate, such as ranch dressing or oatmeal, can cause him to vomit. This makes going to parties or even walking through the food court at the mall difficult. Opal, one of Karls parents, has found that the best strategy for Karl is to give him bodily autonomy. Our kids have control of what they put into their bodies, and if that means they eat crackers and nothing else for a week, thats O.K., Opal said. Karls parents have found that if they just leave food out on the table, or eat it themselves in front of him without any pressure, he will sometimes choose to taste it.

These sensitivities can go beyond taste.

Young kids often dont like loud sounds, such as fireworks, but children who are hyperresponsive to sounds might struggle or shut down in even moderately noisy environments, such as a classroom. I feel like my ears want to jump off my head and go run away, said Milo, a 6-year-old in Berkeley, Calif., who struggles with auditory processing related to his S.P.D. Parents often use noise-canceling headphones as a tool to soothe children with sensitivity to noises. Wearing the headphones in a noisy cafeteria, for instance, can allow such a child to eat lunch with his peers.

Many children want tags cut out of clothing, but a child with a hyperresponsive sense of touch might endlessly balk at the feel and texture of clothing. He might limit himself to a few outfits, or battle over which socks are tolerable each morning. Clothing lines are now emerging for children with sensory difficulties, such as the new Cat and Jack products at Target, which have no tags, softer seams and other adaptations to make them less obtrusive to children who struggle with sensory issues.

If the way your child processes sensory information is negatively affecting her (and your familys) life, there are several steps that you can take.

Many parents report feeling unheard or brushed off by their primary care pediatricians, who tend not to be well versed in sensory issues, and because S.P.D. is not a fully recognized medical diagnosis. However, developmental behavioral pediatricians, occupational therapists and many neurologists and psychologists recognize the way that significant sensory processing difficulties can affect children, and they are your best resources.

Its very clear sensory differences are real, noted Dr. Lauren OConnell, M.D., a developmental behavioral pediatrician at Hurley Medical Center in Flint, Mich., and a professor of pediatrics and human development at the University of Michigan. But she said, sensory processing difficulties are very often linked to specific causes or conditions such as prematurity, trauma or autism, so its important to disentangle them.

Its also important to assess whether S.P.D.-related responses are actually having negative impacts on a childs life, since its not generally beneficial to treat symptoms that are not impairing a childs function, Dr. OConnell said.

Behavioral treatments such as gradually exposing a child to an offending sensory stimulus, or removing it from their environment can help reduce anxiety. I think it ultimately depends on what is driving the symptoms, Dr. OConnell said.

Dr. Ufberg sees strength in a multidisciplinary approach that is, multiple professionals helping the child in each of their areas of specialty: A speech language pathologist might be the best person to work on feeding therapy swallowing, breathing, chewing strength and desensitization to new foods. She has worked with occupational therapists on sensory issues as well, and feels that their approach works well within a psychological framework to help the child. A very good collaboration is key.

Under the federal Individuals With Disabilities Education Act, each state has early intervention programs for children up to age 3 that are offered at low or no cost to families. While each state has different processes and guidelines to qualify for the programs, many children with sensory issues initially start therapy through them.

Some families, particularly those whose children have aged out of early intervention programs, turn to clinical settings, though their criteria for treatment can vary. Testing for sensory issues is also an evolving science: There are several questionnaires and screenings available, such as the Sensory Profile and the Sensory Integration and Praxis Test, but insurance providers have different thresholds for coverage of treatment.

Fleming noted that for many children, sensory differences affect other areas of development, such as their ability to adapt safely to their environments, and these delays are what qualify them for treatment. Therapy varies by child, but the basic principle is to help children learn to manage all the sensory input in their worlds, thus reducing the impact of S.P.D. on their lives.

Occupational therapist Jamie Fleming recommends the following resources for parents seeking more facts on sensory processing disorder:

The Out of Sync Child series by Carol Kranowitz, M.A.

Sensational Kids by Dr. Lucy Jane Miller, a certified occupational therapist and founder of the STAR Institute for S.P.D.

Too Loud, Too Bright, Too Fast, Too Tight by Sharon Heller, Ph.D.

Raising a Sensory Smart Child by Nancy Peske and certified occupational therapist Lindsay Biel

Meg St-Esprit, M.Ed., is a freelance writer based in Pittsburgh, covering issues that affect families, parents and communities.

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What Is Sensory Processing Disorder? - NYT Parenting