Understanding Sensory Processing Disorder for your Child

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Sensory Processing Disorder (SPD) is a condition that affects the bodies neurological processing of sensory information.

One of the simplest ways this can be interpreted, as explained by occupational therapist A. Jean Ayres, Ph.D., is that the sensory signals encounter a ‘traffic jam’ in the body. This blocking of signals from the body to the brain can lead to sensory information being misinterpreted. For example, where SPD presents itself with oversensitivity, then sounds, touch and light can become overwhelming.

Being oversensitive to sensory input is also termed being ‘over-responsive’. However, it is important to note that SPD affects everyone differently. Others may be ‘under-responsive’, and some may be what’s known as ‘sensory seekers’.

Sensory processing is an important part of development, and affects the daily functioning of how the body responds to all sensory experiences it encounters. SPD itself is not considered a problem unless symptoms interfere with daily life. The good news, however, is that there are occupational therapists who specialise in assessing the sensory needs of individuals.

To get more of an idea of what this means for children with SPD, this article will discuss the characteristics of each of the general presenting forms, the role of occupational therapy in managing SPD and then introduce some methods and tools for supporting the sensory needs of your child at home.

SPD, symptoms and senses

The senses

One of the first steps to understanding SPD is knowing what the different channels of sensory input into the body are. There are 8 sensory systems in total. These include, as listed by the STAR Institute, the following:

• Visual
• Auditory
• Tactile
• Olfactory
• Gustatory
• Vestibular
• Proprioception
• Interoception

Some of these you may already be familiar with. We all know the basic five senses (sight, sound, touch, smell and taste) represented in this list as ‘Visual’, ‘auditory’, ‘tactile’, ‘olfactory’ and ‘gustatory’ respectively. However, there are a couple that many people are not so familiar with.

These are proprioception, the sense of the position and movement of the body, and interoception, the sensory signals for understanding your bodies internal functions. Examples of internal functions include hunger, temperature, tiredness and knowing when to go to the toilet.

Learning about the senses is also a great activity to do with children, either at home or at school. To explore and record the senses of sight, sound, smell, taste and touch, simply download our pdf 'Our Five Senses' recording sheet below for your child.

Subtypes of SPD

With so many senses to be processed by the body, there are understandably a broad variety of symptoms that SPD can present with for different individuals. The most general breakdown of SPD symptoms however fit into three patterns. These are explained by Lucy Jane Miller, PhD, OTR, in her book (2014 edition) ‘Sensational Kids: Hope and Help for Children with Sensory Processing Disorder’, as the following:

• Sensory modulation disorder (SMD) is a problem with turning sensory messages into controlled behaviours that match the nature and intensity of the sensory information.
• Sensory-based motor disorder (SBMD) is a problem with stabilizing one’s body or thinking of/planning/sequencing or executing a series of movements based on sensory information outside and inside the body.
• Sensory discrimination disorder (SDD) is a problem with sensing similarities and differences between sensations, basically a problem interpreting sensory input.

Miller (2014) then goes on to simplify these explanations as SMD being a difficulty around regulation, SBMD as a difficulty with interpreting and SDD a difficulty with responding. Within SBMD are the conditions known as dyspraxia and postural disorder. The remainder of this article, however, will focus on SMD.

Symptoms of SMD

The symptoms of each child with SMD will vary. Based on these, SMD can be divided once more into 3 sub-types. As mentioned earlier these include the following:

• Over responsive to sensory input
• Under responsive to sensory input
• Sensory craving, or sensory seeking

There are so many symptoms and sensory environments that can be difficult for a child within each of these sub-types. To get an idea of how they present for those who experience them the table below gives an overview of symptoms for each from Miller (2014), pp. 30-37.

Symptoms of sub-sets within SMD

Dislikes sounds in certain places whilst out including:	Does not respond to certain things, including:	May constantly desire certain things, including:
۰ Large gatherings	۰When their name is called	۰Pushing, rolling and hanging from things
۰Restuarants	۰Normal volume speaking voice	۰Jumping and crashing
۰Gymnasiums	۰When given directions only once	۰Touching people to the point of irritating them
۰ Appliances/small motor noises		۰Making strange sounds
		۰Watching visually stimulating scenes

Dislikes other sounds including:	They do the following:	Other symptoms might include:
۰Dog barking	۰Appear in their own world (tuned out)	۰Being on the move constantly
۰Someone talking while they try to concentrate	۰Leave clothing twisted	۰Unable to stop talking and difficulty taking turns in conversation
۰Alarms		۰Takes excessive risks
		۰Prefers foods with strong flavours and tastes
Dislikes certain tactile sensations including:	May show a less intense response then others to the following:	Behaviours that may be displayed:
۰Glue	۰Bumping into things and falling over	۰Hyperactivity
۰Fuzzy or furry textures	۰Having messy hands and face	۰Angry or explosive when required to sit still
۰Having crumbs around their mouth		۰Intense, demanding and hard to calm
		۰Excessively affectionate
Difficulty with certain aspects of self-care:	Other symptoms may include:
۰Having messy hands	۰Not crying when seriously hurt or bothered by minor injuries
۰Having hair or nails cut	۰Prefers sedentary activities to active ones
	۰Seems unaware of body sensations such as hunger and temperature
Dislikes certain aspects of food and eating, including:	Behaviours that may be displayed:
۰Slimy foods	۰Passive, quiet, withdrawn
۰Soup with vegetables or meat pieces	۰Hard to engage in conversation
۰New and unfamiliar foods	۰Aphetic and easily exhausted
Behaviours that may be displayed:
۰Irritable, fussy, moody
۰Unsociable and avoids group activities
۰Upset by transitions and unexpected change

Diagnosis, assessment and professionals for SPD

It’s important to note that sensory processing is a completely normal part of development and doesn’t cause problems with day to day functioning for many people. Recent studies have estimated ‘that ‘5% to 16.5% of the general population have symptoms associated with sensory processing challenges’ (Miller et al., 2017).  However, Miller et al., (2017) do also note that ‘these estimates are higher for clinical populations such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD)’.

If the sensory symptoms are causing distress or affecting your day to day routines, then there is the process of diagnosis and assessment. This is then followed by the help of trained sensory professionals known as occupational therapists.

As SPD can present with such a complex variety of symptoms, the approach to diagnosis is usually carried out by a multidisciplinary team of professionals. These teams, as noted by Miller (2014), may comprise the following:

• A paediatrician, family doctor, or other physician
• A psychologist
• A psychiatrist, or other mental health professional
• An occupational therapist

Where an assessment indicates the need for additional sensory assessment and support, an occupational therapist (OT) should be consulted. For those that are unsure of this profession, it is stated by Miller (2014) as a therapist that specialises ‘in assisting people with the everyday activities (called occupations) that make life meaningful and productive’.

The OT may assist with different elements of daily routines for your child such as learning, sleeping, playing and eating. The treatment from OTs can be through sensory integration therapy and planned ‘sensory diets’. These consist of a schedule of sensory input specially tailored for each child, and once you know what needs your child has, you may also support these at home.

For a visual overview of SPD symptoms and how Occupational Therapists can help, here's a great animation by Andy Gattis.

Andy Gattis animation - Sensory Processing Disorder: SPD Explained and Simplified

What you can do at home to support your child with SPD

Before moving on to some of the ways you can support the sensory needs of your child at home, there are some important things to note. Firstly, this information does not take the place of a professional assessment and advice from a trained occupational therapist. Also, as already mentioned, all children are different. What may be a good option for one child could be very unpleasant for another. STAR Institute have a great post on home activities which outlines many provisional considerations before beginning any sensory support at home with your child.

Daily activities

One approach to supporting your child’s sensory needs is to fit them around daily activities. This ensures that they are compatible with your home life and that they will be easier to maintain as a way of living. Some of the ways to incorporate sensory needs into your daily routine are highlighted in the table below. The information represented below has been gathered from STAR Institute.

Bath time	Scrub with washcloth or bath brush, try a variety of soaps and lotions for bathing, play on the wall with shaving cream or bathing foam, rub body with lotion after bath time (deep massage), sprinkle powder onto body and brush or rub into skin.
Meal preparation or baking	Let your child mix ingredients, especially the thick ones that will really work those muscles. Let child mix and roll dough and push flat. Allow child to help you carry pots and pans, bowls of water or ingredients (with supervision, of course). Let your child tenderize meat with the meat mallet.
Food shopping	Have your child push the heavy cart (as long as the weight is within their capability). Let your child help carry heavy groceries and help put them away.
Mealtime	Encourage eating of chewy foods and drinking out of a straw. Try having your child sit on an air cushion to allow some movement. A weighted lap blanket may be helpful as well.
Household chores	Allow the child to help with the vacuuming or moving the furniture. Let the child help carry the laundry basket or the detergent. Let the child help with digging for gardening or landscaping.
Play time	Reading books in a rocking chair or bean-bag chair may be beneficial. You can help your child make up obstacle courses in the house or yard using crawling, jumping, hopping, skipping, rolling, etc. Listen to soft music. Play the sandwich game (child lies in between two pillows and pretends to be the sandwich, while you provide pressure to the top pillow to the child’s desired amount). Ask them "harder or softer?" as you push on the pillow. Some children will like much more pressure than you would expect. You can also go for a neighbourhood walk with a wagon and have your child pull it (make it semi-heavy by loading it with something the child would like to pull around). You can do the same with a baby-doll carriage. Swimming in a pool is a wonderful activity if you have that available, as are horseback riding and bowling. Mini or full-size trampolines are excellent for providing sensory input as well. Make sure the child is using them safely. Sandboxes, or big containers of beans or popcorn kernels can be fun play-boxes. too, if you add small cars, shovels, cups, etc.
Errands and appointments	Before visiting the dentist or hairdresser try deep massage to the head or scalp (if tolerated) or try having your child wear a weighted hat. Try chewy foods or vibration to the mouth with an electric toothbrush. Let your child wear a heavy backpack (weighted to their liking with books and with the straps padded as needed). Be sure to give the child ample warning before any changes in routine or any unscheduled trips or errands. Many children with SPD need predictability.

(Source: STAR Institute, Home Activities. [online]. Available at: https://www.spdstar.org/basic/home-activities)

Other sensory input ideas to support your child at home

Another option is to have an allotted time for certain activities, special spaces and/or equipment, all to support your child’s sensory needs. This approach can be beneficial (and fun!) for your child, along with the methods outlined above. However, unlike the above approach, these activities would be interspersed through the week instead of trying to achieve these on a daily basis.

Create an indoor sensory space

This can be your child’s bedroom, a playroom, or even a sensory corner. Within this space, you can add items that support your child’s individual sensory needs. This may be a calming environment for the sensory over-responsive child, with gentle lights and soft furnishings. You may even want to set up a cosy den so they may feel safe and secluded, which can be very calming after a busy day at school. Some children may even love the sensory experience of a dark den. With these dens, you can either enjoy the calming effect of low light or use the darkness to explore fascinating sensory light illuminations.

If your child is sensory under-responsive than this area can have different items for your child to fulfil their sensory input needs. These might include tactile play items that excite the senses through touch, such as tactile discs and steppingstones, or even different textured textiles to explore. Another option is having items for exploring and engaging with movement. These are also a great resource for the sensory craving child. Such items are used to spin, rock, balance or climb. Some great examples are climbing frames or gym equipment for active play and spinning tops and carousels for the excitement of vestibular stimulation (sense of balance).

Create an outdoor sensory space

Getting outdoors is great for all children, and there’s an endless amount of sensory experiences to be enjoyed. Just being in nature offers a whole host of sensory stimulants. The feeling of rain on the skin, the smell of garden plants and the different textured leaves. There are many ways you can create a sensory-rich experience in your own garden using plants and equipment. Some great outdoor items include seating to enjoy relaxing outside, textures and even music. Engaging the senses with musical chimes and bells is great fun for children, and for those who crave activity, there’s outdoor climbing equipment.

Sensory boxes – for school and away from home

There are of course times when your child might crave sensory fulfilment or need to self-regulate, and you will not have these resources to hand. That is why the idea of a sensory box is fantastic. Within this box you can keep items that will help calm or engage your child when they need it, either at school or when you’re out and about.

What you include in your child's sensory box really depends on their own needs. Here are just a few sensory items you might consider:

• Small sensory lights; torches, flashing or colour changing lights and fibre optics
• Squishy items for tactile engagement such as balls, soft toys and even blue tack
• Soft items such as different pieces of fabric and toys
• Glittery, bright and shiny objects and toys
• Soft brushes and massagers

Other more specialist items to consider for when you’re out may include noise-cancelling headphones, weighted vests and lap blankets. Fidget boards for feet or discs for sitting on to maintain motion when having to sit for long periods of time are also a good idea.

These items really depend on the child and what makes them feel calmer or more engaged. You may receive suggestions from your child’s OT, through their school, or even through the trial of different options to see what your child enjoys using.

For more great ideas on what to include in your child's sensory box, you can download our free '28 Sensory Box Ideas' checklist below!

You could also attend a local sensory play session or group to help find the best sensory items for your child. This can be a great way of meeting other parents of sensory children and share your solutions with each other. This also gives your child the chance to try out different types of sensory play equipment to see what they enjoy.

Additional resources

A reference list is included in the footer of this post. However, we want to note a couple of great books and educational resources for further reading.

• Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD) (2014) by Lucy Jane Miller, PhD, OTR.
• Understanding Your Child's Sensory Signals: A Practical Daily Use Handbook for Parents and Teachers (2011) by Angie Voss, OTR.
• The Zones of Regulation (2011) by Leah Kuypers, MA Ed., OTR/L.
• Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues (2018) by Lindsey Biel, M.A., OTR/L, and Nancy Peske.

We would love to hear any tips and suggestions for further resources from our readers. If you have a great solution for your sensory child, you can share it by commenting below.

References:

1. Occupational Therapy International. Identification of Sensory Processing and Integration Symptom Clusters: A Preliminary Study (2017). By Lucy Jane Miller, Sarah A. Schoen, Shelley Mulligan and Jillian Sullivan. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733937/
2. OT Mum Learning Activities. Sensory Integration Activities.
   Available at: https://www.ot-mom-learning-activities.com/sensory-integration-activities.html
3. Sensational Kids: Hope and Help for Children With Sensory Processing Disorder (SPD) (2014) by Lucy Jane Miller, PhD, OTR.
4. STAR Institute. Home Activities.
   Available at: https://www.spdstar.org/basic/home-activities
5. STAR Institute. Understanding Sensory Processing Disorder.
   Available at: https://www.spdstar.org/basic/understanding-sensory-processing-disorder