SENSORY PROCESSING DISORDER (SPD): Dispelling common myths and misconceptions
We often over simplify or misunderstand sensory processing. Rightly so, it’s very complicated. The sensory systems that are taught in school include: Visual (sight), Auditory (sound), Gustatory (taste), Tactile (touch), Olfactory (smell). There are a few more: Vestibular (sense of balance, equilibrium), Proprioception (sense of where my body is in space), Interoception (recognizing the sense of hunger, thirst, bowel/bladder function, hot/cold, etc.) and Nociception (pain receptors). Given this complexity, it’s easy to see how we can misunderstand sensory processing disorders. No two people with SPD are ever alike and their difficulties can even look different on a day to day basis.
The definition of Sensory Processing:
Sensory processing is the process that organizes sensation from one's own body and the environment, thus making it possible to use the body effectively within the environment.
What does “Organize sensations and use the body effectively within the environment” actually mean? Examples:
Babies - can they regulate their sleep/wake/feed cycles and remain fairly calm and content throughout their day? If not, their bodies are not modulating those basic biological processes and they are not organizing sensory input and are unable to give appropriate output.
Toddlers/Preschoolers - Can they tolerate transitions from preferred to non-preferred activities without a meltdown? Do they have impulse control when things don’t go their way? If not, they are not organizing sensory input and are not able to give appropriate output.
Elementary age - Does the child have age-appropriate cognitive, social and emotional progress? Do you see fight/flight/freeze responses that are more frequent than peers? If so, they are not organizing sensory input and are not able to give appropriate output.
As a previous school-based OT, I evaluated children for sensory processing difficulties as it related to academic functioning within the classroom setting. We have many different assessment tools to help us determine eligibility for services. However, these give us a snapshot of performance and are always based on the opinion of the parent/caregiver or staff. There are many children who have experienced prior trauma in the form of abuse, neglect, drug exposure in utero, bonding/attachment issues, etc. that is often undocumented. Their behaviors are often exhibited by sensory processing difficulties. Rarely did I see a formal diagnosis of SPD (in concurrence with other diagnoses) given by a medical doctor. However, it’s very real and interferes with daily functioning at any age. It’s imperative that our schools and other service providers are educated in Trauma Informed Care.
Myth #1 “The child can play in the sand box and touch slime, so they must not have sensory issues.” Just because the child can tolerate messy hands in the sensory bin doesn’t mean they don’t have tactile processing difficulties. Sensory processing is so much more than tolerating touch.
Myth #2 “I’ve offered a weighted blanket, vest and a wiggle seat and it didn’t seem to make a difference in ability to focus/attend, so they must not have sensory issues. You haven’t tapped into the correct sensory systems that are causing the problem.
Myth #3 “I’ve observed the student in various settings and he seems to get along fine most days, so he must not have sensory issues.” The evidence of sensory processing difficulties can vary from day to day, from setting to setting and does not always demonstrate consistency. Behaviors can seemingly come out of no where. We often never know what is lying underneath the tip of the iceberg.
Negative sensory experiences can have a cumulative effect throughout the day. You may not see the result of overload until the end of the day when the child is home in their “safe” environment. You may think it’s curious how they can “hold it together” all day at school then unload all the emotions once at home. It’s a matter of survival. School is a place where expectations have to be met, but it takes every ounce of resources and coping skills they have. Teachers are often dumb-founded when a parent reveals how difficult behavior is at home.
Given our complex sensory systems and the demand to regulate them all efficiently to produce age-appropriate, well-adjusted behaviors to move effortlessly throughout our day, you can see how easy it is for something to go wrong! One day the trigger could be that the grocery store was too loud, then next day it could be that my clothes feel all wrong, the next day it could be that I haven’t eaten anything nutritious for a week because all textures are aversive. Thus, my output (behavior, sleep, routines, etc) is not optimal for learning, building relationships, etc. This maladaptive processing (in any system) will trigger the flight/fight/freeze system thus putting us in a state of survival.
This child is in “flight.” His system says “danger.” Escape and avoid the conflict. Children in school may run out of the classroom, hide under a desk, or choose to play alone on the playground when they are having trouble processing sensory information when they are in the “flight” mode of survival.
The system says, “fight” when it perceives a threat or danger. It may be a misinterpreted touch on the back or another peer coming too close into my personal space. But the system responds with “I must fight to protect myself.”
The system says, “freeze,” I’m on overload and don’t know what to do. I can’t even ask for help. These kids are often “under the radar” but struggle internally just as intensely as those children who are expressing their fear through “fighting.” These children often cannot access the language part of their brain to communicate their feelings.
Sensory Processing is not an easy concept to understand. Thus, intervention strategies and techniques need to be individually suited to meet the need on a personal level. Regardless of the sensory system(s) that is not processing optimally, the best intervention strategy is one of PREVENTION and creating SAFETY for the brain. When we identify what the need is, we are better able to pro-actively address it.
Negative behavior is the output of disorganized internal sensory processing. It is important to remember that the child does not have to think he/she is scared for their body to act scared. When a child feels attached, bonded and safe they will perform at their best.
The interventions used at Pediatric Connections implement sensory-motor reflex integration strategies to address the flight/fight/freeze systems to better regulate behavior, cognitive, emotional and physical development. To all service providers in the health care and school systems, please take time to understand the complexity of sensory processing disorders and what solution best fits the individual’s need to facilitate growth and development.