Understanding Sensory Processing Disorder

Everyone processes sensory information differently. Some people love the feel of velvet while others hate it; the smell of wet soil can be delightful or repulsive; virtually everyone enjoys certain types of music more than others. However, when an individual reacts to sensory input in a dysfunctional manner, they may be experiencing a condition known as sensory processing disorder (SPD).

In child psychology, SPD is often observed as an autism spectrum experience. According to the American Journal of Psychiatry, although there is some debate over whether SPD should be a stand-alone condition, children who have it experience significant distress and behavioral problems. Those with SPD may struggle with sensory overload from loud noises or bright lights, have sensory integration difficulties, or exhibit sensory seeking behaviors in their everyday life. An occupational therapist can help assess a child's behavior and develop a tailored sensory diet to improve sensory processing and manage challenges related to SPD.

Sensory processing disorder

Sensory processing was originally referred to as “sensory integration” and is how the nervous system receives signals from multiple senses, in turn creating motor and behavioral responses. This occurs constantly, and we are faced with thousands of sensations that our nervous system processes every day, from reading to driving, eating, or even sleeping.

Sensory processing disorder (SPD) is when the nervous system is unable to detect or process these signals properly, leading to a processing disorder or a traffic jam in the information. This, in turn, impedes proper responses.

Because our brain is constantly bombarded by messages of sensory information, from the smell of food to the feeling of clothes against our body, we learn at a young age which of these are to be tuned out, so we can focus on what is immediate and important. However, with SPD, certain sensations are experienced close to equally, becoming either over or underwhelming. The struggle is in the organization of the information that the brain receives, leading to sensory stimulation issues or sensory processing problems.

Related disorders and the role of an occupational therapist

How Common Is SPD?

Symptoms of SPD

Symptoms of sensory processing disorder can be mild or severe, but some are especially common.

1. Hypersensitivity

Hypersensitivity, or what some call oversensitivity, is when responses to daily occurrences such as loud noises, touch, or crowds are overwhelming. Sometimes, this oversensitivity will manifest itself in a feeling of fear and paranoia, even when there is no danger present.

2. Hyposensitivity

Hyposensitivity, or under-sensitivity, is just the opposite; individuals are less aware of their surroundings and/or have a very high tolerance to pain.

This is often when those with SPD become "sensory seeking" and try to find new methods of stimulation. Sometimes, this will result in a constant need for the physical touch of people and things, which can sometimes be unwelcome or inappropriate. Sensory-seeking people may also have a constant need to be in motion, often taking risks that can sometimes harm others in their way.

3. Both hypersensitivity and hyposensitivity

While hyposensitivity and hypersensitivity may appear to be opposite, they can occur at the same time. When people are in settings they recognize, they may be fine and comfortable but become overwhelmed with new ones, especially when they are crowded. This often results in meltdowns that can be difficult to control.

Individuals may also experience hypersensitivity to a certain stimulus one day but then be unbothered by it the next day. 

4. Motor skill problems

Those who are hypersensitive often struggle to handle objects, which can affect everything from writing to completing chores. Hypersensitivity to touch may also cause problems with walking properly.

5. Diminished social skills

Individuals living with SPD sometimes have trouble socializing with others. When someone is oversensitive, they are likely to feel anxious or irritable, resulting in a barrier to effective and friendly communication. Under-sensitive people sometimes misunderstand how rough or invasive they are, which can make others uncomfortable and lead to exclusion.

6. Lack of self-control

When people feel overstimulated, it becomes difficult to control or even notice their actions. Because they are so consumed by their sensory experiences, they may act in unusual manners, which can be alarming to others. For example, individuals may need to be in constant motion or abruptly leave situations if they feel overwhelmed by sounds, textures, or bright lights.

Autism spectrum disorder and causes of SPD

While there is much research taking place regarding the causes of SPD, the results are not yet conclusive. Some results indicate SPD may be inherited. Others show that prenatal and birth complications may be associated with it.

Now, many professionals are beginning to utilize brain-imaging techniques to discover the biological implications of the disorder. One study even found a connection between specific areas of the brain and the ability to organize and respond to sensory information. While related disorders like autism spectrum disorder and ADHD relate to the front of the brain, SPD was shown to relate to the back of the brain. This suggests that SPD may be a unique disorder rather than a symptom. However, further research is needed for these results to be considered significant.

Living with SPD

Completing daily tasks can be difficult for those living with SPD. These individuals often struggle to respond to information that is administered through the senses, leading to clumsiness, trouble climbing stairs, reacting to changes in head position, behavioral issues, posture problems, and deficiencies in motor skills. Later, these struggles may lead to anxiety, depression, or difficulties in school/and or work. They may also lead people to avoid certain situations where they know aversive stimuli will be present.

While many experience occasional troubles with processing sensory information, it is common for people with SPD. As with others, symptoms vary from case to case. For some, only one sense is impacted, such as smell or movement. However, others can be affected by multiple senses.

In some circumstances, those with SPD over-respond, becoming overwhelmed by sensory experiences, even by seemingly small circumstances such as minor physical contact. A common response is frustration. Others under-respond and are not affected by intense heat or cold, for example. This can be a danger, as children may not realize they are being burned or be too slow to respond before being harmed.

Diagnosis

Diagnosis of SPD usually takes place during early childhood. Still, it is not uncommon for some with SPD to go through life without being properly diagnosed and seek treatment to help them interpret and react to sensory messages.

When left undiagnosed and untreated, sensory processing disorder in adults can often lead to struggles in retaining relationships and jobs due to depression, social isolation, and underachievement.

If you think your child might have SPD, take notes on their behavior and talk to their teachers at school to see if they are experiencing similar potential symptoms. Start by talking to the child's pediatrician and offering the notes you've taken. If necessary, they may suggest a comprehensive assessment. They will also likely recommend a specialist who can evaluate your young child better. Be sure to let them know when you first started noticing the behaviors, as well as potential triggers or diffusers.

Misdiagnoses

Unfortunately, misdiagnosis for sensory processing disorder is common due to a lack of training among healthcare professionals regarding sensory issues.

For some with SPD, the desire for sensation is intensified, as it is harder to attain. They sometimes develop an addiction to being overstimulated but suffer symptoms when it is present. Therefore, a misdiagnosis of ADHD is common, along with improper medication.

Sometimes those with SPD will also be diagnosed with autism spectrum disorders. While most people with ASD have SPD, not everyone who has SPD has ASD.

Recognition and diagnosis 

While sensory processing problems are now a part of some areas of new research, the topic is still controversial in many medical circles. SPD has not yet been added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is considered the official guide among doctors and therapists for diagnosing disorders regarding behavior and attention. This may be part of why misdiagnoses are so common. 

Sensory processing disorder also is not included in the disabilities included in the Individuals with Disabilities Education Act (IDEA). Awareness is growing, however, and there is a possibility that SPD will be added to these official documents. 

Despite not being included in the Individuals with Disabilities Act, there are alternative options for special education for those with sensory processing issues. If an individual is found to have a learning disability, whether connected to sensory processing disorder or not, they will be eligible.

Sensory processing disorder treatment

SPD treatment is available, but due to the lack of diagnosis or misdiagnosis, many are unable to take advantage of it. This can cause frustration for those experiencing SPD and many parents caring for children living with SPD.

While occupational therapies are often used to help those with SPD navigate the world, behavioral therapy can help individuals learn to accept and manage their body awareness and unique needs and cope with sensory triggers. However, sitting in a traditional therapist’s office may be difficult for someone living with SPD. Therefore, online therapy may be an appealing alternative since it allows individuals to complete therapy from anywhere with a strong internet connection.

There hasn’t been much research done comparing online vs. in-person therapy when it comes to sensory processing disorder. However, research suggests that online cognitive behavioral therapy (CBT) is an effective alternative to in-person therapy for many mental health disorders.