Sensory Processing Disorder

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 An interview with Lucy Jane Miller, MD and Sarah Schoen, PhD, OTR

Do you have to cut the tag out of all your kid’s shirts?  Intense reactions to sight, sound, smell, and touch. Some kids are super sensitive, but sometimes it’s more than that.  Sensory Processing Disorder is a condition commonly associated with autism, but some kids that aren’t autistic experience it, too. In fact, researchers say it affects 1 out of 6 children in varying degrees of acuteness. Doctors Lucy Jane Miller and Sarah Schoen from the Sensory Processing Disorder Foundation share their expertise, enlightening us all on this common condition. — Laurel Moglen, Web Managing Editor

What percentage of American children have SPD?

Research has found that 5-10% of the American child population has SPD. One study (Ahn, Miller, Milberger, McIntosh, 2004) shows that at least 1 in 20 children’s daily lives is affected by SPD. Another research study by the Sensory Processing Disorder Scientific Work Group (Ben-Sasson, Carter, Briggs-Gowen, 2009) suggests that 1 in every 6 children experiences sensory symptoms that may be significant enough to affect aspects of everyday life functions.

Symptoms of Sensory Processing Disorder, like those of most disorders, occur within a broad spectrum of severity. While most of us have occasional difficulties processing sensory information, for children and adults with SPD, these difficulties are chronic, and they disrupt everyday life.

What is it like to have SPD?

Sensory Processing Disorder is a rather complex condition that manifests in a multitude of ways. Mostly we see the behaviors not the sensory reactions. So that a child who does not like touch may have meltdowns every day before school when putting on their clothes. It isn’t usually evident to family members that their child’s behavior has a sensory basis. And even when the clothes finally get on their body, their child may be distracted all day at school because they never habituate to the feeling of the pants on their legs or the sleeves of their shirt.

Difficulties in processing everyday sensory stimuli may produce a range of problems including any or all of the following: motor clumsiness, behavioral problems, anxiety, depression, school failure or social isolation. Frequently children with Sensory Processing Disorder are misunderstood, misdiagnosed and unfairly disciplined because their actions are interpreted as “bad” behavior rather than a neurophysiological problem.

Are there such subtle cases of SPD, that it’s hard to detect in a child?

We are all sensory beings and each of us present with unique idiosyncrasies regarding our experience of the sensory world. With that said, many individuals present with what we might label as extreme sensory needs that could be labeled SPD but rather they have found a way to adapt their daily life to satisfy those sensory needs. For example, I cut out all the labels in my clothes, I never wear wool and I don’t attend loud concerts. I take yoga classes weekly and avoid large gatherings. Do I have SPD…? Maybe, but we try not to label children with a condition unless it is significantly interferes with their every daily life. That is the criteria that should be used to define a disorder.

Do most kids with autism have SPD?

The surprising finding is that most children with autism have SPD as well. In fact, the research shows that 80- 90% of children on the autism spectrum have sensory symptoms. This makes differential diagnosis challenging because in cases where the SPD is severe, the child may be misdiagnosed with autism. With these children, we find early, intensive intervention can completely change the presentation of their symptoms and subsequent label.

Is the condition of SPD on the autism spectrum?

Yes, that’s a very good question. SPD should be considered a spectrum disorder in the same way that autism is described. There is definitely a broad range of how symptoms manifest in different children. There are cases in which the presentation of symptoms are broad, across multiple sensory systems impacting every aspect of daily life to those in which the sensory symptoms are restricted to a single sensory domain with less significant interference with daily life. For example, some children are just over-responsive to sound, thus limiting their participation in certain events such as going to large gatherings, eating in the cafeteria, playing in the gymnasium or attending a movie. While other children are not only over-responsive to sound but also touch, but may have difficulty sitting still and attending to class, due to an insatiable desire to move, their motor skills may be awkward and they have a restricted repertoire of play skills and thus are unable to establish meaningful peer relationships.

How is it most effectively treated?The most effective treatment for children with Sensory Processing Disorder is Occupational Therapy. We advocate for an intensive treatment model such as the one offered at the Sensory Therapy And Research (STAR) Center which offers a multidisciplinary, research-based occupational therapy program that incorporates relationship-based and sensory-based strategies with the context of extensive parent education and parent support services.

Occupational therapy for children with SPD typically takes place in a sensory-rich environment sometimes called the “OT gym.” During OT sessions, the therapist guides the child through fun activities that are subtly structured so the child is constantly challenged but always successful.

The goal of Occupational Therapy is to foster appropriate responses to sensation in an active, meaningful, and fun way so the child is able to behave in a more functional manner. Over time, the appropriate responses generalize to the environment beyond the clinic including home, school, and the larger community. Effective occupational therapy thus enables children with SPD to take part in the normal activities of childhood, such as playing with friends, enjoying school, eating, dressing, and sleeping.

The Sensory Processing Disorder Foundation published results of the first randomized controlled study examining the effectiveness of occupational therapy for children with SPD (Miller, et. al. 2007). In this preliminary study, we compared three treatment conditions: occupational therapy with a sensory-based approach, an activity protocol, and no treatment. Occupational therapy with a sensory-based approach was significantly more effective than the other treatment conditions. Specifically it was reported that after occupational therapy with a sensory-integration approach children had better attainment of desired treatment goals, increased attention, and increased social behaviors.

Since that time, over 1,000 children have participated in the STAR Center’s updated and enhanced intensive program and we have impressive preliminary findings that suggest children show significant changes in self-regulation, social participation, self-confidence and self-esteem and school performance. Additionally there is data to suggest that children who have gone through the STAR Center occupational therapy program demonstrate brain wave activity that appears to look more like that seen in typically developing children.

Is it a life-long condition or otherwise?

Because our brains are plastic, e.g. changeable, throughout our lives, SPD does not have to be a life-long challenge. Occupational therapy is an effective intervention for changing the way a child organizes and interprets sensory information from their daily environments. This, in combination with creating a new “sensory lifestyle” that incorporates activities that addressed one’s unique sensory idiosyncrasies means leading a productive, happy life.

Lucy Jane Miller, MD founded the Sensory Processing Disorder Foundation in 1979, serving as its executive director since then. For the past 35 years, she has devoted herself to the study and treatment of Sensory Processing Disorder. She is a prolific author, with over 50 articles in peer-reviewed journals. Her book, Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (SPD) has become the definitive source of information on SPD. Dr. Miller’s most recent book, No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges offers on-the-spot problem-solving tips to use for children with sensory issues.

Sarah Schoen, PhD, OTR, is Associate Director of Research at the Sensory Processing Disorder Foundation. Dr. Schoen is an Occupational Therapist with 28 years of clinical experience and a doctorate in Occupational Therapy from New York University (2001). Dr. Schoen has advanced training in Sensory Integration Therapy and clinical expertise with infants/toddlers with Regulatory Disorder, children with Sensory Processing Disorder, Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

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Comments (12)

  1. Okan

    We have a time timer for our 3 year old son and 18 month old daughter.We use it to help them tsnraition through activities throughout the day and teach them about the passing of time. A great example is nap time which used to be a difficult time of day until we started with the time timer. Here’s how I use it: First, I explain to my son that when the time timer goes beep beep it will be time for bed. I set the timer for around 30 minutes (or whenever nap time is supposed to be) and my son and I settle into an activity. Throughout our play I ask him how much red he has left and if he wants to do more things, he’ll make sure to move on to the next activity before the red disappears. When the red is gone there is a quiet, short tone sounds. I intentionally bought the product with the tone for this very reason its not loud or on-going like an alarm clock so you’ll need to stay close by but its just enough to get your attention. My son shouts out beep beep’ and gets up and heads to his room. He’s getting to the point that he doesn’t need us to remind him to watch the time but instead, he points it out to us as if to say look how much red is left! I have read the previous reviews that say its flimsy. I think the time timer is a tool that we as parents / educators use and then set it up on the shelf for the children to watch. I didn’t want my son to play with it as I was concerned he would want to change the time, drop it, etc.This is a great product for teach toddlers how to tsnraition, maintaining routine (which toddlers thrive with!) and helping them learn about time management.

  2. ann may

    Can we get our insurance to reimburse for OT to treat SPD or do they have to treat something else like fine motor delays?

  3. Lisa zeroles

    My daughter has been having issues and her therapist wants me to see her neurologist to test for this. She is three. What is the process for testing?

    • Jagath

      As soon as this timer arrived I didn’t think it would last, and I was right. Currently we use a big, old loud bell kcthien timer to limit my son’s TV and computer time. I wanted to try a visual timer as I heard it was great for kids on the Autism spectrum as they don’t really understand the concept of time passing. I chose this one because it also had an audible alarm so he would hear it if he was concentrating on something else. Right out of the box the thing felt so light and cheap I couldn’t imagine letting my 3.5 year old touch it. Basically the red part that shows time passing is a thin piece of plastic you dial around the clock part and the alarm is so quiet it might as well not be there. You certainly can’t hear it from another room-it’s just a tiny beep beep . Still, I’d heard great things so I gave it a try. My son mostly ignored it, but the thing still broke when he wasn’t even playing with it. The flimsly red thing kept coming off line and getting stuck. Within a week it stopped counting down the minutes, but would just beep for no reason. I had it sitting on my dresser and I just gave up on when my son found it and promptly ripped the red part right in half (the plastic was that thin and flimsy that he ripped it like a candy wrapper.) Now I’m sure I can’t return it and it was a huge waste of money. Good concept, but they need to make a stronger product, especially if it’s going to be anywhere near a kid.

  4. Jill.H. Tindal

    I love this article. I want to learn more about SPD and its affect on preschool and younger children.

  5. Jamie

    Great article. My son is a teen now but when he was young he could not stand noise. As a toddler he refused to wear clothes in the house and from the time he was an infant could not stand wearing overall type outfits that are so common with babies and toddlers. I never put the two things together. He has adapted to most sound now and keeps his clothes on but he still hates going to weddings and such because they are just too loud for him. I realize his was mild compared to what some deal with-but this brought about an understanding that i didn’t have before…

  6. Tracey

    My daughter has just been tested for this and I am due the results at the end of the week. This article was helpful in explaining some in answered questions. Thank you so much

  7. Rebecca Goniwich

    Hi April,

    You are right this is a great article on SPD.
    I just wanted to comment on your comment that loud noises are still physically painful. The Star Center uses Integrated Listening Systems (iLs) to help with sound sensitives. You can buy a home unit from them and they can coach you to use it at home.

    I have used iLs both professionally and with my own children. Two of my children had sound sensitives and by using iLs they no longer have that issue or have the need to cover their ears.

    Wishing you all the bestm

  8. April

    I am 32 with autism and loud noises are still physically painful and I have to cut my tags out too. I swear sometimes I can see sounds. I smell EVERYTHING. Wonderful article on SPD and how it affects us. Thank you.

    • Annie Thome

      Ainsley is now 11 years old with ADHD, Sensory Processing Disorder and Asperger’s. I am so very worried, because in 1 week she will start middle school with 6 teachers, 6 classrooms with 6 different seating positions, kids talking, laughing and moving in the hallway, lights flickering, etc. Tell me what the next 4 – 6 years of school will be like?


  9. Corrine

    Such a wonderful article thank you for it!

    • Andrea

      Autistic children are viausl learners so this device is perfect for them. This timer is great for working with special needs children both at school and at home. It helps with the anxiety and temper tantrums often related to transitioning between activities. I’ve used this timer in working with my own autistic son for homeschooling purposes in past years. He has always liked using it as an aid. Since he is now a young teen but still has difficulty judging time, it is still a great way for him to pace himself. I would think that this could be used for all classrooms as a subtle cue for any timed activity. As far as durability, the face of the timer is open (no protective piece over the face) and the face material appears to be only a thick type of paper. It does not appear to be sealed or laminated so you would want to handle it with some care.