Sensory Processing Disorder Sensory Processing Disorder (SPD)(SPD)

By Kimmer Collison-RisBy Kimmer Collison-Ris

MSN, FNP-C, WOCN, MS CAMMSN, FNP-C, WOCN, MS CAM

What is SPD?What is SPD? Sensory Processing is the way the Sensory Processing is the way the

nervous system receives messages nervous system receives messages from the senses; converting them into from the senses; converting them into motor and behavioral responses.motor and behavioral responses.

SPD is also known as "sensory SPD is also known as "sensory integration dysfunction"integration dysfunction"

SPD sensory signals don't get SPD sensory signals don't get organized into appropriate responsesorganized into appropriate responses

A. Jean Ayres, PhD, compared SPD A. Jean Ayres, PhD, compared SPD to a neurological "traffic jam" that to a neurological "traffic jam" that prevents certain parts of the brain prevents certain parts of the brain from receiving the information needed from receiving the information needed to interpret sensory information to interpret sensory information correctlycorrectly

www.rollingrains.com

SPD & Brain FunctionSPD & Brain Function

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 (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.

Sensory ProcessingSensory Processing "Countless bits of sensory "Countless bits of sensory

information enter our brain at information enter our brain at every moment, not only from every moment, not only from our eyes and ears, but also our eyes and ears, but also from every place in our from every place in our bodies”. bodies”.

““The brain must organize and The brain must organize and integrate all of these integrate all of these sensations if a person is to sensations if a person is to move and learn normally.”move and learn normally.”

• Williams & Shellenberger's, Williams & Shellenberger's, How How Does Your Engine Run? A Does Your Engine Run? A Leader's Guide to The Alert Leader's Guide to The Alert Program for Self-RegulationProgram for Self-Regulation

SPD…SPD… most commonly diagnosed in most commonly diagnosed in

childrenchildren occurs within a broad spectrum occurs within a broad spectrum

of severityof severity difficulties are chronic, and difficulties are chronic, and

disrupt everyday life for children disrupt everyday life for children & adults& adults

Untreated SPD that persists Untreated SPD that persists into adulthood can affect an into adulthood can affect an individual's ability to succeed in individual's ability to succeed in marriage, work, and social marriage, work, and social environmentsenvironments

speech-language-pathology-audiology.advanceweb.com

HeredityHeredity

Researchers believe sensory integration Researchers believe sensory integration issues can be inheritedissues can be inherited

Implies there is a genetic coding for the Implies there is a genetic coding for the causes of SPD. causes of SPD.

Prenatal and birth complications, such as Prenatal and birth complications, such as preemies or fetal alcohol syndrome, have preemies or fetal alcohol syndrome, have also been blamed for some cases of also been blamed for some cases of sensory challengessensory challenges

Environmental FactorsEnvironmental Factors

What appears to contribute to a rise in sensory processing difficulties?What appears to contribute to a rise in sensory processing difficulties? Exposure to environmental toxins Exposure to environmental toxins or inability of a child to fight off these toxinsor inability of a child to fight off these toxins

http://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO6nhttp://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO6n

SPD Common w/Other DisordersSPD Common w/Other Disorders

Sensory processing disorder (SPD) very common in childrenSensory processing disorder (SPD) very common in children AutismAutism ADHDADHD fragile X syndromefragile X syndrome

http://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO6nhttp://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO6n

Nutritional Deficiences Impact Nutritional Deficiences Impact

Children who commonly have Children who commonly have sensory problemssensory problems picky eaters picky eaters or have food allergiesor have food allergies

Many parents believe a lack Many parents believe a lack of certain nutrients plays a of certain nutrients plays a role in sensory integration role in sensory integration issuesissues

• http://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO6nhttp://www.livestrong.com/article/19379-causes-sensory-processing-disorder/#ixzz1QPUixO6n

DefinitionDefinition Sensory Processing Disorder Sensory Processing Disorder

(SPD) is (SPD) is the inability to properly the inability to properly

perceive and interpret perceive and interpret sensory information through sensory information through the senses that affects daily the senses that affects daily functioning. functioning.

Previously referred to as Previously referred to as Sensory Integration Sensory Integration Dysfunction, SPD is not one Dysfunction, SPD is not one specific disorder. specific disorder. http://www.child-behavior-guide.com/sensory-processing-disorder.htmlhttp://www.child-behavior-guide.com/sensory-processing-disorder.html

"Five Caveats" "Five Caveats" 1. "The child with sensory dysfunction does not 1. "The child with sensory dysfunction does not

necessarily exhibit every characteristic. necessarily exhibit every characteristic. ie: child with vestibular dysfunction may have poor balance but ie: child with vestibular dysfunction may have poor balance but

good muscle tone." good muscle tone." 2. "Sometimes the child will show characteristics of a 2. "Sometimes the child will show characteristics of a

dysfunction one day but not the next.dysfunction one day but not the next. ie: child with proprioceptive problems may trip over every bump in ie: child with proprioceptive problems may trip over every bump in

the pavement on Friday yet score every soccer goal on Saturday. the pavement on Friday yet score every soccer goal on Saturday. Inconsistency is a hallmark of every neurological Inconsistency is a hallmark of every neurological

dysfunction.dysfunction. " "3. "The child may exhibit characteristics of a particular 3. "The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. dysfunction yet not have that dysfunction.

Ie: the child who typically withdraws from being touched may seem Ie: the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, instead, have to be hypersensitive to tactile stimulation but may, instead, have an emotional problem." an emotional problem."

““5 Caveats”....5 Caveats”.... 4. "The child may be both hypersensitive and 4. "The child may be both hypersensitive and

hyposensitive. hyposensitive. ie: the child may be extremely sensitive to light touch, jerking ie: the child may be extremely sensitive to light touch, jerking

away from a soft pat on the shoulder, while being rather away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inocculation." indifferent to the deep pain of an inocculation."

5. "Everyone has some sensory integration problems 5. "Everyone has some sensory integration problems now and then, because no one is well regulated all the now and then, because no one is well regulated all the time. time.

All kinds of stimuli can temporarily disrupt normal All kinds of stimuli can temporarily disrupt normal functioning of the brain, functioning of the brain,

either by overloading it of sensory stimulationeither by overloading it of sensory stimulation Or by depriving it of sensory stimulation." Or by depriving it of sensory stimulation."

• Carol Stock Kranowitz Carol Stock Kranowitz ""The Out-Of-Sync ChildThe Out-Of-Sync Child"" (1995) (1995)

Signs Of Tactile DysfunctionSigns Of Tactile Dysfunction __ becomes fearful, anxious or aggressive with __ becomes fearful, anxious or aggressive with

light or unexpected touchlight or unexpected touch

__ as an infant, did/does not like to be held or __ as an infant, did/does not like to be held or cuddled; may arch back, cry, and pull awaycuddled; may arch back, cry, and pull away

__ distressed when diaper is being, or needs to __ distressed when diaper is being, or needs to be, changedbe, changed

__ appears fearful of, or avoids standing in __ appears fearful of, or avoids standing in close proximity to other people or peers close proximity to other people or peers (especially in lines)(especially in lines)

__ becomes frightened when touched from __ becomes frightened when touched from behind or by someone/something they can not behind or by someone/something they can not see (such as under a blanket)see (such as under a blanket)

__ complains about having hair brushed; may __ complains about having hair brushed; may be very picky about using a particular brushbe very picky about using a particular brush

__ bothered by rough bed sheets (i.e., if old __ bothered by rough bed sheets (i.e., if old and "bumpy")and "bumpy")

__ avoids group situations for fear of the __ avoids group situations for fear of the unexpected touchunexpected touch

__ resists friendly or affectionate touch from __ resists friendly or affectionate touch from anyone besides parents or siblings (and anyone besides parents or siblings (and sometimes them too!)sometimes them too!)

Signs Of Tactile Dfxn cont.Signs Of Tactile Dfxn cont. __ prefers hugs__ prefers hugs

__ a raindrop, water from the shower, or wind blowing on the skin may feel __ a raindrop, water from the shower, or wind blowing on the skin may feel like torture and produce adverse and avoidance reactionslike torture and produce adverse and avoidance reactions

__ may overreact to minor cuts, scrapes, and or bug bites__ may overreact to minor cuts, scrapes, and or bug bites

__ avoids touching certain textures of material (blankets, rugs, stuffed __ avoids touching certain textures of material (blankets, rugs, stuffed animals)animals)

__ refuses to wear new or stiff clothes, clothes with rough textures, __ refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans, hats, or belts, etc.turtlenecks, jeans, hats, or belts, etc.

__ avoids using hands for play__ avoids using hands for play

__ avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue, __ avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam etc.glitter, playdoh, slime, shaving cream/funny foam etc.

__ will be distressed by dirty hands and want to wipe or wash them __ will be distressed by dirty hands and want to wipe or wash them frequentlyfrequently

__ excessively ticklish__ excessively ticklish

__ distressed by seams in socks and may refuse to wear them__ distressed by seams in socks and may refuse to wear them

Signs Of Tactile Dfxn cont.Signs Of Tactile Dfxn cont. __dislikes kisses, will "wipe off" place where kissed__dislikes kisses, will "wipe off" place where kissed

__ distressed by clothes rubbing on skin; may want to wear shorts and short __ distressed by clothes rubbing on skin; may want to wear shorts and short sleeves year round, toddlers may prefer to be naked and pull diapers and sleeves year round, toddlers may prefer to be naked and pull diapers and clothes off constantlyclothes off constantly

__ or, may want to wear long sleeve shirts and long pants year round to __ or, may want to wear long sleeve shirts and long pants year round to avoid having skin exposedavoid having skin exposed

__ distressed about having face washed__ distressed about having face washed

__ distressed about having hair, toenails, or fingernails cut__ distressed about having hair, toenails, or fingernails cut

__ resists brushing teeth and is extremely fearful of the dentist__ resists brushing teeth and is extremely fearful of the dentist

__ is a picky eater, only eating certain tastes and textures; mixed textures __ is a picky eater, only eating certain tastes and textures; mixed textures tend to be avoided as well as hot or cold foods; resists trying new foodstend to be avoided as well as hot or cold foods; resists trying new foods

__ may refuse to walk barefoot on grass or sand__ may refuse to walk barefoot on grass or sand

__ may walk on toes only__ may walk on toes only

Hyposensitivity To Touch (Under-Responsive)Hyposensitivity To Touch (Under-Responsive)

__ may crave touch, needs to touch everything and __ may crave touch, needs to touch everything and everyoneeveryone

__ is not aware of being touched/bumped unless done with __ is not aware of being touched/bumped unless done with extreme force or intensityextreme force or intensity

__ is not bothered by injuries, like cuts and bruises, and __ is not bothered by injuries, like cuts and bruises, and shows no distress with shots (may even say they love shows no distress with shots (may even say they love getting shots!)getting shots!)

__ may not be aware that hands or face are dirty or feel __ may not be aware that hands or face are dirty or feel his/her nose runninghis/her nose running

__ may be self-abusive; pinching, biting, or banging his own __ may be self-abusive; pinching, biting, or banging his own headhead

__ mouths objects excessively__ mouths objects excessively

Hyposensitivity To Touch (Under-Responsive)Hyposensitivity To Touch (Under-Responsive)

__ __ frequently hurts other children or pets while frequently hurts other children or pets while playingplaying__ repeatedly touches surfaces or objects that __ repeatedly touches surfaces or objects that are soothing (i.e., blanket)are soothing (i.e., blanket)

__ seeks out surfaces and textures that provide __ seeks out surfaces and textures that provide strong tactile feedbackstrong tactile feedback

__ thoroughly enjoys and seeks out messy play__ thoroughly enjoys and seeks out messy play

__ craves vibrating or strong sensory input__ craves vibrating or strong sensory input

__ has a preference and craving for excessively __ has a preference and craving for excessively spicy, sweet, sour, or salty foodsspicy, sweet, sour, or salty foods

Poor Tactile Perception And Discrimination Poor Tactile Perception And Discrimination __ has difficulty with fine motor tasks such as buttoning, zipping, __ has difficulty with fine motor tasks such as buttoning, zipping,

and fastening clothesand fastening clothes

__ may not be able to identify which part of their body was touched __ may not be able to identify which part of their body was touched if they were not lookingif they were not looking

__ may be afraid of the dark__ may be afraid of the dark

__ may be a messy dresser; looks disheveled, does not notice __ may be a messy dresser; looks disheveled, does not notice pants are twisted, shirt is half un tucked, shoes are untied, one pant pants are twisted, shirt is half un tucked, shoes are untied, one pant leg is up and one is down, etc.leg is up and one is down, etc.

__ has difficulty using scissors, crayons, or silverware__ has difficulty using scissors, crayons, or silverware

__ continues to mouth objects to explore them even after age two__ continues to mouth objects to explore them even after age two

__ has difficulty figuring out physical characteristics of objects; __ has difficulty figuring out physical characteristics of objects; shape, size, texture, temperature, weight, etc.shape, size, texture, temperature, weight, etc.

__ may not be able to identify objects by feel, uses vision to help; __ may not be able to identify objects by feel, uses vision to help; such as, reaching into backpack or desk to retrieve an itemsuch as, reaching into backpack or desk to retrieve an item

Vestibular Sense:Vestibular Sense: Input from the inner ear about equilibrium, Input from the inner ear about equilibrium,

gravitational changes, movement gravitational changes, movement experiences, and position in space. experiences, and position in space.

Signs Of Vestibular Dysfunction1. Hypersensitivity To Movement (Over-Responsive) 2. Hyposensitivity To Movement (Under-Responsive 3. Poor Muscle Tone And/Or Coordination

Hypersensitivity To Movement Hypersensitivity To Movement (Over-Responsive)(Over-Responsive)

__ avoids/dislikes playground equipment; i.e., swings, ladders, __ avoids/dislikes playground equipment; i.e., swings, ladders, slides, or merry-go-roundsslides, or merry-go-rounds

__ prefers sedentary tasks, moves slowly and cautiously, avoids __ prefers sedentary tasks, moves slowly and cautiously, avoids taking risks, and may appear "wimpy"taking risks, and may appear "wimpy"

__ avoids/dislikes elevators and escalators; may prefer sitting while __ avoids/dislikes elevators and escalators; may prefer sitting while they are on them or, actually get motion sickness from themthey are on them or, actually get motion sickness from them

__ may physically cling to an adult they trust__ may physically cling to an adult they trust

__ may appear terrified of falling even when there is no real risk of it__ may appear terrified of falling even when there is no real risk of it

__ afraid of heights, even the height of a curb or step__ afraid of heights, even the height of a curb or step

__ fearful of feet leaving the ground__ fearful of feet leaving the ground

__ fearful of going up or down stairs or walking on uneven surfaces__ fearful of going up or down stairs or walking on uneven surfaces

Hypersensitivity To Movement Hypersensitivity To Movement (Over-Responsive)(Over-Responsive)

__ afraid of being tipped upside down, sideways or backwards; will __ afraid of being tipped upside down, sideways or backwards; will strongly resist getting hair washed over the sinkstrongly resist getting hair washed over the sink

__ startles if someone else moves them; i.e., pushing his/her chair __ startles if someone else moves them; i.e., pushing his/her chair closer to the tablecloser to the table

__ as an infant, may never have liked baby swings or jumpers__ as an infant, may never have liked baby swings or jumpers

__ may be fearful of, and have difficulty riding a bike, jumping, __ may be fearful of, and have difficulty riding a bike, jumping, hopping, or balancing on one foot (especially if eyes are closed)hopping, or balancing on one foot (especially if eyes are closed)

__ may have disliked being placed on stomach as an infant__ may have disliked being placed on stomach as an infant

__ loses balance easily and may appear clumsy__ loses balance easily and may appear clumsy

__ fearful of activities which require good balance__ fearful of activities which require good balance

__ avoids rapid or rotating movements__ avoids rapid or rotating movements

Hyposensitivity To Movement Hyposensitivity To Movement (Under-Responsive)(Under-Responsive)

__ in constant motion, can't seem to sit still__ in constant motion, can't seem to sit still

__ craves fast, spinning, and/or intense movement experiences__ craves fast, spinning, and/or intense movement experiences

__ loves being tossed in the air__ loves being tossed in the air

__ could spin for hours and never appear to be dizzy__ could spin for hours and never appear to be dizzy

__ loves the fast, intense, and/or scary rides at amusement parks__ loves the fast, intense, and/or scary rides at amusement parks

__ always jumping on furniture, trampolines, spinning in a swivel chair, or __ always jumping on furniture, trampolines, spinning in a swivel chair, or getting into upside down positionsgetting into upside down positions

__ loves to swing as high as possible and for long periods of time__ loves to swing as high as possible and for long periods of time

__ is a "thrill-seeker"; dangerous at times__ is a "thrill-seeker"; dangerous at times

__ always running, jumping, hopping etc. instead of walking__ always running, jumping, hopping etc. instead of walking

__ rocks body, shakes leg, or head while sitting __ rocks body, shakes leg, or head while sitting

__ likes sudden or quick movements, such as, going over a big bump in the __ likes sudden or quick movements, such as, going over a big bump in the car or on a bikecar or on a bike

Poor Muscle Tone And/Or Coordination

__ has a limp, "floppy" body__ has a limp, "floppy" body

__ frequently slumps, lies down, and/or leans head on hand or arm while __ frequently slumps, lies down, and/or leans head on hand or arm while working at his/her deskworking at his/her desk

__ difficulty simultaneously lifting head, arms, and legs off the floor while __ difficulty simultaneously lifting head, arms, and legs off the floor while lying on stomach ("superman" position)lying on stomach ("superman" position)

__ often sits in a "W sit" position on the floor to stabilize body__ often sits in a "W sit" position on the floor to stabilize body

__ fatigues easily!__ fatigues easily!

__ compensates for "looseness" by grasping objects tightly__ compensates for "looseness" by grasping objects tightly

__ difficulty turning doorknobs, handles, opening and closing items__ difficulty turning doorknobs, handles, opening and closing items

__ difficulty catching him/her self if falling__ difficulty catching him/her self if falling

__ difficulty getting dressed and doing fasteners, zippers, and buttons__ difficulty getting dressed and doing fasteners, zippers, and buttons

Poor Muscle Tone And/Or Coordination __ may have never crawled as an baby__ may have never crawled as an baby

__ has poor body awareness; bumps into things, knocks things __ has poor body awareness; bumps into things, knocks things over, trips, and/or appears clumsyover, trips, and/or appears clumsy

__ poor gross motor skills; jumping, catching a ball, jumping jacks, __ poor gross motor skills; jumping, catching a ball, jumping jacks, climbing a ladder etc.climbing a ladder etc.

__ poor fine motor skills; difficulty using "tools", such as pencils, __ poor fine motor skills; difficulty using "tools", such as pencils, silverware, combs, scissors etc.silverware, combs, scissors etc.

__ may appear ambidextrous, frequently switching hands for __ may appear ambidextrous, frequently switching hands for coloring, cutting, writing etc.; does not have an established hand coloring, cutting, writing etc.; does not have an established hand preference/dominance by 4 or 5 years oldpreference/dominance by 4 or 5 years old

__ has difficulty licking an ice cream cone__ has difficulty licking an ice cream cone

__ seems to be unsure about how to move body during movement, __ seems to be unsure about how to move body during movement, for example, stepping over somethingfor example, stepping over something

__ difficulty learning exercise or dance steps__ difficulty learning exercise or dance steps

Proprioceptive SenseProprioceptive Sense Input from the Input from the

muscles and joints muscles and joints about body position, about body position, weight, pressure, weight, pressure, stretch, movement, stretch, movement, and changes in and changes in position in spaceposition in space..

Signs Of Proprioceptive Dysfunction1. Sensory Seeking Behaviors2. Difficulty With "Grading Of Movement“

Sensory Seeking BehaviorsSensory Seeking Behaviors __ seeks out jumping, bumping, and crashing activities__ seeks out jumping, bumping, and crashing activities

__ stomps feet when walking__ stomps feet when walking

__ kicks his/her feet on floor or chair while sitting at desk/table__ kicks his/her feet on floor or chair while sitting at desk/table

__ bites or sucks on fingers and/or frequently cracks his/her __ bites or sucks on fingers and/or frequently cracks his/her knucklesknuckles

__ loves to be tightly wrapped in many or weighted blankets, __ loves to be tightly wrapped in many or weighted blankets, especially at bedtimeespecially at bedtime

__ prefers clothes (and belts, hoods, shoelaces) to be as tight as __ prefers clothes (and belts, hoods, shoelaces) to be as tight as possiblepossible

__ loves/seeks out "squishing" activities__ loves/seeks out "squishing" activities

__ enjoys bear hugs__ enjoys bear hugs

__ excessive banging on/with toys and objects__ excessive banging on/with toys and objects

Sensory Seeking BehaviorsSensory Seeking Behaviors

__ loves "roughhousing" and tackling/wrestling games__ loves "roughhousing" and tackling/wrestling games

__ frequently falls on floor intentionally__ frequently falls on floor intentionally

__ would jump on a trampoline for hours on end__ would jump on a trampoline for hours on end

__ grinds his/her teeth throughout the day__ grinds his/her teeth throughout the day

__ loves pushing/pulling/dragging objects__ loves pushing/pulling/dragging objects

__ loves jumping off furniture or from high places__ loves jumping off furniture or from high places

__ frequently hits, bumps or pushes other children__ frequently hits, bumps or pushes other children

__ chews on pens, straws, shirt sleeves etc.__ chews on pens, straws, shirt sleeves etc.

Difficulty w/"Grading Of Movement“Difficulty w/"Grading Of Movement“ __ __ misjudges how much misjudges how much

to flex and extend muscles to flex and extend muscles during tasks/activities (i.e., during tasks/activities (i.e., putting arms into sleeves putting arms into sleeves or climbing)or climbing)__ difficulty regulating __ difficulty regulating pressure when pressure when writing/drawing; may be writing/drawing; may be too light to see or so hard too light to see or so hard the tip of writing utensil the tip of writing utensil breaksbreaks__ written work is messy __ written work is messy and he/she often rips the and he/she often rips the paper when erasingpaper when erasing__ always seems to be __ always seems to be breaking objects and toysbreaking objects and toys

Difficulty w/"Grading Of Movement“Difficulty w/"Grading Of Movement“ __ misjudges the weight of an __ misjudges the weight of an

object, such as a glass of juice, object, such as a glass of juice, picking it up with too much picking it up with too much force sending it flying or force sending it flying or spilling, or with too little force spilling, or with too little force and complaining about objects and complaining about objects being too heavybeing too heavy__ may not understand the __ may not understand the idea of "heavy" or "light"; would idea of "heavy" or "light"; would not be able to hold two objects not be able to hold two objects and tell you which weighs moreand tell you which weighs more__ seems to do everything with __ seems to do everything with too much force; i.e., walking, too much force; i.e., walking, slamming doors, pressing slamming doors, pressing things too hard, slamming things too hard, slamming objects downobjects down__ plays with animals with too __ plays with animals with too much force, often hurting themmuch force, often hurting them

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