Early Childhood Education

Sensory Processing Disorder (SPD)

Sensory processing (also known as sensory integration) is the normal neurological process of organizing sensations for our use in everyday life. We use sensations to survive, to satisfy our desires, to learn, and to function smoothly. Sensory Processing Disorder (SPD), also called Sensory Integration Dysfunction, occurs when the brain inefficiently processes sensory messages coming from a person’s own body and his or her environment. The person has difficulty responding in an adaptive way to everyday sensations that others hardly notice or simply take in their stride. These preschoolers described below all have SPD.

Darwin, 4, shrinks away from touch sensations, and his feet never leave the ground; he is a sensory avoider. Eddie, 31/2, needs sensory stimulation to get up and go but does not usually know how to go get it; he is a sensory disregarder. Ben, 3, constantly seeks all kinds of stimuli; he is a sensory craver. Andy, 41/2, has trouble differentiating between hot and cold, heavy and light, and other sensations; he is a sensory jumbler. Carrie, 5, with poor posture and no “oomph,” is extraordinarily clumsy; she is a sensory fumbler.

Typically, the brain receives sensory information from the body and surroundings; interprets these messages; and organizes purposeful responses. As we climb the stairs, our brain senses that we’re moving upward, forward, and from side to side. Usually without conscious effort, we make adaptive responses. We flex and extend our legs, alternate our feet, slide our hand along the banister, maintain our balance, keep upright, and watch where we are going. We are probably not even aware that our bodies are making these adjustments.

In addition to vision, hearing, smell, taste and touch, we have several other vital senses. According to the research of A. Jean Ayres, PhD, OTR, who formulated the theory of sensory processing, the fundamental sensory systems include the following:

1. The tactile sense, which provides information, primarily through the surface of our skin, from head to toe, about the texture, shape, and size of objects in the environment. It tells us whether we are actively touching something or are passively being touched. It helps us distinguish between threatening and nonthreatening touch sensations.

2. The vestibular sense, which provides information through the inner ear about gravity and space, about balance and movement, and about our head and body position in relation to the surface of the earth.

3. The proprioceptive sense, which provides information through our muscles and joints about where our body parts are, how they are stretching, and what they are doing.

These sensory systems develop prenatally. They interact with vision and hearing, smelling and tasting, which develop slightly later. As a result of typical sensory processing, self-control, self-esteem, motor skills, and higher-level cognitive functions can develop.

Sensory Processing Is Necessary for These Everyday Functions:

*Praxis: the ability to conceptualize (or “ideate”), to plan and organize, and to carry out a sequence of unfamiliar actions; to do what one needs and wants to do in order to interact successfully with the physical environment.

Difficulty in these areas may be caused by sensory processing disorder. Generally, the red flags of SPD are unusual responses to tactile, vestibular, and proprioceptive sensations—the sensations of touching and being touched, of moving and being moved. The senses of seeing, hearing, smelling, and tasting may be involved, too.

Sensory processing disorder plays out differently from person to person. It can also vary in the same person from day to day, depending on factors such as fatigue, emotional distress, or hunger. It may coexist with attention deficit/hyperactivity disorder (ADHD), Asperger syndrome, autism, cerebral palsy, Down syndrome, fetal alcohol syndrome, fragile X, spina bifida, pervasive developmental delay (PDD), nonverbal learning disorder, bipolar disorder, and other problems. Sometimes SPD is severe, sometimes mild.

The child who avoids ordinary sensations or seeks excessive stimulation, whose body is uncooperative, whose behavior is difficult, and who doesn’t “fit in” might be called an out-of-sync child. The out-of-sync child receives sensory information just like everybody else. He, too, receives tactile sensations about the clothes touching his skin. He, too, gets movement sensations on a playground swing. He, too, hears a dog bark, smells a banana, chews toast and sees people coming and going. But unlike most people, the child may misinterpret or be unable to use that information effectively. For instance, he may have a tantrum because the tag in his shirt scratches his skin—or, he may not notice that his pants are on backwards. He may feel seasick swinging for a few seconds—or persist in swinging for a “million minutes.” He may panic when the dog barks a greeting—or ignore the dog’s eagerness to knock him down. He may gag at food smells and textures— or cram all sorts of things, edible or not, into his mouth. He may shrink from visual stimulation such as flashing neon lights—or ignore the sight of rushing cars and run heedlessly into the street. Why is this child out of sync? The underlying problem may be one or more patterns of dysfunction.

1. If the child has Sensory Modulation Dysfunction (SMD), his reactions to stimuli may be out of sync because, deep inside, his central nervous system organizes and regulates them inaccurately. These physiological reactions are internal, unconscious—and out of the child’s control. While what happens in his brain is invisible, his responses may be frequent, intense, long-lasting, and very noticeable, indeed.

One way this ineffective processing plays out is that the child like Darwin may be over-responsive, or “sensory defensive,” to certain sensory stimuli. For example, a door clicking shut may sound too loud; a shimmering Christmas tree may look too bright; a rising elevator may move too fast; an elastic waistband may feel too tight. Usually, the over-responsive child is a sensory-avoider and tends to be either fearful and cautious, or negative and defiant.

Another way that out-of-sync processing plays out is that the child like Eddie may be under-responsive to certain sensory stimuli. He may be difficult to arouse or may withdraw from the scene because he does not know what to do. Sensations do not bother this sensory disregarder; they just do not seem to attract his attention.

A third outcome of SMD is that the child like Ben may be a sensory craver and constantly seek intense sensations, such as spinning, jumping, twirling, climbing, stuffing his mouth, turning up the volume, bumping and crashing into furniture and other people.

Another child with SMD may have a combination of over- and under-responsiveness to stimuli. This sensory fluctuator may avoid some stimuli, such as light, unexpected touch sensations, while craving other stimuli, such as intense proprioceptive and vestibular experiences.

2. If the child has sensory discrimination dysfunction, like Andy, he has difficulty differentiating among and between stimuli. His central nervous system inaccurately processes sensations, with the result that he cannot use the information to make purposeful, adaptive responses and get on with the day.

The child misgauges the significance and value of things. He may not “get” sensory messages that other children use to protect themselves, to learn about their world, and to relate successfully to other people. Is this an eraser—or a cookie? A snap—or a button? How hot is this birthday candle? How high is the curb? How loud is his voice? How full is his mouth? How full is his cup? How hard should he pedal? How soon should he brake? How low should he duck? How much force is he using to hold a pencil, draw with a crayon, change a doll’s outfit, add blocks to a structure, kick a ball, stroke a kitten, or lean on a friend? For the child with poor sensory discrimination, interpreting such ordinary demands and responding appropriately may require enormous effort.

3. If the child like Carrie has postural disorder and/or dyspraxia—that is, dysfunction in praxis—she has difficulty conceiving of, planning, organizing, and carrying out a sequence of unfamiliar actions. Dyspraxia interferes with doing what one needs and wants to do to interact successfully with the physical environment. (The dyspraxic child often has poor sensory modulation and poor sensory discrimination, too.)

Performing unfamiliar actions is difficult for the dyspraxic child, and successfully going through all the steps of a familiar action may be difficult, as well. Getting dressed, pouring milk into the cereal bowl, climbing into the school bus, and opening her locker may be hard. Sharpening a pencil, putting papers in a three-ring binder, and organizing the steps to write a book report may be daunting. Tying shoes, kicking balls, and skipping ... making a sandwich and setting the table ... saying vocabulary words ... going after school to a new friend’s house—all these undertakings may be troublesome, indeed. Struggling to keep up with other children can be discouraging and not much fun.

Sensory processing disorder is a complex problem. Unfortunately, children don’t grow out of it; they grow into it, finding compensatory ways to cope with confusing, unpredictable, and threatening sensations. SPD may affect children’s development, behavior, learning, communication skills, friendships, and play. It may affect one or all of their sensory systems and impede sensory-related skills needed for daily functioning. It may make children overly self-protective, or not self-protective enough. Their strongest sense may be a sense of uncertainty.

Sensory integration therapy. A child with SPD needs extra coping assistance. Sensory integration-based occupational therapy (“OT/SI”) is highly recommended. Occupational therapy is the use of purposeful activity to maximize the independence and health of people with various physical, cognitive, psychosocial, or developmental needs. For a child, purposeful activities include swinging, climbing, jumping, buttoning, drawing, and writing—the child’s “occupation.” Other therapies are beneficial also, as increasing numbers of pediatric therapists receive added training in sensory integration theory and treatment. Therapy may take place at school, in a clinic, hospital, community health center, or home.

Under the guidance of a sensory integration-trained therapist, the child actively takes in movement and touch information in playful, meaningful, and natural ways. The child responds favorably to sensory integration treatment because it helps him learn to succeed—and he loves it!

Sensory-motor activities at home and school. Meanwhile, what can parents, teachers, and others do to help a child get in sync? At home and school, adults can incorporate sensory experiences into the day, as a “sensory diet.” A balanced sensory diet, like a fitness plan, is a planned and scheduled activity program that a therapist develops to meet the needs of a specific child’s nervous system. Its purpose is to help the child become better regulated and more focused, adaptable, and skillful.

A sensory diet includes a combination of activities. An alerting or calming activity may come first, depending on the child’s needs.

Alerting activities help the child become effectively aroused:

• Crunching cereal, popcorn, nuts, pretzels, carrots, celery, apples, or ice cubes

• Bouncing on a therapy ball or beach ball

• Jumping on a mattress or trampoline

Organizing activities help regulate the child’s responses:

• Chewing gum, granola bars, dried fruit, or bagels

• Hanging from a chinning bar

• Pushing, pulling, lifting or carrying heavy loads

• Getting into an upside-down position

Calming activities help decrease sensory over-responsivity or over-stimulation:

• Sucking a pacifier, hard candy, frozen fruit bar, or spoonful of peanut butter

• Pushing against walls with the hands, shoulders, back, buttocks, and head

• Rocking, swaying, or swinging slowly to and fro

• Cuddling or back rubbing

• Taking a bath or playing in water

At school, the child with SPD needs understanding and support to succeed. A teacher may want to help an out-of-sync student but lack training in the appropriate techniques. If so, the following suggestions may help:

• Reduce sensory overload

• Provide comfortable furniture

• Develop a consistent routine

• Plan transitions as carefully as lessons

• Inject movement breaks between and during activities

• Encourage students to be active rather than passive learners

• Give children plenty of time to answer or complete assignments

• Simplify instructions

• Give the child alternatives

• Emphasize the positive

• Provide physical feedback, with frequent “bear hugs” for soothing deep pressure

When the out-of-sync child begins to feel more in control, his schoolwork and social skills will improve. When he is less distracted, he distracts the other children less. Inclusive classrooms that have the support of early childhood special education professionals enhance the likelihood that all students are working to their best ability, and that teachers can teach.

Indeed, at home and school, every child benefits from a safe, calm, and distraction-free environment. Every child requires frequent breaks from work to move and stretch. Every child needs to know that someone is paying attention to his strengths and weaknesses, likes and dislikes, ups and downs. Every child needs to be shown how to find solutions to problems. Every child needs assurance that his ideas have merit and that it’s okay to have differing abilities. See also Inclusion.

Further Readings: Ayres, A. J. (2005). Sensory integration and the child. Rev. ed. Los Angeles: Western Psychological Services. Kranowitz, C. S. (2005). The out-of-sync child: Recognizing and coping with sensory processing disorder. Rev. ed. New York: Perigee; Kranowitz, C. S. (2005). Preschool sensory scan for educators (preschool SENSE), a collaborative tool for occupational therapists and early childhood teachers. Las Vegas: Sensory Resources; Kranowitz, C. S., Stacey Szklut, Jane Koomar, and Sharon Cermak (2004). Making sense of sensory integration. Las Vegas: Sensory Resources [compact disc]; Kranowitz, C. S., and Stacey Szklut, et al. (2001). Answers to questions teachers ask about sensory integration. Las Vegas: Sensory Resources; Miller, L. J. (2006). Sensational kids: Hope and help for children with sensory processing disorder. New York: Putnam.

Web Sites: www.SPDnetwork.org; www.SensoryResources.com; www.out-of-sync-child.com

Carol Kranowitz