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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Sensory Processing Disorder/ Sensory Integration Dysfunction

April_2012_01What is it?
Sensory processing disorder (SPD), also known as sensory integration dysfunction, was first recognized and defined by A. Jean Ayres, a psychologist and occupational therapist. SPD involves a mixed bag of syndromes, all relating to difficulties involving the processing of sensory information- sight, smell, hearing, taste and touch, as well as the proprioceptive and vestibular senses, which tell us where our arms and legs are in relation to the rest of us and how our body is oriented toward gravity.

SPD is currently not recognized as a disorder in its own right by medical texts or in the DSM-IV, the bible of psychiatric disorders. As a result these sensory problems are often diagnosed and treated, as being part of autism or ADHD, rather than a stand-alone disorder.

Teachers may find the symptoms challenging and medical insurance may refuse to pay for therapy. In order to be included in the DSM-V, the core symptoms and typical course of SPD need to be clearly defined, possibly together with good treatment outcomes. Treatment is highly individualized, but largely involves encouraging and guiding children to do things they can’t do easily and respond less to things they can’t abide. Families are also taught how to adjust and accommodate their children’s sensory needs, to help them function more effectively at home and in school.

What is Sensory Integration?
Sensory integration describes the way in which our brains organize or sort information that we receive or take in from sensory stimuli; how we interpret the stimuli; process the stimuli into a response; and adaptively respond to the stimuli. In other words, our sensory systems take in information from the surrounding environment, through taste, touch, smell, sound, vision, movement and gravity. This sensory information is then processed or interpreted, so that we are able to make sense of our environments. The process of sensory integration lays the foundation for the effective functioning of the nervous system and other part of our bodies, which respond to the signals sent by the nervous system. We then respond to these sensory inputs and make the appropriate motor and behavioural responses. For example, biting into an apple, riding a bicycle or reading a book, all require successful sensory integration.

SPD is a chronic condition that exists when sensory signals consistently don’t get organized into appropriate responses. Ayres likened SPD to a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to correctly interpret sensory input. These sensory issues make the tasks of everyday life, social and family relationships, emotion regulation, the development of a healthy self-esteem and learning challenging. It is believed that 1 in 20 children suffer from SPD.

SPD can affect a person in only one sense (just touch) or in multiple senses (taste, movement and smell). While one person with SPD may over-react to certain stimuli and find the sensation of clothing, light and food to be unbearable, for example; another may under-respond to stimulation, even extreme pain or hot and cold. If a child’s processing of sensory information from the muscles and joints is impaired, they are likely to have problems with posture and motor skills. These children are often “floppy babies “and frequently get teased on the playground, or are labeled as “spazes” or a “klutzes”.

Causes
Like many other neurodevelopmental disorders, the exact cause of SPD has not been identified and several parents feel that they are somehow to blame for their child’s sensory issues. Preliminary research suggests that SPD is inherited and the causes are therefore coded in a child’s genetic material. Prenatal and birth complications have also been implicated, as well as environmental factors. Further research is required to establish the role of each.

Signs & symptoms
The following behaviours are commonly but not exclusively associated with sensory integration problems. These problems may manifest themselves differently in each child and some children tend to fluctuate between the various extremes (constantly on the move vs. fatigued or over- vs. under-stimulated).
  • Overly sensitive to sensory information, such as touch, movement, sights or sounds. Behaviourally, this may translate into irritability or avoidance when touched, the avoidance of certain clothes or foods, solely on the basis of texture, and a fearful reaction to everyday activities such as bathing or brushing teeth.
  • Children who are under-reactive to sensory stimulation will often seek out sensory experiences. For example, a child who is under-reactive to tactile experiences may constantly touch you or seem oblivious to pain.
  • The activity levels of children with SPD tend to be unusually high or low, or they may fluctuate between the two extremes. These children may appear to be constantly on the move or “all over the place”. Alternatively, they may be easily fatigued and difficult to motivate.
  • Co-ordination problems can be seen in either fine or gross motor co-ordination activities, or both. Some children experience balancing difficulties and find it hard to learn tasks involving motor planning.
  • Speech and language problems are more obvious and are often the first to be addressed.
  • Delays in motor skills or academic achievement. In younger children, problems may be seen when a child participates in projects involving the use of scissors, markers or paintbrushes. Preschoolers with SPD may have difficulties related to indoor or outdoor play equipment. Despite being within the normal IQ range, older children may struggle academically.
  • Poor organization of behaviour. Children with SPD may be highly distractible especially in a group setting. They may appear extremely impulsive, possibly due to a lack of planning and may have trouble adjusting to new situations or react to failure with aggression, frustration or withdrawal.
  • Children with SPD often experience negative self-esteem. This is not only related to the way in which their immune systems are functioning, but to the feelings of frustration and inadequacy that arise when they cannot do things well, and other people’s negative reactions to what they do.


Diagnosis

If you suspect your child has SPD and would like to gain a deeper understanding about the disorder, Tum2Mom has a sensory processing disorder checklist that you can use for educational purposes. Discuss your concerns with your paediatrician and ask for a referral to an Occupational Therapist. You may also be referred to a developmental therapist, who can rule out or pick up if there are other developmental disorders.

Testing should involve multiple disciplines, but can be done by a qualified OT. The testing process should include; interviews and questionnaires (if the child is not too young) for the child, family, teachers, or other professionals who interact with the child to evaluate whether further evaluation is required, and the performance of tests relating to the child’s sensory system, developmental milestones, and their reactions to sensory information. These findings will help identify which, if any, sensory systems are significantly impacted, and if so, how, when and why. This is important because children (especially those with SPD) tend to act differently in different settings and are highly influenced by situational, contextual and environmental factors.

Treatment
Most children with SPD are just as intelligent as their peers and many are intellectually gifted. Their brains are just wired differently. As a result, they need to be taught in alternate ways, how to process and handle sensory information and require leisure activities that suit their sensory processing needs.

Occupational therapy (OT) with a sensory integration (SI) approach is integral in the treatment of SPD because it focuses on the more primal occupations of life, such as working, dressing, eating and playing.

Therapy generally takes place in a sensory-rich environment, known as an “OT gym”. The therapist guides the child through subtly structured activities, which are challenging but always allow the child to be successful. Treatment is highly individualized and looks at each child’s unique needs, based on their sensory discomfort. For example a therapist may begin tackling noise sensitivity by playing a series of calibrated tapes. Food intolerances may be lessened by gradually introducing the child to different textures. After allowing them to touch these concoctions, the therapist is eventually able to place them ever nearer to the child’s mouth.

In the school environment, a child who has tactile hypersensitivity may be allowed to sit with a weighted blanket on their lap during classes. This satisfies the child’s need for tactile input and helps them to focus on their lessons. Within the family context, a child’s need to be in constant motion may be met by allowing them to perform a movement related activity while performing their schoolwork. For example, a father reported that his son does math flash cards while standing on his head.

The treatment goal is to help the child to respond to sensory information in an active, meaningful and fun way, so that they are able to behave in a more functional manner. Over time, these appropriate responses will generalize to other environments, including home, school and the larger community.

Therapy is family centered and parents are encouraged to be involved in therapy and work with the therapist to learn more about their child’s sensory challenges. They are taught how to engage in therapeutic activities (sometimes referred to as the “sensory diet”) at home. Therapists may also give teachers and others who interact with the child on a regular basis, ideas on how to accommodate the child’s sensory needs.

Psychologists can help both parent and child deal with the issues they are facing, or that may arise individually or in the family context at a later stage.

Prognosis
Effective treatment for SPD is available, however if misdiagnosed and left untreated, children with the condition are at high risk for various emotional, social and educational problems. These may include; difficulties making friends or belonging to a social group, poor self-esteem, academic failure, and being perceived and/or labeled as clumsy, “out of control”, disruptive, belligerent and uncooperative. Those who are unaware of the child’s sensory difficulties may blame parents for their child’s “bad” behaviour. SPD that persists into adulthood may affect an individual’s ability to thrive in marriage, work and social environments.

In contrast, children with SPD who receive appropriate therapy, will be able to participate in the normal activities of childhood, such as playing with friends, enjoying school, eating, dressing and sleeping. Treatment of SPD helps parents and those who work with sensational children, better understand that SPD is a real problem. This assurance assists them in becoming better advocates for their child at school and within the community.

For a deeper understanding of SPD, watch this well-illustrated video of what it means to have the disorder.

http://www.youtube.com/watch?v=6O6Cm0WxEZA&feature=email

References
http://www.featchatt.org/
http://www.time.com/
http://www.spdaustralia.com.au/
http://www.sinetwork.org/