Portal: Sensory Disabilities

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Sensory processing disorder (SPD) is a condition in which multisensory input is not adequately processed in order to provide appropriate responses to the demands of the environment. Sensory processing disorder is present in many with Autism spectrum disorders and Attention Deficit Hyperactivity Disorder. Individuals with SPD may inappropriately process visual, auditory, olfactory (smell), gustatory (taste), tactile (touch), vestibular (balance), proprioception (body awareness), and interoception (internal body senses) sensory stimuli.

Sensory processing disorder was formerly known as sensory integration dysfunction.

Sensory integration was defined by occupational therapist Anna Jean Ayres in 1972 as "the neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment".<ref name="Ayres 1972">Template:Cite book</ref><ref name="Ayres AJ 1972">Template:Cite journal</ref> Sensory processing disorder has been characterized as the source of significant problems in organizing sensation coming from the body and the environment and is manifested by difficulties in the performance in one or more of the main areas of life: productivity, leisure and play<ref name="Cosbey 2010">Template:Cite journal</ref> or activities of daily living.<ref>Template:Cite web</ref>

Sources debate whether SPD is an independent disorder or represents the observed symptoms of various other, more well-established, disorders.<ref name="research gate">Template:Cite web</ref><ref name="child mind institute">Template:Cite web</ref><ref>Walbam, K. (2014). The Relevance of Sensory Processing Disorder to Social Work Practice: An Interdisciplinary Approach. Child & Adolescent Social Work Journal, 31(1), 61-70. Template:Doi</ref><ref>Template:Cite web</ref> SPD is not included in the Diagnostic and Statistical Manual of the American Psychiatric Association,<ref name="medpage today">Template:Cite web</ref><ref name="psych central">Template:Cite web</ref> and the American Academy of Pediatrics has recommended that pediatricians not use SPD as a stand-alone diagnosis.<ref name="medpage today" />

Signs and symptoms[edit | edit source]

Sensory integration difficulties or sensory processing disorder (SPD) are characterized by persistent challenges with neurological processing of sensory stimuli that interfere with a person's ability to participate in everyday life. Such challenges can appear in one or several sensory systems of the somatosensory system, vestibular system, proprioceptive system, interoceptive system, auditory system, visual system, olfactory system, and gustatory system.Template:Citation needed

While many people can present one or two symptoms, sensory processing disorder has to have a clear functional impact on the person's life:

Signs of over-responsivity,<ref>Template:Cite journal</ref> including, for example, dislike of textures such as those found in fabrics, foods, grooming products or other materials found in daily living, to which most people would not react, and serious discomfort, sickness or threat induced by normal sounds, lights, ambient temperature, movements, smells, tastes, or even inner sensations such as heartbeat.Template:Citation needed

Signs of under-responsivity, including sluggishness and lack of responsiveness.

Sensory cravings,<ref>Template:Cite journal</ref> including, for example, fidgeting, impulsiveness, and/or seeking or making loud, disturbing noises; and sensorimotor-based problems, including slow and uncoordinated movements or poor handwriting.

Sensory discrimination problems, which might manifest themselves in behaviors such as things constantly dropped.Template:Citation needed

Symptoms may vary according to the disorder's type and subtype present.Template:Citation needed

Relationship to other disorders[edit | edit source]

Sensory integration and processing difficulties can be a feature of a number of disorders, including anxiety problems, attention deficit hyperactivity disorder (ADHD),<ref name="Ghanizadeh 2011">Template:Cite journal</ref> food intolerances, behavioral disorders, and particularly, autism spectrum disorders.<ref name="Lane 2010A"> Template:Cite journal</ref><ref name="Tomchek 2007"> Template:Cite journal</ref><ref name="Kern 2007"> Template:Cite journal</ref><ref name="Russo 2010"> Template:Cite journal</ref><ref name="Green 2010"> Template:Cite journal</ref><ref name="Baron-Cohen 2008"> Template:Cite journal</ref><ref name="Marco 2011"> Template:Cite journal</ref> This pattern of comorbidities poses a significant challenge to those who claim that SPD is an identifiably specific disorder, rather than simply a term given to a set of symptoms common to other disorders.<ref name="Flanagan">Template:Cite web</ref>

Two studies have provided preliminary evidence suggesting that there may be measurable neurological differences between children diagnosed with SPD and control children classified as neurotypical<ref>Template:Cite journal</ref> or children diagnosed with autism.<ref>Template:Cite journal</ref> Despite this evidence, that SPD researchers have yet to agree on a proven, standardized diagnostic tool undermines researchers' ability to define the boundaries of the disorder and makes correlational studies, like those on structural brain abnormalities, less convincing.<ref name="Slate">Template:Cite web</ref>

Causes[edit | edit source]

The exact cause of SPD is not known.<ref>Template:Cite web</ref> However, it is known that the midbrain and brainstem regions of the central nervous system are early centers in the processing pathway for multisensory integration; these brain regions are involved in processes including coordination, attention, arousal, and autonomic function.<ref name="Stein 2009">Template:Cite journal</ref> After sensory information passes through these centers, it is then routed to brain regions responsible for emotions, memory, and higher level cognitive functions. Damage in any part of the brain involved in multisensory processing can cause difficulties in adequately processing stimuli in a functional way.Template:Citation needed

Mechanism[edit | edit source]

Current research in sensory processing is focused on finding the genetic and neurological causes of SPD. Electroencephalography (EEG),<ref name="Davies 2007">Template:Cite journal</ref> measuring event-related potential (ERP) and magnetoencephalography (MEG) are traditionally used to explore the causes behind the behaviors observed in SPD .

Differences in tactile and auditory over-responsivity show moderate genetic influences, with tactile over-responsivity demonstrating greater heritability.<ref>Template:Cite journal</ref> Differences in auditory latency (the time between the input is received and when reaction is observed in the brain), hypersensitivity to vibration in the Pacinian corpuscles receptor pathways and other alterations in unimodal and multisensory processing have been detected in autism populations.<ref name=":1">Template:Cite journal</ref>

People with sensory processing deficits appear to have less sensory gating than typical subjects,<ref name="Davies 2009">Template:Cite journal</ref><ref name="Kisley 2004">Template:Cite journal</ref> and atypical neural integration of sensory input. In people with sensory over-responsivity, different neural generators activate, causing the automatic association of causally related sensory inputs that occurs at this early sensory-perceptual stage to not function properly.<ref name="Brett-Green 2010" /> People with sensory over-responsivity might have increased D2 receptor in the striatum, related to aversion to tactile stimuli and reduced habituation. In animal models, prenatal stress significantly increased tactile avoidance.<ref name="Schneider 2008">Template:Cite journal</ref>

Recent research has also found an abnormal white matter microstructure in children with SPD, compared with typical children and those with other developmental disorders such as autism and ADHD.<ref name="Owen Marco 2013">Template:Cite journal</ref><ref name="Chang Yi-Shin 2014">Template:Cite journal</ref>

One hypothesis is that multisensory stimulation may activate a higher-level system in the frontal cortex that involves attention and cognitive processing, rather than the automatic integration of multisensory stimuli observed in typically developing adults in the auditory cortex.<ref name=":1" /><ref name="Brett-Green 2010">Template:Cite journal</ref>

Diagnosis[edit | edit source]

Sensory processing disorder is accepted in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R). It is not recognized as a mental disorder in medical manuals such as the ICD-10<ref>ICD 10</ref> or the DSM-5.<ref>Template:Cite web</ref>

Diagnosis is primarily arrived at by the use of standardized tests, standardized questionnaires, expert observational scales, and free-play observation at an occupational therapy gym. Observation of functional activities might be carried at school and home as well.Template:Citation needed

Though diagnosis in most of the world is done by an occupational therapist, in some countries diagnosis is made by certified professionals, such as psychologists, learning specialists, physiotherapists and/or speech and language therapists.<ref name="Sensory Integration Network Course">Template:Cite web</ref> Some countries recommend to have a full psychological and neurological evaluation if symptoms are too severe.

Standardized tests[edit | edit source]

  • Sensory Integration and Praxis Test (SIPT)
  • Evaluation of Ayres' Sensory Integration (EASI) - in development
  • DeGangi-Berk Test of Sensory Integration (TSI)
  • Test of Sensory Functions in Infants (TSFI)<ref name="Eeles 2013">Template:Cite journal</ref>

Standardized questionnaires[edit | edit source]

  • Sensory Profile (SP)<ref name="Ermer 1998">Template:Cite journal</ref>
  • Infant/Toddler Sensory Profile<ref name="Eeles 2013" />
  • Adolescent/Adult Sensory Profile
  • Sensory Profile School Companion
  • Indicators of Developmental Risk Signals (INDIPCD-R)<ref name="Bolaños_2016">Template:Cite journal</ref>
  • Sensory Processing Measure (SPM)<ref name="Miller-Kuhaneck_2007">Template:Cite journal</ref>
  • Sensory Processing Measure Preeschool (SPM-P)<ref name="Glennon 2011">Template:Cite journal</ref>

Classification[edit | edit source]

Sensory Integration and Processing Difficulties[edit | edit source]

Construct-related evidence relating to sensory integration and processing difficulties from Ayres' early research emerged from factor analysis of the earliest test the SCISIT and Mulligan's 1998 "Patterns of Sensory Integration Dysfunctions: A Confirmatory Factor Analysis".<ref>Template:Cite journal</ref> Sensory integration and processing patterns recognised in the research support a classification of difficulties related to:

  • Sensory registration and perception (discrimination)
  • Sensory reactivity (modulation)
  • Praxis (meaning "to do")
  • Postural, Ocular & Bilateral Integration

Sensory Processing Disorder (SPD)[edit | edit source]

Proponents of a new nosology SPD have instead proposed three categories: sensory modulation disorder, sensory-based motor disorders and sensory discrimination disorders <ref name="Miller 2007">Template:Cite journal</ref> (as defined in the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood).<ref name="Miller Nielsen 2009">Template:Cite journal</ref><ref name="Zimmer 2012">Template:Cite journal</ref>

1. Sensory modulation disorder (SMD)[edit | edit source]

Sensory modulation refers to a complex central nervous system process<ref name="Miller 2007" /><ref name="Schaaf 2010">Template:Cite journal</ref> by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted.<ref name="Miller 2001">Template:Cite book</ref>

SMD consists of three subtypes:

  1. Sensory over-responsivity.
  2. Sensory under-responsivity
  3. Sensory craving/seeking.

2. Sensory-based motor disorder (SBMD)[edit | edit source]

According to proponents, sensory-based motor disorder shows motor output that is disorganized as a result of incorrect processing of sensory information affecting postural control challenges, resulting in postural disorder, or developmental coordination disorder.<ref name="Miller 2007" /><ref name="Bair 2012">Template:Cite journal</ref>

The SBMD subtypes are:

  1. Dyspraxia
  2. Postural disorder

3. Sensory discrimination disorder (SDD)[edit | edit source]

Sensory discrimination disorder involves the incorrect processing of sensory information.<ref name="Miller 2007" /> The SDD subtypes are:<ref>Template:Cite web</ref>

  1. Visual
  2. Auditory
  3. Tactile
  4. Gustatory (taste)
  5. Olfactory (smell)
  6. Vestibular (balance, head position and movement in space)
  7. Proprioceptive (feeling of where parts of the body are located in space, muscle sensation)
  8. Interoception (inner body sensations).

Treatment[edit | edit source]

Sensory Integration Therapy[edit | edit source]

File:Tire Swing.JPG
The vestibular system is stimulated through hanging equipment such as tire swings.

Typically offered as part of occupational therapy, ASI that places a child in a room specifically designed to stimulate and challenge all of the senses to elicit functional adaptive responses.<ref name=":0">Template:Cite book</ref>

Although Ayres initially developed her assessment tools and intervention methods to support children with sensory integration and processing challenges, the theory is relevant beyond childhood.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Sensory integration therapy is driven by four main principles:Template:Citation needed

  • Just right challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
  • Adaptive response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
  • Active engagement (the child will want to participate because the activities are fun)
  • Child directed (the child's preferences are used to initiate therapeutic experiences within the session)

Sensory processing therapy[edit | edit source]

This therapy retains all of the above-mentioned four principles and adds:<ref name="spdfoundation jan 2013">Template:Cite web</ref>

  • Intensity (person attends therapy daily for a prolonged period of time)
  • Developmental approach (therapist adapts to the developmental age of the person, against actual age)
  • Test-retest systematic evaluation (all clients are evaluated before and after)
  • Process driven vs. activity driven (therapist focuses on the "just right" emotional connection and the process that reinforces the relationship)
  • Parent education (parent education sessions are scheduled into the therapy process)
  • "Joie de vivre" (happiness of life is therapy's main goal, attained through social participation, self-regulation, and self-esteem)
  • Combination of best practice interventions (is often accompanied by integrated listening system therapy, floor time, and electronic media such as Xbox Kinect, Nintendo Wii, Makoto II machine training and others)

While occupational therapists using a sensory integration frame of reference work on increasing a child's ability to adequately process sensory input, other OTs may focus on environmental accommodations that parents and school staff can use to enhance the child's function at home, school, and in the community.<ref name="Peske 2005">Template:Cite book</ref><ref name="Sensorysmarts.com">Template:Cite web</ref> These may include selecting soft, tag-free clothing, avoiding fluorescent lighting, and providing ear plugs for "emergency" use (such as for fire drills).Template:Citation needed

Evaluation of treatment effectiveness[edit | edit source]

A 2019 review found sensory integration therapy to be effective for autism spectrum disorder.<ref>Template:Cite journal</ref> Another study from 2018 backs up the intervention for children with special needs,<ref>Template:Cite journal</ref> Additionally, the American Occupational Therapy Association supports the intervention.<ref>Template:Cite web</ref>

In its overall review of the treatment effectiveness literature, Aetna concluded that "The effectiveness of these therapies is unproven",<ref name="Aetna">Template:Cite web</ref> while the American Academy of Pediatrics concluded that "parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive."<ref name="Medicine 1186–1189">Template:Cite journal</ref> A 2015 review concluded that SIT techniques exist "outside the bounds of established evidence-based practice" and that SIT is "quite possibly a misuse of limited resources."<ref name="Fads">Template:Cite book</ref>

Epidemiology[edit | edit source]

It has been estimated by proponents that up to 16.5% of elementary school aged children present elevated SOR behaviors in the tactile or auditory modalities.<ref>Template:Cite journal</ref> This figure is larger than what previous studies with smaller samples had shown: an estimate of 5–13% of elementary school aged children.<ref name="Ahn 2004">Template:Cite journalTemplate:Dead link</ref> Critics have noted that such a high incidence for just one of the subtypes of SPD raises questions about the degree to which SPD is a specific and clearly identifiable disorder.<ref name="Slate" />

Proponents have also claimed that adults may also show signs of sensory processing difficulties and would benefit for sensory processing therapies,<ref name="Urwin 2005">Template:Cite journal</ref> although this work has yet to distinguish between those with SPD symptoms alone vs adults whose processing abnormalities are associated with other disorders, such as autism spectrum disorder.<ref name="Brown Shankar 2009">Template:Cite journal</ref>

Society[edit | edit source]

The American Occupational Therapy Association (AOTA) and British Royal College of Occupational Therapy (RCOT) support the use of a variety of methods of sensory integration for those with sensory integration and processing difficulties. Both organization recognise the need for further research about Ayres' Sensory Integration and related approaches. In the USA this important to increase insurance coverage for related therapies. AOTA and RCOT have made efforts to educate the public about sensory Integration and related approaches. AOTA's practice guidelines and RCOT's informed view "Sensory Integration and sensory-based interventions"<ref>Template:Cite web</ref> currently support the use of sensory integration therapy and interprofessional education and collaboration in order to optimize treatment for those with sensory integration and processing difficulties. The AOTA provides several resources pertaining to sensory integration therapy, some of which includes a fact sheet, new research, and continuing education opportunities.<ref>Template:Cite web</ref>

Controversy[edit | edit source]

There are concerns regarding the validity of the diagnosis. SPD is not included in the DSM-5 or ICD-10, the most widely used diagnostic sources in healthcare. The American Academy of Pediatrics (AAP) in 2012 stated that there is no universally accepted framework for diagnosis and recommends caution against using any "sensory" type therapies unless as a part of a comprehensive treatment plan. The AAP has plans to review its policy, though those efforts are still in the early stages.<ref>Template:Cite web</ref>

A 2015 review of research on Sensory Integration Therapy (SIT) concluded that SIT is "ineffective and that its theoretical underpinnings and assessment practices are unvalidated", that SIT techniques exist "outside the bounds of established evidence-based practice", and that SIT is "quite possibly a misuse of limited resources".<ref name="Fads" />

Some sources point that sensory issues are an important concern, but not a diagnosis in themselves<ref>Center for Autism and the Developing Brain</ref><ref name="Child Mind">Template:Cite web</ref>

Critics have noted that what proponents claim are symptoms of SPD are both broad and, in some cases, represent very common, and not necessarily abnormal or atypical, childhood characteristics. Where these traits become grounds for a diagnosis is generally in combination with other more specific symptoms or when the child gets old enough to explain that the reasons behind their behavior are specifically sensory.<ref name="sciencedirect_2020-07-01">Template:Cite journal</ref>

Manuals[edit | edit source]

SPD is in Stanley Greenspan's Diagnostic Manual for Infancy and Early Childhood and as Regulation Disorders of Sensory Processing part of The Zero to Three's Diagnostic Classification.

Is not recognized as a stand-alone diagnosis in the manuals ICD-10 or in the recently updated DSM-5, but unusual reactivity to sensory input or unusual interest in sensory aspects is included as a possible but not necessary criterion for the diagnosis of autism.<ref>Template:Cite book</ref><ref name="sciencedirect_2020-07-01"/>

History[edit | edit source]

Sensory processing disorder as a specific form of atypical functioning was first described by occupational therapist Anna Jean Ayres (1920–1989).<ref>Template:Cite book</ref>

Original model[edit | edit source]

Ayres's theoretical framework for what she called Sensory Integration Dysfunction was developed after six factor analytic studies of populations of children with learning disabilities, perceptual motor disabilities and normal developing children.<ref name="Bundy Lane 2002">Template:Cite book</ref> Ayres created the following nosology based on the patterns that appeared on her factor analysis:

  • Dyspraxia: poor motor planning (more related to the vestibular system and proprioception)
  • Poor bilateral integration: inadequate use of both sides of the body simultaneously
  • Tactile defensiveness: negative reaction to tactile stimuli
  • Visual perceptual deficits: poor form and space perception and visual motor functions
  • Somatodyspraxia: poor motor planning (related to poor information coming from the tactile and proprioceptive systems)
  • Auditory-language problems

Both visual perceptual and auditory language deficits were thought to possess a strong cognitive component and a weak relationship to underlying sensory processing deficits, so they are not considered central deficits in many models of sensory processing.Template:Citation needed

In 1998, Mulligan found a similar pattern of deficits in a confirmatory factor analytic study.<ref name="Mulligan">Template:Cite journal</ref><ref name="Smith 2007">Template:Cite journal</ref>

Quadrant model[edit | edit source]

Dunn's nosology uses two criteria:<ref>Template:Cite journal</ref> response type (passive vs. active) and sensory threshold to the stimuli (low or high) creating four subtypes or quadrants:<ref name="Dunn 2001">Template:Cite journal</ref>

  • High neurological thresholds
  1. Low registration: high threshold with passive response. Individuals who do not pick up on sensations and therefore partake in passive behavior.<ref name="ReferenceA">Template:Cite journal</ref>
  2. Sensation seeking: high threshold and active response. Those who actively seek out a rich sensory filled environment.<ref name="ReferenceA"/>
  • Low neurological threshold
  1. Sensitivity to stimuli: low threshold with passive response. Individuals who become distracted and uncomfortable when exposed to sensation but do not actively limit or avoid exposure to the sensation.<ref name="ReferenceA"/>
  2. Sensation avoiding: low threshold and active response. Individuals actively limit their exposure to sensations and are therefore high self regulators.<ref name="ReferenceA"/>

Sensory processing model[edit | edit source]

In Miller's nosology "sensory integration dysfunction" was renamed into "Sensory processing disorder" to facilitate coordinated research work with other fields such as neurology since "the use of the term sensory integration often applies to a neurophysiologic cellular process rather than a behavioral response to sensory input as connoted by Ayres."<ref name="Miller 2007"/>

The sensory processing model's nosology divides SPD in three subtypes: modulation, motor based and discrimination problems.<ref name="Miller 2007" />

See also[edit | edit source]

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References[edit | edit source]

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Template:Sensation and perception Template:Adhd Template:Pervasive developmental disorders Template:Autism resources