When Senses Don't Make Sense

Children who have Sensory Processing Disorder have trouble interpreting touch, sound, smell, and other sensory input. What's a parent to do when a trip to the supermarket, a day at the playground--even a meal or a bedtime cuddle--overloads your child's senses? 

By Marybeth Lambe, M.D.

Diana and her husband, Robert, brought home baby Olivia in the spring of 2006. Olivia's early transition into her new family and surroundings seemed to parallel her older sister's. Yet Amelia gradually adjusted, while Olivia seemed to become more agitated as time passed. She cringed when wrapped in a blanket, cried when her shirt tag touched her skin, and howled when sock seams were pulled against her tiny feet. Diana was often in tears herself as she struggled to feed and care for this little girl who hated textured foods and wouldn't let a toothbrush near her mouth. The family was convinced this was a disaster in the making. They now know that Olivia was showing classic signs of Sensory Processing Disorder.

A 2004 study conservatively estimated that five percent of all children have Sensory Processing Disorder (SPD), and some professionals place the prevalence closer to 10 to 13 percent, yet it is still one of the least understood neurodevelopmental disorders. While researchers believe SPD is primarily inherited, environmental effects may play a role. SPD has been associated with maternal illness during pregnancy, pre-term labor, birth trauma, and institutional care, which may explain the elevated incidence within the adoptee population. SPD is diagnosed at higher rates in children with other disorders, such as autism, language disorders, and post-traumatic stress disorder.

What Is Sensory Processing Disorder?
Have you ever had a terrible sunburn, when everything that touched your skin hurt? That's what SPD can feel like, but, unlike a sunburn, it's not visible. When SPD causes a child to cringe and recoil from touch, the casual observer might think him fussy or belligerent or out of control. And when a child is 10 months old and non-verbal, he can't communicate that he's suffering. If a child can't trust his senses, how can he learn to trust his world, or those who care for him?

Sensory processing involves the five main senses--taste, touch, smell, sight, and hearing--as well as proprioception, the awareness of your body position in space, and vestibular sense, the awareness of your movement and balance. People with SPD receive sensory input but can't filter or process it.

"Sensory Processing Disorder is a neurological problem," says Carol Stock Kranowitz, M.A., author of The Out-of-Sync Child (Perigee). "For some reason, sensations coming in through one's body and from the environment are not processed accurately in the central nervous system. When we are born, we should have an intrinsic knowledge about how touch and movement feel--where our body is, whether we are falling, how far we must stretch to reach the toy, and so on. But in some babies, this knowledge is not well-founded."

Simply knowing what was behind their daughter's struggles brought Olivia's family a great sense of relief. Diana, who is afraid of heights, could imagine what it must be like for Olivia when she was faced with unwelcome sensory situations.

What Does SPD Look Like?
SPD can affect one or multiple senses, and children may display a range of symptoms. One of the reasons SPD is an elusive diagnosis is that the disorder looks different in different people. "One person may not be able to tolerate wool or noisy restaurants. Another person may crave a lot of movement, and love to go on amusement park rides," says Lindsey Biel, M.A., OTR/L, an occupational therapist and coauthor, with Nancy Peske, of Raising a Sensory Smart Child (Penguin). Biel notes that such things are sensory preferences. "It's also a matter of degree. Further along the continuum of severity, you may have a child for whom a loving caress might feel like sandpaper or gentle rocking may feel like bungee jumping."

In general, children with SPD are either over-responders or under-responders to particular sensations. A child who is hypersensitive to touch may dislike the feel of seams and tags in clothes, sand, wool and other scratchy fabrics, bathing, or soft touches. He may avoid dirty messes, finger paints, or standing close to others. Sensitivities to sound--bells, clanging pots, music--and aversions to movement--merry-go-rounds, vibrating toys, a game of catch--are also common. Over-responders may develop sensory defensiveness and try to control every part of their lives in order to avoid unwanted sensations. This defensiveness makes them appear angry, picky, and demanding.

Children who under-respond need to immerse themselves to an abnormal degree in order to experience certain senses. Because they cannot modulate touch, they may squeeze a kitten too hard. They may crave motion and jump, swing, spin, or run excessively. Others, if insensitive to touch, may be unaware of bleeding cuts or even a broken collarbone (as was one of my sons).

Many signs of SPD (see box, below) seem appropriate at certain ages--what two-year-old is not fussy and impulsive? SPD is characterized by severity and consistency--in a child who throws a tantrum at the lightest touch or howls every time he hears a car horn. Adoptive parents may not know what's normal and what falls outside the typical range. If you have concerns, seek an evaluation.

Signs of SPD Oversensitive/undersensitive to touch, sound, sight, movement, taste, and/or smell Intense, out-of-proportion reactions to everyday experiences Dislikes getting messy (from food, sand, glue, paint, lotion), especially on hands or face Bothered by certain fabrics or tags, seams, and waistbands in clothing Resists grooming activities, such as brushing teeth, washing hair, or clipping nails Pushes, hits, bites, or bangs into other children, even though he isn't aggressive Has poor balance, falls often, or runs awkwardly  Resists changes in routines and moving from one activity to another Has an unusually high or low tolerance for pain Doesn't seem to hear you, although you know he can hear Withdraws, "tunes out," or cries in group situations Avoids/excessively craves slides, swings, bouncing, rocking, jumping Avoids touch, or needs it more than other children --Lindsey Biel, sensorysmarts.com

Who Can Diagnose SPD?
As one might imagine, diagnosing SPD requires a practiced eye. It is normal for kids to show many of its signs and symptoms at different ages. And any child, depending on how she is feeling, and whether it is the morning or the afternoon of a long day, may behave differently. Parental input is critical to a diagnosis because the practitioner will be looking for patterns.

SPD should be diagnosed by a qualified occupational therapist (OT). If your child is age three or younger, you should qualify for free screening and services through your state's Early Intervention (EI) program. (Click on "How to find an OT trained in sensory integration" at sensorysmarts.com for a listing of EI programs by state.) If your child is older than three, you may request an OT assessment through your school district's department of special education. If your child is diagnosed with SPD through a school-based assessment, the school must pay for the therapy.

Parents may choose to employ an OT privately. (Most insurance plans cover occupational therapy.) To find an OT who has experience with SPD, begin your search at spdfoundation.net or aota.org (click on the "Consumers" tab).

What Does Treatment Involve?
Children with SPD generally have normal intelligence, and many of them are gifted. However, their brains have taken a different path, and they need to be trained to process information. SPD therapy does this by providing a rich "sensory diet." Depending on a child's sensory needs and "triggers," therapy may involve jumping on a trampoline, sifting through tubs filled with dried beans, playing with finger paints, or being brushed with a clean paintbrush.

There is no medication for SPD, so treatment won't involve pills. "You do need to get your kids moving, though," says Kranowitz. "Children are born to run. We mistakenly praise them for not fidgeting, when moving is the way to stay alive and awake. I think there are more sensory issues in the world because society doesn't encourage kids to be active. We can and must change that."

Occupational therapy may take place at an OT's office, a school, or a nearby gym, and it is usually paired with a home program. Parents reinforce the OT's treatment by engaging in similar activities with their kids on a daily basis. Kranowitz says, "Learning about SPD helps the whole family support the child. Start by making your home environment as sensory-rich as possible. Have your child help you around the house, by carrying in groceries, stirring cookie dough, raking leaves, and washing the car. Parents should never force their child to touch something, but they should make a variety of tactile things, such as loofah sponges, pot scrubbers, or thick terry washcloths, readily available." OTs can also offer parents advice on making life more enjoyable and tolerable for their kids with SPD. Biel suggests the following in Raising a Sensory Smart Child:

Clothing

• Many parents swear by the supersoft, all-cotton, tagless clothing made by Land's End and Hanna Andersson. You can also peruse thrift shops to find pre-worn (and, thus, pre-softened) clothing.
• Some children like the feel of snug clothing, possibly worn beneath other clothes. Try bicycle shorts, tights, T-shirts in smaller sizes, and so on.
• Buy seamless socks from sensorycomfort.com and smartknit.com.

Bathing

• If your child doesn't like "slimy" soap or shampoo, try self-foaming soap, which is also good for tactile play.
• Try using a large container of water for rinsing--the extra weight of the water might feel soothing. If your child needs to feel "in control" of the situation, let him use a toy sprinkling can or a handheld shower attachment. Count down together to rinsing: "1, 2, 3, rinse."
• If your child hates water on his face, have him wear a foam visor or hold a washcloth over his face when rinsing. You might also have him dry his face immediately after washing it, even if he's still in the shower or bath.
• Experiment with different towel textures.

Why SPD Should Not Be Ignored
Because of the subtlety of SPD symptoms, I have seen a few parents make the mistake of deciding not to seek diagnosis and treatment for a child who may have it. One father I met was proud of his son's ability to withstand pain without a blink or a grimace. He spoke of his three-year-old as being "thick-skinned" and "rugged." (Parents would never similarly convince themselves to let a child with poor eyesight go without glasses.)

Children with SPD need help, and the earlier they get it, the better. "Sensory problems make adjusting to a new family and a new culture even harder," Biel points out. "And new parents, filled with love and a desire to shower their child with affection, may inadvertently overstimulate him. It's essential to learn about your child's sensory experiences, so you can be the parent he needs."

If a child's SPD goes undiagnosed, the inability to tolerate touch and noise, difficulty modulating volume, poor motor control, and other symptoms can lead to problems in the social arena. Kranowitz points to the gradual improvement in self-esteem as one of the biggest benefits of successful therapy. The disorder itself may never be fully corrected, but the self-awareness a child gains will last a lifetime.

We did not adopt our children to let them fall through the cracks. If your child has SPD, diagnosis will prevent her from struggling, and therapy will offer the full life you envisioned for her when you became her parents.

Diana reports that Olivia's SPD therapy has transformed their home life. She used to be so sensitive to touch, she hated even to put her feet on the floor. The last time I saw Olivia, she was laughing with her sister as they chased each other through the house. She also fusses less over clothing and food sensations. Best of all, Olivia lets her family hug her now, as much as they want. And she hugs them back. 

Marybeth Lambe, M.D., is a freelance writer and family physician who lives in Washington. She's raised three children with SPD. This article is dedicated to Bo Shen.

Family Story: Sensory Overload by Billy Cuchens My wife, Laurie, and I had a serious problem with our son, Isaac, running off in public places. He'd see something that intrigued him and take off with no fear of getting lost. We took Isaac to an aquarium just after his third birthday. As we strolled along, admiring the marine life, Laurie suddenly spun around and shouted, "Where'd he go?" We frantically retraced our steps, looking for a snack stand, a loud television, anything that might have caught his attention. Finally, I spotted him climbing over a rail, his foot hoisted on a sign reading, "Do not climb over the rail." I grabbed him just before he jumped into a freezing pool of penguins. Laurie and I scolded Isaac, blamed each other, and blamed ourselves. Isaac had come home two years earlier, as our foster son, and we thought most of his developmental concerns had been resolved. We assumed that all three-year-old boys were full of energy and perpetually on high volume. (Whether he's at home, in the car, or at a crowded restaurant, Isaac's voice can get piercingly loud.) But finally, we had to admit that something else was probably going on, and we took him for an evaluation. A play therapist diagnosed Isaac with mild Sensory Processing Disorder. As she explained it, he couldn't coordinate his senses with his environment. Children with SPD can become overexcited by the slightest stimuli--bright lights, loud sounds, spicy food, even someone bumping into them. At one session, the therapist hid some toys in a bucket filled with uncooked rice. When she asked Isaac to retrieve the toys, he said, "I don't want to." She explained to me that he didn't like getting his hands dirty or sticky. I thought about our fights at the family dinner table, when Isaac refused to eat unless we gave him the right silverware and a napkin. Laurie and I thought he was just being picky. As Isaac's behavior began to change, I noticed my patience  with him improving. The therapist's explanations helped Laurie and me understand why our son acted the way he did. Rather than punish him for running off, we've become better about avoiding opportunities for him to do so. We don't get as frustrated when he gets overexcited or loud at the playground. The way Laurie and I see it, as a multiracial family, we already get plenty of odd looks. What's a few more because we're a little louder than everyone else? Billy Cuchens lives with his wife and two children in Texas. He blogs at goggycoffee.blogspot.com.

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