October is National Sensory Awareness Month. I know, I know…..every other day celebrates awareness about something! But this is an important one for me and for many kids in our community. I’ve been an occupational therapist for 17 years, and I can say that even some of my closest friends and family have no idea what I do much less what sensory awareness means! I might not either if I hadn’t changed my mind about wanting to be a child psychologist during my last year at LSU. At that time many people encouraged me to look into physical therapy, but while observing a pediatric physical therapist, another therapist playing dress-up and eating Cheerios with clothespins caught my attention. The therapist and child appeared to be having so much fun! I had never heard of occupational therapy (OT), and it certainly didn’t sound like anything you would do with children! I always associated the word “occupation” with the word “job” as in what someone does to make a living. However Webster defines an occupation as “an activity in which one engages”. The primary occupations for a child are playing, learning, self-care and interacting with peers. An OT assists the child with improving skills such as fine motor, gross motor, visual motor, sensory motor, and social so he can be successful in these occupations. I went back to that clinic to observe the OT with several other children and was hooked on this profession. I completed my psychology degree that year and was accepted into Texas Woman’s University for their Masters of Occupational Therapy program the next semester. I loved my first job at the children’s hospital, but it was at a specialty clinic in Dallas where I discovered my true passion. My co-workers, who were certified and incredibly talented, trained me in treating children with Sensory Processing Disorder (also known as sensory integration dysfunction). Sensory Processing Disorder (SPD) is a neurological disorder in which the child receives information from his senses but either perceives, modulates, or interprets it incorrectly and therefore produces a response that is inappropriate to his situation. While many of us have occasional difficulties processing sensory information (my husband still cuts the tags out of his shirts), for those with SPD, these difficulties are chronic, neurological and they disrupt everyday life. Because there is a lack of awareness by parents, teachers, and some medical professionals, the child’s symptoms often go untreated. Untreated SPD leads to developmental delays and difficulty in normal childhood activities at home, school, and the community. I specialize in the treatment of children with SPD and know that knowledge leads to early diagnosis, which leads to early intervention, which results in an increased chance for success. So in honor of National Sensory Awareness Month, let me give you a closer look at what SPD really is and looks like. I am sure you know about the five basic senses as most of us learned about these in grade school: hearing, seeing, touching, smelling, tasting. Although, you may not be familiar with the vestibular, proprioceptive, and interoceptive senses that play a major role for the child with SPD. The vestibular sense tells us where the body is in space by giving us information about our movement and head position. This is essential to develop good balance and coordination. The proprioceptive sense gives us information from our muscles, joints, and ligaments for motor control and posture. It tells our brain where the body is in relation to other objects and how to move. The interoceptive sense tells us about our breathing, hunger and thirst, heart rate, and the need to use the bathroom. Within this diagnosis, the child can either be hyper or hypo sensitive to sensory information or a combination of the two. The hypersensitive child is more sensitive to sensation and typically avoids those sensations. The hypo sensitive child is less sensitive to sensation and therefore craves excessive amounts of those sensations. Here are just a few examples. A child who is hypersensitive to touch may only want to wear “soft” clothing such as sweat pants so he certainly throws a fit about his itchy school uniform. If he is hypo sensitive to touch then he may touch everything and everyone to the point of irritation. A child who is hypersensitive to vestibular input may be clumsy and avoid riding a bike or swinging at recess. If the child is hypo sensitive to vestibular input then it will seem as though he is in constant motion as he desires more movement than is typical. A child who is hypersensitive to proprioceptive input may hold himself in awkward positions. If he is hypo sensitive to proprioceptive input, he may crave jumping and crashing into things. His handwriting may be very dark on the page from the excessive pressure he applies with his pencil. If he is hypersensitive to interoceptive input he may not like the feeling of hunger so he eats all the time to avoid hunger pains. If he is hypo sensitive to interoceptive input he may not feel the urge to use the bathroom in time and have accidents. The child with SPD often produces what we call a “flight-or- fright” response to sensory overload. They either become aggressive or cry (fight), run away (flight), or freeze when their brains panic in response to everyday sensations that the rest of us may not even notice. While the fight-or- flight response is normal when a child is approaching real danger, it becomes a problem when it is elicited in response to something as simple as entering a busy grocery store. The child with SPD does not typically develop motor skills appropriately. When his gross motor skills are delayed, he may struggle with activities requiring coordination such as catching and throwing balls. He may lose his balance easily or have decreased strength and endurance. This in turn can make it difficult for him to be successful at recess or team sports, which also may result in poor social skills and self-esteem. When his fine motor skills are delayed, he may lack the dexterity required to hold a pencil correctly for good handwriting. He may struggle to manipulate buttons and zippers for dressing or have difficulty using a spoon or toothbrush effectively. Having delayed fine motor skills decreases the chances he will have a successful start in school. The child with SPD typically also has difficulty with praxis. Praxis is a complex concept that involves many processes, although simply put it is the ability to translate an idea into action. Poor praxis, or dyspraxia, makes it difficult for the child to plan and coordinate physical movement which leads to struggles with many developmental tasks. Every child I see in my practice loves coming to OT! Through active play, I guide them in fun, structured activities that are challenging while at the same time allowing them to be successful. Over time, the child is able to produce these appropriate responses in other environments as well. I like to focus my intervention on younger children as their immature brains have more plasticity which makes it easier for them to change and intervention more effective. Although, older children can certainly benefit from therapy! If you spot red flags of SPD in your child or a child you know, please seek out an OT with extensive knowledge and special training in this area.
Red Flags of SPD- Infant/Toddler
Eating problems; extremely picky
Bites toys or people for no reason
Difficulty falling asleep or staying asleep
Irritable when being dressed; seems uncomfortable in clothes
Rarely plays with toys
Resists cuddling; arches away when held
Cannot calm self
Floppy or stiff body; motor delays
Walks on toes
Slow to respond when hurt; does not notice pain
Easily startled
Little or no babbling, vocalizing
Extremely active; in constant motion
Red Flags of SPD- Preschoolers
Over-sensitive to touch, noises, smells, or other people
Difficulty with grooming tasks such as hair or nail cutting and tooth brushing
Difficulty making friends; overly aggressive or passive/withdrawn
Clumsy; poor motor skills; weak
Constant roughhousing, climbing, jumping; in everyone’s “face and space”
Makes constant noises
Fearful of movement; scared of playground equipment
Frequent or long temper tantrums
Difficulty toilet training
Difficulty learning new tasks
Avoids fine motor tasks such as using crayons and fasteners on clothing
Difficulty with transitions or changes in routines
Prefers sedentary activities
Hard to understand speech
Constantly biting or chewing on non-food items
Doesn’t seem to understand verbal instructions or slow to respond