Sensory Processing Issues Explained
Oversensitivity, tantrums, clumsiness: all could point to problems taking in the world
by Beth Arky
Sensory processing issues are often first recognized during the toddler years, when parents notice that a child has an unusual aversion to noise, light, shoes that are deemed too tight and clothes that are irritating. They may also notice clumsiness and trouble climbing stairs, and difficulty with fine motor skills like wielding a pencil and fastening buttons.
More baffling — and alarming — to parents are children who exhibit extreme behaviors:
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- Screaming if their faces get wet
- Throwing tantrums when you try to get them dressed
- Having an unusually high or low pain threshold
- Crashing into walls and even people
- Putting inedible things, including rocks and paint, into their mouths
These and other atypical behaviors may reflect sensory processing issues — difficulty integrating information from the senses, which may overwhelm children and result in confusing behavior. Parents of children with these issues often call it Sensory Processing Disorder, or SPD. Psychiatrists, however, are quick to note that SPD is not a recognized disorder in the Diagnostic and Statistical Manual.
Sensory processing problems are now considered a symptom of autism because the majority of children and adults on the autism spectrum also have significant sensory issues. However, most children with sensory issues are not on the spectrum. They can also be found in those with ADHD, OCD and other developmental delays — or with no other diagnosis at all.
Dramatic mood swings and tantrums
What parents often notice first is odd behaviors and wild mood swings, strange at best, upsetting at worst. Often it’s an outsized reaction to a change in environment — a radical, inexplicable shift in the child’s behavior.
For instance, a first-grader may do fine in a quiet setting with a calm adult. But place that child in a grocery store filled with an overload of visual and auditory stimulation and you might have the makings of an extreme tantrum, one that’s terrifying for both the child and parent.
“These kids’ temper tantrums are so intense, so prolonged, so impossible to stop once they’ve started, you just can’t ignore it,” notes Nancy Peske, whose son Cole struggles with sensory issues. Peske is coauthor with occupational therapist Lindsey Biel, who worked with Cole, of Raising a Sensory Smart Child.
Fight-or-flight response
Another response to being overwhelmed is to flee. If a child dashes out across the playground or parking lot, oblivious to the danger, Peske says that’s a big red flag that he may be heading away from something upsetting, which may not be apparent to the rest of us, or toward an environment or sensation that will calm his system. Or a child might become aggressive when in sensory overload, she says. “They’re actually having a neurological ‘panic’ response to everyday sensations the rest of us take for granted.”
Some kids on the spectrum are known to wander to water, too often with deadly results. One theory is that water offers input they crave because of sensory issues. “Not all sensory kids do this,” Peske says, “but most gravitate toward the sensations and environments they find calming or stimulating. Their self-regulation is not great, so safety takes a back seat to their need to get that input or that calming experience of being in water.”
Children, teens and adults with sensory challenges experience either over-sensitivity (hypersensitivity) or under-sensitivity (hyposensitivity).
What are sensory processing issues?
Sensory processing difficulties were first identified by occupational therapist Dr. A. Jean Ayres. In the 1970s, Dr. Ayres introduced the idea that certain people’s brains can’t do what most people take for granted: process all the information coming in through seven — not the traditional five — senses to provide a clear picture of what’s happening both internally and externally.
Along with touch, hearing, taste, smell and sight, Dr. Ayres added the “internal” senses of body awareness (proprioception) and movement (vestibular). When the brain can’t synthesize all this information coming in simultaneously, “It’s like a traffic jam in your head,” Peske says, “with conflicting signals quickly coming from all directions, so that you don’t know how to make sense of it all.”
What are these two “extra” senses in Dr. Ayres’ work?
The internal senses
Proprioceptive receptors are located in the joints and ligaments, allowing for motor control and posture. The proprioceptive system tells the brain where the body is in relation to other objects and how to move.
Children who are hyposensitive crave input; they love jumping, bumping and crashing activities, as well as deep pressure such as that provided by tight bear hugs.
If they’re hypersensitive, they have difficulty understanding where their body is in relation to other objects and may bump into things and appear clumsy; because they have trouble sensing the amount of force they’re applying, they may rip the paper when erasing, pinch too hard or slam objects down.
The vestibular receptors, located in the inner ear, tell the brain where the body is in space by providing the information related to movement and head position. These are key elements of balance and coordination, among other things.
Those with hyposensitivity are in constant motion; crave fast, spinning and/or intense movement, and love being tossed in the air and jumping on furniture and trampolines.
Those who are hypersensitive may be fearful of activities that require good balance, including climbing on playground equipment, riding a bike, or balancing on one foot, especially with eyes closed. They, too, may appear clumsy.
A sensory checklist
To help parents determine if their child’s behavior indicates serious sensory issues, Peske and Biel have created a detailed sensory checklist that covers responses to all types of input, from walking barefoot to smelling objects that aren’t food, as well as questions involving fine and gross motor function, such as using scissors (fine) and catching a ball (gross).
The list for infants and toddlers includes a resistance to cuddling, to the point of arching away when held, which may be attributed to feeling actual pain when being touched. By preschool, over-stimulated children’s anxiety may lead to frequent or long temper tantrums.
Grade-schoolers who are hyposensitive may display “negative behaviors” including what looks like hyperactivity, when in fact they’re seeking input. Those who are hypersensitive are avoiders; this can translate into refusing to brush their teeth or have their faces painted. To make things even more complicated, kids can be both seekers and avoiders and have both proprioceptive and vestibular challenges, along with issues relating to the traditional five senses.
Misinterpreted behavior
Peske sums up the way sensory issues can affect kids this way:
“If you’re a child who is oversensitive to certain sensations, you are not only likely to be anxious or irritable, even angry or fearful, you’re likely to be called ‘picky’ and ‘oversensitive.’ If you rush away because you’re anxious or you’re over-stimulated and not using your executive function well because your body has such a powerful need to get away, you’re ‘impulsive.’ If you have trouble with planning and executing your movements due to poor body awareness and poor organization in the motor areas of the brain,” she adds, “you’re ‘clumsy.’ Because you’re distracted by your sensory issues and trying to make sense of it all, you may be developmentally delayed in some ways, making you a bit ‘immature’ or young for your age.”
Amid this confusion, there may be relief for more than a few parents in recognizing what maybe causing otherwise inexplicable behavior. “When I describe sensory issues to parents whose kids have them,” Peske says, “the usual reaction is ‘Oh, my gosh, that’s it!’ They’ve been trying to put a finger on ‘it’ for many months, even years! The sense of relief that they finally know what ‘it’ is is humongous.”
Treating Sensory Processing Issues
Specialized gyms help over-sensitive (or under-sensitive) kids
Beth Arky
On a gray Sunday afternoon in December, families are flocking to a small, colorful gym housed in a school on a quiet block in Brooklyn. Inside, children are jumping into a ball pit, crashing into mountains of supersized pillows, rolling and bouncing on huge balls, and swinging and spinning wildly inside a cocoon-like sling.
This 877-foot-space would be nirvana to any child—and all are welcome—but in fact it’s a new parent-run, nonprofit sensory gym modeled on occupational therapy facilities. Space No. 1 is the brainchild of Extreme Kids and Crew founder Eliza Factor, a dynamic mother of three who created it as a place for special-needs families to de-stress and have fun in a warm, accepting environment.
In designing Space No. 1 Factor worked closely with Huck Ho, her son Felix’s occupational therapist and the program director at the SMILE Center in Manhattan. Felix, 8, has cerebral palsy and autism spectrum disorder.
While the bouncing, crashing and spinning are fun, these activities are key tools in sensory integration (SI) therapy, a treatment used by occupational therapists to help kids who have problems with what’s called sensory processing. These kids experience too much or too little stimulation through their senses and have trouble integrating the information they’re getting. As a result, it’s difficult, if not impossible, for them to feel comfortable and secure, function effectively, and be open to learning and socialization.
What is sensory integration therapy?
The idea behind SI therapy is that specific movement activities, resistive body work, and even brushing of the skin can help a child with sensory problems experience an optimal level of arousal and regulation. This, according to some OTs, can actually “rewire” the brain so that kids can appropriately integrate and respond to sensory input, allowing them to both make sense of and feel safer in the world. Such “rewiring,” writes OT and SMILE Center clinical director Markus Jarrow in Cutting Edge Therapies for Autism, can decrease anxiety, making them “more confident, successful and interactive explorers.”
This assertion is controversial, as is the term many OTs use to describe these issues: sensory processing disorder (SPD). SPD is not recognized by psychiatrists as a diagnosis, though they acknowledge that children do have problems based on over- or under-receptivity of their senses. Most, if not all, children and adults with ASD have significant sensory issues. But not all who do are on the spectrum; they may have ADHD, OCD or other developmental and learning delays, or no other diagnosis.
The seven (or eight) senses
Both the description and treatment of SPD are based on the work of Dr. A. Jean Ayres, an OT who added to the traditional five senses two “internal” senses: body awareness (proprioception) and movement (vestibular). Proprioceptive receptors, found in the joints and ligaments, facilitate motor control and posture; vestibular receptors, located in the inner ear, tell the brain the body’s position and where it is in space, key to balance and coordination, among other things.
Meanwhile, leading SPD researcher and advocate Lucy Jane Millera dds an eighth sense, interoception, to the mix. The founder of the SPD Foundation and author of Sensational Kids: Hope and Help for Children With Sensory Processing Disorder, who was trained by Ayers, explains that this internal sense relays sensations that come from the organs.
When the brain is connecting the dots, these seven (or eight) senses afford a clear understanding of what’s happening both inside and outside the body. But when it isn’t, the mangled messages can become impairing or overwhelming, leading to a wide variety of defensive or compensatory behaviors. Those with SPD can be over-reactive (hypersensitive), under-reactive (hyposensitive), or both, which can lead to meltdowns and tantrums, as well as behaviors from picky eating to hitting and hugging too tightly.
Balancing sensory imput
How does sensory integration therapy work? First, an OT evaluates the child for what they call sensory defensiveness and sensory cravings using a battery of tests, as well as observations and interviews with caregivers. “SI is a complex, ongoing forensic analysis of each child,” Jarrow says. “It doesn’t lend itself well to a cookie-cutter approach.”
Treatment usually takes place in a setting outfitted with specialized equipment, called a sensory gym. Interestingly, the same therapy is used for different types of issues, according to Nancy Peske, coauthor of the book Raising a Sensory Smart Child with OT Lindsey Biel. “A child who is overreactive (hypersensitive) to vestibular input needs to swing and spin to retrain his brain,” she says, “just as a child who is underreactive to vestibular input does. The difference is that if he’s hypersensitive to movement, he’s more likely to resist it, whereas if he’s hyposensitive, or undersensitive, he’s more likely to seek it out.” Sensory gyms may also be outfitted with things like weighted vests and “squeeze machines”—developed by noted Aspie Temple Grandin— to provide deep, calming pressure.
OTs also use something called “brushing,” which, Jarrow says, can be a powerful tool particularly for those children with clear-cut tactile defensiveness. Most parents whose children have received OT have been trained to do a particular kind of routine called the Wilbarger protocol, which involves using a soft-bristled brush applied in a specific way to provide deep pressure, followed by joint compressions, several times a day. While most OTs only use the Wilbarger protocol, Jarrow says he has devised four to five different brushing protocols that are graded based on the level of a child’s responses.
Strengthening spacial awareness
While traditional OT has focused on the tactile, proprioceptive, and vestibular systems, pioneering occupational therapists have been targeting the vestibular-visual-auditory “triad,” which, according to the SMILE Center site, allows us to “perform many important tasks by helping us understand the three-dimensional space, or spatial envelope, that surrounds us wherever we go.”
One new therapeutic approach involves listening programs, which, according to Raising a Sensory Smart Child, use specially designed CDs and headphones to exercise specific muscles in the middle ear. Children can wear the headphones while doing crafts or even swinging and bouncing, further enhancing the integration of auditory input with other types of sensory input.
Children with vestibular issues have poor motor skills and a lack of balance and may seem “lost in space”—not unlike the sensation astronauts experience in zero gravity. Something called Astronaut Training, which employs things like spinning to music, has been developed to address that issue.
Sensory diet
Because therapists may only see a child an hour or two a week, SI therapy needs to be carried over into the home and in school in what’s most often called a “sensory diet.” Caregivers work with OTs to create a detailed schedule of therapies specific to each child. (Meanwhile, Miller, who does intensive parent training at her STAR Center in Denver, prescribes not a sensory diet but a “sensory lifestyle.” “We’re all too busy” to maintain a sensory diet, Miller says, “so we need to build it into our family routine.”)
Adaptations to make the home more “sensory smart,” such as creating quiet spaces and reducing visual clutter, are often suggested. Parents may also opt to buy items from a long list that includes weighted vests or blankets, pressure garments, fidget toys or even chewable “jewelry,” all aimed at providing regulating input.
Seeing results
Does this stuff work? Peske says it made huge changes in her son, Cole, now 12.
She noticed that there was something unusual about Cole even in the womb. “He did not stop spinning, moving and kicking,” she says. By the time he was 3, she was noting sudden meltdowns. One time, when she suggested he put on his shoes to go get ice cream with a friend and his dad, the toddler came unglued. He “screamed, fell to the ground, and begin slamming his head against the floor.” Only later did she realize his tantrum had been set off by the idea of putting on shoes and a quick transition, something children with SPD find particularly difficult.
There were many other signs. “Cole couldn’t get to sleep unless we held him for a long time,” Peske adds, “and he couldn’t have his teeth brushed without a major screaming fit. When he was on a swing, he’d laugh hysterically, and if you tried to take him out after he’d been in as long as 45 minutes, he would scream bloody murder.”
At 3, Cole was diagnosed with SPD and multiple developmental delays. He was enrolled in a therapeutic preschool, Biel treated him in OT, and Peske’s husband, George, worked with him an additional two to three hours a day. After preschool, Cole was able to move to a mainstream classroom. “His issues appear so mild at this point,” Peske says, “I wouldn’t be surprised if family, friends, and neighbors who didn’t know him when he was a preschooler think I’m crazy.”
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