1 Sensory Processing DisorderBy Sadie Bradshaw, OTS

2 What is Sensory Processing?Our brain’s ability to take in information from our 7 senses, organize and interpret this information to respond to the world in a meaningful way. Sensory processing is the way we learn about the world and function effectively.

3 What is Sensory Processing Disorder?A neurological disorder where the sensory information the individual perceives results in abnormal responses. It causes difficulty, or inability to function in daily life. Unlike people who have impaired-sight or hearing, those with SPD do detect sensory information. The information gets “mixed up” in their brain which can lead to inappropriate responses. Pioneering occupational therapist, psychologist, and neuroscientist A. Jean Ayres, Ph.D., likened SPD to a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly.

4 SPD continued 3 types SMD is most commonly seen and discussedSensory Modulation Disorders(SMD) Sensory Based Motor Disorder (SBMD) Sensory Discrimination Disorder (SDD) SMD is most commonly seen and discussed We will focus on SMD for this lecture, just making aware of other diagnosis under SPD

5 How common? Used to be 1 in 20, now considered 1 in 16That is one child in every class. Autism Spectrum Disorder 9 in 10 HAS to impact function in daily life We all have a little sensory problems 1 in 16 typically developing child. What about ASD Population? That is more like 9 out of 10.

6 Associated problems “That some people with autism have some degree of SPD is a recognized fact” (Kranowitz 2005) Premature babies, orphanages, highly deprived of sensory opportunities at a young age, autism, highly gifted children, fragile X, mild cerebral palsy

7 Causes Exact cause is unidentified Thought to be inheritedPrenatal and birth complications Environmental factors Prenatal- Chemicals, medications, toxins, smoke, drugs, alcohol, great emotional stress, virus, chronic illness or problem with the placenta Birth-multiple births at once, emergency cesarean section, lack of oxygen, surgery soon after birth Postnatal- environmental pollutants, child abuse, not enough stimulation of senses from limited interaction and play, lengthy hospitalization, and placement in an orphanage.

8 Our 7 senses Visual Olfactory (smell) Gustatory (taste)Tactile (touch) Auditory (hearing) Proprioception( body awareness/deep pressure) Vestibular (movement/balance)

9 Imagine if: You could not tune out that flickering light in the classroom The buzzing of the refrigerator in the next room made you lose sleep every night Every time you try to write with your pencil you push too hard and break it. Every time someone touches you it feels like sandpaper on your skin OR the tag on the back of your shirt itches and feels uncomfortable. OR sitting for 15 minutes makes you have to run around because your muscles feel like they are going crazy or your body is unaware of its location in space so deep pressure helps.

10 Problem areas related to SPDSelf-care ex: Feeding Delayed speech development Poor attention span or difficulty focusing Unusually high or low activity level Oversensitivity to touch, sights, or sounds Emphasize feeding and Speech as this is SLP Targeted lecture. Delayed speech=not motor, maybe auditory Coordination/muscle problems- clumsy child, weak or stiff. Distally strong, proximal weak (core)

11 3 categories of Sensory Modulation DisorderSensory Avoiders Over-responsive Respond too much Sensory Seekers Craving more Sensory under-responders Respond too little Difficult to treat and more uncommon *talk about tests done on children with feather. Sensory avoiders high response all the time. Sensory seekers have low response and need more stimulus to reach normal. Sensor under-responders will not respond no matter how much stimuli is presented.

12 Sensory Avoiders Red flagsFight: aggressive or forceful behavior in response to sensation Hitting, biting, kicking Flight: flea situations Freeze: may completely shut down Could try and talk their way out of activity that includes the over stimulating sensation Respond as painful or irritating *discuss fight or flight and how that is incorporated in real fear of these sensations. *fleaing could be shutting down

13 Sensory Seeker Red FlagsObvious craving for sensory inputs Never seems satisfied May look like ADHD

14 Sensory under-responder Red FlagWill give less of a response to sensory stimulation than peers May need stronger input than peers Reactions may appear slow May appear lazy or disinterested

15 Combinations 7*7*7=21 different areasCan be an avoider in one sensory input and a seeker in another sensory input Most common: tactile avoider and vestibular seeker Can be seeking, avoiding, under-responsive in different sensory inputs Most Common: proprioception seeker and vestibular seeker Autism spectrum: most common is proprioceptive seeking with some other things. With auditory avoidance or seeking or vestib seeking

16 Most Common SMDs Vestibular(movement) Seekers Auditory SeekersAuditory Avoiders Proprioception (body awareness/deep pressure) Seekers Tactile Avoiders (tactile defensiveness)

17 Remember… Not every symptom will appear in every clientThey have good days and bad days Likely to have problems with more than one sensory input

18 Proprioception SeekersCrashing into things/slams doors Pushes heavy objects Stomps feet down the hallway Aggressive behaviors Hitting, biting, kicking Chews on shirt collar, sleeves, or non-edible objects Likes tight clothing and shoes

19 Proprioception Seeker SuggestionsJumping on mini trampoline Pushing therapist on swing Crash pad breaks Play dough or clay activities Wear weighted back packs or weighted blankets Focus on seating for child Bean bag vs hard back Keep feet on floor when seated *add difference between bean bag vs hard

20 Tactile avoiders Avoid messy situations or want to wash hands immediately Restricted eaters Grooming or bathing can be difficult Do not want physical affection Kissing, hugging, holding hands Extreme behaviors to light touch and/or certain textures

21 Tactile Avoider SuggestionsPEP: Look, touch, kiss, eat progression Use firm touches, pats or hugs Do not force touch Use food play and be a model Do not surprise child Decrease lighting and lower your voice Talk less

22 Vestibular Seekers May be unable to sit stillLoose floppy body “wet noodle” Can appear as ADHD Some children will have ADHD, but do not rely on this! May appear recklessness or take safety risks Seem impulsive Repeated shaking of head, rocking back and forth, jump up and down Intense movement experiences Bouncing, flipping, spinning

23 Vestibular Seeker SuggestionsConsider developmental level with movement Ex: A toddler 3-4 min vs elementary can sit quietly a max of min Movement breaks are important! Change the movement activities on a regular basis Use Big transition movements Bug crawls, animal walks, hop, skip, march *With movements like rocking it can be slow and calming, but bouncing or running will alert the client. It is important to know that each child will be different, and have different sensory needs. Based on those needs you can determine if a child needs to calm or alert during mealtime. *this is important to keep in mind when doing a session with any child

24 Seating Options for MovementWhy it is important- allows them to sit but still move, ball chair

25 When swinging (vestibular) WATCH OUT FOR:Excessive giggling, yelling, or talking Excessive movement on the swing Turning pale or sweating Marked mood swings following stimulation Tone down and put up with vestibular What are you using swing for? Swings (vestibular stimulation) used to feed their sensory, but be an observer Be aware that vestibular input can quickly overwhelm

26 How to respond to OverstimulationSlowly stop input/swinging If child is dizzy do heavy work activity Push ups, hopping Help child breath deeply and slowly Provide deep pressure (Ex. Bear hugs) Focus on one object that is not moving until dizziness stops Move it up

27 Auditory Seeker Talks very loud Seeks loud noisesHolds musical objects to ear Will clap, sing, or slam loudly More common with autism

28 Auditory Seeker suggestionsUse noises as rewards Do not use ear plugs Use music in therapy Listen to tape or CD Sing a song with hand motions

29 Auditory Avoiders Oversensitivity to noisesVacuum, thunder, train whistle, siren, horn or loud room, air conditioning Express excessive emotions with noises May put fingers in ears to drown out noises May yell to drown out noises Very typical with autism

30 Auditory Avoiders SuggestionsDifferentiation between sounds may be difficult for child When using music: Rhythmic or steady beats Watch the level and other stimuli in room Background music is not recommended Private areas and breaks from noise Ear plugs, headphones or earmuffs *don’t have a lot of music or background noise

31 Suggestions for all Prevention of sensory based behaviorWatch for overstimulation or seeking behaviors Read cues and give breaks as needed Use breathing Breath in 4 counts, hold it, breath out 4 counts We want to catch before they loose it. That is the art, and observation is key. What is precursor because once they blow it is very hard to get them to a learning spot

32 References Ernsperger, L., & Stegen-Hanson, T. (2004). Just take a bite: easy, effective answers to food aversions and eating challenges. Arlington, TX: Future Horizons. Isbell, C., & Isbell, R. T. (2007). Sensory integration : a guide for preschool teachers. Beltsville, MD : Gryphon House, ©2007. Kranowitz, C. S. (1998). The out-of-sync child : recognizing and coping with sensory integration dysfunction. New York : Perigee Book, 1998.