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Sensory Integration Disorder: A Misunderstood Form of ADD/ADHD in Children

It is understood that no two children are the same. However there may come a point in time when, as a parent, you will find that your child’s behaviour may be slightly different in the way he/she reacts and interacts with other children, and you can’t seem to quite put your finger on it? Does your child’s tantrums seem endless over the little things, meal-times are a nightmare as she refuses to open her mouth, school days are a challenge as teachers complain that your child’s grades are falling and that he can’t focus in class. And though everyone around you reassures that its part of a growing phase, you can’t help worrying.

Scientific studies have shown that 5-15% of schooling children in the general population have difficulties in their sensory regulation to their environment (Reynolds, et al, 2008). This means that some children may have more difficulties than others in processing the differences between emotional, motion and sensory stimulations that are required for their daily living. In such cases, intervention and treatments may be helpful in addressing the child’s needs, their behaviour, ability in coping and interacting with their surroundings and other children.

What is Sensory Processing Disorder?

Sensory Integration Disorder (SPD) was initially defined by Dr. A. Jean Ayres PHD, OTR, an occupational therapist and educational psychologist as a neurological “traffic jam” that prevents certain parts of the brain from receiving the information to interpret the appropriate sensory response to the body. Since her earlier findings, her publications have inspired many others to study and further address SPD in children and adults alike.

Sensory Integration Disorder
Sensory Integration Disorder

Sensory processing disorder (SPD) can also be described as a condition whereby the nervous system receives messengers from our senses but has difficulties in processing the sensory information to relay them to appropriate motor and behavioural responses. “People with Sensory Processing Disorder (SPD) misinterpret everyday sensory information such as touch, sound and movement. They may feel overwhelmed by sensory information, may seek out sensory experiences or may avoid certain experiences.” (SPD Australia, 2011)

Examples of outward behaviours include being oversensitive to sensations such as texture in clothing, close physical contact, bright light and certain sounds that may be overwhelming or cause irritation in SPD children. Other children may be under sensitive or non-responsive to environment or stimulation even when pain or extreme heat or cold should normally cause a reaction. Sometimes the disorder in their sensory processing may impair their muscles and joints, affecting the child’s motor skill development, posture and body balance.

Signs Of Sensory Processing Disorder
Signs of Sensory Processing Disorder

How SPD can affect daily living and interactions

Regardless of whether one or more senses affect children with SPD, their difficulties in sensory processing may lead to emotional, social or educational problems, especially when they find it hard to make friends or be part of a social group. This may result in feelings of low self-esteem, leading them to prefer isolation rather than interacting with their peers. Other SPD children exhibit over-reactivity behaviour that may lead them to be labelled as naughty, “out of control” or disruptive in class, thus affecting their academic performance in school.

Sadly the poor understanding of how to respond to SPD children by parents and educators alike, often leads to feelings of frustration, possible depression or aggression behaviour in SPD children. Furthermore research studies into SPD have shown that at least 1 in 20 children’s daily lives can be affected by SPD (Ahn et al 2004). Supportive to that finding, another study suggested that as high as one in six children experiences sensory challenges sufficient to disrupt their academic, social, and/or emotional development (Ben-Sasson et al 2009).

SPD, a distinctive disorder and separate to ASD, ADD or ADHD

Unfortunately, although SPD is more prevalent in children than autism and as common as attention deficit hyperactivity disorder (ADD), there seem to less recognition for this disorder partly because it has never been recognized as a distinct disease. Regardless, the need for better research on how to treat and manage this disorder has been echoed among parents of SPD children. In a recent study, researchers from the USA have found that SPD children have quantifiable differences in brain structure, thereby demonstrating for the first time a biological basis that sets SPD apart from other diagnosis like ADD or ASD. Using MRI and diffusion tensor imaging (DTI), researchers were able to demonstrated that there was abnormal white matter of the brain tracts (essential for perceiving, thinking and learning) in the SPD subjects, primarily involving areas in the back of the brain, that serve as connections for the auditory, visual and tactile systems involved in sensory processing.

“More frontal anterior white matter tracts are typically involved in children with only ADHD or autistic spectrum disorders. The abnormalities we found are focused in a different region of the brain, indicating SPD may be neuro-anatomically distinct” (Mukherjee et al 2013). Hence, this study clearly indicates that exhibiting sensory issues alone is in itself a separate and distinctive disorder and that specific treatment should be tailored to meet children affected with SPD.

Pyramid of Learning and SPD treatment with occupational therapy

Williams and Shellenberger (1996) formulated their pyramid of learning and highlights how sensory integration processing relates to the child’s learning process (see Figure 1).

The Pyramid Of Learning
Figure 1 – The Pyramid Of Learning

They demonstrated that by taking a bottom up approach of the pyramid & targeting the sensory processing modalities, can result in more pronounced changes to behavioral as well as academic learning without specifically addressing specific sensory difficulties individually.

The seven sensory systems make up the foundation of the developmental pyramid of learning. It is beleived, that once all the senses are able to work together, it will then lead to a happy growing child to explore and develop skills in to his/her environment, thus optimizing the child developmental potential.

Occupational therapy uses a lot of techniques to improve children who have sensory needs. More importantly, occupational therapist utilizes sensory integration as a “clinical framework” for intervention in SPD children.

Occupational Therapists are health care professionals and are well trained in the knowledge about child’s condition and development. Occupational therapist has the required skills and expertise to determine the barriers that hinder the child’s ability to play, do self-care, socialize, and learn through a detailed assessment. Occupational therapist identifies, modifies and overcomes barriers that interfere with, restrict or inhibit a child’s functional performance, with the goal as to help enhance the child’s development, making them as independent as possible in all areas of their lives.

When should parents seek occupational therapy for their child?

Occupational Therapist
Occupational Therapist

Parents often have to weigh between being overly worried in certain growing milestones in their child’s development or seeking early intervention when they first suspect sensory issues. The question remains as to whether any therapy intervention is required and when therapy should be administrated, or will the symptoms improve as the child’s grows older in maturity.

Although these emotional struggles remain personal to each parental upbringing of their child, the more important question remains: “why wait for the symptoms to be worse before seeking help?” It has been known that early intervention provides SPD children with a higher probability in making significant differences in the child’s development, thus improving the symptoms and better integration into their environment, As every child is different, occupational therapy can provide a child centered approach to maximize every child’s potential in managing its sensory issues.

How can occupational therapy help my SPD child?

  • Help prepare for and perform important learning and development activities
  • Assess sensory needs and implement strategies to better suit in environment
  • Regulate overactive or underactive sensory system
  • Help them to remain focused in class and get their homework done.
  • Enhance self esteem and self accomplishments
  • Develop appropriate play skills
  • Improve gross motor skills like jumping, play ball biking
  • Help them learn to cope with disappointment or failure
  • Build skills for sharing, taking turn and play with peers
  • Cope up and manage anger and stress
  • Comply with the rules and transition well
  • Organize self and things
  • Improve balance, coordination and strength
  • Develop or improve hand writing and eating habits

What are some programs and techniques used by Occupational Therapist for children?

  • Techniques used by occupational therapistsSensory integration
  • Behaviour modification
  • Environmental modification
  • Hand writing without tears
  • Anger management
  • Therapeutic listening
  • Cognitive behavioural approach
  • Group therapy
  • Therapeutic use of self and activities

In BackUp, we provide personalised therapies that cater to the needs of each child. Our highly trained Occupational Therapist and Physiotherapists can help with assessing your child’s developmental difficulties, strategise therapy that may help reduce stress and inappropriate or disorganised behaviour caused by poor sensory registration, sensory defensiveness, sensory overload, and poor praxis.

Sheena Peregrina, OTRP
Occupational Therapist of BackUp Centre
APL Tower 25th Floor / T3 Podomoro City
Jl. S. Parman Kav. 28, Jakarta Barat 11470

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