Last week, I attended a training on self-regulation in children. The training addressed some common problems that occur in children that can affect a child’s ability to self-regulate (i.e. calm their bodies, minds and emotions enough to function in school and social situations).
One of the common problems that was addressed was Sensory Processing Disorder, or SPD. As a mental health professional who works primarily with the early childhood population, SPD has become a significant part of my practice.
Many of the young kids who come to see me have developed some behavioral problems at home, daycare and/or preschool because of the way their bodies respond to sensory stimulation. Their bodies overreact or underreact so much that they don’t act like the “typical” child does. Those with some of the more extreme reactions are likely to be viewed as mean, defiant, aggressive, out of control, or someone who needs to be on medication…yesterday!
When young kids who are acting aggressively or defiantly come to my office for their first appointment, I start out by asking questions that could help me to understand if their behavioral problems actually have a root cause of SPD. Many times when I ask parents a question like, “Is he bothered by the tags in his shirt or the seams in his socks?” the parent looks at me and says, “How did you know that?!”
The truth is that many kids who are acting out in a variety of ways could be doing so because of the way their body is processing the sensory stimuli, so their inability to pay attention or follow your directions has a lot more to do with their sensory processing than it does with their desire to defy you.
SPD is sort of a complex idea, but I wanted to share the Cliff’s Notes version, to help you understand what it is and how it might be affecting a child’s behaviors, just in case you know a kid who is acting out for this very reason. If you try to punish, discipline or bribe a child with SPD into compliance, you won’t be very effective. But, if you learn how that same child experiences the senses and tailor your repsonses to help him to better understand his body, you may be surprised to know that you can get rid of those punishments and bribes and possibly have better behavior that you ever could have imagined for him!
What is It?
When the average person receives information from the senses, the nervous system processes the information and then provides a motor or behavioral response. For example, you touch a hot stove and your nervous system almost instantly tells you to move your hand away. In someone with SPD, the nervous system still processes the information, but the responses simply aren’t right. For example, you touch sand paper and your body reacts as if you’ve touched a hot stove, or you touch a hot stove and your nervous system responds as if you are touching a room-temperature stove.
The Senses and How They Are Affected
SPD can affect all of the senses, but it doesn’t have to. For example, some people may underrespond (like not reacting to a hot stove) or overrespond (like touching sand paper and feeling like it’s a hot stove) to sight and sound, but not react to the other senses. And others may react to all of them.
Some children may show a sensitivity to touch, or the tactile sense. There are a variety of irregular responses that may occur here, some of which I’ve already listed above. The main problems that I see in children related to touch include:
- Bothered/annoyed by tags, seams and tight clothing
- Rashes and bumps from exposure to many products
- Avoidance of foods with certain textures or inability to eat food if it isn’t ground up
- Obsessive-like compulsion with having hands clean (i.e. may have to wash hands multiple times during any activity because they got “messy” from paint, chalk, food or even soap).
Other children may show a sensitivity to sight through their visual sense. Again, there are a variety of different ways that a child may respond inappropriately to their visual sense, but the main issues I see include:
- Sensitivity to light that requires sunglasses or a hat (sometimes needed indoors) or the child can’t even keep his eyes open
- Overstimulation or overwhelming feelings when looking at too many things at one time (classroom walls filled with letters, numbers, shapes, colors, student art, days of the week, rules lists, etc.).
- Overstimulation, possibly resulting in an emotional meltdown when in the presence of a lot of activity or people, such as attending a carnival
Many children have issues with the way they process their auditory sense. They may have trouble hearing things that most people can hear (underresponsive) or they may hear things that most people can’t hear (overresponsive). In my office, the auditory processing issues that I typically see include:
- Avoidance of noises that are tolerable to the “normal” person (usually evidenced by running and hiding or cupping hands over the ears)
- Hearing background noises as clearly, or more clearly, than the foreground noises (i.e. mom is asking the child to clean his room and while she speaks, he hears the lawmower outside and the dog barking next door just as clearly as he is supposed to hear his mom’s words).
- Not responding to words spoken to the child
While all of the senses are a big deal with SPD, taste may be one of the most affected areas (at least within my practice). A child’s taste buds could underrespond to different tastes, meaning that the child may not really like anything because everything tastes dull, or overrespond to different tastes, meaning that the child may hate most things because his sense of taste is so intense. In my practice, I’ll see kids who avoid different foods because of textures, as I mentioned in the Touch section, but I’ll also see kids who will specifically avoid certain tastes, and will fight to the death to make sure that that food does not touch their tongue…ever!
Just like all of the other senses, the body can over or underrespond to the olfactory sense in a variety of ways. Basically this just means that reactions can range from the nose having a very difficult time detecting any scents, or the nose detecting even the slightest hint of a scent. You’re probably familiar with people who can’t be around the smells of perfumes because their body overreacts to these scents. SPD could be the issue. In my practice and conversations with other providers, I’ve seen or heard the following reactions to the olfactory sense:
- A child walks around the classroom and in the hallway sniffing others
- A child sits in a classroom with closed windows but still can easily smell the flowers outside the window
- A child begins to gag while he sits at the lunch table and smells his peer’s lunch
When you think of the senses, balance doesn’t typically draw your attention. But when discussing SPD, there are more than just the 5 senses that we typically think of. The vestibular sense is basically the ability of the body to maintain balance when exposed to a variety of stimuli. I actually see a lot of this in my practice and some of the issues include:
- Refusal to participate in a variety of activities that involve gross motor skills (jumping, bouncing, etc)
- Avoidance of unstable areas, like stairs, elevators, escalators, boats, etc.
- Avoidance of activities that involve a lot of unstable movement, like swings, merry-go-rounds, and other rides
- Difficulty climbing, jumping, running and participating in most gross motor activities, despite an honest effort to try
Once again, the proprioceptive sense is not one that we typically think of when naming the senses, but with SPD, this is relevant. In layman’s terms, the proprioceptive sense is how the body produces muscular reactions to stimuli. The proprioceptive system works together with the vestibular system to use the muscles to control and balance the body appropriately.
What I’ve learned throughout the last few years of working with children who are experiencing this disorder, is that when any of the other senses are experienced at an uncomfortable level, the child may choose to avoid an activity. That avoidance leads to poor development of the vestibular and proprioceptive senses, because the muscles aren’t participating in the activity.
Why Is It Important?
Why am I going on and on about SPD and how it affects the senses? Because SPD in itself can create such an imbalance in a child that the child can’t even think about listening to your directions or using his kind words instead of smacking his friends because he is so overwhelmed.
When the teacher says, “Sit criss cross applesauce” to her preschool class, Andrew is thinking to himself “My tag hurts. It’s itchy. My tag hurts. Stop it tag!” until his teacher raises her voice loud enough and gives him a stern face, and then he cries.
Addison is sitting at her desk listening to the loud sound of the buzzing fluorescent lights when her teacher asks her to identify the letter. Addison is staring everywhere else besides the teacher. The teacher repeats her request two times before Addison even looks her direction. Then Addison says, “What?”
During free play time at preschool, Zoe is playing with the doll house when three other giggling girls join her in the station. Zoe instantly feel threatened, grabs all of the dolls and curls into a ball with them. The other girls look at her funny and then walk away.
In gym class, all of the children are asked to walk across the balance beam. When Logan is given a turn, he runs away and refuses. His gym teacher allows him to sit out and watch the rest of the class and go last. When he refuses at the end of the class period, his gym teacher writes a note about his defiance and sends him to the principal’s office.
In all of these cases, one of the child’s senses overwhelmed the child to the point that he or she couldn’t achieve the simple task at hand. It wasn’t necessarily that the child didn’t want to do the task that he or she was asked to do, but instead that the child’s body was so overwhelmed by the sensory input or distracted to the point that it was impossible to accomplish the task.
If you’re like most adults, you may be saying to yourself, “Ok, so the kid has SPD, but I’m still the adult and he still has to listen to me!” This is somewhat true. All of the kids that come to see me will have to learn how to react to their environment, because unfortunately, the rest of the world isn’t going to change and neither is the way that their body processes the senses. Instead, the child will need to learn how to better understand his body and to teach himself skills to get though those tasks that are difficult due to his senses. However, this does not equate to the concept of “I’m the adult, he’s the kid and he has to listen.”
If you’re having a hard time with this, think of this example:
Your back is hurting and you need to go to the chiropractor to get things realigned. Your boss asks you to go unload a truckload of office supplies that just got delivered. Do you agree to complete the task because your boss is your authority? Most likely not. Most likely, as an adult you recognize your right to say that you can’t or should not participate in that activity right now because of the condition of your back.
Asking a child to behave, listen to directions or accomplish some task before the child’s body has been “re-aligned” is basically the same thing. The child’s body, mind and emotions have to be regulated and prepared for the activity first, or you won’t get much accomplished. And this has nothing to do with the child’s will to participate in the activity, but instead their physical ability to do so.
How Is It Treated?
The primary professionals who treat SPD are occupational therapists (OT). The child will get to participate in fun activities that help the child to better learn how he processes sensory input and how his body responds to the input, so that he can learn to function better on a daily basis.
In my case, if a child seems to be showing some sensory processing concerns, I’ll send the child and his family to an OT and then collaborate with the OT to ensure that his mental health therapy aligns consistently with it. That way, if there is any lapse between the sensory issues and the causes of the behavior problems, I’m there to identify where SPD stops and negative, defiant or other behavior problems start.
If you’ve read this article and thought that possibly your child could be experiencing SPD, or a sensory processing issue of some kind, consider talking with a mental health professional or an OT to learn if your child would benefit from either type of therapy.
In Sioux Falls, SD, you can find an occupational therapist at any of the following locations:
If you’d like to see what it’s like to experience SPD from the point of view of a child, check out this awesome video about a little boy with SPD talking about how the SPD affects him on a daily basis.