Case Presentation
7-year-old boy with “frequent meltdowns”. He has daily meltdowns (crying, hitting) with loud sounds or when asked to wear certain clothing. He wants to make friends but has poor boundaries and accidentally hurts peers at school when he is playing with them. His teacher reports he has a hard time sitting during seat work at school and prefers to move around when doing his work. There is no known language delay or intellectual delay.
The prevalence of Sensory Processing Disorder (SPD) is from 5-15% of school-aged children. SPD is commonly misunderstood and either under-diagnosed or misdiagnosed as autism or Attention Deficit Hyperactivity Disorder (ADHD). While children with autism commonly have sensory processing difficulties, it is possible for a child to have sensory processing challenges without an autism diagnosis.
Sensory processing is how the nervous system manages incoming sensory information and generates responses. Sensory integration is how the body’s eight senses work together to create the body’s responses. The eight senses include:
Sight Touch
Hearing Proprioception: the body’s sense of where it is in space
Smell Vestibular: the body’s sense of balance
Taste Interoception: the body’s sense of what is going on internally
A child is diagnosed with a SPD when there is difficulty taking in and interpreting sensory information so that an appropriate response can be generated. Here are some indicators that there might be a concern for SPD.
- Hyper-acute hearing
- Hypersensitive hearing
- Touch aversion
- Poor motor coordination
- Poor sense of boundaries
- High pain tolerance
- Aggression
- Distractibility
- Delayed language development
- Difficulty learning new things
It is not hard to see how these children can be misdiagnosed with autism or ADHD. Children with autism also have impairments in communication, social interactions and present with repetitive behaviors and restricted interests, symptoms that are not seen in SPD alone. Children with ADHD present with hyperactivity, impulsivity and inattention without other sensory processing difficulties.
The behavioral symptoms that are seen with SPD (namely aggression, distractibility, difficulty learning new things) occur as a result of the sensory processing difficulties. Sensory input is organized in a manner that enables an individual to establish a sense of where the body is in time and space, to feel safe in one’s own body and to accurately perceive the body’s relationship to the environment. When this doesn’t happen, it can lead to poor arousal regulation. One significant problem is that SPD is not identified as a diagnosis in the DSM, making it difficult to diagnose. Another barrier is that psychiatrists and medical professionals in general are not well trained in diagnosing SPD.
If there are concerns related to sensory processing, it is important to discuss with the treating provider(s) and consider a referral for an appropriate evaluation, most likely with an occupational therapist, who are trained to diagnosis SPD and other sensory challenges and make recommendations for the appropriate treatment.
Case Presentation
Parents discussed their concerns with their pediatrician and a referral was made to occupational therapy. The occupational therapist diagnosed the boy with a sensory processing disorder and provided sensory strategies to improve his regulation. The pediatrician also referred him to a child psychiatrist who diagnosed him with ADHD. Over time, parents noticed an improvement in behavioral concerns with OT and ADHD treatment.