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Sensory processing disorder | |
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Other names | Sensory integration dysfunction |
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An SPD nosology proposed by Miller LJ et al. (2007) [1] | |
Specialty | Psychiatry, occupational therapy, neurology |
Symptoms | Hypersensitivity and hyposensitivity to stimuli, and/or difficulties using sensory information to plan movement. Problems discriminating characteristics of stimuli. |
Complications | Low school performance, behavioral difficulties, social isolation, employment problems, family and personal stress |
Usual onset | Uncertain |
Risk factors | Anxiety, behavioral difficulties |
Diagnostic method | Based on symptoms |
Treatment |
Sensory processing disorder (SPD, formerly known as sensory integration dysfunction) is a condition in which multisensory input is not adequately processed in order to provide appropriate responses to the demands of the environment. Sensory processing disorder is present in many people with dyspraxia, autism spectrum disorder and attention deficit hyperactivity disorder. Individuals with SPD may inadequately process visual, auditory, olfactory (smell), gustatory (taste), tactile (touch), vestibular (balance), proprioception (body awareness), and interoception (internal body senses) sensory stimuli.
Sensory integration was defined by occupational therapist Anna Jean Ayres in 1972 as "the neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment". [2] [3] Sensory processing disorder has been characterized as the source of significant problems in organizing sensation coming from the body and the environment and is manifested by difficulties in the performance in one or more of the main areas of life: productivity, leisure and play [4] or activities of daily living. [5]
Sources debate whether SPD is an independent disorder or represents the observed symptoms of various other, more well-established, disorders. [6] [7] [8] [9] SPD is not included in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, [10] [11] and the American Academy of Pediatrics has recommended in 2012 that pediatricians not use SPD as a stand-alone diagnosis. [10]
Sensory integration difficulties or sensory processing disorder (SPD) are characterized by persistent challenges with neurological processing of sensory stimuli that interfere with a person's ability to participate in everyday life. Such challenges can appear in one or several sensory systems of the somatosensory system, vestibular system, proprioceptive system, interoceptive system, auditory system, visual system, olfactory system, and gustatory system. [ citation needed ]
While many people can present one or two symptoms, sensory processing disorder has to have a clear functional impact on the person's life:
Signs of over-responsivity, [12] including, for example, dislike of textures such as those found in fabrics, foods, grooming products or other materials found in daily living, to which most people would not react, and serious discomfort, sickness or threat induced by normal sounds, lights, ambient temperature, movements, smells, tastes, or even inner sensations such as heartbeat.[ citation needed ]
Signs of under-responsivity, including sluggishness and lack of responsiveness.
Sensory cravings, [13] including, for example, fidgeting, impulsiveness, and/or seeking or making loud, disturbing noises; and sensorimotor-based problems, including slow and uncoordinated movements or poor handwriting.
Sensory discrimination problems, which might manifest themselves in behaviors such as things constantly dropped.[ citation needed ]
Symptoms may vary according to the disorder's type and subtype present.[ citation needed ]
Sensory integration and processing difficulties can be a feature of a number of disorders, including anxiety problems, attention deficit hyperactivity disorder (ADHD), [14] food intolerances, behavioral disorders, and particularly, autism spectrum disorders. [15] [16] [17] This pattern of comorbidities poses a significant challenge to those who claim that SPD is an identifiably specific disorder, rather than simply a term given to a set of symptoms common to other disorders. [18]
Two studies have provided preliminary evidence suggesting that there may be measurable neurological differences between children diagnosed with SPD and control children classified as neurotypical [19] or children diagnosed with autism. [20] Despite this evidence, that SPD researchers have yet to agree on a proven, standardized diagnostic tool undermines researchers' ability to define the boundaries of the disorder and makes correlational studies, like those on structural brain abnormalities, less convincing. [21]
The exact cause of SPD is not known. [22] However, it is known that the midbrain and brainstem regions of the central nervous system are early centers in the processing pathway for multisensory integration; these brain regions are involved in processes including coordination, attention, arousal, and autonomic function. [23] After sensory information passes through these centers, it is then routed to brain regions responsible for emotions, memory, and higher level cognitive functions.
Research in sensory processing in 2007 is focused on finding the genetic and neurological causes of SPD. Electroencephalography (EEG), [24] measuring event-related potential (ERP), and magnetoencephalography (MEG) are traditionally used to explore the causes behind the behaviors observed in SPD.
Differences in tactile and auditory over-responsivity show moderate genetic influences, with tactile over-responsivity demonstrating greater heritability. [25] Differences in auditory latency (the time between the input is received and when reaction is observed in the brain), hypersensitivity to vibration in the Pacinian corpuscles receptor pathways, and other alterations in unimodal and multisensory processing have been detected in autism populations. [26]
People with sensory processing deficits appear to have less sensory gating than typical subjects, [27] [28] and atypical neural integration of sensory input. In people with sensory over-responsivity, different neural generators activate, causing the automatic association of causally related sensory inputs that occurs at this early sensory-perceptual stage to not function properly. [29] People with sensory over-responsivity might have increased D2 receptor in the striatum, related to aversion to tactile stimuli, and reduced habituation. In animal models, prenatal stress significantly increased tactile avoidance. [30]
Recent research has also found an abnormal white matter microstructure in children with SPD, compared with typical children and those with other developmental disorders such as autism and ADHD. [31] [32]
One hypothesis is that multisensory stimulation may activate a higher-level system in the frontal cortex that involves attention and cognitive processing, rather than the automatic integration of multisensory stimuli observed in typically developing adults in the auditory cortex. [26] [29]
Sensory processing disorder is accepted in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R). It is not recognized as a mental disorder in medical manuals such as the ICD-10 [33] or the DSM-5. [34]
There is not single test to diagnose this. Diagnosis is primarily arrived at by the use of standardized tests, standardized questionnaires, expert observational scales, and free-play observation at an occupational therapy gym. Observation of functional activities might be carried at school and home as well. [35]
Though diagnosis in most of the world is done by an occupational therapist, in some countries diagnosis is made by certified professionals, such as psychologists, learning specialists, physiotherapists and/or speech and language therapists. [36] Some countries recommend to have a full psychological and neurological evaluation if symptoms are too severe.[ citation needed ]
Construct-related evidence relating to sensory integration and processing difficulties from Ayres' early research emerged from factor analysis of the earliest test the SCISIT and Mulligan's 1998 "Patterns of Sensory Integration Dysfunctions: A Confirmatory Factor Analysis". [42] Sensory integration and processing patterns recognised in the research support a classification of difficulties related to:
Proponents of a new nosology SPD have instead proposed three categories: sensory modulation disorder, sensory-based motor disorders and sensory discrimination disorders [1] (as defined in the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood). [43] [44]
Sensory modulation refers to a complex central nervous system process [1] [45] by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted. [46]
SMD consists of three subtypes:
According to proponents, sensory-based motor disorder shows motor output that is disorganized as a result of incorrect processing of sensory information affecting postural control challenges, resulting in postural disorder, or developmental coordination disorder. [1] [47]
The SBMD subtypes are:
Sensory discrimination disorder involves the incorrect processing of sensory information. [1] The SDD subtypes are: [48]
Typically offered as part of occupational therapy, ASI that places a child in a room specifically designed to stimulate and challenge all of the senses to elicit functional adaptive responses. Occupational therapy is defined by the American Occupational Therapy Association (AOTA) as "Occupational therapy practitioners in pediatric settings work with children and their families, caregivers and teachers to promote participation in meaningful activities and occupations". In childhood, these occupations may include play, school and learning self-care tasks. An entry-level occupational therapist can provide treatment for sensory processing disorder; however, more advanced clinical training exists to target the underlying neuro-biological processes involved.
[49] Although Ayres initially developed her assessment tools and intervention methods to support children with sensory integration and processing challenges, the theory is relevant beyond childhood. [50] [51] [52]
Sensory integration therapy is driven by four main principles: [53]
Serious questions have been raised as to the effectiveness of this therapy [54] [55] [56] [57] particularly in medical journals where the requirements for a treatment to be effective is much higher and developed than its occupational therapy counterparts which often advocate the effectiveness of the treatment. [58] [59]
This therapy retains all of the above-mentioned four principles and adds: [60]
While occupational therapists using a sensory integration frame of reference work on increasing a child's ability to adequately process sensory input, other OTs may focus on environmental accommodations that parents and school staff can use to enhance the child's function at home, school, and in the community. [61] [62] These may include selecting soft, tag-free clothing, avoiding fluorescent lighting, and providing ear plugs for "emergency" use (such as for fire drills).[ citation needed ]
A 2019 review found sensory integration therapy to be effective for autism spectrum disorder. [63] Another study from 2018 backs up the intervention for children with special needs, [64] Additionally, the American Occupational Therapy Association supports the intervention. [65]
In its overall review of the treatment effectiveness literature, Aetna concluded that "The effectiveness of these therapies is unproven", [66] while the American Academy of Pediatrics concluded that "parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive." [67] A 2015 review concluded that SIT techniques exist "outside the bounds of established evidence-based practice" and that SIT is "quite possibly a misuse of limited resources." [68]
It has been estimated by proponents that up to 16.5% of elementary school aged children present elevated SOR behaviors in the tactile or auditory modalities. [69] This figure is larger than what previous studies with smaller samples had shown: an estimate of 5–13% of elementary school aged children. [70] Critics have noted that such a high incidence for just one of the subtypes of SPD raises questions about the degree to which SPD is a specific and clearly identifiable disorder. [21]
Proponents have also claimed that adults may also show signs of sensory processing difficulties and would benefit for sensory processing therapies, [71] although this work has yet to distinguish between those with SPD symptoms alone vs adults whose processing abnormalities are associated with other disorders, such as autism spectrum disorder. [72]
The American Occupational Therapy Association (AOTA) and British Royal College of Occupational Therapy (RCOT) support the use of a variety of methods of sensory integration for those with sensory integration and processing difficulties. Both organizations recognise the need for further research about Ayres' Sensory Integration and related approaches. In the USA this important to increase insurance coverage for related therapies. AOTA and RCOT have made efforts to educate the public about sensory Integration and related approaches. AOTA's practice guidelines and RCOT's informed view "Sensory Integration and sensory-based interventions" [73] currently support the use of sensory integration therapy and interprofessional education and collaboration in order to optimize treatment for those with sensory integration and processing difficulties. The AOTA provides several resources pertaining to sensory integration therapy, some of which includes a fact sheet, new research, and continuing education opportunities. [74]
There are concerns regarding the validity of the diagnosis. SPD is not included in the DSM-5 or ICD-10, the most widely used diagnostic sources in healthcare. The American Academy of Pediatrics (AAP) in 2012 stated that there is no universally accepted framework for diagnosis and recommends caution against using any "sensory" type therapies unless as a part of a comprehensive treatment plan. The AAP has plans to review its policy, though those efforts are still in the early stages. [75]
A 2015 review of research on Sensory Integration Therapy (SIT) concluded that SIT is "ineffective and that its theoretical underpinnings and assessment practices are unvalidated", that SIT techniques exist "outside the bounds of established evidence-based practice", and that SIT is "quite possibly a misuse of limited resources". [68]
Some sources point that sensory issues are an important concern, but not a diagnosis in themselves. [76] [77]
Critics have noted that what proponents claim are symptoms of SPD are both broad and, in some cases, represent very common, and not necessarily abnormal or atypical, childhood characteristics. Where these traits become grounds for a diagnosis is generally in combination with other more specific symptoms or when the child gets old enough to explain that the reasons behind their behavior are specifically sensory. [78]
SPD is in Stanley Greenspan's Diagnostic Manual for Infancy and Early Childhood and as Regulation Disorders of Sensory Processing part of The Zero to Three's Diagnostic Classification.
Is not recognized as a stand-alone diagnosis in the manuals ICD-10 or in the recently updated DSM-5, but unusual reactivity to sensory input or unusual interest in sensory aspects is included as a possible but not necessary criterion for the diagnosis of autism. [79] [78]
Sensory processing disorder as a specific form of atypical functioning was first described by occupational therapist Anna Jean Ayres (1920–1989). [80]
Ayres's theoretical framework for what she called Sensory Integration Dysfunction was developed after six factor analytic studies of populations of children with learning disabilities, perceptual motor disabilities and normal developing children. [81] Ayres created the following nosology based on the patterns that appeared on her factor analysis:
Both visual perceptual and auditory language deficits were thought to possess a strong cognitive component and a weak relationship to underlying sensory processing deficits, so they are not considered central deficits in many models of sensory processing.[ citation needed ]
In 1998, Mulligan found a similar pattern of deficits in a confirmatory factor analytic study. [82] [83]
Dunn's nosology uses two criteria: [84] response type (passive vs. active) and sensory threshold to the stimuli (low or high) creating four subtypes or quadrants: [85]
In Miller's nosology "sensory integration dysfunction" was renamed into "Sensory processing disorder" to facilitate coordinated research work with other fields such as neurology since "the use of the term sensory integration often applies to a neurophysiologic cellular process rather than a behavioral response to sensory input as connoted by Ayres." [1]
The sensory processing model's nosology divides SPD in three subtypes: modulation, motor based and discrimination problems. [1]
Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a term formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.
Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.
Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.
Multisensory integration, also known as multimodal integration, is the study of how information from the different sensory modalities may be integrated by the nervous system. A coherent representation of objects combining modalities enables animals to have meaningful perceptual experiences. Indeed, multisensory integration is central to adaptive behavior because it allows animals to perceive a world of coherent perceptual entities. Multisensory integration also deals with how different sensory modalities interact with one another and alter each other's processing.
High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.
A hug machine, also known as a hug box, a squeeze machine, or a squeeze box, is a therapeutic device designed to calm hypersensitive persons, usually individuals with autism spectrum disorders. The device was invented by Temple Grandin to administer deep-touch pressure, a type of physical stimulation often self-administered by autistic individuals as a means of self-soothing.
Sensory processing is the process that organizes and distinguishes sensation from one's own body and the environment, thus making it possible to use the body effectively within the environment. Specifically, it deals with how the brain processes multiple sensory modality inputs, such as proprioception, vision, auditory system, tactile, olfactory, vestibular system, interoception, and taste into usable functional outputs.
Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.
Auditory integration training (AIT) is a procedure pioneered in France by Guy Bérard. Bérard promoted AIT as a cure for clinical depression and suicidal tendencies, along with what he said were very positive results for dyslexia and autism, although there has been very little empirical evidence regarding this assertion. AIT typically involves 20 half-hour sessions over 10 days listening to specially filtered and modulated music. It was used in the early 1990s as a treatment for autism. Since, it has been promoted as a treatment for ADHD, depression, and a wide variety of other disorders. AIT has not met scientific standards for efficacy that would justify its use as a treatment for any condition.
Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia, is a neurodevelopmental disorder characterized by impaired coordination of physical movements as a result of brain messages not being accurately transmitted to the body. Deficits in fine or gross motor skills movements interfere with activities of daily living. It is often described as disorder in skill acquisition, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age. Difficulties may present as clumsiness, slowness and inaccuracy of performance of motor skills. It is often accompanied by difficulty with organisation and/or problems with attention, working memory and time management.
The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation.
Sensory integration therapy (SIT) was originally developed by occupational therapist A. Jean Ayres in the 1970s to help children with sensory-processing difficulties. It was specifically designed to treat Sensory Processing Disorder. Sensory Integration Therapy is based on A. Jean Ayres's Sensory Integration Theory, which proposes that sensory-processing is linked to emotional regulation, learning, behavior, and participation in daily life. Sensory integration is the process of organizing sensations from the body and environmental stimuli.
Auditory processing disorder (APD), rarely known as King-Kopetzky syndrome or auditory disability with normal hearing (ADN), is a neurodevelopmental disorder affecting the way the brain processes sounds. Individuals with APD usually have normal structure and function of the ear, but cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech. It is thought that these difficulties arise from dysfunction in the central nervous system. This is, in part, essentially a failure of the cocktail party effect found in most people.
The American Occupational Therapy Association (AOTA) is the national professional association established in 1917 to represent the interests and concerns of occupational therapy practitioners and students and improve the quality of occupational therapy services. AOTA membership is approximately 63,000 occupational therapists, occupational therapy assistants, and students.
Anna Jean Ayres was an American occupational therapist, educational psychologist and advocate for individuals with special needs. She became known for her work on sensory integration (SI) theory.
Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.
Doing business as STAR Institute the STAR Center Foundation is a registered 501(c)(3), nonprofit organization dedicated to treatment, research and education related to sensory integration and processing.
Elnora M. Gilfoyle is a retired American occupational therapist, researcher, educator, and university administrator. She worked at several hospitals before accepting a professorship at Colorado State University, later serving as Dean of the College of Applied Human Sciences and Provost/Academic Vice President at that university. She is also a past president of the American Occupational Therapy Association. With research interests in child development, developmental disabilities, and child abuse, she has led studies on the state and federal levels. The co-author of two books and many articles, she was inducted into the Colorado Women's Hall of Fame in 1996.
Lorraine E. Bahrick is a developmental psychologist known for her research on intermodal perception and effects of inter-sensory redundancy on learning in infancy and early childhood. Her work in these areas involves investigating how the integration of information from various sensory modalities, such as vision, hearing, and touch, contributes to the cognitive, perceptual, and social development of infants and children. She also explores how the redundancy or overlap of sensory information, influences these developmental processes. She is Distinguished University Professor of Psychology at Florida International University and the Director of Infant Development Lab.
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