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Sensory processing disorder
Difficulty processing and responding to multiple sensory inputs From Wikipedia, the free encyclopedia
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Sensory processing disorder (SPD), formerly known as sensory integration dysfunction, is a condition in which the brain has trouble receiving and responding to information from the senses. People with SPD may be overly sensitive (hypersensitive) or under-responsive (hyposensitive) to sights, sounds, touch, taste, smell, balance, body position, or internal sensations. This can make it difficult to react appropriately to daily situations.
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SPD is often seen in people with other conditions, such as dyspraxia, autism spectrum disorder, or attention deficit hyperactivity disorder (ADHD). Symptoms can include strong reactions to sensory input, difficulty organizing sensory information, and problems with coordination or daily tasks.[1][2][3]
There is ongoing debate about whether SPD is a distinct disorder or a feature of other recognized conditions.[4][5][6][7] SPD is not recognized as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or by the American Academy of Pediatrics, which recommends against using SPD as a stand-alone diagnosis.[8][9]
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Signs and symptoms
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People with sensory processing disorder (SPD) have ongoing trouble handling information from their senses. These difficulties can make daily life more challenging at home, school, or work. SPD can affect one or more senses, such as touch, balance, body awareness, signals from inside the body, hearing, sight, smell, or taste.[10]
For a diagnosis of SPD, these issues must clearly interfere with daily activities.[11] Symptoms can vary from person to person.[citation needed]
Main types of symptoms
Common symptom patterns include:
- Over-responsivity: Strong or uncomfortable reactions to normal sensations, such as textures, sounds, lights, smells, tastes, temperature, movement, or feelings inside the body.[12][citation needed]
- Under-responsivity: Not noticing or reacting to sensations that most people would, such as loud noises, pain, or movement.
- Sensory seeking: Frequently looking for stronger or more varied sensory input, such as fidgeting, making loud noises, or moving around a lot.[13]
- Movement and coordination problems: Trouble with balance, clumsiness, or tasks like writing or tying shoes.
- Sensory discrimination difficulties: Difficulty telling apart similar sensations, which can lead to dropping objects or missing changes in the environment.[citation needed]
These symptoms may appear alone or together, and their severity can range from mild to severe.
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Relationship to other conditions
Sensory processing difficulties can also be present in anxiety disorders, attention deficit hyperactivity disorder (ADHD),[14] food intolerances, behavioral disorders, and especially autism spectrum disorder (ASD).[15][16][17] This overlap makes it challenging to determine whether SPD is a separate disorder or a set of symptoms found in other conditions.[18]
Some research has found measurable neurological differences in children with SPD compared to both neurotypical children and those with autism.[19][20] However, the lack of standardized diagnostic criteria for SPD limits the interpretation of these findings.[21]
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Causes
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.
Mechanism
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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]
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Diagnosis
Sensory processing disorder (SPD) is recognised in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R), but it is **not** included in either the ICD-10[33] or the DSM-5.[34]
There is no single test for SPD. Clinicians typically combine:
- Standardised performance tests
- Care-giver or self-report questionnaires
- Structured observations in clinic, home, and school settings
Assessment is usually led by an occupational therapist; in some regions psychologists, physiotherapists, speech-language therapists, or other certified professionals may also diagnose SPD.[35] A full psychological or neurological evaluation is often recommended for severe cases.[citation needed]
Standardised tests
Standardised questionnaires
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Classification
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Early research by Anna Jean Ayres and a 1998 study by Mulligan[41] identified patterns of sensory integration and processing difficulties, such as:
- Sensory registration and perception (discrimination)
- Sensory reactivity (modulation)
- Praxis (planning and doing movements)
- Postural, ocular, and bilateral integration
Some researchers have proposed three main categories of sensory processing disorder (SPD): sensory modulation disorder, sensory-based motor disorder, and sensory discrimination disorder.[42][43][44]
Sensory modulation disorder (SMD)
Sensory modulation refers to how the nervous system manages messages about the strength and type of sensory input.[42] SMD includes:
- Sensory over-responsivity
- Sensory under-responsivity
- Sensory seeking/craving
Sensory-based motor disorder (SBMD)
Sensory-based motor disorder affects movement due to problems with sensory processing.[42] This includes:
- Dyspraxia
- Postural disorder
Sensory discrimination disorder (SDD)
Sensory discrimination disorder means difficulty telling differences between sensory inputs.[42] Types include:
- Visual
- Auditory
- Tactile
- Gustatory (taste)
- Olfactory (smell)
- Vestibular (balance)
- Proprioceptive (body position)
- Interoceptive (internal body signals)
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Treatment
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Sensory integration therapy (ASI)
Ayres Sensory Integration (ASI) is usually delivered by an occupational therapist in a space designed to provide graded sensory-motor challenges. The goal is to support a child's engagement in everyday occupations such as play, learning and self-care.[45] Although developed for children, the approach has been applied across the lifespan.[46][47]
Four core ASI principles are commonly cited:
- Just-right challenge – tasks are achievable yet novel.
- Adaptive response – the child develops new, useful strategies.
- Active engagement – activities are play-based and intrinsically motivating.
- Child-directed – the child's interests guide the session.[48]
Evidence of effectiveness
Systematic reviews report mixed findings. Several medical reviews question the quality of the evidence base,[49][50] and the American Academy of Pediatrics advises that evidence remains limited and inconclusive.[51] In contrast, occupational-therapy reviews find moderate support for ASI when fidelity to the Ayres framework is high.[52]
Sensory processing therapy
This approach applies the same four ASI principles and adds: greater treatment intensity, a developmental focus, pre-/post-testing, strong parent education, and emphasis on ‘‘joie de vivre’’.[53]
Environmental and task adaptations
When underlying sensory processing cannot be changed quickly, therapists may recommend environmental modifications—for example:
- soft, tag-free clothing
- avoidance of fluorescent lighting
- ear defenders or ear-plugs for sudden loud sounds[54]
Evaluation of treatment effectiveness
A 2019 systematic review supported ASI for children on the autism spectrum,[55] and similar findings were reported in an earlier OT review.[52] The American Occupational Therapy Association recognises ASI as an intervention option.[56]
By contrast, an insurer's technology assessment concluded that evidence was insufficient,[57] and an academic review classified sensory-based interventions as outside established evidence-based practice.[58]
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Epidemiology
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.[59] This figure is larger than what previous studies with smaller samples had shown: an estimate of 5–13% of elementary school aged children.[60] 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,[61] 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.[62]
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Society and culture
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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"[63] 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.[64]
Controversy
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.[65]
A 2015 article 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".[66]
Some sources point that sensory issues are an important concern, but not a diagnosis in themselves.[67][68]
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.[69]
Manuals
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.[70][69]
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History
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Sensory processing disorder as a specific form of atypical functioning was first described by occupational therapist Anna Jean Ayres (1920–1989).[71]
Original model
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.[72] Ayres created the following nosology based on the patterns that appeared on her factor analysis:
- Dyspraxia: poor motor planning (more related to the vestibular system and proprioception)
- Poor bilateral integration: inadequate use of both sides of the body simultaneously
- Tactile defensiveness: negative reaction to tactile stimuli
- Visual perceptual deficits: poor form and space perception and visual motor functions
- Somatodyspraxia: poor motor planning (related to poor information coming from the tactile and proprioceptive systems)
- Auditory-language problems
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.[73][74]
Quadrant model
Dunn's nosology uses two criteria:[75] response type (passive vs. active) and sensory threshold to the stimuli (low or high) creating four subtypes or quadrants:[76]
- High neurological thresholds
- Low registration: high threshold with passive response. Individuals who do not pick up on sensations and therefore partake in passive behavior.[77]
- Sensation seeking: high threshold and active response. Those who actively seek out a rich sensory filled environment.[77]
- Low neurological threshold
- Sensitivity to stimuli: low threshold with passive response. Individuals who become distracted and uncomfortable when exposed to sensation but do not actively limit or avoid exposure to the sensation.[77]
- Sensation avoiding: low threshold and active response. Individuals actively limit their exposure to sensations and are therefore high self regulators.[77]
Sensory processing model
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."[78]
The sensory processing model's nosology divides SPD in three subtypes: modulation, motor based and discrimination problems.[78]
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See also
- Auditory processing disorder – Developmental or acquired neurological disorders
- Catatonia – Psychiatric behavioural syndrome
- Hyperacusis – Increased sensitivity to sound and decreased tolerance of noise
- Hyperesthesia – Abnormal increase in sensitivity to sensory stimuli
- Misophonia – Disorder of decreased tolerance to specific sounds
- Music therapy – Health profession
- Neurologic music therapy – Health profession
- Occupational science – Scientific discipline
- Sensory friendly – Sensory processing disorder accommodation
- Sensory integration therapy – Therapy designed to treat sensory processing disorder
- Sensory overload – State of overwhelm caused by an excess of sensory input
- Sensory processing sensitivity – Personality trait of highly sensitive people
- Snoezelen – Form of therapeutic relaxation
- Somatosensory disorder
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References
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