Signs of Sensory Processing Disorder in Children with ADHD

How Sensory Processing Disorder Looks A Lot Like ADHD

Sensory Processing Disorder is not just about itchy tags. It is a complex and multi-faceted condition that is often mistaken for ADHD, anxiety, and other conditions. A must-read for parents by the author of “The Out-of-Sync Child.”

At First, I Thought It Was ADHD

I got my start in Sensory Processing Disorder when I was a teacher — some of the kids I was teaching seemed so out-of-sync, and I couldn’t understand why. What was so dreadful about a tambourine being played? Why did some children avoid the jungle gym at all costs, while others could never get off? Why did one child never take his feet off the ground, ever? I wondered if it was ADHD — but the diagnosis didn’t quite fit. When I finally discovered SPD, it opened my eyes to what these children were dealing with.

Our 8 (Yes, 8) Senses

We have at least eight senses. Most people know about the classic five: seeing, hearing, smelling, tasting, and touching. But many are unaware of the other three:
1. The vestibular sense: the “master sense” connected to our inner ear, which tells us where we are, how fast we’re moving, if we’re falling, etc.
2. Proprioception: the muscle and joint sense, which helps us know how to get into a coat or how to get up the stairs
3. Interoception: internal organs senses that let us know if we’re hungry, thirsty, have to go to the bathroom, etc.

Typical Sensory Processing

Senses serve a number of purposes. First and foremost, they keep us safe — they tell us that a Frisbee is coming toward our head, for example — and we need to duck! Once we’re safe, we can follow up on sensory stimuli, and start to learn. This is calleddiscrimination — we can look at the people playing Frisbee and teach ourselves what they’re doing, so maybe next time we can jump up and catch the Frisbee and start to play.

Next, we use our senses forsatisfaction  — we identify things that feel good, and we continue to do those things because they bring us joy. Finally, we need our senses foraction — we plan out what we’d like to do, then combine our senses together to execute the action.

How SPD Scrambles Messages

These tools — reacting, learning, enjoying, and taking action — are used every moment of our lives. Sensory processing disorder puts all those everyday functions out of order.

Ordinary sensory experiences — like things we see, feel, and do — are processed in anatypical way when you have SPD. The term “atypical” can mean a lot of things in SPD — perhaps the brain responds late, or perhaps it doesn’t respond at all. Perhaps it responds incorrectly. But ultimately, we don’t respond to our sensory input as we typically should, and that leads to a host of problems.

3 Types of Sensory Processing Disorder

SPD is far from a one-size-fits-all disorder. There are three major categories — each with a few subtypes! It’s important to remember that these categories are not mutually exclusive; someone with SPD can have symptoms from more than one category and subtype, which can confuse parents or professionals striving to make an accurate diagnosis.

1. Sensory Modulation Disorder

Sensory modulation is the first category of SPD, with three subtypes of its own. The first is sensory over-responsivity. We call this child the “avoider,” because she goes out of her way to avoid sensory stimulation — by covering her ears, hiding under her desk, or closing her eyes. Her sensory input is too sensitive, and everything seems like too much for her.

Modulation Problems, Continued

The second subtype is under-responsivity; this child is the “disregarder.” This child won’t notice what’s going on around him — even if it’s extra loud, bright and colorful, or an extreme temperature. His sensory input is muted, so he often seems uncaring or withdrawn. In reality, he just isn’t noticing what’s happening to his senses.

Sensory-Seeking Kids

The third subtype is sensory craving; this child is known as the “seeker,” or sometimes, the “bumper and crasher.” This childwants sensations, as many as possible. She’ll be a daredevil, climbing to the highest branch or swinging the farthest on the tire swing. Her sensory input is never enough, and she always wants more, more, more.

2. Sensory Discrimination Difficulties

The second category of SPD is difficulty with sensory discrimination, or using the senses to learn. Let’s call this child the “jumbler.” This child struggles to use his senses to make judgments, so even if he’s done a task many times before, he goes into it blind each time. If he has to pick up a bucket of water every day, for example, he forgets the information he learned the last time he picked something up. He doesn’t use his proprioception to evaluate how much the bucket might weigh, and perhaps he picks it up with too much force and water slops everywhere. Or he may not use enough and can’t get a grip on it. For children, being the jumbler can be embarrassing. They’re always “messing up” simple tasks, and are often teased by others.

3. Sensory-Based Motor Disorder

The final category of SPD, sensory-based motor disorder, has two subtypes. The first is postural disorder — let’s call this child the “slumper.” The slumper has difficulty with movement, and moves in a clumsy, disorganized way. He may have difficulty stabilizing himself. He may struggle to run without tripping over his feet. Kids with postural disorder have difficulty crossing the midline, or using the hands and feet on one side of the body on the other side.

Dyspraxia

The second subtype is dyspraxia, or the “fumbler.” This child will have difficulty planning and executing actions. If you hand him a box, for example, and ask him to do something with it, he won’t know what to do. A neurotypical child will say, “I can climb in the box. I can go under the box. I can push the box.” The fumbler will struggle to come up with an “action idea.” He’ll prefer toys, games, and situations that are familiar, instead of novel — new situations require new motor planning, and a child with dyspraxia will shy away from that.

Is My Child Affected By SPD?

Put on your sensory goggles to find out! “Sensory goggles” is a term invented by two SPD moms, Laurie Wienke and Carrie Fannin. Essentially, it encourages parents to look at their child’s behaviors through a sensory point of view, to try to determine if they may be caused by SPD. Ask yourself: Is my child seeking more touch or movement than other children do? Is my child avoidingeveryday touch and movement? Does she have difficulty functioning in certain environments where a lot of senses are used? If your child expresses some or all of these behaviors, consider SPD.

Is Your Child Using Self-Therapy?

If you answer yes to some or all of your “sensory goggle” questions, follow up with one more: What is my child’s self-therapy?

Children with SPD may not know they have a “disorder,” but they instinctively know what situations are difficult for them, and what they can do to seek relief. A child who is a “seeker,” for instance, may stay on the swings for hours, trying to swing higher and higher each time. A child who is an “avoider,” on the other hand, may spend entire days under his comforter on his bed, where he feels safe and unstimulated. If your child engages in unusual behaviors or does certain things significantly more than other children his age, look into SPD.

Symptom Overlap Between SPD and ADHD

Surprisingly, some of the most outwardly obvious symptoms of SPD are inattention, hyperactivity, and impulsivity. Sound familiar?

SPD is misdiagnosed as ADHD all the time. So, when faced with common symptoms, parents and doctors need to look at other possibilities — particularly SPD. Why are children inattentive? It could be ADHD, sure. Or it could be a child with SPD, unable to focus because his chair is wobbly — and his vestibular sense is reacting improperly, making him feel like he’s going to be thrown off the face of the earth.

Hyperactivity in SPD

Hyperactivity and impulsivity can be symptoms of SPD as well. A child who can’t sit in his seat may be “seeking” more sensory input, or trying to escape an overwhelming sensation. He may be unconsciously trying to escape from a flickering florescent light, for example, that’s irritating his senses and driving him crazy. Young children, in particular, may not be able to explain why they act the way they do, so it’s important for adults to carefully observe the child’s behaviors — and ask the right questions.

How Parents Can Help

What can you do, as a parent, to help your child with SPD? First, you can get your kids playing vigorously with open-ended fun — outside whenever possible. Outdoor play — without unnecessary rules and restrictions — is key to developing and enhancing a child’s sensory processing. Dr. Jean Ayres, the SPD pioneer, once said, “Fun is the child’s word for sensory integration.” If your child is engaged in using his senses, he’s strengthening his sensory responses and his brain.

The Power of Touch

The right kind of touch can be very soothing for a child, especially when she’s upset. If your child is having a meltdown, the best course of action may be to embrace her in a strong hug, or have him lay on the couch while you gently press on his back and legs. Teach her how to squeeze her own body when she’s upset — squeezing the forearms, biceps, shoulders, or thighs can deliver calming pressure to an overstimulated child.

Treatment with OTSI

The most effective treatment for SPD is occupational therapy, more commonly referred to as OT. The specific type of OT is called OTSI — or occupational therapy using sensory integration techniques.

Specific techniques can vary widely from child to child, depending on their particular difficulties, but the overall goal is always the same: to get the brain-body connection working more smoothly. The therapist will try to engage the child in activities that interest her, while speaking to her sensory difficulties. An “avoider” child, for instance, may be presented with fun prizes hidden inside various materials — shaving cream is a common example. He may be hesitant to touch at first, but he’ll eventually become curious for the prize and dig his hands into the shaving cream — strengthening his sensory response and helping him manage his aversion to new textures.

Timing of Treatment

With SPD treatment, younger is usually better — young children’s brains are more malleable, and respond well to effective early intervention. But OTSI can be implemented at any age — even for adults! Old dogs may take longer to learn new tricks, but therapy can “bend” the brain of someone with SPD, making it possible for them to function more happily.

Treating ADHD and SPD

Some studies have shown that as many as 40 percent of a population of SPDers and ADHDers will actually have both conditions. This overlap is important for doctors to know, because treatment should be tailored to each child’s unique situation. Stimulant medication for ADHD, for example, won’t help a child’s SPD. Occupational therapy, on the other hand, may not fully control ADHD symptoms, but it will most likely benefit the child regardless. My suggestion is to start with OT — if ADHD symptoms remain a problem, revise your treatment strategy to include ADHD-specific interventions.

Think Your Child Has SPD?

If you suspect that your child may have some sensory issues, don’t hesitate to go for an evaluation. Sometimes, you don’t need a full assessment — just a conversation with a qualified OT may help you solve the puzzle. If you’d like, it’s okay to try a few sessions of OT without a formal diagnosis, just to see how your child responds. Almost every child loves sensory integration techniques, and even those who don’t qualify for a formal SPD diagnosis will most likely benefit from some fun OT sessions.

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