Making Sense
Out of Sensory
Processing
Disorder
Kay Kopp, OTR/L
Tanyia Schier, MS,OTR/L
Mentorship at STAR Center
(Sensory Therapies and Research) near Denver, CO
Historical Evolution of SPD
A. Jean Ayres, PhD, OTR, sensory integration pioneer,
developed the theory, assessment and treatment methods
for sensory integration dysfunction
Lucy Jane Miller, PhD, OTR studied under Jean Ayres and has
furthered the work through her sensory research, education,
and treatment
Terminology
Originally termed sensory integration dysfunction
New terminology of sensory processing disorder
adopted
SPD Definition
A neurophysiologic condition in which sensory
input either from the environment or from one’s
body is poorly detected, modulated, or
interpreted and/or to which atypical responses
are observed. (Miller 2013)
Indicators of SPD includeinappropriate or
problematic motor, behavioral, attentional,
or adaptive responses following or anticipating
sensory stimulation
Sensory differences are only considered a “disorder”
when they cause significant difficulties with daily
routines and tasks (e.g. individual can’t cope or
compensate)
Quality of life is key in understanding the significance
of sensory impact on an individual
Etiology
Exact cause of SPD is not identified but preliminary
studies suggest a role of:
Genetics
Prenatal/birth complications
Environmental factors
SPD in Medical Community
Not recognized as a formal medical dx at this time
– came close in ICD-10 formulation
Sensory differences are included in DSM-5
diagnostic criteria for ASD
Included in the Diagnostic Manual for Infancy and
Early Childhood -
Section I – Primary Diagnosis: Axis I: Regulatory-Sensory Processing
Disorders
8 Sensory Systems
Auditory Vestibular System
sense of position & movement
Visual
Taste Proprioceptive System
joint & muscle sense
Smell
Touch Interoception System
sense of internal organs
Sensory Processing Disorder
(SPD)
Sensory Sensory-Based Sensory
Modulation Motor Disorder Discrimination
Disorder (SMD) (SBMD) Disorder
Postural Visual
SOR SUR SC Dyspraxia
Disorder
Auditory
Tactile
SOR=Sensory Over-Responsivity
SUR=sensory UnderResponsivity
SC=Sensory Craver Taste/Smell
Position/Mvmt
Interoception
Miller, L J, et. al., 2007
Phenotypes within
Sensory Modulation Disorder (SMD)
SMD = Impairment in detecting, modulating,
interpreting, or responding to sensory stimuli
Sensory over-responsivity
Sensory under-responsivity
Sensory craving
Sensory Over-Responsivity (SOR)
Hypersensitivity to sensations (visual stimuli,
sounds, touch, movement, tastes, smells)
Sensory Over-Responsive
Behaviors
Respond too much, too frequently, or too long to
sensory stimuli
Get aggressive or impulsive when overwhelmed
by sensory stimuli
Irritable, fussy, moody (hyperalert emotions)
Unsociable; avoids group activities, difficulty
forming relationships (social scene too overwhelming)
Excessively cautious and afraid to try new things
Upset by transition and unexpected changes
Sensory Under-Responsivity (SUR)
Individual is less sensitive to and less aware of
sensory stimuli than most people
Sensory Under-Responsivity
Behaviors
High pain threshold
Doesn’t noticed when touched
Unaware of need to go to the bathroom
Usually prefers sedentary activities
Passive, quiet, withdrawn
Difficult to engage in social interactions
Excessively slow to respond to directions
Lack motivation or drive
Sensory Craving
Individualseems to need much more
sensory stimuli than most people
Sensory Craving Behaviors
Constantly on the move
Likes crashing, jumping, rough housing
Excessive spinning, swinging, rocking
Constantly touches objects or people
Seeks vibration
Watches spinning objects
Constant talking; trouble turn taking in
conversation
Variability with SPD
Sensory differences can impact any individual sensory
system or multiple senses. Individual can have mixed
responses –
across sensory systems:
e.g. under-respond to touch input but over-respond to
auditory input
within sensory systems:
e.g. be over-responsive to light touch and craver of
deep touch
Quick Poll
Do you view yourself more as a sensory:
1.over-responder
2.under-responder
3. craver
Incidence of SPD
Present in children and adults
5 - 16% of typically developing children
70 – 90% children and adults with ASD have
impairments in sensory processing
40 – 60 % with ADHD have SPD
Difference between
ADHD and SPD
ADHD is more impulsive
ADHD has anxiety specific to social concern, not
sensory aspects
SPD and ADHD have similar reactions to initial
stimulus, ADHD habituates, SPD does not
Current Research on SPD
Children affected with SPD have quantifiable
differences in brain structure
For the first time shows a biological basis that
sets it apart from other neurodevelopmental
disorders.
(Shivani Desai, BS, Emily Fourie, BS, Julia Harris, BS, and Susanna Hill, BS, all of UCSF,
and Anne Arnett, MA, of the University of Denver, 2013)
Current Research on SPD
Children with SPD have decreased structural brain
connection in specific sensory areas different than
those in autism
Chang YS, Owen JP, Desai SS, Hill SS, Arnett AB, Harris J, Marco EJ, Mukherjee P. (2014)
SPD is a stand alone diagnosis
References
Chang Y., Owen J. Desai S., Hill S., Arnett A., Harris J. Marco E., Mukherjee P.
(2014)Autism and sensory processing disorders: shared white matter disruption in
sensory pathways but divergent connectivity in social-emotional pathways. PLoS
One. 9(7):e103038.
James, K., Miller, L.J., Schaaf, R.C., Nielsen, D.M., Schoen, S.A. (2011) Phenotypes
within sensory modulation dysfunction. Comprehensive Psychiatry. 52, 715-724.
Doi:10.1016/i.comppsych.2010.11.010.
Miller, L.J., Sensational Kids –Revised Edition , 2014.
Ognibene, T. (2002). Distinguishing sensory modulation dysfunction from attention-
deficit-hyperactivity disorder: Sensory habituation and response inhibition
processes. PhD Dissertation, University of Denver.
Owen, J. , Marco, E., Desai, S., Fourie, E., Harris, Julia , Hill, Susanna S., Arnett, Anne B.,
Mukherjee, Pratik. (2013) Abnormal white matter microstructure in children with
sensory processing disorders. Neurolmage: Clinical. DOI:10.1016/j.nicl.2013.06.009
Clinician Background &
Training
Post Professional Training
Certification: Sensory Integration and Praxis Tests
(SIPT)
Intensive Mentorships: SPD Foundation, Spiral
Foundation
Workshops
Evaluation
Sensory Integration and Praxis Test (SIPT)-
standardized test
Sensory Processing Measure (SPM)-questionnaire
Sensory Profile-questionnaire
Clinical Observations
Parent reports on participation in activities of daily
living
Teacher reports on sensory and academic challenges
Purpose of the Sensory Profile and
the Sensory Processing Measure
Questionnaires
Aids the team in determining what are the sensory
challenges
Examines social participation in relation to sensory
issues
Allows comparison across and between environments-
home and school
Promotes team problem solving for program planning
Information courtesy of SPD Foundation
SPM
The SPM is a standardized school and home based
questionnaire for children Preschool to 6th grade
An infant/toddler version is in the works
Sensory Profile 2
5 questionaires in the kit:
Infant
Toddler
Child
School Companion
Short
Sensory Profile
for Adolescents and Adults
Adolescent/Adult Self Rating Questionnaire
Adolescent/Adult Caregiver Questionnaire
It’s never too late to seek help for sensory
processing challenges
Sensory Integration and Praxis
Test(SIPT)
Standardized for ages 4 yrs to 8 yrs, 11 months
Clinical Observations
Some of the behaviors seen in an evaluation:
Frustration tolerance
Attention to task
Persistence with task
Response to transitions
Impulse control
Direction following
Motor planning
Eye hand coordination
Postural control
Tactile Defensiveness
Auditory Defensiveness
Information courtesy of SPD Foundation
Caregiver Report
Activities of Daily Living
Dressing
Grooming/Hygiene
Bathing
Eating
Sleeping
Playing
Sensory Evaluation At CHDD
An OT evaluation of Sensory Challenges includes:
Parent questionnaire- SPM or Sensory Profile
Clinical observation
Play observation
Evidence-Based Practice
There is extensive and ongoing research on the efficacy
of occupational therapy for the intervention of sensory
integration
In 2007, a randomized controlled study of “The
Effectiveness of Occupational Therapy for Children
with Sensory Modulation Disorder” demonstrated that
OT-SI was effective.
Miller, L.J., Coll, J.R., & Schoen, S.A. (2007).
The Sensory Processing Disorder Foundation is the first
organization to operate a full-time program of research
into SPD
Intervention for SPD
Clinic
School
Home
In the Clinic
The goal is to decrease the impact of sensory
challenges through rehabilitation, remediation,
modifications, adaptations and parent
education.
Sampling of Items Seen in a
Sensory Clinic
sensorycityot.com/open-sensory-gym/
Swings
Therapeutic Listening
Programs
A type of brain fitness that trains the neurological
pathways needed for daily functioning.
Used in clinic and home in conjunction with other
interventions
Learning
Neuro-Development
Social and Emotional Behavior
Intervention for SPD at the
STAR Center
Role of OT in the Home
Direct intervention
Coach parents
Educate family to help their home
be more sensory friendly
Feeding Therapy
Picky Eater or Problem Feeder-
Is Sensory Processing Disorder affecting the child’s
ability to eat?
Play Intervention
DIR Floortime
Supporting relationships through play
OT Consultation
Home Environment
Consult re: equipment, toys and materials
Home modifications
OT Consultation at Home
Sensory Lifestyle
A Sensory Lifestyle
Heavy Work
Examples of Heavy Work at Home
Vacuuming
Sweeping
Mopping
Carrying laundry basket
Examples of Heavy Work at School
Chair push ups, wall push ups
Animal walks
Chewy snacks (fruit roll-ups, jerky, dried fruit).
Crunchy snacks (dry cereal, vegetables, pretzels, popcorn)
Carry appropriately heavy notebooks to the office or from class to class.
OT in the Schools
Occupational Therapy is a “related service” in
the child’s Individualized Educational Plan (IEP)
The child must qualify for special education
services to be eligible for OT at school
The goal is to increase participation in the
academic environment
Role of OT in the School
Direct treatment in the classroom or motor room
Consultation with teachers
Accommodations or modifications
Sensory Accommodations
at School
Fidgets
Wiggle cushion
Noise reduction headphones
Weighted lap pads, vests
Weighted pencils, utensils
Theraband
Brain Breaks
Heavy work
Sensory Modifications in
Schools
Alternate seating
Look at lighting
Suggest desk arrangement
Provide education on sensory regulation tools
The Zones of Regulation
The Alert Program
Sensory Regulation Tools to
Build Self Awareness
Alert Program
Quick Poll
Does your profession support and encourage sensory
awareness?
1. Not supported
2. Informally supports
3. Somewhat supports
4. Fully supports
References
Ahn, Roianne, PhD, Sensory Processing in Adults, SPD Foundation
Braddock, George: Creative Housing Solutions – gbcchs.com/
DIR Floortime: http://www.icdl.com/DIR
Haber, Elizabethe and Iris Sava, Deanna; Heavy Work Activities List for Occupational Therapists --
Useful for Designing a Sensory Diet for Children with Sensory Processing Disorders; retrieved from:
http://www.skillsonthehill.com/wp-content/uploads/2012/01/Heavy-Work-List-for-Parents.pdf
Miller, L.J., Coll, J.R., & Schoen, S.A. (2007). A randomized controlled pilot study of the effectiveness
of occupational therapy for children with sensory modulation disorder. American Journal of
Occupational Therapy, 61, 228-238
Research: http://spdfoundation.net/research.html
Sensory Processing Measure- http://www.wpspublish.com/store/p/2991/sensory-processing-measure-spm
Sensory Profile 2 - http://www.pearsonclinical.com/therapy/products/100000822/sensory-profile-2.html
SIPT Certification Program and Praxis Test, sponsored by USC/WPS
http://www.wpspublish.com/store/c/340/si-certification-program-sponsored-by-uscwps
SPD Foundation: Parent Tips: Picky Eaters by Bethany Fenhaus MA OTR/L ;
spdfoundation.net/newsletter/2011/10/starlights-parent.htiml
Video: Star Center Tour; http://spdstar.org/videos/
Wilbarger, Patricia OTR/L : http://www.avanti-ed.com/2.html
Resources
Sensory Processing Book List
Websites/Resources on Sensory Processing
Sensory Materials/Equipment Vendor List
sensoryplaytray.com
Be sure to consult with an Occupational Therapist for guidance
on what sensory tools would benefit you or your child
Thank You
Support for attending the advanced
mentorship at STAR Center was
generously provided by The
University of Washington CHDD
and the LEND Program.
Center on Human Development and Disability
Questions?
