Sensory Processing Disorder Subtypes

As I wrap up this series on sensory processing, I’m going to talk a little about some of the “terminology” that is used in the classification of the particular subtypes of Sensory Processing Disorder (SPD). Each of the subtypes has particular characteristics/symptoms, and it is important to remember that most children with SPD don’t fall neatly in to one classification. Most have a combination of symptoms from the different subtypes. One term that is important to know as you start to read about the subtypes is “registration”.  Registration means the awareness of incoming sensations from the environment. Someone who under-registers sensory input (such as auditory, visual, touch, pain, and/or movement) needs more of that input in order to be aware of it. For example, if you under-register input, it is sort of like you are wearing gloves, earplugs, or sunglasses, etc.

If you over-register input, the input seems much more intense than it actually is. Sensory defensiveness falls under the category of over-registration, for example, touch can feel painful, and one can be over-aware of sounds and light.

A list of the subtypes of SPD follows with a brief description of each:

Sensory Over-Responsivity- A child with this subtype “over-registers” sensory input, and is easily overwhelmed by input, such as movement, sound, touch, smell, and taste. The body reacts by developing a fight or flight reaction. If the child develops a “flight reaction”, they might be classified as “sensory avoiding”. In that case, the child often attempts to control the amount of sensory input coming into his system, by withdrawing or holding hands over the ears).

Sensory Under-Responsivity- Children with this suptype “under-register” input and often appear lethargic. In school, these children may slump in their desk, and may not sense pain, pressure, or temperature as others do, but despite this, they will not crave or seek out sensory input.

Sensory Seeking/Craving- Children with this suptype also “under-register” input, and need or crave deep touch or pressure in order to “feel” input. These little ones often demonstrate behaviors such as pinching, biting, and hitting in order to seek out sensory input.

Dyspraxia- Praxis is the ability to plan out action for motor activities. With dyspraxia, a child has difficulty planning, coordinating and recognizing new or unfamiliar movements, and often appears clumsy and has difficulty sequencing any new motor movements.

Postural Disorder- A child with this subtype has low muscle tone throughout the body, and weakness in the core muscles, such as the trunk, shoulders, hips and back. These little ones often find it difficult to sit up straight in their desks at school and pay attention to task.

Sensory Discrimination Disorder- Children with this sub-type have difficulty recognizing and interpreting differences or similarities in specific types of sensory input. For example, they often have trouble distinguishing between similar items such as a nickel and dime, or a ping-pong ball and a golf ball.

As I said earlier, most children diagnosed with SPD don’t fall neatly into one of these subtypes, but exhibit certain symptoms from one or more of the categories. The most important thing to remember, is that dealing with SPD on a daily basis can affect one’s quality of life, and interfere with the ability to engage in the classroom activities, which impacts learning. If this is the case, it’s time to seek out a therapist trained in the treatment of SPD.

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Reference:

http://spdfoundation.net/

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The Oprah Show Controversy

Many of you may be aware of the controversy regarding the portrayal of Sensory Processing Disorders on a recent Oprah show. The show featured a very disturbed young man who attempted to kill his mother, and during the interview the boy’s mother shared that his first diagnosis was SPD. Obviously, the boy was later given another diagnosis (I would assume some sort of mental illness), but that was never made clear in the remainder of the show. I recently wrote an article for a website called Our Journey Through Autism, that summarizing the facts about SPD, and there is now a letter writing campaign encouraging people to write to the Oprah show asking her to clarify what SPD is on a future show (http://spdfoundation.net/oprah/oprah-letter.html). I would encourage you to click on this link and join the letter writing campaign, so that we can get accurate information out to the public about SPD!

Oral Defensiveness

Another type of sensory issue is oral defensiveness. The common symptoms of a child with oral defensiveness include:

• Picky eater…avoids certain textures, temperatures, or flavors of food 
• Gags easily or gags with certain food textures or smells
• Difficulty sucking, chewing, or swallowing 
• Chokes easily 
• Avoids/dislikes toothbrushing or facewashing
• Dislikes going to the dentist 
• Avoids/dislikes getting hands or face messy  
• Inappropriate tasting or mouthing of non-food items

Activities to address oral defensiveness:

• Use pretend shaving cream or whipped cream and let your child pretend to “shave” or put on make-up using a popsicle stick  
• Use soap crayons or face paints to paint your child’s face. Avoid the eye area and always test for allergies first.  
• Blowing bubbles or whistles  
• Rubbing the face, around the mouth, with cloths of different textures of fabrics (like satin, velvet, etc.).  
• Have your child name and touch the various parts of his or her face while looking in the mirror 
• Imitate different tongue and lip movements, and/or speech sounds. You can exaggerate the movements for demonstration
• Make a “bubble” face by closing your lips tightly and puffing your cheeks out with air and pop the “bubble” by poking your cheeks with your hands.  
• Before eating or drinking, use your own hands or a soft cloth to gently tap or pat around your child’s mouth  
• Introduce one food item at a time  
• Provide as much positive reinforcement during mealtime as possible...stickers, songs, etc.
• Use a soft toothbrush to gently brush across the tongue and the sides of the mouth  
• Use a vibrating toothbrush – let your child hold it and bring it up to their face rather than you doing it. 

Living with Auditory Defensiveness

Auditory defensiveness is an over sensitivity to sounds in the environment. Children with auditory defensiveness can present with some or all of the following symptoms:

• Seems unsettled or distressed in loud environments

• Frequently cover their ears to sounds that other children tolerate

• Are bothered by noises made by things like the vacuum cleaners, hair dryers, etc.

• Avoids activities that have loud environments such as parties, ballgames, and movies.

• Possible language difficulties

There are strategies are available to help children with auditory processing issues.

• Modify the environment (such as in a school) by considering the acoustics in the classroom. Changing seating arrangements may be beneficial and limiting extraneous noise from the hallway by closing the door or windows is also helpful. It may be necessary to cover the loud speaker with material to tone down the volume.

• Having rugs or carpet on the floor will decrease echo and extraneous noises.

• Whenever possible, children should be forewarned about bells, announcements, fire drills, etc.

• Have the child wear headphones or earmuffs that that cover the entire ear to filter out extraneous background noises.

• Play calming music such as Mozart in the headphones or as background music.

• If concentration is an issue, the child should chew gum, suck on sour candies, and/or eat fruit roll ups, or crunchy snacks.

• Therapeutic Listening® is a program that may help a child with issues such as auditory defensiveness, hypersensitivities, sensory modulation, and general organization issues. For more information, go to http://www.vitallinks.net/ and click on parent info.

Gravitational Insecurity

On February 8^th, I shared how children with sensory issues can be classified as having sensory defensiveness, registration problems, modulation issues, and sensory integration problems. In that blog entry, I reviewed tactile defensiveness (sensitivity to touch), which falls under the category of sensory defensiveness. Today, I’m going to talk about another type of sensory defensiveness, specifically gravitational insecurity. A child with gravitational insecurity typically responds to movement activities with exaggerated emotional responses. This is because their vestibular system is not functioning properly. (For more information about the vestibular system, see the entry on Feb. 11^th)

Gravitationally insecure children prefer to stay low to the ground. You will typically find them lying down or seated, trying to prevent any possibility of movement. Children with this type of defensiveness avoid most active physical tasks and may get upset when movement is required of them. To get a gravitationally insecure child moving, it may be helpful to physically guide them during play activities such as climbing, sliding and swinging. I’ve gone down a slide with a child in my lap, and sometimes, this provides that extra security needed to tolerate the vestibular input. Also, role-playing can also be beneficial, tell your child, “watch me to this, or do it just it the way I do,” then provide demonstration. If you attempt any of the activities suggested in the Feb. 11^th post, be sure to stop if your child fervently resists an activity. Always introduce new movement activities gradually and in small doses, and ALWAYS stop if your child appears to be frightened or over stimulated. If your child has extreme responses to movement activities, I would recommend that you pursue occupational or physical therapy.

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Calming Activities

Proprioception is the awareness of joint and body position. It helps us know where our bodies are in space along with the tactile and vestibular systems. There are “receptors” that receive body position information located deep within our muscles, joints, ligaments, tendons, and connective tissues. These receptors transmit information about motion or position in space to the brain by sensing subtle changes in movement, position, tension, and force. When our proprioceptive system is functioning properly, we make consistent, automatic changes in our body position as needed to stay upright and maneuver the environment safely. This system should work in sync with the other sensory systems, but problems with proprioceptive functioning can lead to big problems.

Individuals with Poor Proprioceptive Processing sometimes exhibit these signs:

• Inability to maintain stationary positions (stay seated upright in a chair) 
• Frequently bumps into items/people in the environment  
• Stands to close or far away from others  
• Unable to apply the appropriate amount of pressure when writing, holding utensils, etc.  
• Clumsy- poor motor planning  
• Playing to rough/Over-activity

Proprioceptive Activities: Proprioceptive input is calming for children and improves muscle/joint awareness. Give your child jobs that involve big muscle groups such as carrying books, laundry, groceries, as well as push-pull activities.

• Pushing or pulling wagons, heavy “wheeled” toys  
• Climbing ropes  
• Jumping- on beanbag chairs, playing on couch cushions/making forts, etc. 
• Wheelbarrow walks  
• Wrestling  
• Tug-of-War  
• Punching bags  
• Pushing others on a swing  
• Swimming  
• Deep pressure given between mats or blankets (“make a sandwich- add lettuce, pickles, cheese)  
• Position your child on the stomach and roll a large therapy ball over him or her, then flip over and do the same (do not put pressure on the stomach)  
• Have your child close their eyes and get into different positions by instructing, “put your finger on your nose, etc.”  
• Sitting in a beanbag chair with heavy blankets or light weights in lap  
• Tossing a weighted ball while sitting on a therapy ball  
• Chair Push-ups  
• Using a hole punch on index cards or file folders  
• Popping packaging bubbles  
• When teaching your little one a new skill that involves motor planning, provide extra proprioceptive input through the use of light wrist or ankle weights.  
• Guide your child through an action, teaching the “motor pattern” providing light resistance to increase the awareness of body position.  
• Gentle but firm massage

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Vestibular Activities

       The vestibular system helps us know where our bodies are in space and provides a sense of balance and posture. As we move about, our eyes and ears take in sensory information and send it to the brain. The vestibular system is made up of 3 fluid filled canals, a “sack-like” structure, and a “pouch-like” structure, and all of these components work together to respond to movement, gravity, and changes in direction and in head position. The visual system works in conjunction with the vestibular system, allowing both eyes to work together and contributing to smooth eye movements. The proprioceptive system also plays a role in this process (which I will discuss in more detail in another post). As the brain coordinates all of this input, this provides a foundation for the timing and spatial orientation of our movements, allowing us to navigate our environment in a coordinated manner. In one way or another, this system influences everything we do. Think of the vestibular system as functioning like a switchboard, directing individual sensations where and when to go or stop. Considering all of the important functions of this system, it is quite apparent why a vestibular problem can lead to many problems that impact daily functioning.

Signs of Poor Vestibular Processing include: 

• Motion Sensitivity 
• Clumsiness- difficulty learning to ride a bicycle, hopping, and stair climbing  
• Low Muscle Tone  
• Visual-Spatial Problems  
• Poor Eye-Hand Coordination  
• Fear of Heights  
• Dizziness and/or Nausea

Vestibular Activities: Movement experiences are very important for the vestibular system during development, especially those that are child-directed rather than passive. Here are some ideas to help with vestibular functioning:

• Encourage activities in which the child is positioned on the stomach, holding the head in an upright position
•  Playground equipment – merry-go-rounds, slides, swings, teeter totter jungle gym, monkey bars 
• Rides at amusement parks  
• Jumping (games like leap frog), hopping, skipping  
• Balance games- walking on a line, twister, skating and bike riding  
• Spinning games- sit-n-spin, swing (never twirl or spin a child for prolonged periods of time as this can impact heart and breathing rates; let the child direct the spinning if possible)  
• Jump rope games  
• Tumbling- somersaults, rolling in all directions  
• Slow rocking – over a therapy ball, in a rocking chair, on a rocker, rocking horse  
• Obstacle courses that incorporate lots of head and body movements

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Other Types of Sensory Defensiveness

If your child has tactile defensiveness, it’s likely that there are some other issues going on as well. You might notice a resistance to eating certain textures of food, which is called oral defensiveness. If your child demonstrates oversensitivity to light and visual distractibility, it’s possible that there is some visual defensiveness going on. If certain sounds are particularly annoying or even painful to your child, this is called auditory defensiveness. One type of defensiveness that I didn’t mention in my earlier post is gravitational insecurity. This is an extreme sensitivity to heights, movement and/or a change in head position in space.

When a child is experiencing defensiveness in more than one sensory system, it’s likely that this is impacting his or her quality of life. That means it’s time to seek therapy from an experienced therapist. A common treatment for sensory defensiveness is the Wilbarger Brushing program. This involves deep touch pressure using a special brush along with joint compressions. The program is typically done in conjunction with a “sensory diet” of activities that include vestibular and proprioceptive input. For little ones with oral defensiveness, there are special techniques that a trained therapist will utilize to address this issue. With the brushing program, the therapist will provide hands-on training so that the parents and other adults who work with the child can administer the program. It is typically carried out approximately every 2 to 3 hours throughout the day. Your therapist will supply brushes and replace them when needed.

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Give Away-"The Out of Sync Child has Fun" Book

If you're interested in having a copy of the book, The Out of Sync Child Has Fun, by Carol Stock Kranowitz, you're in luck! Just sign up as a follower of this blog, and on February 20th, I'm going to draw names from all my followers for a winner! This book is a follow-up to The Out-of-Sync Child. It is a "parent friendly" book that provides at home activities for kids with Sensory Processing Disorders. It's a wonderful resource for parents, teachers and therapists. Good luck!!!
http://www.amazon.com/Out-Sync-Child-has-Fun/dp/0399528431

Tactile Tips

 

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        Children with sensory issues can be classified as having sensory defensiveness, registration problems, modulation issues, and sensory integration problems. In this entry, I’m going to share a little about sensory defensiveness, specifically tactile defensiveness. A child with general sensory defensiveness is overly sensitive to certain types of input from the environment, such as touch, textures (including food textures), sounds, lights (usually fluorescent), smells, and movement. When someone reacts negatively to touch in particular, that is called tactile defensiveness. Remember in the last post how I briefly explained the tactile system? Well, just imagine if this system was not functioning efficiently. All sorts of problems can present themselves!

        There are five sensory nerve receptors in the skin that let the central nervous system know what’s going on in the environment. These receptors are light touch (top of the skin), deep pressure, temperature (hot & cold) and pain. It is likely for one type of receptor to be overly sensitive and the other to not have a problem, which explains why some children may tolerate firm hugs, and then freak out when touched lightly. Here are some signs and symptoms that you might see with a child who is dealing with tactile defensiveness.

• Frequently resists being held or cuddled by unfamiliar people
• Dislikes water splashing or bath-time
• Difficulty falling into a regular sleep/wake schedule
• Dislikes being moved quickly such as being tipped in the air, swung around, bounced, or rocked suddenly
• Difficulty with sucking, chewing, or swallowing new textures
• Does not tolerate new foods or food textures – diet is limited
• Exaggerated separation anxiety
• Sensitivity to bright lights, loud noises, crowds
• Dislikes hands or face to be dirty
• Uncomfortable around strangers or unfamiliar people
• Late with milestones such as talking, walking, sleeping through the night, etc.
• Problems with reflux or allergies to foods
• Must be in a familiar environment to fall asleep
• Prefers to be swaddled tightly, likes weight and deep pressure
• Toe walks
• Dislikes shoes and socks
• Does not crawl before walking
• Craves movement such as swinging, rocking or bouncing

       If a child has tactile sensitivity, here are some activities to try. Any child's sensory system will benefit from these activities, defensive or not. Just be sure and remember to start slowly, and DO NOT force any input that your child resists. If your little one is extremely resistant, it’s probably time to consult your pediatrician and ask about the possibility of occupational therapy. There are more advanced treatments that can only be carried out under the supervision of a therapist. 

• Spend a few extra minutes after bath time to vigorously rub the child with a towel, or guide them in doing so.  
• Rub lotion or powder on the legs, hands and arms while singing (for distraction purposes). Let them also rub the lotion or powder on you, especially if they won’t tolerate it on their own extremities.
• Pretend face washing or shaving- with different textures of cloth or towels.
• Use a variety of textured materials such as corduroy, fur, terry cloth, etc. and rub on your child’s back, arms and legs.
• Put textured mittens or puppets on child’s hands and let him or her take them off.
• Encourage your child to play in binds of sand, rice, beans or popcorn. Hide items and have the child locate them, guessing what they are while still covered. If your child won’t touch the textures, provide cups and shovels for play.
• Have the child roll up in a blanket or sheet, then play hot dog – press on mustard, relish, etc., and then have them roll out.
• Put shaving cream, lotion, or pudding on a large piece of aluminum foil and have the child draw a picture or write spelling words. Be sure to get both hands messy!
• Finger painting or body painting with water-based paints. 
• Play in play dough or putty. Pulling, squeezing, rolling, etc.
• Draw numbers/letters on the child’s back, arms, lets, etc. and have him identify. You can make it a multiple choice or yes-no question - Is this a 2 or a 5?
• Provide activities that provide tactile input on the child’s entire body, such as a kid pool full of styrofoam, big soft pillows, or balls.
• Games with physical contact are good – bear hugs, piggyback rides, wrestling, back rubs, petting animals.
• Identifying objects with eyes closed – keys, comb, marble, block, coins, shapes, etc.

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The Tactile, Vestibular, and Proprioceptive Systems

Welcome to Pediatric Occupational Therapy Tips!
I’d like to talk a little more about sensory processing disorders. Yesterday, I answered the question "What is a sensory processing disorder?"  For this post, I plan to share more information about a few of the senses that most of us don’t know that much about. I’ll start with the sense of touch….

Tactile System: The tactile system is the sense of touch. This is the sensory system that helps us learn about our bodies and our environment. It is important in the development of a child’s body scheme (the internal map of our body and how we use our body to interact with the world around us). This system is composed of two subsystems: (1) discriminatory- allows us to know where we are being touched, (2) protective- lets us know if we are in contact with something dangerous. Tactile input is very important for the development of fine-motor skills, visual perception skills, and articulation of sounds.

The Vestibular System: The vestibular system is the sensory system that responds to accelerated and decelerated movement. It is through the vestibular system that we learn directions and are aware of our body position in space. This input helps us to form a basic reference for all sensory experiences. This system has interconnections with many parts of the body and influences many different functions, for example muscle tone, postural control, balance, eye and neck muscles.

The Proprioceptive System: Proprioceptive information is sensations from muscles and joints. Proprioceptive input tells the brain when and how muscles are contracting and stretching and how joints are being compressed or stretched. It helps us to know where our bodies are in space and how they are moving. Proprioceptive input provides a calming effect. It works along with the vestibular system.

            With sensory processing disorders, one, two, or all three of these sensory systems might be involved (as well as any of the other senses). An experienced therapist can evaluate and determine which systems are involved, allowing for more specific treatment planning, which leads to more effective treatment! In my next entry, I’ll share a variety of sensory activities that are alerting, calming, etc. Cheers!

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