Sensory Processing Disorder

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Sensory processing disorder (SPD) is a neurological condition that affects how your brain processes sensory input. A person with SPD can be more sensitive or less sensitive to sounds, smells, textures, and other stimuli than the average person.

In children, SPD can look like meltdowns in the grocery store, picky eating, socks that are too lumpy, or chewing on their shirt collar. In adults, SPD can feel like anxiety, irritability, or overwhelm, which can interfere with executive functioning.

Previously called sensory integration dysfunction, SPD is not a stand-alone diagnosis but often occurs alongside autism, ADHD, or other conditions. A healthcare provider can assess for SPD using clinical observations and questionnaires. Sensory integration therapy, a type of occupational therapy, is used to treat SPD.

This article discusses sensory processing disorder. It describes what SPD is and its common signs in children and adults. It also explains how SPD is diagnosed and treated.

What Is SPD?

SPD is a condition where the brain has difficulty receiving sensory information and responding to it appropriately.

Sensory processing is a complex neurodevelopmental function. It enables us to perceive internal and external sensory inputs, coordinate the information, and take appropriate actions. For example, if you smell smoke, you look around for a fire, or if you feel cold, you put on a sweater.

While you're likely familiar with the five senses—sight, sound, touch, smell, and taste—sensory processing also involves three lesser-known sensory systems:

  • Proprioception is your internal awareness of muscle and joint movements. This sense impacts your ability to recognize the body's position, location, orientation, and movement. 
  • Vestibular refers to inner-ear spatial recognition. This sense contributes to balance, orientation in space, movement, and the position of your head in relation to gravity. 
  • Interoception relates to internal sensations: breathing, heartbeat, hunger, thirst, temperature, and the need to use the bathroom. This sense can also impact how you feel emotions in your body.

When these systems are working properly, sensory input allows children to respond, learn, and adapt to daily life and their surroundings effectively.

However, with sensory processing disorder, one or more of the sensory systems are off-balance. As a result, sensory inputs can feel either overwhelming or understimulating.

An off-kilter sensory system can make it difficult to regulate your emotions, behave in age-appropriate ways, and perform routine tasks. It can also impact a child's motor development and lead to learning disabilities.

Symptoms of Sensory Processing Disorder

SPD can present as being overly sensitive (hyper-responsive) or less sensitive (hypo-responsive) to sensory input. It can also involve a combination of both.

People who are hyper-responsive are often classified as sensory avoiders. In children, sensory avoidance can look like:

  • Behavior problems 
  • Clothing textures or tags that are itchy, scratchy, or lumpy (like seams in socks)
  • Clumsiness or lack of coordination
  • Covering ears or eyes
  • Easily startled by loud noises or sudden movements
  • Emotional outbursts and meltdowns
  • Focus and attention problems
  • Low pain threshold
  • Picky eating or gagging with certain textures 
  • Sensitivity to smells

People who are hypo-responsive are often classified as sensory seekers. In children, sensory seeking can look like: 

  • Behavior problems
  • Chewing on clothing, fingers, or other items 
  • Crashing into people and things
  • Difficult sleeping
  • High pain threshold
  • Inability to sit still
  • Missing social cues
  • Not noticing if their nose is running or their face is dirty 
  • Problems recognizing personal space
  • Roughhousing
  • Seeking visual stimulation, like electronics and gaming
  • Spinning, swinging, rocking, swaying, or bouncing 
  • Thrill-seeking 
  • Trouble keeping their hands to themselves or not touching things

In adults, SPD can feel like an assault of competing stimuli or not enough stimulation. Adult SPD can look like: 

  • Anxiety, depression, or other mood disorders
  • Being easily distracted or unable to filter out background noise 
  • Difficulty concentrating, focusing, or making decisions
  • Disliking being touched or hugged
  • Feeling overwhelmed in crowds 
  • Having a short fuse or being easily angered or triggered
  • Having difficulty noticing if you are too hot or too cold
  • Inability to tolerate strong smells, like scented candles or the perfume department
  • Irritability and moodiness
  • Irritation with clothing tags and textures
  • Lack of coordination, often viewed as clumsy or klutzy
  • Limited diet due to a strong dislike of certain textures or tastes
  • Messy handwriting 
  • Perfectionism
  • Problems focusing or concentrating 
  • Thrill-seeking behaviors like speeding, riding motorcycles, or skydiving

What Causes SPD?

Research suggests 10% to 15% of children in the United States are affected by SPD, but experts aren't quite sure what causes it. Genetic and environmental factors are believed to play a role.

Some research suggests a link between SPD and prenatal or birth complications. This includes premature birth, low birth weight, parental stress, and alcohol or drug use during pregnancy. A 2022 study also found higher rates of SPD in children delivered by cesarean section. 

There is a strong link between sensory processing disorder and neurodivergence. It commonly occurs alongside other conditions, including:

  • Autism spectrum disorder (ASD)
  • Attention deficit hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Disruptive Mood Dysregulation Disorder (DMDD) 
  • Dyspraxia, a coordination disorder
  • Eating disorders
  • Functional neurological disorder
  • Hypermobile joint disorders, like Ehlers-Danlos syndrome
  • Major depressive disorder
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia

Diagnosing Sensory Processing Disorder

Diagnosing sensory processing disorder can be difficult. It is not a stand-alone condition in the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5), which lists it as a symptom of autism.

However, many practitioners now recognize SPD as a separate condition apart from autism. To assess for sensory processing disorders, healthcare providers rely on developmental history, clinical observations, and caregiver reports in children or self-reports in adolescents and adults. 

Assessments

Several different questionnaires are used to assess for sensory processing disorder. The one your healthcare provider uses will depend on the person's age:

  • Birth to age 3: The Infant/Toddler Sensory Profile (ITSP) or the Sensory Rating Scale (SRS) filled out by the caregiver
  • Ages 5 months through 6 years: The Sensory Experiences Questionnaire (SEQ) filled out by the caregiver
  • Ages 3 to 10: The Sensory Processing Measure (SPM) assessment filled out by the caregiver and child's teachers
  • Ages 3 to 16: The Sensory Profile (SP), Child Sensory Profile 2 (SP-2), or Short Sensory Profile (SSP) filled out by caregivers
  • Ages 3 to 55: The SensOR Inventory (SensOR) filled out by caregivers for children or self-report for adolescents and adults to measure for sensory over-responsiveness
  • Ages 11 to 65: The Adolescent/Adult Sensory Profile (AASP) filled out by the individual

Other Testing

In some cases, additional tests may be used to assess for SPD, such as:

  • Diffusion tensor imaging (DTI)
  • Electroencephalogram (EEG)
  • Functional Magnetic Resonance (fMRI)
  • Magnetic resonance spectroscopy (MRS)
  • Magnetoencephalography (MEG)

 However, these tests are more commonly used for research and not clinical settings.

How SPD Is Treated

The frontline treatment for SPD involves a form of occupational therapy (OT) known as sensory integration therapy.

Sensory OT can help you to develop a personalized sensory diet. This is not an eating plan, but a daily menu of individualized, supportive sensory strategies.

A sensory diet includes a variety of activities designed to either stimulate or desensitize the senses, depending on the situation.

Strategies for Hyper-Reactive Senses

For someone who is hyper-reactive or sensory avoidant, these might include:

  • Dimming the lighting or wearing sunglasses or visor to block overhead fluorescent lighting
  • Wearing earplugs or headphones in noisy environments
  • Avoiding strongly scented products (e.g., perfumes, air fresheners, soaps)
  • Limiting food options to avoid personal aversions (e.g., intensely spicy, specific textures, cold, hot)
  • Wearing clothing that accommodates personal sensitivities (e.g., not wearing tight waistbands, scratchy fabric, seams, and tags)
  • Brushing, a technique in which a soft-bristled brush is used on the skin to help someone tolerate touch

Strategies for Sensory Seekers

People who are under-reactive or sensation-seeking can benefit from the following:

  • Sensory-stimulating toys (e.g. safe chewies and fidget items)
  • Opportunities for rocking, swinging, and other sensory-stimulating activities
  • Strong tasting and/or textured foods, cold and hot beverages
  • Furniture arrangements that reduce chances of bumping into sharp or hard surfaces

Cognitive behavioral therapy may also be effective to help gradually increase tolerance for overwhelming sensory experiences.

Managing SPD in Adults

Sensory OT can also help adults with sensory processing disorder learn to manage their symptoms. An OT session may involve tactile stimulation, movement, auditory input, and other sensory experiences.

A sensory diet for adults involves activities and tools designed to increase your tolerance to different sensations and normalize your reactions. This can include:

  • Aromatherapy
  • Arts and crafts using different mediums and textures
  • Body brushing
  • Jumping on a trampoline
  • Kneading dough or clay
  • Listening to music
  • Meditation
  • Massage
  • Physical activity, such as taking a walk, lifting weights, riding a bike, stretching, or swimming
  • Sensory fidgets, like spinning rings, textured stickers, or thinking putty
  • Sensory-friendly spaces, such as a calm room with low lights
  • Swinging or rocking
  • Wearing compression clothing for more input or soft, loose clothing for less sensory input
  • Wearing noise-cancelling earbuds or sunglasses

In addition to OT, psychotherapy, speech therapy, therapeutic listening, and vision therapy may help adults manage SPD.

Summary

Sensory processing disorder is a neurological condition that affects how you respond to sensory input. This includes the traditional five senses (sight, sound, touch, smell, and taste) and less well-known sensory systems of proprioception, vestibular, and interoception. 

Some people with SPD are less responsive to sensory stimuli and engage in sensory-seeking behaviors. Other people with SPD are hypersensitive to stimuli, which can cause sensory avoidance.

In children with SPD, behavioral issues, emotional outbursts, and sensory meltdowns are common. In adults, SPD can make it difficult to tune out background noise, cause problems with executive functioning, and leave you anxious, irritable, or overwhelmed. 

SPD is not a stand-alone diagnosis. It often co-occurs with autism, ADHD, OCD, and other conditions. It is treated using sensory integration occupational therapy and a sensory diet. 

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By Lisa Jo Rudy
Lisa Jo Rudy, MDiv, is a writer, advocate, author, and consultant specializing in the field of autism.