SPD

Sensory Processing Disorder:

Facts, Assumptions and Myths

Jacci Siebert
BSc (OT) Hons
Specialist Childrens OT
Advanced SI Practitioner & SI mentor

Sens.ations, Leicester, 7th March 2012

SPD is a barrier to engagement in

OCCUPATION
OT - art and science of helping people do the day-today activities that are important to them despite
impairment, disability, or handicap.
Occupation in occupational therapy refers to all the
activities that occupy peoples time and give meaning
to their lives. (Neistadt & Blesedell Crepeau, 1998).
Occupational deprivation - opportunity to engage in
occupations.

Occupational justice principles all people helped to

live a life filled with meaningful and health-promoting
occupation.

SPD facts
SPD is a complex disorder of the brain that affects developing children
and adults.
Parent surveys, clinical assessments, and laboratory protocols exist to
identify children with SPD.
At least 1 in 20 people in the general population may be affected by SPD.
In children who are gifted and those with ADHD, Autism, and fragile X
syndrome, the prevalence of SPD is much higher than in the general
population.
Studies have found a significant difference between the physiology of
children with SPD and children who are typically developing.
Studies have found a significant difference between the physiology of
children with SPD and children with ADHD.
SPD has unique sensory symptoms that are not explained by other
known disorders.
Heredity may be one cause of the disorder.
Laboratory studies suggest that the sympathetic and parasympathetic
nervous systems are not functioning typically in children with SPD.
Preliminary research data support decades of anecdotal evidence that
OT is an effective intervention for treating the symptoms of SPD.
from Sensational Kids: Hope and Help for Children With Sensory
Processing Disorder (SPD ) p. 249-250 by Lucy Jane Miller, PhD, OTR

What is SPD?
Previously referred to as DSI or Sensory
Integration Dysfunction.
First described and studied in the 1960s by A.
Jean Ayres, an occupational therapist,
educational psychologist and neuroscience
researcher.
Causes: hereditary? prematurity?
A.Jean Ayres
1920-1988

The term Sensory Integration

can refer to:
Ayres theory of normal development

A process of evaluating Sensory Processing

Disorders (SPD) so we can better understand
the behaviour we see in individuals.
A specific approach to intervention Ayres
Sensory Integration

7 SENSES

Far senses Near Senses

o Sight (Visual)
o Sound (Auditory)
o Smell (Olfactory)

Taste (Gustatory)
Touch (Tactile)
Vestibular
(movement and balance sense)-provides
information about where the head and body are in
space and in relation to the earth's surface.

Proprioception
(joint/muscle sense)-provides information about
where body parts are and what they are doing .

Tactile +
Proprioception
=
Somatosensory
perception
(body awareness)

Vestibular +
Proprioception
=
Movement sense
and postural
control

Autonomic Nervous System

Typical Brain

Sound, Sight, Taste

Touch, Smell,
Body Position sense,
Movement Sense

Response
(timed and adapted
to the environment)

The brain makes sense of the sensory input we gain from the
environment and designs & implements an appropriate response.

Five interrelated components that help to

explain how Sensory Integration occurs:

Sensory Registration
Orientation
Interpretation
Organization of a response
Execution of a response

What are the results of

Sensory Integration?
Self Regulation
The nervous systems ability to attain, maintain, and
change levels of arousal or alertness.

Motor Planning
The process of deciding what your body has to do
and then doing it (praxis).

SPD Brain

Sensory Info

Sensory seeker
Sensory disregarder
Sensory avoider
Sensory sensitivity

Problems interpreting, modulating and discriminating sensory

inputs:
Sensory defensiveness
Poor sensory awareness
May or may not contribute to sensory distortions
(receptor/brainstem/cortical problem):
Auditory distortions (hyperacuisis, tinnitus, misophonia)
Vertigo
Visual distortions (prosopagnosia, hallucinations)
Synaesthesia

Identifying Sensory Processing

Disorder
5-15 percent of general population (Miller, 2006)
Sensory processing impacts on occupation
SI trained therapist (typically OT) assesses
clients:

Sensory Discrimination
Sensory Modulation
Posture, co-ordination, balance, motor skills
Praxis
Visual spatial organisation

What does SPD look like?

Symptoms and Red Flags individuals experience
sensations differently more or less intensely, dont
get sensory messages right. Sensory problems are
chronic and disrupt everyday life (Miller, 2006).
Confusion about symptoms commonly result in
other diagnoses being given (Oppositional Defiant
Disorder, Failure to Thrive, Infantile Annorexia)
(Miller, 2006)
Co-morbidity of SPD ADHD, ASD
The road to an SPD diagnosis begins with a
physician in order to rule out other neurological
conditions.

What is the impact of SPD on

function?

Emotional regulation
Social participation
Play
Learning
Coping skills

Sensory Processing Problems

Sensory Registration Deficits
Registration deficits limit the amount of sensation that the individual
detects, thereby limiting relevant information from their perception.
Registration is the initial point of perception from the sensory organs.

Sensory Modulation
Modulation deficits affect the way the individual perceives the
intensity of the stimuli, thereby altering the ability to cope with,
tolerate, or orient to the information, especially in the presence of
stress, unexpected sensations, or in high stimulus environments.

Sensory Discrimination
Discrimination deficits lead to inadequate or distorted perceptions
due to slow or inaccurate information processing about the details of
the sensory input such as shape, size, location, quantity and quality.

Miller et al (2007) proposed Nosology for SPD

Sensory
Processing
Disorder (SPD)

Sensory
Modulation
Disorder
(SMD)

Sensory-Based Motor
Disorder (SBMD)
-Dyspraxia -Postural Disorder

-SOR -SUR -SS

SOR = sensory overresponsivity

SUR = sensory underresponsivity
SS = sensory seeking

Sensory
Discrimination
Disorder (SDD)
-Visual
-Auditory
-Tactile
-Vestibular
-Proprioception
-Taste/smell

Diagram from Pre-school Sensory Scan for Educators by Carol Stock Kranowitz

Sensory Integration
Disorder

Sensory Modulation
Disorder

Sensory
Overresponsivity
(Sensory
Avoider)

Sensory
Underresponsivity
(Sensory
Disregarder)

Sensory
Discrimination
Disorder
(Sensory Jumbler)

Sensory
Seeking
(Sensory
Craver)

Sensory
based
Motor
Disorder

Postural
Disorder
(Sensory
Slumper)

Dyspraxia
(Sensory
Fumbler)

Sensory Profile
by Winnie Dunn PhD, OTR , FAOTA
This is a
standardised
caregiver
questionnaire
which seeks
to identify the
nature of the
childs
sensory
processing

Neurological
Threshold
Continuum

Behavioural Response Continuum

HIGH
(habituation)

Poor Registration

Sensory Seeking

Uninterested, Apathetic
Dull affect
Withdrawn
Overly tired
Self-absorbed

Active
Continuously engaging
Fidgety
Excitable

Acting in ACCORDANCE
with Threshold

Acting to COUNTERACT
Threshold

difficulties.
Mainly looks
at sensory
modulation

Distractible
Hyperactive

LOW
(sensitization)

Sensitivity to Stimuli

Resistant to change
Reliant on rigid rituals

Sensation Avoiding

Neurological
Threshold
Continuum

Behavioural Response Continuum

HIGH
(habituation)

Bystander

LOW
(sensitization)

Acting in ACCORDANCE
with Threshold

Acting to COUNTERACT
Threshold

Seeker

Easy-going and not easily ruffled,

have to be called several times to
get their attention, miss signposts,
may leave dirt on their face or
hands, find scratches and bruises
and dont know how they got them,
dont notice clutter until someone
points it out.

Enjoy going to firework displays,

make noises such as humming and
whistling, order or cook spicy food,
tend to touch people when talking to
them, walk around barefoot, change
daily routines to keep them
interesting.

Distracted by sounds, startle easily,

are bothered by fast changing
images on TV, have precise ideas
about clothing textures, repeatedly
pick the same food in restaurants,
prefer clean design in the home,
select only a few chosen rides at
amusement parks.

Leave the room when a crowd starts

to gather, like their surroundings
clean and tidy, keep curtains or
blinds drawn or partially drawn,
make narrow food choices, dont like
getting their hands mucky, select
solitary leisure activities

Sensor
Cited from Living Sensationally by Winnie Dunn

Avoider

The Aim of OT with children with

SPD
Reframe the observable behaviour using sensory
glasses child is often then seen in a more positive
light.
Provide a toolbox of sensory related strategies for
home and school.
Teach reasoning strategies to parents, carers or
teachers so that tasks, environments, relationships
can be modified for better functioning.
Direct therapy programme designed to improve
quality of childs life in 3 occupations central to
childhood: school, play, self care.

Treatment methods
Occupational therapy (and physiotherapy) using various
approaches : sensory-motor, psychosocial, neurodevelopmental, cognitive and motor learning approaches.
Occupational therapy using sensory stimulation and Sensory
Diets:
Henry OT toolbox
Alert programme
Therapressure (Willbargers)
Therapeutic Listening Programme
Weighted or pressure vests
Therapy balls as seat alternative
Occupational therapy using a Sensory Integration Approach
(OT:SI):
Ayres Sensory Integration intervention or ASI

Sensory Integration
Treatment Principles

Creation of a therapeutic environment

Address underlying deficits in neural and sensory
processing
See movement, think sensory
Provide planned and controlled sensory inputs
designed to childs specific needs
Elicit an adaptive response to environmental
demand
Grade activities from simple to complex
Use a child centred approach
Use non-directive purposeful activities
Balance of facilitation and inhibition
Encourage active participation
Capitalise on the childs inner drive and self
direction.
To learn how to learn
Therapy must be fun

Ayres SI Fidelity Tool

(Parham et al, 2007)

Structural elements
Professional
background
Clinical experience
Room set up
Type of equipment

Process elements
Provide sensory opportunities
Provide just-right challenge
Collaborate on activity choice
Guide self organisation
Support optimal arousal
Create play context
Maximise childs success
Ensure physical safety
Arrange room to engage child
Foster therapeutic alliance

Author

Recent OT-SI Effectiveness

Design
SubjectsStudies
Age
Intervention Outcome
range
(years)

Smith
2005

ABAB
OT-SI vs
tabletop
activities

7 PDD or
8-19
Mental
retardation

5 sessions
per week of
30 minutes

Significant reduction in
self stimulatory
behaviour

Miller
2007

OT-SI vs
activity
protocol
vs no
treatment

24 SMD
(15 ADHD,
1 Anxiety)

3-11

20 x 1 hour
sessions
over 10
weeks

Significant gains in
individualised GAS,
Attention,
Cognitive/social and
reduced electrodermal
responsivity ampitude

Pfeiffer
2011

OT-SI vs 37 ASD
fine-motor

6-12

18 x 45 min
sessions
over 6
weeks

Significant positive
changes in GAS
(sensory processing,
motor skills and social
functioning)

Efficacy of ASI Intervention

(May Benson and Koomar 2010, Pfeiffer et al 2011)
Evidence suggests that SI may result in positive
outcome in the areas of:

Sensorimotor skills
Motor planning
Socialization
Attention
Behavioral regulation
Reading and reading related skills
Individualized goals
Autistic behaviors

Therapy
Space

Mary Sheridan Centre, Lambeth (2004)

Russet House School, Enfield (2005)

Early diagnosis prevents long term

issues developing
Plasticity remains throughout the lifespan, so its never
too late, but a more optimal outcome is gained with
early diagnosis and intervention.
Who benefits from screening for SPD?
- Fussy babies with feeding and sleeping issues
- Infants with atypical developmental milestones
- All 0-5 year olds with suspected ASD and ADHD.
- Majority of children with ASD
- Majority of children with ADHD
- Children & adults with motor learning and
coordination difficulties, balance and muscle fatigue
issues, fine motor and handwriting difficulties.

What happens when intervention is

not available?
SMD

- secondary mental health complications,

depression, borderline personality
disorder, bipolar mood disorder,
obsessive compulsive disorder.
- possible drug and alcohol addiction.
- antisocial behaviour.
- relationships in family are stressed.

SBMD

- poor self esteem, poor achievement

despite clear strengths, social rejection.

Reasoning Strategies
A SECRET (Miller, 2006)
A Attention
S Sensation
E Emotion
C Culture
R Relationship
E Environment
T Task
Cited from Sensational Kids: Hope and Help for Children
with Sensory Processing Disorder (SPD) by Lucy Jane
Miller, Ph.D., OTR

Support available
Books
The Out-of-Sync child by Carol Stock Kranowitz
Sensational Kids by Lucy Jane Miller
Baby Sense by Megan Faure & Ann Richardson
Websites
www.sensoryintegration.org.uk
www.spdfoundation.net
www.thespiralfoundation.org
Local services: screening & referral to OT via, GP, HV,
SENCo, Paediatrician, Midwife.

Independent Occupational Therapists

www.cotss-ip.org.uk

Thank you for Listening

Contact details: jacci@sensoryjunction.co.uk

References

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occupational therapy for children and adolescents with difficulty processing and
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Ben-Sasson, A., Hen, L. Fluss, R. Cermak, S.A. Engel-Yeger, B. & Gal, E. (2009) A
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SPD red flags for:

Infants and toddlers
____ Problems eating or sleeping
____ Refuses to go to anyone but me
____ Irritable when being dressed; uncomfortable in clothes
____ Rarely plays with toys
____ Resists cuddling, arches away when held
____ Cannot calm self
____ Floppy or stiff body, motor delays
from www.spdfoundation.net

SPD red flags for:

Pre-schoolers
____ Over-sensitive to touch, noises, smells, other people
____ Difficulty making friends
____ Difficulty dressing, eating, sleeping, and/or toilet training
____ Clumsy; poor motor skills; weak
____ In constant motion; in everyone else's face and space
____ Frequent or long temper tantrums
from www.spdfoundation.net

SPD red flags for:

Grade schoolers
___ Over-sensitive to touch, noise, smells, other people
___ Easily distracted, fidgety, craves movement; aggressive
___ Easily overwhelmed
___ Difficulty with handwriting or motor activities
___ Difficulty making friends
___ Unaware of pain and/or other people
from www.spdfoundation.net

SPD red flags for:

Adolescents and adults
___ Over-sensitive to touch, noise, smells, and other people
___ Poor self-esteem; afraid of failing at new tasks
___ Lethargic and slow
___ Always on the go; impulsive; distractible
___ Leaves tasks uncompleted
___ Clumsy, slow, poor motor skills or handwriting
___ Difficulty staying focused
___ Difficulty staying focused at work and in meetings
from www.spdfoundation.net