Won’t do or can’t do?: An introduction to sensory processing disorder
Ryan’s teacher catches your eye as you walk across the playground at home time, mouthing “Can I have a word?” Your heart sinks. What now, you wonder. Wandering around the classroom and refusing to take his seat? A meltdown prompted only by a request to do some writing?
“He’s not had a good day today,” says Miss Sharpe. “He hit Mrs Meddling when she told him to put the Lego away and then he trashed all the children’s models. That wasn’t kind, was it Ryan?”
Ryan is standing silently, staring at a spot on the floor. In case he isn’t listening Miss Sharpe leans into his face. “Let’s see if you can try to have a better day tomorrow Ryan, and make sensible choices.” Ryan shifts his body but won’t look up. Miss Sharpe sighs.
What is sensory processing disorder?
What Miss Sharpe doesn’t know is that Ryan has sensory processing disorder (SPD, sometimes referred to as sensory integration disorder or SID), a lack of connectivity in parts of his brain that means he struggles to make sense of the information his body is taking in. This can cause a wide range of symptoms including hypersensitivity to sound, sight and touch, poor motor skills (Ryan’s struggle to hold a pencil; the little girl in the video below’s inability to make her feet go the way she wants them to) and easy distractibility. Some children with SPD can’t bear the sound of a vacuum cleaner or hand dryer, while others can’t make sense of spoken instructions. Some are under and some are over-responsive to environmental stimuli and different states – being tired, hungry, or anxious – can influence the extent of their difficulty.
We all know about the five senses – sight, hearing, touch, taste and smell – but there are three others, equally vital in helping us navigate our way in the world. Just as people with an impaired sense of taste may seek out spicier or stronger flavoured foods, children with impairments in these senses may use more extreme or prolonged behaviours as their brains try to understand the messages from their environment.
Vestibular, or balance, lets us know which way is up, judge speed and recognise direction of movement. Children who spin a lot or like to hang upside down from playground bars may be having issues processing what their vestibular sense is telling them.
Proprioception is the sense that lets us know where our bodies are in relation to the world from the information sent to the brain from our muscles and joints. Children who are too rough in their contact, can’t apply the right amount of pressure to write with a pencil or put a glass down safely, walk on tiptoe or who crash about the house or classroom may have difficulties processing this information.
Interoception is our awareness of what’s going on inside our bodies, knowing when we need to go to the toilet, for example, or when we are too hot or cold, or hungry or full up.
Research into sensory processing disorder is in its early days, and recognition of it as a standalone neurological condition lags even further behind. Children with autism often have similar sensory behaviours – intolerance for certain clothing, water or loud noise for example – but brain mapping has shown that children with SPD generally don’t suffer with lack of connectivity in parts of the brain associated with facial recognition and processing of emotion. Children who have suffered early trauma, including many fostered or formerly looked after children, are often found to have issues with sensory processing.
To put yourself in Ryan’s shoes for a moment, try this simple exercise: put on a pair of bulky gardening gloves, the kind you’d use to cut brambles without getting spiked, or woollen mitts. Then try to take the paper off a tightly-wrapped sweet such as a Starburst. While you’re doing this, and failing, imagine someone you’d like to please standing over you telling you to try harder or not to remove the wrapper with your teeth because it’s not good manners. How does it make you feel?
Now watch this one-minute video of a little girl trying to master the basics of ballet.
These difficulties to perform simple tasks in the high pressure environment of the modern classroom can lead children to experience a welter of emotions, from frustration and anger to embarrassment and shame, all compounded by the tellings-off such children regularly receive. Anxiety can set in and behaviour take a downward spiral. Untreated anxiety is regularly a factor in depression and alcohol or drug abuse in later life, so helping children overcome their difficulties at an early stage will have a lifelong impact on their well-being.
Diagnosing sensory processing disorder
Diagnosis can only be carried out by an occupational therapist specially trained in sensory processing disorder, and as yet assessments are not available on the NHS and typically cost between £400 and £600. Some councils and community interest companies, such as ADDvanced Solutions in Liverpool, have set aside or raised funds to make free assessments available, but waiting lists are long.
The good news is that children’s brains can be rewired with the right support. On diagnosis a child can be helped with direct therapy using specialised equipment, consultation and education with carers and school, and the provision of a ‘sensory diet’ and sensory based therapeutic activities for home and school. Examples of activities might include doing wall push ups between lessons or jumping up and down on a trampette when they come home from school (saving your sofa at the same time), sitting at their desk on a yoga ball so the constant need to balance stops them fidgeting or leaving their seat to walk around, providing ear defenders in noisy places or having their carer give them a deep massage or regular ‘squeezy’ hugs to provide the calming sensory input the brain craves.
If you think a child you care for may have sensory processing difficulties speak to your GP and ask for a referral to a paediatrician, but be prepared to push for help as not all health professionals are familiar with SPD. You could also seek an assessment by an occupational therapist specialising in SPD in your area.
For useful resources, please see below: