Case Presentation
7 year old boy with chief complaint of “frequent meltdowns”. Additional history: daily meltdowns (crying, hitting) with loud sounds or when asked to wear certain clothing; wants to make friends but poor boundaries and accidentally hurts peers at school when he is playing with them; hard time sitting during seat work at school and prefers to move around when doing his work. There is no known language delay or cognitive delay.
Sensory Processing Disorder
It is thought that the prevalence of Sensory Processing Disorder (SPD) is from 5-15% of school-aged children. SPD is commonly misunderstood and either under-diagnosed or misdiagnosed as Autism or Attention Deficit Hyperactivity Disorder (ADHD). While children with Autism commonly have sensory processing difficulties and some children with autism can also have SPD, the diagnostics features of autism are different than for SPD.
Sensory processing is how the nervous system manages incoming sensory information and generates responses. Sensory integration is how the body’s eight senses work together to create the body’s responses. Most people know about the five senses but there are actually eight senses:
1. Sight 5. Touch
2. Hearing 6. Proprioception (the body’s sense of where it is in space)
3. Smell 7. Vestibular (the body’s sense of balance)
4. Taste 8. Interoception (the body’s sense of what is going on internally)
Signs of sensory processing concerns:
A child is diagnosed with a SPD when there is difficulty taking in and interpreting sensory information so that an appropriate response can be generated. Here are some indicators that there might be a concern for sensory processing challenges:
1. Hyper-acute hearing
2. Hypersensitive hearing
3. Touch aversion
4. Poor motor coordination
5. Poor sense of boundaries
6. High pain tolerance
7. Aggression
8. Distractibility
9. Delayed language development
10. Difficulty learning new things
It is not hard to see how these children can be misdiagnosed with Autism or ADHD. Children with Autism also have impairments in communication, social interactions and present with repetitive behaviors and restricted interests, symptoms that are not seen in SPD alone. Children with ADHD present with hyperactivity, impulsivity and inattention without other sensory processing difficulties.
The behavioral symptoms that are seen with SPD (namely aggression, distractibility, difficulty learning new things) occur as a result of the sensory processing difficulties. Sensory input is organized in a manner that enables an individual to establish a sense of where the body is in time and space, to feel safe in one’s own body and to accurately perceive the body’s relationship to the environment.
When this doesn’t happen, it can lead to poor arousal regulation. One significant problem is that SPD is not identified as a diagnosis in the DSM, making it difficult to diagnose. Another barrier is that psychiatrists and medical professionals in general are not well trained in identifying sensory processing challenges.
Further Assessment
The goal of this article is to help us to be better aware when sensory concerns might be present and refer for an appropriate evaluation, most likely with an occupational therapist. OTs are trained to diagnosis SPD and other sensory challenges and make recommendations for the appropriate treatments. The next newsletter will address various treatment options and interventions.
AUTHOR: Charmi Patel Rao MD, DFAACAP
Co-Medical Director, Vista Hill Foundation
Health Science Clinical Professor, UCSD Department of Psychiatry
President, San Diego Academy of Child and Adolescent Psychiatry