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Sensory Processing Disorder

Article via Psychology Today

Sensations: Too Much, Too Confusing, or Not Enough?

Sensory Processing Disorder appears in a variety of ways.

Posted Nov 27, 2018

What is the matter with Mary Jane?
She’s crying with all her might and main,
And she won’t eat her dinner—rice pudding again—
What is the matter with Mary Jane?

A.A. Milne’s poem about miserable Mary Jane used to mystify me. As a child, I knew that not everyone loves rice pudding, but I wondered why she was having a tantrum. Couldn’t she say, “No, thank you,” and then just get over it?

Now that my older eyes are open, I’m more sympathetic. Evidently, Mary Jane can’t communicate to her grownups that she hates rice pudding.  Maybe she’s two, so she behaves like a two-year-old. Maybe she is full. Or—what is now my go-to answer—maybe she has Sensory Processing Disorder(SPD), which makes “just getting over it,” all by herself, difficult or even impossible.

Like Mary Jane, some children withdraw not only from grainy or odd-textured food, but also from physical contact. They may refuse to participate in experiences that other kids enjoy, communicate ineffectively, and respond in unusual ways to ordinary sensations of touch, movement, sight, sound, smell, and taste. These kids may have SPD, so they don’t behave as we expect—not because they won’t, but because they can’t.

SPD is real—and it’s common, affecting about 17 percent of children and adults. SPD begins as a physical condition but may later develop into a psychological condition; if underlying sensory issues are ignored, a little kid often begins to feel shame, low confidence, rage, and loneliness.

Sensory processing is what everyone does, all day. Sensory messages come in through receptors near the surface of, and deep within, the body—the skin, eyes, nose, mouth, outer ear, inner ear, muscles and joints, and internal organs.

For a typical person, the central nervous system efficiently processes the incoming sensory information so she can use it to yank her hand from a scorching frying pan, pull the right boot onto the right foot, or catch herself before she trips.

But for an atypical, “out-of-sync” person with SPD, an inefficient central nervous system garbles sensory messages—meaning that he can’t use them to function smoothly in daily life. He burns his hand on the pan handle; he mismatches his boots and feet; he stumbles and falls.

The most common and easily observed SPD issue is over-responsivity.  Over-responsive kids may be provoked by an unexpected touch, lumpy sock, speed bump, siren, fluorescent light, scented crayon, rice pudding, and so forth.

But though this is SPD’s most common outward presentation, not everyone with the condition has over-responsivity. In fact, children or adults with SPD may not be bothered by sensations at all and may seek more, not less stimulation. Many of these individuals have less obvious types of SPD—these can look like ADHD, Oppositional Defiant Disorder, or other psychological issues in the DSM-V.

What is the matter with Mary Jane? SPD may be—or it may be exacerbating—the main problem. Put on imaginary “sensory spectacles” to examine the situation and ask yourself, “What sensations are too much, or too confusing, or not enough?”

Here are possible reasons for Mary Jane’s behavior:

  • Sensory over-responsivity. Sensations threaten her. She sees and smells the dessert and anticipates how disgusting it will feel and taste in her mouth. Her sensory systems say, “If you eat it, you’ll die.”
  • Poor sensory discrimination. Sensations confuse her. She may be unable to discern textural differences between grainy rice and smooth pudding in her mouth. Even if she likes the flavor, rice pudding may make her gag.
  • Sensory craving. Ordinary sensations are insufficient. She needs constant, intense sensory input. Pudding is not the problem; inactivity is. Today, she hasn’t played outdoors enough, and her body yearns for sensory-motor activity. She may feel as though she cannot sit still a minute longer.

What helps? If, through your sensory spectacles, you see that Mary Jane is overwhelmed, then lower the sensory load. Replace the offending food with one she likes so she will stay peacefully at the table. Or, if you see that she is fidgety and craves movement, then raise the sensory load. Let her go jump rope, stretch an exercise band, dance to music, or hang from a chin-up bar.

If Mary Jane’s behavior is frequently out-of-sync at school, at home, and out and about, it may be necessary to have an occupational therapist who uses a sensory integration approach evaluate the child. Insisting that she eat rice pudding will never work; addressing her sensory processing challenges with understanding and appropriate treatment will.

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Sleep disorders & behavioral issues

An article in the Washington Post has highlighted a new theory into some diagnoses of ADHD – they may actually be an undiagnosed sleep disorder instead.

Growing evidence suggests that a segment of children with ADHD are misdiagnosed and actually suffer from insufficient sleep, insomnia, obstructed breathing or another known sleep disorder. But the most paradigm-challenging idea may be that ADHD may itself be a sleep disorder. If correct, this idea could fundamentally change the way ADHD is studied and treated.

Karen Bonuck, a professor of family and social medicine at Albert Einstein College of Medicine in New York, is known for her work on a 2012 study of 11,000 children published in the journal Pediatrics. It found that those with snoring, mouth breathing or apnea (in which a person’s breathing is interrupted during sleep) were 40 percent to 100 percent more likely than those without the sleep issues to have behaviors resembling ADHD by age 7….“There’s a lot of evidence that sleep is a big factor in behavior in children,” Bonuck said in a recent interview.”

In a recent Yahoo article, one mom shared her story of learning that her son’s undiagnosed sleep apnea was behind his behavioral problems. An imaging done by an ENT revealed that the child’s sinuses were completely inflamed and blocked and a sleep study showed he received no amount of REM sleep and oxygen saturation in the low 80s.

Mouth breathing and the long term issues associated with it are also highlighted by pediatric dentist, Sherry Sami, formerly a clinical instructor of dentistry at UCLA. She lists bed wetting, cavities and behavior changes as sings to look for.

The take away is to consult a pediatric ENT and do a sleep study if you suspect a sleep disorder may be contributing to behavioral challenges. Other signs to look for are teeth grinding, mouth breathing, snoring, frequent nighttime wake ups and bed wetting.