Difficulty concentrating. Unable to sit still. Won’t listen. This may sound like typical toddler behaviour, but occasionally, it might indicate something more serious. We talk to Hannah Greenwood-Berry, from kidsFIRST.
Sensory processing disorder, also known as sensory integration dysfunction, is when sensory signals are misinterpreted by the nervous system, resulting in motor and behavioural responses that just aren’t quite right.
Hannah Greenwood-Berry, occupational therapist and clinical manager at kidsFIRST Medical Centre talks about the condition. She says, ‘Sensory processing disorder and sensory integration dysfunction are two different terms that explain the same difficulty. Sensory dysfunction means that the individual has difficulty or disordered processing of the information or inefficient interpretation of the sensations from the body. For example, the child is oversensitive to touch, so she or he might find clothes irritating, or the tags on them. They may not like wearing shoes or socks, or the texture of aertex shirts, or someone taking their hand unexpectedly. Their reaction might be to pull at their clothes or refuse to walk on grass.
‘It can also manifest itself in not being able to ‘zone out’, in that the sound of a clock or an AC system is as loud as a teacher’s voice, making the teacher’s voice very difficult to isolate.
‘We have seven systems – sight, touch, taste, smell, hearing, vestibular (relating to movement, balance and spacial orientation) and proprioception (the sense of the relative position of parts of the body).’
Hannah explains that, considering all aspects of the sensory system, it’s important to note that the integration of vestibular, tactile — and proprioceptive senses has an effect on eye movements, posture, balance, muscle tone, activity level, attention span, and emotional stability. These systems ultimately affect eye-hand co-ordination, handwriting, visual perception and gross motor skills.
How can you diagnose SID?
Hannah understands that finding out whether a child has sensory difficulties can be tricky. ‘It is difficult to ask a child – how do you see or hear this? ‘It is only possible to identify their reactions through motor reactions – are they recoiling from touch? Do they struggle to sit still? This can indicate a difficulty with internal processing of external stimulus.’
So how can it be assessed? Hannah explains, ‘Trained SIPT certified therapists use the Sensory Integration and Praxis Test (A. Jean Ayres 1989). It consists of 17 subtests requiring children to perform visual, tactile, kinesthetic and motor tasks. It identifies what elements of a child’s sensory system is being impacted and also highlights possible areas of motor dysfunction in a child.
‘For non-SIPT certified therapists, the Sensory Profile (Winnie Dunn 1999) is typically used as an assessment tool to highlight areas of difficulty within the sensory system and resulting motor and emotional responses. It is a questionnaire that can be completed by both the caregiver and teacher. It determines how children process sensory information in everyday situations.’
What’s the treatment?
‘Once we have a diagnosis, or seen indicators that there might be some form of sensory integration dysfunction, we can start a treatment programme,’ explains Hannah. ‘This is in the form of occupational therapy using a sensory integration approach. This takes place in a sensory rich-environment, where we guide the child through activities that are structured to offer a ‘just right’ challenge.
The sensory diet
‘Another important part of therapy is to have the child complete a “sensory diet”, says Hannah. ‘It is a personalised schedule that provides the sensory input a child needs to remain focused and organised throughout the day.
‘Each child has a unique set of sensory needs. Generally, a child whose nervous system is causing them to be hyperactive needs more calming input, while the child who is more underactive or sluggish needs more arousing input. The effects of a sensory diet are usually immediate and cumulative. Activities that perk up your child or calm them down are not only effective in the moment; they help to restructure your child’s
nervous system over time so that they are better able to:
• tolerate sensations and situations they find challenging
• regulate their alertness and increase attention span
• limit sensory seeking and sensory avoiding behaviours
• handle transitions with a lot less stress
Hannah Greenwood-Berry, kidsFIRST Medical Center, Al Wasl Road, (04 348 5437). Abu Dhabi, Khalifa City A. (02 555 1437). www.kidsfirstmc.com.
SPD, in my experience
Lucy Parley, 36, is co-founder and editor of fussybird.co.uk. She lives with her husband Simon and their two children, Reuben, four, and Lois, 20 months
‘My son has always been a bit of a handful, but when he started a new pre-school at three and a half, I noticed every day was becoming unbelievably challenging. After three months of almost constant meltdowns and frustrations plus some funny little habits (putting on a strange voice at times, a developing difficulty with food textures, a ‘floppy’ body, unable to handle too many voices at once) I started to wonder whether it was something more than just problems with discipline, lack of patience or just “his age”. His pre-school had also brought up concerns with his inability to sit still, his funny voice and how he removes himself from any group activities or situations.
‘Our GP referred him to see a paediatrician who assessed him and put him forward for some blood tests to rule out any underlying physical problems, then recommended us to see an occupational therapist. The therapist checked his fine and gross motor skills, audio senses, balance and physical strength through a series of tests. He was identified as having sensory modulation difficulties (he finds it hard to regulate his moods and the data his senses are taking in), poor postural control, balance and some audio sensitivity.’
Ru’s ‘sensory diet’
‘We were given exercises to do at home and assured that these difficulties could be overcome, but that without intervention they would only get worse. We have now begun fortnightly sessions, which involve therapeutic listening among other physical activities, and are working on his “sensory diet”. This involves not food but tailoring his physical and daily activities to give his senses the input they need to help him self-regulate. Being more switched on to him having difficulties has made a big shift with how I react to his meltdowns. Physical activity certainly improves his mood and I always take a buggy or buggy board wherever I go, as he gets tired easily and this can trigger a meltdown. While there are still days when my patience wears thin, we’re making improvements and I’m very proud of my little boy and how far he’s come already.’