Let’s say one night your 4-year-old son protests that his toothpaste is “too spicy.” Another night he complains that the bristles on his toothbrush are “too sharp.” He suddenly wails that the music in the car is “blasting his ears,” even though it’s no louder than usual. He hollers if tickled, breaks pencils because he pushes too hard, and gets car sick on short drives.
Many children — about 10 to 20 percent of children without other developmental problems, according to one large study — find ordinary sounds and tactile sensations unpleasant. In most toddlers, the discomfort goes away by the school years. But in some 2.5 percent of all children the discomfort persists and becomes troublesome. These children are often also anxious and may be clumsy in unexpected ways, perhaps having trouble walking up stairs. In some cases they lack perception in one or more senses.
As a parent, you may have heard the terms “sensory processing disorder” (SPD) and “sensory integration disorder,” used interchangeably. Our brains do a whole lot of work we take for granted absorbing sensory data; one theory has it that, in some children, systems at the top of the chain have gone awry. There’s some evidence from twin studies that SPD has a genetic basis, and is a stand-alone problem. One small 2013 study zeroed in on evidence from brain scans of a difference in 8 to 11-year-old boys considered to suffer from SPD. However, SPD is not a diagnosis recognized by insurers, or every doctor.
Don’t get bogged down in controversies over words; focus on getting any help your child needs. If you think your child’s symptoms are causing difficulties, prepare by keeping a journal for a week or two, looking for clumsiness, oversensitivity (or lack of response), agitation, or frustration doing tasks that should be easy. Then bring your list of concerns to your child’s pediatrician.
The pediatrician may tell you not to worry, and could very well be correct. The answer may be to wait and see if the problems persist. If you remain concerned, ask for referrals to a developmental specialist — to rule out (or pick up) autism or attention issues — and an occupational therapist (OT).
An OT will evaluate the sensory problems and give you tools to address them. Make sure you keep your journal: you’ll be expected to complete a detailed questionnaire. Children over the age of 7 or so can help with the answers, and some OTs will give you forms for family, teachers, and babysitters. The OT will follow up on all the data with questions directly to your child. The next step is the testing room, where the OT will look on and score your child as he or she performs a range of tasks and responds to sensory prompts. You should end up with an explanation of which, if any, sensory systems are causing problems, and when and why; and a treatment plan including goals. Insurers generally cover treatment that falls under the appropriate codes.
Bone up yourself by reading “The Out-of-Sync Child,” by preschool teacher Carol Stock Kranowitz, and other books about SPD. If there’s family friction or trouble at school, consider calling in a psychotherapist or psychiatrist as well. The OT may give you a “sensory diet” for your child to pursue at home, either to stimulate certain senses or to tame unpleasant sensations and focus kids who are flying off the walls. Michelle Morris, the mother of six, bought her child a yard-sale couch to jump on and surrounded it with pillows; later on she acquired a trampoline.
February 02, 2016
Christopher Nystuen, MD, MBA