Seattle Anxiety Specialists - Psychiatry, Psychology, and Psychotherapy

Sensory Processing Disorder 

Overview

Sensory Processing Disorder is a condition where an individual experiences difficulty integrating information from the senses.[1] Individuals may experience over-sensitivity, under-sensitivity, or a combination; thus, they may seek to avoid sensory stimulation or crave more.[2] It is estimated that 5%-16.5% of the general population have symptoms of sensory processing dysfunction.[3] These estimates are higher for clinical populations such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD).[4]

Symptoms

According to the Child Mind Institute and the Sensory Processing Disorder Foundation, examples of symptoms of Sensory Processing Disorder include the following descriptors for over-sensitive or under-sensitive persons.[5,6]

Individuals who experience over-sensitivity and are highly reactive to sensory stimulation:

• Are unable to tolerate bright lights and loud noises like ambulance sirens

• Refuse to wear certain articles of clothing because it feels scratchy or irritating (even after cutting out all the tags and labels) or shoes because they feel “too tight.”

• Are distracted by background noises that others don’t seem to hear

• Are fearful of surprise touch, avoid hugs and cuddling even with familiar adults

• Are overly afraid of swings and playground equipment

• Often have trouble understanding where their body is in relation to other objects or people

• Bump into things and appear clumsy

• Difficulty with tasks that require fine motor skills (e.g., writing, buttoning clothes) 

• Have trouble sensing the amount of force they’re applying (e.g., may rip the paper when erasing, pinch too hard, or slam objects down)

• Resistance to change or difficulty adapting to new situations

• Difficulty processing time and sequencing

Individuals who experience under-sensitivity and want to seek out more sensory stimulation:

• Have a constant need to touch people or textures, even when it’s not socially acceptable

• Do not understand personal space even when kids the same age are old enough to understand it

• Have an extremely high tolerance for pain

• Do not understanding their own strength

• Are very fidgety and unable to sit still

• Seek out strong sensory experiences (e.g., loud music, spicy foods)

• Love jumping, bumping, and crashing activities

• Enjoy deep pressure like tight bear hugs

• Crave fast, spinning, and/or intense movement (e.g., being tossed in the air and jumping on furniture and trampolines)

Sensory Processing issues are typically noticed in the toddler years.[7] Further, multiple combinations of over-sensitivity and under-sensitivity symptoms are often found in individuals. A study by Miller et al. (2017) supported three distinct groups within the umbrella of over-sensitivity:[8] 

• High Sensory Over-Responsivity Only

• High Sensory Over- and Under-Responsivity

• High Sensory Craving and Sensory Over-Responsivity

Causes

There are various biological theories on why sensory processing dysfunction may occur in some individuals. One view is that abnormalities in the forebrain limbic system lead to issues processing sensory information, which has been supported by studies showing adults with ASD have reduced amygdala and hippocampus volume compared to individuals not on the spectrum.[9] Additionally, a study by Narayan et al. (2021) postulated that alterations in the organization of the brain’s white matter are associated with complex sensory behavior and attention in sensory processing disorder.[10] 

Risk Factors

90 to 95% of children with autism spectrum disorder (ASD) are estimated to have sensory processing difficulties.[11] Thus, problems with sensory processing are considered a symptom of ASD. However, individuals with sensory issues can also be found within populations with ADHD, OCD, developmental delays, or no other diagnosis.[12]

Diagnosis

Sensory Processing Disorder is not considered a diagnosis by some psychiatrists due to the disorder not being a part of the DSM-5 (the diagnostic manual used by mental health professionals in the United States).[13] However, sensory deficits are typically measured by creating a sensory profile consisting of interviews with parents, reviewing child evaluation reports, and observing behaviors to target areas of concern.[14] Diagnosing Sensory Processing Disorder can be more difficult for adults than for children, since symptoms can be misinterpreted as “quirks”.[15] However, a thorough evaluation by an occupational therapist, psychologist, or other licensed professional with expertise in sensory processing can help determine if the disorder is the underlying cause of an individual’s symptoms.[16]

Complications

There are a plethora of ways disordered sensory processing can affect an individual. Children with sensory processing deficits may struggle to regulate their responses to everyday situations such as dressing, playing, mealtime, and social interactions.[17] Miller et al. (2017) found that over-sensitive children with sensory-related motor dysfunction have more difficulty with social participation and performance of daily activities compared to children with sensory under-responsivity.[18] There are also a multitude of studies on how sensory processing difficulties impact people with autism spectrum disorder. Lane et al. (2022) found a co-existence of sleep concerns (e.g., bedtime resistance, sleep anxiety, delayed sleep onset, night awakening, short sleep duration) and sensory processing difficulties in autistic individuals.[19] Another study by Thye et al. (2018) found that disordered sensory processing in ASD affected an individual’s language, communication, emotion, response to rewards, and interpersonal functioning.[20]

Treatment 

Occupational therapists are specialists who work with children and adults with sensory issues to engage them in physical activities designed to regulate their sensory input and make them feel more comfortable, secure, and able to focus.[21] Occupational therapists may use sensory integration therapy (SIT), which uses physical contact and movement (e.g., spinning, crashing, and jumping) to provide therapeutic sensory input to help patients reach an ideal level of sensory regulation.[22] A study by Kashefimehr et al. (2018) studying the effect of SIT on children with ASD supported that the therapy improved occupational performance and sensory processing abilities.[23] However, some studies a study by Devlin et al. (2011) found behavioral intervention to be more effective than sensory integration therapy in reducing the frequency of self-injurious behaviors.[24]

The Child Mind Institute provides a few suggested steps parents can take to help their child with disordered sensory processing:[25,26]

• Create quiet spaces

• Reduce visual clutter 

• Use items to provide regulating input (e.g., weighted vests/blankets, pressure garments, fidget toys, chewable “jewelry”)

• Minimize loud noises or bright lights if the child is sensitive to them

The Sensory Processing Disorder Foundation also lays out the following at-home strategies to help adults manage their symptoms:[27]

• Create a sensory-friendly environment by adjusting lighting, reducing noise levels, and choosing comfortable clothing and furniture.

• Engage in regular physical activity, such as yoga or swimming, to help improve balance, coordination, and overall sensory processing.

• Practice relaxation techniques like deep breathing, mindfulness, or progressive muscle relaxation to help manage stress and anxiety related to sensory overload.

• Establish a daily routine to help reduce anxiety and make transitions easier.

If you think you or someone you know may have Disordered Sensory Processing, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.

Contributed by: Maria Karla Bermudez

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Rosenthal, M. (2023, January 30). Sensory processing FAQ. Child Mind Institute. https://childmind.org/article/sensory-processing-faq/

2 Ibid. 

3 Miller, L. J., Schoen, S. A., Mulligan, S., & Sullivan, J. (2017). Identification of Sensory Processing and Integration Symptom Clusters: A Preliminary Study. Occupational therapy international, 2017, 2876080. https://doi.org/10.1155/2017/2876080

4 Ibid. 

5 Rosenthal (2023)

6 Fowler, L. (2023, June 21). 10 signs of sensory processing disorder (SPD) in adults - what you need to know. SPD Foundation. https://www.spdfoundation.net/signs-of-spd-in-adults/#:~:text=Diagnosing%20SPD%20in%20adults%20can,SPD%20is%20the%20underlying%20cause

7 Rosenthal (2023) 

8 Miller et al., (2017)

9 Cheung, P. P. P., & Lau, B. W. M. (2020). Neurobiology of sensory processing in autism spectrum disorder. Progress in molecular biology and translational science, 173, 161–181. https://doi.org/10.1016/bs.pmbts.2020.04.020

10 Narayan, A., Rowe, M. A., Palacios, E. M., Wren-Jarvis, J., Bourla, I., Gerdes, M., Brandes-Aitken, A., Desai, S. S., Marco, E. J., & Mukherjee, P. (2021). Altered Cerebellar White Matter in Sensory Processing Dysfunction Is Associated With Impaired Multisensory Integration and Attention. Frontiers in psychology, 11, 618436. https://doi.org/10.3389/fpsyg.2020.618436

11 Guardado KE, Sergent SR. Sensory Integration. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559155/

12 Rosenthal (2023)

13 Ibid. 

14 Guardado et al., (2022)

15 Fowler (2023)

16 Ibid. 

17 Ibid. 

18 Miller et al. (2017)

19 Lane, S. J., Leão, M. A., & Spielmann, V. (2022). Sleep, Sensory Integration/Processing, and Autism: A Scoping Review. Frontiers in psychology, 13, 877527. https://doi.org/10.3389/fpsyg.2022.877527

20 Thye, M. D., Bednarz, H. M., Herringshaw, A. J., Sartin, E. B., & Kana, R. K. (2018). The impact of atypical sensory processing on social impairments in autism spectrum disorder. Developmental cognitive neuroscience, 29, 151–167. https://doi.org/10.1016/j.dcn.2017.04.010

21 Rosenthal (2023)

22 Ibid. 

23 Kashefimehr B, Kayihan H, Huri M. The Effect of Sensory Integration Therapy on Occupational Performance in Children With Autism. OTJR: Occupational Therapy Journal of Research. 2018;38(2):75-83. doi:10.1177/1539449217743456

24 Devlin S, Healy O, Leader G, Hughes BM. Comparison of behavioral intervention and sensory-integration therapy in the treatment of challenging behavior. J Autism Dev Disord. 2011 Oct;41(10):1303-20

25 Rosenthal (2023)

26 Arky, B. (2023, February 20). Treating sensory processing issues. Child Mind Institute. https://childmind.org/article/treating-sensory-processing-issues/#balancing-sensory-input 

27 Fowler (2023)