Occupational Therapy for Sensory Processing Disorder | A Comprehensive Guide

Introduction 

If your child shows unusual reactions to sensory experiences, such as aversion to certain food or clothing textures, yet enjoys activities like spinning and jumping, it could be indicative of sensory processing disorder (SPD). These peculiar behaviors reflect how they perceive and respond to sensory input from their body and surroundings.

Children with SPD frequently have difficulty managing their responses to everyday tasks, including social interactions, play, and self-care. This challenge can hinder their effective participation in these activities and may result in frustration, stress, and behavioral issues such as tantrums and aggression.

Recent estimates suggest that 5 to 16.5% of the population experiences sensory processing challenges [1]. However, because sensory processing issues are hard to spot, differ a lot between children, and can change in intensity in the same child over time, they can be easily misunderstood and missed [2].

Children with sensory processing difficulties are typically referred to occupational therapy (OT) for evaluation and treatment. Occupational Therapists (OTs) provide sensory integration therapy (SIT) and sensory-based activities to help them participate in everyday tasks they need or want to do.

This article provides a comprehensive discussion of SPD and what occupational therapy can do for sensory processing disorder, including its evaluation and treatment. Lastly, we list some support resources for parents and answer commonly asked questions about the condition.

Key Take-Away Messages

How can occupational therapy help kids with Sensory Processing Disorder (SPD)?

Frequently, kids with behavioral, sensory, motor coordination, or academic difficulties are recommended for occupational therapy.  With thorough evaluation, occupational therapists (OTs) can determine if sensory processing issues contribute to these concerns. They then develop an individually tailored program designed to enhance the child’s ability to engage in the activities they need or want to engage in.

Try Soundsory®, a unique blend of music and movement therapy, to enhance your child’s neurodevelopment.

What is a Sensory Processing Disorder (SPD)?

Sensory processing disorder can be described as “difficulty detecting, modulating, interpreting, and/or responding to sensory experiences.” [3] Children with SPD cannot accurately process and interpret the information from the sensory systems to respond meaningfully to them.

Eight Senses

Our bodies and the environment provide us with information through our senses. Besides the well-known five senses – sight, smell, taste, sound, and touch – Jean Ayres, a key figure in sensory integration, included two more internal senses: proprioception and the vestibular system. Additionally, Lucy Jane Miller, an SPD researcher and founder of STAR Institute for SPD, introduced another internal sense, interoception, in her book “No Longer a SECRET.”

Here are the eight sensory systems and their functions [4]:

• Auditory system: processes and interprets sounds from both ears
• Visual system: gathers information through the eyes and tells us where we are in space. 
• Olfactory system: relays information from the things we smell
• Gustatory system: informs us about the quality of the foods and liquids we taste
• Tactile system: provides sensory information from the skin and includes detailed information about objects outside the body
• Vestibular system: indicates our body’s orientation in space, influenced by head position relative to gravity.
• Proprioceptive system: provides feedback on our body’s position based on receptors in joints, ligaments, and muscles
• Interoceptive system: conveys internal sensations, such as hunger and thirst, from receptors in organs 

The brain actively organizes and makes sense of sensory input from these systems for the child to perform goal-directed actions toward their environment — this is foundational to skill development and learning. In SPD, there is a problem in the brain’s ability to detect, modulate, organize, and interpret this information, so they respond differently to sensory experiences.  

What are the signs of SPD?

Because of the difficulty taking in and interpreting sensory information, children with SPD typically demonstrate inappropriate responses or behavior to their sensory experiences.

They might react too much or too little or seek out really strong feelings [5]. They might respond even with minimal stimuli or, on the flip side, not notice things unless they’re very strong (sensory modulation disorder or SMD). They might have a hard time telling different sensations apart (sensory discrimination disorder or SDD) or struggle with movement, balance, and posture (sensory-based motor disorder, or SBMD).

Here are some ways SPD can present itself in different sensory systems:

Visual

• Does not like bright lights
• Squints to protect eyes from light
• Stares intently at people or objects

Tactile

• Avoids getting messy
• Shows distress during nail-cutting and other grooming activities
• Sensitive to certain fabrics

Auditory

• Cries or runs away from loud or unexpected noise 
• Holds hands over ears
• Distracted when there is too much noise

Gustatory/Olfactory

• Avoids certain foods
• Shows a strong preference for certain foods/smells
• Mouths objects

Vestibular

• Doesn’t like feet to leave the ground
• Can’t sit still and prefers a lot of movement
• Twirls and spins frequently

Proprioceptive

• Locks elbows or knees for stability
• Tires easily
• Enjoys falling, climbing, and risky play

Typically developing children can handle sensory information well and use it to face challenges around them. They’re also good at arranging their actions in more advanced ways. This helps them to be more independent and skilled at doing everyday tasks they need to or want to, whether at home, in school, or their community.

In contrast, children with sensory processing difficulties might not reach their full potential at school, at home, or in the community. They may struggle with or become frustrated or upset doing everyday tasks, which leads to task avoidance. In turn, they miss out on important experiences and cannot fully participate in activities they need or want to do.

Here’s a helpful checklist by STAR Institute outlining behaviors that are considered outside the typical range, arranged according to different age groups. This checklist does not diagnose SPD but can help identify if your child needs occupational therapy for sensory processing disorder.

Occupational Therapy Evaluation and Diagnosis for SPD

An OT uses various methods to assess a child’s sensory integration. To thoroughly explore their participation in all the “occupations” that are important for them and their family, they gather insights through interviews, questionnaires, and checklists with the child’s family, caregivers, and teachers.  Such questionnaires include the Sensory Profile and the Sensory Processing Measure (SPM) [3]. These tools help OTs identify their problems and gather crucial information about sensory processing problems that may be present in the child in different contexts.

Additionally, OTs observe the child in their natural setting (informal observation) and create structured scenarios (clinical observation) to assess skills impacted by sensory processing challenges [2]. They also employ standardized tests like the Sensory Integration and Praxis Test (SIPT) for a detailed evaluation of their sensory integration.

Diagnosing SPD Versus Related Conditions

SPD isn’t officially recognized as a medical diagnosis. Instead, sensory processing issues are categorized under autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition, which clinicians like pediatricians and psychiatrists use for diagnosis. The American Academy of Pediatrics highlights that SPD often overlaps with conditions like ASD and ADHD, with insufficient evidence distinguishing it as a unique disorder [6].

Nonetheless, occupational therapists (OTs) know best how to help a child with sensory processing disorder. They play a crucial role in identifying the type of SPD a child has and their sensitivities to stimuli. From here, they devise a tailored treatment plan to improve the child’s sensory processing, aiding their participation in daily activities at home, school, and the community.

Occupational Therapy Approaches for Children with SPD

OT uses sensory integration therapy (SIT), an intervention program incorporated into play, to tackle a child’s specific sensory integration issues. The goal is to help them better handle sensory information, especially when these problems affect their daily activities at home, play, school, or community [2].

During treatment, OTs provide sensory-based activities that provide the child with tactile, proprioceptive, auditory, and vestibular stimuli, which organize their sensory system. Therapists use tools and equipment such as brushes, swings, trampolines, balls, weighted vests, and pressure garments [7]. 

Sensory Diet

Since sessions only happen once or twice a week, OTs also prepare a sensory diet for the children that they should integrate into their schedules. Sensory diets provide sensory-based activities at appropriate intensities and durations that meet the child’s sensory needs [2]. OTs typically work with parents and teachers to educate them about the child.

Support Resources for Parents

Dealing with SPD is not easy. Parents and children with SPD can benefit from resources and support groups that can help them understand SPD better and provide tips to manage the condition better. Here are some of them:

• STAR Institute: STAR Institute is the premiere research, education, and treatment center for SPD. The non-profit organization provides many resources about SPD, including checklists, blogs, podcasts, and presentations that will benefit children and parents with SPD
• Sensory Processing Disorder Parent Support: a parent-led community that seeks to become a place for parents who are struggling with their children with SPD.
• Sensory Processing Disorder (SPD) Support Facebook Group: this is a private Facebook group for parents raising children with SPD.

Conclusion

Sensory processing disorder is a complex condition affecting how the brain processes, modulates and interprets information received from the senses. This may cause a child with SPD to react differently to the sensory information they’re receiving from their environment, leading to behaviors like frustration, embarrassment, and sometimes aggression.

Occupational therapists assess these sensory processing challenges and create tailored treatment plans for each child. Through play-based activities, they assist children with SPD in engaging in meaningful activities, aiding them in appropriately responding to the sensory challenges they face in their everyday lives.

Many OTs also use complementary treatment strategies like Soundsory® and Forbrain® to complement their treatment. Soundsory®  provides children with sensory processing issues a combination of rhythmic music and movement-based activities to stimulate their auditory, proprioceptive, and vestibular systems simultaneously. Meanwhile, Forbrain® uses the child’s own voice to stimulate and train their brain to process sensory information more effectively. This in turn boosts attention, memory, and learning. 

FAQs 

References 

1. 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
2. Case-Smith J. & O’Brien J. C. (2010). Occupational therapy for children (6th ed.). Mosby/Elsevier.
3. Passarello, N., Tarantino, V., Chirico, A., Menghini, D., Costanzo, F., Sorrentino, P., Fucà, E., Gigliotta, O., Alivernini, F., Oliveri, M., Lucidi, F., Vicari, S., Mandolesi, L., & Turriziani, P. (2022). Sensory Processing Disorders in Children and Adolescents: Taking Stock of Assessment and Novel Therapeutic Tools. Brain sciences, 12(11), 1478. https://doi.org/10.3390/brainsci12111478
4. Bialer, D. & Miller, J. (2011). No longer a secret: unique common sense strategies for children with sensory or motor challenges. Future Horizons.
5. Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: a proposed nosology for diagnosis. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 61(2), 135–140. https://doi.org/10.5014/ajot.61.2.135
6. Zimmer, M.,  Desch, L.,  Rosen, L.,;  Bailey, M., Becker, D., Culbert, T., McClafferty, H.,  Sahler, O.,  Vohra, S., Liptak, G., Adams, R., Burke, R., Friedman, S., Houtrow, A.,  Kalichman, M., Kuo, D., Levy, S., Norwood, K., Turchi, R., & Wiley, S. (2012). Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics (2012) 129 (6): 1186–1189. https://doi.org/10.1542/peds.2012-0876
7. Guardado K., & Sergent SR. (2023). Sensory Integration.In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
8. McCormick, C., Hepburn, S., Young, G. S., & Rogers, S. J. (2016). Sensory symptoms in children with autism spectrum disorder, other developmental disorders and typical development: A longitudinal study. Autism : the international journal of research and practice, 20(5), 572–579. https://doi.org/10.1177/1362361315599755