Sensory Processing FAQ
What it is, how it's treated, and why it's controversial
Clinical Expert: Michael Rosenthal, PhD
What are sensory processing issues?
Some kids seem to have trouble handling the information their senses take in—things like sound, touch, taste, sight, and smell. Besides these common senses, there are also two other less well known ones that can be affected—proprioception, or a sense of body awareness, and vestibular sense, which involves movement, balance, and coordination.
Kids with sensory processing issues experience too much or too little stimulation through these senses. They may also have difficulty integrating sensory information—for example things that they see and hear simultaneously, like a person speaking—might seem out of sync for them.
These problems can be tough on kids, and get in the way of them functioning effectively, learning, and making friends.
Note: These problems are sometimes referred to as sensory processing disorder (SPD), even though psychiatrists don’t consider it an actual clinical diagnosis.
What are the signs?
Sensory processing problems tend to come in two types, under- and over-sensitivity, although it’s common for one child to experience both kinds.
Hypersensitive kids are extremely reactive to sensory stimulation, and can find it overwhelming. They may:
- Be unable to tolerate bright lights and loud noises like ambulance sirens
- Refuse to wear clothing because it feels scratchy or
irritating—even after cutting out all the tags and labels-or shoes
because they feel “too tight.”
- Be distracted by background noises that others don’t seem to hear
- Be fearful of surprise touch, avoid hugs and cuddling even with familiar adults
- Be overly fearful 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
- Have trouble sensing the amount of force they’re applying; so for
example, they may rip the paper when erasing, pinch too hard or slam
Hyposensitive kids are under-sensitive, which makes them want to seek out more sensory stimulation. They may:
- Have a constant need to touch people or textures, even when it’s not socially acceptable
- Not understand personal space even when kids the same age are old enough to understand it
- Have an extremely high tolerance for pain
- Not understand their own strength
- Be very fidgety and unable to sit still
- Love jumping, bumping and crashing activities
- Enjoy deep pressure like tight bear hugs
- Crave fast, spinning and/or intense movement
- Love being tossed in the air and jumping on furniture and trampolines.
Why do kids with sensory issues have tantrums?
Kids with sensory issues sometimes exhibit extreme behaviors: screaming if their faces get wet, throwing violent tantrums when you try to get them dressed, because the physical sensations involved are overwhelming to them.
They may have surprisingly wild mood swings as a reaction to a change in the environment. For instance, a first-grader might be fine in a quiet setting with a calm adult. But place her in a grocery store filled with an overload of visual and auditory stimulation and she might melt down, i.e. have a severe tantrum that seems to be of her control, and isn’t likely to stop, whatever a caregiver might do, until she is exhausted.
In addition to this “shutting down” because of sensory overload, a child might also lash out, or become aggressive. Or she might flee—a fight-or-flight response. If a child dashes out across the playground or parking lot, oblivious to the danger, it may be because she is heading away from something upsetting, which may not be apparent to the rest of us, or toward an environment or sensation that will calm her system.
Who can help?
Occupational therapists (or OTs) are the specialists who work with kids who have sensory issues. Your child may be referred to an OT at his school, or you may want to find one who is in private practice. OTs engage kids in physical activities that are designed to regulate their sensory input, to make them feel more comfortable, secure, and able to focus.
There are no scientifically sound studies proving that the work occupational therapists do with kids who have sensory processing challenges is effective. But many parents have found that the therapies and exercises help kids to feel better and function better. “It works like a reset button,” one mom reports.
Michael Rosenthal, PhD, a pediatric neuropsychologist and the son of an occupational therapist, explains it this way: “It’s clear that identifying sensory issues and working with an OT help many children become calmer and better regulated.”
But since kids with sensory issues are all so different, and since occupational therapists usually aren’t connected with research institutions, the science isn’t there to back up the clinical evidence. “The thing we don’t really understand is how and if this approach works for every kid who has sensory issues.”
Is there an evaluation process?
Yes. Every child’s sensory issues will be different, so before therapy can begin the OT will need to evaluate your child through tests and by observing him and talking to teachers and caregivers. Then the OT will come up with a sensory treatment plan, sometimes called a “sensory diet,” that is custom-made for your kid’s needs.
How does the treatment work?
OTs use something called sensory integration therapy, which aims to help kids reach an ideal level of sensory regulation. This is accomplished through physical contact and movement like spinning, crashing, and jumping, all which provide therapeutic sensory input. The OT helps to formulate what will be therapeutic for each child.
What is a sensory gym?
Treatment often takes place in a sensory gym, which is a space outfitted with equipment like weighted vests, trampolines, supersized pillows, ball pits, and more—all which can provide therapeutic sensory stimulation under the supervision of an OT.
What can parents do?
Pay attention to what your child is reacting to. For example if he is sensitive to loud noises or bright lights, try to minimize them in his environment.
If you are working with an OT, ask what work you can be doing at home to continue reinforcing his sensory diet.
How do I know if treatment is working?
Work with your OT or your pediatrician to find ways to measure therapy outcomes, to get a better sense of whether it’s helping. You can create a scale of behaviors to compare how your child is doing before and after treatment, and some specific goals you’d like to work towards, such as the ability to focus better, to stay calm in a loud room, or have fewer meltdowns.
Are kids who have sensory processing issues autistic?
Not all autistic children have sensory processing issues, but many of them do, and they are one of the things doctors look for when they are diagnosing autism.
However, many children with sensory processing issues are not on the spectrum. Sensory issues can also be found in those with ADHD, OCD and other developmental delays—or with no other diagnosis at all.
Are sensory processing issues visible in the brain?
Yes. Experts have used brain imaging to demonstrate in real time sensory processing delays in children with autism.
Why is there a debate?
Many parents are confused when they learn that their child has a diagnosis for something that isn’t considered a disorder by psychiatrists and some other mental health professionals.
In fact, most mental health professionals do recognize that sensory processing differences are real. However, they don’t consider them to be a disorder in itself.
The effectiveness of sensory integration therapy is also debated because it hasn’t been rigorously studied, although many parents say it has helped their children.