SPD Modulation Disorders: Sensory Over-Responsivity

As I shared in a previous post, Dr. Lucy Miller has identified six sub-types of SPD under the umbrella term of sensory processing disorder. In the next few posts, I want to discuss in detail the definition of each sub-type, the red flags you might notice, and the associated behaviors you might be dealing with.

It’s important to keep in mind that a child (or adult) may have any combination of the sub-types, and each of the sub-types can affect any one or more of the 8 sensory systems. It’s largely true that no two experiences with SPD are the same!

The information contained in this post comes from the STAR Institute and Dr. Miller’s book Sensational Kids, and is readily available in more detail through those resources, if you’re interested in digging deeper.

Modulation Disorders

Modulation disorders are characterized by chronic and severe problems with turning sensory information into behaviors that match the nature and intensity of the message. Individuals with modulation disorders often have difficulty regulating responses to sensory stimuli.

Sensory Over-Responsivity (SOR)

  • Sometimes referred to as “sensory defensiveness”
  • Predisposition to respond too much, too soon, or for too long to sensory stimuli most people find quite tolerable
  • Can occur in any one or more of the sensory systems and in combination with other SPD subtypes
  • Most common sensory areas affected are tactile and auditory but all systems may be affected with different behavioral manifestations

Red Flags of SOR

Individuals who experience SOR are frequently bothered by:

  • Textures (clothing, food, environment)
  • Noise or sounds, especially when loud or unexpected
  • Movement, such as swings or slides, hanging upside down
  • Bright lights, sunshine
  • Background noise, unable to concentrate
  • Loud, unexpected sounds or noisy environments
  • Smells, fragrances in surroundings
  • Having hair, fingernails or toenails cut
  • Substances on body (dirt on hands, crumbs on face, water on clothes)

Behaviors Associated with SOR

  • Aggressive or impulsive when overwhelmed by sensory information
  • Irritable, fussy, moody
  • Unsociable, avoids group activities and has difficulty with forming relationships
  • Excessively cautious and afraid to try new things
  • Upset by transitions and unexpected changes

Children with SOR can appear to always be on “high alert” or display heightened anxiety in some situations or settings. It’s likely that this is caused by repeated exposure to sensory input that is uncomfortable or unsettling. For some, their behavioral response is to withdraw and seek out quiet spaces, or to avoid participation in daily activities such as socializing or community outings.

For others, the response might be to become loud and aggressive as a way to express their discomfort or over-whelmed feelings. Some children who experience SOR become very controlling and demanding so as to protect themselves from what they perceive as painful experiences (ie: being exposed to loud sounds or painful touch).

Children with SOR are most often helped by accommodations to reduce the intensity of the sensory experiences, such as by reducing sounds (through use of headphones or environmental modifications), and by empathic responses from those around them, helping to validate their experiences and alleviate anxiety.

Some of my favorite resources for better understanding SOR include:

And don’t forget: if you’re local, join us at our Introduction to SPD with Q&A events on October 26 and 30. Learn more here, and contact us for more information about SPD or to discuss your child’s needs.

Here’s What Sensory Processing Disorder is NOT

Last post, I shared some information about what SPD is. This time I want to talk about what it is NOT. I am a big advocate for understanding sensory processing and helping families navigate the difficulties that come with the various sub-types, affecting a child’s development and participation in daily life. As part of that advocacy, I often find myself responding to mistaken ideas that people have about SPD.

While October is SPD Awareness Month, it seems that in some circles SPD is a trending topic year-round. And there is misinformation that comes with that sort of fame. So, just to set the record straight and improve our understanding of sensory processing disorder, here are a few points of clarification:

Sensory Processing Disorder (SPD) is NOT a medical diagnosis.

The STAR Institute worked for more than a decade to have SPD added to the Diagnostic and Statistical Manual – 5th Edition (DSM-5). These listings include clear diagnostic criteria and guide a physician in making medical diagnoses for mental and neurological disorders. When the DSM-5 was published in 2015, the editing board ultimately determined that there was not enough evidence to support the addition of SPD as a separate diagnostic category. They did, however, add sensory processing issues (sensory hyper- or hypo-sensitivity) as an additional criteria of Autism Spectrum Disorders. The STAR Institute continues to support research in this area to help identify SPD as a unique diagnosis.

SPD is not what everyone with “quirks” has.

We all have sensory differences, and some of us have specific preferences or needs when it comes to sensory input. If you don’t like scratchy sweaters or need to have silence to get work done, you don’t have SPD. Individuals with SPD experience the world very differently and struggle to participate fully in it due to their difficulty interpreting and responding to sensory input. The hallmark of SPD, as described by Dr. Lucy Miller (STAR Institute founder), is that the condition is chronic and disruptive to daily life. 

SPD is not something that can be “fixed” or “cured” by treatment.

BUT, the symptoms can often be reduced in intensity, with a resulting decrease in the impact of SPD on a person’s daily life. A comprehensive therapy approach includes direct treatment to help with learning skills and potentially altering how sensory information is received and processed. It would also include education regarding how to manage daily tasks and accommodate the individual’s unique sensory needs. Skilled therapists help individuals to advocate for themselves and better understand how to cope with SPD, while educating families (and others) to facilitate an understanding of the condition that changes relationships and supports participation in daily life.

Sensory-sensory based treatment is not the answer to every problem.

Issues with learning, behavior, social interactions, or daily task participation may not all be solved with therapy. There is a growing trend toward using sensory based strategies to support all children who exhibit difficulty with self-regulation, attention, learning, behaviors, and social interaction, but using a “sensory lens” to address these issues may be only one piece of a complex puzzle that needs to be solved in order to best support a child’s development and success in daily life. Understanding SPD can be helpful in solving problems for children who exhibit symptoms of the disorder, but it is most powerful when you combine it with a full understanding of the child and the specific challenges they experience.

Our blog series for SPD Awareness Month continues soon, with more information on the sub-types and resources to help children with them.

And don’t forget: if you’re local, join us at our Introduction to SPD with Q&A events on October 26 and 30. Learn more here, and contact us for more information about SPD or to discuss your child’s needs.

The Six Sub-Types of Sensory Processing Disorder

Understanding sensory processing disorder can be difficult in large part due to the fact that there is not currently a medical diagnostic description for it. Other disorders like autism, ADD, or specific learning disorders have this kind of outline, and are known well to health professionals and parents alike.

While Jean Ayres, PhD, OTR defined sensory integration and sensory integration dysfunction in the 1970’s, there has been on-going research and diverging theories that actually make it even harder for us to talk about SPD as a condition. One could argue semantics over a philosophical debate, but when discussing a medical condition, it’s most helpful to have a common language. It ensures we’re all on the same page.

To that end, Dr. Lucy Miller has proposed using the term “Sensory Processing Disorder” as an umbrella term that includes six sub-types of the disorder. The below graphic is a little dense, but it gives you an idea of the umbrella and everything that’s underneath it.

Subtypes of SPD

 

In upcoming blog posts, I’ll explore each sub-type more in depth. But to start, here are some key points that are helpful in understanding SPD:

  • SPD is not one condition but rather a collection of conditions that are each unique in terms of symptoms.
  • SPD includes disorders of the 8 sensory systems:
    • Visual
    • Auditory
    • Tactile (touch)
    • Gustatory (taste)
    • Olfactory (smell)
    • Vestibular (movement)
    • Proprioception (body awareness, position)
    • Interoception (internal organs)
  • Dyspraxia and Postural Disorder – motor-based disorders – are most closely associated with problems in processing vestibular (movement) and proprioceptive (body awareness) input.
  • Modulation disorders (when it’s hard for someone to regulate their level of alertness) can affect any of the 8 sensory systems and often appear in combination.
    • For example, a person might be SOR (sensory over-responsive) in auditory, SUR (sensory under-responsive) in tactile, and sensory craving in vestibular/movement.
  • Sensory discrimination disorders are the inability to perceive subtle differences in sensory information. That leads to poor interpretation or perception of information, and these disorders can affect any of the 8 systems.
  • An individual can have any of the 8 systems affected by sensory processing issues. This creates a huge list of potential combinations of SPD sub-types – millions of possible combinations when you do the math!
  • In order to determine what approach, strategies, and accommodations will help with reducing the impact of the disorder, in-depth examination and understanding of an individual is essential.

Hopefully, that’s a good start on the basics of SPD, and what’s meant by sub-types and various disorders with in the condition. Next up: We’ll look at each sub-type individually and explore the various associated behaviors you might encounter in children struggling with them.

And don’t forget: if you’re local, join us at our Introduction to SPD with Q&A events on October 26 and 30. Learn more here, and contact us for more information about SPD or to discuss your child’s needs.

October is Sensory Processing Awareness Month

In addition to our in-clinic treatment, it’s a goal at STEPS For Kids to bring you factual, helpful information on the conditions, issues and discussions that matter to you. As part of our education and advocacy efforts, this month we’re excited to bring you information about sensory processing and SPD (sensory processing disorder).

All month, I’ll share my thoughts and some educational information here. Plus, we’re hosting an Introduction to SPD presentation at the clinic later in October. I hope you find the information helpful and enlightening, whether you have been dealing with sensory processing disorder for a long time or have just discovered SPD and its impact on behavior and learning.

According to the STAR Institute, many people think that SPD is something that only children with autism have. While it is true that many individuals on the autism spectrum also display signs of SPD, recent research indicates that SPD is in fact a unique condition. Most individuals who have SPD actually do not have autism.

Research also shows that while some individuals have SPD and other conditions such as attention disorders, learning disorders, and developmental delays, there are some individuals who only have SPD.

There will be much more information to come as the month goes on, but to get started, here are some things to know about SPD:

  • It is a condition that was first described by Jean Ayres, PhD, OTR in the 1970’s, following her research working with children who had cerebral palsy and learning disorders. She created a body of work that described sensory integration as the neurological process and referred to sensory integration dysfunction.
  • Sensory integration assessment and treatment are based on neurological principals of how the brain receives and organizes sensory information so as to produce an adaptive response that lets us be successful in a task.
  • Sensory Processing Disorder is an umbrella term for the disorder and includes six sub-types, as described by Lucy Miller, PhD, OTR of the STAR Institute.
  • The six sub-types include:
    • Modulation Disorders (Over-responsive; Under-responsive; Craving)
    • Sensory Based Motor Disorders (Dyspraxia; Postural Disorder)
    • and Sensory Discrimination Disorders
  • There are 8 sensory systems that can be affected:Visual
    • Auditory
    • Olfactory (smell)
    • Gustatory (taste)
    • Tactile (touch)
    • Vestibular (movement)
    • Proprioceptive (body awareness)
    • Interoception (internal organs/systems)
  • A person can have multiple sub-types, impacting one or more sensory systems. For example: being over-responsive to auditory stimulation, under-responsive to touch, and have a postural disorder.
  • Sensory processing occurs on a continuum. We all have sensory differences and none of us has all 8 sensory systems operating at 100% all the time. The hallmark of SPD is when the impact of symptoms is chronic and disruptive in daily life.
  • Research indicates that between 5 and 16% of children have SPD symptoms that are significant enough to negatively daily life activities, including play, social skills, learning, and self-care.
  • Negative behavior associated with SPD can disrupt relationships and impact a child’s self-esteem significantly. A child who doesn’t respond to the world appropriately is perceived as “bad” and receives negative responses from others, which in turn creates more problem behavioral responses and “keeps the child in misery” as described by Dr. Ayres.
  • Occupational therapists who have advanced training in SPD can help to remediate symptoms and improve daily task participation, address social and play skills, and support relationships for lifelong success.

There is so much to know about the current state of SPD assessment, treatment, and accommodations. Learning more about the disorder, separating fact from myth, and understanding each other through a “sensory lens” is one way that we can support others to be competent and confident in daily activities. I hope you’ll stay with us all through October to learn more!

And don’t forget: if you’re local, join us at our Introduction to SPD with Q&A events on October 26 and 30. Learn more here, and contact us for more information about SPD or to discuss your child’s needs today.

School Or Clinic Therapy: What’s the Difference?

Many children with special needs qualify for therapy services in the school. Parents sometimes think that these services are enough to meet their child’s needs and do not pursue options for clinic based therapies which might greatly enhance their children’s development. Some children are struggling at home but don’t qualify for therapy services in the school. Parents may assume that their child wouldn’t benefit from therapy in a clinic setting or don’t know that this option is available. It’s important to know the difference between therapy services provided in different settings.

School Based Therapy:

  • Is provided as a related service to support the child’s participation in and ability to benefit from educational programs.
  • Is required by law to be a part of the child’s Individualized Education Plan (IEP) when deemed appropriate by the educational team.
  • Is limited to the needs identified by the educational team and only addresses needs that impact educational performance or participation.
  • Is not provided if the child is not demonstrating a need in the school setting that requires specific therapy interventions.
  • Is subject to the limitations of service identified by the IEP and requires a team meeting to make changes, such as increasing therapy time.
  • Only occurs during school hours; often limited by school calendar and staff shortages.

Clinic Based Therapy:

  • Can be provided for any child who has demonstrated need for therapy support services.
  • Is provided in the clinic with options for home and community based services
  • Addresses the needs of the child in the context of the family, identifying strengths and supporting access to community resources.
  • Is usually covered under medical insurance plans or can be paid for privately without limitations placed by insurance providers.
  • Can be scheduled with frequency and duration most appropriate for the child’s needs with flexibility for modifying the plan as needed.
  • Clinic therapists collaborate with the schools when child is receiving both types of services, thus enhancing treatment outcomes in all settings.

Whether a child is currently receiving school based therapies or has been found not eligible for services in the school setting, clinic based therapy may be a good choice for supporting development.  If you have questions about the difference between therapy services please contact our office for more information or to discuss your child’s therapy needs.

Tips for IEP Review Time

It’s that time of year when we look forward to the coming of warmer weather and signs of spring.  For some, it’s that time of year for the annual IEP review,  which you may not be looking forward to.  Meeting with school staff, hearing updates on progress and reviewing the written plan can be a daunting process for parents. Here are a few tips to help you navigate through it and be sure your child’s needs are being met.

 Mother and child drawing together1.  Prior to the meeting, review your child’s progress over the last 6 months to a year.  Make notes about skills he’s improved in and what skills need to be addressed.  Not sure about skills? Just look at performance and behaviors.  Is homework easier to complete, with less crying or frustration? Is her handwriting more legible? Does he seem happier heading off to school or are mornings difficult at home because he doesn’t want to go?  Write these things down and bring the list, good and bad, to the meeting.

2.  If you notice positive changes and improvements, tell the staff!  Parents often head into a school meeting armed and ready to fight for their child’s needs and rightly so. You are going to spend a lot of time at this meeting working on problems.  Try to identify an area where your child is doing well and has shown improvements. Educational staff want to hear about your child’s strengths, too. They also want to know when their efforts are working.  Notice that a teacher has spent extra time with him to advance reading skills? Tell them you appreciate that effort.

3.   If there are many issues on your mind, choose one or two to focus on for this meeting.   Sometimes a child’s needs are many. Where to start is overwhelming and it’s difficult to address all the needs at once. It can be more productive to focus on the most crucial need first which can then indirectly address other needs.  Look at your list (see #1) and decide which area is of most concern to you. This allows the team to focus on solutions for the problem that will have the greatest impact on you, your child and your family.  Issues not addressed at this meeting can be tackled at another time.

4.  Take notes or bring a scribe along with you.   It’s always important that you write down your understanding of what is agreed on at the meeting.  Listen to the reports being presented and make notes of your questions for later.  Ask for clarification of actions to be taken or follow up needed and write down the responses.  If it is too much for you to take notes while listening and talking, bring along someone who will be able to do that for you.   There is always a lot of information offered up at an IEP review, especially if it happens to be a three year re-evaluation.  Taking notes means you don’t have to try to remember all that is said and will help you organize your thoughts later.

5.  Ask questions, share your ideas.  You are a part of your child’s educational team. While it often seems like a room full of people telling you all about your child, the IEP process is a team event and that team includes you, the parent.  Your role is not just to receive the information from the staff but to give them information that will help them help your child.  By sharing your concerns and helping them understand your child you help the teachers and support staff better meed your child’s needs.  By asking questions about school performance you may find a way to do things better at home.

6.  Make a connection with one or two members of your child’s team.  Sometimes a child’s team may include just a few people but sometimes there are as many as 10 professionals and paraprofessionals supporting your child’s needs.  While it is hard to be in regular contact with everyone, you can reach out to one or two people who may have the best connection with your child or who are in a position to help the most.  This may be the classroom teacher but may also include the special education case coordinator, the speech therapist, OT or social worker (or other staff member) depending on your child’s needs. As a parent you will have a sense of who connects with your child, that staff person who really understands.  Reach out to this person and stay in contact with them after the meeting.  They can help you advocate for your child to the whole team.

 

 

Sensory Awareness Month: Resources and Support

October is Sensory Awareness Month! A great time to share information and advocate for those with sensory differences and sensory processing disorders which complicate participation in daily activities.  If you are looking for information on sensory processing you can follow our blog right here and follow us on Pinterest.  Here are five other places on the internet to find helpful information:

1) Sensory Processing Disorder Foundation:  This is the premier research and treatment center founded and directed by Lucy Jane Miller, PhD, OTR.   The SPD Foundation and the STAR Center offer cutting edge information and support for parents and children coping with SPD.  Explore the latest research, take a webinar or learn more about signs and symptoms of SPD.

2) The Spiral Foundation:  Another great research and learning center with a focus on educating the community and advocating for people coping with SPD and its impact on daily life.

3) Raising A Sensory Smart Child:  The book authored by Lindsey Biel, OTR/L provides comprehensive information on what SPD is and ways to manage SPD in a variety of settings.

4) Angie Voss, OTR, author of Understanding Your Child’s Sensory Signalsprovides resources, tips and information to help with better meeting your child’s needs from a sensory perspective.

5)  Sensory Processing Disorder Parent Support website offers a parent’s perspective and lots of tips, strategies and equipment suggestions to guide you through the journey of parenting a child with SPD.

While virtual sites and support are wonderful, sometimes we all need a little more face to face support.  In response to our community, STEPS for Kids is pleased to announce our new SPD Parent & Caregiver Support Group that will be meeting at our Yorkville clinic on Tuesday October 28, 2014 from 7:30 pm until 9:00 pm.   The meeting will be facilitated by STEPS for Kids owner/director, Debra Johnson, MS, OTR/L.  The first meeting will be organized around establishing the needs of our community and setting up regular monthly meetings for supporting parents, caregivers,  children and families affected by SPD and related conditions.

No registration is required for this event but seats are limited.                                          Please call us at 630-552-9890 to reserve your seat today!   You can contact our office with questions or sign up for our newsletter to stay informed about events.

We hope you can join us for our first Parent & Caregiver Support Group and look forward to seeing both new and familiar faces!

NEW: SPD Parent & Caregiver Support Group

STEPS for Kids will be hosting the first Parent & Caregiver Support Group on Tuesday October 28, 2014, from 7:30 pm to 9:00 pm.  The group will meet at our clinic in Yorkville and will be a source of support and education for parents and caregivers who are interested in knowing more about SPD and related conditions.

Our first meeting will include an overview of SPD and behavioral issues related to sensory disorders.  We will take time to get to know one another and gather information to help shape the focus of the group so that it meets the needs of those attending.  Facilitated by Debra Johnson, MS, OTR/L, the group will offer an opportunity to connect with others who face similar challenges everyday while learning new skills and strategies to make everyday life easier.

This support group is designed for parents, grandparents, extended family members, foster parents/guardians, teachers and daycare providers.  All who are interested and invested in the care of a child coping with the impact of sensory processing disorder are invited to attend.  The group will be meeting the last Tuesday of each month.  We look forward to providing on-going support for our community members.

There is no registration required to attend but seats are limited. Please contact the office by phone (630-552-9890) or email to let us know if you are planning on attending so we can reserve a seat for you.

SPD Parent & Caregiver Support Group

Tuesday October 28, 2014           7:30 pm until 9:00 pm

STEPS for Kids, Inc  1555 Sycamore Rd. Yorkville, IL  60560  P: 630-552-9890

 

NEW! Story Time Language Group

Our newest group is now enrolling!

Designed for children who are in Pre-K or Kindergarten, the Story Time Language Group meets one time a month to help children develop language skills through reading and themed activities. Each month will include reading a story together and then completing social and craft activities related to the theme that help develop language skills such as phonological awareness (rhyming and sounds), sequencing, categorization, vocabulary,  following directions and more.

Story Time Language Group is led by Amy McDowell, MS, CCC-SLP/L, speech language pathologist. Amy has over three years experience working with children in clinic, home and school settings.  She has special interest in literacy and language skills as well augmentative communication. Amy provides speech therapy services at STEPS for Kids and also runs our social skills groups.

This group meets on Saturday mornings from 11:00 am – 12:00 pm (see full schedule below) and enrollment is available on a monthly basis. Sign up for one, two, four or all nine group meetings!

2014 Dates/Themes

September 20:  Fall Fun

October 25:  Halloween

November 22:  Thanksgiving

December 13: Christmas

2015 Dates/Themes

January 17:  Winter Fun

February 14: Valentine’s Day

March 14: St. Patrick’s Day

April 18:  Springtime Fun

May 16:  School’s Out for Summer

NOTE:  Children must be able to communicate their needs independently (with assistive device if needed) and must be able to attend to group activities without one-on-one supervision (unless parent stays for duration of the group meeting).  Group enrollment is 3 minimum (for each session to run) and 6 maximum.  No refunds are provided for missed sessions.  STEPS for Kids reserves the right to reschedule meeting dates/times due to therapist absence or extenuating circumstances such as inclement weather. 

Group Cost:  $20 per group meeting;  $160 for all nine sessions

Payment is due in full at time of registration.

Call the office at 630-552-9890 or email info@rightstepsforkids.com with the subject line “Story Time” to register for Story Time Language Group today!

“Write STEPS for Kids” Handwriting Camp

Looking for fun summer activities that support academic skills?  Our Write STEPS for Kids Handwriting Camp is just the thing!  Children enjoy group activities that include play, arts & crafts and music while developing skills to support handwriting.  Led by our Occupational Therapists, each section of camp consists of 8 one hour long sessions of fun and games that address foundational skills for written expression.  Starting at the end of July and finishing right before school starts, this is a great way to give your child a head start into the new school year!

Mother and child drawing togetherIn the age of technology, many children lack opportunities to develop handwriting skills. While learning the mechanics of forming letters and numbers is a basic step, many other skills act as foundations for the complex task of writing.  Children may struggle with any one or more of the underlying skills and so benefit from a comprehensive approach that addresses all the components. When underlying skills are not mastered, rote handwriting practice is frustrating and often counter-productive.  By weaving skill development into play based activities children learn and master the basics without the frustration!

Young children participate in gross motor play to develop body awareness, spatial awareness and perceptual skills to better understand direction of writing strokes, how writing goes on a page and improve postural control to support fine motor skills of holding a pencil. Older children learn how to position themselves properly, improve motor control and appreciate the importance of writing in daily life activities.  Each session includes home activity suggestions to carry over skill development and encourage your young writer.

What other parents are saying about our Handwriting Camps:

“A great program that promotes not only correct writing skills but teaches the parent how to strengthen and reinforce those skills..”                           Lisa W. 

“I learned ways to work with my child that are a lot more fun for him, making him much more willing to practice!”                                                              Ellen M. 

“My daughter looked forward to every session, learned a lot and had a lot of fun doing it.”                                                                                                        Jennifer P. 

“She has more confidence about writing letters…..The best thing was the smile on her face each morning of camp!”                                                         Susan N. 

Handwriting Camp sessions are divided into sections based on skill level and provide a mix of activities that are developmentally appropriate.  While age/grade levels are provided as guidelines, children are placed into groups based on cognitive abilities and current handwriting skills.  Contact us for a free screening if you are unsure which group is best suited for your child.

Please see full descriptions of Write STEPS for Kids Handwriting Camps for summer 2014 and contact us to register today!

For more information call 630-552-9890  or email us at  info@rightstepsforkids.com