As public and private schools around the country gear up for opening their doors to in-person learning later this month, it is important to acknowledge and accommodate the millions of children who deal with sensory processing disorders.
An estimated 5 to 16 percent of school-aged children have difficulties processing the senses either by overreacting or underreacting to sensory information. This includes not only the five senses of touch, sound, taste, smell and light but also body awareness (proprioception) and movement (vestibular).
With an estimated 49.7 million children ages 6-17 years old in the U.S. in 2022, (and the number increasing each year), as many as 8 million children may have sensory processing disorders that can cause long-term deficits in intellectual and social development.
Research shows that treatment improves socialization, attention, behavior regulation, academics and participation. Children saw gains in active play, gross motor skills, reading and achievement of individual goals.
An individual could be hyper-sensitive to loud or soft noise, hugs, fabrics, textures, fragrances and lights. Difficulties with proximity to others make it hard to stand in line or participate in circle time at school. Some people cannot stand crowds for both proximity issues and noise. Sensitivity to the volume of someone’s voice or textures of foods are common issues.
Avoidance of the trigger may lead to a child’s anxiety, fear, anger and sometimes can escalate to them being overly reactive and physical. Physical manifestations such as yelling, hyperactivity and aggression may be signs of the reaction to sensory triggers. They may be sensory-seeking and look for input that is sensory-soothing.
Hypo-sensitivity or hypo-arousal sometimes presents as having low energy, and a person may look tired or depressed. They may have poor eye contact. Conversely, they may search for input and could be sensory-seeking to help improve their arousal level.
Sensory processing disorder can contribute to a variety of issues such as attention deficit hyperactivity disorder (ADHD), learning disabilities, anxiety, depression, sleep issues and anger issues.
As part of my practice, I evaluate individuals who come in with symptoms associated with autism, but these symptoms sometimes are due to sensory issues alone and not due to autism.
Recently, I evaluated an individual who had poor eye contact, restricted affect, struggled with answering questions, and was not engaging in back and forth reciprocal conversation.
This individual’s presentation was consistent with possibly having autism. However, the arousal level was low. Having the person run and jump gave enough sensory input to drastically change their demeanor. The individual’s eye contact improved, their effect brightened, they engaged in reciprocal conversations and requested to play with others.
Other individuals are so dysregulated they cannot engage in social interactions and need sensory input to calm them enough to focus on their environment and engage with others. I see teens in my practice who cut themselves to find relief from the stress. All of these could be due to sensory issues.
Sensory seeking can be part of normal child development, and as children develop, these issues resolve. Oral sucking, such as the use of a pacifier or bottle or toe-walking, can be very soothing to young children.
Children will usually grow out of these sensory-seeking behaviors by the time they are in grade school. For individuals who continue to have sensory issues, it is important to evaluate if this impacts functioning and if treatment would be beneficial.
Sensory sensitivity, such as hyper- or hypo-reactivity to sensory input, sensory-seeking activities or unusual interest in sensory aspects of the environment, is one of the hallmark symptoms of autism.
However, not everyone with sensory issues has autism. It is important for clinicians, parents and teachers to recognize sensory issues in non-autistic individuals. Clinicians can provide sensory screeners such as the Short Sensory Profile. Sensory Smart Parent offers a free screener.
Treatment for sensory processing disorders is through occupational therapy. Several techniques can be helpful in finding appropriate sensory input as well as helping individuals recognize their own arousal level and help themselves feel more regulated.
Physical activities such as running, swimming, yoga and basketball can all be sensory-soothing. Tools such as weighted blankets and trampolines can also be sensory-soothing. It is important to find the right fit for each child. Not all sensory-soothing activities or tools will work for a given child.
Research has shown there are structural differences in the brains of children with a sensory processing disorder. Yet access and funding for services can be difficult to obtain, especially if a child does not have a neurodevelopmental disorder like autism. Many physicians do not recognize it as a separate entity from autism, leading to a misconception about the impact and importance of treatment.
For children with autism or other neurodevelopmental difficulties, most states prioritize urgency of needs services (PUNS) funding to help obtain services or equipment. However, for children without a disability like a sensory processing disorder, PUNS funding cannot be used, and other funding is extremely limited.
In school, a child’s individualized education plan can include occupational therapy services. An IEP is a plan set up for a child when they have a physical, emotional, or neurodevelopmental issue impacting school functioning.
To get an IEP, parents can request a case study to evaluate their child’s difficulties and what support will be needed. Unfortunately, since sensory processing disorder is not recognized as a medical illness, a child with SPD alone may not qualify for an IEP.
Schools do not always have occupational therapists who are trained to treat sensory processing issues. In many school systems, resources may be scarce, and therapy is often limited to 15 minutes a week. Outside of school, individuals will need a physician’s order for occupational therapy.
If insurance does not cover treatment, grants can be found locally or nationally. The Healthwell Foundation and the United Healthcare Children’s Foundation have grants that will help cover out-of-pocket expenses. The Sensory Processing Disorder Parent Support website lists other possible funding.
Understanding and recognizing sensory processing issues may help improve functioning and quality of life for many individuals, starting with children in school. While many are preparing for back to school, it is important for parents, teachers, health care providers, guardians, and policymakers to be aware that millions need funding to get the care they need to succeed.
Lisa Yeh is a psychiatrist.
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