(2010) Two “Look-Alikes”: Sensory Processing Disorder and Attention Deficit Disorder
Published Summer 2010.
Picture Brian. While the other children are settling down to a workbook task, Brian rocks in his seat, whining, “Owwuu,” and rubbing his arm where a classmate grazed him en route to her chair. Abruptly, he stands and shoves his desk away from passing children.
The teacher frowns. “Sit down, stay put, and start working, Brian!”
He wriggles in his seat. “Um, what are we supposed to do?”
“Pay attention! Page 36, even-numbered questions.”
He gropes inside his messy desk, finally locates the workbook, and drops it. Retrieving it, he sags to the floor. He plops into the chair again, grips a pencil like a dagger, and starts writing — but presses so hard that the point breaks. He hurls the pencil across the room and screams, “I hate this!”
Brian is inattentive, impulsive, and fidgety. Does he have Attention Deficit Hyperactivity Disorder – or Sensory Processing Disorder? Recognizing the differences between these two disorders and providing appropriate treatment can greatly benefit children and adults like Brian.
Like ADHD, SPD is a neurological problem affecting behavior and learning. Unlike ADHD, SPD is not treated with medicine. Instead, occupational therapy using a sensory integration framework (“OT-SI”) helps most. This therapy addresses underlying difficulties in processing sensations that cause inattention and hyperactivity.
In The Out-of-Sync Child, I define SPD as the “difficulty in how the brain takes in, organizes, and uses sensory information, causing a person to have problems interacting effectively in the everyday environment.” Sensory stimulation – too much, too little, or the wrong kind – may cause poor motor coordination, incessant movement, attentional problems, and impulsive behavior as the person strives to get less, or more, sensory input.
Brian’s central nervous system inefficiently processes tactile sensations. The slightest touch overwhelms him. A “sensory avoider,” he is over-responsive and cannot regulate, or “modulate,” sensory input. Also, touch stimulation confuses him. A “sensory jumbler,” Brian cannot discriminate differences among sensations.
How does his SPD play out? Brian cannot interpret how objects feel when they contact his skin. His chair, desk contents, workbook, pencil, and classmates bother or befuddle him. Fidgeting and squirming, he pays a lot of attention to averting ordinary tactile sensations. Meanwhile, he pays scant attention to the teacher’s words or classroom rules.
Imagine Dana, a child who processes movement and balance sensations very slowly. This under-responsive child, or “sensory disregarder,” has difficulty starting or stopping an activity. With encouragement, she eventually settles into a swing, enjoying the movement that helps her nervous system get organized. However, Dana does not know when to stop. She swings and swings, inattentive to her own body-centered sensations screaming, “Enough!”
Envision Jayson, a “sensory craver” who needs much more action than his peers. An impulsive “bumper and crasher,” he seeks intense, vigorous movement. Constantly, he rocks, climbs, gets upside-down, and gyrates, darting from one experience to another. He pays much attention to satisfying his craving for movement and little attention to his mother’s instructions or where he left his shoes.
Inattention . . . impulsivity . . . fidgetiness … constant movement … these are definitely symptoms of SPD.
Now consider this definition for Attention Deficit Disorder: a “neurological syndrome characterized by serious and persistent inattention and impulsivity. When constant, fidgety movement (hyperactivity) is an additional characteristic, the syndrome is called Attention Deficit Hyperactivity Disorder.”
Inattention … impulsivity … fidgetiness … constant movement. These are definitely symptoms of ADHD.
SPD and ADHD are certainly “look-alikes.” However, they are distinct disorders, and optimum treatment for the two problems is very different. Before jumping to conclusions (and to drug therapy), professionals, parents, and teachers should consider the whole child to thoughtfully determine the best support.
If the child is frequently, but not always, inattentive, it is useful to observe her behavior and ask: Where, when, and how often does her inattention occur? What is happening, or not happening, when she concentrates well? What is her “self-therapy”?
When overloaded, an over-responsive child needs less stimulation. How can we help? We can undo something! Over-the-counter first aid for this child might be decreasing the offending sensations. We can make the environment softer, dimmer, quieter, calmer.
Then, we can do something! Comfort her with “deep pressure,” such as a massage or bear hug. Create a retreat under the dining room table or in a classroom corner, with pillows and a sleeping bag to burrow into. Apply deep pressure on skin and muscles to get her organized and ready to participate and learn. Provide heavy-work activities: pushing a grocery cart, pulling a wagon, lifting weights, or carrying a book carton. Ensure daily outdoor play. (Movement always helps, so the more recess, the better.) Jog together around the block or playground. Offer 3 opportunities for gentle roughhousing. Give her a rolling pin for pressing dough, a shovel for digging, a bar for chinning, a hammock for swaying, a wad of gum for chewing, a trampoline for jumping.
When “underloaded,” an under-responsive or sensory-seeking child needs extra sensory stimulation. Again, we can do something! Provide sensory-motor experiences like those mentioned above. The under-responsive or seeking child needs them, too, in varying degrees, for similar activities may calm one type of child and invigorate or satisfy another.
Providing just the right sensory-motor input will certainly help a child with SPD. No surprise, sensory-motor input will also help the child with ADHD. Indeed, it will help everyone, because we all require frequent, daily sensory-motor experiences.
Not psychostimulants, but a sensory diet may be the best “medicine” for the child with attention problems. (An occupational therapist can develop an individualized sensory diet with appropriate touch and movement experiences.) An approach that excludes drugs and includes movement, deep pressure, and heavy work never hurts and often helps the inattentive child whose problem is not ADHD but developmentally delayed sensory processing.
Ayres, A.J., PhD (2005). Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Los Angeles: Western Psychological Services.
Biel, L., & Peske, N. (2005). Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues. New York: Penguin.
Kranowitz, C. (2005). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder. New York: Perigee. Kranowitz, C. (2006). The Out-of-Sync Child Has Fun: Activities for Kids with Sensory Processing Disorder. New York: Perigee.
Kranowitz, C., & Newman, J. (2010). Growing an In-Sync Child. New York: Perigee.
Miller, L.J., PhD, with Fuller, D.A. (2006). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. New York: Putnam.
Smith, K.A., PhD, & Gouze, K.R., PhD (2004). The Sensory-Sensitive Child: Practical Solutions for Out-of-Bounds Behavior. New York: Harper Collins.