Eide Neurolearning Clinic
6701 139th Place SW
Edmonds, WA 98026
ph: 425-742-2218
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email:
drseide@neurolearning.com
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Sensory Processing Disorders in a Learning Disorders Clinic
by Brock Eide, M.D. M.A. and Fernette Eide, M.D.
In her groundbreaking work Sensory Integration and the Child Jean Ayers estimated that 5-10% of all children had disordered sensory integration. Carol Kranowitz, in her more recent sensory processing disorders classic The Out of Sync Child, places this number between 12-30%.
Although a precise tally of the number of children affected by sensory processing disorders or dysfunction of sensory integration (DSI) is difficult to come by for a variety of reasons, our own experience as physicians specializing in treating children with learning disorders leads us to agree with these authors that sensory processing disorders is a vast, and vastly under-recognized, problem among pre-school and school aged children. In this article, we'd like to describe our experience with sensory processing disorders in children referred to our clinic by schools, physicians, or parents for evaluation of learning problems.
Sensory Processing Problems are Common in Kids with Learning Disorders
Using a set of diagnostic criteria combining patient history and clinical observation, we determined that of our last fifty consecutive patients, 52 percent had difficulties with sensory integration severe enough to contribute to their learning problems. The frequency of sensory processing disorders varied markedly according to age. In our 30 children under age 10, 70% had sensory processing disorders, while in children 10 and over, only 20% had sensory processing disorders.
The reasons for this striking difference are not entirely clear. It is possible that the incidence of sensory processing disorders diminishes with age because the sensory processing disorder tends to lessen or resolve. However, it is also possible that the sensory processing disorder persists, but that many children tend over time to develop compensatory strategies for dealing with it so that it no longer produces so many bothersome complications. Most experts in sensory processing disorders lean toward the latter explanation. They feel that even in persons who have been treated with sensory integration therapy some signs of the disorder are still usually detectable, and that in untreated persons these signs are usually readily apparent.
Our thoughts are somewhere in the middle. In our experience, the persistence of sensory processing disorders tends to vary according to its severity. Severely affected children (who are, probably not coincidentally, the ones most likely to have come to the attention of the occupational therapists who've done most of the research in this field) are likely to have the most persistent and troublesome symptoms later in life. On the other hand, children with mild to moderate symptoms may improve symptomatically, even without therapy, to show few or no signs of DSI as adolescents of adults. Even among more mildly affected children, though, therapy may be helpful in speeding progress and preventing emotional and behavioral complications that can persist lifelong.
Diagnosing Sensory Processing Disorders in the Clinic: History
Of the various historical and physical data we use to diagnose sensory processing disorders, no one type is able by itself either to make or break the diagnosis. We tend to view the information as a whole to see whether a pattern of sensory dysfunction and behavioral difficulties consistent with the diagnosis of sensory processing disorders emerges.
Currently, we gather historical information on the children we see by having their parents answer a battery of 28 questions probing sensory seeking or avoidance, balance and motor issues, and energy level. Table 1 displays some of the most revealing data from the fifty children in our sample.
In our current sample, parents of children diagnosed with sensory processing disorders were over five times more likely than parents of children without sensory processing disorders to say that their child: had a weak grasp and floppy muscle tone; was insecure with slides and escalators; avoided rough play and playground equipment; or, had unexpected falls while sitting in a chair or playing.
This historical information is interesting in several respects. First, the importance of balance and gravitational security issues in children with sensory processing disorders suggest why vestibular/proprioceptive therapy as pioneered by Jean Ayers has been so successful in treating children with this disorder.
Second, it is important to note how many children with sensory processing disorders have difficulties in the areas of motor energy and motor weakness. Our observations along these lines have led us to place a higher priority on motor conditioning and strengthening than that accorded by some traditional therapies.
Third, this information is important because of what it suggests about the etiology of sensory processing disorders. Our own suspicion is that many of these clinical manifestations of sensory processing disorders may be due to a functional disorder of a specialized type of sensory nerve cell called "spindle afferents". Spindle afferents are important in regulating muscle tone, in muscle fatigue, and in spatial localization at the joints: all functions that are affected in sensory processing disorders .
Returning to the data, all of our questions about tactile sensitivities and most of our questions about auditory sensitivities tend to be endorsed by more of the parents of sensory processing disorders kids. These questions, however, are not as specific for the disorder as the items mentioned above.
Most of the questions we've tested regarding sensitivity for vision, smells, tastes, and sensory-seeking behavior have not been either sensitive or specific in identifying children with sensory processing disorders.
Interestingly, most of the questions we ask parents regarding mood, affect, social and emotional behaviors tend to sort poorly for kids with sensory processing disorders. Only one item is consistently endorsed by more parents of sensory processing disorders kids: "Has tantrums". In our current sample, 71% of parents whose child has sensory processing disorders said "yes" to this item. Only 46% of other parents endorsed it.
Diagnosing Sensory Processing Disorders in the Clinic: Physical Exam
On physical exam, kids with sensory processing disorders had low or abnormal muscle tone almost twice as often as kids without sensory processing disorders . Almost sixty percent of our sample had unusually floppy or spastic muscle tone. Nearly forty percent had a condition called "scapular winging" in which the muscles of the back are too weak to hold the shoulder blades in place: roughly twice the frequency as in children without sensory processing disorders .
The proprioceptive or "spatial-positioning" problems in children with sensory processing disorders were reflected in their almost universal inability to feel the positions of their fingers in space. This condition, called "finger agnosia", affects just over half of our non-sensory processing disorders population, reflecting the numbers of children we see with primary motor, graphomotor, and sensory problems. Still, it is almost twice as common in our patients with sensory processing disorders . To understand what this condition means to a child, try to imagine what it must be like to attempt to write your name, draw a picture, button your shirt, or tie your shoes with fingers that don't know where they are in space or in what directions they're moving.
Third, although our parent questionnaires didn't demonstrate a clear difference in sensory seeking behaviors between kids with sensory processing disorders and those without, our physical examination did show evidence of sensory seeking behavior in a full 85% of children with sensory processing disorders . Only 54% of children without sensory processing disorders showed such behavior. These activities included chair spinning, table and paper picking, fidgeting, kicking (table, chair, and examiner), crashing and bumping.
Finally, although our historical questionnaire did not show variations in impulsive or hyperactive behaviors that correlated with the sensory processing disorders diagnosis, our examinations found marked discrepancies in such behaviors. Impulsive behaviors, such as grabbing items without asking, beginning test segments without waiting, and answering questions in an unplanned manner, were almost four times more common in children with sensory processing disorders . Hyperactive behaviors, such as running around the exam room, jumping and crashing into things, and fidgeting, were over five times more common in kids with sensory processing disorders.
Attentional difficulties, which were present in essentially all children in both groups, did not superficially differ between groups. These findings raise important issues regarding the relationship of sensory processing disorders and ADHD, whose three cardinal manifestations are impulsivity, hyperactivity, and attentional disorder. Please see are article on sensory processing disorders and hyperactivity for more discussion.
Conclusions
Sensory processing disorders are remarkably common in the children we see with learning problems, especially in children under 10. The obvious, indeed inescapable, conclusion is that sensory processing disorders contribute significantly to the learning problems facing many of our children. We are encouraged by signs that this long neglected and profoundly important condition is finally beginning to receive the attention it deserves. We are optimistic that the future will bring many more advances in our understanding of this disorder and in our ability to help the children it affects.
Table 1: Questionnaire Items Endorsed
|
Questionnaire Item |
Sensory |
Non-Sensory |
|
Unexpected falls out of chair or on playground |
19% |
0% |
|
Floppy or loose muscle tone |
29% |
5% |
|
Weak grasp |
29% |
5% |
|
Doesn't like rough housing |
19% |
5% |
|
Doesn't like messy play or splashing in water |
29% |
10% |
|
Fatigues easily |
52% |
19% |
|
Avoids physical closeness |
19% |
10% |
|
Covers ears to loud noises |
52% |
29% |
|
Has tantrums |
71% |
46% |
Table 2: Clinical Exam Findings
|
Clinical Finding |
Sensory |
Non-Sensory |
|
Abnormal Muscle Tone |
58% |
29% |
|
Scapular Winging |
38% |
21% |
|
Finger Agnosia |
86% |
52% |
|
Hyperactivity |
50% |
9% |
|
Impulsivity |
31% |
8% |
About the Authors: Brock and Fernette Eide are physicians and consultants to a wide range of parent, teacher, and clinical professional groups seeking more information about brain-based difficulties and their solutions. Together they have authored more than 50 articles and they speak internationally for keynote lectures, seminars, workshops, and small groups. The Eides can be contacted through their website at: www.neurolearning.com or by email at: feide@u.washington.edu or drseide@neurolearning.com.