SPD FAQs

Frequently asked by parents or teachers
Frequently asked by clinicians
Frequently asked by health care providers

FAQs: Parents or Teachers

Q. What is Sensory Processing Disorder (SPD)?

A: Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children and adults who were not treated in childhood. Children with SPD misinterpret everyday sensory information, such as touch, sound, and movement. Some feel bombarded by sensory information; others seek out intense sensory experiences or have other problems. This can lead to behavioral problems, difficulties with coordination, and other issues.

Symptoms of SPD, like those of most disorders, occur within a broad spectrum of severity. While most of us have occasional difficulties processing sensory information, for children and adults with SPD, these difficulties are chronic, and they disrupt everyday life. Click here to read about SPD Red Flags.

There are several types of Sensory Processing Disorder, and each one may result in a number of different behavioral and sensory patterns. Click here to learn more about the Defining SPD and its subtypes.

Q: Is Sensory Processing Disorder different from "dysfunction of sensory integration" or "sensory integration dysfunction"?

A: No. Sensory Processing Disorder is a new term that health care professionals are now using to describe dysfunction of sensory integration/sensory integration function. Sensory Processing Disorder or SPD is an umbrella term for several distinct forms of sensory processing issues. Read more about the types of SPD in Defining SPD and its subtypes.

Q: Is there proof that SPD is real?

A: Following a hiatus after sensory pioneer Dr. A. Jean Ayres died in 1988, research into SPD has recently entered a massive growth phase. The sensory processing abilities of hundreds of children are being tested in multiple laboratories, providing the replicate data that are the cornerstone of scientific credibility. Research scientists from numerous, diverse disciplines are conducting primate studies, rat studies, anatomic studies, electroencephalographic, and other psychophysiological studies, plus studies of twins, other familial studies, and more. Results are being reported in refereed professional journals where research must meet exacting standards to be published.

Scientists are hard at work on questions such as these:

What's going on in the brains of these children?
How is SPD similar and different from other disorders
What does SPD look like
Does treatment work?
How many people have SPD?
Where does SPD come from?
Is heredity a factor?

Visit Ten Fundamental Facts about SPD to see a summary list of some findings. Clinical reports on specific topics can be found in Our Library. Clinical reports on specific topics can be found in Our Library.

Q: How is Sensory Processing Disorder treated?

A: SPD is typically treated with a program of occupational therapy (OT) conducted in a sensory-rich environment. Appropriate OT can change the neurological functioning in children with SPD so they can manage their responses to sensations and behave in a more functional manner. Successful OT enables them to take part in the normal activities of childhood such as playing with friends, enjoying school, eating, dressing, and sleeping. Therapy can take place in a hospital OT department or in a private practice setting. The most effective treatment is tailored to the needs of the individual child. Read more about occupational therapy in How SPD is Treated.

Q: What evidence is there that occupational therapy "works" for treating SPD?

The question posed by the trial: Is OT-SI effective in ameliorating the difficulties of children with Sensory Over-Responsivity compared to a placebo treatment and no treatment (a comparison of three groups). Children in the OT-SI group received OT with a sensory integration approach twice a week for 10 weeks. The treatment was "manualized" (based on a written manual) using principles proposed by Dr. A. Jean Ayres, who first identified sensory integration dysfunction (now called SPD).

The results: Compared with children who received an alternative treatment or no treatment at all, children with Sensory Over-Responsivity who received OT-SI made statistically significant improvements on several key measures including cognitive and social measures and parent priorities for changes.

The study group was small – 24 children – so caution is required in interpreting the results. Even so, the research represents a landmark as the first scientifically rigorous study of the effectiveness of OT-SI, and the results are promising for helping children with sensory challenges.

Q. How can I find an occupational therapist to work with my child?

A: A good place to start is in Find Service Providers, the SPD Foundation's one-of-a-kind online national directory of health care, educational, and community resources experienced in working with children who have SPD and other special needs. Many occupational therapists who have experience in working with Sensory Processing Disorder have registered with the directory; searching for one near you is very easy.

Also take a look at How to Find an Occupational Therapist for ideas on how to find a professional with the credentials and experience most likely to lead to effective therapy for your child.

Q: Are children entitled to Sensory Processing Disorder therapy in school by law?

A: The Individuals with Disabilities Education Act (IDEA) guarantees a free and appropriate public education with peers, to the maximum extent appropriate, to all eligible children with disabilities (ages 3-21) who need special education and related services in order to learn in school. Children with disabilities can receive occupational therapy (OT) if they qualify for special education. In addition, a school team, including the parents, must decide if the therapy is necessary. (Some school districts will provide OT in other instances, e.g., to give teachers suggestions before referring a child to special education, called a pre-referral.)

There are no provisions in state or federal law that specify how OT, once recommended by the team, must be provided. This includes the service model, frequency of intervention, and the frame of reference.

In due process hearings and the courts, the issue of theory base or frame of reference has been referred to as a methodology decision. One of the latest court decisions regarding methodology centered around individual instruction for a student with dyslexia using the Ortho-Gillingham method (E.S. v. Independent Sch. Dist. No. 196). The district court disallowed the parent's request for this kind of reading instruction, stating that schools have discretion over methodology decisions as long as the program provides a free and appropriate public education.

Therapists who recommend school-based sensory integration therapy must show how the student needs this kind of occupational therapy in order to benefit from participation in the curriculum and specific school activities. Important issues to address (in jargon-free language) include:

The student's performance levels in educationally relevant areas
How OT services using sensory integration would support team goals
The specific instructional methods and materials (including those based on sensory integration principles) needed to assist the student in reaching specified educational goals

More information about the schools and SPD is located in Our Library.

Sources

AOTA (1997). OT services for children and youth under the IDEA. Bethesda MD.
AOTA (1997). Statement-Sensory integration evaluation and intervention in school-based occupational therapy. Bethesda MD. (Available from FAX-on-Request from the AOTA National Office, 800-701-7735, document #903)
E.S. v. Independent Sch. Dist. No.196, 27 Individuals with Disabilities Education Act Law Review 503, 96-4214, 8th Cir. 1998.

Q: How can I find a doctor or dentist who is aware of sensory processing issues?

A: The best place to start is in Find Service Providers, the SPD Foundation's one-of-a-kind online national directory of health care, educational, and community resources experienced in working with children who have SPD and other special needs. Many doctors and other health care professionals have registered with the directory.

Q: Are there any classes or workshops I can attend to learn more about Sensory Processing Disorder? Are there any that I can recommend to the teachers at my child's school?

A: The most economical, accessible source of SPD education for parents and teachers are online e-Learning classes from the SPD Foundation. SPD University is unlike any other educational program about Sensory Processing Disorder. The unique environment was created specifically for web-based education. Classes are taught and vividly illustrated by sensory experts with decades of experience in resedarching, assessing, and treating SPD. SPD University is accessible 24/7.

In addition to e-Learning, the SPD Foundation sponsors International Symposiums throughout the United States. These are designed for parents, teachers, and therapists and provide two intensive days of learning opportunities.

Visit our Education page for a complete list of educational opportunities.

Q: Can children who have an autistic spectrum disorder also have Sensory Processing Disorder?

A: A. Jean Ayres, PhD, OTR, who developed sensory integration theory and therapy, and another well-known occupational therapist, Lorna Jean King, believe that many children with autism also have Sensory Processing Disorder. The presence of SPD, they believe, contributes to many of the behavioral and learning problems experienced by children with autistic spectrum disorders, such as over- or under-reactivity to sensations and problems in making sense of auditory and visual input to understand and use language. Pilot research by the SPD Foundation indicates that as many as 80% of children with autism also have SPD. (The reverse is not true.)

To learn more about autism and Sensory Processing Disorder, visit Our Library. You may also want to read some of Temple Grandin's books. Dr. Grandin has a type of autism known as Asperger's Syndrome and also has sensory and perceptual disorders. She has earned a PhD in animal science and is one of the world's foremost experts in the design and construction of livestock facilities. She believes her diagnosis is also a gift, giving her an extraordinary ability to visualize events and interactions in her mind. In her books she describes how she learned to accommodate to the "regular" world. You can find her books at Amazon.com: "Autism: Handle with Care!" and "Thinking in Pictures."

Q: How can I help my child adapt to his sensory issues while at home?

A: Our colleague Heather Miller-Kuhaneck, MS, OTR/L, BCP, has written an excellent article on what parents can do at home to help their children. You can read Heather's suggestions at Home Activities for Children with Sensory Integration Problems. If you order Heather's book on autism after clicking through to amazon.com from this site, the SPD Foundation will receive a portion of your purchase.

Q: Can you suggest some books or other materials I can read on Sensory Processing Disorder?

A: Lucy Jane Miller, PhD, OTR/L, founder and executive director of SPD Foundation, has written a groundbreaking book for parents, teachers, and health care providers. Sensational Kids: Hope and Help for Children with Sensory Processing Disorder has been called by reviewers "every parent's 'go-to' book for questions about their child's sensory development issues." The book describes and provides strategies for children with the major subtypes of SPD and also details the latest research on SPD. No Longer a SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges is the newest resource for parents, teachers and therapists, helping children with sensory or motor issues. Includes cost-effective, functional, on the spot tips to use for children with sensory issues at home, at school or in a community setting.

You will find additional materials – activity books, books for teachers, textbooks, sensory products, music, CDs, and videotapes – under Books and Product Guide.

FAQs: Clinicians

Answers provided by Barbara Hanft, MA, OTR, FAOTA, an occupational therapist with more than 25 years of clinical and policy experience in pediatrics, early intervention, and special education, and Lucy Jane Miller, PhD, OTR, executive director of the SPD Foundation.

Q: How are sensory integration theory, sensory integration dysfunction, Sensory Processing Disorder, and Sensory Modulation Disorder related?

A: Sensory integration theory was formulated by A. Jean Ayres, PhD, OTR, an occupational therapist who practiced from the mid-1950s until 1988. Based on neuroscience principles, the theory describes an underlying rationale for the diagnosis and treatment approach that Dr. Ayres founded to evaluate and intervene with children who have particular sets of sensory and/or motor symptoms and who may have learning disabilities. Her basic concept was that the individual had a deficit in the central nervous system's ability to receive, filter, organize, and integrate stimuli, which resulted in a non-adaptive response.

Sensory integration dysfunction (DSI) was the term used by Dr. Ayres to refer to this broad theory, as well as to the diagnosis and the treatment (e.g., sensory integration treatment) of children who have the dysfunction.

These terms and the relationships between them have been clarified for the purposes of this web site. The current terminology is explained below.

"Sensory integration" is now recommended for use only to refer to Dr. Ayres' theories about mechanisms of the disorder and their intervention. Intervention is now referred to as "occupational therapy (OT) with a sensory-based (or SI, sensory integration) approach," or "OT using Ayres' sensory-based (or sensory integration) approach."

Sensory Processing Disorder (SPD) is the label used on this web site to denote the diagnosis of difficulty in processing sensory input in an efficient and accurate manner, and includes the accompanying behavioral, attentional, motor, and functional manifestations.

Sensory Modulation Disorder (SMD) is one of the three primary subtypes of Sensory Processing Disorder. Individuals with SMD have difficulty adjusting their responses to match the needs of the situation. They often have patterns of over-responsivity, under-responsivity, or sensory-seeking (or a combination of those patterns) in response to levels of stimulation that typically developing individuals respond to with a brief orienting response (noticing the new stimulus) and then habitation (ignoring the new stimuli) once it is interpreted as non-threatening.

For more information, see also Defining SPD and its subtypes.

Sources

Ayres AJ. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.
Roley SS, Wilbarger J. (1994). What is sensory integration? A series of interviews on the scope, limitations, and evolution of sensory integration theory. Sensory Integration Special Interest Section Newsletter, 17(2), 1-7.

Q: How can I assess Sensory Processing Disorder if I'm not certified in administration of the Sensory Integration and Praxis Tests (SIPT)?

A: The basis of all occupational therapy assessment is to evaluate the impact of underlying components, including sensory integrative function, that affect an individual's functional performance in the context of specific settings in which the individual must perform.

In addition to the Sensory Integration and Praxis Tests (whose use may be limited due to a child's age or ability to understand the test directions), clinical observations and sensory history questionnaires can provide information about sensory integration (see Cook, 1991; Dunn & Westman, 1997; Royeen & Fortune, 1990). Many standardized perceptual and motor tests (see Carrasco, 1993) also provide an opportunity to observe aspects of sensory integrative function.

For advanced clinicians who desire to develop or enhance their diagnostic skills, the SPD Foundation offers a five-day mentorship program that includes training in choosing appropriate tools to evaluate children with SPD;

administering, scoring, interpreting ,and writing up standardized scales reliably; and interpreting findings from evaluations for treatment planning. The program is AOTA-approved for continuing education credit. Learn more about the program at Advanced Mentorship Program.

Sources

Carrasco R. (1993). Key components of sensory integration evaluation. Sensory Integration Special Interest Section Newsletter, 16(2), 1-7.
Cook D. (1991). The assessment process. In W. Dunn (Ed.), Pediatric occupational therapy. Thorofare, NJ: Slack, Inc. (includes a functional behavior assessment for children with Sensory Processing Disorder).
Dunn W, Westman W. (1997). The sensory profile: The performance of a national sample of children without disabilities. American Journal of Occupational Therapy, 51, 25-34.
Royeen C, Fortune J. (1990). TIE: Touch Inventory for School-aged Children, American Journal of Occupational Therapy, 44, 155-160.

Q: Are children entitled to Sensory Processing Disorder therapy in school by law?

The student's performance levels in educationally relevant areas
How OT services using sensory integration would support team goals
The specific instructional methods and materials (including those based on sensory integration principles) needed to assist the student in reaching specified educational goals

More information about the schools and SPD is located in Our Library.

Sources

AOTA (1997). OT services for children and youth under the IDEA. Bethesda MD.
AOTA (1997). Statement-Sensory integration evaluation and intervention in school-based occupational therapy. Bethesda MD. (Available from FAX-on-Request from the AOTA National Office, 800-701-7735, document #903)
E.S. v. Independent Sch. Dist. No.196, 27 Individuals with Disabilities Education Act Law Review 503, 96-4214, 8th Cir. 1998.

Q: How can I best apply Sensory Processing Disorder principles in school settings?

A: The effective application of Sensory Processing Disorder (SPD) principles in school settings is an important role for occupational therapists. When you are in this situation, try to focus on articulating the educational benefit for the student and planning interventions that will improve outcomes related to the student's role in a school setting (e.g., develop goals and objectives for increasing attention for school tasks versus reducing sensory defensiveness).

Use consultation and integrated therapy within the classroom to help teachers and parents reframe their perspectives about the student's behavior and abilities as well as adapt the school environment, the educational task, and specific materials used in lessons. Mailloux (1997) states "..it is also the job of the occupational therapists to educate the team about how sensory integrative disorders are affecting the child's educational performance and how appropriate intervention based on sensory integrative concepts can be incorporated into all aspects of their educational program."

Sources

Sarracino T. (1997). Applying a sensory integrative frame of reference in school practice. Sensory Integration Special Interest Section Newsletter, 20(3), 1-2.
Mailloux Z. (1997). Sensory integration and role performance in students. Sensory Integration Special Interest Section Newsletter, 20(3), 3-4.
Bundy A. (1991). Consultation and sensory integration theory. In Fisher, Murray, Bundy (Eds.), Sensory integration: Theory and practice (pp. 318-332). Philadelphia: F.A. Davis.

Q: How can I assess the sensory integrative function of children from birth to 3 years of age?

A: Gather your information from several sources. Most important are the child's parents and child care provider. Interview them to find out how processing of sensory information affects the child's interaction with others, sleep/wake cycles, and play and eating behaviors (DeGangi et al, 1995; Jirgal, Bouma, 1989).

Clinical observation and a thorough knowledge of sensory integration theory and typical and atypical development are also essential. Although formal tests may be difficult to administer to very young children, DeGangi and Greenspan (1989) have a test of sensory integration function, and Miller (1994) has developed assessments of the quality of movement based on SI and neurodevelopmental therapy principles for this age group. Many other developmental tests also contain items that provide information about an infant's sensory processing, coordination, and motor planning abilities (see Stallings, 1993, for a description of items for birth-3 in these tests).

The SPD Foundation offers a five-day mentorship program in advanced clinical assessment and treatment of SPD. The program is AOTA-approved for continuing education credit. Learn more about the program at Advanced Mentorship Program.

Sources

DeGangi G, Greenspan S. (1989). Test of sensory functions in infancy. Los Angeles CA: Western Psychological Services.
DeGangi G, Poisson S, Sickel R, Wiener A. (1995). Infant/toddler symptom checklist: A screening tool for parents. San Antonio, TX: The Psychological Corps/Therapy Skill Builders.
Jirgal D, Bouma K. (1989). Sensory integration interview guide for infants. Sensory Integration Special Interest Section Newsletter, 12(2), 5.
Miller L. (1994) The T.I.M.E. Toddler and Infant Motor Evaluation. San Antonio TX: The Psychological Corps/Therapy Skill Builders.
Stallings S. (1993). Assessment of sensory integrative dysfunction. In J. Case-Smith (Ed.), Pediatric occupational therapy and early intervention (pp. 309-341). Boston: Andover Medical Publishers.

FAQs: Healthcare Providers

Answers provided by Edward Goldson, MD. Dr. Goldson is a professor of pediatrics at the University of Colorado Health Sciences Center in Denver, Colorado, and has been on the staff of The Children's Hospital in Denver, since 1976.

Q: What is sensory integration? What is a Sensory Processing Disorder (SPD)?

A: All human beings receive information from their internal and external environments through the senses: vision, hearing, touch (somatosensory), taste (gustatory), smell (olfactory), vestibular, and proprioceptive. We respond to these stimuli automatically.

The term sensory integration refers to the process by which 1) we receive this information, 2) the central nervous system directs the information to the appropriate parts of the brain, and 3) the information is "integrated" or synthesized, so that we can respond to the stimuli in an adaptive manner.

When there is a disturbance in this capacity to automatically integrate sensation and respond adaptively, the individual has Sensory Processing Disorder (SPD). These disorders can have a negative impact on a child's capacity to learn, to function in socially appropriate ways, and to perform the daily tasks of living.

Q: Is there proof that SPD is real?

A: Following a hiatus after Dr. Ayres died in 1988, research into SPD has recently entered a massive growth phase. The sensory processing abilities of hundreds of children are being tested in multiple laboratories, providing the replicate data that are the cornerstone of scientific credibility. Research scientists from numerous, diverse disciplines are conducting primate studies, rat studies, anatomic studies, electroencephalographic, and other psychophysiological studies, plus studies of twins, other familial studies, and many more. Results are being reported in refereed professional journals where research must meet exacting standards to be published.

Research completed or currently underway or in press includes studies investigating:

What are the underlying physiological, neurological, and biochemical mechanisms implicated in SPD?
What is the concurrent and divergent evidence that SPD is a valid separate syndrome and not just a set of correlated symptoms within ADHD, Autism, fragile X syndrome, or another disorder?)
What is the behavioral phenotype of SPD?
What empirical evidence documents the effectiveness of occupational therapy in ameliorating SPD as well as in changing self-regulation, self-esteem, and social participation in children with the disorder?
What is the prevalence of SPD in the typically developing population and in populations that have disabilities?
What is the etiology of SPD?
Is there a familial component to SPD?

Abstracts and clinical reports may be found in Our Library.

Q: What is the purpose of a Sensory Processing Disorder assessment?

A: The capacity to process information has an effect on an individual's learning, social participation, self-regulation, and ultimately his or her self-confidence and self-esteem. When there are disturbances in sensory processing, these functional domains can be adversely affected. Examples of sensory disorders include problems with tactile discrimination, touch localization, graphesthesia, imitating postures, perception of body position in space, and bilateral motor coordination, in the absence of any frank peripheral or central nervous system damage.

There are a variety of scales and clinical observations that can be used to identify and assess the degree of disturbance. Such an assessment, performed by a highly trained occupational therapist, is necessary prior to determining the appropriate intervention to assist in remediation of, or compensation for, the SPD difficulties. The focus of the assessment and the intervention is to identify the underlying sensory disturbance(s) that may be adversely influencing the child's ability to function adaptively in his or her environment and to provide occupational therapy to enhance the child's functional abilities.

Q: What is the significance of "soft neurological" signs?

A: In and of themselves or from a purely functional perspective, soft neurological signs have no significance. However, from a diagnostic view the signs may be significant, suggesting neurological immaturity and/or the presence of a Sensory Processing Disorder.

Q: What is occupational therapy? What does an occupational therapist do?

A: Occupational therapy (OT) is a developmental intervention that seeks to enhance an individual's ability to function successfully in the community.

The occupational therapist starts with an evaluation of the child's capabilities that influence performance of tasks (called "occupations") necessary to function in his natural environment. The occupational therapist then assesses the child's specific strengths and weaknesses with respect to self-care, play/leisure skills, academic abilities, and sensory-motor capabilities. When therapeutic intervention is recommended, it is used to enhance the child's capabilities and includes aspects such as accommodations in positioning, adaptive equipment, modification of the environment, and functional enhancement of sensory perception, motor responses, and functional mobility and manipulation to accomplish the daily tasks ("occupations") of living. Whenever possible, natural environments are the venue for intervention, although clinics and inpatient settings are also employed. There are carefully delineated techniques for helping children with sensory processing disorders.

Q: What evidence is there that occupational therapy is an effective intervention for SPD?

A: The American Journal of Occupational Therapy in March-April 2007 published the first research study ever to evaluate the outcome of occupational therapy with a sensory integration approach (OT-SI) that met all four criteria of a randomized control trial (RCT). This study was the culmination of 10 years of research by the SPD Foundation and addressed the limitations of the estimated 80 previous studies of treatment effectiveness by (1) using a homogeneous sample, (2) manualizing treatment, (3) including outcome measures that were shown previously to be sensitive to change from OT-SI, and (4) using randomized treatment groups and blinded evaluators.

All p values are p. The findings were that children in the OT-SI group made gains that were significantly greater than the children in the other two groups (No Treatment and Activity Protocol, a placebo treatment) on Goal Attainment Scaling (p < 0.001). The OT-SI group also increased significantly more than the other groups on Attention (p = .03 compared to No Treatment; p = .07) and on the Cognitive/Social Composite of the Leiter-R (p = .02 compared to Activity Protocol). On both the Short Sensory Profile Total Score and the Child Behavior Checklist Internalizing Composite, change scores were greater for the OT-SI group, but not statistically significant. Physiologically, even with a very small sample, the OT-SI group showed greater reduction in amplitudes of EDR compared to the Activity Protocol and No Treatment groups.

The children in the Activity Protocol group, made greater but non-significant gains compared to the other two groups on Socialization (Vineland). Children in Group C (No Treatment) made greater but non-significant gains on the CBCL Externalizing Composite.

The findings suggest that OT-SI appears to be effective in ameliorating difficulties of children with SPD who have Sensory Over-Responsive subtype. Children in the OT-SI group made significant changes compared to the Alternate Treatment and the No Treatment groups on several key measures. In addition, trends occurred toward greater improvement in the OT-SI group on Internalizing (CBCL) and the SSP Total Score. The small sample size and lack of statistical power mandate caution in interpretation of results.

Source

Miller L, Schoen SA, James K, Schaaf RC (2007). Lessons Learned: A pilot study of occupational therapy effectiveness for children with Sensory Modulation Disorder. American Journal of Occupational Therapy, 61(2), 161.