SENSORY PROCESSING DIFFERENCES Exploring the Line Between Personal Quirks and Functional Impairments by Jenny Lujan, OTR Definition of Sensory Processing Sensory processing refers to the ability to take information from our senses (touch, movement, smell, taste, vision, and hearing) and put it together with prior information, memories, and knowledge stored in the brain to make a meaningful response. Definition of Sensory Processing Sensory processing occurs in the central nervous system and is generally thought to take place in the portions of the brain responsible for such tasks as coordination, muscle tone, attention, arousal levels, autonomic functioning, emotions, memory and higher-level cognitive functions. Sensory Processing Abilities The way an individual processes and responds to sensation has an impact on their daily life activities and activity choices. (Zuckerman, 1994, & Dunn, 1997) Atypical sensory processing refers to both hyper and hypo reactivity to sensation. Poor or atypical sensory processing abilities have been associated with problems in social participation and behavioral self-regulation, as well as learning, leisure, and occupational activities. (Dunn, 2001) Sensory Processing Abilities Other common behavioral manifestations of atypical sensory processing include distractibility, impulsiveness, abnormal activity level, disorganization, anxiety, and emotional lability. (Mallioux and Parham, 1995) Sensory Systems are the Building Blocks Position Sense (Proprioception) Proprioception is the information you receive from your muscles about where your body parts are and where your body is in space : This information allows us to know where our body is when we close our eyes. These sensory receptors are in our muscles and tendons. It also helps to regulate how you feels about your body and the environment around you. The brain needs continuous and current information about your body, so it can plan how to use the body to do things. Movement Sense (Vestibular) This is the sensory system that responds to changes in head position, to body movement through space, and regulates our balance system. It also coordinates movements of the eyes, head, and body. The receptors are located in the inner ear. Accurate processing of vestibular information is what allows us to easily move through our environments. The vestibular system also helps keep the level of arousal of the nervous system balanced. Touch Sense (Tactile) Tactile refers to our sense of touch and to the information our body gets through the skin. Our sense of touch is important because it helps us learn about our body and the environment we live in. Some of the tactile receptors are close to the surface of the skin and others are deep in the skin. Light Touch gives the brain an alerting message, “Pay attention”. It is a useful sensation to increase a person’s awareness of what is going on. Touch Pressure sensation occurs when you get a firm touch on your skin. Many people find comfort in touch pressure input. Oral Sense (Gustatory) The sense of taste provides sensory information that is critical for monitoring and controlling the ingestion of food, including swallowing and salivation. There are many gustatory sense receptors in our mouth that we can get a lot of information quickly. Visual Sense Vision is the process of gathering, analyzing, storing, and responding to light information. Vision includes visual acuity (seeing), coordination of the two eyes, focusing, eye movement control, and visual perceptual skills. When we use our eyes, we are developing visual maps, which we use with our body maps to figure out how to move around successfully. Sound Sense (Auditory) Audition is the process of hearing. Hearing, adequate auditory processing (understanding what is being said), and language response is an important aspect for one's interaction with the environment. We collect sound memories that allow us to distinguish what an object is or who a person is by sound alone. Sound travels across distances and we learn to associate sound with distance. Smell Sense (Olfactory) Your sense of smell processes odors and can distinguish between thousands of scents. Olfactory information travels not only to the limbic system (which governs emotions, behaviors, and memory storage) but also to the brain's cortex, where conscious thought occurs. It combines with taste information in the brain to create the sensation of flavor. Sensory Processing Differences “The way a person processes sensory information is just that-the way the person processes sensory information. No way of processing sensory information is inherently good or bad-it just is.” “People with every pattern of sensory processing are living successfully and unsuccessfully…” [A sensory difference] “is not a problem to resolve; living a satisfying life is the challenge to address.” (Dunn, 2001) Sensory Processing Differences There are many ways to look at how individuals process sensory information. Instead of looking at how an individual process each type of sensory input, Winnie Dunn, OTR developed a working foundation that there are four sensory preferences that influence how each of us relate to the sensory stimuli that are in our everyday life. After determining what are the sensory preferences, we can look at if an individual’s processing is causing functional impairments in his or her life. Dunn describes the four types of sensory differences as follows: Low Registration Types of Sensory Differences Low Registration. Individuals with low registration tend to miss or take longer to respond to things in their environment. These individuals tend to have trouble reacting to rapidly presented or low-intensity stimuli. However, these individuals find it easier to focus on tasks of interest in distracting environments. They tend to be more flexible and comfortable in a wide range of sensory environments. Sensation Seeking Types of Sensory Differences Sensation Seeking Individuals with sensory seeking behaviors create additional stimuli or look for environments that provide sensory stimuli. They do this in order to activate their arousal system. An interest in exploring the environment is a feature of individuals with sensory seeking behavior. These individuals find sensory experiences pleasurable. However, these individuals tend to become bored easily and may find low-stimulus environments intolerable. Sensory Sensitivity Types of Sensory Differences Sensory Sensitivity Individuals with sensory sensitivity respond readily to sensory stimuli. Behaviors associated with sensory sensitivity include distractibility and discomfort caused by intense stimuli. These individuals have a tendency to notice each stimulus as it presents itself. However, some advantages of sensory sensitivity include a high level of awareness of the environment and an ability to discriminate or attend to detail Sensation Avoiding Types of Sensory Differences Sensation Avoiding Individuals who engage in sensation avoiding behaviors are overwhelmed or bothered by sensory stimuli. Consequently, sensation avoiders actively engage with their environments to reduce sensory stimuli. Individuals with sensation avoiding tendencies may use ritual to increase predictability of their sensory environment. However, advantages of sensation avoiding include the ability to create structure and environments that provided limited sensory stimuli, as well as tolerance-even an enjoyment- of being alone. General Treatment Ideas For All Types of Sensory Processing Differences Use of visuals can be especially helpful with helping others deal with sensory processing differences. Use of visual schedules can provide structure so that children and adolescents who are sensory seekers will know when more movement activities will happen. A visual schedule will also provide children and adolescents who are sensory sensitive or avoiders with the opportunity to prepare for the upcoming activity. General Treatment Ideas For All Types of Sensory Processing Differences The use of sensory choice boards can provide younger children with the opportunity to control what type of sensory input they receive to help calm their bodies. The use of social stories about sensory behaviors can be helpful. These can also be called “Sensory Stories”. Sample Visual General Treatment Ideas For Low Registration Goal of Intervention is to Increase Intensity of Sensory Experiences in Daily Activities. Ask others to slow down, speak up, and repeat as needed. Have child/adolescent explain or repeat information back to you to make sure he or she has processed what was said. Use an alarm for reminders. Make visual cues more noticeable- underline, bold, highlight, use color, etc. Ideas For Low Registration More Ideas include: Place important objects (school supplies, backpack) in the same obvious place each day. Use lists, reminders, date books, calendars, etc. as cues. Talk self through a task to make sure of awareness of all steps. Visit places that have a variety of sensory experiences (parks, zoos, interactive exhibits). Be aware of safety measures when the child or adolescent is moving about (may not notice objects, stairs, changes in terrain). Information obtained in part from Sensory Profile Supplement, Winnie Dunn. Information is reproducible. General Treatment Ideas For Sensory Seeking Goal of Intervention is to Increase Intensity of Sensory Experiences In Daily Activities. This will help the child/adolescent to use more appropriate avenues to get the sensory stimulation that their bodies are seeking. A caveat for remembering general treatment ideas for sensory seeking is that Proprioception (deep pressure) is a child’s/adolescent’s friend. Ideas For Sensory Seeking Ideas that can easily be incorporated into every day include: Several times a day, provide a crunchy or chewy type of snack such as fresh apples, carrots, fruit roll-ups, fresh almonds, fruit leather, dried pasta, gum etc Provide with regular opportunities to run and play throughout the day. Be sure to monitor for safety. Because actions are often driven by the need for increased sensory input, the child or adolescent requires concrete information about what activities are safe. For example, tell and show what places can safely be jumped off of (i.e. the front porch, the last 2 steps of the stair case, etc.). Also tell and show what places can not jumped or fallen off of. (i.e. the top of the tree, the top of the playground equipment, the top of the stairs, etc.) Ideas For Sensory Seeking Encourage participation in a "hard work" activity 3x/day (mopping the floor, pushing or pulling heavy objects, doing push-ups, etc.). More ideas include: Staple paper onto the bulletin boards Move the furniture in the classroom. Carrying a heavy backpack. Be sure to only put weight in the backpack that equals 10%-20% of the child's body weight. At home, encourage participation in physically demanding work activities such as: Yard work Digging in the dirt to help plant flowers. Sweep the sidewalks, playground, etc. Raking grass/leaves. Ideas For Sensory Seeking Promote engagement in a physical activity before a thinking task. Allow child/adolescent to hold onto objects such as fidget toys or weighted lap buddy during table top activities and/or circle/group time. Allow use of disc-o-sit cushions or therapy ball chairs in the classroom. Ideas For Sensory Seeking A study was completed by Pfeiffer B, Henry A, Miller S, and Witherell, S. and was reported in the American Journal of Occupational Therapy, 2008, May-June. “Effectiveness of Disc 'O' Sit cushions on attention to task in second-grade students with attention difficulties”. Sixty-three second-grade students participated in the study. 31 students were assigned to a treatment group, and 32 were assigned to a control group. Treatment group participants used Disc 'O' Sit cushions throughout the school day for a 2-week period. The teachers completed the Behavior Rating Inventory of Executive Functioning (Gioia, Isquith, Guy, & Kenworthy, 1996) for each participant before and after the intervention. An analysis of variance identified a statistically significant difference in the attention to task before and after the intervention for the treatment group. The results of the study provide preliminary evidence for the use of the Disc 'O' Sit cushion as an occupational therapy intervention to improve attention in the school setting. Ideas For Sensory Seeking More ideas include: Make a "Smell Good Station“ using cotton balls and small containers (film canisters) Certain types of smells can be calming and comforting. The following are calming Scents (generally) almond extract, apple extract, banana extract, chamomile, cinnamon extract, lavender, pine needles, vanilla extract, peppermint extract,gingerbread cookies Organized sports Football Track and Field Martial Arts General Treatment Ideas For Sensory Sensitivity Goal of Intervention is to Provide Structured Patterns of Sensory Experiences in Daily Activities. Limit the amount of information/steps provided at any one time. Reduce the volume or the amount of auditory stimuli. Use earplugs, white noise, or calming repetitive sounds (i.e. fan) to drown out distracting noises. When having a conversation or passing on important information, decrease background noise Ideas For Sensory Sensitivity More ideas include. Look for opportunities to engage in small groups activities or in one-on-one situations versus large crowds. When completing work that requires focus, go to a quiet area of the room. Maintain consistency and try to reduce disruptions. Establish routines that are comforting and supportive. Incorporate breaks and time-outs into her daily routine. Use proprioceptive activities to help calm the body. Information obtained in part from Sensory Profile Supplement, Winnie Dunn. Information is reproducible. General Treatment Ideas For Sensory Avoiding Goal of Intervention is to Decrease Sensory Experiences in Daily Activities. Provide written instructions or pictures to supplement verbal information. Designate an assigned desk or work area with sufficient space to prevent jostling/bumping. Incorporate need for personal distance from others in sitting arrangements and activities. Ideas For Sensory Avoiding More Ideas include: Limit large group exposure; find opportunities for small groups or one-on-one interaction. Develop routines for outings to familiar places. Limit large unstructured time in public. Select non-peak times for outings and errands. Incorporate routine and repetition in movement activities. Encourage “quiet”time or opportunities for sedentary activities. Information obtained in part from Sensory Profile Supplement, Winnie Dunn. Information is reproducible Questions? References Bundy, A.C., Lane, S., & Murray, E.A., (Eds). (2002) Sensory Integration: Theory and Practice (2nd ed). Philadelphia: F.A. Davis Davies, P., & Chang, W., Studying Sensory Processing Disorders in Children Using Electroencephalography Dunn, W. (1997). The impact of sensory processing abilities on the daily lives for young children and their families: A conceptual model. Infants and Young Children, 9 (4), 23-35. Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy, 55, 608-620 References Kinnealey, M., & Fuiel, M., (2006). The relationship between sensory defensiveness, anxiety, depression, and perception of pain. Occupational Therapy International. 6(3), 195-2006. McIntosh, D., Miller, L., Shyu, V., & Hagerman, R. (1999). Sensory modulation disruption, electrodermal responses and functional behaviors. Developmental Medicine and Child Neurology, 41, 608-615. Parham, D. & Mailloux, Z. (1995). Sensory Integrative principles in intervention with children with autistic disorder. In J. Case-Smith, A.S. Allen, & P.N. Pratt (Eds.),Occupational Therapy for Children (pp. 329-382). St. .Louis, MO: Mosby. References Pfeiffer, B., & Kinnealey, M., (2006). Treatment of sensory defensiveness in adults. Occupational Therapy International, 10(3), 175-184. Stephens, C.L., & Royeen, C.B., (1998). Investigation of tactile defensiveness and self-esteem in typically developing children. Occupational Therapy International, 5(4), 273-280. Wakeford, L. (2006), Sensory Processing: Strategies to Increase Engagement #3. Zuckerman, M. (1994). Biological Bases of Sensation Seeking, Impulsivity, and Anxiety. Hillsdale, NJ. Larenece Erlbaum Associates, Publishers.