Sensory Processing Disorders in Pediatric Patients: A Brief Review

Educational Objectives

The goal of this program is to improve management of sensory processing disorders. After hearing and assimilating this program, the clinician will be better able to:

1. Differentiate subtypes of sensory disorders from one another.
2. Select treatments for autism spectrum disorder and attention deficit hyperactivity disorder.

Summary

Sensory integration (SI): the organization of sensation for daily life, in particular the proximal senses that develop early and need to be integrated and modulated for further progress; the foundational senses include vestibular (sense of spatial orientation), tactile (sense of touch), and proprioception (sense of body positioning); difficulties in integrating the foundational senses may hinder the development of distal senses such as vision and hearing

Epidemiology: 1 in 6 children 7 to 11 yr of age have symptoms of sensory processing disorders (SPD); the incidence is 1 in 20 for younger children; 80% to 100% of children with developmental behavioral problems (eg, autism, fetal alcohol syndrome, Down syndrome, attention deficit hyperactivity disorder [ADHD]) have a sensory processing issue

Risk factors: cluster into medical (eg, low birth weight, prematurity, complications, maternal stress and illness), environmental (affects ability for early regulation), and social risk factors (which may cause major sensory processing problems)

Owen et al (2013): found that posterior cerebral white matter microstructure correlated with sensory behavior; diffusion tensor imaging may be used to distinguish SPD from autism spectrum disorder (ASD) and ADHD

Types of SPD

Sensory Modulation Disorder (SMD): sensory modulation is the conversion of sensory messages into controlled behaviors that match the nature and intensity of the sensory information; over-responsivity — involves quick or intense responses, exaggerated (fight or flight) or withdrawal (flight or freeze) responses; under-responsivity — (“spacey”) slow to respond to sensory stimulus; high intensity or increased duration has to be added to invoke a response; seeking or craving — may seek visually stimulating scenes

Sensory discrimination disorder (SDD): sensory discrimination is perceiving similarities and differences between sensations; children with SDD are not able to differentiate senses

Sensory-Based Motor Disorder (SDMD): involves stabilizing, moving, or planning a series of movements in response to sensory demands; includes dyspraxia (sequenced movements) and postural disorder (control of their bodies); children experience difficulties in ideating motor inputs over time

SPD Overlaps

ASD: formally recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5; emphasizes social communication difficulties and restricted repetitive behaviors; sensory processing issues are now acknowledged as a significant component of ASD and are highlighted in the DSM-5 criteria as hyper- or hyporeactivity to sensory input; persons with autism experience sensory processing challenges; research using neuroimaging techniques has shown increased subcortical to cortical connectivity in children with autism; overconnectivity in the brain, possibly related to sensory integration difficulties, may contribute to challenges in social interaction seen in persons with autism

ADHD: may present with symptoms which overlap with symptoms of sensory processing issues (eg, difficulties with focus, auditory and language processing, impulsivity, hyperactivity); whether ADHD stems from a baseline sensory processing issue is not known; a combination of factors may be responsible; sensory strategies may help re-regulate children with ADHD, but are considered to be adjunctive therapies and not primary treatments; core interventions for ADHD include behavioral interventions and medications, with behavioral therapy (BT) recommended for younger children and medications often prescribed for older children; incorporating sensory approaches alongside core interventions may be beneficial

Developmental coordination disorder (DCD): characterized by motor skill deficits which affect planning and execution of tasks; may manifest as motor incoordination, delays in fine and gross motor skills, balance deficits, and poor praxis; DCD has similarities with SPD, particularly in the struggle to integrate sensory information during task planning

Diagnostic tests: standardized questionnaires are often not available; the Sensory Integration and Praxis Test (SIPT) is considered the gold standard for assessing sensory integration (SI) in children aged 4 to 9 yr, regardless of whether they have severe motor or mental disorders; the test consists of 17 subtests and takes 2 hr to complete; occupational therapists (OTs) administer the SIPT and identify common patterns that emerge from the results, eg, difficulties in vestibular processing, gravitational insecurity, tactile discrimination

Principles of SI therapies: involve proactive strategies to anticipate and prevent sensory overload, similar to approaches used in addressing temperament; includes using calm and quiet voices, providing sensory controls (eg, noise-canceling headphones, sunglasses) and creating social stories to prepare children for expected sensory inputs; occupational therapy employs SI therapy, which emphasizes family-centered, child-directed approaches; the body, oral motor skills, and ocular motor skills are targeted to facilitate environmental sensory processing; equipment (eg, swings, balance beams) is used to address vestibular, proprioceptive, and tactile senses

Developmental, individual differences, and relationship-based model (DIR Floor-Time): incorporates a SI perspective and emphasizes self-regulation; the model integrates sensory principles into therapeutic interventions; therapists teach families how to address SI principles within a therapeutic context to support sensory needs and promote self-regulation

SPD framework: found in various diagnostic frameworks (eg, DC:0-5, Greenspan formulation) which incorporate specific categories for SPD; SPD is not explicitly labeled in the DSM-5 but is recognized within, eg, autism, DCD; OT and DIR Floor-Time approaches support SPD interventions

American Academy of Pediatrics (AAP) recommendations (2012): the AAP advises against the use of SPD as a standalone diagnosis; evaluating developmental disorders (eg, autism, ADHD, DCD, anxiety) is recommended before considering SPD; communication with families about limited data on SI therapies is emphasized; monitoring therapy effectiveness and exploring alternatives if progress stalls are key; setting time limits and prioritizing treatment based on impact on sensory issues are suggested; families may prefer sensory therapies over core therapies (eg, BT) for autism; sensory therapies may help, but BT is vital for addressing core autism symptoms

Weitlauf et al (2017): found that SI interventions may offer modest short-term improvements in sensory and autism severity symptoms; however, the evidence base for these interventions is limited and their long-term effects are uncertain; further research is needed to identify which aspects of SI interventions are beneficial and for which patient populations; integrating sensory processing theory with descriptions of child behavior into a larger framework may be beneficial

Readings

Bar-Shalita T, Granovsky Y, Parush S, Weissman-Fogel I. Sensory modulation disorder (SMD) and pain: A new perspective. Front Integr Neurosci. 2019;13:27. Published 2019 Jul 18. doi:10.3389/fnint.2019.00027; Cerliani L, Mennes M, Thomas RM, Di Martino A, Thioux M, Keysers C. Increased functional connectivity between subcortical and cortical resting-state networks in autism spectrum disorder. JAMA Psychiatry. 2015;72(8):767-777. doi:10.1001/jamapsychiatry.2015.0101; Kong M, Moreno MA. Sensory processing in children. JAMA Pediatr. 2018 Dec 1;172(12):1208. doi: 10.1001/jamapediatrics.2018.3774; Lorenzini L, van Wingen G, Cerliani L. Atypically high influence of subcortical activity on primary sensory regions in autism. Neuroimage Clin. 2021;32:102839. doi: 10.1016/j.nicl.2021.102839; Nazarova VA, Sokolov AV, Chubarev VN, Tarasov VV, Schiöth HB. Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials. Front Pharmacol. 2022;13:1066988. Published 2022 Nov 17. doi:10.3389/fphar.2022.1066988; Owen JP, Marco EJ, Desai S, et al. Abnormal white matter microstructure in children with sensory processing disorders. Neuroimage Clin. 2013 Jun 23;2:844-53. doi: 10.1016/j.nicl.2013.06.009; Section On Complementary And Integrative Medicine; Council on Children with Disabilities; American Academy of Pediatrics; Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012 Jun;129(6):1186-9. doi: 10.1542/peds.2012-0876; Weitlauf AS, Sathe N, McPheeters ML, et al. Interventions targeting sensory challenges in autism spectrum disorder: a systematic review. Pediatrics. 2017 Jun;139(6):e20170347. doi: 10.1542/peds.2017-0347.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Vanderbilt was recorded at Aloha Update: Pediatrics 2023, held September 30, 2023 to October 6, 2023, on Kauai, HI, and presented by the Children’s Hospital Los Angeles Medical Group. For information on upcoming CME activities from this presenter, please visit https://www.chla.org/chla-medical-group/cme-conferences. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 1.00 CE contact hours.

Lecture ID:

PD701802

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.