Two “Look-alikes:” Sensory Processing Disorder and Attention Deficit/Hyperactivity Disorder
by Carol Kranowitz, M.A., author of The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder
Picture Brian. While the other children are settling down to a workbook task, Brian rocks in his seat, whining, “Owwuu,”
by Carol Kranowitz, M.A., author of The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder
Picture Brian. While the other children are settling down to a workbook task, Brian rocks in his seat, whining, “Owwuu,”
And rubs 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 and says,“Sit down,
stay put and start working, Brian!”
He wriggles in his seat and asks, “Um,
what are we supposed to do?”
The teacher replies, “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 (ADHD)or sensory processing
disorder (SPD)? 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 best treated with occupational therapy using a sensory integration
framework. 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, attention problems and impulsive behavior as the child strives to get
less—or more—sensory input.
Brian’s central nervous system inefficiently processes tactile
sensations. The slightest touch
overwhelms him. As a “sensory avoider,” he is over-responsive and cannot regulate,
or “modulate,” sensory input. Also, touch stimulation confuses him. As 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 ADHD: a “neurological syndrome characterized
by serious and persistent inattention and impulsivity. When constant, fidgety movement
(hyperactivity) is an additional characteristic, the syndrome is called ADHD.”
Inattention,
impulsivity, fidgetiness, constant movement—these are definitely symptoms of
ADHD. SPD and ADHD are certainly “lookalikes.” However, they are distinct disorders, and
optimum treatment for the two problems is very different. Before jumping to conclusions, 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
his or her behavior and ask: Where, when
and how often does his or her inattention occur? What is happening,
or not happening, when he or she concentrates well? What is his or 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 may be decreasing the offending sensations. We can make his or her environment softer,
dimmer, quieter and calmer.
Then,
we can do something! Comfort the child
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 the child organized
and ready to participate and learn. Provide heavywork activities, including
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 opportunities for gentle
roughhousing. Give the child a rolling pin for pressing dough, a shovel for
digging, a bar for chinning, a hammock for swaying, a wad of gum for chewing or
a trampoline for jumping.
When
“underloaded,” an underresponsive or sensory-seeking child needs extra sensory
stimulation. Again, we can do something! Provide sensorymotor experiences like
those mentioned above. The under-responsive or seeking child needs them, too,
in varying degrees. Similar activities may calm
one type of child and invigorate or satisfy another.
Providing
just the right sensorymotor 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.
A
sensory diet may be the best “medicine” for the child experiencing attention
problems as a result of SPD. An
occupational therapist can develop an individualized sensory diet with appropriate
touch and movement experiences. An approach that excludes medications 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.
To
learn more about SPD, contact Carol Kranowitz, M.A., at
CarolKranowitz@out-of-sync-child.com.
Suggested
Reading
Ayres,
A.J., Ph.D. (2005). Sensory Integration
and
the Child: Understanding Hidden Sensory
Challenges.
Los Angeles
Services.
Sensory
Smart Child: The Definitive Handbook
for
Helping Your Child with Sensory Integration
Issues.
New York
Kranowitz,
C. (2005). The Out-of-Sync
Child:
Recognizing and Coping with Sensory
Processing
Disorder. New
York
Kranowitz,
C. (2006). The Out-of-Sync
Child
Has Fun: Activities for Kids with Sensory
Processing
Disorder. New
York
Kranowitz,
C., & Newman, J. (2010).
Growing
an In-Sync Child. New
York
Miller,
L.J., Ph.D., with Fuller, D.A. (2006).
Sensational
Kids: Hope and Help for Children with
Sensory
Processing Disorder. New
York
Smith,
K.A., Ph.D., & Gouze, K.R., Ph.D.
(2004).
The Sensory-Sensitive Child: Practical
Solutions
for Out-of-Bounds Behavior. New
York
Harper
Collins
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