SPD: Such a Perplexing Diagnosis
I was recently contacted by a group of moms who were looking for clarification regarding their children's SPD diagnosis. They had several questions and weren't sure where to go for answers. Never one to shy away from a challenge, I told them that I would do my best to help them out!
What is SPD?
SPD stands for Sensory Processing Disorder. Before you can understand what sensory processing disorder is, you must first understand sensory processing. Everyone has a nervous system that takes in information about our surroundings (our senses) and responds through movement (our motor system).
The information that we take in is through one of our eight sensory systems:
Proprioceptive (Muscles & Joints)
Interoception (Internal messages)
When these eight systems work well together, we get an accurate representation of the world around us. For those with SPD; however, the information goes into the brain in a disorganized fashion. Their responses; therefore, are often deemed inappropriate. The official definition of SPD is as follows:
SPD is a neurophysiologic condition in which sensory input either from the environment or from one’s body is poorly detected, modulated, or interpreted and/or to which atypical responses are observed.
Clear as mud? I've heard several OT's describe SPD as a traffic jam in the brain. There's often too much information for the brain to make sense of it all.
What does SPD look like?
It can look like a million different things:
Decreased tolerance to touch
Covering ears in loud environments
Squinting or covering eyes in bright sunlight
For a more detailed checklist, check out the Symptoms Checklist on STAR Institute's website.
Is SPD an official diagnosis?
This is where things start to get complicated. Dr. Jean Ayres coined the term Sensory Integration Dysfuction in the 1960's and dedicated her career to studying the effects of sensory integration on the brain. The field has been growing steadily ever since, but, until recently, was only known to occupational therapists. In recent years, SPD has become more well known, mostly because of it's connection to Autism.
The Diagnostic and Statistical Manual (DSM) is THE guide used by psychiatrists, psychologists and paediatricians to diagnose mental disorders, During the most recent revision to the DSM there was discussion about adding SPD to the newest edition (DSM-V). In the end, it was decided that there was not enough scientific evidence to support SPD as an official disorder. It was acknowledged that working with OT can help children become calmer and more regulated; however, clinical observations could not be generalized to a wider population.
That being said, there is no "official" SPD diagnosis at this time.
How do I proceed if I think my child has SPD?
Parents usually initially approach their child's family doctor or paediatrician with concerns such as "my child refuses to wear socks", "my child crashes into things" or "my child melts down in public situations". After asking a few more questions, the physician will typically refer to an Occupational Therapist.
If it is decided that OT is the right fit, there are a few options:
Seek out publicly funded options such as a local hospital or school. This is usually the most popular option as there is no cost to the parent. The drawbacks; however, are long waitlists, potentially long periods between appointments and service limitations. For example, my last position was at a general hospital, my waitlist was over six months long and I was only able to see children of certain ages and diagnoses. When I worked in the school system, I was not able to see students with printing concerns.
The second option is to find a private OT in your area. Generally private OTs have a shorter waitlist and have more flexibility with the services they provide. The downside is that since most insurance companies do not cover OT, parents end up paying out of pocket.
During the first appointment, the OT will gather information about the child's sensory processing preferences. This could be in the form of a parent interview, teacher interview, child observation during activity and/or standardized assessment. Personally, I prefer to use the Sensory Profile 2 to gather information.
Once the OT has gathered enough information, something called a Sensory Diet is generally put in place. A Sensory Diet is a carefully designed activity plan that provides the sensory input a child needs throughout the day. The goal of the sensory diet is to allow the child to be focused and alert throughout the day. The OT will also make recommendations to alter the child's environment (home, classroom, etc) so that distractions are limited.
Despite the OT's knowledge in sensory processing, we are not able to make a formal diagnosis. I tend to use the term "sensory processing issues" rather than "sensory processing disorder".
Thoughts from Yours Truly
I am, by no means, an expert in SPD. I have dedicated a lot of time to better understanding sensory processing and have never felt that an official diagnosis is required to benefit from occupational therapy. Humans are sensory beings by nature and we can all benefit by fine tuning our sensory systems. Some of us just need more tweaking than others!