A Version of Perfection: Feeling Our Way through Autism & Sensory Processing Disorder: April 2013

Now that we know what Sensory Processing Disorder is, and how it can affect a child's day to day activities, lets talk about how it can affect other aspects of a child's life - even mimicking disorders like OCD and ADHD.

SPD and Speech Development:

JC has a significant speech delay. He is doing well and is learning new words each week through therapy but he seems to still struggle with certain sounds which may require him to utilize motor skills which he has not yet mastered. If you think of the normal course of a child learning to talk... they spend months "hearing" speech, months "watching" your mouth when you speak, and months prepare their own mouths for speech by babbling. They also develop their own motor muscle skills through mouthing objects and eating. Now imagine a child with SPD, like JC. JC spent months being preoccupied by pain stimuli from his food allergies and health problems related to that. He spent months crying to tell me that his world just wasn't right. He spent months NOT eating. So you can see how having SPD affected JC's speech even before he was ever able to speak. He never received those auditory or visual cues that are the building blocks of speech because he was "distracted" by other stimuli. He also has some motor skills problems that affect both eating and speech, but SPD early in life certainly contributed to his speech delay as well.
Another key aspect of speech development is processing language that is heard. With children who have issues with sensory processing, there may also a breakdown in the way the brain interprets auditory input. For example, if you imagine yourself at a party or in a crowd, you are able to key into someone's voice and maintain a conversation by "tuning out" the remaining sounds. However, for someone with SPD that ability is minimal. Therefore, they hear all sounds at once. Imagine yourself in a crowded elevator with the music playing and 5 conversations happening at once. You may hear a jumbled mess of sounds but picking out words or sentences will be very difficult. Now imagine that you are an infant learning to speak in that elevator. The inability to discern and process those individual sounds makes understanding, learning and then repeating very difficult.

SPD vs ADHD:

Similarly to the difficulty in discerning auditory cues, another aspect of SPD may be the inability to discern visual cues. Both of these issues may manifest during school years as a failure to focus or pay attention. In most cases ADHD is suspected but in many of these cases the true culprit may be SPD. The difference between the two isn't seen in the symptoms, since they can both exhibit the same synptoms. The difference is in the cause behind the symptoms. Does the child show a difficulty concentrating on a constant basis or only when overwhelmed by sensory stimuli? Does sensory activity help alleviate this symptoms? Its the Who, What, When, Where and Why that goes into a diagnosis that makes the difference evident. This is why it is important to be aware of SPD and the possible implications it may have for a child.
I have heard it said that SPD is the new ADHD, insinuating that it is an overused diagnosis that explains away behavioral problems. But I would suggest that SPD has in fact been an overlooked problem for years and that many diagnosed with ADHD are actually suffering from SPD. In fact, one study found that over 95% of children who had been diagnosed with ADHD showed improvement after occupational therapy. This suggests that at least some component of the ADHD diagnosis was actually SPD.

SPD or OCD:

I can tell you that I have questioned many times whether or not JC may have OCD. There are times when I cannot alter our daily schedule without a meltdown. There are times that I have to backtrack and re-do the same thing again because it didn't happen the "right" way the first time. For example, if we leave the house and I push the button to open the garage door I hear a wail of screams. JC usually pushes the button and if it doesn't happen that way, he cannot move forward until it does. So, we close the garage door and HE pushes the button again. There are many of these little nuances that all add up to a very long day at times, but is it really OCD? Most likely it isn't. It is simply a manifestation of SPD.

The best way that I have seen this link described was this:
If your child is hypersensitive to information coming in through her senses — that is, she perceives a threat from a touch or sight or sound that others would find harmless — she may set up routines and defenses for herself that could be mistaken for OCD. Additionally, if she has problems with planning out how to do a particular activity, she may become strongly attached to the one way of doing it that she has already worked out, or she may stick stubbornly to activities that are much simpler.
A child with OCD is obsessed with things that aren't real and develops compulsions to deal with them, whereas a child with sensory integration disorder is bothered by real things in her environment and develops routines and defenses to deal with them. If you can change those real things, you can most likely change the behaviors.

This is EXACTLY the case with JC. Changing the environmental factors affecting the behavior (perhaps the anxiety of the morning routine) may lead to a reduction in that behavior (insisting on opening the garage door himself). However, one developmental psychologist that we recently met with believes JC to have an anxiety disorder with OCD tendencies. I'm not quite convince of this just yet. But I do see the possibility. (This sounds much like JC: http://www.ocdsite.com/how-to-identify-ocd-symptoms-in-toddlers/)

SPD and Autism

Autism is usually characterized by 3 things: impairments in communication, social interaction, and by repetitive behaviors (such as self-stimulation: "Stimming"). Each of the 3 are required for an Autism diagnosis. Sensory issues may play a large role in any of these factors, but a person with autism usually experiences many other symptoms besides sensory issues. For example, according to "Love to Know Autism" a child with autism may have limited to no speech, difficulties understanding word contexts and developing a vocabulary, a need for strict routines, obsessive interest in an unusual activity or problems with social cues. But a child with SPD alone may only experience issues with sensory input. (more about The a difference between Autism and SPD)

Distinguishing between each of these disorders is very difficult as a mother. I feel so blessed to have a wonderful pediatrician and great therapists for JC who help me navigate through these issues.