Brotherly Love

SPD.... Could it be more? How SPD can Affect Speech, Attention, and other behaviors

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.

References:

http://www.chicagospeechtherapy.com/chicago-speech-therapy-the-effects-of-sensory-processing-disorder/

http://www.netplaces.com/sensory-integration-disorder/look-alike-problems/obsessive-compulsive-disorder.htm

http://www.sciencedaily.com/releases/2005/05/050513103548.htm
http://sfari.org/news-and-opinion/news/2012/new-rules-allow-joint-diagnosis-of-autism-attention-deficit
http://www.spdfoundation.net/otherdisorders.html

Messy Play Day

Messy Play with Shaving Cream. Less than a year ago, JC wouldn't even touch it. He now squishes it around eagerly ... For a short time. 

Video of SPD as explained by a child

Click here for a very insightful video of SPD from the perspective of a child

This little boy is very similar to JC!

What is the Difference Between Sensory Processing Disorder and Autism?

What is the Difference between SPD and Autism?

The answer to this question is easy... I have no idea. Autism and SPD are both neurological conditions that can impact the way the brain perceives and responds to information.  But what are the differences?

This topic is of special interest to me.  I am currently struggling with whether or not Sensory Processing Disorder explains all of the intricacies of JC's behavior.  For example, at 18 months the assumption was made (not by me, but by medical professionals) that he would most likely develop autism because of his severe sensory issues and speech delay.  He was also showing several "red flags" on the M-Chat  at that time. But at his 2 year checkup, his pediatrician verbalized her surprise that he had shown marked improvement on his M-Chat scores and was not inclined to test him for Autism.  I believe that because of the early intervention and intensive therapy both during sessions and at home, he has shown so much improvement that Autism is no longer an assumption, but merely a possibility (and yes, it is still a possibility).  There have been new and worsening behaviors over the past few months and I can't help but wonder (and by "wonder" I really mean "over-analyze" and be "paranoid" about) whether or not he may actually have signs of Autism.  So the research behind this blog entry was as much for me as it was for any reader.  I needed to know the answer to the question: What is the difference between SPD and Autism?

I started my research with definitions:

One Autism publication that I found describes autism as "a group of developmental disabilities that affect a person's ability to understand what they see, hear and otherwise sense."
Wikipedia describes Sensory Processing Disorder as follows: "sensory information may be sensed and perceived in a way that is different from most other people. Unlike blindness or deafness, sensory information can be received by people with SPD, the difference is that information is often registered, interpreted and processed differently by the brain. The result can be unusual ways of responding or behaving, finding things harder to do. Difficulties may typically present as difficulties planning and organizing, problems with doing the activities of everyday life (self care, work and leisure activities), and for some with extreme sensitivity, sensory input may result in extreme avoidance of activities, agitation, distress, fear or confusion."

Am I the only one that thinks those two definitions sound exactly the same?

I have to say, those medical professionals who tend to believe SPD is a subset of another disorder may have a good point.  If we can't determine a difference by definition, then how can we diagnose SPD as a singular diagnosis?  However, I tend to believe that SPD can be a stand-alone diagnosis, even though it isn't spelled out in black and white.

So what does the research suggest?

Research shows that 80%+ of children (4 out of 5) diagnosed with Autism also have sensory issues.  But the reverse is not true.  Only 2 out of every 5 children with SPD are also diagnosed with Autism (1 in 20 children have SPD while 1 in 50 are diagnosed with autism according to a new data).   For boys though, the prevalence of both disorders almost doubles.
So there seems to be a definite difference in the prevalence of Autism and SPD, and the two are certainly not the same, but the question remains, "What is the DIFFERENCE between SPD and Austism?"  How can I know that my child, who has SPD, doesn't also have Autism?

I have researched and asked questions of therapists and medical professionals and this is the most reliable answer that I can find:

The Difference between Sensory Processing Disorder 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.

I hate to say it, but this sounds a lot like my JC.  Are his behaviors signs of Autism or just quirks?  I don't know... but I will continue to research and seek out professional opinions until I do know for sure.  But for now, I am feeling much more knowledgable and prepared to address his issues as they arise and to be the best advocate possible for the care he needs.

Update:  JC was actually diagnosed with Autism Spectrum Disorder.  For more information, click HERE.

Resources:

http://en.wikipedia.org/wiki/Sensory_processing_disorder
http://www.cbsnews.com/8301-204_162-57575282/1-in-50-u.s-school-kids-has-autism-govt-survey/
http://autism.lovetoknow.com/sensory-integration-disorder-autism
This is a great study that I found to describe the connection between symptoms of SPD and Autism actually studied the behaviors associated with SPD and how prevalent they were in children with Autism vs children without Autism.  Although most of the behaviors were described in the Autistic children, many were also found in the non-Autistic children.   http://www.sinetwork.org/pdf/tomcheck_dunn.pdf

Venting: Ignorance and The Media

I read an article about a mother who threatened a principal because her child wasnt receiving help and was having behavior problems. This hurts my heart. Yes, this mother was way out of line, but in a way I can understand from her perspective. Her child has special needs which the school, school system, and state apparently don't acknowledge. So he is labeled as a "behavior problem".  From her actions, it does seem that perhaps she contributes to the overall problem, but deep down the frustration has been felt by all parents of children with Special Needs. I can tell you, if one more person in the hospital said to me that JC shouldn't be crying because the IV blood draw wasn't painful, I can't say that I wouldn't have gone a little batty. What strikes me the most is one of the last paragraphs in the article:  

"There are so many diagnoses these days that every time they revise the DSM it seems there are a plethora of new mental illnesses to ascribe our everyday woes; what used to be an energetic kid is now ADHD, somebody who was very meticulous is now OCD, and violent kids are now SPD."

This "journalist" obviously did little or no research on the subject matter of Sensory Processing Disorder.  To attribute violence to a broad diagnosis is not only factless, but dangerous and to indicate that SPD (ADHD or OCD) is a label that is overused for our "everyday woes" is simply ignorant. 
It is media like this that leads to misconceptions and assumptions that do so much harm to our children. This is a perfect example of why I started this blog!

10 Ways we are Breaking all of the Rules, and Loving it!

How many times were we told as children: "Clean your plate", "Don't talk with your mouth full", "Don't play with your food"?  I'm not saying that our mothers, and those generations of mothers before us, we're wrong. But sometimes rules are made to be broken.  And when you are a mother of a child who has sensory processing disorder, often those rules are thrown out the window altogether. But that isn't necessarily a bad thing, and it doesn't mean that the children are running wild with no discipline at all. It simply means that the "rules" aren't as important as the development of the child.

Here are some ways that we are breaking all of the rules, and loving it:

1.  Don't play with your food:  A huge part of JC's therapy for tactile aversion is messy play and we often use food for this. If he can't stand to touch applesauce, he will never eat it!  So desensitizing him to the feel of those textures is an important way to pave the path for him to eventually explore them with his mouth. Creating a fun activity with those items that he avoids reduces the anxiety that he feels and will hopefully allow him to associate food with fun rather than pain, angst and fear.

2. Clean your plate:  When a child has anxiety related to food, adding to that anxiety by forcing them to eat is going to be counter-productive. I have even found that limiting the amount of food that I put on JC's plate helps this anxiety level a great deal. If he has more than a few bites on his plate at once, it seems too overwhelming and he will push the plate away and refuse to eat altogether.  Likewise, if there is more than one type of food on his plate, its harder to get him to eat anything at all.  So I try using separate bowls so that he can focus on one item at a time.  It also helps that he knows he can push one bowl away and still have the other to eat from.  I also only put a small amount out at first. If he starts to eat it, he will usually ASK for more which gives him a more proactive role in the meal-time process.

3. No dessert until AFTER you clean your plate:  Let's face it, if JC hasn't eaten in 2 days and he asks for a cookie, I'm going to give it to him. With his food allergies, there are very few "treats" that he can have but he can have Oreos. I have found that ANY form of eating usually leads to more eating so I will allow the cookie on occasion to break down that wall of resistance to food.  After all, the anxiety and aversion isn't because he isn't hungry, or because he is being difficult. It's because during those periods he simply cannot stand the thought of putting food in his mouth. If we get be done that, the result is eating... No matter what it is that he is eating.  And sometimes I will add a cookie to his dinner plate with a banana or a bit of chicken. Seeing the cookie helps him to not reject the plate immediately.

4.  He is too old for a bottle:  Well, ok. Maybe he is.  My older son was bottle-free at a year old and JC is 28 months old now.  Am I just too lenient?  Am I loosing my touch as a mom?  Have simply decided that at this point, pushing JC to give up the only source of nutrients that keeps him healthy and thriving would do more harm than good. Maybe I'm wrong, but with all that he has been through, having a bottle is the least of my worries.  And yes, I have tried to transition to a sippy cup. He seems to have difficulty in drinking from a sippy (oral motor skills problem) and often ends up choking are spitting/drooling the liquid out of his mouth.  And remember, we are talking about a child who hates to have certain textures in his mouth. A hard rubbery sippy cup spout seems to be one of those textures. I should also note that JC never used a pacifier. The bottle also gives him that oral stimulation of sucking that many children with SPD continue to need beyond infancy.  Ok, enough about food...

5.   Don't climb on the furniture:  Movement and climbing I a necessity for many children with SPD (see JC's Extra-Special Needs ). So how do you encourage that movement when its 40 degrees outside or raining?  Furniture jungle gym!  Yes, there are limits.  JC would love to climb up the stairs on the outside of the railing like a  monkey if I would let him. But what I can do is provide a structured play area where he can get this type of physical activity. Today we used an ottoman and chair and JC climbed from one to the other and then jumped off into my arms. We also sometimes create a maze of bar stools for him to climb under and through.  Bottom line:  climbing is good, as long as it is safe and supervised.

6.  Don't climb UP the slide, use the stairs:  Climbing up the slide is one of the most available and effective activities at providing a workout in balance, heavy work, and proprioceptive input. We have a rope hanging over the slide outside of this very purpose. JC loves to walk up the slide while pulling himself up with the rope.  Again, as long he is supervised and safe, I encourage that activity as often as possible.

7.  Don't talk with your mouth full:  Granted, this rule exists for the benefit of the onlooker more than for the child, but for a child like JC who exhibits problems with eating AND speech I will never squash either activity - even if they happen at the same time.

8.  Don't give gum to young children:  I realize this is a safety concern, and as I have already mentioned, this activity also needs supervision. For children with problems related to oral motor skills, chewing gum is a great way to strengthen those muscles.  It also provides that oral sensory input that many crave.

9.  You should not co-sleep with your children:  At some point, after months of sleepless nights, I decided that forcing my infant to sleep in a separate room wasn't worth the agony that it was causing for him and for me. That was 6 years ago when BB (my oldest) was an infant. It was a survival mechanism.  I was exhausted from getting up 5 times a night to soothe him and I refused to use the "cry it out method".  At that point I knew nothing of SPD, but I think he would have benefited from a weighted blanket.  But once we started co-sleeping, we both were much happier.  So when JC was born I vowed not to even fight the battle of sleeping apart.  As I have mentioned, JC was a miserable infant.  He cried most of the time and nursed constantly.  He had severe reflux and spit up most of what he at so he was hungry an hour later.  There was no way that I was going to get up every hour to feed him!  So, he slept with me. It was the only time that he seemed at ease.  He is now 2 and still sleeps with me.  Our bedtime routine is a soothing, enjoyable experience unlike the hours of struggle that I put myself through with BB.  Bedtime became a time that we both dreaded.  Co-sleeping is a personal decision.  I'm not saying that every person should do it and if your child is happy sleeping in another room - great. But I wish there wasn't such judgement placed on those of us who do.  It is in fact very natural.  I recently read about  study that looked at various cultures and their sleeping methods.  They found that children in those cultures that accepted co-sleeping were much less anxious and were more secure in their emotional attachments.  (Read the article HERE - its a great read!) For a child like JC who struggles with anxiety - co-sleeping may help to soothe him and provide that attachment that he knows is always there.  Plus, some SPD children crave the pressure of weight or feeling of touch on then while the sleep - JC is definitely one of these.

10.  Don't coddle that child!:  This one probably sends my blood boiling more than any of the others. JC doesn't have a behavior problem. I am not coddling him by "giving in" to his needs. I am creating an environment that is suitable for him to feel safe and comfortable. When your child has special needs, you see the world through their eyes.  I walk into a situation and immediately evaluate what he may have difficulties with and try to avoid or accommodate his needs. Are the lights too bright? Maybe we can sit somewhere else.  Is the crowd too loud? Maybe we can use headphones.  Is there too much stimulation for him to focus and listen to me? Maybe I can provide an activity that channels his focus so that he doesn't become overwhelmed.   If he is overstimulated and needs to bury his head in my neck and have some mommy snuggles, then I am happy to provide that safe place for him to feel at ease.  Trying to get him to go outside of his comfort zone may be necessary in some situations, but at 2 years old he doesn't understand that. So it is important to him that I am there to help him cope and adapt, not just change his behavior.

Breaking the rules is working for us. And we are creating our own rules along the way.