An OT Answers Your Most Pressing Questions About Sensory Processing
Every week I talk to and work with parents of kids who struggle with sensory processing. While each child’s struggles are different, their parents have some common questions.
This week, I sat down with Occupational Therapist, Kaitlin Dollard to get an OT’s perspective on some of the most common questions parents ask about SPD.
During her nine years as an occupational therapist, Kaitlin has worked in a variety of settings including clinics, public schools and charter schools. She spent 3 years working under the mentorship of Tracy Murnan Stackhouse, MA, OTR/L at her non-profit clinic in Denver, Colorado, Developmental FX, where she received continuing education and training in neurodevelopment and sensory integration. She currently lives in San Diego where she works at Personalized Optimal Wellness (POW) and has a private OT practice through which she helps dozens of kids who struggle with sensory processing, including mine!
Here are Kaitlin’s answers to your most pressing SPD questions...
Q: For parents who have just been told their child may have “sensory issues,” how would you define “Sensory Processing Disorder (also called Sensory Integration Disorder)?”
A: Sensory processing is an unconscious process through which the brain organizes information it receives from the senses. The way we process this information gives meaning to our experience.
When our brains process this information efficiently, we’re able to respond to situations in an adaptive and purposeful way. The way our brains process sensory input forms the foundation for our ability to grow, learn and engage socially.
When a child doesn’t have good sensory processing, they’ll have trouble engaging and interacting with their environment in a functional and purposeful way. It will affect things like their ability to pay attention, their cognitive skills, their play skills and their ability to feel ok in their own skin.
Q: What is Sensory Integration Therapy?
A: Sensory Integration Therapy is a term used to describe an intervention developed by A. Jean Ayres, PhD, OTR. It includes the theory of sensory integration and Ayres' core principles which are utilized to directly target the child's ability to modulate, process and discriminate sensory information for enhanced function and performance across all aspects of daily life.
Q: When a child is referred to you and there is no formal diagnosis, what is your first step? What assessment tools do you use and what are you looking for?
A: First I’m going to make clinical observations to see how the child is moving and how he interacts with the environment. I’m trained to look at the subtleties of that engagement- how well the child maintains a purposeful engagement with the environment, their attention, their affect and arousal level… are they overresponsive, underresponsive or presenting with defensive or variable responses to specific sensory input?
The vestibular, proprioceptive, tactile, auditory, visual and interoceptive systems are all evaluated using clinical observations, parent/caregiver interview and standardized assessments. In unison I'm evaluating postural mechanisms and motor planning abilities
As far as clinical reasoning assessments, I use the Sensory Processing/Integration Reasoning Tool (SpIRiT) which is devised and copyrighted by Tracy Murnan Stackhouse, MA, OTR/L & Angela Sauer Graf, MS, OTR/L, with myself, Emily Marshall, MS, OTR/L, Ruth Meissner, MA, CCC-SLP and Jess Rempel, MOT, OTR/L.
Another well-respected and utilized standardized assessment for evaluating sensory processing difficulties is called the Sensory Integration and Praxis Test (SIPT).
Q: Why do kids who have sensory processing challenges also struggle with self-regulation? What is the link?
A: The first thing to consider is that, developmentally children don’t have the capacity to start conceptualizing self-regulation until they're around five years old. Up until that point, they're co-regulating with their caregivers.
Self-regulation is a higher level executive functioning skill, located in the prefrontal cortex. The reason kids who have difficulty with sensory processing struggle more with self-regulation is because they are more primed to go into a fight, flight or freeze response.
Because the brain stem isn’t processing input in an organized manner, an autonomic nervous system response (fight, flight or freeze) gets triggered and the child can’t access the higher levels of the brain where self-regulation occurs.
Think of it like a thermostat- if hyper arousal is up (fight, flight or freeze), skill is turned down (self-regulation).
Q: What is your advice for parents of kids who have underlying sensory processing challenges?
A: The more a parent can understand their own sensory processing difficulties and quirks, the more compassionate they’ll be towards someone else’s and the less reactive they’ll be when their child is dysregulated.
Parents of kids with sensory processing difficulties need to have compassion and flexibility and they need to understand that addressing their child’s sensory needs is a process. It takes work on everyone’s part to make changes.
Q: Why do you think sensory processing is so misunderstood? Why don’t more pediatricians, educators and psychologists know about it and its impact on a child’s development and behavior?
A: I think a lot of professionals are saying the same thing, but we’re just saying it in different ways; there isn’t a common language across the fields. There’s also a lot of oversimplification of sensory processing issues which can be a detriment.
Another big reason for the lack of awareness in other fields is that it’s not part of their curriculum, it’s not in their wheelhouse, so they just don’t have the training to understand sensory integration and its impact on development.
OTs should take on the role of explaining the foundations of what’s happening, we need to educate and collaborate with other professionals and not just label kids.
There is a lot of labeling because that’s what gets insurance reimbursement. Since SPD is not yet in the DSM, there’s a lot of resistance and people aren’t considering it as a stand alone disorder.
Q: What should parents of kids with sensory processing issues look for in an OT? What questions should parents ask when looking for an OT?
A: They should look for someone who is SI certified, who has a SIPTs background. However, it's also important, regardless of that certification, to look at the clinician's experience and continuing education. The biggest factor, in my opinion, is that the clinician has a strong foundation in Jean Ayres’ theories.
They should ask: What experience do you have? What kind of environments have you worked in? What theories are you using in your practice? What interventions do you use?
Parents should look for a clinic with a dynamic treatment space (a large gym) and an OT who looks at the whole child, who will focus on the foundation of the sensory processing challenges, not just on the symptoms.
You want an OT who is going to take the time to really observe and analyze how the child is processing sensory input, then put together a thoughtful treatment plan.
Q: What do you think are the biggest misconceptions about sensory processing issues?
A: I feel like, a lot of times, things are oversimplified and the child’s issues are not evaluated to the degree they need to be. Instead of taking time to collaborate, sometimes things are just thrown at families- try this, try that… and a lot of times the things that are being suggested aren’t the best fit and won’t work for the child. It leads to frustration for everyone.
I get worried about Sensory Diets- they are not always thought out to the degree they should be and they’re provided too quickly which just puts a bandaid over what’s actually happening.
Another misconception is that development and progress are a straight line forward. The reality is that it’s going to be a continuum of steps forward and steps back; it’s a process. Parents shouldn’t expect things to move in a straight line. Changes are not going to happen overnight; it’s going to take time.
This isn’t necessarily a misconception, but I think a big problem is that there isn’t enough collaboration between families, clinicians, teachers and other professionals. To get the full picture of the child, everyone needs to be working together. OT’s should be collaborating with the parent, the teacher, the pediatrician and any other therapists the child is seeing.
Q: Any last words of wisdom for parents?
A: It’s so important for parents to focus on their self-care, to dial things back and to maintain as healthy and peaceful of a family dynamic as possible. I think it’s important for parents not to view the clinician as the end all be all “expert,” rather as an educator and a navigator through this sensory processing dynamic. Think of your child’s therapy as a collaboration, and ask a lot of questions.
There you have it, an experienced OT’s answers to your questions about sensory processing. A huge thank you to Kaitlin- she is passionate about what she does, is a wealth of knowledge and is doing so much to help kids and families.
If you have any unanswered questions, write them in the comments below… The Sensory Mom community and I would love to hear from you.