Disorder of the sensory processing

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The sensory processing disorder (also known as a disturbance of sensory integration) a disease that is present when multisensory integration is not properly processed to provide appropriate responses to the demands of the environment.

The senses provide information in different ways. This can take place in different ways such as visual perception , acoustic perception , haptic perception , olfactory perception , gustatory perception , proprioceptive perception and vestibular perception . Humans need all of these types of perception in order to function. The disruption of sensory integration is characterized by a significant problem in processing impressions from one's own body or the environment. This causes a reduced performance in the most essential areas of life such as work, social life or everyday activities. The severity of the difficulties in processing sensory impressions differs from person to person affected. In particular, there are the haptic area (sensitivity to substances due to itching when other people have no problems), the vestibular area (motion sickness when driving a car) or the proprioceptive area (difficulties in assessing the force required to hold or close a pen write).

Sensory integration was defined by the occupational therapist Anna Jean Ayres in 1972 as follows: "The neurological process that organizes sensory impressions from our own body and from the environment and enables us to use the body effectively in the environment."

Classification

Disorders of the sensory processing are divided into three areas: disruption of the modulation of sensory signals, sensorimotor disorder and sensory discrimination.

  • Disturbance of the modulation of sensory signals is distinguished in terms of three subtypes: overreactivity, underreactivity and sensory desire (search). Accordingly, it is characterized by overstimulation , too weak a response to sensory stimuli or the excessive impulse to search for sensory stimulation. Modulation of sensory signals is a complex process in the central nervous system. in which neural signals, which information about the intensity, frequency, duration, complexity and novelty are adjusted. Those affected show behavioral problems that can appear fearful, dismissive, stubborn or self-centered in their dealings, or result from the creative and active search for sensory input, which in the end can, however, in some cases significantly impair social participation and social ties.
  • Sensorimotor disorder shows disorganized motor output as a result of improper information processing that affects balance control. This leads to posture problems and / or coordination and development disorders .
  • Sensory discrimination or incorrect processing of sensory information. This is about incorrect processing of visual or auditory input, such as inattentiveness, disorganization or poor school performance. It can be visual, auditory, haptic, smell / taste, position or movement, or interoceptive .

Signs and symptoms

The symptoms vary depending on the type and subtype of the disorder. It can affect only one sense or several senses. While many people show one or more symptoms, the sensory processing disorder must have a clear functional impact on the person's life.

People who experience overreaction can, among other things:

  • show an aversion to certain tissues and fabrics, foods, care products or materials of everyday use to which most people do not react. The aversion must interfere with normal behavior, such as a child who refuses to put on socks or an adult whose eating habits are so selective that they cannot go out with others in restaurants.
  • Avoid groups or public places out of sensitivity to noise.
  • Develop motion sickness from driving so bad that they refuse to get into a vehicle.
  • Do not hug or kiss other people because the skin contact will perceive the irritation as negative.
  • Feeling very uncomfortable or threatened by normal sounds, movements, smells, tastes, or even internal sensations such as heartbeat.
  • Detect sleep disorders (by waking up in response to very low sounds or difficulty falling asleep from sensory overload.)
  • Being babies who refuse to cuddle
  • Have difficulty calming yourself because they are under constant stress.

People who experience underreaction may, among other things:

  • Having severe problems waking up.
  • appear absent or slow.
  • being unaware of pain and / or other people's.
  • appear deaf even though the hearing function has been checked.
  • Being children who are longer in the diaper age because they don't notice that they have canned.

Individuals suffering from sensory cravings may include:

  • be very fidgety.
  • Look for loud, disturbing noises or cause them yourself.
  • constantly climbing, jumping or falling.
  • looking for very extreme sensory impressions.
  • sucking or biting clothes, fingers or pens.
  • act impulsively.

Individuals who suffer from sensorimotor disorders can, among other things:

  • appear slow and uncoordinated.
  • appear clumsy or slow and have poor motor skills or handwriting.
  • have bad posture.
  • Being children who later learn to crawl, stand, walk and run.
  • become dissolute in order to avoid motor tasks.

Individuals suffering from sensory discrimination can, among other things:

  • keep dropping objects.
  • have poor handwriting.
  • Have difficulty getting dressed or eating.
  • use undue pressure when handling objects.

Other signs and symptoms

  • poor integration of balance and reflexes to correct direction.
  • weak muscle tone in extensors and flexors against gravity
  • poor posture control
  • weak eye muscle movement
  • non-integrated reflexes like the fencing pose
  • jerky eye movement
  • Inadequate motor, ideal or constructive practice
  • Difficulty planning movements using feedback information
  • Difficulty planning movements using feedforward information
  • poor motor coordination

causes

The midbrain, the region of the brain stem of the central nervous system, are the early centers for the processing pathways of multisensory integration and are involved in processes such as coordination, attention, arousal and vegetative functions. After sensory information has passed through these centers, it is passed on to other brain regions that are responsible for emotions, memory and demanding cognitive functions. A disruption of the process of sensory processing affects not only the interpretation of and reaction to stimuli but also more demanding functions. An injury in a part of the brain that is involved in processing multisensory stimuli can cause difficulties in adequate and functional processing of stimuli.

Current research in sensory processing focuses on genetic and neurological causes of sensory processing disorders. EEG and the measurement of event-related potentials are traditionally used to investigate the causes of the behaviors that occur when sensory integration is impaired. Some suggestions for the underlying causes from current research are:

EEG recording
  • Overreactive in haptic and acoustic perception seem to be genetically influenced, with haptic overreactivity being more likely to be inherited. Bivariate genetic analysis showed various genetic factors for individual abnormalities in auditory or haptic processing disorders.
  • Individuals with impaired sensory integration have a lower number of cycles in electrophysiology than normal examiners.
  • People with sensory overreactivity may have an increased occurrence of dopamine D2 receptors in the striatum , which correlates with an avoidance of haptic stimuli and a reduced habituation effect.
  • Studies using event-related potentials in children with sensory overreactivity found atypical neuronal integration of sensory input. Various neural generators could be activated earlier in the process of sensory information processing than in normally developed individuals.

The automatic association of causally related sensory inputs that occurs at an early stage of sensory perception of the stimulus may not work properly in children with impaired sensory integration. One thesis is that when a multisensory stimulus occurs, sophisticated systems in the frontal lobe and cognitive processes are activated, instead of the automatic integration of multisensory stimuli, as occurs in normally developed adults in the auditory cortex .

  • recent research found abnormal white matter microstructures in children with sensory integration disorder compared to normal children or children with other neurological disorders such as autism or ADHD.

diagnosis

Sensory processing disorder is currently accepted in the diagnostic classification of childhood mental and developmental disorders (DC: 0-3R) but is not recognized as a mental disorder in medical manuals such as the ICD-10 or the DSM-5 .

A diagnosis can be made through the implementation of standardized tests, standardized questionnaires, professional observation standards and observation of free play in occupational therapy. Observation of the functional activity can also be done at school or at home. Some metrics that are not used exclusively for assessing sensory integration disorder can measure visual perception, function, neurology, and motor skills.

Depending on the country of origin, the diagnosis is made by various professions such as occupational therapists , psychologists , specialists in support of learning, physiotherapists and / or speech therapists. In some countries, a comprehensive psychological and neurological assessment is recommended if symptoms are too severe.

Testing

Standardized tests

  • Sensory Integration and Practice Test. (SIPT)
  • DeGangi-Berk Test of Sensory Integration (TSI)
  • Test of Sensory Functions in Infants (TSFI)

Standardized questionnaires

  • Sensory Profile, (SP)
  • Sensory Profile 2 (SP 2)
  • Infant / Toddler Sensory Profile
  • Adolescent / Adult Sensory Profile
  • Sensory Profile School Companion
  • Sensory Processing Measure (SPM)
  • Sensory Processing Measure Preeschool (SPM-P)

Other tests that can be used

  • Clinical Observations of Motor and Postural Skills (COMPS)
  • Developmental Test of Visual Perception: Second Edition (DTVP-2)
  • Beery-Buktenica Developmental Test of Visual-Motor Integration, 6th Edition (BEERY VMI)
  • Miller Function & Participation Scales
  • Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
  • Behavior Rating Inventory of Executive Function (BRIEF)

treatment

Several therapies have been developed to treat sensory processing disorders.

Therapy of sensory integration

Stimulation of the vestibular system through the hanging equipment of a tire swing

The main form of sensory integration therapy is a type of occupational therapy for a child in a room specially designed to activate all of the senses.

In the treatment session, the therapist works closely with the child to provide the exact level of sensory stimuli that the child can cope with and encourage them to move around the room. Therapy of sensory integration is driven by four principles:

  • Just the right requirement (the child must be able to successfully cope with the requirements posed by the playful activities.)
  • Adaptive response (the child adapts their behavior through new and useful strategies in response to the demands made)
  • active participation (the child wants to get involved as the activities are fun)
  • child-friendly (the child's preferences are used to initiate therapeutic experiences in the session)

Therapy of the process of sensory processing

This form of therapy maintains the four principles mentioned above, adding the following:

  • Intensity (the person attends the sessions daily for an extended period of time)
  • Developmental approach (the therapist starts with the developmental age as opposed to the real age of the person)
  • systematic test-retest assessment (all clients are assessed before and after treatment)
  • Process-driven vs. activity-driven (the therapist focuses on the "just right" emotional bond and the process that strengthens the relationship)
  • Parent education (parent education is included in the therapy process)
  • "Joie de vivre" (happiness in life is the main goal of therapy. It is achieved through social participation, voluntary self-control, and self-awareness)
  • a combination of best practice measures (are often accompanied by integrative systems therapy of listening and electronic media such as Xbox Kinect, Nintendo Wii, Makoto II machine training and others)

Other methods

Some forms of treatment (such as sensorimotor manipulation) have questionable justification and no empirical basis. Still other forms of treatment (such as corrective lenses, exercise and auditory training) have shown little success after studies, but few conclusions can be drawn from methodological problems with the studies. Although reproducible treatments have been described and the benchmarks for treatment outcomes are known, there are gaps in knowledge about the sensory processing disorder and its therapy. The empirical basis is limited, which is why a systematic evaluation is necessary if these measures are applied.

Under-reactive children can be exposed to strong stimuli such as brushing with a comb, vibration or rubbing. Many materials can be used in the game to stimulate the senses, such as plasticine or finger paint.

Children who are overreactive may have trouble calming down before bed. Performing calming activities with the child, such as listening to soft music, rocking, yoga, or deep breathing techniques in a softly lit room can help calm them down and make it easier for them to fall asleep.

Rewards can be used to motivate children to tolerate activities that they would normally avoid.

While some occupational therapists mostly rely on a framework of reference studies and forms of therapy in order to increase the child's ability to process sensory stimuli appropriately, other therapists focus on the environment being accommodated by parents and school staff, which enhances the child's ability to function at home , in school and in the community. This concession may include choosing special clothing, avoiding fluorescent lighting, and providing earplugs in case of emergency (such as fire alarm drills).

Adults

There is increasing scientific evidence that adults also suffer from the sensory processing disorder. In the UK, recent research and improved clinical outcomes in patients diagnosed with sensory processing disorder have established that therapy is an appropriate type of treatment. The adult patient exhibits a wide range of developmental disorders such as autism and Asperger's syndrome , as well as difficulties with coordination and some psychological problems. Some therapists believe that this disease is caused by the problems these adults have with the process of sensory processing in their attempt to cope with the demands of the environment in everyday life.

Epidemiology

It is assumed that up to 16.5% of school-age children show increased behavior of impaired sensory integration, both in the hapitschen and auditory areas. However, this number could represent an underestimation of overreactivity, as the study did not include children with developmental disabilities or premature babies who are more likely to have the disease.

The number is, however, larger than earlier studies with smaller samples had shown: These assumed an estimate of 5-13% of children of school age. The frequencies for other subtypes of sensory integration disorder are unknown.

Relationship to other diseases

Since many disorders occur at the same time as the impairment of sensory integration, those affected usually have other diseases as well. Individuals diagnosed with sensory processing disorder may also have anxiety problems, ADHD food intolerance, behavioral disorders, and other illnesses.

Spectrum of autism and disorder of the sensory processing

The sensory processing disorder often occurs at the same time as a diagnosis on the autism spectrum . Although a sensory stimulus problem is common in autistic children and adults, there is insufficient evidence that sensory symptoms distinguish autism from other developmental disorders. Anomalies are greater in the area of ​​underreactivity (for example, running against things) than in the area of ​​overreactivity (for example stress from loud noises) or in the area of ​​active search for stimuli (such as rhythmic movements). The symptoms might be more common in children: some studies showed that autistic children had a limited sense of touch while autistic adults did not have these problems.

The sensory experience questionnaire is designed to identify the patterns in the process of sensory processing in children who may be autistic.

Disorders of the sensory processing and ADHD

It is speculated that sensory processing disorders are misdiagnosed in those with attention problems. An example of this would be when a student who is unable to repeat what was said in class (out of boredom or distraction) is instructed to be screened for a sensory integration disorder. This student could then be examined by an occupational therapist to see if he has difficulty concentrating and perhaps by an audiologist or speech therapist for auditory or language processing disorders. Likewise, a child could be mistakenly diagnosed with ADHD because impulsivity has occurred when impulsivity actually only occurs when certain stimuli are sought or avoided. One could also get up from the chair regularly in class, despite having been admonished several times because their poor proprioception (perception of body movement) causes them to fall from the chair and the fear of avoiding sitting down wherever possible. If the child can sit longer by giving them a padded pillow (which provides more sensory input), or if they can sit at home or in a particular classroom but not in the main classroom, that is a sign that someone is closer Investigation for the cause of the impulsivity is needed.

Other comorbidities

Many diseases can be associated with impaired sensory processing, such as schizophrenia , succinate semi-aldehyde dehydrogenase deficiency , primary nocturnal enuresis , prenatal alcohol use , learning disorder and autism , or people with traumatic brain injury or who have had a cochlear implant . and who can have genetic problems like Fragile X Syndrome . Sensory integration disorder is not seen as part of the autism spectrum and a child can be diagnosed with no other comorbidities present.

controversy

Medical manuals

Sensory integration disorder appears in Stanley Greenspan's Diagnostic Manual for the Infancy and Early Childhood , SPD in Stanley Greenspan's Diagnostic Manual for Infancy and Early Childhood, and Regulation Disorders of Sensory Processing as part of The Zero to Three's Diagnostic Classification . The disorder is not included in the ICD-10 and DSM-5 . However, the unusual response to sensory input and an unusual interest in sensory aspects is a possible but not necessary criterion for diagnosing autism.

Misdiagnosis

Some believe that the sensory processing disorder is a diagnosis in its own right, while others say that abnormalities in sensory reactivity are part of other diagnoses. The American Academy of Pediatrics , for example, advises not making a self-made diagnosis of sensory processing disorder without being a symptom of the autism spectrum , ADHD , dyspraxia, or childhood anxiety disorder. Neuroscientist David Eagleman has suggested that sensory processing disorders should be viewed as a form of synesthesia in which separate areas of perception are linked in processing. Eagleman assumes that this can specifically be traced back to the physiology of the central nervous system: For example, a sensory stimulus that should correctly be connected to the area for color perception is rather physiologically linked to brain regions that are associated with the occurrence of pain, aversion or Nausea are involved.

Researchers have described the treatable disease as hypoaclemic sensory overstimulation, which meets the criteria for both a diagnosis of ADHD and a disorder of sensory perception.

research

Over 130 articles on the subject of sensory integration have been published in peer-reviewed journals (mostly in the field of occupational therapy). The difficulty of doing double-blind studies on sensory processing disorder was raised by Temple Grandin and others. Further research is necessary.

The American Academy of Pediatrics advises paediatricians to inform families about these limits of application, the trial period for the therapy, because the state of research has not progressed far enough, is limited with regard to the disturbance of the sensory processing and the effectiveness of the forms of therapy is not conclusive coordinate with them and explain how to judge the effectiveness of the therapy.

history

The disturbance of the sensory processing was first described in detail by the occupational therapist Anna Jean Ayres (1920–1928). According to your treatises, a person has a reduced ability to organize sensory information while it is being perceived.

Ayres' model

Ayre's theoretical framework for sensory processing disorders was developed by her after six factor-analytical studies of groups of children with learning disabilities, perceptual motor disorders, and normally developed children.

Ayres developed the following nosology (systematic description of the disease) based on the patterns that emerged in the factor-analytical studies:

  • Dyspraxia : poor movement planning (more in relation to the balance organs and proprioception )
  • poor bilateral integration: inadequate use of both halves of the body at the same time
  • Haptic hypersensitivity: negative reactions to haptic stimuli
  • Deficits in visual perception: poor perception of space and shape and poor eye motor skills
  • somatic dyspraxia : poor movement planning (related to insufficient information coming from the haptic or proprioceptive perception system)
  • auditory- language-related problems

Both visual perception and deficits in the auditory-language-related area should have a strong cognitive component and only weak relationships to deficits in sensory processing, so they are not seen as central deficits in sensory processing in many models.

In 1998, Mulligan conducted a study of 10,000 sets of data, each representing an individual child. She performed confirmatory and exploratory factor analysis and found data similar to Ayres'.

Dunn's model

Dunn's nosology uses two criteria: the reactive type (passive or active) and sensory stimulus threshold to input (low or high) creating 4 types:

  • low stimulus registration, high stimulus threshold with passive reaction.
  • Avoidance of stimuli, low stimulus threshold and active response.
  • Search for stimuli, high stimulus threshold and active response.
  • sensory sensitive, low stimulus threshold with passive reaction.

Miller's model

In Miller's nosology , “sensory processing disorder” has been renamed to “sensory processing disorder” to simplify coordinated research in areas such as neurology, since “the use of the term sensory integration is often more related to neurophysiological cellular processes as a behavioral response to sensory input, as is common with Ayres. ”The current nosology of disorders of the sensory processing was developed by Miller and is based on neurological principles.

Other models

A large number of approaches have included stimuli in influencing learning and behavior.

  • For example, the “Altert Program for Self-Regulation” is a complementary approach that increases cognitive awareness of attention and often uses sensory strategies to support learning and behavior
  • Other approaches primarily use passive sensory experiences or sensory stimulation according to specific protocols, such as the Wilbarger approach or the Vestibular-Oculomotor Protocol

See also

literature

Web links

Individual evidence

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  2. ↑ J Cosbey, SS Johnston, ML Dunn: Sensory processing disorders and social participation . In: Am J Occup Ther . 64, No. 3, 2010, pp. 462-73. doi : 10.5014 / ajot.2010.09076 . PMID 20608277 .
  3. ^ Sensory Processing Disorder Explained . SPD Foundation. Archived from the original on May 17, 2010. Retrieved June 6, 2010.
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  5. ^ AJ Ayres: Types of sensory integrative dysfunction among disabled learners . In: Am J Occup Ther . 26, No. 1, 1972, pp. 13-8. PMID 5008164 .
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