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Sensory Processing Disorder: What the DSM Doesn’t Tell You

by Sarah Bartholomew, Music Therapy Intern

When you think of sensory processing, you might initially think of smelling perfumes and flowers, feeling a soft blanket, listening to traffic outside your apartment, and so on. These are certainly important aspects of sensory processing, but this is only a small part of the whole experience.

What is Sensory Processing Disorder?

To understand what sensory processing disorder is, we should first break this down into two sections: what our sensory systems are and how they are processed typically.

We have eight primary sensory areas:
1. Auditory → sound
2. Visual → sight
3. Tactile → touch
4. Gustatory → taste
5. Olfactory → smell
6. Proprioceptive → spatial awareness and awareness of own body and movements
7. Vestibular → balance
8. Interoceptive → internal organs and awareness of bodily function needs (STAR Institue, 2021)

Here’s how we process all of that information:
1. Registration → the first step is for the brain to receive the information
2. Modulation → we then regulate the intensity of the stimuli
3. Discrimination → we organize and interpret the information
4. Response → finally, after integration of all the stimuli, we form a response, or a reaction,
to it (Galiana-Simal et al, 2020)

With sensory processing disorder, one or more of the four phases listed above are impaired, leading to incorrect processing of sensory stimuli. This can impact all sensory areas as well, so it is not just limited to one sense.

A close up of fingers snapping.

What Does Sensory Processing Disorder Look Like?

There are many niche areas of sensory processing disorder, but the two primary types are sensory-seeking and sensory-avoiding.

Sensory seeking behaviors can look like:

  • Touching surrounding objects
  • Playing rough
  • High pain and temperature tolerance
  • Restlessness, fidgety, and constantly moving
  • Difficulties recognizing personal space
  • Distracted and anxious
  • May use loud sounds and/or actions like self-biting or self-hitting as regulatory behaviors

Sensory avoiding behaviors can look like:

● Avoiding certain fabrics or avoiding clothing with tags
● Seeking quiet areas away from crowds and loud noises
● Aversion to certain sounds, smells, and visual input
● Aversion to physical contact
● Aversion to certain foods based on taste or texture
● Difficulties adjusting to new routines or changes in routines
● Stress from overstimulation can lead to frustration, anger, and meltdowns (Baltazar Mori & May-Benson, 2017)

It should also be taken into consideration that someone may be sensory-seeking in one sense while also being sensory-avoiding in another. Within that, there may also be both seeking and avoiding behaviors within one sense. A primary example is gustatory: someone may love crunchy foods, like carrots and chips, and seek out eating foods with such textures while simultaneously avoiding soft foods, like oatmeal and yogurt.

What can Accommodations Look Like?

Of course, each individual will experience sensory processing disorder in a unique way and may have accommodations that differ from others. However, here is a brief list of some common
accommodations:
● Reduced-distraction environment for working, school, and test-taking
● Noise-canceling headphones
● Having a specific diet
● Removing clothing tags
● Using fidget cubes or other tactile stimuli when needed
● Using dim-lit lamps instead of incandescent overhead lights
● Using a routine and giving sufficient preparation for upcoming changes
● Replacing harmful regulatory behaviors with safe ones, such as offering to use a chewie instead of self-biting

It is important to note that if someone is using sensory stimulation as a regulatory behavior, the behavior should not be changed. The only exception to this is if the behavior is harmful, like mentioned in the list above. Self-biting can certainly be harmful, but you don’t want to take away the regulatory behavior completely.  Instead, recognize they may be looking for tactile oral stimulation and therefore, replacing the biting with using a chewie would suffice. It fulfills the sensory need safely without removing it completely.

Common Comorbidities

Sensory processing disorder is a diagnosis on its own, although it is not in the DSM-5. It is still recognized by many, including the American Occupational Therapy Association (Baltazar Mori & May-Benson, 2017). However, sensory processing issues are also seen alongside other diagnoses.

These include:
1. Autism spectrum disorder and attention deficit/hyperactivity disorder → typically
presenting as sensory seeking and sensory avoiding behaviors
2. Post-traumatic stress disorder → typically involving stimuli that trigger memories
3. Depression → typically presented as sensory avoiding behaviors with responses that lean more towards irritability and anxiety (American Psychiatric Association, 2013)

Conclusion

Sensory processing disorder is certainly its own unique entity, and as mentioned above, can also be seen in other diagnoses. There is still much to learn about it and what really happens when the processing experience is impaired, but with understanding the basics, we can at least recognize its impact on individuals and how we can accommodate, whether that be accommodating for ourselves or for someone else in our lives.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). https://doi.org/10.1176/appi.books.9780890425596

Baltazar Mori, A. and May-Benson, T. A. (2017). Occupational therapy using a sensory integration–based approach with adult populations. Aota.org. Retrieved November 29, 2021,
from https://www.aota.org/About-Occupational-Therapy/Professionals/HW/Using-Sensory-
Integration-Based-Approach-With-Adult-Populations.aspx

Galiana-Simal, A., Vela-Romero, M., Romero-Vela, V. M., Oliver-Tercero, N., García-Olmo, V.,
Benito-Castellanos, P. J., Muñoz-Martinez, V., & Beato-Fernandez, L. (2020). Sensory
processing disorder: Key points of a frequent alteration in neurodevelopmental disorders.
Cogent Medicine, 7(1), DOI: 10.1080/2331205X.2020.1736829

Understanding sensory processing disorder. Sensory Processing – STAR Institute. (2021).
Retrieved November 29, 2021, from https://sensoryhealth.org/basic/understanding-sensory-processing-disorder

Chime in!

What is your experience having sensory processing disorder? What about working with folks with SPD? Let us know in the comments below!

Sarah Bartholomew

Music Therapy Intern

sarah@heartandharmony.com

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