June 27, 2012

Defining the 6 Subtypes of SPD

Dr. Lucy J Miller poses there are 6 subtypes of SPD which help us better understand the children that we are working with. We all know about the 8 sensory systems with the newest system being interoception (sense of internal organs) but how can we determine what areas a child is having difficulty with and how to treat it?

A. Sensory Modulation Disorder
a. Sensory Over-Responsivity (SOR)
b. Sensory Under-Responsivity (SUR)
c. Sensory Craving (SC)
B. Sensory Based Motor Disorder
a. Postural Disorder
b. Dyspraxia

C. Discrimination Disorder
a. Visual
b. Auditory
c. Tactile
d. Taste/smell
e. Position/movement
f. Interoception

What Does Over-Responsivity Look Like?
If a child is Sensory Over-Responsive, their bodies feel things too quick too fast and their system can go into fight, flight or freeze mode. Some children may fear movement, unexpected noises, tactile input, and/or new or unfamiliar tastes or smells. These children tend to look like they are in an anxious state a lot of the time, especially when they are introduced to something that makes them uncomfortable.

How About Under-Responsive Kids?
Sensory Under-Responsive are children who are slow to move, the “couch potato” kiddo who is difficult to motivate. They may choose sedentary activities over movement most or all of the time. These children may appear withdrawn or self-absorbed. They may show signs of weak muscles, slumping in their chair or having to lean on things to stand.

Constant Sensory Cravers
If a child is a Sensory Craver they actually “crave” the input to their bodies almost like an addiction. These children seem to constantly need deep pressure input, constantly touching others, moving and crashing into things all the time. You might see a kiddo who gives hard high fives, pets animals with too much force, always wants you to hug them really tight; they may have liked being swaddled tight as an infant. These kiddo’s also may push down so hard when coloring they break their crayons, or tear the paper. They may not be able to sit still at school, or slow their bodies down enough to control their impulses.

Postural Disorders & Dyspraxia
When moving into the second category of SPD we talk about Postural Disorders and Dyspraxia. Children who demonstrate decreased postural control can be clumsy, uncoordinated, have poor posture and have trouble even maintaining a sitting position. Children with Dyspraxia can have difficulty with coming up with new play ideas, sequencing a task, or motor planning how their body needs to carry out that new motor task.

Sensory Discrimination Disorder
The third category is Sensory Discrimination Disorder and a child can demonstrate difficulties in any of the 8 systems. They may not know how much force to use when trying to pick up something heavy, they may not be able to discriminate the amount of pressure they use when writing or drawing. You may see a child who has trouble judging how much force to use during motor tasks like kicking a ball, opening and closing doors. SDD kiddo’s can have difficulty discriminating between familiar sounds, or when reading and writing letters. You also may experience a child who does not understand when they have to use the bathroom, or know how to tell you they are hungry.

Clinical Solutions
When you notice a child having difficulties with any of the above listed sensory subtypes, they probably are having issues with multiple sensory systems. As a clinician, you want to focus on following the child’s lead and building a relationship with them first. Then as you gain their trust, you can slowly introduce them to more sensory stimuli through play activities. You never want to force a sensory activity on a child. If you are targeting their proprioceptive system, you may want to combine certain play ideas to help them activate several sensory systems at once. Maybe they have to create a swing obstacle course to get to the burning building up a ladder. Have them participate in the heavy work activities while setting up the game for deep proprioceptive input to help organize them. Then as they are going through, if they become too over-aroused and excited, slow your body and voice down and create a scenario where they have to stop and cognitively process how they are going to play out the game or activity. This will help slow down their impulse control as well.

Another example may be if a child has difficulties with Dyspraxia and completing new motor tasks, you can challenge them to a game where they can’t touch the hot lava on the ground as they cross over the jungle. The child may struggle with grading their movements appropriately and knowing how hard or fast to move their bodies to get to the next obstacle in the jungle. You can have them help set up going through a tire, over a bolster, climbing onto a swing and timing a jump to a crash pad all pretending these are part of the jungle and if they fall into the hot lava they have to start over again. You may need to help them physically with some of the obstacles especially if they have poor body awareness.

Parent Education by a Trained OT is Key!
Occupational Therapists who have been trained in the focus of relationship/engagement based therapy with a high priority on parent education can best differentiate between the 6 subtypes and set up the best therapeutic plan for the child and their family. A high priority when working with any child with special needs is Parent Education! It is very important to train the parents and caregivers on how to carry out therapeutic interventions and create a Sensory Lifestyle into the home, school and community. OT’s should be working together with all the individuals in the child’s life that are involved. That means parents, teachers, assistants, all other therapists, doctors, nannies, grandparents, siblings and the list goes on. We as OT’s see a child between 1-5 times a week depending on what type of setting you work in. Whether you are receiving intensive therapy 3-5 days a week for a 30 session round of therapy or 30 minutes a month of consultation in the classroom, there should be open communication and dialog for us to all learn from each other.

No comments:

Post a Comment