3 Types of Sensory Disorders That Look Like ADHD

I got my start in Sensory Processing Disorder when I was a teacher — some of the kids I was teaching seemed so out-of-sync, and I couldn’t understand why. What was so dreadful about a tambourine being played? Why did some children avoid the jungle gym at all costs, while others could never get off? Why did one child never take his feet off the ground, ever? I wondered if it was ADHD — but the diagnosis didn’t quite fit. When I finally discovered SPD, it opened my eyes to what these children were dealing with.

We have at least eight senses. Most people know about the classic five: seeing, hearing, smelling, tasting, and touching. But many are unaware of the other three:

1. The vestibular sense: the “master sense” connected to our inner ear, which tells us where we are, how fast we’re moving, if we’re falling, etc.
2. Proprioception: the muscle and joint sense, which helps us know how to get into a coat or how to get up the stairs
3. Interoception: internal organs senses that let us know if we’re hungry, thirsty, have to go to the bathroom, etc.

Senses serve a number of purposes. First and foremost, they keep us safe — they tell us that a Frisbee is coming toward our head, for example — and we need to duck! Once we’re safe, we can follow up on sensory stimuli, and start to learn. This is called discrimination — we can look at the people playing Frisbee and teach ourselves what they’re doing, so maybe next time we can jump up and catch the Frisbee and start to play.

Next, we use our senses for satisfaction  — we identify things that feel good, and we continue to do those things because they bring us joy. Finally, we need our senses for action — we plan out what we’d like to do, then combine our senses together to execute the action.

[Take This Test: Sensory Processing Disorder in Children]

These tools — reacting, learning, enjoying, and taking action — are used every moment of our lives. Sensory processing disorder (SPD) puts all those everyday functions out of order.

Ordinary sensory experiences — like things we see, feel, and do — are processed in an atypical way when you have SPD. The term “atypical” can mean a lot of things in SPD — perhaps the brain responds late, or perhaps it doesn’t respond at all. Perhaps it responds incorrectly. But ultimately, we don’t respond to our sensory input as we typically should, and that leads to a host of problems.

SPD is far from a one-size-fits-all disorder. There are three major categories — each with a few subtypes! It’s important to remember that these categories are not mutually exclusive; a highly sensitive child with SPD can have symptoms from more than one category and subtype, which can confuse parents or professionals striving to make an accurate diagnosis.

A sensory processing disorder, however, should not be confused for sensory processing sensitivity (SPS), a biologically-based trait characterized by increased awareness and sensitivity to the environment. SPS is not associated with dysregulation, but with awareness, depth of processing, and needing time to process information and stimuli.

Sensory modulation is the first category of SPD, with three subtypes of its own. The first is sensory over-responsivity. We call this child the “avoider,” because she goes out of her way to avoid sensory stimulation — by covering her ears, hiding under her desk, or closing her eyes. Her sensory input is too sensitive, and everything seems like too much for her.

The second subtype is under-responsivity; this child is the “disregarder.” This child won’t notice what’s going on around him — even if it’s extra loud, bright and colorful, or an extreme temperature. His sensory input is muted, so he often seems uncaring or withdrawn. In reality, he just isn’t noticing what’s happening to his senses.

The third subtype is sensory craving; this child is known as the "seeker," or sometimes, the "bumper and crasher." This child wants sensations, as many as possible. She’ll be a daredevil, climbing to the highest branch or swinging the farthest on the tire swing. Her sensory input is never enough, and she always wants more, more, more.

[Take This Test: Is It Sensory Processing Disorder or ADHD?]

The second category of SPD is difficulty with sensory discrimination, or using the senses to learn. Let’s call this child the “jumbler.” This child struggles to use his senses to make judgments, so even if he’s done a task many times before, he goes into it blind each time. If he has to pick up a bucket of water every day, for example, he forgets the information he learned the last time he picked something up. He doesn’t use his proprioception to evaluate how much the bucket might weigh, and perhaps he picks it up with too much force and water slops everywhere. Or he may not use enough and can’t get a grip on it.

For children, being the jumbler can be embarrassing. They’re always “messing up” simple tasks, and are often teased by others.

The final category of SPD, sensory-based motor disorder, has two subtypes. The first is postural disorder — let’s call this child the “slumper.” The slumper has difficulty with movement, and moves in a clumsy, disorganized way. He may have difficulty stabilizing himself. He may struggle to run without tripping over his feet. Kids with postural disorder have difficulty crossing the midline, or using the hands and feet on one side of the body on the other side.

The second subtype is dyspraxia, or the “fumbler.” This child will have difficulty planning and executing actions. If you hand him a box, for example, and ask him to do something with it, he won’t know what to do. A neurotypical child will say, “I can climb in the box. I can go under the box. I can push the box.” The fumbler will struggle to come up with an “action idea.” He’ll prefer toys, games, and situations that are familiar, instead of novel — new situations require new motor planning, and a child with dyspraxia will shy away from that.

Put on your sensory goggles to find out! “Sensory goggles” is a term invented by two SPD moms, Laurie Wienke and Carrie Fannin. Essentially, it encourages parents to look at their child’s behaviors through a sensory point of view, to try to determine if they may be caused by SPD. Ask yourself:

• Is my child seeking more touch or movement than other children do?
• Is my child avoiding everyday touch and movement?
• Does she have difficulty functioning in certain environments where a lot of senses are used?

If your child expresses some or all of these behaviors, follow up with one more question: What is my child’s self-therapy?

Children with SPD may not know they have a “disorder,” but they instinctively know what situations are difficult for them, and what they can do to seek relief. A child who is a “seeker,” for instance, may stay on the swings for hours, trying to swing higher and higher each time. A child who is an “avoider,” on the other hand, may spend entire days under his comforter on his bed, where he feels safe and unstimulated. If your child engages in unusual behaviors or does certain things significantly more than other children his age, look into SPD.

Surprisingly, some of the most outwardly obvious symptoms of SPD are inattention, hyperactivity, and impulsivity. Sound familiar?

SPD is misdiagnosed as ADHD all the time. So, when faced with common symptoms, parents and doctors need to look at other possibilities — particularly SPD. Why are children inattentive? It could be ADHD, sure. Or it could be a child with SPD, unable to focus because his chair is wobbly — and his vestibular sense is reacting improperly, making him feel like he’s going to be thrown off the face of the earth.

Hyperactivity and impulsivity can be symptoms of a sensory disorder as well. A child who can’t sit in his seat may be “seeking” more sensory input, or trying to escape an overwhelming sensation. He may be unconsciously trying to escape from a flickering florescent light, for example, that’s irritating his senses and driving him crazy. Young children, in particular, may not be able to explain why they act the way they do, so it’s important for adults to carefully observe the child’s behaviors — and ask the right questions.

What can you do, as a parent, to help your child with SPD? First, you can get your kids playing vigorously with open-ended fun — outside whenever possible. Outdoor play — without unnecessary rules and restrictions — is key to developing and enhancing a child’s sensory processing. Dr. Jean Ayres, the SPD pioneer, once said, “Fun is the child’s word for sensory integration.” If your child is engaged in using his senses, he’s strengthening his sensory responses and his brain.

With SPD treatment, younger is usually better — young children’s brains are more malleable, and respond well to effective early intervention. But OTSI can be implemented at any age — even for adults! Old dogs may take longer to learn new tricks, but therapy can “bend” the brain of someone with SPD, making it possible for them to function more happily.

The right kind of touch can be very soothing for a child, especially when she’s upset. If your child is having a meltdown, the best course of action may be to embrace her in a strong hug, or have him lay on the couch while you gently press on his back and legs. Teach her how to squeeze her own body when she’s upset — squeezing the forearms, biceps, shoulders, or thighs can deliver calming pressure to an overstimulated child.

The most effective treatment for SPD is occupational therapy, more commonly referred to as OT. The specific type of OT is called OTSI — or occupational therapy using sensory integration techniques.

Specific techniques can vary widely from child to child, depending on their particular difficulties, but the overall goal is always the same: to get the brain-body connection working more smoothly. The therapist will try to engage the child in activities that interest her, while speaking to her sensory difficulties. An “avoider” child, for instance, may be presented with fun prizes hidden inside various materials — shaving cream is a common example. He may be hesitant to touch at first, but he’ll eventually become curious for the prize and dig his hands into the shaving cream — strengthening his sensory response and helping him manage his aversion to new textures.

Some studies have shown that as many as 40 percent of people with SPD or ADHD will actually have both conditions. This overlap is important for doctors to know, because treatment should be tailored to each child's unique situation. Stimulant medication for ADHD, for example, won’t help a child’s SPD. Occupational therapy, on the other hand, may not fully control ADHD symptoms, but it will most likely benefit the child regardless. My suggestion is to start with OT — if ADHD symptoms remain a problem, revise your treatment strategy to include ADHD-specific interventions.

If you suspect that your child may have some sensory issues, don’t hesitate to go for an evaluation. Sometimes, you don’t need a full assessment — just a conversation with a qualified OT may help you solve the puzzle. If you’d like, it’s okay to try a few sessions of OT without a formal diagnosis, just to see how your child responds. Almost every child loves sensory integration techniques, and even those who don’t qualify for a formal SPD diagnosis will most likely benefit from some fun OT sessions.

[Read This: "My Senses Are in Overdrive — All of the Time"]