My recent research with Quinnipiac University found that over half the children and adolescents referred for occupational therapy at my pediatric psychiatry hospital had significant sensory processing difficulties. The most common difficulties were auditory filtering in three quarters, under-responsive/seeks sensation (60%), and tactile sensitivity in half the sample. Sensory Processing difficulties were found through definite differences on the Short Sensory Profile (where only 2% of individuals would score). Three separate studies similarly found over one-third of preschoolers and 40% of elementary school students with significant sensory processing difficulties had psychiatric diagnoses. Sensory processing disorders occur at significantly higher rates in children and adolescents with psychiatric diagnoses.
The findings that sensory processing problems are significantly higher in children and adolescents with behavioral and psychiatric challenges can guide therapists in their clinical interventions. First, it is important to assess and if needed address sensory processing disorders in youngsters with behavioral and psychiatric difficulties. Difficulty with sensory over-responsivity, the most common sensory processing problem, is extremely important to address in individuals with behavioral and psychiatric challenges. Several FAB strategies include environmental adaptations and sensory modulation strategies that help children and adolescents maintain a quiet alert state. A simple but effective strategy is to first decrease, then if needed incrementally increase sensory stimulation, until a quiet alert state is achieved.
Additionally, the high incidence of difficulties with tactile sensitivity and auditory filtering are particularly relevant. The high frequency of problems with tactile sensitivity in my psychiatric patients referred to occupational therapy suggests why the use of restraint in pediatric psychiatry has been so problematic and the need for FAB pressure touch strategies as a component of intervention. The high incidence of auditory filtering difficulties is also extremely relevant given that verbal counseling and coaching intervention is so extensively used. It is important to distinguish when children and adolescents don’t follow verbal directions because they can’t understand them. Children and adolescents with auditory processing and behavioral challenges could benefit from the strategic use of visual supports to convey counseling and coaching instructions.
The fields of occupational, speech-language, and physical therapy and our use of sensory processing interventions is criticized by pediatricians and behaviorists as an absurd fad despite our repeated clinical success. It is time to publicize the extensive research and clinical evidence that shows sensory considerations are crucial in intervention with children and adolescents who have behavioral and psychiatric challenges. The biases against occupational, physical, and speech therapists using appropriate caring touch and strategic visual supports is depriving young people of important intervention for improving their functional behavior.
References:
Carter, A.S., Ben-Sasson, A., & Briggs-Gowan, M. J. (2011). Sensory over-responsivity, psychopathology, and family impairment in school-aged children. Journal of the American Academy of Child & Adolescent Psychiatry, 50(12), 1210-1219.Gourley, L., Wind, C.,
Henninger, E. M. & Chinitz, S. (2012). Sensory processing difficulties, behavioral problems, and parental stress in a clinical population of young children. Journal of Child and Family Studies, 1-10.
Gouze, K.R., Hopkins, J., LeBailly, S.A., & Lavigne, J.V. (2009). Re-examining the epidemiology of sensory dysfunction and comorbid psychopathology. Journal of Abnormal Child Psychology, 37(8), 1077-1087.
1079-1085.
Van Hulle, C.A., Schmidt, N.L., Goldsmith, H.H. (2012). Is sensory over-responsivity distinguishable from childhood behavior problems? A phenotypic and genetic analysis. Journal of Child Psychology and Psychiatry, 53(1), 64-72.