"Sensory Processing Disorder" and "Central Auditory Processing Disorder"

By Dr Megan Yap - PaediatricianGeneral28 Jul 2019

As always, it’s been a busy last couple of months on the work front for me.  Biggest news is that I have submitted what I hope to be my last ever assignments, and my lecturer has just emailed me to let me know that I passed both!  WOOT! WOOT! Crack out the champers!! (*insert happy dance*)

Resisting the urge to go on a permanent celebratory holiday, I have come back to the blogging grindstone to see if I can shed some light on a controversial “condition” that many people have heard of, but few people really understand.  This term is “Sensory Processing Disorder.”

It is not a wonder that parents find this term very confusing, because there is much debate between health professionals around what it is and whether or not it actually exists.  The term was originally used and continues to be used by occupational therapists and describes deviations in the way that different individuals receive, interpret and process sensory information as compared to the general population.

People who identify with having a “Sensory Processing Disorder” may find that they either a heightened or dulled reactivity to sensory input from their environment through their hearing, vision or sense of touch.   This might appear as a child who hates loud noises and covers their ears, a child with an abnormally high pain threshold, or a child who is constantly putting non-food items in their mouth… amongst many other things. In children, it is often flagged in kids who have difficulties with attention and concentration at school and is associated with diagnoses like ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autistic Spectrum Disorder).

Now whilst it is true to say that some children have unusual or very specific sensory preferences, it would also be true to say that EVERYONE on Earth has their own individual profile of sensory preferences and aversions.  Just like the colour of our hair, or eyes or features of our personalities, this is part of what makes us individuals and it is not abnormal to have different sensory preferences and aversions as compared with other people.

It only becomes problematic if these preferences or aversions prevent us from functioning normally in everyday life or cause us a disproportionate level of distress.

Let me give you an example. I hate loud noise.  In fact, I hate any kind of background noise including the TV, radio/music, people talking etc etc if it is not what I am primarily focussed on.  I have never been able to study in anything other than complete silence and as a person who has studied pretty much all my life, I found this sensory aversion VERY challenging to manage when studying after I had children (read: the noisiest 2 children on the face of the planet). My solution?  My husband’s noise-cancelling lawnmowing earmuffs (Note: also very helpful when you are subjected to the repetitive and very annoying “Mum? Mum?  Mum? Mum? Mum? Mum…” – just point to your earmuffs, shrug and say, “Go ask your father, I can’t hear you”).

So why then is it controversial if “Sensory Processing Disorder” is a real “thing” or not?  I think there is controversy and disagreement between professionals regarding this for several reasons.

  1. Sensory preferences (and thereby differences) are part of life and are not necessarily abnormal (eg if one person prefers crunchy sweet food and the another prefers soft, savoury food – neither of them are abnormal).  It is hard to differentiate between what is normal and abnormal when certain sensory tendencies mean different things to different people.
  2. There is no evidence to show that “treating” sensory differences (eg with a sensory “diet”) makes a consistent positive difference for all children.  Anecdotally, certainly trying to meet sensory “needs” helps some children, but for others it can make things much worse!  More about this later**
  3. The term “Sensory Processing Disorder” was first used by occupational therapists but is not listed as a diagnosis in the DSM-5 (Diagnostic and Statistical Manual) that we use clinically to make diagnostic decisions.  That is, it is not formally recognised as a diagnosis in its own right.

Our paediatric occupational therapy colleagues are trained in doing “sensory profiles” for children.  Sometimes, for some children, trying to identify certain preferences or needs and trying to meet them, can be helpful for a child.  For example, in a child who is very motor active and who constantly seeks movement (eg rocking on their chair, kicking their legs), this can be very distracting and prevent the child from being able to focus on their school work.  If we try to facilitate this movement for the child in an unobtrusive way (eg a Hoki stool, a wobble cushion or an elastic/lycra band to kick around the legs of their chair), then sometimes it can help them to focus by alleviating their need to move and giving some sensory feedback.

For other children, these tools may be more distracting than helpful, and frequent movement breaks may be a better alternative.

The “developmental and behavioural paediatrician” in me also thinks about the need to avoid inadvertent rewarding of bad behaviour. Think about it… a child plays up in class and we interpret this as the child having an “unmet sensory need” – so we allow them access to a “sensory toolkit” or to a “sensory gym” to help them calm down.  This is enjoyable for the child (because they get to bounce on a fit ball and not do school work), so the process reinforces the problematic behaviour and the child plays up more frequently in order to access the “reward.”

Difficult isn’t it?

I think it is undeniable that there are some children who have more unusual sensory preferences (and aversions) than others and potentially problematic behaviour around these.  I see no harm in trialling sensory interventions in these children to see if they help, and to stop them if they don’t.  The term “disorder” is unhelpful because implies that children are abnormal just because their sensory preferences differ from other people’s.  In any case, “Sensory Processing Disorder” is not currently a diagnosis that can be “made” as such so instead I prefer to use “sensory differences” as a way to describe individuals that have more difficulty with coping with sensory inputs from their environment as compared to an average child.

This article wouldn’t be complete without mention of a similar term, “Central auditory processing disorder (CAPD).” Again this is a term used frequently, but is not a diagnosis listed in the DSM-5.  Expensive testing is available for CAPD, but in reality, this testing is non-evidence based and unnecessary.  Like the term SPD, CAPD refers to individuals who have a difficulty in processing sensory input but is specific to hearing.

Children who have auditory processing difficulties have trouble with filtering out background noise and as a result are easily distracted by it.  These are the kids who struggle to focus on the teacher’s voice in a noisy classroom or who are most easily distracted by a noise made outside.  In actuality, we don’t need expensive testing to tell us what the child’s behaviour already indicates – that they cannot filter out irrelevant background noise and are easily distracted by it.  Often these children are found to meet criteria for ADHD.

We can help the child by giving them noise cancelling headphones (helps to lower background noise when they are trying to concentrate on a task) or with FM (frequency modulation) devices – a type of wireless assistive hearing device that can amplify a teacher’s voice via a microphone worn on the teacher’s lapel and an earpiece worn by the child. As with SPD, CAPD is not a formal diagnosis but rather a way to describe children who have more difficulty coping with multiple auditory stimuli then the average child.

I hope that this article has helped to clear a few things up for some of you out there, because I know with the number of times I have been asked about these conditions there are BOUND to be parents out there wanting to know more.

Leave me a comment, a like or a SHARE to help reach as many parents and carers as we can out there!

Until next time, stay well!

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/


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