Updated: Oct 9, 2020
Sensory Processing Disorder (or Sensory Integration Dysfunction) is one of the most misdiagnosed mental health related issue in children. Many with SPD are diagnosed as ADHD and given medication that does not work.
ADHD or Sensory Processing Disorder (SPD)
If your child exhibits the following behavioural patterns: impulsive, hyper, inappropriate touching of others, inappropriate taking of things that belong to others, inappropriate and frequent movement, distractible, unaware when spoken to, and experience difficulty following multi-step directions. What would be the diagnosis for this child? The behaviours that are listed are common in both ADHD and SPD. Often a child with SPD is labelled as ADHD and to make things more confusing, a child can have both ADHD and SPD. ADHD and SPD are to separate disorders. There are commonalities between them but there are distinct differences as well. ADHD and SPD are both disorders that impact the brain. Both disorders show strong signs of being largely hereditary, but pre-natal, peri-natal and environmental factors have been linked to each disorder. In ADHD, current understanding points to problems with neurotransmitters (not enough dopamine and norepinephrine) and structural abnormalities in the front part of the brain (the seat of judgment and executive functions). This directly impacts the ability to attend, focus, plan, and persist with mental challenges. The causes of SPD is very different. Recent brain imaging research has demonstrated that children with SPD have abnormal white matter structure in the posterior (rear) part of the brain. White matter is responsible for carrying electrical impulses (information) from one part of the brain to another – it’s like the highway system of the brain. The posterior parts of the brain have been identified as where sensory integration occurs. For someone with SPD, the white matter in the posterior part of the brain is not effectively carrying electrical impulses. Important information about the physical world is not being processed correctly as a result. The brain with SPD is using incorrect or partial information as a basis for how it interacts in the environment. The resulting behaviors and responses are maladaptive.
ADHD is a more likely diagnosis if a person:
Cannot stop impulsive behavior regardless of sensory input.
Craves novelty and activity that is not necessarily related to specific sensations.
Does not become more organized after receiving intense sensory input.
Waits or takes turns better with cognitive rather than sensory inputs.
Calms or improves attention when presented with constant novelty.
SPD is a more likely diagnosis if a person:
Calms or focuses when provided sensory inputs.
Becomes more dysregulated when provided novelty related to sensory input.
Dysregulation issues seem to follow pattern (occur at a particular time of day, or during particular activities).
Sensory sensitivities and/or craving behaviors do not seem to resolve with ADHD medication.
The tricky part is when a person has both. These are people who still demonstrate significant, functional issues after receiving specific treatment (either for ADHD alone, or for SPD alone). Remember, studies suggest that up to 40% of children who have ADHD also have SPD. In these cases, a collaborative team approach that involves the physician, OT and mental health provider is most effective.
According to the Center for Disease Control, 11% of children aged 4-17 years in the United States have been diagnosed with ADHD. Statistically, if you put 100 children in a room, eleven of them will have been diagnosed with ADHD. The Center for Disease Control does not keep statistics on SPD. Fortunately, we have research that gives us an idea of how common it is. Studies indicate that 5% to 16% of children exhibit symptoms of SPD (Ahn, Miller et. al., 2004; Ben-Sasoon, Carter et. al., 2009). In that same room of 100 children, five to sixteen of them will have SPD, potentially outnumbering the children identified with ADHD. Equally important is that many of these kids have both disorders. A national stratified sample of children suggests that 40% of children with ADHD also have SPD (Ahn, Miller et. al., 2004). Back in our room of 100 children, four of the eleven ADHD identified children will ALSO have SPD. Thus, SPD is statistically a bigger issue than ADHD but ask anyone on the street and majority would have heard about ADHD but will have no idea about SPD.
Since ADHD and SPD cause very different issues in the brain, the approaches to treating them are also very different. Studies have shown that medication, behavioral management and most recently neuro-stimulation are the most effective forms of treatment for ADHD. Medication is helpful with balancing out the insufficiencies in neurotransmitters. Behavioral management addresses the deficits in executive functioning by teaching skills for the person to learn. Neuro-modulation helps modulate the neurotransmitters. This is a “top-down” approach. Physicians and mental health providers who specialize in ADHD typically are the primary providers. There is currently no medication that addresses the underlying components of SPD. Instead, SPD treatment relies heavily on a “bottom-up approach to improving the impacted neurological systems. Active participation of a person in a structured, sensory-rich environment by a trained occupational therapist provides them with specific, graded sensory inputs presented in meaningful and supportive activities. This kind of sensory processing therapy facilitates improved and efficient neurological responses, eventually leading to overall improved processing in the brain. Additionally, sensory strategies and sensory lifestyle components are used to support the person outside of the treatment session. tDCS is a revolutionary treatment to stimulate the electrical impulses of the brain. Sensory-trained Occupational Therapists are typically the primary providers of this type of treatment.
ADHD and SPD may look similar at passing glance, but it is important to remember that they are two different disorders. They have different causes, effect different areas of the brain by different mechanisms, and have different evidence-based treatments. Understanding and sharing the differences between ADHD and SPD helps ensure that anyone suffering from one or both of these disorders gets the proper care they deserve. 360 Wellness Hub is the ONLY facility available in Malaysia that has all the facilities to treat ADHD and SPD. We have the longest sensory tunnel in the world (150 feet), neuro-stimulator and modulators machine treatments, and trained ADHD/SPD therapists.