Understanding Regulation Disorders of Sensory Processing in Children

Management Strategies for Parents and Professionals

Pratibha Reebye, Aileen Stalker

• Publisher: Jessica Kingsley Publishers
• Year: 2007
• Print ISBN: 9781843105213
• eBook ISBN: 9781846427145
• Topic: Medicine
• Subtopic: Occupational Therapy

Children with Regulation Disorders of Sensory Processing struggle to regulate their emotions and behaviors in response to sensory stimulation. This book explains how to recognize these disorders, which are often misdiagnosed, and offers practical ways of helping children with regulation disorders.

The authors describe the everyday experiences of those who interact with infants and children with Regulation Disorders of Sensory Processing. They explain the distinguishing characteristics, symptoms, diagnosis, assessment and treatment approaches for the disorder. Focusing on early intervention, they present a range of management strategies for sensory sensitivities, motor problems, over- or under-reaction, and extremes of behavior. These practical strategies for parents and professionals will help children with regulation disorders integrate and succeed in the family, at school and in the community.

This concise book will be of interest to those who assess, educate and parent children with regulation disorders.

Part One

UNDERSTANDING REGULATION DISORDERS

Chapter 1

INTRODUCTION

What are Regulation Disorders of Sensory Processing?

Human infants are able to maintain an internal equilibrium by modulating sensory stimulation from the environment. Their regulation capacities include the ability to modulate the intensity of arousal experienced while remaining engaged in an interaction or being able to disengage easily from an activity.

Regulation capacities increase with age and by age six most children have learned to adjust their behaviors and sensory needs. However, infants and toddlers with Regulation Disorders (RDSP) may continue to have mild to intense difficulties in some areas of their sensory, motor and behavioral regulation throughout their childhood.

It was recognition of the persistent characteristics of these difficulties that established Regulation Disorders of Sensory Processing (RDSP) as a diagnostic category within early childhood disorders. The presence of sensory reactivity, motor and behavioral patterns across settings and within multiple relationships characterize this disorder (Diagnostic Catergory [DC]: 0–3R, ZERO TO THREE 2005).

Long before a clinical diagnosis is made, astute parents of a child with RDSP have observed that their child does not react like other children of the same age, or how their siblings responded at a similar age. Questions the parents may ask before they received a diagnosis are: “Is there something really wrong? Is it a phase? Is it just my child’s temperament? My child is really bright; how can there be this other aspect to his behavior and reactions? Do I have to place him in a specialized school environment? How can I help him to have joy in his life?”

Parents’ own instincts that there is something unusual with their child’s responses are often negated by those around them. Friends, relatives, and passing strangers frequently offer their advice and observations about the cause of the child’s behaviors, saying, “Have another one and that will sort him out”, “It’s your first child…”, “You are spoiling your child”, “You are doing it wrong”, “You are over-focusing because he is the first boy…”

Medical professionals may respond by suggesting it is a stage the child is going through or that the child will “grow out of it.”

However, parental descriptions of their children indicate a spectrum of symptoms that exceed those of typically responding children.

During infancy, parents describe their children as active, fussy, rigid, and having excessive crying, sleep problems, eating problems and touch sensitivity, as well as experiencing “colic-like” behaviors for their whole infancy. These babies are ones that need complete darkness to sleep, need to be driven around in a car for the vibration or “white noise” effect to help them calm, and are hypersensitive to sound and images. They may also have difficulty regulating their eating and elimination patterns, and difficulty self-calming generally.

During toddler and preschool years, parents relate that their children demonstrate a lack of awareness of personal space, safety and judging distances, experience tactile and noise sensitivity, fine motor problems, food allergies, excessive movement in sleep, and night terrors. The children sometimes are advanced in cognitive areas but often have poor social skills, seek out and play better with younger or older children and desperately want control of their environment. Although they may be engaging and charming, they can rapidly switch to violent outbursts or reactions manifested as aggression or negativity. Their conversational ability may be high but they may have slow speed in completion of goal-directed activities.

As the children become older preschoolers, the parents report that the children have difficulty tolerating the feeling of certain clothes, have difficulty with temperature control, and may perspire a lot. They want to eat only certain foods, are fearful of the flushing of the toilet, or hate to have their teeth or hair brushed or cut. These children may also become perseverative and get stuck in a play routine, repeating the same play over and over, or only play with certain toys. They may fear the unknown, such as when they see a Santa Claus or a clown, as the distortion of the human image is confusing for them. They may crave the feeling of gravity – and enjoy swinging and rides at amusement parks for long periods of time.

During primary school years, the parents describe that their children have difficulty with transitions, are reactive to noises and touch, and demonstrate more fine and gross motor problems compared to their peers. They may make impulsive responses, which are frequently interpreted as aggressive behavior, and exhibit poor social skills. Because of impulsivity and aggression, it is difficult to include them in shopping or many outside events. Their difficulty with perspective taking and their own bossy and aggressive behaviors result in few sustained friendships. Although they can attend to play for short periods of time, their play then shifts, and may be interrupted by their constant craving for personal attention. The children can not stand to lose face or be wrong, but they can find something wrong in everything. They may have obsessive behaviors where they over-focus or are preoccupied with a certain method or behavior, although they often are verbally adept.

Although parents can describe many troubling aspects of their children, these children are difficult to describe precisely or define because they change from day to day and are complex and individual in their sensory and behavioral responses.

However, to assist professionals and those who work or play with the child, it is often helpful to have a specific diagnosis that matches a clinical description.

A clinical description of Regulation Disorders

In both the International Classification of Diseases (ICD-9-CM) and the Diagnostic and Statistical Manual Text Revised (DSM-IV-TR), there is no description or provision for the diagnosis of Regulation Disorders/Regulation Disorders of Sensory Processing.

This diagnosis is a category in the DC: 0–3R, Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, which is a diagnostic manual produced by the ZERO TO THREE organization. Recently revised (2005), the disorder is now called Regulation Disorders of Sensory Processing, to emphasize that difficulty in sensory processing is a pivotal symptom observed in these disorders.

When establishing the diagnosis within infants, clinicians looked at the babies that used to be called “fussy” or “colicky” babies in infancy and early childhood.

They recognized that the concept of regulation was important and that development of regulation of mood, impulse, and an internal state of regulation was an essential developmental process. When Dr. Georgia DeGangi, Dr. Serena Weider, Dr. Winnie Dunn and Dr. Stanley Greenspan began focusing their work in the area of children under the age of four, they provided insights into the development and interactions of attachment, emotional regulation, and internal regulation. The diagnosis of RDSP has been supported within their research and the research of other clinicians during the last ten years.

RDSP is not designated as a diagnostic category by exclusion (if it is not that, then it is this). It represents a definite entity that requires a distinct behavioral pattern for diagnosis. The diagnosis is not related to a child’s intelligence but rather to a pattern of responses and behaviors observed over time. Sensory, motor (gross and fine motor), physiological (sleep, eating and elimination), behavioral processing and organizational (attention and affect, and overall behavior) responses are all considered. (Sleeping and eating difficulties can be considered symptoms of RDSP or as separate problems.) The disorders affect daily adaptation, interactions and relationships (DC: 0–3R 2005).

Regulation Disorders – what causes them?

RDSPs are most evident in infancy and early childhood. The causes are unclear. Each child has his individual sensory, motor, physiological and behavioral processing and organizational pattern and needs. The child with RDSP has more accentuated patterns in one or many of these areas.

Symptoms of infants with RDSP are not static and evolve over time. Early detection may therefore prevent more serious, long-term perceptual, language, sensory integrative and behavioral difficulties. Parents and others involved with the infants or children need to know that RDSPs are multifactorial in origin. The theories range from having an overlap with difficult temperament (DeGangi et al. 1993) to speculations about atypical central nervous system functioning.

Parents are often surprised that all the children in their family show some type of regulation difficulties, either sleep, feeding or sensory issues. That observation often gives rise to fears that RDSP may be a genetic disorder. At the time of writing, there are no literature references to support this notion.

The behavioral responses of infants, toddlers and children with RDSP are easily misinterpreted and causes misattributed. The toddler or child with RDSP is not hyperactive, aggressive or oppositional as judged on an overall behavioral response but may demonstrate these behaviors because of difficulty in emotional regulation related to specific sensory responses. They are often on an emotional roller-coaster rather than having persistent negative emotional responses.

Research in the causes and stability of Regulation Disorders

Fortunately, new findings on self-regulation capacities of infants and young children are emerging. Some clues that point toward physiological and central nervous system adaptability are important to discuss. We would like to remind readers that not all the work mentioned here is specific to RDSP. It does, however, help to explain some of the peculiarities and sensitivities exhibited by children with RDSP.

Porges et al. (1996) discuss variations in psychophysiology that allow us to understand differential responses that we see clinically among children with RDSP. One example is an inefficient physiological response such as ...

Table of contents

• Cover
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgements
• Part One: Understanding Regulation Disorders
• Part Two: Managing Regulation Disorders
• Part Three: The Impact of Regulation Disorders
• Glossary
• References
• Resources
• Subject Index
• Author Index