SPD or ADD/ADHD?, Part 2
How do you know for sure?
Once you recognize the possibility of SPD in your child, the next step is to locate a knowledgeable professional, usually a trained occupational therapist, to evaluate him. Many kids with SPD never receive an accurate diagnosis. The condition can resemble other problems, and can be misdiagnosed as ADD/ADHD, a learning disability, or even pervasive developmental disorder. In some children, the symptoms are so subtle and so similar to developmental behaviors, that they can be mistaken for mere personality quirks. Friends and family may, with all good intentions, say, “She’s just a late bloomer. Uncle Fred was always a sensitive child, and look how successful he is.” Our first pediatrician suggested that Elisabeth’s resistance (to put it mildly) to haircutting and shampooing was simply one of the factors that make her a unique individual.
Another barrier to diagnosis is the nature of the disorder itself. Many children with SPD intelligently develop coping strategies -- social withdrawal, ways to avoid certain activities and textures. The coping masks, but doesn’t eradicate, the condition. Some children have a small degree of dysfunction but crave the kinds of activities that help them cope and even excel. Thus, they find their own antidote and may not need diagnosis or formal treatment. I know a boy who is more attentive and cooperative in class after swinging on the monkey bars at recess. My daughter is more easygoing after swimming. Swinging and swimming are activities that regulate the brain pathways responsible for integrating the senses.
“Sometimes it’s just an immature sensory system, and a child will outgrow it,” says Stock Kranowitz. “Other times, a person doesn’t outgrow it, but grows into it.” As a person matures, she might, for instance, find an occupation that is comfortable. Consider the professor who is able to work in comfort behind the desk that “protects” her from the stimuli of classroom sights, sounds, and smells.
What do doctors say?
The biggest barrier to recognizing and diagnosing SPD may be the skepticism of the health care community. Much of this doubt stems from the medical model of health and disease, which requires evidence. Thus far, SI problems have not been quantified, in part because symptoms are variable and often dissimilar from one child to the next. But more research is being conducted to clarify the specific physiology, symptoms, and effective treatment of SPD, says Dr. Miller, who suggests that SPD’s eventual inclusion in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders is probable -- if not just over the horizon.
Until then, the coexisting symptoms of SI and ADD/ADHD may be confusing. A child with ADD/ADHD can be inattentive (or hyperattentive -- aware of too many things), distractible, easily frustrated, poorly organized, forgetful, fidgety, and impulsive. So can a child with SI problems. So a superficial description of a child with SPD will sound the same as a superficial description of a child with ADHD. But a closer examination of the child with SPD will reveal symptoms that likely will not be seen in the child with ADHD (unless he has both): an intense desire for or aversion to swinging and spinning, a terror of walking on grass or other unstable or bumpy surfaces, and extreme sensitivity to noise.
My daughter’s developmental psychiatrist has observed that for most of the children he has seen (all with ADD/ADHD), various treatments for SPD have not produced sustained improvements, and that makes him doubt the diagnosis. But for some, including Elisabeth, the therapies have produced long-term results.
What’s the treatment?
The two disorders may present similarly, but the medication and behavior-modification therapies that work for ADD/ADHD do not work for SPD. SI treatment consists of working with an occupational therapist on a set of activities that help retrain the senses. The little I knew about it was baffling, but after seeing them in action, the strategies made complete sense. The basis of the therapy is a varied sensory “diet,” to stimulate all the senses. Since each child has his or her own sensory strengths and weaknesses, the sessions are tailored to the child, and change as she or he progresses. The earlier dysfunction is recognized and treated, the better.
Elisabeth spent a lot of time swinging -- sitting up, lying on her stomach, on her back, and on a trapeze. She was encouraged to touch lots of different textures, she searched for buried “treasure” in containers of Play Doh, poured uncooked beans and dried peas from one container to another, finger-painted on mirrors with shaving cream, carried big jars of sand up a slanted surface, somersaulted down a soft incline, and jumped into piles of huge beanbags.
We began new activities for a few minutes at a time. Once she overcame her initial fears and aversions, Elisabeth began to seek out the kinds of activities that helped her -- some of them the very ones she had avoided. Within about a month, she seemed less fearful, more cooperative, and physically stronger. She started to make friends on the playground, her play was more organized, and she stuck with activities for longer periods of time.
SI treatment is not a panacea and certainly not a quick fix. Although some children need less therapy than others, for many it’s a years-long proposition. By the time Elisabeth was 7 years old, it was clear that SPD could not account for all of her learning and attention problems, and she was diagnosed with ADHD. She now takes medication and receives behavior modification strategies at her school, along with occupational therapy. But the two conditions need to be differentiated, because, again, ADD/ADHD medication and behavior modification will not fix SPD, even if the conditions coexist.
Elisabeth still sometimes yells when I wash her hair, but she doesn’t scream anymore. She fusses about waistbands and sock seams that aren’t exactly right, but says it’s OK, “I’ll get used to it.” Best of all, she is making her way in the world, has lots of good friends, and is thriving at school and at home.
More About Conditions Related to ADD/ADHD
Is It Anxiety or ADD/ADHD?
Is It Asperger's Syndrome or ADD/ADHD?
Is It Auditory Processing Disorder (APD) or ADD/ADHD?
Is It Autism or ADD/ADHD?
Is It Bipolar Disorder or ADD/ADHD?
Is It Depression or ADD/ADHD?
Is It Executive Function Disorder (EFD) or ADD/ADHD?
Is It a Learning Disability or Inattentive ADD/ADHD?
Is It OCD or ADD/ADHD?
Is It Oppositional Defiant Disorder (ODD) or ADD/ADHD?
This article comes from the June/July 2004 issue of ADDitude.