Is It SPD or ADHD?
ADHD... Is it? Or isn't it?
Let's talk about differing schools of thought in regard to ADHD and SPD. The books written and available on this subject are growing as fast as the clinical studies and research. We have, at this moment in time, very strong and varying opinions. Continued research will continue to enlighten us.
In the meantime, my own perspective, as the International Administrator of SPD Parent S.H.A.R.E. (currently SPD Support, which is in frequent consultation with researchers and authors in our SPD field) is primarily from the viewpoint of neurological and regulatory processing. The recently defined types and subtypes of SPD, which I will post below, and how processing is observed, defined and treated within the frame of co-occurring disorders.
The question of which is it? ADD/ADHD or SPD? We are asked frequently, and previously well established thoughts are being reconsidered. The DSM IV lists the diagnostic criteria very specifically, and it contains symptoms and behaviors that are commonly associated with - SPD. We are now seeing different opinions depending on who you talk to.
I am offering my own opinion. At SPD International, our focus is on providing hope, help and information about treatment options to those who believe they or someone they know may have Sensory Processing Disorder, or any co-occurring disorder that has inherent sensory processing or regulation type deficits.
Previously, (and by this I mean only a couple years ago!) the opinion presented to me through researchers, doctors and other professionals in the world on SPD was this:
When parents and adults ask: "How do we know if it's ADHD or SPD?" We tell them:
If the child or the adult does soothing or stimulating activities that should be calming, and no matter what, they can't calm down...if provided with deep pressure, and heavy muscle movement, and they still can't slow down. If they simply can't focus and pay attention (with the exception of hyperfocus) - No Matter What You Do - it's probably ADHD.
This informal school of thought was that sensory activities will not calm a child or adult who is ADHD. This was how we differentiated between the two, in an unprofessional way. The way a family can tell what's happening and possibly be alerted to seek further diagnostic help. Not the DSM IV criteria, or diagnostic procedures performed by a professional, but parents and adults who were questioning.
Dr. Lucy Jane Miller, in her recent (Putnam, 2006) book "Sensational Kids : Hope and Help for Children with Sensory Processing Disorder", outlines very clearly, according to her research, what she believes are ADHD symptoms and what are SPD symptoms. Which behaviors and symptoms stand alone, and how they can overlap.
Dr. Miller wrote:
"Defining the difference between ADHD and SPD:
- 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.
- Has difficulty waiting or taking turns.
- Waits or takes turns better with cognitive rather than sensory input.
- Tends to talk all the time, impulsively interrupting, has trouble waiting for turn in any conversation."
Meanwhile, a leading OT who is also a published SPD researcher reported to me: "I am seeing significant improvements in diagnosed, medicated ADHD kids, using Sensory Integrative Therapy only. They are calmer, more focused and attentive, and we are going to do a study on these kids to find out just how much they are improving!"
And she and a couple other fine researchers did just that. They did two groups, starting with the SIPT test (Sensory Integration and Praxis Test) treating a little over half the kids for six months, then retesting. A majority of these kids did indeed respond to treatment and some were able to go completely off medications. These children did respond, neurological changes did appear to occur and they did show improvements per parent report and clinic testing.
Here is an article on that study:
ADHD Improves with Sensory Integrative Treatment Study (PDF format - 18.5KB)
In the control group of kids (pre- and post tested, but untreated), the results showed most stayed the same or declined more during the six months they were untreated, even though they were on medications. So this changed, and opened a new door of possibility for how I perceive ADHD. The bottom line for me now, is that Sensory Integrative Occupational Therapy that helps SPD may also help with the treatment and potential to improve behaviors and symptoms commonly associated with ADHD.
Regardless of the diagnosis - Is it SPD or ADHD? Many of us now recommend Sensory Integrative OT therapy, as one treatment option that research shows may be effective. Are there other possible and credible forms of treatment? Of course! Medications, diet, nutritional supplements, chiropractic care, cranio sacral therapy and a wide array of products in use today including: Interactive Metronome, Neurobiofeedback, NeuroKinesiology, Listening Therapy, and more. All of which could potentially help both the ADHD and the SPD child. With so many companion programs available today, that were not available just a few years ago, we may actually address and improve, remarkably in some cases, the neurological processing, possibly rendering medications as unnecessary.
Other opinions
Two prominent neurologists, Drs. Eides, who wrote the "The Mislabeled Child": (mislabeledchild.com) believe ADHD may in some cases be misdiagnosed. In their book, they discuss Sensory Integrative Occupoational Therapy as one treatment option to consider.
And in the book: " Fidget to Focus - Outwit Your Boredom: Sensory Strategies for Living with ADD" by Roland Rotz, Ph.D., and Sarah D. Wright, M.S. A.C.T. (www.fidgettofocus.com) present ADD as a regulation disorder and discuss sensory integrative techniques as a means to improve the condition or reported symptoms of ADD/HD.
These books, studies and research give parents, doctors and therapists another treatment option to consider, and judge the potential value thereof. Whether or not a child or an adult has been diagnosed as ADD/HD or SPD or both, a potentially effective course of treatment, barring any other complications or co-occurring disorders, may be Sensory Integrative OT therapy.
A family may choose, or a doctor may recommend therapy for the different sensory issues, and wait to see what behaviors/symptoms are left, that did not improve in therapy. We now may have the choices available with children and adults to treat it with SI OT therapy, check for any underlying issues, allergies, food intolerance, etc. and abstain on the medications to wait and see what issues and symptoms are left, before the decision to medicate.
In some cases, symptoms are severe, life is intolerable, education is challenged, or therapy cannot be effective if the child or adult cannot attend or participate, and may need the medications. There are or can be co-occuring disorders and other variables that would make medication absolutely necessary to treat the child or adult in an OT clinic setting. I think there is no one right answer, when so many possibilities exist and we need professional help to determine all the conditions that may co-existent. If so, the patient can be reevaluated after six months of therapy, and every six months there after to see if the patient needs medication anymore. They may not. And some may.
Regarding the types and sub-types of Sensory Processing Disorder. To understand why and how we see SPD as the umbrella under which all processing/regulation disorders occur, look at the new, proposed diagnostic categories:
"Sensory Processing Disorder recognized by the Interdisciplinary Council on Developmental and Learning Disorders."
Sensory Processing Disorder is now recognized in one diagnostic taxonomy - the new Diagnostic Manual of the Interdisciplinary Council on Developmental and Learning Disorders (ICDL). Dr. Stanley I. Greenspan is Chair of ICDL. The formal diagnostic category is "Regulatory /Sensory Processing Disorder," (code #200).
Sensory Processing Disorder
is a broad spectrum of processing disorders that fall under the heading of SPD.
The Sub-Types
Sensory Modulation Disorder (SMD):
- Sensory Over-Responsivity
- Sensory Under-Responsivity
- Sensory Seeking/Craving
Sensory Based Motor Disorder (SBMD):
- Dyspraxia
- Postural Disorder
Sensory Discrimination Disorder (SDD):
Includes, but is not limited to:
- Visual Processing
- Auditory Processing
- Tactile processing
- Oral/Olfactory Processing
- Position/Movement
Also noted in some scientific circles are probable subtypes under this:
- Dyslexia - Language Processing
- Dysgraphia - Handwriting
- Dyscalculia - Math
My goal, as International Administrator of SPD International and Parent S.H.A.R.E., is to promote recovery, in as much as possible, of inefficient processing and regulation. And to make available information on all the options for treatment, to discuss, analyze and report on what is or is not working for children and adults.
This is why we...the Hosts of SPD Parent S.H.A.R.E., recognize processing/regulatory deficits in whatever disorder they may co-exist. In other words, simply put: Treat the processing, you are treating the disorder. Improve the processing, you are in effect improving the severity of the underlying disorder, to various degrees, per patient.
Some see improvements with Sensory Integrative OT therapy and say..."Maybe this patient never actually had ADD or ADHD." Maybe so, maybe no. I certainly would have no way of knowing. But they were either suspected according to DSM IV criteria, or diagnosed and medicated as such. And these suspected and/or diagnosed and medicated patients may possibly, and have the potential to...show improvement of neurological processing through this type of therapeutic approach. It is definitely worth much more discussion and consideration, I believe.