The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder
As human beings, we rely on the fact that our body is able to accurately perceive the world around it. Every decision we make, whether it be that our coffee is too hot to drink or that it is safe for us to drive through an intersection or that we need to shift our fingers slightly to accurately tie our shoelaces is based on sensory information that our body receives from the world and sends to our brain.
But what if this ability to perceive the world, in all of its dimensions, was impaired? What if we were unable to trust our senses, because the information our brain received from the world was not strictly accurate? These are questions explored in Carol Stock Kranowitz’s The Out-of-Sync Child, which explores Sensory Processing Disorder and the vast challenges experienced by individuals whose bodies are unable to accurately interpret (and thus interact) with the world.
Prior to reading this book, I had very little knowledge about Sensory Processing Disorder (SPD). Through my work with individuals on with Autism Spectrum Disorder (ASD), I knew that many of my clients had difficulty integrating certain sensory stimuli and at times required specific kinds of sensory input. But I had no idea of the vast complexities and nuances of sensory integration, let alone that there was a diagnosable disorder related to these sensory needs. Fortunately, The Out-of-Sync Child proved to be an excellent source of instruction relating to all the questions I did not even know I had.
To begin, it must be stated that Sensory Processing Disorder covers a wide spectrum of sensory challenges, and that while it is diagnosable, treatment for this disorder is not covered by medical insurance plans. The disorder itself is a neurologic disability that causes one’s nervous system to fail to interpret and act upon the various sensory stimuli that are encountered by human beings in everyday life. Within this framework, there are multiple different components that can affect individuals with SPD. Kranowitz explains that there are three primary categories within the SPD diagnosis: Sensory Modulation Problems (how an individual responds to sensory information they are receiving), Sensory Discrimination Problems (whether or not an individual can differentiate between different types of sensory information), and Sensory-Based Motor Problems (difficulties in perceiving one’s body’s positioning in space and executing actions based on this perception). Within these categories are even more categories as pertains to the senses themselves: the tactile sense (feeling), auditory (hearing), visual (seeing), proprioceptive (body position), and vestibular (balance).
Despite the potentially overwhelming nature of such a plethora of information, Kranowitz does an excellent job of presenting the different aspects of SPD in an organized, accessible format. She begins by introducing and defining SPD, listing typical symptoms displayed by those with this diagnosis, and describing different areas of life that can impact or can be impacted by the challenges SPD brings (think school, sleep, or even eating). She then devotes one chapter to each of the five senses listed above, detailing the appropriate functioning of each of the senses and how this functioning may look different for individuals with SPD, specific challenges these individuals may have due to these dysfunctions, and providing common traits of these different dysfunctions for parental reference. Kranowitz spends the last third of the book emphasizing the importance of early intervention and diagnosis, providing recommendations for sensory adaptations at home and at school, and providing a scientific overview of the neurologic components of sensory processing.
One component of this book worth mentioning is the Appendix B, in which Kranowitz reviews Dr. Jane Ayres’s Four Levels of sensory integration. According to Dr. Ayres, the development of a functional sensory system that primes a child for the highest level of success begins with the development of the tactile, proprioceptive, and vestibular systems. These systems provide the foundation for the child to explore and interact with his/her environment, and to know how to safely, accurately, and appropriately respond. Only once this basic system is established and solidified can the child progress to developing sensory motor skills (level two), perceptual-motor skills (level three), and academic readiness (level four). In other words, a child (and any individuals) needs to feel secure in knowing that the sensory information he/she is receiving is accurate before progressing to higher levels of functioning. It therefore goes to say that a child who struggles to integrate sensory information at a basic level may not have the sensory resources they need to be confident and secure in other aspects of life. As a therapist (and any adult working with children with sensory integration problems), this hierarchy is especially important to note, as I am frequently asking my clients to complete tasks that will further their sensory-motor, perceptual-motor, and academic skills. Yet if my clients do not feel safe or secure due to a lack of sensory integration, it is my priority to make sure they feel grounded in their environment before we begin to address any of their other goals. To do otherwise would be both frustrating for the client and counterproductive for both of us.
As I mentioned previously, most of the clients I work with have been diagnosed with ASD, and to the best of my knowledge, none of them have been diagnosed with SPD. Yet it is fascinating to me how exactly some of my clients’ symptoms match the descriptions of SPD presented in this book. Particularly when reading Kranowitz’s list of symptoms for the various categories of SPD (Sensory Modulation Problems, Sensory Discrimination Problems, and Sensory-Based Motor Problems), I felt as if I were reading detailed accounts of some of my clients’ symptoms and behaviors. Many of them do struggle to integrate visual and auditory stimuli without becoming deregulated, and many of them also struggle to control their physical movements due to a lack of sensory input regarding their body’s positions in space. These observations lead me to wonder if SPD and ASD are more closely related than has been previously discussed. Certainly there is supportive literature that indicates that many individuals with ASD struggle with sensory integration. But the amount of correlation between symptoms of these two diagnoses for at least some of my clients makes me want to explore research as to how the diagnoses relate, and the exact nature of that relationship
Overall, I thoroughly enjoyed the accessible, anecdotal nature of The Out-of-Sync Child. Kranowitz is a gifted writer who manages to keep her readers engaged while explaining difficult, broad concepts. As a resource for parents, teachers, and therapists working with children and individuals with Sensory Processing Disorder, I believe that this book provides a good foundation for diagnosis, treatment, and understanding. However, I personally would have found it more meaningful if the book included testimonials from individuals with SPD. I know from both research and personal experience how powerful it can be to hear about a disorder from individuals diagnosed with that particular disorder, and how important it is to include the voices of those with the diagnosis in the discussion of the diagnosis itself. Perhaps in future editions Kranowitz can include such testimonials to provide a more expansive, comprehensive picture of Sensory Processing Disorder and all of its nuances. With that being said, if you are unfamiliar with SPD and want to learn more, this book is a good place to start.
Citation: Kranowitz, C.S. (2005). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder. New York, NY. The Penguin Group.