Some children have atypical reactivity, either hypo- or hyper-reactivity (over or under responsivity), to a single or combination of tactile, auditory, visual, vestibular, olfactory, and gustatory stimulation, a condition known as sensory processing disorder (SPD) or sensory integration disorder. Children with this disorder have difficulty responding appropriately to external stimuli, which can lead to problems such as anxiety, challenging behaviors, attention difficulties, feeding problems, and poor academic performance. Although SPD is not specified in the DSM-5 or the ICD-10, it is listed in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R).

• SPD is more common in boys, more common in children who were born preterm, have ADHD or autism, and/or Developmental Coordination Disorder. SPD is thought to occur in 5-16% of children. [Gouze: 2009]
• Suspect SPD when a child is hyper-sensitive to some stimuli and/or hypo-responsive to other stimuli. This may appear as seeking or avoiding stimuli.

Essential features of SPD include atypical responses to typical stimuli, including sounds, touch, movement/body awareness, taste/smells, and sights. The child should not have severe delay or show significant abnormalities on neurologic exam; these are flags for different disorders. Ideally, the medical home should consult with a multidisciplinary team including developmental pediatrics and occupational therapy trained in standardized tools to assess children if SPD is suspected.

Children with SPD should be referred to occupational therapy to help organize their environment at both home and school to minimize disruption as well as for sensory integration therapy. Behavioral therapy may be needed for secondary problems such as difficult behaviors and/or anxiety.

• Identify concern and consider an occupational therapy assessment for the treatment of sensory processing disorder.
• Explain to child/family the nature of the condition.
• Consider developmental pediatrics consultation.
• Ensure parents know how to access services needed via school system (e.g., OT consultative input if needed).
• Seek associated problems such as autism, ADHD, anxiety and manage as needed.