In Speech Therapy, Special Education

Case Study 1: It’s 7:00pm on a Thursday night. My family and I pile out of the car and walk toward a popular restaurant in town. We go in the doors and my husband puts in our name with the hostess. I see my son walk up and run his hands along every single knee of the people sitting in the waiting area. I watch him squeeze in between two benches to look out the window. I see him trip over someone’s foot and fall down, but gets back up without noticing his scraped knee. He stands on the bench next to me, ready to jump off. Our table is ready and I have to grab his hand to be sure he sees us leaving. Our time in the restaurant continues like this until we leave an hour later.

Case Study 2: It’s 4:30pm on a Wednesday afternoon. I sit at the table with my daughter; I’m working on my laptop while she finishes her homework. I notice that she is tapping her legs on the floor, then stands up, then sits on her knees, then taps her pencil, then rocking back and forth…she’s always fidgeting. Next she is staring out the window and jumping up and down. I kindly remind her to sit down so she can complete her assignment. This pattern continues for the next 45 minutes, until she has finally finished her 3 math problems.

Can you related to one of these stories? The first is an example of SPD (Sensory Processing Disorder) and the second of ADHD (Attention-Deficit Hyperactivity Disorder), which are difficult to differentiate. Although ADHD is an official and well-known diagnosis, SPD is not recognized with the Diagnostic Manual (DSM V) or the International Classification of Diseases (ICD-10), two common diagnostic manuals for mental health diagnoses. Both display similar symptoms and if your child has one of these diagnoses, there is a 40-60% chance that he/she will also have the other. But it’s important to separate the two since they each require a different path of treatment. So, what makes them similar and what distinguishes each from the other?

 

The Basics of SPD

SPD can be described as inappropriate reactions to sensory stimuli, and may be divided into three categories.

  • Sensory-Over- Responsivity (SOR) promotes lengthy, exaggerated, and too intense reactions. For example, the loud cheering of student’s at a school assembly causes Jason to cover his ears and yell.
  • Sensory-Under-Responsivity (SUR) leads to under-responsiveness or complete unawareness of sensory stimuli. For example, Sally often seems to be “in her own world” and often doesn’t hear instructions directed towards her.
  • Sensory-Seeking/Craving (SS/C) children desire sensory input. For example, Max likes to jump off of tall things onto the ground or asks mom for a big hug because he wants to feel deep pressure.

These outbursts or lack of reactions impair the child’s ability to engage in typical activities like school, recreational sports, or play. Many children with SPD seek certain types of input while avoiding others, and have a difficult time adapting to changes or new routines. Sometimes inattention or concentration on the task at hand are symptoms, but typically go away once the child engages in a healthy sensory diet. Over 30% of those diagnosed with a developmental disability have sensory symptoms, and it is estimated that 5-16% of the normal population also experience sensory symptoms.

 

The Basics of ADHD

Inattention, impusivity, and hyperactivity are the three most common characteristics of ADHD. Similar to SPD, there are three categories of ADHD:

  • Predominantly inattentive is when one has an impairment in focusing, sustaining and switching attention.
  • Predominantly hyperactive and impulsive, where one is excessively active and has difficulty controlling responses.
  • Combined inattentive and hyperactive/impulsive is a combination of both previously listed types.

Developmentally inappropriate behaviors impair learning, socializing, working, and playing across all environments, and are not resolved by modifying the environment like in SPD. A common struggle for a student with ADHD is that completing a basic homework assignment requires a high amount of effort and much additional time.

Sensory problems are also more common for kids with ADHD, which has been shown to lead to higher rates of aggression and delinquency. But, early detection and management of ADHD sensory problems can lead to better cognitive skills and academic levels as time progresses.

Similarities

Both SPD and ADHD have a list of overlapping symptoms, including but not limited to: inattention, easily distracted, difficulty sitting still, forgetful, impulsive, or has trouble completing daily tasks. Often both diagnoses make it hard for the child to follow directions, control emotions and engage in social activities. Aggression or tantrums are also characteristic; although most children have outbursts, these are inappropriate for one’s age and more extreme than normal. This makes it understandable, yet inexcusable, that diagnoses are confused.

 

Differences

A noteable difference between these two diagnoses is the person’s reactions to situations. Often a child with SPD will overreact or under-react to an extreme degree, struggle to adapt to the unexpected, and may be viewed as more anxious or withdrawn. A child with ADHD is more likely to be inattentive or un-phased by change, and more likely to have trouble concentrating on tasks.

The cause of both SPD and ADHD are unknown, but research suggests that each are best treated with different forms of treatment. SPD responds best to a “sensory diet,” activities that allow them to recognize their fears and overcome them in a safe environment, gradually handling different textures and forms of play. It is not treatable by medicine, but ADHD is best treated with medicine, which is thought to target a chemical imbalance of the brain.

Conclusion

The concurrence of symptoms between these two diagnoses makes it understandable why so many confuse the two. Study your child’s behavior and reactions to different sensory stimuli and among all environments. Note his/her reactions to smells, textures, sounds, and visual stimuli. Watch for where and when inattention or hyperactivity occur. Consider how your child finishes school assignments or interacts with his/her peers. Maybe your child is simply overloaded with stimulation in that moment and place. Consult with your pediatrician to discuss your observations and pathways of treatments. Remember, you child may have either SPD or ADHD, both SPD and ADHD, or neither, and it’s best to be officially tested by a qualified occupational therapist with specific training in sensory integration.

 

Has your child been diagnosed with ADHD, SPD, or both? Share with us what the diagnosis process was like. What symptoms or triggers alerted you to the need for an assessment? What signs made it easy or difficult to distinguish between the two diagnoses? Did your child receive one diagnosis, only to later be redefined as the other? Also add in any other comorbidities your child has so our other readers can relate to your story.

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