Defining the Six Subtypes of SPD

Defining the Six Subtypes of SPD



subtypes of spdA leader in the field of all things sensory, Dr. Lucy J. Miller of the STAR Center – Sensory Therapies and Research, poses that there are six subtypes of SPD.  SPD is an acronym for Sensory Processing Disorder.

There are eight sensory systems – visual, auditory, tactile, taste, olfactory, proprioception, vestibular and interoception.  There are many subtypes of SPD.  How can we determine what areas a child is having difficulty with and how to treat it?

Subtypes of SPD

Let’s look at the following subtypes of SPD.

Sensory Modulation Disorder 

a. Sensory Over-Responsivity (SOR)
b. Sensory Under-Responsivity (SUR)
c. Sensory Craving (SC)

Sensory Based Motor Disorder 

a. Postural Disorder
b. Dyspraxia

Sensory Discrimination Disorder 

a. Visual
b. Auditory
c. Tactile
d. Taste/smell
e. Position/movement
f. Interoception

Let’s explore the first category of subtypes of SPD – Sensory Modulation Disorder. As previously mentioned, sensory modulation includes over and under responsivity, as well as, the sensory craver.

Over-Responsivity 

If a child is Sensory Over-Responsive, their bodies feel things too quick – too fast.  Their system can go into fight, flight or freeze mode.

Some children may fear movement, unexpected noises, tactile input, and new or unfamiliar tastes or smells. These children tend to look like they are in an anxious state a lot of the time, especially when they are introduced to something that makes them uncomfortable.

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Under-Responsivity 

Sensory Under-Responsive children are slow to move.  They are the the “couch potato” kiddo who is difficult to motivate.

These children may choose sedentary activities over movement activities most or all of the time. These children may appear withdrawn or self-absorbed. They may show signs of weak muscles, slumping in their chair or having to lean on things to stand.

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Sensory Cravers 

If a child is a Sensory Craver, they actually “crave” sensory input to their bodies almost like an addiction. These children seem to constantly need deep pressure input.  You will find them consistently touching others or moving and crashing into things all the time.

You might see a kiddo who gives hard high fives, pets animals with too much force, or always wants you to hug them really tight.  They may have liked being swaddled tight as an infant.

These children may also push down so hard when coloring they break their crayons or tear the paper. They may not be able to sit still at school or slow their bodies down enough to control their impulses.

Postural Disorders & Dyspraxia 

Moving into the second category of subtypes of SPD, we discuss Postural Disorders and Dyspraxia.

Children who demonstrate decreased postural control can be clumsy, uncoordinated, have poor posture and have trouble maintaining a sitting position.

Children with Dyspraxia can have difficulty with coming up with new play ideas, sequencing a task, or motor planning how their body needs to carry out that new motor task.

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Sensory Discrimination Disorder 

The third category in the subtypes of SPD is Sensory Discrimination Disorder (SDD).  A child can demonstrate difficulties in any of the eight sensory systems mentioned above.

The child may not know how much force to use when trying to pick up something heavy.

He may not be able to discriminate the amount of pressure they use when writing or drawing.

You may see a child who has trouble judging how much force to use during motor tasks like kicking a ball, opening and closing doors.

SDD children can have difficulty discriminating between familiar sounds when reading and writing letters.

You also may experience a child who does not understand when they have to use the bathroom or know how to tell you they are hungry.

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Clinical Solutions 

When you notice a child having difficulties with any of the above listed sensory sub-types, they probably are having issues with multiple sensory systems.

Build the Relationship

As a clinician, you want to focus on following the child’s lead and building a relationship with them first.  As you gain their trust, you can slowly introduce them to more sensory stimuli through play activities. You never want to force a sensory activity on a child.

Proprioceptive Solutions 

If you are targeting the child’s proprioceptive system, you may want to combine specific play ideas to help activate several sensory systems at once.  For example, consider playing Fireman.

To play Fireman, create a swing obstacle course to get to the burning building.  Be sure to have a ladder the child must climb to rescue the victim inside the burning building. Weave in heavy work activities while setting up the game such as having the child carry the ladder or carry boxes to build the building.  Heavy work offers deep proprioceptive input that is organizing and regulating.

As the child is moving through the obstacle course, you may find the child becomes over-aroused and excited.  If this occurs, slow your body and voice down.  Create a scenario where the child has to stop and cognitively process how they are going to play out the next few steps of the activity.  This will help slow down their engines and their impulses.  This is also a great way to teach children impulse control too.

Solutions for Dyspraxia 

If a child has difficulties with Dyspraxia and completing new motor tasks, you can challenge the child to an imaginary game of “Hot Lava”.  In this game, the child can’t touch the hot lava on the ground as they cross over the jungle.  Have the child help you set up the obstacle course, otherwise known as the jungle.

Have them move through a tire, climb over a bolster, hop onto a swing and close the obstacle course with a big jump into a crash pad.   Remind the child that he is in a jungle and if he falls into the hot lava, he will have to start all over again.  You may need to physically support some children with some of the obstacles especially if they have poor body awareness.

The child with Dyspraxia may struggle with appropriately grading their movements.  The child may not know how hard or fast to move his body to get to the next obstacle in the jungle.

Parent Education

Occupational Therapists (OT) who have been trained in the focus of relationship/engagement based therapy place a high priority on parent education.  These OT’s can best differentiate between the six sensory sub-types and set up the most optimal therapeutic plan for the child and their family.

A high priority when working with any child with sensory isms is parent education! It is very important to train the parents and caregivers on how to carry out therapeutic interventions.  OT’s can teach families to  create a sensory lifestyle that can be weaved into the home, school and community.

It is most beneficial for occupational therapists to be able to work collaboratively with all the individuals involved in the child’s life.  These individuals include parents, teachers, assistants, all other therapists, doctors, nannies, grandparents, siblings.  The list can go on and on.

Occupational Therapists may only see a child one day a week.  Depending on the setting, some children may receive intensive therapy up to five times a week.  Whether the child is receiving intensive therapy 3-5 days a week or 30 minutes a month of consultation in the classroom, there should be open communication and dialog among all caregivers to ensure adequate follow through and support of the child with any subtype of SPD.