Ph.D. 4 Kids!

Sensory Integration and ADHD

Most, ballpark, 90% of the kids I see, including my own children and myself, have what I call sensory issues. Sensory Integration Deficit almost made it into the psychology “bible” last time it was updated. Keyword: almost. It’s really a shame that it did not. I believe it did not because most of the people making those decisions are academics and aren’t in the trenches seeing kids.

Kids with sensory issues are usually pretty to extremely intuitive. I would not have called my daughter intuitive when she was young, but starting in middle school or adolescence, I would call her pretty intuitive. Interestingly, her focus issues didn’t bother her until then either, even though she had all kinds of “soft signs” of ADD when she was little. Soft signs of ADHD are anecdotal things that are often present when a diagnosis of ADHD is made. Sensory issues are soft signs of ADHD, so is a history of many ear infections, sloppy handwriting, clumsiness, chewing on clothing, as are high video game use and/or television viewing.

Cutting out all the tags from your clothes, having to have the seam line across the toe of your sock just right, bed sheets having to be or feel just right, are common tactile sensory issues. High or low pain tolerance is another sensory issue. These are the kids that always have a stomach ache, head ache, or any other kind of ache and they usually think that they are dying of some terrible disease they have researched online. Light and sound sensitivity are also common. I have bionic hearing. Loud music has always bothered me. I had one boy who covered his ears when we popped the popper on the Trouble game! Public toilet flushes are also common for younger children who are high sensory to avoid. Oral sensitivity is also common. Picky eaters or kids who put everything into their mouth even when it is not age appropriate are usually high sensory in other ways, like the ones listed above, too.

I think of people who are high sensory as two types of people and the world is sandpaper. One type avoids the sandpaper at all costs. The other throws themselves against the sandpaper and rubs! Sensory issues are also almost always present in Autistic Spectrum Disorders. They are usually more extreme. In my opinion, sensory issues, especially in kids, are often misdiagnosed as Obsessive Compulsive Disorder.

Another really controversial opinion I have developed after seeing hundreds of kids is that I believe if mishandled or unrecognized, sensory issues have a great potential to become Obsessive Compulsive Disorder (OCD). When high intelligence combines with sensory issues, a highly intuitive kid, and the ability to hyper-focus associated with ADHD, it produces a perfect storm for OCD. This type of kid also tends to be a bit high maintenance. Suddenly, they won’t do something, like spend the night at a friend’s house, that they were doing days or weeks ago. They often can’t tell you why and they are often between the ages of 9 and 12-years-old. Younger children who have difficulty with change and transition also may fit this pattern.

The only explanation I have been able to come up with is that it is because of their developmental stage. They are starting the rumblings of abstract reasoning that officially begins in adolescence. They start to “what if” at a higher level combined with bionic hearing and the ability intuition gives them to check out an environment just by how it “feels.” An example would be a 9-year-old, highly intelligent, boy spending the night at a friend’s house for the 50th time and he hears a noise from the air duct system. He immediately begins thinking, “What if that is someone trying to break in and my parents aren’t here?” Then it all gets wrapped up with anxiety and a lot of hyper-focus and he ends up with anxiety problems.

Looking at this type of kid through not only an ADHD “lens” but adding a sensory “filter” to the lens is the key to successfully parenting a child with this temperament. An example would be a 5-year-old boy screaming in the doctor’s office for 45 minutes because he won’t get dressed. The boy is then offered to go to the office next door to get a special prize that he likes. The prize overpowers the issue he is having because he suddenly stops crying and says, “I need to wipe my nose before I can put my shirt on or it will get on my shirt and make it wet.” He accepts help getting dressed and runs happily to the office next door to get his prize!

What makes it appear as if he was faking discomfort is actually the key to parenting this type of kid. If you can offer something that is more motivating than the sensory discomfort itself, then this kind of kid can move on through the sensory issue they are having at the moment. Especially little kids don’t even know why they are uncomfortable. It’s the way they have always been so they don’t know that being wet sets them off. If my description fits your child, and they are under the age of 10, most likely you are working with sensory issues, possibly ADHD, but not OCD. If you are not sure, consult your pediatrician or a behavioral health professional.

A quick way to test would be to check for ANYTHING that could be hanging them up from a sensory processing perspective. If he won’t get dressed. It might be the cloths are too tight, long, itchy, etcetera. If he won’t eat, it may be the texture. If he won’t pick a toy, he might have trouble visually when there are too many choices. If he won’t go to the bathroom in a public restroom, it may be because it is so loud to him. View the behavior through a sensory lens.

One last anecdote about my own son. When he was about 15-months-old, his dad brought him a foam airplane stress ball that had been handed out on one of his trips. It had black wheels painted on the bottom. When he gave it to my son he started screaming! When we put it away, he was fine. Months later he walked over to where I had put the plane, and he took it out and pulled the black wheels off. He carried it around for the next couple of days!

I finally understood what was happening when we got him his first kite around the same time. He loved it when it was on the ground, but the minute it went up into the air, he started screaming and was scared to death. He was such a high sensory kid that when something looked like it was suddenly alive, it scared him. The wheels on the plane had scared him because they had looked like eyes!

Thankfully, I figured it out. Otherwise, he would have appeared to have major anxiety issues at the age of two! Ironically, when you have a major reaction like I have described the best way to handle it is to continue to expose them to what they are reacting to in a sensory way. It is called a sensory diet and if you have a child with this temperament, I highly recommend you research the whole sensory processing area of study and ideas.

There are local organizations and books that will offer support and ideas. A solutions-based book I like is The Out-Of-Sync Child Has Fun. I don’t love the title, but there are activities you can use, broken down by each of the senses, that help kids to slowly get used to what makes them uncomfortable. Some kids need an Occupational Therapist to help and they often use a great curriculum called Superflex. Superflex teaches kids about sensory issues as superpowers!