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Sensory processing disorder since 1994 is accepted in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R) and is not recognized as a mental disorder in medical manuals such as the ICD-10 or the DSM-5.
Diagnosis is primarily arrived at by the use of standardized tests, standardized questionnaires, expert observational scales, and free play observation at an occupational therapy gym. Observation of functional activities might be carried at school and home as well. Some scales that are not exclusively used in SPD evaluations are used to measure visual perception, function, neurology and motor skills.
Depending on the country, diagnosis is made by different professionals, such as occupational therapists, psychologists, learning specialists, physiotherapists and/or speech and language therapists. In some countries it is recommended to have a full psychological and neurological evaluation if symptoms are too severe.
It is estimated that up to 16.5% of elementary school aged children present elevated SOR behaviors in the tactile or auditory modalities. However, this figure might represent an underestimation of Sensory Over Responsivity prevalence, since this study did not include children with developmental disorders or those delivered preterm, who are more likely to present it.
This figure is, nonetheless, larger than what previous studies with smaller samples had shown: an estimate of 5–13% of elementary school aged children.
Incidence for the remaining subtypes is currently unknown.
1. SCAN is the most common tool for diagnosing APD, and it also standardized. It is composed for four subsets: discrimination of monaurally presented single words against background noise, acoustically degraded single words, dichotically presented single words, sentence stimuli. Different versions of the test are used depending on the age of the patient.
2. Random Gap Detection Test (RGDT) is also a standardized test. It assesses an individual’s gap detection threshold of tones and white noise. The exam includes stimuli at four different frequencies (500, 1000, 2000, and 4000 Hz) and white noise clicks of 50 ms duration. It is a useful test because it provides an index of auditory temporal resolution. In children, an overall gap detection threshold greater than 20 ms means they have failed.
3. Gaps in Noise Test (GIN) also measures temporal resolution by testing the patient's gap detection threshold in white noise.
4. Pitch Patterns Sequence Test (PPT) and Duration Patterns Sequence Test (DPT) measure auditory pattern identification. The PPS has s series of three tones presented at either of two pitches (high or low). Meanwhile, the DPS has a series of three tones that vary in duration rather than pitch (long or short). Patients are then asked to describe the pattern of pitches presented.
It has been discovered that APD and ADHD present overlapping symptoms. Below is a ranked order of behavioral symptoms that are most frequently observed in each disorder. Professionals evaluated the overlap of symptoms between the two disorders. The order below is of symptoms that are almost always observed. This chart proves that although the symptoms listed are different, it is easy to get confused between many of them.
There is a high rate of co-occurrence between AD/HD and CAPD. Research shows that 84% of children with APD have confirmed or suspected ADHD. Co-occurrence between ADHD and APD is 41% for children with confirmed diagnosis of ADHD, and 43% for children suspected of having ADHD.
Sensory dysfunction disorder is a reported neurological disorder of information processing, characterized by difficulty in understanding and responding appropriately to sensory inputs. Sensory dysfunction disorder is not recognized by the American Medical Association. "Sensory processing (SP) difficulties have been reported in as many as 95% of children with autism, however, empirical research examining the existence of specific patterns of SP difficulties within this population is scarce."
The brain receives messages from the body's sensory systems, which informs the brain of what is going on around and to a person's body. If one or more of these systems become overstimulated, it may result in what is known as Sensory Dysfunction Disorder. An example of a response to overstimulation is expressed by A. Jean Ayres, in "Sensory Integration and the Child: Understanding Hidden Sensory Challenges". She writes, "When the flow of sensations is disorganized, life can be like a rush-hour traffic jam” (p. 289). The following sensory systems are broken down into individual categories to better understand the impact a sensitivity can have on an individual.
Assessments for developmental coordination disorder typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate developmental coordination disorder, including balancing, physical sequencing, touch sensitivity, and variations on walking activities.
The American Psychiatric Association has four primary inclusive diagnostic criteria for determining if a child has developmental coordination disorder.
The criteria are as follows:
1. Motor Coordination will be greatly reduced, although the intelligence of the child is normal for the age.
2. The difficulties the child experiences with motor coordination or planning interfere with the child's daily life.
3. The difficulties with coordination are not due to any other medical condition
4. If the child does also experience comorbidities such as mental retardation; motor coordination is still disproportionally affected.
Screening tests which can be used to assess developmental coordination disorder include:-
- Movement Assessment Battery for Children (Movement-ABC – Movement-ABC 2)
- Peabody Developmental Motor Scales- Second Edition (PDMS-2)
- Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-BOT-2)
- Motoriktest für vier- bis sechsjährige Kinder (MOT 4-6)
- Körperkoordinationtest für Kinder (KTK)
- Test of Gross Motor Development, Second Edition (TGMD-2)
- Maastrichtse Motoriek Test (MMT)
- Wechsler Adult Intelligence Scale (WAIS-IV)
- Wechsler Individual Achievement Test (WAIT-II)
- Test of Word Reading Efficiency (TOWRE-2)
- Developmental Coordination Disorder Questionnaire (DCD-Q)
- Children's Self-Perceptions of Adequacy in, and Predilection for Physical Activity (CSAPPA)
Currently there is no single gold standard assessment test.
A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.
However, research in the "British Journal of Special Education" has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including developmental coordination disorder, dyslexia and deficits in attention, motor control and perception (DAMP). The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning difficulties in class if their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children with learning difficulties."
Diagnosing a patient can be difficult as they are often frustrated from ineffective therapy and being told they have mental illnesses. Some patients actually have trouble deciding whether they have a taste or smell problem. In this case asking questions about food choices will help determine whether a patient has a smell or taste disorder. It is important to identify whether the distortion applies to an inhaled odorant or if an odor exists without the stimulus. The distortion of an odorant is presented in two types: the stimuli are different from what one remembers and in the second, everything has a similar smell. A clinical history can also help determine what kind of disorder one has because events such as respiratory infection and head trauma are usually indications of parosmia where as phantosmias usually have no history of such events and occur spontaneously. Unfortunately there are no accurate diagnostic tests or methods for dysosmia. Evaluation must be done through questionnaires and medical history.
Developmental coordination disorder is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition.
Sensory aphasia cannot be diagnosed through the use of imaging techniques. Differences in cognition between asymptomatic subjects and affected patients can be observed via functional magnetic resonance imaging (fMRI). However, these results only reveal temporal differences in cognition between control and diagnosed subjects. The degree of progression during therapy can also be surveyed through cognition tests monitored by fMRI. Many patients’ progress is assessed over time via repeated testing and corresponding cerebral imaging by fMRI.
Tests of vestibular system (balance) function include electronystagmography (ENG), Videonystagmograph (VNG), rotation tests, Computerized Dynamic Posturography (CDP), and Caloric reflex test.
Tests of auditory system (hearing) function include pure-tone audiometry, speech audiometry, acoustic-reflex, electrocochleography (ECoG), otoacoustic emissions (OAE), and auditory brainstem response test (ABR; also known as BER, BSER, or BAER).
Other diagnostic tests include magnetic resonance imaging (MRI) and computerized axial tomography (CAT, or CT).
Sensory aphasia is typically diagnosed by non-invasive evaluations. Neurologists, neuropsychologists or speech pathologists will administer oral evaluations to determine the extent of a patient’s comprehension and speech capability. Initial assessment will determine if the cause of linguistic deficiency is aphasia. If the diagnosis is then confirmed, testing will next address the type of aphasia and its severity. The Boston Diagnostic Aphasia Examination specializes in determining the severity of a sensory aphasia through the observation of conversational behaviors. Several modalities of perception and response are observed in conjunction with the subject’s ability to process sensory information. The location of the brain lesion and type of the aphasia can then be inferred from the observed symptoms. The Minnesota Test for Differential Diagnosis is the most lengthy and thorough assessment of sensory aphasia. It pinpoints weaknesses in the auditory and visual senses, as well as reading comprehension. From this differential diagnosis, a patient’s course of treatment can be determined. After treatment planning, the Porch Index of Communicative Ability is used to evaluate prognosis and the degree of recovery.
There are ways that children with Sensory Dysfunction Disorder may still have fun. The book "The Out-of-Sync Child Has Fun Activities for Kids with Sensory Processing Disorder", written by Carol Stock Kranowitz, M.A., provides different activities for the various sensory systems. These activities can be tools to help strengthen these senses.
The difficulty of making the right vestibular diagnosis is reflected in the fact that in some populations, more than one third of the patients with a vestibular disease consult more than one physician – in some cases up to more than fifteen.
Diagnosis of a balance disorder is complicated because there are many kinds of balance disorders and because other medical conditions—including ear infections, blood pressure changes, and some vision problems—and some medications may contribute to a balance disorder. A person experiencing dizziness should see a physiotherapist or physician for an evaluation. A physician can assess for a medical disorder, such as a stroke or infection, if indicated. A physiotherapist can assess balance or a dizziness disorder and provide specific treatment.
The primary physician may request the opinion of an otolaryngologist to help evaluate a balance problem. An otolaryngologist is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck, sometimes with expertise in balance disorders. He or she will usually obtain a detailed medical history and perform a physical examination to start to sort out possible causes of the balance disorder. The physician may require tests and make additional referrals to assess the cause and extent of the disruption of balance. The kinds of tests needed will vary based on the patient's symptoms and health status. Because there are so many variables, not all patients will require every test.
Thompson and Nunn were the first to introduce diagnostic criteria for PRS in 1997. The current diagnostic criteria consists of:
- A) Partial or complete refusal in three or more of the following areas: (1) eating, (2) moving, (3) speech, (4) interest to personal care
- B) Active and angry resistance to acts of help and support
- C) Social withdrawal and school refusal
- D) No organic condition accounts for the severity of the degree of symptoms
- E) No other psychiatric disorder could better account for the symptoms
- F) The endangered state of the patient requires hospitalization
The frequency of phantosmia is rare in comparison with the frequency of parosmia. Parosmia has been estimated to be in 10-60% of patients with olfactory dysfunction and from studies, it has been shown that it can last anywhere from 3 months to 22 years. Smell and taste problems result in over 200,000 visits to physicians annually in the US. Lately, it has been thought that phantosmia might co-occur with Parkinson's disease. However, its potential to be a premotor biomarker for Parkinson's is still up for debate as not all patients with Parkinson's disease have olfactory disorders
As of 2014, no clinical trials had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people (two to twelve per report) with clomipramine, flunarizine, nifedipine, topiramate, carbamazepine, methylphenidate. Studies suggest that education and reassurance can reduce the frequency of EHS episodes. There is some evidence that individuals with EHS rarely report episodes to medical professionals.
There have not been sufficient studies conducted to make conclusive statements about prevalence nor who tends to suffer EHS. One study found that 13.5% of a sample of undergrads reported at least one episode over the course of their lives, with higher rates in those also suffering from sleep paralysis.
Sensory processing sensitivity (SPS), a personality trait, a high measure of which defines a highly sensitive person (HSP), has been described as having hypersensitivity to external stimuli, a greater depth of cognitive processing, and high emotional reactivity. The terms SPS and HSP were coined in the mid-1990s by psychologists Elaine Aron and husband Arthur Aron, with SPS being measured by Aron's Highly Sensitive Person Scale (HSPS) questionnaire. Other researchers have applied various other terms to denote this responsiveness to stimuli that is evidenced in humans and other species.
According to the Arons and colleagues, people with high SPS comprise about 15–20% of the population and are thought to process sensory data more deeply due to the nature of their central nervous system. Although many researchers consistently related high SPS to negative outcomes, Aron and colleagues state that high SPS is a personality trait and not a disorder; other researchers have associated it with increased responsiveness to both positive and negative influences.
Pervasive refusal syndrome is for the most part frequently seen in girls and less so in boys. The average age of onset is between the ages of 7 and 15. Affected children are usually high achievers with high self-expectations, fears of failure, and difficulty dealing with failure to achieve personal standards. The onset of PRS is usually acute.
To date, there is no successful method of treatment that "cures" musical hallucinations. There have been successful therapies in single cases that have ameliorated the hallucinations. Some of these successes include drugs such as neuroleptics, antidepressants, and certain anticonvulsive drugs. A musical hallucination was alleviated, for example, by antidepressant medications given to patients with depression. Sanchez reported that some authors have suggested that the use of hearing aids may improve musical hallucination symptoms. They believed that the external environment influences the auditory hallucinations, showing worsening of symptoms in quieter environments than in noisier ones. Oliver Sacks' patient, Mrs. O'C, reported being in an "ocean of sound" despite being in a quiet room due to a small thrombosis or infarction in her right temporal lobe. After treatment, Mrs. O'C was relinquished of her musical experience but said that, "I do miss the old songs. Now, with lots of them, I can't even recall them. It was like being given back a forgotten bit of my childhood again." Sacks also reported another elderly woman, Mrs. O'M, who had a mild case of deafness and reported hearing musical pieces. When she was treated with anticonvulsive medications, her musical hallucinations ceased but when asked if she missed them, she said "Not on your life."
Serotonin and norepinephrine reuptake inhibitor, venlafaxine, were given to case study KS four months after initial stroke that started symptoms of witzelsucht. Changes back to his original behavior were noticeable after daily dose of 37.5 mg of venlafaxine for two weeks. In subsequent two months, inappropriate jokes and hypersexual behavior were rarely noticed. Due to the rareness of this disorder, not much research into potential treatments has been conducted.
In 73 individual cases reviewed by Evers and Ellger, 57 patients heard tunes that were familiar, while 5 heard unfamiliar tunes. These tunes ranged from religious pieces to childhood favorites, and also included popular songs from the radio. Vocal and instrumental forms of classical music were also identified in some patients. Keshavan found that the consistent feature of musical hallucinations was that it represented a personal memory trace. Memory traces refer to anything that may seem familiar to the patient, which indicated why certain childhood or familiar songs were heard.
Elaine Aron's book "The Highly Sensitive Person" was published in 1996. In 1997 Elaine and Arthur Aron formally identified "sensory processing sensitivity" (SPS), the scientific term for highly sensitive or hypersensitivity, as the defining trait of highly sensitive persons (HSPs). By way of definition, Aron & Aron (1997) wrote that "sensory processing" here refers not to the sense organs as such, but to what occurs as sensory information is transmitted to or processed in the brain. They assert that the trait is not a disorder but an innate survival strategy that has both advantages and disadvantages.
Aron's professional journal articles and self-help publications have focused on distinguishing high SPS from socially behavior and disorders with which high SPS can be confused; overcoming the social unacceptability that can cause low self-esteem; and emphasizing the advantages of high SPS to balance the disadvantages emphasized by others.
In 2015 Elizabeth Bernstein wrote in "The Wall Street Journal" that HSPs were "having a moment," noting that several hundred research studies had been conducted on topics related to HSPs' high sensitivity, and that a First International Scientific Conference on High Sensitivity or Sensory Processing Sensitivity had been held at the Vrije Universiteit Brussel. By 2015, more than a million copies of "The Highly Sensitive Person" had been sold.
Loss of language and skills related to social interaction and self-care are serious. The affected children face ongoing disabilities in certain areas and require long term care. Treatment of CDD involves both behavior therapy, environmental therapy and medications.
- Behavior therapy: The main aim of Applied Behavior Analysis (ABA) is to systematically teach the child to relearn language, self-care and social skills. The treatment programs designed in this respect "use a system of rewards to reinforce desirable behaviors and discourage problem behavior." ABA programs may be designed by a board-certified specialist in behavior analysis called a "BCBA" (Board Certified Behavior Analyst), but ABA is also widely used by a number of other health care personnel from different fields like psychologists, speech therapists, physical therapists and occupational therapists with differing levels of expertise. Parents, teachers and caregivers are instructed to use these behavior therapy methods at all times.
- Environmental Therapy: Sensory Enrichment Therapy uses enrichment of the sensory experience to improve symptoms in autism, many of which are common to CDD.
- Medications: There are no medications available to directly treat CDD. Antipsychotic medications are used to treat severe behavior problems like aggressive stance and repetitive behavior patterns. Anticonvulsant medications are used to control seizures.
Witzelsucht (from the German "witzeln", meaning to joke or wisecrack, and "sucht", meaning addiction or yearning) is a set of rare neurological symptoms characterized by a tendency to make puns, or tell inappropriate jokes or pointless stories in socially inappropriate situations. A less common symptom is hypersexuality, the tendency to make sexual comments at inappropriate times or situations. Patients do not understand that their behavior is abnormal, therefore are nonresponsive to others' reactions. This disorder is most commonly seen in patients with frontal lobe damage, particularly right frontal lobe tumors or trauma. The disorder remains named in accordance with its reviewed definition by German neurologist Hermann Oppenheim; its first description as the less focused "Moria" ("stupidity"), by German neurologist Moritz Jastrowitz, was in 1888.
Due to similarity of symptoms of the disorder to the mannerisms of Batman's arch-rival Joker, it is sometimes known as 'The Joker Syndrome'