Paeds · growth-development-and-behaviour
Sensory processing differences
Also known as Sensory processing disorder · Sensory integration difficulties · Sensory over-responsivity · Sensory under-responsivity · Sensory seeking · Tactile defensiveness
Fellowship-level approach to sensory processing differences in children: dimensional features, classification, medical mimics, functional assessment, environmental supports, occupational therapy evidence and controversies, comorbidity, and ethics of care when tactile defensiveness collides with indicated treatment.
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Red flags
- Using tactile defensiveness to refuse indicated life-sustaining or urgent medical care
- Missing hearing or vision impairment framed as 'just sensory'
- New pain, limp, fever or neurological change attributed only to sensory behaviour
- Severe self-injury or aggression without a safety plan
- Diagnostic overshadowing of autism, ADHD, anxiety or medical disease
- Expensive unproven 'cures' delaying school supports and basic environmental changes
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Overview & Definition
Parents often say: “He melts down at the supermarket,” “She screams when we wash her hair,” or “He only eats three foods.” Those stories may point to sensory processing differences — ways of responding to sound, touch, movement, taste, smell, vision or interoception that make everyday life harder. Your job is not to argue about a perfect label. Your job is to protect function, exclude disease, and build a plan the family can use tomorrow. [1] [8]
Sensory processing is how the nervous system receives, organises and responds to sensory information. When that process is inefficient or atypical for the child’s developmental stage, behaviour and learning can suffer. Miller and colleagues proposed a nosology that separates sensory modulation problems, sensory discrimination problems and sensory-based motor problems (praxis). You do not need every subtype name in clinic. You do need a clear picture of what happens, in which context, and what it costs the child and family. [1]
“Sensory processing disorder” (SPD) is a contested stand-alone diagnosis. It is widely used in occupational therapy and community language. It is not a clean universal DSM-5-TR category that every paediatrician should write as a final diagnosis in isolation. Safer fellowship language is sensory features / sensory processing differences, especially when autism, ADHD, anxiety or developmental disability is also present. [1] [3]
References16ShowHide
- [1]Miller LJ, Anzalone ME, Lane SJ, et al. Concept evolution in sensory integration: a proposed nosology for diagnosis The American journal of occupational therapy, 2007.PMID 17436834
- [2]Ben-Sasson A, Hen L, Fluss R, et al. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders Journal of autism and developmental disorders, 2009.PMID 18512135
- [3]Ben-Sasson A, Gal E, Fluss R, et al. Update of a Meta-analysis of Sensory Symptoms in ASD: A New Decade of Research Journal of autism and developmental disorders, 2019.PMID 31501953
- [4]Case-Smith J, Weaver LL, Fristad MA A systematic review of sensory processing interventions for children with autism spectrum disorders Autism, 2015.PMID 24477447
- [5]Pfeiffer BA, Koenig K, Kinnealey M, et al. Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study The American journal of occupational therapy, 2011.PMID 21309374
- [6]Clark GF, Watling R, Parham LD, et al. Occupational Therapy Interventions for Children and Youth With Challenges in Sensory Integration and Sensory Processing: A School-Based Practice Case Example The American journal of occupational therapy, 2019.PMID 31120849
- [7]Kuhaneck HM, Watling R, Glennon TJ Ayres Sensory Integration® for Addressing Play in Autistic Children: A Multiple-Baseline Examination The American journal of occupational therapy, 2023.PMID 37083975
- [8]Schoen SA, Miller LJ, Mulligan S Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure The American journal of occupational therapy, 2021.PMID 33657351
- [9]Kirby AV, Williams KL, Watson LR, et al. Sensory Features and Family Functioning in Families of Children With Autism and Developmental Disabilities: Longitudinal Associations The American journal of occupational therapy, 2019.PMID 30915965
- [10]Wolfe ID, Brunnquell D, Sorensen R, et al. Should Tactile Defensiveness Exclude a Life-Sustaining Intervention in an Adolescent With Autism? Pediatrics, 2022.PMID 35229117
- [11]Schaaf RC, Ridgway EM, Jones EA, et al. A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children Autism research, 2025.PMID 40815044
- [12]Schiano NR, Sivori TT, Dumont RL, et al. A Feasibility Trial of a Telehealth-Adapted Ayres Sensory Integration® Intervention for Autistic Children The American journal of occupational therapy, 2026.PMID 41910582
- [13]Cakar ME, Okada NJ, Cummings KK, et al. Functional connectivity of the sensorimotor cerebellum in autism: associations with sensory over-responsivity Frontiers in psychiatry, 2024.PMID 38590791
- [14]Than A, Patterson G, Cummings KK, et al. Sensory over-responsivity and atypical neural responses to socially relevant stimuli in autism Autism research, 2024.PMID 38949436
- [15]Uygun SD, Kara E, Temeltürk RD, et al. Exploring self-regulation deficits in sensory over-responsivity disorder: A preschool comparative analysis Global mental health (Cambridge, England), 2025.PMID 41292601
- [16]Flanagan JE, Schoen S, Miller LJ Early Identification of Sensory Processing Difficulties in High-Risk Infants The American journal of occupational therapy, 2019.PMID 30915974