The OPEN minute newsletter / Red Flags for Sensory Processing Disorder
September 13, 2022

Red Flags for Sensory Processing Disorder

Sensory Processing Disorder (SPD), also called Sensory Integration Dysfunction or Sensory Integration Disorder, is an inability to pull together and understand (or process) sensory input. We receive sensory input through external and internal senses. Difficulty taking in or interpreting this input can lead to problems with daily functioning, social and family relationships, self-regulation, self-esteem, behavior, and/or learning.

Information about our bodies and our world is received through eight primary senses that work in combination to allow us to feel safe, have fun, learn, and interact successfully within our environment. Our eight sensory systems include: Touch (Tactile System), Body Awareness – (Proprioceptive System or Muscle and Joint Input), Movement and Balance (Vestibular System), Hearing (Auditory System), Sight (Visual System): Taste (Gustatory System): Smell (Olfactory System), Internal Signals (Interoceptive System):

Parents are the adults in the best position to know when their child has a sensory problem, but their observations are often discounted because they are ‘just the parents.’ If the family’s health care provider isn’t familiar with SPD, the clues that triggered the parents’ alarm may be overlooked, misinterpreted, or dismissed. The parents may be scolded for over-reacting, or they may be offered assurances that their child is ‘just a little delayed’ or ‘going through a phase’ or ‘showing his personality or ‘just being a boy.’ The child may be misdiagnosed and even treated for another already familiar disorder to the doctor rather than for the real culprit: Sensory Processing Disorder.

“By the time I meet families through the STAR Institute, at our Treatment Center in Denver, or in one of the workshops I teach, the parents are often near despair because they have tried and failed to convince somebody that red flag symptoms exist and are disrupting their child’s life in basic ways. . . . The parents are convinced that something isn’t right, but they are intimidated, frustrated, or downright discouraged because nobody believes them”.

Lucy Jane Miller, PhD, OTR”

Red Flags for:

Infants and toddlers

  • Problems eating or sleeping
  • Refuses to go to anyone but their mom for comfort
  • Irritable when being dressed; uncomfortable in clothes
  • Rarely plays with toys
  • Resists cuddling, arches away when held
  •  Cannot calm self
  •  Floppy or stiff body, motor delays



  • Over-sensitive to touch, noises, smells, and other people
  • Difficulty making friends
  • Difficulty dressing, eating, sleeping, and/or toilet training
  • Clumsy; poor motor skills; weak
  • In constant motion, in everyone else’s “face and space.”
  • Frequent or long temper tantrums



  • Over-sensitive to touch, noise, smells, and other people
  • Easily distracted, fidgety, craves movement, aggressive
  • Easily overwhelmed
  • Difficulty with handwriting or motor activities
  •  Difficulty making friends
  • Unaware of pain and/or other people


Adolescents and adults

  • Over-sensitive to touch, noise, smells, and other people
  • Poor self-esteem, afraid of failing at new tasks
  • Lethargic and slow
  • Always on the go, impulsive, distractible
  • Leaves tasks uncompleted
  • Clumsy, slow, poor motor skills or handwriting
  • Difficulty staying focused
  • Difficulty staying focused at work and in meetings
  • Unmotivated; never seems to get joy from life


Causes of SPD

The exact cause of Sensory Processing Disorder has not yet been identified. Preliminary studies and research suggest that SPD is often inherited. Prenatal and birth complications have also been implicated as causal in SPD, as well as certain environmental factors.

Ten Fundamental Facts About SPD

When extended family, teachers, neighbors, other parents, and service providers ask you what Sensory Processing Disorder is, the following are research-supported statements you can make.

  1. Sensory Processing Disorder is a complex disorder of the brain that affects developing children and adults.
  2. Parent surveys, clinical assessments, and laboratory protocols identify children with SPD.
  3. At least one in twenty people in the general population may be affected by SPD.
  4. In gifted children and those with ADHD, Autism, and fragile X syndrome, the prevalence of SPD is much higher than in the general population.
  5. Studies have found a significant difference between the physiology of children with SPD and typically developing children.
  6. Studies have found a significant difference between the physiology of children with SPD and children with ADHD.
  7. Sensory Processing Disorder has unique sensory symptoms that are not explained by other known disorders.
  8. Heredity may be one cause of the disorder.
  9. Laboratory studies suggest that the sympathetic and parasympathetic nervous systems are not typically functioning in children with SPD.
  10. Preliminary research data support decades of anecdotal evidence that occupational therapy is an effective intervention for treating SPD symptoms.


Sensory Processing Disorder Checklist: Signs and Symptoms of Dysfunction

The purpose of this sensory processing disorder checklist aims to help professionals who interact with children become educated about particular signs of sensory processing dysfunction.

It should not be used as the absolute diagnostic criteria for labeling children with a sensory processing disorder. Professionals who can diagnose this disorder have their own tools in addition to checklists to observe and test for sensory integration dysfunction.

The “Five Caveats” that Carol Stock Kranowitz points out in her book, The Out-Of-Sync Child (1995), about using a checklist:

  1.  “The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus, the child with vestibular dysfunction may have poor balance but good muscle tone.”
  2. “Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, a child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday. Inconsistency is a hallmark of every neurological dysfunction. ”
  3. “The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may have an emotional problem.”
  4. “The child may be both hypersensitive and hypersensitive. For instance, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation.”
  5. ” Everyone has some sensory integration problems now and then because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt the brain’s normal functioning, either by overloading it with or depriving it of sensory stimulation.”


Symptoms Checklist include:

  • Signs of Tactile Dysfunction (tactile defensiveness, under-responsive or poor tactile perception and discrimination)
  • Signs of Vestibular Dysfunction(over-responsive, under-responsive, or poor muscle tone and/or coordination)
  •  Signs of Proprioceptive Dysfunction(sensory seeking behaviors, difficulty with “grading of movement”)
  • Signs of Auditory Dysfunction: no diagnosed hearing problem (auditory defensiveness, under-registers)
  • Signs of Oral Input Dysfunction (oral defensiveness, under-registers)
  • Signs of Olfactory Dysfunction /Smells/ (over-responsive, under-responsive)
  • Signs of Visual Input Dysfunction: no diagnosed visual deficit (over-responsiveness, under-responsive or difficulty with tracking, discrimination, or perception)
  • Internal  Regulation (The Interoceptive Sense)


Sensory processing disorder treatment

Treatment is usually done through therapy. Research shows that starting therapy early is key for treating SPD. Therapy can help children learn how to manage their challenges.

A trained therapist leads therapy sessions. The therapist will help the child learn how to cope with the disorder. Sessions are based on if the child is oversensitive, under-sensitive, or a combination of both. There are different types of therapy:

   1. Sensory integration therapy (SI). 

This type of therapy uses fun activities in a controlled environment. With the therapist, the child experiences stimuli without feeling overwhelmed. He or she can develop coping skills for dealing with that stimuli. These coping skills can become a regular, everyday response to stimuli through this therapy.

   2. Sensory diet. 

Many times, a sensory diet will supplement other SPD therapies. A sensory diet isn’t the typical food diet. It’s a list of sensory activities for home and school. These activities are designed to help the child stay focused and organized during the day. Like SI, a sensory diet is customized based on the child’s needs. A sensory diet at school might include:

A time every hour when the child could go for a 10-minute walk.

A time twice a day when the child could swing for 10 minutes.

Access to in-class headphones so the child can listen to music while working.

Access to fidget toys.

Access to a desk chair bungee cord. This gives the child a way to move his or her legs while sitting in the classroom.

   3. Occupational therapy. 

The child also may need this therapy to help with other symptoms related to SPD. It can help with fine motor skills, such as handwriting and using scissors. It also can help with gross motor skills, such as climbing stairs and throwing a ball. It can teach everyday skills, such as getting dressed and how to use utensils.
Hope this helps!
Best regards,
Gayane Zakaryan, Head of Rehabilitation Services,  “ArBeS”  Healthcare Center

References and Resources

Kranowitz, C.S. (1998). The out-of-sync child: Recognizing and coping with Sensory Processing Disorder. TarcherPerigee.

Schoen, S. A., Miller, L. J., Brett-Green, B. A., & Nielsen, D. M. (2009). Physiological and behavioral differences in sensory processing: a comparison of children with autism spectrum disorder and sensory modulation disorder. Frontiers in integrative neuroscience, 3, 29.

Our sensory stories: Meet Nimish. STAR Institute. Retrieved September 7, 2022.

Research. Children’s Support by LifeWorks. Retrieved September 7, 2022.

Rodil, J. (2020, June 4). Sensory Processing Disorder checklist and symptoms. NAPA Center. Retrieved September 7, 2022.

Sensory Integration Disorder. Children’s Support by LifeWorks. Retrieved September 7, 2022.

Sensory Processing Disorder (SPD). (2020, August 31). – American Academy of Family Physicians (AAFP). Retrieved September 7, 2022.

Understanding Sensory Processing Disorder. STAR Institute. Retrieved September 7, 2022.

Your 8 senses. STAR Institute. Retrieved September 7, 2022.

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