Sensory processing disorder
|Sensory processing disorder|
|Classification and external resources|
Sensory processing disorder (SPD; also known as sensory integration dysfunction) describes a condition in which multisensory integration is not adequately processed in order to provide appropriate responses to the demands of the environment.
The senses provide information from various modalities—vision, audition, tactile, olfactory, taste, proprioception, interoception and vestibular system—that humans need to function. Sensory processing disorder is characterized by significant problems in organizing sensation coming from the body and the environment and is manifested by difficulties in the performance in one or more of the main areas of life: productivity, leisure and play or activities of daily living. Different people experience a wide range of difficulties when processing input coming from a variety of senses, particularly tactile (e.g., finding fabrics itchy and hard to wear while others do not), vestibular (e.g., experiencing motion sickness while riding a car) and proprioceptive (having difficulty grading the force to hold a pen in order to write).
Sensory integration was defined by occupational therapist Anna Jean Ayres in 1972 as "the neurological process that organizes sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment". Sensory processing disorder is gaining recognition, although it is still not recognized by the Diagnostic and Statistical Manual. Despite its proponents, it is still debated as to whether SPD is actually an independent disorder or the observed symptoms of various other, more well-established, disorders.
Signs and symptoms
Symptoms may vary according to the disorder's type and subtype present. SPD can affect one sense or multiple senses. While many people can present one or two symptoms, sensory processing disorder has to have a clear functional impact on the person's life:
Signs of over-responsivity, including, for example, dislike of textures such as those found in fabrics, foods, grooming products or other materials found in daily living, to which most people would not react, and serious discomfort, sickness or threat induced by normal sounds, lights, movements, smells, tastes, or even inner sensations such as heartbeat.
Signs of under-responsivity, including sluggishness and lack of responsiveness; and Sensory cravings, including, for example, fidgeting, impulsiveness, and/or seeking or making loud, disturbing noises; Sensorimotor-based problems, including slow and uncoordinated movements or poor handwriting.
Sensory discrimination problems, that might manifest themselves in behaviors such as things constantly dropped.
Critics have noted that what proponents claim are symptoms of SPD are both broad and, in some cases, represent very common, and not necessarily abnormal or atypical, childhood characteristics. The checklist of symptoms on the website of the SPD Foundation, for example, includes such warning signs as “My infant/toddler has problems eating,” “My child has difficulty being toilet trained,” “My child is in constant motion,” and “My child gets in everyone else's space and/or touches everything around him.” -- "symptoms" which read much like the day-to-day complaints of an average parent.
- Difficulties with planning movement using feedforward information
Relationship to other disorders
Sensory processing issues represent a feature of a number of disorders, including anxiety problems, ADHD, food intolerances, behavioral disorders, and particularly, autism spectrum disorders. This pattern of comorbidities poses a significant challenge to those who claim that SPD is a identifiably specific disorder, rather than simply a term given to a set of symptoms common to other disorders. Dr. Catherine Lord, a leading autism expert and the director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital, argues that sensory issues are an important concern, but not a diagnosis in themselves. “I do think there’s a value in attending to how a child is perceiving sensations, thinking about whether he could be uncomfortable. Where I get concerned is labeling that as a separate disorder.”
Two studies have provided preliminary evidence suggesting that there may be measurable neurological differences between children diagnosed with SPD and control children classified as neurotypical  or children diagnosed with autism. Despite this evidence, the fact that SPD researchers have yet to agree on a proven, standardized diagnostic tool undermines researchers’ ability to define the boundaries of the disease and makes correlational studies, like the ones about structural brain abnormalities, less convincing.
The exact cause of SPD is not known. However, it is known that the mid-brain and brain stem regions of the central nervous system are early centers in the processing pathway for multisensory integration, these brain regions are involved in processes including coordination, attention, arousal, and autonomic function. After sensory information passes through these centers, it is then routed to brain regions responsible for emotions, memory, and higher level cognitive functions. Sensory processing disorder not only affects interpretation and reaction to stimuli at the midbrain areas, but impacts several higher functions. Damage in any part of the brain involved in multisensory processing can cause difficulties to adequately process stimuli in a functional way.
Current research in sensory processing is focused on finding the genetic and neurological causes of SPD. EEG and measuring event-related potential (ERP) are traditionally used to explore the causes behind the behaviors observed in SPD. Some of the proposed underlying causes by current research are: EEG recording
- Differences in tactile and auditory over responsivity show moderate genetic influences, with tactile over responsivity demonstrating greater heritability. Bivariate genetic analysis suggested different genetic factors for individual differences in auditory and tactile SOR.
- People with Sensory Processing Deficits have less sensory gating (electrophysiology) than typical subjects.
- People with sensory over-responsivity might have increased D2 receptor in the striatum, related to aversion to tactile stimuli and reduced habituation. In animal models, prenatal stress significantly increased tactile avoidance.
- Studies using event-related potentials (ERPs) in children with the sensory over responsivity subtype found atypical neural integration of sensory input. Different neural generators could be activated at an earlier stage of sensory information processing in people with SOR than in typically developing individuals. The automatic association of causally related sensory inputs that occurs at this early sensory-perceptual stage may not function properly in children with SOR. One hypothesis is that multisensory stimulation may activate a higher-level system in frontal cortex that involves attention and cognitive processing, rather than the automatic integration of multisensory stimuli observed in typically developing adults in auditory cortex.
- Recent research found an abnormal white matter microstructure in children with SPD, compared with typical children and those with other developmental disorders such as autism and ADHD.
Although sensory processing disorder is accepted in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R), it 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.
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.
- Sensory Integration and Praxis Test (SIPT)
- DeGangi-Berk Test of Sensory Integration (TSI)
- Test of Sensory Functions in Infants (TSFI)
- Sensory Profile, (SP)
- Infant/Toddler Sensory Profile
- Adolescent/Adult Sensory Profile
- Sensory Profile School Companion
- Indicators of Developmental Risk Signals (INDIPCD-R)
- Sensory Processing Measure (SPM)
- Sensory Processing Measure Preeschool (SPM-P)
- Clinical Observations of Motor and Postural Skills (COMPS)
- Developmental Test of Visual Perception: Second Edition (DTVP-2)
- Beery–Buktenica Developmental Test of Visual-Motor Integration, 6th Edition (BEERY VMI)
- Miller Function & Participation Scales
- Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
- Behavior Rating Inventory of Executive Function (BRIEF)
The large number of different forms and tools of assessment listed here reflects what critics have argued is a fundamental problem with the diagnosis process: SPD researchers have yet to agree on a proven, standardized diagnostic tool, a problem that undermines the ability of researchers to define the boundaries of the disorder.
Sensory processing disorders have been classified by propoenents into three categories: sensory modulation disorder, sensory-based motor disorders and sensory discrimination disorders  (as defined in the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood).
Sensory modulation disorder (SMD) Sensory modulation refers to a complex central nervous system process by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted.
SMD consists of three subtypes:
- Sensory over-responsivity.
- Sensory under-responsivity
- Sensory craving/seeking.
Sensory-based motor disorder (SBMD) According to proponents, sensory-based motor disorder shows motor output that is disorganized as a result of incorrect processing of sensory information affecting postural control challenges, resulting in postural disorder, or developmental coordination disorder.
The SBMD subtypes are:
- Postural disorder
Sensory discrimination disorder (SDD)
1. Visual 2. Auditory 3. Tactile 4. Gustatory (taste) 5. Olfactory (smell) 6. Vestibular (balance) 7. Proprioceptive (feeling of where parts of the body are located in space)
Sensory integration therapy 
The main form of sensory integration therapy is a type of occupational therapy that places a child in a room specifically designed to stimulate and challenge all of the senses.
During the session, the therapist works closely with the child to provide a level of sensory stimulation that the child can cope with, and encourage movement within the room. Sensory integration therapy is driven by four main principles:
- Just right challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
- Adaptive response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
- Active engagement (the child will want to participate because the activities are fun)
- Child directed (the child's preferences are used to initiate therapeutic experiences within the session)
Sensory processing therapy This therapy retains all of the above-mentioned four principles and adds:
- Intensity (person attends therapy daily for a prolonged period of time)
- Developmental approach (therapist adapts to the developmental age of the person, against actual age)
- Test-retest systematic evaluation (all clients are evaluated before and after)
- Process driven vs. activity driven (therapist focuses on the "Just right" emotional connection and the process that reinforces the relationship)
- Parent education (parent education sessions are scheduled into the therapy process)
- "joie de vivre" (happiness of life is therapy's main goal, attained through social participation, self-regulation, and self-esteem)
- Combination of best practice interventions (is often accompanied by integrated listening system therapy, floor time, and electronic media such as Xbox Kinect, Nintendo Wii, Makoto II machine training and others)
The treatments themselves may involve a variety of activities and interventions (for example, prism lenses). Children with hypo-reactivity may be exposed to strong sensations such as stroking with a brush, vibrations or rubbing. Play may involve a range of materials to stimulate the senses such as play dough or finger painting. Children with hyper-reactivity, on the other hand, may be exposed to peaceful activities including quiet music and gentle rocking in a softly lit room. Treats and rewards may be used to encourage children to tolerate activities they would normally avoid. While occupational therapists using a sensory integration frame of reference work on increasing a child's ability to adequately process sensory input, other OTs may focus on environmental accommodations that parents and school staff can use to enhance the child's function at home, school, and in the community. These may include selecting soft, tag-free clothing, avoiding fluorescent lighting, and providing ear plugs for "emergency" use (such as for fire drills).
Evaluation of treatment effectiveness
Some of these treatments (for example, sensorimotor handling) have a questionable rationale and no empirical evidence. Other treatments (for example, prism lenses, physical exercise, and auditory integration training) have had studies with small positive outcomes, but few conclusions can be made about them due to methodological problems with the studies.   In its overall review of the treatment effectiveness literature, AETNA concluded that "The effectiveness of these therapies is unproven.", while the American Academy of Pediatrics concluded that "parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive." A 2015 review concluded that SIT techniques exist "outside the bounds of established evidence-based practice" and that SIT is "quite possibly a misuse of limited resources."
It has been estimated by proponents that up to 16.5% of elementary school aged children present elevated SOR behaviors in the tactile or auditory modalities. This figure is larger than what previous studies with smaller samples had shown: an estimate of 5–13% of elementary school aged children. Critics have noted that such a high incidence for just one of the subtypes of SPD raises questions about the degree to which SPD is a specific and clearly identifiable disorder.
Proponents have also claimed that adults may also show signs of sensory processing difficulties and would benefit for sensory processing therapies, although this work has yet to distinguish between those with SPD symptoms alone vs adults whose processing abnormalities are associated with other disorders, such as Autism Spectrum Disorder.
There are concerns regarding the validity of the diagnosis. SPD is not included in the DSM-5 or ICD-10, the most widely used diagnostic sources in healthcare. The American Academy of Pediatrics (AAP) states that there is no universally accepted framework for diagnosis and recommends caution against using any "sensory" type therapies unless as a part of a comprehensive treatment plan. In fact, in a 2012 statement, the AAP states that "Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed." When an occupational therapist does recommend sensory integration therapy, the AAP instructs that the therapist is aware that, "parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive." As such, most health insurance considers sensory integration therapy to be "investigational" and will not cover it. In the United States and UK, sensory processing disorder is not likely to qualify an individual for disability benefits, so the supporters of sensory processing disorder recommend having a child diagnosed for a related disorder that will qualify them for disability insurance.
A 20 review of research on Sensory Integration Therapy (SIT) concluded that SIT is "ineffective and that its theoretical underpinnings and assessment practices are unvalidated." Moreover, some authors warned in 2015 that SIT techniques exist "outside the bounds of established evidence-based practice" and that SIT is "quite possible a misuse of limited resources."
SPD is in Stanley Greenspan's Diagnostic Manual for Infancy and Early Childhood and as Regulation Disorders of Sensory Processing part of The Zero to Three's Diagnostic Classification. but is not recognized in the manuals ICD-10 or in the recently updated DSM-5. However, unusual reactivity to sensory input or unusual interest in sensory aspects is included as a possible but not necessary criterion for the diagnosis of autism.
Some state that sensory processing disorder is a distinct diagnosis, while others argue that differences in sensory responsiveness are features of other diagnoses and it is not a standalone diagnosis. The neuroscientist David Eagleman has proposed that SPD may be a form of synesthesia, a perceptual condition in which the senses are blended.Specifically, Eagleman suggests that instead of a sensory input "connecting to [a person's] color area [in the brain], it's connecting to an area involving pain or aversion or nausea".
Researchers have described a treatable inherited sensory overstimulation disorder that meets diagnostic criteria for both attention deficit disorder and sensory integration dysfunction.
Distinguishing SPD from Autism
Recent studies have helped to physiologically differentiate typically developing children from children with SPD, and from children with autism. Approximately 1% of the United States child population has been diagnosed with autism, while approximately 5-16% of children have been found to have difficulty processing sensory input. In a recent study performed by Owen et al., diffusion tensor imaging (DTI) was used to exam white matter tracts in a group of children with sensory processing disorder compared to a group of typically developing children. Results of the study showed less white matter microstructure, particularly in the posterior cerebrum, in the children with SPD compared to the typically developing children. This finding illustrates a physiological variation in an area of the brain that involves sensory processing and integration, which may help to explain some of the challenges children with SPD have. This particular study suggested that DTI may be used in the diagnosis and differentiation of SPD and autism.
In a follow-up study pertaining to differentiation of SPD from autism, Chang et al. examined white matter tract differences in a group of children with SPD compared to a group of children with autism, and also in relation to a group of typically developing children. The results of this study showed significantly less white matter connectivity between the parietal and occipital lobes in the children with SPD and ASD compared to the typically developing children. As stated above, these connections play a large part in sensory perception and integration. However, the study only found reduced connectivity in the temporal lobe of the group of children with ASD. This area of the brain contributes to social-emotional processing. These findings reveal a significant association between white matter circuitry and cognitive progressing, particularly in the areas of auditory integration, social skills, memory, and attention. These findings may help guide treatment and provide more personalized interventions for children with SPD, ASD, and other diagnoses. However, more research needs to be done with larger groups and more attention to other neural circuitry changes.
The American Occupational Therapy Association (AOTA) supports the use of a variety of methods of sensory integration for those with sensory processing disorder. The organization has supported the need for further research to increase insurance coverage for related therapies. They have also made efforts to educate the public about sensory integration therapy. The AOTA's practice guidelines currently support the use of sensory integration therapy and interprofessional education and collaboration in order to optimize treatment for those with sensory processing disorder. The AOTA provides several resources pertaining to sensory integration therapy, some of which includes a fact sheet, new research, and continuing education opportunities.
Ayres's theoretical framework for what she called Sensory Integration Dysfunction was developed after six factor analytic studies of populations of children with learning disabilities, perceptual motor disabilities and normal developing children. Ayres created the following nosology based on the patterns that appeared on her factor analysis:
- Dyspraxia: poor motor planning (more related to the vestibular system and proprioception)
- Poor bilateral integration: inadequate use of both sides of the body simultaneously
- Tactile defensiveness: negative reaction to tactile stimuli
- Visual perceptual deficits: poor form and space perception and visual motor functions
- Somatodyspraxia: poor motor planning (related to poor information coming from the tactile and proprioceptive systems)
- Auditory-language problems
Both visual perceptual and auditory language deficits were thought to possess a strong cognitive component and a weak relationship to underlying sensory processing deficits, so they are not considered central deficits in many models of sensory processing.
- High neurological thresholds
- Low registration: high threshold with passive response. Individuals who do not pick up on sensations and therefore partake in passive behavior.
- Sensation seeking: high threshold and active response. Those who actively seek out a rich sensory filled environment.
- Low neurological threshold
- Sensitivity to stimuli: low threshold with passive response. Individuals who become distracted and uncomfortable when exposed to sensation but do not actively limit or avoid exposure to the sensation.
- Sensation avoiding: low threshold and active response. Individuals actively limit their exposure to sensations and are therefore high self regulators.
Sensory processing model
In Miller's nosology "sensory integration dysfunction" was renamed into "Sensory processing disorder" to facilitate coordinated research work with other fields such as neurology since "the use of the term sensory integration often applies to a neurophysiologic cellular process rather than a behavioral response to sensory input as connoted by Ayres."
- Van Hulle, C., Lemery-Chalfant, K., & Goldsmith, H. H. (2015). Trajectories of Sensory Over-Responsivity from Early to Middle Childhood: Birth and Temperament Risk Factors. Plos ONE, 10(6), 1-20. doi:10.1371/journal.pone.0129968
- Cosbey, J.; Johnston, SS; Dunn, ML (2010). "Sensory processing disorders and social participation". Am J Occup Ther. 64 (3): 462–73. doi:10.5014/ajot.2010.09076. PMID 20608277.
- "Sensory Processing Disorder Explained". SPD Foundation. Archived from the original on 2010-05-17.
- Ayres, A. Jean (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services. ISBN 0-87424-303-3. OCLC 590960.
- Ayres AJ (1972). "Types of sensory integrative dysfunction among disabled learners". Am J Occup Ther. 26 (1): 13–8. PMID 5008164.
- Bunim, J. (2014). Kids with autism, sensory processing disorders show brain wiring differences. University of California San Francisco. Retrieved from https://www.ucsf.edu/news/2014/07/116196/kids-autism-and-sensory-processing-disorders-show-differences-brain-wiring
- Walbam, K. (2014). The Relevance of Sensory Processing Disorder to Social Work Practice: An Interdisciplinary Approach. Child & Adolescent Social Work Journal, 31(1), 61-70. doi:10.1007/s10560-013-0308-2
- Palmer, Brian (2014-02-27). "Get Ready for the Next Big Medical Fight". Slate. ISSN 1091-2339. Retrieved 2017-12-27.
- "AAP Recommends Careful Approach to Using Sensory-Based Therapies". www.aap.org. Retrieved 2017-12-27.
- Hulle, Carol Van; Lemery-Chalfant, Kathryn; Goldsmith, H. Hill (2015-06-24). "Trajectories of Sensory Over-Responsivity from Early to Middle Childhood: Birth and Temperament Risk Factors". PLOS ONE. 10 (6): e0129968. doi:10.1371/journal.pone.0129968. ISSN 1932-6203.
- Peters, Sarika U.; Horowitz, Lucia; Barbieri-Welge, Rene; Taylor, Julie Lounds; Hundley, Rachel J. (2012-02-01). "Longitudinal follow-up of autism spectrum features and sensory behaviors in Angelman syndrome by deletion class". Journal of Child Psychology and Psychiatry. 53 (2): 152–159. doi:10.1111/j.1469-7610.2011.02455.x. ISSN 1469-7610.
- Palmer, Brian. "Get Ready for the Next Big Medical Fight Is sensory processing disorder a real disease?". Slate. Slate. Retrieved 12 September 2018.
- Ghanizadeh A (June 2011). "Sensory processing problems in children with ADHD, a systematic review". Psychiatry Investig. 8 (2): 89–94. doi:10.4306/pi.2011.8.2.89. PMC 3149116. PMID 21852983.
- Lane AE, Young RL, Baker AE, Angley MT (January 2010). "Sensory processing subtypes in autism: association with adaptive behavior". J Autism Dev Disord. 40 (1): 112–22. doi:10.1007/s10803-009-0840-2. PMID 19644746.
- Tomchek SD, Dunn W (2007). "Sensory processing in children with and without autism: a comparative study using the short sensory profile". Am J Occup Ther. 61 (2): 190–200. doi:10.5014/ajot.61.2.190. PMID 17436841.
- Kern JK, Trivedi MH, Grannemann BD, et al. (March 2007). "Sensory correlations in autism". Autism. 11 (2): 123–34. doi:10.1177/1362361307075702. PMID 17353213.
- Russo N, Foxe JJ, Brandwein AB, Altschuler T, Gomes H, Molholm S (October 2010). "Multisensory processing in children with autism: high-density electrical mapping of auditory-somatosensory integration". Autism Res. 3 (5): 253–67. doi:10.1002/aur.152. PMID 20730775.
- Green SA, Ben-Sasson A (December 2010). "Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: is there a causal relationship?". J Autism Dev Disord. 40 (12): 1495–504. doi:10.1007/s10803-010-1007-x. PMC 2980623. PMID 20383658.
- Baron-Cohen S, Ashwin E, Ashwin C, Tavassoli T, Chakrabarti B (May 2009). "Talent in autism: hyper-systemizing, hyper-attention to detail and sensory hypersensitivity". Philosophical Transactions of the Royal Society B. 364 (1522): 1377–83. doi:10.1098/rstb.2008.0337. PMC 2677592. PMID 19528020.
- Marco EJ, Hinkley LB, Hill SS, Nagarajan SS (May 2011). "Sensory processing in autism: a review of neurophysiologic findings". Pediatr. Res. 69 (5 Pt 2): 48R–54R. doi:10.1203/PDR.0b013e3182130c54. PMC 3086654. PMID 21289533.
- Joanne Flanagan (2009). "Sensory processing disorder" (PDF). Pediatric News. Kennedy Krieger.org.
- Arky, Beth. "The debate over sensory processing". Child Mind Institute. Child Mind Institute. Retrieved 12 September 2018.
- Owen, Julia; Marco, Elysa; Desai, Shivani; Fourie, Emily; Harris, Julia; Hill, Susanna; Arnett, Anne; Mukherjee, Pratik (June 17, 2013). "Abnormal white matter microstructure in children with sensory processing disorders". NeuroImage: Clinical. 2: 844–853. doi:10.1016/j.nicl.2013.06.009. Retrieved 11 October 2017.
- Chang, Yi-Shin; Owen, Julia; Desai, Shivani; Hill, Susanna; Arnett, Anne; Harris, Julia; Marco, Elysa; Mukherjee, Pratik (July 2014). "Autism and Sensory Processing Disorders: Shared White Matter Disruption in Sensory Pathways but Divergent Connectivity in Social-Emotional Pathways". PLOS ONE. 9 (7): 1–17. doi:10.1371/journal.pone.0103038. Retrieved 11 October 2017.
- ICD 10
- Lucy Jane Miller. "Final Decision for DSM-V". Sensory Processing Disorder Foundation. Archived from the original on 4 October 2013. Retrieved 3 October 2013.
- "Course information and booking". Sensory Integration Network. Archived from the original on 10 June 2013. Retrieved 23 July 2013.
- Eeles AL, Spittle AJ, Anderson PJ, et al. (April 2013). "Assessments of sensory processing in infants: a systematic review". Dev Med Child Neurol. 55 (4): 314–26. doi:10.1111/j.1469-8749.2012.04434.x. PMID 23157488.
- Ermer J, Dunn W (April 1998). "The sensory profile: a discriminant analysis of children with and without disabilities". Am J Occup Ther. 52 (4): 283–90. doi:10.5014/ajot.52.4.283. PMID 9544354.
- Bolaños, C., Gomez, M. M., Ramos, G., & Rios del Rio, J. (2016). Developmental Risk Signals as a Screening Tool for Early Identification of Sensory Processing Disorders. Occupational Therapy International, 23(2), 154-164. doi:10.1002/oti.1420
- Miller-Kuhaneck H, Henry DA, Glennon TJ, Mu K (2007). "Development of the Sensory Processing Measure-School: initial studies of reliability and validity" (PDF). Am J Occup Ther. 61 (2): 170–5. doi:10.5014/ajot.61.2.170. PMID 17436839. Archived from the original (PDF) on 2018-05-19.
- Glennon, Tara J.; Miller Kuhaneck, Heather; Herzberg, David (2011). "The Sensory Processing Measure–Preschool (SPM-P)—Part One: Description of the Tool and Its Use in the Preschool Environment". Journal of Occupational Therapy, Schools, & Early Intervention. 4 (1): 42–52. doi:10.1080/19411243.2011.573245. ISSN 1941-1243.
- Wilson B1, Pollock N, Kaplan BJ, Law M, Faris P (September 1992). "Reliability and construct validity of the Clinical Observations of Motor and Postural Skills". Am J Occup Ther. 46 (9): 775–83. doi:10.5014/ajot.46.9.775. PMID 1514563.
- Brown T, Hockey SC (January 2013). "The Validity and Reliability of Developmental Test of Visual Perception-2nd Edition (DTVP-2)". Phys Occup Ther Pediatr. 33 (4): 426–39. doi:10.3109/01942638.2012.757573. PMID 23356245.
- Deitz JC, Kartin D, Kopp K (2007). "Review of the Bruininks–Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)". Phys Occup Ther Pediatr. 27 (4): 87–102. doi:10.1080/j006v27n04_06. PMID 18032151.
- Gioia GA, Isquith PK, Guy SC, Kenworthy L (September 2000). "Behavior rating inventory of executive function". Child Neuropsychol. 6 (3): 235–38. doi:10.1076/chin.126.96.36.19952. PMID 11419452.
- Gioia GA, Isquith PK, Retzlaff PD, Espy KA (December 2002). "Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample". Child Neuropsychol. 8 (4): 249–57. doi:10.1076/chin.188.8.131.5213. PMID 12759822.
- Miller LJ, Anzalone ME, Lane SJ, Cermak SA, Osten ET (2007). "Concept evolution in sensory integration: a proposed nosology for diagnosis" (PDF). The American Journal of Occupational Therapy. 61 (2): 135–40. doi:10.5014/ajot.61.2.135. PMID 17436834.
- Miller LJ, Nielsen DM, Schoen SA, Brett-Green BA (2009). "Perspectives on sensory processing disorder: a call for translational research". Front Integr Neurosci. 3: 22. doi:10.3389/neuro.07.022.2009. PMC 2759332. PMID 19826493.
- Zimmer M, Desch L (June 2012). "Sensory integration therapies for children with developmental and behavioral disorders". Pediatrics. 129 (6): 1186–9. doi:10.1542/peds.2012-0876. PMID 22641765.
- Schaaf RC, Benevides T, Blanche EI, et al. (2010). "Parasympathetic functions in children with sensory processing disorder" (PDF). Front Integr Neurosci. 4: 4. doi:10.3389/fnint.2010.00004. PMC 2839854. PMID 20300470. Archived from the original (PDF) on 2012-10-25.
- Miller, L. J.; Reisman, J. E.; McIntosh, D. N; Simon, J. S. S. Roley, E. I. Blanche, & R. C. Schaff, eds. An ecological model of sensory modulation: Performance of children with fragile X syndrome, autistic disorder, attention-deficit/hyperactivity disorder, and sensory modulation dysfunction (PDF). Understanding the nature of sensory integration with diverse populations. Tucson, AZ:: Therapy Skill Builders. pp. 75–88. ISBN 9780761615156. OCLC 46678625. Archived from the original (PDF) on 2012-10-25. Retrieved 2013-07-26.
- Bair WN, Kiemel T, Jeka JJ, Clark JE (2012). "Development of multisensory reweighting is impaired for quiet stance control in children with developmental coordination disorder (DCD)". PLOS ONE. 7 (7): e40932. doi:10.1371/journal.pone.0040932. PMC 3399799. PMID 22815872.
- Lonkar, Heather. "An overview of sensory processing disorder". ScholarWorks at Western Michigan University. Western Michigan University. Retrieved 4 October 2017.
- C., Bundy, Anita (2002). Sensory integration : theory and practice. Lane, Shelly., Murray, Elizabeth A., Fisher, Anne G., 1946- (2nd ed.). Philadelphia: F.A. Davis. ISBN 0803605455. OCLC 49421642.
- Miller, Lucy Jane; Collins, Britt (2013). "The "So What?" of Sensory Integration Therapy: Joie de Vivre" (PDF). Sensory Solutions. Sensory Processing Disorder Foundation. Archived from the original (pdf) on 4 March 2016. Retrieved 11 January 2016.
- Nancy Peske; Lindsey Biel (2005). Raising a sensory smart child: the definitive handbook for helping your child with sensory integration issues. New York: Penguin Books. ISBN 0-14-303488-X. OCLC 56420392.
- "Sensory Checklist" (PDF). Raising a Sensory Smart Child. Retrieved 16 July 2013.
- Baranek GT (2002). "Efficacy of sensory and motor interventions for children with autism". J Autism Dev Disord. 32 (5): 397–422. doi:10.1023/A:1020541906063. PMID 12463517.
- Schaaf RC, Miller LJ (2005). "Occupational therapy using a sensory integrative approach for children with developmental disabilities". Ment Retard Dev Disabil Res Rev. 11 (2): 143–8. doi:10.1002/mrdd.20067. PMID 15977314.
- Hodgetts S, Hodgetts W (2007). "Somatosensory stimulation interventions for children with autism: literature review and clinical considerations". Can J Occup Ther. 74 (5): 393–400. doi:10.2182/cjot.07.013. PMID 18183774.
- "Sensory and Auditory Integration Therapy". Aetna Insurance. Aetna Insurance. Retrieved 10 September 2018.
- Medicine, Section on Complementary and Integrative; Disabilities, Council on Children With (2012-06-01). "Sensory Integration Therapies for Children With Developmental and Behavioral Disorders". Pediatrics. 129 (6): 1186–1189. doi:10.1542/peds.2012-0876. ISSN 0031-4005. PMID 22641765.
- Smith, T., Mruzek, D. W., & Mozingo, D. (2015), "Sensory integration therapy.", in Richard M. Foxx, James A. Mulick, Controversial therapies for autism and intellectual disabilities: Fad, fashion, and science in professional practice, pp. 247–269
- Carter, A. S.; A. Ben-Sasson; M. J. Briggs-Gowan (2009). "Sensory Over-Responsivity in Elementary School: Prevalence and Social-Emotional Correlates" (PDF). J Abnorm Child Psychol. 37 (5): 705–716. doi:10.1007/s10802-008-9295-8. PMID 19153827. Archived from the original (PDF) on 2013-06-27.
- Ahn, RR.; Miller, LJ.; Milberger, S.; McIntosh, DN. (2004). "Prevalence of parents' perceptions of sensory processing disorders among kindergarten children" (PDF). Am J Occup Ther. 58 (3): 287–93. doi:10.5014/ajot.58.3.287. PMID 15202626.[permanent dead link]
- Urwin R, Ballinger C (February 2005). "The Effectiveness of Sensory Integration Therapy to Improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs". Brit. J. Occup. Ther. 68 (2): 56–66.
- Brown, Stephen; Shankar, Rohit; Smith, Kathryn (2009). "Borderline personality disorder and sensory processing impairment". Progress in Neurology and Psychiatry. 13 (4): 10–16. doi:10.1002/pnp.127. ISSN 1367-7543.
- "Sensory Integration". The American Occupational Therapy Association, Inc. Retrieved 4 October 2017.
- Ayres, A. Jean.; Robbins, Jeff (2005). Sensory integration and the child : understanding hidden sensory challenge 25th Anniversary Edition. Los Angeles, CA: WPS. ISBN 978-0-87424-437-3. OCLC 63189804.
- Bundy, Anita. C.; Lane, J. Shelly; Murray, Elizabeth A. (2002). Sensory integration, Theory and practice. Philadelphia, PA: FA Davis Company. ISBN 0-8036-0545-5.
- Mulligan, Shelley (1998). "Patterns of Sensory Integration Dysfunction: A Confirmatory Factor Analysis". American Journal of Occupational Therapy. 52 (November/December): 819–828. Retrieved 11 September 2018.
- Smith Roley, Susanne; Zoe Mailloux; Heather Miller-Kuhaneck; Tara Glennon (September 2007). "Understanding Ayres Sensory Integration" (PDF). OT PRACTICE. 17. 12. Archived from the original (PDF) on 24 August 2014. Retrieved 19 July 2013.
- Dunn, Winnie (April 1997). "The Impact of Sensory Processing Abilities on the Daily Lives of Young Children and Their Families: A Conceptual Model". Infants & Young Children: April 1997. 9 (4). Retrieved 2013-07-19.
- Dunn W (2001). "The sensations of everyday life: empirical, theoretical, and pragmatic considerations". Am J Occup Ther. 55 (6): 608–20. doi:10.5014/ajot.55.6.608. PMID 12959225.
- Engel-Yeger, Batya; Shochat, Tamar (June 2012). "The relationship between sensory processing patterns and sleep quality in healthy adults". Canadian Journal of Occupational Therapy. 79 (3): 134–141. doi:10.2182/cjot.2012.79.3.2.
- "Sensory processing disorder". Frontiers in Integrative Neuroscience – Research Topics. Retrieved 24 August 2013.