Debra Johnson, MS, OTR/L has 24 years experience as an Occupational Therapist and is currently owner/ director of STEPS for Kids, Inc, where she specializes in treating children who have Sensory Processing Disorder and related conditions. She is the parent of a gifted child with Over-Excitabilities and sensory sensitivities who has inﬂuenced her work and fueled her passion in working with gifted children and their families.
Gifted children (and adults) are often described as being intense and sensitive. Dabrowski’s Theory of Overexcitabilities (OE) speciﬁcally identiﬁes the areas of Psychomotor OE and Sensual OE which include a surplus of energy with intense physical activity and an enhanced sensory awareness, respectively. Gifted children whose physical activity level or sensory sensitivities are great enough to be disruptive to daily activities are sometimes referred to occupational therapists and identiﬁed as having a sensory processing disorder (SPD). The question “is it SPD or OE?” then becomes central to understanding the child’s behaviors and providing the right support for the child’s well-being and development.
What is SPD? Originally presented by A. Jean Ayres, OTR, PhD in the 1970s, the theory of sensory integration is based on the premise that our central nervous system is designed to facilitate “the interaction and coordination of two or more functions or processes in a manner which enhances the adaptiveness of the brain’s response.” (Ayres, 1972) Accurate processing of sensory information allows us to relate to the world around us with appropriate motor and emotional responses, resulting in efﬁcient and effective performance of daily activities. Sensory Processing Disorder (SPD) is a term coined by Lucy Miller, OTR, PhD and is “a global umbrella term that includes all forms of the disorder, including three primary diagnostic groups and the subtypes found within each group (Miller, 2004).
The three primary groups of SPD are modulation disorders (over-responsivity, under-responsivity and sensory seeking/craving), motor disorders (dyspraxia, postural disorder), and discrimination disorders. A child with SPD may exhibit any one or a combination of these subtypes. The disorder is characterized by chronic and severe problems with turning sensory information into behaviors that match the nature and intensity of the message (Miller, 2006).
SPD is a condition that can:
- Impact developmental skills (motor, social, emotional & cognitive).
- Disrupt family life and strain relationships.
- Make it difficult for a child to participate in activities due to impaired skills and/or related behaviors.
- Impact a child's self-esteem, confidence and competency in daily activities.
SPD & Gifted (from the SPD Foundation, 2013) Some studies of gifted children have found that gifted children are more likely than the general population to have symptoms of SPD with one study ﬁnding 35% of children at a GT center ﬁtting criteria for SPD compared to 5% in the general population. Sensory modulation disorder is the most common subtype of SPD in the gifted population, but many gifted individuals also demonstrate signs of dyspraxia (motor planning impairments, incoordination). The higher the level of giftedness in a child, the more likely that introversion is linked with increased responsivity to pain, sound, touch, and smell.
Subtypes of SPD most often compared to or confused with OE theory are:
- Sensory Modulation Disorder, Over-Responsivity Subtype compared to Sensual OE
- Sensory Modulation Disorder, Sensory Seeking/Craving compared to Psychomotor OE
So, what IS the difference between SPD and OE? “Overexcitability….means that the person may require less stimulation to produce a response, as well as stronger and more lasting reactions to stimuli. Another way of looking at it is of being spirited – more intense, sensitive, perceptive, persistent, energetic.” (from Living with Intensity, Daniels & Piechowski, 2009) SPD, however, is characterized by chronic and severe problems in responding to sensory information resulting in disruption of daily life. Children with SPD tend to get “stuck,” and they are unable to modify their responses to their surroundings on their own or even with whatever strategies a parent may try to help the child.
A child who experiences Psychomotor OE will demonstrate a surplus of energy, desire for intense physical activity, pressure for action (e.g.: organizing), and marked competitiveness. Increased emotional tension may result in compulsive talking/chattering, impulsive actions, nervous habits, or acting out. Sensory Seeking/ Craving type of SPD is characterized not by a surplus of energy and a drive to action, but by an intense need for obtaining sensory input. While the child with Psychomotor OE may want to participate in an activity to an intense level, it is usually done with a purpose (to master the sport, to win the game, to feel the physical/emotional rush). For the child with sensory seeking/craving behaviors there is often no goal other than “crash and bump” play, often a lack of social interaction in the play, and a lack of play scheme or ideation of pretend play. These children often not only demonstrate impulsivity, but have poor ability to regulate their responses, often escalating in behaviors to the point of risk taking with lack of awareness for personal safety or dangers in the activity.
Piechowski identiﬁes Sensual OE as enhanced sensory and aesthetic pleasure and describes it as including intense awareness of speciﬁc sensory experiences with “delight in beautiful objects, sounds of words, music, form, color and balance.” Children with an over-responsivity modulation disorder do not display appreciation of the sensory information, but rather experience the sensory information to an extent that is described as painful, are unable to regulate their responses to the sensory information, and demonstrate negative behaviors related to the stress and anxiety caused by exposure to the aversive sensory input.
Stress, emotional tension, anxiety and poor ﬁt with the environment can contribute to increased behaviors associated with both SPD and OE. Children may then exhibit decreased ﬂexibility, poor ability to adapt or transition, and increased need to control their surroundings. Children with SPD lack the ability to adapt and demonstrate poor coping skills when faced with a poor ﬁt between their abilities and the environmental demands. Gifted children with OE may also have poor ability to adapt due to asynchronous development, lack of coping strategies, presence of strong Emotional OE, or immature executive function skills.
Whether SPD or OE, children beneﬁt from similar approaches that limit the offensive stimuli, maximize comforting stimuli, foster the child’s control of their environment, provide for appropriate and safe movement, increase the child’s self-awareness of their own sensory needs, and facilitate self-acceptance for their own uniqueness.
Posted retroactively on March 13, 2015.