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As a child, Dan (not his real name) was labelled “stupid” because he could not answer questions correctly.
He was branded a troublemaker and it was only recently that Dan, who is now in his mid-20s, realised that his woes were actually caused by a rare condition.
Dan’s hearing is normal, but he suffers from auditory processing disorder, which makes it difficult for him to differentiate between the sounds he hears, even when they are spoken loudly and clearly. If left undiagnosed and untreated, the disorder can cause problems at work and in daily life. A person suffering from the condition is able to hear sounds normally but, for unknown reasons, his brain processes and interprets the sounds abnormally.
Someone suffering from auditory processing disorder can recognise simple sounds, such as a dog’s bark or a bell chime. Speech presents particular challenges as the sounds it creates are not just complex, but are linked to meanings stored in the brain.
The disorder is hard to diagnose as people with the condition often suffer from other conditions with similar symptoms, such as autism, attention deficit hyperactivity disorder, dyslexia as well as language impairments.
The child has to listen to the person speaking more softly and repeat what is said, while ignoring the speaker with the louder voice. Corneal TransplantPost your questions related to corneal transplant and hear from our expert! 2.      Our self-regulation strategies (how we use strategies to manage this sensory input). Keep in mind that sensory processing is a continuum and that we all require proprioceptive (physical, external) feedback to regulate our sensory system.  What we are really concerned about is one’s extreme responses to sensory input and the negative affect these responses have on a person’s ability to communication and participate in daily living activities. IF you feel your child exhibits numerous characteristics in one or more areas, please follow up on your concerns by contacting an OT that has experience in sensory integration.  They can perform a complete evaluation and make recommendations. Check out Sensory Processing Disorder website for a complete checklist on sensory processing disorder.
About MariaMaria is a pediatric speech-language pathologist who holds her Certificate of Clinical Competence from the American Speech-Language and Hearing Association (ASHA) and is licensed in the state of Arizona. Not only do children with CAPD experience these behavioral symptoms, but because the child is either not understood or has trouble understanding others, she may become socially withdrawn and develop social-emotional-behavioral problems. Take a good look at the list of symptoms associated with ADHD in the DSM.  Without having further information, the obvious diagnosis is ADHD. If you ever wondered what school was like through the eyes of a child with autism, Mikey takes you there! In this book, Mikey explains how a young child with autism sees, hears, and feels the world around him in his school environment. Mikey is intended to educate adults as well as young children with a goal to create an empathetic understanding of the child with autism.
Mikey was inspired by the author’s vast experiences in education working with children with autism. It is not known how many people in Singapore suffer from the disorder, but the incidence in the West is 2 to 5 per cent of children. Ms Kristl Alphonso, Senior Speech Therapist, Singapore General Hospital (SGH ), said Dan sought help after failing to get a promotion.
Sounds entering the ear are converted into electrical impulses that are transmitted to the brain through the auditory nerve. They require interpretation and that is where a patient with the disorder encounters difficulty. Parents and teachers are usually the first to notice, typically when a child displays poor listening skills, or has problems remembering what he has been told. If there is nothing wrong, you know he is just being disobedient, or ignoring you on purpose,” said Ms Alphonso. These results are combined with other findings for a detailed assessment before the child is referred to speech and language therapists. Postgraduate Student Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health Science, University of Witwatersrand Paediatric Occupational Therapy Practice: Sensory Matters Inc IIOT (Pret) MSc OT (Wits). Mikey is sure to be a wonderful book to share with students as celebrations begin for Autism Awareness Month in just a few short weeks. The brain then decodes the electrical signals in a way that allows a person to understand what the sounds mean. This inability to remember or comprehend becomes more pronounced when the child is in a noisy environment. Adjunct Professor and Head, Dept of Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health Science, University of the Witwatersrand IIIB Sc OT (Wits) MSc OT (Wits) DHT (Pret). Self esteem is affected, and the CAPD child can act out with opposition, defiance or aggression. The sensory diet was viewed as a complementary programme and was based on the Sensory Integration theory of Jean Ayers. Infants were divided into two combined age bands as prescribed for the administration of the Infant Toddler Symptom Checklist.
One group fell into the age band of 7-12 months of age and the other into the 13-24 months age band. Pre and post intervention measures allowed for comparison of data to determine the effect of the programme.
Difficulties with tactile, vestibular and auditory sensitivities related to sensory processing persisted indicating the need for further sensory integrative therapy. Despite the small sample size, the results contribute to the emerging understanding of the influence of sensory modulation on dysfunctional infant behaviour.
This self-regulation is described as an interaction between physiological maturation; the parents' sensitivity to the infants' needs as well as the infant's adaptation to the environmental demands. The foundation for self-regulation is the infant's ability to develop homeostasis during the early months of life. Homeostasis refers to the ability of the infant to regulate and develop sleep-wake cycles, to digest food, to self soothe in response to changing stimuli from the environment and to respond appropriately to social stimuli3. As a result they may have difficulties in transitioning between arousal states, become overwhelmed quickly and avoid self soothing behaviours such as sucking their fingers or dummies. They often dislike swaddling and move into extension patterns when crying and irritable.

Some infants demonstrating these behaviours have been described as meeting the criteria for Regulation Sensory Processing Disorder (RSPD).
This disorder is evident early in life5 and it has been reported in infants older than six months who appear to be fussy, irritable, with poor self-calming behaviours and who show intolerance to change6,7. Problems with physiological maturation, caregiver response or the infant's adaptation to environmental demands may also play a role in the development of RSPD8,9. Ayers' theory of Sensory Integration is well recognised within occupational therapy and has been the departure point for later research and theory development by other occupational therapists, such as de Gangi and colleagues in 1993 and 19952,3.
Through this it was hoped to increase understanding of the infant's behaviour and facilitate change. Sensory diets are viewed as being complementary to sensory integration based on Ayers' theory15.
Self-control begins to emerge from 18 months of age as the child is able to use language and play to internalise routines and instructions from others6.
It may also result in emotional or behavioural challenges such as frequent emotional outbursts and poor adaptability to change5. Lane confirmed that RSPD is identified only in infancy, although these infants may possibly present later with a sensory processing disorder if their difficulties persist19. The disorder was first described in 2006 in the USA and has not been classified in either the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10)20 or the Diagnostic and Statistical Manual - Text Revised (DSM IV - TR)21. This manual is not yet in common use in South Africa, therefore, the diagnosis of RSPD is infrequently made in South Africa.
The items on this test allow parents to observe and report on their experience of their infant's fussiness. The test has been standardised and assesses a range of behavioural and sensory domains including: self-regulation, attention, touch, movement, listening and language, looking and sight as well as attachment. At risk scores which indicate regulatory and sensory disorders are provided for each age band2. In the standardising procedure and to establish norms, the items were tested on a sample of predominantly middle-class Caucasian infants in the USA2. Thirty infants who were developing typically and 15 infants with RSPD were included in the pilot study. After analysis and revision of items, data collection was conducted over a three year period.
The test was then validated on two samples of infants between 7 and 30 months of whom 154 were developing typically and 67 who had been identified with RSPD. Construct validity was established by comparing the scores of the sample of infants with regulatory disorders to that of infants whose parents were not concerned about their infants' behaviour2. The authors report that 78% of infants identified by the ITSC as having problems were later diagnosed with developmental or behavioural problems when assessed with the Child Behavior Checklist2. The inclusion criteria reported in this paper are the same as those used in the reported studies, which were used to determine whether infants could be identified as having RSPD2. DeGangi suggests three formal approaches including parent guidance, child-centred interactions which are based on developmental individual differences, and thirdly, Ayers Sensory Integration13. No published research could be found on the long-term prevention of developmental, learning, sensory integrative, behaviour and emotional difficulties by providing intervention in infancy for RSPD.
It has also not been determined what duration, frequency and type of intervention would work best25. In addition, scheduling feeding at a relaxed time, the development of a predictable routine, or sequence of events, and the slow introduction of different food textures were advocated28. Burnham et al.29 described infants spending most of their sleep time in their own cots and parents waiting before responding to infant awakenings as the two main indicators of improved self-soothing in infants at 12 months of age. They reported that an infant's ability to fall and stay asleep was influenced by specific sensory modulation difficulties related to auditory, tactile or vestibular processing. A survey design was used to determine the parents' knowledge about RSPD and what help they had received in dealing with their infant's problems and the effectiveness of this help. This selection method allowed for voluntary participation as parents could decide whether or not to contact the researcher and participate in the study. Infants were excluded if they were medically unhealthy or had a medical condition which explained excessive fussy behaviour, for example, soft cleft palate affecting feeding.
Of the 12 participants included in the study, seven of participants were male and five were female. Six participants were aged between 7 and 12 months and six were between 13 and 24 months. Infants aged six months or younger were not included, as fussiness at this age can be associated with the high incidence of colic and reflux3. Toddlers from 24-36 months were also excluded as fussiness in this age group is to be considered developmentally appropriate2. Appointments were made at their convenience at their home,work or the researcher's private practice for interview purposes. Firstly a questionnaire was completed by the parent that detailed demographic information, medical details of the pregnancy and birth of the child.
Finally the parent was asked to complete the parent self-report Infant-Toddler Symptom Checklist(ITSC)2, which was then scored and reviewed by the researcher. The ITSC assesses self-regulation, attention, touch, movement, listening and language, looking and sight as well as attachment and is a valuable tool for occupational therapy as it focuses on occupational performance areas like sleep, eating or feeding, dressing, bathing, in which the parent's experience their infant's fussiness.
The ITSC was designed for the 7- to 30-month age range, with six checklists that cover five different age bands, 7 to 9 months, 10 to 12 months, 13 to 18 months, 19 to 24 months, and 25 to 30 months.
Cut off scores which indicate regulatory and sensory disorders are provided for each age band2.
The impact of the condition on occupational performance in sleep, feeding and attachment were presented verbally using supporting diagrams.
This was true even when symptoms presented after the age of six months, although it is recognised that colic typically resolves by six months of age through natural maturation3.
When the various domains of the ITSC were analysed for the 1 3-24 month old infants none of the domains showed significant change although there was improvement in four domains (Figure 1). The scores for the vestibular and auditory domains increased and the visual domain was unchanged. Another two reported the fussiness starting between four and six months and one parent stated that the fussiness was only noted from 7 months.

When asked to rate their greatest concerns in relation to RSPD, parents were most concerned about sleep (35%), self-regulation and feeding (13%), followed by attachment (8%). Further research would be needed in a younger age group to establish how the fussiness relates to colic and whether the symptoms of RSPD were present and contributing to problems before the age of six months. However, parents reported that the advice given, along with information from books and the internet did not adequately equip them to deal with their infants' problems31,32.. The lack of referral to occupational therapists appears to confirm a lack of awareness of RSPD amongst health professionals dealing with infants.
Furthermore, there appears to be a lack of knowledge of sensory integration- based intervention in treating this condition.
Thus more teamwork between disciplines and education about regulatory disorders for other professionals is required. By implication, the criteria could be used by other health professionals to identify possible cases of RSPD, for referral to a Sensory Integration trained occupational therapist. However, these findings will need to be confirmed in future research on a larger sample size.
This method was chosen as the researcher felt that the parents would be in the best position to indicate a reduction in signs of RSPD as they had the most contact with the child.
The reliability of this method of assessment in determining change could thus not be confirmed. Therefore, the researcher ensured that the parents had a sound understanding of the condition and understood how to implement the sensory diet appropriately.
The importance of parent education on addressing their infants dysfunction is supported by two studies which specifically assessed the parents' perspectives on the benefits of education as part of the therapeutic process31,32.
This may suggest that, in some cases, rather than the infants improving, changes reported were due to the change in parental knowledge and understanding of RSPD and not necessarily in objective changes in infants' symptoms. This variable can be addressed in future research by the addition of the Test of Sensory Functions in Infants23 which is completed by an occupational therapist and not the parents. This form of indirect therapeutic intervention allowed parents to implement the programme and fit it into their daily schedules. However, these results need to be confirmed in a study with a larger sample size and for a longer period of intervention, across a variety of age bands.
All infants displayed a reduction in signs of RSPD with seven of the 12 infants moving to within the normal range and were to deemed no longer be at risk for RSPD. Although five of the infants remained at risk for RSPD, four of the five showed a six or more point improvement on the ITSC with an effect size of 1.47. It would be beneficial to reassess the infants at 36 months, to determine the long-term effects of the intervention. This would have allowed a comparison with other studies which were conducted over a longer period3,33. Sleep problems found in this study, which included aspects like an inconsistent sleep routine, taking a long time to fall asleep but once asleep either sleeping through or waking once a night, were not assessed. In this group, there was a significant improvement in self-regulation difficulties, improvement in sleep and attachment difficulties but a slight increase in tactile and auditory difficulties.
The sensory diet home programme improved only the behavioural and emotional components as assessed on the ITSC. These results are similar to those of DeGangi et al.25 who found improvements in behaviour and emotional regulation in 36 month old children who received 12 weeks of intervention during infancy. These findings were not unexpected as the sensory diet was based on sensory strategies used to manage behaviour in occupational performance areas of dressing, bathing, feeding and sleeping1,6. The intervention activities focussed on providing calming and organising vestibular, proprioceptive and deep pressure stimuli.
Sensory processing and underlying modulation difficulties in the infants were not addressed in this study. The greater improvement seen in the younger group could also be attributed to the habit-formation around the behaviours being less established and the parents of the older infants being less willing to follow through with some strategies.
In this study, both the sample size and the short period of intervention limit the confidence of interpretation. Cohen's d effect size analysis was used to determine the size of difference between the total, pre and post-intervention scores30.
An effect size of more than 1 standard deviation was considered significant for this study, while an effect size of 0.5 standard deviation was seen as a moderate change. It also provided valuable information for current practice in South Africa regarding the lack of awareness of RSPD and knowledge of Ayres -Sensory Integration based occupational therapy as a therapeutic intervention to assist in managing this condition. The study showed that parents recognised children as being unusually fussy within a very short period after birth (75% before 6 weeks), but they did not recognise it as a condition which might require intervention.
Other health professionals did not recognise that unusual fussiness may be indicative of RSPD and therefore did not know how to advise parents or refer them to an occupational therapist. The fact that the diagnostic manual describing RSPD is not commonly used in South Africa contributes to this problem. Despite the fact that the results cannot be generalised before further research with a large sample, it may guide occupational therapy Sensory Integration practice to explore the use of similar strategies required for infants presenting with RSPD in clinical practice. The study suggested that infants presenting with high attachment and poor self-regulation scores may benefit from parent education and a sensory diet home programme to manage RSPD. Those presenting with specific and severe sensory-based processing difficulties may require individualised Sensory Integration therapy by a certified occupational therapist. Sensory integration and self regulatoin in infants and toddlers: helping very young children interact with their environment. International Classification of Diseases (ICD) International Statistical Classification of Diseases and Related Health Problems (10th ed). Nightime sleep-wake patterns and self soothing from birth to one year of age: a longitudinal interventions study. Prediction of childhood problems at three years in children experiencing disorders of regulation during infancy.

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