ADD or Sensory Integration? Tips for Differential Diagnosis

March 20th, 2010
By Jackie Zagrans, LMFT HCC Psychotherapist
Sensory processing disorders are often misdiagnosed as Attention-Deficit Disorder (ADD) or Attention-Deficit-Hyperactive Disorder (ADHD) because the behavioral symptoms can be very similar. However, it is important to know the true derivation of these symptoms so that the best interventions can be applied. Optimal treatments for the two disorders are different. If a child is dealing with sensory integration (SI) issues, interventions specific to those concerns can help keep him/ her off needless medication.
Sensory integration problems occur when a child cannot efficiently process information from the five senses: sound, sight, taste, smell, and touch. This sensory malfunction then has a negative impact on the development of skills in learning, behavior, and socialization. The “look alike” symptoms of Sensory Integration Dysunction and ADD/ADHD are typically seen as inattention, impulsivity, and fidgety movement. Some more specific signs of sensory integration disorders are below, though this is by no means an exhaustive list. There is an array of other behaviors that may be observed in children dealing with SI issues. Auditory
  • Responds negatively to unexpected or loud noises
  • Holds hands over ears
  • Cannot walk with background noise
  • Seems oblivious within an active environment
Visual
  • Prefers to be in the dark
  • Hesitates going up and down steps
  • Avoids bright lights
  • Stares intensely at people or objects
  • Avoids eye contact
Taste/Smell
  • Avoids certain tastes/ smells that are typically part of children's diets
  • Routinely smells nonfood objects
  • Seeks out certain tastes or smells
  • Does not seem to smell strong odors
Body Position
  • Continually seeks out all kinds of movement activities
  • Hangs on other people, furniture, objects, even in familiar situations
  • Seems to have weak muscles, tires easily, has poor endurance
  • Walks on toes
Movement
  • Becomes anxious or distressed when feet leave the ground
  • Avoids climbing or jumping
  • Avoids playground equipment
  • Seeks all kinds of movement which interferes with daily life
  • Takes excessive risks while playing; has no safety awareness
    • Touch
  • Avoids getting messy in glue, sand, finger paint, tape
  • Is sensitive to certain fabrics (clothing, bedding)
  • Touches people and objects at an irritating level
  • Avoids going barefoot, especially in grass or sand
  • Has decreased awareness of pain or temperature
Attention, Behavior & Social
  • Jumps from one activity to another frequently in a way that interferes with play
  • Has difficulty paying attention
  • Is overly affectionate with others
  • Seems anxious
  • Is accident prone
  • Has difficulty making friends; does not express emotions
If you recognize these behaviors in a child in your home, classroom, or office, it may be appropriate and advisable to have them evaluated for a Sensory Processing Disorder. An Occupational Therapist is typically the best resource for this type of evaluation and can be found through your child’s pediatrician. If the issues you are seeing really are related to Sensory Integration, the recommended interventions may include a “sensory diet”. A sensory diet is a schedule of certain activities for the child to complete throughout the day to help him/ her regulate sensory input. A thorough evaluation is the best way to determine if your child meets the criteria for a Sensory Processing Disorder. However, if you are interested in learning more, below are some useful resources:
  • Biel, Lindsey. Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues
  • Kranowitz, Carol. The Out of Synch Child
  • Miller, Lucy Jane. Sensational Kids: Hope and help for children with Sensory Processing Disorder