Understanding sensory integration therapy
While sensory processing challenges are commonly associated with pediatric practice, sensory issues in adults and, specifically, sensory integration dysfunction in adults represent a significant, though often overlooked, area of clinical concern.
Many children with sensory processing difficulties transition into adulthood with persistent challenges, as these neurological differences typically require lifelong management rather than resolution.
For mental health therapists, speech-language pathologists (SLPs), and occupational therapists (OTs) working in private practice, understanding adult sensory processing can unlock new treatment approaches and improve client outcomes across diverse populations.
Summary
Sensory integration dysfunction in adults affects daily functioning, relationships, and occupational performance, yet remains under-recognized in clinical practice compared to pediatric sensory processing challenges.
Adults with sensory issues experience hyper-responsivity (over-sensitivity), hypo-responsivity (under-sensitivity), or discrimination difficulties across eight sensory systems, often manifesting as workplace struggles, anxiety, or relationship challenges.
Sensory processing disorder (SPD) in adults is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) but frequently co-occurs with autism, ADHD, anxiety, and PTSD, requiring interdisciplinary assessment using tools like the Sensory Profile-2 and clinical observation.
Evidence-based interventions include environmental modifications, sensory integration therapy, cognitive-behavioral approaches, structured sensory diets, and assistive technology to help adults manage sensory challenges effectively.
Practitioners should prioritize comprehensive sensory histories, functional impact assessments, and collaborative treatment planning while advocating for workplace accommodations and family education to support long-term success.
Understanding sensory integration and processing
Sensory integration dysfunction in adults occurs when the brain struggles to effectively receive, organize, and respond to sensory information from both the body and environment. This fundamental neurological process affects how adults navigate daily activities, relationships, and occupational demands.
The theoretical foundation for understanding sensory processing was established by Jean Ayres, PhD, OTR, in the 1950s-70s, with significant contributions from practitioners like Winnie Dunn, OTR, FAOTA, and Lucy J. Miller, PhD, OTR, continuing through the late 1970s and beyond.
These models examine how the brain interprets sensory information and its profound impact on learning, behavior, and functional performance.
The eight sensory systems
Contemporary sensory processing frameworks recognize eight distinct sensory systems:
Proprioception: Body position and spatial awareness
Vestibular: Balance, coordination, and movement processing
Interoception: Internal body signals and physiological awareness
Tactile: Touch perception and discrimination
Visual: Light, color, and spatial processing
Auditory: Sound processing and discrimination
Gustatory: Taste perception
Olfactory: Smell processing
Recognizing sensory issues in adults
Sensory issues in adults manifest differently than in children, often presenting as seemingly unrelated challenges in work performance, relationship difficulties, or unexplained anxiety and stress responses.
Adult clients may not recognize that their struggles stem from sensory processing differences, instead attributing difficulties to personality traits or moral failings.
Hyper-responsivity patterns
Adults with sensory over-responsivity demonstrate heightened sensitivity to environmental stimuli:
Tactile hypersensitivity in adults may include:
Extreme discomfort with clothing textures, tags, or seams
Avoidance of physical contact or specific fabrics
Difficulty tolerating medical or dental procedures
Pain or distress from light touch that others find pleasant
Auditory hypersensitivity often presents as:
Overwhelm in restaurants, shopping centers, or open office environments
Difficulty filtering background noise during conversations
Physical pain or anxiety from sudden or loud sounds
Need for quiet environments to concentrate effectively
Visual sensitivity may manifest through:
Discomfort with fluorescent lighting or bright environments
Preference for dimly lit spaces
Difficulty with busy visual patterns or crowded spaces
Eye strain and headaches in typical lighting conditions
Hypo-responsivity patterns
Adults with sensory under-responsivity seek additional sensory input:
Tactile-seeking behaviors include:
Preference for tight-fitting clothing or weighted blankets
Enjoyment of deep pressure activities like massage
Fidgeting or need for tactile stimulation during focus tasks
Difficulty registering light touch or temperature changes
Movement seeking may present as:
Preference for intense physical activities or amusement park rides
Restlessness in sedentary work environments
Better concentration while moving or standing
Seeking activities with vestibular input
Sensory discrimination challenges
Symptoms of sensory processing disorder in adults often include difficulty distinguishing between similar sensory experiences.
For example, sensory challenges may include:
Inconsistent force regulation, leading to broken items or overly gentle handshakes
Difficulty focusing when multiple conversations occur simultaneously
Challenges with fine motor tasks requiring precise pressure
Problems with spatial awareness in crowded environments
Clinical considerations
The distinction between sensory processing disorder adults experience and typical sensory preferences is crucial for clinical practice.
While many adults have sensory preferences (such as disliking certain textures or sounds), SPD in adults significantly disrupts daily functioning.
Diagnostic complexity
Sensory processing disorder symptoms in adults present unique diagnostic challenges.
SPD is not recognized as a standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which creates barriers for insurance coverage and standardized treatment approaches.
That said, sensory processing difficulties frequently co-occur with recognized conditions including:
Autism spectrum disorders
ADHD
Anxiety disorders
PTSD
Depression
Chronic pain conditions
Functional impact assessment
When evaluating sensory integration dysfunction in adults, consider how sensory challenges affect the following areas.
Occupational performance:
Workplace productivity and comfort
Career choices and advancement opportunities
Ability to work in team environments
Social relationships:
Intimate partnerships and physical closeness
Social gatherings and community participation
Family dynamics and parenting challenges
Daily living activities:
Self-care routines and personal hygiene
Meal preparation and eating behaviors
Sleep quality and bedroom environment
Shopping and errands in sensory-rich environments
Assessment strategies for practitioners
Clinical observation techniques
Systematic observation during intake sessions can reveal sensory issues in adults:
Note client's positioning, movement patterns, and environmental preferences
Observe responses to office lighting, sounds, and textures
Document self-regulation strategies the client employs
Watch for signs of sensory overwhelm or seeking behaviors
Standardized assessment tools
Sensory integration therapy requires thorough assessment using validated instruments, such as:
Sensory Profile-2 Adult/Adolescent: Provides comprehensive sensory processing patterns across daily activities and environments.
Sensory Processing Measure (SPM): Offers multi-environment assessment including home, work, and community settings.
Sensory Integration and Praxis Tests (SIPT): Requires specialized training but provides detailed analysis of sensory integration and motor planning abilities.
Collaborative assessment approaches
Effective assessment of sensory integration dysfunction in adults often requires interdisciplinary collaboration:
Medical professionals for ruling out underlying conditions
Mental health providers for diagnosing co-occurring anxiety or mood disorders
Occupational therapists for functional capacity evaluation
Speech-language pathologists for oral-motor and auditory processing concerns
Evidence-based intervention strategies
Environmental modifications
Creating sensory-friendly environments can help to address sensory issues in adults through:
Lighting adjustments:
Replacing fluorescent bulbs with full-spectrum or LED alternatives
Adding task lighting and dimmer controls
Positioning workstations away from windows or bright lights
Acoustic modifications:
Installing sound-absorbing materials in therapy spaces
Using white noise machines or nature sounds
Creating quiet zones for sensitive individuals
Tactile considerations:
Offering various seating options including stability balls or cushions
Providing fidget tools and textured objects
Ensuring comfortable room temperature and air circulation
Specific interventions for tactile sensitivity in adults
For adults with tactile sensitivity, graduated exposure and desensitization approaches prove effective, including:
Systematic desensitization protocols:
Begin with preferred textures and gradually introduce challenging ones
Use self-directed exploration rather than imposed touch
Combine tactile experiences with calming activities
Progress at the individual's pace with clear consent
Adaptive strategies:
Identify clothing brands and styles that provide comfort
Develop personal care routines that minimize tactile distress
Create tactile emergency kits for unexpected sensory challenges
Cognitive and behavioral interventions
Sensory integration therapy increasingly incorporates cognitive-behavioral approaches:
Mindfulness-based interventions include:
Body awareness meditation to improve interoceptive skills
Breathing techniques for sensory overwhelm management
Progressive muscle relaxation for hyper-arousal states
Cognitive restructuring is the process of:
Identifying and challenging sensory-related catastrophic thoughts
Developing realistic expectations for sensory experiences
Building self-advocacy skills for environmental needs
Sensory diet development
Structured sensory “diets” help adults with SPD maintain optimal arousal levels throughout the day.
Morning activation strategies include:
Joint compression exercises or yoga
Aromatherapy with alerting scents
Textured breakfast foods or crunchy snacks
Brief cold water exposure
Midday regulation techniques include:
Proprioceptive activities like wall push-ups
Fidget tools during meetings or focused work
Noise-canceling headphones in overwhelming environments
Evening calming routines may include:
Weighted blankets or compression garments
Warm baths with Epsom salts
Gentle stretching or yoga
Dim lighting and reduced sensory stimulation
Technology and assistive tools
Modern technology offers innovative solutions for sensory integration dysfunction in adults.
Wearable devices that may be helpful for adults with sensory issues include:
Noise-canceling headphones with adaptive sound control
Smartwatches with vibration alerts for interoceptive awareness
Compression garments with variable pressure settings
Environmental control systems include:
Smart lighting that adjusts throughout the day
Air purifiers for scent-sensitive individuals
Apps for monitoring and managing sensory exposure
Communication tools that may be helpful include:
Sensory break reminder apps
Environmental noise measuring devices
Social scripts for requesting sensory accommodations
Working with families and support systems
Sensory integration dysfunction in adults affects not only the individual, but their entire support network.
Education and support for family members should address:
Partner and spouse education
Understanding sensory needs as neurological differences, not preferences
Learning to recognize early signs of sensory overwhelm
Developing household routines that accommodate sensory needs
Creating intimate relationships that respect sensory boundaries
Workplace accommodations
Flexible seating arrangements and workspace modifications
Modified lighting or noise levels when possible
Break schedules that allow for sensory regulation
Work-from-home options for sensory-sensitive days
Research developments and future directions
Current research in sensory integration dysfunction in adults focuses on:
Neuroplasticity studies: Investigating how sensory integration therapy can promote brain changes throughout the lifespan.
Comorbidity research: Examining relationships between sensory processing challenges and mental health conditions.
Technology integration: Developing virtual reality and biofeedback tools for sensory training.
Outcome measurement: Creating standardized tools for measuring intervention effectiveness in adult populations.
Clinical recommendations and takeaways
For practitioners working with sensory integration dysfunction in adults, consider the following:
Assessment priorities
Conduct comprehensive sensory histories including childhood experiences
Use standardized tools alongside clinical observation
Assess functional impact across life domains
Consider comorbid conditions and their sensory components
Intervention planning
Prioritize client-identified goals and functional outcomes
Integrate sensory strategies into existing therapeutic approaches
Address environmental factors alongside individual interventions
Monitor progress through objective measures and subjective reports
Professional development
Pursue specialized training in adult sensory processing assessment
Develop collaborative relationships with occupational therapists trained in sensory integration
Stay current with emerging research and evidence-based practices
Advocate for increased awareness and recognition of adult sensory processing needs
Understanding sensory issues in adults opens new pathways for therapeutic intervention and client support.
By recognizing sensory processing as a fundamental aspect of the human experience that continues throughout the lifespan, practitioners can provide more comprehensive, effective care that addresses the root causes of many seemingly unrelated difficulties.
The growing recognition of sensory integration dysfunction in adults represents an important shift in therapeutic practice.
As research continues to expand our understanding of these neurological differences, practitioners have increasing opportunities to provide targeted, effective interventions that significantly improve quality of life for adult clients with sensory processing challenges.
Sources
Ayres, A. Jean. (1971). Characteristics of types of sensory integrative dysfunction. American Journal of Occupational Therapy
Costa-López, Beatriz, Ferrer-Cascales, Rosario, Ruiz-Robledillo, Natalia, Albaladejo-Blázquez, Natalia, & Baryła-Matejczuk, Monika. (2021). Relationship between sensory processing and quality of life: A systematic review. Journal of Clinical Medicine
Gomez, Ivory N., & Medallon, Karen G. (2022). Assessing sensory processing in adults. Current Developmental Disorders Reports
Lane, Shelly J., Mailloux, Zoe, Schoen, Sarah, Bundy, Anita, May-Benson, Teresa A., Parham, L. Diane, Smith Roley, Susanne, & Schaaf, Roseann C. (2019). Neural foundations of Ayres sensory integration®. Brain Sciences
Metz, Alecia E., Boling, Dana, DeVore, Ashley, Holladay, Heather, Liao, Jun F., & Vlutch, Kristina V. (2019). Dunn's model of sensory processing: An investigation of the axes of the four-quadrant model in healthy adults. Brain Sciences
SPIRAL Foundation. (n.d.). Sensory processing in adults.
STAR Institute for Sensory Processing. Sensory processing disorder.
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