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===Other comorbidities===
===Other comorbidities===
Various conditions can involve SID, such as [[schizophrenia]],<ref name="Ross 2007">{{cite journal |author=Ross LA, Saint-Amour D, Leavitt VM, Molholm S, Javitt DC, Foxe JJ |title=Impaired multisensory processing in schizophrenia: deficits in the visual enhancement of speech comprehension under noisy environmental conditions |journal=Schizophr. Res. |volume=97 |issue=1-3 |pages=173–83 |year=2007 |month=December |pmid=17928202 |doi=10.1016/j.schres.2007.08.008 |url=}}</ref><ref name="Leavitt 2007">{{cite journal |author=Leavitt VM, Molholm S, Ritter W, Shpaner M, Foxe JJ |title=Auditory processing in schizophrenia during the middle latency period (10-50 ms): high-density electrical mapping and source analysis reveal subcortical antecedents to early cortical deficits |journal=J Psychiatry Neurosci |volume=32 |issue=5 |pages=339–53 |year=2007 |month=September |pmid=17823650 |pmc=1963354 |doi= |url=}}</ref><ref name="Rabinowicz 2000">{{cite journal |author=Rabinowicz EF, Silipo G, Goldman R, Javitt DC |title=Auditory sensory dysfunction in schizophrenia: imprecision or distractibility? |journal=Arch. Gen. Psychiatry |volume=57 |issue=12 |pages=1149–55 |year=2000 |month=December |pmid=11115328 |doi= |url=}}</ref> [[succinic semialdehyde dehydrogenase deficiency]],<ref name="Kratz 2009">{{cite journal |author=Kratz SV |title=Sensory integration intervention: historical concepts, treatment strategies and clinical experiences in three patients with succinic semialdehyde dehydrogenase (SSADH) deficiency |journal=J. Inherit. Metab. Dis. |volume=32 |issue=3 |pages=353–60 |year=2009 |month=June |pmid=19381864 |doi=10.1007/s10545-009-1149-1 |url=}}</ref>primary [[nocturnal enuresis]],<ref name="Tian 2008">{{cite journal |author=Tian YH, Cheng H |title=[Sensory integration function in children with primary nocturnal enuresis] |language=Chinese |journal=Zhongguo Dang Dai Er Ke Za Zhi |volume=10 |issue=5 |pages=611–3 |year=2008 |month=October |pmid=18947482 |doi= |url=}}</ref> [[prenatal alcohol exposure]], [[learning difficulties]]<ref name="Schneider 2008">{{cite journal |author=Schneider ML, Moore CF, Gajewski LL, ''et al.'' |title=Sensory processing disorder in a primate model: evidence from a longitudinal study of prenatal alcohol and prenatal stress effects |journal=Child Dev |volume=79 |issue=1 |pages=100–13 |year=2008 |pmid=18269511 |doi=10.1111/j.1467-8624.2007.01113.x |url=}}</ref> and [[autism]],<ref name="Lane 2010">{{cite journal |author=Lane AE, Young RL, Baker AE, Angley MT |title=Sensory processing subtypes in autism: association with adaptive behavior |journal=J Autism Dev Disord |volume=40 |issue=1 |pages=112–22 |year=2010 |month=January |pmid=19644746 |doi=10.1007/s10803-009-0840-2 |url=}}</ref><ref name="Tomchek 2007">{{cite journal |author=Tomchek SD, Dunn W |title=Sensory processing in children with and without autism: a comparative study using the short sensory profile |journal=Am J Occup Ther |volume=61 |issue=2 |pages=190–200 |year=2007 |pmid=17436841 |doi= |url=}}</ref><ref name="Kern 2007">{{cite journal |author=Kern JK, Trivedi MH, Grannemann BD, ''et al.'' |title=Sensory correlations in autism |journal=Autism |volume=11 |issue=2 |pages=123–34 |year=2007 |month=March |pmid=17353213 |doi=10.1177/1362361307075702 |url=}}</ref> as well as people with [[traumatic brain injury]]<ref name="Slobounov 2006">{{cite journal |author=Slobounov S, Tutwiler R, Sebastianelli W, Slobounov E |title=Alteration of postural responses to visual field motion in mild traumatic brain injury |journal=Neurosurgery |volume=59 |issue=1 |pages=134–9; discussion 134–9 |year=2006 |month=July |pmid=16823309 |doi=10.1227/01.NEU.0000219197.33182.3F |url=}}</ref> or who have had [[cochlear implant]]s placed.<ref name="Bharadwaj 2009">{{cite journal |author=Bharadwaj SV, Daniel LL, Matzke PL |title=Sensory-processing disorder in children with cochlear implants |journal=Am J Occup Ther |volume=63 |issue=2 |pages=208–13 |year=2009 |pmid=19432059 |doi= |url=}}</ref>


Children with FAS ([[Fetal Alcohol Syndrome]]) display many sensory integration problems.
Children with FAS ([[Fetal Alcohol Syndrome]]) display many sensory integration problems.


Version vom 19. Juli 2013, 03:07 Uhr

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Sensory processing disorder or SPD is a group of neurological disorders in which the person presents abnormalities in the neurological process known as multisensory integration. The fail to organize sensation coming from multiple modalities, such as proprioception, vision, auditory system, tactile, olfactory, vestibular, interoception, and taste results in difficulties in function. The capacity to use Multisensory integration in normal day function is called Sensory processing by Occupational therapy.

Previously known as Sensory Integration, Sensory processing was defined by Dr. 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". Hence, a sensory processing disorder is characterized by problems to organize sensation coming from the body and the environment and manifested by a significant difficulty in one of more of the main areas of occupation: productivity, leisure and play or activities of daily living. [1]

Classification

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Sensory processing disorders are classified into 3 broad categories: Sensory modulation disorder, Sensory based motor disorders and Sensory discrimination disorders.

  • Type I – Sensory modulation disorder
    • Subtypes: over-responsivity, under-responsivity and sensory craving (seeking)[2]
  • Type II – Sensory-based motor disorder
    • Subtypes: postural disorder, dispraxia
  • Type III – Sensory discrimination disorder
    • Subtypes: visual, auditory, tactile, taste/smell, position/movement, interoception

Sensory modulation disorder (SMD)

Over, or under responding to sensory stimuli or seeking sensory stimulation. Sensory modulation refers to a complex central nervous system process[3] by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted.

This group may include a fearful and/or anxious pattern, negative and/or stubborn behaviors, self-absorbed behaviors that are difficult to engage or creative or actively seeking sensation.[2]

Sensory-based motor disorder (SBMD)

Shows motor output that is disorganized as a result of incorrect processing of sensory information affecting postural control challenges and/or dyspraxia.

Sensory discrimination disorder (SDD)

Sensory discrimination or incorrect processing of sensory information. Incorrect processing of visual or auditory input, for example, may be seen in inattentiveness, disorganization, and poor school performance.

Causes

Current research in sensory processing is focusing on finding the neurological causes of SPD. EGG and Event-related potential are traditionally used to explore the causes behind the behaviors observed in SPD. Some of the proposed underlying causes by current research are:

  • 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, it has been observed the effect of prenatal stress on tactile avoidance, where prenatal stress significantly increased the avoidance.[6]

Signs and symptoms

Symptoms may vary according to the disorder's type and subtype present,

People suffering from over responsivity might:

  • Dislike textures in fabrics, foods, grooming products or other materials found in daily living, to which most people would not react to and this dislike interferes with normal function. Like a child who refuses to wear underwear or a grown up who is so "picky" he can't go to restaurants with friends.
  • Get so car sick they refuse to be in a moving vehicle.
  • Refuse to kiss or hug, not because they don't like the person, but because the sensation of skin contact can be very negative
  • Feel seriously discomforted, sick or threatened by normal sounds, lights, movements, smells, tastes, or even inner sensations as heartbeat.

Diagnosis

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Treatment

Sensory integration therapy

Several therapies have been developed to treat SPD. 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.[7] Although replicable treatments have been described and valid outcome measures are known, gaps exist in knowledge related to sensory integration dysfunction and therapy.[8] Empirical support is limited, therefore systematic evaluation is needed if these interventions are used.[9]

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).

Children with lower sensitivity (hyposensitivity) 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 heightened sensitivity (hypersensitivity) 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 tolerate and integrate 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 (Biel and Peske, 2005).[10][11] These may include selecting soft, tag-free clothing, avoiding fluorescent lighting, and providing ear plugs for "emergency" use (such as for fire drills).

There is a growing evidence base that points to and supports the notion that adults also show signs of sensory processing difficulties. In the United Kingdom early research and improved clinical outcomes for clients assessed as having sensory processing difficulties is indicating that the therapy may be an appropriate treatment (Urwin and Ballinger 2005)[12] for a range of presentations seen in adult clients including for those with Autism and Asperger's Syndrome, as well as adults with dyspraxia and some mental health difficulties [13] that therapists suggest may arise from the difficulties adults with sensory processing difficulties encounter trying to negotiate the challenges and demands of engaging in everyday life (Brown, Shankar and Smith 2006).[14]

Epidemiology

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History

was first described in-depth by occupational therapist Anna Jean Ayres (1920–1989), who defined sensory integration as the ability to organize sensory information for use by the brain. According to Ayres's writings, an individual with SID would, therefore, have a decreased ability to organize sensory information as it comes in through the senses.[15]

Relationship to other disorders

Autistic spectrum disorders and difficulties of sensory processing

Sensory processing disorder is a common comorbidity with autism spectrum disorders.[16] Although responses to sensory stimuli are more common and prominent in autistic children and adults, there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.[17] Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for seeking (for example, rhythmic movements).[18] The responses may be more common in children: a pair of studies found that autistic children had impaired tactile perception while autistic adults did not.[19]

SPD and ADHD

It is speculated that SPD may be a misdiagnosis for persons with attention problems. For example, a student who fails to repeat what has been said in class (due to boredom or distraction) might be referred for evaluation for sensory integration dysfunction. The student might then be evaluated by an occupational therapist to determine why he is having difficulty focusing and attending, and perhaps also evaluated by an audiologist or a speech-language pathologist for auditory processing issues or language processing issues. Similarly, a child may be mistakenly labeled "Attention deficit hyperactivity disorder (ADHD)" because impulsivity has been observed, when actually this impulsivity is limited to sensory seeking or avoiding. A child might regularly jump out of his seat in class despite multiple warnings and threats because his poor proprioception (body awareness) causes him to fall out of his seat, and his anxiety over this potential problem causes him to avoid sitting whenever possible. If the same child is able to remain seated after being given an inflatable bumpy cushion to sit on (which gives him more sensory input), or, is able to remain seated at home or in a particular classroom but not in his main classroom, it is a sign that more evaluation is needed to determine the cause of his impulsivity.

Other comorbidities

Various conditions can involve SID, such as schizophrenia,[20][21][22] succinic semialdehyde dehydrogenase deficiency,[23]primary nocturnal enuresis,[24] prenatal alcohol exposure, learning difficulties[6] and autism,[25][26][27] as well as people with traumatic brain injury[28] or who have had cochlear implants placed.[29]


Children with FAS (Fetal Alcohol Syndrome) display many sensory integration problems.

Children who receive the diagnosis of sensory integration dysfunction may also have signs of anxiety problems, ADHD, food intolerances, and behavioral disorders, as well as for autism, and may have genetic problems such as Fragile X syndrome. Sensory integration dysfunction is not considered to be on the autism spectrum, and a child can receive a diagnosis of sensory integration dysfunction without any comorbid conditions.

Because comorbid conditions are common with sensory integration issues, a child may have other conditions as well which make him or her reactive, "touchy", or unpredictable, and manifest in a manner similar to that characterized by occupational therapists as sensory integration dysfunction.

Controversy

Manuals

SPD is not yet recognized in standard medical manuals such as the ICD-10[30] or the DSM-IV-TR,[31] The American Psychiatric Association recently rejected SPD as a diagnosis to be included in the recently updated DSM-5.[32] but has included abnormalities in sensory modulation as the 4th main criteria for Autism diagnosis

On the other hand, SPD is in Stanley Greenspan’s Diagnostic Manual for Infancy and Early Childhood and as Regulation Disorders of Sensory Processing part of the The Zero to Three’s Diagnostic Classification.[33]

Misdiagnosis

Some state that sensory processing disorder is a distinct diagnosis, while others argue that differences in sensory responsiveness are features of other diagnoses.[34] The American Academy of Pediatrics, for example, advises against a diagnosis of SPD unless it is a symptom due to autism spectrum disorder, attention-deficit/hyperactivity disorder, developmental coordination disorder, or childhood anxiety disorder.[35] The neuroscientist David Eagleman has proposed that SPD may be a form of synesthesia, a perceptual condition in which the senses are blended.[36] 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".[37]

Researchers have described a treatable inherited sensory overstimulation disorder that meets diagnostic criteria for both attention deficit disorder and sensory integration dysfunction.[38]

Research

Recent research by Owen and colleagues (2013)[39] at the University of California, San Francisco have found a neurological difference in children with SPD, compared to normal children and those with other neurological disorders such as autism and ADHD.

Additionally, over 130 articles on sensory integration have been published in peer-reviewed (mostly occupational therapy) journals. The difficulties of designing double-blind research studies of sensory integration dysfunction have been addressed by Temple Grandin and others. More research is needed.

Because the amount of research regarding the effectiveness of SPD therapy is limited and inconclusive, the American Academy of Pediatrics advises pediatricians to inform families about these limitations, talk with families about a trial period for SPD therapy, and teach families how to evaluate therapy effectiveness.[35]

See also

References

Vorlage:Reflist

Vorlage:Pervasive developmental disorders Vorlage:Autism resources Vorlage:Autism films

  1. ↑ Sensory Processing Disorder Explained. SPD Foundation;
  2. ↑ a b James K, Miller LJ, Schaaf R, Nielsen DM, Schoen SA: Phenotypes within sensory modulation dysfunction. In: Compr Psychiatry. 52. Jahrgang, Nr. 6, 2011, S. 715–24, doi:10.1016/j.comppsych.2010.11.010, PMID 21310399 (spdfoundation.net [PDF]).
  3. ↑ Schaaf RC, Benevides T, Blanche EI, et al.: Parasympathetic functions in children with sensory processing disorder. In: Front Integr Neurosci. 4. Jahrgang, 2010, S. 4, doi:10.3389/fnint.2010.00004, PMID 20300470, PMC 2839854 (freier Volltext) – (spdfoundation.net [PDF]).
  4. ↑ Davies PL, Chang WP, Gavin WJ: Maturation of sensory gating performance in children with and without sensory processing disorders. In: Int J Psychophysiol. 72. Jahrgang, Nr. 2, Mai 2009, S. 187–97, doi:10.1016/j.ijpsycho.2008.12.007, PMID 19146890, PMC 2695879 (freier Volltext).
  5. ↑ Kisley MA, Noecker TL, Guinther PM: Comparison of sensory gating to mismatch negativity and self-reported perceptual phenomena in healthy adults. In: Psychophysiology. 41. Jahrgang, Nr. 4, Juli 2004, S. 604–12, doi:10.1111/j.1469-8986.2004.00191.x, PMID 15189483 (spdfoundation.net [PDF]).
  6. ↑ a b Schneider ML, Moore CF, Gajewski LL, et al.: Sensory processing disorder in a primate model: evidence from a longitudinal study of prenatal alcohol and prenatal stress effects. In: Child Dev. 79. Jahrgang, Nr. 1, 2008, S. 100–13, doi:10.1111/j.1467-8624.2007.01113.x, PMID 18269511 (sinetwork.org [PDF]). Referenzfehler: Ungültiges <ref>-Tag. Der Name „Schneider 2008“ wurde mehrere Male mit einem unterschiedlichen Inhalt definiert.
  7. ↑ Baranek GT: Efficacy of sensory and motor interventions for children with autism. In: J Autism Dev Disord. 32. Jahrgang, Nr. 5, 2002, S. 397–422, doi:10.1023/A:1020541906063, PMID 12463517.
  8. ↑ Schaaf RC, Miller LJ: Occupational therapy using a sensory integrative approach for children with developmental disabilities. In: Ment Retard Dev Disabil Res Rev. 11. Jahrgang, Nr. 2, 2005, S. 143–8, doi:10.1002/mrdd.20067, PMID 15977314.
  9. ↑ Hodgetts S, Hodgetts W: Somatosensory stimulation interventions for children with autism: literature review and clinical considerations. In: Can J Occup Ther. 74. Jahrgang, Nr. 5, 2007, S. 393–400, doi:10.2182/cjot.07.013, PMID 18183774.
  10. ↑ Nancy Peske; Lindsey Biel: Raising a sensory smart child: the definitive handbook for helping your child with sensory integration issues. Penguin Books, New York 2005, ISBN 0-14-303488-X.
  11. ↑ Sensory Checklist. In: Raising a Sensory Smart Child. Abgerufen am 16. Juli 2013.
  12. ↑ Urwin R, Ballinger C.: The Effectiveness of Sensory Integration Therapy to Improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs. In: Brit J. Occupational Therapy. 68. Jahrgang, Nr. 2, Februar 2005, S. 56–66 (ingentaconnect.com).
  13. ↑ Stephen Brown, Rohit Shankar, Kathryn Smith: Borderline personality disorder and sensory processing impairment. In: Progress in Neurology and Psychiatry. 13. Jahrgang, Nr. 4, 2009, ISSN 1367-7543, S. 10–16, doi:10.1002/pnp.127.
  14. ↑ Brown S, Shankar R, Smith K, et al. Sensory Processing Disorder in mental health. Occupational Therapy News 2006;May:28-29.
  15. ↑ Ayres, A. J. (2005). Sensory Integration and the Child: 25th Anniversary Edition. Los Angeles, CA: Western Psychological Services.
  16. ↑ Russo N, Foxe JJ, Brandwein AB, Altschuler T, Gomes H, Molholm S: Multisensory processing in children with autism: high-density electrical mapping of auditory-somatosensory integration. In: Autism Res. 3. Jahrgang, Nr. 5, Oktober 2010, S. 253–67, doi:10.1002/aur.152, PMID 20730775.
  17. ↑ Rogers SJ, Ozonoff S: Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence. In: J Child Psychol Psychiatry. 46. Jahrgang, Nr. 12, 2005, S. 1255–68, doi:10.1111/j.1469-7610.2005.01431.x, PMID 16313426.
  18. ↑ Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E: A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. In: J Autism Dev Disord. 39. Jahrgang, Nr. 1, 2008, S. 1–11, doi:10.1007/s10803-008-0593-3, PMID 18512135.
  19. ↑ Williams DL, Goldstein G, Minshew NJ: Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing. In: Child Neuropsychol. 12. Jahrgang, Nr. 4–5, 2006, S. 279–98, doi:10.1080/09297040600681190, PMID 16911973, PMC 1803025 (freier Volltext).
  20. ↑ Ross LA, Saint-Amour D, Leavitt VM, Molholm S, Javitt DC, Foxe JJ: Impaired multisensory processing in schizophrenia: deficits in the visual enhancement of speech comprehension under noisy environmental conditions. In: Schizophr. Res. 97. Jahrgang, Nr. 1-3, Dezember 2007, S. 173–83, doi:10.1016/j.schres.2007.08.008, PMID 17928202.
  21. ↑ Leavitt VM, Molholm S, Ritter W, Shpaner M, Foxe JJ: Auditory processing in schizophrenia during the middle latency period (10-50 ms): high-density electrical mapping and source analysis reveal subcortical antecedents to early cortical deficits. In: J Psychiatry Neurosci. 32. Jahrgang, Nr. 5, September 2007, S. 339–53, PMID 17823650, PMC 1963354 (freier Volltext).
  22. ↑ Rabinowicz EF, Silipo G, Goldman R, Javitt DC: Auditory sensory dysfunction in schizophrenia: imprecision or distractibility? In: Arch. Gen. Psychiatry. 57. Jahrgang, Nr. 12, Dezember 2000, S. 1149–55, PMID 11115328.
  23. ↑ Kratz SV: Sensory integration intervention: historical concepts, treatment strategies and clinical experiences in three patients with succinic semialdehyde dehydrogenase (SSADH) deficiency. In: J. Inherit. Metab. Dis. 32. Jahrgang, Nr. 3, Juni 2009, S. 353–60, doi:10.1007/s10545-009-1149-1, PMID 19381864.
  24. ↑ Tian YH, Cheng H: [Sensory integration function in children with primary nocturnal enuresis]. In: Zhongguo Dang Dai Er Ke Za Zhi. 10. Jahrgang, Nr. 5, Oktober 2008, S. 611–3, PMID 18947482 (chinesisch).
  25. ↑ Lane AE, Young RL, Baker AE, Angley MT: Sensory processing subtypes in autism: association with adaptive behavior. In: J Autism Dev Disord. 40. Jahrgang, Nr. 1, Januar 2010, S. 112–22, doi:10.1007/s10803-009-0840-2, PMID 19644746.
  26. ↑ Tomchek SD, Dunn W: Sensory processing in children with and without autism: a comparative study using the short sensory profile. In: Am J Occup Ther. 61. Jahrgang, Nr. 2, 2007, S. 190–200, PMID 17436841.
  27. ↑ Kern JK, Trivedi MH, Grannemann BD, et al.: Sensory correlations in autism. In: Autism. 11. Jahrgang, Nr. 2, März 2007, S. 123–34, doi:10.1177/1362361307075702, PMID 17353213.
  28. ↑ Slobounov S, Tutwiler R, Sebastianelli W, Slobounov E: Alteration of postural responses to visual field motion in mild traumatic brain injury. In: Neurosurgery. 59. Jahrgang, Nr. 1, Juli 2006, S. 134–9; discussion 134–9, doi:10.1227/01.NEU.0000219197.33182.3F, PMID 16823309.
  29. ↑ Bharadwaj SV, Daniel LL, Matzke PL: Sensory-processing disorder in children with cochlear implants. In: Am J Occup Ther. 63. Jahrgang, Nr. 2, 2009, S. 208–13, PMID 19432059.
  30. ↑ ICD 10.
  31. ↑ APA Diagnostic Classification DSM-IV-TR | BehaveNet.
  32. ↑ American Psychiatric Association Board of Trustees Approves DSM-5. Abgerufen am 15. Juli 2013.
  33. ↑ Infants and Toddlers Who Require Specialty Services and Supports. (pdf) In: Department of Community Health—Mental Health Services to Children and Families.
  34. ↑ Joanne Flanagan: Sensory processing disorder. In: Pediatric News. Kennedy Krieger.org, 2009;.
  35. ↑ a b Sensory Integration Therapies for Children With Developmental and Behavioral Disorders. Pediatrics: Official Journal of the American Academy of Pediatrics;
  36. ↑ Cytowic RE and Eagleman DM (2009). Wednesday is Indigo Blue: Discovering the Brain of Synesthesia. Cambridge: MIT Press.
  37. ↑ The blended senses of synesthesia, Los Angeles Times, Feb 20, 2012.
  38. ↑ Segal MM, Rogers GF, Needleman HL, Chapman CA: Hypokalemic sensory overstimulation. In: J Child Neurol. 22. Jahrgang, Nr. 12, 2007, S. 1408–10, doi:10.1177/0883073807307095, PMID 18174562.
  39. ↑ Julia P. Owen, Elysa J. Marco, Shivani Desai, Emily Fourie, Julia Harris, Susanna S. Hill, Anne B. Arnett, Pratik Mukherjee: Abnormal white matter microstructure in children with sensory processing disorders. In: NeuroImage: Clinical. 2. Jahrgang, 2013, ISSN 2213-1582, S. 844–853, doi:10.1016/j.nicl.2013.06.009.
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