Sensory processing is a general term that refers to the continuum of interaction in which neurological processing of sensory input affects behavioral response. Broadly, it concerns the way that sensory inputs (auditory, visual, tactile, gustatory, olfactory, proprioceptive, and vestibular) are received, modulated, discriminated, and organized into a behavioral response.1 Sensory processing difficulties can be seen across the age spectrum, from children to young adults with a high prevalence observed in certain patient populations, such as those with autism spectrum disorder (ASD), Down syndrome, prematurity, attention-deficit/hyperactivity disorder (ADHD), and fetal alcohol syndrome.2,3,4,5 What this means for us as medical providers are that across all specialties, we are bound to encounter these patients within our practice, whether it be in the clinic, emergency department (ED), or in the inpatient setting. These patients can have varied sensory difficulties that can range from hypersensitivity to certain inputs (for instance, loud noises, bright lights, or tags on hospital gowns) to difficulty with proprioceptive and vestibular input (manifesting as constant jumping or rocking). They may also have difficulties with filtering irrelevant environmental stimuli that subsequently leads to an overwhelming experience and sensory overload. Often, these behaviors are magnified when the patient is feeling unwell, and in a new environment. A visit to the clinic or hospital is often a change in the patient’s normal routine and leads to continuous exposure to not just new but different interactions (from reception, nurses, therapists to physicians), procedures, and sensory stimuli. To compound the situation, often these individuals may have additional limitations in their social and communication skills decreasing their ability to convey their challenges to providers.

Take for instance this encounter: J.K. was an 8-year-old patient with a history of prematurity and ASD who presented to the ED with a chief complaint of fever. While he waited to be triaged in the crowded waiting room, he began to cup his ears and rocked in the chair. By the time he was brought to the exam room, he was combative and refused to be still for an intravenous (IV) catheter placement. In the end, three additional staff members were called in to restrain him while the IV was placed. The mother later reported that he was sensitive to loud noises and bright lights, and that his level of agitation was atypical.

The unfamiliar setting, bombardment of new and different sensory inputs during an illness can often lead to a situation of sensory overload. For these patients, such can present as maladaptive behaviors, including hostility and violence towards self and others. Sensory processing difficulties have also been linked to anxiety, and can be particularly stressful for the nonverbal patient who lacks the ability to express their anxiety effectively. Families and individuals with special needs often report worse provider–patient interaction and overall patient experience. The environment in which patients are seeking medical help as well as their acute illness combines to exacerbate their underlying sensory difficulties, leading to a confusing and more challenging clinical presentations.

To meet the unique needs of patients with sensory processing difficulties, we need to reframe our mindset from being reactive to being proactive. Often in the case of these patients, the focus is on their presenting medical symptom, and no procedure is in place to address the sensory difficulties. It is only when the patient has a maladaptive response that actions are taken to de-escalate the situation. In contrast, by being proactive, preemptive steps are taken early on to guard against sensory overload. In order to be proactive, providers and healthcare organizations need to have an awareness of the prevalence of sensory processing difficulties. By recognizing sensory issues early, specific triggers, preferences, and communication strategies can be identified and these insights used to optimize care delivery. For instance, in the case of J.K., by eliciting the information that he is highly sensitive to noise and light, the provider may strategically place him in a quieter room, and dim the lights, or offer J.K. a noise cancelling headphone. In another example, for a patient who is highly sensitive to certain tactile input, the provider may elect to allow the patient to wear in his or her own outfit vs. insisting that the patient wear a hospital gown.

Early identification will also allow the provider to plan the care team in order to limit the number of new personnel encounters. It is important to inquire about the patient’s preferred communication method, whether it is via verbal language, via an assistive communication device, or by using visual cue cards. For patients with limited verbal skills, it is equally important to address and speak to them (vs. only with the caregiver) as it signals to the patients that they are competent and can participate in their healthcare visit.

Sensory tools should be made available, and used according to the individual patient’s need and preferences. Example of tools include noise cancelling headphones for auditory sensitivities, “fidget tools” for tactile needs, and light spinners for those in need of visual stimulation. In addition, “social stories,” which are stories describing a particular encounter or procedure (for instance IV catheter placement) can be used to precondition the patient to an experience, and potentially reducing his or her level of anxiety. One should strongly consider involving allied professionals (i.e., child life services, social services, etc.) in the care of the patient from the outset.

In conclusion, sensory processing difficulties are prevalent and providers across disciplines will encounter these patients in varied settings. These patients will manifest behaviors in response to real-world stimulation that is magnified when they are ill, adding complexity to clinical presentations that can potentially complicate and become barriers to timely medical diagnosis and management. Having an awareness of sensory processing difficulties in our patients allows us to be equipped to integrate the information and observation of our patients that is in addition to their presenting illness. It will enable us to determine the extent to which sensory inputs are posing a hindrance to patient management, and guide our approach for optimized care delivery. By shifting our mindset and taking a proactive approach both personally and organizationally, we have the potential to mitigate some of these challenges, and along the way, improve patient care delivery and experience.