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.

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