Invited Commentary on Sensory Sensitivities of Gifted Children

Winnie Dunn

KEY WORDS gifted,child interpersonalrelations mentalprocesses problemsolving sensation

This commentary provides an analysis of an article by Gere, Capps, Mitchell, and Grubbs (2009) about sensory sensitivities of gifted children. The article reports that children who are gifted are more sensitive to sensory experiences. Researchers hypothesized that childrens sensitivities contribute to their excellent problem-solving skills and might contribute to their challenges with social interaction. The coexistence of a helpful and challenging characteristic that may be related to sensory sensitivity suggests the need for additional intervention paradigms that support all aspects of childrens participation. The Gere et al. (2009) study invites occupational therapists to consider broader perspectives about who would benefit from services and how we might provide services in a school context. This article offers suggestions that would strengthen future studies with gifted children and outlines strategies for evidence-based practice that include children who are gifted.
Dunn, W. (2009). Invited commentary on Sensory sensitivities of gifted children. American Journal of Occupational Therapy, 64, 296300.

Winnie Dunn, PhD, OTR, FAOTA, is Professor and Chair, Department of Occupational Therapy Education, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160; wdunn@kumc.edu

ere, Capps, Mitchell, and Grubbs (2009) present an interesting study in which they apply concepts of sensory processing to the gifted population. By studying a group of 80 children classified as gifted, the authors illustrate how to apply occupational therapy knowledge to everyone, not just to those who are classified with specific disabilities. In doing so, they invite us to think expansively about our contributions to research, knowledge development, and practice. Gere et al. (2009) provide a brief but informative literature review that points out some of the critical issues that arise when serving children who are gifted. They describe children who are gifted as more sensitive and responsive than others, leading to greater perceptual processing; some authors have concluded that this sensitivity contributes to gifted childrens superior performance (e.g., Helmbold, Troche, & Rammsayer, 2006; Li, Jordanova, & Lindenberger, 1998). Other authors (e.g., Roedell, 1984; Silverman, 1997) have suggested that intense sensitivity to the environment might also create a vulnerability resulting from an overload of information that can contribute to challenges with their social interactions. Gere et al. (2009) hypothesize that knowing more about gifted childrens sensory-processing patterns might contribute to understanding the factors that facilitate superior problem solving or that interfere with socialization.

TheStudysDesign
As with any study, some aspects of design would make the study stronger. Researchers weigh these factors each time they create and conduct a study. We might wonder why researchers do not include design features that would make their studies stronger, but many legitimate reasons exist. For example, a change in study design might make the study too long to carry out within particular time contraints, or the cost of an alternate
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study design might be prohibitive. Researchers might also not have access to cohorts of participants. Sometimes, the expertise or tools needed to complete the alternative design are not available. In some investigations, additional design features might distract from a primary study question or, in the case of preliminary work, might be premature. Science builds systematically, and several small and effective steps can be more helpful to knowledge development than one large study that risks obscuring the core investigation. With all these factors in mind, and with full understanding that the Gere et al. (2009) study has made a good first-step contribution to knowledge about both education and occupational therapy, I offer some considerations about what would make future studies like this one stronger. Selecting the Comparison Group The researchers compare their group of 80 children to the Sensory Profiles (Dunn, 1999) normative sample. Using the normative sample is a practical strategy because the cut scores (which are based on the standard deviation points above and below the mean) can easily provide an indication of whether a group of children is more like or different from their peers. If a particular group (in this case, children who are gifted) clusters between 1 and 2 standard deviations from the mean, we document that the group pattern indicates that they engage in certain behaviors more than their peers. The study would have been stronger if Gere et al. (2009) had used an exact comparison group. With raw scores from each group, calculations of difference would have allowed a more exacting comparison. Gere et al.s (2009) first analysis compared the means of the two study groups. When researchers compare only mean scores, loss of consideration for the samples variability results. For example, two samples can have the same mean score but different variability (as represented by the standard deviations of each distribution). Many groups of children with disabilities are heterogeneous even though they have the same overarching diagnosis, and yet their wide range of performance distinguishes them from children without disabilities, who tend to be more homogeneous on the sensory-processing variables considered in this study. Comparing samples on raw scores provides the opportunity to calculate both the mean and the standard deviation, which enables researchers to know both the central tendency and the variability of each sample. For some samples, the variability is what marks them as different from a typical population. Considering the Sources for Inclusion Criteria Gere et al. (2009) used school records to determine childrens eligibility for the study. This example is a practical design decision because some scientists would require separate testing to verify the childrens gifted status. If we consider that
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the researchers wanted to characterize the sensory-processing patterns in a group of gifted school-age children, their decision to accept the schools designation may be reasonable. As therapists, we work in many public schools that have different populations and criteria for selecting children; studies that situate themselves in that context ought to reflect the public school milieu. Would the study have been technically stronger by controlling the assessment of giftedness? Yes. Was it necessary for the findings of this preliminary study? I would argue that it was not. The researchers found significant differences even with less control, so one might look back on this study and say that the findings are more generalizable because they reported but did not control all of the factors that might influence the study findings.

ImplicationsoftheFindings
I have a multifaceted positive experience when I see interdisciplinary colleagues reporting their findings in an occupational therapy journal. This action suggests that they have used the occupational therapy literature to inform their work and value perspectives unique to occupational therapy. Gere et al.s (2009) submission to the American Journal of Occu pational Therapy is an acknowledgment that we would find their study informative to our work as well. I hope their contribution serves as an invitation to all readers to find related research in interdisciplinary journals (dont you want to know what else these authors have been finding?). Lets consider what meaning this study may have for occupational therapy practice and interdisciplinary research in the future. Sensory-Processing Patterns Reflect a Human Experience, Not a Disability Experience The cut scores on the Sensory Profile (Dunn, 1999) were established on a national sample of children without disabilities, using the standard deviations as the cut scores for each subtest. This approach suggests that we would expect to see approximately 68% of the population perform in the midrange of any subtest (i.e., 1 standard deviation to +1 standard deviation). It also suggests that even in the typical population, some children will engage in the behaviors on the Sensory Profile more than do their peers (i.e., their scores will be >1 standard deviation from the mean score). We experience this occurrence in our everyday lives when we encounter family or friends who are overly sensitive to sounds, spend more time seeking out touch experiences, or avoid movementor when we have these characteristics ourselves. The fact that some people can experience sensory events more intensely than others and that the Sensory Profile scores can document their significant differences suggests that a more-than-others score alone is not enough to
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indicate a disorder. In addition to having differences in sensory processing patterns from the majority of people, people must have sensory experiences that interfere with their everyday lives for their behavior to be considered maladaptive. When we consider the data provided by Gere et al. (2009), we see that the children who are gifted have many more than others scores than the national sample. This studys findings are consistent with the observation in the literature that children who are gifted tend to have more intense sensory experiences than their peers. With these data alone, however, we cannot know how their sensory-processing patterns affect their everyday lives. To address the need for the connection between sensory-processing patterns and participation in everyday life, Gere et al. (2009) suggest two possible links. First, there may be a link between the social skills challenges and the intense sensory-processing patterns in children who are gifted. This possible link is also discussed in studies of other groups that have sensory-processing differences, such as children with Asperger syndrome, attention deficit hyperactivity disorder, or autism (Ben-Sasson et al., 2007; Dove & Dunn, in press; Dunn, 2007; Ermer & Dunn, 1998; Kientz & Dunn, 1997; Myles et al., 2004; Tomchek, 2007). Another possible link to participation resides in the hypothesis that gifted children are able to produce gifted responses because their intense sensoryprocessing patterns enable them to perceive and solve problems more effectively than their peers. We have been less likely to consider the affordances that sensory-processing patterns create, and so this idea extends our thinking. By making two hypotheses about the meaning of their data, Gere et al. (2009) introduce us to the possibility that everyones sensory-processing patterns provide both challenges and affordances. We think a lot about how definite difference scores interfere with school and home activities. How might the definite difference patterns help a child? For example, Baranek (2002) reported that boys with Fragile X syndrome who had an aversion to touch were more independent in their self-care skills than other children in their study. It is more common for professionals to identify challenges associated with aversions to touchand there certainly are challenges for children, parents, and teachershowever, in the case of self-care, these boys need to prevent others from touching them may have motivated independence in self-care. Perhaps we need to expand our thinking about the impact of sensory-processing patterns on everyday life to include the positive possibilities for independence and problem solving. Provide Services Based on Participation Needs, Not Diagnoses This study introduces an interesting paradox for providers. If the very characteristic that makes it possible for a child who
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is gifted to respond with complex problem solving is also the characteristic that could be interfering with the childs socialization, then what do we do with that information? We are linking their sensory-processing patterns to participation, but in one case that link affords better performance (i.e., problem solving), and in the other case that link might interfere with performance (i.e., social development). This paradox demands that we act as good stewards of what we know about children and consider carefully what we do with the information. We would not want children who are gifted to be less sensitive if diminishing their sensitivities would also diminish their edge for problem solving. Yet, we certainly want to support more adaptive social development. Gere et al. (2009) report that children who are gifted may be more likely to have intense sensory-processing patterns. Alternatively, children who are gifted may have heightened language abilities that enable them to be a great source of insight about how to manage intense sensory patterns in everyday life. Perhaps we need to interview and observe these children to identify how they are using their sensory processing to solve problems and to socialize, given that it seems that the same underlying characteristic (i.e., intense sensoryprocessing patterns) may be helping in some ways and interfering in others. We have profited from other personal experiences being given a voice; for example, Temple Grandin (2008) has spoken and written eloquently about her intense sensory experiences as a person who has autism. She is a cherished colleague in animal husbandry because she designed an innovative method for keeping cattle calm. She based her design on her early experiences trying to manage anxiety and using deep pressure to calm herself. Her descriptions of what it feels like to have intense sensory experiences have informed people, families, and professionals who serve people with autism. In this example, we find the same paradox: Grandins intense sensory patterns were both beneficial to and interfering with her life. Perhaps we need to recast our thinking to consider both affordances and barriers regarding sensoryprocessing patterns before we embark on an intervention program set to change individual sensory patterns. Grinker (2007), speaking about his daughter, said, Her sensitivities didnt go away, they just lost their grip on her (pp. 277278). What can we do in our intervention programs to ensure that the interfering factors lose their grip on the people we serve and their families while preserving the persons unique perspective and experience? This question invites us to use our expertise by supporting engagement rather than by focusing on repairing the persons challenging sensory experiences. Gere et al.s (2009) study helps us see the delicate nature of our wisdom about sensory processing. Because
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these children are highly capable, it is easier to understand how they use their characteristics to engage throughout the day. Perhaps these children could help us understand how it feels to be an intense sensory being; perhaps their intense sensory view makes it easier to see options in problem solving. But intense sensory-processing patterns also interfere with everyday life. For children who are gifted, sensoryprocessing knowledge may help everyone understand how they might get tripped up in social situations. Therefore, we can help them in social skills by understanding their intense sensory-processing patterns without trying to change their patterns of sensory processing (which they may need to solve problems). We can gain insights from their adaptive skills and unique ways of looking at the world. We can also help them use their unique perspectives to navigate social situations they find challenging. In this scenario, we are making sure that their intense sensory experiences lose their grip on their social development. Everyone Can Get Help With Participation If we embrace the idea that children who are gifted may also profit from the expertise of occupational therapy, we must consider a paradigm shift in our thinking. Being gifted is not a disability; therefore, we would have to think more broadly about how to apply our craft. A diagnosis would no longer be the ticket into occupational therapy services. We could shift our emphasis toward people who have participation challenges as those who receive occupational therapy. What would our practices and our profession look like if we said that a participation need was the ticket to eligibility for occupational therapy services? Although it is true that diagnoses currently provide access to funding for services, perhaps studies like this one illustrate the need for us to provide leadership to change this policy. In schools, occupational therapists could serve as members of a school community the way that counselors do, being available to any student or teacher who needed assistance to make the learning environment and experiences more friendly to a wide range of students. Anyone who works in public schools has entered a classroom and seen possibilities for service that extend beyond the students who are assigned on a caseload based on diagnostic eligibility.

sample. They hypothesize that intense sensory patterns may be linked to both the childrens good problem-solving abilities and their awkwardness in social situations. The study invites us to consider several ways to expand our thinking about providing services. First, we must consider expanding our thinking about who we serve and for what reasons. Children who are gifted are not disabled, yet they might profit from the expertise of occupational therapy. Second, we must consider both the positive and the negative impact of any sensory-processing pattern on participation. If intense sensory-processing patterns enable a child who is gifted to solve problems better than other children, then we would not want to make the intensity go away. However, Gere et al. (2009) also suggest that intense sensory processing might interfere with socialization; perhaps good problem solving can serve as a tool to help these children gain insights about their ways of responding in social situations. Gere et al. (2009) have given us much to think about to advance the knowledge and practices in our profession. s

References
Baranek, G. (2002). Sensory processing correlates of occupational performance in children with Fragile X syndrome: Preliminary findings. American Journal of Occupational Therapy, 56(5), 538546. Ben-Sasson, A., Cermak, S., Orsmond, G., Tager-Flusberg, H., Carter, A., Kadlec, M., et al. (2007). Extreme sensory modulation behaviors in toddlers with autism spectrum disorders. American Journal of Occupational Therapy, 61(5), 584592. Dove, S., & Dunn, W. (in press). Sensory processing patterns in learning disabilities. Occupational Therapy in Early Intervention, Preschool, and Schools. Dunn, W. (1999). Sensory Profile users manual. San Antonio, TX: Psychological Corporation. Dunn, W. (2007). Supporting children in everyday life using a sensory processing approach. Infants and Young Children, 20(2), 84101. Ermer, J., & Dunn, W. (1998). The Sensory Profile: A discriminant analysis of children with and without disabilities. American Journal of Occupational Therapy, 52(4), 283290. Gere, D. R., Capps, S. C., Mitchell, D. W., & Grubbs, E. (2009). Sensory sensitivities of gifted children. American Journal of Occupational Therapy, 64, 288295. Grandin, T. (2008). The way I see it: A personal look at autism and Aspergers. Arlington, TX: Future Horizons. Grinker, R. R. (2007). Unstrange minds: Remapping the world of autism. New York: Basic Books. Helmbold, N., Troche, S., & Rammsayer, T. (2006). Temporal information processing and pitch discrimination as predictors of general intelligence. Canadian Journal of Experimental Psychology, 60, 294306. Kientz, M. A., & Dunn, W. (1997). Comparison of the performance of children with and without autism on the Sensory
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Summary
Gere et al. (2009) present interesting preliminary data on the sensory-processing patterns of gifted children. They report that these children have more intense sensory experiences than the children in the Sensory Profiles national
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Profile. American Journal of Occupational Therapy, 51(7), 530537. Li, S., Jordanova, M., & Lindenberger, U. (1998). From good senses to good sense: A link between tactile information processing and intelligence. Intelligence, 26, 99122. Myles, B. S., Hagiwara, T., Dunn, W., Rinner, L., Reese, M., Higgins, A., et al. (2004). Sensory issues in children with Asperger syndrome and autism. Education and Training in Developmental Disabilities, 39(4), 283290.

Roedell, W. (1984). Vulnerabilities of highly gifted children. Roeper Review, 6, 127130. Silverman, L. (1997). What we have learned about gifted children? Retrieved February 26, 2009, from www.gifteddevelopment. com/What_is_Gifted/learned.htm Tomchek, S. D. (2007). Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile. American Journal of Occupational Therapy, 61(2), 190200.

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