Professional Counseling for Children With Sensory Processing Disorder

Mar 3, 2015 | Article, Volume 5 - Issue 2

Emily Goodman-Scott, Simone F. Lambert

Sensory processing disorder is a complex neurological disorder affecting approximately 5–17% of the population, yet professional counselors often misunderstand and misdiagnose this disorder. A child’s academic, emotional and social functioning can be substantially impacted by sensory processing disorder; early diagnosis and treatment is crucial. In this article, the authors describe the disorder, discuss its impact on children and their families, and provide recommendations and resources for both mental health counselors and school counselors to utilize when serving this unique population with special needs. A case study is included, in addition to suggestions for treatment collaboration and advocacy on behalf of clients with sensory processing disorder.

 Keywords: Sensory processing disorder, special needs, children, school counselors, mental health counselors

Children experience the world through their senses—the sound of the air conditioner running in their classroom, the feel of a chair under their legs, the sight of a colorful wall, the smell of food cooking, the muscle movement used to pick up a toy. The typical child can accurately perceive, process and respond to the myriad stimuli in their environment, focusing on important stimuli, such as a parent’s voice, and filtering out unimportant ones, such as a humming refrigerator. For other children, the same environment and accompanying stimuli can be uncomfortable, overwhelming, unnoticeable and even frightening. Researchers estimate that approximately 5–17% of the population has sensory processing disorder (SPD), a neurological disorder in which sensory input is irregularly sensed, processed, organized, and responded to, creating sensory challenges that negatively impact daily functioning (Ahn, Miller, Milberger, & McIntosh, 2004; Ben-Sasson, Carter, & Briggs-Gowan, 2009). As a result of poor sensory processing, individuals with SPD may overreact or underreact to stimuli (Byrne, 2009; Dunn, 1997, 2001; James, Miller, Schaaf, Nielsen, & Schoen, 2011; Katz, 2006; Miller, Anzalone, Lane, Cermak, & Osten 2007; Walbam, 2013; Withrow, 2007). SPD is a lifelong disorder; while typically developing children gain the ability to increasingly suppress stimuli with age, children with SPD tend to struggle throughout their lifetime (Davies & Gavin, 2007), particularly if SPD is unidentified, misdiagnosed or inaccurately treated.

Professional counselors are called to accurately diagnose and treat clients’ mental health and co-occurring disorders (American Counseling Association [ACA], 2014). However, SPD is widely unrecognized and misdiagnosed in the counseling field (Collier & Falls, 2010; Katz, 2006; Murphy, 2011; Withrow, 2007). With increasing research supporting the legitimacy of the SPD diagnosis (e.g., Chang et al., 2014; Davies & Gavin, 2007; Owen et al., 2013), counselors can be on the forefront of screening and providing counseling services to children with SPD. This article will provide readers with background information on SPD, implications for clinical mental health and school counseling practice, a case study example, and recommendations for future professional education, advocacy and research. In the literature, SPD has been referred to by similar terms such as sensory integration disorder or categorized by subtype (e.g., sensory modulation disorder). However, the term sensory processing disorder (SPD) will be utilized in this article, since SPD is the most prevalent term used in recent years (Miller, Nielsen, Schoen, & Brett-Green, 2009). Similarly, we will use the term sensory processing to also encompass sensory integration, as they are often used interchangeably in the literature.

Background

     The most commonly known senses are auditory (sound), olfactory (smell), tactile (touch), visual (sight) and gustatory (taste); two less known senses are proprioception and the vestibular sense (James et al., 2011; Katz, 2006; Withrow, 2007). Proprioception is a sense found in muscles, tendons and joints that deciphers bodily awareness and coordinated movements. The vestibular sense is located in the inner ear and provides sensory input regarding one’s balance and gravity. Sensory processing is a complex neurobiological process in which individuals’ seven senses perceive information or stimuli from the environment, sending data to the brain to interpret, process and respond to; the senses and brain are constantly engaged in a process of perceiving, interpreting, processing, and responding to environmental stimuli (Byrne, 2009; Katz, 2006; Miller et al., 2009; Parham & Mailloux, 2015; Walbam, 2013; Withrow, 2007). Sensory processing is a developmental process, and thus especially crucial in the children’s first 10 years of life (Ayres, 1979). In summary, a typically developing child may easily and accurately perceive and process environmental stimuli, yet this is not the case for all children.

Sensory processing has been well studied in the occupational therapy profession during the last 50 years, beginning with the groundbreaking work of Dr. A. Jean Ayres, occupational therapist, psychologist and neuroscientist (Parham & Mailloux, 2015). During the last several decades Ayres and others discovered patterns of atypical sensory processing in children, which have collectively come to be labeled as SPD. “Sensory processing disorder is a heterogeneous condition that includes a variety of subtypes. Individuals with the disorder have impaired responses to, processing of, and/or organization of sensory information that effects [sic] participation in functional daily life routines and activities” (Miller et al., 2009, p. 1). Further, Parham and Mailloux (2015) described SPD as “patterns that emerge developmentally . . . and are thought to reflect subtle neural processing differences involving sensory and motor systems” (p. 266). Thus, children with SPD struggle with the neurobiological cycle of receiving, sending, processing and responding to stimuli, and they experience a severity that negatively impacts their daily functioning (Ayres, 1979; Davies & Gavin, 2007; Owen et al., 2013; Parham & Mailloux, 2015). As a result of skewed sensory processing, individuals with SPD may overreact or underreact to stimuli, perceiving stimuli to much greater or lesser degrees than peers (Byrne, 2009; Dunn, 1997, 2001; James et al., 2011; Katz, 2006; Miller et al., 2007; Walbam, 2013; Withrow, 2007). For example, a crowded indoor playground could be loud to one child, but frightening or even physically painful for a child with auditory sensitivities. While a typical child may get dizzy from spinning around, a child with an underdeveloped vestibular system may rarely become dizzy and seek spinning to feel soothed.

Although children with SPD may have neurological similarities, SPD is a highly individualistic disorder that presents differently in each child and can be described by corresponding subtypes (Dunn, 1997, 2001; James et al., 2011; Murphy, 2011; Walbam, 2013; Withrow, 2007). While there is consensus on an overarching definition for SPD, there is not a consistent nosology for describing the subtypes (Miller et al., 2009). Proposed nosologies of SPD subtypes typically include hyposensitivity, hypersensitivity and sensory-seeking subtypes (Ayres, 1979; Dunn, 1997, 2001; Interdisciplinary Council on Developmental and Learning Disorders, 2012; James et al., 2011; Katz, 2006; Miller et al., 2007; Walbam, 2013; Zero to Three, National Center for Infants, Toddlers and Families, 2005).

Subtypes

Those with hyposensitivities, one subtype of SPD, often have a high threshold for sensation, are under-sensitive, and receive or process too few stimuli (Dunn, 1997, 2001; James et al., 2011; Katz, 2006; Walbam, 2013; Withrow, 2007). A child with hyposensitivities may seem to have poor social skills and miss social cues; some behavioral examples include not hearing a teacher calling his or her name, being unaware of food on the face, or lacking culturally appropriate personal space. Social skill deficits can negatively impact children’s friendships and group participation in both academic and social environments (Dunn, 1997; Kranowitz, 2005; Withrow, 2007).

Children with hypersensitivities, a second subtype of SPD, have a low threshold for sensation and may receive an overwhelming amount of stimuli, be unable to prioritize their sensory messages and be easily overstimulated (Dunn, 1997, 2001; James et al., 2011; Katz, 2006; Walbam, 2013; Withrow, 2007). As a coping technique against stimuli perceived as uncomfortable and even painful, children with hypersensitivies may have heightened alertness, act aggressively toward others in response to perceived threats, and engage in behavioral outbursts and rigid routines in attempts to avoid or escape stimuli (Dunn, 1997; Withrow, 2007). These children may be described as generally anxious, aggressive, distracted or unfocused, or as picky eaters.

Lastly, some children with a third subtype of SPD crave and actively seek sensory input and increased stimuli (Dunn, 1997, 2001). These children may seek constant movement to receive sensations from their environment, and exhibit behaviors including running, jumping, chewing, tapping, humming and squeezing (Dunn, 1997, 2001). Individuals with sensory-seeking behaviors may appear impulsive, unpredictable, and have inappropriate personal space which may negatively impact academics and social relationships. Children who seek sensations may be described as rambunctious, aggressive, or bouncing off the walls (sometimes literally). They may seek spicy foods and not be bothered by intense flavors.

Sensitivities and sensation seeking occur on a spectrum from mild to severe (James et al., 2011). Furthermore, these variations can present differently in each of the seven senses (Dunn, 1997, 2001), and children can even experience both hypersensitivities and hyposensitivities within the same sense (Withrow, 2007). This circumstance may baffle parents, who question how a child can watch a movie at a loud volume at home, yet be unable to tolerate the noise of a crowded restaurant. Children and the adults around them may need assistance recognizing children’s placement on the hyposensitivity, hypersensitivity and sensory-seeking spectrums before, during and after an event which can facilitate children successfully coping and thriving in various settings.

Prevalence

Researchers have estimated that SPD occurs in approximately 5–17% of children (Ahn et al., 2004; Ben-Sasson et al., 2009). In one study examining the prevalence of SPD in children 4–6 years old, the parents of incoming kindergarten students in one U.S. school district (N = 1,796) were asked to complete the Short Sensory Profile, a parental-report screening tool used to determine parents’ perceptions of SPD correlates (Ahn et al., 2004). Approximately 14% of those who completed the survey (with a 39% return rate) met the criteria for SPD. However, researchers conservatively estimated that if all non-responders were free from meeting the SPD criteria, then approximately 5% of this population would meet the screening criteria for SPD. Thus, the number of incoming kindergarten students who met the criteria for SPD based on parental perceptions ranged from 5–14%. Similarly, Ben-Sasson et al. (2009) used a longitudinal birth cohort sample of children to study sensory over-responsivity (SOR) and related correlates. They found that nearly 17% of the 7–11 year olds in their study (N = 925) had clinically significant elevated SOR scores. However, these researchers believe the number to be a conservative estimate of the population, as children with diagnosed medical and developmental conditions were excluded from the study.

Secondary Symptoms

All areas of a child’s life can be impacted by SPD (Walbam, 2013; Withrow, 2007). In addition to children presenting primary symptoms of the disorder, they often face a host of secondary emotional and behavioral difficulties as a result of the disorder, such as frustration, loneliness, low self-esteem, a greater risk for strained peer relationships, discouragement, and social, emotional and academic challenges (Champagne & Koomar, 2012; Katz, 2006; Miller, Nielsen, & Schoen, 2012; Walbam, 2013; Withrow, 2007). Also, those with SPD tend to be more likely to struggle with depression and anxiety than their typically developing peers (Miller et al., 2012) and may need assistance with self-regulation (Katz, 2006). These secondary symptoms may result from attempted self-regulation due to negatively perceived sensory stimuli as well as feelings of isolation and being misunderstood due to undiagnosed, untreated and mistaken symptoms (Miller et al., 2012; Withrow, 2007). In this article, we describe the experiences of children with SPD as comparable to those of children with special needs including disabilities and chronic illnesses.

Diagnosis and Treatment

Early SPD diagnosis and treatment is crucial in assisting children with both primary and secondary SPD symptoms (Ben-Sasson et al., 2009; Byrne, 2009; Miller, 2006). SPD diagnosis and treatment early in life is highly impactful on a child’s developing brain and behavioral symptoms (Ben-Sasson, et al., 2009; Miller, 2006). While occupational therapists (OTs) are charged with diagnosing and treating the primary symptoms and underlying conditions associated with SPD, counselors need to be aware of SPD in order to appropriately screen for, avoid misdiagnosing, make appropriate referrals for, and treat the secondary symptoms related to SPD.

Occupational therapy. Typically, OTs evaluate for and treat SPD (Castaneda, Olson, & Radley, 2013; Champagne & Koomar, 2012; Katz, 2006; Parham & Mailloux, 2015; Walbam, 2013). Children are often referred to OTs by parents, teachers and physicians (Parham & Mailloux, 2015); however, before making an OT referral, physicians need to rule out medical conditions and medication side effects. OTs assist people with daily living and occupational skills, and they are trained in mental and physical disorders (Castaneda et al., 2013). Since school is “work” for children, OTs help children with SPD to function more effectively in their academic work and social living skills. OTs can be school-based or work in community or hospital settings (Castaneda et al., 2013).

OTs use several strategies to assess for SPD, including interviews and questionnaires, direct observations (e.g., naturalistic and structured clinical) and standardized testing (Parham & Mailloux, 2015). SPD diagnoses often begin with the use of a screening tool to determine the existence of symptoms signifying possible sensory irregularities. The Sensory Profile 2 (Dunn, 2014) is a standardized, parental-report tool for evaluating children’s sensory processing patterns in various environments and requires a B-level qualification to administer (Dunn, 2014). The Sensory Integration and Praxis Tests (SIPT) is a popular, recommended and standardized comprehensive test for measuring sensory integration and requires a C-level qualification to administer (Ayres, 1989). The SIPT was normed on approximately 2,000 children in North America and is considered a valid and reliable assessment.

The sensory integration approach to occupational therapy is commonly used to treat SPD; the overarching goal of this intervention is to enable a child’s nervous system to more efficiently process and respond to sensory information (Parham & Mailloux, 2015). Occupational therapy is highly specialized based on the child’s unique needs and diagnosis. Further, occupational therapy also may include the use of a sensory diet—an individualized program for children with sensory challenges including a specific combination of sensory activities throughout the day (Parham & Mailloux, 2015). A sensory diet provides a wide range of sensory input; for example, activities may evoke the senses through music, new smells, visual stimulus, as well as “movement, heavy work, or tactile stimulation” (Hall & Case-Smith, 2007, p. 212).

Clinical diagnosis. The occupational therapy profession has treated SPD for decades. Furthermore, the SPD Scientific Work Group, including approximately 40 interdisciplinary research scientists from various specialties (e.g., neurology, pediatrics, occupational therapy, psychiatry, autism, psychology) has regularly met since 2002 with the aim of studying SPD; members’ efforts have been funded through both the Wallace Research Foundation and National Institutes of Health (SPD Foundation, 2014). However, much controversy has existed regarding SPD as an independent disorder, particularly in the psychiatry and psychology professions, whose members have raised the following criticisms: “(1) an absence of formal diagnostic criteria, (2) high prevalence among children with developmental disorders such as autism spectrum disorders . . . (3) unknown etiology, and (4) lack of epidemiological evidence related to this condition” (Ben-Sasson et al., 2009, p. 706). These criticisms will be addressed in the subsequent paragraphs.

Diagnostic criteria. Sensory disorders are found both in the Diagnostic Manual for Infancy and Early Childhood (Interdisciplinary Council on Developmental and Learning Disorders, 2012) and the Zero to Three’s Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised (Zero to Three, 2005). For example, the Zero to Three was created by an interdisciplinary group of researchers and clinicians to complement the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) with a specific focus on the unique development of and disorders found among infants and young children. This nosology includes two sensory-related disorders: Hyposensitive/Underresponsive (420) and Sensory Stimulation-Seeking/Impulsive (430), describing the sensory reactivity patterns, motor patterns and behavioral patterns of each disorder (Zero to Three, 2005).

The APA reviewed SPD for consideration in the DSM-5 (Levingston, 2014; Murphy, 2011) and groups such as the SPD Scientific Work Group lobbied for its inclusion (SPD, 2012, 2014). The full diagnosis of SPD was not included in DSM-5 reportedly due to lack of research (Levingston, 2014). However, the new Avoidant/Restrictive Food Intake Disorder does recognize that sensory aspects of food can cause a significant food disturbance (e.g., texture, smell, spiciness; APA, 2013). Further, in the DSM-5 the APA recognized sensory issues as a part of autism spectrum disorder (ASD), including: “hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment” (APA, 2013, p. 50). While the DSM-5 does not recognize SPD as an individual disorder, we find it promising that SPD was considered for inclusion and that sensory issues were added to the most recent DSM. The DSM has evolved and will likely continue to evolve based on research advances (APA, 2013) and we are hopeful that SPD will be considered for inclusion in the next edition of the DSM, especially with recent research advances (e.g., Chang et al., 2014; Owen et al., 2013).

In addition to the DSM, the 10th revision of the International Statistical Classification of Diseases (ICD-10; World Health Organization, 2013) and the ICD-9 (Centers for Disease Control and Prevention, National Center for Health Statistics, 1991) are other commonly used nosologies. Although the ICD does not specifically identify sensory issues, OTs may use the following codes to diagnose clients: lack of normal physiological development, unspecified (783.40; ICD-9); other symptoms involving nervous and musculoskeletal systems (781.99; ICD-9), and unspecified lack of expected normal physiological development in childhood (R62.50; ICD-10; E. Smolak, personal communication, January 15, 2015). Thus, professionals can use ICD codes related to SPD.

SPD research. Researchers have determined distinct patterns among children with SPD varying from those among their typically developing peers. Specifically, when comparing children with clinically determined atypical sensory processing to their typically developing peers, researchers found that the former exhibited differences in their physiological responses to sensory stimuli (McIntosh, Miller, Shyu, & Hagerman, 1999), parasympathetic nervous system functioning (Schaaf et al., 2010; Schaaf, Miller, Seawell, & O’Keefe, 2003), and differences in both behavioral and physiological measures (Schoen, Miller, Brett-Green, & Nielsen, 2009). Additionally, Davies and Gavin (2007) and Gavin et al. (2011) found differences in brain activity between children with and without SPD using electroencephalography. In fact, “brain activity correctly distinguished children with SPD from children who were typically developing with 86% accuracy” (Davies & Gavin, 2007, p. 176). Finally, in a recent study (N = 40), Owen et al. (2013) found neurological differences in brain structure between children with and without SPD, specifically stating:

Children with SPD show specific reduction in the white matter microstructure primarily affecting posterior cerebral tracts. . . . These findings suggest that children with SPD have a specific imaging biomarker for their clinical disorder and the pattern of their shared structural difference. (p. 850)

Significant sensory abnormalities (e.g., SPD) can be comorbid with several childhood clinical disorders such as ASD, attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, depression, Fragile X syndrome and obsessive-compulsive disorder (Ghanizadeh, 2011; Goldsmith, Van Hulle, Arneson, Schreiber, & Gernsbacher, 2006; Tomchek & Dunn, 2007; Van Hulle, Schmidt, & Goldsmith, 2011). At the same time, researchers are suggesting that SPD is a separate and distinct disorder. For example, when studying youth with ASD and SPD, Schoen et al. (2009) demonstrated differences in sympathetic nervous system functions and sensory-related behaviors between children in the two samples, while Chang et al. (2014) reported differing patterns of brain connectivity in adolescents with the two separate diagnoses. In addition, Miller et al. (2012) studied differences between youth with SPD, ADHD and the two dual diagnoses by using several parental-report instruments and measuring physiological reactions to sensory stimuli by electrodermal response. They found that participants with ADHD had greater inattention and participants with SPD had the most sensory issues, while those with both diagnoses experienced inattention and fewer sensory issues than those who only had SPD. Further, participants with SPD had greater physiological or electrodermal reactivity to sensory stimuli than participants with ADHD (Miller et al., 2012). Overall, differences seem to exist between participants with SPD and those with similar but varying clinical diagnoses (e.g., ADHD and ASD), suggesting SPD as an individual disorder.

Etiology. While the etiology of SPD is still largely unknown, several researchers believe that SPD may have a genetic basis (e.g., Goldsmith et al., 2006; Miller et al., 2009; Owen et al., 2013; Van Hulle et al., 2011). For example, Goldsmith et al. (2006) studied the tactile and auditory defensiveness, temperament, and behavior problems of toddler-aged twins as determined by parent reports. Researchers determined moderate genetic influences with tactile defensiveness, leading them to suggest more research investigating the heritability of SPD and sensory issues.

Overall, although SPD is controversial, there is substantial evidence for SPD as a distinct disorder in children. According to the APA (2013),

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. (p. 20)

Based on the literature review, we believe that SPD meets the APA’s criteria for a mental health disorder, due to an irregular neurological pattern of receiving, sending, processing and responding to stimuli, which results in impairment to an individual’s regular behavioral and emotional functioning.

Professional counseling. SPD has received some, albeit limited recognition in the counseling field (e.g., Collier & Falls, 2010; Katz, 2006; Withrow, 2007), including an article featured in Counseling Today (Murphy, 2011). However, SPD seems to be widely unrecognized in the counseling profession. Counselors may often misdiagnose this neurological condition due to clients’ highly individualized presentations, as well as SPD symptoms mirroring those of other disorders (Collier & Falls, 2010; Katz, 2006; Murphy, 2011; Walbam, 2013). SPD can present as ADHD through impulsive and inattentive behaviors; ASD through social deficits, rigidity and sensory symptoms; and depression and anxiety through withdrawn and lethargic behaviors. Well-known author and OT Carol Kranowitz wrote the following:

Many parents, educators, doctors, and mental health professionals have difficulty recognizing SPD. When they don’t recognize the problem, they may mistake a child’s behavior, low self-esteem, or reluctance to participate in ordinary childhood experiences for hyperactivity, learning disabilities, or emotional problems. Unless they are educated about SPD, few people understand that bewildering behavior may stem from a poorly functioning nervous system. (2005, p. xxiv)

SPD and sensory challenges are often unrecognized, misdiagnosed and considered solely behavioral, psychological or emotional issues (Parham & Mailloux, 2015).

An accurate diagnosis is imperative for client treatment and is included as follows in the 2014 ACA Code of Ethics, section E.5.a.: “Counselors take special care to provide proper diagnosis of mental disorders” (ACA, 2014, p. 11). Counselors are ethically required to thoughtfully consider mental diagnostic possibilities and to accurately diagnose clients. However, medical and mental disorders can be commonly misdiagnosed, especially when many disorders have similar symptoms and overlapping criteria (Pollak, Levy, & Breitholtz, 1999). Misdiagnoses may have long-term ramifications for individuals, including ineffective treatment and secondary concerns due to unmet needs, such as anxiety, depression, low self-esteem, and poor academic and social functioning (Katz, 2006; Kinnealey & Fuiek, 1999; Miller, 2006, Miller et al., 2012; Withrow, 2007). Lack of an accurate diagnosis also can lead to poor use of resources and harmful or even fatal client outcomes (Pollak et al., 1999). In order to uphold the ACA’s ethical standards for accurately diagnosing clients, as well as to meet clients’ needs, it is imperative that counselors are aware of SPD and work in tandem with other service providers when warranted in order  to ensure that each client receives an accurate diagnosis and treatment.

Counselor Implications

All Professional Counselors

Given the prevalence of SPD, counselors are likely already working with clients who have SPD. Thus, counselors across settings need to be aware of SPD and related counseling implications. Since early intervention is preferred, counselors who work with children should be at the forefront for recognizing and addressing SPD in session. This section will focus on the following: awareness and education, screening and diagnosis, treatment team, treatment goals, counseling strategies, and counseling accommodations.

Awareness and education. First and foremost, counselors must possess knowledge of SPD as a neurological disorder and awareness of SPD characteristics in children. There is limited counseling-related SPD literature (e.g., Collier & Falls, 2010; Katz, 2006; Murphy, 2011; Withrow, 2007), and in our experiences as counselor educators and practitioners, we have seen very little SPD information in counseling textbooks or at counseling conferences. Thus, counselors may need to seek educational and training opportunities outside the counseling field in order to stay abreast of SPD.

Screening and diagnosis. Counselors can screen for SPD through the process of differential diagnosis to see if the symptoms (a) are part of a separate mental health diagnosis, (b) indicate SPD misdiagnosed as another disorder or (c) are co-occurring (Byrne, 2009). Screening and diagnosis are complicated due to SPD often co-occurring with other mental health disorders (Walbam, 2013). Additionally, context is critically important when counselors identify diagnostic criteria, as well as triggers and antecedents to emotional and behavioral responses. For example, a child who presents characteristics of ADHD (e.g., impulsiveness and hyperactivity) also should be considered for SPD, as this child could lack physical stimulation and seek sensory input to self-modulate. Dr. Roianne Ahn, a licensed psychologist, SPD researcher and staff member at the Sensory Therapies and Research Center provides training to mental health clinicians regarding recognizing SPD in clients. When clinicians suspect that a child has sensory abnormalities, Dr. Ahn encourages them to use a parental-report screening checklist (e.g., Appendix A: Sensory Processing Disorder Checklist or the Sensory Profile 2) to initially screen for SPD symptoms and then recommend a formal occupational therapy evaluation (R. Ahn, personal communication, November 7, 2014). With the high prevalence of SPD, professional counselors may want to consider including a screening checklist in initial client paperwork.

Treatment team. Counselors can consult and collaborate with stakeholders through the use of a treatment team (Katz, 2006; Murphy, 2011; Walbam, 2013). The purpose of the treatment team is to collaborate on the child’s needs and treatment across various settings, gaining the perspectives of diverse stakeholders. A treatment team can be comprised of the counselor (e.g., school counselor, mental health counselor), OT, parents or caregivers, and teachers. The treatment team may include the child’s pediatrician and potentially a nutritionist when appropriate. Counselors can play a vital role as part of a treatment team by coordinating the interdisciplinary team. Also, family involvement is crucial—parents or caretakers often know their child best, children are heavily impacted by their families, and parents or caretakers often advocate for their child on a long-term basis.

Through the collaborative treatment team, counselors can identify and advocate for resources for children with SPD and their families in order to improve their daily functioning (Walbam, 2013; Withrow, 2007). Treatment teams can discuss children’s needs, accommodations and resources, ensuring that stakeholders are working collaboratively to serve the child. For example, one function of the treatment team may be consultation to discuss the child’s sensory diet in multiple settings, such as chewing gum to remain attentive in class or receiving calming deep pressure before school in the morning (Parham & Mailloux, 2015).

Treatment goals. Counseling treatment goals can incorporate suggestions from the treatment team. For instance, counseling treatment goals may focus on children’s emotions, cognitions and behaviors pertaining to SPD (Kranowitz, 2005). Children with SPD may have a number of mental health concerns including anxiety, depression, low self-esteem, poor social skills and frustration (Champagne & Koomar, 2012; Katz, 2006; Miller et al., 2012; Walbam, 2013; Withrow, 2007). Similar to those with chronic illness (Cheu, 2013), children with SPD may have additional concerns including fear, grief, shame, anger or frustration. Furthermore, children may misunderstand SPD; thus, educating children and normalizing their experiences may be appropriate treatment goals (Withrow, 2007).

Other treatment goals can include the child adjusting to the diagnosis of SPD and identifying strategies for coping in social situations when SPD symptoms often occur (Murphy, 2011). For example, although home environments may be easily controlled to meet the child’s sensory needs, children with SPD may need to cope with uncontrolled environments, such as a crowded grocery store or an odorous and loud public restroom. Thus, counseling treatment may include systematic desensitization—children increasingly coping with uncomfortable stimuli through increased exposure. Counseling can assist with behavioral, social and emotional symptoms related to SPD (Kranowitz, 2005), in addition to other disorders that may co-occur including anxiety, depression, ASD, attention-deficit disorder and learning disorders (Ostovar, 2009). Further, one disorder can exasperate another (i.e., the child may have difficulty adjusting to a new environment if there is a change in sensory input, such as street noise by the child’s bedroom window).

Counseling strategies. Counselors can provide individual, group and family counseling modalities (Withrow, 2007) using solution-focused and cognitive-behavioral techniques to address children’s mental health needs and co-occurring disorders. For example, through individual counseling, children may increase their coping skills and self-esteem; through group counseling, children can improve their social skills. Further, counselors can assist clients to understand their disorder (Withrow, 2007), adjust to their limitations and capitalize on their strengths (Miller, 2006). Through the use of psychoeducation and bibliotherapy (see Appendix B), counselors can educate children about SPD, normalizing their experience. Further, by focusing on the child’s strengths, counselors can emphasize the positives of SPD. For example, children who seek sensory input from spinning may excel in gymnastics or ice skating, while those who need physical input may thrive in contact sports.

Some mental health issues, such as children’s anxiety, can be exacerbated by contextual factors like an unpredictable environment that may occur in everyday life situations as well as at special events (Ostovar, 2009). Taking a systems approach, counselors can work with family members and other service providers (e.g., teachers) to increase the predictability and children’s understanding of their environment (Withrow, 2007). Thus, counselors can assist in identifying sensory triggers and establishing accommodations, while simultaneously addressing secondary emotional and behavioral symptoms that occur in various settings and situations.

Counseling accommodations. In conjunction with the treatment team’s recommendations, counselors can make a number of small accommodations during their counseling sessions to support children with SPD as they engage in the counseling process (Withrow, 2007). First, counselors should be mindful of environmental stimuli in their offices, such as bright lights, highly decorated offices or intense smells, which may be distracting for a child with SPD. Counselors can keep smells to a minimum, for example, by not wearing perfume and asking office mates to refrain from using incense or scented candles. Next, varied seating options can increase children’s comfort, as their needs may vary from firm to soft cushions and from smooth to more textured upholstery.

Similar to OTs (Kranowitz, 2005), counselors working with young children typically have numerous toys and materials to use in therapy (Landreth, Ray, & Bratton, 2009). Counselors may find that covering a shelf and only displaying a couple of items at once reduces children’s feelings of being overwhelmed. Likewise, many children may enjoy a variety of arts and crafts materials, yet some children with SPD may not be able to tolerate getting glue or paint on their hands. Using a paintbrush for glue application and using hand wipes or a nearby sink to clean their hands may allow children to fully engage in the activity. In consultation with an OT, alternative materials can be selected. Based on the client’s needs, therapeutic putty could be substituted for a regular modeling compound to provide more sensory input; a dry food box (e.g., uncooked rice, beans, pastas) could be substituted for a traditional sand tray to provide more tactile input through different textures; and markers with or without scents could be used as part of a child’s sensory diet.

In consulting with the treatment team, the counselor may learn of the child’s need to implement other movement strategies as part of a sensory diet to increase his or her participation during counseling. These movements may include use of a rocking chair, proprioceptive exercises or a fidget. Balancing counseling interventions with attending to sensory inputs may help the child best focus during counseling sessions.

Mental Health Counselors

Play-based strategies. Children, particularly young children, express their emotions, thoughts and experiences through the language of play (Trice-Black, Bailey, & Riechel, 2013). Children with SPD may have qualitatively different playing styles, which may affect their social development (Cosbey, Johnston, Dunn, & Bauman, 2012). Counselors can foster the achievement of social development therapeutic goals by examining the nature of children’s play and the activities that children find most fulfilling. Cosbey et al. (2012) reported that children with SPD tend to participate in more solitary play, less complex play and greater overall conflict in play when compared to peers’ play. Therefore, social development and play strategies may be a focus of counseling for children with SPD. Furthermore, Cosbey, Johnston, and Dunn (2010) recommended three potential goals in working with children with SPD: (a) identify activities that bring joy and meaning to the individual child, (b) strategize ways that the child can successfully engage in the activity, and (c) use these activities to build his or her social circles with peers. Similarly, counselors may use such activities to assist children with SPD in improving relationships and interactions with family members.

Family counseling strategies. A substantial aspect of serving a child with SPD involves working with and supporting the people important in the child’s life, such as parents, siblings and other family members (Parham & Mailloux, 2015). When working from a family systems perspective, counselors should recognize the adjustment process for both parents and siblings. Just as children with SPD need to adjust to the diagnosis, so do their family members. The SPD diagnosis may bring a sense of relief to parents who have spent a long journey attempting to find an accurate diagnosis for their child (Parham & Mailloux, 2015). Some parents may feel grief and loss when their child is diagnosed with special needs, guilt for not obtaining the diagnosis sooner, and overwhelmed by navigating a new world of treatment expenses and accommodations (Anderson & Davis, 2011; Grossman & Okun, 2009; Marshak, Dandeneau, Prezant, & L’Amoreaux, 2010). Gourley, Wind, Henninger, and Chinitz (2013) found that parental stress was positively correlated with SPD severity, and that parents whose children had SPD had greater stress than those who had children without SPD. Thus, counselors can assist parents in processing their emotions, learning coping strategies, developing a plan of action and gaining a better understanding of SPD. Through psychoeducation (see suggestions in Appendix B), parents can learn about SPD and counselors can teach parents how to advocate for their children in various settings and situations (e.g., birthday parties, classroom activities, family gatherings; Ostovar, 2009; Withrow, 2007).

Another of the counselor’s essential tasks may be providing support for parents (Cohn, May-Benson, & Teasdale, 2011), which can be accomplished through a local support group for parents of children with SPD or through family therapy. As the severity of SPD increases, so does the level of support needed by parents (Cohn et al., 2011). Cohn et al. (2011) found a significant correlation between an increase in a child’s SPD severity and a decrease in parents’ perceived parental competence. Informing parents about the benefits of proper treatment may not only increase the likelihood of children receiving the needed treatment, but also decrease parents’ stress and anxiety related to parenting a child with special needs. Finally, family counseling may include treatment goals that center on establishing balance for the family system, as many families may have spent a large amount of family time and resources seeking an accurate diagnosis for their child (Gladding, 2015).

Siblings of children with special needs such as SPD may be negatively impacted in various ways, including greater likelihood of psychological or behavioral concerns, stressed relationships with parents, and missing parental attention (Anderson & Davis, 2011; Cohen, 1999). Engaging siblings in counseling can assist all the children in the family with adapting to the new family norms, routines and rules. For example, siblings can benefit from learning more about SPD (Parham & Mailloux, 2015) and processing their reactions to the SPD diagnosis, treatment and changes to the family system. Depending on the siblings’ ages and developmental levels, understanding SPD and the related issues may be difficult for them to comprehend. For example, siblings’ interactive play may change significantly once triggers are identified for the child with SPD. Siblings may need to process their emotions in their own space; thus, a referral to a sibling support group or individual counseling may be warranted.

School Counselors

According to the American School Counselor Association (ASCA, 2013), school counselors are charged with serving all students, including students with disabilities and special needs. School counselors can serve students through increasing their own awareness of SPD, consulting and collaborating with stakeholders, advocating for necessary student services and accommodations, and providing students with individual and small group counseling (ASCA, 2013). Thus, school counselors can apply these strategies to their work with children who have SPD.

Education, consultation and collaboration. To serve students with SPD, school counselors should educate themselves about the disorder and be vigilant about the signs and symptoms. School counselors can consult with other school professionals such as the OT and parents or caretakers if they suspect SPD. As teachers and family members may possess little knowledge of SPD, school counselors can educate, consult and collaborate with these stakeholders (ASCA, 2013) to increase their understanding of the disorder and to learn to best support the child with SPD.

Accommodations. The 2008 amendments of Section 504 of the Rehabilitation Act of 1973 constitute a “federal law designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the U.S. Department of Education” (U.S. Department of Education, 2013, Introduction, para. 2), including students in public schools. To be eligible under Section 504, students must have a confirmed physical or mental impairment that substantially impacts their functioning (U.S. Department of Education, 2013). If a student’s SPD significantly impedes his or her school participation and learning, that student may be eligible for Section 504, including relevant accommodations, supports and a documented plan. School counselors can advocate for students receiving services under Section 504, as well as assist students and parents in navigating the educational system as they seek services.

To promote academic performance and social and emotional functioning in schools, 504 services vary based on the unique needs of each student. Accommodations should be individualized and based on information gathered from the student, family, teacher and diagnosing professionals. Once the student’s sensory triggers are identified, the school counselor can examine each aspect of the child’s day for potential triggers and modifications; small changes can make a significant difference. SPD accommodations in the classroom may include preferential seating, possibly with a larger personal space circumference (e.g., the student’s own table for classroom work and testing), sensory breaks in the classroom, “heavy work” (e.g., delivering books to the library), increased time for assignments and tests, and a quiet location for testing. Some students with poor muscle coordination may require accommodations for underdeveloped fine motor skills, such as using a mechanical pencil for short assignments, a computer for longer writing assignments and pencil grips. In coordination with an OT, other accommodations may include a weighted vest or lap pillow, a balance ball chair instead of a traditional seat, and fidgets or stress balls to help increase attending behavior, reduce stress and increase hand muscle strength. If available and as needed, students can meet with a school-based OT to further address SPD symptoms in the classroom.

In addition to focusing on student accommodations for accessing the core curriculum, students with SPD may struggle with the elective or “specials” classes, unplanned situations, transitions and unstructured time outside of the classroom. While many children love playing tag during recess or physical education (P.E.), a student who is sensory defensive may dread this and similar activities. Thus, a P.E. accommodation may be engaging in a different noncontact sport. Alternatively, children who need sensory input may have accommodations to complete additional jumping jacks or wall pushes beyond P.E. class. In addition, a child with gross motor skill challenges could receive accommodations to strengthen and develop those areas without being penalized for failure to meet grade-level expectations. With any sport, an OT can assess a child’s physical strengths and challenges, working with P.E. teachers, coaches and parents to select appropriate individual or group activities based on the SPD presentation in each child (Kirkpatrick, 2012).

As previously mentioned regarding play-based techniques, some creative arts activities may be troublesome for children with SPD. Accommodations in art class should ensure that students with SPD participate to the best of their ability, and receive modified assignments and grading protocols (e.g., extra time to complete assignments). Likewise, students in music class may need to utilize their noise reduction headphones. Finally, school counselors should be mindful of students’ schedules, advocating for “specials” classes to be spaced out and at the end of the day when possible, as children with SPD who have multiple triggers are apt to have challenges concentrating once back in their regular classroom.

Children with SPD may be fearful of unexpected situations due to concern that a sensory trigger will occur. Providing students with advance warning can assist them during these situations. For instance, students can receive advance notice for fire drills and prearranged substitute teachers. The school counselor can check on the students during such triggering events to determine their reactions and ensure that accommodations are implemented. The school counselor can coach children to advocate for themselves in these situations, for example, by asking a substitute teacher to reduce the classroom noise level, or wearing noise-canceling headphones during fire drills.

Students with SPD may benefit from accommodations assisting them with daily school transitions. For example, a visual reminder (e.g., written schedule) may help reduce students’ anxiety surrounding transitions. To preserve personal space when transitioning between classes, younger students can receive preferential order in line, while older students can receive permission to walk in the hallways immediately before or after their peers.

Children with SPD may find unstructured school time to be difficult due to the magnitude of overwhelming sensory input. School counselors can assist students with SPD by collaborating with them and other stakeholders to create modifications for unstructured school times (e.g., recess, lunch, school assemblies, class parties, bathroom breaks, transportation to and from school). Accommodations may include preferential seating, noise-canceling headphones and decreased time in such situations. Further, students should be provided a safe place to decompress when overstimulated.

When annually reviewing 504 plans and adjusting accommodations, school counselors need to be aware that students’ triggers and challenges may change at different developmental and chronological ages. For example, high school students with SPD may require unique accommodations in various situations such as the following: during driver’s education (e.g., not driving with other students in the car), while dissecting frogs in biology or when using odorous chemicals in chemistry. Biological changes in adolescence produce new and potentially triggering smells, such as the P.E. locker room at the secondary level. Thus, school counselors may need to (a) advocate for accommodations to counter these scenarios that may emerge in middle and high school, and (b) further address the emotions related to dealing with SPD symptoms in the classroom and in social situations with classmates that may occur with the onset of adolescence.

Counseling. In addition to assisting with accommodations, school counselors can conduct individual and small group counseling for students with SPD in order to help them succeed in school (Collier & Falls, 2010). School counselors can provide counseling to address students’ emotional and mental health concerns, which may include anxiety, depression, low self-esteem, poor social skills and frustration (Champagne & Koomar, 2012; Katz, 2006; Miller et al., 2012; Walbam, 2013; Withrow, 2007). School counseling may address students’ anxiety about school transitions and school-related sensory reactions by teaching students coping skills. School counselor-led counseling can normalize the experience of children with SPD, combating potential feelings of self-consciousness and isolation. Through the use of bibliotherapy and psychoeducation (see Appendix B), students can learn improved self-regulation and organization skills as well as self-advocacy and assertiveness. For example, students can learn to advocate for themselves by participating in their 504 plan meeting, as well as learn to develop strategies for communicating with teachers when becoming overwhelmed by sensory stimuli.

When students with SPD receive accommodations and counseling, classmates may express jealousy or frustration, similar to siblings. The school counselor can help process these situations and role-play social interactions in individual or group settings. Further, school counselors can assist teachers in offering sensory modulation strategies for an entire class, in order to prevent the child with SPD from being singled out. The following is a case study of how a counselor can intervene with a child who has SPD.

Case Study

     Euna is a 6-year-old, second-generation Korean American attending her first year of school as a first-grade student in public school. Her parents are professionals, and she is an only child who had an in-home nanny and no formal preschool. At school, she shows little variation in affect and rarely speaks to peers. However, she and her parents speak at home, often in quiet voices. Euna flinches when touched and her parents describe her as a picky eater and uncoordinated. She does not like school; at home she has daily outbursts prior to departing for the school bus. Euna does not have reciprocal friendships in school and often sits alone in the cafeteria during lunch. Often she requests to visit the nurse to avoid the cafeteria during lunch.

Euna visits a mental health counselor for anxiety; this counselor has basic awareness of SPD. After the intake and initial counseling session with Euna, the mental health counselor suspects SPD and gathers additional background information from Euna’s parents as well as a release of information to speak to Euna’s teacher and school counselor. Next, the mental health counselor gathers background information from Euna’s school counselor and teacher about her school functioning. After completing screening checklists (e.g., Appendix A: Sensory Processing Disorder Checklist or the Sensory Profile 2), the mental health counselor and school counselor provide Euna’s parents with an OT referral for formal evaluation and recommend that her parents first speak to the pediatrician; the counselors obtain a release of information to be able to speak with the OT and pediatrician. The OT determines that Euna does have SPD, and through the physical examination, Euna’s pediatrician rules out other potential physiological causes for symptoms. The pediatrician also provides a referral to a nutritionist who can ensure that Euna is obtaining proper nutrition and gradually increase the types and textures of food in Euna’s diet.

After consulting with the OT and pediatrician, the school and mental health counselors work together to provide bibliotherapy resources for the family, education for the teacher and school staff, and coping strategies for Euna in school, at home and in the community. They collaborate with the OT to incorporate sensory strategies that will enhance counseling sessions with Euna. Lastly, the school counselor invites the OT and mental health counselor to participate in the development of the 504 plan to provide accommodations for Euna to be successful in school.

During the last several years, authors have presented variations of the Euna case study to audiences in counseling classes and conferences, asking for participants’ thoughts on a preliminary diagnosis for further exploration. Common participant responses include trauma, anxiety and school phobia; this is not surprising, as SPD can be easily misdiagnosed as other disorders.

Summary and Recommendations

SPD is a neurological disorder that impacts the daily functioning of children across settings. Thus, to advocate on behalf of children with SPD in mental health and school settings, counselors need to increase their SPD-related education, advocacy, screening, treatment, stakeholder collaboration and research. First, counselors should become increasingly knowledgeable about and advocate for an increased awareness of SPD within the counseling profession. We recommend that counselors advocate for the inclusion of SPD in diagnostic standards, such as the future edition of the DSM, and in counselor education, professional development and counseling literature. By increasing the counseling profession’s knowledge of SPD, counselors can provide children with more appropriate and earlier treatment interventions.

Next, counselors need to effectively screen for SPD and collaborate with parents and other professionals to treat the primary and secondary needs of children with this disorder. Also, counselors can educate stakeholders on SPD, including teachers and parents. By further demystifying and clarifying SPD for professionals and family members, these stakeholders can best support children with SPD, improving their quality of life and achieving treatment goals.

Conducting and publishing counseling-related SPD research can add professional credibility and recognition of SPD. In the future, researchers should investigate the following: (a) counselors’ awareness of SPD; (b) mental health, school, and family counseling interventions used for children with SPD; (c) consultation practices with other service providers to serve children with SPD; and (d) perceptions and outcomes of clients with SPD receiving counseling services in an effort to develop future evidence-based best practices. Also, researchers can explore the psychometric properties of instruments used to screen for SPD, perceptions regarding these instruments, and effectiveness of counselors using these instruments. Finally, counselors can conduct interdisciplinary research with OTs, as future SPD research areas outlined by the American Occupational Therapy Association (2014) are related to counseling treatment goals pertaining to SPD (e.g., social communication, anger management, academic performance, behavior issues). When counselors and researchers engage in self-education and professional education, more accurate screening, evidence-based counseling treatment strategies, stakeholder education and collaboration, and research, they advocate for children with SPD across settings and have the potential to dramatically improve the lives of many children.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of

interest or funding contributions for

the development of this manuscript.

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Appendix A

Sensory Processing Disorder Checklist

© Sensory Therapies And Research (STAR) Center, 2006

Retrieved from http://spdfoundation.net/library/checklist.html

Many of the symptoms listed in the following categories are common to that particular age group. Where more than a few symptoms are found in a child, we recommend you talk to your doctor or check the SPD Foundation’s Treatment Directory for a professional experienced with treating Sensory Processing Disorder.*

Infant/ Toddler Checklist: 
____ My infant/toddler has problems eating.
____ My infant/toddler refused to go to anyone but me.
____ My infant/toddler has trouble falling asleep or staying asleep
____ My infant/toddler is extremely irritable when I dress him/her; seems to be uncomfortable in clothes.

____ My infant/toddler rarely plays with toys, especially those requiring dexterity.
____ My infant/toddler has difficulty shifting focus from one object/activity to another.
____ My infant/toddler does not notice pain or is slow to respond when hurt.
____ My infant/toddler resists cuddling, arches back away from the person holding him.
____ My infant/toddler cannot calm self by sucking on a pacifier, looking at toys, or listening to my voice.
____ My infant/toddler has a “floppy” body, bumps into things and has poor balance.
____ My infant/toddler does little or no babbling, vocalizing.
____ My infant/toddler is easily startled.
____ My infant/toddler is extremely active and is constantly moving body/limbs or runs endlessly.

____ My infant/toddler seems to be delayed in crawling, standing, walking or running.

Pre-School Checklist:
____ My child has difficulty being toilet trained.
____ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
____ My child is unaware of being touched/bumped unless done with extreme force/intensity.
____ My child has difficulty learning and/or avoids performing fine motor tasks such as using crayons and

fasteners on clothing.
____ My child seems unsure how to move his/her body in space, is clumsy and awkward.
____ My child has difficulty learning new motor tasks.
____ My child is in constant motion.
____ My child gets in everyone else’s space and/or touches everything around him.
____ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
____ My child is intense, demanding or hard to calm and has difficulty with transitions.
____ My child has sudden mood changes and temper tantrums that are unexpected.
____ My child seems weak, slumps when sitting/standing; prefers sedentary activities.
____ It is hard to understand my child’s speech.
____ My child does not seem to understand verbal instructions.

School Age: 
___ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
___ My child is easily distracted in the classroom, often out of his/her seat, fidgety.
___ My child is easily overwhelmed at the playground, during recess and in class.
___ My child is slow to perform tasks.
___ My child has difficulty performing or avoids fine motor tasks such as handwriting.
___ My child appears clumsy and stumbles often, slouches in chair.
___ My child craves rough housing, tackling/wrestling games.
___ My child is slow to learn new activities.
___ My child is in constant motion.
___ My child has difficulty learning new motor tasks and prefers sedentary activities.
___ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
___ My child gets stuck on tasks and has difficulty changing to another task.
___ My child confuses similar sounding words, misinterprets questions or requests.
___ My child has difficulty reading, especially aloud.
___ My child stumbles over words; speech lacks fluency, and rhythm is hesitant.

Adolescent/Adult: 
___ I am over-sensitive to environmental stimulation: I do not like being touched.
___ I avoid visually stimulating environments and/or I am sensitive to sounds.
___ I often feel lethargic and slow in starting my day.
___ I often begin new tasks simultaneously and leave many of them uncompleted.
___ I use an inappropriate amount of force when handling objects.
___ I often bump into things or develop bruises that I cannot recall.
___ I have difficulty learning new motor tasks, or sequencing steps of a task.
___ I need physical activities to help me maintain my focus throughout the day.
___ I have difficulty staying focused at work and in meetings.
___ I misinterpret questions and requests, requiring more clarification than usual.
___ I have difficulty reading, especially aloud.
___ My speech lacks fluency, I stumble over words.
___ I must read material several times to absorb the content.
___ I have trouble forming thoughts and ideas in oral presentations.

*While this checklist can’t diagnose a child with SPD, it can be a helpful guide to see if additional testing should be done. When filling out this checklist, think about the child’s behavior during the past six months.

Appendix B

Abbreviated List of Sensory Processing Disorder Resources

Resources for Parents, Teachers and Counselors

• Answers to Questions Teachers Ask about Sensory Integration: Forms, Checklists, and Practical Tools for Teachers and Parents by Jane Koomar, Carol Kranowitz, Stacey Szklut, Lynn Balzer-Martin, Elizabeth Haber, Deanna Iris Sava
• Building Sensory Friendly Classrooms to Support Children with Challenging Behaviors: Implementing Data Driven Strategies! by Rebecca A. Moyes
• The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder by Carol Stock Kranowitz
• The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition by Carol Kranowitz and Lucy Jane Miller
• Parenting a Child with Sensory Processing Disorder: A Family Guide to Understanding and Supporting Your Sensory-Sensitive Child by Christopher R. Auer
• Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues by Lindsey Biel and Nancy Peske
• Sensational Kids: Hope and Help for Children with Sensory Processing Disorder by Lucy Jane Miller and Doris A. Fuller
• Sensory Parenting, From Newborns to Toddlers: Everything is Easier When Your Child’s Senses are Happy! by Britt Collins and Jackie Linder Olson
• Sensory Parenting, The Elementary Years: School Years Are Easier when Your Child’s Senses Are Happy! by Britt Collins and Jackie Linder Olson
• Sensory Processing Disorder Foundation: http://www.spdfoundation.net/index.html
• Starting Sensory Therapy: Fun Activities for the Home and Classroom! by Bonnie Arnwine
• The Survival Guide for Travelling with a Sensory Kiddo: From Amusement Parks, to the Beach or a Weekend Road Trip to Visit Relatives…Sensory Help is Here! by Angie Voss
• Too Loud, Too Bright, Too Fast, Too Tight: What to Do If You Are Sensory Defensive in an Overstimulating World by Sharon Heller
• Understanding Your Child’s Sensory Signals: A Practical Daily Use Handbook for Parents and Teachers by Angie Voss
• Your Essential Guide to Understanding Sensory Processing Disorder: When You See a Child Through Sensory Goggles…It ALL Makes More “Sense”! by Angie Voss

Sensory Processing Disorder Checklists

• http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html
• http://sinetwork.org/library/checklist.html
• http://www.sensationalbrain.com/sensory-activities-6-quick-ideas/

For Children

• The Adventures of Sensory Avoider Allie: Allie Only Eats Three Foods by Angie Voss and Dillon Seglem
• Arnie and His School Tools: Simple Sensory Solutions That Build Success by Jennifer Veenendall
• Ellie Bean the Drama Queen: A Children’s Book about Sensory Processing Disorder by Jennie Harding and Dave Padgett
• I’m Not Weird, I Have Sensory Processing Disorder (SPD): Alexandra’s Journey (Growing with Love) by Chynna T. Laird
• Meghan’s World: The Story of One Girl’s Triumph over Sensory Processing Disorder by Diane M. Renna and Regina Stark
• Picky, Picky Pete by Michele Griffin
• Sensitive Sam: Sam’s Sensory Adventure has a Happy Ending! by Marla Roth-Fisch
• Squirmy Wormy: How I Learned to Help Myself by Lynda Farrington Wilson
• This is Gabriel Making Sense of School: A Book About Sensory Processing Disorder by Hartley Steiner
• Why Does Izzy Cover Her Ears? Dealing with Sensory Overload by Jennifer Veenendall

Emily Goodman-Scott, NCC, is an Assistant Professor at Old Dominion University. Simone F. Lambert, NCC, is the Counseling Department Chair and Associate Professor at Argosy University. Correspondence may be addressed to Emily Goodman-Scott, 110 Education Building, Old Dominion University, Norfolk, VA 23529, egscott@odu.edu.

The U.S. Workforce from 1960 to 2010: A RIASEC View

Feb 9, 2015 | Article, Volume 5 - Issue 1

Mary-Catherine McClain, Robert C. Reardon

In this article, the authors analyze ways of categorizing civilian occupations and employment data collected by the U.S. Census Bureau over 6 decades (1960–2010) with respect to six kinds of work (Holland’s RIASEC classification), occupational titles used, employment and income. O*NET provided data for the 2010 census regarding employment and income. The authors discuss the distribution of employment changes over time and the examination of findings in relation to science, technology, engineering and mathematics fields. The article concludes with practical implications for counseling and guidance practice.

Keywords: Holland, RIASEC, census, employment, occupations, income

Holland’s (1997) RIASEC theory is generally recognized as one of the most important and influential in the field of counseling and career development. Foutch, McHugh, Bertoch, and Reardon (2014) sought to verify such an observation by using bibliographic research tools and identified all publications based on this theory from 1953–2011. They found over 1,970 reference citations to Holland’s theory and applications, and categorized them in terms of practice, specific populations (e.g., K–12), instruments, diverse populations and theory. These citations appeared in 275 publications (e.g., books, journals, periodicals, reports) produced in varied professional fields and disciplines worldwide.

Many counselors know relatively more about Holland’s RIASEC personality typology than corresponding environmental models (Reardon & Lenz, 1998). From the outset, Holland believed that the environmental aspects of the typology needed further examination (Weinrach, 1980). Occupations, fields of study or academic disciplines, organizations, leisure activities, and jobs (positions) are aspects of the environment included in the theory. In this article, we address the interaction between RIASEC theory and the environment by examining 2010 census data and updating prior studies of occupational employment in 1960, 1970, 1980, 1990 and 2000 in relation to RIASEC codes and Holland’s theory (Reardon, Bullock, & Meyer, 2007).

Various people contemplating career decisions can benefit from understanding the scope and nature of the labor force and employment from this psychological, counseling-based point of view. Moreover, given characteristics of the contemporary U.S. economy, it is important to know how the distribution of jobs is changing over time. For example, the distribution of jobs across the RIASEC categories has changed from 1960–2010 in some ways, but not in others. An analysis of occupational employment, then, can be beneficial to counselors and career services providers assisting those who are unemployed, displaced or exploring the labor force. This work is important for both theoretical and practical reasons. For example, the number of annual job openings is strongly related to the number of people currently working in an occupation, so knowing the number employed is of practical importance in job hunting because of the need to replace workers.

Authors of recent literature have identified concerns about the use of outmoded concepts such as occupation in career/life counseling at a time of unprecedented socioeconomic change in the global economy. For example, Savickas et al. (2009) noted that new social arrangements for work and the digital revolution have led to unstable occupations and frequent job transitions for individuals: “Today, occupational prospects seem far less definable and predictable, with job transitions more frequent and difficult” (Savickas et al., 2009, p. 240). Sampson and Reardon (2011) summarized these ideas: “Occupations have changed in fundamental ways as technology and globalization have reshaped the workplace. Occupations have become fluid and organizations are evolving rapidly, adapting their workforce to respond to a rapidly evolving marketplace” (p. 41). We agree that some occupations are changing but conclude that the concept of an occupation remains common and useful in the social sciences as a way of categorizing work activities and employment.

In contrast to this view, Murray (2012) suggested that the workplace has not transformed for the 82% of American workers in occupations other than managerial professional positions. Teachers, police, plumbing contractors, insurance agents and carpenters have the same duties and routines that these occupations have always required, although some of the work tasks may have been affected by technology. Sampson and Reardon (2011) noted that the perception of massive occupational change has been exacerbated by inaccuracies in media presentations and the failure to use career theory to examine occupational changes.

In the present article, we examine occupational information using Holland’s (1997) RIASEC theory. This theory rests on four basic assumptions: (a) individuals can be categorized into Realistic (R), Investigative (I), Artistic (A), Social (S), Enterprising (E) and Conventional (C) types; (b) environments (i.e., occupations) also can be categorized into these same six types; (c) individuals tend to choose environments that fit their personality types; and (d) behavior is determined by the fit between an individual’s personality and environment. Examination of the occupational titles used to describe current work in the United States, including information about employment and income, can increase understanding of the workplace from this theoretical perspective.

Holland’s (1997) typological theory specifies a theoretical connection between vocational personalities and work environments that makes it possible to use the same RIASEC classification system for both persons and occupations. Many inventories and assessment tools also use the typology to enable individuals to categorize their interests and personal characteristics in terms of the six types and combinations of the types. These six types are briefly defined as follows:

1. Realistic (R) types are found in occupations such as auto mechanic, surveyor, electrician and farmer. The R type usually has mechanical and athletic abilities, likes to work outdoors and with tools and machines, and might be described as conforming, hardheaded, honest, humble, materialistic, practical and thrifty.
2. Investigative (I) types like occupations such as a biologist, chemist, geologist, anthropologist and medical technician. The I type usually has math and science abilities, and likes to work alone and to solve problems. The I type might be described as analytical, critical, curious, independent, intellectual, pessimistic and rational.
3. Artistic (A) types are found in occupations such as musician, dancer, interior decorator, actor and writer. The A type usually has artistic skills, enjoys creating original work and has a good imagination. The A type may be described as disorderly, emotional, idealistic, imaginative, impulsive, independent, introspective and original.
4. Social (S) types like occupations such as teacher, speech therapist, counselor, clinical psychologist and nurse. The S type generally likes to help, teach and counsel people, and may be described as friendly, generous, helpful, idealistic, kind, responsible, tactful, understanding and warm.
5. Enterprising (E) types like occupations such as buyer, sports promoter, business executive, salesperson, supervisor and manager. The E type usually has leadership and public speaking abilities, is interested in money and politics, and likes to influence people. The E type is described as acquisitive, ambitious, domineering, extroverted, optimistic, self-confident and sociable.
6. Conventional (C) types are found in occupations such as bookkeeper, financial analyst, banker and secretary. The C type has clerical and math abilities, likes to work indoors and to organize things. The C type is described as conforming, efficient, obedient, orderly, persistent, practical and unimaginative.

The six RIASEC types are optimally represented by a circular order, also commonly referred to as the hexagonal model. Holland’s (1997) structure of the six types as a hexagon is one of the most well-replicated findings in the history of vocational psychology (Rounds, 1995). The six domains are arranged according to their relative similarity in a hexagonal formation of R-I-A-S-E-C. For example, according to Holland’s theory, the Social and Enterprising types appear in adjacent positions on the hexagon because they are alike; in contrast, the Social and Realistic types are dissimilar and appear in opposite positions from one another on the hexagon.

Prior Studies

In the early 1970s, researchers began to examine the U.S. labor market using the RIASEC classification system (Reardon et al., 2007), and the present study is a continuation of that line of research. Using data provided by the decennial census in 1960, 1970 and 1980, researchers (G. D. Gottfredson & Daiger, 1977; G. D. Gottfredson & Holland, 1996; G. D. Gottfredson, Holland, & Gottfredson, 1975; L. S. Gottfredson, 1978; L. S. Gottfredson, 1980; L. S. Gottfredson & Brown, 1978) analyzed U.S. employment patterns using Holland’s theory. These studies examined a number of variables with respect to the Holland RIASEC classification, including the percentages of men and women working in hundreds of occupations, salaries earned during the preceding year by incumbents, educational and training levels associated with occupations, occupational prestige, and the education levels or cognitive complexity ratings for occupations. These studies provided practitioners and scholars with more theory-based, detailed information about work environments and the characteristics of workers.

After a 15-year hiatus in research on census employment and Holland codes, Reardon, Vernick, and Reed (2004) analyzed the 1990 census data in relation to data from 1960, 1970 and 1980. They considered the variables of gender, income and cognitive complexity and reported stability in the census data for occupational titles and six kinds of work from 1960–1990. For example, the Realistic area included many more named occupations in the census than the other five areas, averaging between 46% and 50% of all named occupations over the 40-year period.

Reardon et al. (2004) found that while employment declined by 18% in the Realistic area relative to other Holland types, it remained the largest area of employment and actually increased in real numbers through 1990. Only 1% of employment was in the Artistic area. Reardon et al. (2004) also reported marked differences in employment between men and women across the six areas from 1960–1990. Reardon et al. (2004) further examined income and gender by six kinds of work and found that the average income profile ranging from highest to lowest was IESARC. The discrepancy across the six areas was very large, with the average Investigative income being two times the average Conventional income.

In a later study, Reardon et al. (2007) examined trends in labor market characteristics using census data from 1960–2000. They found stability in occupational constructs for six kinds of work from 1960–2000; for instance, the Realistic area included many more named occupations in the census than the other five areas, ranging between 43% and 50% of all occupations included over the five census periods. Reardon et al. (2007) reported that although employment in the Realistic area declined by 25% from 1960–2000, this area remained the largest area of employment and actually increased in real numbers from 1960–2000. As before, only 1% of employment was in the Artistic area. Finally, Reardon et al. (2007) examined income and gender by kinds of work and found that the average income profile for six kinds of work ranging from highest to lowest was IESARC in 1990 and ISEARC in 2000. The discrepancy across the six areas was very large, with the average Investigative income about twice as large as the average Conventional income.

In summary, the data included in these studies (Reardon et al., 2007; Reardon et al., 2004) were unique in several ways and have special implications for counselors. First, as an independent branch of the federal government, the U.S. Census Bureau reported actual numbers of people working in different occupations based on an accounting of persons in households. Second, these data provided a retrospective look at the labor markets, and by examining them over time it was possible to view changes in the economic lives of persons in the United States. Third, the occupational titles included in the census have remained constant over the years, reinforcing the use of the occupational schema in matching persons and environments. Fourth, these studies were conducted by researchers in the counseling field rather than economists or sociologists, which helps counselors use occupational data organized by Holland codes to illustrate and explain where jobs exist in relation to their clients’ interests. For example, a client may have a strong interest in Artistic occupations, and census data may help a counselor explain the relatively small number of persons working in Artistic fields.

The Present Study

We examined the employment trends reported in earlier research and added a new analysis based on the 2010 census and O*NET data. Research questions included the following:

1. What were the numbers of occupational titles reported in the census from 1960–2010 relative to the six areas of work?
2. What were the numbers and percentages of occupational employment in 1960, 1970, 1980, 1990, 2000 and 2010 in relation to six kinds of work?
3. What were the mean incomes for six different kinds of work in 1990, 2000 and 2010?

Methods

Procedures and Research Tools

Varied procedures have been used to collect occupational data for the decennial census over the past 6 decades.

1960, 1970, 1980 census. In the 1960 census, the sampling unit was the housing unit, or the person in the case of group housing. This method provided information about 297 detailed occupational categories. L. S. Gottfredson and Brown (1978) described the methods they used to derive Holland codes for the 1960 census data using 1970 census data as a point of reference. In the 1970 census, the sampling unit again was the housing unit, and 440 detailed occupational titles were included in these data, 143 more than in 1960. As with the 1960 census, the data included only employed persons and excluded members of the armed forces. G. D. Gottfredson, Holland, and Gottfredson (1975) analyzed data from the 1970 census involving 424 occupations, and excluded men (5.6%) and women (6.6%) not classified according to one of the detailed occupations. Information about the 1980 census was taken primarily from G. D. Gottfredson and Holland (1989) and G. D. Gottfredson (1984). The 1980 analysis was based on 503 selected occupations.

1990 census. Comprehensive information about the 1990 census was provided by the U.S. Census Bureau (1992a, 1992b), and was based on 500 selected occupations. G. D. Gottfredson and Holland (1996) indicated that this classification was most closely related to the Standard Occupational Classification (SOC; U.S. Department of Commerce, 1980). The U.S. population count in 1990 was 283,928,233 (U.S. Census Bureau, 1992b). Four new categories of work were added to the 1990 census while six from the 1980 census were eliminated.

2000 census. The 2000 census counted 281,421,906 people in the 50 states and the District of Columbia. As in the past, short and long forms were used with about 17% (1 in 6 households) receiving the latter (U.S. Census Bureau, 2002). The 2000 census included 471 occupations classified using the SOC (U.S. Department of Labor, 2000).

2010 census. The 2010 census counted 308,745,538 people in the 50 states and the District of Columbia. This census included 539 occupations, including those with “all other” titles representing occupations with a wide range of characteristics not fitting into one of the O*NET detailed occupations. However, as in prior studies, the focus was on the detailed occupations in the 2010 census (N = 494) and excluded military-based occupations.

The information collected in the 2010 census was based on the short form rather than the long form, which means that demographic information about gender, salary and age was not collected relative to occupations. Lowe (2010) noted that the introduction of the American Community Survey by the U.S. Census Bureau provided the most sweeping change in census data collection in 60 years. The American Community Survey is a nationwide, continuous survey designed to provide reliable and timely demographic housing, social and economic data every year, in contrast to the long form, which provided data only at the beginning of each decade.

After locating the 2010 census data from the U.S. Census Bureau with lists of occupations categorized with census and SOC codes, we organized the information into a spreadsheet using the following headings: Occupation 2010 category description (e.g., management occupations), Occupation (e.g., chief executive), 2010 Census Code (e.g., 0010) and 2010 SOC Code (e.g., 11-1011). Additional columns were created to incorporate Holland code information for 2010 employment data and mean annual wages. The SOC (U.S. Department of Labor, 2010) was used to collect employment and salary information from the O*NET system (http://online.onetcenter.org/). O*NET is a comprehensive database that provides information on 780 occupations, worker skills and job training requirements. O*NET is sponsored by the U.S. Department of Labor’s Employment and Training Administration. The Self-Directed Search Occupations Finder—Revised Edition (OF; Holland & PAR Staff, 2010) and the Dictionary of Holland Occupational Codes (DHOC; G. D. Gottfredson & Holland, 1996) also were used to obtain the first-letter Holland code for each specific occupation. Employment data and mean annual wages for census occupations were found in O*NET.

A Note about Data Analysis

Previous studies of employment using census data and Holland codes have reported frequency and percentage distributions, and this study continued that approach. As earlier researchers have noted (G. D. Gottfredson & Daiger, 1977), the sample sizes are so large that the magnitude of observed differences is more important than statistical differences. Rounded numbers are used in this report to the nearest percent or thousand in order to avoid communicating a misplaced sense of precision in the findings.

Results

Occupational Titles in the Census for Six Kinds of Work, 1960–2010

For the first question, we examined the number of occupational titles used in the census and O*NET, and categorized these in relation to the six areas of work. Occupational titles provide schemas for career exploration using Holland’s (1997) RIASEC codes—tools for the exploration and examination of occupational information. As in previous studies (Reardon et al., 2007), the Realistic area included many more named occupations in the census than the other five areas (see Table 1, updated with 2010 data). For example, the 2010 census specified 211 occupations in the Realistic area and 283 occupations in the other five areas combined. Only 19 occupations were identified in the Artistic area. Overall, occupations in the Enterprising area increased from 27 in 1960 to 88 in 2010. Finally, 282 occupations were included in the 1960 analysis, which increased to 465 in 1970, 502 in 1980 and 500 in 1990, dropped to 434 in 2000, and increased again to 494 in 2010.

Table 1 also shows that occupational titles were not equally distributed across the six areas of work over the past six decades and have changed very little during this period. For example, the Realistic area consistently has the most occupational titles and the Artistic area the fewest. Figure 1 shows the average percentages of occupational titles in the census across six decades, as follows: Realistic 46%, Investigative 12%, Artistic 3%, Social 12%, Enterprising 18% and Conventional 9%. This distribution is similar to what was found in 2010: Realistic 43%, Investigative 11%, Artistic 4%, Social 13%, Enterprising 18% and Conventional 11%. Figure 1 shows in graphic form that the schemas used to describe work activities in the U.S. economy have remained relatively stable over 6 decades.

Employment in Six Kinds of Work, 1960–2010

In analyzing U.S. employment data over 6 decades, we focused on the detailed occupations as in previous census studies (Reardon et al., 2007). Table 2 indicates that the total estimated employment increased over the 6 decades from 64.1 million in 1960 to 119.8 million in 2010. Table 2 and Figure 2 reveal that the percentage of Realistic employment declined 28% from 1960–2010, an average of about 4.7% for each decade. However, and in spite of this decline, the Realistic area showed that 31.9 million persons were employed in 2010, and the Realistic area had the highest level of employment across the six RIASEC areas in each census period. The Artistic area had the fewest number employed in 2010 with 2.0 million. Table 2 and Figure 2 show that the percentage of employment in the Social area increased from 9% in 1960 to 24% in 2010, or 5.6 million to 29.6 million persons. During the same period, employment in the Investigative area increased from 3% in 1960 to 10% in 2010, or 2.0 million to 11.5 million persons. Employment in the other four areas remained more stable. Figure 2 graphically shows that the RIASEC employment profile for highest to lowest areas was RSECIA in 1960 compared to RECSIA in 2010. The Realistic, Investigative, and Artistic areas maintained their positions over this time period.

Table 2

Number and Percentage of Persons Employed in Six Kinds of Work, 1960–2010

Note. Employment numbers are in millions rounded to the nearest thousand.

^aUsed by permission of Academic Press Inc., Journal of Vocational Behavior, 10, p. 131. Copyright 1977 Academic Press Inc.

Income and Kinds of Work, 1990–2010

For the third question, we focused on mean income levels for persons employed in six kinds of work in 1990, 2000 and 2010. Inspection of Figure 3 shows the results of this analysis. These data reveal the continued discrepancy with regard to income among the Holland types across the three most recent census periods. The RIASEC profiles for highest to lowest income were IESARC, ISEARC and IEASRC in 1990, 2000 and 2010, respectively. The Investigative area consistently showed the highest income levels over the 3 decades, while the Conventional and Realistic areas tended to show the lowest. The average income over the 3 decades for the Investigative area was $54,587, compared to Conventional, $28,047 and Realistic, $27,981. Data in Figure 3 continue to show wide variations in income levels among the six RIASEC groups. For example, in 2010 the income in the Investigative area was almost double that of the Conventional area.

Discussion

The principal findings of this study are examined in terms of the three questions that guided the research, followed by a discussion of the study’s limitations and implications for counseling practice.

Occupational Titles by RIASEC Code

Information about jobs and employment used in counseling may be affected by the uneven distribution of occupational titles describing work across RIASEC areas. Over 60% of the titles used in 2010 were in the Realistic and Enterprising areas, and this distribution has been consistent over the past 6 decades. It is noteworthy that the percentages of occupational titles in the Investigative and Conventional areas in 2010 were the same, but the income reported across the six areas was the most discrepant between these two areas. Labor market information across the six areas is not always equivalent.

G. D. Gottfredson and Holland (1989) reported that the Dictionary of Occupational Titles also showed variations in the distribution of RIASEC codes for occupational titles. They were interested in the number of times each RIASEC letter appeared somewhere in the three-letter code for each occupation in the Dictionary of Occupational Titles and reported the following: Realistic, 10,708 times; Investigative, 2,551; Artistic, 570; Social, 6,606; Enterprising, 10,405; and Conventional, 5,999. These data reveal that upon examining the world of work from a RIASEC perspective, counselors can obtain a theory-based view of work environments that is not equitable across the six areas. Counselors can use RIASEC codes to inform clients about work and to increase their understanding of occupations and employment.

Information about jobs and employing organizations changes more frequently than information about occupations (e.g., typical work duties, training requirements, working conditions; Reardon, Lenz, Sampson, & Peterson, 2012). Perhaps lessons from the field of general semantics (Johnson, 1946) can be useful here. For example, the word chair can communicate information about the arrangement of furniture in a room, but this word does not communicate everything known about chairs, which in reality may take many different forms and be built of varied kinds of materials. The same is true for occupational terms. There are many different carpenters working in varied job positions and for varied employers, but the term carpenter still has meaning in communications because it is generally understood that not all carpenters are the same.

Over the 6 decades of this analysis, the number of census occupations in each RIASEC area has been relatively static. This stability indicates that there is considerable permanence in the array of the named occupations in the census reports about the workforce. This finding is contrary to the observations by Savickas (2012) and Savickas et al. (2009) regarding instability of the concept of an occupation in the contemporary global economy.

Employment in Six Areas of Work

The findings of this study report both the numbers of persons employed and the percentages of employment across RIASEC areas for six census periods. We believe that information about employment in the past can be instructive for future career planning. Table 2 reports the numeric and percentage changes in employment over 6 decades. The table shows the actual number of persons employed according to the decennial censuses over the 60-year period. This table and Figure 2 show the percentage change­s—the distribution of the workforce within the RIASEC categories. Occupations that employ the largest numbers of people are in the Realistic, Social and Enterprising areas, with less employment in the Investigative and Artistic areas. The latter two areas report both the fewest numbers employed and the smallest percentages of employment across the six RIASEC areas.

The current emphasis on preparation for careers in science, technology, engineering and mathematics (STEM) fields involves occupations that do not employ large numbers of people. These occupations, often found in the Investigative and Artistic areas, employed relatively small numbers of people in 2010 compared to the other four areas: 12% versus 88%. The STEM fields are not big-growth occupational areas that employ many hundreds of thousands or millions of people (e.g., nurses, retail salespersons, office clerks, teachers). However, the STEM fields are generally characterized by fast growth that involves a few thousand or more persons (e.g., biomedical engineers, veterinary technicians, glaziers, physical therapists). Persons in these occupations typically have higher salaries and better employment opportunities (Horrigan, 2003–2004).

The findings of the present study indicate that most people are employed in Realistic, Enterprising and Conventional (REC) occupations. Public attention to employment and career preparation often is directed at occupations with code combinations in the Investigative, Artistic and Social (IAS) areas because the percentage rate of employment growth is often greater there than in the REC areas (Reardon et al., 2012). The IAS areas provide higher levels of prestige and income, but employ fewer people (Reardon et al., 2004). One must remember that these are projected new jobs, which seem to capture more public attention and interest than the census data regarding actual employment.

A large number of jobs actually involve replacement of older workers, perhaps as much as one-third of employment (Mittelhauser, 1998). The U.S. Bureau of Labor Statistics (BLS; 2012) used data from the Current Population Survey and found that the replacements provide many more job openings in most occupations than straight employment growth does.

While the census data provide information about past employment that can inform career planning, the U.S. BLS provides additional labor market forecast information based on occupational projections. Lockard and Wolf (2012) identified the 20 occupations expected to have the most job openings each year through 2020 (big-growth occupations). Four of these occupations—registered nurses, retail salespeople, home health aides and personal care aides—will add more than half a million jobs each through 2020. These occupations are not new, different or unique, and they are unrelated to STEM fields. Reardon et al. (2012) noted that the Holland summary code order for these 20 big-growth occupations was SREICA. In the current study, the profile for employment in the 2010 census was RECSIA. It is not surprising that the Realistic area is prominent in both of these projections, because according to the census, it is the area of largest employment in the economy.

Given the overall increase in actual employment from 64.1 million in 1960 to 119.8 million in 2010, there has been a corresponding increase in employment across the six areas of work. For example, the number of persons employed in the Investigative area has grown from over 1.9 million in 1960 to 11.5 million in 2010, and in the Social area from 5.6 million in 1960 to 29.6 million in 2010. Employment growth has been less dramatic in the Artistic, Enterprising and Conventional areas, and growth has declined slightly in the Realistic area from 35.0 million in 1960 to 31.9 million in 2010.

In addition, the percentages of the U.S. population employed in the six areas of work also have changed from 1960–2010, but in a less dramatic way (see Figure 2). For example, the employment percent profile from highest to lowest employment in 1960 was RECSIA, and in 2010 it was RSECIA, with only the ECS areas alternating in order. However, the percentage difference between the Realistic and Artistic areas was greater in 1960 (54%) than in 2010 (25%). This may be evidence of a decline in manufacturing.

Income Across Six Areas of Work

Our findings indicate that income is not equitable across the six RIASEC areas, with the Investigative area consistently having the highest income and the Realistic and Conventional areas the lowest. Research using census data by Huang and Pearce (2013), Reardon et al. (2004), and Reardon et al. (2007) revealed similar findings. We find that although the RIASEC schema is familiar to counselors using the Self-Directed Search, the Strong Interest Inventory and many other career assessments, the idea of using this schema to analyze occupational information is more novel. For example, thinking of income levels in terms of the RIASEC schema means using an order of IEASRC per the 2010 census data when discussing occupational information with clients.

Reardon et al. (2007) reported that examining levels of cognitive complexity associated with occupations may provide an explanation for the income disparity among the six RIASEC areas. G. D. Gottfredson and Holland (1996) created the Complexity Rating (Cx) to estimate the cognitive skill and ability associated with an occupation. In developing the Cx, the authors wanted to make greater use of job analysis ratings obtained by the U.S. BLS and also create a single measure of cognitive or substantive complexity associated with an occupation. They noted that cognitive complexity of work demands (G. D. Gottfredson & Holland, 1996) might be an appropriate term for the Cx. A Cx rating of 65 or higher could be associated with an occupation requiring a college degree and possibly postgraduate work and on-the-job training of 4–10 years, while a Cx level of 50 might characterize an occupation requiring a high school diploma and a year or more of on-the-job training. Reardon et al. (2007) found that Cx levels were highest in the Investigative and Artistic areas and that the Conventional area was associated with the lowest ratings. They found that employment in the Investigative area occurred only at the highest two levels of Cx (i.e., baccalaureate or higher) while the other four areas—Realistic, Social, Enterprising and Conventional—showed employment at all six levels of Cx.

Huang and Pearce (2013) reported that higher annual incomes in 2010 were found in occupations associated with greater Investigative and Enterprising traits. In addition, they found that the differentiation of an occupational interest profile positively predicted median annual income and moderated the effect across each of the six RIASEC areas. In other words, the more the occupation was characterized by a single, robust RIASEC code letter, the greater the income level for the occupation.

Reardon et al. (2007) examined income by kinds of work and found that the average income profile for six kinds of work ranging from highest to lowest was IESARC. In the current study, the income profile was almost identical—IEASRC. These findings are very similar to those reported by Huang and Pearce (2013). Given that the Investigative area of work requires more education and training than the other five areas, these findings from census data provide evidence that education pays. Reardon et al. (2012) reported that the unemployment rate is clearly related to educational attainment. Those with more education are less frequently unemployed and have higher weekly earnings—more education is connected to more income.

Limitations

As with earlier studies (Reardon et al., 2007; Reardon et al., 2004), several limitations in the present study should be noted. First, the occupational titles included in the census have changed only slightly over the years. The U.S. BLS conducts extensive research to determine whether a new occupation should be added to its list of detailed occupations. A new occupation is one that includes duties not previously identified, one that has been recognized in small numbers and continues to grow (e.g., now has its own professional association or trade group), or one that is evolving and whose tasks have changed significantly. These new occupations arise from technological advances, new laws or regulations, or changing demographics. However, we believe that this issue has minimal impact on the findings of the present study because changes in occupational codes are unlikely to affect the first letter of a code. First-letter codes of occupations are much more stable over time and across industries than second or third letters.

A second limitation of this study is related to the classification of hundreds of thousands of jobs into 350–500 occupational categories, which requires considerable judgment and skill by occupational analysts. These specialists base their judgments on the application of classification criteria, and there is the possibility of error in the use of this system of analysis. Third, we used the first letter in each Holland code in our analysis in order to simplify reporting. While this decision reduced some of the precision inherent in the Holland classification when three-letter codes are used, it increased the accuracy of occupational classification.

Fourth, our analysis was based on a sampling procedure used by the U.S. Census Bureau over 6 decades, and we generalized from this sample to the entire U.S. population. We assumed that the sampling procedure used by the U.S. Census Bureau was appropriate for this study. Fifth, the method for calculating the income levels reported in this study differed across the 3 decades, and comparisons should be made with caution. We used mean levels rather than median levels, and information about the skew of the distribution is not provided in this study. For example, Lowe (2010) noted that while the American Community Survey data are more current, they are not as precise (margins of error are generally higher) as data obtained in the long form used by the U.S. Census Bureau previously. Finally, it is possible that occupations may be shifting within or among industry groups, which would mask some of the findings regarding income reported in the present analysis.

Implications for Counseling Practice

Limitations notwithstanding, the results of this analysis of six kinds of work and employment over 6 decades have implications for counselors. Holland (1997) noted several rules to use in interpreting the Self-Directed Search interest inventory, such as the Rule of Asymmetrical Distribution of Types and Subtypes. This rule reminds both counselor and client that the distribution of types across the six RIASEC areas is very uneven and unequal; moreover, the distribution of jobs across the six types is not symmetrical or equal. Codes associated with small employment numbers may have fewer positions and fewer openings. The research in the present article underscores the validity of this rule. In each census period, the Artistic area was the smallest area of employment at 1% or 2%. At the other extreme, the Realistic area was the largest area of employment, ranging from 55% in 1960 to 27% in 2010. Career counselors should be cautious in advising workers to look for employment outside the Realistic area, because it has been the largest area of employment for the past 6 decades, with ongoing replacement needs (Reardon et al., 2007).

We can add that even the numbers of named census occupations are extremely uneven across six kinds of work. For example, the schema based on RIASEC types used in 2010 to examine occupations was heavily skewed in the direction of the Realistic area (N = 211), with very few occupational titles associated with the Artistic area (N = 19). We surmise that these findings reveal little evidence of instability and change in the use of the occupational schema by the U.S. Census Bureau, at least from a RIASEC perspective.

Some of these findings may be interpreted in different ways. For example, the Realistic area employed the most persons in 2010, but employment in that area has dropped 28% over the 6 decades. The loss of jobs in the Realistic area is greater than the changes in any other area, decreasing from 42.7 million in 1990 to 31.8 million in 2010. The Investigative area almost tripled in employment from 1960–2010, from 3% to 10%, but fewer than 10% of total U.S. jobs are in the Investigative area (11.5 million). These findings seem related to the issue of big-growth and fast-growth jobs described by Horrigan (2003–2004), in which very few occupations appear at the top of both lists. For example, only home health aides and personal care aides are included in both the top 20 big-growth and fast-growth employment areas. This information underscores the importance of understanding demography and an aging population in using labor market information. The information used in career guidance programs often touts the rapid growth in information and technology jobs; however, this information must be balanced with the understanding that only 8% of U.S. employment is in the Investigative area.

The findings of the current study can update and enhance a counselor’s view of labor market information based on Holland’s career theory. We suggest that a RIASEC perspective on jobs in the labor market indicates that things are not really changing as much as others sometimes discuss. U.S. census data compiled over 6 decades (1960–2010) can inform counseling practice and career interventions for students and others exploring occupational changes. These findings can assist counselors and their clients in better matching personal characteristics with occupational and work environments.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of

interest or funding contributions for

the development of this manuscript.

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Mary-Catherine McClain is a postdoctoral fellow at the University of Georgia. Robert C. Reardon is a professor emeritus at Florida State University. Correspondence can be addressed to Robert C. Reardon, FSU Career Center, PO Box 3064162, 100 South Woodward Avenue, Tallahassee, FL 32306-4162, rreardon@admin.fsu.edu.