Noise, light in stores can be harsh. Sensory

The unrelenting hum of harsh, fluorescent lights. Aisles crowded with people jostling your cart. Startling announcements blaring over loudspeakers. For some, these common shopping experiences are extremely stressful, debilitating or even painful.

They have what is known as sensory processing disorder, a neurological condition that can cause people to be either over- or under-responsive to different internal and external sensory stimuli, as well as experience other sensory processing differences that can lead to challenges with language, coordination, movement or intellectual milestones.

Sensory processing disorder could affect about 5 to 16 percent of school aged children who have no other conditions such as autism or attention-deficit/hyperactivity disorder. The overall percentage of people with sensory processing disorder is likely much higher because it is also common in people with other conditions such as autism, ADHD, dyslexia, post-traumatic stress disorder, chronic migraines and traumatic brain injuries, experts say.

Despite the condition’s seemingly high prevalence, it is not recognized as a separate medical or psychiatric disorder and has only just begun to gain awareness and acceptance in mainstream culture, advocates say. Walmart recently announced that it would offer sensory-friendly hours during the back-to-school shopping season. The company joins a growing number of businesses and organizations that provide accommodations for those with sensory challenges.

Some now offer special screenings or performances. AMC Theatres offers sensory-friendly film screenings where they turn the sound down and keep the theater lights on. Go Live Theatre Projects, which works with West End productions in London offers “relaxed performances,” where audiences are told what to expect, and during the show, houselights are kept on low, certain triggers such as flashing lights, loud noises or loud music are eliminated or toned down, and audience members can stand up, move around or make noise.

Others have offered sensory-friendly hours. The Smithsonian Institution runs a “Mornings at the Museum” program where museums open an hour early for preregistered families to visit with less crowds.

During Walmart’s sensory-friendly hours — 8 to 10 a.m. Saturdays until the end of August in most stores — select stores dim their overhead lights, turn off radios and replace moving images on TV with static images.

“We’re viewing this as a test and learn opportunity right now and are excited about future ways we can continue to provide excellent shopping experiences for our customers,” Walmart said in a statement.

Nicole Filippone, 39, who lives in a Detroit suburb, said these types of changes make it easier for her and her three children, all of whom are neurodivergent and have sensory processing differences, to shop for school items.

Certain situations and sounds, such as vibrations from music or people popping gum, trigger anxiety attacks for Filippone, who is also autistic. She has been overstimulated to the point of experiencing stress-induced cardiomyopathy — a heart condition that mimics symptoms of a heart attack.

No amount of exposure or training reduces her reactions, she said. Getting an accommodation to reduce triggers is difficult. In many cases, she said her only options are to either avoid triggers or try to mask them with headphones or other sounds such as a whirring fan.

“In my entire life, I never felt accommodated for these differences,” she said. “I think it’s absolutely wonderful that Walmart is doing what they’re doing.”

The sensory system is one of the very first parts of the brain that develops and is critical for giving the brain information about the outside world, said Pratik Mukherjee, a radiology and bioengineering professor at the University of California at San Francisco.

To process sensory data, the brain relies on white matter to connect different parts of the brain and transmit information in a rapid manner, Mukherjee said. This becomes more complex and difficult in a human brain, roughly 50 percent of which is composed of white matter.

When Mukherjee studied brain images of people with sensory processing disorders, he found that they had noticeable abnormalities in their white matter structures. Most of these differences were found in the back areas of the brain, where sensory information like sound or sight is initially processed.

White matter is like a highway for information to travel from one part of the brain to another, he said. People with a sensory processing disorder seem to have highways with too few lanes or poorly organized lanes, which can get bogged down with traffic — an overload of information that their brain can’t process fast enough.

Someone with a sensory processing disorder can also under-register sensory information and need more stimulation, said Cynthia Martin, psychologist and senior clinical director of the Child Mind Institute’s Autism Center. Examples include when someone uses fidget toys or listens to music to focus or calm down, she said.

Not all people with a sensory processing disorder have additional neurodivergent conditions — an umbrella term used to describe various neurological conditions such as ADHD, autism, learning disorders and anxiety. The overlaps, though, are so significant that some researchers hypothesize that sensory processing disorders are not merely adjacent to those conditions, but could be the initial signs of them.

The sensory processing system develops first, and any abnormalities in it could have downstream effects on other areas of the brain and cause them to be wired differently, said Elysa Marco, a cognitive and behavioral neurologist at Cortica and at the Lifetime Neurodevelopmental Care Center.

“Our labeling system is broken,” she said. “We have kids who come in and get diagnosed with six different disorders all stemming from the same cause.”

In her research, Marco found that in children who are overresponsive to sound and touch, 40 percent also have problems with attention — a characteristic commonly found in individuals with ADHD. Hyper- or hypo-reactivity to sensory information also is part of the diagnostic criteria for autism.

Many with sensory processing disorder describe feelings of panic, anxiety or stress when they get overstimulated. Mandy Ealey, 31, says the amount of noises she hears in Walmart can cause her to completely shut down, and she must be guided out of the store.

“I can’t think straight,” she said, “and I’m on edge, crawling out of my skin.”

Walmart is especially overwhelming because it’s such a large store, but in her small town of Alva, Okla., there aren’t many other shopping options, she said. Ealey, who is autistic, wears noise-canceling earplugs and tries to shop during less busy hours, but they don’t always help her avoid a bad reaction. Walmart’s sensory-friendly hours helped her relax and enjoy shopping more, she said.

Initiatives such as sensory-friendly hours could benefit a broader range of people, even those who don’t have a sensory processing disorder, said Virginia Spielmann, the executive director of the STAR Institute for Sensory Processing, an organization that researches and promotes sensory health and provides therapeutic support for people with sensory processing differences.

She believes that a much higher percentage of people have sensory processing differences, which may not always create challenges or be considered a disorder, but can still affect their overall emotional well-being and mental health.

“I’d love to see people doing a bit of reflection on just generally how bombarded we are by sensation and how that might be affecting all of our health,” she said. “We now don’t even go to the toilet without having a flickering screen in front of us all the time.”

Decades of research have shown that there is an inextricable link between sensation and emotion, and some studies have linked sensory processing difficulties to mood disorders, anxiety and depression.

People don’t often talk about their sensory needs, though, Spielmann said. If someone ignores or covers up a sensory difference, it can have negative consequences on their mental health, she said.

Often, she works with clients with a variety of mental health diagnoses who have never thought deeply about how their body experiences various sensations. “If we started to pay attention to those things,” she said, “our lifestyles could change dramatically.”

While we usually only learn about five senses in school (sight, hearing, taste, touch and smell), the brain processes sensory information from many other parts of the body, she said.

For example, proprioception is a sensory system that relates to limb position, movement and muscle force — someone who has issues with this sense may use too much or too little force when they close a door, or may appear clumsy. Interoception refers to sensory systems that relate to signals from your internal organs — someone who struggles with this sense may not realize when they are hungry or full.

Spielmann hopes that Walmart’s initiative encourages more businesses, schools and other organizations to think about how they can best accommodate a variety of sensory differences.

“Differences in sensory processing don’t have to be disabling and, if they are, it’s often because of the rigid and quite inhospitable world we live in,” she said.

People with sensory processing difficulties can try to go to the store only during less busy hours, such as early mornings or late nights, which takes away the additional chaos that a crowd can bring, Martin said.

They can work with a mental health professional or therapist to learn additional techniques to recognize warning signs when their body is reacting negatively to their environment and avoid an emotional breakdown. They can also help someone figure out what accommodations they need and explore techniques for gradual exposure to triggers, which may help reduce overwhelming feelings, Martin said. Since sensory processing differences are so varied, strategies to manage them can be extremely personalized, she said.

Avoiding sensory triggers, however, isn’t always possible for people with sensory processing disorders, and it can be difficult to regulate their responses.

“If everyone with sensory sensitivities avoided everything that affected us, we would just be sitting in a room,” said Angie Glaser, 34, of Costa Mesa, Calif.

Glaser was diagnosed with migraines at the age of 3. Over time, her migraines have gotten worse and can be triggered by light, sound, movement or even smells. She wears light blocking glasses and earplugs, but it’s impossible for her to block all possible triggers when she leaves her home.

She already limits her activities significantly by rarely going to movie theaters, restaurants or concerts and only going to the store when absolutely necessary. She’s hopeful, though, that society can become more inclusive of people like her.

“What’s really powerful about what Walmart is doing is that kids now know what it’s like to be in an environment that’s accessible for them,” she said. “If I was a kid and I could go back to school shopping without the anxiety, that would be pretty empowering.”

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