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Helping a Child With Sensory Smarts - October 2009

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Helping a Child With Sensory Smarts
© Lindsey Biel, OTR/L 2009

By: Lindsey Biel, M.A. OTR/L

When Katie puts on her socks in the morning, they so scratchy, and if they have seams or little pills in them, they make her skin crawl all day long. She cannot tune out everyday tactile sensations. A gentle breeze on her arms feels like icky little insects. She is concerned that classmates might brush up against her so pushes children away if they get too close. She loves to read but will touch only certain kinds of paper. She hates using glue, paint, and lotion. Her hearing is so acute that she can make out what the teacher in the next room is saying. She is terrified of fire drills, so much so that she used to fall apart and stay apart for the rest of the school day and into the night. Luckily, her school now has a classroom aide take her outside before the alarm goes off. She loves going to the playground, but she falls a lot and sometimes it is just too busy and chaotic for her to handle. When she lays down for bed each night she feels like the room is spinning, so she rocks from side to side until she finally falls asleep. Katie has sensory integration dysfunction, also known as sensory processing disorder (SPD).

Sensory processing refers to how a person registers, processes, and uses all the various sensations coming from within the body and the environment. All of us learn about and comprehend the world through our senses. We see things, we hear things, we touch things, we experience gravity, and we move around. All of this sensory input works together to give us a reliable picture of the world and our place in it.

Children and adults with sensory processing issues experience the world differently. They don’t take in and use sensory information the same way. They may have problems perceiving some of the incoming sensory input or linking these inputs together so that all of the information makes sense. And because their brains and bodies struggle to make sense of their experiences, they can have significant difficulties with activities such as learning, playing, eating, socializing, self-care and even sleeping.

For a child with significant sensory issues, walking into a classroom can feel like walking into a rock and roll concert. Such a child may be able to see and hear the fluorescent lighting, a chair being moved on a bare floor may sound like nails on a blackboard, other kids may smell like a fish market, the carpet may feel like quicksand, and walking into the playground may feel like being on a merry-go-round. What seems normal to us can easily overwhelm a child with sensory problems. It takes a lot of energy to keep it all together for such a child. Add academic and behavioral demands at school and you can see why such a child would have a hard time. At school, students with sensory problems have particular difficulty during circle time, transitions between activities or classes, in the cafeteria, in gym class, recess and in many other situations. Their brains and bodies just can’t handle the barrage of sensory information. More than likely you will see such a child going into sensory overload and having a total meltdown or simply tuning out.

Kids with sensory problems may show hypersensitivity, hyposensitivity, or mixed reactivity. Hypersensitive children like Katie strong reactions to sensory experiences that are out of proportion. They tend to isolate themselves and either tune out or tantrum in response to overwhelming sensations. The child who is mostly hypersensitive tends to be a sensory avoider. The hyposensitive child is often a “sensory seeker” who is always on the move, and may enjoy rough play, loud music, and frequently smell, lick, or throw, or bite or hit even when he’s not angry because obtaining intense sensory input helps him stay tuned in. Most kids with sensory issues are oversensitive to some sensations and undersensitive to others. Likes and dislikes seem to change from day to day, hour to hour because the nervous system is functioning so poorly. One day a child might be happy to fingerpaint, but the next day he freaks out at the sight of paint because his system just can’t handle it. One of the hallmarks of SPD is inconsistency and that’s part of what make it so confusing to parents and professionals.

Common Signs of SI Dysfunction
  • Over- or undersensitivity to touch, sounds, sights, movement, tastes, or smells
    • Bothered by particular clothing fabrics, labels, tags, etc.
    • Distressed by light touch and/or unexpected touch
    • Dislikes getting “messy”
    • Resists grooming activities
    • Sensitive to volume and frequency
    • Distracted/distressed by ambient noise
    • Easily overloads visually
    • Squints, blinks, or rubs eyes frequently (may be a sign of a vision problem)
    • Gets dizzy easily or never at all
    • Constantly on the go or avoids movement
    • Craves or avoids particular tastes or smells
    • Very high or very low pain threshold
  • Problems with vestibular (movement) and proprioceptive senses (body sense)
    • Poor fine and gross motor skills
    • Poor body awareness and motor coordination
    • Poor eye-hand coordination skills
    • Poor motor planning (praxis)
  • Oral motor and feeding problems
    • Oral sensitivity
    • May drool excessively, have poor latch
    • Avoids foods most children enjoy
    • May have speech/language delays
  • Poor attention and focus: “tunes out” or “acts up”
  • Uncomfortable in group settings: does better one on one
  • Developmental delays, learning, and organizational difficulties

We don’t know exactly what causes SPD, but we do know that it has to do with differences in how a child’s nervous system is wired. Research is beginning to point to specific anatomical and physiological differences related to sensory problems, including abnormalities in the cerebellum, reticular formation, and autonomic nervous system.

There is a high incidence of sensory problems in children adopted from overseas institutions, premature infants, and in those who have experienced birth trauma, prolonged hospitalization, or exposure to heavy metals. Sensory problems are frequently a “co-morbid” symptom of diagnoses such as autism, ADD/ADHD, Down Syndrome, Fragile X, developmental disabilities, bipolar disorder, anxiety, and other mood disorders.

It’s estimated that there’s one child with SI issues in every regular education classroom, roughly 10-15% of the population. In a classroom of students on the autistic spectrum that figure is between 50- 80%. In a study of adults and children with autism, researchers at the Geneva Centre for Autism in Toronto found that 80% are hypersensitive to touch, 87% to sound, and 86% had visual issues. Thirty percent reported taste or smell sensitivities. High functioning autistic people such as Temple Grandin write eloquently about their very severe sensory issues. Temple wears old soft shirts under all of her clothes, and turns her underwear inside out because she can’t tolerate the seams. Certain sounds, like nails on a blackboard, aren’t just annoying—they feel like a dentist drill hitting a nerve. Some people have very severe problems with visual processing, even though they can pass an eye exam. Some act as though they are blind when they are in a strange place, and others have problems with visual whiteouts, which can be like seeing snow on a vacant television channel. Fluorescent lighting may be intolerable because many autistic people can see and hear the rapid flicker. Some people use their peripheral vision due because visual distortions are reduced when they look out of the corners of their eyes.

What To Do

Get Expert Help. Fortunately a great deal can be done to help children and adults with sensory problems. The first step is to get expert help, which usually consists of evaluation and treatment by an occupational therapist who has specialized training and expertise in this area. The OT’s interventions will be designed to increase the person’s ability to handle incoming sensory input and to link it up with other sensory systems. It is very important that parents and other caregivers carry over recommended therapeutic exercises and activities to achieve maximum effectiveness.

If your child is under age 3, ask your pediatrician for the name of a local early intervention (EI) agency. Unfortunately, some pediatricians are not knowledgeable about early intervention, so you may need to contact the state EI office for a referral to a local agency. For EI offices in your states, go to and look under “How to find an OT.” For children age 3 and older, you can contact your local school board. Keep in mind, though, that not all school-based OTs have knowledge and training regarding sensory issues. You may find that an OT who works in private practice, an independent clinic, or in a hospital. You can go to for a directory of OTs, physical therapists, speech-language pathologists and others who are experienced in helping children with sensory processing problems.

Feed Sensory Needs. The second step is to implement a “sensory diet. “ A sensory diet is a schedule of activities designed to meet sensory needs and it has very little to do with food. Just as you don't wait until dinnertime to give a child the nutrition he needs for the day, you also can't wait until evening to feed a child's sensory needs. You've got to keep him full all day so he feels calm and alert and stays tuned in. Even if a child gets OT five days a week, it’s not going to make as profound an impact as parents and other caregivers providing well-thought out sensory input from morning until night. While a sensory diet needs to be carefully individualized for each child, a large section of Raising A Sensory Smart Child is filled with ideas and suggestions for creating and implementing a sensory diet. Most sensory diets include a lot of vestibular (movement) and proprioceptive activities that ground a child in his body by pushing joints together. This might include having a child wheelbarrow walk, jump on a mini-trampoline, push a baby stroller or weighted shopping cart, bounce on a hop-it ball, play tug of war, play catch with a weighted ball, climb stairs and march, carry books, wear a loaded backpack and so on.

“Deep pressure” activities are also important. A massage using long, firm strokes can be very soothing, as can more playful approaches like making a sandwich out of sofa cushions or pillows with your child’s body as the “peanut butter and jelly” (or whatever sandwich ingredients your child likes). Tactile exploration should also be included: use Play-doh or Sculpey, explore textured books and toys, use a sandbox or a sensory bin of dry rice and beans. And don’t forget the mouth! Provide crunchy foods like pretzels and celery sticks, chewy foods like bagels and dried fruit, salty foods and sour foods too. Blowing bubbles and whistles are be great too.

Rethink activities and environments. All too often, we ask kids to fit into our home and school environments rather than asking if we provide homes and classrooms that are well-designed for that child. Making simple changes in the home, daycare, or school environment can make a big difference in a child’s ability to focus and learn. Here are just a few ideas:
  • Avoid fluorescent lighting. Use natural lighting when possible. If you can, have a child use a table lamp at eye level to cut out some of the visual flicker and glare from the overheads.
  • Most parents have too many toys and books out which can overwhelm a child. Select a few toys your child enjoys to encourage exploration and creative play and put the rest in opaque storage bins. You can rotate items so they always stay interesting.
  • If a child says his ears hurt, believe him. After making sure he doesn’t have an ear infection, speak with an OT or audiologist about an auditory desensitization program. Meanwhile, have your child use ear plugs, headphones, or ear muffs during painfully loud situations such as during fireworks, fire drills, crowded shopping malls, and so on. Do NOT allow the child to wear them all the time or they won’t be effective.
  • Cut out clothing tags and labels. Buy seamless socks. Provide well-laundered clothing washed with perfume-free detergent. Cotton and polar fleece are often most easily tolerated. Be flexible about what your child wears.
  • Bring along acceptable foods to parties and family gathering, despite raising a few eyebrows. Social events are not the time to force new foods on a child with a very limited repertoire of foods he can tolerate.

Remember that respecting your child’s sensory needs does not mean that you are spoiling him—no matter what your in-laws say!

Helping with Transitions
Many children with special needs have difficulty with transitions between activities that require them to shift attention, process new instructions, and plan the movements needed. Here’s a few ways to help:

  • Increase predictability. Review the schedule of activities verbally and using a picture schedule. This helps kids to learn the sequence of activities, and mentally prepare for changes.
  • Always use clear directions. Avoid using confusing idioms such as “hold your horses” or “bite your tongue.” A concrete thinker takes what you say literally.
  • During clean-up, assign a concrete two-step task using simple directions, e.g., get all of the silverware from the table and put them in the sink. If your hypersensitive child is playing with a group of children, allow her to help clean up on the edge of the clean-up chaos such as to neaten up blocks in the corner.
  • • Use transition times for movement to help children reorganize, including doing jumping jacks, “Head Shoulders Knees and Toes,” wheelbarrow walking, alternating noisy monster steps and quiet mouse steps, etc.

Tabletop activities and crafts

  • Use size-appropriate chairs and tables. Feet should be able to be flat on the floor, knees at a 90-degree angle, and arms resting comfortably on the tabletop. Use a footstool or box if needed. Provide a chair with arms to a child with poor body awareness. Examine the child’s posture. A low tone child might appear slumped, craning his neck to look up. Provide a chair with back support (you can use a pillow) and/or a positioning wedge (such as the Move N’ Fit seat cushion). A child may need an inflatable cushion, a ball chair with feet, or a strip of stretchy tubing or lycra on the front chair legs.
  • Have good ventilation during craft time and snack time so smells don’t overwhelm.
  • Many kids can’t tolerate smocks and bibs with itchy closures. Cover the closure with soft material or use an oversize shirt.
  • Desensitize, e.g., have kids rub hands briskly before starting.
  • If your child dislikes getting fingers messy with glue or paint, acknowledge the experience but encourage him to rethink the experience (“It feels really weird, but it’s kind of cool too!”), but never force him.
  • Provide squeeze glue containers, glue sticks and paintbrushes. It may be hard enough for the child to participate at all, so how they participate is secondary.
  • Provide a damp paper towel to wipe hands without going to the sink. Increase the time between handwashings. For example, if you are gluing items on to a craft project, do not let your child wash her hands after each one. Instead, tell her she can wash her hands after gluing every 3-5 items. Often kids can tolerate getting “messy” for a few moments as long as they are guaranteed that the sensation won’t last.
  • Use firm touch rather than light touch when assisting.

15 Ways to Calm a Child

  1. Dim the lights if possible.
  2. Lower your voice.
  3. Teach the child breathe deeply 10 times at a time he is calm. Do it together when needed.
  4. Be sure the child isn’t overheated--remove a sweater or bring near air conditioner or fan.
  5. Change where the child is located. For example, in a shopping mall, he may need to go to a quiet area where there is little to look at.
  6. Offer the child a bear hug or cuddle or rhythmically, firmly rub back or press downward on shoulders.
  7. Give the child water or something to suck on like a hard candy. Crunchy food like goldfish crackers can also soothe, as can an oral comfort item like a “chewy.”
  8. Bring the child to a less busy part of the room for a few minutes—not as punishment, but to enable the child to self-regulate.
  9. Let the child listen to calming music using headphones.
  10. Take the child to a “cozy corner” to relax. This space may have a bean bag chair, soft lighting, and a book or a soft toy to enjoy until he regroups.
  11. Have the child sit in a rocking chair or bounce on a ball chair.
  12. Help the child do wall push-ups or chair push-ups.
  13. Provide a hand fidget like a koosh ball, provided the child does not throw it.
  14. Take the child outdoors for a few minutes to jump around and get the wiggles out-or have him climb up and down stairs.
  15. Repeat a soothing phrase over and over such as “It will be okay” or “everything is alright.”

For more information on special needs and sensory issues, sensory diet, modifying environments, handling behavior issues, and more, see Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues by Lindsey Biel, OTR/L and Nancy Peske. Or visit

This Month's Featured Author:Lindsey Biel, M.A., OTR/L

Lindsey Biel, M.A., OTR/L (left ) is an occupational therapist specializing in pediatrics and the co-author of the award winning book Raising a Sensory Smart Child. Through her private practice in New York City and the NY State early intervention program, she works with infants, toddlers, and older children with sensory processing disorder, developmental delays, autism spectrum disorders, learning disabilities, and other challenges. She is a popular speaker, teaching workshops to parents, teachers, therapists, doctors, and other professionals across the country, and a contributing writer for Autism Asperger Digest Magazine.

Please support our contributing authors and visit Please visit the website of the Sensory Smart Child

Tags: Sensory Motor Skills - Sensory Integration Sensory Processing Disorder OT October 2009 Newsletter Article