Sensory processing difficulties

Everybody's sensory regulation levels differ, overtime we learn what we can/cannot cope with and express this in a socially acceptable way. However, our tolerance to certain stimuli can be reduced if we are anxious or upset.

Many children have inconsistent organisation of sensory input, their reactions to this may appear unexplained but to the child it is meeting a need. A child can be over or under responsive in each sensory area.

Vestibular - Over responsive

- Observations

• Reluctant to participate in PE
• Prefers sedentary activities (very little movement)
• Afraid of heights/fearful of having their feet off the ground
• Dislikes tipping of the head forwards or backwards
• Complains of headaches and sickness after movement activities
• Holds on to things when moving
• Appears clumsy and hesitant when moving
• Poor balance
• Moves cautiously, avoids moving when others are moving
• Has an excessive fear of falling

- Strategies

• Using rocking chairs
• Weight transferring activities
• Slow rhythmical dances
• Balancing activities
• In PE, provide a controlled area to work in
• Leave class early to move to the next room

Vestibular - Under responsive

- Observations

• Craves movement – fidget sand rocks or swings in chair
• Stumble/fall frequently
• Jiggle about when speaking to you
• Require alerting activities to get them going
• Spins excessively and do not appear dizzy
• Find it difficult to hold their head up when seated
• Enjoys excessive bouncing, somersaults and forward rolls
• Always appears to be ‘on the go’
• Appears restless
• Poor spatial awareness
• Enjoy speedy activities but do not work in a controlled manner
• Reversal of letters
• Struggle to follow a moving object

- Strategies

• Spinning activities using office chair, or rocking chair
• Wobble boards, gym balls, space hoppers & peanut balls
• Move and sit cushion on chair
• Cycling
• Swimming
• Trampolining
• Balance activities, for example walking along a rope, balance beam or bench
• Bilateral activities, for example skipping, star jumps, walking on stilts
• Rhymes that incorporate movement, for example Row, row, row your boat

Proprioceptive – Over Responsive

- Observations

It is much less common to be under responsive in this area

• Body appears tense and uncoordinated
• Stretches their arms and legs regularly
• Aware of what their joints and muscles are doing
• Often tired
• Often complains of joint aches, pains and muscle cramps
• Complains of pins and needles
• Avoids activities that involve moving and stretching body parts, for example PE
• Jerky movements and tense body position when running due to a fear of falling

- Strategies

• Weighted blanket on lap when seated
• Regular massage of joints and limbs
• Yoga and mindfulness activities
• Chair press ups
• Wall press ups
• Press ups
• Arm spirals
• Theraband around chair legs

Proprioceptive – Under Responsive

- Observations

• Crashes, bumps and bashes into things
• Wriggles or fidgets
• Leans into people and objects
• Often gets into squashed positions
• Walk on tiptoes
• When sitting still will appear sleepy and lethargic
• Slumps forward at the desk
• Heavy handed and footed
• Struggles co-ordinating fine and gross motor movements
• Poor hand-eye coordination
• Appear unhurt when they fall

- Strategies

• Movement breaks
• Movin’ sit cushion on chair
• Theraband round chair legs
• Pushing and pulling activities
• Heavy lifting
• Gymnastics
• Sit in a bean bad/lay bed
• Stretching activities – use a theraband or lycra
• Jumping jacks
• Cycling
• Climbing
• Messy play on the floor
• Blowing bubbles
• Sharpening pencils

Tactile – Over Responsive

- Observations

• Dislikes wearing certain materials
• Dislikes shoes and socks
• Overreacts to minor scruffs and scrapes
• Avoids messy play and art lessons that involve different textures
• Washes every bit of dirt from their hands
• May lash out or flinch when touched
• Dislikes hair washing, nail cutting, washing face or brushing of hair or teeth
• Avoids touch – avoids kisses, prefers a hug. Hold arms across chest to prevent being touched
• Struggles in busy areas
• Struggles in busy areas and when lining up. Can be seen standing away from peers to avoid being touched
• May avoid certain food textures
• Walks on tiptoe

- Strategies

• Allow them to sit away from others and be the first or last in a queue
• When touching the child use firm pressure and never touch from behind
• Provide mouth fidgets such as chewing foods, chew buddies
• Blowing bubbles, using whistles, playing the recorder
• Use massage rollers
• Child to rub body lotion on their own skin – same direction
• Remove labels and tags from clothing or wear garments inside out
• Allow them to wear a sweater or jacket indoors to feel more secure

Tactile – Under Responsive

- Observations

• Picks up and touches things all time
• Poor fine motor skills
• Struggles to use cutlery
• Place heavy pressure through toys
• Unaware of scrapes and bumps
• Unaware of messy hands and face
• Clothing often twisted, may have difficulty dressing and undressing at speed
• Frequently bumps into or pushes others
• Struggle to use two hands together
• Struggle to identify objects by touch alone
• Relies on vision for all manipulative tasks
• Bites themselves or picks at their nails

- Strategies

• Handwriting on sandpaper
• Activities that cause vibration to the skin and muscles such as chalk on pavement, vibrating pens
• Using hard theraputty
• Tweezer and tongue games that involve pressure through their finger tips
• Feely bag activities or exploring textured boxes
• Drinking through a sports bottle,
• Bubble wrap – popping, twisting, squeezing, rolling along, walking on
• Finger painting

Visual - Over Responsive

- Observations

• Distracted by visual stimuli
• Becomes upset with changes to the environment or someone’s appearance
• Unsure where to start writing on the page
• Struggles to organise maths calculations
• May say that small print is blurry or bounces
• Poor eye contact
• Distractions cause them to lose attention/concentration
• May appear sensitive to bright lights
• May rub their eyes after reading or looking at the board
• Try to avoid cluttered and busy environments

- Strategies

• Warn the child in advance about changes to the environment/a person’s appearance
• Reduce the amount of clutter in the room
• Reduce visual distractions from outside the classroom
• Do not use red or green on the whiteboard
• Tint the whiteboard to reduce the contrast of black on white
• Remove dangling objects from the classroom such as washing lines and mobiles
• Use lined paper and a writing slope
• Don’t present the child with too much work at once
• Provide a quiet area for them to access

Visual - Under Responsive

- Observations

• Struggle to maintain focus and have difficulty knowing what to focus on
• Struggle to find things in a drawer or cupboard
• Struggles to copy from the board/book onto paper
• May reverse letters
• Have difficulties following print when reading
• Struggles to organise their work on the page and gets confused completing written calculations
• Cannot follow printed instructions
• Struggles to locate relevant information on a page
• Appears tired when completing work
• Finds jigsaw puzzles difficult
• Bumps into objects

- Strategies

• Create a central focus point in the classroom
• Change tone of voice when talking to the child
• Staff to wear a brightly coloured scarf/tie
• Check the child understands the instructions
• Use symbols and signs to support communication
• Complete visual discrimination activities such as odd one out
• Use coloured lines on paper
• Use grid paper to help the child organise their calculations
• Complete sorting activities
• Use computer games to develop focus

Auditory - Over Responsive

- Observations

• Regularly cover their ears with their hands or gets upset when sounds are sudden or unpredictable
• Sudden change in behaviour (including aggression) due to frustration caused by sound
• May dislike someone because of their voice
• Frequently ask people to be quiet
• Repeats the same words, phrases or sentences to soothe themselves and may occasionally have echolalia
• Fear loud noises
• Prefers quiet areas
• Avoids noisy areas such as the corridor, assembly and dinner hall

- Strategies

• Ask the child which sounds are distracting them
• Avoid or pre-warn the child about unpredictable sounds
• Allow the child to hum
• Conduct an auditory review of the classroom. Consider internal noises that may not be irritating to others e.g. sniffing
• Provide music played at a low level through headphones at the times of the day that the child finds most difficult
• Provide a quiet space for when the child is feeling overwhelmed

Auditory - Under Responsive

- Observations

• Finds it difficult to identify a voice in a large group
• May appear to be day dreaming and ignoring instructions
• Frequently ask for instructions to be repeated
• Don’t always respond when others are speaking directly to them
• May be oblivious to certain sounds
• Talk or hum to themselves whilst working
• Play music or put the television on extremely loud
• Appear to make noises just for the sake of it

- Strategies

• Regularly change the tone of your voice to maintain the child’s attention
• Use a whistle
• Use visual clues to support auditory messages e.g. handouts
• Play listening games
• Play auditory memory games
• Play action games that require listening e.g. Simon says, drawing a picture following a partners verbal instructions
• Use visual clues to support auditory messages e.g. handouts

Olfactory (smell) - Over Responsive

- Observations

• Avoid certain areas of school or specific people due to a smell
• Avoid certain foods
• Gag or be sick at certain smells
• Complains about smells that other people can’t detect
• Becomes preoccupied by a certain smell

- Strategies

• Carry a smell the child likes in a container with a hole in the top or on a tissue
• Use meditation and calming activities to help calm the child when overwhelmed
• Complete relaxation activities followed by a gradual exposure to a new smells
• Ask adults to avoid wearing strong perfumes/aftershaves

Olfactory (smell) - Under Responsive

- Observations

• Unaware of personal hygiene - poor toilet and oral hygiene
• Unaware of areas that other people may find offensive, such as toilets
• May crave food with strong smells or spices
• Poor eating habits
• Be unaware of dangerous smells

- Strategies

• Play games such as guess the smell
• Teach hygiene routines
• Develop routines around changing and washing clothes

Gustatory (taste) - Over Responsive

- Observations

• Dislikes meal times
• Prefers bland foods
• Reluctant to try new foods
• Chokes and gags easily
• Dislikes food related activities and social situations that include food

- Strategies

• Complete oral activities such as blow football & blow painting
• Play wind instruments
• Use musical toys such as kazoos and whistles
• Gradually introduce new foods
• Keep track of their eating to ensure they don’t avoid food
• Teach the child about food groups and the importance of a healthy, balanced diet

Gustatory (taste) - Under Responsive

- Observations

• Often crave foods with strong tastes
• Mouths non-food objects
• In some extreme cases may have an appetite for unusual substances

- Strategies

• When their attention is wavering allow them to suck sweets with strong flavours
• Don’t use meals as a reward
• Provide foods that have a strong flavour
• Include a variety of textures in meals
• Provide them with foods that require a lot of chewing
• Teach the child about a healthy diet

Training and useful links

Developing an awareness of sensory processing difficulties (August 2021)

Interoception: What It Is, How It Works, & How to Improve Interoception (hes-extraordinary.com)