Sensory Modulation Disorder

Chapter 2: Sensory Modulation Disorder

An import aspect of sensory integration is modulation.  Modulation is the brain’s internal thermostat that automatically adjusts and balances arousal level based on the stimulation being experienced by a person.  For instance, a person who feels sluggish may exercise, chew gum, or listen to music to increase his arousal level.  A child with sensory integrative problems does not have this internal capacity to modulate their level of arousal.1

Children with sensory modulation disorder have processing difficulties that interfere with daily functioning at home, at school, or in interactions with peers or adults. In other words, a child with sensory modulation disorder has trouble translating sensory messages into regulated behavior.

According to Webster’s Dictionary, to modulate is to “regulate by or adjust to a certain measure of proportion.” A modulation disorder is one in which the brain cannot adjust or regulate the degree, intensity, and nature of sensory stimuli so that the body can produce appropriate physiological and behavioral adaptive responses. An adaptive response is a successful, goal-directed action on the environment.2 An inability to produce an appropriate adaptive response may result in the following:

• Aggression, meltdowns, and defiant behavior

• Inability to tolerate transitions

• Sleep problems

• Eating problems

• Attention and memory problems

• Hyper- or hyposensitivity to noises, visual stimulation, touch, or movement

• Motor planning problems

• Communication difficulties

 Sensory modulation occurs in three phases:

• Sensory registration is the detection and recognition of sensory input. Children with sensory processing disorder can register low or high sensory information. In order to store information about a current experience, a child must be able to register adequate sensory information. Once information is registered, the child filters through previous situations that are similar to the one he is registering to determine the stimulus. If no match is made, a typical child will orient to the stimulus and store the information for future use. In some sensory children, low registration prevents this storing of information, impacting the child’s motor planning and other functions. Low registration refers to a pattern of sensory processing in which children notice sensory stimuli much less than other children. Children who have low sensory registration appear unengaged, self-preoccupied, and may be flat in affect. They often seem unaware of their surroundings and miss environmental cues that would direct their actions.3 High registration patterns refer to a child’s inability to filter out irrelevant sensory information, subsequently overregistering the input. High registration may result in distractibility, hyperactivity, inattentiveness, disorganization, shutdown, or fight, flight, or freeze behaviors.4

• Orientation is the process of taking a registered sensory stimulus and deciding what action needs to be taken.

• Arousal is the reaction to a stimulus.

 Modulation of sensory input is critical to our engagement in daily living. Modulation enables us to filter sensations, maintain an optimal level of arousal and attention, and respond appropriately to sensory input. When modulation is inadequate, behaviors may appear exaggerated in comparison to the sensory input, the child may have trouble adapting to changes in the environment, and attention levels may be either too low or too high. Children whose attention levels are too high cannot filter out irrelevant information as their attention is perpetually diverted to every change in the environment resulting in a constantly distracted child.  Conversely, children’s attention levels may be too low if they do not register enough sensations that would generate notice of things in their environment. Either way, they are no longer in the calm-alert state, the optimal arousal state where maximum learning and teachable moments occur.5 Additional cognitive functions may also be impacted such as short-term memory, motor planning, and language. Deficits may appear when the child is out of the calm-alert state.  Therefore, these deficits may come and go fluctuating with the child’s regulation level.

Modulation disorders are presented linearly in this book for learning ease, but this does not represent the majority of children with sensory modulation disorder. The three identified states include the overresponsive child, the passive underresponder, and the sensory craving underresponder; each is detailed below. Dr. Lucy Jane Miller’s preliminary research indicated that of the 25 percent of children who only present with one subtype of modulation disorder, 10 percent will be pure overresponders, 5 percent will be pure passive underresponders, and 10 percent will be pure sensory cravers.6 This data came from only one treatment center, so it is not representative of all children with SPD.  Additional data will be necessary to be confident in these numbers.

The remaining 75 percent of children with either two or three subtypes will present with a combination of regulatory states and fluctuate from day to day or even hour to hour. These children may be standing lethargically in the middle of the preschool classroom at 9:00 a.m. (passive underresponder) and be busy crashing, banging, and shouting at the top of their lungs by 10:00 a.m. (sensory craver). At the end of preschool, these same children may become overresponsive and meltdown or become aggressive as the result of a seemingly innocuous stimulus. In other words, most of these children experience several regulatory states every day or hour and will exhibit characteristics of more than one of the overresponsive and underresponsive subtypes below.

Sensory Overresponsivity

“Imagine if something as harmless as a song on the radio, the smell of pizza wafting from the oven, or somebody accidentally brushing against you readied you for a fight, and you could not flee or calm down…. Imagine what a struggle it would be to stay composed and get through a day!”7 This can be a typical day for a child with sensory overresponsivity.

Children with sensory overresponsivity (SOR) cannot filter out the irrelevant sensory stimuli resulting in a surplus of sensory stimulation within their neurological system.  As a result, children with SOR respond quickly with too much intensity, are extremely sensitive to their environments, and get overloaded easily.  Subsequently, these children often experience behavioral and emotional issues including severe anxiety, fear, aggression, distractibility, emotional distress, problems with social interactions, and withdrawal.8

The extreme registration of sensory input can result in great distress in the child’s daily living.  One of the most common sensory modulation problems observed is tactile overresponsiveness (defensiveness).  Children with tactile defensiveness experience irritation or discomfort from tactile sensations that are not bothersome for peers.9 This discomfort may be comparable to the experience of trimming your fingernails too close.  The raw sensation experienced by the nerves no longer protected by the fingernail can be irritating or painful.  This is similar to the way that a person with extreme touch sensitivity may experience sensations except for two important differences.  First, in the case of the person who just clipped their nails, the discomfort comes because previously sheltered nerves are now exposed making the person acutely aware of sensations not ordinarily felt.  In this case, the nerve function is normal, but the experience is abnormal.  For a child who is overly sensitive to touch, the experiences are normal and the nerve function is abnormal.  Secondly, the child who has clipped his nails will soon become accustomed to the sensation (called habituation), while the child with the overresponsive system does not habituate to the sensations no matter how much exposure.

Dr. Lucy Jane Miller’s research supports the notion that an overresponsive child cannot habituate to a stimulus the way typical children do.  Her electrocardiogram (EEG) research showed a big spike in their brains’ electrical activity with an initial stimulus and, even after the stimulus was removed, they had repetitive spikes.10 The repetitive spikes indicate that the child is not becoming accustomed to the sensation, i.e. habituating.  Habituation is what enables a child to tune out the sounds of other children rustling their papers or the fan running in the classroom in order to focus on the teacher’s instructions.

Due to the lack of habituation, the child may feel bombarded by dozens of unpleasant sensory experiences on a daily basis.  The child may be acutely aware of the clothes on his body to the point of distraction as he cannot habituate to the sensation. The child may be distressed or feel pain from light touch such as “itchy” tags or seams in their clothes.  The child may demand to dress from head to toe in soft sweat clothes, even in hot weather, as this prevents his skin from being exposed to tactile stimulation which decreases the sensory invasion of his nervous system.

School work may be challenging because the child’s filtering system is not screening out the feel of the hard chair, the bumps on the pencil, the sharp edges of the paper or the air current blowing through the room. The child may dread art projects that include finger-painting, glue and clay due to the heightened discomfort he feels when touching these substances.  He may dislike group games like tag, dodge ball or soccer due to the fear of being touched by another child. Typical preschool games such as Ring around the Rosie are often avoided as this game requires holding hands; agonizing for the child with sensory overresponsivity. Standing apart from other children to prevent being bumped is common for the SOR child and often inhibits her social interactions.  The slightest accidental bump from another child may feel threatening and he may lash out aggressively.  Behaviors of the SOR child may appear impulsive and spontaneous when she becomes aggressive, but in reality she is defending the perceived raid of her space as interpreted by her brain. This aggression is generated by the sympathetic nervous system and is referred to as the fight, flight, fright, or freeze response.  The sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS) together are parts of the autonomic nervous system, and the two systems work in tandem to balance the autonomic nervous system. The SNS is responsible for firing up the nervous system, and the PNS “calms down” the nervous system.

Another common sensory overresponsivity problem is gravitational insecurity.  Gravitational insecurity is overresponsiveness to vestibular sensations involving linear movement.  These children often exhibit fear during everyday activities, especially those characterized by changes in head movements (e.g., tipping the head backwards when getting their hair washed) or movements upward through space (heights).  Stairs, escalators, elevators, ferris wheels, playground equipment, balance beams, or uneven surfaces (stepping off a curb) may inspire fear, anxiety or avoidance behaviors.

Typical childhood activities may be challenging such as bicycle riding, skating or skateboarding. Therefore, social interactions are adversely affected leaving some of these children isolated with a lack of self-confidence and low self-esteem.

Another form of vestibular defensiveness is intolerance to movement. This type of modulation challenge results in fear of movement on playground equipment, moving walkways, riding in a car, or being moved by other people (e.g., a teacher pushes a child’s chair in toward their desk).  Some children with vestibular defensiveness may react with fight, flight, fright, or freeze responses when forced into situations that they would typically avoid.

Fight, flight, fright, or freeze responses are common in children with SOR and exhibited when the child feels assaulted by sensory input that typical people would consider harmless or nonirritating or when they cannot avoid the aversive stimulus. For example, a baby may cry at the sound of a sneeze.  SOR babies are often fussy and irritable due to misinterpretation of sensory signals.11 These babies may either cry excessively with difficulty self-calming or sleep most of the time in an effort to avoid or “shut down” the level of stimulation. Toddlers may display discomfort by fleeing from the stimulus, retreating to a safe haven, or lashing out at the person or object that imposed the aversive stimulus.  For instance, a toddler may run away at the sound of tearing paper or slap a parent in the face when overstimulated.  Hitting, biting, and throwing are behaviors that are often related to overresponsiveness.12  Some children with SOR will tolerate sensation if they can initiate and control the interaction.  For example, the child may refuse hugs but agree to give one if she can feel a sense of power and predictability over the situation.13

Children with SOR will avoid or attempt to escape sensory input when possible. However, the child may develop inappropriate behaviors in an attempt to escape sensory input and decrease arousal levels. For example, a child may carry an object with him such as a stick to poke other children that come too close. Or one child would put his hands around the neck of another child that came too close to keep the other child at bay prompting the nickname “strangler.”14

Behavioral reactions may be related to a single event or cumulative sensation throughout the entire day.  In the case of a cumulative reaction, the child’s response may seem to appear out of the blue unrelated to the current context. Often, these children cannot process all the sensory information as it accumulates, and when their sensory buckets overflow, behavioral outbursts manifest. These same children tend to have temper tantrums, meltdowns and aggressive behavior when they are required to process a lot of sensory stimuli during a single event, such as at a party or a mall. The threshold will vary from child to child, from day to day, and throughout the day depending on context. Most overresponsive sensory children work hard to control their responses to sensory stimuli throughout the day (especially at school, which is why the after-school transition is so fraught with drama), and this accumulation may manifest as an intense meltdown or other “fight, flight, fright or freeze” response to an otherwise innocuous stimulus after school or during the evening because they feel safe at home; safe enough to let out the stress of the day.

Overresponsivity to sensory stimuli in multiple sensory systems is often referred to as sensory defensiveness. Rather than being sensitive to all stimuli in a particular domain, children are overresponsive to specific types of stimuli within that domain (e.g., in the tactile domain, they respond defensively to light touch but not deep pressure). SOR can occur in one or multiple sensory systems; children are typically overresponsive to more than one sensory channel.  Here are examples of how children may be overresponsive to stimuli in each sensory system:

• Vision (sight): Distressed or feels pain by bright, flashing, or fluorescent lights

• Auditory (hearing): Trouble tolerating loud noises that are painful to the child

• Olfaction (smell): Has excessive negative reactions to certain odors

• Gustation (taste): Distressed or feels pain by certain tastes and textures of food

• Tactile (touch): Distressed or feels pain by light touch such as an itchy tag

• Vestibular (movement): Fears heights; distressed by moving walkways, elevators, or cars (resulting in car sickness)

• Proprioceptive: (position): Rigid posture as muscles and joints are overregistering proprioceptive input.

• Interoceptive (internal): Constantly feels the need to urinate; easily overheated

Reactions to sensory stimuli in overresponsive children occur along a spectrum, with some children managing their responses most of the time (usually through either socially inappropriate or sensory-avoiding behaviors) and other children in a continuous state of alert with elevated blood pressure and heart rate twenty-four hours a day. This continuous overalert state leaves the child overwhelmed and anxious around the clock.  Parents are often exasperated when their words and instructions are unheeded by the child with SOR. The escalated state of alert takes priority over all other brain signals and the resulting anxiety snatches their attention away from other important information, such as when a parent or teacher are delivering instructions.15   Therefore, the SOR child’s anxiety will interfere with learning and their grades may suffer.

SOR children are generally irritable, moody, and have difficulty with transitions, unexpected change, and social interactions.16 Some specific behaviors related to children with SOR are listed below.

Behavioral Indicators of the Overresponsive Child

Ø  Can be visually distracted by too much on the walls or by activity outside a window. May cover her eyes or hide under a desk, table, or chair. Prefers low light to bright light and may squint or get headaches when in the presence of fluorescent or bright light. If she isn’t overresponsive to tactile sensations, she will prefer to wear caps, hats, or sunglasses to protect her eyes from the sun and may avoid eye contact with others because it is threatening.

Ø  Fears noisy environments such as movies, concerts, fireworks, a sudden siren, or competitive sports games. Fears certain environmental sounds such as the vacuum cleaner, flushing toilets, slamming doors, sneezes, or cell phones. May hold his hands over his ears to protect himself from loud sounds. May not be able to do homework in the presence of background noise.

Ø  Responds unfavorably to certain smells (e.g., he may not like certain people because of the smell of their deodorant, perfume, or cologne). Notices and has adverse reactions to smells that others do not notice, such as lotion, soap, shampoo, or cooking smells in restaurants and home.

Ø  Avoids certain tastes and textures that are part of a typical child’s diet. Can be a very picky eater and will refuse new foods. Cannot tolerate extremes in temperatures of foods and may have an overactive gag reflex. Often, the issues of SOR show up first in feeding when the child is very young due to the extreme level of touch required in that activity and the tendency of the suck swallow breathe pattern to get out of order.17

Ø  Reacts negatively toward certain mediums, such as glue, dirt, shaving cream, or finger paint, because the tactile stimulation he experiences is heightened. This results in a range of behavior anywhere from signs of discomfort to screaming and tantrums.

Ø  Reacts negatively toward tags in her clothes, hats, headbands, seams in her socks or pants, or anything around the neck such as a shirt collar or jewelry. May complain about or refuse to wear certain textures or fabrics of clothing and avoids going barefoot due to the tactile stimulation. Reacts negatively toward brushing her teeth or hair, getting nails clipped, taking baths or showers, or being gently touched. May refuse to wash with a washcloth or use soap.

Ø  May try to rub, wipe, scratch or squeeze the place where she has been kissed or touched.18

Ø  May avoid group sports or games such as dodge ball or tag for fear of being hit with a ball or touched by another child.  As a result, the child may be socially compromised, as the child will always prefer isolation due to the fear of being bumped or touched by other children. This will prevent the child from interacting with peers in a typical way.

Ø  Becomes distressed when her feet leave the ground or her head changes position. This condition is called gravitational insecurity and is thought to be caused by difficulty processing sensory information received by the otolith organs in the inner ear. She may avoid climbing, jumping, and taking escalators and elevators. She may have a significant fear of going up and down stairs and fear of heights. May avoid having her head tipped back when washing her hair. She may avoid sleeping in her bed and demand to sleep on the floor. Many of these children have poor eye convergence, which is thought to be responsible for their fear of having objects thrown toward them, such as a ball. Postural problems, low muscle tone and poor body awareness may also be present with this condition.

Ø  Avoids playground equipment that requires movement, such as merry-go-rounds, slides, or swings. This condition is referred to as intolerance to movement. May hate riding in a car and may scream from the time she is put in her car seat until she is taken out of the car seat. May refuse to get on moving walkways.  May become anxious if she is physically moved by someone else (e.g., if the teacher pushes her chair closer to her desk).

Ø  May refuse to jump, hop or skip and may not like the feeling of pressure on legs or feet. Therefore, these children may avoid sports or activities that require a lot of running, jumping or crashing.  They may have rigid or tense posture since they are getting too many proprioceptive signals. The child may have difficulty tolerating other people moving their body, hugging, or stretching limbs or other body parts.

Ø  Elimination challenges such as potty training problems, wetting the bed, or constant trips to the bathroom due to overresponsivity to sensations in the bladder and bowel are common in the child with SOR.

Ø  Temperature modulation difficulties (too hot or too cold for situational context), are often present in the child with SOR.  The overresponsive child may also be oversensitive to pain and react to a scraped knee as if it were a deep, excruciating gash.

Ø  Has trouble falling asleep, which requires calm and relaxation. Children with SOR have internal engines that are constantly running too high.  Sensations for the SOR child are overly magnified resulting in night awakenings when she hears sounds from another room or typical home noise such as the dishwasher or air conditioning kicking on.19

Ø  Has fight, flight, fright, or freeze responses. For example:

o   May develop pinching, hitting, slapping, biting, or kicking behaviors designed to keep peers from coming too close. May carry a stick or other object to poke other children who enter his personal space. She may kick or hit another child who gets too close to her in line at school.

o   May get overwhelmed easily in busy environments, such as a sports arena, birthday party, mall, or state fair, and scream, tantrum, run away, or become aggressive through biting, hitting, and kicking.

Ø  Falls apart during transitions. There are certain parts of the day when SOR children will predictably fall apart: getting ready for school, leaving the house for school, coming home from school, eating dinner, and transitioning to bed. See “Chapter 9: Transitions” for information and strategies on how to manage transitions.

Ø  Insists on organization of food, toys, or other things. These behaviors may border on ritualistic or compulsive.  Children with SOR are unable to filter out sensory information from their environment and lining up their toy cars along a wall may help relieve the anxiety in an otherwise chaotic and unpredictable world.20

Ø  Experiences stress and anxiety physically more than other children. May have frequent headaches, stomachaches, and muscle aches. Children with SOR may visit the nurse’s office at school frequently with complaints of discomfort, as they are overly aware of sensations from the alimentary tract (tubular passage that extends from the mouth to the anus that functions in digestion and elimination) such as nausea, hunger, fullness, and thirst.

Ø  Can become overstimulated in play with another child and become aggressive. This translates into an unpredictable child, and other children are often reluctant to play with them. The child with SOR becomes isolated which may affect his self-esteem and self-confidence.

Ø  Experiences motor-planning deficits only when dysregulated, whereas the child with a sensory-based motor disorder (see chapter three) will suffer from these deficits continuously. Motor planning is negatively affected when the sympathetic nervous system is activated by significant anxiety. This anxiety propels the child into the overresponsive window interfering with motor system performance.

Ø  Has compromised communication skills when experiencing emotions such as anxiety.  The level of speech loss varies depending on whether the situation elicits the fight, flight, fright or freeze response. In the case of the maximum stress response, the child will be unable to speak at all. In less severe cases, he will lose partial communication skills and have difficulty organizing thoughts and speech, i.e., the child may have trouble getting sentences out.

Ø  Exhibits attention and/or memory problems when she gets out of the calm-alert (optimal arousal) state, as her attention is constantly diverted to the ongoing sensory environment and short-term memory is compromised.

Ø  Exhibits behaviors associated with high anxiety, such as high-pitched squeals in his voice, talking rapidly, or chewing on clothing, shirts, or sleeves.

Sensory Underresponsivity

Jenny is sitting in the family room playing a video game.  Her mother calls from the kitchen, “Jenny, it’s time for your soccer game.”  Jenny does not respond and continues playing her game.  Her mother calls two more times without any response from Jenny.  Finally, her mother touches Jenny on the shoulder and looks her in the eyes, “did you hear me?”  “Oh, no I didn’t hear you, what did you say?”  “It’s time for your soccer game.”  Jenny goes to her room to change clothes and takes an excessive amount of time.  Finally, Jenny comes out complaining that she does not want to go.  Once there, she engages for a few minutes and then stops running up and down the field.  Jenny “runs out of gas” during the game.  Afterwards, Jenny and her mother are walking to their car when Jenny trips, falls and skins her knee.  She shows no reaction as her mother scurries to find her first aid kit in the car.  After attending to Jenny’s knee, her mother drives home.  Once home, Jenny’s mother suggests she go outside and play with the neighborhood kids. Jenny refuses and heads to her room to read a fantasy book.

The above is a typical example of a passive underresponder.  These children are very slow to respond to sensory information in their environment.  As a result, they look listless, withdrawn and lethargic typically not engaging with people or children around them.  SUR children underrespond to sensory information and therefore situations.  These children require relatively intense or extended duration of sensory messages before they are moved to action.21

Due to poor registration of sensory input, children with SUR do not adequately respond to environmental stimuli at the level of typically functioning children. For example, they may not notice you calling their name or touching them on the shoulder. As a result, it may take longer for them to react even as their parents repeat themselves over and over. They may not notice if they are bleeding due to a limited ability to register tactile information from their touch and pain receptors. Passive underresponders often do not seek out the sensory input they need to become actively engaged in the environment, task, or interaction.  Therefore, most of these children register some sensory information, but the information is inappropriate, irrelevant, or too minimal for suitable arousal.

Intervention for a child with low sensory registration is geared to increasing the intensity of sensory input to expand the opportunity for noticing and reacting to environmental demands.22 For example, getting your child out of bed in the morning may require some intense sensory input, such as loud music, hand clapping, bright lights, and significant animation and emotion on your part.  Parents often need to use animated communication in order to attract the attention and engagement of the child.

Researchers hypothesize that children with SUR may be receiving an overabundance of parasympathetic nervous system (PNS) signals and/or too few sympathetic nervous system (SNS) signals that may explain low arousal, an inability to register pain, danger, and other sensory warnings that should register automatically.23

There are two different profiles for the passive underresponder identified by The Interdisciplinary Council on Developmental and Learning Disorders. Some children tend to be self-absorbed, unaware, and disengaged, while others are self-absorbed but very creative and overly focused on their own fantasy lives.

1. Self-Absorbed, Unaware and Difficult to Engage

These children are often quiet, passive, apathetic, withdrawn and lethargic.  They are difficult to engage and typically are self-preoccupied due to the lack of sensory registration.24  Children with this profile fail to notice things in their environment such as their name being called or the fact that they got a substitute teacher midway through the day. These children may seem to lack the inner drive that most children have for socialization and motor exploration because they do not notice the potential opportunities around them for interaction and play.  These children often cannot keep up with fast-moving children on the playground. By the time they notice opportunities to join in play, the other children have already moved on to other peers or activities.25 Due to their low registration of sensory input, parents may have to repeat instructions, such as ‘it’s time to get dressed now,’ over and over.  It can appear that these children do not hear well, leaving parents with the impression that their child has a hearing deficiency and subsequently take the child for hearing tests.26

Emotional expression in children with SUR is often restricted and very limited.27 Infants with this pattern may be overlooked or thought of as the “easy baby” because they are quite and non-demanding. Or toddlers may not cry when injured in situations that would elicit emotional distress in typical children. Children who are underresponsive have a particularly difficult time being aware of their own emotional state because this awareness requires sufficient sensory information. And a child must be able to identify her own emotions before she can identify others’ emotional states. Therefore, not only do these children often have trouble understanding what they are feeling, but they may not be able to read the emotions of others, such as the disapproval or frustration of their parents. For more information on reading non-verbal cues and understanding others emotions, see “Chapter 10: Emotions.”

Due to their inability to engage with peers, these children are often isolated with few friends which limits their opportunities to develop social skills.  School work is challenging because the child cannot keep pace with peers as it takes longer for these children to respond.  Their social isolation and academic difficulties may leave the child with low self-esteem and a lack of self-confidence.  Below are some specific behaviors related to the self-absorbed, unaware, and disengaged child.

Behavioral Indicators of the Self-Absorbed, Unaware, and Disengaged Child:

o   Often appears quiet and withdrawn from people and the environment.

o   May be thought of as a “good baby” simply because the baby fails to make demands.

o   Toddlers may skip the “terrible twos” because they have difficulty expressing emotions.28

o   Lacks interest in exploring objects, new activities, and surroundings; seems unaware of what is going on around him.

o   Is apathetic and easily exhausted; may appear to “run out of gas.”

o   Often accompanied by low muscle tone, poor posture, and low endurance.29

o   May have difficulty reading others’ emotions or understanding his affective (emotional) states.

o   May be slow to process emotions, reacting to some situations hours, days, or even weeks later.

o   May have slow information processing speed. This is the symptom that most often elicits a red flag in school-age children, as they are often unable to keep up with their schoolwork.

o   Lacks social engagement. Due to their inactive and uncommunicative nature, they are uninterested in things and peers around them. They end up being ignored by active children who want to run and play.

o   May verbally communicate less than peers.

o   Doesn’t cry when seriously hurt; has high tolerance to pain.

o   Doesn’t notice when someone touches her or tries to get her attention. The child is difficult to engage.

o   Prefers sedentary activities to physical ones.

o   Appears slow or unmotivated when learning to dress and/or feed himself.

Parents and caregivers need to provide intense sensory stimulation for the child with SUR in order to help engage the child in activities and relationships with others.

1. Self-Absorbed and Creative

Behavior patterns of self-absorbed and creative children are based on a tendency to tune into their own sensations, thoughts, and emotions rather than to communication from other people.30 Children with this pattern are most characterized by their lack of interest in reciprocal interaction and communication with others due to a preoccupation with their own cognitive processing. These children may turn to a world of cognitive ideas to obtain the stimulation their brains need.31 Infants may prefer to explore objects alone rather than in play with another infant or parent.  When preschoolers are tested by their environment they may retreat into fantasy.  For example, a task that requires skill such as a preschool craft or competition from peers.  If peers do not join in their imaginative and creative fantasy life, the preschooler prefers to play in isolation.32

The behaviors associated with the self-absorbed and creative child include all the behaviors’ above for the self-absorbed and difficult-to-engage type. In addition, this child is highly intelligent and so engrossed in his own fantasy world that it is difficult to engage the child.

If left unabated, this preoccupation with the self could result in large impacts socially and emotionally. Socially, collaborative pretend play helps a child to learn negotiation skills, problem solving, decision making, turn taking, and sharing. Collaborative play facilitates motor planning through ideation and sequencing. Ideation is necessary when formulating a concept for play and sequencing when the child moves through the actions of the concept (see chapter three for more information on motor planning). Development of expressive language is also enhanced since collaborative pretend play encourages expressive language that the child would not otherwise use. Emotionally, collaborative pretend play builds self-esteem and emotional security by allowing them to act out their own fears as they take control in play what they are lacking in the real world.33 Lastly, pretend play is the basis of creativity.  As a result, parents should involve these children in collaborative pretend play rather than allow the child to constantly engage in solitary play.

Sensory Craving

Harry wakes up an hour earlier than everyone else but it is impossible to sleep once he is up. Harry is heard running through the house, jumping on the sofa and shrieking with pleasure.  Once the rest of the family is up, it is time for Harry to get dressed.  Breakfast is ready and he is still not downstairs.  Harry’s mother hears earsplitting music coming from his room and goes to see what he is doing. He has dragged his mattress off the bed and is jumping from the top of his dresser onto the mattress below while listening to his loud music. His mother tells him to get dressed immediately and come down to breakfast.  Harry sits down at the breakfast table, but only remains seated for a couple of minutes. Harry pops out of his chair and grabs a nearby ball.  He starts bouncing the ball off the wall much to the displeasure of his parents.

This may be a typical start of the day for a school-age sensory craving child.  Children with this subtype actively seek or crave sensory stimulation and seem to have an almost insatiable desire for sensory input. They vigorously participate in activities or actions that deliver more intense sensations to satisfy this sensory appetite. The quest for sensation may be contained in one sensory domain or involve two or more sensory areas.  For example, a child may seek extreme movement (vestibular), loud noises (auditory), and deep-pressure input in the muscles and joints (proprioceptive) simultaneously.  Some sensory cravers actually start the day as passive underresponders but transition at some point during the day to actively seeking information, and others wake up in sensory craving mode and continue the quest for input throughout the day.34

“The function of the behaviors in a sensory craving child is to obtain sensory input in an attempt to increase his arousal, attention, postural tone, registration, focus and pleasure.”35  In other words, the sensory craver attempts to acquire the sensory input she needs in an effort to self-regulate her body and mind. “They tend to be constantly moving, crashing, bumping, and jumping, needing to touch everything and have difficulty inhibiting this behavior.…They may play music or the TV at loud volumes, may fixate on visually stimulating objects or events, or may seek unusual olfactory (smell) or gustatory (taste) experiences that are more intense and last longer than those of children with typical sensory responsiveness.”36 Sensory cravers engage in these behaviors at a much higher level than a typical child and do not have any cognitive awareness of their behavior; they are driven to do it because it feels good.  As they age and are able to observe and verbalize their own patterns, they may describe their need for activity and stimulation as a way to feel alive, vibrant, and powerful.37

Sometimes, children engage in repetitive sensory activities such as spinning on a Sit ’n Spin, swinging, or jumping up and down on the bed as they need the intensity or repetition of these activities in order to acquire the level of sensory input they need. However, the frantic, unstructured sensory stimulation that sensory craving children seek may increase their overall state of arousal and result in disorganized behavior. What the sensory craving child needs is interrupted sensation instead of disorganized frenzied activity.  It would not be advantageous to put the child in a rotary swing and spin them around and around.  Instead, spinning the child in one direction and stopping, then spinning them in another and stopping, and then asking him to throw a beanbag into the middle of a hula hoop on the ground would be beneficial for this child.38   Starting and stopping activates the semicircular canals in the inner ear enabling the therapist to activate vestibular motion through all planes (linear and rotary) providing additional input that the sensory craving child seeks without the disorganizing effect of rotary swinging.39 For example, on a safety-netted trampoline, the child jumps 10 times, then stops and gives you a five, or spells horse, then jumps again for 10 jumps, etc. You can also wrap language goals into this by asking ‘would you like to do it again?40

While many sensory children benefit from rotary stimulation, such as a tire swing, this is generally discouraged for children who shift into SOR quickly or are pure overresponders unless under the guidance of a therapist. Registration of linear and rotary motion is through the inner ear, which is part of the vestibular system. Linear motion produces calmness, relaxation and lowered tone, and rotary motion produces excitation, arousal and increased tone.41 Therefore, a child with SOR or a sensory craving child that shifts into SOR quickly would want to limit rotary activities.

Because sensory cravers cannot slow their bodies down, they cannot find the calm-alert state. Some children will move from passive underresponder right through the calm-alert state to overresponder.42 Children may lose motor planning and language abilities, have meltdowns, and exhibit aggressive and defiant behavior when in the overresponsive window.  In addition, any activity or task that requires a sensory craving child to remain motionless is excruciating and usually elicits a meltdown. For example, sensory craving children may have problems riding in a car seat or sitting quietly at school, movies, church, libraries, or the dinner table.

Due to their hyperactivity and lack of impulse control, these children are often confused with children that have ADHD.  Because parents and doctors often misdiagnose sensory craving as ADHD, these children are at a high risk of being unnecessarily medicated. Dr. Lucy Jane Miller’s research suggested that ADHD and SPD are distinct diagnoses that could occur together or independently in children.43   Additional information on her research may be found in Sensational Kids: Hope and Help for Children with Sensory Processing Disorder.

Because sensory cravers constantly move whenever they can, they develop great gross motor skills but have little chance to develop fine motor abilities and discrimination, which would require sitting still. These children may crawl and walk early but be delayed in developing the fine motor dexterity and precision to put small food objects in their mouths, use crayons, or cut with scissors. Frequently, they may fall out of chairs due to vestibular modulation difficulties.

Modulation difficulties may interfere with motor planning, speech, and social interactions.  These difficulties may result in inconsistent performance as the child’s regulation levels often fluctuate.  One day, your child may be able to dress himself, participate in activities and move through transitions smoothly.  The next day, the reverse may be true.  Below is a discussion of sensory craving behaviors by age.

Sensory Craving Behaviors by Age

Sensory craving infants love strong movement, sound, touch, or visual sensation. In addition, they are often restless and do not sleep or nap well. They may be irritable babies, crying much of the time and appearing to have colic. If all other causes for the colicky baby have been ruled out, the likely culprit is misinterpretation of sensory signals. They may have trouble with self-soothing activities like getting fingers in their mouths or curling up in the fetal position.44 These babies often put their mouths on everything excessively, as sensory cravers learn through touch and movement.

When the sensory needs of preschool and early elementary children are not met, they can become demanding and explosive in their attempts to fill their quota for sensation and will have a difficult time controlling their aggressive or impulsive behaviors. They have a tendency to “stay in trouble,” constantly engaging in situations considered reckless or dangerous. These children tend to violate personal bubble space as they come too close to people, constantly touch others, run over other kids, and seek physical contact and stimulation through deep pressure. During circle time or quiet play time at school, they have trouble sitting still and may wander or run aimlessly around the classroom until an adult intervenes.  Or alternatively, they may throw themselves against the floor seeking proprioceptive input.

Extreme seeking or craving of sensory input can also disrupt school-age children’s ability to maintain attention for learning. These children may have trouble academically because of their powerful drive to obtain extra sensory stimulation instead of focusing on tasks. These children are often exceptionally disorganized; their rooms are a war zone and their backpacks are a disaster.  They have a chronic and consistent inability to keep track of their belongings both at home and school.45 Sensory craving children often exhibit impulsivity.  For example, these children may provide answers in the classroom prior to being called on and get out of their seats frequently.

Unfortunately, sensory craving behavior may be interpreted by others as aggression rather than excitability—and once a peer reacts aggressively toward the child, his own behavior may become aggressive in response. For example, a sensory craving child may jump on top of another child, pushing against the child and applying pressure as he jumps, satisfying his need for deep pressure into his muscles and joints. However, the other child will likely perceive this as an aggressive act and may become aggressive in return. Due to the reckless behavior of these children, they often get kicked out of multiple preschools, daycares, and playgroups.

Without intervention, these children are at high risk for social, emotional, and societal consequences of being rejected and labeled—not as different, but as dangerous or antisocial—and ultimately of being expelled from schools.  These children may grow up thinking they are bad when they are just physiologically different and may learn to see themselves in exactly the negative and self-destructive terms that others apply to them.46 This self-image may ultimately reinforce their way of coping, which is to play the role of the bad kid, fall in with the wrong crowd, and live the labels applied to them.

Sensory cravers may be hyperactive, aggressive and intense.  They may be overly emotional and hard to calm.  These children may, at times, be excessively affectionate and crave attention.47  Specific behavioral descriptions are below.

Behavioral Indicators of the Sensory-Craving Child:

Ø  Craves sensory input in one or more sensory systems; this may look like attention-seeking behavior but is actually a quest for sensation.

Ø  Constantly moves and crashes, bumps, jumps, and roughhouses into objects, people, or other children. May jump on top of other children, parents, or pets and apply pressure in order to get deep pressure into her joints.

Ø  Has difficulty sitting still at movies, school, church, and home and is hyperactive.

Ø  Takes excessive risks during play (e.g., climbs high into trees, jumps off tall furniture, swings too high on a swing, runs across the street without looking, and creates situations that are dangerous).  Sometimes, parents of high-risk kids are perceived as “helicopter” or overprotective parents hovering over their kids instead of letting them learn through experience. However, as a parent, you must protect these high-risk children from themselves; they are driven not by logic but neurological deficits.

Ø  Constantly touches objects or physically intrudes on people; leans against objects that vibrate, such as stereo speakers, the dryer, etc.

Ø  Seems unable to stop talking and has trouble taking turns in conversation.

Ø  Plays music or TV very loudly.

Ø  Often licks, sucks, and chews on nonfood items such as hair, pencils, or clothing.

Ø  Gets angry or explosive when asked to sit still or cease an activity.

Ø  May not notice when they are dirty or hurt.

Ø  Watches visually stimulating scenarios. Fast-moving and brightly lit TV or video games would engage this child, along with marble runs, moving water, etc.

Ø  Seeks olfactory (smell) or gustatory (taste) experiences that are more intense and longer lasting than those sought by children with typical sensory desires. For example, the child may love to eat jalepenos or may crave an intense smell.

Ø  Engages in repetitive sensory activities like spinning, playing on a Sit ’n Spin, swinging, jumping up and down on a bed, slamming doors, turning the lights on and off or lining up toys, objects, or food.

Ø  Often experiences elevated anxiety levels that put him in the overresponsive arousal state. The child may experience motor planning deficits in this state as anxiety interferes with the motor system and compromises performance.  For example, the child may be unable to generate ideas for a project or have trouble with transitions.

Ø  Has trouble communicating when suffering from significant anxiety. The child may be unable to speak or have partial language skills, giving rise to disorganized thoughts and speech. He may have trouble getting his ideas out in coherent, organized language. Written narratives or stories may have a beginning and ending but the middle of the story may lack content as the child’s anxiety will interfere with the child’s ability to sequence through the steps of a story.

Ø  Often struggles with transitions. See “Chapter 9: Transitions” for more information.

Ø  Has trouble keeping personal spaces organized such as their room at home or desk at school.

Ø  Has trouble falling asleep due to her never-ending quest for sensation. Her love of movement leaves her overaroused, which makes falling and staying asleep difficult. See “Chapter 6: Internal Regulation” for more information on sleep.

When treatment is implemented, children with modulation disorder can grow up to lead healthy, happy, and successful lives.  Parents are instrumental in the treatment process and below are strategies that parents can employ at home to assist the child with modulation disorder.

Parental Strategies for Sensory Overresponsivity

• Sensory Diet. Start with some linear swinging—such as a playground swing—adding in starts and stops for fifteen minutes twice a day, e.g. once in the morning and once later in the day. For example, have your child swing 10 times, stop at the bottom and throw a beanbag into a container. Follow this with deep-pressure activities to calm these children. Push-ups (floor or wall); animal walks, such as crab, bear, or duck walk; or wheelbarrow walking are great options. Swaddling for very young children is helpful in soothing them. See “Chapter 7: Sensory Diet” for more deep-pressure activity options.

• Environmental Modification. Modify the environment by implementing a clutter-free quiet environment with low natural lighting.

• Parental Interaction Modification. Modify parental interactions by using a slow, soft, monotonous voice and calm speech. Avoid animation and exaggerated movements.

• Oral Motor Activities. Use oral motor activities that are calming, such as sucking a smoothie through a straw, chewing on gummy candy, hard candies, taffy, or chewing gum. Sweet flavors are soothing and will help to relax your child. You can find organic and natural candy at http://www.naturalcandystore.com. Search “Xylitol Gum” and options will come up for chewing gum sweetened with the natural sweetener xylitol. However, be aware that xylitol is toxic to dogs if ingested, so keep it out of reach of furry household members. Some children with chronic anxiety love to chew. Chewlery (chewable jewelry), chewable pencil toppers or objects are good options for this child. These items can be located in special needs stores, see Appendix B for a resource list.

• Sensory Retreat. Provide a sensory retreat for the child when she gets overwhelmed, e.g., a box with a top or a tent. Place some pillows, stuffed animals or a beanbag chair for the child to sink into—if space allows—in their sensory retreat to provide proprioceptive (muscles and joints) input. You can purchase a big floor pillow at http://ultimatesack.com/pillow_builder.asp or make your own by taking a duvet cover and filling it with pillows. There are multiple options for creating a sensory retreat. Occupational therapist Angie Voss has a website replete with ideas for sensory retreats. You can find it here http://asensorylife.com/sensory-retreats.html. Placing a weighted blanket over the child while in their safe haven is also helpful. Additionally, provide those things that are the most calming for your child. For example, music (slow, rhythmic songs), art supplies, books, fidget toys, and oral motor items.

• Hand Activities. Koosh balls, Play-Doh, Silly Putty, clay, bendable figures, rubber cars, or Wikki Stix are examples of fidget toys that provide some deep touch pressure. You can place some of these toys in a box in the child’s sensory retreat. Make sure your box is portable as fidget toys are perfect aids for waiting periods during transitions.

• Transition and Emotion Strategies. Lower anxiety by using the strategies in “Chapter 9: Transitions;” “Chapter 8: Aggression, Meltdowns, and Defiant Behavior;” and “Chapter 10: Emotions.” Transition strategies will help to build structure and routine into the child’s day, alleviating anxiety by reducing the unknown. Processing the child’s emotions is also critical to relieving the child’s anxiety, and these associated strategies may be found in “Chapter 10: Emotions.” Handling the child’s outbursts, aggression, or defiant behavior in an empathic way is also important in building the proper emotional connection with your child, thereby facilitating coregulation. Coregulation is a term denoting that one person’s actions can be modified by another in the context of a relationship. In other words, parents have the power to modify their child’s behavior through the emotional relationship the parent has with the child.

Parental Strategies for Sensory Underresponsivity

• Sensory Diet. Start with swinging first for at least 15 minutes. Ask your child’s OT if rotary swinging would be appropriate for your child as this is often recommended for the passive underresponder. Subsequently, incorporate a sensory diet of bouncing on a therapy ball or jumping on a safety-netted trampoline or pogo stick. Any of the other deep-pressure activities listed in “Chapter 7: Sensory Diet” would be great options as well. Because this child loves to spend time on the computer and playing video games, games such as Wii and Xbox Kinect that get them moving are great choices for these kids.

• Environmental Modification. Modify the child’s environment by turning up the lights, using bright colors (wearing a bright color also helps), and playing up-tempo songs at a louder volume.

•  Parental Interaction Modification. Modify parental interactions by using a louder voice with changing inflections. Maintain enthusiastic animated communication with lots of gestures when speaking to the child.

•  Oral Motor Activities. Use arousing oral motor activities such as chewing on crunchy foods such as pretzels, chips, or raw carrots. Use arousing flavors such as sour, bitter, spicy, or hot.

•  Transition and Emotion Strategies. Use the strategies in “Chapter 9: Transitions” and “Chapter 10: Emotions.” Passive underresponders often need help navigating through transitions and understanding the emotions of others.

Parental Strategies for Sensory Craving

• Sensory Diet. Incorporate a sensory diet of swinging and deep-pressure activities. Have your child linearly swing for 15 minutes in the morning and evening, followed by deep-pressure activities. Any of the deep-pressure activities listed in “Chapter 7: Sensory Diet” would be great options.

• Many of the strategies delineated above for the overresponder are also appropriate for the sensory craving child. For example, many sensory craving children chew on non-edible objects and can benefit from chewlrey and chewable pencil toppers.

•  Some sensory craving children are underresponsive first thing in the morning or sporadically throughout the day. For the child that has trouble getting up in the morning, use the morning transition strategies for the underresponder in Chapter 9: Transitions. The use of deep-pressure activities will help the sensory craving child transition into the calm-alert state regardless of whether they are underresponsive or overresponsive.

The sensory craving child often demonstrates unacceptable behaviors. Below are common behavioral problems of the sensory craving child with suggested replacement strategies for caregivers to try. Please note that sensory children can demonstrate the same behavior for different underlying reasons if the child has more than one type of sensory processing disorder, e.g., the child that leans on furniture may lean on it for the proprioceptive pressure it provides (a symptom of a modulation disorder), fatigue related to low muscle tone (a symptom of sensory-based motor disorder), or both. The strategies mentioned below are limited to the child with modulation disorder.

Jumping off dressers, chairs, or any high place: Provide safe alternatives for them to jump. You can make a huge launch pillow by taking a duvet cover and filling it full of firm pillows and placing it next to a surface higher than the pillows, e.g. mini-trampoline or you can buy one from http://ultimatesack.com/pillow_builder.asp  Another alternative is to play Simon says and have the child be a frog. “Let’s see how far you can jump!”

Bumping or crashing into people or objects: Provide large inflatable toys (such as football players, dinosaurs, punching bags, etc., available at local or online retailers), cardboard blocks, a launch pillow, or old mattress to bump or crash into.

Always leaning into furniture, walls, or people: Try using a weighted blanket. You can play games such as hamburger, explained in “Chapter 7: Sensory Diet.” Any of the deep-pressure activities listed in the sensory diet chapter would also help to alleviate this behavior.

Throwing things in the house: Have the child throw weighted beanbags into a box or bucket. Alternatively, you can also play beanbag toss using conventional game boards utilizing weighted beanbags.

Always running instead of walking: Invent a skipping game; it will at least slow them down. If they cannot skip, engage them in marching. Suggest a parade and march toward your destination.

Trying to roll on and squish their siblings or pets. Alternatively, they may slide underneath sofa cushions or mattresses: Incorporate some “pillow squishies” into the child’s sensory diet. Take a pillow and squish the child on the back and legs. You can also use a giant rolling pin, therapy ball, or foam roller on the back and legs to implement the deep pressure the child is craving.

Kicking their heels against their chair or unable to sit still at the kitchen table, getting up constantly and running around: If they are kicking their heels against the chair while eating, a great option for kids of all ages is to put a Thera-Band on the bottom of their chair, which they can push their feet into when eating. If they have enough balance and core strength, you can have them sit on an exercise ball and eat if they are old enough. Movin’Sit blue seat wedges or lower back massage mats help these children stay seated as well. Activities such as jumping on a trampoline with a safety net, walking along a beam (tape on the floor), or doing figure eights with eyes closed provide these children with the intense vestibular input they require.

Constantly chewing on nonedible objects such as shirt collars, hood strings, pencils, toys, or their own hair (the mouth provides more intense information than hands): Provide safe alternatives such as chewelry, available from special needs stores.  Also helpful for these children are chewable pencil toppers. Chewing gum, gummy candy, taffy, hard candies, dried fruit, or chewy bread also help to reduce chewing on undesired objects. You can find these items at http://www.naturalcandystore.com. When selecting chewing gum, select gum that is naturally sweetened.  Also, keep a sippy spouted sports water bottle handy to suck on as needed, and always use straws in older children’s drinks; smoothies are great for sensory kids! Nuk brushes are also great for oral stimulation. Be aware that some children will chew due to zinc or essential fatty acid deficiencies. Have your child’s vitamin levels, essential fatty acids, and complete blood work tested to check for deficiencies. Anemic children who have iron and zinc deficiencies and chew or eat nonedible materials such as dirt, sand, clay, paper, etc., for over one month are considered to have a condition called pica. Your child’s pediatrician will recommend treatment for this condition should the need arise.

Engaging in head banging: Children may head bang due to a number of medical conditions: ear infections, teething problems, headaches due to sinus pressure from food allergies/sensitivities or environmental allergies, vision problems, abnormal brain fluid buildup, or seizures. Take your child to a doctor who can perform blood work to test for food allergies/sensitivities than can result in increased mucus, inflammation of sinus cavities, or biochemical changes internally resulting in headaches. Have your child tested for environmental allergens that may be resulting in sinus pressure as well.  Comprehensive vision exams with a developmental optometrist will rule out vision problems. A condition called hydrocephalus, which is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain, can cause a child to head bang as well. In rare instances, head banging can be the only sign of seizure. Talk to your pediatrician about these potential causes.

• Some children will head bang either for self-stimulation or self-soothing. You can try the following tips for these children:

• Regularly massage her head and face with hands or vibrator. 

• If banging is intense, your pediatrician or OT may suggest using a helmet or weighted hat.

• Pull the crib or bed away from the wall and place it on a thick rug.

• In concert with your OT’s recommendations, provide a daily sensory diet.

• Let the child push items with her forehead.  For example, encourage your child to push her head into a pillow or beanbag chair.

• Try pressing your chin into her forehead, moving your jaw back and forth while you hum.

• Speak to your occupational therapist and pediatrician for any additional recommendations concerning head banging.

Assuming upside-down positions, bouncing on furniture, spinning in a swivel chair and pivoting around his head on the floor: These are all signs of the need for intense vestibular input. Jumping on a trampoline with a safety net or holding hands with them while on an indoor mini-trampoline, walking along a balance beam (made with tape or chalk on the floor), or doing figure eights with eyes closed will provide intense vestibular input (closing the eyes isolates the vestibular system, thereby providing more intensity). Eyes-closed activities are the best source of intense vestibular input, but you can also give your child opportunities to wheelbarrow walk, hang upside down from monkey bars, or do handstands. Eyes-open activities are not as effective as eyes-closed activities but will definitely provide some of the needed input.

Getting messy. Sensory-seeking children love to get messy. If you don’t give them an acceptable way to do it, they will indulge in unacceptable activities: These children need lots of messy play such as finger painting, playing in goop, shaving cream, etc. Pinterest is a good resource for sensory play.  Just type in “messy play” and many options will come up.   

Touching and feeling everything in sight (e.g., bumping and touching others even if unwelcome, running his hands over furniture and walls). The child may touch things that other children understand are not to be touched. He may walk on certain surfaces and textures that other people would find uncomfortable: Let him play with different mediums such as finger paint, sand, water, Play-Doh, or clay. The more varied the textures you can present to the child, the better. Collect different textures such as smooth, slimy, dull, pointy, wet, hard, bumpy, rough, soft, etc. Have the child play with or touch all the different textures and discuss the differences between them. For example, you can use a Q-tip, fork, ice cube, feather, or loofah. You can also play a second round with the child blindfolded. Can he guess what touched him? Sculpt with a sheet of aluminum foil. Try making cups, balls, boxes, waves, etc. Afterward, paint the crinkled surface of the foil and place on a piece of paper and make a print of your “texture.”

Rubbing, sucking, or biting own skin excessively: Incorporate deep-pressure activities (see list in “Chapter 7: Sensory Diet”) along with the use of a weighted blanket.

Turning lights on and off in the house: Get the child a disco ball, strobe light, and other toys that light up with a switch that he can turn on/off. Put this toy in an acceptable place in your home so that the child may use it when he desires.

Dumping bins of toys into the floor and/or pulling DVDs and books from shelves: Dumping bins of toys or pulling things from shelves is thought to be a visual craving behavior.  Therefore, some OT’s recommend giving the child visual toys such as small waterfalls, marble runs, disco balls, that can fulfill this visual need.

Excessively splashing, jumping, and making waves in the tub or disliking bath time: Lay a warm, wet towel over her shoulders and back. Keep it warm by pouring more warm water on it during the bath. The deep pressure of the weighted towel and the warmth are calming.

Engaging in hand flapping: Hand flapping may occur until the child gains shoulder stabilization, at which point he may start opening and closing his fingers rapidly (called distal cupping).

Engaging in distal cupping: Children who have shoulder stability may not ever engage in hand flapping but may demonstrate distal cupping. Once the child is old enough video tape him engaging in distal cupping and explain when he is most likely to demonstrate this behavior. Likely times will be when the child is watching a moving object or visualizing a moving object in his mind. Have your child place Koosh balls or other preferred objects in his pockets.  When your child starts to engage in distal cupping, have him put his hands in his pockets squeezing the objects.

Opening and shutting doors repetitively: When your child demonstrates this behavior, get on the other side of the door and make a game of it to help give the activity some meaning. For example, pretend you are a mail carrier, knock on the door, have your child open it, and deliver a package. You can also exert pressure on the door and ask the child to try to move the door. This deep pressure will help to alter her arousal level into the calm-alert state.

Summary

Current understanding of sensory modulation disorder reveals that many challenging behaviors are a result of neurological sensory deficits. Parents should use this knowledge to guide and discipline their sensory children. Love, compassion, and empathy are golden keys to a successful relationship with any child, and these keys will go a long way toward promoting self-regulation.