Understanding the Sensory System and Sensory Processing

The Seven Senses

If you asked someone to think about their senses, most people would name the following five: vision, hearing, taste, smell, and touch. Often what is less familiar are the other two senses: vestibular and proprioception.

The vestibular system is part of the sensory system that controls the sense of balance and spatial orientation for the purpose of coordinating movement with balance. Examples include maintaining balance while learning to walk, holding objects, and turning pages of a book.

Proprioception refers to the sense of the position of parts of the body, relative to other neighbouring parts of the body. Focuses on the body’s cognitive awareness of movement. Examples of proprioception include stepping off a curb without looking at your feet and knowing how much pressure to apply when pressing an elevator button.

Sensory Processing

Sensory processing is the way our brain accepts, interprets and organizes information from our seven senses to create a response. No two people will react exactly the same way; everyone has their own unique response to sensory stimuli.

Sensory processing is automatic for most individuals. However, sometimes children have trouble organizing and responding to information from the senses, which can lead to sensory processing challenges.

One common way of understanding sensory processing challenges is by using Dunn’s Four Quadrant Model of Sensory Processing. This model divides sensory processing into four patterns. These are: low registration, sensation seeking, sensory sensitive, and sensory avoiding. Sensory processing depends on the interaction between your child’s neurological threshold and their self-regulation strategies.

A Neurological threshold: Information coming to a child from the environment triggers activation of the children’s nervous system at a particular threshold. This threshold indicates how intense the stimulation has to be for the child to notice it and falls on a continuum from low to high. For example, children with low thresholds notice even low levels of input to the nervous system, while children with high thresholds require a greater level of input to notice the stimuli. Children with high thresholds may miss information that others receive because they need more input to notice something. For a child with a high neurological threshold, a teacher may have to say the child’s name several times as well as touch them on the shoulder to get their attention. However, one type of sensory input may be enough for a child with a low threshold.

Self-regulation strategies are the strategies a child uses to manage incoming sensory information. These range from active strategies to passive strategies.

A child with active self-regulation strategies will act immediately in overwhelming situations to either avoid (e.g., run away), compensate for (e.g., cover their ears) or seek more sensory stimulation (e.g., hold toys in their hands).

On the contrary, a child with passive self-regulation strategies might not react in an overwhelming situation. They typically do not respond, may shut down, or complain about the stimuli, but may become frustrated later in response to the stimulation which could be expressed as an outburst.

An Occupational Therapist may use an assessment known as the Sensory Profile 2 to categorize a child’s sensory patterns. In this assessment, the Occupational Therapist will seek information from the parent, Early Childhood Educator and/or teacher who will be asked to report on the child’s everyday activity and their responses to sensory stimuli. The information will be summarized to help you understand which pattern the child identifies with for each sense. These categorizations are important because they can help you and Occupational Therapists create a plan to accommodate your child’s sensory needs. For e.g., a child may have low registration for touch, but be sensory sensitive for sound.

Case Example:

To better understand each of the four patterns of sensory processing, we will use Ayub as an example. Ayub is a 6-year old boy in Senior Kindergarten.

Ayub loves playing at the playground, constantly jumping from high surfaces and running around. He enjoys climbing very high on the playground structure which makes his teachers and parents nervous. Further, while at the playground Ayub and his brother enjoy playing catch. Ayub’s brother gets frustrated with him as he often unknowingly throws the ball down to the ground rather than to his brother, and has trouble catching the ball.

Ayub is uncomfortable in the lunchroom as he often finds other children’s food smells offensive. When he notices these smells, he tends to run out of the room and refuses to go back inside. Additionally, he is sensitive to the noises of other children at lunchtime and will become frustrated in loud environments.

The Four Patterns of Sensory Processing

Ayub’s active movement behaviour at the playground may be classified as sensation seeking. He requires a lot of motion input and actively seeks out motion by climbing to high heights, jumping, and running.

Ayub’s body awareness while playing catch may be classified as low registration. Ayub does not have awareness of his force on the ball or his arm and body positioning to catch the ball.

Ayub’s sense of smell may be classified as sensation avoiding. He notices smells with a low threshold and avoids the situation by leaving the space.

Finally, Ayub’s sense of hearing may be classified as sensory sensitive. Ayub has a low threshold for noises as he becomes easily bothered by the noises of other children, but he does not avoid the situation. Instead he passively becomes frustrated.

Now that you know about each pattern of sensory processing, it is important to understand how this relates to each sense individually, and what can be done to accommodate your child’s specific sensory needs. There are tip sheets in this module that detail information and strategies to support sensory processing for each of the seven senses.

Definitions of Occupational Therapy Terms

There are numerous terms used by Occupational Therapists in everyday practice. Below is a list of the most commonly used terms.

Occupation – groups of activities and tasks of everyday life that are meaningful to the individual and include things that people need to do, want to do, or are expected to do.

Activities of Daily Living (ADLs) – a common term used by many professionals referring to the activities and tasks we do every day.

ADLs can be divided into two main categories: Basic ADLs (bADL) and instrumental ADLs (iADL). BADLs include the routine activities we do every day. For example, brushing teeth, showering, toileting, and eating. IADLs are more complex, and involve activities that help us to be independent, including cleaning (toys, play area), preparing meals, and money management.

Self-Care – everyday tasks and actions that a person does to take care of themselves and prepare for participation in daily activities (Kid Sense, 2020).

Examples of self-care can include brushing teeth, getting dressed, toileting and eating.

Productivity – tasks and actions that a person does for the purpose of being productive.

Examples of activities of productivity include writing, colouring, cutting, attending school, going to work, and participation in community events.

Leisure – tasks and actions that a person does to enjoy life (Townsend & Polatajko, 2013).

Examples of leisure activities can include sports, arts and crafts, and play.

Baseline: A minimum or starting point to be used for comparison.

Client-Centered – an approach to therapy which allows the client (for example, child, parents, Early Childhood Educator) to be actively involved in the therapy process by setting goals and developing a plan for intervention.

Occupational Performance – the ability to choose, organize, and perform meaningful occupations for self-care, productivity, and leisure in a way that one is satisfied with (Townsend & Polatajko, 2013).

Occupational Engagement – the act of participating in activities and occupations (Townsend & Polatajko, 2013).

Enabling Occupation – the ability to collaboratively support an individual to participate in meaningful occupations.

Fine Motor Skills– physical skills involving small muscle groups in the hands. For example, writing, colouring, and cutting.

Gross Motor Skills – physical skills involving the entire body, large muscle groups and movements. For example, running, jumping, throwing a ball, and riding a bike.

Cognition – the ability to process information in the brain. It involves many different functions such as memory, perception, judgement, thinking, and problem-solving.

Sensory Processing – the way our body and nervous system accepts and organizes information from our senses: sight, touch, smell, taste, hearing, body positioning (proprioception), and movement and balance (vestibular).

Motor Planning – the brain’s ability to organize and plan purposeful movements. For example, the ability to plan the movements required to ride a bicycle.

References

Kid Sense (2020). Self care skills. Retrieved from https://childdevelopment.com.au/areas-of-concern/self-care/self-care-skills/

Canadian Association of Occupational Therapists. (2016). What is occupational therapy?. Retrieved from https://caot.in1touch.org/site/aboutot/whatisot?nav=sidebar

Townsend, E.A. & Polatajko, H. J. (2013). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT Publications ACE.

The Vestibular Sense

The vestibular system (inner ear balance mechanism) helps us maintain awareness of positioning of our bodies when for example we are walking, running or riding in a vehicle. This sense is linked to other systems such as vision (eye and the muscles and parts of the brain that work together to let us see). It helps children with many activities including learning to crawl, jumping up and down, writing, and following an object with their eyes.

Each child receives and processes vestibular information differently. Some children are hyposensitive to vestibular input and need constant input such as swinging and jumping. On the contrary, some children are hypersensitive to vestibular input and dislike movement and balance activities.

There are the four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding.

Low registration: A child with low registration does not recognize or process all of the incoming sensory information, and they do not compensate by trying to gain more sensory input to meet their needs. They may seem uninterested, and inattentive to their surroundings.

Sensation seeking: A child classified as sensation seeking does not recognize or process all of the incoming sensory information, but contrary to low registration, they actively try to gain this sensory input to meet their needs. They may be hyperactive, touch others often or engage in unsafe activities like jumping from heights.

Sensory sensitive: A child classified as sensory sensitive feels overwhelmed by sensory information, but they do not actively try to avoid the overstimulation, instead they may just display frustration. They may be easily distracted, and irritable, cautious, and uncomfortable in loud or bright environments.

Sensation avoiding: A child that is sensation avoiding feels overwhelmed by sensory information and will actively avoid the stimulation. They may run away from loud, busy environments, cover their ears when overstimulated by noise, or wear gloves to avoid touching certain materials such as paint.

Hyposensitivity

Children who have low registration or are sensation seeking may require extra vestibular input in order to process sensory information and their environment.

If a child has a low registration pattern for vestibular processing they may:

Be described as clumsy, often falling over, tripping and losing their balance. They may have to look at the floor while walking.
Be able to spin in circles for a long time without becoming dizzy.
Have a poor awareness of safety such as running into objects without noticing.
Be unable to follow moving objects, such as cars with their eyes.

If a child has a sensation seeking pattern for vestibular processing they may:

Be described as a risk taker and fearless. They may jump from high heights and spin in circles fast on the swings at the park.
Enjoy a large amount of bouncing, jumping and spinning without becoming nauseous or dizzy. They may be described as having too much energy.
Enjoy thrill seeking activities, such as roller coasters.
Rock back and forth while standing or sitting.
Love being upside down. For example, while on the monkey bars at the park.

Case example:

Marwan is a 5-year-old boy. His teacher at school has observed that he likes to climb on top of the desks in his classroom and jump off them. They worry about Marwan’s safety constantly in the classroom but can’t seem to stop this behaviour from occurring. Marwan’s teacher has expressed this concern to his parents, who claim he behaves similarly while at the playground. He likes to jump from the top of the slide down to the ground. He also enjoys being spun on the swing repeatedly. He never seems to become dizzy or nauseous after this. Marwan’s parents and teacher decide to work together collaboratively with Marwan to come up with a solution for this unsafe behaviour.

Marwan has a sensation seeking pattern for vestibular processing. He requires a large amount of vestibular input and constantly seeks it out by jumping from high heights, engaging in unsafe activities and spinning.

Strategies to assist a child with hyposensitivity for vestibular processing:

Have your child jump on a trampoline, or an air mattress.
Allow for your child to bounce on large exercise balls, with physical support from an adult at their waist or hands.
Play on the swings at the park.
Encourage your child to play spinning games using a desk chair that spins.
Incorporate rocking activities into your child’s daily routine. This can be done with the help of a rocking chair and can be very calming for children. As a game, you can try being a rocking horse for your child. You can get on your hands and knees, have your child sit on your back and rock back and forth.
Teach your child to use playground equipment correctly. You can go down the slide with them or swing on the swings with them.
Use songs to teach your child body awareness. You can make this fun by adding in dance moves that require energy. For example, teach your child the song “Head and Shoulders, Knees and Toes.”

Hypersensitivity

A child classified as sensory sensitive or sensory avoiding may become easily overwhelmed by vestibular input and avoid this input.

If a child has a sensory sensitive pattern for vestibular processing they may:

Dislike sleeping on a bed or cot above the ground due to a fear of falling off.
Become frustrated and anxious while on a roller coaster or ride such as a merry-go-round.
Dislike many sports including soccer, basketball, and swimming.
Be afraid of heights and having their feet off the floor.
Dislike being rocked.
Easily and frequently become motion sick or dizzy. This may happen in car rides, or at the park.

If a child has a sensory avoiding pattern for vestibular processing they may:

Avoid using the playground equipment at the park. Instead they may prefer to sit and play in the grass or sit on a bench.
Avoid activities that involve running, spinning and jumping. They may be less active than other children their age.
Refuse to go on any roller coasters or rides such as a merry-go-round.
Easily becomes motion sick or dizzy. This may happen in the car or at the park.

Case example:

Harshita is a 6-year-old girl. Harshita’s teachers are concerned that she does not have many friends at school. They report that she spends her time in recess alone sitting in the grass. Her peers like to play on the playground and play games such as hopscotch and four-square. Her teachers and peers have tried to engage with her outdoors however, she tends to run away and hide whenever the activity involves heights, being upside down, or vigorous movement.

Harshita has a sensory avoiding pattern for vestibular processing. She is hypersensitive to vestibular stimuli, such as jumping, being upside down and running and responds by avoiding activities that involve these stimuli.

Strategies to assist a child with hypersensitivity for vestibular processing:

Provide your child with a safe space to enter in the event they become overwhelmed with vestibular input. This can be a small tent or even a quiet room which will enable them to feel safe and regulate their emotions.
Slowly desensitize the child by incorporating rocking, spinning or swinging activities into their routine within their comfort zone. It is important to note that if you choose to do this you need to do it very slowly. Provide the child with as much support as possible. For example, you can use a rocking chair with your child. Initially, you can go in the chair with the child and talk with them about what they are experiencing. Then slowly you can remove yourself from the rocking chair working within their comfort zone.
Provide the child with alternate activities during recess or outdoor times. For example, you can play board games with them outside.
To incorporate more physical activity into the child’s routine, use activities that are active, but do not have fast and unpredictable movements in them. For example, you can go for a walk, throw a ball together, have children hold a parachute and gently move it up and down, garden together or play a treasure hunt game outside.
While sitting in class, at the dinner table or in the washroom, ensure that the child’s feet are on the floor. If they are in a higher chair, provide them with a stool to rest their feet on.
Allow for the child to sit in the front of a vehicle or bus to prevent motion sickness, if safe.

Vision

Sensory processing for the visual system uses light, colour, shape and movement to detect information through our eyes and then the brain interprets that information. Some children can become overwhelmed based on the stimuli in the environment such as having a reaction to bright lights/sunshine or cluttered walls and toy shelves. On the contrary, other children may need additional visual stimulation in order to attend to and process visual information, such as toys that have bright lights or contrasting colours.

Difficulties with receiving or processing visual information may result in either seeking or withdrawing from stimulating visual input. This may also lead to difficulties with aspects of vision such as depth perception (judging the distance of objects), hand-eye coordination, tracking moving objects or sustaining eye contact.

There are four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding.

Hyposensitivity

A child who has low registration or is sensation seeking may require extra visual input in order to process their environment.

If a child has a low registration pattern for visual processing they may:

Trip or fall down stairs or curbs because they did not see them or cannot tell how far they are
Miss objects when trying to grab them, or be unable to locate objects that are obvious to others
Often bump into objects or other people

If a child has a sensation seeking pattern for visual processing they may:

Stare or become excited when they see bright flashing lights or bright colours
Often watch others in the environment
Gravitate towards high contrast pictures or patterns

Case example:

Adison is a 5-year-old girl and is new to your senior kindergarten class. On her first day of school you notice that Adison tends to bump into tables and cubbies, as if she is not aware of where they are and does not seem to be interested in many of the toys in the classroom.

Adison has low registration. She does not notice many of the visual stimuli in her environment and does not actively seek out visual stimuli or compensate for this.

With a child who has challenges noticing, or processing visual stimuli, either because of low vision, or a high neurological threshold, you may want to provide activities or put them in environments that are very visually stimulating. Helpful tools for this are activities or objects with bright colours, lights or movements.

For example, you can try activities that include:

Bubbles, flashlights or flashing balls
Rolling a ball
Creating a ‘visual wall’ with lots of colours and patterns to look at
Use brightly coloured paper or tape on the corners of tables to make them more noticeable

Hypersensitivity

A child who is sensory sensitive or sensation avoiding may be very sensitive to visual stimuli in the environment and become easily overwhelmed with sensory input.

If a child has a sensory sensitive pattern for visual processing they may:

Prefer environments with low lighting
Appear uncomfortable or frustrated in highly lit areas
Be uninterested in toys with bright lights or vibrant colours

If a child has a sensation avoiding pattern for visual processing they may:

Prefer dim lights or dull patterns
Avoid eye contact, cover or close their eyes or squint
Avoid bright stimulating lights

Case example:

Nolan is an 8-year old boy. Every day, when it is time for outdoor recess, Nolan refuses to line up with the rest of the class to go outside. He sits in his chair, closes his eyes and will not make eye contact when you try to talk to him. After trying to understand why Nolan does not like going outside, you discover that he avoids going outside because the sun bothers him and he cannot keep his eyes open.

From the case you can see that Nolan’s visual processing pattern is sensation avoiding as his nervous system becomes easily overwhelmed by the sun, and he reacts by actively avoiding this uncomfortable stimulus.

With a child who becomes easily overwhelmed with sensory stimuli due to a low neurological threshold, you may want to use strategies that create a visually pleasing environment, and limit excess visual stimuli.

Strategies that you can try to create a visually pleasing environment:

Whenever possible, limit excess visual stimuli. For example, you can dim the lights indoors when possible and remove wall art with vibrant colours.
Avoid the use of fluorescent lights wherever possible. If this is not possible, you can create a sensory friendly room or area for the child to go to for self-regulation in the event they become overwhelmed by the lights.
Provide the child with a hat, or sunglasses while outside to limit visual input.
Incorporate rhythmical, predictable activities such as lava lamp, hourglass timer, glitter bottle, tornado tube or clear magic wand filled with sparkles. These activities have a predictable visual flow and is less overwhelming for a child.

Taste/Oral Motor

Sensory processing for taste, also known as oral sensation processing, is the way that our brain processes information from our mouth and taste buds. Some children are hyposensitive to taste and oral input and need extra stimulation in their mouth and to attend to tastes, textures, and quantity of food. On the contrary, some children are hypersensitive to taste and oral stimulation and become overwhelmed by sensations in the mouth, tastes, textures, smells, and objects. A person’s sense of smell is closely connected to taste. When a person smells something, it can cause a reaction in their mouth such as watering or cause a negative reaction such as nausea.

There are four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding.

Hyposensitivity

A child who has low registration or is sensation seeking may require extra oral input in order to process tastes, textures, quantity of food and the environment (e.g., food utensils, straws).

If a child has a low registration pattern for oral sensory processing they may:

Have poor awareness of the temperature or amount of food.
Drool frequently.
Spill food or liquid from their mouth while eating or drinking.

If a child has a sensation seeking pattern for oral sensory processing they may:

Explore objects with their mouth, such as toys, books, sand, and clothes.
Crave certain foods, tastes, or smells.
Bite their tongue or lips more often than other children.

Case example:

Jackson is a 4-year-old boy. You are concerned that Jackson is constantly biting his lips and inner cheek throughout the day. You notice that he often places non-food objects in his mouth, such as toys and clothes. He also gets into trouble in class for biting the other children, although this does not occur when he is angry or frustrated.

Based on this information you can see that Jackson is presenting with sensation seeking for oral input. He needs a large amount of oral stimulation and seeks it out by biting his cheek and other objects.

For a child who has difficulty noticing or processing oral information, you can try to provide the child with foods or items that can provide extra, noticeable sensation for them.

Strategies to assist a child with hyposensitivity for oral sensory processing:

Give the child items that are intended for biting, such as gum or chew jewelry (jewelry that is intended to chew on).
Incorporate oral activities throughout the day. For example, blow bubbles, drink thick liquids from a straw, or blow cotton balls across the table.
Provide chewy or crunchy foods that will provide extra oral sensory input. For example, apples, granola, bagels, crushed ice, and dried fruit.
Massage the child’s gums or use vibration provided from items such as an electric toothbrush which will help to decrease the need to chew by providing alternate input.
Use hot packs and cold packs on the face and near the mouth to help develop a child’s awareness of different temperatures.
Use ‘alerting snacks’ such as salt and vinegar, hot or sour candies, and ice chips. These snacks provide intense oral sensations desired by children with hyposensitivity.

Hypersensitivity

Children who have sensory sensitive or sensory avoiding for oral sensation may be considered over-sensitive to tastes, textures or smells.

If a child has a sensory sensitive pattern for oral sensory processing they may:

Gag with certain food textures, food utensils, or a toothbrush in the mouth.
Be described as a picky or selective eater, especially with regards to food textures. When the child eats nonpreferred textures, they may become frustrated or upset.
Only eat foods with specific, preferred tastes.

If a child has a sensory avoiding pattern for oral sensory processing they may:

Reject certain tastes, textures, or food smells that are typically part of a child’s diet. They may throw the food away from them, run away from the food, or just refuse to eat it.
Only eat foods with specific, preferred tastes.
Limit themselves to a very small variety of foods.
Refuse to try new, unknown foods.

Case example:

Alex is a 7-year-old girl. Alex brings the same lunch to school every day, a white bread sandwich with cream cheese and the crust cut off. According to her parents, Alex refuses to eat anything else and will gag or cry when offered other food choices. She also refuses to join the other children in the general lunchroom at school because the different smells make her gag. Whenever she is in the lunchroom, she runs away to eat alone in a different room.

Alex has a sensory avoiding pattern for oral sensory processing.

For a child with hypersensitivity to taste, textures, and smells, slowly increase their food tolerance and give them strategies to navigate their sensitivity to smells.

Strategies to assist a child with hypersensitivity for oral sensory processing:

Slowly introduce new foods by giving the child variations of their preferred foods. For example, if the child will only eat cereal and you want them to eat blueberries, you can start by introducing blueberry flavoured cereal, then introduce blueberries together with the cereal and gradually reduce the amount of cereal until the child is eating plain blueberries.
Encourage the child to drink between bites of food to clear their mouth.
Use unscented cleaners and soaps around the house or use essential oils to help lessen overall scents.
Create a mealtime routine and serve meals at the same time every day.
To help prepare children for mealtime transitions. Provide a consistent reminder prior to the meal, have child engaged in preparation for the meal (e.g., set the table)
Wash the child’s face with a cloth or give them ice to chew on to decrease their sensitivity to textures and tastes.

Touch

Sensory processing for touch, also known as tactile processing, is the way that our brain processes information about our environment through messages from our skin. This includes light touch, pressure, vibration, temperature sensitivity and pain. With maturity and experience, children are able to process information about touch from our environment, put meaning to it and differentiate between elements of touch.

Each child receives and processes tactile information in different ways. Some children are hyposensitive and need extra stimulation to experience light touch, vibration, pressure, temperature sensation or pain. On the contrary, some children are hypersensitive and may become overwhelmed by tactile information. If a child has difficulties with receiving or processing tactile information, they may have challenges in the development of their body awareness, and automatic reactions. For example, they may not develop the ability to pull their hand away when something is too hot.

There are four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding.

Hyposensitivity

A child who has low registration or is sensation seeking may require extra tactile input in order to process light touch, pressure, vibration, temperature sensitivity and pain.

If a child has a low registration pattern for tactile processing they may:

Be able to tolerate very hot or cold temperatures. They may seem unaware of these extreme temperatures and changes in temperature.
Be able to tolerate high levels of pain or seem unaware of pain. For example, they may not notice a large scrape on their knee or complain of any pain after a bad fall.
Be unaware when their hands or face is dirty. For example, they may not notice if their hands are covered in dirt after playing outside.

If a child has a sensation seeking pattern for tactile processing they may:

Seem unaware of their own strength, and as a result, play in a rough way.
Squeeze too hard while holding hands with others.
Rub or scratch at parts of the body to gain extra input.
Touch people or objects and show a need to touch toys, surfaces, or textures more than others.

Case example:

Laith is a 6-year-old boy who loves to play roughly with other children. As a parent you notice that he is always hitting hard surfaces with his hands and feet and pushing other children at the park. In addition, he often squeezes your hand very tight while you are crossing streets together. He also tends to feel and touch everything in his environment. When you went to the park the other day, Laith wanted to rub his hands in the sand, touch every swing and slide, and even went over to touch a stranger’s picnic blanket.

Based on the case you can see that Laith is sensation seeking for tactile input. He needs a large amount of tactile stimulation, and seeks it out by squeezing, playing roughly with other children and touching objects.

For a child who is hyposensitive to tactile information, you can try to provide the child with tactile input to provide extra, noticeable sensation.

Strategies to assist a child with hyposensitivity for tactile processing:

Use firmer brushes and different textured cloths to provide extra tactile sensation.
Encourage the child to play with playdough and goop as they can provide tactile input for children who like to squeeze things. You can change the texture by adding small beads or other materials into the playdough or goop.
Play games such as One Potato, Two Potato or Hot Potato with hot packs and cold packs. This can help your child become aware of and sensitive to different temperatures.
Encourage your child to pop bubble wrap or provide them with other fidget toys such as a fidget spinner or squeezy ball.
Engage your child in tasks that involve “heavy work” such as pulling a peer in a wagon, stacking chairs or picking up heavy toys at tidy up time. These activities provide children with tactile stimulation through the use their muscles.

Hypersensitivity

Children who are sensory sensitive or sensory avoiding of tactile sensation may appear over-sensitive to light touch, pressure, vibration, temperature sensitivity and pain.

If a child has a sensory sensitive pattern for tactile processing they may:

Show distress and anxiety during grooming. For example, while brushing their hair, washing their face, or cutting their fingernails.
Strongly dislike light or unexpected touch.
Become anxious while standing close to others.
Become irritated while wearing shoes or socks.
Become irritated if their hands or face are messy.

If a child has a sensory avoiding pattern for tactile processing they may:

Try to avoid being touched or show an emotional response when they are touched. For example, they may push you away if you try to hold their hand.
Hold objects using only their fingertips and avoid using the palms of their hands.
Avoid signs of affection such as hugging or holding hands.
Insist on exclusively wearing soft clothing and the same clothing for multiple days. They may even prefer to be naked and require you to cut out clothing tags.

Case example:

Jessica is a 5-year-old girl who does not like to be in crowded areas. She becomes anxious when others stand near her and yells when others touch her. She also does not like to give or receive hugs and kisses from anyone, including her family. She is very selective with the clothes that she wears. She insists on wearing the same cotton t-shirt with no seams or tags every day.

You notice Jessica has a sensory avoiding pattern for tactile processing. She is hypersensitive to feelings of touch, textures, and pressure and actively tries to avoid them.

Strategies to assist a child with hypersensitivity for tactile processing:

Give the child advanced warning before doing an activity. For example, you can say “after your bath, we’ll brush your hair.” This allows for the child to process what is going to happen and prepare themselves.
Encourage your child to take the lead when they get dirty during play. You can inform the child but allow them to clean up themselves, if possible.
Try to avoid unexpected light touch and try to promote deep pressure such as through hugs, a weighted blanket or weighted toys.
Try to show affection in alternate ways. If the child does not like being hugged, it is possible that a “high five” or encouraging words can accomplish the same feeling of affection.
Provide the child with a ‘touch and feel’ box or bag. Place different objects into a box for the child to feel and explore. This allows for the child to experience different tactile sensations in a controlled setting. Examples of objects to put in the box at different times include sand, beads, marbles, wooden blocks, and slime. Over time you can add to the number of texture or objects in the box as the child’s tolerance and enjoyment increases.

Hearing

Sensory processing for hearing, also known as auditory processing, is the way our brains process the things that we hear. We spend a majority of our day listening to many different sounds. For example, the sound of an alarm clock in the morning, the sounds your family members make while speaking, and the sounds of cars going by during the day. Some children are hypersensitive to sounds, and become overwhelmed with common, everyday sounds like the sounds of other children in their class. On the other hand, some children are hyposensitive to sounds and need extra stimulation to attend to certain sounds, like their name being called in a classroom.

Children that have difficulties with auditory processing may seek or withdraw from auditory input. They may have additional issues understanding speech, remembering instructions, or following a conversation. Children with auditory processing challenges are sometimes misunderstood to have hearing problems, when their hearing may be completely intact.

There are the four patterns of sensory processing: low registration, sensation seeking, sensory sensitive and sensation avoiding.

Hyposensitivity

A child who has low registration, or is sensation seeking may require extra auditory input in order to process their environment.

If a child has a low registration pattern for auditory processing they may:

Need you to repeat things multiple times to understand what you are saying
Not respond when their name is called
Be unable to locate where sounds come from

If a child has a sensation seeking pattern for auditory processing they may:

Be very excited with loud music or noises
Listen to the TV or music with a very high volume
Be described by others as loud or noisy

Case example:

Hugo is a 4-year-old-boy. Hugo’s parents complain that he ignores them when they call his name. Hugo often does not answer or make eye contact with his parents. His parents find that they need to repeat things many times, in a loud voice for Hugo to acknowledge them. Hugo’s parents recently brought him to the doctor and confirmed he does not have any problems with his hearing.

Based on the case you can see that Hugo has a low registration pattern for auditory processing. He does not notice his name being called or the sound of his parents speaking to him and does not actively try to seek out more auditory stimulation or sounds to compensate for this.

With a child who has difficulty in noticing and processing auditory stimuli you can put them in environments that are stimulating with a variety of different sounds.

Strategies to assist a child with hyposensitivity for auditory processing:

Have them play with musical instruments, practice humming, or sing. You can do all of these activities alongside the child! Making music offers children a fun, engaging activity while teaching them to attend to different sounds in the environment.
To teach children to respond to their name, first practice calling their name in an environment with no distractions. Once they start to respond to their name with no distractions, slowly build up the distractions in the room.
Use visuals whenever possible. Show pictures of your request, to remove auditory demands.
If the child cannot detect where a sound is coming from, play games with them such as “find the noise.” Hide an object that makes a noise (cell phone playing music, buzzer, etc.) under a blanket, or table, and have them try to locate the sound.
If the child prefers to listen to loud music or a loud TV, provide them with headphones to accommodate this need.

Hypersensitivity

Children who are sensory sensitive or sensory avoiding to sounds may be considered over-sensitive to everyday sounds such as a class bell, a car honk, or the voices of other children.

If a child has a sensory sensitive pattern for auditory processing they may:

Cry from loud or sudden noises.
Be able to hear and become distracted by background noise others may not notice.
Prefer the TV or music volume to be low, or off.
Become upset while eating crunchy foods due to the noise from the crunch.

If a child has a sensory avoiding pattern for auditory processing they may:

Run away from or avoid situations with loud or sudden noise such as a toilet flush, hair dryer, or lawn mower.
Avoid situations or places with large numbers of people, such as an indoor playground.
Place their hands over their ears in situations with loud or sudden noises. For example, during a fire drill at school.

Case example:

Lia is a 7-year-old-girl. Lia frequently becomes overwhelmed by noises at school. During outdoor recess, she will cover her ears, cry, and run inside if the children playing around her are laughing loudly, yelling, or singing. She uses this same pattern of behaviour in shopping malls, and parks.

Based on this case you can see that Lia has a sensory avoiding pattern for auditory processing. She becomes easily overwhelmed by sounds from others in busy environments and responds by trying to avoid these sounds.

With any child that may be hypersensitive for auditory stimuli, or sounds, you may want to give them strategies to limit the overwhelming sounds in loud environments, and provide them with a quiet, calm environment wherever possible.

Strategies to assist a child with hypersensitivity of auditory stimuli:

Use white noise. This can include noise from a white noise machine, a fan, or radio static. White noise can help to soften and minimize the effects of loud and overwhelming sounds.
Give the child advanced warning anytime a loud sound, such as a fire alarm will be going off. Helping them feel prepared can minimize the effects of these sounds.
Use noise-cancelling headphones, or earplugs to muffle the effects of loud sounds in overwhelming situations.
Create a quiet, calming room at home, or in the school for the child to go to when they feel overwhelmed to calm their nervous system down.

Occupational Therapy and Paediatrics Part 2

How is an Occupational Therapist different from a Physical Therapist?

An Occupational Therapist is commonly confused with a Physical Therapist as the two professions often work side-by-side. The main difference is that Occupational Therapy is centred on the person’s ability to perform activities of daily living, and Physical Therapy treats the person’s physical ability and focuses on movement and function.

For example: Sara is a 5-year-old girl diagnosed with cerebral palsy. She walks on her toes and has challenges with getting dressed. The Physical Therapist may give her orthotics to prevent toe walking, or work on muscle strengthening. The Occupational Therapist may provide her with aids such as adaptive zipper pulls that can help with her dressing challenges.

How is an Occupational Therapist different from a Behaviour Consultant?

Behaviour Consultants address complex behaviours by looking at a child across a variety of situations for patterns and the function of the child’s behaviour. This includes observing environmental factors including the relationships between the child and their caregivers.

In contrast, Occupational Therapists will look at the barriers limiting the child’s ability to engage in or perform their occupations. Occupational Therapists also consider a child’s behaviour, as well as sensory challenges, environmental factors, and motor skills impacting occupational performance.

For example: Jake is a 7-year-old boy with Autism Spectrum Disorder. He becomes stressed at unexpected, loud noises in his class at school. Also, when he gets frustrated with his tasks in school, he engages in screaming and throwing his pencils. The Occupational Therapist may provide him with large headphones to block out unsettling noise. Additionally, they may help him with emotional regulation skills for his frustration. The Behavioural Consultant will focus on establishing the cause and outcome of the child’s screaming and throwing of pencils. They will develop strategies to reduce or prevent this behaviour in all environments.

Despite the differences between Occupational Therapy, Physical Therapy, and Behavioural Consultation, the three professions have a lot of overlap. The chart below compares the areas of overlap between the professions.

Challenges	Occupational Therapists (OTs)	Behaviour Consultants (BCs)	Physical Therapists (PTs)
Sensory Does the child avoid activities with certain textures, (gluing, finger-painting), have sensitivity to loud noises or smells, frequently pull, hit, seek touch (hugs, tight spaces), or avoid active games and slides?	✅ OTs will help children find strategies to manage their sensory challenges. For example, they may suggest headphones to block out loud noises, or help children become tolerable of different sensory stimuli.	❌	❌
Behaviour Does the child display repetitive behaviours, restrictive interests, low frustration tolerance, difficulty with transitions, or impulsive behaviour?	✅ OTs will assess aspects of the person, environment, or occupation to ultimately support the child’s ability to perform their occupations.	✅ BCs can conduct assessments of the child and the environment to determine the triggers and responses to the challenging behaviours. They will develop strategies that will address the purpose of the behaviours by preventing future occurrences of challenging behaviours, teaching more appropriate behaviours to replace the problem behaviours, and responding to challenging behaviours in order to make them ineffective, inefficient, and irrelevant.	❌
Gross Motor Does the child have postural challenges, difficulty achieving motor milestones (walking, crawling, etc.), clumsiness, (often tripping and falling), difficulty with age-appropriate bicycle/tricycle riding, throwing a ball, kicking a ball, climbing stairs, or tire easily?	✅ OTs can help with many of these areas with a focus on occupation. They may teach the steps required to ride a bike or throw a ball. They may suggest energy conservation strategies or provide strategies to increase coordination. The key is that they will focus on these challenges in relation to occupation.	❌	✅ PTs frequently assist children with gross motor challenges, by providing specific exercises aimed at improving their physical abilities.
Fine Motor Does the child have difficulty with age appropriate dressing, the use of eating utensils, handwriting, colouring, cutting, using both hands together, or manipulating toys?	✅ OTs will provide suggestions to develop and enhance fine motor skills or adaptive equipment such as a weighted spoon.	❌	✅ PTs can help with improving physical strength and coordination for fine motor skills, especially handwriting.
Equipment Does the child have equipment needs including: prescribed equipment such as wheelchairs, walkers, standers?	✅ OTs can prescribe and fit children for adaptive equipment.	❌	✅ PTs can prescribe and fit children for adaptive equipment.
Oral Motor Does the child have difficulty chewing, keeping food in their mouth, swallowing, drinking from a cup? Are they very slow eaters?	✅ OT’s will provide strategies for a child to learn to chew, swallow, and drink. The OT will first make sure that there are no medical or postural reasons for difficulty in eating and drinking.	❌	❌
Social Does the child have difficulty making and maintaining friends, making eye contact or using other non-verbal communication, playing with other children, or listening to and following instructions?	✅ OT’s may conduct assessments to determine potential reasons for the social difficulties. OT’s will also assess how these difficulties are impacting the child’s occupations and will give strategies on how to include the child in play and help the child participate in activities.	✅ BCs can conduct assessments and observations to determine supports in programming to develop the child’s social skills and have appropriate interactions with others. BCs will focus on changing socially significant behaviours that will support the child’s inclusion in all their environments.	❌
Cognitive Does the child have memory impairments, attention deficits, difficulty with decision making or problem solving, or difficulty following multi-step directions?	✅ OT programming can also focus on cognitive skills to determine possible adaptive or remedial strategies for the challenges listed.	✅ BCs assess the child’s current cognitive abilities and break down complex skills into smaller steps for the child to learn. BCs design individualized strategies/ adaptations to support skill development.	❌

Occupational Therapy and Paediatrics Part 1

What is Occupational Therapy?

Occupational Therapists work with clients of all ages, with any challenge preventing them from performing their occupations. Occupational Therapists look at aspects of the person, environment, and occupation to discover the factors contributing to the barriers to the clients’ participation. They have specialized training and use a strengths-based approach to work with each client and tailor the therapy to their individual needs.

Paediatric Occupational Therapists help children to perform and engage in their occupations of self-care, leisure, and productivity. These include activities individuals want to do, are expected to do, or need to do to (Canadian Association of Occupational Therapists, 2016):

Take care of themselves
Participate in a group setting
Have fun

Occupational Therapists work with children in various settings including home, early learning environments, schools, and medical facilities. The main occupation of children is play; as a result, Occupational Therapists incorporate play interests in their work with children.

Initial visit with an Occupational Therapist: The Occupational Therapist will ask questions to gain a better understanding of the child, their environment (home, family, playroom or school) and the task that they are having difficulty with. To support the collection of informal information, the Occupational Therapist may conduct specific, evidence-based assessments to understand the child’s challenges in more detail.

After the initial visit: Occupational Therapists use a number of different interventions. Each intervention is collaborative and focuses on improving occupational performance and engagement in tasks that you and the child determine are important.

The following are some examples of Occupational Therapy Interventions:

If a child is having difficulty with the washroom routine, an Occupational Therapist may introduce a visual schedule that breaks down the steps of using the washroom for the child to follow. If a child’s washroom difficulties are sensory-based the Occupational Therapist may suggest the use of potty seats or a change of location of the potty.
If a child is having sensory challenges, the Occupational Therapist recommendations may include adjusting the task or environment for an individual’s needs, introducing movement breaks, using weighted products, headphones, organizing spaces or providing quiet times.
If the environment is limiting the child’s occupational performance, the Occupational Therapist may suggest modifying spaces for accessibility by providing ramps, adaptive bathroom equipment such as toilet seat insert, or alternative lighting to reduce brightness.

References

Canadian Association of Occupational Therapists. (2016). What is Occupational Therapy?. Retrieved from https://caot.ca/site/aboutot/whatisot_test

Dunn., W. (2017). Strengths-based approach: what if even the ‘bad’ things are good things?. British Journal of Occupational Therapy. 80(7): 395-396.

Creating a Calming Environment

Providing a calming and nurturing environment for children requires a safe and inviting space for both adults and children to explore together. Calm and engaging environments offer predictability, stability and positivity for children. This is especially true when children have experienced challenging or stressful situations that upset their sense of security.

Educators and families can set the stage for a calming environment through three key approaches; 1) positive relationships, 2) organizing the environment, and 3) consistent routines. When the environment is predictable, supportive, and consistent, children feel safe to explore and learn, which in turn promotes the development of self-esteem and resilience.

Building a Positive Relationship

Consider the following when building supportive relationships and a welcoming environment.

Greeting your child by name will strengthen your relationship with them and help you understand and respond to how your child may be feeling that day.
Have appropriate expectations for your child – When setting your expectations, take into consideration your child’s likes, dislikes, interests, skills and learning style.
Follow your child’s lead – Plan activities that capture your child’s interests and abilities.
Provide opportunities for your child to have individual attention from a responsive adult. Even a few minutes of quality interaction using listening and eye contact will show your child that they are heard, they are special and that you are happy to be with them.
Comfort and reassure your child quickly when they are distressed. It is important to recognize and label your child’s feelings.
Include family and cultural practices throughout the day, ones that will help your child find a way to ground themselves within their identity.

Organizing the Environment

A well-designed environment promotes independence and fosters a sense of calmness. Consider the following when planning the play space.

Create defined play areas – if possible, break up the room into areas using shelves, tables and other furniture.
Create space to sit and relax where your child can take a break from loud sounds.
Keep the room tidy, clearing away unnecessary clutter may reduce visual stimulation and help your child find what they need more easily.
Reduce the number of toys available at the same time.
Rotate play materials as necessary to continue to keep your child interested and engaged.
Adjust the sensory input in the environment to support well-being. Can lighting or the noise level of the room be adjusted?
Incorporate opportunities for movement and music into the daily routine.

Consistent Routines

The more consistent your daily routine, the easier it is for your child to anticipate what will happen next and make sense of the day. This predictability may help them cope with stressors. Consider the following.

Use a visual schedule, showing pictures of the daily routine and step-by-step mini-schedules for parts of the day that are more stressful. This will increase predictability of the routine and help your child understand what is happening next. Model using the visual schedule and make it a fun experience with your child. Let them point out what is happening next.
If your child has a high interest in technology, such as computers or tablets, structure their time for using technology by including this in the scheduled routine.
Prior to transitions, give warnings that the transition is coming. Get down at their level and make sure they have heard you and are aware that the transition is coming.

Remember

Creating a safe, secure environment where your child can form meaningful and supportive relationships is critical to their social and emotional development. Providing consistent environments, relationships and routines can help your child feel safe to explore the world around them.

References

Burnett, Christie. (2020). Managing Big Emotions Through Movement: Yoga for Kids. Retrieved from https://childhood101.com/yoga-for-kids/.

Coping Skills for Kids. (2019). Deep Breathing Exercises for Kids! Retrieved from https://copingskillsforkids.com/deep-breathing-exercises-for-kids.

Kostelyk, Sharla. (2020). 175 Sensory Activity Ideas for Kids. Retrieved from https://www.thechaosandtheclutter.com/archives/175-sensory-activity-ideas-kids/.

Minero, E. & Fleming, N. (2020). DIY Ways to Meet a Child’s Sensory Needs at Home. Retrieved from https://www.edutopia.org/article/diy-ways-meet-childs-sensory-needs-home.

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The Seven Senses

Sensory Processing

Case Example:

The Four Patterns of Sensory Processing

References

Hyposensitivity

Case example:

Hypersensitivity

Case example:

Hyposensitivity

Case example:

Hypersensitivity

Case example:

Hyposensitivity

Case example:

Hypersensitivity

Case example:

Hyposensitivity

Case example:

Hypersensitivity

Case example:

How is an Occupational Therapist different from a Physical Therapist?

How is an Occupational Therapist different from a Behaviour Consultant?

What is Occupational Therapy?

Links

References

Building a Positive Relationship

Organizing the Environment

Consistent Routines

Remember

References