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Four Patterns of Sensory Processing

All children are unique and it is likely you will encounter children with different sensory processing challenges at the same time. 

There are tip sheets on each of the seven senses:  smell, taste, touch, vision, hearing, vestibular, and proprioceptive.  Each sheet provides detailed information for programming on those individual senses.  When developing any programming for a child, it is common to identify if the child is sensitive to stimuli within a particular sense.  Below is a chart to help you understand an individual child’s needs.

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. 

Here are some general strategies you can use to manage a large number of children with different sensory processing challenges: 

  • Whenever possible try to minimize the sensory stimuli in a room. For example, avoid fluorescent lighting and loud noises. Although some children may require extra input, it is easier to give them this input individually in alternate ways that do not involve disturbing the hypersensitive individuals in the room.  For e.g., for children that require additional visual input, provide visually stimulating items such as a lava lamp.  For children who require extra auditory input, provide sound-producing toys, such as a shaker.
  • Have a designated area in the classroom that children can go to and calm their nervous system if they become overwhelmed. This strategy is useful with most children that are hypersensitive to any of the seven senses. 
  • Give children options. Provide children materials such as a fidget spinner or exercise ball to use if they are seeking this type of input. 
  • Communicate with the child’s caregivers to learn about the child’s likes and dislikes and strategies that work at home that can be easily transferred to the classroom environment.

Reference:

Dunn, Winnie (2007), Dunn’s Four Quadrant Model of Sensory Processing.

Sensory and Beyond

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. 

Hearing

Sensory processing for hearing, also known as auditory processing, is the way our brains process the things that we hear. Read more »

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. Read more »

Smell

Our sense of smell is extremely important in everyday life. It can impact our memories and emotions. Read more »

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. Read more »

Taste

Sensory processing for taste, also known as oral sensation processing, is the way that our brain processes information from our mouth and taste buds. Read more »

Proprioception

Proprioception is a sense that tells us about the position of our body parts in relation to each other, other individuals and the environment. Read more »

Vestibular

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. Read more »

Understanding the Sensory System and 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. Read more »

In Conclusion

All children are unique and it is likely you will encounter children with different sensory processing challenges at the same time. When developing any programming for a child, it is common to identify if the child is sensitive to stimuli within a particular sense.  Read more »

Smell

Our sense of smell is extremely important in everyday life. It can impact our memories and emotions. Our brain’s ability to process the smells in our environment through receptors in our nose is called olfactory processing. There are individual differences in sensory processing; some children can be hypersensitive to smells and be bothered by subtle smells in the environment. On the contrary, some children can be hyposensitive to smells and not seem to notice smells in the environment that other people easily sense, such as strong brewing coffee or a skunk. 

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

A child who has low registration for smell, or is sensation seeking may require extra olfactory input (smells) in order to process their environment. 

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

  • Be unaware of very strong or unpleasant smells that others notice, such as the smell of exhaust fumes.
  • Be unable to label or recognize certain smells.
  • Be unaware of the smell of smoke from a fire or other dangerous smells in the environment.
  • Be unaware of smells others may enjoy, such as the smell of freshly baked bread. As a result, they may not have a strong preference for the foods that many others may like. 

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

  • Explore a variety of non-food objects by smelling them. For example, they may smell various people, foods, markers, and toys to explore them. They may also want to smell odors that others would perceive as unpleasant, such as the smell of soured milk or gasoline. 
  • Play with feces, due to the strong scent. 
  • Crave and actively seek out particular smells, both of food and non-food items. For example, they may be very drawn to a particular flower at the park or the smell of bubble bath. 
  • Enjoy eating foods with strong scents such as oranges, garlic, or pickles. 

Case example:

Sarah is a very curious 8-year-old-girl. Her teachers notice that she frequently hovers over the garbage cans in the classroom and playground to smell the contents. When redirected from this behaviour, she will seek out other objects to smell, including classmates. She is having trouble making friends at school because of this, and her parents are very concerned. 

Sarah has a sensation seeking pattern for olfactory processing. She continuously seeks out very strong scents to meet her needs. 

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

  • Provide the child with strong scents such as peppermint, citrus, perfume/cologne or use scented laundry detergent. These scents can provide the child with the required amount of stimulation to increase their alertness. You can teach them to use these scents to gain stimulation, as opposed to people or inappropriate objects such as feces. 
  • Play games such as “guess that scent.” Try using scented candles, essential oils, or different types of foods and without showing the child have them guess the scent. 
  • Create a routine for washing hands, bathing, and cleaning if the child is unaware of their own scent. 
  • Provide the child with scented playdough or scented markers. 
  • Teach older children strategies to compensate for their hyposensitivity. For example, if they are unable to tell if food has gone bad due to their sensory processing differences, teach them to read expiry dates. 

Hypersensitivity 

Children who are sensory sensitive or sensory avoiding to smells may be considered picky or selective eaters due to a dislike of certain food scents. 

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

  • Become anxious while in rooms recently cleaned with cleaning products, or with air fresheners. 
  • Dislike the scent of laundry detergent on their clothing.
  • Gag when presented with certain foods or other scents.
  • Be anxious about their own scent, particularly if they perceive they “smell bad.” They may want to bathe numerous times a day to remove this smell from their bodies. 
  • Become distracted in school because of the smells in the environment. 

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

  • Be a very selective or picky eater, refusing to eat certain foods based on scent. They may refuse to eat certain foods even if they are extremely hungry.  
  • Run away from or avoid shared lunch spaces due to the dislike of other lunch smells. 
  • Plug their nose when in the presence of particular smells, such as the smell of a flower, perfume/cologne, another child, or food item.
  • Refuse to use public bathrooms due to the scent.
  • Refuse to go to a particular place, such as a friend’s house because of the smell. 

Case example:

Sebastian is a 5-year-old-boy. Sebastian’s parents are concerned as he will often come home from school with his pants soiled. His teachers have shared that he refuses to use the washroom in the classroom. After discussing with Sebastian, you discover he refuses to use the washroom because of the smell of the air fresheners and products used to clean it. 

From the case, you can see that Sebastian has a sensory avoiding pattern for olfactory processing. He has hypersensitivity towards the scent of the washroom and copes by avoiding this non-preferred scent. He avoids it daily and ends up with soiled clothing. 

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

  • In some cases, you can try to desensitize a child to a particular scent by slowly increasing their exposure to the scent. However, be aware that the child may not wish to proceed with desensitization if they become uncomfortable and have a negative emotional response. 
  • Use fragrance free cleaning products including laundry detergent. 
  • Avoid wearing perfume or cologne or using strongly scented personal care products if you are near the child on a regular basis.
  • In class, seat the child away from triggering scents such as the garbage bin. You can seat them next to the window if they are tolerant of the smell outside. This ventilation can help them to cope. 
  • Provide the child with a preferred scent, such as an essential oil to use throughout the day if they feel overwhelmed by other scents. 

Proprioceptive Sense

Proprioception is a sense that tells us about the position of our body parts in relation to each other, other individuals and the environment. Proprioception also communicates information about how our body parts are moving. For example, how much force our muscles need to use for different activities, such as holding a paper cup as opposed to a plastic cup. 

Sensory processing for proprioception is the way our brains process information from our muscles and joints about the position of our bodies in space. Each child receives and processes proprioceptive information in different ways. Some children are hyposensitive and need constant input to feel where their body is in space or in relation to others. On the contrary, some children are hypersensitive to proprioception and may become overwhelmed. If a child has difficulties with receiving or processing this information, they may have trouble with body awareness or planning their body movements.

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 

A child who has low registration or is sensation seeking for proprioception may require input to their muscles and joints to feel calm and to understand where their bodies are in space. 

If a child has a low registration pattern for proprioception they may: 

  • Have difficulty navigating rooms and avoiding objects when moving around.
  • Appear floppy and have difficulty with balance. They may have difficulties sitting upright in a chair or on the floor and keeping their head upright. The child may lean against people, furniture and walls for support.
  • Stumble and fall more than other children their age.
  • Have difficulty with some activities that require balance. For example, riding a bike.
  • Have difficulty with activities that require a change in body positioning. For example, playing sports.
  • Sit in a “W” stance on the floor.
  • Hold onto items with a weak grasp and drop objects easily. For example, they may be unable to hold a marker tight enough to use it and they may often drop their toys.
  • Have a limited sense of personal space. They may unknowingly stand too close to other individuals or objects.

If a child has a sensation seeking pattern for proprioception they may:

  • Push or play roughly with other children or objects. For example, they may purposely bump or run into people or objects such as walls, tables and doorframes.
  • Press too hard on paper when writing which may result in tears or holes in the paper. 
  • Bang or hit their body parts. For example, they may hit their head with their hands, bang their hands together or bang their head on a wall.
  • Prefer tight clothing. Tight clothing can give a large amount of proprioceptive input.
  • Constantly be in motion. For example, they may constantly flap their hands and fidget and not be able to sit still. This may impact their ability to focus in class, as they may constantly be trying to gain proprioceptive input through movement instead of listening. 
  • Prefer to run, jump or stomp instead of walking. They may walk very loudly, by stomping their feet on the ground.
  • Walk on their tip toes.

Case example:

Ameer is a 5-year-old boy. You notice that Ameer gets tired very easily while standing or sitting for long periods of time. He tends to lean on tables and walls to support himself. Ameer’s friends enjoy playing games such as hopscotch and soccer. Ameer has trouble kicking a ball and balancing on one foot and consequently does not participate in these games with his friends. You try to practice some kicking and balancing skills with him at home, but you find that he just doesn’t know what to do with his body and often falls. 

Ameer has a low registration pattern for proprioceptive input. He has trouble supporting his weight while sitting and standing. He also has trouble with activities that use balance such as standing on one foot or kicking a ball.  

For children who are hyposensitive to proprioceptive information, try to provide them with activities that use their muscles and joints to calm the child and increase their responsiveness to sensory input.

Strategies to assist a child with hyposensitivity for proprioception:

  • Incorporate activities that put weight on the muscles and joints such as crawling or push-ups. For example, games where the child needs to copy different walks such as a crab or wheelbarrow walks.
  • Incorporate activities where the child does heavy lifting. For example, at cleanup time, you can ask the child to pick up a stack of books or bins of toys.
  • Provide activities that use a lot of energy, such as running or jumping on a trampoline. Create obstacle courses for the child or have them bounce on an exercise ball. 
  • Place a piece of TheraBand (large, stretchy elastic) on the legs of their chair and allow for them to kick the band while sitting. 
  • Position furniture around the edge of the room to minimize the risk of falling and make navigation simpler.
  • Provide the child with non-slip shoes to prevent falls. 
  • Use deep pressure by giving the child hugs or a weighted/heavy blanket. This can be calming for children as it will give them their required proprioceptive input and calm their nervous system.
  • Use fine motor activities in their daily routine. For example, encourage them to draw, build, or play with a fidget spinner. 
  • Use an “arm’s length rule” or hula hoop to help judge personal space and reinforce them when necessary to maintain this practice. 

Hypersensitivity 

Children who are sensory sensitive or sensory avoiding for proprioception may be very sensitive to active movement and interacting with others. They may appear uncoordinated or be misjudged as lazy. 

If a child has a sensory sensitive pattern for proprioception they may: 

  • Hold their bodies in odd positions or appear lethargic (tired and slow movements). They may become tired easily after standing for long periods of time.
  • Appear stiff while walking or standing and walk with their legs wide apart.
  • Have difficulty moving small objects around in their hand such as buttons or shoelaces. They may have difficulty turning doorknobs or opening/closing containers.
  • Move their whole body, not just their head to look at something.
  • Appear uncoordinated in their movements. For example, while catching a ball.
  • Be hypersensitive to pain. For example, they may complain that their finger hurts after touching a pencil. 

If a child has a sensory avoiding pattern for proprioception they may: 

  • Avoid wearing tight clothing.
  • Avoid and refuse to participate in activities that require physical effort such as riding a bike, climbing or running.
  • Be extremely sensitive to touch and avoid situations where others may touch them. This is due to proprioceptive input received by touch. These children may strongly dislike hugs and other signs of affection. Tactile and proprioceptive processing are closely linked.

Case example:

Alice is a 4-year-old girl in kindergarten. You notice that Alice tends to remain in the same area and avoids participating in activities with the other children. She gets tired very easily, even while standing. She often refuses to participate in any activities that require significant amounts of energy. She is also very selective with clothing. When her parents dress her in tight clothing for the day, she complains that she feels uncomfortable and will often take her clothes off. Alice has a sensory avoiding pattern for proprioception. 

For children that are hypersensitive to proprioceptive stimuli, strategies can be used to help them build awareness of their movements and body positions. 

Strategies to assist a child with hypersensitivity for proprioceptive processing:

  • Use calming strategies frequently. For example, have them tightly squeeze an object such as playdough or a squeezy ball and then relax. 
  • Incorporate activities that focus on fine motor skills such as beading, stacking, colouring or building with Lego.
  • Slowly desensitize the child to varying body positions within their comfort zone. For example, you can practice animal walks with increasing difficulty. Start by walking like a bear and progress to walking like a crab on their hands and feet. This allows for the child to focus on their body movements in a controlled environment.
  • Incorporate yoga stretches to move the muscles and joints in a relaxing way.
  • Play games that increase body awareness, such as “Head and Shoulders” which can help to calm the nervous system and increase awareness of body parts. 
  • Provide the child with a quiet, calm area to go to if they feel overwhelmed. 

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. 

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 

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. 

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 

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. 

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 

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.
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