Friday, May 17, 2013

Sensory Processing Disorder - what are the signs

Webpages come and go. In attempting to make sure that I can help other families get early and proper treatment for Sensory Processing Disorder, I found this information helpful and it was copied directly from the website

Sensory integration is a normal, neurological, developmental process which begins in the womb and continues throughout one’s life. Although, it is important to note, the most influential developmental time is in the first seven years of life. Sensory processing is the process by which our brain takes in sensory input and interprets this information for use.
When talking about typical sensory processing, a productive, normal and “adaptive response” happens as:

  • our neurological system takes in sensory information

  • the brain organizes and makes sense of it

  • which then enables us to use it and act accordingly within our environment to achieve “increasingly complex, goal-directed actions”.

  • ** It is this “adaptive response” which facilitates normal development.**

    We, therefore use our sensory processing abilities for:

  • social interaction

  • motor skill development

  • focusing and attending so we can learn

  • If this neurological process becomes disrupted somewhere in the loop of intake, organization or output, then normal development and adaptive responses will not be achieved. 

    Learning, physical and emotional development, as well as behavior will therefore be impacted; sometimes severely!

    It is this disruption which yields a neurological dysfunction called Sensory Integration Dysfunction/Sensory Processing Disorder.

    Keep in mind, sensory processing functions on a continuum. Please understand that we all have difficulty processing certain sensory stimuli (a certain touch, smell, taste, sound, movement etc.) and we all have sensory preferences. **It only becomes a sensory processing disorder when we are on extreme ends of the continuum or experience “disruptive, unpredictable fluctuations which significantly impact our developmental skills or everyday functioning”.**

    That being said, it is important for us to break the sensory integration dysfunction symptoms down into categories based on each of the senses.These categories are: 

  • Tactile: the sense of touch; input from the skin receptors about touch, pressure, temperature, pain and movement of the hairs on the skin.

  • Vestibular: the sense of movement; input from the inner ear about equilibrium, gravitational changes, movement experiences and position in space.

  • Proprioception: the sense of "position"; input from the muscles and joints about body position, weight, pressure, stretch, movement and changes in position.

  • Auditory: input relating to sounds; one's ability to correctly perceive, discriminate, process and respond to sounds

  • Oral: input relating to the mouth; one's ability to correctly perceive, discriminate, process and respond to input within the mouth

  • Olfactory: input relating to smell; one's ability to correctly perceive, discriminate, process and respond to different odors.

  • Visual: input relating to sight; one's ability to correctly perceive, discriminate, process and respond to what one sees.

  • Since we are talking about input into the senses, it is those senses which must be looked at carefully and which will be affected. It is a careful observer (the one I wish for in every child's life!) who will pay close attention to which senses are affected and the frequencyduration, and intensity of these sensory integration dysfunction symptoms.
    As I have said, we all have some types of sensory preferences and perhaps even a mild case of "dysfunction". However, it is the frequency, intensity, duration and functional impact of these symptoms which determines dysfunction.

    Signs Of Tactile Dysfunction:

     1. Hypersensitivity To Touch (Tactile Defensiveness)

    __ becomes fearful, anxious or aggressive with light or unexpected touch

    __ as an infant, did/does not like to be held or cuddled; may arch back, cry, and pull away

    __ distressed when diaper is being, or needs to be, changed

    __ appears fearful of, or avoids standing in close proximity to other people or peers (especially in lines)

    __ becomes frightened when touched from behind or by someone/something they can not see (such as under a blanket)

    __ complains about having hair brushed; may be very picky about using a particular brush

    __ bothered by rough bed sheets (i.e., if old and "bumpy")

    __ avoids group situations for fear of the unexpected touch

    __ resists friendly or affectionate touch from anyone besides parents or siblings (and sometimes them too!)

    __ dislikes kisses, will "wipe off" place where kissed

    __ prefers hugs

    __ a raindrop, water from the shower, or wind blowing on the skin may feel like torture and produce adverse and avoidance reactions

    __ may overreact to minor cuts, scrapes, and or bug bites

    __ avoids touching certain textures of material (blankets, rugs, stuffed animals)

    __ refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans, hats, or belts, etc.

    __ avoids using hands for play

    __ avoids/dislikes/aversive to "messy play", i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam etc.

    __ will be distressed by dirty hands and want to wipe or wash them frequently

    __ excessively ticklish

    __ distressed by seams in socks and may refuse to wear them

    __ distressed by clothes rubbing on skin; may want to wear shorts and short sleeves year round, toddlers may prefer to be naked and pull diapers and clothes off constantly

    __ or, may want to wear long sleeve shirts and long pants year round to avoid having skin exposed

    __ distressed about having face washed

    __ distressed about having hair, toenails, or fingernails cut

    __ resists brushing teeth and is extremely fearful of the dentist

    __ is a picky eater, only eating certain tastes and textures; mixed textures tend to be avoided as well as hot or cold foods; resists trying new foods

    __ may refuse to walk barefoot on grass or sand

    __ may walk on toes only

    2. Hyposensitivity To Touch (Under-Responsive):

    __ may crave touch, needs to touch everything and everyone

    __ is not aware of being touched/bumped unless done with extreme force or intensity

    __ is not bothered by injuries, like cuts and bruises, and shows no distress with shots (may even say they love getting shots!)

    __ may not be aware that hands or face are dirty or feel his/her nose running

    __ may be self-abusive; pinching, biting, or banging his own head

    __ mouths objects excessively

    __ frequently hurts other children or pets while playing

    __ repeatedly touches surfaces or objects that are soothing (i.e., blanket)

    __ seeks out surfaces and textures that provide strong tactile feedback

    __ thoroughly enjoys and seeks out messy play

    __ craves vibrating or strong sensory input

    __ has a preference and craving for excessively spicy, sweet, sour, or salty foods

    3. Poor Tactile Perception And Discrimination:

    __ has difficulty with fine motor tasks such as buttoning, zipping, and fastening clothes

    __ may not be able to identify which part of their body was touched if they were not looking

    __ may be afraid of the dark

    __ may be a messy dresser; looks disheveled, does not notice pants are twisted, shirt is half un tucked, shoes are untied, one pant leg is up and one is down, etc.

    __ has difficulty using scissors, crayons, or silverware

    __ continues to mouth objects to explore them even after age two

    __ has difficulty figuring out physical characteristics of objects; shape, size, texture, temperature, weight, etc.

    __ may not be able to identify objects by feel, uses vision to help; such as, reaching into backpack or desk to retrieve an item

    Vestibular Sense: input from the inner ear about equilibrium, gravitational changes, movement experiences, and position in space.

    Signs Of Vestibular Dysfunction:

    1. Hypersensitivity To Movement (Over-Responsive):

    __ avoids/dislikes playground equipment; i.e., swings, ladders, slides, or merry-go-rounds

    __ prefers sedentary tasks, moves slowly and cautiously, avoids taking risks, and may appear "wimpy"

    __ avoids/dislikes elevators and escalators; may prefer sitting while they are on them or, actually get motion sickness from them

    __ may physically cling to an adult they trust

    __ may appear terrified of falling even when there is no real risk of it

    __ afraid of heights, even the height of a curb or step

    __ fearful of feet leaving the ground

    __ fearful of going up or down stairs or walking on uneven surfaces

    __ afraid of being tipped upside down, sideways or backwards; will strongly resist getting hair washed over the sink

    __ startles if someone else moves them; i.e., pushing his/her chair closer to the table

    __ as an infant, may never have liked baby swings or jumpers

    __ may be fearful of, and have difficulty riding a bike, jumping, hopping, or balancing on one foot (especially if eyes are closed)

    __ may have disliked being placed on stomach as an infant

    __ loses balance easily and may appear clumsy

    __ fearful of activities which require good balance

    __ avoids rapid or rotating movements

    2. Hyposensitivity To Movement (Under-Responsive):

    __ in constant motion, can't seem to sit still

    __ craves fast, spinning, and/or intense movement experiences

    __ loves being tossed in the air

    __ could spin for hours and never appear to be dizzy

    __ loves the fast, intense, and/or scary rides at amusement parks

    __ always jumping on furniture, trampolines, spinning in a swivel chair, or getting into upside down positions

    __ loves to swing as high as possible and for long periods of time

    __ is a "thrill-seeker"; dangerous at times

    __ always running, jumping, hopping etc. instead of walking

    __ rocks body, shakes leg, or head while sitting

    __ likes sudden or quick movements, such as, going over a big bump in the car or on a bike

    3. Poor Muscle Tone And/Or Coordination:

    __ has a limp, "floppy" body

    __ frequently slumps, lies down, and/or leans head on hand or arm while working at his/her desk

    __ difficulty simultaneously lifting head, arms, and legs off the floor while lying on stomach ("superman" position)

    __ often sits in a "W sit" position on the floor to stabilize body
    __ fatigues easily!

    __ compensates for "looseness" by grasping objects tightly

    __ difficulty turning doorknobs, handles, opening and closing items

    __ difficulty catching him/her self if falling

    __ difficulty getting dressed and doing fasteners, zippers, and buttons

    __ may have never crawled as an baby

    __ has poor body awareness; bumps into things, knocks things over, trips, and/or appears clumsy

    __ poor gross motor skills; jumping, catching a ball, jumping jacks, climbing a ladder etc.

    __ poor fine motor skills; difficulty using "tools", such as pencils, silverware, combs, scissors etc.

    __ may appear ambidextrous, frequently switching hands for coloring, cutting, writing etc.; does not have an established hand preference/dominance by 4 or 5 years old

    __ has difficulty licking an ice cream cone

    __ seems to be unsure about how to move body during movement, for example, stepping over something

    __ difficulty learning exercise or dance steps

    Proprioceptive Sense: input from the muscles and joints about body position, weight, pressure, stretch, movement, and changes in position in space.

    Signs Of Proprioceptive Dysfunction:

    1. Sensory Seeking Behaviors:

    __ seeks out jumping, bumping, and crashing activities

    __ stomps feet when walking

    __ kicks his/her feet on floor or chair while sitting at desk/table

    __ bites or sucks on fingers and/or frequently cracks his/her knuckles

    __ loves to be tightly wrapped in many or weighted blankets, especially at bedtime

    __ prefers clothes (and belts, hoods, shoelaces) to be as tight as possible

    __ loves/seeks out "squishing" activities

    __ enjoys bear hugs
    __ excessive banging on/with toys and objects

    __ loves "roughhousing" and tackling/wrestling games

    __ frequently falls on floor intentionally

    __ would jump on a trampoline for hours on end

    __ grinds his/her teeth throughout the day

    __ loves pushing/pulling/dragging objects

    __ loves jumping off furniture or from high places

    __ frequently hits, bumps or pushes other children

    __ chews on pens, straws, shirt sleeves etc.

    2. Difficulty With "Grading Of Movement":

    __ misjudges how much to flex and extend muscles during tasks/activities (i.e., putting arms into sleeves or climbing)

    __ difficulty regulating pressure when writing/drawing; may be too light to see or so hard the tip of writing utensil breaks

    __ written work is messy and he/she often rips the paper when erasing

    __ always seems to be breaking objects and toys

    __ misjudges the weight of an object, such as a glass of juice, picking it up with too much force sending it flying or spilling, or with too little force and complaining about objects being too heavy

    __ may not understand the idea of "heavy" or "light"; would not be able to hold two objects and tell you which weighs more

    __ seems to do everything with too much force; i.e., walking, slamming doors, pressing things too hard, slamming objects down

    __ plays with animals with too much force, often hurting them

    Signs Of Auditory Dysfunction: (no diagnosed hearing problem)

    1. Hypersensitivity To Sounds (Auditory Defensiveness):

    __ distracted by sounds not normally noticed by others; i.e., humming of lights or refrigerators, fans, heaters, or clocks ticking
    __ fearful of the sound of a flushing toilet (especially in public bathrooms), vacuum, hairdryer, squeaky shoes, or a dog barking
    __ started with or distracted by loud or unexpected sounds
    __ bothered/distracted by background environmental sounds; i.e., lawn mowing or outside construction
    __ frequently asks people to be quiet; i.e., stop making noise, talking, or singing
    __ runs away, cries, and/or covers ears with loud or unexpected sounds
    __ may refuse to go to movie theaters, parades, skating rinks, musical concerts etc.
    __ may decide whether they like certain people by the sound of their voice

    2. Hyposensitivity To Sounds (Under-Registers):

    __ often does not respond to verbal cues or to name being called
    __ appears to "make noise for noise's sake"
    __ loves excessively loud music or TV
    __ seems to have difficulty understanding or remembering what was said
    __ appears oblivious to certain sounds
    __ appears confused about where a sound is coming from
    __ talks self through a task, often out loud
    __ had little or no vocalizing or babbling as an infant
    __ needs directions repeated often, or will say, "What?" frequently

    Signs Of Oral Input Dysfunction:

    1. Hypersensitivity To Oral Input (Oral Defensiveness):

    __ picky eater, often with extreme food preferences; i.e., limited repertoire of foods, picky about brands, resistive to trying new foods or restaurants, and may not eat at other people's houses)
    __ may only eat "soft" or pureed foods past 24 months of age
    __ may gag with textured foods
    __ has difficulty with sucking, chewing, and swallowing; may choke or have a fear of choking
    __ resists/refuses/extremely fearful of going to the dentist or having dental work done
    __ may only eat hot or cold foods
    __ refuses to lick envelopes, stamps, or stickers because of their taste
    __ dislikes or complains about toothpaste and mouthwash
    __ avoids seasoned, spicy, sweet, sour or salty foods; prefers bland foods

    2. Hyposensitivity To Oral Input (Under-Registers)

    __ may lick, taste, or chew on inedible objects
    __ prefers foods with intense flavor; i.e., excessively spicy, sweet, sour, or salty
    __ excessive drooling past the teething stage
    __ frequently chews on hair, shirt, or fingers
    __ constantly putting objects in mouth past the toddler years
    __ acts as if all foods taste the same
    __ can never get enough condiments or seasonings on his/her food
    __ loves vibrating toothbrushes and even trips to the dentist

    Signs Of Olfactory Dysfunction (Smells):

    1. Hypersensitivity To Smells (Over-Responsive):

    __ reacts negatively to, or dislikes smells which do not usually bother, or get noticed, by other people
    __ tells other people (or talks about) how bad or funny they smell
    __ refuses to eat certain foods because of their smell
    __ offended and/or nauseated by bathroom odors or personal hygiene smells
    __ bothered/irritated by smell of perfume or cologne
    __ bothered by household or cooking smells
    __ may refuse to play at someone's house because of the way it smells
    __ decides whether he/she likes someone or some place by the way it smells

    2. Hyposensitivity To Smells (Under-Responsive):

    __ has difficulty discriminating unpleasant odors
    __ may drink or eat things that are poisonous because they do not notice the noxious smell
    __ unable to identify smells from scratch 'n sniff stickers
    __ does not notice odors that others usually complain about
    __ fails to notice or ignores unpleasant odors
    __ makes excessive use of smelling when introduced to objects, people, or places
    __ uses smell to interact with objects

    Signs Of Visual Input Dysfunction (No Diagnosed Visual Deficit):

    1. Hypersensitivity To Visual Input (Over-Responsiveness)

    __ sensitive to bright lights; will squint, cover eyes, cry and/or get headaches from the light
    __ has difficulty keeping eyes focused on task/activity he/she is working on for an appropriate amount of time
    __ easily distracted by other visual stimuli in the room; i.e., movement, decorations, toys, windows, doorways etc.
    __ has difficulty in bright colorful rooms or a dimly lit room
    __ rubs his/her eyes, has watery eyes or gets headaches after reading or watching TV
    __ avoids eye contact
    __ enjoys playing in the dark

    2. Hyposensitivity To Visual Input (Under-Responsive Or Difficulty With Tracking, Discrimination, Or Perception):

    __ has difficulty telling the difference between similar printed letters or figures; i.e., p & q, b & d, + and x, or square and rectangle
    __ has a hard time seeing the "big picture"; i.e., focuses on the details or patterns within the picture
    __ has difficulty locating items among other items; i.e., papers on a desk, clothes in a drawer, items on a grocery shelf, or toys in a bin/toy box
    __ often loses place when copying from a book or the chalkboard
    __ difficulty controlling eye movement to track and follow moving objects
    __ has difficulty telling the difference between different colors, shapes, and sizes
    __ often loses his/her place while reading or doing math problems
    __ makes reversals in words or letters when copying, or reads words backwards; i.e., "was" for "saw" and "no" for "on" after first grade
    __ complains about "seeing double"
    __ difficulty finding differences in pictures, words, symbols, or objects
    __ difficulty with consistent spacing and size of letters during writing and/or lining up numbers in math problems
    __ difficulty with jigsaw puzzles, copying shapes, and/or cutting/tracing along a line
    __ tends to write at a slant (up or down hill) on a page
    __ confuses left and right
    __ fatigues easily with schoolwork
    __ difficulty judging spatial relationships in the environment; i.e., bumps into objects/people or missteps on curbs and stairs

    Auditory-Language Processing Dysfunction:

    __ unable to locate the source of a sound
    __ difficulty identifying people's voices
    __ difficulty discriminating between sounds/words; i.e., "dare" and "dear"
    __ difficulty filtering out other sounds while trying to pay attention to one person talking
    __ bothered by loud, sudden, metallic, or high-pitched sounds
    __ difficulty attending to, understanding, and remembering what is said or read; often asks for directions to be repeated and may only be able to understand or follow two sequential directions at a time
    __ looks at others to/for reassurance before answering
    __ difficulty putting ideas into words (written or verbal)
    __ often talks out of turn or "off topic"
    __ if not understood, has difficulty re-phrasing; may get frustrated, angry, and give up
    __ difficulty reading, especially out loud (may also be dyslexic)
    __ difficulty articulating and speaking clearly
    __ ability to speak often improves after intense movement

    Social, Emotional, Play, And Self-Regulation Dysfunction:


    __ difficulty getting along with peers
    __ prefers playing by self with objects or toys rather than with people
    __ does not interact reciprocally with peers or adults; hard to have a "meaningful" two-way conversation
    __ self-abusive or abusive to others
    __ others have a hard time interpreting child's cues, needs, or emotions
    __ does not seek out connections with familiar people


    __ difficulty accepting changes in routine (to the point of tantrums)
    __ gets easily frustrated
    __ often impulsive
    __ functions best in small group or individually
    __ variable and quickly changing moods; prone to outbursts and tantrums
    __ prefers to play on the outside, away from groups, or just be an observer
    __ avoids eye contact
    __ difficulty appropriately making needs known


    __ difficulty with imitative play (over 10 months)
    __ wanders aimlessly without purposeful play or exploration (over 15 months)
    __ needs adult guidance to play, difficulty playing independently (over 18 months)
    __ participates in repetitive play for hours; i.e., lining up toys cars, blocks, watching one movie over and over etc.


    __ excessive irritability, fussiness or colic as an infant
    __ can't calm or soothe self through pacifier, comfort object, or caregiver
    __ can't go from sleeping to awake without distress
    __ requires excessive help from caregiver to fall asleep; i.e., rubbing back or head, rocking, long walks, or car rides

    Internal  Regulation (The Interoceptive Sense):

    __ becoming too hot or too cold sooner than others in the same environments; may not appear to ever get cold/hot, may not be able to maintain body temperature effectively
    __ difficulty in extreme temperatures or going from one extreme to another (i.e., winter, summer, going from air conditioning to outside heat, a heated house to the cold outside)
    __ respiration that is too fast, too slow, or cannot switch from one to the other easily as the body demands an appropriate respiratory response
    __ heart rate that speeds up or slows down too fast or too slow based on the demands imposed on it
    __ respiration and heart rate that takes longer than what is expected to slow down during or after exertion or fear
    __ severe/several mood swings throughout the day (angry to happy in short periods of time, perhaps without visible cause)
    __ unpredictable state of arousal or inability to control arousal level (hyper to lethargic, quickly, vacillating between the two; over stimulated to under stimulated, within hours or days, depending on activity and setting, etc.)
    __ frequent constipation or diarrhea, or mixed during the same day or over a few days
    __ difficulty with potty training; does not seem to know when he/she has to go (i.e., cannot feel the necessary sensation that bowel or bladder are full
    __ unable to regulate thirst; always thirsty, never thirsty, or oscillates back and forth
    __ unable to regulate hunger; eats all the time, won't eat at all, unable to feel full/hungry
    __ unable to regulate appetite; has little to no appetite and/or will be "starving" one minute then full two bites later, then back to hungry again (prone to eating disorders and/or failure to thrive)

    If you observe many of these signs in a child you know, please talk to a professional, such as an Occupational Therapist who can further evaluate and decide whether your child has a sensory processing disorder.

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