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Sensory Responsiveness: What's Normal and What Isn't

Behavioral symptoms

Sensory Responsiveness: What's Normal and What Isn't We're not big believers in the term normal. All it really means is that something falls within the norm, meaning it is average statistically. Of course, as a parent, you want all the things you find delightful about your child to be better than average or even extraordinary, which, of course, would fall under the definition of abnormal. So, you might want to toss out that normal label altogether.

While it's typical to have some sensory issues, kids with SI dysfunction have much more trouble with sensory processing. They usually show many of the following behavioral symptoms, which can interfere with daily activities and learning:

• oversensitivity or undersensitivity to touch, sights, sounds, movement, tastes, or smells
• high distractibility, with problems paying attention and staying focused on a task
• an unusually high or low activity level
• frequent tuning out or withdrawing
• intense, out-of-proportion reactions to challenging situations and unfamiliar environments
• impulsiveness, with little or no self-control
• difficulty transitioning from activity to activity or situation to situation
• rigidity and inflexibility at times
• clumsiness and carelessness
• discomfort in group situations
• social or emotional difficulties
• developmental and learning delays and acting silly or immature
• awkwardness, insecurity, or feeling "stupid" or "weird"
• trouble handling frustration, tendency to tantrum longer and more intensely than other children do, and more difficulty returning to a calm state
• problems transitioning from an alert, active state to a calm, rested state (for example, difficulty falling asleep or waking, or doing a quiet activity after being very active or vice versa)

Lots of kids show these signs for lots of reasons. Some of these behaviors are appropriate at certain ages. Most toddlers are pretty impulsive – that's the terrific but terrible twos. But a four-year-old who acts on every little impulse is a different story. A strong dislike of wool clothing, discomfort making eye contact with strangers, or fear of a goat that bleats loudly and unexpectedly at the petting zoo fall within the range of so-called typical sensory sensitivity for a child so long as these sensory experiences do not interfere with daily function. A child with sensory problems usually has maladaptive responses to everyday situations, consistently showing behaviors that are not age-appropriate and that can't just be dismissed.

Inconsistent responsesHypersensitivity and Hyposensitivity

A hallmark of SI dysfunction is inconsistent responses to sensory information. Your child may very well be oversensitive (hypersensitive) to certain types of sensory input and undersensitive (hyposensitive) to other types of input. A child with auditory sensitivity may love sounds within a certain frequency range (such as a low-frequency lawn mower) and detest sounds at a different frequency range (such as a high-frequency ringing telephone). Another way to think of it is that a child who is hypersensitive may avoid that sensation, while a child who is hyposensitive may actually seek it out because it is calming and comforting. There are also children with mixed reactivity who may be oversensitive to a sensation one day, and undersensitive to it the next day. This can be really confusing and look like a behavioral issue more than anything else. Say, one day your son craves splashing around in a bubble bath, but the next day, he absolutely refuses to step foot in it. Rather than assuming he's just being difficult, it may be that yesterday his nervous system was "organized" enough to enjoy it, but today his "disorganized" nervous system just can't tolerate it. You can't always predict how a malfunctioning nervous system is going to react from day to day – or even hour to hour – or when a new sensory challenge is going to crop up.

To make matters more confusing, children may accustom themselves to a "repulsive" sensation and suddenly develop another sensitivity. A child who finally starts to tolerate having his hair brushed, washed, and cut might suddenly find it unbearable to have clothing tags or seams touch his skin. If you previously knew nothing at all about the nuances of sensory input, having a child with sensory problems will make you hyperaware of them!

The common denominator in these sensitivities and the resulting seeking and avoiding behaviors is that these responses to sensory experiences are not completely voluntary. They are unusual neurological responses that result in unusual behaviors.

So why doesn't your child just put mind over matter and tolerate the feel of the brush against his scalp and the foam of the toothpaste in his mouth? Well, many children do attain higher tolerance as they mature. And the older we get, the more we figure out ways to adapt to please other people, to be accepted, and to get along in the world while meeting our own needs. Those of us with typical sensory integration skills put up with scratchy clothing for a business meeting or eat calamari because we don't want to embarrass our hostess, but the younger a child is, the harder it is for him to fake it.

Also, the more outside stresses a child has in his life – the demands of school, illness, lack of sleep, tension at home, hormonal fluctuations of adolescence, changes in any medications – the harder it will be for him to "buck up" and tolerate his sensory issues as well.

Needing less inputSensory Problems Affect Every Aspect of Life

How do sensory issues impact your child from day to day? Of course, life is a multisensory experience and most children with SI dysfunction have trouble with more than one sensory system. For the sake of simplicity, though, let's just consider just one sense: touch.

Tactile Oversensitivity

A child who is tactile oversensitive will have difficulty in one or more of these areas:

• Sensory exploration. She might avoid making physical contact with other people and things in the environment, leading to impoverished sensory experiences and social isolation. A child uncomfortable with touch may not feel safe and comforted by a parent's hug. A child who avoids cold, wet textures won't discover the delight of making a snowman.
• Emotional and social. He may have trouble behaving according to social norms, may isolate himself from others, and become aggressive or depressed. A child who dislikes having other kids brush up against him or bump into him might avoid getting physically close and refuse to stand on line or hold another child's hand as requested. He may also refuse to participate during group activities by pushing other kids away or withdrawing into himself.
• Motor. She may be unwilling to try new fine and gross motor activities such as cutting with scissors or swimming, and have poor physical coordination. She may have trouble with motor planning, that is, doing physical things in sequence (such as holding both feet together while jumping, and landing with both feet together).
• Cognitive. Because he is distracted by his need to avoid tactile input, he may show attention and learning deficits. An infant may avoid learning to hold his bottle because he is distressed by how it feels in his hand. A teenager may be so distracted by the possibility that a rowdy classmate will bother him that he can't follow what the teacher is saying.
• Speech-language. If she avoids interaction with others, she may have poor communication skills. If she has tactile issues inside her mouth she may have trouble speaking and making her ideas, needs, and wants known.
• Eating. If he avoids certain food textures, he may become malnourished – often in subtle ways, as we shall see later on. If he hates the feel of eating with utensils, he may refuse to eat at all unless he can eat with his fingers. He may avoid social situations where he feels pressured to eat foods he finds repulsive, or even act out or have a meltdown when faced with this possibility.
• Grooming and dressing. She may refuse to brush her teeth or hair, use shampoo, or shower. She might insist on wearing clothing that is comfortable and familiar even if it is very dirty or inappropriate for the occasion or weather.

Needing more inputTactile Undersensitivity

Children can also be undersensitive, needing more intense touch input to obtain the tactile information they need. A child who is undersensitive to touch may have these difficulties:

• Sensory exploration. He makes excessive physical contact with people and objects, perhaps even licking them, touching other children too forcefully or inappropriately (such as biting or hitting), fingering all the objects in a store, perhaps to the point of injuring others and breaking things.
• Emotional and social. She may crave touch to the extent that friends, family, and even strangers become annoyed and upset, scolding her and making her feel unwanted or weird. She might be the baby who constantly needs to be held, or the toddler who hangs on to her mother's leg, craving continual physical contact.
• Motor. The child who is undersensitive doesn't adequately register tactile input. To get more tactile sensory information, he may need to use more of his skin surface to feel he's made contact with an object. He may use his whole fist to really feel that marker in his hands, or sprawl on the floor to really know that it's beneath him. Because his ability to sense tactile input is impaired, he may have limited skills needed for precise motor tasks such as writing and catching a ball.
• Cognitive. Because she is distracted by her need to obtain tactile input, she may show attention and learning deficits. For example, if she is too absorbed in checking out how the pencil, paper, desk, and chair feel, she will be unable to concentrate on learning to form letters proficiently, or to put her thoughts together well on paper.
• Speech-language. If he doesn't process tactile sensations inside his mouth well, he may have trouble mastering the precise movements of the lip and tongue needed to produce articulate speech.
• Eating. If the skin in and around her mouth is undersensitive, she may drool, and food may pool inside her cheeks or remain in her mouth or on her lips. She might stuff her mouth with too much food to feel that there's something in there, to the point where it poses a choking hazard.
• Grooming and dressing. He may choose clothing that is, to you, unacceptably tight or loose. He may brush his teeth so hard that he injures his gums; a girl may wear braids so tight and keep them in for so long that it damages her hair. A child may insist on wearing her favorite sneakers even though they're way too small and cause blisters.

All of these examples may ring true for your tactile sensitive child – or not. Your child may not have tactile issues at all and may be struggling instead with her other senses. Whatever the case, if your child is having difficulties handling certain kinds of sensory input, you need to be aware that he may be experiencing problems in many areas of daily life that you may not have imagined.