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Q&A: Cannot Tolerate Clothing?


I have started working with a  5-year-old girl with tactile sensitivities, among other things, but this was the primary reason the parents sought OT. She cannot tolerate wearing underwear and will only wear very specific loose dresses. This of course is a big issue. She also is a very picky eater, but other than that she tolerates other tactile activities without difficulty. She loves to swim but is very bothered by the swimsuit touching her body. We have started the Wilbarger Therapressure protocol and will be starting Therapeutic Listening this week. During our last session she teared up and said if the clothing touches her stomach she can’t breath. I am also providing the family with a sensory diet focusing on calming activities as I do believe she has some over-responsiveness to vestibular and auditory. I was wondering if you might having any other suggestions. I appreciate any and all input.


You are already doing all the right things. I would keep up with the  Wilbarger and Therapeutic Listening. I would also set up an overall sensory diet approach, like the BrainWorks File Folder, to help her learn self-regulation through the use of red-arrow (calming) activities. With the combination of these strategies, I would expect to see significant improvement within a couple of months. For now, I wouldn’t push the underwear issue, but as soon as you start seeing some adaptive changes, here is what I would do:

* I would make a social story about the need for underwear. I would start only with underwear and deal with pants and other clothing later.
* I would show her a calendar and mark a day when underwear are no longer going to be optional. I would remind her about this change frequently and allow her to choose some underwear at the store in preparation for this.
* Create a schedule strip for dressing with about 5 spots on it. Put “Get Dressed” on the 3rd spot. Put the brush on spot #1 to indicate the Wilbarger Protocol. Let her choose a red arrow activity for spot #2. Allow her to choose any highly preferred yellow or red arrow activities for spots 4 and 5. Explain to her that clothes might feel uncomfortable at first, but if she stays busy it will give her brain something else to
think about while her skin gets used to the feel. If she is stressed after getting dressed, just keep diverting her attention and reminding her to keep her brain busy.

I hope that helps! Please keep me posted if you find something that works well for this child.

Best Wishes!