QUESTION:

I have just completed the Sensory Symptoms Checklist with a 9-year-old boy I am working with and have found that he really does show symptoms of being over-responsive AND under-responsive to most far/distal sensory stimuli. For example, he reacts negatively to bright light but also seeks visual stimuli in the form of closely held spinning objects. He’s easily distracted by noise but also consistently misses his name/instructions in class.

Since he shows signs of being solely under-responsive to vestibular and proprioceptive input, maybe it is just a case of treating each distal sensory input case by case. While viewing your presentation, I wondered what you would do with a child who was both under- and over-responsive to vestibular input at different times.

I hope this make sense! I have two babies and I’m a tad sleep deprived!

GWEN’S ANSWER:

It’s definitely common to see kids that are under-responsive in two or three sensory systems and over-responsive in two or three other systems. However, when we see signs of over- and under-responsiveness within the same sensory system, it gets more complicated! Typically, I try digging a little deeper. Here are some tips for making the determination of over- or under-responsiveness when there are symptoms of both:

  • An isolated checkmark here or there is probably indicative of a nonsensory issue. For example, if the checklist shows a few signs of over-responsiveness to visual input but “Loves action-packed TV shows” (a possible symptom of under-responsiveness to visual input) is also checked, I likely assume TV is just a preferred activity for him, not necessarily a sensory issue. It’s important to remember that while everything on the list can be a symptom of a sensory issue, they can also be personal preferences or traits based on cultural or psychosocial influences as well.
  • If you see more than one checkmark in both columns (over- and under-responsiveness) within the same sensory system, make your determination based on maximum impact on the student’s life. For example, if you have a student who “Dislikes noisy places” (symptom of auditory over-responsiveness) but who also plays his preferred music and TV shows loud (symptom of auditory under-responsiveness), I would ask more questions. Is he so bothered by noisy places that he often refuses to enter the gym or cafeteria? If so, I would err on the side of treating him as an auditory over-responder. He may be using loud music of his own choosing as a coping mechanism.
  • Think about how these symptoms impact one another. For example, you said your student reacts negatively to bright lights (symptom of visual over-responsiveness) but also likes to hold spinning objects close to his eyes. While a preference for spinning objects can be a symptom of visual under-responsiveness, anything that happens close to the eyes can actually be a coping technique for over-responsiveness. If I am holding a spinning toy close to my eyes (or any other kind of stimming behavior), I am using something preferred that I can control to help me tune out nonpreferred visual input in the environment that I cannot control (like bright lights). If this seems to be the case, I would treat that student as a visual over-responder.
  • Always begin with the end in mind. Think through the target behavior first. If the target behavior is that he will remain on task during class instruction, ask yourself “Which of these symptoms is most likely playing a role in his difficulty remaining on task?” If it’s the fact that he is easily distracted by noise in his environment, address that issue and don’t worry too much about making sense of the symptoms that aren’t impacting the target behavior at this time.

Now, about kids who show both over- and under-responsiveness to vestibular input: I see that from time to time as well. Typically, what I notice is that they seek vestibular input they are in control of and can impose on themselves while avoiding or overreacting to input that is imposed upon them. You may see a child who frequently spins himself and is constantly on the go, but who becomes carsick quickly. I suspect the movement he imposes on himself is probably modulated by the proprioceptive input inherent in the activity, which allows him to tolerate even enjoy it. Think about ways that same child can get proprioceptive input before he gets in the car (crab walking to the car maybe?) as well as while he is in the car (e.g., isometrics, resistive toys). Hopefully that will help.

I hope all this makes sense. And I hope your sleep-deprivation ends soon! Life gets easier as they grow up, but I still miss my babies (three teenagers now)!

Best Wishes,
Gwen