Having Trouble Understanding Your Child’s Challenging Behaviors? His Sensory Processing System May Provide Important Clues

I always thought Samantha was just more ‘intense’ than other children. Her reactions to nearly everything were incredibly strong. She threw massive tantrums at least 5-10 times per day over things such as having to sit in her car seat or accidentally getting water in her eyes during bath time. People would tell me tantrums were “normal,” but I felt it wasn’t normal to be having such intense tantrums so many times each day. She was incredibly impulsive and constantly reached out to touch interesting things she saw, regardless of the appropriateness (such as clothing on someone’s body) or the danger (such as a burning candle). She also seemed to both seek physical input (for example, by climbing on others) while also protesting intensely to any physical touch that she didn’t like (for example, an adult restraining her from an unsafe situation). She would melt down if someone else did something she wanted to do like flush the toilet, push a button, or turn on the faucet to wash hands, and she often didn’t “recover” for several minutes, even an hour at times. She also had a hard time listening to and following directions, so things like getting her dressed were often very difficult. I felt completely overwhelmed and lost.
— Samantha's mom

About 10 years ago, I was feeling increasingly frustrated with the limited progress many children I was working with—such as two-year-old, Samantha—were making using the typical tools of my trade. Trained as a clinical social worker, my focus was on helping parents understand their children’s emotions and providing them with strategies to help their children learn to manage their feelings so they could behave in constructive, “pro-social” ways. No matter how tuned in, loving, and empathetic parents were, and how clearly and consistently they were setting limits and boundaries, their children continued to struggle with typical challenging behaviors such as: biting/hitting/kicking, defiance, extreme fearfulness/anxiety, impulsivity, or an overall lack of self-regulation.   

Around this time, a friend was telling me about problems she was having with her then 3-year-old, “Ruben”. He was very impulsive, aggressive, defiant, and wasn’t tuning in to others—all behaviors very typical of the kids I was having the hardest time helping.  She told me that after trying many different failed behavioral interventions, they were referred to an occupational therapist (OT) who identified underlying sensory processing challenges that were at the root of many of the problematic behaviors Ruben was exhibiting. Further, she explained how the therapy Ruben was doing with the OT was yielding very positive results for the first time. I am embarrassed to admit that at that time I was mostly ignorant about OT for kids. I thought of it as an intervention for adults with carpal tunnel syndrome or who had been injured on the job. What could the “occupation” of a child possibly be? So, I asked my friend for permission to observe a few sessions of her son’s OT.  

That experience proved to be a watershed moment: I saw first-hand how many challenging behaviors children exhibit are rooted in problems in their sensory processing systems and that this was a critical piece of the puzzle that I was missing as I tried to make sense of the meaning of children’s behaviors. For example, some of Ruben’s challenges were the result of a low threshold for tactile input. When people got too close to him, he pushed them away—by biting, hitting, kicking—to protect himself. Through targeted activities, the OT incrementally exposed Ruben to tactile experiences to help his system better detect, regulate, and interpret these sensations and respond to them more appropriately. In effect, OTs help children do their most important “jobs”, which include the ability to: manage their bodies and feelings, learn, play, get along with others, and work well in groups—pretty much everything that enables children to function effectively in the world!

So, what is sensory processing? According to The Star Institute, sensory processing is the way the nervous system receives information from the senses and turns it into appropriate behavioral responses. For example, a child walks into preschool and is able to navigate around the kids scattered across the classroom who are engaged in different activities so as not to bump into them, walk over them, or accidentally destroy whatever it is they may be working on (a block tower, a train track.) She automatically “reads the room” and responds appropriately. On the other hand, a child whose system is not processing this visual-spatial information accurately, and who doesn’t have a firm grasp of where her body is in space, may end up looking like a bull in a china shop and inadvertently hurt peers or objects in the process.

Some children have systems that are over-responsive to sensory input, such as sights and sounds. They may get easily distracted by the range of sensations they experience and have a hard time maintaining their focus during circle time or other group activities. Or, they may tune out—seeming to be in their “own world”. This is a common coping mechanism that protects over-responsive children from what feels like an onslaught of unmanageable sensations. For some children the sensory-overload may lead to restlessness and over-activity. These are all behavioral responses that stem from the same root cause—a difficulty in processing sensory information—which results in children having a hard time doing what’s “expected” in any given situation and unable to fully participate in and benefit from their experiences in the world.

In general, children with well-functioning sensory processing systems are more adaptable and flexible than children whose systems are not working effectively. For example, the first few days at preschool may feel overwhelming, but their brains quickly adapt to all the sounds, the high activity-level, the frequent transitions, etc., and they are able to thrive in the program. For children whose sensory systems take longer to adapt or that have trouble adapting at all, experiences with varied or more intense stimulation may be especially challenging, such as: school, group classes, large family gatherings or birthday parties. This can lead to significant discomfort for children which puts them in a higher state of reactivity. They feel more on edge and vulnerable. This can amplify both their emotional reactions and their response to sensory input. They may fall apart or lash out when being given a seemingly benign direction or suggestion such as guidance on how to hold scissors correctly or how to balance on a scooter. A child I recently worked with, who had full-on meltdowns at birthday parties when everyone started singing “Happy birthday!”, began refusing to go to birthday parties at all. Just like adults, when kids are in high-arousal/reactivity mode and feeling agitated and anxious, they have a much harder time coping.

In addition to being less flexible, children whose sensory processing systems aren’t working most effectively tend to be more controlling than children who are not struggling with this challenge. It doesn’t take much for them to reach their threshold and feel overwhelmed by the world around them. And, when children feel out of control on the inside, they tend to become controlling on the outside in an effort to cope—to minimize their discomfort. Typical behaviors include:

  • Telling other people what they can and can’t do—where they can sit, who they can talk to, what they can play with, whether the music can be on or off.

  • Having total meltdowns when something unexpected happens, such as:

    • daddy does pick-up at the end of the day vs. grandma whom the child was expecting

    • being served his favorite cereal in the green bowl, not his favorite red bowl

    • you push the elevator button when he wanted to do it

    • you cut his sandwich horizontally instead of diagonally

You can see how foundational the sensory processing system is as it impacts all of a child’s functioning. Here are some examples from my work in preschools and family homes of how sensory processing challenges can affect behavior:

Angela fiercely protests diaper changes and hair brushing. She will throw a massive tantrum to avoid these tasks. She is very picky about the clothes she will wear and refuses to play in the sand table or do the shaving cream activity at school. She is also picky about the kinds of foods she will eat based on their texture. She only likes crunchy foods.

Angela is over-sensitive to tactile (touch) input. What feels good to other children is very uncomfortable for her. She is not being purposefully difficult or defiant, she is trying to avoid discomfort.  

Shane is not a fan of the playground, much to his parent’s chagrin. They are a very action-oriented couple and had hoped for a child who would be athletic, like them. But when they go to the park, Shane avoids the playground equipment. He won’t go near the swing, slides or climbing equipment. His parents are at a loss as to why he is not like the other children who seem to thrive on the playground. They try to push him to join the kids on the monkey bars, but the more they push, the more he clings.

The sensory systems that work together to tell our bodies how to maintain balance—that help figure out where we are in space and help our muscles respond to movement—are not activating or registering input as they should for Shane. He does not have a good “body map” in his brain to help him coordinate his body and feel confident to explore the playground. This makes him feel unstable and insecure when his feet are not firmly planted on the ground.

 Radtha seems to be driven by a motor. She has a very hard time slowing down. She craves fast and intense movement experiences—running, jumping, spinning. She is a "thrill-seeker" and seems to have no fear of danger. She has a very hard time calming her mind and body. This makes getting through daily tasks, such as dressing and eating meals, maddening and exhausting for Radtha’s parents and teachers who find her very uncooperative.  

Radtha’s system is not accurately processing the input to the systems that control her sense of movement and balance. She is under-responsive to the signals her body is taking in. To compensate for this, Radtha’s system craves these intense movement experiences to “feed” her system. Telling her to slow down is rarely, if ever, useful because she can’t control this response. This results in constant frustration for all the adults caring for Radtha, and for Radtha, too, who can’t meet the expectations she knows others have of her.

 Darnell has trouble in circle time. The teacher keeps telling him to sit “criss-cross applesauce” but he prefers to sit on his knees or “w” sit. Often, he ends up lying down on the carpet or leaning into the peer next to him who is annoyed by this intrusion. He appears clumsy and uncoordinated, often tripping over things that other children seem to automatically avoid. He gets fatigued in the afternoons and has a hard time staying focused on tasks. He often becomes very silly which results in his teachers removing him from activities.

Darnell’s system is not processing input that activates and enables us to sustain contraction of the muscles needed for sitting upright—to control our posture. This set of muscles, when activated, provides a strong core that enables us to maintain an upright position. (Kids who can’t regularly sit “criss-cross applesauce” are often struggling with a lack of his core muscle control.) Laying down and w-sitting are ways for Darnell to cope with his weak or poorly activated postural muscles. He tires more easily because he has to work harder to keep his body upright against gravity.

 Callie is a picky eater. She will only eat bland foods and resists trying new foods. She fights toothbrushing because she dislikes the taste of the toothpaste.

Callie is over-responsive to oral and olfactory (smell) input. She finds many foods overwhelming and unpleasant that taste and smell good to other kids. Her rejection of these foods is a natural effort to avoid discomfort.

 Amir can’t keep his hands to himself. He is constantly getting into trouble at school for squeezing other kids’ arms, putting his hands on everything in his path, and constantly knocking objects off the tables and shelves. He smears his body with paint, glue, and shaving cream for which he gets reprimanded. He frequently bangs into other kids who are now starting to avoid playing with him.

 Amir is under-responsive to tactile sensations. His threshold for input is very high. His behavior is an effort to seek the sensation he needs to feed his system.

 Marnie doesn’t follow directions. When the teacher gives the class an instruction, such as to clean up or line up, Marnie needs a lot of reminders. She is also often unable to answer questions about the book the teacher is reading to the class. Her responses are frequently illogical, having nothing to do with the content of the question. She gets very distracted by sudden or loud sounds that don’t seem to bother the other kids. The teacher keeps telling her to pay more attention.

Marnie is not processing auditory information accurately. This makes it hard for her to respond appropriately to instructions and other information she receives.  (Note: auditory processing is different than hearing. Many children who have auditory processing problems have perfect hearing. The issue is in making sense of speech, discriminating sounds and following directions.)

 Leo is very anxious and clings for dear life when going to a birthday party, a kids’ gym, or other highly-stimulating event. His parents have to drag him there and then try to force him to engage. They are very worried about him missing out.

 Leo has a low threshold for visual, auditory, and tactile input. Lots of activity, noise and unexpected touch, especially in an unfamiliar environment, are overwhelming and understandably make him very anxious.

As you think about your own child or the children in your care, it is important to keep in mind that children often behave very differently from one environment to another. The demands on their sensory systems vary based on the characteristics of the setting. For example, some children exhibit challenging behaviors at school that parents don’t see at home. This is often due to the fact that group settings include many more stressors than homes, such as: dealing with many other children in their space who act unpredictably; lots of activity and noise; and, countless limits and transitions. In an environment in which a child feels comfortable and calm, he is better able to cope and function more effectively than in a setting where he feels overwhelmed and uncomfortable.

Note that if your child exhibits some of the behaviors above, it does not necessarily mean that they are all rooted in a sensory processing challenge. The same behaviors can have different causes. For example, significant changes in a child’s world or experiencing a trauma can cause children to have trouble focusing, or to become easily distractible, overactive, or too physically forceful. Further, not all children who exhibit these behaviors need special intervention. It all depends on the frequency and intensity of the behaviors and whether they interfere in a child’s overall functioning—specifically, his ability to learn, to adapt to family and school/childcare routines and to get along with others. If the latter is the case, then I recommend starting with an occupational therapy assessment to either identify or rule out a sensory processing problem.  The brain is most adaptable in the early years, so the sooner a child receives intervention to help his sensory system function more effectively the better. If you are not sure about whether any special intervention is needed, seeking a consultation from a child development specialist can be very useful to help guide you in doing the detective work to decode the meaning of your child’s behavior and find solutions that are loving and effective.

Understanding the underlying sensory processing challenges that were the cause for many of Samantha’s behaviors led us to occupational therapy which has greatly improved Samantha’s ability to cope with the world. Although we are still a work in progress, OT has provided us with the tools and vocabulary to work on improving Samantha’s impulsivity and flexibility. It has helped us identify her threshold and what she may or may not be capable of handling at any given moment. It has helped us recognize her need for physical input as well as the calming effect of certain tactile sensations (such as playing with sand, her water table, and rice bins). It has helped Samantha practice using her body in new situations so that she can be aware of her body in space and make safer body choices. Most importantly, it has given us an explanation for many of her behaviors so that we can be as helpful, patient, and understanding as possible.
— Samantha's mom

All behavior has meaning. Once we stop judging behavior and instead do more observing and wondering, asking ourselves: “Why would my child act this way? What need is it meeting? What purpose is it serving? What is he/she trying to cope with?”, it leads us down a path to understanding what makes our children tick and what they need to best cope and thrive.

To learn more about sensory processing, go to The Star Institute’s website, which has excellent resources for parents and professionals.

Special thanks to my OT colleagues, Teri Kozlowski, Sami Cook and Jane Rutt for their input on this blog and for helping me be exponentially more helpful to the children and families I serve.



 

 

DON’T ever say that to me again! Do you understand? DO YOU UNDERSTAND?!: How to Respond to Highly Sensitive, Reactive Children

This morning I very calmly and gently explained to Martin, my 4-year-old, that when he places a cup down on our glass coffee table he needs to be gentle. His response: “It’s not fragile! DON'T EVER SAY THAT TO ME AGAIN! Do you understand? DO YOU UNDERSTAND?!  And this is not atypical—he explodes like this on a regular basis, whenever we need to correct him or set a limit, or when he can’t do something perfectly right away. When we try to reason with him he shuts down—he’ll often just cover his ears or run away.  We are at a loss as to why he is so hyper-sensitive and how we are supposed to set limits with him.

Children like Martin have a more sensitive temperament, meaning they experience and react to their feelings and experiences in the world more deeply. (They are sometimes referred to as “orchids” because they are affected by and reactive to even minor changes in their environment versus “dandelions” who are tough and thrive even in challenging circumstances.)

Temperament is a child’s inborn way of approaching the world—the “why” that explains the meaning of his behavior. Temperament is something we are all born with, not something children choose or that parents create. It’s why some of us revel in new experiences and others are anxious and need time to warm up to unfamiliar situations. It’s how we’re wired which influences the way we process our experiences in the world.

Sensitive children tend to have a harder time handling typical stressors, such as not being able to master a new skill right away or having to adapt to a change, such as a new teacher or a shift in their daily routine. And, like Martin, highly sensitive children are also more likely to feel overwhelmed or out of control when being corrected by an adult. When they feel out of control on the inside, they act out of control on the outside. While Martin expresses his feelings--in this case by shouting--another child might burst into tears or throw a tantrum when feeling overwhelmed.

Highly sensitive children are also more likely to experience anxiety. They lack an internal filter which means they are processing everything going on around them. Parents often describe these kids as not having an "off" button. They live in a state of high-alert to prepare and protect themselves from a world that can feel very overwhelming.  

What can parents do to help especially sensitive children learn to manage their emotions and cope?

  • Remain calm and try not to get reactive yourself. When we get revved up it tends to increase children’s distress, leading to more out-of-control behavior. Remember not to take their words literally. Young children are driven by emotions and are irrational by nature. When children lash out, it is their way of saying they are overwhelmed and are having a hard time coping. They don’t mean what they say. (“I hate you” doesn’t mean they actually hate you. It usually means they don't like a limit you are setting.) The more you react to their behavior, the more you reinforce it. When you remain calm they are likely to settle down more quickly. 

  • Acknowledge your child’s feelings and keep language brief and simple. We tend to say too much when trying to calm children, thinking (hoping!) that, somehow, we can talk them out of their upset. But when children are out of control, they can’t process all those words and ideas. Attempting to do so just further overwhelms them. The most sensitive and effective response is to simply acknowledge your child’s emotional state. Say something brief and empathetic such as, “Wow, those are very big feelings.” (Avoid telling him exactly how he is feeling as that just triggers more defiance: "I am not angry!!") When you stay empathetic and calm, it communicates that you are his rock; that you understand and that he is not alone. 

  • Reflect on the encounter when your child is calm. Our natural impulse as adults is to use logic to teach our kids a lesson in these maddening moments. But when children are overwhelmed emotionally, they don’t have access to the part of the brain that enables them to think and reason. Wait until your child has calmed down to engage in any reflecting and teaching.

  • Retell the story: “Mommy asked you to be gentle when you put your cup down on the glass table because it is fragile and can break. I meant this to be helpful — just like when your teachers give you a direction at school — but you got very upset.” Pause to allow your child to respond. You might ask to see if he thought you were angry or were criticizing him. Explain that sometimes people hear things in a way that the other person doesn’t mean. This helps him begin to understand his feelings and reactions.

  • Recall past experiences when your child successfully managed a challenging moment. “Remember when you fell off your scooter. Daddy tried to help but you got really mad at him because you didn’t like the feeling of falling. It made you feel out of control. Daddy understood and just stayed by your side. When you were calm he showed you how to balance and you were off!”

  • Let your child know you will be his partner in learning to manage his big feelings. One of the greatest gifts you give your child is letting him know you understand, accept and appreciate him; that you won’t minimize or judge his feelings and will help him cope when he is having a hard time managing his big emotions.

It’s important to be aware that some children who are emotionally sensitive also have some sensory sensitivities. For example, a child who gets very distressed when something unexpected happens, or who flies off the handle when any limit is set, may be over-responsive to sensory experiences like sounds or tactile sensations (such as clothing with tags or seams). Children whose sensory systems are highly sensitive and reactive tend to feel overwhelmed by the world. They feel bombarded with sensations they can't cope with which can result in big emotional reactions. This is something to keep in mind and potentially explore as you are decoding the meaning of your child’s behavior. (To learn more about how sensory processing challenges can impact behavior, read this blog.)