the sensational child

By Pat Blackwell, Ph.D.

Highly sensitive children can learn to manage their environment, and you can remain calm in the process.

“My shoes don’t feel right.” “This cereal tastes too crunchy!” “Pleeeease no hair brush!” When my daughter was a preschooler, she would remove and replace her socks and shoes over and over until the seam of the sock was placed perfectly across her toes and the tension of the shoes laces felt “just right.” It nearly drove me insane until I realized that Olivia was not trying to test me. She was actually and profoundly bothered by sensory stimuli. In my practice I have shared this story with many exasperated parents who are experiencing the same situation with their own sensory-sensitive children.

As infants, highly sensitive children are colicky and resistant to soothing. They may even reject their parents’ efforts to hold and play with them. Sleep problems, feeding issues and irregular “poops” can be very trying for parents. While typical children may be initially startled by sounds and other sensory stimuli, they tend to “get used to” or habituate to the stimuli. Sensitive children do not. They overreact to stimuli and respond with a startle to each presentation of a loud sound or tickle touch.

As toddlers and preschoolers, sensitive children may be very bossy and controlling. They may react with aggression when children approach. They may shriek or push other children if the come near their toys; or they become biters. These children may stay on the periphery of the play yard or class and not engage with other children. If they do engage, they prefer to be the chasers and hate being chased. They resist sitting near others in circle time and wander off. Klutzy and socially inept are adjectives used to describe some sensitive children because they invade other’s space or run full force into friends.  These negative traits can take a toll on the child’s social-emotional development and self esteem.

At home, sensitive toddlers may be described as “princesses” or “tyrants” who rule all with their tantrums and bossiness. They need an eternity to get dressed, reject all but a narrow range of foods (prepared just right, served on the same plate, with the same spoon, same cup) and resist grooming (hair and teeth brushing). What these behaviors have in common is self defense and protection. Children become controlling of their environment to protect themselves from the physical discomfort of sensory stimulation. But what makes some children so sensitive?

let’s get clinical

Sensory Processing Disorder (SPD) is a highly heritable neurological condition that impacts the way the brain responds to sensory stimuli. While it may be a stand alone condition, it often co-occurs with Attention Deficit Hyperactivity Disorder (ADHD) and Pervasive Developmental Disorder (or Autism Spectrum Disorders). In fact, children with SPD are often misdiagnosed with Autism or ADHD or even oppositional defiant disorder when a sensory issue is the main problem.

Presently, SPD is not included in the Diagnostic and Statistical Manual (DSM), the “Bible” of psychiatric disorders. And many pediatricians and other diagnosticians may be unaware of it. Effective treatment for SPD does exist, but it must be provided by a specially trained occupational therapist; Crane Rehab in Jefferson is a great resource. In severe cases of SPD, a multi-disciplinary approach including occupational therapy and psychology including a full developmental evaluation and parenting and school-based behavior plan is warranted.  For older children treatment with medication may be in order if it co-occurs with ADHD or a Pervasive Developmental Disorder. Medication is not a treatment for Sensory Processing Disorder if it occurs alone.

compromise and support

Children with SPD deserve understanding and treatment. Their difficult behavior must be understood in the context of their disability. However, limits must be set at home and at school by patient caregivers who allow some accommodations for children with sensory issues. Some school-based examples include allowing children to stand during circle time or eat their lunch outside of the noisy cafeteria.

At home, parents can compromise on their expectations regarding dressing and grooming. My experience with Olivia taught me to add 10 minutes to the morning routine.  I then left my child to her “shoe business,” breathed deeply and went to my “happy place.” Understanding and patience make all the difference with a “sensational child.”