Understanding Sensory Processing

This list is not to be used as the absolute diagnostic criteria for labeling children with sensory processing disorder. But rather, as an educational tool and checklist for your own knowledge. Professionals who can diagnose this disorder have their own tools in addition to checklists to observe and test for sensory integration dysfunction.

Please understand the “Five Caveats” that Carol Stock Kranowitz points out in her book, “The Out-Of-Sync Child” (1995), about using a checklist such as this. She writes:

“The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus, the child with vestibular dysfunction may have poor balance but good muscle tone.”
“Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, the child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday. Inconsistency is a hallmark of every neurological dysfunction. “
“The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, instead, have an emotional problem.”
“The child may be both hypersensitive and hyposensitive. For instance, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation.”
“Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or by depriving it of, sensory stimulation.”

Tactile Sense: input from the skin receptors about touch, pressure, temperature, pain, and movement of the hairs on the skin.

Signs Of Tactile Dysfunction
Hypersensitivity To Touch (Tactile Defensiveness)

becomes fearful, anxious or aggressive with light or unexpected touch
as an infant, did/does not like to be held or cuddled; may arch back, cry, and pull away
distressed when diaper is being, or needs to be, changed
appears fearful of, or avoids standing in close proximity to other people or peers (especially in lines)
becomes frightened when touched from behind or by someone/something they can not see (such as under a blanket)
complains about having hair brushed; may be very picky about using a particular brush
bothered by rough bed sheets (i.e., if old and “bumpy”)
avoids group situations for fear of the unexpected touch
resists friendly or affectionate touch from anyone besides parents or siblings
dislikes kisses, will “wipe off” place where kissed
prefers hugs
a raindrop, water from the shower, or wind blowing on the skin may feel like torture and produce adverse and avoidance reactions
may overreact to minor cuts, scrapes, and or bug bites
avoids touching certain textures of material (blankets, rugs, stuffed animals)
refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans, hats, or belts, etc.
avoids using hands for play
avoids/dislikes/aversive to “messy play”, i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream/funny foam etc.
will be distressed by dirty hands and want to wipe or wash them frequently
excessively ticklish
distressed by seams in socks and may refuse to wear them
distressed by clothes rubbing on skin; may want to wear shorts and short sleeves year round, toddlers may prefer to be naked and pull diapers and clothes off constantly
or, may want to wear long sleeve shirts and long pants year round to avoid having skin exposed
distressed about having face washed
distressed about having hair, toenails, or fingernails cut
resists brushing teeth and is extremely fearful of the dentist
is a picky eater, only eating certain tastes and textures; mixed textures tend to be avoided as well as hot or cold foods; resists trying new foods
may refuse to walk barefoot on grass or sand
may walk on toes only

Hypo-sensitivity To Touch (Under-Responsive)

may crave touch, needs to touch everything and everyone
is not aware of being touched/bumped unless done with extreme force or intensity
is not bothered by injuries, like cuts and bruises, and shows no distress with shots
may not be aware that hands or face are dirty or feel his/her nose running
may be self-abusive; pinching, biting, or banging his own head
mouths objects excessively
frequently hurts other children or pets while playing
repeatedly touches surfaces or objects that are soothing (i.e., blanket)
seeks out surfaces and textures that provide strong tactile feedback
thoroughly enjoys and seeks out messy play
craves vibrating or strong sensory input
has a preference and craving for excessively spicy, sweet, sour, or salty foods

Poor Tactile Perception And Discrimination

has difficulty with fine motor tasks such as buttoning, zipping, and fastening clothes
may not be able to identify which part of their body was touched if they were not looking
may be afraid of the dark
may be a messy dresser; looks disheveled, does not notice pants are twisted, shirt is half untucked, shoes are untied, one pant leg is up and one is down, etc.
has difficulty using scissors, crayons, or silverware
continues to mouth objects to explore them even after age two
has difficulty figuring out physical characteristics of objects; shape, size, texture, temperature, weight, etc.
may not be able to identify objects by feel, uses vision to help; such as, reaching into backpack or desk to retrieve an item

Vestibular Sense: input from the inner ear about equilibrium, gravitational changes, movement experiences, and position in space.

Signs Of Vestibular Dysfunction
Hypersensitivity To Movement (Over-Responsive)

avoids/dislikes playground equipment; i.e., swings, ladders, slides, or merry-go-rounds
prefers sedentary tasks, moves slowly and cautiously, avoids taking risks, and may appear “wimpy”
avoids/dislikes elevators and escalators; may prefer sitting while they are on them or, actually get motion sickness from them
may physically cling to an adult they trust
may appear terrified of falling even when there is no real risk of it
afraid of heights, even the height of a curb or step
fearful of feet leaving the ground
fearful of going up or down stairs or walking on uneven surfaces
afraid of being tipped upside down, sideways or backwards; will strongly resist getting hair washed over the sink
startles if someone else moves them; i.e., pushing his/her chair closer to the table
as an infant, may never have liked baby swings or jumpers
may be fearful of, and have difficulty riding a bike, jumping, hopping, or balancing on one foot (especially if eyes are closed)
may have disliked being placed on stomach as an infant
loses balance easily and may appear clumsy
fearful of activities which require good balance
avoids rapid or rotating movements

Hypo-sensitivity To Movement (Under-Responsive)

in constant motion, can’t seem to sit still
craves fast, spinning, and/or intense movement experiences
loves being tossed in the air
could spin for hours and never appear to be dizzy
loves the fast, intense, and/or scary rides at amusement parks
always jumping on furniture, trampolines, spinning in a swivel chair, or getting into upside down positions
loves to swing as high as possible and for long periods of time
is a “thrill-seeker”; dangerous at times
always running, jumping, hopping etc. instead of walking
rocks body, shakes leg, or head while sitting
likes sudden or quick movements, such as, going over a big bump in the car or on a bike

Poor Muscle Tone And/Or Coordination

has a limp, “floppy” body
frequently slumps, lies down, and/or leans head on hand or arm while working at his/her desk
difficulty simultaneously lifting head, arms, and legs off the floor while lying on stomach (“superman” position)
often sits in a “W sit” position on the floor to stabilize body
fatigues easily!
compensates for “looseness” by grasping objects tightly
difficulty turning doorknobs, handles, opening and closing items
difficulty catching him/her self if falling
difficulty getting dressed and doing fasteners, zippers, and buttons
may have never crawled as an baby
has poor body awareness; bumps into things, knocks things over, trips, and/or appears clumsy
poor gross motor skills; jumping, catching a ball, jumping jacks, climbing a ladder etc.
poor fine motor skills; difficulty using “tools”, such as pencils, silverware, combs, scissors etc.
may appear ambidextrous, frequently switching hands for coloring, cutting, writing etc.; does not have an established hand preference/dominance by 4 or 5 years old
has difficulty licking an ice cream cone
seems to be unsure about how to move body during movement, for example, stepping over something
difficulty learning exercise or dance steps

Proprioceptive Sense: input from the muscles and joints about body position, weight, pressure, stretch, movement, and changes in position in space.

Signs Of Proprioceptive Dysfunction
Sensory Seeking Behaviors

seeks out jumping, bumping, and crashing activities
stomps feet when walking
kicks his/her feet on floor or chair while sitting at desk/table
bites or sucks on fingers and/or frequently cracks his/her knuckles
loves to be tightly wrapped in many or weighted blankets, especially at bedtime
prefers clothes (and belts, hoods, shoelaces) to be as tight as possible
loves/seeks out “squishing” activities
enjoys bear hugs
excessive banging on/with toys and objects
loves “roughhousing” and tackling/wrestling games
frequently falls on floor intentionally
would jump on a trampoline for hours on end
grinds his/her teeth throughout the day
loves pushing/pulling/dragging objects
loves jumping off furniture or from high places
frequently hits, bumps or pushes other children
chews on pens, straws, shirt sleeves etc.

Difficulty With “Grading Of Movement”

misjudges how much to flex and extend muscles during tasks/activities (i.e., putting arms into sleeves or climbing)
difficulty regulating pressure when writing/drawing; may be too light to see or so hard the tip of writing utensil breaks
written work is messy and he/she often rips the paper when erasing
always seems to be breaking objects and toys
misjudges the weight of an object, such as a glass of juice, picking it up with too much force sending it flying or spilling, or with too little force and complaining about objects being too heavy
may not understand the idea of “heavy” or “light”; would not be able to hold two objects and tell you which weighs more
seems to do everything with too much force; i.e., walking, slamming doors, pressing things too hard, slamming objects down
plays with animals with too much force, often hurting them

Signs Of Auditory Dysfunction: (no diagnosed hearing problem)
Hypersensitivity To Sounds (Auditory Defensiveness)

distracted by sounds not normally noticed by others; i.e., humming of lights or refrigerators, fans, heaters, or clocks ticking
fearful of the sound of a flushing toilet (especially in public bathrooms), vacuum, hairdryer, squeaky shoes, or a dog barking
started with or distracted by loud or unexpected sounds
bothered/distracted by background environmental sounds; i.e., lawn mowing or outside construction
frequently asks people to be quiet; i.e., stop making noise, talking, or singing
runs away, cries, and/or covers ears with loud or unexpected sounds
may refuse to go to movie theaters, parades, skating rinks, musical concerts etc.
may decide whether they like certain people by the sound of their voice

Hypo-sensitivity To Sounds (Under-Registers)

often does not respond to verbal cues or to name being called
appears to “make noise for noise’s sake”
loves excessively loud music or TV
seems to have difficulty understanding or remembering what was said
appears oblivious to certain sounds
appears confused about where a sound is coming from
talks self through a task, often out loud
had little or no vocalizing or babbling as an infant
needs directions repeated often, or will say, “What?” frequently

Signs Of Oral Input Dysfunction
Hypersensitivity To Oral Input (Oral Defensiveness)

picky eater, often with extreme food preferences; i.e., limited repertoire of foods, picky about brands, resistive to trying new foods or restaurants, and may not eat at other people’s houses)
may only eat “soft” or pureed foods past 24 months of age
may gag with textured foods
has difficulty with sucking, chewing, and swallowing; may choke or have a fear of choking
resists/refuses/extremely fearful of going to the dentist or having dental work done
may only eat hot or cold foods
refuses to lick envelopes, stamps, or stickers because of their taste
dislikes or complains about toothpaste and mouthwash
avoids seasoned, spicy, sweet, sour or salty foods; prefers bland foods

Hypo-sensitivity To Oral Input (Under-Registers)

may lick, taste, or chew on inedible objects
prefers foods with intense flavor; i.e., excessively spicy, sweet, sour, or salty
excessive drooling past the teething stage
frequently chews on hair, shirt, or fingers
constantly putting objects in mouth past the toddler years
acts as if all foods taste the same
can never get enough condiments or seasonings on his/her food
loves vibrating toothbrushes and even trips to the dentist

Signs Of Olfactory Dysfunction (Smells)
Hypersensitivity To Smells (Over-Responsive)

reacts negatively to, or dislikes smells which do not usually bother, or get noticed, by other people
tells other people (or talks about) how bad or funny they smell
refuses to eat certain foods because of their smell
offended and/or nauseated by bathroom odors or personal hygiene smells
bothered/irritated by smell of perfume or cologne
bothered by household or cooking smells
may refuse to play at someone’s house because of the way it smells
decides whether he/she likes someone or some place by the way it smells

Hypo-sensitivity To Smells (Under-Responsive)

has difficulty discriminating unpleasant odors
may drink or eat things that are poisonous because they do not notice the noxious smell
unable to identify smells from scratch ‘n sniff stickers
does not notice odors that others usually complain about
fails to notice or ignores unpleasant odors
makes excessive use of smelling when introduced to objects, people, or places
uses smell to interact with objects

Signs Of Visual Input Dysfunction (No Diagnosed Visual Deficit)
Hypersensitivity To Visual Input (Over-Responsiveness)

sensitive to bright lights; will squint, cover eyes, cry and/or get headaches from the light
has difficulty keeping eyes focused on task/activity he/she is working on for an appropriate amount of time
easily distracted by other visual stimuli in the room; i.e., movement, decorations, toys, windows, doorways etc.
has difficulty in bright colorful rooms or a dimly lit room
rubs his/her eyes, has watery eyes or gets headaches after reading or watching TV
avoids eye contact
enjoys playing in the dark

Hypo-sensitivity To Visual Input
(Under-Responsive Or Difficulty With Tracking, Discrimination, Or Perception)

has difficulty telling the difference between similar printed letters or figures; i.e., p & q, b & d, + and x, or square and rectangle
has a hard time seeing the “big picture”; i.e., focuses on the details or patterns within the picture
has difficulty locating items among other items; i.e., papers on a desk, clothes in a drawer, items on a grocery shelf, or toys in a bin/toy box
often loses place when copying from a book or the chalkboard
difficulty controlling eye movement to track and follow moving objects
has difficulty telling the difference between different colors, shapes, and sizes
often loses his/her place while reading or doing math problems
makes reversals in words or letters when copying, or reads words backwards; i.e., “was” for “saw” and “no” for “on” after first grade
complains about “seeing double”
difficulty finding differences in pictures, words, symbols, or objects
difficulty with consistent spacing and size of letters during writing and/or lining up numbers in math problems
difficulty with jigsaw puzzles, copying shapes, and/or cutting/tracing along a line
tends to write at a slant (up or down hill) on a page
confuses left and right
fatigues easily with schoolwork
difficulty judging spatial relationships in the environment; i.e., bumps into objects/people or missteps on curbs and stairs

Auditory-Language Processing Dysfunction

unable to locate the source of a sound
difficulty identifying people’s voices
difficulty discriminating between sounds/words; i.e., “dare” and “dear”
difficulty filtering out other sounds while trying to pay attention to one person talking
bothered by loud, sudden, metallic, or high-pitched sounds
difficulty attending to, understanding, and remembering what is said or read; often asks for directions to be repeated and may only be able to understand or follow two sequential directions at a time
looks at others to/for reassurance before answering
difficulty putting ideas into words (written or verbal)
often talks out of turn or “off topic”
if not understood, has difficulty re-phrasing; may get frustrated, angry, and give up
difficulty reading, especially out loud (may also be dyslexic)
difficulty articulating and speaking clearly
ability to speak often improves after intense movement

Social, Emotional, Play, And Self-Regulation Dysfunction

Social

difficulty getting along with peers
prefers playing by self with objects or toys rather than with people
does not interact reciprocally with peers or adults; hard to have a “meaningful” two-way conversation
self-abusive or abusive to others
others have a hard time interpreting child’s cues, needs, or emotions
does not seek out connections with familiar people

Emotional

difficulty accepting changes in routine (to the point of tantrums)
gets easily frustrated
often impulsive
functions best in small group or individually
variable and quickly changing moods; prone to outbursts and tantrums
prefers to play on the outside, away from groups, or just be an observer
avoids eye contact
difficulty appropriately making needs known

Play

difficulty with imitative play (over 10 months)
wanders aimlessly without purposeful play or exploration (over 15 months)
needs adult guidance to play, difficulty playing independently (over 18 months)
participates in repetitive play for hours; i.e., lining up toys cars, blocks, watching one movie over and over etc.

Self-Regulation

excessive irritability, fussiness or colic as an infant
can’t calm or soothe self through pacifier, comfort object, or caregiver
can’t go from sleeping to awake without distress
requires excessive help from caregiver to fall asleep; i.e., rubbing back or head, rocking, long walks, or car rides

Internal Regulation (The Intero-ceptive Sense)

becoming too hot or too cold sooner than others in the same environments; may not appear to ever get cold/hot, may not be able to maintain body temperature effectively
difficulty in extreme temperatures or going from one extreme to another (i.e., winter, summer, going from air conditioning to outside heat, a heated house to the cold outside)
respiration that is too fast, too slow, or cannot switch from one to the other easily as the body demands an appropriate respiratory response
heart rate that speeds up or slows down too fast or too slow based on the demands imposed on it
respiration and heart rate that takes longer than what is expected to slow down during or after exertion or fear
severe/several mood swings throughout the day (angry to happy in short periods of time, perhaps without visible cause)
unpredictable state of arousal or inability to control arousal level (hyper to lethargic, quickly, vacillating between the two; over stimulated to under stimulated, within hours or days, depending on activity and setting, etc.)
frequent constipation or diarrhea, or mixed during the same day or over a few days
difficulty with potty training; does not seem to know when he/she has to go (i.e., cannot feel the necessary sensation that bowel or bladder are full
unable to regulate thirst; always thirsty, never thirsty, or oscillates back and forth
unable to regulate hunger; eats all the time, won’t eat at all, unable to feel full/hungry
unable to regulate appetite; has little to no appetite and/or will be “starving” one minute then full two bites later, then back to hungry again (prone to eating disorders and/or failure to thrive)

http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html