Excerpted from Chapter 8 of Coping in Young Children: Early Intervention Practices to Enhance Adaptive Behavior and Resilience, by Shirley Zeitlin, Ed.D., & G. Gordon Williamson, Ph.D., O.T.R.

Copyright © 1994 by Paul H. Brookes Publishing Co., Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Through spontaneous interaction and planned intervention, parents and practitioners have an opportunity to influence a child’s sensory experience. During caregiving and play, for example, adults modulate the type, intensity, and frequency of sensory stimulation. The processing of sensory information forms the foundation for the infant’s attention, self-regulation, and coping capability. Young children vary greatly in their capacity to control states of arousal, habituate to environmental events, and perform adaptive skills in response to their surroundings. Some infants and toddlers are hyporeactive and require active stimulation to become engaged. However, many children with special needs are hyperreactive and readily overload with multisensory stimulation. These children develop defensive behaviors that are exaggerated emotional responses to specific sensory stimuli — most commonly hypersensitivity to touch, movement, and/or sounds. They tend to develop either a fearful and cautious behavioral pattern or a negative and defiant one (DeGangi, 1991; DeGangi, Craft, & Castellan, 1991; Greenspan, 1992).

Tactile defensiveness is the tendency to react negatively to sensations of touch — a child is overly sensitive to tactile input that others would hardly feel. Because his or her immature central nervous system is unable to manage the sensation, this child reacts with flight (i.e., avoidance, withdrawal) or fight (i.e., anger, hostility). Certain parts of the body may be particularly hypersensitive, such as the face, mouth, hands, and feet.

Intolerance to movement in the young infant may be indicated by persistent irritability, fussing, and crying in response to being moved, and an inability to be calmed with slow, rhythmic rocking by the parent. A resistance to prone positioning may also be seen. Such behaviors not only affect the infant’s course of motor development but they may influence the development of attachment and social interaction with the parents. Intervention emphasizes the introduction of slow, carefully graded movement experiences based on the infant’s ability to integrate the sensory input in order to respond adaptively. Care is taken that passive and active movement is encouraged only to an extent that is within the tolerance level of the child.

A child with auditory defensiveness, especially an infant, may react to sounds with hyperirritability, distractibility, or restlessness. These children cry at unexpected or high-pitched sounds and may even cover their ears. As they grow older, this sensitivity to sound can interfere with their ability to attend to a task.

Hypersensitivity

The following intervention guidelines are helpful when working with infants and toddlers who are hypersensitive. An individualized sensory approach is recommended because these children vary greatly in their preferences and levels of tolerance. These guidelines are relevant when planning for young children prenatally exposed to drugs; these children often exhibit fussiness, resistance to change, poor self-regulation, and sensory disorganization.

• Watch for early signs of distress. If there are signs of distress, stop the activity and provide time to recover. (Slowing the pace, rather than stopping the activity, is sufficient for some infants but not for others.)
  
  
• Use a calming technique that is effective with the child and be consistent in its application (i.e., stay with a procedure and do not jump from one to another). Examples include:
  
  
  • Firm pressure on the skin (avoid a light touch that tickles and is excitatory)
    
    
  • Massage for relaxation
    
    
  • Slow repetitive rocking of the infant held in a vertical position in the adult’s arms or on the adult’s lap over the knees (gentle patting on the infant’s back can also be soothing)
    
    
  • Rhythmic motion (e.g., rocking infant seat, wind-up infant swing, ride in a baby carriage or automobile)
    
    
  • Swaddling
    
    
  • Soft melodic lullabies and music boxes
    
    
  • Sucking on a pacifier
    
    
• Encourage the child to develop self-comforting behaviors (e.g., mouthing, cuddling a soft toy, hugging hands against chest, using transitional objects such as a blanket or teddy bear, snuggling into a quiet place such as the corner of the crib).
  
  
• Consider the complexity of the sensory input during interaction. Some infants may only be able to handle one sensory modality at a time (i.e., looking, listening, feeling, or moving, but not two together). Other infants may require specific multisensory combinations.
  
  
• Notice that the infant’s irritability may tend to cause the adult to overreact emotionally. To avoid escalating tension, caregivers need to take breaks.
  
  
• Be careful that the child’s difficult behavioral pattern does not condition the adult to avoid presenting appropriate developmental challenges (e.g., avoiding textured foods or making disciplinary demands, overuse of a walker that the infant prefers).
  
  
• Grade environmental stimulation (e.g., avoid overcrowding, loud noises, glaring sunlight).
  
  
• Engage the child in activities of high interest; sensory tolerance increases when the child enjoys the task.
  
  
• Provide a routine that is reasonably consistent, predictable, and structured.

It is important to be aware of signs that a child is becoming sensorially overloaded, such as active withdrawal (e.g., arching, running away); tuning out (e.g., staring into space, yawning); rejection (e.g., pushing away with the hands or feet); or signaling distress (e.g., crying, verbalizing). When a child is in such a emotional state, muscle tension is increased, undesired movement patterns are reinforced, and the child cannot learn. Likewise, the child’s trust of the adult is undermined. The intervention challenge is to grade the choice, intensity, and variety of environmental demands based upon the child’s changing ability to process sensory information and respond adaptively.