The first clue sensory experiences may be unbalanced is a child’s behaviour. An over-stimulated child who does not yet have the literacy nor the words to express sensory distress will turn to “out of control” behaviours to indicate something is wrong. If as a parent we can learn to recognize that cue, we can then turn our attention to the child’s experience in that specific situation.
When a child’s behaviour changes, parents should try to understand what in his/her experience is unusual. Using the four quadrants as a guide, we can begin to ask ourselves questions related to his/her experience, to his/her behaviour, and to their social and cultural dimensions. If away from home, what new stimuli has been introduced? If at home, is it happening in a specific room or social situation? Who was there, how are they feeling, is the room hot, cold, full of technologies? Did the child react after eating or coming home from a lot of stimuli? Etc.
Nonetheless, understanding why our children’s behaviours change is not necessarily an easy process. First because the sensory causes of the discomfort are hidden, but also because our medical culture does not recognize the side effects the senses can have on us as needing to be addressed. In skipping this step, medications, disabilities and pathologies are quickly assigned to a child whose sensory life is simply too intense. Yet, the way our nervous system deals with sensory input can influence many aspects of our being: from motor skills, cognitive skills, learning and our perceptions of the world.
The Nervous System: A Hub of Complex Sensorial Processes
Three distinct sensory processes actually take place that a parent can explore to be able to analyze a highly sensitive child’s sensory discomfort: sensory processing, sensory integration and sensory modulation. These three processes should be examined prior to considering other quadrants of health as when they are imbalanced, the physiology as well as emotional, psychological and genetic aspects of well-being may be affected. Let’s start with some definitions.
Sensory processing represents the way we deal with information processing (Ayers 1989)[i]. According to the Sensory Processing Disorder Foundation[ii], sensory processing refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioural responses[iii]. Sensory processing is a neurological process that organizes sensation from one’s body and the environment and makes it possible to use the body effectively within the environment. It includes three steps:
- Recognizing sensory information from any sensory systems;
- Interpreting the sensory information;
- Creating a motor response to the sensory information.
According to Elaine Aron, Ph.D., Barbara Allen-Williams, and Jacquelyn Strickland, LPC , Highly sensitive people have a sensory processing sensitivity:
“Sensory Processing Sensitivity (SPS, HSP, or Highly Sensitive Person) is not a condition, a disorder, or a diagnosis. It is a neutral trait that evolved in 20% of the human population and many non-human species as well, because it is a survival advantage in some situations and not in others. Their survival strategy is to process information (stimuli) more thoroughly than others do, for which there is considerable evidence. This can certainly lead to overstimulation and possibly efforts to protect one’s self against that. However, SPS is not a disorder, but a reasonable strategy.”[iv]
While heightened sensory sensitivity is not a disorder, a highly sensitive child who is in a state of constant overload of sensory input, or social/cultural stress will begin to have a different body chemistry and brain balance and could eventually be traumatized. As a result, he or she may begin to show signs of a sensory disorder. This makes diagnostic of a highly sensitive child difficult. The process of diagnostic itself may change the child’s behaviour and fit the criteria that the medical profession has categorized as ADHD, autism, etc. Part of the confusion is that all involve intense reactions to what the senses, spatial and social awareness read.
Elaine Aron, Ph.D., Barbara Allen-Williams, and Jacquelyn Strickland, LPC provide clues that can help parents analyse what is happening to their child. As they explain:
“HSPs process stimuli in a highly organized, big picture way, which includes awareness of nuances and subtleties that others might not notice. Again, at times, HSPs can become extremely overstimulated by the sheer amount of information they may be asked to process. Non-HSPs in our society, who make up about 80% of the general population, do not experience the same level of overstimulation that causes distress to HSPs, and therefore we might say that the amount of stimulation in the environment is set up for the other 80%, not for HSPs.
Sensory Processing (Integration) Disorder, on the other hand, is a neurological disorder. (…) It causes sensory information to get “mixed up” in the brain resulting in responses that are inappropriate in the context in which they find themselves. This can include random and disorganized processing of external stimuli, and can cause great distress, intensity and overstimulation. This overstimulation is sometimes confused with the overstimulation HSPs clearly experience, but it should be noted that the root cause of the overstimulation is not the same.” [v]
Thus the importance of studying your child and to create a “sensory sensitivity” profile and to spend the time to learn what are his/her sensory stressors, what behaviours relate to which stress and to eliminate the sensory toxins from your child’s environment as much as possible.
The following section explains the subtle nuances in sensory processing disorders. It may be useful to help understand what is happening to your child and which sensory process is being compromised. This can be helpful both in becoming literate about sensory health and to understand which aspect of sensory processes requires to be addressed via a sensory diet.
Once sensory input has been processed, it needs to be integrated and organized. In occupational therapy the term sensory integration is used to describe this “organization of sensation for use… (so that) the brain can use those sensations to form perceptions, behaviours, and learning” (Ayres, 1979, p.5)[vi]. Yack, Sutton and Aquilla (2002) describe it as follows:
“Sensory integration is a neurological process that occurs in all of us. We all take in sensory information from our bodies and the world around us. Our brains are programmed to organize or “integrate’’ this sensory information to make it meaningful to us. This integration allows us to respond automatically efficiently, and comfortably in response to the specific sensory input we receive.” (2002,p21)[vii]
Sensory Integration “use” affects our perception of the body or the world, our adaptive response, our learning process, and the development of some neural function. Through sensory integration, the many parts of the nervous system work together so that a person can interact with the environment effectively and experience appropriate satisfaction (Ayres, revised and updated by Pediatric Therapy Network, 2005).
While sensory integration is often considered similar to sensory processing, since they both influence our behaviours, it does affect us differently. Sensory processing influences our motor responses. While sensory integration affects our cognitive abilities: our perception of the world and learning abilities.
The “Pyramid of Development” developed by Taylor and Trott (1991) shows the importance of integration in a child’s development.
|Figure 1 Taylor and Trott’s Pyramid of Development|
It is recognized that the integration of the sensory systems is the prerequisite for all higher level skills. The lower levels of the pyramids are the foundations /building blocks of development. They greatly influence a child’s ability to integrate higher-level skills. When they are not functioning optimally, or are “Out of Sync”, the symptoms they create can be misunderstood as learning disability or mental health problems.
Finally, modulation is another important distinct sensorial process that most directly influences our ability to pay attention and focus. Modulation is the brain’s regulation of sensory input. It helps us to regulate our level of attention and concentration by filtering out background distractions, focusing on important sensory information and regulating how much sensory input we are exposed to. In the article “Modulation: we all do it, but how well?!”, this useful analogy is given:
“ One common analogy for modulation is likening it to the volume control on a radio. We would turn the volume up to enhance important incoming sensory information or turn the volume down to inhibit unimportant incoming sensory information. Let’s take sitting in a classroom for example. A child who can modulate appropriately would be enhancing the sound of the teacher’s instructions, whilst inhibiting the background noise of the air conditioner humming and the groundskeeper mowing outside. Furthermore, the child wouldn’t be paying any attention whatsoever to the feel of the tag on the bag of their shirts or brightness of the fluorescent bulbs. This modulation would all be happening automatically for them, happening on a subconscious level and requiring no effort or attention to occur.
Some children may not be able to modulate their senses so efficiently. For some, a little bit of sensory information may actually feel like A LOT. These are the over-sensitive (hypersensitive) children who may be distressed by unpredictable sounds and noisy surroundings, they may avoid being touched by others or they may fear movement activities such as swings.
On the other end of the scale are the children where a lot feels like A LITTLE. These are the under-sensitive (hyposensitive) children who often seek lots of sensory input (sensory seeking), such as engaging in messy play, seeking lots of movement or mouthing objects. They may not be able to consciously register certain sensory input (low registration), such as someone giving them instructions or tapping them on the shoulder, and may often appear daydreamy and lazy. Children with low registration commonly have difficulties with low muscle tone and poor body awareness.”[viii]
Sensory modulation is an important part of the puzzle as difficulties with sensory modulation may often result in social, emotional and behavioural difficulties. According to Dr. Sutton[ix], Any sensory modulation imbalance affect the ability to regulate and organize the degree, intensity and nature of responses to sensory input in a graded and adaptive manner. It also strongly influences arousal levels. Modulation must be maintained for people to maintain an optimal range of performance and to adapt to challenges in everyday life. Sensory modulation can impact academic learning, social interactions and self-esteem.
While the concept of a disruption in sensory modulation (SMD) has become an important topic in mental health, sensory disruption can be tied to different senses. If we understand which sense is affected, we can begin to develop strategies to help a child learn to self-regulate this difference in an aware and educated way.
Sensory Sensitivities and Disruption
In the presentation “Using Sensory Interventions To Support Recovery”, Dr Sutton[x], identifies 3 types of sensorial perceptions: Interoception, which relates to awareness of one’s internal state (ie. hunger, tiredness, illness); Exteroception, relating to awareness of the world in relation to one’s self: ‘Distal’ senses (sight, hearing, smell, taste, touch); and proprioception addressing awareness of one’s body in relation to the world (works with vestibular and tactile input): the ‘Proximal’ senses (body scheme, movement, orientation).
These three types of perceptions are important to understand as they dictate how we feel in the world and when disrupted can lead to behavioural difficulties. Researchers have identified three patterns of sensorial disruptions that correlate to these three forms of perception, which are summarized below (Miller et al., 2007)[xi]. Bolded are elements parents can use as clues of issues related to their child’s behaviours.
Pattern 1: Sensory Modulation Disorder (SMD)
Sensory modulation occurs as the central nervous system regulates the neural messages about sensory stimuli. SMD results when a person has difficulty responding to sensory input with behaviour that is graded relative to the degree, nature, or intensity of the sensory information. Responses are inconsistent with the demands of the situation, and inflexibility adapting to sensory challenges encountered in daily life is observed. Difficulty achieving and maintaining a developmentally appropriate range of emotional and attentional responses often occurs.
An important challenge is that overactive and impulsive symptoms in sensory sensitivities can easily be confused with (and often co-occur with) attention deficit hyperactivity disorder (ADHD).
Pattern 2: Sensory Discrimination Disorder (SDD)
People with SDD have difficulty interpreting qualities of sensory stimuli and are unable to perceive similarities and differences among stimuli. They can perceive that stimuli are present and can regulate their response to stimuli but cannot tell precisely what or where the stimulus is.
SDD can be observed in any sensory modality. A person with SDD may have different capacities in each modality (e.g., a visual or auditory discrimination disorder but good discrimination in all other modalities).
Traditional models of sensory discrimination focus on visual, auditory, and tactile perceptions. Unique to the model proposed here is the focus on somatic senses.
Discrimination in the tactile, proprioceptive, and vestibular systems leads to smooth, graded, coordinated movement. SDD in these three systems results in awkward motor abilities. SDD in the visual and auditory systems can lead to a learning or language disability.
A person with SDD may require extra time to process the salient aspects of sensory stimuli, leading to “slow” performance. Low self-confidence, attention-seeking behavior, and temper tantrums may result.
Pattern 3: Sensory-Based Motor Disorder (SBMD)
People with SBMD have poor postural or volitional movement as a result of sensory problems. There are two subtypes of SBMD.
SBMD Subtype 1: Postural Disorder (PD)
(PD) is difficulty stabilizing the body during movement or at rest to meet the demands of the environment or of a given motor task. PD is characterized by inappropriate muscle tension, hypotonic or hypertonic muscle tone, inadequate control of movement, or inadequate muscle contraction to achieve movement against resistance. Poor balance between flexion and extension of body parts, poor stability, poor righting and equilibrium reactions, poor weight shifting and trunk rotation, and poor ocular–motor control also may be noted.
SBMD Subtype 2: Dyspraxia.
Dyspraxia is an impaired ability to conceive of, plan, sequence, or execute novel actions. People appear awkward and poorly coordinated in gross, fine, or oral–motor areas.
People with dyspraxia seem unsure of where their body is in space and have trouble judging their distance from objects, people, or both. They may seem accident-prone, frequently breaking toys or objects because of difficulty grading force during movement. People with dyspraxia usually have poor skills in ball activities and sports. They display difficulty with projected action sequences that require timing.
People with dyspraxia, like most children, learn by trial and error, but they require significantly more practice than is typical and demonstrate decreased ability to generalize skills to other motor tasks.
All these processes have in common to influence our behaviours. But each individual processes sensory input differently. Personality and sensory traits will alter behaviour in different ways. Occupational therapy researcher Winnie Dunn proposed that four sensory processing patterns characterize the perceptual process. These patterns are thought to arise from individual differences in neurological thresholds for stimulation (high-low) and self-regulation strategies (active-passive). Crossing these dimensions gives us four sensory processing styles (Dunn, 2001[xii]; 1997[xiii]):
“P – Low Registration (High, Passive)
Low-registering people might be described as insensitive or disconnected. They do not pick up on subtle environmental cues, and require very clear and surgent directives. Most events of daily life are not intense enough to stimulate deep processing for these people, and their passive-reactive self-regulatory stance makes them somewhat oblivious to ongoing activity that is not explicitly engaging them.
A – Sensory Avoiding (Low, Active)
Sensory input bothers avoidant people, so they try to limit the input they must deal with. Unfamiliar input is distressing and difficult to understand or organize, so avoiders regularize their experience through rituals, rules and habits. These provide a high rate of familiar input while limiting exposure to new input. The threatening nature of change can make sensory avoiders rigid, uncooperative and withdrawn.
E – Sensory Seeking (High, Active)
Sensory seekers need and enjoy high levels of sensory stimulation, and they generate extra input for themselves. They are active, engaging and excitable. They place a high premium on novelty, which can be disruptive in cases where they do not persist in beneficial activities, abandoning them for something new once the novelty of the initial activity has worn off.
I – Sensory Sensitivity (Low, Passive)
Sensitive people detect more input and notice more sensory events than others, and comment on them regularly rather than trying to ward them off. They are distractible and can be complainers. They are helped by participating in structured sensory experiences so they are not overwhelmed by unstructured and disruptive input.”[xiv]
Given that Dunn’s sensory profiles relate these sensory processes to models of temperament, and suggests that sensory preferences form a basis for the manifestation of temperament and personality, and that being highly sensitive is a recognized trait, it is crucial to understand the temperament of your child. A highly sensitive child will uniquely combine different behavioural responses to their unique response to sensory stimuli. This is crucial to understand, as multiple children will have different behavioural cues to the same sensory experience.
Behavioural Cues: Sensory Defensiveness and Dormancy
Occupational therapy researcher A. Jean Ayres first identified characteristics of “defensiveness” behaviours related to aversive responses to tactile input, describing it as “the tendency to react negatively and emotionally to touch sensations” (Ayres, 1979, p. 107). She noted a connection between hyperactivity and tactile defensiveness (Ayres, 1972, 1979).
A few years later, in her book, A Holistic Approach to Learning Disorders, Barbara Knickerbocker expanded Ayres’ work to a broader category of sensory defensiveness, she placed sensory on a continuum with sensory dormancy. She described sensory dormancy as, “too much…inhibition of incoming sensory stimuli” (p. 32)[xv]. In Knickerbocker’s view, too little inhibition resulted in sensory defensiveness and too much inhibition resulted in sensory dormancy.
There can be confusion when reading some of the literature on sensory defensiveness and dormancy as researchers do not agree on how they relate to one another. Ann Fisher and Winnie Dunn (Dunn & Fisher, 1983)[xvi] proposed that tactile defensiveness and registration problems were the opposing ends of a single continuum. Fisher, Murray and Bundy found major observable behavioural signs of Sensory Modulation difficulties — avoidance, distractibility and increased activity level— that they suggested as the end products of such disruption (Fisher, Murray and Bundy, 1990)[xvii]. While Royeen (1989) elaborated on a continuum model where sensory defensiveness and sensory dormancy are part of one circular continuum with sensory dormancy and defensiveness as potentially adjacent functions[xviii]. Wilbarger & Wilbarger (1991) proposed that sensory defensiveness is on a continuum of approach and avoidance behaviours[xix].
Important to parents facing a diagnose of autism, Kimball (1993) introduced the concept of shut down which she described as a protective mechanism against severe overload. She illustrated the notion of a non-linear continuum by describing individuals at the extremes of behaviour, i.e.: “some children even react in a dangerous way and go from overarousal to physiological shut down.”[xx]
As neuroscience advances, it is becoming clear that the brain is a complex heterarchy, therefore, sensory modulation probably includes complex models of stimuli comprised of dynamic, interactive systems. This explains some of the confusion around these issues. This does reinforce what Dunn (1997) suggested: that there are probably multiple, interacting continua[xxi].
It is surprising that this knowledge is not more disseminated within broader contexts such as with doctors and teachers. Living professionals and parents alike struggling to understand what is happening to their children could develop essential insights by understanding sensory processing related issues. Particularly given that occupational therapists understand SMD as a disruption in processing rather than a disorder (Wilbarger and Merman Stackhouse, 1998)[xxii].
Given that the medical culture tends to disregard sensory processing outside of a medical diagnostic, this foundational step of their development is often left to deteriorate or is suppressed via medication. The more we drug children or penalize them for out of sync behaviours, the less likely they will learn to regulate these processes in a positive way. Considering that highly sensitive children are sensory gifted, they could easily display sensory overexitabilities, these reactions are not pathologies but normal reactions given their heightened receptivity to sensory inputs. Whereas our culture accepts intellectual gifteness, if it continues to ignore the other dimensions of giftedness in diagnoses, we will continue to distress these children.
The repression of the senses via medication is particularly problematic for a highly sensitive child, as it is clear that identity formation depends on a positive relationship to their heightened sensory processes. Their access to well being depends on learning to become aware of their heightened senses, to process their sensory inputs and develop sensory and mind sights allowing them to understand how they affect their responsiveness and of course, how they participate in regulating sensory experiences within their multiple dimensions.
When we suspend our cultural/social suppressing mechanism, which makes us react to the situation as something to immediately stop and reprimand, and instead become a sensory detective that try to understand why the child’s behaviour has changed by tuning into the child’s experience, we can begin to put together the puzzles of heightened sensory responsiveness.
Key to sensory well-being is finding the right arousal level. Dr Sutton explains that sensory modulation can lead to feel alert or drowsy and tense or calm and that the optimal arousal state is a “calm and alert” state as can be seen in Dr Sutton’s figure below.
When optimal arousal levels are maintained, a child is in a calm and alert state, which will allow for the rest of his being to function properly. But when arousal is too intense or too little, the rest of the being will suffer.
Understanding the sensory profile of a child makes it possible to analyze the nature of his or her sensory experience and to adjust the environment based on the child’s sensory needs. Similarly to what Dunn understood in sensory processing styles, if we can begin to understand whether there is a sensitivity, or a processing, integration or modulation issue, we can work towards appropriate sensory experiences. The complex landscape of stimuli is coupled to a sensory processing and modulation system calibrated to the uniqueness of each individual. Thus the need to be a “sensory detective’ and to analyze a child’s behaviours and reaction to various sensory inputs from the perspective of his or her unique sensory system.
What I have found with one of my children, is that his sensory sensitivities are not just at the processing stage, they are also embedded within the sensory modulation aspect of sensing. His sensory processes and modulation become irritated by stress and trauma. He then enters a “funnel vision” cognitive state and he can no longer pay attention. As the trauma and stress are reduced, his modulation issues decrease dramatically and his senses go back to a “highly sensitive” range where his holistic nature can flourish. It is a subtle process and I have found that diagnosis are not accurate with him as the stress they create changes his ability to think.
Two questions parents should ask themselves. First, Is it a sensory sensitivity or is something else going on?
Leading specialists in the field of highly sensitive health Elaine Aron, Ph.D., Barbara Allen-Williams, and Jacquelyn Strickland, LPC, provide a questionnaire that can help clarify the sensory issue:
“Regardless of the profound differences in these traits, there are ways to minimize overstimulation. Many with Sensory Processing Disorder have found success with occupational therapists who help them better integrate stimuli into their experience. Indeed, many people without the full-blown disorder benefit from these methods, and some parents of highly sensitive children, children without the disorder, say it has helped them.
In contrast, many with Sensory Processing Sensitivity have found success by simply becoming educated about their genetic trait (or their child’s). They learn to create a proper balance in their day which may include meditation, creative arts, walks in nature, yoga, and learning which environments serve them best. Many have found seeking outside professional help from those who are educated about SPS to be helpful — mainly to help them reframe and understand their experiences as being normal.
Perhaps the truest test of what differentiates SPS from not only SPD, but also other diagnoses such as Autism and Aspergers Syndrome, are the four things all HSPs have in common ~ the D.O.E.S. as defined and eloquently explained in Elaine Aron’s book, Psychotherapy and the Highly Sensitive Person.
D.O.E.S. refers to: Depth of Processing; Overstimulation; Emotional Intensity; and Sensory Sensitivity. For example here are some questions to ask in each category which help identify and differentiate Sensory Processing Sensitivity:
Depth of Processing
- Does this person reflect more than others about the “way the world is going;” the meaning of life or their line of work?
- Is this person slow at making decisions, preferring to have “a little more time,” but often makes very good decisions?
- Is this person known for their good ideas?
- Does this person exhibit personal insight and have a sense of long-term consequences, perhaps leading to unusual conscientiousness?
- Does this person experience overstimulation and burn out due to the sheer amount of incoming information, experiencing a sense of not being able to handle any more? And when in a gentle environment, do they effectively process and integrate stimuli?
- Do others sometimes think something is wrong with them because they cannot handle as much as others seem to? This may be because HSPs often decline activities, even if enjoyable, in order to take care of themselves.
- Does this person need more sleep and downtime than their family and friends?
Emotional Responsiveness and Empathy
- Is this person more easily and appropriately moved to tears of joy, gratitude or relief, and equally moved to laughter whether by sheer silliness or subtle irony?
- Does this person react more to the emotions of others and often know what you are feeling far more than others do?
- Does this person become more distressed by violent TV shows or movies; unfairness, bullying, social injustice, or other disturbing events?
Sensitive to Subtleties
Does this person notice small changes others miss, such as someone looking tired, the décor of a room they have only been in briefly, or small flowers or animals or even animal tracks?
Is this person more aware than others of the sound of a ticking clock or dripping water, or subtle tastes and smells?
Does this person notice what needs to be changed in an environment to make others more comfortable?’ [xxiii]
The second question for a parent becomes, what causes my child’s sensory imbalances? Sensory difficulties can come from many sources. Some may be sensorial but other elements can come into play that will heighten reactions. Emotional or physiological difficulties can trigger a heightened sensory experience and visa versa.
To understand this part of the issue, we must look deeper into what alters a child’s behaviour. The body reacts to anything we sense via changes in behaviours. Thus, we need to understand how the body is connected to sensory experiences since behaviours can be responses to a chemical, emotional, cognitive, physiological, and/or genetic stimuli. As we will explore next.
[i] Ayres, A.J. (1 989). Sensory Integration and Praxis Tests. Los Angeles, Western Psychological Services.
[iii] spdfoundation (2015). “About SPD”. www.spdfoundation.net/about-sensory-processing-disorder/
[iv] Elaine Aron, Ph.D., Barbara Allen-Williams, and Jacquelyn Strickland, LPC (2016): FAQ: Is Sensory Processing (or Integration) Disorder (SPD) the same as Sensory Processing Sensitivity (SPS)? hsperson.com.
[v] Elaine Aron, Ph.D., Barbara Allen-Williams, and Jacquelyn Strickland, LPC (2016): FAQ: Is Sensory Processing (or Integration) Disorder (SPD) the same as Sensory Processing Sensitivity (SPS)? hsperson.com.
[vi] Ayres, A.J. (1 979). Sensory Integration and the Child. Los Angeles: Western Psychological Services.
[vii] E.Yack, S.Sutton, P.Aquilla (2002). Building Bridges Through Sensory Integration. Future Horizons, texas.
[viii] Occupational Therapy for Children (2012). Modulation: we all do it, but how well?!. Occupational Therapy for Children. December 2012. http://www.occupationaltherapychildren.com.au/blog/tag/modulation-difficulties/
[ix] Sutton, D. (2014).“Using Sensory Interventions To Support Recovery”. May 2014.
[x]Sutton, D. (2014).“Using Sensory Interventions To Support Recovery”. May 2014.
[xi] Miller, L.J., Anzalone, M.E., Lane, S.J., Cermak S.A., & Osten E.T. (2007) Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61, 135-140. Retrieved at http://www.spdfoundation.net/files/4114/2430/1280/Miller_Anzalone.pdf
[xii] Dunn, W. (2001). “The sensations of everyday life: empirical, theoretical, and pragmatic considerations.” The American Journal of Occupational Therapy, 55(6), 608-620.
[xiii] Dunn, W. (1997). “The impact of sensory processing abilities on the daily lives of young children and their families: a conceptual model.” Infants and Young Children, 9(4), 23-35.
[xiv] Dunn, W. (1997). “The impact of sensory processing abilities on the daily lives of young children and their families: a conceptual model.” Infants and Young Children, 9(4), 23-35.
[xv] Knickerbocker, B. (I 980). A Holistic Approach to Learning Disabilities Thorofare, NJ: Charles B. Slack.
[xvi] Dunn, W., & Fisher, A. (1983). Sensory registration, autism and tactile defensiveness. Sensory Integration Special Interest Section Newsletter, 6 (2), 3-4. (Published by AOTA, Bethesda, MD)
[xvii] Fisher, A., Murray, E., & Bundy, A. (1991). Sensory Integration Theory and Practice. Philadelphia: F.A. Davis Company.
[xviii] Royeen, C. (1989). Commentary of “Tactile functions in learning disabled and normal children: Reliability and validity considerations”. Occupational Therapy Journal of Research, 9, 16-23.
[xix] Wilbarger, P. & Wilbarger, J. (1991) Sensory Defensiveness in Children 2-12: An Intervention Guide. Avanti Educational Programs, Denver.
[xx] Kimball, J. (1993). Sensory Integration Frame of Reference. In P. Kramer & J. Hinojosa (Eds.), Frames of Reference in Pediatric Occupational Therapy Philadelphia: Williams & Wilkins.
[xxi] Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9 (4), 23-35.