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Sensory integration is the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment. – Jean Ayres                                                                                                                                         

Eye contact is still difficult for me in noisy rooms because it interferes with hearing. It’s like my brain’s wiring lets only one sense function or the other, but sometimes not both at the same time. – Temple Grandin                                                                                  

I knew the world was just too much for me…everything around me is dialed up to maximum intensity.- Anon

Difficulties occur when a child experiences unusual or disruptive physiological states and has psychological or behavioral reactions to their various sensory experiences. Sensory integration issues reflect individual differences in the processing of sensory stimuli, which interfere with the child’s quality of life, with their success in problem solving, with their participation in everyday life and with their interpersonal relationships, their learning and development. The neurodistinct child or adult may have unusual, or disordered sensory perceptions sometimes involving over responsivity, under responsivity, or sensory fixations and cravings.  

Some children experience shifting sensory perceptions. A particular aversive stimulus may, at times, or in different contexts, not be disturbing to the child, and may even be enjoyable and sought after. The child may cover their ears, scream, or run away when they hear certain loud or upsetting sounds, and yet be quite happy and content and even enjoy the same loud sounds at other times, or they can be quite happy with different kinds of loud or irritating sounds. A child may seem to be deaf on certain occasions but react to the slightest sound in the distance at other times.  

Sensory integration issues may have serious effects on the child’s quality of life, their health and safety, their activities of daily living,  their avoidances and interests,  their diagnoses, placements, enrichment opportunities, and on their learning and development.

Sensory integration and sensory processing disorders are not currently recognized as mental disorders in their own right in medical manuals such as the ICD-10 or the DSM-5, but are recognized as an accompanying symptom in certain neurodevelopmental disorders, particularly in certain psychological and occupational therapy models.

Many, probably the majority, of the children with developmental delays and neurodivergences whom I have assessed and treated had significant sensory issues. Sometimes the child was not aware that their sensory perceptions were unusual since they had always experienced them and thought everyone had the same experiences. Sometimes the child hides or masks their sensory issues, not wanting to feel different or may be afraid of being teased or bullied, or that they may be placed in a class for children with special needs.    

The bell rings, the lights hum, a tag brushes the back of the neck, a classmate laughs too loudly. Nothing remarkable unless you are the child for whom these sensations are distracting, disruptive or even frightening and painful attacks.

Sensations are personal, subjective experiences. The world may be perceived differently from that of most other children. The world, places, objects and people can be perceived as too fast, or too bright, or too close, too many, too few, too much, too little or too wrong, too different, or too overpowering.

Each of my children perceives pain differently. One always keeps a stiff upper lip as though the injury has no effect. One child is often overwhelmed by what others might think is a minor event. Another reacts differently to pain stimuli depending on how their day has been going up to that point. Each has their own subjective experience and idiosyncratic responses, the result of their individual histories and physiology, a combination of their nature and nurture.

TOO

“Too” is a relative, subjective term. It differs for each individual and may shift with context, fatigue, stress, illness, hunger, or novelty. What is manageable in the morning may be intolerable by afternoon. What is gentle one day may be piercing and deeply upsetting the next day.

Sometimes when I have the  flu and a fever, my skin feels sensitive and tender, even my pillowcase and my bedsheets feel rough and abrasive. Light seems harsh. Sounds seem loud and irritating. I have no patience to listen, to read, or to speak with people. I can imagine how upsetting it would be to have irritating sensations and feelings every day and night. For many sensory-divergent children, ordinary stimuli are amplified. Raised voices are not merely louder; they are invasive. A crowded school hallway during passing period is not merely busy, it is chaotic, disorganized, like standing alone outdoors in a cold, windy, wet downpour with close-by lightning strikes in a thunderstorm.

The passing bell, alerts and alarms, fire sirens, ambulance sirens, weather alerts, and even an alarm clock suddenly turning on may trigger a full physiological stress response. The child’s heart races, their muscles tighten, they want to run, or they freeze, or even hit themselves or others.

Neurotypical adults have glimpses of this. Think of the jolt when a balloon pops unexpectedly beside your ear. There is a reflexive startle, a surge of adrenaline. Now imagine a child living in anticipation of that pop, never certain when it will come. This balloon experience is too loud, too sudden and unpredictable. A highly sensitive young man we worked with refused to participate in a party because he saw a balloon in the corner of the room.

Texture

A clothing tag against the neck, a wool sweater, sand clinging to damp skin, and soap that may be too oily and difficult to rinse away. For some children, these sensations are sustained irritants that demand their attention, trigger emotions and behaviors and drain cognitive resources.

Light touch can feel sharp or electric. A casual hug may seem overwhelming. Too close, too controlling. Hair brushing, nail clipping, a shower, a toilet flushing can be irritating, even painful. Tooth brushing, dentistry, and inoculations may be too much to tolerate.

Neurotypical adults may recall the shiver of fingernails scraping a chalkboard, or the discomfort of an itchy sweater. Now multiply those irritating sensations, extend their duration, and remove the certainty that they will end quickly. The sensitive child’s withdrawal, resistance or tears make sense.

Vision, Faces, and the Social Field

We think of sight as neutral, but for some children, visual input overwhelms. Bright lights, flickering fluorescent bulbs, moving shadows, birds in flight, too bright, too fast, too many.

Eye contact, often considered a sign of respect or connection, may feel intrusive or destabilizing. A raised eyebrow can appear exaggerated, even threatening. Facial expressions may seem distorted or unpredictable. Clown faces painted beyond natural proportion may provoke terror rather than amusement.

In shopping centers, supermarkets, movie theaters, or playgrounds, stimuli accumulate: echoes, smells, motion, lights, and crowds. The environment becomes too complex, too disorganized, or possibly too organized, or something may seem unsystematic or out of place. Both chaos and order can overwhelm, depending on the child’s perceptual wiring and history.

“Fluorescent lights don’t just look bright; they pulse. It’s a rhythmic stabbing behind my eyes. When too many people talk at once, my skin starts to feel like it’s buzzing with electricity, or like I’m covered in itchy wool that I can’t strip off.” – Anon

Altered Sensations and Perceptions Can Lead to Fragmented Realities

Sensory differences cause distortions making the world lose its cohesion and understanding.

When I showed a child page (A) of line drawings and asked him questions regarding the drawings, he described seeing something like (B) or (C).

When I asked another child to read page (D) written in Hebrew, his mother tongue, he struggled and described seeing something like (E) or (F).  

Imagine the difficulty and the feelings trying to keep up with everyday learning tasks in school, or when trying to read street signs, instructions, or their screens. Or seeing distorted faces and expressions.

Smell and Sound

When we walk into a dentist’s office and immediately detect the unusual and often unpleasant odors of metallic “tooth dust” from drilling, strong antiseptics and disinfectants, latex, the smell of acrylic or antiseptic, and sometimes odor from infection.

Now imagine a child who senses and perceives certain smells in bathrooms, cleaning products, perfumes, particular foods, and even the natural scent of another person’s body, which are far more intense than your unpleasant sensations. The area becomes overpowering and seems inescapable.

Babies crying, wind rushing, thunderstorms, dogs barking, birds chirping, cars and trucks whizzing past, factory sounds, playground shrieks, too loud, too long, too uneven, too inescapable, uncontrollable and unavoidable.

The sensory-defensive child’s nervous system does not easily filter background from foreground. Everything is foreground.

The Cognitive Cost

When the environment is perceived as surprising, distorted, overwhelming, chaotic and crushing, the brain diverts resources toward self-protection. Fight. Flight. Freeze. Under such conditions, problem solving, language retrieval and social interpretation and interactions become much more difficult.

A child may appear oppositional when refusing to enter a noisy gymnasium. Defiant when declining to wear certain fabrics. Aggressive when pushing away a peer’s light touch. Avoidant when escaping the cafeteria. Mentally deficient when unable to follow multi-step instructions in a noisy, crowded, fluorescent-lit classroom or shopping mall. This happens when the child’s nervous system is overwhelmed.

Neurotypical children and adults also experience diminished cognition under sensory strain and an overwhelmed nervous system. Try completing tax forms beside a jackhammer. Try learning a new language while someone repeatedly flicks the lights on and off. The mind narrows. Irritability rises. Empathy thins. Patience and perseverance evaporate.

Neurotypical adults can experience sensory discomfort, but the effects are usually temporary, not pervasive, and rarely overwhelm basic cognition or social engagement unless extreme. In contrast, many neurodivergent individuals experience sensations that disrupt attention, trigger anxiety, alter social engagement, and demand avoidance or escape.

Too Fast, Too New, Too Different

Novelty can intensify perception. A new classroom. A substitute teacher. A rearranged bookshelf. Books on a desk in a different order may register as too different, too unpredictable.

Wind on the face may delight one day and distress the next. Balloons floating above a birthday party carry the implicit threat of explosion. Traffic jams or thunderstorms may be irritating events for some but may be just too much for sensory defensive children.

A boy we worked with refused to enter a classroom if he saw books on a desk or even on shelves. He refused to enter bookstores or libraries. The mere visual sighting of a book set off autonomic nervous system stress reactions. There was an adrenaline release, his heart raced, he began rapid breathing and would run away until he felt safe. He told me “books looked like monsters.”

Sometimes, sensory overload and sensory distortions are the result of build-up rather than an isolated sensory event. The shutdown or the meltdown may be building over time. Parents, caregivers, teachers, and therapists need to read the child, recognize signs, help the child to prevent overload if possible, and know how to help when necessary.

Misunderstanding and Mislabeling

When subjective sensory experiences are not experienced in the same way by others, the unusual behaviors of the child with sensory and behavioral differences, and their parents’ child-rearing, are judged. A child who covers their ears during passing bells may be seen as dramatic, attention-getting, weak, or “weird.” One who resists hugs is perceived as cold. A child who melts down in a supermarket is judged by shoppers as spoiled.

Without understanding, negative feelings and responses by parents, siblings, caregivers, teachers and therapists may escalate. They may demand compliance where accommodation is needed. They may interpret withdrawal as rejection, when in fact the child is frightened and hurt and trying to protect themselves.

The child, sensing repeated misunderstanding, may isolate themselves and internalize shame. “Why is everyone else fine? What is wrong with me?”

Certain automatic, involuntary behavioral responses can be set off by negative and aversive sensory experiences. Somewhat surprising to onlookers, similar involuntary behaviors can also be triggered by positive and pleasurable excitement created by idiosyncratic sensory experiences. Jumping up and down, spinning, rocking back and forth, finger flipping, squealing, grunting, shouting, drooling, scratching, running, crying, desk pounding and many other stimming-like behaviors may in some cases be motor responses to positive sensory experiences, or to much enjoyed, or much anticipated, objects, persons or activities.

Assessment and Better Understanding

When connecting with sensory-divergent children do not minimize their experience. Do not say things like “It’s not that loud” or “You’re overreacting.” To support sensory-divergent children adults must first shift from a critical behavioral perspective to a perceptual one. Instead of asking “Why won’t this child comply?” ask, “What might this child be experiencing?”

Assess and Evaluate what Changes in the Environment, and in Ourselves, help to improve this child’s Sensory Experience and Quality of Life

Help to Reduce Sensory Intensity and Triggers Where Possible

• Provide noise-canceling headphones during passing periods or assemblies.
• Offer clothing without tags, allow preferred fabrics. Involve the child in preferred clothing choices.
• Use natural lighting when feasible; reduce flicker from fluorescent lights. Reduce glare. Offer sunglasses or hats with brims.
• Reduce clutter and distractions
• Prepare the child before alarms, drills or transitions. Help support and calm the child.
• Use calmer, clearer, slower, familiar and soothing communication.

Increase Predictability

• Signal transitions gently rather than abruptly.
• Make changes in routines gradually, in small increments, for the child to get used to.
• Use visual schedules.
• Use understandable gestures and clear facial expressions to supplement verbalizations if necessary.
• Organization and structure is reassuring as long as it does not become overly structured.
• Balance predictability with slight variations.

Respect Bodily Autonomy

• Ask before hugging or touching.
• Allow alternatives to eye contact if the child is sensitive to it, (looking at your shoulder, or forehead, instead of directly eye-to-eye, or possibly allow drawing during conversations, etc.).
• Offer choices in bathing and grooming routines when possible.

Create Sensory Safe Zones

• Help the child learn their personal triggers.
• Provide quiet corners at home and in classrooms.
• Permission to step out of overwhelming environments and to re-enter when feeling secure and regulated.

Form ongoing Close, Trusting, Empathic Interpersonal Relationship and Safe Bonding Relationships

• Together with the child, find ways to help the child face uncomfortable sensory experiences and help the child find accommodations and coping mechanisms that may reduce their anxiety and help build self-confidence and resilience.

Health and Wellness

• Regular and thorough medical assessments
• Help improve sleep and rest, nutrition, daily movement and exercise, opportunities for fresh air and temperature adjustment
• Deep breathing instruction for stress reduction
• Nature
• Creativity

Adjust Communication

• Speak in calm, measured tones.
• Use clear, concise language.
• Avoid escalating volume in response to distress.
• Does adding visuals improve auditory processing?
• Does adding gestures non-verbal cues improve auditory processing?

6. Reframe Behavior

• Interpret stimming or avoidance as communication.
• View sensory based meltdowns as neurological overload, not manipulation.
• Help the child understand their feelings.
• Help the child learn alternative and implement alternative behaviors if sensory overload reactions are unsafe or dangerous to the child or to others. Parallel Assessment will help you determine specific goals, priorities, prerequisites, strategies and progress (evaluations of outcomes)

7. Regular and Frequent Joyful Activities

• Interactions and activities so motivating, interesting and fun that they help to offset the difficult times
• Nature
• Creative Activities

8. The Child Needs to Feel they are Understood, that they Matter, that they are Appreciated and Valued

• The child needs to feel connected and not just cared for.
• The child needs to feel agency and purpose in their lives.
• The child needs values, responsibilities and a positive identity.
• Feelings of worth and self-confidence increase feelings of belonging, and vice versa.

9. Investigate Sensory Assistance Devices

• Low-Gain Hearing Aids
• Noise Cancelling Headphones
• Irlen Lenses (Irlen Spectral Filters)
• Weighted Blankets
• Deep Pressure

Neurotypical caregivers, teachers and therapists who also experience unusual and possibly aversive sensory issues, including siblings and family members with sensory issues, are often the most sensory aware, intuitive, empathic and successful mediators.

Parallel Assessment of Each of the Child’s Interactive Developmental Domains

This OM blog post on Parallel Assessment and Sensory Integration focuses primarily on children’s Sensorimotor Developmental Domains. But this is only an introductory discussion of some sensorimotor functions. Parallel Assessment involves further investigation of the many important interactive linkages between the child’s sensorimotor domain functions and the reciprocal influences between each child’s sensorimotor domain and all of their other developmental domain functions and interactions: sensorimotor interactions with emotion/motivation, cognition (attention, memory, executive functions, etc.), social/interpersonal and communication and their enrichment and development through enjoyable real-life activities.

In later OM blog posts, we hope to discuss the assessment of a child’s interactive developmental domain functions and how this information helps us connect with, and mediate with, the whole child we are assessing.

Copyright © 2025 Shlomo Chaim    

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