Pediatric Occupational Therapy in Charlotte

Children who have difficulty with fine motor skills can better develop them by utilizing basic toys such as play-doh or putty, coloring, and playing other games. Development of the grasping skills that come naturally with learning to manipulate small or challenging objects in a variety of ways is imperative for appropriate and successful development of the grasping skills needed for writing, dressing, feeding oneself, and a variety of other every day activities including bathing and hygiene performance. 

Children who have difficulty with social skills can often benefit from being given appropriate opportunities and venues for interacting with others their age, participating in activities, developing and executing games and crafts, and completing a variety of tasks which require social interaction for best success. These activities also require development of self-control and self-regulation in order to participate with others, sustain attention to complete a task, and behave appropriately and successfully throughout a task while interacting with others.

Children who have difficulty with executive function can benefit from activities such as those that require appropriate sequencing for success, following directions, and execution of a variety of skills such as cutting, writing, and coloring. There is skill involved in cutting and pasting a picture together. It requires not just the control and coordination to color within the lines, cut on the lines, and then paste the objects to the paper where intended. It also requires developing a plan of what order to best color, cut and paste those items; where to do these things, as well as developing an accurate mental picture of the end product (either by using an example or better yet by using your imagination and problem solving skills) and being able to reach that goal. It requires children to develop a plan and execute it.


We have a lot of fun "playing" here in OT at C&FD.  Your children don't usually even know that they've learned the fine motor control and coordination as well as the self-control and social skills required to execute a plan that they learned how to develop all on their own and couldn't have done before they came to with us. 

As an adult with proprioceptive hyposensitivity, I find myself seeking proprioceptive input. Typically, this is a type of input that can be calming and organizing. Most people are calmed and feel better able to function if they are stressed and they get proprioceptive input. This can come in many forms and variations. Proprioceptive input is given in different degrees by hugs, wrapping yourself in a blanket, sitting criss-cross or crossing your arms and squeezing yourself, water from a bath, wet tactile activities such as finger painting or playing in mud, using vibrating massagers, swimming, running, jumping, or climbing.

I have learned that in order for me to feel calm and organized throughout the day it is important for me to get the proprioceptive input that I need on a regular basis. I run, swim, do yoga and aerobics or go for walks. You may notice these are really all solo activities, I have found that group sports are too overwhelming for me. Getting this physical activity is something helps me feel like I’m on an even keel throughout most days. When I first started to be more active it was for health reasons. I found in time though that I felt much more able to handle stressors, I was not as sensitive to inputs that used to overwhelm me easily, and I was happier overall as a result. I also noticed that if I did not get this physical activity on a regular basis I would begin to feel more sensitive to inputs again and be more easily overwhelmed and generally uncomfortable. 

As a child with proprioceptive hyposensitivity in the classroom, when I had to sit all day without any proprioceptive input that I needed, I began to feel uncomfortable and stressed. This was distracting and gave me a lot of anxiety in school and social situations.  

You might think I could have gotten this need satisfied in gym class or on the playground, but think about the other sensitivities I’ve described to you. I’m visually and tactilely over-stimulated and these are very strong motivators for me to avoid physical activities. Different people will have different levels of sensitivity. For me, the visual and tactile hypersensitivities are stronger than the proprioceptive needs that I have. This meant that I would not easily get the proprioceptive input that I needed. This resulted in me feeling clumsier and more awkward than my peers. 

Ultimately I was left feeling uncomfortable in my own skin most of the time. I had to think a lot about how to move my body appropriately to participate in activities. I had to learn to accept and cope with overwhelming sensory inputs because I didn’t know how to make them feel more manageable.

First, what is the proprioceptive system? In every joint in your body is a sensor to tell your brain what position that joint is in. These sensors are stimulated as you change your position and as you move throughout the day. 

I am hyposensitive to proprioceptive input. I was a child who sought proprioceptive inputs. As a child I was happier to be hugged tightly instead of lightly. I was sometimes too rough when playing with toys or other kids, and I frequently felt clumsy.   I was often told to be more gentle, more quiet too now that I think about it, and had to learn to grade my movements. Grading your movements means to touch items with appropriate pressure and be able to modify that pressure appropriately, or to adjust your movements to be appropriate in size for the task at hand. 

I was the child in my family who my mom referred to as “strong like bull” because I would always do heavy work like throwing bales of hay or moving furniture from one end of the house up two flights of stairs to the far end of the attic. These chores were a form of heavy work and when I wasn’t required to do them for a while I found myself seeking, and satisfying, that need for input by rearranging my bedroom furniture.  

As an adult with tactile hypersensitivity I have never bought sheets or towels without feeling them first. I buy my clothes online from very few stores and very hesitantly at that since I can’t feel them first. In fact, the only store I shop for clothes at online, my mother bought clothes from first so I happened to know what they would probably feel like in advance. When my husband and I go to home décor stores I touch all of the towels, throw pillows, and blankets. It is not at all uncommon for me to find the softest throw pillow or stuffed animal in the store and carry it around for our entire shopping trip. Thankfully, my husband tolerates this as long as I don’t expect to buy these things. 

I’m very particular about the items that touch my skin. I can’t fall asleep if the sheets on the bed are crooked because if there is more blanket hanging off one side of the bed (and me) than the other then I can feel the unevenness in the weight of it. I’m picky about our furniture, our floor and window coverings. Most of the textured items in our home are bought with the feel of them being the primary concern, even above what it looks like. 

I am hypersensitive to tactile input. As a tactilely hypersensitive child this meant that often playing dress-up was not as fun for me as for other kids because I would be easily distracted and deterred by the scratchiness of the cheap costumes that are typically used for dress-up clothes. I never liked to wear hats because they would press my hair down. I spent a lot of my time in older baggy clothing even though my girlfriends were wearing more feminine outfits. I hated to wear stockings, ruffles, tulle, zippers, new denim, or to walk on rough carpet. 

As a tactilely hypersensitive child I was always very aware of how close other people were to me. I would be worried about them touching my unexpectedly and it would distract me to the point of losing track of what to do in an activity if someone bumped into me or was too close to me. I was also distracted by my own clothing and shoes. 

Typically light touch is something that most people don’t like. A firm touch is more soothing and welcome. If a child is hypersensitive to touch you can imagine their difficulty interacting in a busy classroom or on the playground where it’s difficult to predict what they could bump into. 

A tactilely hyposensitive child may be seen seeking tactile input. They may be fidgety or constantly touching all variety of items in their environment. They may be less aware of different tactile inputs such as if their hair isn’t brushed straight, if their clothes are twisted, or if a sock is missing or inside out. These children may play more roughly or be less aware of injuries such as scrapes or bumps. 

As a child with auditory hypersensitivity, I disliked going to the lunch room at school. I would cringe in my seat in the auditorium during assemblies and anxiously wait for when everyone hushed for a performance or assembly. It was very difficult for me to follow a conversation if there was too much background noise, such as socializing in the hallways or during small group activities.

If people were making noise during a test it was difficult to concentrate on my own test. I frequently missed verbal instructions in class and always hoped for written ones. If there’s background noise while someone is giving instructions I have often had to have them repeated several times over. 

A hyposensitive child may be seen to seek out auditory input such as seeking noises for the sake of hearing the noise. These kiddos are less likely to respond immediately when you call their name or if there is a sound in the room whereas other kids may answer to their name or look toward that sound to find out what it is. These children may have more difficulty being aware that they need to adjust the volume of their voice. They may feel like they function better in busier environments.

Children with auditory hyposensitivity may also have difficulty in a classroom setting, for example, if there is suddenly too much noise going on around them. As a result of not having a typical sensitive to auditory input, these children may be less familiar with processing a variety of auditory inputs. This means that they may be less familiar with different sounds, and with this inexperience they also are less skilled at tuning out unwelcome sounds. This can impact their ability to focus in a school setting. When they are suddenly hearing a lot of noise around them they may have difficulty regulating the noises and can be overwhelmed. 

I am mildly hypersensitive to auditory input. This means that on some days, when my sensitivity is higher, a voice at a typical volume can grate on my nerves. It can sound too loud, even though I know it’s not. This can be so upsetting that it becomes difficult to participate in conversations or really listen to what a person is saying. 

It can be described as painful to listen to sounds that should not be unwelcome. Even though the sound is not actually physically hurting me, my body still interprets it as a painful stimulus. If I can’t adjust the volume or sound somehow to be more tolerable then it can be upsetting enough to make me cringe, or cry, or get angry.

It’s not just about the volume of a sound either. I also dislike music that is at a quick tempo, such as when they change the beat of a pop song so that it’s got a faster tempo for a dance club to use it. If I hear that type of tempo then it can be such a distraction that I can’t focus on anything else. When people talk too loudly it makes me flinch and it’s difficult for me to adjust to. I startle easily at unexpected noises. I will even at times cover my ears while someone (who is familiar with me and won’t judge me poorly) is talking too loudly and won’t lower their voice. 

A child with vestibular hyposensitivity may be seeking vestibular input in order to stimulate their vestibular system. Vestibular input can be very alerting. This means that it can help to increase attention and energy level. Due to how alerting it can be, balance should be sought when giving vestibular input because it can make some children very alert to the point that they have trouble sitting still or learning. It is also a particularly important type of input for us to maintain eye contact. 

Children with vestibular hyposensitivity may have difficulty learning situations. This can be observed in the classroom if a child is constantly moving in their seat because they’re seeking input. This need for movement could be similar in social situations as well. For example, a child may have difficulty sitting to play a board game or for creative activities due to their need to participate in big movement activities instead. 

Some hyposensitive children need vestibular input, such as from swinging, in order to be alert enough to learn successfully. If they are hyposensitive to vestibular input then they may likely need more of this type of input, either in intensity or frequency, in order to satisfy their system. Our systems rely on vestibular input to keep us alert, and aware, and enable us to maintain good eye contact and posture more naturally. Children who are not getting the level of vestibular input that is appropriate to satisfy their systems may have difficulty attending in a classroom setting or appropriately engaging in social situations.

In addition to the classroom difficulties (such as difficulty attending or being alert) they may also have difficulty interacting with peers if they are not receiving the input they need. If they need vestibular input in order to be alert enough to learn, it follows they may also need it to be alert enough to socialize and interact successfully.

Children who are vestibularly hypersensitive are likely to be easily overwhelmed by movement activities. This overwhelming feeling can be similar to anxiety and to children can feel simply scary. They may avoid playing on swings or participating in any jumping or tumbling activities. 

This can have an impact on their ability and desire to participate in activities such as in gym class or playing with their peers on the playground. These children likely don’t understand why they feel the way that they do, why they’re so afraid to use the swings or slides when their friends are all having such a good time. 

This can have a negative impact on their emotional and social development as a result of their insecurities and their discomfort within their own bodies. This can have an impact on the development of skills that require balance and coordination and are naturally developed during typical movement and play experiences.  

Since they are so sensitive to movement input, situations where they need to balance or adjust their body in a specific way can be more difficult or challenging. This extra challenge can be due to the distraction of being overwhelmed by the movement they’re feeling. It’s definitely more difficult to perform an activity if you’re under stress or feeling fear while you do it. 

First, what is the vestibular system? This is the system that, generally speaking, tells you when you’re moving. How is it impacted? It is stimulated by giving input to the inner ear. There are three semi-circular canals inside of each of your ears that sense which direction you’re moving. For example, they let your brain know if your body is moving around in a circle, forward, or side to side.

I have no significant sensitivity to vestibular input that I’m aware of. The visual and vestibular systems are closely connected because typically you are not only aware that you’re moving by how your body feels, but also by what you see moving passed you as you move within your environment. Those two inputs typically work closely together to tell you about your movement. My visual sensitivity results at times in my feeling as if I’m moving even though I’m stationary, for example if I’m watching a camera pan around a room or down a mountain it can make me feel like I’m moving with it. 

I am able to feel motion sick due to visual input, but not vestibular. This means that if I feel motion sick, all I have to do is close my eyes (to shut out that visual input) and it will go away. Children who are hypersensitive to vestibular input, on the other hand, would not be able to just close their eyes and be okay. They may actually be more comfortable if they are able to see some steady object to use as an anchor of sorts, and closing their eyes would make everything feel more intense as it would deny them that visual anchor that allows them to feel more stabilized. 

As an adult who is hypersensitive to visual input, I don’t ride roller coasters. I am able to go to an amusement park and watch my husband on them, but the few times I have been brave enough to go on them I’ve gotten off crying and had to keep my eyes closed for the ride. I can go to concerts but I make a concerted effort to be in a section with nicely anchored seats to organize that crowd, as opposed to a standing room only area. Once the lights go down and the show starts the lighting enables me to focus on the stage alone and visually tune out the crowd. I prefer to get to the movies very early so I can find a seat and watch the crowd of people come in and fill the theater slowly, this is much better for me than walking into a crowded theater and having to look around to find a seat. 

I don’t like to drive at night, the headlights are in much sharper contrast and then more overwhelming than driving in daylight. My outfits almost never have bright colors. I own no printed or patterned clothes, except for a few gifts, only organized stripes or organized writing. I am very aware that the right hand margin of this text is not in a straight vertical line to match the left side. 

These details or quirks can at times impact my ability to socialize, how efficient I am in the work I produce, the stores I’m willing to enter, and what time of day and where I’m comfortable driving.   At this age I have learned a lot of coping skills to enable myself to participate in all my chosen activities. Sensory sensitivities are important to treat and work with when they limit your ability to participate in desired activities. Some days I am limited, but most days I am able to participate in spite of this.

In the classroom, children who are visual hyposensitive may be seeking visual input in order to get needed stimulation. These children may appear to be easily distracted if they’re seeking visual input and attending to that need rather than attending to classroom activities. They may have a very hard time switching between looking at the board and looking at their paper because there are so many fascinating things for them to look at when their eyes are travelling between the board and their paper. 

If a child isn’t seeking visual input for stimulation that they feel they are lacking, but they are hyposensitive, then they may be less likely to notice changes in their environment such as visual cues that help them to participate successfully. This can be because the visually hyposensitive child requires a larger stimulation in order to be aware of a new input. For example, an average child may notice a light turn on even if it’s a dim light; whereas a hyposensitive child may need that light to be a very bright one in order for the change in light in the room to register for them as being something new or different. This is similar to a smell or a sound needing to be strong enough for you to notice it, visually hyposensitive children may need much stronger than typical visual inputs in order to be aware of changes or details. 

A hyposensitive child may appear to have a few different things going on. Some children who are hyposensitive may appear to simply be unaware of the visual inputs I described before. For example, they may not seem to notice when the lights come on in a dim room, they may not notice if someone enters a room, if something changes in their environment, if there is a large busy crowd instead of a small group, or if something in their environment is moving. 

At the same time, some children who are hyposensitive may appear to be seeking visual input. This would mean that all of those visual inputs I described as things that I dislike or avoid, these children may be seeking them out within their environments. They may be watching the fan more than other children typically might or the blinking lights. They may be absorbed in watching all of the people moving within a busy room because watching all of this movement is stimulating their visual system in a way that they are craving because they are not as easily stimulated as their peers.

As a child with visual hypersensitivity, when it was time for recess my favorite part was when everyone was still in line waiting to be released. Getting on the bus at the end of the day gave me anxiety. I was happiest when it was time for everyone to sit at their desks, I was miserable in those moments where kids were milling freely around between activities or during social times. 

You can imagine from what I’m saying that it was difficult for me to interact well with my peers. I was the shy kid and I was awkward within myself. Even if I was naturally shy to begin with, because of how easily overwhelmed I was, I avoided social situations and this resulted in it being more difficult for me to make friends and interact successfully with people as I got older.

Not interacting with peers meant less running, jumping, climbing, baseball, basketball, soccer, dancing, etc. I am now not good at group sports. They’re very hard for me. Avoiding these activities resulted in not developing skills that maybe I could have had. Maybe I’m not well coordinated, but maybe I could have been a good enough ball player in school if I’d been able to get myself up to the bat.

Ultimately the negative impact of being visually hypersensitive as a child was inhibited development of social skills and physical abilities. Children are supposed to play freely and easily with other children. If we’re not doing that, then there is reason for concern.

I am hypersensitive to visual input. For me, this means that crowds of moving people give me anxiety because they are so overwhelming to look at. I get motion sick sitting on my couch watching the cameraman on House Hunters pan from the tippy-top of a Miami condo building all the way down to the ocean. I’m not afraid of heights and would even love to go sky-diving, but I can’t look down. I can ride a roller coaster but only if my eyes are closed from beginning to end so I never see it move. I have anxiety at concerts if I’m in the packed lawn area, but if I’m in an area with fixed seats where people move less I’m okay. The vibrations from the concert music, since it’s usually so very loud, help me modulate my sensory systems. That’s another blog post you’ll see later. Blinking lights agitate me, fans give me stress, and I really don’t like strobe lights or the light up spinning toys that a lot of kids like. I can’t watch when my husband, who is a sensory seeker, taps his foot while he’s sitting next to me.

All of us have our own sensory preferences and sensitivities. Some of us have sensitivities that fluctuate, or appear to be at both ends of the spectrum of hyper- to hypo-sensitivity. Just as on some days people are more tired or awake, or more irritable, calm, hungry, happy, etc. than on other days our sensory difficulties are stronger on some days than others. 

Being able to develop coping skills and a healthy and appropriate sensory diet can assist in keeping these sensitivities within the realm of successful functioning. A sensory diet can assist in keeping a person on a more even keel, rather than having them wake up and unexpectedly be so sensitive for the day that they can’t function successfully. 

Imagine being in a room of crying infants. If you have a normal sensitivity level to noise, or auditory input, then you will likely have several minutes before you begin to feel utterly overwhelmed by the noise. In that time you are able to take stock of the situation and begin to problem solve. You are able to take the time to see an end to this problem and hopefully sort out how to get there. This is important because once you get to that tipping point where the noise is intolerable, then that noise becomes so distracting and overwhelming that it makes problem solving, and thus coping, very difficult if not impossible. This can be the scenario some kids with sensory processing difficulties, specifically if they’re hypersensitive to a type of sensory input, experience on a regular basis: they enter a stimulating situation and become overwhelmed before they can begin to problem solve or cope and then they just can't cope with it at all.

On the other side of the coin, imagine being in a room and perhaps one crying child doesn’t register right away. If it’s an emergency this can be a problem. Being able to register changes in our environment can be extremely important to our safety and well-being, as well as to the safety and well-being of those around us. Imagine being in a classroom and trying to keep up with the changes that are going on between and during activities. If it’s difficult to register these changes you may be missing a lot and not really be aware of it. This can be the reality for some kids who are hyposensitive to some types of sensory inputs.

As a child, I would likely have met the criteria for Sensory Processing Disorder (SPD). As an adult I am definitely persnickety about some things, and prefer to be in control of my environment. I am also an Occupational Therapist. 

I don’t believe that sensory sensitivities can be “fixed”. We all have our preferences, most of us are able to cope and then still live full lives in spite of these sensitivities. When these sensitivities are a problem is when they limit our ability to participate in our daily life activities.  For example, when a child can't or won't play on the playground because they are too overwhelmed by the sensations they experience there; or if they can't participate in the classroom for similar reasons.

Within each of the sensory systems there are feelings of hyper-sensitivity, or being too sensitive to sensations or inputs, and there are feelings of hypo-sensitivity, or being less sensitive to sensations or inputs. As a child I was that kid who was clinging to my mom's leg. I cried a lot. I’m the one with the tear-stained face in school pictures. I never really wanted to go out on the playground. Recess really wasn’t very exciting for me. I hated going to the mall or the grocery store. Family get-togethers gave me anxiety.  I was a sweet, friendly, child; but I was so easily overwhelmed by my environment. I didn’t understand those feelings and when that tipping point was crossed where it was just more than I could handle I would cry or look for my mom or want desperately to go home or to some other safe and familiar space.  I didn't know how to cope.

If I sound like a child you know, or your own child, or if it even sounds like yourself, I hope you’ll keep reading. My goal here is to talk a little bit about each of the sensory systems that are typically involved in SPD, tell you about my own experiences as a child where they're relevant, and how those experiences have impacted me as an adult.