In this occasional series by Paediatric Occupational Therapist Mariza Ferreira, we consider some of the sensory, motor coordination and emotional regulatory issues which could be affecting children with high learning potential.
A few years ago I worked with a 6 year old boy who had Dual or Multiple Exceptionality, in other words he was cognitively very bright but he also had a special educational need or disability / SEND which was stopping him from reaching his full potential. Amongst his difficulties, he struggled with tactile hypersensitivity. This means that he had a very negative reaction to being touched because, instead of perceiving everyday touch sensations in the normally expected way, his brain was telling him that it was a threat to be dealt with. So he was generally on high alert for anyone or anything touching him. I kind of forgot this one day at the start of one of his therapy sessions, and when he succeeded in an activity I naturally put out my hand and said, “High five!” Well, instead of high fiving me back, he just looked at me as if I had lost the plot. My initial reaction was that I thought he was rude, replaced straight after by my OT-hat-on-reaction of realising he didn’t want to touch my hand as he naturally avoided touch. So I adjusted and high fived my hand with my other hand!
I seem to often revert to telling people about this experience when I explain tactile sensitivity, as I feel it is a simple but powerful illustration of both tactile hypersensitivity and how it can negatively impact others’ perception of a child. We rely on our tactile systems hundreds of times a day to give us information about whether the “world” we are interacting with is safe or whether it is a threat to be avoided. When our tactile sensory system processes touch (through receptors mainly located in the skin) correctly, we are able to have an appropriate reaction. So when there is something truly dangerous or threatening in our environment such as a hot plate, we will immediately pull away when we accidently touch it. Similarly, when there is something not dangerous or threatening, such as wearing long sleeved tops, our brains will just ignore it. Furthermore, our tactile systems help us to discriminate the characteristics of the objects we are touching which of course goes hand in hand with having learnt about an object first.
You can probably see how interpreting tactile sensory information correctly is crucial to a child feeling safe in his own body in order to allow him to interact with his world to learn, develop emotional resilience, bond with others and develop socially. And it will hopefully make sense that a child whose neurological system perceives everyday touch as harmful, will expend a lot of mental energy to constantly be on the ‘lookout’ for and trying to avoid touch. This in turn means that they have less mental energy available for learning in the classroom, may not appear to be listening to what you are saying, and are often prone to being misunderstood by others. Over the years of working with children with tactile hypersensitivity, I have noticed that they typically display the following behaviours:
● Aggressive / lashes out at other children when standing in a line
● Hits other children when sitting on the carpet during circle time, or physically swings their arms in wide arches when sitting down (younger children)
● Flinches and/or pulls away from being touched
● Meltdowns when unexpectedly touched from behind
● Reluctant to participate in messy activities / using only fingertips / asks to wash hands immediately after an activity is completed
● Refusing to wear long sleeved tops or jackets, trousers or even socks despite very cold weather conditions
● Seems fidgety and constantly pulling on clothes.
I know from working with these kids that they do not want to have these types of behaviours. They have a fundamental need to ‘fit in’ and ‘be good’ but they cannot help themselves as the “protection armies” in their brains are in control. It is our job to help them deal with tactile hypersensitivity as best we can. Doing this can be very straightforward or very difficult – depending on whether they are dealing with other sensory processing difficulties, physical difficulties or emotional problems. There are various approaches that occupational therapists will use, but working with teachers to make some basic adjustments in the classroom environment is a crucial part of helping these kids. I have written down my four top tips for you as teacher, which I trust will help you:
Top Tip One
Allow the child to stand either at the very back or front of the line. This way she can survey her environment and feel safer in the knowledge that she won’t be bumped accidentally by one of her classmates. Similarly, during carpet time, let the child have a designated space to sit on such as her own ‘mat’, leaving enough space around her to avoid accidental touching by other children. It can also help to sit the child near you or on the edges of the circle. When you are not sure exactly where to sit the child try talking to her about the options available. You may be surprised that she knows exactly where she will feel the most comfortable.
Top Tip Two
It goes without saying that we should always respect a child’s personal physical boundaries. But when you do have to touch a child, approach him from the front whenever possible and give ample warning. For example, when you want to help a child to learn how to write by giving ‘hand over hand assistance’, say something like, “X, I am going to place my hand over yours to help you make this letter”. Alternatively, you could opt for offering the child to place his hand over yours as you form the letter.
Top Tip Three
When you are doing a messy activity in class, tell all the children at the start that they can wash their hands immediately after they have finished the activity. In addition, it is a good idea to have some disposable gloves to hand so that the child can wear this during the activity if she wants to.
Top Tip Four
Helping a child who struggles with wearing clothes because it hurts him, is difficult in the classroom context. However, when you notice some behaviours that you think are related to tactile hypersensitivity, it is essential that you have a conversation with the child’s parent/s or carer/s. Parents are often acutely aware of the problem, and may be able to offer some advice on the strategies that they use at home – such as buying seamless socks for their child and removing all labels from clothing. You can then make some concessions at school such as allowing the child to wear their own socks during PE lessons, instead of expecting him to wear the particular PE kit socks. If you speak to parents and they have no idea that their child may be tactile hypersensitive, then it is important that you encourage them to look into this matter further, and perhaps get the advice of an occupational therapist.
Look out for my next blog, in which I will explain how you can help THAT child who is struggling with visual sensory processing.
Your specialist Paediatric Occupational Therapist
Mariza Ferreira is an independent specialist children’s Occupational Therapist, who runs The OT Company. Her motto is ‘Change The World One Child At A Time’. Mariza received the Above and Beyond Inspirational Therapist Award in 2019 for her work with children with high learning potential or dual or multiple exceptionality. Discover more about her online courses at https://the-ot-company-online-courses.teachable.com/ and find out more about Mariza in her blog One Occupational Therapist’s Journey into Dual or Multiple Exceptionality.