Tolerating Touch

The top graph illustrates a typical pattern of an adult coping with stress throughout the day.   As anxiety producing events occur, the stress level  spikes.  After the event, however,  the stress gradually reduces and the person resumes a relatively happy or comfortable state.

The middle graph illustrates a person with sensory processing difficulties.  With each new stress related event, the anxiety increases, but never comes back down.  By the evening,  having the unanticipated dinner prepared caused an angry explosion.  Variation from the set schedule was too much for this individual’s system.  The need for routine was so important that appreciation for the kind gesture of a surprise meal was too much.

The bottom graph shows a tactile defensive preschooler unable to manage small stressors during the day.  Note, activities listed normally would not be “stressful” to a regular child.  New shoes and needing to sit in a new location can be extremely discomforting to a tactile defensive child.  By the end of the day, this child refused everything at home.  Tantrums, crying and unreasonable behavior are typical of this child after a difficult day.

How does one become tactile defensive?

Babies with  premature and/or difficult  births and early life histories may be tactile defensive because they lack the movement experiences that help mediate the neurological system.  In addition, the  first sensory input tends to be painful; needles, tubes, bright lights, poking, prodding and the rest.  These things are a necessary evil to keep the child alive, but difficult for the immature  neurological system to cope with.  Defensive reactions develop as a way to cope with the world.

Children who have undergone extended or acute illness/injury frequently develop defensive reactions as well.  When the body is constantly bombarded by painful input, the body learns to automatically react defensively. It is a survival mechanism.  Child with other forms of early traumatic life experiences may also develop tactile defensive behaviors.

Many people are simply born with tactile sensitivities.  For some it is simply discomfort with tags sticking into the back or a scratchy sweater. For others it is life debilitating.

The scientific jury is still out in explaining the cause of Sensory Processing difficulties.  It is known that an immature or inefficient neurological system leads to sensory processing deficits, one of which is tactile defensiveness.

How does one “FIX” tactile defensiveness?

There are several approaches to increasing comfort levels with touch.  Each approach has its own merits and combining approaches is often quite effective.

• Boosting the sensory processing system: This relates to activating the parts of the brain that  manage sensory information as it comes into the brain.  As this system becomes more efficient, the child  can manage touch and other sensory stimuli more effectively.
• Desensitization:  This is a gradual process, in which the child is introduced to a variety of textures and materials and over time, becomes more comfortable in feeling them.
• Compensation:  This relates to helping the individual cope in the existing tactile defensive state.  It may be identifying stressors and finding ways to substitute for these.

I will begin by addressing #1-Boosting the sensory processing system.  In my experience, this is the long term, most effective strategy.  By helping the brain become more receptive to touch in general, learning to manage tactile information improves without the painful “learning to cope” method of sensitization.  Once the system is working better, introducing new touch input occurs with greater success and less “pain.”

Boosting the Sensory Processing System:

The part of the brain that handles incoming touch information has excitation and inhibitory nerve cells.  The tactile defensive child does not have enough of the inhibitory nerve cells working.  These are the ones that go around saying, don’t pay attention to this…don’t pay attention to that …  Imagine Mario Brothers videos with the little brush machine going around erasing things on the screen.

The way you wake up or activate these nerve cells is by moving in certain ways.  We call the kind of movement that stimulates the inhibitory neurons, HEAVY WORK.  Here is a list of heavy work activities.

HEAVY WORK ACTIVITIES:

                            

Photos:  Eileen Counihan

• Lying on the stomach for babies and adults requires working against gravity.
• Wheel barrow walking
• Crab walking
• Rolling
• Scooter board activities – especially on stomach
• Jumping
• Jumping on a small exercise tramp (not a large one)

                                                                               Photo:  Eileen Counihan

• Jumping board

• Rolling over exercise ball

                                                                            Photos:  Eileen Counihan

• Belly or snake crawling
• Crawling
• Climbing through pillows
• Sitting on bean bag chairs
• Pushing/lifting heavy objects
• Modeling Clay work
• Squeezing toys

For older children/adults:

• Push ups
• Weighted Ball activities

ORAL HEAVY WORK:

• Chewing crunchy/chewy foods:  bagel rather than sliced bread
• Cheese cube rather than slice
• Chunks of fruit
• Large wads of gum
• Sucking with resistance:    straws of a small circumference
• Looping straws
• Thick shakes

PASSIVE SENSORY INPUT:

• Applying deep pressure to joints and muscles
• Deep massage
• Rolling exercise ball over body-exerting firm pressure to child’s preference
• Applying “traction” (stretching or pulling movement):   carefully making sure not to injure muscles and joints

                                                                            Photo:   Eileen Counihan

• Hanging is a form of “traction” as the muscles stretch.
• Wrap tightly in lycra or some other stretch fabric
• Weighted vests and blankets

DESENSITIZATION:  This is a process in which the child is exposed to a variety of touch sensations that feel uncomfortable to the child.  Brief exposure gradually extends and the intensity of immersion increases.

Steps to introduce tactile stimuli to a tactile defensive child:

•  NEVER FORCE engagement.
• Begin each session with Heavy Work and end session with Heavy Work.
• Have a towel or sink nearby so the child can readily clean off hands.
• Provide deep pressure to hands immediately before and after exposure.
• Allow one index finger touch and then immediate removal (and cleaning) first time.
• Attempt to increase time and amount of surface area covered each time.

Appealing/ intriguing games should draw the child in to overcome the avoidance.

• Provide rewards for being “brave” and working hard at touching
• Alternate favorite feeling things with difficult things.

Add a discrimination element to the game once the child can tolerate touch.

• Always have a tactile box, bag or basket for self exploration.  Make sure favorite textures are mixed in with difficult ones.  Squeezing toys are important to have in there.
• Make a project of choosing the items to go in the container together.
• Invite the child to use this frequently during the day.
• Items can be common household objects or picked up at local hardware and pharmacy type stores.

 Examples:

• Sandpaper blocks
• Scraps of fabrics
• Plastic combs
• Sponges/scrub pads
• Hairbrushes  and Toothbrush
• Rollers
• Hand towels and face cloths
• Paint brushes/rollers
• Feather duster
• Packaging materials
• Baskets  (textured)
• Cotton balls

Items purchased at local toy stores and novelty shops:

• Vibrators
• Kooshes
• Squiggle Writer
• Textured stuffed toys and textured toys

• Tubes

• Squeeze toys
• Pin Art

• Finger paints
• Gluing activities (e.g.collages)
• Handcrafts-with varied textured fabrics
• Sand art
• Paper Mache’*

*I once worked with a child who would wretch (and throw up) when he had to do a paper mach’ project in art class.  So, tread very lightly when introducing these activities to a child hypersensitive to touch!!
Compensations for Living in a Tactile Defensive State:

Long ago, at a parent conference,  I explained that this particular little girl was suffering from  hypersensitivity to touch.  As I explained what this meant, that dad sat straighter in his chair.  Soon he interrupted.  “I don’t understand where the problem is.  I never go outside without my driving gloves on.”  Case in point, there beside him sat a lovely pair of black leather gloves.

Many human beings go through life with some level of tactile hypersensitivity.  Some people avoid wool, others prefer worn in clothing and tend to choose outfits that have a certain texture.  Many people avoid “gooey”  things and prefer to be very neat.  People who get genuinely upset when tickled suffer as well.  The problem arises when the discomfort generalizes into  every day functioning.  Once the gentleman referred to earlier had his gloves on, he could face the world. If the “leather gloves” don’t do the trick, issues of anxiety, stress and avoidance can plague an individual’s life.

Here are some suggestions on how to cope while working on improving sensory processing of touch.

• Establish set routines related to time and space.  Predictability is key.
• Prepare the individual for events about to occur.

For example:

• “I am going to put this shirt over your head-let’s count together and see how long it takes …1 ..2  3 ..”
• “I am going to rub this sun tan lotion on your skin.  Tell me whether you want me to rub harder or softer.
• “Some friends of yours are coming over to play.  You can stay by my side until you are ready to join in.”
• “We have to mix this cookie dough, tell me what it feels like to you.”

Incorporated into those statements are strategies that help the individual feel in control and focus on concrete elements such as how long it will take, how much pressure, what it feels like.    This gives the child a sense of control over the situation. AND reduces anxiety.

• Careful consideration should be taken in preserving the personal space of the child.
• Sitting at the end of a row or near the teacher at circle time (who is presumably more predictable that the squirming children)
• Carpet squares can help for circle and floor time
• Walk at the beginning or end of a line
• Position desk at end of row, seat at corner of table
• Never sit in the middle between siblings during car (etc.) rides

(Why do you think the center seat is least desirable on airplanes?)

• -Vigilance when others are nearby to make sure the child’s personal space is preserved.

Teach self advocacy strategies to the child:

Help the child understand how s/he feels about certain things and then voice concern when confronted with them.

For example:

• “I don’t like it when you sit so close to me.”
• “I don’t want to use the glue, I don’t like the sticky feeling.”
• “I  do not want to eat the grapes because they make me choke.”

Offer “crutches” when engaged in tactile loaded activities:
For example:

• Provide a towel so hand can be wiped off immediately during a messy activity
• Provide squeezing type objects for the child to hold
• Provide a chewy toy
• While working/playing with the child, provide a firm touch of the hand arm or shoulder.
• Sometimes a big hug helps (these provide deep pressure)
• Always avoid light touch experiences

There are several therapeutic programs to address tactile defensive behaviors and sensory processing disorders.  These require assessment and guidance by a professional trained in the specific approach and/or technique.

A few examples:

• Wilbarger Deep Pressure Brushing Program
• For information on this and Sensory Processing Disorders:  http://www.thetherapyplace.net/newsletter/3_2.htm
• Therapeutic Listening (There are many Listening Programs)
• For a review of these refer to: http://www.otawatertown.com/pdfs/listening-inter.pdf

 ADDITIONAL THOUGHTS …

Many Sensory Defensive children are fearful of animals due to the unpredictable nature of pets.  They smell different, FEEL different and their movements may cause TOUCH contact.  Learning to enjoy animals often helps the child to integrate sensory stimulation, especially tactile.  I have had many children in my practice overcome a fear of dogs by visiting mine.  The lush shiny black fur of Cassie was so tempting that they just had to touch her.

 Cassie enjoying her last snow experience at fifteen.

                                                  The goofy behavior of Phoebe is irresistible as well.

And regarding pets, you can think outside of the box …

                                                                 Willie and Marilyn taking a stroll