Johnny is a difficult child. His parents have had to learn how to approach him so as not to “set him off.” They never do anything on the spur of the moment because Johnny just cannot cope with the unexpected. The entire family adheres to a strict routine so Johnny will be able to maintain his composure. Yet, despite all their efforts, Johnny has at least 5 meltdowns each week, some of them lasting as long as an hour, when he cries, kicks, spits and yells. Sometimes he even bangs his head on the wall. Johnny’s parents are perplexed-they can’t figure out what they are doing wrong.
Carrie has always been slow to start in the mornings, taking almost 2 hours to be ready to interact. As the time for her to go to kindergarten approaches, her parents become more and more apprehensive about how she will fare. As they feared, the first day is a disaster. Carrie can’t get going, does not want to get dressed, and has a tantrum when she is expected to brush her teeth before she is ready. By the time Carrie’s parents have her ready for the bus, she has already had 3 tantrums. They miss the bus and end up having to drive her to school. Things continue to go downhill when they arrive at the school and Carrie needs to go into an unfamiliar building and a new classroom. She clings to her Mom and screams. Carrie’s parents can hear her screams all the way down the hallway as they leave the school.
Are these two children emotionally disturbed, or could there be another explanation for their extreme behavior? Many people are unaware that a dysfunction in the area of sensory modulation can significantly impact a child’s behavior and ability to self-regulate. These children could be experiencing symptoms related to poor modulation of sensory inputs.
Modulation refers to the ability to regulate and appropriately respond to input in the nervous system by staying in the mid-range and not being over- or under-responsive or seeking inputs. This is a neurophysiological process, and it is related to an individual’s ability to maintain homeostasis (internal stability). All of us must be able to both receive and prioritize sensory information from the outside world (what we see, hear, touch, taste, smell) as well as from the internal senses (proprioceptive, vestibular, and interoceptive) and then respond appropriately. Modulation is the process whereby the nervous system adjusts the intensity of responses, so they are appropriate to the situation. When an individual can do this skillfully, he can respond gracefully to life’s stresses and can rebound easily when things don’t go his way. He will instinctively respond appropriately to situations that are challenging. For example, even if he is tired, he will be able to cope with the stress and frustration of a traffic jam by taking a deep breath or putting on a classical music radio station to calm himself.
For children with poor sensory modulation skills, the inability to adjust the intensity of their responses can affect their functioning in many different ways. These are children who get upset easily and are difficult to calm. They tend to have reactions that seem out of proportion to the situation. Even a small upset can literally ruin the whole day. Children with poor sensory modulation often rely on familiar routines to have a sense of control. They seek predictability in their lives because they have difficulty coping with unexpected events or changes in plans. They are also often challenged by having to move from one activity to another (transitions), even as a part of their regular routine.
For the under-responsive child, sensory modulation difficulties may make the child appear extremely passive or disinterested. Or, the child may be compelled to seek additional sensory inputs in an effort to increase her level of alertness.
Sensory modulation issues can cause difficulties with sleep and with maintaining an optimal level of alertness. Some children may have trouble settling down for the night and may take hours to get to sleep. Others may wake several times during the night and have difficulty getting back to sleep. Still others can’t seem to wake up in the morning and get going in a reasonable amount of time.
Sensory modulation issues can also affect social functioning, including a child’s ability to make and keep friends. These children may respond to peers in ways that seem unusual. They may overreact to another child’s perceived insult or they may resist interacting with other children. Peers may perceive the child with modulation difficulties as coming on too strong or may find their behavior off-putting.
When dealing with challenging behaviors exhibited by children, it is helpful to try to determine the underlying causes. For a child with sensory modulation difficulties, unusual or extreme behaviors are caused by a difference in their neurophysiological functioning and are not caused by a personality flaw or a desire to be difficult or to behave badly.
If you suspect that your child is having difficulty with sensory modulation, an occupational therapist with training in sensory integration should evaluate your child. The therapist will be able to confirm the probability of sensory modulation issues and provide suggestions for home management, as well as providing direct treatment. Direct treatment is aimed at assisting the child’s nervous system to improve in its efficiency with processing sensory inputs and in developing the pathways needed for better modulation of sensory input. This will improve the child’s ability to self-regulate and respond to life’s everyday challenges. You may be surprised how much your child’s behavior can improve if you correctly identify a sensory modulation problem and learn how to manage it properly.