Strategies for Tactile Defensiveness!

                                                     

Touch is the first sensation that starts developing in the womb at five weeks. Some children react adversely, negatively or display  escape-like behaviour on being touched, hugged or kissed since they have difficulties in processing sensory information due to the poor tactile system. This behaviour is referred as Tactile Defensiveness.

Due to the inaccurate functioning of touch mechanism and neural system, these children are often in the state of 'red alert'. They may react by clinging or complaining (fright) to someone, or lashing out (fight) and running away (flight).

Often children displaying tactile defensiveness may also have self-stimulating behaviour. Repeated movements such as hand flapping, body rocking, hand gazing, spinning have been found prevalent in children with developmental disabilities and Autism.

Research done by Feig et al (2012), concludes that there is a significant relationship between Tactile defensiveness and Self-stimulatory behaviours.They both are problematic as they appear and interfere in child's day-to-day activities. For example, a child who engages in hand flapping may not be able to do any other activity such as washing herself or eating on her own. Likewise, due to tactile defensiveness doing teeth-brushing or other self-care activities will be difficult.


Here are some of the suggestions for tactile defensiveness which may or may not be helpful, as each child is different, however making appropriate changes within child’s environment or strategies according to his needs and priorities can support him to live better and stay calmer.

A) Understand your child: (Address child's issues seriously= Trustworthy relationship + better behaved child)

Most importantly, it is parent’s responsibility to understand their child and her problems. Giving labels such as she has "bad behaviour" or "poor "attitude will not solve the issue. 

If she says “something always hurts me” or gets irritated due to scratching herself all the time, do not think she is pretending to gain empathy or purposefully trying to seek attention. 

There must be something unusual happening causing her to behave in this manner. 

Developing trust and developing an understanding of child's difficulties are essential parts of combating any problem. 

It will be great if parent and child both stay on the same team as good team players to resolve the issue rather than opponents where parents label the child for being anti-social frequently, and child reacts impulsively and aggressively on hearing those words over and again. 

B) Deep Pressure: (Leads to release of Dopamine or "happy neurotransmitter"= Calm brain & relaxed body)

Firm massage or deep pressure with pillows, cushions or rolling in a weighted blanket is very calming. Parents should understand signals when these strategies are needed. Children having sensitivities are overloaded with touch or noise in crowded places or parties. Parents should be aware of these situations and intervention should be provided before emotional or anger outbursts happens.Children get sleep disturbances caused due to sensory issues.Using techniques like Wilbarger Brushing Protocol  has been found to be an effective way of calming child for better sleep.
This should be under the supervision of Occupational Therapist or consult child's OT before trying Brushing Technique.

C) Weighted Items: (Stimulates body joints & muscles = Improves self-regulation,modulation,stress and anxiety)

Wearing weighted blankets, vests, backpacks or hats can have the calming effect in the classroom as well as at home. Great range of weighted items is available on Amazon such as ankle weights, lap weights shoulder and neck weights. They help to calm down a child in the classroom as well as any other environment leading her to focus on the task and reduce distraction. Weighted blankets are very helpful in calming the child’s distractibility, emotional liability, and hyper activeness. Another very good resource is TFH, South Paw. 
T-Jackets have been found to be a good resource of calming down a child. They have been scientifically customised for providing deep pressure and calming effects. 

D) Safety: (Prevention is better than cure so TAKE-CARE of child!)

Children who are hypo-responsive or sensory seeking towards touch are unaware of bruises and injuries. They do not get pain sensation messages from brain centers due to which they are prone to injuries. They may display self-stimulating or self-injurious behaviours along with tactile defensiveness.The stereotyped behaviours are common among Autistic children. Most common form is motor patterns are hand flapping, body gazing or object manipulation. Temple (1992) in her study Calming Effects of Deep Touch Pressure in Patients with Autistic Disorder, College Students, and Animals has suggested that Tactile Defensiveness co-exists with Stereotypical behaviour in Autism .Sensory Modulation and regulation is an important function which does not work well in both hyper and hyposensitivity of touch.It is important to follow some hands-on strategies such as:

• Use of sensory experiences :Such as trampoline jumping,obstacle course, running
• Follow Routines and maintain structure: e.g., planning a week ahead
• Communication: Understanding child's behaviour in anticipation, environment, emotional liability.
• Visual Support: Emotion's chart, use of PECS.
• Talk to GP about Medication.
• Use Barriers such as using cushions or pillows if the child does head banging,or tie the cloth on his hand to reduce self-biting.
• Use soft furniture.
• Keep rooms safe, the child should not be able to lock himself in a room, windows should not be wide-open.
• Keep sharp objects like knife, fork, scissors, razors out of reach of the child.

F) Fabrics: (Removal of unpleasant sensory input = Relief & physical comfort)

Pay attention to the different fabrics. Following tips may be helpful related to fabrics:-

• Give preference to child's fabric or texture.Some children like to wear cotton and avoid woolens, synthetics or any other texture that might irritate them. 
• Wearing skin fit clothing is preferable than loose clothing. 
• Stick to seamless clothing. 
• Liners and tags are always irritable making child impulsive and distracted easily. Removing or cutting tags is the simple solution for this. 
• As far as footwear is concerned, it should be comfortable and slip on type. Fasteners are also the good option if he finds tying laces complicated.
• Long sleeves are preferable than short arm sleeves. 
• Do not force him to wear belts, waistbands if he doesn’t feel good about it.

H) Active Involvement: (Child knows himself better than anyone else)

Self-directed tactile experiences are more calming then done by anyone else. Therefore, encourage the child to perform activities himself rather than done passively, by anyone else for him, however, assistance or supervision may be needed for completing tasks. After bath let him rub himself or put lotion independently since he can judge well how much deep firm pressure will be calming for self. Make your own Play-Doh at home.

I) Classroom Strategies: (Favourable IEP = Better provisions = Better behaved child + raised self-esteem)

Let the child stand last in a row in school. Let him

sit alone if he gets distracted by other pupil’s touch. Talk to teachers and school management to create awareness about your child’s difficulties. Teachers should know what child is going through and why is he distracted multiple times or scratches himself during the lessons. They should allow the child to do wall pushes or chair pushes if he feels calming during break times. The child should also get movement breaks if the teacher allows.  This should be included in his IEP. http://www.additudemag.com/adhd/article/5894.html

J) Inform before touching: (Respect child's integrity)

Hugs, kisses or any other type of touch should be done with consent. Ask or inform him before touching the child. This reduces anxiety levels and arousal too.Touching without consent can create disruptive behaviour. To know more about cause and neuroscience of tactile defensiveness click here.

K) Heavy Work Activities (Proprioceptive Input): (Tactile + proprioceptive input = calming effects,reduced anxiety,disruptive behaviour)

Pushing and pulling heavy objects such as barrels, carts, large bean bags,
the pile of chairs or pushing another child on the swing. All this 
gives proprioceptive input!

These activities provide deep pressure to muscles, joints, ligaments and key points of the body (Shoulders, Pelvis, Hips) to a tactile defensive child. 
Moreover, giving movement breaks will support a child to concentrate better in studies, such as sending him to an office to handover papers or asking him to distribute assignments in the classroom. See Classroom strategies for more information.

Deep Pressure: Magic of Weighted Blanket!

                                                     

                                                  

John diagnosed Autistic at age of 6 years got admission in special needs school for progressive future. His parents did not inform school staff much about his maladaptive behaviours except being picky eater, impulsive and having tactile defensiveness. On first day to his school, he was introduced to classmates and support assistant (Ms. Johnson) by his class teacher (Ms. Winslet). As the day progressed, John seemed calm and settling within the classroom surrounded by some new friends.

During the lunch-time, Ms. Winslet told him about rules of eating in classroom and ensured that he is doing fine.  John without making any eye contact heard everything and absorbed all in (taking in too much information from new environment,resulting in sensory overloading) while eating his sandwich and nodded head.
All of a sudden, after fraction of seconds, everyone heard John shouting, being physically aggressive on child sitting next to him and crying without listening to anyone. He also bitten the support assistant who tried to stop him from hitting. Due to extreme kicking, hitting, pushing and biting behaviour (physical violence) he was restrained by two male staff members.

School OT intervened and he was taken to therapy room where she wrapped John in a weighted blanket (deep firm pressure) and rolled on floor until he calmed down.

Later, this little man mentioned that he got angry because child sitting next to him was eating crisps and making noise, that John didn’t like!!

Phew!! so, now we know why John behaved in such a manner.

Well, but what happened when he was wrapped in a weighted blanket? How so much angry young man (who needed male staff for restraining) calmed down so easily? Why didn’t he resist to weighted blanket?

This happened due to MAGIC of DEEP PRESSURE!!

Tactile Defensiveness Explained!

                                            

In the last post we discussed about sensory modulation and how it affects tactile system. The summary sheet gives the brief review of different characteristics of hypersensitivity, hyposensitivity and tactile discrimination. 

This post is all about Tactile Defensiveness explanation.

Hope it makes sense to readers!!

Tactile defensiveness means a sensory issue related to unusual sensations or heightened sensitivity when a person or child is being touched anywhere on his or her body. It is a tendency to react negatively and emotionally to touch sensations.

Let’s consider an example of lovely boy referred to me  for Occupational Therapy by a class teacher called as Jack (pseudonym). 
He is 6 years old and has got special needs. The reason for referral is functional difficulties in activities of daily living (ADL’s). The observations made about Jack stated that he is accident prone, drops things from his hands, dislikes hair being washed, or being touched in the face or unexpectedly, prefers standing last in the queue, misbehaves on being instructed, and cannot manage buttons, zippers, laces and ties. He is distractible and hyperactive (home /school environment) which makes his learning difficult. Moreover, he was very impulsive and aggressive on Fridays due to whole week fatigue. He is often in fight and flight mode on being touched or spoken about his behaviour.

Now from above mentioned observations regarding Jack’s behaviour what can be concluded?

Well, the child doesn’t behave well in the classroom or at home.

Is this behaviour due to his attention seeking behaviour or Sensory Sensitivities?

The answer is, Sensory!  It can be hypothesised that he has a disorder in tactile processing, showing tactile defensiveness and poor tactile discrimination characteristics.

Most of the times children with ADHD, Developmental Delay, Autism or Dyspraxia show tactile defensiveness in their behaviours and have difficulties in concentrating or paying attention to a particular topic. Their behaviour is antisocial, not because of their bad intentions but due to lack of parent’s and teacher’s understandings about child’s struggle caused by sensory sensitives. These children avoid touch interactions with other people often exhibiting hyperactive and distractible behaviour at home and classroom in an everyday situation.

Making sense of Sensory experiences, let's discuss another example, how would you feel if you are completely wet from top to bottom and you are not allowed to change clothes rather being asked to focus in a lecture fully. Definitely, you will be unfocused and distracted easily since your clothing is not comfortable. 

Furthermore, consider, no one understands your problem, rather the lecturer in lecture room instructs you to be attentive on the topic and stay calm without being distracted. That moment will be so frustrating for you which can lead you to misbehave or speak rudely with the lecturer.

The same issue happens with our sensory kids, they do not misbehave intentionally or on purpose, however, they are trapped by their own body sensitivities. It will be so wrong to reprimand a child who is vulnerable, frustrated and emotional due to his own sensory issues.

Usually, parents show great concern to Occupational Therapist (OT) regarding child's learning processes and behavioural issues. Mostly, they ask whether their child’s learning will be affected due to TD. 

The answer to this is NO! 

TD does not interfere in child’s learning process academically, socially and developmentally, however, it may cause discomfort leading to (emotional liability, distractibility) behavioural problems that can affect his learning to some extent. The emotionally child has to be given extra attention since TD sometimes makes emotions upset.

Due to tactile defensiveness,child’s In-Hand-Manipulation skills are affected means doing buttons, laces or ties can be difficult tasks.

Sensations received from clothes or their tags can be disrupting in nature. Child in classroom will not be able to focus however will constantly keep on scratching himself all over the body. Avoidance for getting hands messy or dirty in glue or finger paint. He may not like walking barefoot in grass or on sand. Fabrics such as synthetic wool or rough textured may cause discomfort He would like to stand last in a queue to avoid touch from other people and also does not like games such as Tag.

To understand physiology of this system in simple terms, consider that brain as an electric circuitry system which has numerous wires (neurons pathways and fibres) working together so that power supply (appropriate functioning & behaviours) can constantly run in the house. Now imagine, one-day power supply of partial house has stopped suddenly however, it is available in other half of house. 

Electrician is being called and mistakenly he reconnects wrong wires together which results in high voltage (hypersensitivity towards touch, hugs) and current over flow in half of house however no light supply (hypo-sensitivity towards touch, poor fine motor skills) in other half of house.

Since the pathways don’t send appropriate messages in required (correct) brain centres therefore child reacts adversely, negatively and shows escape-like behaviour on being touched, hugged or kissed.

Protective system is automatic reaction whereas discriminative system involves complex refinement in brain. Human body switches to which ever system is needed at the particular moment. Pain sensations activate protective touch system however deep pressure sensations activate discriminative touch system.

The child with TD will do too much of protection of himself so that he does not get any pain stimuli and therefore his discrimination activity will also be less.

Different intervention strategies include Deep firm pressure, Wilbarger's Brushing technique, vibration, heavy work activities, Wall or chair push-ups, swing play or therapy ball exercises for core strengthening.

There are no shortage of resources regarding Tactile Defensiveness,

Sensory integration Network
Sensory processing Disorder


To have a brief description about hypersensitivity (tactile defensiveness), hypersensitivity or Tactile discrimination refer to,
Sensory Modulation & Tactile dysfunction

What is Touch (Tactile) System?

5 key support strategies to express thoughts and feelings among aggressive children!

Usually young ones and teens show anger or aggressive behaviour due to fear of disapproval or rejection. It is essential tackle them very carefully during aggression and emotional outbursts. Here are some tips to support kids in expressing their emotions through different mediums!!

Journals

 Journals: Writing journals or simply using diaries to express thoughts is a simple but very expressive way of communication to your child.Personalised diaries can be used for self-expressing thoughts and feeling.Writing poetry sometimes is very calming medium of self-expression and innovation. This helps in distracting the child from aggression and promotes creativity however can be applicable in teens and adults. Through this medium of communication he/she can express himself/herself without shame and guilt. Key Note: Written Expression supports child to release anger without involvement of any other person. This can be child’s individualism.

White Boards-Great source of expression

White Boards: One more medium of expression can be through white boards! This can be something new and altered source of communication for the young kids. Expressing thoughts, emotions and gestures on white or blackboard can also support in vertical writing practice (Good for core hand strengthening and precise writing). It also improves handwriting difficulties among young ones. Encourage kids to write whatever new they learn in school or other social situations. Using colourful marker pens for drawing or writing can make self-expression more interesting and revealing. Key Note: Great resource for expression for young ones and adults!

Building rapport with yout child!

Winning the Trust: Most essential aspect of thought expression is winning the trust. Usually children hide their feelings since they do not consider parents or caregivers trustworthy to share any perceptions and classroom experiences.

It is important for the parents to spend time with children and listen to his or her words wisely without interrupting or discouraging him or her. Additionally, parents should be capable enough to make child understand marked difference between right and wrong.

Let the child express him without any fear of rejection, guilt or shame. This is parent’s responsibility to understand own child’s behaviour in co-correlation with the given situation.

On contrary, sometimes children pretend to express their whole trust on parents expressing themselves as innocent in particular situation to win parent’s trust. However, parents should be able distinguish when child is guiltless and when manipulative. Key Note: Read between the lines!! Analyse when child is expressing right facts and when he is being manipulative in his thoughts.

Quiet Space Area

Give free space: Concept of free area or space is extremely effective. Provision of quiet space area in classrooms and homes support children to calm down and pacify themselves.

            Space and time to think about own mistake helps them act more wisely next time. During these times they can also be given inanimate objects like a stress ball or sand tray to alleviate the anger. Key Note: This resource acts as self-calming.

How do you feel when Angry?

Emotion Chart: Introduction to emotion’s chart is important. Sometimes children are baffled about self-emotions. Show them pictures of different emotions such as anger, being sad, happy etc. so that they better understand the connection between feelings and self-expression.Lack of understanding of feelings is common among teens also. Therefore, imparting education about different emotions is essential part teaching expressions. Key Note:Understanding of different emotions is imperative!

Aggression among kids and teens!