A term you may have heard when it comes to sensory processing is sensory dysregulation. What does this mean? Are there clues for dysregulation? We all have differing sensory needs, and dysregulation can look like different things for everyone. Have you ever wondered about specific sensory strategies for regulation to support a dysregulated sensory system? We’ll cover all of this in this post.
Sensory Dysregulation
Remember your last temper tantrum? Do you remember what it felt like to be suddenly so sad, mad, and completely out of control? Most of us probably had our last true temper tantrum more recently than we care to admit.
A majority of those emotional outbursts were probably exacerbated due to a number of reasons; lack of sleep, poor diet, undesirable environment, discomfort, or pain. Deciphering the difference between a tantrum and sensory meltdown is a must.
One ongoing debate in the pediatric therapy world is discussing what behaviors are due to sensory-related reactions, and what behaviors are due to something else. How many toddlers (or teenagers!) temper tantrums may actually be related to their sensory experience? If it really is sensory-based, then what are the solutions?
The OT Toolbox is here to do our best to answer your sensory-related questions. A great first step in determining whether unwanted behaviors are based on sensory experiences, is to learn about what sensory dysregulation is. To get started, here is an article about sensory processing red flags.
Playing a huge role is understanding self regulation and the ability to select and implement self regulation strategies based on sensory needs.
WHAT IS SENSORY DYSREGULATION?
Sensory dysregulation refers to a mind or body state which occurs when the body is out of balance due to experiences in the sensory environment. Think about how sounds, textures, exercise, movement, smells, light, and other input can affect your mood. Sensory dysregulation is the result of either too much or too little stimulation for best functioning or self-regulation.
For example, overstimulation anxiety can be a result of too much sensory stimulation that results in overwhelming worries or anxiety. This is just one way that the overload of sensory input can impact us.
Read more about mood and affect and how these terms are connected to sensory dysregulation.
It’s more than sensory touch and the input we receive through our skin. It’s the inability to regulate sensory input from ALL the sensory systems.
A key component outcome of sensory dysregulation is self-regulation. There are many ways to define self-regulation, but generally, it is one’s ability to remain at an acceptable level of emotion, energy, behavior, and attention – given the demands of their environment.
In order to achieve self-regulation, one must also have good sensory regulation.
Sensory dysregulation is something that anyone can experience, and most people probably have experienced a level of sensory dysregulation to some degree.
Everyone has sensory preferences, like how loud they listen to music, or if they enjoy lots of hugs. If your preference is to have less, your systems would become out of balance with the music too loud or people getting too touchy.
Each of us has our own limits given any situation – but once you are in tune with your body’s needs, you know when it has become too much. When the system is unbalanced, maladaptive behaviors (tantrums) occur, if no coping strategies are implemented. We covered this individualized preferences and nuances of neurodiversity in greater detail in our post on Sensory Diets for Adults.
People with sensory processing disorder, which is an issue on a larger scale that affects a much smaller portion of the population, feel dysregulated more often and have far less ability to self-regulate. While sensory processing disorders can exist in isolation, they may be most prevalent in those with Autism or ADHD.
One example of dysregulation is the individual with sensory needs dealing with a fire drill. There are a lot of sensory inputs all at once, and navigating that stressor is distressing!
Check out our resources at the end of this article for great coping tools!
WHAT DOES DYSREGULATION LOOK LIKE?
Sensory dysregulation, much like emotional dysregulation, feels uncontrollable. Something is “wrong” and a person may not know what is causing them to feel “off”, or how to solve the problem. Sensory dysregulation may look and feel similar to emotional or behavioral dysregulation, that can cause temper tantrums.
The main difference is that sensory experiences are the root cause of the behavioral responses – not social disagreements or the like. It is complicated to tease out whether the issue is behavior or sensory. Look first at the triggers.
A simpler way to understand of sensory dysregulation, is by breaking it down into two categories: over-responsiveness or under-responsiveness to the environmental stimuli.
- Over-responsiveness may look like: sensory avoidant behaviors such as excessive covering of the ears, hiding, avoiding touch, or extreme picky eating. The body may be responding too much to the incoming information. One reaction is to avoided it to, remain at baseline.
- Under-responsiveness may look like: sensory seeking behaviors such as excessive or repetitive body movements, touching everything, making sounds, or licking/chewing on non-food items. Pushing other students while waiting in line. The body may be responding too little to typical input, to the point that the seeker looks for more of it to remain at baseline.
It is important to begin to recognize sensory over-and-under responsiveness and the role it plays in sensory regulation. Understanding what kind of behaviors a child has, will allow you to choose the right remedy.
- Over-responsive → Sensory Avoider → Need for less
- Solution – calming activities, breathing exercises, variety of activities to slowly increase comfort level
- Under-responsive → Sensory Seeker → Need for more
- Solution: heavy work, brain breaks, fidget tools, variety of sensory experiences
Resources from the OT Toolbox for Deep Breathing, Self-Regulation activities, Emotional Learning and Regulation, and the Sensory Lifestyle Handbook are a perfect starting point.
SENSORY DYSREGULATION IS NOT:
Sensory dysregulation is NOT the same as behavioral or emotional dysregulation, which may look like:
Not sensory dysregulation:
- Crying at the store after they were told “no”
- Pushing their brother after he took their toy
- Eating all foods but never what the family is eating
- Dumping/throwing toys after being told it’s time to clean up
- Covering their ears during a fire alarm
- Screaming after a sibling teased them
You may be thinking, wait a minute…some of those actions are sensory-based behaviors!
You are correct! However, just because something is related to the sensory experience, does not always mean that sensory dysregulation is occurring.
As an example; the sound of a fire alarm is loud auditory input, however, covering your ears during a loud sound is a normal response. If there is more of a reaction than that, for instance, if a child is inconsolable or unable to move on after the fire alarm, that may be considered sensory dysregulation.
Sensory Dysregulation Symptoms
When symptoms of sensory dysregulation is in question, you should be asking:
- What does the environment look like? Feel like?
- What is the child communicating with their actions?
- When and where does this behavior typically occur? In what similar situations does it not occur?
Some behaviors, like pushing, can be tricky to determine if it is sensory or behavior; Look at the trigger. The proprioceptive system can be dysregulated. Is the child pushing for sensory reasons?
- Bumping into things during play, crashing often, seemingly unaware of their body? Then they may have some sensory dysregulation going on that is increasing their need for input. Pushing people who get too close, hugging too hard, or bumping into people, may also be signs of sensory dysregulation.
- If a child pushes a friend after they did something mean, that is just poor social skills.
WHAT ARE THE SYMPTOMS OF DYSREGULATION
Usually we notice the symptoms of dysregulation first. It manifests in behavioral reactions, health consequences, stress, and cognitive difficulty.
- You are constantly on edge – you feel nervous, stressed out, overwhelmed, and have the sense that you can not keep up
- Frequently irritable, snappy, and disagreeable. You might overreact, feel tense, get frustrated easily, and have mood swings like going from happy to sad quickly
- Chronic pain and illness – aches and pains that do not go away, easily getting colds and other illnesses, see several specialists without relief
- Highly sensitive to stimuli. You might identify as a highly sensitive person. Things that people may not even notice bother you. Smells, the sound of people snapping gum, fabrics, clutter, or being in crowds may feel overwhelming. You might be anxious, depressed, or stressed by the amount of information coming in.
- Sleep problems and daytime fatigue – your nervous system has a hard time relaxing to go to sleep, or is hypervigilant during the night. You wake with your gas tank half full, so by mid morning you are fatigued. It may be difficult for you to regulate your temperature and heart rate during the night, leading to additional fatigue.
- Chronic attention and concentration problems – because your system is on high alert, signaling danger, it might be hard to concentrate and pay attention to important information. You may find it difficult to tune out non important stimuli.
- Cravings and extreme appetite changes
- Immune and hormonal symptoms
- Gut and skin conditions like rosacea and IBS. These can be aggravated by stress and dysregulation
- You are highly sensitive to other people’s emotional states – you might be considered an empath. This may seem like a great trait, except it is draining. You take on the emotions of those around you and are constantly trying to help people. No matter how much you do, it never seems enough.
You do not have to have all of these symptoms to be considered dysregulated. Even if you have a couple of these symptoms, it can feel overwhelming and draining.
HOW CAN YOU support Sensory Dysregulation?
If a child’s sensory system is dysregulated, there is good news: there are many ways to help! There is a catch though – there is no “one size fits all”. Trial and error is the name of the game with sensory interventions.
Once you and your child find out what works for them and their changing environments, they will have a deeper understanding of themselves, and display improved behaviors in no time!
Check out these resources for sensory integration, calming exercises, self-regulation activities, and more! Also be sure to read our blog post on Ayres Sensory Integration for information on the theory behind this process, and how it all works together. It’s fascinating!
Tactile Sensory Input:
Heavy Work/ Propceptive Sensory Input:
- Sports Therapy
- Construction Truck Brain Breaks
- Superhero Gross Motor Activity
- Virtual Heavy Work
- Dinosaur Movement Cards
Vestibular Sensory Input:
Combined Sensory Input:
Deep Breathing Activities:
- Breathing & Relaxation
- Deep Breathing Print & Go
- Rainbow Deep Breathing Tool
- Spiderweb Breathing Freebie
- Snow Globe Breath Awareness
Mindfulness:
If you have tried everything, and are feeling a bit lost, you are not alone! Sensory dysregulation is tricky. It should be considered alongside many other aspects of why a child reacts a certain way. In addition to behavior, emotions, and self-regulation; history, habits, trauma, and mental status can have a powerful influence on actions, too.
Keep trying – some things may feel like a roadblocks but there are specific action strategies you can use!
The Sensory Lifestyle Handbook walks you through sensory processing information, each step of creating a meaningful and motivating sensory diet, that is guided by the individual’s personal interests and preferences.
The Sensory Lifestyle Handbook is not just about creating a sensory diet to meet sensory processing needs. This handbook is your key to creating an active and thriving lifestyle based on a deep understanding of sensory processing.
dysregulated nervous system
After reading all of the above about dysregulation, and what a dysregulated nervous system looks like, let’s take a step back. In order to understand the symptoms and signs of dysregulation, we need to understand the basics of the nervous system. That’s a really important piece of the puzzle to help parents that we are supporting as the pediatric occupational therapy provider on a child’s team.
The dysregulated nervous system impacts practically everything that we do and what we see in the form of behaviors, sensory needs, emotions…it’s at the base of it all.
But when we hear from our clients’ families or the parent, the school counselor, the teacher of a child with issues impacting day to day life and learning, the nervous system isn’t’ the first thing to come to mind.
NERVOUS SYSTEM BASICS
The nervous system is made up of two parts; the central and peripheral systems. Together these systems regulate our consciousness, movement, response to the environment, and bodily functions such as digestion, heart rate, and breathing.
- The central nervous system is made up of the brain and spinal cord. It interprets incoming signals, formulates responses, and plays a big role in memory and cognition.
- The peripheral nervous system extends out from the central nervous system out to the limbs. It communicates with the CNS to respond to information coming from the environment and inside our bodies.
- Under the peripheral nervous system is the autonomic nervous system. This can be thought of as the “automatic” nervous system. This system works without conscious thought, controlling the heart rate, digestion, respiratory rate, and fight or flight response.
The stress we feel impacts social emotional skills, behaviors, functioning, learning, and more.
Understanding the stress response
The fight or flight response is important to our survival. It alerts us to dangerous situations to protect us from harm. This is a great system, until it over-responds.
A chronically over-reacted fight or flight response leads to dysregulation. There are times when our nervous system, including the fight or flight response, becomes dysregulated.
This can be caused by stress, genetic predisposition, or trauma. When the system is dysregulated, it can cause more stress, burnout, anxiety, and various types of chronic pain and illness.
Dysregulation and Trauma
Understanding the impact on a dysregulated nervous system trauma has is important because we as pediatric occupational therapy providers see a huge variety of trauma responses in our therapy clients. There can be so many levels to this but one thing is for certain: there will be some level of a dysregulated nervous system when trauma exists.
Read our blog post on trauma informed occupational therapy for information and resources on how to support clients with a history of trauma.
CAUSES OF DYSREGULATION
One thing that comes up from parents or educators who see the results of regulation troubles is the “why”. We need to explain, as occupational therapy providers, the causes of dysregulation so that the child’s team can better understand why they are seeing the resulting behaviors, social emotional challenges, learning struggles and functional task issues.
An over-response of the fight or flight system is often the cause of dysregulation. Where does this come from?
- Chronic stress – when the nervous system suffers from chronic stress, it remains in a state of high alert. Over time, this state of high alert can lead to hypervigilance and overwhelm.
- Trauma can lead to dysregulation. This might come from witnessing traumatic events, abuse, accidents, or surgeries.
- Adverse childhood experiences – negative childhood experiences such as emotional or physical abuse, neglect, living with caregivers who abuse substances, or have mental health issues.
- Genetic factors – certain gene variations make people prone to anxiety and stress.
- Lifestyle factors – poor diet, lack of exercise, and inadequate sleep can contribute to nervous system dysregulation. Stimulants like caffeine, alcohol, and certain medications can lead to dysregulation
- Underlying health conditions – fibromyalgia, chronic fatigue, hormonal imbalance, and some autoimmune disorders can lead to dysregulation of the nervous system. Deficiencies in certain vitamins such as magnesium, B, and omega fatty acids can also lead to dysregulation.
- Environmental factors – heavy metals, pesticides, chemicals, mold, noise pollution.
When you think about the people in your life, especially the young ones, can you see some of these factors in their life? Children chronically have lack of exercise, poor diet, not enough sleep, exposure to chemicals, additives in their food, and often some sort of trauma.
With this type of lifestyle becoming the norm, it is no wonder so many littles are dysregulated.
EMOTIONAL/BEHAVIORAL DYSREGULATION CHANGES
We often notice behavior before other symptoms of dysregulation. This is a classic sign in regulation disorders such as ADHD, ADD, Autism, and bipolar disorder. The behaviors are caused by dysregulation, that usually has an underlying factor. You might feel overly intense emotions, impulsive behavior, lack of emotional awareness, trouble making decisions, inability to manage behavior, and avoiding difficult decisions.
People with emotional/behavioral changes struggle to make and keep friends, difficulty with compliance, can be defiant, and have difficulty completing tasks.
TREATMENT FOR DYSREGULATION
If your dysregulation is part of a larger disorder such as ADD, medication can help with the symptoms.
- Therapy – both talk, play, and occupational therapy to help with regulation and identifying triggers. Dialectical behavioral therapy helps you with mindfulness, identifying your emotions, and separating emotions from facts.
- Be consistent and organized – kids thrive on routine. Give your child/partner a heads up if you plan on changing the plans
- Adjust accordingly – sometimes you need to make accommodations and adaptations to be successful
- Reward positive behavior
- Journal – writing down feelings and thoughts can help you process them. Also looking back at journal entries can give you clarity
- Heavy work helps organize the central nervous system. Chores, exercise, physical activity or taking a walk can help
- Reverse or reduce some of the triggering factors such as sensory overload, overeating, environmental toxins, processed foods, toxic people, drugs, caffeine, technology, and stress
- Add things that are missing such as critical vitamins, healthy food, exercise, communication, and fresh air
- Take care of yourself physically. Seek medical attention for chronic or undiagnosed illnesses. Some illnesses like IBS can go away once stressors are reduced
Sometimes just thinking about all the things wrong in this world can make you feel stressed. Trying to fix everything and everyone is overwhelming. Focus on one thing or one person at a time. Take care of one part of your lifestyle, rather than making radical changes all of a sudden.
Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.
