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My Child Doesn't Have a Diagnosis … But Should She?

Part 2 of 2: CHECKLISTS of SPD Warning Signs

Checklists for School-Age Children/Adolescents and Adults

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Aren’t school-age kids and teenagers too old for an SPD diagnosis? 
While children often receive diagnoses and intervention at an earlier age, there are still many cases when they don’t. And these children, adolescents — and even adults — need the chance to get proper diagnoses and treatment. 

Don’t people outgrow SPD?
In a word, no. As a matter of fact, it’s more difficult to cope with in a bigger person who is overwhelmed by his/her environment and experiencing a sensory meltdown. Your tween simply has a larger body with more physical power and strength than s/he did as a toddler. It takes more of everything to help him or her regulate.

Is it too late to help my teenager?
It’s never too late to help your tween or teen develop smart sensory behaviors. The first step is to identify your particular child’s problem areas, and that’s what these checklists are here to help you do. Remember, everyone will check off several items. You need to allow for how many you check off and how much they affect everyday functioning. If you feel that the issues are impacting your child’s or your life, then please make an appointment with a doctor, psychologist, or occupational therapist who is familiar with SPD to decide if an evaluation and further treatment is indicated.

How do I advocate for my older child?
Make an appointment and let the medical professional get the evaluation process started. Your role is to identify problem areas and issues. So keep notes, keep a daily journal, organize your concerns using a checklist, write down everything that worries you, and bring it all to your appointment. This information can be especially useful if you are participating on your child’s IEP team. 
 
HOW TO USE THE CHECKLISTS
As you read through the appropriate checklist, think about your child’s behavior during the past six months. Check off the behaviors and sensory preferences that apply, and rate how often they occur on a scale of 0-5 (0 being NEVER, 5 being ALWAYS).
 
Symptoms Checklist for School-Age Children
  • My child overreacts to or does not like touch, noise, smells, etc.
  • My child needs structure and routines; dislikes changes in plans and surprises.
  • My child ‘gets stuck’ on tasks and has difficulty transitioning.
  • My child gets frequent panic or anxiety attacks.
  • My child has many fears and/or phobias.
  • My child has OCD-type qualities — can’t let foods touch each other on a plate, has to wear clothes a certain way, etc.
  • My child prefers solitary activities over group ones.
  • My child avoids eye contact.
  • My child is slow to perform tasks.
  • My child has difficulty learning new motor movements and prefers sedentary activities.
  • My child is unable to negotiate stairs, or climb on and off playground equipment without assistance planning the correct movements.
  • My child is unable to stand on one foot with eyes open, eyes closed.
  • My child is unable to kick a moving or stationary ball.
  • My child is unable to toss a ball or beanbag at a target 5 feet away.
  • My child is unable to catch a tossed ball.
  • My child grasps objects too loosely or too tightly.
  • My child has an awkward grip/difficulty using scissors, writing implements, or silverware.
  • My child has difficulty with or avoids fine motor tasks such as handwriting, buttoning, zipping, and fastening clothes.
  • My child has difficulty identifying physical characteristics of objects; shape, size, texture, temperature, weight, etc.
  • My child is not able to identify objects by feel and uses vision to help.
  • My child is not able to identify which part of the body was touched if s/he was not looking.
  • My child is easily distracted in the classroom, often gets out of his/her seat.
  • My child has difficulty imitating block designs or completing puzzles.
  • My child confuses similar sounding words, misinterprets questions or requests.
  • My child has difficulty reading, especially aloud, and his/her speech lacks fluency.
  • My child is unable to visually follow a line of print smoothly and thus loses place frequently when reading or when copying from the board.
  • My child is often unorganized.
  • My child craves roughhousing, tackling/wrestling games.
  • My child is in constant motion, can’t seem to sit still, is fidgety.
  • My child craves fast, spinning, and/or intense movement experiences (i.e., at amusement parks).
  • My child loves being tossed in the air, or swinging as high as possible.
  • My child is always jumping on furniture, spinning in a swivel chair, or getting into upside down positions.
  • My child is a “thrill-seeker”; can be dangerous at times.
  • My child is always running, jumping, hopping etc., instead of walking.
  • My child rocks body, shakes leg, or head while sitting.
  • My child mouths objects excessively.
  • My child repeatedly touches soothing surfaces or objects (i.e., blanket).
  • My child seeks out surfaces and textures that provide strong tactile feedback.
  • My child craves messy play.
  • My child craves vibrating or strong sensory input.
  • My child is very emotional and sensitive, may also be prone to crying.
  • My child is easily frustrated.
  • My child has difficulty accepting defeat or forgiving self.
  • My child frequently gets angry or has moments of rage.
  • My child can’t seem to finish anything.
  • My child has difficulty making decisions.
  • My child is often described as stubborn, defiant, or uncooperative.
  • My child is often described as rigid, bossy, and controlling.
  • My child is often impatient and/or impulsive.
  • My child has difficulty with authority figures.
  • My child doesn’t always register or understand social cues and non-verbal language.
  • My child has difficulty making friends (overly aggressive or passive/withdrawn).
  • My child frequently hurts other children or pets while playing.
  • My child is self-abusive; pinching or biting self, or banging his/her own head.
  • My child is not bothered by injuries like cuts and bruises, and shows no distress with shots.
Symptoms Checklist for Adolescents and Adults
  • Avoids visually stimulating environments.
  • Avoids crowds; plans errands for times when there will be fewer people around.
  • Overly excited in group settings.
  • Avoids groups; prefers solitary activities.
  • Becomes nauseated by cooking, cleaning, perfume, public restroom, or bodily odors.
  • Has to smell everything.
  • Notices and is bothered by background noises other people are not bothered by, such as clocks, refrigerators, fans, people talking, construction, etc.
  • Overreacts to loud noises such as sirens, dogs barking, vacuum cleaners, blenders, etc.
  • Cannot concentrate on a conversation, movie or tv show, or complete tasks if noises are present.
  • Talks too loudly or too softly.
  • Can’t sleep if room isn’t completely dark.
  • Dislikes changes in plans; needs structure and routines.
  • Has difficulty making decisions.
  • Cries easily, is very emotional and sensitive.
  • Is described as stubborn, defiant, or uncooperative.
  • Is rigid and controlling.
  • Is impatient and/or impulsive.
  • Has difficulty with social cues and non-verbal language.
  • Has difficulty with authority figures.
  • Has trouble relating to and socializing with peers and colleagues.
  • Is a “sore loser.”
  • Experiences strong feelings of anger or rage.
  • Is easily frustrated.
  • Has panic or anxiety attacks.
  • Has fears and/or phobias.
  • Has OCD-type qualities: can’t let foods touch; has to wear clothes a certain way; has obsessive routines; repeats actions, etc. 
  • Is very sensitive to pain.
  • Doesn’t seem to notice pain; gets shots/cuts/bruises and barely feels anything.
  • Dislikes showers or getting splashed.
  • Avoids going to the beach because of aversion to sand getting on body.
  • Avoids touching anything “messy” or only touches it with fingertips.
  • Is excessively bothered by hands or face being dirty; washes hands frequently.
  • Doesn’t notice if hands or face are dirty.
  • Is bothered by new or “stiff” clothes; certain materials; tags; seams; pantyhose; ties; belts; turtlenecks; etc.
  • Hates to be barefoot.
  • Hates to wear shoes and/or socks.
  • Is excessively ticklish.
  • Gets distressed by others’ touch; would rather touch than be touched; has difficulty “snuggling” with partner.
  • Loves to sleep under multiple or heavy blankets.
  • Fidgets and fiddles with things all the time (pocket change, keys, pens/pencils, paper clips, rubber bands, one’s own hair, etc.).
  • Often feels lethargic and slow in the mornings.
  • Often begins new tasks simultaneously and leaves many of them uncompleted.
  • Uses an inappropriate amount of force when handling objects.
  • Is clumsy, uncoordinated, and accident-prone.
  • Has difficulty walking on uneven surfaces.
  • Confuses right and left.
  • Gets disoriented easily, even in familiar environments.
  • Has difficulty learning new motor tasks or sequencing steps of a task.
  • Prefers sedentary activities; avoids sports or physical activities.
  • Has difficulty with fine motor tasks such as buttoning, zipping, tying, knitting, sewing, playing games with small parts, closing ziploc bags, writing by hand.
  • Can’t identify objects by feel; has difficulty finding things in purse or pocket without looking.
  • Frequently gets car sick, air sick, motion sick.
  • Has difficulty riding on elevators, escalators, or moving sidewalks.
  • Avoids amusement park rides that spin or go upside down.
  • Is a thrill seeker; loves fast, spinning, and/or dangerous rides, leisure activities, and sports.
  • Will often rock or sway back and forth while seated or standing still.
  • Frequently tips chair on back two legs.
  • Has difficulty staying focused; needs physical activities to help maintain focus.
  • Misinterprets questions and requests, needs extra clarification.
  • Speech lacks fluency.
  • Has difficulty reading, especially aloud.
  • Has to read material several times to absorb the content.
  • Has trouble forming thoughts and ideas in oral presentations.
  • Has trouble generating ideas for essays or written tasks.
  • Has difficulty reading and understanding a map, bus schedule, directions.
  • Has difficulty organizing and grouping things by categories, similarities, and/or differences.
  • Can’t seem to find words in word search puzzles.
  • Has difficulty following multi-step directions.
  • Constantly chews on ends of pens and pencils.
  • Has difficulty eating foods with mixed textures, or with a particular texture.
  • Prefers foods with very strong flavors.
  • Prefers very bland foods.
  • Constantly bites nails, fingers, lips or insides of cheeks.
  • Loves crunchy foods.

Why are so many symptoms exact opposites of each other?
Symptoms differ depending on the sub-type of SPD and on each individual’s personal triggers. That creates a wide range of possible behaviors.

A lot of these symptoms describe myself. Could I have SPD?
That makes sense. Preliminary research suggests that SPD is often inherited. Multiple family members often show sensory processing problems. Working with a medical professional will help both you and your child deal with the multiple issues that have come up, and will continue to arise, both individually and as a family. Be proactive; don’t wait any longer.

Looking ahead:
In the next few posts, we’ll discuss in detail the different types of SPD and the role of the OT as “sensory investigator,” diagnosing and working with sensory children to create individualized therapy plans and strategies for success.

Which symptoms do you relate to? How do you deal with them? Please share your thoughts in the comments section below. Also, let me know there or via email what topics you would like to discuss or hear more about. 
 
Feel free to share or quote from this blog (with attribution, please, and if possible, a link), and to repost on social media.
 
 
I look forward to hearing from you!
 
 

All the best,
Miriam

About Miriam:
Miriam Skydell MS, OTR/L is a pediatric OT with 30 years experience and a strong commitment to empowering every child and every family with the skills, confidence and emotional stability necessary for a meaningful, independent life. In addition to her Masters degree from NYU (1986) and membership in the AOTA (American Occupational Therapy Association), Miriam is a licensed Interactive Metronome®,  HWT (Handwriting Without Tears®), and TLP (The Listening Program®) provider.

Miriam performs preschool screenings, contracts experienced OTs, PTs and STs to schools, helped implement the HWT curriculum, and lectures extensively for parent and support groups and at teacher conferences for public and private schools throughout New Jersey. Through her private practice in Fair Lawn, Miriam Skydell and Associates, established in 1995, Miriam has helped countless children with a wide range of diagnoses improve functional living skills, manage the impact of sensory processing dysfunction, and meet their individual potentials.

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