Regulation Disorders of Sensory Processing

Definitions

Regulation Disorders of Sensory Processing (DC: 0-3R and Associated CHADIS Criteria) Normal text is quoted directly from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition (DC: 0-3R; Zero to Three, 2005). Italicized text conveys information about the CHADIS items assessing the DC: 0-3R criteria.

General Information (p. 29) The diagnosis of Regulation Disorders of Sensory Processing includes the presence of THREE FEATURES: (1) sensory processing difficulties, (2) motor difficulties, and (3) a specific behavioral pattern.

Hypersensitive Type A: Fearful/Cautious (pp. 30-32)

1. Sensory Reactivity Patterns: These patterns are characterized by overreactivity to sensory stimuli, including light touch, loud noises, bright lights, unfamiliar smells and tastes, rough textures, or movement in space...("Does your child over-react to any of the following? Being touched lightly; Being touched firmly; Loud noises; Bright lights; Smells; Tastes; The feeling of clothing; Swinging or being tossed in the air)
2. Motor Patterns (one or more of the below)
   1. Difficulties with postural control and tone ("Does your child seem coordinated?" --Never/Almost Never; OR "Does your child's body seem too tense or stiff?" --Almost Always; OR "Does your child's body seem too floppy?--Almost Always)
   2. Difficulty in fine motor coordination... (Only assessed among children older than 6 months: "Does your child use his/her hands well?--Never/Almost Never)
   3. Difficulty with motor planning (Only assessed among children older than 6 months: "Would you use the word "clumsy" to describe your child?" --Yes)
   4. Less exploration than expected for age (Is your child very hesitant to try new physical moves like jumping or being swung? --Often or Almost Always)
   5. Limited sensory-motor play (Only assessed among children older than 6 months: "Does your child avoid touching or mouthing certain things because of how they feel?" --Almost Always)
3. Behavioral Patterns: Behavioral patterns of infants and young children with Type A: Fearful/Cautious Hypersensitivity include excessive cautiousness, inhibition, and fearfulness ... (one or both of the following)
   • (Children over 6 months) "Would you use the word 'cautious' to describe your child?" (Yes)
   • "Does your child quit doing something because it gets to be too much for him/her?" (Often or Almost Always)

Hypersensitive Type B: Negative/Defiant (pp. 32)

1. Sensory reactivity patterns are identical to those of Type A
2. Motor Patterns are also identical to those described in Type A: Fearful/Cautious
3. Behavioral patterns in type B, however, are different from those in Type A. The child with Negative/Defiant Hypersensitivity tends to avoid or be slow to engage in new experiences and, in general, is aggressive only when provoked. The behavior patterns of infants and young children with Type B: Negative/Defiant Hypersensitivity include:
   1. Negativistic behavior... (one or more of the following)
      • Does your child act fussy or cranky? -- Often or Almost Always
      • Does your child tantrum? - Often or Almost Always
      • How often does your child get angry? --Often or Almost Always
   2. Controlling behaviors (For children older than 12 months: "How often is your child bossy or demanding?" --Almost Always)
   3. Defiance ... ("Does your child do the opposite of what you are trying to get him/her to do?" --Almost Always)
   4. Preference for repetition, absence of change, and, if change is necessary, change at a slow pace ("Does your child like to have things be the same every time?" --Often or Almost Always)
   5. Difficulty adapting to changes in routines or plans (one or both of the following)
      • "Does your child adapt well to changes in his/her routine?" --Sometimes or Never/Almost Never
      • "Does your child have difficulty going from one activity to another?" -- Often or Almost Always
   6. Compulsiveness and perfectionism ("Does your child insist on things being 'just so'?" --Almost Always)
   7. Avoidance or slow engagement in new experiences or sensations ("Does your child take a long time to get used to something new?"--Almost Always)

Hyposensitive/Underresponsive (pp. 32-33)

1. Sensory Reactivity Patterns
   1. Underreactivity to sounds, movement, smell, taste, touch, and proprioception ("Does your child under-react to any of the following?" --Being touched lightly; Being touched firmly; Loud noises; Smells; Tastes; Swinging or being tossed in the air)
   2. In infants, lack of responsivity to sensations and social overtures
2. Motor Patterns (two or more of the following)
   1. Limited exploration (For children greater than 6 months: "Is your child very hesitant to try new physical moves like jumping or being swung?" --Often or Almost Always)
   2. Restricted play repertoire (For children greater than 6 months; one or both of the following)
      • "Does your child only play in a few ways?" --Almost Always
      • "Does your child play in the same way over and over?" --Often or Almost Always
   3. Search for specific sensory input, often found in repetitive sensory activities, such as swinging or jumping up and down on a bed ("Does your child seek out the same feelings of swinging or spinning or jumping over and over?" --Often or Almost Always)
   4. Lethargy (one or both of the following)
      • "Would you say your child doesn't move around as much as expected?" --Often or Almost Always
      • "Does your child seem slow moving?" -- Often or Almost Always
   5. Poor motor planning and clumsiness ... (one or more of the following)
      • "Does your child seem coordinated?" -- Never/Almost Never. For children over 6 months: "Would you use the word 'clumsy' to describe your child?" --Yes
      • "Does your child's body seem too tense or stiff?" -- Almost Always
      • "Does your child's body seem too floppy?" -- Almost Always
3. Behavioral Patterns (one or more of these)
   1. Apparent lack of interest in exploring properties of objects, playing challenging games, or engaging in social interactions (one of more of these)
      • "Does your child show interest in playing with you?" --Never/Almost Never
      • "Does your child show interest in playing with others?" -- Never/Almost Never
      • "Does your child give up too easily on activities that might be hard for him/her?" --Almost Always
   2. Apathetic appearance ("Does your child seem to not be interested in things?" --Often or Almost Always)
   3. Fatigability ("Does your child get tired too easily?" --Often or Almost Always)
   4. Withdrawal from stimuli ("Does your child seem sad or withdrawn?" -- Often or Almost Always)
   5. Inattentiveness ("Does your child have a problem settling down and paying attention?" --Almost Always)

In addition to the above symptoms, infants with Hyposensitive/Underresponsive Regulation Disorder may appear delayed or depressed. Preschoolers with the disorder may 'tune out' from conversation and may reveal only a limited range of ideas and fantasies in everyday behavior or imaginative play (one or more of the following)

• "Does your child seem delayed?" --Yes
• "Does your child show happiness, joy, or pleasure?" --Sometimes or Never/Almost Never
• "Would you use the word 'sad' to describe your child?" --Yes
• For children 24 months and older: "Does your child play make-believe?" --Never/Almost Never
• For children 24 months and older: "Does your child tune out from conversation he/she can understand?" --Often or Almost Always

Sensory Stimulation-Seeking/Impulsive (pp. 33-34)

1. Sensory Reactivity Patterns
   1. Craving for high-intensity sensory stimuli. Such a craving may lead to destructive or high-risk behaviors (one or both of these)
      • "Does your child under-react to any of the following?" --Being touched lightly; Being touched firmly; Loud noises; Smells; Tastes; Swinging or being tossed in the air
      • "Does your child crave and get excited by strong touch, sounds, or movement?" --Often or Almost Always
2. Motor Patterns (one or more of these)
   1. High need for motor discharge ("Does your child seem driven to move around, as if by a motor?" --Almost Always)
   2. Diffuse impulsivity (For children 18 months and older: "Does your child do things without thinking?" --Almost Always)
   3. Accident proneness without clumsiness (For children 18 months and older: "Is your child so active that he/she crashes into things or breaks things?" --Often or Almost Always)
3. Behavioral Patterns (one or more of these)
   1. High activity levels ("Is your child extremely active?"--Often or Almost Always)
   2. Seeking constant contact with people and objects (For children 18 months and older: "Does your child touch people or things too much?" --Often or Almost Always)
   3. Seeking stimulation through deep pressure ("Does your child love to be held or wrapped firmly?" --Often or Almost Always)
   4. Recklessness (For children 18 months and older: "Would you use the word 'daredevil' to describe your child?" --Yes)
   5. Disorganized behavior as a consequence of sensory stimulation (For children 18 months and older: "Do you find that the more your child plays, the wilder he/she gets?" --Often or Almost Always)