Difficulty grasping writing and drawing tools Trouble writing letters, drawing shapes, tracing, or coloring within lines Challenges with using utensils while eating Difficulty playing with small toys (e.g., lego, beads, blocks) Struggles with picking up objects with hands and fingers

Difficulty with crawling, walking, climbing stairs, running, jumping, hopping, climbing, or catching/throwing a ball Trouble balancing on one foot Challenges with reaching across the body to pick up objects Appears less skilled in sports, dancing, or learning new movements Tires easily with physical activity compared to peers

Difficulty completing shoelaces, buttons, snaps, buckles, hooks, or velcro straps Trouble putting on or taking off clothes, underwear, or socks Struggles with brushing teeth, brushing hair, or bathing/showering thoroughly Difficulty wiping self thoroughly after using the restroom Resistance to self-care tasks, often preferring caregiver to handle more steps than age-appropriate

Difficulty with discriminating between letters, shapes, sizes, or colors Trouble copying shapes, letters, or words from a board Difficulty differentiating between left and right Struggles with following an object with eyes Challenges with completing puzzles Difficulty with searching for a specific item Trouble recalling the details of a picture Difficulty recognizing familiar faces, objects, or shapes Trouble keeping track of place while reading a book or copying sentences Difficulty making or maintaining eye contact

Difficulty interacting with others Struggles with making or maintaining friendships Difficulty taking turns or sharing Trouble sustaining attention during play Frequently switches between activities Difficulty with transitioning away from preferred activities Trouble with imaginative play Engages in repetitive play (e.g., lining up toys, stacking toys, throwing toys)

Difficulty chewing food properly Trouble drinking from a bottle, cup, or straw Tends to drool often Coughs or gags while eating or drinking often Difficulty with eating certain textures of foods (e.g., soft, lumpy, slimy, bread crusts) Has limited food preferences Dislikes or avoidance of certain foods or food groups

Difficulty with coming up with ideas with how to move one’s body Struggles with interacting with objects or navigating the environment Difficulty with planning and organizing novel movements Appears clumsy, uncoordinated, or awkward while moving Seems confused when expected to do something and may have trouble getting started

Difficulty with jumping jacks Riding a bike Difficulty holding the paper and cutting Trouble holding the paper while writing/drawing/coloring

Difficulty maintaining a stable posture while moving, standing, or sitting still for extended periods (tends have slumped posture, leans on table, holds head up in hands while seated, or changes position often when sitting) May avoid or appear hesitant/fearful of engaging in motor activities requiring postural control (e.g., climbing across playground equipment, climbing on ladders, swinging, navigating balance beams, dancing, or playing sports) Leans on walls, furniture, or other people for support at times when standing or sitting Does not have a preferred hand for writing

Loses place while reading, or skips words or sentences at times Trouble copying words from board to paper Difficulty following moving objects smoothly with eyes (e.g., while playing sports, video games) Difficulty keeping eye contact or focusing on a single point/object

Sensory processing involves the brain’s ability to interpret and respond to the signals it receives from the body and the environment. Our senses include what we see, hear, touch, taste, and smell, along with our body awareness (proprioception), internal bodily sensations such as hunger or pain (interoception), and our sense of balance and spatial orientation (vestibular sense). Effective sensory processing skills enable us to engage in everyday activities and regulate our responses to different stimuli. Sensory processing skills are important because they allow us to do simple yet important things we engage in daily (e.g., recognize familiar faces, enjoy the taste of our favorite foods, put on a jacket if becomes cold, maintain our balance while walking or running, regulate our emotions and behaviors).

Children who are highly reactive to sensory input often show stronger responses to their senses in what they see, hear, touch, taste, or smell. Children may also exhibit stronger reactions to stimuli related to body awareness (proprioception), internal bodily sensations such as hunger or pain (interoception), and their sense of balance and spatial orientation (vestibular sense). What concerns do children with sensory over-reactivity often face? They might avoid bright lights and cover their eyes often, and they can react strongly to certain patterns or colors. Loud or sudden noises can startle them, and they might feel distressed in noisy or crowded places. They may also be bothered by certain textures in clothing, tags, or seams, and may not like getting messy during play or grooming. Touching them might elicit a stronger reaction than expected. With food, they can be very particular about tastes, textures, and smells, and strong odors like perfumes or cleaners can be uncomfortable for them. They might have difficulty with balance and coordination and may avoid intense physical activities like climbing or swinging. They can be very sensitive to hunger, minor discomforts, temperature changes, and bodily functions, or reacting strongly to small changes.

Children who are less reactive to sensory input often show less intense reactions, delayed reactions, or may not notice information from their senses in what they see, hear, touch, taste, or smell. They might not react much to things like their own body movements, feelings of hunger or pain, or how they balance and move in space. What concerns do children with sensory under-reactivity often face? They may show a strong interest in bright lights, spinning objects, or visually stimulating activities because they need more visual input to stay focused or alert. This often impacts their ability to focus and attend in their daily lives. They might not always respond to loud or sudden sounds, like when their name is called, and may even seek out loud noises themselves for stimulation. When it comes to touch, these children often crave intense experiences, such as playing with slime or engaging in rough play that involves deep pressure, like hugging or squeezing. They might also have strong tastes and smell preferences, seeking out bold flavors and unusual smells. They may also struggle to recognize internal body cues, like feeling hungry or needing to use the restroom, and might not notice minor injuries or pain. Movement is another area where sensory-seeking children often crave more stimulation. They may engage in repetitive actions like rocking or spinning, and may not consistently react to activities like swinging, which typically engage a child’s vestibular system. These children often crave intense physical play, and may have trouble staying still for quiet tasks or activities.

Children who are sensory seekers actively look for or crave certain sensory experiences to feel engaged or calm. These children often seek more stimulation than usual from their senses—like touch, sound, sight, movement, or taste. They may enjoy activities like jumping, spinning, or making loud noises. They might touch things or people constantly, or seek out strong smells or bold flavors. This need for extra sensory input helps them feel more grounded, but it may significantly interfere with their daily life. What concerns do children with sensory seeking challenges often face? Children who have an excessive need for sensory input may find it difficult to sit still, focus on tasks, or follow routines, which impacts their ability to concentrate at school or engage in stationary activities. In social situations, sensory-seeking children may struggle to interact appropriately, often interrupting conversations or being in constant motion, which can affect their relationships. Additionally, they may have difficulty self-regulating, which can lead to restlessness or becoming overwhelmed. Safety concerns may arise if they engage in risky behaviors or don’t notice pain. In occupational therapy, sensory-seeking children can learn to manage their sensory needs more effectively.

Children who have difficulty with sensory perception have trouble with identifying, interpreting, or distinguishing between their senses. They might find it difficult to recognize objects, faces, or shapes and may confuse similar-looking letters. Understanding what someone is saying in a noisy environment can be challenging, as well as distinguishing between different sounds and similar-sounding words. Tasks like finding objects by touch alone or buttoning shirts without looking can also be difficult. They may have trouble detecting or differentiating flavors in food and may struggle to identify or distinguish between different scents. They might find smells that are generally pleasant to others extremely unpleasant, or vice versa. These children often have issues with using the right amount of force when throwing or kicking a ball, and may apply too little or too much pressure during activities like writing or coloring. Coordination, balance, and spatial awareness may be poor, which can lead to avoiding movement activities or, conversely, seeking out motion behaviors like spinning, rocking, or jumping to fulfill their sensory needs. They also struggle to recognize and respond to internal sensations, such as hunger or pain, which can impact their ability to manage their needs effectively.

Children with sensory based motor challenges usually have difficulties with praxis, bilateral coordination, postural control, and ocular-motor control (see above). This impacts ability to coordinate movements based on sensory input, impacting activities like planning/executing novel movements, coordinating movements from both sides of the body, and/or reading/writing. Sensory Based Motor Subcategories: 1. Dyspraxia: Children with dyspraxia have difficulty planning, timing, organizing, sequencing, or performing new movements. These children may appear awkward and uncoordinated due to difficulties with motor planning. 2. Postural-Ocular: Children with postural-ocular disorder have trouble with coordinating bilateral movements and maintaining a stable posture. They may slouch in their seats, have weak muscles, low tone, or poor balance. They also show challenges with functional vision. Functional vision skills refer to how effectively the eyes work together to process and interpret visual information. These skills extend beyond clear eyesight, involving eye movement and visual processing abilities. Eye Movement Skills Fixation: The ability to keep the eyes steadily focused on a single point. Visual Tracking: The skill that enables the eyes to smoothly follow a moving object in a controlled manner. This is essential for tracking moving targets. Saccades: Rapid, precise eye movements that allow for quick shifts in focus between different points in a visual scene. The eyes momentarily fixate on one spot before swiftly jumping to the next. Vergence: The coordinated movement of both eyes to adjust focus at varying distances. Convergence occurs when the eyes move inward to focus on a nearby object, while divergence happens when they move outward to focus on something farther away. Visual Processing Skills Visual Perception: The ability to recognize and differentiate shapes and forms, recall visual information, understand spatial relationships, and locate objects in a busy setting. Difficulties with visual perception can affect school performance, making it challenging to learn letters and numbers. Visual-Motor Integration (Eye-Hand Coordination): The ability of the eyes and hands to work together smoothly and efficiently. This skill is essential for everyday tasks such as dressing, buttoning, and tying shoes, writing, cutting or catching a ball.