The Sensory Bounce Therapy Blog:
Sensory Processing, Motor and Social Skills Resources
for Parents of Special Needs Children
Sensory Processing, Motor and Social Skills Resources
for Parents of Special Needs Children
My Child Doesn't Have a Diagnosis … But Should She?
Part 1 of 2: CHECKLISTS of SPD Warning Signs
Checklists for Infants/Toddlers and Pre-Schoolers
Does your child act in ways that worry you?
With the caveat that Dr. Google, your mother-in-law, and your best friend’s brother who has a son “just like yours” aren’t qualified to diagnose your child, a parent’s intuition should never be discounted. If you think there’s something “wrong,” you need to get your child evaluated by a medical professional. Keep notes, keep a daily journal, write down everything that concerns you, and bring it all to the appointment. Here are checklists to help you organize and communicate your concerns.
How will the checklists help me?
While a checklist can’t diagnose a child, it can be a useful tool to see if additional testing should be done. I’ve put together SPD Symptoms Checklists for four different age groups to make it easier for you to collect information, get your conversation started with the doctor, and get your daughter or son the help s/he needs to live a functional, productive life.
Your role is not to diagnose.
As you read through these lists, you may feel that your child has so many of these characteristics/behaviors that s/he must have a sensory processing disorder. That MAY be true. But it equally possibly may NOT.
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).
- My infant/toddler refuses to go to anyone but me.
- My infant/toddler resists being held or cuddled; may arch back, cry, and pull away
- My infant/toddler becomes frightened, anxious or aggressive when touched unexpectedly or by someone out of his/her eyesight.
- My infant/toddler becomes distressed when diaper is being/needs to be changed.
- My infant/toddler has difficulty falling asleep or staying asleep.
- My infant/toddler is irritable when being dressed; seems to be uncomfortable in clothes.
- My infant/toddler can not calm self by sucking on a pacifier, looking at toys, or listening to my voice.
- My infant/toddler is not sitting by one year.
- My infant/toddler never crawled.
- My infant/toddler is not walking by 18 months.
- Delays in self-care skills.
- My infant/toddler does not initiate feeding self by 1-1/2 years.
- My infant/toddler is not able to drink from a cup at 1-1/2 years.
- My infant/toddler has difficulty biting/chewing food.
- My infant/toddler is not gaining words by age 2.
- My infant/toddler rarely plays with toys, especially those requiring dexterity.
- My infant/toddler has difficulty shifting focus from one object/activity to another.
- My infant/toddler does not notice pain or is slow to respond when hurt.
- My infant/toddler is extremely active and is constantly moving or running.
- My toddler is walking on toes rather than on soles of feet.
- My toddler falls frequently for no apparent reason.
- My toddler prefers to be naked and constantly pulls off diapers and clothes.
- My child does not imitate actions of others by age two.
- My child does not exhibit pretend play by age two.
- My child mouths objects to explore them after age two.
- My child is a picky eater; is only willing to eat certain tastes and textures; avoids mixed textures; avoids hot or cold foods; resists trying new foods.
- My child has difficulty with toilet training.
- My child’s speech is hard to understand.
- My child refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, etc.
- My child is bothered by seams in socks and refuses to wear them.
- My child refuses to walk barefoot on grass or sand.
- My child is distressed about having face washed.
- My child is distressed about having hair, toenails, or fingernails cut.
- My child complains about having hair brushed.
- My child resists brushing teeth and is extremely fearful of the dentist.
- My child overreacts to noise.
- My child overreacts to smells.
- My child overreacts to raindrops, water from the shower, etc.
- My child overreacts to minor cuts, scrapes, and bug bites.
- My child dislikes kisses and will “wipe them off.”
- My child resists friendly or affectionate touch from anyone besides parents or siblings (and sometimes from them as well).
- My child is excessively ticklish.
- My child is unaware of being touched unless done with extreme force/intensity.
- My child touches everything, including people, and often “gets into other people’s space.”
- My child does not like to touch.
- My child is distressed by dirty hands and wants to wash or wipe them frequently.
- My child avoids “messy play,” i.e., sand, mud, water, glue, glitter, playdoh, slime, shaving cream, etc.
- My child is hyper/hypotonic (rigid or floppy muscle tone).
- My child often sits in a “W” position.
- My child seems weak, slumps when sitting/standing, prefers sedentary activities, gets tired easily.
- My child is fearful of feet leaving the ground.
- My child is clumsy, awkward, uncoordinated.
- My child uses one hand to participate in activities.
- My child exhibits no hand preference/dominance by 4 or 5 years old, frequently switching hands for coloring, cutting, writing etc.
- My child avoids performing fine motor tasks such as using crayons and fasteners on clothing.
- My child uses a fisted grasp on crayons.
- My child is not able to copy simple lines and a circle by age 4.
- My child has difficulty learning.
- My child does not seem to understand verbal instructions.
- My child does not display joint attention (instead, wants others to pay attention to what s/he is attending to).
- My child is in constant motion.
- My child is afraid of swinging movements, does not like to be upside down.
- My child is over/under reactive to pain.
- My child has difficulty calming down.
- My child does not make eye contact.
- My child does not appear to hear sounds or people’s voices.
- My child has difficulty making friends (too aggressive or too withdrawn).
- My child has difficulty with transitions.
- My child has sudden mood changes and temper tantrums.
- My child does not demonstrate typical play with toys.
- My child dislikes playground equipment; i.e., swings, ladders, slides, or merry-go-rounds.
- My child moves slowly and cautiously, and avoids taking risks.
- My child dislikes elevators and escalators; may prefer sitting while on them or even experience motion sickness from them.
- My child is overly fixated on a limited repertoire of activities which interferes with social interaction or other daily activities.
Why are so many symptoms complete opposites of each other?
Symptoms depend on the sub-type of SPD. Someone with difficulty regulating responses to sensory input is going to react differently than someone with low muscle tone or poor vision. Even within the same type of SPD, one child may react to texture and another to noise, for example.
I can’t possibly make sense of all this!
You don’t have to. That’s your child’s doctor’s job. The checklists are to help compile information so you can clearly explain to your doctor and/or other medical professional why you think your child may need help. Bring the completed checklist to your child’s pediatrician, discuss it with him/her, and ask for a referral for an evaluation by an occupational therapist or developmental specialist. If the pediatrician does not “believe in” SPD, or refuses to refer you to a specialist, find a new doctor.
In the next post, you’ll find checklists for SPD warning signs in school-age children and in adolescents/adults.
Which symptoms stand out to you as being the hardest to manage? How are you coping? 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.
All the best,
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.