Sensory Processing Pre Referral Advice Oct18

OCCUPATIONAL THERAPY ADVICE
Sensory Pre-Referral Graded Approach
Paediatric Occupational Therapy Department

Trafford Children’s Therapy Service
1st Floor Waterside House
Sale Waterside
Sale
Manchester, M33 7ZF
Tel: 0161 912 4335 / 4495
Compiled by- Alannah Mckaskie

Specialist Occupational Therapist
April 2018
PURPOSE OF THIS PACK
This pack has been developed for those working with children in schools and/or at
home with potential sensory difficulties. The aim is to help identify which senses may
be impacted upon and why this may result in the child having difficulties dealing with
certain sensory stimulus and/or environments and why an individual may present
with certain behaviours. This information pack will not provide a diagnosis for a child
but instead will guide you to support a child to develop coping strategies to better
manage their sensory needs or to inform a more comprehensive assessment.
The pack contains advice on:

 The senses
 How an individual might present who is over or under responsive
 Calming and alerting strategies
If after using the advice provided in the pack the child still continues to have
difficulties regulating sensory information to a point that it impacts upon their ability to
participate in daily activities; then it may be appropriate for the child to be referred to
occupational therapy for further evaluation. A referral will only be accepted if it meets
the referral criteria and the correct referral documentation has been completed. A
referral documentation pack is available at the end of this document on pages 32-43,
incomplete or referrals that do not meet the criteria will be rejected.
Referral Criteria
To meet the threshold for a referral a child must meet the following criteria:
 The child must present with having difficulties in two or more sensory areas
 Be aged 5-18 and in education
 The child must have two or more of the following: Trafford School, Trafford
Residence, Trafford GP
 Sensory difficulties that impact upon the child’s function and ability to
participate in daily activities
The referral must include evidence of the following prior to being accepted:
 Parental consent gained prior to referral being made (signed on referral form).
 Evidence that pre-advice (strategies/interventions) have been followed in
school for a full term/12 weeks. Relevant evidence record sheets and referral
documentation are attached at end of this pack.
Please feel free to contact the department if you have any questions, comments or
suggestions about the pack at:

1st Floor, Waterside House, Sale Waterside,
Sale, Manchester, M33 7ZF
Tel: 0161 912 4335 / 4495
Email: pcn-tr.tctsNoReply@nhs.net
Page 2 of 43
Complied by Alannah Mckaskie (OT) - Version 1 (2018)
Content Page
Pathway for children in pre-school setting ……………….………………………….………..…... 4
Pathway for children in full-time education setting …………………………..………………..….. 5
Checklist ………………………………………………………………………………………….…... 6-9
The Senses ………………..…………………………………………………………….…….…..…. 10
Sensory Processing ……………………..………………………………………………………….. 10
Additional Online Resources ……………………………………………………………................ 11
Over-Responsive & Under-Responsive …………..……………………………….…………….... 11
Self-Regulation ……………………………………………………………………..………………... 12
Just Right Engine ………………………………………………………………..…………………... 12
Window of Arousal …………………………………………………………….………………..…… 13
Tactile (Touch) ...…………...……………………………………………….............................. 14-15
Tactile Strategies …………………………………………………….……….……………………... 16
Proprioception (Body Awareness) ..………………………………….…................................ 17-18
Proprioception Strategies ………………………………………………….…………………….…. 19
Vestibular (Posture/Balance) ………………………..…………………………...……………. 20-21
Vestibular Strategies ……………………………………………………………………………..…. 22
Olfactory (Smell) …………………………………………………………………………………….. 23
Gustatory (Taste) ………………………………………………………………………………….… 23
Olfactory/Gustatory Strategies ……………………………………………………………………... 24
Oral Motor …………………………………………………………………………………………….. 25
Oral Motor Strategies ………………………………………………………………………….......… 25
Visual (Sight) ……………………………………………………………………………................... 26
Visual Strategies ………………………………………………………………………………………. 27
Auditory (Hearing) ………………………………………………………………………................... 28
Auditory Strategies ……………………………………………………………………………………. 29
Sensory Toy/Resources ………………………………………………………………………..…….. 30
References / Useful Book Resources ……………………………………………………………..… 31
Appendices/Referral Pack – Referral, Questionnaires & Evidence Sheets …......…………. 32-43
Page 3 of 43
Sensory Service Pathway Pre-School Age (Under 5)
Referral Criteria:
 The individual must present with having difficulties in two or more sensory areas
 Aged below 5 years.
 The individual must have two or more of the following: Trafford School, Trafford Residence, Trafford GP
 Sensory difficulties that impact upon the individual’s function and ability to participate in daily activities
Referrals can be made via:

 A referral for an initial sensory assessment can be made by a medical professional or SENCO.
 Review - If the child has previously had a sensory assessment from the service a request for a review
can be made via school/parents if the child is presenting with a new functional need from previous
assessment.

Referrer to complete the appropriate referral documentation (service referral with signed parent consent,
checklist, parent and/or education questionnaires).
Incomplete referrals will be rejected until all completed documentation is received to the service.
Referrals will be considered and a decision made whether input is appropriate or required.
Sensory assessment not

Sensory assessment agreed and Review sensory assessment agreed by service. Parents
accepted into the service. accepted. and referrer notified that
request has been declined.
Sensory Processing Measure (SPM) or Sensory Profile (SP) Questionnaires forwarded to parents and/or pre-
school setting (if involved) to complete prior to appointment being provided.
Occupational Therapist to complete telephone triage to discuss appropriate environment for observation.
Once the questionnaires are returned to the service the Occupational Therapist will interpret results.
Occupational therapist to complete pre-school and/or home observation to outline potential sensory difficulties.
OT sensory assessment report (with recommendations) written and distributed to parents and/or education setting.
Meeting arranged with parents and/or education setting to explain and discuss recommendations.
Education setting and/or parents to continue with recommendations and advice provided in the report and episode
of care will be closed. The child may be re-referred by parents/education if there is an impact by a new functional
need.
Page 4 of 43
Sensory Service Pathway School Age (5+)
Referral Criteria:
 The individual must present with having difficulties in two or more sensory areas
 Be aged 5-18 and in education
 The individual must have two or more of the following: Trafford School, Trafford Residence, Trafford GP
 Sensory difficulties that impact upon the individual’s function and ability to participate in daily activities
 Evidence that pre advice (strategies/interventions) has been followed in for a school a full term/12
weeks.
Referrals can be made via:

 Initial referral - Medical Professional or SENCO: via the graded approach pathway.
 Review - If the child has previously had a sensory assessment from the service a request for a review
can be made via school/parents if the child is presenting with a new a functional need from previous
assessment.
Referrer to complete the appropriate referral documentation (service referral with signed parent consent,
checklist, supplementary sheets to evidence strategies implemented, parent and school questionnaires).
Incomplete referrals will be rejected until all completed documentation is received to the service.
Referrals will be considered and a decision made whether input is appropriate or required.
Review sensory assessment

Initial sensory assessment agreed Sensory assessment not
agreed and referral accepted into
and referral accepted into the agreed by service. Parents and
the service. Outlining new
service, alongside evidence of referrer notified that request
functional need in order to meet
graded approach from school. has been declined.
requirement for review.
Sensory Processing Measure (SPM) or Sensory Profile (SP) Questionnaires forwarded to parents and School to
complete prior to appointment being provided.
Once the questionnaires are returned to the service the occupational therapist will interpret results.
Occupational therapist to complete school and/or home observation to outline potential sensory difficulties.
OT sensory assessment report (with recommendations) written and distributed to parents and school.
Meeting arranged in school with parents and suitable representative from school (Teacher, TA, SENCO) to explain
and discuss recommendations and how they can be best implemented.
School and Parents to continue with recommendations and advice provided in the report and episode of care will be
closed. The child may be re-referred by parents/education setting if there is an impact by a new functional need.
Page 5 of 43
Checklist
This checklist is intended to be used as a tool and a guide in becoming more aware and
understanding a child’s sensory needs and differences. This is not a diagnostic tool, nor is the
number of areas that you check off an indicator of a sensory disorder.
The checklist includes many of the most common sensory preferences and differences, and is divided
into categories based on the sensory system and how the brain and nervous system may process the
input. After completion, take note of the categories where you have checked off the most items
(significant difficulty rather than checking 1 or 2 items). This will help guide you in determining the
sensory systems that may need the most attention and support.
You should use the pack to locate the advice and strategies that apply to the area outlined as a
potential difficulty or sensitivity; e.g. if a child presents with the majority of checked items in tactile
over-responsive/avoiding you should refer to the tactile over-responsive/calming strategies section of
the booklet (page 16).
Written by Angie Voss, OTR (ASensoryLife.com) Copyright 2014 – Sensory Difference Awareness Checklist
Child’s Name ………………………… D.O.B ………………. School: …………………………
Tactile Input
Over-responsive/Tactile Avoiding (page 16)
 Becomes fearful, anxious or aggressive with light or unexpected touch
 As an infant, did/does not like to be held or cuddled; may arch back, cry, or pull away
 Distressed with nappy changes
 Appears fearful, or avoids standing in close proximity to other people or peers
(especially in lines or crowds)
 Becomes frightened when touched from behind or by someone / something they
cannot see (such as under a blanket)
 Complains about having hair brushed
 Bothered by rough bed sheets (example: old and “bumpy”)
 Avoids group situations for fear or unexpected touch
 Resists friendly or affectionate touch from anyone besides parents or siblings (and
sometimes them to)
 Dislikes kisses, will “wipe off” the place where kissed
 A raindrop, water from a shower, or wind blowing on the skin produces an adverse
response or avoidance reaction
 Overreacts to minor cuts, scrapes, and/or bug bites
 Avoids touching certain textures of material (blankets, rugs, stuffed animals)
 Refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans,
hats, or belts
 Avoids using hands for play or approaches with a closed fist
 Avoids or dislikes messy play such as mud, glue, or finger paints
 Avoids getting messy with food textures
 Distressed by dirty hands and wants to wipe or wash them frequently
 Excessively ticklish
 Distressed by seams in socks and may refuse to wear them
 Distressed by clothes rubbing on skin; may want to wear shorts and short sleeves
year round, toddlers may prefer to be naked or pull nappies and clothes off
constantly
 Distressed about having face washed
 Distressed with haircuts, nail trimming
 Resists brushing teeth, may be extremely fearful of the dentist
 Refuses to walk barefoot on grass or sand
 Walks on toes on new surfaces or textures
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Tactile
Under responsive/Tactile Seeking (page 16)
 Craves touch or needs to touch everything and everyone
 Is not aware of being touched/bumped unless done with extreme force or
intensity
 Is not bothered by injuries and shows no distress with painful stimuli
 Not aware that hands or face are dirty or the feeling his/her nose running
 Frequently hurts other children or pets while playing
 Repeatedly touches surfaces or objects that are soothing
 Seeks out surfaces and textures that provide strong tactile feedback
 Thoroughly enjoys and seeks out messy play
 Craves vibration
Vestibular (Movement)
Over-responsive/Vestibular Avoiding (page 22)
 Avoid/dislikes playground equipment which involves movement; slides, swings
 Prefers seated/inactive tasks, moves slowly and cautiously, avoids taking risks
 Avoids/dislikes elevators and escalators
 Physically clings to and adult they trust
 Appears terrified of falling even when there if no real risk
 Afraid of heights; even the height of a curb or step
 Fearful of feet leaving the ground
 Gets carsick easily
 Fearful of going up or down stairs or walking on uneven surfaces
 Afraid of being tipped upside down, sideways or backwards
 Startles if someone else moves them
 As an infant, did not like baby swings or jumpers
 Fearful or have difficulty riding a bike, jumping, hopping, balancing
 As an infant, disliked being on tummy
 Loses balance easily and may appear clumsy
 Fearful of activities which require good balance
 Avoids rapid or rotating movements
Under-responsive/Vestibular Seeking (page 22)
 In constant motion, can’t seem to sit still
 Craves fast, spinning, and/or intense movement experiences
 Loves being tossed in the air
 Can spin for hours and never appears to be dizzy
 Always jumping on furniture, trampolines, spinning in swivel chair
 Loves being in upside down positons
 Loves to swing as high as possible and for long periods of time
 Is a thrill seeker, dangerous at times
 Always running, jumping, hopping instead of walking
 Rocks body, shakes leg, or moves head while sitting
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Proprioception (Body Awareness)
Under-responsive/Proprioception Seeking (page 19)
 Seeks out jumping, bumping, and crashing activities
 Stomps feet when walking
 Has a limp, ‘floppy’ body
 Frequently slumps, lies down, or leans head on hands or arm while at desk or
table
 Frequently cracks knuckles
 Loves to be wrapped tight in blankets**
 Loves ‘tight’ and small spaces**
 Enjoys bear hugs**
 Bumps into things/appears clumsy
 Difficulty turning doorknobs, handles, opening and closing items
 Often sits in a “W” positon on the floor
 Excessive banging on/with toys and objects
 Loves wrestling and rough play**
 Frequently falls intentionally
 Grinds teeth
 Loves pushing, pulling, dragging objects
 Frequently hits, bumps, or pushes other children
 Difficulty regulating pressure when writing or drawing, too light or too hard
 Often rips paper when erasing
 Complains about objects being too heavy
 Does not understand the meaning of too heavy or too light
 Seems to do everything with too much force (slamming doors)
 Plays with animals with too much force, often hurting them
**Deep pressure touch is also an influencing component
Over registration and proprioception avoiding is very rare, therefore this section only has
one category.
Auditory
Over-resposnive/Auditory Avoiding (page 29)
 Distracted by sounds not normally noticed by others; humming of lights, clocks
ticking
 Fearful of the sound of a flushing toilet, vacuum, hairdryer, dog barking
 Startled or distracted by loud or unexpected sounds
 Distracted by environmental sounds such as lawn mower, trucks
 Frequently asks others to be quiet, to stop talking or singing
 Runs away or covers ears with loud or unexpected sounds
 Refuses or does not like to go to cinema, crowded environments, school halls
 Finds some voices to be very disturbing, dislikes loud laughter
Auditory
Under-resposnive/Auditory Seeking (page 29)
 Often does not respond to verbal cues or to name being called
 Makes noise just to make noise
 Loves excessively loud music or TV
 Oblivious to certain sounds
 Appears confused about where a sound is coming from
 Little or no babbling or vocalising as an infant
 Says “what?” frequently, needs directions/instructions repeating
Page 8 of 43
Oral Sensory
Over-resposnive/Oral Sensory Avoiding (page 25)
 Picky eater, extreme food preferences
 Only eats “soft” or pureed foods past 24 months of age
 Gags with textured foods
 Extremely fearful of the dentist
 Dislikes toothpaste and teeth brushing
 Prefers bland foods
 Only eats certain textures, sensitivities to hot and cold foods, resists trying new foods
Oral Sensory
Under-resposnive/Oral Sensory Seeking (page 25)
 Mouths objects excessively past the age of two
 Bites or sucks on fingers
 Has difficulty with sucking, chewing, and swallowing
 Licks or chews on inedible objects
 Prefers food with intense flavours
 Excessive drooling
 Frequently chews on hair, shirt, or fingers
 Seeks vibration to the mouth
 Prefers excessively spicy, sweet, sour, or salty foods
Olfactory (Smell)
Over-resposnive/Olfactory Avoiding (page 24)
 Reacts negatively to smells which do not usually bother others
 Tells others people how bad or funny they smell
 Refuses to eat certain food because of the smell
 Offended or nauseated by bathroom odours or personal hygiene smells
 Bothered by smell or perfume, deodorant, aftershave
 Bothered by household or cooking smells
Olfactory (Smell)
Under-resposnive/Olfactory Seeking (page 24)
 Will smell an entire room including objects and walls before interacting
 Unable to identify smells from scented stickers/pens
 Does not notice odours that others usually complain about
 Excessive use of smelling when introduced to objects, people, or places
 Use smells to interact with others
Visual
Over-resposnive/Visual Avoiding (page 27)
 Sensitive to bright lights, possibly headaches from the light
 Easily distracted from other visual stimuli in the room
 Has difficulty in bright colourful rooms
 Rubs eyes or has watery eyes after reading or looking at a screen
 Avoids eye contact
 Enjoys playing in the dark
Visual
Under-resposnive/Visual Seeking (page 27)
 Craves bright and colourful (often busy and cluttered) spaces
 Loves to line things up
 Loves to look at spinning objects
 Enjoys looking at shiny objects
Page 9 of 43
The Senses
As many of you will be aware there are 5 main senses:
 Sight (Visual)
 Smell (Olfactory)
 Touch (Tactile)
 Taste (Gustatory)
 Hearing (Auditory)
When referring to sensory processing there are an additional three senses,
these include:
 Vestibular - This sense relates to the inner ear function and response to
head movements. The information carried to the brain outlines the
direction an individual is moving (forward, backwards, side to side etc.) If
the information is carried effectively this sensory information assists the
body in carrying out planned movements while maintaining balance.
 Proprioception – This sense relates to an individual’s body awareness
and ability to navigate movements around an environment. Sensory
feedback is provided through muscles, joint, ligaments etc. Having an
awareness of where our bodies are in spaces allows individuals to plan
and coordinate actions without the need for input from the additional
senses. For example being able to put an arm into a coat or foot into a
shoe without looking.
 Interoception – This sense is not as well known, it relates to sensory
feedback from inside the body and organs. For example the feedback
from the stomach to inform the individual they are full/hungry; or that an
individual may feel anxious due to their heart beating faster.
What is Sensory Processing?

Sensory processing is used to explain how an individual’s brain collects,
interprets and processes sensory information to allow the individual to participate
in daily activities.
Problems will tend to present with an individual’s sensory processing if the

senses are not working effectively or if the pathways from the sensory receptors
to the brain are damaged or have not been fully established through early
development.
In these situations an individual may find it difficult to regulate the incoming

sensory information and respond inappropriately; either being under-responsive
with no or little response or being over-responsive and being over-whelmed by
the sensory input.
Page 10 of 43
Additional Online Resource
Additional information on the theory behind sensory processing and sensory
integration is available via the following websites:
Sensory Integration Network -

www.sensoryintergration.org.uk
The National Autistic Society -
www.autism.org.uk
STAR Institute for Sensory Processing Disorder -
www.spdstar.org
Sensory Processing Disorder Resources Centre -
www.sensory-processing-disorder.com
Over-Responsive & Under-Responsive

In some situations you may find that the child may respond inappropriately to a
sensory stimulus. They may shout out when touched, or wretch at the sight or
smell of foods. This would be described as an individual being over-responsive to
the sensory stimuli and therefore responding in a way that would not be
described as a typical response. Over-responsive means the child has a low
threshold to certain sensory experiences and are sensitive to the smallest input
which may result with an inappropriate response.
In comparison an individual who is under-responsive may fall over and cut their
knee but will not respond as being in pain or aware they have hurt themselves.
They may not feel changes in temperature (hot or cold). The individual may keep
their jumper on when it is a hot day; they may not recognise or feel hot but may
physically appear to be sweating or over-heating.
It is common that a child can fluctuate throughout the day between being under
and over-responsive. In other situations it may be identified that a child only
presents with needs in one environment e.g. at home but not in school. It may be
that during school the individual is able to self-regulate and suppress their
sensory input during day due to the strategies and routines put in place. However
at night when they return home and experience a less structured and un-
timetabled environment they can become overwhelmed and find it challenging to
cope with the sensory input; therefore may participate in sensory seeking or
avoiding behaviours.
It is therefore essential that those involved with the child have an awareness of
the coping strategies that are implemented across both the school and home
settings to support the individual; even if they may not present with sensory
behaviours in all environments. Two diagrams are attached below to explain how
a child may present and why they may respond in a certain way to sensory
information.
Page 11 of 43
Self-regulation
Self-regulation refers to an individual’s cognitive ability to recognise incoming
information and respond appropriately, while making ongoing alterations to thoughts,
behaviours, strategies and actions. Bundy et al (2002) defines self-regulation as the
“Adaptability during daily unstructured tasks; sustained concentration and ability to
divide attention between two or more focused tasks; task completion; and ability to
monitor own behaviours in context before it becomes a problem.”
If an individual is finding it challenging to regulate their sensory input due to sensory
processing difficulties then they may require additional support and strategies to
support self-regulation. This pack aims to support those working with children to
implement these potential strategies. And individual with self-regulation difficulties
may present with; difficulty accepting changes to routines and transition, become
easily frustrated, impulsive, quick/unexpected mood changes, avoids eye contact,
prefers repetitive familiar play, difficulty calming themselves, difficulty with sleep
routine and distress relating to falling to sleep and wakening.
Just Right Engine
“How Does Your Engine Run?”
The Alert Program® for Self-Regulation
Developed by two internationally known Occupational Therapists, Mary Sue
Williams and Sherry Shellenberger.
All individuals are expected to fluctuate throughout stages of arousal throughout the
day/night; an appropriate level of arousal will be to stay between the green and
amber levels. If an individual has difficulty processing sensory information then they
may find it challenging to stay between these levels and may spend more time over
or under stimulated by sensory information. An individual who is under-responsive
may be slow, sluggish and switch off from tasks. An individual who is over-
responsive may be in a meltdown and over whelmed stage, where they are
struggling to regulate their incoming sensory information to a point that they cannot
cope with the situation.
Frustrated, angry, irritable
Relaxed, Calm Overwhelmed
Diagram based on Just Right Engine Theory – “How Does Your Engine Run” William and Shellenberger
Page 12 of 43
Window of Tolerance
High Arousal
Low Arousal
Key:
Individual without difficulty processing sensory information
Individual with difficulty processing sensory information
Diagram based on the Window of Tolerance – by M. Dezelic, 2013.
This diagram aims to help understand individuals who struggle to regulate their
levels of arousal in response to sensory information:
 The blue line represents an individual without difficulty who is able to maintain
an even level of arousal throughout the day with minimal increases and
decreases in responses to sensory stimuli.
 The black line represents an individual with difficulties processing sensory
information. This line reflects a more extreme fluctuation in level of arousal in
response to sensory stimulus; spending more time in the high and low
threshold than within the normal range.
Page 13 of 43
Tactile System (Touch)
The tactile system covers a range of different types of touch including:
 Temperature - ability to regulate temperature.

 Pain
 Pressure
 Vibration
 Body position (proprioception)
 Crude touch - sense that something has touched them without being able to
locate where they body been touched.
 Discriminative touch - also known as fine touch, ability to sense and locate
where they have been touched.
 Protective touch links to; pain, temperature and light touch and alerts to
potentially trigger the fight or flight response.
How might an individual present who is over-sensitive/responsive to tactile

input?
These individuals may present with the following behaviours:
 May avoid messy play, will touch only with finger tips for minimal contact
and will want to wash hands during or immediately after activities.
 Will avoid or dislikes eating foods with fingers/hands.
 Constantly touching or feeling objects around them.
 May dislike certain textures of foods.
 May avoid brushing hair or teeth.
 Dislikes hair being cut or touched.
 Child avoids crowds or dislikes busy times such as lunch or assembly.
 Avoid potential contact from others; locates themselves at the edge of
groups, dislike of being bumped into or brushed passed. May become
distressed or upset from minimal or light touch.
 May dislike being barefoot or certain clothing textures, may be irritated by
seams and labels in clothing. May dislike getting dressed or undressed or
will remove clothing.
 May have poor social/emotional relationships as dislikes being touched e.g.
being hugged or kissed.
 Touch may be perceived as a threat and may respond with physical or
verbal aggression or appear startled/alarmed.
 Dislike or avoid sand play, finger painting, glue, baking etc.
 Overreacts if falls over in playground.
 Sleep may be impacted due to bed liner or blanket textures.
Page 14 of 43
How might an individual present who is under-sensitive/responsive to
tactile input?
 May appear not to be aware or respond to touch, if bumped into may be

unaware.
 Clothing may be back-to-front, twisted or shoes on the wrong feet.
 After eating may have messy face and hands but will not appear to notice.
 Difficulty with manual dexterity or fine motor tasks such as gripping and
manipulating scissors or pencils.
 May fall over and appear to hurt themselves but does not appear to react.
 May have cuts and bruises that find difficult to explain as may not have
noticed when has happened.
 Seeks out touch, craves hugs, or may touches objects constantly within
their environment.
 Difficulty manoeuvring around their environment may bump into tables or
doorways.
Page 15 of 43
Tactile Strategies
Calming Strategies – Over-Responsive
Predictable/Slow/Soft Touch:
 Weight-bearing activities, press-ups, 4-point kneeling.

 Play dough activities – deep pressure, kneading and rolling, pressing with
biscuit cutters.
 Using dry (sand, rice) or wet (water) textures for play.
 Avoiding using or mixing multiple textures when playing or with foods.
 Alter the environment; allow the child to go earlier or later at busy times of
the day. E.g. changing in lessons, lunch or assembly.
 Thinking of where the individual is placed in the class environment to
reduce the likelihood of being bumped into or brushed passed.
 Having a peg or drawer at the end of a row. Seating the child towards the
edge of a table or classroom rather than next to a through passage for the
other children.
 Modifying arts and craft activities to allow alternatives; using tools such as
glue paddle, paint brush. This may encourage a child to participate more
within these tasks allowing to build up participation.
 The use of heavy work (proprioception) activities prior to busy times of the
day to help reduce anxieties or impact of tactile activity or experience.
 Avoid light touch, use firm pressure when touching the individual.
 Avoid approaching from behind as child may be startled if touched without
warning.
Alerting Strategies – Under Responsive
Unexpected/Fast/Rough Touch:
 Using light touch soft objects such as feathers.

 Making foods with mixed textures.
 Use play dough with a range of textures, hide objects in the play dough.
 Using sticky/slimey textures such as foam, wet sand etc. Games such as
hiding objects for the child to find.
 Use of fidget toys – varying or firm textures.
 Encourage participation in tactile experiences; messy play, sand/water
play and finger painting.
 Encourage working with a range of material and textures; sand paper,
tissue paper, wool, cotton wool, pasta and other dried foods.
 Use of a feel box – place objects inside of box with a whole for the child to
place their hand to feel the objects and guess what it is without visibly
seeing.
Page 16 of 43
Proprioception System (Body Awareness)
The proprioception system is how an individual perceives their own body
image and their ability to locate their body in space. The body image is
developed through feedback provided by the individual’s muscles and joints.
Having this body awareness allows an individual to plan, sequence and
complete movements correctly. An effective Proprioception system is required
to time and sequence movements in a graded and coordinated
action. Proprioception interlinks closely with the vestibular system, when these
senses are integrated they aid body awareness, balance and motor-control.
An individual who has an impaired Proprioception system may present
with:
 Poor motor planning and praxis.
 Avoid completing tasks, especially complex and refined gross motor
actions e.g. playing sports.
 May appear clumsy and fall over frequently.
 Find planning actions such as coordinating stairs or sitting down on a
chair challenging.
 Have impaired concept of force (too little/too much) and participate in
rough play or regularly bump into things.
 May have been delayed with their development e.g. late crawler and
walker.
How might an individual present who is over-sensitive/responsive to
proprioception input?
 It is very uncommon that an individual will present with being over-
responsive as proprioception is useful for being both calming and
alerting.
 The use of proprioception techniques is useful as a calming technique to
override other sensory systems.
proprioception input?
 The individual may constantly seek out movement or proprioceptive
information which may be described as “Sensory Seeking”. They may
fidget on their seat or shift their body position and limbs.
 They may find it challenging to stand or sit still.
 Appear or described as heavy handed or struggling to grade force;
impacts upon handwriting – increased pressure put through pen/pencil,
bumping into other children during P.E.
 Finds P.E. challenging, ball games, climbing, using equipment and
apparatus.
 Finds it difficult to plan action or movement of limbs, benefits from
looking at limbs and hands to control movements. e.g. looking at hand
Page 17 of 43
when using pen/pencil. Looking at feet when riding bike or coordinating
pedalling action.
 Chewing down hard on objects such as buttons, pens, sleeves, clothing
(inedible hard objects).
 Difficulty sitting on the carpet.
 Child described as heavy handed; throws ball too hard, gives really firm
hugs.
 Seeks extra movement, will crash onto the floor and/or constantly
jumps.
 High pain threshold does not appear to respond to pain.
 Participates in rough play, may break toys without meaning to.
 Finds activities that require co-ordination challenging to complete e.g.
riding bike, swimming, team sports.
 Appears to have low tone (floppy) or weak muscles.
Page 18 of 43
Proprioception Strategies
Joint compresion/heavy resistance:
 Resistence activities – pulling, pushing, carrying objects.
 Lifting items with some weight, heavier shopping bag, backpack with books
in (within reason for the size of the individual).
 Encouraging to complete stairs.
 Weight bearing activities – wall push ups, press ups.
 Oral chews / crunchy or chewy foods types / drinking through a straw /
blowing through a straw or blowing bubbles.
 Climbing – park aparatus etc.
 Crashing onto soft mats / soft play area
 Use of therapy ball; bouncing on, rolling over and for applying light
pressure.
Alerting Strategies – Under-Responsive
Quick change/Fast Movements:
 Jumping on tramopline.
 Incorporate proprioception activities into P.E. e.g. tug of war, wheelbarrow
races, use of theraband for pulling activities (standing with both feet on the
band and pulling upwards and outwards hold for approx 10 seconds).
 Chair push ups, wall presses. 4-point kneeling, kneeling press ups.
 Wearing a backpack with some weight in e.g. books, useful to use at transition
times. (no more than 10% of child body weight)
 Physical sports activities – running, swimming, climbing, circuits or obstacle
courses.
 Upper limb resistance activities, pressing palms together, press open palms
onto desk in standing, play dough warm up tasks (pressing, squeezing and
rolling). Useful to use prior to handwriting or focused work.
 Use of wheatbag or larger beanbag on lap or over shoulders during focused
activites when seated. To use for short periods of time e.g during a lesson with
space gaps between. Or use of leg weights – no more than 10% of body
weight.
 Allow regular movement breaks during school day, to promote through the use
of a task e.g. taking register or messages to office etc.
 Theraband around front two chair legs, to be off the floor to allow child to rest
feet on and push through allowing some resistance.
 Use of fidget toys.
 If re-arranging classroom or chairs at end or beginning of class or assembly’s
to allow to assist if appropriate and when supervised.
 Oral motor activities for proprioception relating to the mouth. Jaw contains lots
of proprioceptor receptors.
 Use of wobble cushion to provide additional movement feedback.
 Have a beanbag area or mats in classroom that can remove self to and crash
onto if required.
Page 19 of 43
Vestibular System
(Posture, Balance and Arousal)
The vestibular system supports individuals:
 Balance and Posture – supports in staying upright against gravity and is
engaged when there is movement involving the head position, may
prevent from falling over if bending down and supporting an upright
posture when seated.
 Impacts upon the sleep/wake cycle and impacts arousal and attention
levels.
 Controlling eye movements - supports in stabilising visual fields to
participate in an action while in motion.
 Detecting head movements.
The most important thing to consider with vestibular input is the speed and
quality of the movements. Carrying something heavy or regulating the
rhythm of the activity. E.g. slow rhythmic movements can be calming while
faster movements can be alerting.

vestibular input?
 Moving in their seat or getting up and moving without a purpose.
 Poor sitting posture, slumping over desk or lying head on table.
 Poor balance skills and low muscle tone.
 Does not enjoy or find P.E/sports challenging.
 Often falls over, trips or stumbles.
 Difficulty with co-ordaining both sides of the body, lacks hand dominance
or preference, avoids crossing mid-line, struggles with bilateral
activities.
 Lack of awareness of right and left or will mix up regularly.
 Enjoys fast movements without appearing dizzy, e.g. will spin constantly
on a roundabout or fast on swing with minimal impact.
 Difficulty holding head upright while seated, may rest head on hand or
on table.
 Delayed or impaired balance.
 Excessive movement and spinning, enjoys spinning and watching
objects spin.
 Difficulty focusing or listening without constantly moving.
 Reduced awareness of danger and may jump from high heights with
minimal fear.
 Difficulty maintaining balance especially when walking on uneven
surfaces.
 Poor hand eye-coordination.
 Difficulty reading and scanning.
Page 20 of 43
vestibular input?
 Hesitates or avoid walking downstairs.
 Gets dizzy easily.
 Gets car sick; even on short trips.
 Dislike of Rollercoasters or theme park rides.
 Dislikes climbing frames, trampolines.
 Dislikes jumping up and down or off heights, swinging, leaning
backwards.
 Seek physical support from adults, holding hand when using stairs etc.
 Poor balance (static and dynamic).
 Difficulty scanning or reading.
 Poor hand eye-coordination.
 Appears to control environment to reduce vestibular input.
There is some overlap with how an individual may present with some
similarities across the areas. The easiest way to distinguish between over or
under-responsiveness is that an individual who is over-responsive will avoid
and resist vestibular input or movement. However an individual who is under-
responsive will seek out and will enjoy moving constantly or spinning.
Page 21 of 43
Vestibular Strategies
Slow/One Direction Movement:
 Linear rocking – rocking horse, chair, zuma chair.
 Slow predictable movemnet in linear pattern – e.g. use of park swing.
 Swimming in a planned liner pattern.
 Trampoline – rhythmic slow up and down.
 Prone (on stomach) rolling backwards and forwards over a therapy/gym ball.
 Keeping objects at or above waist heigh to prevent unnecassary bending,
e.g. higher school draw, books and other resources.
 When travelling in a car or other transport to position so can see out of the
front of the vehicle, e.g. front or middle seat of the car.
 Use of a firm supportive seat that doesn’t tip to maintain feeling of safety and
support for the individual, feet fully supportive flat on ground or on a stable
footboard.
 Altering P.E. to reduce vestibular activities or allowing to participate in
different/alternate activites if unable to avoid. Avoiding activities where feet
are off the floor or rolling.
 Allow individual time when completing stairs, allowing to go first or last in line
of others. To use quieter stair cases is possible.
 To have a hand rail for individuals to use when ascending or descending
stairs.
 Allow individual to leave class earlier at busy times of the day e.g between
class change over, lunch-times.
Alerting Strategies – Under-Responsive:
 Promoting gymnastics, yoga, pilates – forward rolls, positions that promote
regular changes in positon and challenge centre of gravity through moving
head out of midline.
 Use of wobble cushion (Move’n’sit cushion)
 Placing objects nearer to the ground or below waist level to encourgae
bending (moving head out of midline).
 Movement breaks – allowing to stand up and alter position or to move
around the room. It may be that a child needs prompting to do so by
providing with a task e.g. to put something in the bin, or collect in school
books at the end of the session.
 Jumping on a trampoline, faster movements.
 Running, jumping, skipping, hopping, climbing etc.
 Use of park or school apparatus – swings, slides, climbing frames.
 Rolling over or bouncing in a seated positon on a therapy/gym ball.
 Wheelbarrow walks, walking on all fours.
 Promoting any physcial activities in and out of school – football, sports,
swimming.
*Caution: Do not complete unless competent or trained as altering vestibular input can have
lasting effects after completed. If vestibular strategies are implemented they should be
followed by calming or proprioception activity to lower arousal and regulate.
Page 22 of 43
Olfactory System (Smell)
The olfactory system includes several functions including:
 Protection – avoiding environmental hazards e.g. chemicals/fire.
 Eating and ingestion – smell to find food, discriminating safe smells.
 Social communication – associating smells to individuals and
maintaining and sustaining relationships.
 Memory – smell can be one of the most important smells to trigger
memories and past experiences.
Gustatory System (Taste)

Taste systems can help to provide a range of experiences including:
 Enjoyment and pleasure from food as well as protection from dangerous
foods (chemicals).
 Taste also aids balancing bodily functions and ensuring the appropriate
nutrients and vitamins are ingested.
 Recognising the changes in tastes.
 Providing protection, taste in conjunction with smell can support in the
body recognising danger e.g. poisonous food, off food.
 As a result of the taste of food the gastrointestinal system can be
activated, salivation, swallowing, gag reflex or regurgitation.

smell/taste input?
 Individual becomes distracted by a smell or cannot focus on a task as they find
the smell over powering.
 May constantly comment on smells, cover nose from smells others may
not notice.
 Avoid foods most young people would enjoy.
 Craves or gets upset by certain tastes/smells.
 Does not appear to get used to smells or tastes.
 Dislikes teeth brushing and toothpaste.
 Individual gags or has aversive response to smells/tastes.
 Individual may struggle at meal or snack times due to mixture of smells
and strong smells being present.
 Dislikes foods with strong flavours, may prefer bland, plain, dry foods.
 Dislikes foods with different textures or consistencies, food with sauce or
lumpy textures, wet and dry foods mixed together.
 The individual may present with a behavioural responses, may become
upset, or lash out (especially if taste and smell systems associate as a
threat).
Page 23 of 43
smell/taste input?
 Individual will constantly seek out smelling objects both foods and non-
foods.
 Enjoys foods with strong tastes, e.g. spicy or sour foods.
 Will add flavours to food or mixtures of flavours, e.g. sauces, salt and
pepper.
 Packs food into mouth before swallowing, large amounts appears to
pocket food in mouth.
 Eats food very quickly
Olfactory/Gustatory Strategies
Calming Strategies – Over-Responsive:
 Use of familiar smells and tastes
 Use of smells such as lavender, camomile in stressful situations.
 Chew toys, suck/chew sweets
 Keep smells and taste familiar.
 Use of room sprays, incense, candles.
 Use of prioriception activities as explained above.
 Allow the individual to choose smells that are comforting to them, use of
bracelet or wrist strap sprayed with chosen smell. Child can smell to
override other unpleasant smells.
 Never force an individual if responding as being uncomfortable. To grade
exposure to activities; change minimal elements; taste, texture, smell.
 Using strong altering smells such as mint, citrus, strong perfumed
smells.
 When washing hands use strong smelling soaps.
 Sour sweets, popping candies, spicy, sour, citrus - strong and contrating
tastes.
 Strong smelling incense and room sprays.
 Using a mixture of contrasiting smells, tastes, textures.
 Smelling pens, scrack and smell stickers.
 Alternating textures of foods, crunchy & soft, hot & cold.
**Note: It is ok to have food preferences and sometimes individual just won’t like food and
that’s acceptable and should not be forced, that does not always mean they have sensory
difficulties.
When relating to food it may be beneficial to liaise with speech and language therapist
(SALT) or dietician if already actively involved. If there is concern about poor diet or avoiding
food which has resulted in loss of weight then a referral would be recommended to a
dietician. If there are concerns about ability to chew, swallow, coughing at mealtimes then a
referral to SALT would be recommended. It would be advised to discuss further with the
childs family and signpost to their GP.
Page 24 of 43
Oral Motor
Oral motor has many important roles including:
 Managing production of salvia
 Speech
 Feeding
 Swallowing
 Chewing
 Development of muscles in mouth, face and tongue.
 Oral motor can be supportive in self-regulating and calming as well as
increasing alertness.
oral motor input?
 Individual may put non-food objects in their mouth to chew and suck;
e.g. toys, buttons, clothing.
 Individual may over fill their mouth when eating.
 Individual puts food too far back in mouth, can be prone to coughing or
gagging on foods.
 Individual dribbles or appears to produce excessive spit/saliva.
How might an individual present who is over-sensitive/responsive to oral
motor input?
 Individual dislikes having their teeth cleaned.
 Individual appears as a picky eater.
 Individual gags easily while eating.
 Individual avoids food based activities.
Oral Motor Strategies
 Blowing bubbles
 Sucking through straw – thick drinks such as milkshakes.
 Chewing/eating crunchy food and vegetables
 Chanting / singing (auditory and oral)
 Chew toys
 Z vibes (vibrating pen)
 Use activities for under responsive as these use the proprioceptive
systems to help reduce sensitivities.
 Be considerate to individuals dislikes, don’t force to eat things or
activities they do not enjoy or strongly dislike.
 Sucking or crunching on cold foods e.g. ice, ice lollies.
 Popping candies and sour sweets
 Eating strong tastes e.g. citrus.
Page 25 of 43
Visual System (Seeing)
The purpose of our visual system is to navigate around our world and to intake social
information such as faces and body language.
Eye movement:
 Controlled by the eye muscles; these allow us to fixate on an object, scanning
when reading, allow to follow trajectory of objects in motion.
Visual processing:
 Brain’s response to select and respond appropriately to input. Able to
concentrate and focus without becoming distracted by other visual stimulus.
The visual system has many functional components including:

 Clarity of vision
 Eye movements
 Colour perception
 Contrast recognition
 Figure ground discrimination
 Peripheral vision
 Visual attention
 Assigning meaning from print - needed for reading
 Object and force recognition – moving objects
How might an individual present who is under-sensitive/responsive to visual
input?
 Likes to watch things that are moving/spinning, washing machine, quick
spinning movements (toys).
 Will spin and watch objects.
 Stares intensively at people or objects.
 Will blink repetitively or excessively.
 Closes eyes tightly when blinking.
 Squints when looking at objects.
 Brings things close to their eyes to see, holds head close to paper when
reading or writing.
 Child will look at or watch objects from the corner of their eyes.
How might an individual present who is over-sensitive/responsive to visual
input?
 Prefers to be in the dark or with minimal visual input.
 Becomes frustrated when trying to find objects in messy environments or
varying backgrounds.
 Express discomfort to bright lights, struggles with changes in lights between
environments, dislike flashing lights etc.
 Takes longer to adjust to lights and changes in lights, e.g. going inside to
outside.
 Complains of headache in bright rooms or in un-natural lights – (if no medical
reason).
Page 26 of 43
Visual Strategies
 Store clutter and objects away in labelled boxes.

 Keep colours of rooms calm and uncluttered.
 Use of soft and non-contrasting colours to decorate rooms or displays.
 To wear sunglasses and sun caps to reduce visual stimulation and sun
exposure.
 Use of black out blinds at home.
 Use of visual timetables, interactive timetables where can move
throughout the day.
 Use proprioception activities as explained above.
 Where possible reduce visual distractions or have set area with reduced
visual stimulus for work station - use of desk screens or to position near
or facing wall in class to reduce visual stimulation at focused times.
 Positon child near the front of classroom, avoid facing windows if busy
environment outdoors, or doorway that leads to busy corridors.
 Clearly display important information and highlight in the same area on
board e.g. date and objectives in same place on the board each day.
 Provide print outs for homework or class objectives where possible,
using neutral colours for text and work sheets.
 Consider lighting in the classroom, if bright fluorescent lights consider
placing the child near natural light (window).
 Use of bold contrasting colours.

 Use highlighters to outline important information
 Bright lighting
 Sit close to window if busy environment outdoors or near busy corridors.
 May benefit from using IT such as tablet, laptop.
 Completing mazes, dot to dots, words searches, interative books,
colour/painting by numbers.
 Provide objectives and homework where possible on bright paper or
using bright text.
 Clearly display important information and highlight in the same area on
board e.g. date and objectives in same place on the board.
**A child will benefit from regular visual checks to ensure no other visual
issues are impacting upon their performance. Individuals with suspected
difficulties with eye movement please make referral to ophthalmology.
Page 27 of 43
Auditory System (Hearing)
The auditory system refers to the brains ability to organise and process auditory
information; recognising the frequency, tone, intensity and pitch.
More refined functions of the auditory system are to:
 Interpret sounds against background noises
 Interpreting sounds coming in both ears
 Sound localization - the ability to work out the direction of the sounds in
relation to its loudness.
 Timing of auditory information (ability to fill in gaps if not heard).

auditory input?
 The individual speaks in a loud voice to increase noise or drown out other
noises.
 May hum constantly to increase noise or drown out other noises.
 Appears not to hear although hearing abilities outlines no formal issues.
 Seems to ignore when being spoken to, does not always respond to name
being called.
 Difficulty pronouncing words.
 Trouble hearing in groups and loud environments.
 Difficulty remembering and sequencing multi-step verbal instructions.
 May appear distractible or inattentive.

auditory input?
 Puts hands over ears when the noise level gets too loud within class or
other environments.
 Responds negatively to loud or unexpected noises.
 May put hands over ears when unexpected or loud noises such as school
bells or fire alarms activated.
 Over react to sounds not noticed by others, may be distracted by distant
noises e.g. lawn mower outdoors, clock in classroom.
 Distracted by noises such as clock ticking or light buzzing.
 Finds challenging to block out background noise to focus on someone
talking directly to them.
 May appear distractible or inattentive.
 Takes a lot of physical effort to concentrate.
 Behaves erratically when changing settings, swapping classrooms.
**All children should have their hearing tested regularly, if a child is suspected to
have auditory issues to rule out potential issues with hearing and underlying
difficulties that may contribute to difficulties. Individuals with auditory issues may
present with sensory behaviours.
Page 28 of 43
Auditory Strategies
Expected/Precitable Sounds:
 Low voices with predictable tones
 Use familiar and calming songs such as nursery rhymes
 Use rhythmic drumming or clapping noises, especially at transition time
 Listen to natural sounds or rhythmic songs (60 bmp as similar to heart beat
sound which calms the nervous system).
 Respect that sensitivities can be portrayed as hurting the individual and that
they may present as fearful and required reassurance.
 Warning the individual of potential noises, if aware of fire alarm, school bell at
end of lesson 5 minute warning.
 Minimise auditory distractions, quiet clocks, using rugs on loud flooring to
reduce excessive noise.
 Consider use ear defenders, ear plugs or sound cancelling headphones if
overwhelmed regularly on an on-going basis, only use at noisey transiton
times so do not become dependent on using all of the time.
 Individuals to work in quieter areas when required to focus for longer lengths
of times.
 Providing the individual with the choice to eat at quieter times or in a quieter
room for lunch or snack times.
 Allow the individual to go into assembly or lunch first to allow them to get used
to increasing noises gradually.
 Allow the individual to sit at the end of row in assembly to minimise noise.
 Allow child to leave the classroom a couple of minutes earlier to transition and
avoid noisy times.
 Use of visual cues to support auditory instructions and minimise the number
of verbal instructions given.
Alterting Strategies – Under-Responsive
Unexpected/Loud Sounds:
 Exposure to loud noises and unpredictable sounds
 Exposure to vary intonation – rising and falls in voices.
 Play music with fast changing sounds
 Call a persons name prior to speaking
 Play listening games – guess the sound
 Make sure the child is facing the front of the room or directly infront of the
teacher when giving instructions.
 Give simple instructions, don’t use too many words and support with visual
cues.
 Speak loudly and clearly.
 Support by asking class to be quiet when giving instructions.
 Ask the individual to repeat instructions back to ensure have been heard and
understood.
 Wait for the individual to process and respond to the auditory information,
acknowledging that it may take longer than peers.
 Get the child to focus on the task.
Page 29 of 43
Sensory Toys/Resources
There are a range of online websites that outline useful resources and sensory toys that may
be beneficial for meeting a child’s sensory needs or assist in implementing strategies.
Some examples of useful toys/resources that may provide positive sensory feedback are:
 bubble machine
 bubble tube
 fibre optic toys
 colour torch
 drawing, colouring and painting
 music or musical instrument
 swing
 slide
 trampoline
 rocking horse
 climbing frame
 football
 bicycle, toy tractor, scooter etc
 paddling pool and water play toys
 sand pit
 basketball net
 textured play dough
 large gym/therapy ball
 wobble cushion
 pop up or books that include different textures or experiences
Some examples of possible suppliers:
 Early Learning Centre - https://www.elc.co.uk/

 Explore your senses - http://www.exploreyoursenses.co.uk/
 Excitim - https://www.special-needs-toys.co.uk/
 Fledglings - https://www.fledglings.org.uk/
 Learning Development Aids - https://www.ldalearning.com/
 Rompa - http://www.rompa.com/
 Sensory Direct - https://www.sensorydirect.com/
 SenseToys - https://www.sensetoys.com/
 Sensory Toy Warehouse - https://www.sensorytoywarehouse.com/
 SpaceKraft - https://www.spacekraft.co.uk/
 TFH UK - http://www.specialneedstoys.com/uk/
Please note: the organisations above are not connected with Trafford Council and/or
Pennine Care NHS Foundation Trust in any way. We cannot recommend any of the above
organisations and accept no liability with regards to any purchases from the companies list.
The list of companies provided is not exhaustive and there are alternate provides available.
Page 30 of 43
REFERENCES
Ayres, J. (2018) ‘What is Sensory Intergration?’ [Online] Available at:
https://www.sensoryintegration.org.uk/What-is-SI [Accessed: 1st August 2018].
Bundy, A., Lane, S. and Murray, E. (2002). Sensory Integration Theory and Practice.
2nd Ed. Philadelphia: F. A. Davis Company, pp.439.
Dezelic, M. (2017) ‘Window of Tolerance’ [Online] Avaiable at:

https://www.drmariedezelic.com/window-of-tolerance--traumaanxiety-rela [Accessed:
1st August 2018].
Williams, M.S., and Shellenberger, S. (1994). ‘How Does Your Engine Run? The
Alert Programme for Self-Regulation. Alberquerque NM: Therapy-Works.
Useful Book Resources

Understanding Your Child’s Sensory Signals …………………………………..………….. Angie Voss
The Out-of-Sync Child ……………………………………….….......................... Carol Stock Kranowits
Building Bridges Through Sensory Intergration …………. Ellen Yack, Paula Aquilla & Shirley Sutton
Appendices / Referral documents checklist

Please ensure all of the below paperwork is completed and enclosed with each
referral and sent by post to –
Occupational Therapy Department
1st Floor Waterside House
Sale Waterside
Sale
M33 7ZF
Incomplete referrals will not be accepted and it would be recommended that you take
a copy for your records.
 Checklist: 32 – 35
 Supplementary evidence sheets: 36
 Teacher questionnaire: 37 – 38
 Parent questionnaire: 39 – 41
 Referral form: page 41 – 43
Page 31 of 43
Checklist
This checklist is intended to be used as a tool and a guide in becoming more aware and
understanding a child’s sensory needs and differences. This is not a diagnostic tool, nor is the
number of areas that you check off an indicator of a sensory disorder.
The checklist includes many of the most common sensory preferences and differences, and is divided
into categories based on the sensory system and how the brain and nervous system may process the
input. After completion, take note of the categories where you have checked off the most items
(significant difficulty rather than checking 1 or 2 items). This will help guide you in determining the
sensory systems that may need the most attention and support.
You should use the pack to locate the advice and strategies that apply to the area outlined as a
potential difficulty or sensitivity; e.g. if a child presents with the majority of checked items in tactile
over-responsive/avoiding you should refer to the tactile over-responsive/calming strategies section of
the booklet (page 16).
Written by Angie Voss, OTR (ASensoryLife.com) Copyright 2014 – Sensory Difference Awareness Checklist
Child’s Name ………………………… D.O.B ………………. School: …………………………
Tactile Input
Over-responsive/Tactile Avoiding (page 16)
 Becomes fearful, anxious or aggressive with light or unexpected touch
 As an infant, did/does not like to be held or cuddled; may arch back, cry, or pull away
 Distressed with nappy changes
 Appears fearful, or avoids standing in close proximity to other people or peers
(especially in lines)
 Becomes frightened when touched from behind or by someone / something they
cannot see (such as under a blanket)
 Complains about having hair brushed
 Bothered by rough bed sheets (example: old and “bumpy”)
 Avoids group situations for fear or unexpected touch
 Resists friendly or affectionate touch from anyone besides parents or siblings (and
sometimes them to)
 Dislikes kisses, will “wipe off” the place where kissed
 A raindrop, water from a shower, or wind blowing on the skin produces an adverse
response or avoidance reaction
 Overreacts to minor cuts, scrapes, and or bug bites
 Avoids touching certain textures of material (blankets, rugs, stuffed animals)
 Refuses to wear new or stiff clothes, clothes with rough textures, turtlenecks, jeans,
hats, or belts
 Avoids using hands for play or approaches with a closed fist
 Avoids or dislikes messy play such as mud, glue, or finger paints
 Avoids getting messy with food textures
 Distressed by dirty hands and wants to wipe or wash them frequently
 Excessively ticklish
 Distressed by seams in socks and may refuse to wear them
 Distressed by clothes rubbing on skin; may want to wear shorts and short sleeves
year round, toddlers may prefer to be naked or pull nappies and clothes off
constantly
 Distressed about having face washed
 Distressed with haircuts, nail trimming
 Resists brushing teeth, may be extremely fearful of the dentist
 Refuses to walk barefoot on grass or sand
 Walks on toes on new surfaces or textures
Page 32 of 43
Tactile
Under responsive/Tactile Seeking (page 16)
 Craves touch or needs to touch everything and everyone
 Is not aware of being touched/bumped unless done with extreme force or
intensity
 Is not bothered by injuries and shows no distress with painful stimuli
 Not aware that hands or face are dirty or the feeling his/her nose running
 Frequently hurts other children or pets while playing
 Repeatedly touches surfaces or objects that are soothing
 Seeks out surfaces and textures that provide strong tactile feedback
 Thoroughly enjoys and seeks out messy play
 Craves vibration
Over-responsive/Vestibular Avoiding (page 22)
 Avoid/dislikes playground equipment which involves movement; slides, swings
 Prefers seated/inactive tasks, moves slowly and cautiously, avoids taking risks
 Avoids/dislikes elevators and escalators
 Physically clings to and adult they trust
 Appears terrified of falling even when there if no real risk
 Afraid of heights; even the height of a curb or step
 Fearful of feet leaving the ground
 Gets carsick easily
 Fearful of going up or down stairs or walking on uneven surfaces
 Afraid of being tipped upside down, sideways or backwards
 Startles if someone else moves them
 As an infant, did not like baby swings or jumpers
 Fearful or have difficulty riding a bike, jumping, hopping, balancing
 As an infant, disliked being on tummy
 Loses balance easily and may appear clumsy
 Fearful of activities which require good balance
 Avoids rapid or rotating movements
Under-responsive/Vestibular Seeking (page 22)
 In constant motion, can’t seem to sit still
 Craves fast, spinning, and/or intense movement experiences
 Loves being tossed in the air
 Can spin for hours and never appear to be dizzy
 Always jumping on furniture, trampolines, spinning in swivel chair
 Loves being in upside down positions
 Loves to swing as high as possible and for long periods of time
 Is a thrill seeker, dangerous at times
 Always running, jumping, hopping instead of walking
 Rocks body, shakes leg, or moves head while sitting
Page 33 of 43
Proprioception (Body Awareness)
Under responsive/Proprioception Seeking (page 19)
 Seeks out jumping, bumping, and crashing activities
 Stomps feet when walking
 Has a limp, ‘floppy’ body
 Frequently slumps, lies down, or leans head on hands or arm while at desk or
table
 Frequently cracks knuckles
 Loves to be wrapped tight in blankets**
 Loves ‘tight’ and small spaces**
 Enjoys bear hugs**
 Bumps into things/appears clumsy
 Difficulty turning doorknobs, handles, opening and closing items
 Often sits in a “W” positon on the floor
 Excessive banging on/with toys and objects
 Loves wrestling and rough play**
 Frequently falls intentionally
 Grinds teeth
 Loves pushing, pulling, dragging objects
 Frequently hits, bumps, or pushes other children
 Difficulty regulating pressure when writing or drawing, too light or too hard
 Often rips paper when erasing
 Complains about objects being too heavy
 Does not understand the meaning of too heavy or too light
 Seems to do everything with too much force (slamming doors)
 Plays with animals with too much force, often hurting them
**Deep pressure touch is also a influencing component
Over registration and proprioception avoiding is very rare, therefore this section only has
one category.
Auditory
Over-resposnive/Auditory Avoiding (page 29)
 Distracted by sounds not normally noticed by others; humming of lights, clocks
ticking
 Fearful of the sound of a flushing toilet, vacuum, hairdryer, dog barking
 Startled or distracted by loud or unexpected sounds
 Distracted by environmental sounds such as lawn mower, trucks
 Frequently asks others to be quiet, to stop talking or singing
 Runs away or covers ears with loud or unexpected sounds
 Refuses or does not like to go to cinema, crowded environments, school halls
 Some voices may be very disturbing, loud laughter
Auditory
Under-resposnive/Auditory Seeking (page 29)
 Often does not respond to verbal cues or to name being called
 Makes noise just to make noise
 Loves excessively loud music or TV
 Oblivious to certain sounds
 Appears confused about where a sound is coming from
 Little or no babbling or vocalising as an infant
 Says “what?” frequently, needs directions repeating
Page 34 of 43
Oral Sensory
Over-resposnive/Oral Sensory Avoiding (page 25)
 Picky eater, extreme food preferences
 Only eats “soft” or pureed foods past 24 months of age
 Gags with textured foods
 Extremely fearful of the dentist
 Dislikes toothpaste and teeth brushing
 Prefers bland foods
 Only eats certain textures, sensitivities to hot and cold foods, resists trying new foods
Oral Sensory
Under-resposnive/Oral Sensory Seeking (page 25)
 Mouths objects excessively past the age of two
 Bites or sucks on fingers
 Has difficulty with sucking, chewing, and swallowing
 Licks or chews on inedible objects
 Prefers food with intense flavours
 Excessive drooling
 Frequently chews on hair, shirt, or fingers
 Seeks vibration to the mouth
 Prefers excessively spicy, sweet, sour, or salty foods
Olfactory (Smell)
Over-resposnive/Olfactory Avoiding (page 24)
 Reacts negatively to smells which do not usually bother others
 Tells others people how bad or funny they smell
 Refuses to eat certain food because of the smell
 Offended or nauseated by bathroom odours or personal hygiene smells
 Bothered by smell or perfume, deodorant, aftershave
 Bothered by household or cooking smells
Olfactory (Smell)
Under-resposnive/Olfactory Seeking (page 24)
 Will smell an entire room including objects and walls before interacting
 Unable to identify smells from scented stickers/pens
 Does not notice odours that others usually complain about
 Excessive use of smelling when introduced to objects, people, or places
 Uses smells to interact with others
Visual
Over-resposnive/Visual Avoiding (page 27)
 Sensitive to bright lights, possibly headaches from the light
 Easily distracted from other visual stimuli in the room
 Has difficulty in bright colourful rooms
 Rubs eyes or has watery eyes after reading or looking at a screen
 Avoids eye contact
 Enjoys playing in the dark
Visual
Under-resposnive/Visual Seeking (page 27)
 Craves bright and colourful (often busy and cluttered) spaces
 Loves to line things up
 Loves to look at spinning objects
 Enjoys looking at shiny objects
Page 35 of 43
Sensory Processing Progress Record Form
Please print or photocopy several sheets to evidence strategies tried over the 12 week
graded approach period e.g. one sheet per sensory area difficulty.
To be completed by the staff member working with the child to implement the strategies.
Child’s Name: ………………………………………… Class: ………….……………
Teacher/TA’s Name’s: …………………………………………………………………
Area of difficulty / sense impacted:
How does the child present:
What areas of performance / activities are impacted:
Activities / Strategies implemented: Outcome – child’s response / progress:
Page 36 of 43
Sensory Questionnaire for TEACHERS
Date: ………………………………………………………………………….
Child’s Name:…………………………………………………………………
D.O.B: ……………………………………. Age: …………..
Teacher’s Name: …………………………………………………………
SENCO’s Name: …………………………………………………………..
School: ……………………………………………………………………
School Contact Details: ……………..…………………………………..
Please answer the following questions with as much details as possible.
1) Is this child on the school’s special needs register? If yes, what level?
2) Is this child receiving additional education support? If yes, what?
3) Can the child organise themselves for class work e.g. having correct
equipment?
Page 37 of 43
4) Can this child work individually or in groups without support from teachers?
5) Does the child have any difficulties with behaviours, attention, listening or
processing?
6) Please comment on the child’s social skills and relationships (peers and
adults)?
7) What are your main concerns?
Page 38 of 43
Sensory Questionnaire for PARENTS
Date: ………………………………………………………………………….
Child’s Name:…………………………………………………………………
D.O.B: ……………………………………. Age: …………..
Address: ………………………………………………………………….
………………………………………………… Postcode: ……………...
Telephone: …………………………. Mobile: ……………………………
School: ……………………………………………………………………..
GP/Address: ……………………………………………………………….
Parent Name: ………………………………………………………………
Does your child have a social worker YES/NO? If yes please give details
………………………………………………………………………………….
Please answer the following questions with as much details as possible.

1) Please give details of any brothers or sisters
2) Brief history e.g. weeks’ gestation, type of delivery any complications, feeding
difficulties etc.
3) Brief past medical history and any current medical problems?
Page 39 of 43
4) Details of last hearing and vision tests?
5) Please give details of approximate ages your child achieved these

milestones?
Sitting …………………………………
Crawling ………………………………
Standing ……………………………..
Walking ………………………………
6) Do you feel that your child avoids activities they have difficulty with?
7) What do you feel your child’s main strengths are?
8) What are your child’s main difficulties, which cause you most concern?
Page 40 of 43
9) Have school raised any concerns regarding your child?
10) Have school discussed any extra activities that would help your child?
11) Please give a list of other professionals involved in your child’s care.
12) Any other comments?
Page 41 of 43
Referral for Trafford Children’s Therapy Service
PLEASE COMPLETE ALL SECTIONS IN BLOCK CAPITALS
NOTE: Incomplete referrals cannot be processed and will be rejected.
Family Name Child’s first
name(s)
NHS Number:
Gender M F Date of birth
Address
Postcode Telephone:
Mobile:
Email address:
Ethnicity If other please specify:
White British White Irish Any other White background
Gypsy/Roma Traveller of Irish Heritage Black Caribbean
Black African Any other Black background Indian
Pakistani Bangladeshi Chinese
Any other Asian background White & Black Caribbean Any other ethnic background
White & Asian White & Black African Any other Mixed background
Info not obtained Refused
Child’s first Parent/Carer’s
language first language
Is an interpreter Religion
Yes No
required?
Trafford GP School/ Nursery
Who else is involved with the child?

Please attach any relevant forms, observations, programmes of work.
Educational Psychologist □ Teaching Assistant □ Clinical Psychologist □
Psychiatrist □ Paediatrician □ Orthopaedic Consultant □
Social Services □ Consultant ( Other) Other ( AHP)
Name and telephone number of Social Worker _____________________________
Others: ______________________
Stage of SEND Code of Practice: _________________________________________
Page 42 of 43
Reason(s) for referral
Please give specific details of the difficulties using extra pages if necessary
Past Medical History – including allergy status
Current Investigations / Treatment
>X- rays > Injection

> Drugs >Other
Indicate Therapy Service required:
Physiotherapy □ Occupational Therapy □ Orthotics / Hand Splinting □
DCD/Motor Skills □ Sensory □
Consent: Yes No
I agree to this referral □ □
I give permission for other professionals to be contacted about this
referral (this includes school/nursery). □ □
I give permission for the Therapist to leave text, or telephone □ □
messages regarding appointments.
Parent/Carer signature……………………………………… Date:
(BLOCK CAPITALS) ………………………………………
Referrer details (BLOCK CAPITALS):

Name Role
Address Telephone
Email
I have discussed the referral with the parent/carer and have agreed to sign on their behalf:
REFERRER SIGNATURE:……………………………………………………Date:……………….……
Please send completed forms to:
Trafford Children’s Therapy Service, 1st Floor, Sale Waterside. Sale. M33 7ZF TEL: 0161 912 4495 /4335
Page 43 of 43

Sensory Processing Pre Referral Advice Oct18

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OCCUPATIONAL THERAPY ADVICE

Sensory Pre-Referral Graded Approach

Paediatric Occupational Therapy Department

Compiled by- Alannah Mckaskie

The pack contains advice on:

Trafford Children’s Therapy Service

Pathway for children in full-time education setting …………………………..………………..….. 5

Checklist ………………………………………………………………………………………….…... 6-9

The Senses ………………..…………………………………………………………….…….…..…. 10

Sensory Processing ……………………..………………………………………………………….. 10

Additional Online Resources ……………………………………………………………................ 11

Over-Responsive & Under-Responsive …………..……………………………….…………….... 11

Just Right Engine ………………………………………………………………..…………………... 12

Window of Arousal …………………………………………………………….………………..…… 13

Tactile (Touch) ...…………...……………………………………………….............................. 14-15

Tactile Strategies …………………………………………………….……….……………………... 16

Proprioception (Body Awareness) ..………………………………….…................................ 17-18

Proprioception Strategies ………………………………………………….…………………….…. 19

Vestibular (Posture/Balance) ………………………..…………………………...……………. 20-21

Vestibular Strategies ……………………………………………………………………………..…. 22

Olfactory (Smell) …………………………………………………………………………………….. 23

Gustatory (Taste) ………………………………………………………………………………….… 23

Olfactory/Gustatory Strategies ……………………………………………………………………... 24

Oral Motor …………………………………………………………………………………………….. 25

Oral Motor Strategies ………………………………………………………………………….......… 25

Visual (Sight) ……………………………………………………………………………................... 26

Visual Strategies ………………………………………………………………………………………. 27

Auditory (Hearing) ………………………………………………………………………................... 28

Auditory Strategies ……………………………………………………………………………………. 29

Sensory Toy/Resources ………………………………………………………………………..…….. 30

References / Useful Book Resources ……………………………………………………………..… 31

Appendices/Referral Pack – Referral, Questionnaires & Evidence Sheets …......…………. 32-43

Referrals can be made via:

Sensory assessment not

Referrals can be made via:

Review sensory assessment

Child’s Name ………………………… D.O.B ………………. School: …………………………

What is Sensory Processing?

Problems will tend to present with an individual’s sensory processing if the

In these situations an individual may find it difficult to regulate the incoming

Sensory Integration Network -

Over-Responsive & Under-Responsive

Frustrated, angry, irritable

Relaxed, Calm Overwhelmed

Individual with difficulty processing sensory information

Diagram based on the Window of Tolerance – by M. Dezelic, 2013.

 Temperature - ability to regulate temperature.

How might an individual present who is over-sensitive/responsive to tactile

These individuals may present with the following behaviours:

These individuals may present with the following behaviours:

 May appear not to be aware or respond to touch, if bumped into may be

 Weight-bearing activities, press-ups, 4-point kneeling.

Alerting Strategies – Under Responsive

 Using light touch soft objects such as feathers.

How might an individual present who is under-sensitive/responsive to

Gustatory System (Taste)

How might an individual present who is over-sensitive/responsive to

The visual system has many functional components including: