Wednesday, April 6, 2011

Treating Tactile Defensiveness

Treating tactile defensiveness will vastly improve a child's ability to learn, explore, play, and socialize.  A tactile defensive child is in survival mode much of the time when he should be feeling at home and happy in his body and with the world.

Many problematic behaviors can be attributed to tactile defensiveness.  A few of the classic signs are complaints about clothing, especially tags, elastic waistbands, and the seams in socks, refusing to touch certain textures like lotion, glue, or liquid soap, lashing out when others are too close, wiping off kisses, tantrums over being groomed,  poor ability to transition between activities, being controlling or rigid in personality, not being very physically affectionate {or insisting on being hugged as tightly as possible} habitually fisting the hands,  and refusing to walk barefoot and/or preferring to walk on tiptoes.

Tactile defensive skin is overly sensitive and is wired to a part of the brain that alerts the system to danger.  It has little ability to filter out unimportant sensations, like the feel of clothing, and can't easily distinguish between what is neutral and what is a threat.  This puts the child on high alert in situations where there is no reason for it.  Is Grandma zeroing in for a hug or for the kill?  The child's nervous system is telling him that danger is approaching and to defend himself, even when she has a loving look and her arms open wide.

  Ever had a spider crawl on your skin and have an extreme panic reaction?  Ever had a fever and just want to wear your softest jammies because your skin was so sensitive that your clothing felt prickly and awful?   That's what tactile defensive skin feels like much of the time.

Tactile defensive children generally don't do well with change, especially with sudden, unexpected deviations from daily routine.  They have a higher than normal need to control what is happening around them and tend not to be very mentally or emotionally flexible.  The reason for this is because so much of what comes their way during a typical day is interpreted by their nervous systems as threatening, noxious, and painful.  They have to expend an enormous amount of energy coping with unpleasant perceptions and sensations that a normally functioning nervous system would not even register, so they don't have a whole lot of mental energy left to be able to roll with the punches.  Transitions are especially difficult for them, more so if the child is not expecting one.  He doesn't adapt to novelty well, and so he can't easily shift gears.  A child who habitually responds to life with a resounding "NO!" is struggling with sensory defensiveness.

 In school, the amount of energy the tactile defensive child must expend coping with the sensations of the classroom, which he perceives as an assault, often leaves little left for learning or socializing.

I've never seen any research about this, but I have often thought that untreated tactile defensiveness, because it is so anxiety provoking, forces the child to self soothe with stereotyped behaviors and rituals, which then develop into obsessive compulsive disorder, or OCD.  The reason I say this is because I have spoken to many, many parents over the years whose children, when they were very small, demonstrated classic symptoms of tactile defensiveness that no one knew how to diagnose or treat.  As the children got older and their self soothing behaviors became more and more ritualized, compulsive and bizarre, they were diagnosed with OCD.

 I have also worked with dozens of small children over the years who had OCD like behaviors {compulsively picking at clothing, pulling sleeves over hands, facial tics} that promptly extinguished when they were put on regimens to treat tactile defensiveness.

If your child is exhibiting signs of tactile defensiveness, or is unusually rigid and controlling, seeking out a good sensory integration therapist and having your child evaluated and treated for sensory processing difficulties can make an enormous difference in the child's ability to function.  The therapist can show you how to administer a program to reduce tactile defensiveness.  The protocol was developed by Patricia Wilbarger, an occupational therapist who has contributed a great deal to the body of knowledge about treating sensory processing disorders.  It consists of firmly and slowly brushing the child's skin with a specific surgical brush in a specific way, followed by a series of joint compressions.  The deep pressure overrides the fight or flight response that is constantly being triggered by light touch. Over a period of time the protocol will shut the inappropriate responses down completely, normalizing the way the child takes in and processes sensory information from his skin.   I have been using her techniques for many years in my practice and have had wonderful results.

Here are a few recent examples of the changes that the Wilbarger protocol has brought about for the children I treat:

After about a month of therapeutic brushing, the little girl I mentioned last week, who kept to herself all the time at school and spent all of her time at home alone in her bedroom, suddenly began to join in when her sister had friends over to play.   She stopped keeping to herself so much at school and started interacting with her classmates.  Instead of habitually turning down invitations for playdates and birthday parties, she began to initiate invitations herself.   Her nanny told me that she has begun to slip into her sister's bed at night for some pillow talk and a snuggle.  Now that's making up for lost time!

The little boy who was so anxious and picked at his clothing  stopped picking, stopped hiding in the corner, and started joining in with the other children at school, using all of the craft materials, and willingly painting and gluing along with everyone else.  He also, for the first time, had a wonderful vacation visiting his older cousins.  Instead of hanging back and clinging to his mother, he fearlessly played all of their rough and tumble games with them,  challenging himself to keep up.

A little boy who refused to ever go barefoot and would have a panic attack when required to take off his shoes is now completely insouciant about his feet, pulling off his shoes and socks with ease at home and in the clinic.  His attention span, which was almost non existent at school, is now age appropriate.

The little girl who insisted on going bare legged and commando dressed herself the next morning after the protocol had been started, choosing a pair of corduroy slacks that she had previously refused to consider, and wore them to school.

Another mother just reported that her son had mostly stopped trying to control everyone and everything at home, and was amazingly loving and cuddly instead of being standoffish and rigid.  She said he was like a different child.

The little boy who was highly aggressive at school, who joined in every altercation and lashed out whenever anyone got too close, was so out of control that during the spring, the administration threatened to ask his parents to find a new school for him unless they got him some help.  He was put on the Wilbarger protocol, and it was carried out all summer.  At the start of the new school year,  I called his new teacher to check on his progress.  She was surprised that he was in occupational therapy, since his behavior was now no different than that of the other children in his classroom.

For a child who has difficulty touching a variety of textures, I recommend messy play. {This is often easier just after the child has been brushed.} In the clinic, we play with cornstarch mixed with water, shaving cream, Funny Foam, artificial snow, Flarp, {I buy mine at Michael's} tubs of kidney beans mixed with little toys for the children to dig around for and pour from container to container, Play-Doh, finger paints, and Moon Sand.  If you, his friends, and his siblings play with gusto, he will be persuaded to join in.

If left untreated, tactile defensiveness can seriously interfere with a child's quality of life.  We can grow out of some things, it's true, and some sensory issues lessen in severity as the child matures,  but I have seen adults who have very unhappy lives because their tactile defensiveness prevents them from having loving relationships.  They want to be good partners, but the pain, anxiety, and revulsion that intimate touch evokes in them makes it impossible.  They also tend to need to control their environments and have a hard time being flexible.  This affects not only them, but everyone around them.

If you know of an adult who has tactile defensiveness issues, a consult with a sensory integration therapist can be tremendously helpful.  The Wilbarger Protocol works well on adults, too.

For more information on sensory defensiveness, I recommend the book Too Loud, Too Bright, Too Fast, Too Tight, by Sharon Heller.


therapydoc said...

This is just amazing stuff. I'm going to link over here, okay?

Anonymous said...

I don't know if I should be concerned about my 4 year old son. He has had problems with clothing since he was 2, mostly with socks and underwear because they feel like they have "rocks" in them, as well as tags and any kind of patches or thick lettering on shirts. However, a few months ago he decided over night that all of his clothes feel horrible and hurt and give him "wedgies". But these are clothes that he has worn previously without any problems and they still fit him fine. He will hit the clothes and bite them, twitch around on the ground, and scream and cry. He has never been a child that throws tantrums except with clothing and it really seems like they are bothering him, except as soon as I drop him off at daycare he doesn't mention them again until I pick him up. He says he doesn't want to feel this way and asks me if I can please hold him until he can get used to his clothes (if I carry him around after I dress him, take him outside and distract him he will eventually get used to them). He is a very intelligent child, loves hugs and kisses and is social. The only other possible symptoms he has are issues with grooming--hates the feeling of his hair buzzed short and his fingernails after I cut them--will cry and complain long after they have been cut, sometimes for days. Is he just being as sensitive child or is there more to it than that?

Anonymous said...

My girl is 10 years old now, her sensitivities started at 2 as well. I thought she would get over them, but it just got worse. What you explained about your child is exactly what mine does and others as well.
My child and I have been through a lot of hard times. My child doesn't want to feel this way. At the moment everything is a mess, but I got her into Occupational Therapy and that seemed to work much better than counseling. It is just such a struggle and I feel so bad for her. She has been diagnosed with Tactile Sensitivity/Skin Sensation Disturbance. I been looking this up on the internet for years and I came to the conclusion that she had Sensory Integration Dysfunction, but it is in the same lines as Tactile Sensitivity. Horrible thing for our loved ones to go through. Peace to you and hope your child has healed.

Anonymous said...

I've just discovered your site, to my delight and I am sharing your story if that's ok. I have a 6 year old who has been tactile defensive since she was 2, but it has become gradually worse and she is now in OT. We;ve just been given the copression and loofah glove exercise to do and it's made a world of difference (in jsut the first week). It's incredible!

Anonymous said...

Wow. I was thought to have this as a child (I am 28 now) and it blows me away how many people have it. I eventually grew out of the worst of it, however its still a battle some days

kimberley scott said...

Have you got any recommedations for treating tactile defensive if you are not trained in Wilbarger protocol? I am learning disability OT and this course is not avialable in the UK?

Loren Shlaes said...


The Wilbargers have taught in the UK. They may have plans to teach there again at some point. If you would like to send me an email I can give you Julia's contact information {look at my profile to get my address}.

You can contact the nearest branch of the INPP for help. The work of Peter and Sally Goddard Blythe has had a profound influence on how I approach these children. Also, you can try using Therapeutic Listening if that is available in the UK.

Clare Westwell said...

I first noticed my little girl had sensory difficulties from about the age of 2. Problems with socks, shoes, having to cut labels out and difficulties with many items of clothing. About 5 weeks ago she started to have massive meltdowns one after another. Trying to pull her hair out of her head as she couldn't stand the feeling of it against her skin. She has been completely naked for nearly 3 weeks now therefore she can't leave the house. We met with an ot 6 days ago and she told us to start with the willbarger protocol which we have but the last couple of days she says she can't stand having her palms or soles of her feet brushed. The meltdowns have pretty much stopped now and she doesn't seem to have a problem with her hair but she still can't put any clothing on. Has any one else had a similar experience? We are desperate to get something on her and get her out of the house.

bilal said...

We have a 2.5yr old son. He started sitting by himself a year before, but, he still doesn't sit still and will rock back and forth all the time. when in highchair he will hit his back with the chair and wouldn't focus on what is in the tray. He also have some vision problem and wouldn't track anything and is non-verbal. But the most annoying problem with him is that he wouldn't grab anything. Anything that we put in his hand and he will throw it not because that he can't grab it.
The only thing he will hold for a little longer is his bottle and as soon as he finished it he will unhold it. We want him to hold stuff for a little longer so he could eat by himself and can also learn standing with the support. Currently when we help him stand with the support, he would hold the support and will immediately leave it as if it is burning his hands.
After reading your blog I think he is also suffering from the tactile defensiveness. Please give me your opinion based on your experience. We live in Pakistan and wouldn't have any resources about the OT. Regards, Bilal.

Loren Shlaes said...

Hi Bilal, yes, it does very much sound as if your son"s behaviors and difficulty holding objects and sitting up stem from neurological delays and sensory defensiveness. It's a long shot but you can try contacting WFOT and see if they have any leads for you for resources. Best of luck.