Understanding Self-Regulation in Kids: More Than Sensory Issues

It’s not uncommon in schools for a child with behavior issues to be referred to occupational therapy for a sensory processing evaluation. In fact, self-regulation difficulties are often assumed to be sensory-related. However, there are many factors that influence self regulation. Sensory issues are often not an underlying cause to behavior, but a symptom that may be a sign of something else. Therapists, parents, and educators should keep all of these areas in mind when a child presents with self-regulation challenges.

Basic Health and Sensory Signs

Nutrition

Blood sugar levels can affect alertness levels and focus. Many of the children who have difficulty self-regulating also have limited diets and may not eat foods that sustain their energy levels. Having a decreased appetite is also a side effect of several medications for ADHD. 

Sleep

Without adequate sleep it’s harder to focus, and fuses are shorter for handling frustration. Years ago, there was a post in one of my therapy groups from an OT who was a parent to a child whose behavior was so significant he ended up in a residential treatment facility. She had tried all of the things an OT is trained to do, and more. Ultimately they realized that he had a tongue tie that caused his tongue to cut off his airway while he slept. This awoke him repeatedly throughout the night which caused him to never fully sleep. 

Medical Condition or Sensory Processing?

I was asked to do a sensory evaluation once on a child who was later found to have diabetes. This was the reason for her difficulty staying focused and regulated at school. They discovered this before my evaluation, but I expect that she likely would have had sensory symptoms had her teacher completed a standardized questionnaire. This is a good example of why it is important to consider sensory signs as symptoms, not an underlying cause, without more information. 

Anxiety 

People with anxiety often show signs of sensory symptoms, including behavior, chewing non-food objects, and difficulty focusing. Consider, is the child not focused on the lesson because they are focused on their worried thoughts?  

Executive Functioning

I believe this is one of the areas that is most significant to acknowledge because it explains so many of the behaviors we see in schools. Executive functions include task initiation, sustained attention, working memory, processing speed, and more. Sensory symptoms of distractibility to what children see and hear can often be significant on the Sensory Processing Measure (SPM-2), but when these are the primary areas identified, I always review the Planning and Ideas section. It often reveals that executive functioning may be more of an issue affecting behavior and that sensory strategies may not have as much of an effect accommodations like their location in the classroom, using study carrels, checklists, and repeated directions.

Trauma

Trauma rewires brains. There may be sensory signs and symptoms, but the underlying trauma needs to be addressed as well to truly support the child’s social emotional well-being and self-regulation. 

Unmet Basic Needs

A child who is unhoused or does not know where the next meal is coming from may show sensory signs and symptoms because they are unsure whether basic survival needs will be met. Focusing on a math lesson is secondary to survival. Of course the child is also likely having difficulty with nutrition, sleep, and possibly medical needs if they have limited access to healthcare as well. 

Language Delays

A child who does not understand the directions given may appear to be noncompliant or unfocused. They may have sensory signs like distractibility or be fidgety. 

Boredom

Academically gifted children may have difficulty self-regulating because they are bored. As a result they may fidget more or appear to be distracted. 

Unfortunately, we don’t always have information in all of these areas when we are assessing children for sensory processing. However, it is important to acknowledge that sensory signs and symptoms can be present because of these factors as well. 

Sensory Signs Can Be Symptoms

When you consider that sensory signs are often a symptom of something else more areas can be explored so needs can be better met. When we are just addressing sensory symptoms without understanding the underlying causes it does not likely solve the issue with self-regulation alone.  Sensory strategies and tools can help, but often additional interventions are needed.

Want to include a statement in your evaluations that acknowledges self-regulation is bigger than sensory alone? See this blog for a statement you can use. 

This is why the Clue Cards can be helpful. We can learn whether sensory input is a problem for that child because they will rate it as a problem. However, we may also learn that the child is more affected by social worries or a lack of flexibility. The Clue Cards are color-coded to help identify these patterns.