Tactile Defensiveness PDF
Tactile Defensiveness PDF
Tactile Defensiveness PDF
Introduction
The tactile system is our sense of touch through different sensory receptors in our skin. It
is through the tactile system that we first receive information about the world when we
come out from the womb environment. The ability to process tactile information
effectively allows us to feel safe and form bonding with those who love us. It contributes
to our social and emotional development.
One important role of our tactile system is its protective function that alerts us when
something is unpleasant or dangerous. For some children, this function of the tactile
system is not working normally. They may perceive most touch sensations to be
uncomfortable or scary and react with a flight-or-flight response. We call this condition
tactile defensiveness, which was first identified by Dr A.J. Ayres, an American
Occupation Therapist around the 1960s.
Children whose tactile systems give inaccurate information are frequently in the state of
‘red alert’. Casual contracts within an ordinary daily environment could cause extreme
reactions that may be interpreted as bad behaviours. They may react be whining and
clinging (fright), or lashing out (fight) and running away (flight) (Trott, 1993).
The neural disorder that causes a child’s tactile defensiveness does not necessarily affect
the child’s learning ability. However the discomfort and behavioural reactions caused by
this disorder does interfere with the learning process. Very often the child is emotionally
insecure (Ayres, 1979).
Although not well understood, TD has been recognised for many years as a
“Hypersensitivity” or “hyper-responsivity” to touch in a variety of populations (Baranek
and Berkson, 1994). For example, it has been identified in children with specific learning
difficulties (Ayres, 1964, 1972), learning disability (Kinnealey, 1976), autistic spectrum
disorder (Ritvo, Ornitz and LaFranchi, 1968: Ayres and Tickle, 1980 and Grandi, 1984),
and other developmental disorders (Larson, 1982).
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It is important to note that TD and developmental Dyspraxia are two separate conditions.
Occasionally, child could suffer from both conditions at the same time. We call this
situation co morbidity. More commonly, a child with TD may be misdiagnosed as a
child with developmental Dyspraxia. There is some confusion among a number of
professionals about the understanding of the two conditions. Clinically, it is extremely
important to make an accurate diagnosis, as the treatment for TD is different from that for
Dyspraxia.
Children with TD are usually hyperactive and distractible. They over-react to tactile
stimulations so that most people do not particularly notice, or at least are not bothered by
it. However, it is important to note that children with TD will get involved in certain
tactile activities if they are in control. They will also actively seek out a large amount of
muscle stimulation and firm touch stimulation as a means to reduce the level of
hypersensitivity. They may frequently and consistently present some or most of the
following behavioural features (Ayres, 1979: Larson, 1982: Royeen, 1985: Royeen &
Lane, 1991).
• Avoidance of contact with other children, e.g. preference for standing at the end
of line during assembly, staying at the edge of a group during story time etc.
• Avoidance of play activities involving tactile materials (e.g. sand, finger paints) or
body contact, with a tendency to prefer solitary play
• Avoidance of going barefoot, especially in sand and grass (could result in tip-toe
walking)
• Avoidance of a crowded environment, likes to stay under the table, behind the
settee or under the staircase
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Aversive Responses to Non-Painful Touch
• Aversion to certain daily living tasks, e.g. having showers, cutting fingernails and
hair and face washing
• Aversion to dental care and/or brushing teeth
• Aversion to being handled during daily activities, e.g. changing nappy or clothes,
cleaning nose or face
• Aversion to being approached from behind. May rub skin or scratch area being
touched
• Becomes anxious and distressed when being physically close to people, e.g.
during assembly, inside the dining hall, etc.
It is important to note that children with TD quite often present hypersensitivity to other
sensory stimulations, e.g. movements, sights, sounds. When a child presents
hypersensitivity to more than one sensory stimulus, we call this Sensory Defensiveness.
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• Larson (1982) suggested an imbalance in descending mechanisms from the higher
part of the brain, which resulted in either too little or too much inhibition
• Fisher and Dunn (1983) hypothesised that tactile input may be regulated at the
level of the spinal cord by inhibitory influences from higher centres. In the case
of TD, this modulation (i.e. inhibition) may be deficient, causing an over-reaction
to tactile stimuli
• Baranek & Berkson (1994) supported the idea that TD is best conceptualised on a
continuum of responsiveness, rather than as a discrete category of behaviour.
Further research is necessary to validate these hypotheses and clarify the concept of TD
as a discrete condition, or as a part of the overall sensory defensiveness.
• Use firm pressure when touching the child. Never use light touch. Pats on the
head, back or shoulder are not reinforcing for a child with tactile defensiveness.
• Straight, downward firm pushes on the top of the head or on both shoulders are
calming for these children. A heavy bear hug is also excellent. Be sure the child
is expecting your touch; never surprise the child
• Avoid touching or approaching the child from behind. Make sure the child sees
you before giving instruction or asking for responses
• Have the child go first or last in a line. This will minimise possible tactile
contact.
• Allow the child with tactile defensiveness to wear a sweater or jacket indoors if it
can help him/her feel more secure and relaxed
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• Space children so that they are not sitting near enough to touch one another
• Use markers to help designate personal space when sitting on the floor; or allow
the child to choose the position during story time
• Encourage the child to brush the body himself/herself with a natural sponge
during bath time
• Create a quiet corner for the child to go when he/she gets too ‘sensitive’ and
disturbed
• “Heavy work” activities like carrying groceries or laundry bags, wearing a heavy
backpack, push/pull games and jumping activities all provide a type of sensation
which tends to calm down or organise tactile sensitivity. Having your child help
with heavy household tasks and playing jumping and push/pull games may help to
calm and organise him
There are more specific tactile activities your child’s Occupational therapist can suggest
which may be appropriate. Ask your therapist for ideas and be sure to discuss your
child’s reactions to various experiences. Always watch for signs and avoid over-
stimulation and excitability.
Different areas may have different referral criteria and procedures. Usually the first
contact will be your family G.P. Try to gather information based on the set of
behavioural indicators described and discuss your concerns with the G.P. who may be
able to make a referral to your local Paediatric Occupational Therapy Service.
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REFERENCES
Ayres, A.J. (1964). Tactile Functions: Their Relations to Hyperactive and Perceptual-
Motor Behaviour. American Journal of Occupation Therapy 18, pp 221-225
Ayres, A.J. (1972). Sensory Integration and Learning Disorders. Los Angeles, Western
Psychological Services
Ayres, A.J. (1979). Sensory Integration and the Child. Los Angeles, Western
Psychological Services
Ayres, A.J. & Tickle, L. (1980) Hyper-responsivity to Touch and Vestibular Stimulation
as a Predictor or Responsivity to sensory Integrative Procedure by Autistic Children .
American Journal of Occupation Therapy 34, pp 375-381
Fisher, A.F & Dunn, W.D. (1983). Tactile Defensiveness: Historical Perspectives, new
Research – A Theory Grows. Sensory Integration Special Interest Section Newsletter 6,
1-2.
Larson, K.A. (1982). The Sensory History of developmentally Delayed Children With
and Without Tactile Defensiveness. American Journal of Occupational therapy 36, pp
590-596
Mailloux, Z (1992). Tactile Defensiveness: Some People are More Sensitive. Sensory
Integration Quarterly, Vol XX, No.3, pp 10-11
Ritvo, E.R. Ornitz, E.M. & LaFrachi, S (1968) Frequency of Repetitive Behaviour in
Early Infantile Autism and its Variants. Archives of General Psychiatry 19, pp 341 – 347
Royeen, C.B (1985). Domain Specifications of the Construct Tactile Defensiveness. In:
Fisher, E. Murray & Bundy, A (Eds). Sensory Integration: Theory and Practice.
Philadelphia: F A Davis
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Further Reading
Arkwright, N (1998). An Introduction to sensory Integration. San Antonio, Texas:
therapy Skill Builders
Kranowitz, C.S. (1998) The Out of Sync Child – recognizing and Coping with Sensory
Integration Dysfunction. New York, NY: The Berkeley Publishing Group