#123 - Breaking Down Sensory Modulation Disorder- Over/Under Responsive + Sensory Craving

by Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L October 14, 2020

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Breaking Down Sensory Modulation Disorder- Over/Under Responsive + Sensory Craving

Welcome to episode 123! Today we are diving into Sensory Modulation Disorder. This particular subtype of Sensory Processing Disorder consists of 3 sub-categories: Under-Responsive, Over-Responsive, and Craving. You’ll definitely want to take notes, listen more than once, and share this episode with your friends, family, and colleagues! 



Breaking Down Sensory Modulation Disorder - Over/Under Responsive + Sensory Craving

It is not unusual to feel perplexed when observing how your child responds to different sensory inputs. While your child may show heightened sensitivity in one sensory domain, they may also exhibit reduced sensitivity in another.

Sensory Modulation Disorder (SMD) encompasses the wide range of reactions individuals display toward different sensory inputs. Essentially, SMD is the difficulty in processing and integrating sensory information, leading to two main manifestations: over-responsiveness and under-responsiveness.

Let us delve into the intricate workings of the sensory system. As an added benefit, you may discover your sensory preferences, identifying where you actively seek input and where you instinctively avoid it.


What Is Sensory Processing Disorder?

Children with sensory processing difficulties often struggle to accurately interpret everyday sensory messages like touch, sound, and movement. It is crucial to recognize that they may react uniquely to these stimuli.

They may also exhibit sensory-motor symptoms. These symptoms can manifest as muscle weakness, clumsiness, awkwardness, or delayed motor skills.

Interestingly, delayed motor skills are not typically associated with sensory processing disorder. Therefore, if your body struggles to process sensory information and interpret it effectively, it can lead to delayed motor skills and developmental milestones.

Moreover, children may display symptoms that manifest as emotional, behavioral, social, and motor difficulties. The secondary challenges can vary significantly depending on the unique child and their environment, which is crucial in shaping responses and reactions to sensory information.


The Eight Senses of Your Sensory System

Within your sensory system, your body possesses eight senses: visual, auditory, tactile, smell, taste, vestibular, proprioception, and interoception. We meticulously analyze and provide detailed insights into activities and information related to these senses.

Here’s a concise overview highlighting the significance of each sense in the functioning of your bodies responses:

  • Visual: processing stimuli through our eyes and interpreted by the brain.
  • Auditory: processing sound and noise and interpreted by the brain.
  • Tactile: ability to feel the world around us.
  • Smell: the sense of smell.
  • Taste: the ability to perceive flavors.
  • Vestibular: processing movement, balance, and spatial awareness.
  • Proprioceptive: the sense of your body’s position and movement, and can be thought of as your inner GPS.
  • Interoceptive: understanding of the internal state of your body, such as hunger, thirst, temperature, or pain.

Your sensory system is like a finely tuned instrument that sometimes requires maintenance and adjustment. It should be monitored and supported as needed.


Sensory Modulation Disorder

Children who often struggle with filtering out distracting noises, maintaining proper posture and concentration, or have a strong urge to fidget or move as a coping mechanism may receive a diagnosis of Sensory Modulation Disorder (SMD). This disorder manifests in three forms: over-responsiveness, under-responsiveness, and craving.

When a child is over-responsive to sensory stimuli, even the slightest sensations can become overwhelming, making engaging in everyday activities challenging. On the other hand, an under-responsive child may appear disinterested in their environment and need more sensory input to become aware of their surroundings.

A child with strong cravings actively pursues experiences like spinning or jumping and may feel overwhelmed if their sensory needs are unmet. Recognizing and understanding the signs of Sensory Modulation Disorder is crucial to developing an effective intervention plan.


Distinguishing Between Sensory Processing Disorder and Sensory Modulation Disorder

A child experiencing sensory processing disorder may possess an exceptionally heightened perception, occasionally to an overwhelming degree. Constantly bombarded with information, your child might frequently exhibit a fight-or-flight response to different sensations, known as sensory defensiveness.

They may actively avoid or downplay certain sensations, resulting in behaviors like withdrawal, covering their ears, eloping, gagging, or even vomiting. Their goal is to minimize these sensations as much as possible.

Conversely, children diagnosed with sensory modulation disorder may tend to gently collide with objects and display an amplified pain response to tactile stimuli that would typically be non-painful. They may also eagerly seek sensory input, like spinning or climbing, to regulate their arousal level.

The critical difference between these two disorders is the child’s relationship with sensations. With sensory processing disorder, a child actively shuns and suppresses certain sensations, while with sensory modulation disorder, they merely seek to maintain a certain level of comfort and balance.


The Impact of Sensory Modulation Disorder on Your Sensory System

It’s essential to recognize that when your child displays heightened sensitivity in one area, decreased sensitivity in another, and a strong inclination in a third, it’s a common manifestation of their sensory system. Let’s explore how your child may exhibit over-responsiveness, under-responsiveness, or a craving for sensory stimulation across the eight senses.


  • Over-responsive: experience discomfort in the presence of bright lights, avoid crowded places, get easily distracted by excessive visual stimuli, and find it challenging to maintain eye contact.
  • Under-responsive: prefers objects that move, shine, or spin. They may also struggle with hand-eye coordination activities and identifying letters and experience difficulties with visual tracking and reading.
  • Craving strikes: gravitate towards vibrant colors, captivating motion, and action-packed videos, and thrive in bustling environments.


  • Over-responsive: prone to easy startle reactions, feelings of anxiety in noisy environments, avoidant of loud noises, difficulty in focusing when multiple sounds vie for their attention and may cover their ears even in situations where the sounds are not objectively loud.
  • Under-response: despite having normal hearing, they might not react when called by their name. They tend to favor a louder environment, having the TV or music playing at a high volume and frequently make loud noises, such as singing or humming, without being aware.
  • Craving: incessantly producing noise and engaging in excessive self-talk.


  • Over-responsive: avoid physical contact, being bothered by clothing tags and textures, experience discomfort from seams and waistbands, struggle with grooming and hygiene tasks, easily startling when touched, and display exaggerated reactions to what may seem like minor injuries.
  • Under-responsive: a tendency to drool, stuff their mouths with food, may not be aware of cuts, bruises, or scrapes, dislike wearing socks and shoes, may not notice when they get messy and are too rough while playing with other kids or pets.
  • Craving: constantly touching others or objects and mouthing objects, and craving intense flavors when they eat, like sour or spicy things.


  • Over-responsive: avoid trying new foods, tend to be more selective eaters, and experience gagging or vomiting when faced with unfamiliar foods and textures.
  • Under-responsive: tend to lick or explore objects with their mouth even beyond 18 months and develop a preference for foods with more robust flavors.
  • Craving: desire for intense flavors and a constant need to have something in their mouth.


  • Over-responsive: a heightened ability to detect scents that others may not notice, frequently discussing smells, repeatedly plugging their nose, and actively avoiding locations in the community with strong odors, such as public restrooms.
  • Under-responsive: preference for potent odors such as perfume, gasoline, and cleaning products, exhibit a constant urge to smell things and may experience a delayed response to detecting smoke in their homes.
  • Craving: intensely needs to smell everything.


  • Over-responsive: not commonly observed.
  • Under-responsive: preference for movement, heavy walking, thumb sucking, excessive chewing on toys, frequent finger-sucking, and exerting excessive force during activities.
  • Cravings: walking on their toes, preference for crunchy or chewy foods, engaging in self-injurious behaviors like head banging, pinching, biting, or pulling hair, preferring wearing tight clothing, and may grind their teeth or crack their knuckles.


  • Over-responsive: may dislike being held away from an adult’s body or being thrown in the air, avoid activities like slides, swings, and climbing gyms that involve having their feet off the ground, feel uncomfortable on escalators, elevators, or in situations involving heights, experience motion sickness, and have difficulty tilting their head back while washing their hair in the bathtub.
  • Under-responsive: may require constant rocking to avoid crying, struggle to self-soothe, exhibit lower muscle tone, and display compensatory seating positions such as w-sitting.
  • Craving: a strong desire for constant motion, thrill-seeking, restless or fidgety, and an increased likelihood of being diagnosed with ADHD.


  • Over-responsive: may exhibit a lower pain threshold, experience discomfort with extreme temperatures, have significant anxieties related to medical procedures such as injections, and frequently express discomfort or physical distress.
  • Under-responsive: difficulties with potty training, lack of awareness of hunger and thirst, high pain tolerance, struggle to dress appropriately for the weather, and may not recognize when they are unwell.
  • Craving: actively seeking out extreme temperatures, including exposure to excessive heat or cold, fascination with fire, and unsafe eating patterns.


Addressing Concerns About Sensory Modulation Disorder

Suppose you have concerns about your child’s sensory responses; consult with your physician and request a referral for occupational therapy. An occupational therapy assessment comprehensively evaluates your child’s sensory processing and provides a personalized treatment plan tailored to their specific needs.

Moreover, numerous lifestyle adjustments can significantly benefit children with sensory modulation disorder. These include:

  • Minimizing environmental stimuli.
  • Providing suitable sensory inputs for calming activities.
  • Incorporating a well-balanced diet and regular exercise routine.
  • Explore sensory-friendly products, such as weighted blankets, fidgets, and chewable.
  • Be attuned to your child’s emotions and adapt activities accordingly.

Remember that you are not alone on this journey, no matter the treatment plan or lifestyle modifications chosen. Many online communities offer support and resources for parents of kids with sensory modulation disorder.

Acknowledge your child’s strengths and be mindful of their weaknesses as you help them grow and develop into their best selves. With patience, understanding, and love, we can help kids with sensory modulation disorder achieve success and reach their full potential.



    While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

    Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

    This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

    Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L
    Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L

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