- Environmental and sensory issues are real and can cause anxiety and social problems.
- Sensory issues are over- or under-reactions to touch, sound, light, taste, and other sense-based stimuli.
- Misattributions can be caused by missing sensory sensitivities in neuropsychological and/or learning difference (LD) evaluations.
- These misattributions prevent relevant interventions and mitigations.
Co-authored by Miranda Melcher
Children experiencing sensory difficulties may react in ways that are viewed as problematic because of the hidden quality of their challenges. Thus, it is crucial to understand that environmental and sensory issues are real and are potential causes of anxiety and social problems. While these “invisible disabilities” are frequently associated with autism spectrum disorders, they also appear in some children diagnosed with attention-deficit/hyperactivity disorder (ADHD), nonverbal learning disorder (NVLD), and other learning disorders (Broitman et al., 2020).
Sensory issues are essentially someone finding touch, sound, light, taste, or other sense-based stimuli either too much or too little compared to “normal.” These issues can often be unnoticed, including by the affected person, since what is considered normal is subjective, making it hard to compare. For example, consider how a child might know whether their idea of what is “too loud” or “too hot” is different from others'.
Overreacting to sensory stimuli can alter one’s ability to behave the same way as others, potentially causing social problems. Sensory stimuli that may be completely unnoticeable to one person could be so overwhelming to another that, for example, they cannot follow a conversation or instructions.
In many cases, there are low-cost, easy ways to address sensory issues, and detection is mainly a matter of guided self-reflection. Therefore, it is straightforward and sensible to check for sensory issues as part of a general diagnostic process for anyone being screened for any educational or behavioral issues (Broitman et al., 2020).
Misattributions caused by sensory sensitivities
Sensitivities can be inappropriately translated as behavioral abnormalities when they may have pure or partial sensory causes. For example, difficulty filtering out background noise from the conversation could look like ignoring a conversational partner or failing to follow the discussion. In fact, the patient is unable to distinguish the words from other conversations in the vicinity, such as during group discussions in a classroom or a meeting in a coffee shop.
Another example would be a child being inconsistently social on a seemingly random basis until the environment of the social interactions is considered. Maybe the child finds bright light challenging and so is less willing or able to socialize in a sunny park or a bright classroom but is merrily chatting with friends in a darker environment like the library or under a large tree. These sorts of sensory or environmental aspects may be contributing factors for an apparently inconsistent willingness or ability to socialize (Broitman et al., 2020). If identified, relevant support can be provided and created: for example, moving activities rather than advising social skills training.
Beyond these immediate sensory stimuli, there are other environmental factors to consider, such as the physical aspects of an environment, including how crowded an area might be, size, amount of light, amount of noise, temperature level, or clothing requirements. For example, the discomfort of a particular item of mandatory school clothing may, in fact, be a cause for not enjoying school rather than anything about the school itself. If discovered, this can lead to simple solutions around modifying the clothing. Relatedly, someone with a temperature sensitivity may dislike warmer, smaller spaces and therefore prefer larger work areas or classrooms. Again, this might be an easily made accommodation.
Similarly, the environments involved in getting to or from an activity should be considered. The environment at school might not have sensory challenges, but the walk home in the afternoon could pose problems. Consider the amount and complexity of transit time, the familiarity of the transit route, and the flexibility of arrival and departure times from the event or place as presenting sensory challenges and potential solutions (Broitman et al., 2020).
The case of Moira
Moira was not assessed until she was 19, and even then, she was not accurately diagnosed until a second consultation. A host of additional psychological issues resulted from this late diagnosis. Among other concerns, Moira had many unaddressed environmental and sensory issues, including heat, texture, and light.
From a very early age, Moira remembered hating being outside in bright light and warm temperatures. She first began complaining about light sensitivity in 4th grade—specifically that the classroom lights were too bright. Taken to get her eyes checked, she was given glasses despite the fact she did not have actual “vision” issues but hypersensitivity to light. The glasses did not solve the issue, resulting in years of headaches that impacted her social and academic engagement in brightly-lit school environments.
It took a neuropsychological evaluation to finally understand the problem correctly and get her dark glasses, which significantly reduced the pain and discomfort in school settings. As this case suggests, it is critical for clinicians to understand the impact of environmental and sensory issues as actual concerns that cause anxiety and social challenges. Children who are experiencing sensory difficulties may react in ways that are viewed as pathological, as discussed further by myself and colleagues.
Diagnostic questions to check for sensory processing concerns
An abbreviated list developed by Broitman et al. 2020 can be found in our book, NVLD and Developmental Visual-Spatial disorders in Children. We suggest that a patient should be asked about their reactions to light, heat, sound, tactile, touching, and taste. In addition, we offer a Problem Breakdown Checklist (Melcher and Broitman, 2020) to aid in treatment planning. Melcher explains that the addition of these investigations to “evaluate potential environmental and sensory challenges does not require any additional training or specialized skills; in fact, it’s the mundane nature of the five senses that means these issues are often overlooked.” She recommends that you “take the time to think about, and ask the patient about, their sensory experience of challenging areas. You may be surprised by the problems surfaced, but also how they can often be simply solved.”
Psychological aspects of dealing with difficult environments
Finally, it is important to understand that sensory issues are additionally often underdiagnosed due to societal pressures. Due to the subjectivity and misunderstanding of any individual’s sensory perceptions, it can take years to be recognized. Rarely discussed explicitly, a patient with sensory issues may need assistance identifying the psychological aspects of dealing with difficult environments and developing coping strategies.
These issues may precipitate social anxiety and psychological reactions, sometimes bolstered by outside influences, of how the patient “should” feel and behave in different environments. These expectations, learned before sensory sensitivities are understood and addressed, can result in long-lasting psychological issues due to the patient attempting to deny and repress their sensory reactions. Without proper identification of environmental/sensory issues, these misattributions prevent relevant mitigations by either the patient or the person treating them.
Up next: What’s needed in a thorough neuropsychological or psychoeducational evaluation? Discover the 16 key domains to consider when assessing learning disorders.
Broitman, J., Melcher, M., Margolis, A., & Davis, J. M. (2020). NVLD and Developmental Visual-Spatial Disorder in Children. Springer.
Margolis and Broitman, 2023. Learning Disorders Across the Lifespan: A Mental Health Perspective. Springer.