The 2001 Eleanor The experience of being human is embedded in sensory

Clarke Slagle Lecture events of everyday life. This lecture reviews sensory processing
literature, including neuroscience and social science perspec-
tives. Introduced is Dunn’s Model of Sensory Processing, and
the evidence supporting this model is summarized.
Specifically, using Sensory Profile questionnaires (i.e., items
describing responses to sensory events in daily life; persons
The Sensations of mark the frequency of each behavior), persons birth to 90
years of age demonstrate four sensory processing patterns:
Everyday Life: Empirical, sensory seeking, sensory avoiding, sensory sensitivity, and low
registration. These patterns are based on a person’s neurolog-
Theoretical, and ical thresholds and self-regulation strategies. Psychophysiology
studies verify these sensory processing patterns; persons with
strong preferences in each pattern also have unique patterns
Pragmatic Considerations of habituation and responsivity in skin conductance. Studies
also indicate that persons with disabilities respond different-
ly than peers on these questionnaires, suggesting underlying
poor sensory processing in certain disorders, including
autism, attention deficit hyperactivity disorder, developmen-
Winnie Dunn tal delays, and schizophrenia.
The author proposes relationships between sensory pro-
cessing and temperament and personality traits. The four
Key Words: sensory processing • tempera- categories of temperament share some consistency with the
ment • threshold four sensory processing patterns described in Dunn’s model.
As with temperament, each person has some level of respon-
siveness within each sensory processing preference (i.e., a
certain amount of seeking, avoiding, etc., not one or the
other). The author suggests that one’s sensory processing
preferences simultaneously reflect his or her nervous system
needs and form the basis for the manifestation of tempera-
ment and personality. The final section of this lecture out-
lines parameters for developing best practice that supports
interventions based on this knowledge.

Dunn, W. (2001). The sensations of everyday life: Empirical, the-

oretical, and pragmatic considerations, 2001 Eleanor Clarke Slagle lec-
ture. American Journal of Occupational Therapy, 55, 608–620.

T
he experience of being human is imbedded in the
sensory events of everyday life. When we observe
how people live their lives, we discover that they
characterize their experiences from a sensory point of view.
People talk about the intensity or dullness of an image.
When they explain a dream or an event of the prior day,
they use sensory words to characterize the dream’s ele-
ments. Sensation is the common language by which we
share the experience of being human; it provides a com-
Winnie Dunn, PhD, OTR, FAOTA, is Professor and Chair, mon ground for understanding.
Department of Occupational Therapy Education, University of Yet sensation also is so intimate and personal that we
Kansas, 3033 Robinson, 3901 Rainbow Boulevard, Kansas City, use it to define our individuality. We describe the difference
Kansas 66160-7602. between one person and another in relation to those per-
This article was accepted for publication July 9, 2001.
sons’ interest in, tolerance for, and pleasure with sensations.
Because of our personal experiences with sensation, it is
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 sometimes hard or even inconceivable to imagine another tion, creating thresholds for responding at the point that
person’s experience with an object or event or context. We the proper amount of input has accumulated (Dunn,
want to frame the sensory experiences within our own 1998). Genetic and environmental factors contribute to
parameters; we think of another person’s description as each person’s ways of responding to excitation and inhibi-
“same,” “somewhat similar,” or “very different” from our tion. Therefore, people have different thresholds for notic-
own. All art is an expression of the artists’ personal experi- ing, responding to, and becoming irritated with sensations;
ences with the universe and might be described as their per- these thresholds, in turn, affect their daily choices and are
sonal sensory history shared in the form of the art; everyone reflected in their mood, temperament, and ways of orga-
responds differently to particular art. nizing their lives (Baranek, 1999; Dunn, 1997, 2000;
The discipline of occupational therapy has had a col- Rothbart & Jones, 1999; Zuckerman, 1994).
lective interest in sensory processing across the entire evo- Cognitive mechanisms, such as attention, organiza-
lution of our profession. We have generated and continue tion, memory, and problem solving, operate with informa-
to generate a wealth of information about how persons tion from the sensory systems and, therefore, illustrate
process sensory information and how those methods guide balancing threshold demands. A natural tension exists in
choices. These choices ultimately affect a person’s ability to the brain’s processing between internal information (sensa-
live a satisfying life. Everyone is personally interested in the tions of the body, i.e., touch, visceral) and external infor-
experiences of sensation, and occupational therapists can mation (sensations of the environment, i.e., auditory,
advance thinking about the contribution of sensory pro- visual). Cognitive processing is optimal when internal and
cessing to our understanding of the human experience both external information processing afford task performance
in the typical course of the day and as it might interfere together (Gijsbers van Wijk & Kolk, 1997b). For example,
with living a satisfying life. Shumway-Cook and Woollacott (2000) tested cognitive
The unique contribution of occupational therapy processing in relation to internal and external information
knowledge is in attaching understanding and meaning to processing in young and older adults. They created several
sensory experiences. We make the applications to daily life conditions of imbalance in internal and external informa-
to which other disciplines only allude. We might charac- tion processing demands and found that older adults need
terize our role as translator: We stand in the space between to have both external (visual) and internal (somatosensory,
abstract constructs and application to practice, looking vestibular, proprioceptive) cues available for postural con-
back and forth, translating for each group what the other trol in order to perform a demanding cognitive task.
has to say. Therefore, we can inform colleagues about the The mechanisms of sensory processing are intertwined
meaning of their research and families about their situa- with many other brain functions. By studying these phe-
tions, enabling each group to advance their own thinking nomena in various combinations, the actual contributions
and relationships can be revealed and then applied to other
and ultimately advance knowledge overall.
scholarly inquiries, such as the role of sensory processing in
Background Knowledge Related to Sensory individual differences and various human conditions.
Processing
Data Indicating Individual Differences in Sensory
Scholars from many disciplines have studied aspects of sen- Processing
sory processing. Their work provides evidence about how
the sensory systems contribute to the experience of being Studies employing psychophysiological methods provide
human. Neuroscientists have identified the unique quali- evidence about the nature of individual differences when
ties of each sensory system that make it possible for processing sensory events in the nervous system.
humans to take in information for the brain’s use (Kandel, Researchers have produced a body of literature about sen-
Schwartz, & Jessell, 2000). The brain initially becomes a sation seeking as a biosocial phenomenon in humans
repository for this sensory input, creating maps of the body (Carton, Morand, Bungenera, & Jouvent, 1995;
and the environment from each sensory system’s point of Glicksohn & Abulafia, 1998; Sarmany-Schuller, 1999;
view (Dunn, 1998). As these maps form, the brain begins Zuckerman, 1994; Zuckerman, Ulrich, & McLaughlin,
to integrate information from multiple sensory systems, 1993). Zuckerman (1994) reported on physiological dif-
forming higher order schemas of performance in contexts. ferences in persons with high and low sensation-seeking
Throughout life, these maps are modified in relation to the traits. Persons who are high sensation seekers experience a
person’s activities, forming the background for learning and reduction in heart rate with the introduction of a new stim-
understanding. ulus, which is interpreted to be an orienting response that
In addition to considering the basic sensory input and makes the person available to receive the stimuli.
processing occurring in the nervous system, scientists have Conversely, low sensation seekers experience an accelera-
reported on the nervous system’s methods for mediating its tion of heart rate, presumably triggering fear or threat, lead-
own input (Kandel et al., 2000). Neural regulation occurs ing to inhibition and avoidance of new stimuli.
through mechanisms that balance excitation and inhibi- Interdisciplinary teams, including occupational therapy
The American Journal of Occupational Therapy 609

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 researchers, have taken advantage of psychophysiology that both children with Fragile X syndrome and children
methods to investigate the relationships among the nervous with sensory modulation disorder responded to sensory
system’s responses and patterns of sensory processing in stimuli at higher levels, at higher rates, and with lack of
daily life. In studies with preschoolers (McIntosh, Miller, habituation (McIntosh, Miller, Shyu, & Hagerman, 1999;
Shyu, & Dunn, 1999) and adults (Brown, Tollefson, Dunn, Miller et al., 1998) than peers without disabilities.
Cromwell, & Filion, 2001), researchers found distinct pat- Therefore, conditions that affect the nervous system, like
terns of noticing and habituation that coincided with the Fragile X syndrome and Down syndrome, also change the
four categories of sensory processing proposed in Dunn’s ways that persons respond to sensory input.
Model of Sensory Processing (Dunn, 1997). These findings Baranek et al. (1997a) studied sensory defensiveness
suggest that we can characterize the ways that humans take and its relationship to stereotypic behaviors in children and
in sensation and that individual differences exist in how we adults with developmental disabilities. They reported on
use those sensations to construct our daily lives. two factors emerging from the data: auditory and other
hypersensitivities and tactile defensiveness. In another
Data Indicating Differences in Sensory Processing Related report, Baranek et al. (1997b) identified a relationship
to Human Conditions between tactile defensiveness and rigid, inflexible behavior
In addition to identifying patterns of individual difference patterns. Hotz and Royeen (1998) found that children
in sensory processing, researchers have studied the unique rated their own tactile defensiveness as more intense than
features of sensory processing that occur for persons with did their mothers, although a high correlation existed
various conditions. These data reveal the broad influence between the mothers and their own children. Kinnealey
that sensory processing has on every aspect of daily life. The (1998) reported on a preschooler with sensory defensive-
studies suggest that attention to the person’s sensory pro- ness who also had difficulty with age-appropriate learning
cessing patterns may provide insight for understanding at preschool; the child also demonstrated anxiety and need
these conditions and for deriving meaning from the per- for control, which affected her school and family relation-
son’s performance repertoire. Knowledge about a person’s ships. Kinnealey and Fuiek (1999) tested adults with sen-
patterns of sensory processing may contribute to the design sory defensiveness and found them to be more anxious and
of more effective interventions and the advancement of depressed, but they did not experience more pain than
knowledge. their peers without defensiveness. Perhaps rigidity and
Accumulating evidence identifies distinct sensory pro- inflexibility are behaviors reflective of coping with very low
cessing patterns in children and adults with various condi- thresholds that quickly overwhelm some persons’ nervous
tions (Ayres, 1989; Baranek, 1999; Baranek, Foster, & systems.
Berkson, 1997a; Brown & Dunn, in press; Brown et al., In another set of studies, Baranek (1999) found that
2001; Case-Smith, Butcher, & Reed, 1998; Cermak & children with autism and developmental disabilities dis-
Daunhaur, 1997; Cooper, Majnemer, Rosenblatt, & played different ways of responding to visual, auditory,
Birnbaum, 1993; DeGangi & Greenspan, 1989; Dunn, touch, and body position stimuli in relation to each other
and cohorts without disabilities. DeGangi and Greenspan
1999, 2000; Dunn & Daniels, 2001; Johnson-Ecker &
(1989) found tactile defensiveness, vestibular dysfunction,
Parham, 2000; Larson, 1982; Provost & Oetter, 1993;
and poor ocular motor control in children with develop-
Royeen & Fortune, 1990; Wiener, Long, DeGangi, & mental delays and children with regulatory disorders. Lai,
Battaile, 1996). Researchers use a variety of data collection Parham, and Johnson-Ecker (1999) reported a strong rela-
methods, including criterion measures, direct evaluation of tionship between sensory defensiveness (i.e., overrespon-
performance, interviews, questionnaires, and observations, siveness to stimuli) and sensory dormancy (i.e.,
to characterize sensory processing. In spite of the variety of underresponsiveness to stimuli) in children with disabili-
methods, researchers have reported distinct sensory process- ties, suggesting interrelatedness between these two ways of
ing characteristics in persons with various human conditions. responding. The children with disabilities in their study
Genetic and developmental disorders. Some researchers had a higher rate of both dormancy and defensiveness than
have studied sensory processing patterns in children with the comparison group of children without disabilities, sug-
genetic disorders. Belser and Sudhalter (1995) measured gesting that modulation of input was in question.
skin conductance and found that boys with Fragile X syn- Brain disorders. Sensory processing also affects cogni-
drome are more physiologically aroused by eye contact tive performance for persons with brain dysfunction; audi-
than boys with Down syndrome. They also found that boys tory factors seem particularly relevant (Arciniegas et al.,
with Fragile X syndrome who also had autism demonstrat- 1999; Denney, 1997; Madigan, DeLuca, Diamond,
ed more avoidant reactions than boys with autism only. Tramontano, & Averill, 2000; Ragneskog & Kihlgren,
Belser and Sudhalter concluded that difficulty with modu- 1997). Ragneskog and Kihlgren (1997) found that audito-
lating arousal may be a distinguishing characteristic of ry environments affected level of cognitive awareness in
Fragile X syndrome. Other researchers also have verified patients with dementia; background music engendered

610 November/December 2001, Volume 55, Number 6

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 calming, whereas more uncontrolled sounds increased agi- stimulation attractive. Because fatigue reports are generally
tation. Denney (1997) also found that persons in a reha- related to internal cues (e.g., tiredness, dullness, body com-
bilitation unit demonstrated 57% less agitation after 1 plaints), Gijsbers van Wijk and Kolk (1997b) concluded
week of quiet music in the dining room. The negative that both too few (leading to boredom) and too many
behaviors rebounded when the music was stopped and (leading to being overwhelmed) external cues can lead to
returned to lower levels when the music was reintroduced, increased attention to internal cues and, therefore, higher
providing stronger evidence that the music affects the cog- rates of fatigue. They recommended changes in daily life to
nitive state. reestablish the balance between internal and external infor-
Although cognitive processing speed is slower for most mation processing demands to reduce fatigue and therefore
persons who have had traumatic brain injury, auditory improve performance and satisfaction.
input slows these persons’ processing even more (Madigan This review provides a sample of the extensive inter-
et al., 2000). For example, in a study of persons with trau- disciplinary interest in phenomena related to sensory pro-
matic brain injury, researchers found that attentional cessing and its impact on performance. Data from
mechanisms failed in persons who were unable to filter children and adults, persons with and without disorders,
stimuli and took a longer time to respond to auditory cues and out-of-laboratory and natural environment settings
(Arciniegas et al., 1999). Therefore, it is possible to under- indicate that sensory processing has a pervasive influence
stand the relationship between cognition and sensory pro- on the human experience. Furthermore, the apparently
cessing by looking at performance when the balance in far-reaching effect of sensory processing on peoples’ abili-
attention to internal (body) and external (environment) ty to experience a satisfying life underscores the impor-
sensory cues is disrupted. tance of studying sensory processing from many
Schizophrenia. Sensory processing challenges are also perspectives, including the unique perspectives offered
prominent for persons who have schizophrenia, and these from the discipline of occupational therapy.
challenges are linked to the cognitive impairments charac-
teristic of the disorder (e.g., Bunney et al., 1999; Cromwell, Explanation of Dunn’s Model of Sensory
1993; Frith, Blakemore, & Wolpert, 2000; Hemsley, 1993;
Processing
Jin et al., 1998; Light & Braff, 2000; McGhie & Chapman, In 1997, I proposed a model for sensory processing that
1961; Venables, 1969). In a classic article, McGhie and accounted for the nervous system’s thresholds for acting
Chapman (1961) identified disturbances of attention, per- and the person’s propensity for responding to those thresh-
ception, and changes in motility and body awareness as key olds (Dunn, 1997). The original model evolved from the
features of the onset of schizophrenia. They categorized per- literature, such as that described previously, and analysis of
sons’ descriptions of their early experiences with schizophre- data gathered with the Sensory Profile measure from a
nia and described them having to face an unstable and national sample of children without disabilities (Dunn,
newly fluctuating relationship between perception of self 1999; Dunn & Brown, 1997; Dunn & Westman, 1997).
(body sensations) and the environment. During this early This model of sensory processing has proven useful in
period, persons seem to have increasing awareness of all guiding subsequent research and providing a structure for
stimuli and cannot organize the myriad of sensations, mak- gaining insights into the nature of sensory processing across
ing it more and more difficult to function. Authors have the life span.
proposed that delusions emerge from attempts to make The primary features of this model are (a) considera-
meaning out of this increasingly undifferentiated sensory tion of one’s neurological thresholds (i.e., reactivity), (b)
input (Frith et al., 2000; Light & Braff, 2000). consideration of one’s responding or self-regulation strate-
Fatigue. Not only chronic brain disorders provide gies, and (c) consideration of the interaction among thresh-
information about sensory processing. Scholars studying olds and responding strategies. Figure 1 illustrates the
fatigue also have reported relationships to sensory process- model, with thresholds on the vertical axis and responding
ing primarily related to balancing internal and external strategies on the horizontal axis.
information processing. Authors have reported evidence of In this model, thresholds and responding strategies
fatigue when persons are experiencing low internal and represent a continuum of possible conditions, such that a
external information processing demands (Finkelman, person’s ways of responding to sensory events in daily life
1994; Gijsbers van Wijk & Kolk, 1997a) and when per- can be characterized as reflecting both a particular thresh-
sons have both too high and too low external demands old and a responding strategy. Although a person’s respons-
(Bensing, Hulsman, & Schreurs, 1999; Rijk, Schreurs, & es to sensory events could fall anywhere on this model, the
Bensing, 1999). For example, Rijk et al. (1999) studied four outermost interaction points are named for the pur-
fatigue in general medicine practices and found that fatigue pose of dialogue. High thresholds with passive responding
was high when persons experienced overload of external strategies are called low registration; high thresholds with
stimuli and decreased when persons found their external active responding strategies are called sensory seeking; low

The American Journal of Occupational Therapy 611

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 thresholds with passive responding strategies are called sen- the room if others are moving, talking, or bumping into
sory sensitivity; and low thresholds with active responding them. They create rituals for daily routines, which may be
strategies are called sensory avoiding (see Figure 1). These an active strategy to generate only familiar, predictable sen-
concepts are explained in greater detail in other sources sory patterns for themselves. They also become unhappy
(Brown et al., 2001; Dunn, 1997, 1998, 2000; Dunn & when these rituals are disrupted perhaps because of increas-
Brown, 1997; Dunn & Daniels, 2001; Huebner & Dunn, ing unpredictability (Brown et al., 2001; Dunn, 1997;
2000). Dunn & Brown, 1997; Dunn & Daniels, 2001).
Sensory processing is a complex endeavor. People do
Description of Anchor Points in the Model not experience sensory events of daily life in a unitary man-
Persons who have high neurological thresholds require a lot ner. As the literature has shown, internal and external con-
of sensory input for responding. When persons have low ditions affect the way people process sensory information.
registration, they do not notice sensory events in daily life They may be more sensitive (have lower thresholds) for
that others notice readily (i.e., passive responding strategy). some types of sensory input, while being less attentive
They may not notice when other people come into the (have higher thresholds) for other types of sensory input. A
model must symbolize complex processes without being
room or food or dirt on their face and hands. Others may
complex itself so that it affords further conceptualization
have to call the person’s name several times or use addi-
and synthesis. This model of sensory processing is meant to
tional cues such as touching to get the person’s attention.
provide a framework for studying, interpreting, and gain-
Persons who are sensation seekers enjoy sensory experiences
ing insights into the nature of sensory processing, includ-
and find ways to enhance and extend sensory events in
ing all of its complexities, and the impact of sensory
daily life (i.e., active responding strategy). They like physi-
processing on daily life.
cal movements such as climbing, twirling, swinging, and
bouncing. They search for additional sensory experiences Evidence Emerging From Studies Using Dunn’s Model of
for themselves, such as humming and other mouth noises, Sensory Processing
touching objects, feeling vibrations in stereo speakers and
appliances, wearing perfume, and smelling flowers (Brown Dunn’s Model of Sensory Processing reflects concepts for
et al., 2001; Dunn, 1997; Dunn & Brown, 1997; Dunn & consideration toward understanding the impact of sensory
Daniels, 2001). processing in daily life. My colleagues and I have used the
Persons who have low neurological thresholds, or sen- various forms of the Sensory Profile—the Infant/Toddler
sory sensitivity, notice sensory stimuli quite readily and Sensory Profile for children birth to 3 years of age, the
more sensory events in daily life than do others. They are Sensory Profile for children 3 years to 10 years of age, and
easily distracted by movements, sounds, or smells while in the Adult Sensory Profile for adolescents and adults—to
groups of people, such as in class or at the movie theatre. conduct studies about the nature of sensory processing as a
They notice food textures, temperatures, and spices more core feature of the human experience. These measures con-
rapidly than others. They may be uncomfortable with tain descriptions of sensory events in daily life; the infor-
clothing tags, elastic, or certain fabric textures. Their high mant (self or parent) uses a 5-point Likert scale (almost
rate of noticing while continuing to experience all of these always to almost never) to record the frequency they engage
is a more passive responding strategy (i.e., letting things in the behaviors described in each item. We have reported
happen) than is seen in sensation avoiders. Sensory avoiders good internal consistency estimates for each measure.
find ways to limit sensory input throughout the day. They Findings from specific studies have been and are being
stay away from distracting settings; for example, they leave reported elsewhere; when considering the findings across
ages and human conditions, some consistent patterns
emerge that provide insights and furnish information for
future interpretations and discoveries.
Sensory seeking is a prominent feature for everyone. To
date, we have conducted factor analyses on infants and tod-
dlers (Dunn, in press; Dunn & Daniels, 2001), children
(Dunn, 1999; Dunn & Brown, 1997), and adults (Brown
et al., 2001) without disabilities. In each case, sensory seek-
ing has emerged as a prominent factor accounting for a large
Figure 1. Dunn’s Model of Sensory Processing. From “The
amount of the variance in the groups (infants and toddlers,
Impact of Sensory Processing Abilities on the Daily Lives of
Young Children and Families: A Conceptual Model” by W. 8%–11%; children, 22%; adults, 7.8%) (see Table 1).
Dunn, 1997, Infants and Young Children, 9(4), 23–25. Perhaps the sensory seeking factor illustrates the pre-
Copyright © 1997 by Aspen Publishers, Inc. Adapted with dominant method that people use for gathering informa-
permission. tion and keeping track of themselves and what is going on

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 Table 1 their own nervous systems. Preliminary evidence shows that
Selected Items From the Sensory Seeking Factor of
Each Factor Analysis
persons with distinct sensory processing patterns consistent
Sensory Profile Form Item
with the quadrants in Dunn’s model also have distinct pat-
Infant/Toddler My child finds ways to make noise with toys. terns of amplitude and habituation responses in skin con-
My child enjoys physical activity (bouncing, being ductance measures (Brown et al., 2001; McIntosh, Miller,
held up high in the air)
Child Twirls/spins self frequently throughout the day. Shyu, & Dunn, 1999; McIntosh, Miller, Shyu, &
Loves to be barefoot Hagerman, 1999; Miller et al., 1998). For example, Brown
Adult I enjoy being close to people who wear perfume
or cologne.
et al. (2001) found that amplitude measurements were high-
I hum, whistle, sing, or make other noises. er for persons with low threshold patterns (sensory sensitivi-
ty, sensory avoiding) than persons with high threshold
around them. As Coren, Porac, and Ward (1984) stated: patterns (low registration, sensory seeking). However, per-
The brain, the organ that is responsible for your conscious experience, sons with sensory avoiding and low registration habituated
is an eternal prisoner in the solitary confinement of the skull...and quickly, whereas persons with sensory sensitivity and sensory
must rely on information smuggled into it from the senses...the world
is what your brain tells you it is, and the limitations of your senses sets
seeking habituated more slowly. McIntosh, Miller, Shyu, and
the boundaries of your conscious experience. (p. 2) Hagerman (1999) also reported a similar pattern when test-
ing children. These psychophysiology measures are consid-
In implementing responsibility for the conscious expe-
ered involuntary nervous system responses. The fact that
rience, the brain exercises vigilance in monitoring the
persons with distinct sensory processing matching each
moment-to-moment changes in body integrity, environ-
quadrant on Dunn’s Model of Sensory Processing also dis-
mental conditions, and the continuous and changing rela-
played a unique pattern of skin conductance (i.e., the pattern
tionship of the body with the environment (Damasio,
of amplitude plus habituation) lends psychophysiological
1999). In all the factor structures, the sensory seeking fac-
support to the model. Possibly the Sensory Profile measures
tor contained items from multiple sensory systems. Not
tap persons’ awareness of their own (or their child’s) nervous
one sensory modality but, rather, one theme characterized
system’s responding patterns, providing valuable information
sensory seeking: searching for and enjoying sensory experi-
about nervous system operations in an accessible format.
ences. Perhaps the sensory seeking factors provide evidence Patterns emerge across ages to reveal both stability and
of the brain’s multisensory vigilance and the universality of developmental factors. Most of the data from the Sensory
seeking sensation as part of the experience of being human. Profile studies indicate that responsiveness and reactivity
The factor structures reflect thresholds and reactivity patterns remain the same across the life span. Despite the
rather than sensory system organization. Evidence suggests wide range of ages we have tested, generally the levels of
that some children who have learning and behavioral dis- responding remain the same across both the sensory sys-
abilities exhibit difficulties processing input from particular tems and the patterns of sensory processing (i.e., the cate-
sensory systems (Ayres, 1979, 1989; Ayres & Tickle, 1980; gories) from Dunn’s model. These findings suggest that
Fisher, Murray, & Bundy, 1991; Kimball, 1986). there is something inherent about sensory processing that
Additionally, researchers and practitioners in occupational is separate from specific learning or experiences. Certainly,
therapy have traditionally constructed sensory histories persons learn from every experience, and sensory process-
using sensory system groupings (i.e., auditory, visual, ing provides the information for that learning. Preliminary
touch, vestibular, proprioceptive, taste, smell) (Ayres, cross-sectional data suggest that people use consistent sen-
1979; Brown & Dunn, in press; Case-Smith et al., 1998; sory processing patterns across time. A person who has low
Cooper et al., 1993; DeGangi & Greenspan, 1989; Dunn, registration, even with variability due to biobehavioral
1999, in press; Dunn & Daniels, 2001; Johnson-Ecker & state, environmental variables, and motivation, will likely
Parham, 2000; Larson, 1982; Provost & Oetter, 1993; have a range of registration that reflects lower registration
Royeen & Fortune, 1990). Consequently, one might than others in similar situations. Thus far, we only have
hypothesize that these sensory system groupings would cross-sectional data and will need to collect longitudinal
emerge as factors in factor analyses. data to verify these hypotheses.
However, the findings from the factor analysis studies Two notable exceptions to these stability patterns seem
of the Sensory Profile indicate that the items cluster on the to reflect active changes in particular developmental peri-
basis of the person’s level of reactivity (i.e., thresholds for ods. Our data on infants and toddlers indicate the existence
responding) rather than by sensory system (Brown et al., of developmental trends for some of the sensory systems
2001; Dunn, in press; Dunn & Brown, 1997; Dunn & (Dunn, in press; Dunn & Daniels, 2001). In the tactile sys-
Daniels, 2001). When persons tend to seek or avoid senso- tem, the youngest infants (birth to 6 months of age) are
ry input, they are likely to seek or avoid input from more very responsive to their parents and rarely resist being held
than one sensory system. or cuddled. Children between 1 and 3 years of age have a
Perhaps the questions on the Sensory Profile enable per- wider range of responses to tactile input, with the average
sons to characterize the excitation and inhibition needs of scores between seldom and occasionally. Perhaps as chil-
The American Journal of Occupational Therapy 613

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 dren grow older, they begin to differentiate the wider range ity differentiated children with ADHD, whereas poor oral
of tactile inputs and learn about becoming part of the sensory processing differentiated children with autism.
world outside the mother’s womb. They also develop more When combined with the data presented in the earlier
skills for negotiating their responses during this period section about sensory processing differences across a num-
(Gormly, 1997). For the visual and oral sensory systems, ber of human conditions, strong evidence appears to indi-
scores steadily progress across the ages of birth to 3 years, cate that sensory processing information can enhance our
with the youngest infants responding frequently to stimuli understanding of human disorders specifically and the
and the older toddlers responding seldom to occasionally. human experience in general. The normative data on the
Again, as the children experience sensations of living in the Sensory Profile suggests a continuum of responding, with
world, they accumulate information and then habituate to persons who have disabilities occupying the ends of the
some sensory events as those events become familiar pat- ranges. Significant differences in sensory processing from
terns to the nervous system. the patterns most people experience may be a considerable
For older adults, low threshold factors (sensitivity, sen- factor contributing to the overall behavioral, cognitive, and
sory avoiding) continue to function at the same level as psychosocial manifestations of particular disorders.
younger adults, but high threshold factors (registration,
seeking) change (Pohl, Dunn, & Brown, 2001). Integrating Data Across Disciplines Provides Insights
Specifically, after 70 years of age, registration gets worse If we are to understand the role of sensory processing in our
(i.e., it gets progressively harder to notice stimuli), and per- humanity, including how it affects people’s lives, we must
sons seek stimuli less (i.e., they engage in fewer and fewer consider how knowledge generated across disciplines
behaviors to add sensation to their experiences). One expla- informs our conception of being human. Researchers have
nation for this phenomenon is that older adults have poor- studied personality, temperament, self-regulation, and
er sensory acuity, such as hearing and vision, thus reducing traits related to responsiveness to understand the nature of
their actual input. Another explanation is related to the being human (Bagnato & Neisworth, 1999; Costa &
wider experiences of older adults; perhaps as persons grow McCrae, 1987; Rothbart, Ahadi, & Evans, 2000; Rothbart
older, more experiences are familiar, thus not triggering & Jones, 1999; Zuckerman, 1994). These bodies of work
thresholds for responding as often as younger adults. The offer important constructs that characterize peoples’ ways
low threshold patterns continue throughout the adult peri- of being. When combined with sensory processing con-
od; consistency in low threshold patterns may reflect the structs, we begin to see the possible impact of sensory pro-
nervous system’s continuing vigilance for protective cessing on behavioral and personality traits.
responses to potentially harmful stimuli, whereas familiari- Studying temperament and personality. Just as in the sen-
ty with a broader range of information produces less sory processing literature, temperament and personality
responding in day-to-day familiar situations. Nonetheless, researchers have conducted factor analytic studies to uncov-
this finding offers information about strategies we might er the constructs underlying self-regulation, personality,
employ for supporting older adults to remain actively temperament, and behavioral response traits (Bagnato &
engaged and participatory as they age. Neisworth, 1999; Costa & McCrae, 1987; Rothbart et al.,
Evidence differentiates patterns of sensory processing across 2000; Rothbart & Jones, 1999; Zuckerman, 1994). These
human conditions. Studies that include persons with various scholars have found factor structures that seem to reflect
disabilities, such as attention deficit hyperactivity disorder levels of reactivity.
(ADHD), autism, Asperger syndrome, schizophrenia, For example, Rothbart and colleagues have studied the
Fragile X syndrome, and sensory modulation disorder, temperament characteristics of infants and young children
indicate that sensory processing is significantly different for and identified factors they called “surgency” (i.e., positive
persons with these disorders compared with peers without affect, activity level), fear, irritability/anger, and persistence.
disabilities (Brown et al., 2001; Dunn & Bennett, in press; These same characteristics emerge in studies of children
Kientz & Dunn, 1997; McIntosh, Miller, Shyu, & Dunn, through school age (Rothbart, et al., 2000; Rothbart,
1999). Additionally, some evidence suggests that disability Derryberry, & Hershey, 2000; Rothbart & Jones, 1999).
groups are significantly different from each other in their Rothbart and Derryberry (1981) believed that these tem-
patterns of sensory processing. For example, Ermer and perament characteristics of development precede and
Dunn (1998) conducted a discriminant analysis on data underlie the development of self-regulatory processes.
from children with autism, children with ADHD, and Researchers studying adults have reported similar con-
children without disabilities and were able to categorize the structs of temperament and have linked these constructs to
children with 89% accuracy on the basis of factor analysis personality traits (Rothbart et al., 2000; Caspi, 2000;
scores alone. (Remember the factor scores are groupings of Starratt & Peterson,1997). Rothbart, Ahadi, and Evans
items that reflect Dunn’s Model of Sensory Processing.) (2000) reported a four-factor temperament structure that is
Low threshold items related to inattention and distractibil- consistent with the child temperament factors. They also

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 studied the relationship between this temperament struc- Illustrating relationships among temperament, personali-
ture and the Big Five personality factor structure defined by ty, and sensory processing. Following the tradition of Keogh’s
Costa and McCrae (1987) and found considerable conver- (1982, 1994) work, Rothbart and Jones (1999), prominent
gence in the two structures. Table 2 illustrates the conver- researchers on children’s temperament, wrote about how to
gence of constructs from the child and adult factor apply temperament knowledge to classroom situations.
structures. They discuss the fact that positive affect and negative affect
Hypothesizing about relationships among temperament, are not anchor points on the same scale—an important
personality, and sensory processing. Four distinct constructs point because it means that children are not “doomed” to
continue to emerge from the temperament and personality experiencing distress and fear if they have a high degree of
literature (see Table 2). The characteristics of these con- negative affect. Rather, studies reveal that children can have
structs appear to be consistent with the four constructs that various degrees of each temperament trait; thus, they can
have emerged from the sensory processing factor analyses as be prone to distress or fear and still possibly experience a
well. Table 2 also contains a column that illustrates hypoth- positive affect. This complexity in the relationships among
esized relationships between the constructs from Dunn’s temperament traits precludes parents and teachers from
Model of Sensory Processing and the temperament and labeling children according to only one feature. Rothbart
personality constructs. In this proposed set of relationships, and Jones concluded that this insight enables caregivers “to
sensory seeking is associated with agreeableness and extra- accentuate the child’s positive tendencies, while at the same
version of adulthood and surgency of childhood. Sensory time diminishing negative reactions that could lead to dis-
avoiding is associated with fear, negative affect, and neu- couragement or conflict” (p. 39).
roticism. Sensitivity is associated with irritability and anger, If we add knowledge about children’s sensory process-
orienting sensitivity, and intellect and openness. Finally, I ing patterns to this story, we provide caregivers information
hypothesize that the temperament characteristics of persis- about how to make adjustments to “accentuate the child’s
tence and effortful attention and the personality trait of positive tendencies” and “diminish negative reactions” and
conscientiousness explain a different facet of task persis- supply data about why these changes might be effective in
tence than low registration. That is, the sensory processing supporting the child’s performance. Sensory processing
pattern of low registration (high thresholds and passive knowledge adds a level of awareness about the conditions
responding patterns) seems to enable task performance necessary for the child to negotiate the demands of the day
because of lack of noticing other stimuli. Table 3 lists some successfully. Rothbart and Jones (1999) gave the example
sample items from the adult temperament and adult senso- of creating a clear routine for a child who is highly anxious,
ry processing measures discussed here. describing a cognitive method for helping the child to
Does this mean that we do not need to study sensory develop expectations. Sensory processing knowledge would
processing because the substantial temperament and per- indicate which sensory systems are likely to trigger anxious
sonality literature could tell us all there is to know? I do not reactions (e.g., low threshold responses) and which sensory
think so. What I believe to be true about these hypothe- input mechanisms might be easier for the child to manage.
sized relationships is that these different areas of inquiry are Armed with this information, the teacher could refine
getting at some universal truths about being human, but instructions, routines, and guidance to minimize low
from different points of view. When we have multiple threshold inputs and take advantage of less sensitive forms
viewpoints, we can inform knowledge development of sensory information. Without sensory information, the
because one way of looking at something can only reveal a teacher might create a routine that continues to employ a
portion of the overall truth. sensitive sensory system and conclude that the overall
approach to the problem was not effective.
Table 2 Speculating about sensory processing using insights from
Comparison of the Factor Structures of Infant/Child
Temperament and Adult Temperament and Personality the personality and temperament literature. Many examples
Scales and Sensory Processing Scales just like this one illustrate the importance of interdiscipli-
Infant/Child Adult Temperament Sensory nary perspectives if we are to understand universal truths
Temperament and Personality Processing about the experience of being human. However, knowl-
Fear Negative affect Sensory avoiding edge will not advance unless each discipline considers how
Neuroticism
other perspectives might inform its work and provide a
Irritability/anger Orienting sensitivity Sensitivity host of questions that could not be generated from a single
Surgency discipline’s perspective. The fact that consistent patterns
Positive affect Intellect/openness Sensory seeking about temperament, personality, and sensory processing
Agreeableness
Extraversion
emerge across studies of children and adults suggests that
there is insight to be had in understanding how these con-
Persistence Effortful attention Low registration structs interact with each other.
Conscientiousness

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 Table 3
Sample Items From the Temperament and Sensory Processing Questionnaires
Temperament Sensory processing
Fear • Loud noises sometimes scare me. Sensory avoiding • I wear gloves or avoid activities that will
Negative affect • Sometimes I feel a sense of panic or terror for make my hands messy.
no apparent reason. • When others get too close, I move away.
Irritability/anger • I often notice mild odors and fragrances. Sensitivity • I become dizzy easily (e.g., after bending
Orienting Sensitivity • I am often aware how the color and lighting of over, getting up too fast).
a room affects my mood. • I startle easily to unexpected or loud noises
Surgency • When listening to music, I usually like to turn (e.g., vacuum cleaner, dog barking, telephone
Positive affect up the volume more than other people. ring).
• I would enjoy watching a laser show with lots Sensory seeking • I enjoy being close to people who wear per-
of bright, colorful flashing lights. fume or cologne.
Persistence • I can easily resist talking out of turn, even when • I enjoy how it feels to move about (e.g.,
Effortful attention I’m excited and want to express an idea. dancing, running).
• When interrupted or distracted, I usually can Low registration • I don’t notice when people come into the
easily shift my attention back to whatever I was room.
doing before. • I get scrapes or bruises but don’t remember
how I got them.
Note. Temperament questions from the Adult Temperament Questionnaire, version 1.3, Mary Rothbart. Sensory processing questions from Adult Sensory Profile,
Tana Brown and Winnie Dunn.

For instance, we might infer some characteristics about demands of life at different ages expose different aspects of
sensory processing (a newer line of research) from the rela- his or her sensory processing strategies.
tionships we hypothesize to exist between the more estab- Speculating about personality and temperament using
lished temperament and personality literature and sensory insights from the sensory processing literature. We are not lim-
processing. Earlier in the temperament line of research, ited to speculating from the more established personality
some controversy existed about whether temperament and temperament literature to the newer sensory process-
characteristics were stable throughout life and whether ing literature. We can also speculate about developed lines
early temperament characteristics predicted personality of research from newer work.
traits in adulthood (Starratt & Peterson, 1997). The now Some studies have linked sensory processing to cogni-
substantial body of evidence seems to illuminate two tive, behavioral, and psychosocial performance, suggesting
important factors. First, longitudinal studies indicate fairly that linking to temperament and personality also would be
high stability in personality (McCrae, Costa, & Arenberg, fruitful. Baranek et al. (1997a) studied sensory defensive-
1980); even studies that showed some changes reported ness and its relationship to stereotypic behaviors in children
that the fluctuations were small overall (e.g., Eysenck, and adults with developmental disabilities. They reported a
1987). Cross-sectional data on sensory processing traits relationship between tactile defensiveness and rigid, inflex-
provide preliminary evidence that sensory processing pat- ible behavior patterns. Kinnealey and Fuiek (1999) tested
terns are stable across the life span. We might hypothesize adults with sensory defensiveness and found that they were
that sensory processing patterns manifest as do tempera- more anxious and depressed but did not experience more
ment and personality (i.e., that they also are stable across pain than their peers without defensiveness. Stephens and
ages), although our hypothesis needs to be tested explicitly. Royeen (1998) found an inverse relationship between self-
Second, personality and temperament researchers indi- esteem and school-aged children’s responses on the Touch
cate that context can affect the manifestation of one’s per- Inventory for Elementary Children, with increasing levels
sonality traits. Starratt and Peterson, (1997) suggested that of tactile defensiveness correlated with poorer self-esteem.
people may not express their personality traits as strongly in Parham (1998) reported changing relationships between
contexts that have variable relevance for them. Perhaps this cognitive performance at school and sensory processing;
same tendency to express traits differently across contexts reading scores were more highly related in younger grades,
also occurs with one’s pattern of sensory processing. A per- whereas math performance was more highly related in later
son might construct a home environment so that it mini- elementary grades. Kinnealey (1998) reported on a
mizes sensory experiences that are more sensitive, whereas preschooler with sensory defensiveness who also had diffi-
at work the person would have to confront these sensory culty with age-appropriate learning at preschool, anxiety,
challenges. Starratt and Peterson also hypothesized that the and need for control, which affected her school and family
expression of one’s personality traits may change across the relationships.
context of time. Extraverts may express themselves differ- With some association between sensory processing and
ently in their 20s than in their 60s. We see this same phe- psychosocial and cognitive performance, we can consider
nomenon of changes across time with the infants, toddlers, how sensory processing knowledge might inform the tem-
and older adults in the sensory processing data (Dunn & perament work. First, sensory processing evidence informs
Daniels, 2001; Pohl et al., 2001). Perhaps a person’s under- about how to support persons to be successful in their daily
lying sensory processing traits remain the same, and the lives. Although the personality and temperament literature

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 makes clear that certain traits are more (or less) conducive This construct of low engagement also has been useful
to certain situations, discussions about what to do about in studies involving disability groups. For example, persons
poorly matched situations are more general. Cohn, Miller, with schizophrenia simultaneously have low registration
and Tickle-Degnen (2000) found that children want to and sensory avoiding (Brown et al., 2001). We hypothesize
participate in social interactions, engage in self-regulation, that this pattern of poor noticing (low registration) and
and perceive competence in performance. Parents in the hyperresponsiveness leading to withdrawal (sensory avoid-
same study reported the desire to learn strategies to support ing) may reflect the small range within which these persons
their children and to obtain personal validation for their can receive sensory input and use it to participate success-
role as parents. The authors concluded that the therapeutic fully. These possible sensory processing relationships may
process needs to center on supporting children and parents provide information about applying temperament con-
in their daily lives and natural contexts; parents need spe- structs to disability groups because our work has been fruit-
cific information to do this successfully. ful in this area.
Jarus and Gol (1995) found that adding kinesthetic Third, one’s sensory processing patterns seem to reflect
input to skills acquisition routines improved performance the way a person’s nervous system functions (Brown et al.,
in both children with and children without sensory inte- 2001; McIntosh, Miller, Shyu, & Dunn, 1999; McIntosh,
grative dysfunction. They hypothesized that proprioceptive Miller, Shyu, & Hagerman, 1999; Miller et al., 1998);
information gained through kinesthesia provides body one’s temperament and personality may be the behavioral
scheme information for postural control to support task manifestation of one’s sensory processing patterns and ner-
performance. Stratton and Gailfus (1998) used sensory vous system functions. Thus, by knowing a person’s senso-
integrative approaches to address overreactivity in adoles- ry processing patterns, one can construct explicit
cents and adults with ADHD who were abusing substances environmental conditions and activities that support both
and could not persist through the substance abuse treat- the nervous system’s functions and its temperament (e.g.,
ment sessions. They found that the sensory integrative enhance positive affect while minimizing negative affect).
approach enabled the clients to take advantage of the sub- We need to conduct studies using both sensory pro-
stance abuse program. Woodbury (1997) used an auditory cessing and temperament–personality measures to investi-
and visual desensitization technique with children with gate the nature of these relationships and gain further
autism. Fewer than half could complete the intervention, insights. Thus far, adequate evidence suggests that these
but those who did could participate more adaptively. This lines of investigation would be fruitful.
finding suggests that we must take care in applying desen-
sitization and that it can be effective with selected persons. Application to Practice
Kinnealey, Oliver, and Wilbarger (1995) found that So what does this knowledge mean for practice? The idea
adults with sensory defensiveness had strategies for coping that one’s sensory processing patterns are relatively stable
with their daily lives, including avoiding aversive stimuli, across one’s life creates a slippery slope for possible applica-
imbedding predictability, preparing mentally for situations, tion to practice. One could deduce that with the view that
talking themselves through situations, counteracting “we are what we are,” there is no reason to provide inter-
uncomfortable sensations, and confronting discomfort. vention because it would be futile; but this would be incor-
This array of strategies suggests that intervention methods rect. Human beings have many relatively stable traits, ones
must include methods not only to resolve the sensory that characterize both our collective humanity and our indi-
defensiveness, but also to manage it within daily life. These viduality, such as the way the circulatory system works or
persons had insight about their sensory defensiveness, yet it our need to be connected with other human beings.
was still part of their identity, suggesting that low thresh- Although we might characterize our need to be connected
olds persist across an extended period of life and, therefore, to other human beings as a limitation, we also might con-
may be underlying factors to one’s temperament. sider the advantages of that need for supporting the overall
Second, all the temperament and personality con- human experience. I think that in knowing one’s “features”
structs represent types of engagement. One of the sensory we might be set free to learn, evolve, and live a satisfying life.
processing constructs, low registration, represents lack of I believe that the essential gift of our sensory process-
engagement. Perhaps lack of noticing is another facet ing knowledge is in providing opportunities for insight.
underlying the personality–temperament traits of persis- Occupational therapists have crafted an entire focus in our
tence, effortful control, and conscientiousness because discipline out of coming to understand sensory processing;
without being distracted by external stimuli, persons can we have information that will inform others about the
persist at task performance. This area may be one in which nature of their humanity. Sensory processing patterns are
sensory processing literature can inform personality and reflections of who we are: These patterns are not a pathology
temperament research by expanding the notion of the that needs fixing. Intervention addresses the interference
underlying features that enable persistence. between our desired life and our current performance; sen-

The American Journal of Occupational Therapy 617

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 sory processing knowledge can narrow this gap and reduce themselves better, therapeutic intervention is only appro-
interference, thereby affording a satisfying life. priate when there is something the person wants or needs
We must take care in sharing this gift. Sensory pro- to do, and their way of sensory processing interferes with
cessing is a deeply personal experience. Because our disci- that aspect of living a satisfying life. Intervention must
pline has studied sensory processing, we can offer people, focus on living; to that end, we construct intervention
families, and colleagues information about the impact of options based on what is respectful and compatible with
sensory processing in daily life. We must not fall into the the person’s life. For example, persons with low registration
trap of thinking that in knowing something about a per- notice much fewer cues than others. Although we have the
son, we as therapists must set out to change it. The way a knowledge to construct an intensive sensory program, and
person processes sensory information is just that—the way persons with low registration will respond to sensory inten-
the person processes sensory information. No way of pro- sity and might come to notice more aspects of engagement
cessing sensory information is inherently good or bad—it during intense sensory stimulation, it is likely that at the
just is. People with every pattern of sensory processing are end of this intensity, these persons will still have low regis-
living successfully and unsuccessfully; you are not doomed tration. Low registration is not a problem to resolve; living
to failure if you have low registration or guaranteed success a satisfying life is the challenge to address. We must use our
if you are a sensation seeker. A sensation seeker in an information so that the person comes to know how to con-
impoverished environment will flounder, whereas a sensa- struct work and living environments and establish rituals to
tion avoider may flourish there. provide intensity routinely as a support for daily life so that
So ask yourself: What would take so much effort for me to he or she can be successful. Many persons have low regis-
do that I would lose myself in the process? Let us consider an tration; only some are struggling in their daily lives. Those
example. If I find the place where you can barely hear my who are struggling may lack insight about the nature of
voice, do you see it as an opportunity to work on your lis- their sensory processing and, therefore, do not make choic-
tening, or do you want me to just speak up? If I just speak es that support both their sensory processing needs and the
up, this is an adaptation to support your current auditory activities of interest in their lives. We have the knowledge
skills so that you can participate in the ideas being shared. and skills to bridge this gap.
People who wear glasses say that they hear better with their Summary
glasses on. Glasses do not affect hearing per se; they provide
Sensory processing is a core feature of our humanity.
support for the load on the nervous system, making atten-
Understanding the nature of one’s sensory processing needs
tional resources available for hearing. Conversely, if I find the provides background knowledge for constructing daily life
place where my voice is quite irritating, do you want me to routines and contexts that are respectful of the nervous sys-
keep it up so you can adjust your frequency range, or do you tem’s need for some balance of excitation and inhibition. It
want me to tone down the screeching so you can pay atten- is possible that sensory processing mechanisms underlie the
tion? Your nervous system is unavailable for learning when it manifestations of one’s temperament and personality, and
is in a fight-or-flight mode. Knowing about your own sen- these relationships need to be tested. ▲
sory processing patterns provides you with a method for
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