Three-year-old Andy was quite a handful for his parents to manage.

He seemed to be constantly "on

the go," climbing on furniture. and counters. pulling things off shelves, and sometimes just running
around aimlessly. He did not seem to hear his parents when they told him to stop, and he became
very upset attempting to kick and bite, if either of them tried to restrain him. At first, his parents
thought that Andy might not hear them, but it was obvious that he heard other sounds. ln fact, he
became quite upset when he heard the vacuum cleaner responding by holding his ears and
screaming. The sound of a lawn mower provoked a similar reaction, and often one parent would
take him for a ride in the car while the other mowed the lawn.

Andy Ioved watching television and could repeat several commercials. including reciting the words
verbatim. But despite his ability to repeat what he had heard, he did not use language
spontaneously. Andy never asked for a snack or toy. lf he did not want to do something, he
screamed, but he never said "no." ln fact, he really did not interact with his parents much at all.

Another of Andy's favorite activities was going to the playground. He could swing for hours, and his
favorite ride was the merry-go-round. Noting his love ot spinning, his parents bought him a Sit 'N'
Spin, a toy on which he could sit and spin himself around in circles. This activity kept him busy and
“out of trouble" for at least part of the day.

Toys, in general, did not interest Andy. However, he did have a large collection of Matchbox cars
that his grandparents had bought for him. He kept them on a shelf in his room, periodically taking
them down and lining them up. He always lined them up in the same order, and he always placed
them back on the shelf in that order. once, when he came into the room after his mother had taken
the cars off and was dusting the shelf, he began to screm and hit, evidently distraught that the cars
had been moved. From then on, Andy's mother dusted the "car shelf" only when he was occupied in
another activity.

Mealtime was particularly difficult for Andy and his family. As an infant he had had no trouble
eating. However, he had resisted the transition to solid foods, and he was still very fussy about what
he ate. He did not like food that was either too hot or too cold. And he tolerated only smooth-
textured foods.

Getting Andy dressed and undressed also presented problems. He did not like being touched or
handled and tried to pull away from his parents as they attempted to dress him. Clothes had to be
washed several times before he would tolerate wearing them.

At their wits end. Andy's parents turned to their pediatrician for help. He, in turn, referred Andy to a
child neurologist and to his local school system for an evaluation and a program that might help
Andy.

The members of Andy's evaluation team found him difficult to assess with standardized tests. They
relied heavily on their own observations as well as on those of Andy's parents. They felt that Andy's
outstanding problems were his total lack of use of language for communication with others, as well
as his limited social interactions with his parents and others. In contrast, Andy's gross motor and
visuomotor skills seemed age-appropriate.

Mike, the occupational therapist on Andy’s evaluation team, noted many indicators of tactile
defensiveness, including his resistance to being handled, and his food and clothing preferences. His
overreaction to noises and his craving of movement also suggested to Mike that Andy had difficulty
modulating sensory inputs.