Sensory processing

Vestibular vs Proprioceptive Processing: What's the Difference?

The two senses most people never name, balance and body position, and what they explain about everyday difficulty.

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Alongside the five senses most people can name, the body has two more that run constantly in the background. The vestibular system, in the inner ear, registers head rotation, movement and gravity; it is how you know you are upright without checking. Proprioception comes from receptors in muscles, joints and skin and tells you where your body is and how much force you are using, which is how you can touch your nose with your eyes closed.⁠^1,3 Both work below awareness, and differences in them can show up as emotional, behavioral, attentional or motor difficulty.⁠^1,4,5 A child who is always on the move, uses too much force, or is frightened of a swing may be telling you something about these two systems.⁠^6,7

Sources

1. Lane SJ, Mailloux Z, Schoen S, Bundy A, May-Benson TA, Parham LD, Smith Roley S, Schaaf RC. Neural foundations of Ayres Sensory Integration®. Brain Sciences. 2019;9(7):153. Published June 27, 2019. Checked October 10, 2026.
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   The vestibular system “contains two receptor types: the semicircular canals that detect angular movement of the head and the otolith organs (utricle and saccule) that detect linear movement, and the pull of gravity”; it “operates continuously and unconsciously in the background of everyday life”; vestibular information serves “arousal regulation, static and dynamic postural control, balance and equilibrium responses, bilateral coordination, maintenance of a stable visual field, and spatial perception”; “rapid or unpredictable acceleration of the body through space, such as occurs during a rollercoaster ride, is associated with increased alertness” while “Slow, rhythmic movement, such as rocking, produces the opposite effect: decreased arousal experienced as calming or drowsiness”; “Vestibular inputs carried via the vestibulospinal tracts selectively activate neck and trunk musculature for effective postural and head control,” refined through the cerebellum; vestibular connections to the eye muscles let a moving person perceive “the visual surround as perfectly stable”; “because the vestibular system is a bilateral system that affects muscle activation throughout the body, it contributes to bilateral motor coordination”; “both Ayres and Mailloux et al. found that decreased vestibular responses during her postrotary nystagmus test were associated with decreased bilateral integration, decreased extension against gravity (i.e., prone extension posture), poor equilibrium reactions and decreased coordination of eye and head movements. She termed this pattern ‘deficits in vestibular-bilateral integration’”; Ayres hypothesized that vestibular inefficiencies would affect “the arousal regulation capacities needed for self-regulation of emotions and behavior,” and cortical areas involved in “spatial memory” receive vestibular information; touch and proprioception “develop very early. A fetus responds to tactile input at 7–8 weeks and proprioception by 10–12 weeks”; “somatosensory–vestibular–visual integration occurs at multiple CNS levels,” foundational to “detection of self-motion, postural stability, and spatial orientation”; analyses of Ayres’ test data confirmed “a somatosensory-based dyspraxia and bilateral integration and sequencing dyspraxia”; Ayres “associated disproportional fear of movement with over-reactivity to vestibular input, naming this condition ‘gravitational insecurity’”; “at least one study indicates that vestibular processing challenges, previously unidentified in this population, may affect some children with this diagnosis” (attention deficit disorders); and some populations show “poor vestibular functions in children with cochlear implants.”
2. National Institute on Deafness and Other Communication Disorders. Balance Disorders. NIH Pub. No. 00-4374, December 2017; last updated March 6, 2018. Checked October 10, 2026.
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   “Within the labyrinth are structures known as semicircular canals. The semicircular canals contain three fluid-filled ducts, which form loops arranged roughly at right angles to one another. They tell your brain when your head rotates”; when you turn your head, fluid in the canals moves and bends the hair cells’ stereocilia, which “creates a nerve signal that is sent to your brain to tell it which way your head has turned”; the utricle and the saccule “tell your brain the position of your head with respect to gravity, such as whether you are sitting up, leaning back, or lying down, as well as any direction your head might be moving, such as side to side, up or down, forward or backward,” using “tiny, dense grains of calcium carbonate called otoconia” that gravity pulls on; these organs “work with other sensory systems in your body, such as your vision and your musculoskeletal sensory system, to control the position of your body at rest or in motion,” which “also helps you keep a stable visual focus on objects when your body changes position”; “Your sense of balance relies on a series of signals to your brain from several organs and structures in your body, specifically your eyes, ears, and the muscles and touch sensors in your legs”; symptoms include “Dizziness or vertigo (a spinning sensation),” “Falling or feeling as if you are going to fall,” “Staggering when you try to walk,” “Lightheadedness, faintness, or a floating sensation,” “Blurred vision” and “Confusion or disorientation”; “Causes of balance problems include medications, ear infection, a head injury, or anything else that affects the inner ear or brain”; “your primary doctor may suggest that you see an otolaryngologist and an audiologist,” and testing may include “a video nystagmogram (a test that measures eye movements and the muscles that control them),” posturography and “rotational chair testing”; “A vestibular rehabilitation therapist can help you develop an individualized treatment plan”; and if the answer is yes to questions such as “Do I feel unsteady?” or “Do I feel as if I’m moving when I know I’m sitting or standing still?”, “talk to your doctor.”
3. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiological Reviews. 2012;92(4):1651–1697. PMID 23073629. Checked October 10, 2026.
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   The abstract: the proprioceptive senses “include the senses of position and movement of our limbs and trunk, the sense of effort, the sense of force, and the sense of heaviness. Receptors involved in proprioception are located in skin, muscles, and joints. Information about limb position and movement is not generated by individual receptors, but by populations of afferents”; “The afferent input is referred to a central body map to determine the location of the limbs in space”; and “tendon organs and possibly also muscle spindles contribute to the senses of force and heaviness.”
4. STAR Institute for Sensory Processing. Your 8 Senses. Undated web page. Checked October 10, 2026.
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   The eight systems include “Proprioceptive (sensations from muscles and joints of body)” and the vestibular system, which “contributes to balance and orientation in space” and “has two related components: the semicircular canal system, (related to detecting rotation) and the otoliths, (related to detecting linear acceleration/deceleration)”; “the horizontal canal ... detects rotation around a vertical axis (as when you do spins in ice skating)”; the proprioceptive system “senses the position, location, orientation, and movement of the body muscles and joints. Proprioception provides us with the sense of the relative position of neighboring parts of the body and effort used to move body parts”; “Generally speaking we do not notice out proprioceptive sense because we disregard through habituation, desensitization, or adaptation sensory stimuli that is continuously present”; “Temporary proprioceptive impairment is reported during times of quick growth, mostly during adolescence”; and interoception “detects responses that guide regulation, including hunger, heart rate, respiration and elimination.”
5. STAR Institute for Sensory Processing. Patterns or Subtypes of Differences in Sensory Integration & Processing. Undated web page. Checked October 10, 2026.
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   Differences “can affect multiple sensory systems, including visual, auditory, tactile, olfactory, gustatory, vestibular, proprioceptive, and interoceptive modalities” and “can also lead to emotional, behavioral, social, attentional, or motor challenges”; people with over-responsivity “often have a ‘fight or flight’ response to sensation” and “may try to avoid or minimize sensations”; people who are under-responsive “require more intensity and repetition of sensation than others. They may appear quiet and passive, oblivious or not responding to stimuli of the usual intensity,” and “Their under-responsivity to tactile and deep pressure input may lead to poor body awareness, clumsiness or movements that are not graded appropriately”; vestibular discrimination is “Related to interpreting details/qualia experienced through movement of the body through space or against gravity,” proprioceptive discrimination “Related to determining/interpreting details/qualia experienced through use of the muscles and joints”; and “An individual with postural disorder has difficulty stabilizing his/her body during movement or at rest.”
6. STAR Institute for Sensory Processing. Symptoms Checklist. Undated web page. Checked October 10, 2026.
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   The infant/toddler list includes “My infant/toddler has a ‘floppy’ body, bumps into things and has poor balance,” “My infant/toddler is extremely active and is constantly moving body/limbs or runs endlessly” and “My infant/toddler seems to be delayed in crawling, standing, walking or running”; the preschool list “My child seems unsure how to move his/her body in space, is clumsy and awkward,” “My child has difficulty learning new motor tasks,” “My child is in constant motion,” “My child has difficulty making friends (touches too much or uses too much force or is passive/ withdrawn)” and “My child seems weak, slumps when sitting/standing; prefers sedentary activities”; the school-age list “My child has difficulty performing or avoids fine motor tasks such as handwriting,” “My child appears clumsy and stumbles often, slouches in chair,” “My child craves rough housing, tackling/wrestling games” and “My child is in constant motion”; the adolescent/adult list “I use an inappropriate amount of force when handling objects,” “I often bump into things or develop bruises that I cannot recall” and “I need physical activities to help me maintain my focus throughout the day”; and “While this checklist cannot diagnose Sensory Processing Disorder, it can be a helpful guide to see if additional testing should be done.”
7. Potegal M, May-Benson TA, Oxborough S, Hall A, McKnight S. Reduced gain and shortened time constant of vestibular velocity storage as a source of balance and movement sensitivities in gravitational insecurity. Occupational Therapy International. 2022;2022:5240907. PMID 35600904; full text on PubMed Central (PMC9106494). Checked October 10, 2026.
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   Most of what is known about gravitational insecurity “comes from its presentation in childhood as a reluctance to move the head out of an upright orientation (e.g., to lay back or somersault), sensitivity to motion (e.g., turning corners in cars), and fear of losing balance (e.g., on uneven or yielding surfaces or playground equipment). These children often refuse to climb, swing, skate, or bike and may be teased about their clumsiness and/or nonparticipation in sports”; “Childhood GrI can continue into adulthood,” with “2% of a normative sample of 1,392 adolescent and adults” reporting “avoiding head positions out of the upright when driving or hair-washing, great fear of falling on slippery, moving or unstable surfaces and climbing chairs/ladders, and a compelling need to ‘keep their feet on the ground,’” and “An additional 17% presented with mild GrI”; “fine and gross motor difficulties and anxiety are the three most commonly associated problems reported by pediatric OTs”; neuroscience recognizes “a reciprocal association between anxiety and imbalance”; and from the abstract, in adults with mild gravitational insecurity “Rotation testing revealed ... significantly less low frequency gain and shortened VVS persistence” and the screening index “correlated with problematic spatial orientation, but surprisingly, not to anxiety.”
8. May-Benson TA, Lopes de Mello Gentil J, Teasdale A. Characteristics and prevalence of gravitational insecurity in children with sensory processing dysfunction. Research in Developmental Disabilities. 2020;101:103640. PMID 32247101. Checked October 10, 2026.
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   The abstract: “Children with sensory processing challenges often demonstrate a specific vestibular dysfunction characterized by an irrational fear of movement experiences referred to as gravitational insecurity”; in “689 children, aged 4-12 years, with Sensory Processing Disorder (SPD) and related parent-reported co-morbid diagnoses,” “The number and patterns of gravitational insecurity symptoms were not significantly different across age, gender or comorbid diagnoses. Prevalence of symptoms of gravitational insecurity in a clinical population of children with SPD was 15 - 21%”; and “Gravitational insecurity is an important vestibular-based dysfunction to identify and treat in children with SPD.”
9. Holst-Wolf JM, Yeh I-L, Konczak J. Development of proprioceptive acuity in typically developing children: normative data on forearm position sense. Frontiers in Human Neuroscience. 2016;10:436. Published August 28, 2016. Checked October 10, 2026.
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   “Proprioception refers to the sense of relative position and movement of the limbs and body. Proprioceptive information is provided through mechanoreceptors embedded in the joints, muscles, tendons and skin. It has long been recognized that intact proprioception is essential for the control of muscle tone and voluntary movement”; “kinesthetic sensitivity and acuity improves in middle childhood and continues to approach adult levels during late adolescence”; “Clinical rating scales are coarse and lack sufficient sensitivity, which allow only for detection of severe deficits in proprioception”; the study tested “308 children (5–17 years old)” and 26 adults with vision occluded, and response variability “significantly decreased with age (Median SDPdiff at 90° target: 9.66° in early childhood; 5.30° in late adolescence; and 3.97° in adults),” so that “proprioceptive development in typically developing children is characterized as an age-related improvement in precision.”
10. Božanić Urbančič N, Battelino S, Vozel D. Appropriate vestibular stimulation in children and adolescents: a prerequisite for normal cognitive, motor development and bodily homeostasis. A review. Children. 2024;11(1):2. Published December 18, 2023. Checked October 10, 2026.
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    “The structural development of the vestibular part of the inner ear is completed by birth but its central connections continue to develop until adolescence. Their development is dependent on vestibular stimulation,” which the authors also call vestibular experience, and vestibular function “also influences cognition, emotion, the autonomous nervous system and hormones”; “Vestibular receptors become active by the 32nd week of gestation”; “The vestibulo-ocular reflex (VOR) is present at birth” and “an absence of the VOR at ten months of age is considered abnormal”; “the vestibular function continues to mature from birth onwards and reaches adult-like values at age fifteen” and “It still takes about 18 years to establish the adult capacity to modulate the temporal and quantitative parameters of postural adjustments”; with suppressed vestibular stimulation, “various difficulties can appear, such as delayed acquisition of motor skills, problems with cognition, reading ... altered spatial representations”; the vestibular nuclei are where information merges, including “head, body and eye motor information, proprioceptive information and visual information”; “The brain builds representations of verticality based on vestibular, somatosensory, proprioceptive and visual information”; some authors screen with the Romberg test, “the ability to maintain erect posture with the eyes closed”; “vestibular dysfunction can not only induce or cause a worsening of anxiety, depression and other affective disorders, but there is evidence that affective conditions may also influence the central vestibular systems”; beneficial activities “include playing on playground equipment, on swings that allow linear and rotary swinging, sliding on slides ... dance or movement activities, skating, swimming”; and the authors urge “vestibular system stimulation through free play instead of prolonged exposure to screen time.”
11. Wiener-Vacher SR, Campi M, Caldani S, Thai-Van H. Vestibular impairment and postural development in children with bilateral profound hearing loss. JAMA Network Open. 2024;7(5):e2412846. PMID 38780940. Checked October 10, 2026.
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    The abstract: a cohort of “592 children” with profound hearing loss assessed before cochlear implantation at a Paris referral center; “Vestibular impairment was found in 44.4% (263 of 592) of the children”; “The odds of having delays in 4 developmental milestones (head holding, sitting, standing with support, and independent walking) were higher in both PVF and CBVL” (partial and complete vestibular loss); and “Children with profound HL may benefit from complete vestibular assessment before cochlear implantation, which would support early and adapted management, such as physical therapy for CBVL and cochlear implantation strategy.”
12. Acuña C, Gallegos-Berrios S, Barfoot J, Meredith P, Hill J. Ayres Sensory Integration® with children ages 0 to 12: a systematic review of randomized controlled trials. American Journal of Occupational Therapy. 2025;79(3):7903205180. PMID 40193295. Checked October 10, 2026.
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    The abstract: RCTs were included if they “compared implementation of ASI with its Fidelity Measure™ with children ages 0 to 12 yr”; “Nine RCTs (N = 344 participants), six with autistic children and three with other child populations, were included”; “Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals. Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability”; and ASI “is not recommended to address behaviors of concern, such as resistance to change or irritability.”
13. Piller A, McHugh Conlin J, Glennon TJ, Andelin L, Auld-Wright K, Teng K, Tarver T. Systematic review of sensory-based interventions for children and youth (2015–2024). Frontiers in Pediatrics. 2025;13:1720179. Published November 12, 2025. Checked October 10, 2026.
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    “Twenty-one studies were included. Strong strength of evidence supported use of deep pressure tactile input and caregiver training on the use of sensory strategies. Moderate strength of evidence supported that alternative seating did not improve attention. Additionally moderate strength of evidence supported targeting a variety of sensory systems is more effective than targeting only one system. There is a lack of evidence on the impact of sensory environmental modifications”; “The aim of SBIs is to temporarily modify a child’s physiological arousal level, creating a better match between the person and task”; sensory-based interventions differ from “direct, one-on-one occupational therapy intervention using Ayres Sensory Integration® intervention,” whose key features include “advanced therapist training and mentorship and adherence to fidelity principles, including active engagement of the child, individually tailored activities, and play opportunities presented at the just-right challenge,” whereas sensory-based interventions “tend to be practitioner or adult-led interventions, involving passive sensory input applied to the child,” such as “passive swinging”; the four deep pressure studies examined “weighted items” and “massage,” and “Deep-pressure tactile stimulation has modulating effects on the nervous system via decreasing sympathetic arousal”; the review’s other studies covered alternative seating, sensory input to multiple systems “(i.e., vestibular, proprioception, tactile, visual, etc.),” single-system techniques (a vibrating treadmill, fidget spinners, earmuffs and headphones), caregiver training and one sensory-adapted dental office; “A third Level II (38) SSD study using sensory diets as part of the regular school day showed three of four participants improving behavior”; stability balls at school brought “no significant improvements in productivity or seatwork,” cube chairs or T-stools no “significant improvements in attention,” and stability balls at home “no statistically significant improvements on attention or behavior”; an earlier review found that “Linear vestibular movement demonstrated improvement in responding to questions, though the sample size was small”; and “Occupational therapists are widely recognized as leaders in the evaluation and treatment of SI/SP challenges.”
14. Centers for Disease Control and Prevention. Concerned About Your Child’s Development? Page dated February 17, 2026. Checked October 10, 2026.
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    “call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services ... You do not need to wait for a doctor’s referral or a medical diagnosis to make this call”; “If your child is younger than 3 years old, contact your local early intervention system”; and “If your child is age 3 or older, call any local public elementary school (even if your child does not go to school there)” and ask for an evaluation.
15. May-Benson TA, Koomar JA. Identifying gravitational insecurity in children: a pilot study. American Journal of Occupational Therapy. 2007;61(2):142–147. PMID 17436835. Checked October 10, 2026.
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    The abstract: “The GI Assessment consisted of 15 activities that created conditions characterized as fear-inducing for children with gravitational insecurity. Three behavioral categories” (avoidance, emotional and postural responses) “were scored for each activity. Participants were 18 children with gravitational insecurity, ages 5-10 years, and a matched group of children who were typically developing”; “Discriminant analysis classified 83% of the gravitationally insecure group and 100% of the typical group”; and “The GI Assessment is a promising clinical tool for objectively identifying children with gravitational insecurity.”
16. Centers for Disease Control and Prevention. Signs and Symptoms of Autism Spectrum Disorder. Page updated May 16, 2024. Checked October 10, 2026.
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    Examples of restricted or repetitive behaviors and interests related to autism include “Flaps hands, rocks body, or spins self in circles” and “Has unusual reactions to the way things sound, smell, taste, look, or feel”; and “It is important to note that children with ASD may not have all or any of the behaviors listed as examples here.”
17. STAR Institute for Sensory Processing. About SPD. Undated web page. Checked October 10, 2026.
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    “In children whose sensory processing of messages from the muscles and joints is impaired, posture and motor skills can be affected. These children have postural disorder and are the ‘floppy’ children who prop themselves up on walls when standing, lean over on their hand when writing and love to hang out, but not to move”; and “other children exhibit an appetite for sensation that is in perpetual overdrive, we call these children sensory cravers. They seem almost addicted to intense stimulation but when they get [it] they become dysregulated.”
18. American Academy of Pediatrics, Section on Complementary and Integrative Medicine and Council on Children with Disabilities; Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129(6):1186–1189. PMID 22641765. Checked October 10, 2026.
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    The abstract of the policy statement: “Sensory-based therapies involve activities that are believed to organize the sensory system by providing vestibular, proprioceptive, auditory, and tactile inputs. Brushes, swings, balls, and other specially designed therapeutic or recreational equipment are used to provide these inputs”; “Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed. Other developmental and behavioral disorders must always be considered, and a thorough evaluation should be completed”; difficulty processing sensory information “may be seen in many developmental behavioral disorders, including autism spectrum disorders, attention-deficit/hyperactivity disorder, developmental coordination disorders, and childhood anxiety disorders”; “parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive”; and clinicians may talk with families “about a trial period of sensory integration therapy, and teaching families how to evaluate the effectiveness of a therapy.”
19. Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Autism Spectrum Disorder. Page reviewed May 8, 2025. Checked October 10, 2026.
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    “To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction ... plus at least two of four types of restricted, repetitive behaviors”; the fourth type is “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).”
20. World Health Organization. ICD-11 for Mortality and Morbidity Statistics: 6A02 Autism spectrum disorder. Version 2025-01, with the clinical descriptions and diagnostic requirements. Checked October 10, 2026.
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    Essential features include “Repetitive and stereotyped motor movements, such as whole body movements (e.g., rocking), atypical gait (e.g., walking on tiptoes), unusual hand or finger movements and posturing” and “Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus”; and on the boundary with developmental motor coordination disorder, autistic individuals “may be reluctant to participate in tasks requiring complex motor coordination skills, such as ball sports, which is better accounted for by a lack of interest rather than any specific deficits in motor coordination. However, Developmental Motor Coordination Disorder and Autism Spectrum Disorder can co-occur.”
21. Centers for Disease Control and Prevention. Milestones by 18 Months. Page dated May 15, 2026. “Developmental milestones are things most children (75% or more) can do by a certain age”; movement milestones include “Walks without holding on to anyone or anything” and “Climbs on and off a couch or chair without help.” Checked October 10, 2026.
22. Centers for Disease Control and Prevention. Milestones by 1 Year. Page dated May 15, 2026. Movement milestones include “Pulls up to stand” and “Walks, holding on to furniture.” Checked October 10, 2026.
23. Centers for Disease Control and Prevention. Milestones by 2 Years. Page dated May 15, 2026. Movement milestones include “Kicks a ball,” “Runs” and “Walks (not climbs) up a few stairs with or without help.” Checked October 10, 2026.
24. Centers for Disease Control and Prevention. Milestones by 30 Months. Page dated May 15, 2026. Movement milestones include “Jumps off the ground with both feet.” Checked October 10, 2026.
25. Centers for Disease Control and Prevention. Milestones by 4 Years. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones include “Catches a large ball most of the time”; and “If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child’s doctor, share your concerns, and ask about developmental screening.”
26. Centers for Disease Control and Prevention. Milestones by 5 Years. Page dated May 15, 2026. Movement milestones include “Hops on one foot.” Checked October 10, 2026.
27. Dunn W. The sensations of everyday life: empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy. 2001;55(6):608–620. PMID 12959225. Checked October 10, 2026.
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    The abstract: using Sensory Profile questionnaires, “persons birth to 90 years of age demonstrate four sensory processing patterns: sensory seeking, sensory avoiding, sensory sensitivity, and low registration,” and “each person has some level of responsiveness within each sensory processing preference (i.e., a certain amount of seeking, avoiding, etc., not one or the other).”
28. Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders. 2009;39(1):1–11. PMID 18512135. Checked October 10, 2026.
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    The abstract: “Results from 14 studies indicated a significant high difference between ASD and typical groups in the presence/frequency of sensory symptoms, with the greatest difference in under-responsivity, followed by over-responsivity and sensation seeking.”
29. Blanche EI, Reinoso G, Chang MC, Bodison S. Proprioceptive processing difficulties among children with autism spectrum disorders and developmental disabilities. American Journal of Occupational Therapy. 2012;66(5):621–624. PMID 22917129. Checked October 10, 2026.
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    The abstract: the Comprehensive Observations of Proprioception was used with “32 children with ASD, 26 children with developmental disabilities excluding ASD, and 28 typically developing control children”; “Children with ASD present with proprioceptive processing difficulties that are different from those of children with developmental disabilities and their typically developing counterparts.”
30. American Occupational Therapy Association. Practice Smart! Undated web page; the recommendations were published from 2018 to 2021 under the Choosing Wisely campaign. Checked October 10, 2026.
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    “1. Don’t provide intervention activities that are non-purposeful”; “2. Don’t provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information”; “6. Don’t initiate occupational therapy interventions without completion of the client’s occupational profile and setting collaborative goals”; and “7. Don’t provide interventions for autistic persons to reduce or eliminate ‘restricted and repetitive patterns of behavior, activities, or interests’ without evaluating and understanding the meaning of the behavior to the person, as well as personal and environmental factors.”
31. Centers for Disease Control and Prevention. Diagnosing ADHD. Page dated July 30, 2026. Checked October 10, 2026.
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    “There is no single test to diagnose ADHD, and many other problems, such as sleep disorders, anxiety, depression, and certain types of learning disabilities, can also have symptoms similar to ADHD”; “One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD”; and “The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician.”
32. Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, Schaaf RC. A systematic review of Ayres Sensory Integration intervention for children with autism. Autism Research. 2019;12(1):6–19. PMID 30548827. Checked October 10, 2026.
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    The abstract: using the Council for Exceptional Children standards, “Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items”; “Based on CEC criteria, ASI can be considered an evidence-based practice for children with autism ages 4-12 years old”; and the intervention “has specific requirements for therapist qualifications and the process of therapy.”
33. Rine RM, Braswell J, Fisher D, Joyce K, Kalar K, Shaffer M. Improvement of motor development and postural control following intervention in children with sensorineural hearing loss and vestibular impairment. International Journal of Pediatric Otorhinolaryngology. 2004;68(9):1141–1148. PMID 15302144. Checked October 10, 2026.
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    The abstract: “Twenty-one children with sensorineural hearing loss and vestibular impairment were randomly assigned to two groups (exercise and placebo)”; “Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. Placebo intervention focused on language development activities,” three times weekly for 12 weeks; “Post-intervention, motor development scores significantly improved in the exercise, not the placebo group”; and “Exercise intervention focused on the enhancement of sensory integrative postural control abilities is effective for the arrest of the progressive motor development delay in children with sensorineural hearing loss and vestibular impairment.”
34. Bodison SC, Parham LD. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: a systematic review. American Journal of Occupational Therapy. 2018;72(1):7201190040. PMID 29280714. Checked October 10, 2026.
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    The abstract: eight studies, including “Qigong massage, weighted vests, slow swinging, and incorporation of multisensory activities into preschool routines”; “Strong evidence supported Qigong massage, moderate evidence supported sensory modifications to the dental care environment, and limited evidence supported weighted vests. The evidence is insufficient to draw conclusions regarding slow linear swinging and incorporation of multisensory activities into preschool settings.”
35. Stephenson J, Carter M. The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism and Developmental Disorders. 2009;39(1):105–114. PMID 18592366. Checked October 10, 2026.
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    The abstract: “Seven studies examining weighted vests are reviewed. While there is only a limited body of research and a number of methodological weaknesses, on balance, indications are that weighted vests are ineffective ... weighted vests cannot be recommended for clinical application at this point.”
36. Gringras P, Green D, Wright B, et al. Weighted blankets and sleep in autistic children: a randomized controlled trial. Pediatrics. 2014;134(2):298–306. PMID 25022743. Checked October 10, 2026.
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    The abstract: participants were “aged between 5 years and 16 years 10 months, with a confirmed ASD diagnosis and severe sleep problems”; “Seventy-three children were randomized and analysis conducted on 67 children who completed the study”; there were “no group differences in any other objective or subjective measure of sleep, including behavioral outcomes”; and “The use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often. However, the weighted blanket was favored by children and parents.”
37. Lönn M, Svedberg P, Nygren J, Jarbin H, Aili K, Larsson I. The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder: a randomized controlled crossover trial. Journal of Sleep Research. 2024;33(2):e13990. PMID 37452697. Checked October 10, 2026.
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    The abstract: “The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years)”; “Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen’s d = 0.24), sleep efficiency (mean diff. 0.82% ...) and wake after sleep onset (mean diff. -2.79 min ...), but not on sleep-onset latency.”
38. American Academy of Pediatrics, HealthyChildren.org. Baby Products to Avoid: Unsafe Registry Picks & Secondhand Gear. Last updated May 29, 2026. Under “What about weighted sleep blankets?”: “Weighted blankets can make it harder for your baby to breathe. Your baby can also get trapped underneath a heavy blanket and suffocate.” Checked October 10, 2026.
39. Centers for Disease Control and Prevention. Child Activity: An Overview. Page dated December 4, 2025. Checked October 10, 2026.
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    “Children 3 to 5 need to be active throughout the day”; “Children and adolescents 6 to 17 need to be active for at least 60 minutes every day,” including “Muscle-strengthening: Includes activities like climbing or doing push-ups, at least 3 days a week” and “Bone-strengthening: Includes activities such as jumping or running, at least 3 days a week.”
40. Mahar MT, Murphy SK, Rowe DA, Golden J, Shields AT, Raedeke TD. Effects of a classroom-based program on physical activity and on-task behavior. Medicine & Science in Sports & Exercise. 2006;38(12):2086–2094. PMID 17146314. Checked October 10, 2026.
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    The abstract: on-task behavior of third and fourth graders was observed “before and after Energizers activities”; “The improvement in on-task behavior of 8% between the pre-Energizers and post-Energizers observations was statistically significant”; and “the least on-task students improved on-task behavior by 20% after Energizers activities.”
41. Murray R, Ramstetter C; Council on School Health, American Academy of Pediatrics. The crucial role of recess in school. Pediatrics. 2013;131(1):183–188. PMID 23277311. Checked October 10, 2026.
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    The abstract: “Recess serves as a necessary break from the rigors of concentrated, academic challenges in the classroom”; “The American Academy of Pediatrics believes that recess is a crucial and necessary component of a child’s development and, as such, it should not be withheld for punitive or academic reasons.”
42. U.S. Department of Education. 34 CFR 303.303, Referral procedures, and 34 CFR 303.521, System of payments and fees. Electronic Code of Federal Regulations, up to date as of October 8, 2026. Checked October 10, 2026.
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    Primary referral sources under §303.303(c) include “Parents, including parents of infants and toddlers”; under §303.521(b), “The following are required functions that must be carried out at public expense, and for which no fees may be charged to parents,” including “Evaluation and assessment.”
43. Pearson Assessments. Sensory Profile 2. Checked October 10, 2026.
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    Product page for the questionnaires by Winnie Dunn. “The Sensory Profile™ 2 family of assessments provides standardized tools to help evaluate a child’s sensory processing patterns in the context of home, school, and community-based activities”; “Completion time: 5–20 minutes”; and “caregivers and teachers report on the child’s response to sensory events throughout the day.”
44. Mailloux Z, Parham LD, Smith Roley S, Ruzzano L, Schaaf RC. Introduction to the Evaluation in Ayres Sensory Integration® (EASI). American Journal of Occupational Therapy. 2018;72(1):7201195030. PMID 29280717. Checked October 10, 2026.
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    The abstract: “To meet the need for a set of tests that will fully evaluate the constructs of ASI with psychometrically strong, internationally appropriate, and easily accessible measurement tools, the development of the Evaluation in Ayres Sensory Integration® (EASI) has been initiated,” with “promising preliminary analyses of discriminative validity data.”
45. Li CM, Hoffman HJ, Ward BK, Cohen HS, Rine RM. Epidemiology of dizziness and balance problems in children in the United States: a population-based study. Journal of Pediatrics. 2016;171:240–247. PMID 26826885. Checked October 10, 2026.
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    The abstract: a nationally representative sample of “children (n = 10,954; aged 3-17 years)” from the 2012 National Health Interview Survey, whose parents were asked about dizziness and balance symptoms in the past year; “Prevalence of dizziness and balance problems was 5.3% (3.3 million US children)”; “Prevalence increased with age, from 4.1% for children aged 3-5 years to 7.5% for children aged 15-17 years”; and “Overall, 36.0% of children with dizziness and balance problems were seen by healthcare professionals during the past year.”
46. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Re M. Prevalence and diagnosis of vestibular disorders in children: a review. International Journal of Pediatric Otorhinolaryngology. 2014;78(5):718–724. PMID 24612555. Checked October 10, 2026.
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    The abstract: ten articles covering 724 subjects “indicated benign paroxysmal vertigo of childhood (18.7%) and migraine-associated vertigo (17.6%) as the two main entities connected with vertigo and dizziness in children. Head trauma (14%) was the third most common cause of vertigo”; and “in children, these symptoms are often connected to different pathologies in comparison to the entities observed in the adult population.”
47. Kimura Y, Kaga K. Comparison of vestibular ocular reflex and gross motor development in children with semicircular canal aplasia and hypoplasia. International Journal of Pediatric Otorhinolaryngology. 2022;162:111303. PMID 36137473. Checked October 10, 2026.
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    The abstract: a case series of “eight children with bilateral complete aplasia of semicircular canals and seven children with bilateral hypoplasia”; “All eight children with semicircular canal aplasia were diagnosed as having CHARGE syndrome”; “The mean age of acquisition of head control was 9.1 ± 6.3 months and that of independent walking was 31 ± 8.1 months in children with semicircular canal aplasia,” against “6.0 ± 2.8 months” and “19.9 ± 4.9 months” with hypoplasia; and the authors suggest that “the combination of visual impairment and mental retardation may delay the development of central-level integrated functions and may further delay motor development.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.