When my youngest was very little, she would scream when she rode in the car seat. We had her evaluated by occupational therapy, as most of her older siblings had sensory processing dysfunction in some way or another, and they found she still had an intact moro reflex, along with a few other fetal reflexes that had never matured. She also had slight #vestibular and #proprioception dysfunction, although quite mild. For her, this presents with her looking behind her when she runs. Her car seat ride was largely fixed by adding a foot rest under her car seat, so her feet didn't dangle. It seems so simple, but sensory processing dysfunction is intricate and gravitational insecurity is lesser known, so often missed.
Children with sensory processing challenges can demonstrate what seems like an irrational fear of movement, a gravitational insecurity (May-Benson, et al., 2020). This is part of a vestibular dysfunction, the part of our brains that give us equilibrium. About 15-21% of little ones with sensory processing disorder have gravitational insecurity. This is an important part of the assessment when being evaluated for sensory integration disorder, and it can be treated and greatly improved with therapy. Medications can also provide support.
Movement-based problems such as dizziness, #vertigo, and balance difficulties are among the most common reasons individuals seek consultation with neurologists and otolaryngoligists (May-Benson, et al., 2020). These issues can create such disruption in one's life that they can suffer life-long disabilities. These symptoms, reported to specialists and diagnosed as movement disorders, are the same symptoms evaluated by occupational and physical therapists when working with children with sensory processing disorder.
When sensory processing and integration problems include difficulties with tactile, visual, and proprioceptive sensations, deficits in processing movement-related sensations are especially common (May-Benson, et al., 2020). Occupational therapy aligns these issues with vestibular discrimination, sometimes referring this to hypo-responsitivity or over-responsitivity, or some combination of visual-vestibular-proprioceptive integration deficit. Therapists much more familiar with sensory dysfunction further identify movement-related, over-responsive dysfunction as gravitational insecurity, which is characterized by #anxiety and exaggerated fear of movement experiences.
While there are a few different causes of sensory integration dysfunction, whether peripheral vestibular deficits, central vestibular processing, or cerebellar dysfunction, gravitational insecurity is thought to be a central nervous system problem (May-Benson, et al., 2020). This was first described in 2005, by Ayres, as a "primal threat in the pull of gravity" and she hypothesized the #limbic system, which controls emotions, motivation, memory, and behavior, played a role in these fears.
What Might This Look Like in My Child?
Like so many things on the neurodiversity spectrum (which is not to say that sensory integration is part of this spectrum, but it is quite often related), these symptoms present in a rather unique way. Some simply identify they have dizziness or vertigo, or balance issues. Some may be mindful that they are fearful or anxious when they move in specific ways, and others don't quite recognize initially, but ultimately discover they are experiencing intense anxiety, discomfort or fear with common activities such as lying down or when bending over, when leaning or tipping their head backwards such as when they wash their hair, or when performing somersaults, stepping over objects, walking on bumpy ground, climbing stairs or up on chairs, jumping, falling, or riding in cars.
In children, these problems interfere with participation in daily life activities such as when they need to go down the stairs, or when they are hoping to play on the playground, engage in sports, roughhouse with friends or family, or when navigating on their bikes or skates outside (May-Benson et al., 2020). As a parent, when our little ones react to scenarios in ways that just don't make sense, we might consider sensory perception as an underlying cause. Anger might also be their reaction. They may yell, "I don't want to do it! I hate this!"
Imagine having gravitational sensory integration, sitting on the toilet with your little feet dangling in space, and having to relax so you can "let things go." It's sometimes not possible, so they may have accidents which are frustrating to both of you. If your little one responds with fear or distress whenever they are in new positions or when someone else tries to control their movement or position, again, this may be related to gravitational sensory integration.
How Might This be Diagnosed?
This is really the wheelhouse of the informed occupational therapist, but not all are educated in these specialty areas. A Gravitational Insecurity Assessment was developed in 2007, by May-Benson and Koomar. It does demonstrate good reliability and discriminative validity. Interestingly, these symptoms seem most significant in the preschool age child, less so as they grow towards ten years. Symptoms in adults with sensory integration disorders are found in about 15% and 12% among those with anxiety. This may look like inability to drive a car or a dysfunction in motor coordination, vestibular functioning, or visual spatial skills. It may also look like significant fears and phobias, even fear of heights, elevators, crowds, amusement park rides, escalators, and planes (May-Benson & Koomar, 2007).
If your little one is not climbing on playground equipment, not exploring new spaces, refusing to go on elevated surfaces and dislikes being tipped backwards on a large therapy ball, these are all indications that evaluation may be appropriate (May-Benson et al., 2020). About half of those with gravitational insecurity will also have unsteady balance, walk slowly or with their feet far apart, or they may be dizzy or report vertigo, and they dislike lying flat on their backs.
This is not outside the scope of your primary care provider's scope to diagnose, and treat, but unless they are well familiar with #neurodiversity, they may not be familiar sensory integration disorder and then certainly not familiar with gravitational insecurity. Even psychologists are not overwhelmingly familiar, and often times will treat for anxiety or phobias without recognizing the underlying vestibular dysfunction. Occupational therapists who specialize in autism are those most likely to be informed, and they can provide therapy that is effective at helping children adjust, but they are not able to prescribe if support is required otherwise. Potentially they could work with your primary care provider to coordinate a plan of care. The diagnosis has long been a subjective evaluation, but an objective 15 item assessment is available for clinicians but this can take 30-40 to evaluate. Not part of the literature, but weighted blankets are super helpful among those with neurodiversity, even when they don't like touch, and I suspect it may be because they help to ground them. You might give this a try, even in the car seat.
One of the Most Basic of All Human Relationships is Our Relationship to the Gravitational Field on the Earth
This relationship is even more primal than the mother-child relationship. Our vestibular system gives us a sort of "gravitational security" - the trust that we are firmly connected to the earth and will always have a safe place to stand. Children spend much of their time developing this relationship. Infants, for example, lift their heads and find out that gravity makes it heavy. Each movement teaches them more and more about gravity. They learn to adapt to #gravity, and how it imposes on every single thing on this planet. This relationship is so central to who we are that we don't think about it or recognize its significance.
Experts in the field however, describe a vital relationship between gravitational security and emotional health that gives us a strong inner drive to explore gravity and master it (Sankar & Prema, 2014). This inner drive is said to be so strong, that a child will intuitively do whatever is necessary to develop their vestibular system. Mothers use rocking to calm their distressed baby. Both young and old find a rocking chair and swinging reduces anxiety and emotional upset. Many children in therapy will rock or move repeatedly for long periods of time, indicating they have a great need for vestibular input. Unfortunately when something goes wrong in our neural functioning that relates to gravity, we never consider that's the actual issue. We look for some other cause, and quite often, too often, that's a pharmaceutical.
Children with vestibular disorder seem to be missing something, as though they were "lost in space." Sometimes they cannot follow their inner drive because they are so afraid of what might happen to them. This causes them to miss many of the sensorimotor experiences that are needed as building blocks for mature emotions and behavior (Sankar & Prema, 2014). This can result in poor development of a body scheme and an inability to resolve sensory conflict. As both a clinician, and momma with neurodiverse children who also have sensory disorders, I look back now and recognize that some of their crying early in their first year was in fact, related to gravitational dysfunction. My daughter was absolutely distraught in her car seat and my son could never be put down. I wish I had better understood back then. It's hard on a momma's heart when your little one is inconsolable.
References
May-Benson, T. A., de Mello Gentil, J. L., & Teasdale, A. (2020). Gravitational insecurity in children with sensory processing dysfunction. Research in Development Disabilities, 101. doi: 10.1016/j.ridd.2020.103640
May-Benson, T. A. & Koomar, J. A. (2007). Identifying gravitational insecurity in children: a pilot study. American Journal of Occupational Therapy, 61, 147-147.
Sankar, U. G. & Prema, A. (2014). Standardization of gravitational insecurity assessment among Indian children. International Journal of Scientific and Research Publications, 4(8).
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