Carly: Understanding Sensory Processing Differences in Toddlers Through Real-World Observation and Evidence-Based Support

Carly at 28 Months: A Case Profile Grounded in Developmental Science

Carly is a 28-month-old bilingual toddler (English and Spanish) enrolled in a licensed early childhood program in Portland, Oregon. Over six weeks of structured observation across home, childcare, and community settings, educators and a certified occupational therapist documented consistent patterns of sensory reactivity, motor planning challenges, and adaptive behavior fluctuations tied to environmental input—not temperament or willful defiance. Her profile aligns with Level 2 sensory processing differences per the Sensory Processing Measure–Preschool (SPM-P) (Parham et al., 2019), scoring 3.8 standard deviations above the mean on the Under-Responsive/Seeks Sensation scale and 2.9 SD above on Auditory Processing. This article details how her team translated those metrics into daily supports—without labels, without exclusion, and with fidelity to developmental norms from the CDC’s Milestones Matter tracker and Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4).

Observational Data: What the Numbers Reveal

From March 12 to April 26, 2024, Carly’s team collected 42 hours of time-sampled data using the Early Childhood Environment Rating Scale–Revised (ECERS-R) and the Functional Behavioral Assessment (FBA) Quick Guide (Center for Positive Behavioral Interventions and Supports, 2022). Key quantitative findings include:

• Average latency to transition between activities: 47 seconds (vs. typical 8–12 sec for 24–36 month-olds per ASQ:SE-2 norms)
• Frequency of auditory-related distress (covering ears, vocal protest, fleeing): 11.3 episodes per 2-hour block, concentrated during group song time (Handwriting Without Tears Music & Movement CD, volume measured at 78 dB with a Sound Level Meter app calibrated to ANSI S1.4)
• Duration of self-regulated seated engagement with tactile materials (e.g., kinetic sand, playdough): 22 minutes—5.3× longer than her average attention span for visual tasks (4.2 min)
• Postural control: 72% success rate on unsupported squat-to-stand (vs. 94% benchmark for age per Peabody Developmental Motor Scales–3)

These figures were triangulated across three observers using inter-rater reliability checks (Cohen’s κ = 0.87). Importantly, no medical diagnosis was pursued; instead, the team focused on functional impact and ecological fit—consistent with the American Occupational Therapy Association’s (AOTA) 2023 position on sensory integration in early childhood.

Environmental Triggers Identified

Trigger mapping revealed predictable patterns. Fluorescent lighting (measured at 4,200 K color temperature, 1,200 lux at desk level) correlated with increased blinking frequency (18 blinks/min vs. baseline 6.5) and tactile seeking (rubbing carpet fibers, touching textured walls). The classroom’s acoustics—reverberation time of 0.9 seconds (exceeding the recommended 0.6 sec for preschool spaces per ANSI/ASA S12.60-2023)—amplified vocal strain during circle time. When background music played (Spotify playlist ‘Toddler Calm’, tempo 60 BPM), Carly’s heart rate variability (HRV) dropped by 31% (measured via FDA-cleared WHOOP Strap 4.0), indicating autonomic dysregulation—not disengagement.

Evidence-Based Strategies That Moved the Needle

Carly’s support plan avoided generic ‘sensory diet’ checklists and prioritized individualized, empirically supported actions. Each strategy was piloted for 72 hours before scaling, with progress tracked using the Goal Attainment Scaling (GAS) framework (Kiresuk & Sherman, 1968). Five interventions yielded statistically significant gains (p < 0.01, paired t-test, n = 12 sessions):

Tactile Anchoring Protocol

Instead of offering ‘fidget toys’ generically, the team introduced tactile anchoring: a weighted lap pad (2.2 lbs, Weighted Blankets Co. Toddler Lap Pad, 12” × 18”) used only during transitions and circle time. Data showed a 63% reduction in escape behaviors when paired with a verbal cue (“Feet on floor, hands on pad”). The weight was calculated at 10% of Carly’s body mass (22 lbs), within AOTA safety guidelines for children under 3.

Acoustic Modification

The center installed acoustic panels (3’ × 6’, 1-inch thick, AcoustiPanel Pro, NRC rating 0.85) along the east wall near the rug area. Reverberation time dropped to 0.58 seconds. Within 10 days, Carly’s vocal protest episodes fell from 11.3 to 3.1 per 2-hour block. Teachers reported improved vocal clarity during shared reading—validated by audio spectrogram analysis showing 22% increase in vowel duration consistency (Praat software v6.3.08).

1. Replace overhead fluorescent fixtures with LED panels (Philips WarmGlow 3000K, 350 lux at child eye level)
2. Install noise-dampening carpet tiles (Tarkett LifeGuard Eco, STC rating 58)
3. Use visual timers (Time Timer MAX, 30-min setting) paired with hand-over-hand guidance for transitions
4. Introduce proprioceptive input pre-circle time: 3 sets of wall pushes (10 sec each, 30-sec rest), measured via digital force plate (AMTI OR6-7) to confirm 15–20 lbs of sustained pressure
5. Embed language scaffolds: “Your ears feel loud? Let’s try our quiet headphones”—using Loop Quiet Kids (attenuation: 22 dB SNR, tested per ISO 4869-1)

Parent Partnership: From Home to School Alignment

Carly’s parents, both engineers, requested data transparency—not jargon. At the first family meeting, the team presented a Home-School Sensory Log with quantified inputs:

This table became the centerpiece of biweekly coaching sessions. Parents were trained in responsive observation—noticing micro-behaviors like lip compression (a sign of oral-motor seeking) or toe-walking duration (averaged 6.2 min/day pre-intervention, down to 1.4 min after 8 weeks of targeted vestibular input). They implemented predictable variation: rotating between three textured placemats (Placemat Co. Silicone, Bamboo, and Felt versions) to build tolerance—not avoidance.

Language Development Links

Speech-language pathologist assessments (using the REEL-3) found Carly’s receptive vocabulary at the 78th percentile (standard score 112), but expressive syntax lagged (84th percentile, SS 106). Crucially, her MLU (mean length of utterance) increased from 2.1 to 3.4 morphemes when given tactile anchors during naming tasks—suggesting somatosensory input facilitates linguistic encoding. For example, holding a cold metal spoon while labeling ‘spoon’ boosted correct production from 41% to 89% accuracy across 20 trials. This aligns with neuroimaging research showing cross-modal activation in the left supramarginal gyrus during multisensory word learning (Dickie et al., 2021, Developmental Cognitive Neuroscience).

What Didn’t Work—and Why

Not every strategy succeeded. The team discontinued two approaches after rigorous review:

• Weighted vests: Despite proper sizing (2.2 lbs), Carly exhibited increased postural sway (measured via inertial measurement unit, XSens DOT) and 27% more off-task glancing. Research confirms vests lack evidence for toddlers and may impede respiratory efficiency (Case-Smith et al., 2022, AJOT).
• “Sensory breaks” on demand: Allowing Carly to leave circle time whenever she covered her ears led to 42% fewer peer interactions and no reduction in distress frequency. Instead, co-regulation—teacher sitting beside her with shared tactile input (holding same textured stone)—increased joint attention by 68%.

These failures reinforced a core principle: supports must be embedded, not extracted. Removing a child from context rarely builds capacity; modifying context does.

Measurable Outcomes After 12 Weeks

Using pre/post standardized tools administered by blinded evaluators, the team documented clinically meaningful shifts:

On the Sensory Processing Measure–Preschool (SPM-P), Carly’s scores improved significantly:

• Auditory Processing subscale: −2.1 SD change (from 2.9 SD above mean to 0.8 SD above)
• Body Awareness subscale: +1.6 SD change (from 1.3 SD below mean to 0.3 SD below)
• Balance and Motion subscale: +2.4 SD change (from 2.0 SD below to 0.4 SD below)

Developmentally, she met 4 of 5 targeted CDC milestones ahead of schedule:

1. Runs easily (achieved at 29.2 months; normative range: 30–36 months)
2. Builds tower of 8 cubes (achieved at 28.7 months; normative: 30–36 months)
3. Names at least 2 body parts (achieved at 27.9 months; normative: 24–30 months)
4. Follows two-step commands without gestures (achieved at 30.1 months; normative: 30–36 months)

Her Bayley-4 Motor Composite rose from 78 (11th percentile) to 89 (24th percentile); Adaptive Behavior Composite jumped from 82 (14th percentile) to 94 (34th percentile). Critically, teacher-rated Temperament Assessment (Infant Toddler Social Emotional Assessment, ITSEA) showed no change in ‘negative affectivity’—confirming that observed behaviors reflected sensory processing, not emotional dysregulation.

Classroom-Wide Benefits

Carly’s accommodations benefited peers. Attendance rates for the entire 2-year-old room rose from 87% to 94%—teachers attributed this to calmer acoustics and predictable routines. Two classmates with language delays showed 30% faster acquisition of positional concepts (under, beside) when taught with tactile anchors. The center’s ECERS-R ‘Personal Care Routines’ score increased from 4.2 to 5.8 (out of 7), primarily due to refined transition protocols.

Professional Learning Implications

This case underscores three non-negotiable practices for early childhood teams:

First, measurement precedes intervention. Guessing at sensory needs wastes time and risks misattribution. Using validated tools like the SPM-P, Bayley-4, or even low-cost tech (decibel meters, lux meters) grounds decisions in observable data—not intuition. Second, supports are relational, not technical. The most impactful tool wasn’t a product—it was the teacher’s consistent use of parallel talk (“You’re pushing the cart—feel the wheels roll?”) paired with simultaneous heavy work. Third, family expertise is irreplaceable. Carly’s parents noticed her aversion to polyester tags before any clinician did—and their engineering background helped calibrate vibration thresholds for her vibrating cushion trial.

Training matters. All staff completed 12 hours of AOTA-endorsed sensory integration CEUs, including hands-on practice with force plates, sound meters, and standardized observation coding. They learned to distinguish sensory-seeking (e.g., crashing into cushions) from anxiety-driven avoidance (e.g., freezing near stairs)—a distinction critical for appropriate response. One teacher noted, “Before, I’d say ‘calm down.’ Now I say ‘Let’s get your body ready’ and offer the right kind of input.”

Forward Steps: Sustainability and Scaling

At 32 months, Carly continues to thrive. Her team shifted focus from ‘accommodation’ to ‘capacity-building’: she now selects her own tactile anchor from three options, uses a visual timer independently, and initiates ‘quiet time’ with headphones when overwhelmed. The center adopted her protocol district-wide, training 47 educators across 8 sites. Cost analysis showed ROI: $2,140 in acoustic upgrades yielded $14,200 in reduced staff turnover (per Oregon Department of Education retention data) and $8,700 in avoided special education referrals over one year.

Looking ahead, Carly’s team is piloting neurodiversity-affirming documentation: replacing deficit-based language (“sensory seeking”) with descriptive, strength-based terms (“uses touch to organize attention”). Her portfolio includes video clips of her building complex block structures while seated on a therapy ball—showcasing regulation, problem-solving, and fine motor skill—not just ‘sensory needs.’ As her lead teacher stated, ‘We didn’t fix Carly. We fixed the environment—and discovered her brilliance in the process.’

Data drives dignity. When we measure accurately, intervene precisely, and partner authentically, toddlers like Carly don’t just adapt—they lead. Their nervous systems aren’t broken; they’re wired differently, and that difference holds functional value when met with skill, science, and unwavering respect.

The numbers tell part of the story: 63% reduction in escape behaviors, 22-minute tactile engagement spans, 0.58-second reverberation times. But the deeper metric is qualitative: Carly now laughs during song time—head tilted slightly, fingers gently tapping her thigh, eyes bright and engaged. That laugh isn’t ‘despite’ her sensory profile. It’s because her world finally fits.

Her story isn’t exceptional. It’s replicable. And it starts—not with a label, but with a decibel meter, a stopwatch, and the humility to ask, ‘What does this child need to show us who they are?’

For practitioners: Download the free Sensory Environmental Audit Toolkit (Oregon Early Learning Division, 2024) which includes calibration guides for lux meters, decibel apps, and GAS templates aligned with state early learning guidelines.

For families: Request your child’s Home-School Sensory Log template from your provider—or adapt the table above using a simple notes app. Track just one input (light, sound, texture) and one response for three days. Patterns emerge quickly.

Carly’s journey proves that when early childhood systems prioritize precision over presumption, every toddler has the right—and the capacity—to belong, exactly as they are.

Her growth wasn’t linear. It was iterative, evidence-informed, and deeply human. And it began with listening—not just to her words, but to the language of her nervous system, measured in decibels, lux, seconds, and smiles.

No child should have to shrink themselves to fit a space not built for them. Carly didn’t shrink. Her world expanded. And that expansion—measured, documented, and shared—is how inclusion becomes inevitable.