Off Balance: Understanding Vestibulo-Proprioceptive Challenges in Neurodivergent Children

Off Balance: Understanding Vestibulo-Proprioceptive Challenges in Neurodivergent Children

Introduction

Why does your child avoid swings but spin endlessly without feeling dizzy? Why do they fall out of chairs, bump into others, or seek rough play that seems too intense for their age? These are not just behavioral quirks—they may be signs of vestibulo-proprioceptive dysfunction, a complex but critical piece of sensory development.

For neurodivergent children—including those with Autism, ADHD, Dyspraxia, and Sensory Processing Disorder—the vestibular and proprioceptive systems play a foundational role in body awareness, movement, balance, and emotional regulation. When these systems are out of sync, school becomes overwhelming, movement becomes uncoordinated, and everyday tasks can be a struggle.

The good news? Occupational therapy offers powerful, movement-based strategies that can help children feel more grounded, more in control—and more confident.

⚙️ What Are the Vestibular and Proprioceptive Systems?

The vestibular system is located in the inner ear and helps us detect movement, gravity, and changes in head position. It influences:

• Balance and posture

• Coordination of head and eye movements

• Spatial orientation

• Body stability during movement

The proprioceptive system is based in muscles and joints. It gives us a sense of:

• Where our body parts are in space (body awareness)

• How much force to use when moving

• How to plan and coordinate movements

Together, these systems tell us how to move safely and efficiently in the world.

🚸 How These Issues Present in School-Going Children

When the vestibulo-proprioceptive systems are underdeveloped or over-responsive, children may display behaviors that appear clumsy, inattentive, or overly rough. These challenges can look very different depending on whether the child is sensory-seeking, sensory-avoiding, or fluctuating between the two.

Common signs include:

Balance & Coordination Issues

• Frequent falls, trips, or bumps into people/objects

• Difficulty with stairs, climbing frames, or uneven surfaces

• Poor posture while sitting or standing

• Difficulty riding a bicycle or scooter

Movement-Related Anxiety or Avoidance

• Fear of elevators, escalators, or playground equipment

• Discomfort with being upside down or lifted

• Avoidance of fast movement or spinning activities

Sensory-Seeking Behavior

• Excessive jumping, crashing, spinning, or roughhousing

• Constant fidgeting or rocking in place

• Slamming objects, stomping feet, or pushing too hard in games

Motor Planning and Organisation Challenges

• Difficulty initiating or sequencing physical tasks

• Seeming “uncoordinated” in sports, PE, or group play

• Struggling with handwriting or seated stability in class

Emotional Dysregulation

• Easily frustrated, overly energetic, or appearing disorganized

• Difficulty calming down after excitement or transitions

• Reliance on movement to self-regulate (e.g., pacing, spinning, bouncing)

These children are not trying to be disruptive—they are trying to cope with an internal sense of instability.

🧠 Neurodivergent Children and Vestibulo-Proprioceptive Processing

Sensory differences are a core characteristic of many neurodivergent conditions. Research suggests that:

• 80–90% of autistic children show signs of vestibular and proprioceptive processing challenges.

• Children with ADHD may seek intense movement as a form of self-regulation.

• Dyspraxia (DCD) frequently includes poor motor planning and body awareness.

• Children with SPD often have difficulty integrating vestibular and proprioceptive input with other sensory systems.

When these challenges go unsupported, they can cause physical discomfort, frustration, and even social exclusion.

📉 The Impact on Learning and Participation

In the classroom:

• Fidgeting, falling off chairs, or poor posture may be misread as inattentiveness

• Struggles with handwriting due to poor stability and pressure control

• Difficulty sitting still for long periods leads to behavioral concerns

• Challenges participating in PE, sports, or team-based play

Emotionally:

• Children may feel anxious, overwhelmed, or misunderstood

• They may lash out when dysregulated or withdraw to avoid stimulation

• Repeated failure in physical tasks can erode self-confidence

Socially:

• Peers may see them as “too rough” or “clumsy”

• Struggles with spatial awareness may cause friction in play

• Lack of confidence in group games can lead to isolation

Without early support, these issues can affect a child’s academic, emotional, and social growth.

🛠️ How Occupational Therapy Can Help

Occupational therapists use movement-based, play-oriented strategies to strengthen vestibular and proprioceptive processing in a way that’s engaging and developmentally appropriate.

Key OT interventions include:

1. Sensory Integration Activities:

• Swinging, spinning, rolling, and climbing in controlled environments

• Scooter board activities, balance beams, and trampoline work

• Crawling tunnels, obstacle courses, and animal walks

2. Proprioceptive Input ("Heavy Work")

• Pushing, pulling, lifting, squeezing activities (e.g., wall pushes, therapy putty, wheelbarrow walks)

• Carrying weighted objects, resistance bands, and climbing tasks

• Structured physical routines to improve body awareness and self-regulation

3. Core Strength & Postural Control Training:

• Exercises to improve stability and reduce fatigue in seated positions

• Activities to promote midline crossing, bilateral coordination, and head/eye stability

4. Classroom and Home Adaptations:

• Movement breaks built into the school day

• Use of sensory seating, fidget tools, or weighted lap pads

• Collaboration with teachers to manage regulation needs without stigma

5. Teaching Self-Awareness and Regulation Tools:

• Helping children understand their sensory needs

• Encouraging safe, appropriate strategies to meet those needs (e.g., bouncing on a ball instead of crashing into peers)

🧒 Real-Life Story: Liam Finds His Balance

Liam, age 8, was constantly falling off his chair, fidgeting, and crashing into classmates. He struggled in PE and refused to climb or swing. His teachers thought he was hyperactive; his parents were concerned about safety.

An OT evaluation revealed vestibulo-proprioceptive delays. Through weekly sensory integration sessions and a home-based movement routine, Liam improved his posture, balance, and confidence. He now participates in PE, sits calmly in class—and even rides his bike without fear.

👨‍🏫 What Parents and Teachers Can Do

You don’t need a formal diagnosis to act. If a child consistently shows signs of poor balance, coordination, or sensory-seeking behavior, early OT input can prevent long-term challenges.

Steps to support vestibulo-proprioceptive development:

• Offer movement-rich play: climbing, spinning, jumping, crawling

• Incorporate “heavy work” activities into daily routines (e.g., chores like carrying laundry)

• Use sensory tools like therapy balls, trampolines, or obstacle courses

• Observe when the child seeks or avoids movement—and adapt accordingly

• Advocate for a sensory-friendly school environment

• Request an occupational therapy assessment when needed

Resources like the Locus Therapy App and Newbee Publication's therapy guides can support families with evidence-informed tools and ideas.

🧾 Conclusion

Vestibulo-proprioceptive challenges are often the hidden cause behind a child’s clumsiness, restlessness, or meltdowns. But when understood, they open the door to powerful, movement-based solutions that build regulation, focus, and self-confidence.

With early occupational therapy support and a movement-friendly approach, children can feel more secure in their bodies—and more empowered in their learning.

Let’s give every child the balance they need to grow, move, and thrive.