account for a number of other difficulties, such as her aggressiveness, feeding difficulties, and self-injurious behaviors. When a child is functioning with a significant level of defensiveness, he or she is constantly in a state of irritation. Therefore, crying and tantrums are frequent and may be severe, and the triggers may or may not be apparent to others without the same sensitivities. In particular, her aggressiveness may be due to her reaction of pain to apparently harmless tactile stimulation. It may be just a touch, but it feels like a pinch to her, and she responds in kind.

Isobel's processing difficulties are common in premature infants who require long hospital stays with lots of tubes and needles. The oral defensiveness in particular is often seen in ventilator babies. Her body developed defenses to the onslaught of sensory input that the intervention she required at birth involved.In addition, she was denied the natural enviroment for the further

development of sensory processing that full-term babies enjoy in utero.It has been reported that Isobel's sensory defensiveness has improved a great deal in the past months, but it is still a significant limiting factor to her social and motor development.

Isobel's Peabody fine motor scales were 14 months for grasping and 18 months for visual motor. Two of the skills that were difficult for Isobel on the grasping subtest were picking up two blocks at a time in one hand and using a true pincher grasp for small objects. She uses her third finger with her thumb.

Isobel was noted to have some possible visual problems and left neglect that may be impacting her performance as well. She had difficulty with eye-hand coordination activities that may point to depth perception problems, eye teaming difficulties, and/or visual field deficits. Further observation is needed as she develops to determine the nature of her visual deficits and treat them accordingly.