Today, I review, link to, and excerpt from The Cribsiders‘ #143: Growing Orchids in a Dandelion World: Highly Sensitive Children.*

*Holloway R, Grewal M, Riley C, Berk J, Chiu C, Masur S. “#143: Growing Orchids in a Dandelion World: Highly Sensitive Children”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ June 4, 2025.

All that follows is from the above podcast.

Summary:

In this episode of The Cribsiders, we explore the world of Highly Sensitive Children with expert guest Dr. Caylin Riley, a pediatrician and newborn hospitalist. Dr. Riley breaks down what it means to be a highly sensitive child and offers practical strategies for supporting these kids at home and in clinical settings. We discuss how sensitivity can be a strength, how to recognize and respond to signs of overwhelm, and how to foster resilience. Tune in for a compassionate and insightful conversation that will leave you better equipped to care for the sensitive souls in your life.

Highly Sensitive Children Pearls

1. Sensory processing sensitivity is a normal, heritable personality trait—not a disorder. Unlike sensory processing disorder (SPD), SPS simply reflects a heightened awareness and deeper processing of sensory and emotional input.
2. The D.O.E.S. mnemonic captures the core traits of highly sensitive children (HSCs): Depth of processing, Overstimulation, Emotional responsiveness, and Sensitivity to subtleties.
3. There is no formal diagnostic test for SPS—clinical insight is key. Screening tools like those developed by Dr. Elaine Aron and Professor Michael Pluijm can guide conversations, but diagnosis is based on thoughtful history and understanding the child’s context.
4. Supporting highly sensitive children starts with education, environment, and empathy. Empowered with the right support and scaffolding, HSCs can truly thrive and channel their deep feelings into meaningful action.

Highly Sensitive Children Notes

Definition

A highly sensitive person (HSP) or child (HSC) refers to someone who has a finely tuned nervous system, with heightened sensitivity to their environment and experiences. The term was first coined by Dr. Elaine Aron, a psychologist and researcher, in the late 1990s. While the term does not constitute a medical diagnosis, it does represent a collection of interconnected experiences that many people find valuable in representing their experiences.

Sensory Processing Sensitivity vs. Disorder

Sensory processing sensitivity is a temperamental trait that predisposes an individual to be more sensitive to subtle stimuli and over-aroused by external triggers. It is a normal variation in personality and neurobiology – not pathological.

Sensory processing disorder is a neurologic condition where the brain has difficulty receiving, organizing and responding to sensory input. This manifests as strong aversions to touch or sound, or sensory-seeking behaviors. It is often seen in conjunction with other diagnoses, such as autism or ADHD.

Epidemiology

Studies have estimated that sensory processing sensitivity is found in approximately 15-20% of individuals. This prevalence is consistent across different cultures and age groups. (1, 2)

Studies also suggest that SPS is a heritable trait with a significant genetic component. Assary et al found that the heritability of environmental sensitivity, measured using the Highly Sensitive Child (HSC) Questionnaire, was approximately 0.47, suggesting a significant genetic component (3). Research by Chen et al. demonstrated that dopamine-related genes, including DRD4, contribute significantly to the Highly Sensitive Personality (HSP) trait (4). Homberg et al. discussed the role of the serotonin transporter gene (5-HTTLPR) in modulating environmental sensitivity, noting that both SPS and 5-HTTLPR are associated with deeper processing of sensory information and stronger emotional reactions (5).

Core Traits of HSCs

Dr. Riley likes to use the D.O.E.S. mnemonic to describe the core traits of a HSC.

Depth of Processing – HSCs tend to process information more deeply, reflecting on their experiences and emotions more thoroughly than others.

Overstimulation – Due to their heightened sensitivity of people, noises, visuals and sensory inputs, HSCs can become easily overstimulated in chaotic environments. They may need alone time or quiet spaces to reset and recharge.

Emotional Responsiveness – HSCs experience strong emotions (both negative and positive) and are highly in tune with the emotions of people around them.

Sensitivity to Subtleties – HSCs notice small subtle details around them that others may miss, including non-verbal cues, demeanor changes or environmental adjustments. They are often very sensitive to strong smells, bright lights, loud noises or certain textures. It is managed with occupational therapy with sensory integration techniques.

The Orchids and The Dandelions

The term “orchid” and “dandelion” have been used to categorize children on the spectrum of sensitivity, and can be a useful tool in describing this concept to parents.

“Orchids” are delicate and sensitive, flourishing under optimal conditions and struggling in more chaotic or stressful settings. They require more careful handling – like orchids, they’re delicate but can bloom beautifully when well cared for.

 

“Dandelions” are less sensitive, more resilient to stress and change, and can grow in a wide range of environments – like dandelions sprouting through cracks in concrete. These children tend to be more self-regulating and may not need as much emotional scaffolding to thrive.

This metaphor is a reminder that sensitivity is not a weakness, and it encourages a tailored approach to parenting, teaching and clinical care.

Associations with Other Diagnoses

The highly sensitive trait, in and of itself, is not pathologic, however children can have other neurodivergence including autism spectrum disorder, ADHD, anxiety or depression – just like any other child can, per Dr. Riley.

Diagnosis & Screening

There is no reliable blood test to diagnose sensory processing sensitivity. Diagnosing a highly sensitive child is a clinical evaluation based on strategic interviewing and ruling out other diagnoses with similar, overlapping presentations.

There are two screeners that can be useful in evaluations: highlysensitiveperson.com/test (Dr. Elaine Aron) & https://sensitivityresearch.com/self-tests/ (Professor Michael Pluist). Dr. Riley encourages providers to incorporate sensitivity screening into routine well-child checks to better identify and support HSCs and their families.

Interventions & Therapies

Dr. Riley recommends, first and foremost, helping the child and parents understand what the trait is, and emphasizing that it is not a pathology.  There are many educational resources including podcasts, books and websites that help to explain these concepts – see below for resources that Dr. Riley recommends.

Additionally, here are several ways that parents can create fertile, orchid-like environments for HSCs to grow and thrive:

• Open communication – Encourage HSCs to express their feelings and thoughts openly, without judgement. Also communicate with teachers, caregivers and instructors regarding the highly sensitive trait and how to best nurture HSCs.
• Creating calm environments – Designate quiet and calm spaces in the home where children can retreat when feeling overwhelmed. Consider the colors, textures, sounds and visual colors in these spaces.
• Establish routines – Routine provides predictability and can reduce uncertainty, which can be a trigger for HSCs.
• Limit sensory stimuli – When possible, reduce exposure to overwhelming sensory stimuli and triggers.
• Teach coping strategies – Help children develop coping strategies such as grounding strategies, deep breathing, mindfulness, or creative outlets like art or music.
• Empower empathy – HSCs often feel deeply for those around them and for the world’s challenges, which can be channeled into meaningful action through small or large acts of kindness and advocacy.

There are several educational resources linked below that can be shared with families.

Resources

Scientific research on the trait:

• www.hsperson.com/research
• www.sensitivityresearch.com

Introductory Video by Dr. Caylin Riley (general pediatrician) (YouTube- search “Dayton Children’s Grand Rounds, The Highly Sensitive Child”); check out www.PedsForHSCs.com for resources to share with your favorite pediatric professional (pediatricians, NPs, PAs, OTs, psychologists, therapists/counselors, etc)!

Podcasts

• “Raising Good Humans” podcast with Dr. Aliza Pressman (developmental psychologist), episode 65 “Parenting the Highly Sensitive Child” (guest Dr. Ann-Louise Lockhart, LPC)
• “TILT Parenting” podcast with Debbie Reber (life coach), episode 214 “How to Support and Parent a Highly Sensitive Child” (guest Alane Freund, ICHS/clinical psychologist)
• “Raised Resilient with Dr. Hilary” podcast with Dr Hilary Mandzik (clinical psychologist)
• “Good Inside” podcast with Dr. Becky Kennedy (clinical psychologist), episode 33 “Deeply Feeling Kids Need a Different Approach”
• “Your Parenting Long Game with Rachel Bailey” With Rachel Bailey (clinical psychologist) starting with episode 201 “Why Children with Big Feelings Act So ‘Dramatic’’ (all episodes after that one are HSC-specific)
• “How to Parent Your Highly Sensitive Child like a Ninja” podcast with Megghan Thompson (LPC, Registered Play Therapist- Supervisor) –especially geared for parents of kids showing violence/having frequent meltdowns/having suicidal thoughts)

Online Articles/Websites

• “How to Support Your Highly Sensitive Child” by Dr. Ann-Louise Lockhart, found on pbs.org
• www.alanefreund.com
• www.hsperson.com
• www.thehighlysensitivechild.com (has a list of good children’s books and many free resources)
• All of the professionals listed above have websites, many of them offering coaching, educational programs/courses, free resources, etc.

Books

• The Highly Sensitive Child & The Highly Sensitive Parent by Dr. Elaine Aron (clinical and research psychologist, first to study and fully describe the trait starting in 1991)
• The Strong, Sensitive Boy by Dr. Ted Zeff (clinical psychologist)
• Understanding The Highly Sensitive Child (A Nutshell Guide) by James Williams

The above resources were created by Dr. Caylin Riley, last updated 3/12/2025 with no financial disclosures with any of the above entities except her own website; share widely and freely! Check www.PedsForHSCs.org periodically for updates.

Goal

Listeners will explain the basic clinical features and management of sensory processing sensitivity (SPS) to improve care for highly sensitive children.

Learning Objectives

After listening to this episode listeners will…

1. Define sensory processing sensitivity (SPS) and distinguish it from sensory processing disorder (SPD) and other neurodevelopmental conditions.
2. Identify common characteristics of highly sensitive children, including behavioral and emotional patterns that may present in clinical settings.
3. Describe the “orchid vs dandelion” framework and apply it to understanding individual differences in children’s responses to their environments.
4. Explain supportive strategies for helping highly sensitive children thrive at home, in school, and in medical encounters.