Wilbarger Deep Pressure Protocol

by Denise
(Ohio)

Some friends who went to an Autism Symposium said that the OT presenting said that the Wilbarger Protocol should only be done for 2 weeks and then discontinued. Is this a change that the Wilbargers have recommended?

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It appears there are often misconceptions about the brushing protocol and this is NOT a good thing, for sure!

Here is what I know... In Patricia and Julia Wilbarger's own book,
"Sensory Defensiveness in Children Aged 2-12", copyright 1991, they say on page 16:

"How long do you continue the procedure (brushing and joint compressions)?"

"Each individual responds to this technique differently and will need to continue for a different length of time.

It is often helpful to begin with brushing for two weeks and then re-assess the level of sensory defensiveness. At that time the consultant can make further recommendations to continue or modify the program."


Initially, for the first two weeks, yes, the brushing is intense and very frequent (every two hours)! And at the two week point, it is not meant to be discontinued altogether.

The Wilbarger's suggest a re-assessment which often means the brushing can be reduced to say, 3-5 times a day... done regularly, with commitment and on a consistent daily schedule until the OT decides the child does not need it daily. He may still need it during certain situations however, as a calming or preparatory strategy.

Michelle Morris's experience with brushing and direct knowledge from her son's amazing OT (who is also a researcher) is this:



"At this point, many OT's, if seeing some level of improvement, will reduce the brushing to 3-5 times a day, instead of the recommended initial - every two hours for two weeks.

And then? It goes on as long as that individual child needs it to, until the therapist and parent sees a significant reduction in defensiveness as exhibited by the child.

Then... we go on as "as needed" basis, in times of great stress, developmental changes, or used as a tool, also recommended by Wilbarger, to prevent defensiveness in an upcoming situation."

If there are any OT's out there who have heard differently from the Wilbargers (not any OT, just the Wilbargers, as it is their protocol) PLEASE let us know. The Wilbarger Protocol is the protocol. Individual interpretations of this don't count. Only what the Wilbargers have said.

So, I don't believe that recommendation at the conference was correct. I do believe it was a misinterpretation or based on misguided information.

We will assume that to be true UNTIL we hear directly from the Wilbarger's. For now... two weeks of intense brushing; every two hours followed by joint compressions. A reassessment at two weeks with the OT and the parents trying a less intense schedule... usually 3-5 times per day. Then as needed once this schedule has helped the child regulate his system well enough.

Comments? Concerns? Questions? Reply below! Let's make sure we are all on the same page.

-SPD Editor

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Sep 13, 2011
W Pattern
by: Anonymous

I'm not an OT, but brushing was started on my son a month ago. My understanding of the W pattern is to ensure that you are not crossing the same ground twice, and to avoid the spine on the back. Hope this helps.

May 05, 2011
"W" pattern for the Wilbarger brushing protocol?
by: Chris

We recently had a Child's family indicate to us that they had been trained at their child's school in the brushing program and that they were told to use a "W" pattern that seemed confusing and different than what we had been taught in the past. What is the protocol to follow regarding brushing the limbs and back? Has something changed with this or are we misinformed?

Oct 11, 2010
I follow the program, am an OTR x 16 years
by: Anonymous

I have a 9 Y/O son who is on the brushing program since age 2. We have reduced it to as necessary / PRN when stressful times, changes in routine, school.. It works, I love it, and use it on my patients that need it.

Must be monitored, but I am thankful for the protocol, has helped so many.

Dec 16, 2009
Update on "To Continue or Not" from 2/2009
by: Anonymous

My son is now 5 and in an autism program at the local school district, where he is included in the Kindergarten class as he can tolerate it.

After recommendations from both the school team and our outside OT, we have decided that the protocol (brushing/therapressure) should be an ongoing process for our son. We brush him every day as part of his dressing routine, and they brush him at school as needed: he also is provided a host of other sensory input so he is not going without. He is doing fantastic. We are not doing it every 1.5 to 2 hours as the protocol requires but he is getting daily brushing, and we will monitor it and give him his "tune-up" with full-on every 2 hr brushing for a longer period if needed. To those who have questions about whether or not to continue with brushing continuously or even scaled back, talk with the school's team and/or with your outside therapists and get their feedback. Every child is different and so the protocol should be tailored to your child.

Dec 16, 2009
Wilbarger Protocol with my 3 year old daughter
by: Michelle

I teach Special Ed-and have not seen sensory processing disorder on it's own before. I have brushed kids at school, but never thought that my daughter would need this intervention.
My 3 year old daughter was just diagnosed as having sensory processing disorder.
I am very thankful that The Wilbarger Protocol exists and that my little girl is getting the help that she needs to cope with her body. It amazes me that after only 4 sessions of the protocol that we have already seen an improvement She did not fight bedtime tonight, and was CALM before hand! No tantrums, no screaming, no running and crashing or spinning to fight being tired, or to cope with needing to use the bathroom. She was like a different kid!

Nov 04, 2009
It Has Worked For Us!
by: Aimee

Our son is 3 years old and has high functioning autism. Since he was 15 months old has only slept four hours a night meaning my day started at midnight, waking more than 10-12 times a night. Since using this method our son has been waking only once a night a big change!! And its something he enjoys me doing . Am so glad our OT told us about it!!

Jul 03, 2009
gentle brushing and joint compression works!
by: Anonymous

My son was diagnosed at 18 months with PDD-NOS and SDI. I started speech and language and occupational therapies immediately. At that point he would not wear shoes, eat "most" foods and was markedly upset when wearing clothing that was 'itchy' or had a tag on the collar. Most kids dislike these things, I can't stand it myself, but they distracted him from everyday life, that was the difference. Anyway, one day his OC recommended 'Gentle Brushing' and Joint Compression every 2 hours for a few months.

Well, I thought it sounded crazy but I did it, and you know what IT WORKED!!! My son started walking, wearing shoes, eating new foods. It was amazing. I occasionally did the brushing after or before I knew a potentially traumatic event was going to happen (new school, new bus driver) and it really, really helped him. I still do this and he is 7, he actually asks for it sometimes.

Feb 20, 2009
To Continue or Not?
by: Anonymous

My son, age 4, has been recently diagnosed w/PDD-NOS by our Early Child Special Education team. We've been performing therapressure on him since Dec 2008, so going on 3 months now.

I understand this is supposed to help him be less sensory defensive, and we have seen a great change in his ability to feel hurt when he actually does get hurt. [Prior to the therapy this kid could run into a brick wall, get a big goose-egg on his head, but get right back up and keep going like it never phased him.] He now shows sadness by crying and saying, "I got boo-boo", etc. Quickly after the therapy started we also noticed a greater jump in his ability to verbally communicate.

I too was confused on the duration of this protocol and thought after 2-3 weeks we would be able to slowly reduce the frequency and then drop it altogether, but the OT and his teachers say he "craves the input". We were lucky in that he does tolerate brushing quite well and actually looks forward to the sessions. But now we see some resistance to it, i.e. he doesn't readily come to us when we say it's time for brushing, or he physically resists brushing and tries to get away as it's being done. This happens sometimes but not always.

Is this a sign that it is time to start weaning him off? The school keeps saying he "craves the input" but I am unsure about this. They say we'll reassess this in a few weeks but they aren't taking an initiative to meet as a group to reassess. At this point we (his parents) don't know if we are still reaping the benefits with continuing. We know that in a couple year's time we may need to "recharge" his nervous system by doing the protocol again and are fully committed to doing so.

Knowing each individual is different, what are your thoughts on how can identify when it is time to end the therapy?

Dec 11, 2008
How Long to Continue?
by: Anonymous

Does anyone have an idea of how long the Wilbarger Protocol is supposed to be given to a client?

I know an adult that the caregivers have done the protocol 5 times a day for the last 3 years. Reluctant to just stop it... the adult doesn't mind it, but doesn't ask for it. Just expects it as part of the routine.

But, if it stops, do the behaviors come back or has the protocol "fixed" the problem? As an aside... if the adult expects it in the routine, it's also difficult to change it and reduce that one-on-one time without behaviors resulting as well...

Jul 27, 2008
About teachers etc using the Wilbarger DPPT
by: Jennifer Dodge, OT

It can be a very personal interaction between the child and the adult doing the protocol. I would base who I think appropriate to do this protocol on the individual child and the situation - age of child, shyness, level of defensiveness and fear of imposed touch, relationship to teacher or aide, privacy from the child's peers, etc etc.

As far as "doing it right," I think anyone could be trained to do it, but when addressing this protocol as if it were a prescribed medicine, I think the practicalities of privacy and imposing on personal space get forgotten.

Oct 17, 2007
Who uses sensory brushing? OT, parents, anyone else?
by: Anonymous

I need help to identify exactly who the Wilbarger Protocol recommends that OTs may train to use sensory brushing with children.

Some OTs seem to feel that in the school setting teachers and aides may implement the technique after training by an OT and with the OTs direct and ongoing supervision. Some say that the only person other than an OT to use the technique should be parent.

This poses a problem for school based therapists. We have more opportunity for observation and supervision of school staff utilizing the technique than we would of parents. Furthermore, the protocol cannot be properly administered according to two hour time periods by most school based OTs who travel.

If anyone can refer me to information or protocol regarding this question as outlined by the Wilbargers please let me know.
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Since the answer is too long to put here, I am putting it on a separate page (only 3,000 words allowed)... Here's the link to the information:

The Wilbarger Brushing Protocol: Who Can Do It?


-SPD Editor

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