The Wilbarger Brushing Protocol, formally called the Wilbarger Deep Pressure and Proprioceptive Technique (DPPT), is a clinician-taught sensory approach that combines brushing and joint compressions. It was developed for children with sensory overresponsivity, often called tactile defensiveness. The routine is brief, but its schedule can be demanding: it may be repeated every 90 minutes to 2 hours while a child is awake. Before you consider it, you should know both its limits and its safeguards.
What the Wilbarger Brushing Protocol is meant to address
Patricia Wilbarger, an occupational therapist and clinical psychologist, developed the protocol. Its formal name is Wilbarger Deep Pressure and Proprioceptive Technique, or DPPT; “Wilbarger Brushing Protocol” is the common name. An oral component, the Oral Tactile Technique, is also described in the wider Wilbarger approach, although it may be omitted for hygiene and safety reasons.
The protocol was developed primarily for children ages 2 to 12 with sensory overresponsivity or tactile defensiveness. Tactile defensiveness is an older term associated with unusual sensitivity to touch; sensory overresponsivity is the more current clinical term. A child who dislikes a clothing tag or avoids hair brushing is not automatically a candidate for DPPT, and these responses are not a diagnosis.
Still, the everyday triggers can help explain why families ask about sensory support. In one U.S. estimate of children ages 7 to 11 with sensory overresponsivity, the most common tactile triggers included clothing tags (39%), nail clipping (19%), hair brushing (16%), and mud or dirt (11%). A pediatrician or other doctor can help when there are health or developmental concerns, while an occupational therapist can assess whether a sensory approach fits a child’s needs.
Why occupational therapy training must come before a sensory brush
DPPT is not a casual at-home brushing activity. Training from a specifically trained occupational therapist is necessary before it is used. The therapist evaluates whether the child can cooperate with the process, teaches the caregiver the exact technique, and helps plan timing and follow-up. The literature does not define precise criteria for when an occupational therapist is qualified to train others, but it does emphasize training and current instruction.
That caution is practical. Without training, the technique may be harmful or ineffective. Children should not brush themselves, and a child who runs away or pulls away the brush is not simply being “difficult”; cooperation must be evaluated before the protocol begins. Brushing should never be painful. For someone with sensory defensiveness, it may initially feel uncomfortable or aversive, which is another reason not to improvise.
Occupational therapy is also where the larger plan belongs. DPPT is designed as part of an individualized sensory diet, rather than as a stand-alone answer to every touch-related challenge. If pain, breathing concerns, vomiting, skin irritation, or another medical issue is involved, contact a doctor rather than trying to solve it with brushing.
How the three DPPT components fit together
The protocol has three connected components: brushing with a special surgical brush, joint compressions, and an individualized sensory diet. Brushing plus joint compressions takes about 2 to 3 minutes. The steps below explain the structure, not a substitute for hands-on occupational therapy instruction.
- Use the right brush. DPPT uses a soft, plastic-bristled, non-scratching surgical brush, commonly known as a Therapressure Brush. A hairbrush, paintbrush, or other brush does not provide the consistent pressure required by the protocol and should not be substituted.
- Apply the taught brushing pattern. The trained caregiver uses firm, consistent pressure so the bristles bend, moving from the arms downward toward the feet. The protocol describes three firm strokes per body part and continuous skin contact. Brushing may be done over clothing, although bare skin is more effective; clothing should be pulled taut to avoid folds.
- Follow with joint compressions. Ten rapid compressions are given in sequence at the shoulders, elbows, wrists, fingers, hips, knees, and ankles. These compressions are a required part of DPPT, not an optional add-on.
Some sources describe self-administered proprioceptive activities such as pushing against a wall, jumping jacks, push-ups, or trampoline jumping. Those examples do not turn a do-it-yourself brushing routine into DPPT. The oral technique involves a finger stroke along the inside of the mouth for oral defensiveness and is sometimes left out for hygiene and safety reasons.
Where the brush never goes and why pressure matters
Several body areas are always excluded: the chest, abdomen, face, neck, and head. Brushing the abdomen may trigger gagging or an urge to urinate. Brushing the chest may interfere with breathing. These restrictions make professional teaching essential, not optional.
Pressure is another detail that changes the experience. The DPPT technique uses firm, constant pressure; very light touch can be disorganizing or increase arousal. The brush stays in contact with the skin during the sequence because lifting it can alert the nervous system again when the intended goal is calming and organization. Firm does not mean painful, and a trained occupational therapist is the person to show caregivers what the protocol means in practice.
Why every 90 minutes to 2 hours changes the family routine
The initial recommendation is brushing every 90 minutes to 2 hours during waking hours, commonly 6 to 8 applications a day. The timing is linked to a proposed mechanism: endorphins released by brushing are thought to remain in the system for 90 minutes to 2 hours. That is a theory behind the schedule, not proof that the protocol works for every child.
| Planning point | What the protocol describes |
|---|---|
| One full sequence | About 2 to 3 minutes for brushing and joint compressions |
| Initial daytime interval | Every 90 minutes to 2 hours while awake |
| Typical daily frequency | 6 to 8 applications |
| Before sleep | Stop at least 2 to 3 hours before bedtime because brushing can raise arousal |
| Initial intensive period | 2 to 3 weeks, followed by discussion of fading with the therapist |
A schedule this frequent reaches beyond home. You may need to coordinate with daycare, school, and the occupational therapist. After about 2 weeks, the therapist reassesses the program and may adjust it. Reported overall use ranges from 2 weeks to 6 months, depending on whether the child appears to benefit. Do not extend, intensify, or taper a schedule based only on an online article.
What the evidence says without overpromising
The strongest answer to “Does the Wilbarger Brushing Protocol work?” is that the evidence is limited and inconclusive. A 2012 systematic review by Weeks and colleagues found 4 usable intervention studies among 341 results. The studies were small before-and-after case series, had low methodological quality, and did not measure treatment integrity. The review concluded that high-quality evidence was lacking to support or refute use of the protocol with children.
Other findings do not erase that uncertainty. A 2021 study of 16 autistic children reported a positive change in tactile-response classification after 3 weeks of the protocol. A 2019 case study comparing DPPT with nonspecific child-led brushing did not show a clear DPPT advantage. In a literature search covering 1994 to 2024, 8 autism studies were identified; 3 found no significant effect on challenging behavior, and another found no effect on task engagement. None of the remaining studies isolated brushing as the only intervention.
The American Academy of Pediatrics has described evidence for sensory-based therapies for childhood developmental and behavioral problems as scarce and inconclusive. The Association for Science in Autism Treatment advises families not to pursue the protocol because time and resources would be better spent on evidence-based interventions. This does not tell you what any one child will experience, but it does mean that claims of a proven result are not justified.
Can adults use the brushing protocol?
DPPT was developed mainly for children, but it is occasionally used with adults who have sensory defensiveness. Adults may self-apply only if they are old enough and competent to be trained in the specific technique and protocol. Training remains the threshold, not a product purchase.
The adult evidence is also limited. A pilot study of 15 adults with sensory defensiveness found an association between anxiety and sensory defensiveness and reported improvements with a sensory treatment protocol. It did not prove that brushing alone caused those improvements. An occupational therapist can discuss whether a broader sensory modulation plan is appropriate; see a doctor for health concerns or safety questions.
Common myths that can make brushing less safe
- “Any brush will do.” No. The protocol calls for a soft, non-scratching surgical brush, not a household brush.
- “Light pressure is gentler, so it is safer.” Not in this method. Light pressure can increase arousal or disorganize the nervous system; the protocol specifies firm, constant pressure taught by an occupational therapist.
- “Brushing alone is DPPT.” No. Joint compressions are an obligatory component performed with brushing.
- “A child can learn it from a video.” No. A trained caregiver applies it after occupational therapy instruction; children do not self-brush.
- “If it seems helpful, more is better.” No. Frequency, bedtime cutoff, review, and fading belong in the therapist-guided plan.
- “It is proven to work.” No. Current research cannot support or refute it with high-quality evidence.
Frequently Asked Questions
What is the Wilbarger Brushing Protocol?
It is the common name for the Wilbarger Deep Pressure and Proprioceptive Technique, a sensory approach combining a special surgical brush, joint compressions, and an individualized sensory diet. It was developed primarily for children ages 2 to 12 with sensory overresponsivity or tactile defensiveness.
How do you do the Wilbarger Brushing Protocol?
A trained caregiver uses the specified soft surgical brush with firm, constant pressure from the arms downward to the feet, then gives joint compressions. The chest, abdomen, face, neck, and head are never brushed. Get direct occupational therapy training rather than attempting the sequence on your own.
How often should Wilbarger brushing be done?
Initial guidance describes every 90 minutes to 2 hours while awake, or about 6 to 8 times a day. Brushing stops at least 2 to 3 hours before bedtime, and the occupational therapist should reassess the plan after about 2 weeks.
Does the Wilbarger Brushing Protocol work?
Research is limited, mixed, and low quality. A systematic review found insufficient high-quality evidence to support or refute use with children. Discuss expected benefits, other options, and how progress will be reviewed with the treating occupational therapist.
Can adults use the brushing protocol?
Adults sometimes use it for sensory defensiveness, but it was developed primarily for children. An adult may self-apply only after being trained and judged competent in the specific technique. Seek occupational therapy guidance and see a doctor for health concerns.
