“This book is great! It is a real contribution to the parents of the many children who are so hard to understand. It will let parents off the hook of blaming themselves…and will help them get on to the job of addressing the child’s underlying difficulties.”
—T. Berry Brazelton, MD, founder, Brazelton Foundation, Children’s Hospital, Boston
“Carol Stock Kranowitz has helped many parents understand more about [sensory processing disorder] and how it manifests itself in children.”
—Sunday News (Lancaster, PA)
“Kranowitz writes intelligently about a bewildering topic.…In concise, well-organized chapters, Kranowitz reveals how the tactile, vestibular (pertaining to gravity and movement), and proprioceptive (pertaining to joints, muscles, and ligaments) senses operate.…[She] helps clear the way for families to understand a disorder that they may suspect but have not been able to pinpoint.”
—Publishers Weekly
“A book that demystifies [sensory processing disorder]. As a music, movement, and drama teacher, [Kranowitz] has developed a purposeful curriculum that integrates sensorimotor activities into the preschool day.”
—The Ithaca Journal (Ithaca, NY)
“Warm and wise, this book will bring both hope and practical help to parents who wonder why their kid doesn’t ‘fit in.’”
—Jane M. Healy, PhD, learning specialist and author of Your Child’s Growing Mind
“The Out-of-Sync Child does a masterful job of describing the different ways children react to sensations and integrate their responses to their world. The book provides detailed, practical information that will help parents understand how the nervous system works.”
—Stanley I. Greenspan, MD, child psychiatrist and author (with Serena Wieder) of The Child with Special Needs
“Comprehensive yet easy to understand…helpful tools for parents to promote healthy integration.
“The Out-of-Sync Child is written for and can be easily understood by parents and non-professionals. Carol Stock Kranowitz’s description and discussion of [sensory processing disorder] give a clear and concise picture of a disability. This book is a model for taking a little-known, and often-missed disability and making it accessible to the people most in need of this information.
“Kranowitz gives excellent examples of typical indicators that can signal a parent (or caregiver) that a [sensory processing disorder] may be present.…[She also] gives the reader concrete information and a testing checklist to help evaluate whether a child might have a [sensory processing disorder].
“This is a great book and a must-read for any parent who thinks their child might have unusual behavior difficulties. Kranowitz avoids hypertechnical language and explanations. Instead, her treatment of sensory integration issues relies on common sense and clear examples. The book is so well written that readers will be tempted to use Kranowitz’s analytical approach when they read about other behavior or learning disabilities. Its calming tone and no-nonsense approach give parents the power to positively address their child’s [sensory processing disorder].”
—The Exceptional Parent
THE
OUT-OF-SYNC
CHILD
Recognizing and Coping
with Sensory Processing Disorder
Revised and Updated Edition
CAROL STOCK KRANOWITZ, M.A.
A SKYLIGHT PRESS BOOK
A Perigee Book
A PERIGEE BOOK
Published by the Penguin Group
Penguin Group (USA) Inc.
375 Hudson Street, New York, New York 10014, USA
Penguin Group (Canada), 90 Eglinton Avenue East, Suite 700, Toronto, Ontario M4P 2Y3, Canada (a division of Pearson Penguin Canada Inc.) • Penguin Books Ltd., 80 Strand, London WC2R 0RL, England • Penguin Ireland, 25 St. Stephen’s Green, Dublin 2, Ireland (a division of Penguin Books Ltd.) • Penguin Group (Australia), 707 Collins Street, Melbourne, Victoria 3008, Australia (a division of Pearson Australia Group Pty Ltd.) • Penguin Books India Pvt. Ltd., 11 Community Centre, Panchsheel Park, New Delhi—110 017, India • Penguin Group (NZ), 67 Apollo Drive, Rosedale, Auckland 0632, New Zealand (a division of Pearson New Zealand Ltd.) • Penguin Books (South Africa), Rosebank Office Park, 181 Jan Smuts Avenue, Parktown North 2193, South Africa • Penguin China, B7 Jiaming Center, 27 East Third Ring Road North, Chaoyang District, Beijing 100020, China •
Penguin Books Ltd., Registered Offices: 80 Strand, London WC2R 0RL, England
While the author has made every effort to provide accurate telephone numbers, Internet addresses, and other contact information at the time of publication, neither the publisher nor the author assumes any responsibility for errors, or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.
Copyright © 2005 by Skylight Press and Carol Stock Kranowitz
Cover photograph by Tony Stone Images
Interior illustrations by T. J. Wylie
All rights reserved.
No part of this book may be reproduced, scanned, or distributed in any printed or
electronic form without permission. Please do not participate in or encourage piracy of
copyrighted materials in violation of the author’s rights. Purchase only authorized editions.
PERIGEE is a registered trademark of Penguin Group (USA) Inc.
The “P” design is a trademark belonging to Penguin Group (USA) Inc.
PUBLISHING HISTORY
Original Perigee trade paperback edition / March 1998
Revised Perigee trade paperback edition / August 2005
The Library of Congress has cataloged the original Perigee trade paperback edition as follows:
Kranowitz, Carol Stock.
The out-of-sync child : recognizing and coping with sensory integration dysfunction/by Carol Stock Kranowitz; foreword by Larry B. Silver.
p. cm.
Includes bibliographical references and index.
ISBN: 978-1-101-04261-8
1. Minimal brain dysfunction in children. 2. Sensorimotor integration.
3. Perceptual-motor learning. I. Title.
RJ496.B7K72 1998
618.92’8—dc21 97-14601
Research about sensory processing disorder is ongoing and subject to interpretation. Although all reasonable efforts have been made to include the most up-to-date and accurate information in this book, there can be no guarantee that what we know about this complex subject won’t change with time. Readers with concerns about the neurological development of their children should consult a qualified professional. Neither the publisher, the author, nor the producer take any responsibility for any possible consequences from any treatment or action by any person reading or following the information in this book.
Most Perigee books are available at special quantity discounts for bulk purchases for sales promotions, premiums, fund-raising, or educational use. Special books, or book excerpts, can also be created to fit specific needs. For details, write: Special Markets, Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014.
ALWAYS LEARNING PEARSON
CONTENTS
Preface by Lucy Jane Miller, PhD, OTR
Foreword by Larry B. Silver, MD
Acknowledgments
Introduction
How to Use This Book
PART I: RECOGNIZING SENSORY PROCESSING DISORDER
1: Does Your Child Have Sensory Processing Disorder?
Four Out-of-Sync Children at Home and School
Sensory Processing Disorder: A Brief Definition
Common Symptoms of SPD
What SPD Is Not: “Look-Alike
” Symptoms
Associated Problems
Possible Causes of SPD
Who Has Sensory Processing Disorder?
Don’t We All Experience Sensory Processing Problems?
Sample Sensory-Motor History Questionnaire
Hope Is at Hand
2: Understanding Sensory Processing—and What Can Go Amiss
The Senses
What Is Sensory Processing?
The Typical Development of Sensory Processing in Infants and Children
So, What Is Sensory Processing Disorder?
Six Important Caveats
Comparison of Typical Sensory Processing and Sensory Processing Disorder
3: How to Tell If Your Child Has a Problem with the Tactile Sense
Three Kindergartners at Circle Time
The Smoothly Functioning Tactile Sense
The Out-of-Sync Tactile Sense
How the Tactile Sense Affects Everyday Skills
Characteristics of Tactile Dysfunction
4: How to Tell If Your Child Has a Problem with the Vestibular Sense
Two First-Graders at the Amusement Park
The Smoothly Functioning Vestibular Sense
The Out-of-Sync Vestibular Sense
How the Vestibular Sense Affects Everyday Skills
Characteristics of Vestibular Dysfunction
5: How to Tell If Your Child Has a Problem with the Proprioceptive Sense
One Nine-Year-Old at the Swimming Pool
The Smoothly Functioning Proprioceptive Sense
The Out-of-Sync Proprioceptive Sense
How the Proprioceptive Sense Affects Everyday Skills
Characteristics of Proprioceptive Dysfunction
6: How to Tell If Your Child Has a Problem with the Visual Sense
Two Seventh-Graders at School
The Smoothly Functioning Visual Sense
The Out-of-Sync Visual Sense
Characteristics of Visual Dysfunction
7: How to Tell If Your Child Has a Problem with the Auditory Sense
A Third-Grader in Music Class
The Smoothly Functioning Auditory Sense
The Out-of-Sync Auditory Sense
Characteristics of Auditory Dysfunction
PART II: COPING WITH SENSORY PROCESSING DISORDER
8: Diagnosis and Treatment
A Parent’s Search for Answers
Recognizing When Your Child Needs Professional Help
Documenting Your Child’s Behavior
Diagnosing the Problem
Different Therapies, Different Approaches
Bringing Therapist and Child Together
Keeping a Record
9: Your Child at Home
A Parent’s Revelation
A Balanced Sensory Diet
Promoting Healthy Sensory Processing at Home
10: Your Child at School
What a Difference Communication Makes!
If Only School Were More Like Home
Deciding Whom to Tell
A Good School-and-Child Match
Promoting Your Child’s Success at School
11: Coping with Your Child’s Emotions
A Typically Dreadful Morning
Other Experts’ Advice
Dos and Don’ts for Coping
12: Looking at Your Child in a New Light
A Parent’s Epiphany
Becoming Enlightened
A Parent’s Encouraging Words
Appendix A: The Sensory Processing Machine
Appendix B: Dr. Ayres’s Four Levels of Sensory Integration
Glossary
Resources
Selected Bibliography
Index
PREFACE TO 2ND EDITION
by Lucy Jane Miller, PhD, OTR
In 1955, Dr. A. Jean Ayres wrote her first article related to the theory of sensory integration; in 1972, her first book was published and an entire field was launched. Based on her work, Carol Kranowitz, a preschool educator for twenty-five years, helped dozens of children who manifested “sensory integration dysfunction” with the consultation of an occupational therapist (OT) who had been trained by Dr. Ayres. Dr. Ayres passed away in 1988 and with her went the knowledge base and energy that only a founder of a new vision can have. Although OTs still practiced and taught courses on sensory integration, the field had lost its leader.
In 1998, Carol published The Out-of-Sync Child, a book written for parents and teachers. The book was a down-to-earth explanation of: (1) the complex theory of sensory integration, (2) the treatment, called occupational therapy (OT) with a sensory integration approach, and (3) the disorder, now called Sensory Processing Disorder. The Out-of-Sync Child reenergized the world of sensory integration. Clutching Carol’s book in their hands, parents came into pediatricians’ and OTs’ clinics, saying, “This is my child. We need occupational therapy.”
Carol’s goal was to write an understandable guidebook for parents whose children had sensory processing disorders. The popularity of this bestseller demonstrates both her success in achieving that goal and the urgent need for a book of this sort. The Out-of-Sync Child helps parents discover the missing piece in their kid’s puzzle—the sensory piece. Relieved, they can see that their child’s disturbing behaviors or disorganized motor abilities are related to sensory processing problems; as one parent put it, “The problem is physical, not parental.”
Parents ask, “How could my child’s problem have been overlooked for so long?” The answer is that few professionals, outside of OTs, knew about sensory processing disorder. When Carol’s book took off, the picture changed. The Out-of-Sync Child is on every special needs reading list and is in the curriculum of many educational programs. It is the first book that I hand to bewildered, frustrated parents when they come to my office for answers.
Now we have the second edition of The Out-of-Sync Child. This resource includes updated terminology, information about children on the autistic spectrum, and new chapters on vision and hearing. The explanations of Sensory Modulation Disorder, Sensory Discrimination Disorder and Sensory-Based Motor Disorder (including dyspraxia) provide much needed clarification of the subtypes of sensory processing disorder. Carol’s goal—to write for nonscientists—has remained the same. And she has succeeded again!
In this decade, I predict that we will see more scientific publications on sensory processing disorder, the inclusion of this disorder in standard diagnostic manuals, and more children getting a correct diagnosis and appropriate treatment. We will witness a generation of children with Sensory Processing Disorder grow competent and successful at home and at school. We will see OT treatment with a sensory integration approach accepted by mainstream medical and educational professionals.
Carol’s contribution to the field has been immeasurable. With her book came understanding and hope where none had been before for thousands of parents. Hope…and action…and children with brighter futures and more fulfilled lives. What could be more valuable?
—Lucy Jane Miller, PhD, OTR
Clinical Director, STAR
Center Foundation
Research Director, Sensory Processing
Disorder Foundation
FOREWORD
by Larry B. Silver, MD
The brain and mind are beautifully interwoven. Our feelings, thoughts, and actions can only occur through the complex actions of the brain. Any changes in the brain, even subtle changes, can have a major impact on our feelings, thoughts, and actions. Professionals can no longer understand the psychology of the mind without understanding the biology of the brain. What is equally true is that parents of children and adolescents with modified or faulty “wiring” of the brain cannot fully understand their son or daughter without fully understanding the underlying changes in the brain and the impact these changes have on the mind.
For me, this awakening began in the 1960s. My training in Child and Adolescent Psychiatry focused only on the psychology of the mind. The explosion of brain
research provided understanding of many disorders found with children and adolescents because of microscopic or chemical changes in the brain.
As we gained new knowledge about Learning Disabilities and Language Disabilities, we learned how these problems interfere with reading, writing, math, and organization skills. We learned that these problems interfere not only with academic progress, but also with success in sports, social interactions, and family life. Our growing understanding led to the fields of special education and speech-language therapy, which focus on helping individuals overcome or compensate for their disabilities.
Individuals with these changes look typical. Yet, subtle areas of their nervous systems are not functioning as they should. These changes result in behaviors that confuse, frustrate, and anger parents and teachers. They wonder why these children lack self-help skills, become aggressive or withdrawn in a group, or refuse to participate in activities or sports.
In addition to problems in learning and language, children might have problems developing the ability to process information received through their senses. These children or adolescents might have problems interpreting sights, sounds, and sensations of touch and movement. They might become unusually upset by bright lights or loud noises, or by being touched or moved unexpectedly.
They also might have problems controlling, orchestrating, and using their muscles effectively. When it is hard for them to coordinate groups of large muscles (gross motor) and/or small muscles (fine motor), they might have trouble mastering running, jumping, hopping, or climbing. They might have difficulty with buttoning, zipping, or tying, and with coloring, cutting, or writing. This difficulty getting their hands and body to do what their head is thinking creates problems with catching and throwing balls, with managing forks, pencils, and combs, and with many other essential life skills.
Dr. A. Jean Ayres studied these children with sensory and motor problems. She expanded our thinking to look at the whole integrative process needed for our brain to tell our body what to do. How does a child know how to do such complex and sequential tasks as jumping or climbing? How does a child acquire the complex skills to tie a shoe or write thoughts on the page? Dr. Ayres integrated our thinking about many sensory systems that must work independently and as a team to accomplish these and many other tasks. She described the essential roles our tactile and vestibular systems play in the process of coordinating sensory information with motor activity.
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