The Out-of-Sync Child

by Carol Kranowitz

  We knew that we raised more questions than it was possible to answer in a half-hour conference.

  Thus, this book was conceived to explain sensory processing and its counterpart, Sensory Processing Disorder, to parents, teachers, and other non-OTs who are new at this. This second edition, seven years after the first, contains up-to-date information that may also help those who are already experienced in caring for children with other, more observable disabilities, many of which overlap with SPD.

  I have attempted to make the explanations reader-friendly. They will remind you of or introduce you to terms that early childhood professionals commonly use—terms with which you need to be familiar.

  The viewpoint is “teacherly” and may differ here and there from other clinical or research-oriented points-of-view. Understanding SPD from different perspectives will allow you to understand your child (or student) better, and that is the book’s most important purpose. Then you will be prepared to provide the help the child needs to become as competent and confident as possible.

  HOW TO USE THIS BOOK

  Whether or not your child has been diagnosed, this book will help you understand and cope with Sensory Processing Disorder (SPD), also known as Sensory Integration Dysfunction. The book is not just for parents. It is also for teachers, medical doctors, occupational therapists, psychologists, grandparents, babysitters, and others who care for the out-of-sync child.

  As a teacher, I have witnessed how SPD plays out. I have seen behavior that parents, pediatricians, and even therapists don’t have the chance to observe. Thus, the book, written from a teacher’s perspective, offers insights that a specialist in another field of child development might overlook.

  Part I includes an overview of SPD and how it affects children’s behavior; checklists and a questionnaire (for you to mark) of symptoms, associated problems, and characteristics of out-of-sync children; a guide to typical neurological development; how the fundamental senses work, how they influence everyday life, and what happens when they’re inefficient; anecdotes contrasting the responses of children with and without efficient sensory processing; and the hope that a solution to your child’s difficulties is at hand.

  Part II includes criteria and guidance for getting a diagnosis and treatment; examples of charts for documenting your child’s behavior; tips for keeping a running record; how occupational therapy helps, and a look at other therapies; suggestions for a balanced “sensory diet” and for improving your young child’s skills at home; ideas to share with teachers for helping your child at school; coping techniques to handle your child’s emotions and to improve family life; and encouragement and support—for you and your child are not alone!

  The Out-of-Sync Child concludes with two Appendices—The Sensory Processing Machine, to explain the role of the central nervous system, and Dr. Ayres’ Four Levels of Sensory Integration; Resources for materials and support; a Selected Bibliography; and a Glossary and Index.

  Read the book cover to cover to get a broad picture of Sensory Processing Disorder. Use it as a reference to refresh yourself on a specific area of dysfunction. With pencil in hand, use it as a workbook. Keep it handy as an activity book. Use it to learn about your child—and perhaps to learn about yourself, as well.

  Part I

  RECOGNIZING

  SENSORY

  PROCESSING

  DISORDER

  Chapter One

  DOES YOUR CHILD HAVE

  SENSORY PROCESSING

  DISORDER?

  Surely, you know a child who is oversensitive, clumsy, picky, fidgety, and out of sync. That child may be your son or daughter, your student or Scout, your nephew or neighbor…or the child you were, once upon a time. That child may have Sensory Processing Disorder (SPD), a common, but misunderstood, problem that affects children’s behavior, influencing the way they learn, move, relate to others, and feel about themselves.

  To illustrate how sensory processing problems play out, the stories of four out-of-sync children and the parents struggling to raise them are presented in the next pages. You will also see lists of common symptoms, associated problems, and possible causes.

  This information will help you determine whether SPD affects your child. If your child has a significant problem, the information may strike you like a bolt of lightning. You may instantly recognize the signs and be relieved to have some answers, at last. Even if your child has a mild problem, you can use this information to gain new insight into his or her puzzling behavior.

  Whether SPD is major or minor, the child who is out of sync needs understanding and help, for no child can overcome the obstacles alone.

  FOUR OUT-OF-SYNC CHILDREN AT HOME AND SCHOOL

  Tommy is the only son of two adoring parents. They waited a long time before having a child and rejoiced in his arrival. And when they finally got him in their hands, they got a handful.

  The day after he was born, his parents were told that he could not stay in the hospital nursery because his wailing disturbed the other infants. Once he arrived home, he rarely slept through the night. Although he nursed well and grew rapidly, he adamantly rejected the introduction of solid food and vigorously resisted being weaned. He was a very fussy baby.

  Today, Tommy is a fussy three-year-old. He is crying because his shoes are too tight, his socks too lumpy. He yanks them off and hurls them away.

  To prevent a tantrum, his mother lets him wear bedroom slippers to school. She has learned that if it isn’t shoes and socks that bother him, it’s inevitably something else that will trip him up during the day.

  His parents bend over backwards, but pleasing their healthy, attractive child is a challenge. Everything scares him or makes him miserable. His response to the world is, “Oh, no!” He hates the playground, the beach, and the bathtub. He refuses to wear hats or mittens, even on the coldest days. Getting him to eat is a trial.

  Arranging play dates with other children is a nightmare. Going to the barber shop is a disaster. Wherever they go, people turn away—or stare.

  His teacher reports that he avoids painting and other messy activities. He fidgets at story time and doesn’t pay attention. He lashes out at his classmates for no apparent reason. He is, however, the world’s best block builder, as long as he isn’t crowded.

  Tommy’s pediatrician tells his parents nothing is wrong with him, so they should stop worrying and just let him grow. His grandparents say he’s spoiled and needs stricter discipline. Friends suggest going on a vacation without him.

  Tommy’s parents wonder if yielding to his whims is wise, but it’s the only method that works. They are exhausted, frustrated, and stressed. They can’t understand what makes him tick.

  Sweet Vicki, a pudgy first-grader, is often in a daze. Her response to the world buzzing around her seems to be, “Ho, hum.” She doesn’t seem to see where she is going, so she bumps into furniture and stumbles on grass. When she tumbles, she is slow to extend her foot or hand to break the fall. She doesn’t appear to hear ordinary sounds, either. Other six-year-olds may have developed the sense to stop, look, and listen, but not Vicki. She disregards important sensory information coming at her from all sides.

  In addition, Vicki fatigues easily. A family outing or trip to the playground quickly wears her out. She sighs, “You go. I don’t want to. I’m too pooped.”

  Because of her lethargy, her parents find that getting her out of bed, asking her to put on her coat, or maneuvering her into the car is an ordeal. She takes a long time to carry out simple, familiar movements. In every situation, it is as if she is saying, “Huh? How am I supposed to do this?”

  Nonetheless, she wants to be a ballerina when she grows up. Every day she sprawls in front of the TV to watch her favorite video, The Nutcracker. When her beloved Sugar Plum Fairies begin to dance, she hauls herself to a stand to sway along with them. Her movements, however, do not match the musical rhythm or tempo. Ear-body coordination is not her forte.

  Vicki begged for ballet lessons, but t
hey have not been going well. She loves her purple tutu but cannot differentiate top from bottom and needs help to get into it. Once attired in tulle, tiara, and slippers, she plops down. She has no idea how to bend her knees in a plié or stretch her leg in an arabesque. At dancing school, Vicki usually gets cold feet and clings like taffy to her mother’s leg.

  Vicki’s parents disagree on the best way to handle her. Her father picks her up and put her places—in bed, in the car, on a chair. He also dresses her, as she has trouble orienting her limbs to get into her clothes. He refers to her as his “little noodle.”

  Vicki’s mother, on the other hand, believes Vicki will never learn to move with confidence, much less become a ballerina, if she doesn’t learn independence. Her mother says, “I think she would stick to one spot all day if I let her.”

  Although Vicki lacks “oomph” and is definitely not a self-starter, certain kinds of movement will get her on her toes. She becomes livelier after getting into unusual positions—rocking forward and back while on all fours, hanging over the edge of her bed upside down, and swinging on her tummy. She still has not figured out how to pump. She loves to be pushed for a long time on the playground swing—and when she stops, she is never dizzy, as other children might be.

  Being pushed passively arouses Vicki, as does actively pushing something heavy. Occasionally, Vicki crams books into her doll carriage and shoves it around the house. She volunteers to push the grocery cart and carry bags into the house. She also enjoys pulling her big sister in a wagon. After pushing and pulling weighty loads, she has some energy for half an hour or so and then sinks back into her customary lethargy.

  At school, Vicki mostly sits. Her teacher says, “Vicki has difficulty socializing and getting involved in classroom activities. It’s like her batteries are low. She needs a jump start just to get going. Then she loses interest and gives up easily.”

  Vicki’s behavior mystifies her parents. Their experiences with their two other active children have not prepared them to deal with her atypical behavior.

  Paul is an extremely shy nine-year-old. He also moves awkwardly, has poor posture and balance, and falls frequently. He does not have the know-how to play, and when he’s in a group with other children, usually he watches dolefully or shuffles away. At their grandparents’ house one Sunday afternoon, Paul’s twelve-year-old cousin, Prescott, invites Paul to play marbles and shoot baskets with him. Paul gives the activities a half-hearted try, shrugs and turns away. “I can’t do that,” he says. “Anyway, what’s the point?”

  Paul dislikes school. Sometimes he asks to stay home, and his parents let him. He says he doesn’t want to go to school because he’s no good at anything, and everyone laughs at him.

  Paul’s teacher notes that he has a long attention span and an above-average reading ability. She wonders why a child with so much information to share becomes paralyzed when he has to write a paper. True, his handwriting is laborious, and his papers are crumpled and full of erasure holes. True, he has a “death grip” on pencils, fixes his elbow to his ribs, and sticks his tongue out when he writes. True, he often slips off the chair when he is concentrating hard on written work. His handwriting skills, she hopes, will improve with more practice. She says he just needs to get organized so he can pay more attention to his assignments and do neater work.

  His parents wonder why he is a misfit at school, because he has always fit right into their sedate lifestyle. Paul is a modest child, rarely seeking attention. He can spend hours slumped over his baseball cards, completely self-absorbed.

  Paul’s parents think he is the perfect child. They observe that he is unlike other kids, who are loud and mischievous. He never makes trouble, although he is somewhat clumsy, often dropping dishes and breaking toys that require simple manipulation. But then, his parents are somewhat clumsy, too, and have come to believe that physical prowess is unimportant. They are glad that their son is quiet, well-mannered and bookish, just like them.

  Something, however, is getting in his way. His parents have no idea what.

  Sebastian, eight, fidgets constantly. At school, he riffles book pages, twiddles with markers, taps rulers and breaks pencils. He clicks his teeth and chews his collar.

  Sebastian’s knees bounce, his feet tap, his eyes dart, his fingers flap his earlobes. He tips his desk chair way back and then brings it forward with a jolt. He squirms in his seat, sitting on his feet or squeezing his knees to his chest. He jumps out of his seat every chance he gets to sharpen his pencil or pitch a wadded paper toward the wastebasket.

  His nonstop activity distracts his classmates and teacher. He used to twirl the lanyard with his latchkey around his finger. Once he let go accidentally and it whirled across the room and hit the blackboard. Now he hands the lanyard over to his teacher every morning so it won’t annoy or hurt anyone.

  Sebastian craves sensations: “More, more, more!” He is the child who “gotta touch,” even when it should be clear that touching is inappropriate.

  One day the teacher is preparing a science lesson. She lays out white glue, laundry borax, and water—the ingredients to make a pliable substance called “Stretchy Gook.” Sebastian is interested and hovers nearby, twitching his fingers and hopping from foot to foot. The teacher says, “Please don’t touch a thing until the other kids join us,” but he reaches forward and knocks over the bottle of glue, spilling it across the table.

  “Sebastian! You did it again!” the teacher says.

  “I didn’t mean to!” Sebastian cries. He shakes his head vigorously from side to side and jumps up and down. “Oh,” he moans, “why do I always get in trouble?”

  “Oh,” moans the teacher, mopping up the mess, “what shall I do with you?”

  Why are Tommy, Vicki, Paul, and Sebastian out of sync? Their parents, teachers, and pediatricians don’t know what to think.

  The children have no identified disabilities, such as cerebral palsy or impaired eyesight. They seem to have everything going for them: They’re healthy, intelligent, and dearly loved. Yet they struggle with the basic skills of managing their responses to ordinary sensations, of planning and organizing their actions, and of regulating their attention and activity levels.

  Their common problem is Sensory Processing Disorder.

  SENSORY PROCESSING DISORDER: A BRIEF DEFINITION

  Sensory Processing Disorder (SPD) is the inability to use information received through the senses in order to function smoothly in daily life. SPD is not one specific disorder, as blindness or deafness is, but rather an umbrella term to cover a variety of neurological disabilities. SPD is also called Sensory Integration Dysfunction (SI Dysfunction) and Dysfunction in Sensory Integration (DSI). Chapter Two explains SPD in more depth.

  The late A. Jean Ayres, PhD, an occupational therapist, was the first to describe sensory problems as the result of inefficient neurological processing. In the 1950s and 1960s, she developed a theory of sensory integration and taught other occupational therapists how to assess it.

  Many brilliant occupational therapists—Dr. Ayres’ colleagues and disciples—have continued her work. Over the decades, as other health professionals, parents and educators have become attuned to the subject, some terminology has been confused, misused, or used in conflicting ways.

  For example, you may hear a pediatrician remark, “I believe your child has some SI,” or a mother says, “My child has SI.” The response to those comments is, “Great! SI (sensory integration) is what we all want!” What the doctor and parent mean is, “The child has sensory integration problems.”

  Using inconsistent terminology hurts the child when therapists, doctors, parents, and insurance companies misunderstand one another and disagree on appropriate treatment. In 2004, a group led by Lucy Jane Miller, PhD, including Sharon Cermak, EdD, Shelly Lane, PhD, and Marie Anzalone, ScD, with Beth Osten and Stanley Greenspan, MD, proposed to clarify the terminology so that all parties are in sync when discussing a person with sensory difficulties.

&nb
sp; Using Dr. Ayres’ original concepts, Dr. Miller’s committee classified the diagnostic groups of SPD in an updated version. In this classification, Sensory Processing Disorder is the overall term, encompassing three main categories (Sensory Modulation Disorder, Sensory Discrimination Disorder, and Sensory-Based Motor Disorder) and their subtypes.

  Categories and Subtypes of Sensory Processing Disorder

  The revisions in this second edition of The Out-of-Sync Child reflect Dr. Miller’s work. Her wonderful book, Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (Perigee, 2007), explains the terminology in detail.

  SPD happens in the central nervous system, at the “head” of which is the brain. When processing is disorderly, the brain cannot do its most important job of organizing sensory messages. The child cannot respond to sensory information to behave in a meaningful, consistent way. He may also have difficulty using sensory information to plan and carry out actions that he needs to do. Thus, he may not learn easily.

  Learning is a broad term. One kind of learning is called adaptive behavior, which is the ability to change one’s behavior in response to new circumstances, such as learning to meet different teachers’ expectations. Adaptive behavior—or adaptive responses—is goal directed and purposeful.

  Another kind of learning is motor learning, which is the ability to develop increasingly complex movement skills after one has mastered simpler ones. Examples are learning to use a pencil after learning to use a crayon, or learning to catch a ball after learning to throw one.

  A third kind of learning is academic learning. This is the ability to acquire conceptual skills, such as reading, computing, and applying what one learns today to what one learned yesterday.