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The Out-of-Sync Child

Page 4

by Carol Kranowitz


  HOW INEFFICIENT SENSORY PROCESSING LEADS TO INEFFICIENT LEARNING

  Your child yanks the cat’s tail, and the cat hisses, arches its back, and spits. Normally, through experience, a child will learn not to repeat such a scary experience. He learns to be cautious. In the future, his behavior will be more adaptive.

  The child with SPD, however, may have difficulty “reading cues,” verbal or nonverbal, from the environment. He may not decode the auditory message of the cat’s hostile hissing, the visual message of the cat’s arched back, or the tactile message of spit on his cheek. He misses the “big picture,” and may not learn appropriate caution.

  Or the child can read the cat’s reaction, but is unable to change his behavior and stop himself. He receives the sensory information, but can’t organize it to respond efficiently.

  Or the child sometimes can take in sensations, organize them, and respond appropriately—but not today. This may be one of his “off” days.

  Possible results:

  • The child may never learn and may get repeatedly scratched. Thus, he may continue this risky behavior until someone removes the cat, or the cat learns to avoid the child. The child loses a chance to learn how to relate positively to other living creatures.

  • The child becomes fearful of the cat. He may not understand cause and effect and may be bewildered by what seems to be unpredictable cat behavior. He may become afraid of other animals, too.

  • Eventually, the child may learn about cause and effect, may learn to grade his movements, may learn to treat animals gently, and may grow up to love cats—but this will happen only with much conscious effort, after much time and many, many scratches.

  The brain-behavior connection is very strong. Because the child with SPD has a disorganized brain, many aspects of his behavior are disorganized. His overall development is disorderly and his participation in childhood experiences is spotty, reluctant or inept. For the out-of-sync child, performing ordinary tasks and responding to everyday events can be enormously challenging.

  The inability to function smoothly is not because the child won’t, but because he can’t.

  COMMON SYMPTOMS OF SPD

  Below are four checklists of common symptoms of SPD. The first list, “Sensory Modulation Problems,” pertains to how a child regulates his responses to sensations. Some children with poor modulation are primarily overresponsive, some are primarily underresponsive, some are primarily sensory craving, and others fluctuate.

  The second list, “Sensory Discrimination Problems,” includes examples of how a child may have difficulty in distinguishing one sensation from another.

  The third list, “Sensory-Based Motor Problems,” has examples of how a child may position his body in unusual ways and have difficulty in conceiving of an action to do, planning how to organize and move his body, and carrying out the plan.

  The fourth list, “Associated Regulatory and Behavior Problems,” pertains to issues that can result from inefficient sensory processing as well as from other developmental problems. The child with these problems does not necessarily have SPD.

  As you check the symptoms that you recognize, please understand that they will vary from child to child, because every brain is unique (just as every fingerprint is unique). No child will exhibit all the symptoms. Still, if several descriptions fit your own son or daughter, chances are that he or she has some degree of SPD.

  The child with severe SPD shows many symptoms. Interacting with other people, functioning in daily life, and succeeding in the occupation of being a child are greatly impaired. The child with mild SPD is slightly impaired and may find ways to compensate—but the problem is frequently overlooked. The child with moderate SPD is somewhere in between.

  Whether the child has severe, moderate or mild dysfunction, he or she needs understanding and help. Ignoring problems will not make them disappear.

  Sensory Modulation Problems

  The first and most common category of SPD is Sensory Modulation Disorder. This is suspected when the child exhibits one or more symptoms with frequency, intensity and duration. Frequency means several times a day. Intensity means that he adamantly avoids sensory stimulation, or throws his whole body and soul into getting the stimulation he needs. Duration means that this unusual response lasts for several minutes or longer.

  These charts will give you a quick overview of common problems. Later chapters will provide more details.

  While difficulties with touch, movement and body position are the telltale signs of SPD, the child may also respond in atypical ways to sights, sound, smells, and tastes:

  Sensory Discrimination Problems

  Another category of Sensory Processing Disorder is Sensory Discrimination Disorder, which is the difficulty in distinguishing one sensation from another, or in understanding what a sensation means. The child with poor discrimination may have a problem protecting himself or learning something new. Often, he also is underresponsive and has a Sensory-Based Motor Disorder.

  Sensations Child with Sensory Discrimination Disorder (“Huh?”)

  Touch Cannot tell where on her body she has been touched. Has poor body awareness and is “out of touch” with her hands and feet. Cannot distinguish objects by feel alone (without seeing). Is a sloppy dresser and unusually awkward with buttons, barrettes, etc. Handles eating utensils and classroom tools inefficiently. May also have difficulty processing sensations of pain and temperature, e.g., gauging how serious a bruise is and whether pain is better or worse, or whether she is hot or cold.

  Movement and Balance Cannot feel himself falling, especially when eyes are closed. Becomes easily confused when turning, changing directions, or getting into a stance where his head is outside an upright, two-footed position. May be unable to tell when he has had enough movement.

  Body Position and Muscle Control May be unfamiliar with own body, lacking “internal eyes.” Is “klutzy” and has difficulty positioning limbs for getting dressed or pedaling a bike. Cannot grade movements smoothly, using too much or not enough force for handling pencils and toys or for pushing open doors and kicking balls. May bump, crash, and “dive bomb” into others in interactions.

  Sights If problem is caused by SPD (and not nearsightedness, for example), may confuse likenesses and differences in pictures, written words, objects, and faces. In social interactions, may miss people’s expressions and gestures. Has difficulty with visual tasks, such as lining up columns of numbers or judging where things are in space—himself, included—and how to move to avoid bumping into objects.

  Sounds If problem is caused by SPD (and not ear infections or dyslexia, for example), may have difficulty recognizing the differences between sounds, especially consonants at ends of words. Cannot repeat or make up rhymes. Sings out of tune. Looks to others for cues, as verbal instructions may be confusing. Has poor auditory skills, such as picking out a teacher’s voice from a noisy background, or paying attention to one sound without being distracted by other sounds.

  Smell and Tastes Cannot distinguish distinct smells such as lemons, vinegar, or soap. Cannot distinguish tastes or tell when food is too spicy, salty, or sweet. May choose or reject food based on the way it looks.

  Sensory-Based Motor Problems

  The third category of SPD is Sensory-Based Motor Disorder, which includes two types. One type is Postural Disorder, involving problems with movement patterns, balance and using both sides of the body together (bilateral coordination). The problem often coexists with underresponsivity and poor sensory discrimination.

  Sensory-Based Motor Skills Child with Postural Disorder (“Don’t want to.”)

  Components of Movement May be tense or have “loose and floppy” muscle tone, a weak grasp on objects, and difficulty getting into and maintaining a stable position. Has a problem fully flexing and extending her limbs. Slouches and sprawls. Has difficulty shifting weight to crawl and rotating body to throw a ball.

  Balance Loses balance easily when walking or changing positi
ons. Trips on air.

  Bilateral Coordination Has difficulty using both sides of the body together for jumping symmetrically, catching balls, clapping, holding swing chains, and pumping. Has difficulty using one hand to assist the other, such as holding a paper while cutting, or a cup while pouring.

  Unilateral Coordination May not have a definite hand preference. May use either hand to reach for an object or to use tools such as pens and forks. May switch object from right to left hand when handling it, eat with one hand but draw with the other, or manipulate scissors using both hands.

  Crossing the Midline May have difficulty using a hand, foot, or eye on the opposite side of the body, such as using one hand to paint or reading a line across a paper.

  The second type of Sensory-Based Motor Disorder is Dyspraxia, or difficulty with praxis (Greek for “doing, action, practice”). Praxis is based on unconscious sensory processing as well as conscious thought. The dyspraxic child has problems performing coordinated and voluntary actions.

  Sensory-Based Motor Skills Child with Dyspraxia (“I can’t do that.”)

  Components of Praxis May have difficulty: 1) conceiving of a new, complex action to do, 2) sequencing the steps and organizing body movements to do it, and 3) carrying out the multiple-step motor plan. May be awkward, clumsy, apparently careless (even when trying to be careful) and accident prone.

  Gross-Motor Planning May have poor motor coordination and be clumsy when moving around furniture, in a crowded room or on a busy playground. Has problem with stairs, obstacle courses, playground equipment, and large-muscle activities such as walking, marching, crawling, and rolling. Ability to learn new motor skills, such as skipping, may develop noticeably later than others’.

  Fine-Motor Planning: Hands May have difficulty with manual tasks, including drawing, writing, buttoning, opening snack packages, using eating utensils, doing jigsaw puzzles, playing with and cleaning up Legos.

  Fine-Motor Planning: Eyes May have difficulty using both eyes together, tracking moving objects, focusing, and shifting gaze from far to near point. May have a problem copying from the black-board, keeping his place in a book, and organizing desk space. May have sloppy handwriting and poor eye-hand coordination when drawing, creating art projects, building with blocks, or tying shoes.

  Fine-Motor Planning: Mouth May have difficulty sucking on a nipple or through a straw; eating, chewing, and swallowing; blowing bubbles and breathing; holding mouth closed. May drool excessively. May have problem articulating speech sounds and speaking clearly enough to be understood (by age of three).

  WHAT SPD IS NOT: “LOOK-ALIKE” SYMPTOMS

  Many symptoms of SPD look like symptoms of other common disabilities. Indeed, so many symptoms overlap that differentiating one difficulty from another may be difficult. For example, if a child is inattentive and often has difficulty staying focused on tasks or play activities, he may have SPD. Similarly, if the child is hyperactive, often fidgeting or squirming, he may have SPD.

  But—might something else be going on? Yes, indeed. An alternative diagnosis may be that the child has Attention-Deficit/ Hyperactivity Disorder (ADHD), learning disabilities (LD), poor auditory or visual discrimination, speech/language problems, allergies, nutritional deficiencies, an emotional problem—or that he is behaving just like a typical child!

  Some children have only SPD. Others have SPD in addition to one or more other disabilities, such as ADHD and LD. The overlapping circles in the diagram on page 22 illustrate the relationship of these three common problems that can affect children’s behavior. Please understand that ADHD and LD are just two of the many disorders, including autism, with which SPD can overlap.

  So, how can one tell the difference between SPD and other disabilities? The red flags are a child’s unusual responses to touching and being touched or to moving and being moved.

  The descriptions below provide information about some of the other problems associated with SPD.

  ASSOCIATED PROBLEMS

  A democratic disorder, SPD affects people of all ages, races, and cognitive skills, all over the world. Diverse populations include those with severe neurological disabilities, mild cerebral palsy and autism spectrum disorders, premature babies, sensory-deprived children in Eastern European orphanages, and highly gifted children. Although these children may not seem to have much in common, they frequently experience similar problems in processing sensations.

  How Three Common Problems May Overlap

  Although SPD can stand alone, it often coexists with—and complicates—other problems. For instance, if a child has autism, he may also have overresponsivity to touch. The sensory problem does not cause autism, but it certainly exacerbates it. The more difficulty a child has in one area, the more difficulty he is likely to have in others. This is especially true with neurological disabilities, which are on a continuum.

  Please be aware that the problems discussed below may have a sensory processing component—or they may be caused by another developmental problem altogether.

  Regulatory Disorders

  SELF-REGULATION

  The child may have difficulty modulating (adjusting) his mood. He may be unable to “rev up,” or to calm down once aroused. He may become fussy easily. He may have difficulty with self-comforting after being hurt or upset. Delaying gratification and tolerating transitions from one activity to another may be hard. The child may perform unevenly: “with it” one day, “out of it” the next. Therapy, a “sensory diet” and nutritional supplements are some of the treatments that may help (see Chapter Nine).

  SLEEPING

  Falling asleep, staying asleep, and waking up may be problematic. The child with SPD may need an unusually long afternoon nap, or she may never nap even if exhausted. Because a sleep disorder is often caused by a separation problem, she may want to sleep with her parents. She may have trouble comforting herself to sleep, or may constantly awaken during the night.

  Sleep problems may be associated with a high need for movement. If the child has not had her quota of movement during the day, her arousal levels may fluctuate erratically, and she may become overaroused at night.

  Over- or underresponsivity also may cause the child to feel uncomfortable in bed. The pajamas or sheets may feel scratchy. The pillowcase may not smell right, especially after its familiar, ripe scent has been washed out. The blankets may be too heavy or not heavy enough.

  Sensory integration treatment addresses the underlying problem, which is poor regulation of arousal and self-calming. Until this issue is “put to rest,” try these suggestions to help a child fall and stay asleep:

  • During the day—plenty of movement, such as swinging and jogging; hard work, such as carrying laundry baskets; dietary supplements that calm the brain, such as magnesium, essential fatty acids, and GABA (gamma-aminobutyric acid); no foods with additives including aspartame, MSG and artificial colors, which excite the brain

  • Before going to bed—a warm bath and then right into bed; no TV or computer time for a couple of hours before bed

  • In bed—one great story; a back massage and deep joint compression to the shoulders, arms and legs; a tight tuck-in under a weighted blanket; and saying, “Just pretend to sleep”

  • After the tuck-in—a night light if the child is afraid of the dark; sleepy sounds, e.g., Bach or Mozart adagios; Genevieve Jereb’s Cool Bananas, or white noise such as the sound of rain or waves; and your own parental resolve!

  EATING

  Settling down to eat may be a challenge for the out-of-sync child. One reason may be overresponsivity to tactile sensations. The texture and consistency of the mashed potatoes, rice pudding, applesauce, or turkey burger may be intolerable in a sensitive mouth. Tactile oversensitivity in the mouth is also called “oral defensiveness.”

  Another reason may be that the food looks, smells, or tastes yucky. A picky eater may have trouble getting the food to his mouth because of inefficient processing of sensations coming from the muscles (proprioception
). Or he may need to concentrate not on eating but on staying seated because of inefficient processing about where he is in space and whether he is sitting up or falling off his chair (the vestibular system).

  Still another reason may be that the child has not developed a basic sensory-motor pattern involving the coordination of sucking, swallowing, and breathing. The result is poor oral-motor skills, which affect chewing and eating solid food, trying new food, keeping food down, digesting food, and so forth.

  Whatever the reason for selective eating, the picky eater has unusual food preferences or a limited food repertoire. He may eat only crispy foods, such as bacon and crackers, or only soft foods, such as yogurt and macaroni and cheese, or only cold or hot foods. He may crave sour foods, such as pickles, and sweets, such as sugary snacks and juice. As a result, nutritional deficits and cravings may affect his development, weight, and stamina and cause him to have behavioral ups and downs, much like a yo-yo.

  Usually absent from the picky eater’s diet, and thus from his body and brain, are essential fatty acids, B vitamins, minerals, and fat-soluble antioxidants. A child who rejects peanut butter, broccoli, spinach, beans, and sweet potatoes, for example, may get insufficient magnesium, an essential mineral. A magnesium deficiency may lead to hearing damage, auditory processing problems, muscle spasms, restless sleep, and sensory-motor difficulties associated with frequent ear infections. A deficiency in zinc (found in eggs, peanuts, bran, cocoa, etc.) may affect the child’s sense of taste and, thus, her interest in food. It may also lead to low muscle tone, auditory and visual problems, rashes and “fly away” hair.

  Here are some suggestions to improve your child’s eating:

  • Get rid of junk food

  • Provide nutritional supplements, especially Omega-3 fats (found in flaxseeds, walnuts, and salmon), because the nervous system is made up of about 60 percent fat

 

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