Often____ Sometimes____ Rarely____
5. Tend to be easily frustrated?
Often____ Sometimes____ Rarely____
6. Tend to be unusually uncooperative or stubborn?
Often____ Sometimes____ Rarely____
7. Have temper tantrums or outbursts of anger?
Often____ Sometimes____ Rarely____
8. Seem to need more protection from life than other children?
Often____ Sometimes____ Rarely____
HOPE IS AT HAND
Having looked at the questionnaire, you should be getting a feel for how SPD can get in a child’s way. If you (and the teacher) checked “Often” many times, you may believe you have an out-of-sync child. You may be asking: Is my child’s development out of my hands? Will my child become an out-of-sync adult?
Not necessarily. Your child may develop into a self-regulating, functioning grown-up if he or she receives understanding, support, and early intervention.
Early intervention involves treatment designed to correct or prevent the young child’s developmental delays or disabilities. Treatment for SPD usually comes in the form of occupational therapy in a sensory integration framework (see Chapter Eight). With treatment, the child can become as competent as possible—physically, academically, and emotionally.
Young children respond well to early intervention, because their central nervous systems are still flexible, or “plastic.” Plasticity means that children’s brain functioning is not fixed; it can change or be changed.
As children grow, their brains become less malleable and their unusual reactions to sensations become more established. If your child is older than a preschooler, however, don’t give up hope! Older children and even adults benefit from therapy, too. It is never too late to get help.
For the child with severe sensory dysfunction, treatment is crucial. For the child with moderate or even mild dysfunction, treatment can make a wonderful difference.
How Does Treatment Help?
Treatment helps the child process all the senses, so they can work together. When the child actively engages in meaningful activities that provide the intensity, duration, and quality of sensation his central nervous system craves, his adaptive behavior improves. Adaptive behavior leads to better sensory processing. As a result, perceptions, learning, competence, and self-confidence improve. The child becomes able to plan, organize and carry out what he needs and wants to do. Without treatment, SPD may hamper his life in countless ways.
Treatment helps the child now, when he needs assistance to function smoothly. Treatment now helps him build a strong foundation for the future, when life becomes more demanding and complex. Without treatment, SPD persists as a lifelong problem. Indeed, the child will not grow out of Sensory Processing Disorder, but will grow into it.
Treatment helps the child develop skills to interact successfully in social situations. The out-of-sync child often lacks the skills to play—and play is every child’s primary occupation. Without treatment, SPD interferes with the child’s friendships.
Treatment gives the child the tools to become a more efficient learner. Without treatment, SPD interferes with the child’s ability to learn, at home, school, and abroad.
Treatment improves the child’s emotional well-being. Without treatment, the child who believes she is incompetent may develop into an adult with low self-esteem.
Treatment improves family relationships. As the child responds to sensory challenges with growing self-control, home life becomes more pleasant. With professional support, parents learn to provide consistent discipline and to enjoy their child. In-laws become more empathetic and less critical, and siblings resent the out-of-sync child less. Without treatment, SPD interferes with the interactions and coping skills of everyone in the family.
Johnny is an example of a child who greatly benefited from early intervention. When he was a preschooler, SPD affected his ability to move, play, learn, and relate to others. It affected his posture and balance, hearing and vision, food preferences and sleep patterns. He was fearful, angry, inflexible, and lonely.
Johnny’s feet never left the ground because movement made him uncomfortable. He would stand and watch but not join his schoolmates in playground activities. He always carried a stick, as a buffer against the world. When someone approached him, he would brandish the stick and holler, “You’re fired!” His sole pleasure was curling up in the quiet corner, peering at a book.
Johnny was one of the first children we screened at St. Columba’s Nursery School for SPD. We shared our findings with his parents and suggested occupational therapy, mentioning that early intervention could prevent later problems.
Listening to us, his father folded his arms, scowled, and shook his head. His mother wept and said, “This is all a bad dream.”
Although skeptical, his parents decided to take our advice. They took Johnny to a pediatric occupational therapist twice a week. Working with the therapist and his teachers, they devised a sensory diet with activities at home and school to help him become as competent as he could be.
Gradually, Johnny began to participate in some activities. He didn’t learn to relish messy play or a rowdy game of tag, but he did learn to paint at the easel and pump on the swing. He stopped carrying his stick in self-defense. He started to use his “indoor” voice instead of bellowing. He found a friend, and then two. He was becoming a real kid.
Today, Johnny is a dream-come-true. Now ten, he plays soccer and basketball. He’s a Boy Scout who enjoys camping and climbing rocks. He reads a book every week, for pleasure. Everyone wants to be his friend, because he is reliable and sensitive—in all the right ways. His teacher says, “I wish I had twenty other Johnnys in my classroom.”
Johnny’s story is true. His dysfunction, once severe, is now mild. He still eats carefully, feels uncomfortable in crowds, avoids escalators, and tends to be a perfectionist. But nobody’s perfect!
Not every out-of-sync child will have Johnny’s success. Most children do improve, however, when their parents take action. Here are some suggestions:
• Get information and share it with pediatricians, teachers and other caregivers, when appropriate.
• Although difficult to do, accept that the child does not fit your mental image of the perfect child; acknowledge that it is okay and sometimes preferable to have differing abilities.
• Provide the child with a well-balanced sensory diet (Chapter Nine).
• Be patient, consistent and supportive.
• Help the child take control of his or her body and life.
The journey may be long. It may be expensive. It will certainly be frustrating at times. But the journey will also be wonderful and exciting as you learn to help your son or daughter succeed in the occupation of childhood.
Hope is at hand.
Chapter Two
UNDERSTANDING SENSORY PROCESSING—AND WHAT CAN GO AMISS
Understanding basic information about sensory processing and Sensory Processing Disorder is important. You need to know about the senses, the developmental stages of sensory processing through which a young child normally progresses, and what happens when sensory processing does not go according to Mother Nature’s plan.
THE SENSES
Our senses give us the information we need to function in the world. Their first job is to help us survive. Their second job, after they assure us that we are safe, is to help us learn how to be active, social creatures.
The senses receive information from stimuli both outside and inside our bodies. Every move we make, every bite we eat, every object we touch produces sensations. When we engage in any activity, we use several senses at the same time. The convergence of sensations—especially touch, body position, movement, sight, sound, and smell—is called intersensory integration. This process is key and tells us on the spot what is going on, where, why, and when it matters, and how we must use or respond to it.
The more important the activity, the more senses we use. Th
at is why we use all our senses simultaneously for two very important human activities: eating and procreating.
Sometimes our senses inform us that something in our environment doesn’t feel right; we sense that we are in danger and so we respond defensively. For instance, should we feel a tarantula creeping down our neck, we would protect ourselves with a fight-or-flight response. Withdrawing from too much stimulation or from stimulation of the wrong kind is natural.
Sometimes our senses inform us that all is well; we feel safe and satisfied and seek more of the same stimuli. For example, we are so pleased with the taste of one chocolate-covered raisin that we eat a handful.
Sometimes, when we get bored, we go looking for more stimulation. For example, when we have mastered a skill, like ice skating in a straight line, we attempt a more complicated move, like a figure eight.
To do their job well, so that we respond appropriately, the senses must work together. A well-balanced brain that is nourished with many sensations operates well, and when our brain operates smoothly, so do we.
We have more senses than many people realize. Some sensations occur outside our bodies, and some inside.
The External Senses
The sensory systems that receive sensory messages coming from the outside of our body and beyond are sometimes called the external or environmental senses. The information from these senses is called exteroception, referring to the five senses with which we are most familiar:
• The tactile sense, providing information about touch, which we receive through contact with the skin (see Chapter Three),
The External (Environmental) Senses
• The olfactory and gustatory senses, providing information about smell and taste, through contact with the nose and mouth, and
• The visual and auditory senses, providing information about sights and sounds coming from “out there” in the environment, without actual contact with our eyes and ears. (See Chapters Six and Seven.) Seeing and hearing are sometimes called the “far senses” because the messages come from a distance.
We are conscious of our external senses, and we have some control over them. We can scrutinize a photograph of the third-grade class to pick out our child’s face, or shut our eyes to avoid looking at an unpleasant scene. We can distinguish between a telephone ring and a doorbell, or cover our ears to screen out the dissonance of an untuned violin. We can touch a keyboard letter with one fingertip, or keep our hands jammed in our pockets. As we mature, our brains refine our external senses so that we can respond in a satisfying way to the world around us.
The Internal Senses
When we think about sensory channels, the external senses come first to mind. Less familiar are the internal senses—sometimes called the hidden, special, near, somatosensory (“soma” means “body” in Greek), or body-centered senses. We are unconscious of these senses, yet they are always with us, and we cannot turn them off.
• The interoceptive sense, or interoception, providing information about sensations coming from our internal organs. With a “mind” of its own, it keeps our bodies humming and is essential for survival. It regulates functions such as hunger, thirst, digestion, body temperature, sleep, mood, heart rate, and state of arousal. It runs on autopilot until we become conscious of the need to act, i.e., eat, drink, urinate, remove our sweater, and so forth. Many children lack efficient interoception and, for example, may not sense when they are hungry or need to have a bowel movement.
• The vestibular sense, providing information about the position of our head in relation to the surface of the earth, the movement of our body through space, and balance. Sensations come through the inner ear. (See Chapter Four.)
• The proprioceptive sense, or proprioception, providing information about body position and movement of our body parts. Information comes from stretching and contracting our muscles. (See Chapter Five.)
The Internal (Body-Centered) Senses
Dr. Ayres highlighted the importance of the tactile, vestibular, and proprioceptive senses that provide the sense of oneself in the world. Fundamental for functioning, these three senses lay the groundwork for a child’s healthy development. When they operate automatically and efficiently, the child can turn his eyes, ears, and attention to the external world.
Typically, a child is born with his sensory apparatus intact, ready to begin his lifelong work of sensory processing.
WHAT IS SENSORY PROCESSING?
Sensory processing is the neurological procedure of organizing the information we take in from our bodies and the world around us for use in daily life. Sensory processing is dynamic, ceaseless, and cyclical. It occurs in the nervous system, which consists of 100 billion neurons, a spinal cord, and a brain. (See Appendix A.)
According to Dr. Ayres, “Over 80 percent of the nervous system is involved in processing or organizing sensory input, and thus the brain is primarily a sensory processing machine.” When our brain efficiently processes sensations, we respond automatically with adaptive responses that help us master our environment. Adaptive responses are actions or thoughts that help us meet new challenges and learn new lessons. When we feel safe and need not put every effort into staying alive, we can use sensations to get on with the everyday human occupations of moving, learning, playing, working, and enjoying relationships with others.
Sensory processing involves reception, detection, integration, modulation, discrimination, postural responses, and praxis. These processes are simultaneous. Here are the basics, in an extremely simplified discussion of an extremely complex process.
Reception and Detection
One process is sensory reception. Every minute of every day, millions of sensations are received in the peripheral nervous system (PNS)—the nervous system outside the spinal cord and brain, where nerves begin and end. (“Peripheral” literally means “carried around,” i.e., away from the center.) Sensations from the skin, muscles, ears, eyes, mouth, and nose travel through the PNS to the CNS. Imagine the incoming sensations saying, “Knock, knock! Here we are!”
In the process of detection, the CNS notices these sensory messages. The brain says, “Come in, all you sensations! I can see (hear, touch, smell, etc.) you!”
Integration
Integration is the continuous part of the process whereby sensations from one or more sensory systems connect in the brain. “Meet the gang!” the brain says to the various sensations. “Touch, team up with Vision. Hearing, connect with Movement.” The more sensory systems involved, the more accurate and multidimensional the information will be—and the more efficient the person’s adaptive response will be.
Modulation
Another component of sensory processing is modulation. This is the term used to describe the brain’s regulation of sensory input. Modulation instantly adjusts and balances the flow of sensory information into the CNS. The sensory systems need to work in tandem to keep us in sync.
Incoming sensations activate sensory receptors in a process called excitation. Excitation promotes connections between sensory input and behavioral output. Excitation is alerting. “Pay attention!” the sensations insist.
Most of the time, we do pay attention to meaningful sensory messages. If moving rhythmically in a rocking chair is calming, our brain gives us the go-ahead to continue. If spinning in circles makes us feel sick, our brain usually directs us to stop.
Sensations advising us that we are in danger are highly significant. We are hardwired to regulate our attention to danger signals in order to defend ourselves. Like all creatures, the human baby is born with sensory wariness, which he needs for survival. When potentially harmful stimuli touch him in some way, his nervous system says, “Uh, oh! Quick! Do something!”
The majority of sensations, however, are irrelevant. In a process called inhibition, our brain allows us to filter out useless information and focus on what matters at the moment. Without inhibition, we would be extremely distractible, giving full attention to every sensation, useful or not. For
instance, it is unnecessary to respond to the sensation of air on our skin or of a shift in balance when we take a step, so we learn to ignore the messages. The brain says, “Settle down. That’s nothing to get excited about. Don’t even think about it.”
HOW MODULATION AFFECTS A CHILD’S BEHAVIOR
A Child with Typical Modulation A Child with Sensory Modulation Disorder
During recess, Mandy, seven, plays jacks and ignores the cold pavement because the game interests her. Her hands are cold, though, so she doesn’t play well. The first time she fails to scoop up the jacks, she’s disappointed. The second time, she’s annoyed. The third time, she’s thoroughly frustrated. She says, “I’m going to jump rope.” Jumping for a few minutes warms her up and makes her feel better. After recess, Mandy returns to her classroom and is calm and attentive until lunchtime. Beth, seven, is playing jacks. She can’t concentrate because the cold pavement distracts her. On her first two turns, she has trouble scooping up the jacks. Beth tries again, but her hands are too stiff. Suddenly, she explodes and screams, “I hate jacks!” She jumps to her feet, kicks the jacks into the grass, and leans against the building, crying uncontrollably. Unhappy for the rest of the morning, she can’t calm down to attend to the reading lesson, and she refuses to eat lunch.
Some messages are unimportant now, although they initially grabbed our attention. After a while, when we have become accustomed to familiar messages, habituation occurs. This process tunes sensations out because they are no longer extraordinary. At first, we sense the tautness of the seat belt and the tartness of the lemon drop—and then get used to it.
Habituation does not occur readily for everyone. A process called sensitization may be the norm for sensory-sensitive people. Their brain interprets stimuli as important, unfamiliar or harmful, even if the stimuli are unimportant, familiar, and benign. Quicker and longer than other people, they notice sensations and are bothered or distracted by them. Always, the seat belt feels too tight and the lemon drop tastes too tart.
The Out-of-Sync Child Page 7