If “freeze” is his style, he may stop in his tracks, unable to move, speak, or even breathe.
If “fright” is his way, then the world is a scary place. Everything may make him crumple and cry. Or he may be fearful and cautious, closing out unfamiliar people and situations.
However possible, he will avoid sensations, particularly touch and movement experiences, because he can’t tolerate them. He may misinterpret a casual touch as a life-threatening blow, feel that he will fall off the face of the earth if he is nudged, or be distressed by changes in routine, loud noises, and crowded settings.
For the out-of-sync child with overresponsivity, meltdowns are common. They may be frequent, happening several times a day. They may be intense, emotional and loud. They may last a long time, perhaps hours or all day. They may be “off the scale,”going far, far beyond other children’s responses to the same situation.
The child may have difficulty understanding gestural communication, too. He may overreact to nonverbal cues and respond with anxiety or hostility. He may be extremely sensitive to someone else’s displeasure, even if the displeasure is not directed toward him.
SENSORY UNDERRESPONSIVITY: THE SENSORY DISREGARDER—“HO, HUM”
Underresponsivity to sensations is another type of SMD. (Other terms are hyporesponsiveness, hyporeactivity, hyposensitivity and undersensitivity.)
The child reacts less intensely to sensations than do typically developing children. This sensory disregarder needs a lot of stimulation just to achieve ordinary arousal or alertness. His response to the world is “Ho, hum.”
The child may be one of two types or sensory disregarders. He may be withdrawn and difficult to engage. Or, he may be so gifted and creative that he does notice sensory stimuli because he is self-absorbed and preoccupied with intellectual pursuits. Determining the underlying cause of a child’s problem is essential, and a therapist’s art and science are required to figure it out.
The sensory disregarder may appear to be a “space cadet” or “out to lunch.” He may be passive, lack initiative and unable to get going. He may tire easily and seem sleepy, and as a baby, he may have slept and slept and slept.
Also, the sensory disregarder may eat and eat and eat, perhaps unaware that he is full. A solution for the child who tends to keep eating is to give him water, soup, or fresh fruit to fill him up before meals and to serve smaller portions.
The underresponsive child may miss cues that other children catch easily. He may bump into desks and people because he doesn’t perceive them in time to move aside. He may hurt himself because he doesn’t register “hot” or “sharp” as painful sensations. He may chew on inedible objects, such as shirt cuffs and toys, to get sensory information through his mouth.
The child may have trouble understanding gestural communication. He may misinterpret nonverbal cues and respond slowly to unspoken messages. He may not “read” other people’s facial expressions and body language. He may not laugh at a clown’s antics, may not comprehend that the teacher is beckoning the children to go indoors, and may not respond to a person’s frown or an animal’s growl.
SENSORY CRAVING: THE SENSORY CRAVER—“MORE, MORE!”
The sensory-craving child hungers for more stimulation than other children and never seems to get enough. “More, more, more!” he cries. He is addicted to certain stimuli. He may be a “toucher and feeler” and a “bumper and crasher.” His brain and body are telling him that he must act, but he often acts in a disorganized way.
He likes to burp and flatulate, talk and hum. He may chew on his fingers and shirt cuffs and collar for extra input.
He craves movement and seeks vigorous experiences, such as spinning for exceptionally long times on the tire swing. Often, he will not feel dizzy. He may get into upside-down positions, with his head hanging over the mattress. He is a climber—on the monkey bars at the playground and on the bookshelf, the window sill and the car roof. Another characteristic of the sensory craver is that he may seek one kind of sensation, but pay scant attention to others.
Busy TV screens may attract him, as may strobe lights, loud noises, crowds, and places with plenty of action, such as football games and car races. He may sniff food, people, and objects, seeking strong odors that others find objectionable. He may crave four-alarm chili, spicy Chinese food, pickles and pickle juice, lemons and red-hot candy.
This child is often a risk taker and a daredevil and may also have poor impulse control. No wonder others frequently look upon him as a troublemaker.
SENSORY COMBINATION: THE SENSORY FLUCTUATOR—“I LOVE THIS, I HATE THAT.”
Another possible type of sensory modulation disorder is a combination of overresponsivity and underresponsivity as the child’s brain rapidly shifts back and forth. Fluctuating responsivity interferes with the child’s adaptive responses. She may be overly sensitive to some sensations, yet shrug off others. She may crave movement, yet cringe from messy play. How common it is to be not all one way!
This sensory fluctuator may seek intense sensory experiences—such as spinning on playground equipment—but be unable to tolerate them. Or, she may seek intense experiences some days and avoid them on other days. Her on-again-off-again responses may depend on the time of day, the place, what she ate, how much sleep she had, and the kind of sensory stimuli. Her behavior implies that her nervous system is undecided, saying, “I love this, I hate that.”
Her behavior bewilders the adults who care for her. Sometimes she will seem to be in sync, sometimes she won’t. Her attention span for things she enjoys may be excellent until certain sensations get in her way. This child is particularly challenging to raise and to teach because it is so hard to know how and when to help her.
The child has great difficulty functioning in daily life. She is not on an even keel and becomes easily upset. Once upset, she may have difficulty recovering.
She may be well regulated at home but have problems at school, or vice versa. She may feel safe and in control at one place, but uncertain and out of control in another. The need to feel in control of people, objects, and experiences is a major issue for the child who does not feel in control of herself.
Sensory Discrimination Disorder
THE SENSORY JUMBLER—“HUH?”
The child with sensory discrimination disorder has difficulty differentiating among and between stimuli. His CNS inaccurately processes sensations, so he is unable to use the information to make purposeful, adaptive responses and function throughout the day. He misgauges the importance of objects and experiences. He may not “get” sensory messages that others use to protect themselves, to learn about their environment, and to relate successfully to other people.
The child often has significant difficulty with visual-spatial tasks. He may be unable to judge where objects and people are in space and may miss important visual cues on the page and in social interactions. He often has auditory discrimination problems, too. These cause him to be easily confused by similar sounding words or by verbal instructions.
This sensory jumbler may have poor body awareness, falling frequently and having trouble catching himself. He uses inappropriate force when using pencils, manipulating toys, and playing with other children. He breaks pencils, struggles to fit Legos together, and bumps into people and things because he is not paying attention.
When the sensory jumbler has problems with touch, movement, and body position, he often has dyspraxia, too. That is no surprise, as praxis requires a discriminatory sense of how one’s body works.
Sensory-Based Motor Disorders
In addition to modulation and discrimination problems, a child with SPD may have sensory-based problems that affect how she moves.
POSTURAL DISORDER: THE SENSORY SLUMPER—“DON’T WANT TO.”
Postural Disorder causes the child to have poor posture. She may have low muscle tone and be “loose and floppy.” She slouches while sitting or standing and slumps over the desk and dining room table. This droopy child is
besieged by the “gravity monster.” The reason may be the inefficient sensory processing of vestibular and proprioceptive sensations about where her body is in space and what it is doing.
According to Dr. Ayres, “The major symptoms manifested by children with this type of dysfunction…are related to the fact that man is a bilateral and symmetrical being.” When a child has not developed a sense of two-sidedness, Postural Disorder may interfere with nature’s plan, which is to keep upright and ready to spring into action, using both sides of the body together or separately as needed.
The child may have a problem with bilateral integration, the neurological process of connecting sensations from both sides of the body. The result is poor bilateral coordination, the ability to use both sides of the body together. For instance, she may struggle to gallop, skip, or pedal a bicycle.
She may have difficulties positioning her body and maintaining her equilibrium. Getting into different positions, such as kneeling or stretching to her tiptoes, without tipping over may also be a challenge.
Often the child will have poor ocular (eye movement) control, affecting binocularity—the use of both eyes together as a team. This will hinder depth perception, body movement, motor planning, and reaching for objects. A problem with crossing the midline, i.e., using the eye, hand or foot of one side of the body in the space of the other eye, hand, or foot, may interfere with her ease in painting a horizon at the easel or swinging a baseball bat.
Keeping up with her peers wears her out. Her grasp on doorknobs and faucets, toys and lunchboxes, is weak. When she sits on the floor, her legs are often in the “W” position, with her knees pointing forward and feet splayed to the side for added stability.
Flexing and extending her muscles, shifting her weight from one foot to the other, twisting her body around while planted on two feet, moving like animals, and so forth, are movement activities that we expect children to enjoy. For the sensory slumper, they are often too daunting.
DYSPRAXIA: THE SENSORY FUMBLER— “I CAN’T DO THAT.”
Dyspraxia is the second type of Sensory-Based Motor Disorder. Dyspraxia refers to disruption in sensory processing and motor planning in children who are still developing.
Dyspraxia causes children to be clumsy and ineffective in their actions. They cannot organize their bodies to move. They reach for a stair tread or a soda can and they miss—a problem called “motor overshoot.” Dr. Ayres says that “these children may have normal intelligence and muscles. The problem is in the ‘bridge’ between their intellect and their muscles.” For some reason, accurate information about touch, movement, and body position cannot cross that bridge from the brain to the body, so the child does not “get it” and cannot use it. (Many examples of how sensory dysfunction leads to Dyspraxia are in the next chapters.)
SIX IMPORTANT CAVEATS
In this book, you will find many checklists of characteristics of children with SPD. You will also find numerous examples of out-of-sync behavior that illustrate the various ways SPD plays out at home and school. You may say, “Eureka! This is my child, to a tee!” On the other hand, you may say, “This is definitely not my child, because my child doesn’t have all these symptoms.” Perhaps your child is somewhere in between.
As you read along, please remember the following caveats:
1) The child with SPD does not exhibit every characteristic mentioned in this book. SPD is not one but several disorders, and nobody can have them all.
2) The child with SPD usually has difficulties in more than one sense, but she may have a concentration of problems in one system, such as the tactile system. If so, she will not necessarily exhibit every characteristic of that category. Thus, the child with vestibular dysfunction may have poor balance but good muscle tone; the child with tactile dysfunction may find light touch intolerable but be a good eater.
3) The child may be both overresponsive and underresponsive in one sensory system, or may be overresponsive to one kind of sensation and underresponsive to another, or may respond differently to the same stimulus depending on the time and context, fluctuating back and forth. Yesterday, after a long recess, he may have coped well with a fire alarm; today, when recess is cancelled, he may have a meltdown when a door clicks shut. Context makes a huge difference.
4) Categories of SPD are not always clear-cut and often overlap. Sensory Overresponsivity and Sensory Underresponsivity, for instance, often look like and merge with Sensory Discrimination Disorder and Dyspraxia.
5) The child may exhibit characteristics of a sensory disorder, yet have another disorder altogether. For example, the child who typically withdraws from being touched may seem to have tactile overresponsivity but instead may have a childhood anxiety disorder or may have been abused.
6) Everyone has some sensory processing problems now and then, because we are all on the sensory processing continuum and no one is well-regulated all the time. All kinds of stimuli can temporarily disrupt functioning of the brain, either by too much or too little sensory stimulation.
COMPARISON OF TYPICAL SENSORY PROCESSING AND SENSORY PROCESSING DISORDER
Typical Sensory Processing Sensory Processing Disorder
What: The ability to take in sensory information from one’s body and the environment, to organize this information, and to use it to function in daily life. The ineffective processing of tactile, vestibular, and/or proprioceptive sensations. The person may have difficulty with other basic senses, too.
Where: Occurs in the central nervous system (nerves, spinal cord, and brain), in a well balanced, reciprocal process. Occurs in the central nervvous system, where the flow between sensory input and motor output is disrupted.
Why: To enable a person to survive, to make sense of the world, and to interact with the environment in meaningful ways. Neuronal connections in the central nervous system are ineffective.
How: Happens automatically as the person takes in sensations through sensory receptors in the skin, the inner ear, the muscles, and the eyes, ears, mouth, and nose. Sensory neurons do not send effective messages into the central nervous system, and/or motor neurons do not send effective messages out to the body for adaptive behavioral responses.
When: Begins in utero and continues developing throughout childhood, with most functions established by adolescence. Occurs before, during, or shortly after birth.
Chapter Three
HOW TO TELL IF YOUR CHILD HAS A PROBLEM WITH THE TACTILE SENSE
THREE KINDERGARTNERS AT CIRCLE TIME
The kindergartners are gathering for circle time. In the center of the rug, Miss Baker has arranged a variety of squashes: acorn, butternut, patty pan, pumpkin, summer, and zucchini.
Most of the children sit down on their individual carpet squares. Robert, however, stands aside and waits until the others are seated. Then he gingerly picks up his carpet square and moves it toward the wall. He pulls two plastic dinosaurs from his pocket and grips one in each hand. Finally, he sits down, as far as possible from Lena, his nearest neighbor.
Patrick finds his carpet square, but, instead of sitting, he makes a crash landing, sprawling face down on the rug. He spreads his arms and legs and swishes them on the rug, shouting, “Look! I’m a windshield wiper!”
Miss Baker says, “Please sit up in your own space, Patrick.”
He sits up and begins to wrestle with another boy until Miss Baker says, “Please keep your hands to yourself, Patrick.”
Eventually, circle time begins. Miss Baker passes each squash around the circle, so the children can get a feel for them.
Patrick squeezes every squash when he gets his hands on it. He rolls the summer squash between his hands and rubs it down his legs. He licks the acorn squash and bites the zucchini.
Miss Baker reminds him, “Just use your hands, not your mouth. And please pass the squash to Lena. It’s her turn.”
Lena, however, is not paying attention. She gazes out the window. When Patrick flings each squash into her lap, she looks down in surpris
e. Without examining the squashes, she passes them quickly to Robert.
But Robert refuses to touch the vegetables. When Lena offers him the first squash, he jabs his dinosaurs toward her face.
Lena recoils and drops the squash. Having figured that Robert isn’t receptive, she places the subsequent samples in front of him.
Using his dinosaurs, Robert pushes each squash away.
Miss Baker lines up the squashes in the center of the rug. She says, “Now, look at the squashes. What can you tell me about them?”
Several children volunteer their observations: “The pumpkin is heavy.” “The zucchini is smooth.” “The patty pan has a bumpy edge.”
Miss Baker says, “You are good observers! What about you, Lena? Do you have something to add?”
Lena hesitates. Then she says, “I see six.”
“True!” says Miss Baker. “Anything else?”
“Nothing,” Lena says.
Miss Baker turns to Robert and says, “How about you?”
Robert says, “This is boring.”
“This isn’t boring!” Patrick bellows. He lunges forward, scoops all the squashes into a pile, and rolls on top of them. “This is fun!”
Miss Baker extricates the squashes from Patrick and says, “Let’s put the squashes away now and sing a song. Then it’s time for free play in the classroom.”
Circle time comes to a close.
Atypical Patterns of Behavior
To the casual observer, Robert, Patrick, and Lena may seem like typical preschoolers. It’s easy to look at their behavior and say, “That’s just the way they are.” But if we look closer, we may notice atypical patterns of behavior.
Touching and being touched distress Robert. He avoids being near the other children and defends himself with his dinosaurs. Handling his carpet square is unpleasant. He refuses to touch the squashes with his hands.
The Out-of-Sync Child Page 9