The Out-of-Sync Child
Page 10
Touching and being touched delight Patrick. He uses his whole body to feel the rug. He tackles another child. He manhandles, mouths, and rolls on the squashes.
Touching objects to learn about them is not Lena’s forte. Giving scant attention to the squashes, she doesn’t perceive whether they are heavy or light, big or small, bumpy or smooth. Her only observation is about their quantity, not their quality.
These children may appear to be very different, but they have something in common: an identifiable problem with the tactile sense.
On the next pages you will learn how the tactile sense is supposed to function, followed by an explanation of the types of SPD that affect Robert, Patrick, and Lena.
THE SMOOTHLY FUNCTIONING TACTILE SENSE
The tactile system, or sense of touch, plays a major part in determining physical, mental, and emotional human behavior. Every one of us, from infancy onward, needs constant tactile stimulation to keep us organized and functioning.
We get tactile information through sensory receiving cells—called receptors—in our skin, from head to toe. Touch sensations of light touch, deep pressure, skin stretch, vibration, movement, temperature, and pain activate tactile receptors. These sensations are external and come from stimuli outside our body.
We are always actively touching or passively being touched by something—other people, furniture, clothes, spoons. Even if we are stark naked, our feet still touch the ground, and the air touches our skin.
According to Dr. Ayres, “Touch is one of the senses that is especially involved in the ongoing process contributing to perception of other types of sensation. Touch has been one of the predominating senses throughout evolution, is a predominant sensation at birth, and probably continues to be more critical to human function throughout life than is generally recognized.”
This huge sensory system connects us to the world and bonds us to others, starting when we first nestle at our mother’s breast, skin to skin. It gives us essential information for body awareness, motor planning, visual discrimination, language, academic learning, emotional security, and social skills.
Two Components: Defensive (“Okay!” or “Uh, Oh!”) and Discriminative (“Aha!”)
Two components make up the tactile sense. First is the protective (or defensive) system. Its purpose is to alert us to potentially harmful—or healthful—stimuli. Tactile receptors for this protective system are especially in hairy skin on the head, face, and genitals. Light touch is the stimulus that causes these receptors to respond.
Sometimes a light touch is alarming, such as a mosquito alighting on our skin. “Uh, oh!” our nervous system tells us. We respond negatively, for self-preservation. Sometimes a light touch is charming, such as a lover’s gentle caress, and our nervous system says, “Okay!” We respond positively, for preservation of the species!
Ordinarily, modulation of touch sensations improves as we interact with other people and objects. We learn to inhibit sensations that do not matter and to tolerate trifling touches that would have irritated us in infancy. Of course, when a stranger gets too close, we shrink; when a lash gets in our eye, we blink. But usually, we ignore light touch sensations because they do not grab our attention the way deep pain or extremes in temperature do.
The second component of the tactile sense teaches us to discriminate what kind of touch we are feeling. Feeling the warmth of Mommy’s skin, the roughness of Daddy’s stubble, the crunchiness of gravel underfoot, and the roundness of an orange, we gain conscious insights, intuition, and knowledge about the world. Where have we felt this touch before? What could that touch signify? And what should we do about it? With the capability to remember and interpret the meaning of touches, we gradually develop tactile discrimination.
“Aha!” the nervous system says, telling us:
• That we are touching something or that something is touching us,
• Where on our body the touch occurs,
• Whether the touch is light or deep, and
• How to perceive the attributes of the object, such as its size, shape, weight, density, temperature, and texture.
The receptors for tactile discrimination are in the skin, especially on the palms and fingertips, the soles of the feet, and the mouth and tongue. Deep touch, or “touch pressure,” is the stimulus that causes the receptors to respond.
As you read on, you will understand why a smoothly functioning tactile system is necessary to function normally, and how an out-of-sync tactile system is disruptive.
THE OUT-OF-SYNC TACTILE SENSE
Tactile dysfunction, a major problem, is the inefficient processing in the central nervous system of sensations perceived through the skin. All categories of SPD can interfere with the way a child organizes and uses tactile sensations.
The child has difficulty with touching, and being touched by, objects and people. He may have one or more problems with modulation, discrimination, or sensory-based motor skills as he goes through the day, depending on what subtype(s) of SPD he has. (See chart on page 10.)
Sensory Modulation Disorders
TACTILE OVERRESPONSIVITY—“OH, NO!”
The child with overresponsivity to touch (tactile defensiveness) has the tendency to respond negatively and emotionally to unexpected, light touch sensations. The child will respond this way not only to actual touch but also to the anticipation of being touched. Perceiving most touch sensations to be uncomfortable, scary, or outright terrifying, he overresponds with a fight, flight, fright, or freeze response.
He may wrestle in your arms as you try to dress or lift him. He may wriggle out of his clothes or car seat. He may kick, punch, or scream at anyone who comes too close for comfort.
HOW TACTILE OVERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR
A Child with Typical Modulation A Child with Overresponsivity
Getting ready for school, Daniel, three, tolerates having his father brush his hair and wash his face. He doesn’t enjoy this experience, but he can adapt to it and can recover immediately. His maturing neurological system allows him to suppress a fight-or-flight response. Getting ready for school, Will, three, flinches when his father tries to brush his hair and wash his face. He pushes his father away and cries, “You’re hurting me!” Defensiveness still rules his reactions to touch, so he produces an infantile fight-or-flight response. He’s upset all during breakfast.
The child may flee from contact with finger paints, pets, and people. He may find the touch of unfamiliar people to be intolerable. Or, he may withdraw passively by simply avoiding the objects and people that distress him. He never gets close to them, or he walks away.
He may be afraid and start to cry when he has to take a bath. He may stop dead in his tracks and not know what to do when his cuffs get wet at the sink.
All children need touch information to learn about the world. So how does the child with tactile defensiveness get this information? By touching!
Parents are often mystified when they learn that their child has tactile overresponsivity. They protest, “But he often asks for hugs and back rubs. He usually carries something in his hands. How can you say he has a problem with touch?”
The answer is the type of touch that the child avoids or seeks. The child typically avoids passive, unexpected, light touch, such as a gentle kiss. A kiss is irritating, and the child may try to rub it off. While the child avoids light touch, he not only accepts but also craves deep touch, like a bear hug. A hug provides firm touch and deep pressure, which feels wonderful and actually helps suppress sensitivity to light touch.
While the child may long for the hug, he may reject the hugger unless the hugger is on his “OK” list. A likely OK person is a parent or another predictable individual whom the child trusts. People on his “Not OK” list may be classmates, babysitters, relatives, and even loving grandparents, to their great sorrow.
This child needs touch information more than children with a well-regulated tactile sense who get it just by waking up in the morni
ng and going through the day. To get the stimulation his brain needs, he may actively, repeatedly touch those surfaces and textures that provide soothing and comforting tactile experiences. For example, he may cling to a blanket, like Linus in the Peanuts comic strip. He may also hold objects such as a stick or a toy in his hand. He may mouth toys. Perhaps these objects help him defend himself from the unexpected touch sensations abounding in the environment.
TACTILE UNDERRESPONSIVITY—“HO, HUM.”
The child with underresponsivity to touch tends to disregard touch, whether the touch is soothing or painful.
Instead of murmuring, “Mmm!” when his mother cradles him, he seems to say, “Ho, hum. This TLC has no effect on me.” Instead of crying, “Ouch!” when he stubs his toe, he seems to say, “Ho, hum. I didn’t notice.”
Unlike the ever-alert, overresponsive child, the sensory disregarder may not respond to touch effectively enough to do a good job of self-protection. In fact, he may seem unaware of touch altogether, unless the touch is very intense.
HOW UNDERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR
A Child with Typical Modulation A Child with Underresponsivity
Randy, six, falls off his bicycle, scraping his knees. He runs inside and tearfully tells his babysitter that he had a bad accident. She bandages his wounds and soothes him. Eventually, he stops crying, although he hobbles around the house and complains for a little while. As soon as his friend comes to play, he forgets about his discomfort. Georgio, six, falls off his bicycle. He scrapes both knees, but pays little attention to his injuries. He remounts his bike and continues to ride. When his babysitter notices his wounds and tries to clean them, he brushes her off. “It doesn’t hurt,” he says.
SENSORY CRAVING—“MORE!”
All children need abundant sensations to learn about the world. The sensory craver needs more deep pressure and more skin contact than most. He may touch and feel everything in sight, running his hands over furniture and walls, and handling items that other children understand are “no-nos.” Even if an object is inappropriate to handle, such as a fragile dish or hot candle, he has “gotta touch” it.
Intensely and impulsively, he may seek to touch certain surfaces and textures that are uncomfortable to others, rubbing his hands over rough tree bark and walking barefoot on gravel. He crams his mouth with food. He gets too close to other people, bumping, pawing, and touching them, although they tell him this is unwelcome. Messy play is his true love. He’ll look for and find puddles, mud, clay, glue, and paint. The more, the merrier.
HOW SENSORY CRAVING AFFECTS A CHILD’S BEHAVIOR
A Child with Typical Modulation A Child with Sensory Craving
The kindergarten teacher gathers the children around a table covered with a plastic cloth. She spurts a mound of shaving cream in front of each child. Isaac, five, enjoys finger painting in the cream. He smears it around his table space and writes his name in it. When Bryce begins to bother him, he shouts, “Stop!” and moves back. He rinses his hands and finds a puzzle to do at a table far away from Bryce. Bryce, five, adores playing in shaving cream, the teacher’s smart substitute for finger paint. He smears the cream over his hands, arms, throat, and face. He begins to smear Isaac, who says, “Stop! You’ll get in trouble!” Bryce turns back to the table, spreading shaving cream into other children’s territories. They object and the teacher comes over to intervene. He could play here all day, but his behavior is getting in everyone else’s way.
The sensory craver frequently gets in trouble for his insistent, persistent, tactile explorations. His constant wallowing in messy materials ruins his clothes, trashes the classroom, and repels the people around him. Of course, his motivation is not to infuriate them but to get the sensory input his nervous system needs. Of course, most people do not understand his behavior. And, of course, the child is incapable of explaining his cravings, so everyone around him gets upset and tells him he is being bad.
Therapy can help this child’s nervous system to modulate touch sensations. At home and school, an approach may be to provide him with a lot of safe, appropriate, fun, and easy tactile activities. (See The Out-of-Sync Child Has Fun for specific suggestions.)
SENSORY COMBINATION— “I LOVE THIS, I HATE THAT.”
The sensory fluctuator may have overresponsivity and underresponsivity to sensations, like two sides of a coin. One minute, he may truly love an experience such as having his hair brushed or being cuddled, and the next minute, hate it. He may shriek with alarm when someone touches his arm, yet be indifferent to a broken collarbone. He may love jumping on the mattress and hate getting a back rub. This, but not that! That, not this!
HOW A SENSORY COMBINATION AFFECTS A CHILD’S BEHAVIOR
A Child with Typical Modulation A Sensory Fluctuator
Peter, ten, and his friend Cody decide to kick a can all the way home instead of riding the bus. Invigorated from the walk, the boys are now in the kitchen, twisting dough to make pretzels. Peter does this often and is comfortable getting his hands dirty; he likes to mold and sculpt the dough into animal and people shapes. Today Cody enjoys handling the sticky pretzel dough after walking to Peter’s instead of taking the bus. Everything with Peter is fun. Then Peter’s sister starts to play the saxophone. The squeaky blasts irritate Cody, and suddenly the fun is over. He can’t tolerate the dough on his hands another second. He runs to the sink, scrubs his hands, and rushes out without saying thank you or good-bye.
Tactile Discrimination Disorder: “Huh?”
The out-of-sync child has difficulty paying attention to the physical attributes of objects and people. If he has a modulation problem, his central nervous system is otherwise occupied. If he is a sensory avoider, his hands may “live” in his pockets, or he may keep his fingers curled to protect his sensitive palms. If he is a sensory craver, he may handle—or mishandle—everything in sight without discrimination.
When sensory modulation is out-of-sync, then the child’s discriminative system may not arise to “take charge.” (The child with poor tactile discrimination often has tactile defensiveness, but this is not always the case.) With inefficient or immature discrimination, the child will have difficulty using his tactile sense for increasingly complex purposes, such as learning at school. Even when he has met building blocks or three-ring binders before, he needs to touch and handle them repeatedly to learn about their weight, texture, and shape. “Huh?” he seems to say. “What’s this?”
The child may seem out of touch with his hands, using them as if they were unfamiliar appendages. He may be unable to point a finger toward the book he wants or to button a coat without looking at what he is doing. He may have difficulty learning new manual skills, exploring materials and equipment, using classroom tools, and performing ordinary tasks. If he hurts himself, he may not perceive where he hurts and whether the pain is increasing or lessening. He may not know when he is hungry or needs to urinate.
HOW TACTILE DISCRIMINATION AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Tactile Dysfunction
Kindergartner Ellen is making a “guitar” by pulling rubber bands over a cigar box. Tactile discrimination helps her grasp differences among the rubber bands. She chooses several with various attributes: big and small, skinny and fat, tight and loose. She stretches them over the box and arranges them carefully so they don’t overlap. By strumming or plucking, she can produce a variety of pleasing sounds. Patsy, five, grabs a huge handful of rubber bands, but she has trouble knowing which ones are more or less flexible than others. They all seem the same to her, because her tactile discrimination is inefficient. She struggles to stretch one rubber band around the cigar box and then gives up. Problems with modulation, discrimination, and dyspraxia get in her way.
HOW THE TACTILE SENSE AFFECTS EVERYDAY SKILLS
In addition to helping us to protect ourselves, to discriminate among objects, and to accomplish what we set out to do, the tactile sense gives us information that is necessary for
many kinds of everyday skills:
Body awareness (Body percept)
Praxis (Motor planning)
Visual discrimination
Language
Academic learning
Emotional security
Social skills
Body Awareness (Body Percept)
The tactile sense, along with the proprioceptive sense, affects a person’s subconscious awareness of individual body parts, and how the body parts relate to one another and to the surrounding environment. With good tactile discrimination, a child develops body awareness (body percept), which is like a map of the body, and can then move purposefully and easily. The child has a sense of where he is and what he is doing.
The child with a tactile disorder lacks good body awareness. He is uncomfortable using his body in his environment because moving means touching. He has difficulty orienting his limbs in order to get dressed. He would rather stand in a corner than risk mingling with an unpredictable group. Shifting his position may even make him conscious of how uncomfortable he is in his clothes. Better to stand very, very still, his central nervous system tells him, and avoid it all.
HOW BODY AWARENESS AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Tactile Dysfunction
In his third-grade music class, Tyler is enjoying the song, “Head and Shoulders, Knees and Toes.” He likes it when the tempo speeds up, so that tapping the right body parts at the right time gets harder. Recess is after music, and Tyler slips into his jacket, zips it up, pulls on his gloves, and heads outdoors. Roger slumps in the back row, scowling. He hates the “Head and Shoulders” song. He always gets his body parts mixed up, and he’s embarrassed. Before recess, he concentrates on getting into his coat, still a difficult task. Gloves are too much trouble, so he shuffles outdoors with his hands stuck in his pockets.