The Out-of-Sync Child

by Carol Kranowitz

  Exhibit behavior that seems stubborn, rigid, inflexible, willful, verbally or physically pushy, or otherwise “difficult” for no apparent reason, when it is actually an aversive response to tactile stimuli.

  Rebuff friendly or affectionate pats and caresses, especially if the person touching is not a parent or familiar person. The child may reject touch altogether from anyone except his mother (or primary caregiver).

  Be distracted, inattentive, and fidgety when quiet concentration is expected.

  Prefer receiving a hug to a kiss. He may crave the deep-touch pressure of a hug, but try to rub off the irritating light touch of a kiss.

  Resist having his fingernails trimmed.

  Dislike surprises.

  The same sensory avoider with overresponsivity also has difficulties with active touch. He may:

  Resist brushing his teeth.

  Be a picky eater, preferring certain textures such as crispy or mushy foods. The child may dislike foods with unpredictable lumps, such as tomato sauce or vegetable soup, as well as sticky foods like rice and cake icing.

  Refuse to eat hot or cold food.

  Avoid giving kisses.

  Resist baths, or insist that bath water be extremely hot or cold.

  Curl or protect hands to avoid touch sensations.

  Be unusually fastidious, hurrying to wash a tiny bit of dirt off his hands.

  Avoid walking barefoot on grass or sand, or wading in water.

  Walk on tiptoe to minimize contact with the ground.

  Fuss about clothing, such as stiff new clothes, rough textures, shirt collars, turtlenecks, belts, elasticized waists, hats, and scarves.

  Fuss about footwear, particularly sock seams. He may refuse to wear socks. He may complain about shoelaces. He may insist upon wearing beach sandals on cold, wet, winter days, or heavy boots on hot summer days.

  Prefer short sleeves and shorts and refuse to wear hats and mittens, even in winter, to avoid the sensation of clothes rubbing on his skin.

  Prefer long sleeves and pants and insist on wearing hats and mittens, even in summer, to avoid having his skin exposed.

  Avoid touching certain textures or surfaces, like some fabrics, blankets, rugs, or stuffed animals.

  Need to touch repeatedly certain surfaces and textures that provide soothing and comforting tactile experiences, such as a favorite blanket.

  Withdraw from art, science, music, and physical activities to avoid touch sensations.

  Avoid messy play, such as sand, finger paint, paste, glue, mud, and clay, perhaps becoming tearful at the idea.

  Stand still or move against the traffic in group activities such as obstacle courses or movement games, keeping constant visual tabs on others.

  Treat pets roughly, or avoid physical contact with pets.

  Arm himself at all times with a stick, toy, rope, or other handheld weapon.

  Rationalize verbally, in socially acceptable terms, why he avoids touch sensations, i.e., “My mother told me not to get my hands dirty,” or “I’m allergic to mashed potatoes.”

  Withdraw from a group and resist playing at other children’s homes.

  Have trouble forming warm attachments with others. Experiencing difficulty in social situations, he may be a loner, with few close friends.

  The sensory disregarder with underresponsivity may show atypical responses to passive and active touch. The child may:

  Not notice touch unless it is very intense.

  Be unaware of messiness on his face, especially around his mouth and nose, not noticing a crumby face or a runny nose.

  Be unaware of mussed hair or mulch or sand in hair.

  Not notice that clothes are in disarray, or that cuffs and socks are wet.

  Not notice heat, cold, or changes in temperature indoors or out, often keeping on a jacket even when sweating, or not reaching for a jacket even when shivering.

  Show little or no response to pain from scrapes, bruises, cuts, or shots, perhaps shrugging off a broken finger or collarbone.

  When barefoot, not complain about sharp gravel, hot sand, or stubbed toes.

  Not react to spicy, peppery, acidic, hot or “mouthburning” food—or, on the other hand, may crave this kind of food.

  Be oblivious to weather conditions with wind, rain, or gnats.

  Fail to realize that he has dropped something.

  Not move away when leaned on or crowded.

  Appear to lack “inner drive” to touch, handle and explore toys and materials that appeal to most other children.

  Require intense tactile stimulation to become engaged in the world around him, but not actively seek it.

  Hurt other children or pets during play, seemingly without remorse, but actually not comprehending the pain that others feel.

  The sensory craver needs extra touch stimuli, both passive and active. The child may:

  Ask for tickles or back rubs.

  Enjoy vibration or movement that provides strong sensory feedback.

  Need to touch and feel everything in sight, e.g., bumping and touching others and running hands over furniture and walls. The child has “gotta touch” items that other children understand are not to be touched.

  Rub certain textures over her arms and legs to get light-touch input.

  Rub or even bite his own skin excessively.

  Constantly twirl hair in fingers.

  Frequently remove socks and shoes.

  Seem compelled to touch or walk barefoot on certain surfaces and textures that other people find uncomfortable or painful.

  Seek certain messy experiences, often for long durations.

  Seek very hot or cool room temperature and bath water.

  Have high tolerance for sweltering summer or freezing winter weather.

  “Dive” into food, often cramming mouth with food.

  Prefer steaming hot, icy cold, extra-spicy, or excessively sweet foods.

  Use his mouth to investigate objects, even after the age of two. (The mouth provides more intense information than hands.)

  Show “in your face” behavior, getting very close to others and touching them, even if his touches are unwelcome.

  The child having a problem with tactile discrimination may:

  Have poor body awareness and not know where his body parts are or how they relate to one another. He may seem “out of touch” with hands, feet, and other body parts, as if they are unfamiliar attachments.

  Be unable to identify which body parts have been touched without looking.

  Have trouble orienting his arms, hands, legs, and feet to get dressed.

  Be unable to identify familiar objects solely through touch, needing the additional help of vision, e.g., when reaching for objects in a pocket, box, or desk.

  Be unable to know the difference between similar items he is using, such as a crayon versus a marker.

  Be disheveled, with shoes on wrong feet, socks sagging, shoelaces untied, waistband twisted, and shirt untucked.

  Avoid initiating tactile experiences, such as picking up toys, materials, and tools that are attractive to others.

  Have trouble perceiving the physical properties of objects, such as their texture, shape, size, temperature, or density.

  Be fearful in the dark.

  Prefer standing to sitting, in order to ensure visual control of his surroundings.

  Act silly in the classroom, playing the role of “class clown.”

  Have a limited imagination.

  Have a limited vocabulary because of inexperience with touch sensations.

  The child with dyspraxia may:

  Have trouble conceiving of, organizing, and performing activities that involve a sequence of movements, such as cutting, pasting, coloring, assembling collage pieces or recipe ingredients, applying nail polish, and so forth. Novel experiences as well as familiar activities may be difficult.

  Have poor gross-motor control for running, climbing, and jumping.

  Have poor eye-hand coordination.

 
Require visual cues to perform certain motor tasks that other children can do without looking, such as zipping, snapping, buttoning, and unbuttoning clothes.

  Put on gloves or socks in unusual ways.

  Have poor fine-motor control of his fingers for precise manual tasks, e.g., holding and using eating utensils and classroom tools, such as crayons, scissors, staplers, and hole punchers.

  Struggle with handwriting, drawing, completing worksheets, and similar tasks.

  Have poor fine-motor control of his toes for walking barefoot or in flip-flops.

  Have poor fine-motor control of his mouth muscles for sucking, swallowing, chewing, and speaking.

  Be a messy eater.

  Have poor self-help skills and not be a “self-starter,” requiring another person’s help to get going.

  Your child’s primary problem may be with the tactile sense. He may also have difficulty with the internal vestibular and proprioceptive senses, as well as with the external visual and auditory senses.

  Chapter Four

  HOW TO TELL IF YOUR CHILD HAS A PROBLEM WITH THE VESTIBULAR SENSE

  TWO FIRST-GRADERS AT THE AMUSEMENT PARK

  Jason Green is in perpetual motion, but is not much of a conversationalist. He is a “high motor, low verbal” kid. When he began to talk at three, his few words included “choo, choo” and “toot, toot,” for his passion is trains. Jason loves trains so much that his father calls him “our little locomotive.”

  Kevin Brown, Jason’s best buddy, loves trains, too. Kevin behaves not like a train, however, but like a conductor. He is a “low motor, high verbal” child. His mother jokingly calls him “NATO,” for “No Action, Talk Only.”

  When the boys play, Kevin bosses Jason around, and Jason cheerfully obeys. Once, Kevin proposed making a train by hitching together a little red wagon, a Big Wheel, and an old tricycle. Jason nodded agreement. All thumbs, the boys fumbled with rope and finally managed to connect the vehicles. Then Kevin instructed Jason to push the train down his steep driveway so they could watch it plummet into the garage.

  Instead of pushing the train, however, Jason clambered into the wagon. “Toot, toot!” he yelled as he plunged down the driveway. Kevin froze. He watched, helpless and horrified, as the train careened out of control.

  Jason landed in a heap. He heaved himself up and said, “That was awesome! Totally fantastic! Want to try, Kevin?”

  For once, Kevin was speechless.

  Today is Jason’s sixth birthday, and his parents are taking the boys to the amusement park. Jason loves the Ferris wheel, the merry-go-round, and especially the roller coaster. His idea of heaven is being twirled and tilted in the huge “Teacup.” He never even gets dizzy.

  Kevin is less enthusiastic. He has never found amusement parks amusing, because moving fast, high, and around in circles makes him tip over or fall, and the thought frightens him. He likes only the little train that slowly circles the park.

  The first attraction the group approaches is the “Greased Toboggan.” At the top of a slick ramp, riders sit in padded sacks and then slide down. Jason eagerly pulls on his father’s sleeve to get his attention and permission.

  Mr. Brown and Jason mount the stairs to the top. Jason ascends as fast as he can in his “marking time” fashion. He puts both feet on each step: right first, then left. In his haste, he stumbles twice.

  Kevin lingers below with Mrs. Brown, watching. He doesn’t want to slide; he wants to conduct. He raises his arms and shouts, “Go!” each time someone begins to descend. When he lifts his arms, his shoulders rise, too.

  Mrs. Brown asks Kevin if he would like to get into a sack with Jason. She points out that lots of people are coming down together in the same sack.

  “Oh, no, thank you very much,” Kevin says. “You see, I can’t slide down the ramp because I have to tell everyone when to go. I have to make sure that everyone is doing it just right.”

  Jason and Mr. Brown swoop to the bottom. “That was so awesome!” Jason says. “Now let’s go to the roller coaster. That’s the most fun of all.”

  Kevin says, “No, let’s go to the train. That’s entertaining, and it isn’t dangerous for children.”

  Jason is disappointed but agrees to do whatever his friend wants.

  Toot, toot! Chug, chug! Off they go.

  Atypical Patterns of Behavior

  Kevin and Jason approach movement experiences very differently. They both show atypical patterns of behavior.

  Moving and being moved dismay Kevin. He is uncomfortable on slides and rides that move fast or spin around. He is afraid of heights and prefers to keep his feet on the ground. He relies on his precocious verbal skills to maintain control. Having sensory modulation dysfunction, and overresponsive to most vestibular sensations, Kevin is intolerant of movement and has gravitational insecurity.

  In contrast, moving and being moved thrill Jason. Constantly and impulsively, he seeks fast-moving and spinning activities, but he does not get dizzy. Having the modulation disorder of sensory craving, Jason is addicted to moving, but his movements are too disorganized to develop into more mature motor skills.

  In addition to modulation problems, both boys have sensory-based motor disorder. Kevin has dyspraxia, which interferes with carrying out his complex plan to make a train. On top of that, he has postural disorder, which makes it hard to isolate his movements to raise just one arm without raising the other arm and his shoulders to boot.

  Jason, too, fumbles with the rope and stumbles up the stairs because of dyspraxia and poor bilateral coordination. Jason also has language problems. To communicate, he often uses gestures such as nodding his head or tugging on his father. He tends to be more talkative, however, after intense vestibular experiences such as sliding down the driveway and riding the Greased Toboggan.

  On the next pages you will learn how the vestibular sense is supposed to function, followed by an explanation of the types of dysfunction that derail Kevin and Jason.

  THE SMOOTHLY FUNCTIONING VESTIBULAR SENSE

  The vestibular system tells us about up and down and whether we are upright or not. It tells us where our heads and bodies are in relation to the earth’s surface. It sends sensory messages about balance and movement from the neck, eyes, and body to the CNS for processing and then helps generate muscle tone so we can move smoothly and efficiently.

  This sense tells us whether we are moving or standing still, and whether objects are moving or motionless in relation to our body. It also informs us what direction we are going in, and how fast we are going. This is extremely useful information should we need to make a fast getaway! Indeed, the fundamental functions of fight, flight, and foraging for food depend on accurate information from the vestibular system. Dr. Ayres writes that the “system has basic survival value at one of the most primitive levels, and such significance is reflected in its role in sensory integration.”

  The receptors for vestibular sensations are hair cells in the inner ear, which is like a “vestibule” for sensory messages to pass through. The inner-ear receptors work something like a carpenter’s level. They register every movement we make and every change in head position—even the most subtle.

  Some inner-ear structures receive information about where our head and body are in space when we are motionless, or move slowly, or tilt our head in any linear direction—forward, backward, or to the side. As an example of how this works, stand up in an ordinary biped, or two-footed, position. Now, close your eyes and tip your head way to the right. With your eyes closed, resume your upright posture. Open your eyes. Are you upright again, where you want to be? Your vestibular system did its job.

  Other structures in the inner ear receive information about the direction and speed of our head and body when we move rapidly in space, on the diagonal or in circles. Stand up and turn around in a circle or two. Do you feel a little dizzy? You should. Your vestibular system tells you instantly when you have had enough of this rotary stimulation. You will probably regain your balance
in a moment.

  What stimulates these inner ear receptors? Gravity!

  According to Dr. Ayres, gravity is “the most constant and universal force in our lives.” It rules every move we make.

  Throughout evolution, we have been refining our responses to gravitational pull. Our ancient ancestors, the first fish, developed gravity receptors, on either side of their heads, for three purposes:

  1) to keep upright,

  2) to provide a sense of their own motions so they could move efficiently, and

  3) to detect potentially threatening movements of other creatures through the vibrations of ripples in the water.

  Millions of years later, we still have gravity receptors to serve the same purposes—except now vibrations come through air rather than water.

  In addition to the inner ear, we humans also have outer ears as well as a cerebral cortex, which processes precise vestibular and auditory sensations. These sensations are the vibrations of movement and of sound.*

  Nature designed our vestibular receptors to be extremely sensitive. Indeed, our need to know where we are in relation to the earth is more compelling than our need for food, for tactile comfort, or even for a mother-child bond.

  In her book, Sensory Integration and the Child, Dr. Ayres explains:

  The vestibular system is the unifying system. It forms the basic relationship of a person to gravity and the physical world. All other types of sensation are processed in reference to this basic vestibular information. The activity in the vestibular system provides a “framework” for the other aspects of our experience. Vestibular input seems to “prime” the entire nervous system to function effectively. When the vestibular system does not function in a consistent and accurate way, the interpretation of other sensations will be inconsistent and inaccurate, and the nervous system will have trouble “getting started.”

  Whew! What a heavy load! Isn’t it astonishing how something you may never have heard of before has such a profound and pervasive influence? As the background for all other senses, the vestibular system gives us a sense of where we stand in the world.