The Out-of-Sync Child

by Carol Kranowitz

  The child with poor bilateral coordination may have trouble using both feet together to jump from a ledge, or both hands together to catch a ball or play clapping games. She may have difficulty coordinating her hands to hold a paper while she cuts, or to stabilize the paper with one hand while she writes with the other.

  Poor bilateral coordination, a sensory-based motor disorder, is often misinterpreted as a learning disability such as dyslexia. In fact, this difficulty can lead to learning or behavior problems, but it does not ordinarily mean that a child is lacking in intelligence or academic ability.

  HOW BILATERAL COORDINATION AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Vestibular Dysfunction

  Chelsea, eight, is making a Valentine. On a piece of red paper, she steadies a cardboard heart with her left hand and traces its outline with her right. She uses her right hand to cut out the heart and her left hand to hold and turn the paper. She makes four more Valentines during art period. Celia, eight, wants to make a pink Valentine. She has trouble steadying the cardboard heart on the paper while she traces. Her outline is misshapen but will have to do. She picks up the paper in her right hand and the scissors in her left. No, that’s not correct; she switches hands. She cuts awkwardly. Instead of rotating the paper with her left hand, she moves her right hand, holding the scissors, around the paper. Her Valentine isn’t very good, but she hopes her mother will like it.

  Visual and Auditory Processing

  The vestibular system is intimately involved with vision and hearing. Please see the next chapters to learn more.

  Praxis (Motor Planning)

  Praxis, or motor planning, as you have seen, is the ability to conceptualize, organize, and realize a complex sequence of unfamiliar movements. When our nervous system integrates vestibular sensations with tactile and proprioceptive sensations, we have a good body scheme. When we have a good body scheme, we can motor plan. When we motor plan, we can accomplish what we set out to do.

  HOW PRAXIS AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Vestibular Dysfunction

  Maddy, seven, likes learning new dances. Today the Brownies are mastering the Macarena, a dance that their Brownie leader, Mrs. Hopkins, learned in the 90s. In this dance, the girls move their arms and hands in a complicated sequence, turning them in the air and moving them to touch one body part after another. After completing the sequence, they shimmy, jump a quarter turn, and repeat the motions. The Macarena is much more challenging than the Looby Loo. Maddy loves this. Libby likes being a Brownie, especially when the troop goes to museums and enacts stories, but she doesn’t enjoy dancing. The Looby Loo was hard enough; now she must struggle with the Macarena. Moving her arms and hands is confusing and frustrating, because Libby has dyspraxia. Shimmying is difficult, so Libby just sways. Trying to jump a quarter turn, she goes in the wrong direction. Even when she stops to watch the other girls, it’s hard to learn the sequence of movements. She wishes they could stick to familiar activities, instead of always tackling something new.

  Adapting her behavior to learn a new skill may be very hard for the child with vestibular dysfunction. For instance, this sensory fumbler may be able to step into the bathtub, but have trouble stepping into the car. She may have learned how to roller skate, but have difficulty ice skating or rollerblading. If her central nervous system hasn’t processed movement and balance sensations efficiently, then her brain can’t remember how it feels to move in a certain way. Thus, she can’t easily generalize a learned skill to plan and perform a new skill that is only slightly different.

  Emotional Security

  Emotional security is every child’s birthright, but the child with vestibular dysfunction may not feel totally secure. With the inability to process where she stands and how she moves through space, she may be disorganized in many aspects of her young life.

  The child may have low self-esteem. Aware that ordinary tasks are beyond her ability, she may often say, “I can’t do that.” She may not even try. If she is uncertain about her abilities, even the best-loved child in the world may feel unloved and unlovable.

  HOW EMOTIONAL SECURITY AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Vestibular Dysfunction

  Mark, four, gives Darius a huge, soft baseball and plastic bat for his birthday. After Darius unwraps the gift, Mark says, “Let’s play!” A few children can wield the bat and whack the ball. Mark hits it over the fence. He claps his hands. “I knew I’d be good at this! Your turn, Darius.” He offers the bat to his friend, but Darius frowns and turns away. When Mark’s mother comes to pick him up, he says, “Darius didn’t like the bat, Mommy, but that’s okay. I had a good time at the party anyway.” Darius, four, opens Mark’s present, but he doesn’t want to play with the ball and bat. He knows he won’t be any good. He watches the other children line up to swing the bat, but when Mark urges him to try, he turns away and says, “I can’t.” After the partygoers leave, he says to his mother, “Mark isn’t my friend. He hates me.” His eyes brim with tears, and he collapses in her arms. He whimpers, “Mommy, do you love me?”

  CHARACTERISTICS OF VESTIBULAR DYSFUNCTION

  These checklists will help you gauge whether your child has vestibular dysfunction. As you check recognizable characteristics, you will begin to see emerging patterns that help to explain your child’s out-of-sync behavior.

  The overresponsive child who shows intolerance for movement may:

  Dislike playground activities, such as swinging, spinning, and sliding.

  Be cautious, slow moving, and sedentary, hesitating to take risks.

  Appear to be a sissy.

  Seem willful and uncooperative.

  Be very uncomfortable in elevators and on escalators, perhaps experiencing car or motion sickness.

  Demand continual physical support from a trusted adult.

  The child with gravitational insecurity may:

  Have a great fear of falling, even where no real danger exists. This fear is experienced as primal terror.

  Be fearful of heights, even slightly raised surfaces. The child may avoid walking on a curb or jumping down from the bottom step.

  Become anxious when her feet leave the ground, feeling that even the smallest movement will throw her into outer space.

  Be fearful of climbing or descending stairs, and hold tightly to the banister.

  Feel threatened when her head is inverted, upside down or tilted, as when having her head shampooed over the sink.

  Be fearful when someone moves her, as when a teacher slides her chair closer to the table.

  For self-protection, try to manipulate her environment and other people.

  Have poor proprioception and poor visual discrimination.

  The sensory disregarder with underresponsiveness to vestibular sensations may:

  Not notice or object to being moved.

  Seem to lack inner drive to move actively.

  Once started, swing for a lengthy time without getting dizzy.

  Not notice sensation of falling and may not respond efficiently to protect himself by extending his hands or a foot to catch himself.

  The sensory-craving child with increased tolerance for movement may:

  Need to keep moving, as much as possible, in order to function. The child may have trouble sitting still or staying in a seat.

  Repeatedly, vigorously shake her head, rock back and forth, and jump up and down.

  Crave intense movement experiences, such as bouncing on furniture, using a rocking chair, turning in a swivel chair, assuming upside-down positions, or placing her head on the floor and pivoting around it.

  Be a “thrill seeker,” enjoying fast-moving or spinning playground equipment, or seeking the fast and “scary” rides at an amusement park.

  Not get dizzy, even after twirling or spinning rapidly for a lengthy amount of time.

  Enjoy swinging very high and/or for long periods of time.

  Like seesaws,
teeter-totters, or trampolines more than other children.

  The sensory slumper with sensory-based postural disorder affecting movement of the head, balance, muscle tone, and bilateral coordination may:

  Lose her balance unless both feet are firmly planted, as when stretching on tiptoes, jumping, or standing on both feet when her eyes are closed.

  Easily lose her balance when out of a biped (two-footed) position, as when climbing stairs, riding a bicycle, hopping, or standing on one foot.

  Move in an uncoordinated, awkward way.

  Be fidgety and clumsy.

  Have a loose and floppy body.

  Feel limp (like a wet noodle) when you lift her, move her limbs to help her get dressed, or try to help her balance on a teeter-totter or balance beam.

  Tend to slump or sprawl in a chair or over a table, prefer to lie down rather than sit upright, and constantly lean her head on a hand or arm.

  Find it hard to hold up her head, arms, and legs simultaneously when lying on her stomach.

  Sit on the floor with her legs in a “W,” i.e., with her knees bent and her feet extended out to the sides, to stabilize her body.

  Have difficulty turning doorknobs or handles that require pressure, and have a loose grasp on “tools” such as pencils, scissors, or spoons.

  Have a tight, tense grasp on objects (to compensate for looseness).

  Have problems with digestion and elimination, such as frequent constipation or poor bladder control.

  Fatigue easily during physical activities or family outings.

  Be unable to catch herself from falling.

  Not have crawled or crept as a baby.

  Have poor body awareness.

  Have poor gross-motor skills and frequently stumble and trip, or be clumsy at sports and active games. She may seem to have “two left feet.”

  Have poor fine-motor skills and difficulty using “tools” such as eating utensils, crayons, pencils, and combs.

  Have difficulty making both feet or both hands work together, such as when jumping up and down or throwing and catching a ball.

  Have difficulty using one foot or hand to assist the other during tasks such as standing on one foot to kick a ball, or holding the paper steady when writing or cutting.

  Have trouble using both hands in a smooth, alternating manner, as when striking rhythm instruments together to keep a musical beat.

  Not have an established hand preference by the age of four or five. The child may use either hand for coloring and writing, or may switch the crayon or pencil from one hand to the other.

  Avoid crossing the midline. The child may switch the brush from hand to hand while painting a horizontal line, or may have trouble tapping a hand on her opposite shoulder in games like “Simon Says.”

  Have a hard time with organization and structured activities.

  The sensory fumbler with dyspraxia (poor motor planning) may:

  Have difficulty conceptualizing, organizing, and carrying out a sequence of unfamiliar movements.

  Be unable to generalize what she has already learned in order to accomplish a new task.

  The child who is emotionally insecure may:

  Get easily frustrated and give up quickly.

  Be reluctant to try new activities.

  Have a low tolerance for potentially stressful situations.

  Have low self-esteem.

  Be irritable in others’ company, and avoid or withdraw from people.

  Have difficulty making friends and relating to peers.

  Vestibular dysfunction may be your child’s primary disorder, while the tactile sense (Chapter Three) and the proprioceptive sense (Chapter Five) may cause problems, too. Difficulties with visual and auditory processing are discussed in Chapters Six and Seven.

  * Vibrations stir up all kinds of responses. One day in my music class, I introduced a movement activity by beating a large drum. “Oooo,” said a three-year-old girl, “I can feel that in my bones!” “Me, too,” responded a little boy, “and I can even feel it in my penis!”

  Chapter Five

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

  ONE NINE-YEAR-OLD AT THE SWIMMING POOL

  Tony has tried to play team sports, but it’s hard for him to get his body to work in a coordinated way. He hates it when other kids, including his siblings, say mean things like “You sure have a lousy sense of timing,” or “Nobody picks you for a team because you don’t help.”

  Knowing how Tony longs to participate in a sport, his mother persuades him to join the beginners’ swim team at the neighborhood pool. After shopping for goggles, a team suit, and a new athletic bag, Tony begins to think that swimming might be okay. At least it doesn’t involve hitting balls.

  The first day of practice, Tony inches into the locker room. The other boys dart in and out, joking and laughing, while Tony struggles to change his clothes. He watches every move carefully, especially when he ties the waistband string of his swimsuit. He wants to be sure that his suit is on right, so nobody will laugh at him.

  He goes out to the concrete pool deck and heads for the coach. He walks awkwardly, thudding his heels. He’s watching his feet, not where he’s going. He collides with a chair, which clatters across the concrete.

  The coach glances up and beckons. He calls, “Come on! Get your goggles on! Dive in! Let’s go!”

  Getting the goggles on is tricky because Tony cannot see what he is doing. By the time he adjusts them, the other kids have dived in and begun swimming toward the far end of the pool.

  Tony doesn’t know how to dive, so getting into the pool is another problem. He goes to the ladder and faces the water. With his arms awkwardly stretched behind him as he clings to the railings, he tries to descend. Then he remembers to face the ladder, not the water. He turns around, gropes for the rungs with his feet, and backs slowly into the pool.

  Tony begins to swim. He had swimming lessons, so he knows the basics. However, the pattern of his strokes is uneven. He stretches his right arm nicely but bends his left elbow too much, so he swims with a “limp.” The result is that he keeps veering to the left and bumping into the rope.

  Another problem is breathing. He concentrates hard: right arm, left arm, breathe, right, left, breathe—but he gets the sequence mixed up. When he breathes, his arms stop moving, and he feels as if he is about to sink.

  When he gets to the end of the pool, Tony is exhausted. The other kids are already swimming back to the other end. He’s always the last one. He thinks maybe swimming is not such a good idea after all.

  Atypical Pattern of Behavior

  Tony is out of sync with his body and moves in an atypical pattern. He strikes his heels on the pool deck to get additional information to his muscles and joints. His awkward gait makes him look like a robot.

  Tony has poor body awareness: He cannot perceive how his individual body parts move, or where they are in space. He relies on vision to figure out how to make his body move. Changing into his swimsuit takes a long time because he must watch his hands. Positioning his goggles over his eyes is hard because he can’t see what he’s doing.

  Another challenge is orienting his body to get into the pool. First, Tony has trouble aligning his body properly on the ladder. Then, when he remembers to turn toward the ladder and to back into the water, he labors to find secure footing on the rungs.

  In the pool, Tony’s swimming is irregular. His strokes are erratic because matching his arm movements is difficult.

  Tony works hard to swim; he likes the water and wants to be successful. He is easily frustrated, however, and decides that swimming isn’t his thing. Uncoordinated and unaware of his body, Tony has proprioceptive dysfunction, and, as is common, dyspraxia and some vestibular dysfunction as well.

  On the next pages you will find an explanation of how the proprioceptive sense is supposed to function, followed by an explanation of the types of dysfunction that sink Tony.

  THE SMOOTHLY FUNCTIONING PR
OPRIOCEPTIVE SENSE

  Proprioception tells us about our own movement and body position. (“Proprio” means “one’s own” in Latin.) Like “internal eyes,” proprioception informs us:

  Where our body or body parts are in space,

  How our body parts relate to one another,

  How much and how quickly our muscles are stretching,

  How fast our body is moving through space,

  How our timing is, and

  How much force our muscles put forth.

  This kind of information is fundamental for every move we make. Our reflexes, automatic responses and planned action (praxis) depend on it. The self-awareness that proprioception grants lets us do our job, whether we are a master violinist, downhill skier, or salad chef…or an apprentice tricycle rider, cookie snitcher, or book-report writer.

  Proprioception is both subconscious, such as when we automatically hold our bodies upright on a chair, and conscious, such as when we uncross our legs before arising from the chair. Sometimes teachers and therapists use the term “kinesthesia” to describe the conscious awareness of joint position we use in learning, and it means the same thing.

  Proprioception is the “position sense” or the “muscle sense.” Receptors are mostly in the muscles and skin, and also in the joints, ligaments, tendons, and connective tissue. The stimulus for these receptors is stretch. When muscles or skin stretch or contract, and body parts bend and straighten, messages inform the central nervous system (CNS) about where and how the movement occurs.

  We get the most and best proprioception when we actively stretch and tighten our muscles in resistive motions, against the pull of gravity—say, when we do a push-up or heavy work, such as hoisting a loaded laundry basket. When we are passively moved—say, when a salesclerk lifts our foot to insert it into a shoe—we get modest proprioception.