The Out-of-Sync Child

by Carol Kranowitz

  Even when we are motionless, we receive proprioceptive messages without being consciously aware of them. For instance, if you are seated right now and close your eyes, you are relying on proprioception, not vision, to tell you that you are resting in a chair. Are your feet on a stool? Do your hands hold this book? Proprioception gives you this information without the need to look at your feet and hands.

  Muscle sensations that come through the proprioceptive system are closely connected to both the tactile and the vestibular systems. Proprioception helps integrate touch and movement sensations. Because they are so interrelated, professionals sometimes speak of “tactile-proprioceptive” or “vestibular-proprioceptive” processing.

  Tactile-proprioceptive (or “somatosensory”) discrimination refers to the simultaneous sensations of touch and of body position. This skill is necessary for such ordinary tasks as judging the weight of a glass of milk, or holding a pencil efficiently in order to write.

  Vestibular-proprioceptive discrimination refers to the simultaneous sensations of head and body position when the child actively moves. This is needed for throwing and catching a ball, or climbing stairs.

  What do we need proprioception for? The functions of proprioception are to increase body awareness and to govern motor control and motor planning. Proprioception contributes to visual discrimination; the more we move, the better we make sense of what we see. It helps us with body expression, the ability to sequence our motions and move our body parts efficiently and economically. It allows us to walk smoothly, to run quickly, to carry a suitcase, to sit, to stand, to stretch, and to lie down. It gives us emotional security, for when we can trust our bodies, we feel safe and secure.

  Another very important function is to help modulate our arousal level. It brings you up when you’re way down, and down when you’re way up. Proprioceptive experiences calm and organize us, bringing us back to center when we have been under- or overstimulated in any of the other senses. For instance, the proprioceptive input from pushing against a wall, pulling on rubber tubing, or hanging from a trapeze bar can arouse a person who has been sitting all day. The very same input can calm a person who suffers from sensory overload in a busy classroom.

  Furthermore, the calm and organization that proprioceptive input instills may last a couple of hours, and the person can tap into it to help himself function. Teachers, parents, and therapists who understand this phenomenon know that the best way to get children to settle down for a story or to do their homework is by first providing abundant opportunities for stretching and resistive activities.

  An additional function of proprioception is the discrimination of movement in time and space. An example is tying shoelaces, which requires good proprioception of the muscles in the fingers, coordinated with good visual and tactile discrimination. To know when to let go of one end of the shoelace, and how big to make a loop, and where to stick that loop, we need praxis, praxis, praxis. As an adult, you may be able to tie laces in the dark and in your sleep; imagine trying to do it without proprioception.

  THE OUT-OF-SYNC PROPRIOCEPTIVE SENSE

  Proprioceptive dysfunction is the inefficient processing of sensations perceived through the muscles and skin, as well as the joints. Proprioceptive dysfunction is almost always accompanied by problems with the tactile and/or vestibular systems. Whereas it is common for a child to have only a tactile problem or only a vestibular problem, it is less likely for a child to have only a proprioceptive problem.

  The child with poor proprioception has difficulty interpreting sensations about the position and movement of his body parts. His CNS is inefficient at modulating these ordinarily subconscious sensations. Whether underresponsive or sensory craving, he may be unable to use this information for adaptive behavior. He may show confusion when walking down the street, getting in and out of the bathtub, or crossing the playground. He may tackle everything and everybody.

  Discriminating where his body parts are and the rate and speed of his movements is a problem. Because he cannot monitor his gross-motor and fine-motor muscles, motor control and praxis are challenging. He may be clumsy and easily frustrated. Other people perceive him to be a “klutz.”

  Manipulating objects may be difficult. He may exert too much or too little pressure on objects, struggling to turn doorknobs and regularly breaking toys and pencil points. He may spill the milk every time. The child may have a poor grip on heavy objects, such as buckets of water, or on lightweight objects, such as forks and combs. He may also have trouble lifting and holding on to objects of different weights.

  Because of poor body awareness, the child needs to use his eyes to see what his body is doing. Ordinary tasks, such as orienting his body to get dressed, zipping a jacket, buttoning a shirt, or getting out of bed in the dark, become very difficult without the aid of vision. Unless the child can watch every move, he may be unable to match a movement of one side of his body with a similar movement on the other side.

  The child may be fearful when moving in space because he lacks postural stability. Because each new movement and each new position throws him off guard, he is emotionally insecure.

  The child with an inefficient proprioceptive system may have modulation, discrimination, and motor problems affecting his every move.

  Sensory Modulation Disorders

  PROPRIOCEPTIVE OVERRESPONSIVITY—“OH, NO!”

  The child who is overresponsive to proprioception may avoid stretching and contracting his muscles. He may have poor body awareness and be rigid, tense, and uncoordinated. He lacks “internal eyes” to help him “see” what his body parts are doing.

  He may shun playground activities with a lot of sensory input, such as jumping, hopping, running, bouncing, crawling, and rolling. He may resist getting into unusual positions, such as moving like animals, wriggling between the bars of a climber, or doing calisthenics in P.E. class. Not only active movement, but also passive movement may cause high anxiety when he is tightly hugged or when someone moves his arms and legs.

  HOW OVERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Overresponsivity

  Dominique, thirteen, at a Japanese restaurant for the first time, tries octopus and squid. The texture is rubbery. As she chews and chews, she compares the sensation to other foods she has had before. This is not like other seafood, she decides, but more like licorice or gum. At the Japanese restaurant, Tia, thirteen, wants to be a good sport, so she tries a tiny piece of squid. It feels like chewing rubber, which is not OK. She removes the morsel from her mouth and hides it in her napkin. Then she concentrates on the rice.

  Overresponsivity may also cause the child to be a picky eater. The reason is that certain food textures require forceful, coordinated chewing, and his mouth muscles are not getting the necessary sensory information.

  PROPRIOCEPTIVE UNDERRESPONSIVITY—“HO, HUM.”

  The child who is underresponsive to proprioception seems to lack the inner drive to move and play. He often has poor somatosensory (tactile-proprioceptive) discrimination, as well as postural problems and dyspraxia. This child tends to “fix,” e.g., jam his elbow to his ribs for more input when trying to write, to compensate for postural instability.

  Like the child with overresponsivity, he lacks “internal eyes,” has poor body awareness, and is unusually clumsy with toys and materials. Unlike the sensory avoider, however, the sensory disregarder may not notice that he has been sitting for a long time in an uncomfortable position. The sensation of pins and needles may not bother him. He may be unable to orient his body to get dressed and may not care whether someone moves his arms and legs when the dressing job must be done. “Ho, hum.”

  HOW UNDERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Underresponsivity

  Eden, twelve, has been sitting on the couch for an hour, engrossed in a Harry Potter book. She feels stiff and needs to move. She stands up, laces her hands together and pushes them out in front of
her chest, overhead, from side to side, and behind her head. She repeats the stretching sequence, this time with her palms facing outward. Ahh, her body feels much better. Destiny, twelve, has been in one position all day, deep into Lord of the Rings. Her mother calls. Destiny arises stiffly and stumbles to the kitchen to help prepare dinner. Because she tends to break dishes and cut herself while slicing vegetables, her mother gives her jobs that provide sensory input without doing any damage. Destiny scrubs potatoes, mixes meatloaf ingredients, squeezes lemons, tosses the salad, and takes out the garbage. Now she feels more alert.

  Parents and teachers may notice that the sensory disregarder becomes more alert and organized after heavy work activity. Of course, this child needs someone to get him started. Chores around the house and classroom help, as does sensory integration intervention that provides plenty of proprioceptive feedback to increase arousal level.

  PROPRIOCEPTIVE CRAVING—“MORE!”

  The sensory craving child is a “bumper and crasher.” He craves active movement, pushing, pulling, making “crash landings” by throwing himself to the ground, and lunging into walls, tables, and people. He craves passive input to muscles and joints, as well, such as strong bear hugs, and being pressed, squeezed, or pummeled while roughhousing.

  Always seeking more proprioceptive input, the sensory craver may bite, kick, hit, and behave in a seemingly aggressive manner. Some sensory cravers will engage in self-stimulation, such as biting their own skin or banging their head against the crib or wall. These children benefit from sensory integration treatment with ample opportunities for vigorous proprioceptive input to decrease their high arousal.

  HOW PROPRIOCEPTIVE CRAVING AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Sensory Craving

  Before doing errands, Aaron, five, and his father go to the playground. Aaron can pump on the swing and he likes to move forward and back under his own steam. Now, they are at the grocery store. Aaron helps with the grocery cart. Pushing it forward and pulling it back feels good in his arms, abdomen, and back. On one forward thrust the cart accidentally bumps into the apple bin and a few apples go flying—one right into the cart! Aaron’s father raises an eyebrow. Aaron restrains himself and just pushes and pulls the cart a little bit. Chase, five, and his mother are in the fresh produce aisle. She is in a hurry and he is cranky. He refuses to ride in the kiddie seat, so she lets him push the grocery cart. He pushes and pulls the cart, to and fro, and then leans forward and strikes his head repeatedly on the handlebar. He can’t see where he’s going and crashes into a barrel of peanuts. That felt good! Before his mother can stop him, Chase deliberately shoves the cart into a display of cantaloupes. Next time they do errands together, Chase’s mother will be sure that he has time to run and play beforehand.

  HOW THE PROPRIOCEPTIVE SENSE AFFECTS EVERYDAY SKILLS

  Proprioception works closely with the tactile and vestibular systems, so some functions overlap. These functions include:

  Body awareness

  Motor control

  Grading of movement

  Postural stability

  Praxis (Motor planning)

  Emotional security

  Body Awareness

  Efficient proprioception provides information about body awareness. The child with poor proprioception may be unaware of his body position and body parts.

  HOW BODY AWARENESS AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Proprioceptive Dysfunction

  To settle the children down before reading a story, the teacher of Jonathan’s preschool class leads a stretching exercise. She says, “Close your eyes and stretch one arm way up toward the ceiling. Bring it down and now stretch the other arm, way up high.” Jonathan, three, follows her directions without difficulty. Kenny, three, keeps his eyes open during the stretching exercise. He looks at his right arm to make sure it is moving. When the teacher says to stretch the other arm, Kenny peeks at Jonathan to see what he is doing. Attempting to imitate Jonathan, he gets confused. He raises his right arm again, rather than his left.

  Motor Control

  Proprioception provides information necessary to coordinate basic gross-motor and fine-motor movements. The child with poor proprioception has difficulty controlling large-motor movements, such as getting from one position into another, and fine-motor movements, such as grasping objects.

  HOW MOTOR CONTROL AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Proprioceptive Dysfunction

  Gary, eleven, rounds up some kids for a game of Horse. One by one, each child chooses a spot, and everyone takes a turn to stand there and shoot the basketball into the hoop. With every missed basket, a player gets a letter—H, O, R, S, and E. Gary has good motor control and rarely accumulates all the letters to spell Horse, which would put him out of the game. Jasper, eleven, tries to play Horse on the basketball court. It is his turn and he takes the ball. His motor control is out of sync because discriminating sensations of body position and muscle movement is hard. He tries to catapult the ball into the hoop, but his muscles are too weak. He misses and gets an H. Then he gets an O, an R, an S, and an E. He’s out.

  Grading of Movement

  Proprioception helps us grade our movements. Grading of movement means that we sense how much pressure to exert as we flex and extend our muscles. We can judge what the quantity and quality of muscle movement should be, and how forcefully we should move. Thus, we can gauge the amount of effort necessary to pick up a fluffy dust ball, lift a heavy carton, or yank open a stubborn drawer.

  Suppose you’re at a picnic, and you set down your lemonade on the table beside someone else’s empty cup. Later, you return for another refreshing sip but pick up the other person’s cup. You sense immediately that this cup is not yours, because it doesn’t feel full. And how do you know? Proprioception tells you so!

  Because the child with dysfunction does not receive efficient messages from his muscles and joints, he has difficulty grading his movements to adapt to changing demands.

  HOW GRADING OF MOVEMENT AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Proprioceptive Dysfunction

  Janie, seven, is going to help paint the bike shed at camp. She carries a brush in one hand and a paint bucket in the other. Walking to the shed, she adjusts her body to keep upright despite carrying different weights. Ruth, seven, holds a brush tightly in one hand so she won’t drop it. Her counselor gives her a bucket of paint. As Ruth can’t perceive how heavy it is, she can’t tighten her muscles to stand upright. She leans way over to one side as she lugs the bucket.

  Postural Stability

  Proprioception gives us the subconscious awareness of our body that helps us stabilize ourselves when we sit, stand, and move. The child with dysfunction lacks the stability to make fundamental postural adjustments for these everyday skills.

  HOW POSTURAL STABILITY AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Proprioceptive Dysfunction

  Larry, ten, pulls in his chair and surveys the dinner table. Yippee, corn on the cob! He eats, with his elbows on the table. His mother says, “Manners, please,” and he straightens up. Adam, ten, arranges himself on the chair: one foot tucked under his body and the other on the floor for stability. He knows his mother disapproves of elbows on the table, but he can’t help it when he eats corn.

  Praxis (Motor Planning)

  Praxis depends on accurate modulation and discrimination of proprioceptive messages. Planning and sequencing motor action is a challenge for people with dyspraxia, especially if they have underresponsitivity.

  HOW PRAXIS (MOTOR PLANNING) AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Dyspraxia

  Todd, six, is practicing a marching routine in preparation for Field Day. “Hup, two, three, four, hup, two, three, four,” he chants as he smartly brings up his knees. When the P.E. teacher adds arm swings and counts faster, Todd enjoys the extra challenge. Collin
lingers at the end of the line as his fellow first-graders practice marching. Even when he chants, “Hup, two, three, four,” this sensory fumbler can’t seem to coordinate his knees in a rhythmic pattern. Adding arm swings and moving faster make it all too frustrating. Collin shuffles along and mutters, “I can’t do that.”

  Emotional Security

  Proprioception contributes to our emotional security by orienting us to where our various body parts are and what we are doing with our bodies. The child with poor proprioception is not confident about his own body. Because he lacks the “feel” of it, he is emotionally insecure.

  HOW EMOTIONAL SECURITY AFFECTS A CHILD’S BEHAVIOR

  A Typical Child A Child with Proprioceptive Dysfunction

  Jenny, five, gets out of bed, dresses, walks to school, does her worksheets, plays outside, and goes on errands with her mother. She feels good about herself and the world she inhabits. Her sense of security results, in part, from dependable messages coming from her body. She can easily orient her body, and this ability gives her confidence as she moves through her day. For Sara, five, almost everything she does requires effort—getting out of bed, dressing, walking to school, doing her worksheets, playing at the playground, and going on errands with her mother. She doesn’t feel good about herself or the world she inhabits. Her sense of insecurity results from the undependable messages coming from her body, which doesn’t move the way she wants it to. She has little self-confidence.

  CHARACTERISTICS OF PROPRIOCEPTIVE DYSFUNCTION

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