The Out-of-Sync Child

by Carol Kranowitz

  The child who is overresponsive to proprioceptive input may:

  Prefer not to move.

  Become upset when limbs are passively moved.

  Become upset when it is necessary to stretch or contract his muscles.

  Avoid weight-bearing activities, such as jumping, hopping, running, crawling, rolling, and other physical actions that bring strong proprioceptive input to muscles.

  Be a picky eater.

  The underresponsive child may:

  Have low tone.

  “Fix” elbow to ribs when writing, or knees tightly together when standing, to compensate for low muscle tone.

  Break toys easily.

  The sensory craving child may:

  Deliberately “bump and crash” into objects in the environment, e.g., jump from high places, dive into a leaf pile, and tackle people.

  Stamp or slap his feet on ground when walking.

  Kick his heels against the floor or chair.

  Bang a stick or other object on a wall or fence while walking.

  To modulate his arousal level, engage in self-stimulatory activities, such as head banging, nail biting, finger sucking, or knuckle cracking.

  Rub his hands repeatedly on tables.

  Like to be tightly swaddled in a blanket or tucked in tightly at bedtime.

  Prefer shoelaces, hoods, and belts to be tightly fastened.

  Chew constantly on objects, such as shirt collars and cuffs, hood strings, pencils, toys, and gum. The child may enjoy chewy foods.

  Appear to be aggressive.

  The child with poor discrimination and dyspraxia may:

  Have poor body awareness and motor control.

  Have difficulty planning and executing movement. Controlling and monitoring motor tasks such as adjusting a collar or putting on eyeglasses may be especially hard if the child cannot see what he is doing.

  Have difficulty positioning his body, as when someone is helping him into a coat, or when he is trying to dress or undress himself.

  Have difficulty knowing where his body is in relation to objects and people, frequently falling, tripping, and bumping into obstacles.

  Have difficulty going up and down stairs.

  Show fear when moving in space.

  The child with inefficient grading of movement may:

  Flex and extend his muscles more or less than necessary for tasks such as inserting his arms into sleeves, or climbing.

  Hold pencils and crayons too lightly to make a clear impression, or so tightly that the points break.

  Produce messy written work, often with large erasure holes.

  Frequently break delicate objects, and seem like a “bull in a china shop.”

  Break items that require simple manipulation, such as lamp switches, hair barrettes, and toys that require putting together and pulling apart.

  Pick up an object with more force than necessary, such as a glass of milk, causing the object to fly through the air.

  Pick up an object with less force than necessary—and thus be unable to lift it. He may complain that objects such as boots or toys are “too heavy.”

  Have difficulty lifting or holding objects if they don’t weigh the same. He may not understand concepts of “heavy” and “light.”

  The child with sensory-based postural disorder may:

  Have poor posture.

  Lean his head on his hands when he works at a desk.

  Slump in a chair, over a table, or while seated on the floor.

  Sit on the edge of the chair and keep one foot on the floor for extra stability.

  Be unable to keep his balance while standing on one foot.

  The child with emotional insecurity may:

  Avoid participation in ordinary movement experiences, because they make him feel uncomfortable or inadequate.

  Become rigid, sticking to the activities that he has mastered and resisting new physical challenges.

  Lack self-confidence, saying, “I can’t do that,” even before trying.

  Become timid in unfamiliar situations.

  Proprioceptive dysfunction usually coexists with problems with the tactile sense (Chapter Three) and/or vestibular dysfunction (Chapter Four).

  Chapter Six

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

  TWO SEVENTH-GRADERS AT SCHOOL

  Few would guess that Francesca, twelve, has a visual dysfunction. She is the best reader in the seventh grade and loves literature, such as A Tale of Two Cities. All she ever does is read, read, read.

  Today, after a quick lunch, she scurries from the cafeteria and heads for the library, her haven. She ducks to avoid other students darting through the busy corridor. She enters the library, locates a couple of titles about kites, and goes to an interior corner of the room. Sinking to the floor, she leans against a bookcase, faces the blank wall, and buries her nose in the books.

  Francesca loves the tranquil library, where she doesn’t squint or get headaches. The reason is that the library has full-spectrum light bulbs in the ceiling, unlike the flickering fluorescent lights in classrooms. Also, in her quiet corner, no sunlight glimmering through venetian blinds can irritate her eyes.

  Along comes Charity, also with undetected visual dysfunction, looking for Francesca. Oblivious to most obstacles, Charity bumps into a book cart. The cart tips over; books go flying. She clumsily gathers the books and shoves them onto the cart.

  Charity is often confused about where she is in space and has a poor sense of direction. Paying attention to words on the page or moving her eyes smoothly from one line to the next is also hard. Her strength is listening, so she does well in French and Spanish, poetry, and music. Charity is “smart as the Dickens,” as Francesca says, but not much of a reader.

  Francesca hears Charity coming. “Hi!” she says, glancing up at her friend.

  Charity has asked Francesca to scan the shelves for some titles, because that detailed visual job befuddles her. She whispers, “Did you find some good kite books? Any awesome designs?”

  “Here’s a butterfly pattern for you,” Francesca says, “and here’s the Baltimore oriole I want to copy.” The girls admire the illustrations and whisper about the kites they will be crafting in art class. They are looking forward to an upcoming field trip to Washington, DC, to see the Cherry Blossom Festival parade and to fly kites on the National Mall.

  Later, in art class, they attempt to work on their kites and immediately run into problems. One problem is shifting their gaze from the book illustrations to their work and back again. Focusing and refocusing are hard. Another difficulty is transposing the designs they have chosen onto the kite wings. They cannot visualize how to enlarge the butterfly and bird because relating the parts to the whole is a visual skill they have not yet developed.

  The art teacher comes to their table and frowns at the girls’ cockeyed efforts. She looks for something positive to say. “I see you are both working really hard.”

  The girls stare at her anxiously. Charity wonders if the teacher is angry. Searching her face, she is not sure.

  “Hmm,” the teacher says. “Next time, how about if you start over with something less complex? Sometimes, less is more.”

  “Yes,” agrees Charity. “Something simpler.” She relaxes a bit. Maybe the teacher is not mad. At least, she doesn’t sound mad.

  Francesca sighs. “I guess I could just paint big dots, instead of a bird.”

  The bell rings, and as the girls pack up to leave, the teacher gives them an understanding smile. She cannot understand, however, why such smart pupils struggle over an art project that ought to be well within their capability. Why can’t Francesca and Charity make sense of images right before their eyes?

  Atypical Patterns of Behavior

  Why, indeed, can’t Francesca and Charity make sense of what they see?

  They both show atypical patterns of behavior. Francesca is overresponsive to visual sensations. Her body’s way to compensate is with overaccommodat
ion (a problem with a basic visual skill). Yes, she can read well, but most visual stimulation puts her on overload. She has difficulty negotiating her way through a busy hallway, tolerating flickering light and maintaining direct eye contact.

  Charity is underresponsive to visual stimuli. She has difficulty knowing what she is looking at, where it is in space, and where she is in relation to it. One problem is compression of visual attention; she can focus on just one object at a time rather than see the whole picture. Compressed attention causes poor visual figure-ground (a discrimination problem). She cannot make sense of the cart in her path, titles on the bookshelf, and print on the page. She also misreads visual cues in facial expressions.

  Additionally, both girls have visual dyspraxia. Their brains are inefficient at integrating visual input with motor output. Thus, their visual-motor responses are delayed and clumsy. They cannot easily use vision to guide their movements and carry out a plan, such as reproducing designs from the book illustrations.

  On the next pages you will learn how the visual sense is supposed to function, followed by an explanation of the types of dysfunction that dim these seventh graders’ view of the world.

  THE SMOOTHLY FUNCTIONING VISUAL SENSE

  Vision is a complex sensory system that enables us to identify sights, anticipate what is “coming at us,” and prepare for a response. We use vision, first, to detect contrast, edge, and movement so we can defend ourselves; and second, to guide and direct our movement so we can interact meaningfully in our environment, socialize, and learn.

  The stimulus that triggers vision is light, or a change in light. This stimulus is external, and we have no actual physical contact with it, as we do with tactile, vestibular, and proprioceptive stimuli.

  A unique feature of vision is providing both temporal (time) and spatial (space) information. We see things sequentially and, at the same time, see a volume of space. For instance, when we read, we move our eyes from one group of words to the next. As we move our eyes to a new position we see and take in another group of words. Vision lets us process an enormous volume of space, in the wink of an eye.

  That vision is so important to us now is astounding, because, in terms of evolution, vision is a newcomer to the nervous system. Smell was the dominant sense of our ancient ancestors and still is crucial for many animals. Today, vision is humankind’s dominant sense for learning where we are and what is happening around us, or what may happen at any moment.

  Vision should not be confused with eyesight, which is only one part of vision. Eyesight, the basic ability to see the big “E” on the wall chart, is a given. Eyesight is a prerequisite for vision. Either we see, or we don’t. We can neither learn nor be taught to see.

  INTERESTING FACTS ABOUT VISION

  • 80 percent of the information we take in comes through the eyes.

  • 80 percent of visual processing is responsible for what we see, and 20 percent is responsible for where and how we see.

  • 662⁄3 percent of the brain activity of the brain is devoted to vision when the eyes are open. Three billion impulses come into the CNS every second; two billion of these are visual.

  • 93 percent of human communication is nonverbal; 55 percent of communication comes from seeing the speaker’s facial expressions and body gestures.

  • 75–90 percent of classroom learning depends on vision.

  • 90 percent of visual problems are never diagnosed.

  • 25 percent of all school-age students have undiagnosed vision problems.

  • 70 percent of juvenile delinquents have undiagnosed vision problems.

  Vision, unlike sight, is not a skill we are born with but rather one we develop gradually as we integrate our senses. Growing up, we learn to make sense of what we see.

  How? Through movement! Movement, the basis of all learning, teaches the eyes to make sense of sights, whereas sitting still to read or to gaze at the computer screen does not.

  The vestibular and proprioceptive systems profoundly influence our vision. When we stretch and contract postural muscles to lie down, sit up, or stand on two feet, sensations bombard our brain and facilitate eye movements. When we move around, switch directions, and change the position of our body, head, and eyes, we strengthen visual skills. When we engage in purposeful activity, our eyes become better coordinated. Thus, movement, balance, muscle control, and postural responses are “must haves” for proper vision development.

  The tactile sense, too, has a huge effect on vision. The infant’s hand grazes his toes, and he turns to see what he has touched. The preschooler handles an orange and pays visual attention to its tactile properties. Tomorrow he can see another orange and know that it is round, rough, solid, and just right for holding, squeezing, rolling and tossing. The older student can visualize images, such as a pyramid, a policeman, or a pepperoni pizza without touching or seeing the real thing. To see well, countless, concrete, tactile experiences really count!

  The auditory sense affects vision, as well. When we hear a sound, the auditory information reinforces our visual processing about its whereabouts. A door slams, a friend calls our name, or a bird warbles; we turn to locate and see the source of the sound. Also, hearing reinforces our visual processing about what is being said. For example, hearing or saying the word “apple” triggers a visual image of an apple.

  Indeed, we need all our senses to develop vision, just as we need vision to develop the other senses—including smell and taste. The ability to know many sensory details about what we see, such as a muffin’s aroma and flavor, even before we eat it, is the happy result of sensory integration.

  Two Components: Defensive (“Okay!” or “Uh, Oh!”) and Discriminative (“Aha!”)

  Like the other senses, vision has two components. Our first response is always defensive (see Chapter Two). Vision acts primarily to protect us from danger. When light hits the eye, our immediate response is reflexive, i.e., involuntary and without conscious control. Automatically, we make adaptive responses so we can see clearly, for clear and single vision is an essential survival skill.

  Basic visual skills—the unconscious mechanisms of sight—include:

  • Acuity, the ability to see details of objects.

  • Adjusting from dark to bright light, e.g., when we step from a dim hall into the sun.

  • Accommodation in each eye so we can focus on objects at varying distances, both at far point and at near point, such as looking back and forth from the desk to a scene outside the window or copying problems from the chalkboard into an assignment notebook.

  • Detection of movement, such as the spider creeping up the wall, the car coming down the road, or classmates moving in the schoolroom.

  • Binocularity (two-eyed vision), the ability to sweep the eyes together in a coordinated way and use them as a team to form a single mental picture from the images that the eyes separately record, such as looking skyward with two eyes to see just one moon.

  • Ocular-motor (eye-motor) skills, including steady attention on an object (fixation), efficient movement from point to point or word to word (saccades), and tracking of a moving object (smooth pursuits), such as a ball in the air.

  With healthy, working eyes as the foundation, we can get on with the discriminative component of vision, involving conscious, higher level cognitive functions. (Various terms are used for these functions, including “visual-spatial perception,” “visual cognition,” “spatial cognition,” “form and space perception,” and “visual discrimination,” the term used here.)

  Visual discrimination helps us refine details about what we see, where that object is in space, and where we are in relation to it. This “what, where, and how” of vision guides our responses to what we see.

  HOW BASIC VISUAL SKILLS AFFECT A CHILD’S BEHAVIOR

  A Typical Child A Child with Poor Visual Skills

  Mason, thirteen, lives for baseball. He is a “physical genius,” his coach says, in part because of his excellent visual skills.
Up at bat, he easily keeps his eyes on the ball and shifts his focus quickly from a far point (outfielder Kerry) to a near point (home plate). When he pitches, good eye-teaming helps him see exactly where to place the ball. He is a natural. Until Kerry, an eighth-grader, got glasses and vision therapy, he was not a notable ball player. Now, up at bat, fixing his gaze on the pitcher and tracking fast balls is easier. When Kerry is in the outfield, he no longer strains to coordinate his eye movements. When he is very tired, he may still see double, but most of the time he is one of the team’s most valuable players.

  Discriminative skills include:

  • Peripheral vision—awareness of images that surround us through the sides of our eyes, primarily for detecting motion.

  • Depth perception—seeing objects and spaces around oneself in three dimensions and judging relative distances between objects, or between oneself and objects, in order to descend the stairs and avoid stepping on cracks in the pavement.

  • Stable visual field—discerning which objects move and which objects remain stationary.

  • Spatial relationships—including directionality (judging how close objects are to other objects and to oneself) and laterality (with one’s own two-sidedness as a reference, the awareness of right/left, front/back and up/down).

  • Visual discrimination—discerning likenesses and differences in size, shape, pattern, form, position, and color.

  • Form constancy—recognition of a form, symbol, or shape even when its size, position, or texture changes, in order to match, separate, or categorize objects, or to know whether a letter is “u” or “n,” or “p” or “q.”

  • Visual figure-ground—differentiating objects in the foreground and background, to distinguish one word on a page, or a face in a crowd.

  • Visual attention—using the eyes, brain, and body together long enough to stay with an activity, such as reading, following directions, or looking at an object or person.