Have difficulty seeing objects in three dimensions (depth perception).
Seem overwhelmed by moving objects or people because of a problem discriminating between what moves and what is motionless (stable visual field).
Have difficulty judging relative distances between objects, such as letters, words, numbers, or drawings on a page; between oneself and objects in the environment, often bumping into things (spatial relationships).
Not understand concepts such as up/down, forward/ back, before/after, and first/second. The child may have a problem stringing beads in order, following a pattern to build with blocks, or wayfinding (going from one place to another without getting lost, or finding one’s way in a new place).
Have difficulty in team sports that require awareness of position on the field or court and knowledge of teammates’ positions and movements.
Confuse likenesses and differences in pictures, words, symbols, and objects and have difficulty distinguishing properties of objects.
Repeatedly confuse similar beginnings and endings of words (“tree/three,” “fight/flight/fright,” “window/winter”).
Have difficulty with schoolwork involving the size of letters, the spacing of letters and words on the line, and the lining up of numbers (form constancy). The child may reverse letters (“b/d”) or words (“saw/was”) while reading and writing.
Have difficulty differentiating objects in the foreground and background, necessary to distinguish one word on a page, or a face in a crowd (visual figure-ground).
Be unable to form mental images of objects, people, or scenarios, to envision what she reads or hears, or relate pictures and words to the “real thing” (visualization).
Have difficulty describing thoughts and actions, both verbally and in writing.
Be a poor speller.
Have difficulty remembering what he did or saw during the day.
Be unable to interpret how objects would feel, just by looking at them; the child must touch the kitten to know it is soft and furry.
Fail to comprehend what she is reading, or quickly lose interest.
Have a short attention span for reading or copying information from the board, and have a poor visual memory of what she read.
The child with poor visual-motor skills may:
Have poor eye-hand coordination—the efficient teamwork of the eyes and hands, necessary for playing with toys, using tools, dressing, writing, and academic tasks.
Be unable to use her eyes to guide hand movements necessary for accurate orientation of drawings and words on a page. She may be unable to stay within the lines when she colors, and her writing may be crooked and poorly spaced.
Have difficulty with fine-motor tasks involving spatial relationships, such as doing jigsaw puzzles, rearranging dollhouse furniture, and cutting along lines.
Have poor eye-foot coordination and difficulty walking upstairs or kicking balls.
Have poor gross-motor skills and difficulty moving on playground equipment, such as reaching for and climbing on monkey bars.
Avoid sports and group activities in which movement is required.
Have difficulty with rhythmic activities.
Have poor coordination and balance.
Have difficulty sounding out a word silently and then saying it, or she may mispronounce similar words as she continues reading (eye-ear coordination).
Orient drawings poorly on the page, or write uphill or downhill.
Have exceedingly poor posture while at the table or desk, or twist in an unusual way to see the teacher or book.
Withdraw from classroom participation.
Have low self-esteem.
Chapter Seven
HOW TO TELL IF YOUR CHILD HAS A PROBLEM WITH THE AUDITORY SENSE
A THIRD-GRADER IN MUSIC CLASS
This is the first Monday after vacation, and May has a stomach ache. She doesn’t want to go to school, because on Mondays the third-graders go to the all-purpose room for music. May hates the teacher, crabby old Miss Cross, who insists that the children sit still during the whole lesson. She is not attuned to children like May who learn best by moving.
The children are practicing for the spring concert. When they come into the room, first they sit and sing folk songs. May mouths the words without voicing them, because Miss Cross told her, “If you won’t sing in tune, don’t sing out loud.” Miss Cross doesn’t understand that May would sing in tune if she could, but she can’t.
After singing, the children play instruments. Half the students play the tunes on their recorders, while the others accompany them on drums, rhythm sticks, and other unpitched percussion instruments. Then the groups switch and repeat the repertoire.
May hates the recorder because she never knows if the note she plays sounds as it should. She does not have good pitch, the highness or lowness of sounds in relation to one another. She may try to play B, for instance, but her recorder sometimes squawks out a tone that is too sharp and sounds higher, like C. The other kids sidle away, and Miss Cross glares.
Playing the unpitched instruments is somewhat easier, but May also has problems with rhythm, timing, and dynamics. She comes in late, can’t catch or keep the beat, and plays fortissimo when she should play pianissimo. May just doesn’t “get it” when it comes to making music.
Today, the children enter the room and are surprised to see a new teacher. Mr. Harmon smiles as they sit down. He says, “I’m your teacher now. Miss Cross decided not to come back after vacation. She gave me some tips about managing this class, but I’m going to toss those tips out the window and do something different. Let’s get our whole bodies into this music-making business. Everybody, up! Let’s move!”
Instead of making the children sit, he has them stand in one spot and sing scales, bending to touch the floor and stretching toward the ceiling to match the ascending and descending notes. Then they move around the room singing songs. He instructs them to walk and sing slowly, run and sing fast, stomp and sing loudly, tiptoe and sing softly.
May watches the other children for a moment until she catches on. Once she gets moving, she loves the crouching, stretching, and locomotion. She is not merely hearing the music—she is incorporating it into her body. It’s all beginning to make sense.
Finally, with their bodies and voices primed, the children pick up the instruments. With a new sense of pitch and rhythm in her body, May understands how she can transpose some of that feeling into the music. Playing the recorder isn’t so hard today.
Next Monday, May will be eager to go to school. Stomach aches on music day? Unheard of!
Atypical Pattern of Behavior
When processing sounds, May shows an atypical pattern of behavior. Her auditory processing problems are a type of Sensory Discrimination Disorder.
She sings and plays the recorder out of tune, because she cannot discriminate differences in pitch in the musical tones. She is off the beat when playing the percussion instruments, because of her inadequate sense of timing and rhythm. She must look at the other children when following the teacher’s directions, because hearing the instructions is not enough—she needs visual information to help her understand what she hears.
Many children with Sensory Discrimination Disorder also have modulation problems, but May does not. (She does not have auditory defensiveness; she is not oblivious to sounds; and she does not crave loud and constant noise.) She is somewhat clumsy, but once she understands Mr. Harmon’s expectations, her body movements and motor planning improve.
THE SMOOTHLY FUNCTIONING AUDITORY SENSE
The vestibular and auditory systems work together as they process sensations of movement and sound. These sensations are closely intertwined, because they both begin to be processed by hair cells in the receptors of the ear.
Hearing, or audition, is the ability to receive sounds. We are born with this basic skill. We can’t learn how to do it; either we hear, or we don’t.
Auditory skills begin developing in the womb. The audit
ory nervous system is the first to become functional. In tandem with the vestibular system, it connects with muscles throughout the body and helps to regulate movement, equilibrium, and coordination.
The ear’s influence on physical development is profound. Indeed, the ear is vital not only for hearing, balance, and flexibility, but also for bilateral coordination, respiration (breathing), speaking, self-esteem, social relationships, vision, and, of course, academic learning.
Two Components: Defensive (“Okay!” or “Uh, Oh!”) and Discriminative (“Aha!”)
The auditory sense, like the other senses, begins with a defensive component. As babies, we startle when we hear loud or unexpected noise. Gradually, our brains develop the ability to modulate sensations and tell us whether the sound is one we can enjoy and use or must avoid for self-protection. When we realize that a sound was just a door shutting, and not a danger, we return to a state of being calm and alert.
The abilities to hear and to modulate sensations of sound underlie our ability to really listen to sounds around us and understand their meaning. We are not born with the skill of listening; we acquire it, as we integrate vestibular and auditory sensations. Gradually, as we interact purposefully with our environment, we learn to interpret what we hear and to develop sophisticated auditory discrimination skills.
The discriminative component of the auditory sense evolves as the child moves, touches, and engages in many multisensory experiences. Discriminative functions, which help us refine details about the “what” and “where” of sounds, include:
• Localization—the ability to identify the source of a sound, such as a parent’s voice, or a friend’s “Yoo-hoo!”—and to judge the distance between the sound and oneself.
• Tracking—the ability to follow a sound, such as a helicopter as it putters across the sky or someone’s footsteps as he patters around the house.
• Auditory memory—the ability to remember what was heard, e.g., conversations, directions, homework assignments, or song lyrics, and to refer to it at once (immediate memory) or later (deferred memory).
• Auditory sequencing—the ability to put in order what was heard and repeat it in logical order, such as the alphabet, Spanish verb conjugations, or multisyllabic words like “obstacle” or “nuclear.”
• Auditory discrimination—the ability to compare and contrast environmental sounds, such as a food blender and a vacuum cleaner, and to hear likenesses and differences in word sounds, such as road/load, flute/fruit, cup/cut.
• Auditory figure-ground—the ability to distinguish between foreground and background sounds, in order to hear the main message without being distracted.
• Association—the ability to relate a novel sound to a familiar sound, such as connecting the bark of the neighbor’s new puppy to the category of “dog,” and the ability to relate a visual symbol, such as an alphabet letter or a musical note, with its particular sound.
• Auditory cohesion—the higher level listening ability to unite various ideas into a coherent whole, to draw inferences from what is said, to understand riddles, jokes, puns, and verbal math problems, and to take notes in class.
• Auditory attention—the ability to maintain focus sufficiently to listen to a teacher’s lesson, a conversation, or a story, essential for bringing the other auditory processing skills together.
AN EXAMPLE OF AUDITORY SKILLS AT WORK
You attend Field Day at your child’s school. Two hundred adults and children are milling about, talking, and laughing. All around, the decibel level is high, but you get used to it. Unexpectedly, a P.E. teacher right behind you yells instructions through a bullhorn. You duck and cover your ears. What was he shouting? You aren’t sure because you had to shut out the noise. He moves down the sidelines. Aha, now you can listen to his message about lining up by classes (auditory attention). You hear a different sound now—it is a drummer (auditory discrimination) leading the band from the school building toward the crowd (tracking). You find yourself marching to the steady beat (ear-body coordination) as you move along the edge of the field. You look for your child but don’t see her. Through the din, you hear her calling, “Hi, Mom!” (figure-ground). You turn to the source of the sound (localization), and wave to your child across the field. Then, the band strikes up “The Star Spangled Banner.” The crowd hushes. Everyone sings (auditory memory). Another parent says, “Isn’t this great?” You nod (receptive language) and reply, “Field Day is always fun!” (expressive language). The games begin.
When defensive and discriminative components are in sync, we can respond adaptively to sounds. We know what the sounds are and where they come from, or can make educated guesses based on previous sounds we have heard. With information about the “what” and “where” of sounds, we develop auditory-motor coordination—what I call “ear-body coordination”—and learn how and when to move in accordance with the sounds. Our infant’s hungry cry makes us prepare to nurse. A harsh tirade makes us cringe, rush-hour honking makes us tense, and clear, orderly music, such as Mozart’s, makes us alert and organized.
When we process sounds typically, we can put out the uniquely human products of speech and language. Speech and language are entwined but not the same. Speech is the physical production of sound. Speech depends on smoothly functioning muscles in the throat, tongue, lips, and jaw. The vestibular, proprioceptive, and tactile systems govern motor control and motor planning for using those fine muscles to produce intelligible speech.
Language is the meaningful use of words, which are symbols representing objects and ideas. Thus, language is a code for deciphering what words imply and how we use them to relate to others.
Language that we take in and understand, through listening and reading, is called “receptive.” Receptive language focuses on external sounds, i.e., voices of other people and the noises all around us.
Language that we put out to communicate, through speaking, singing, or writing, is “expressive.” Expressive language focuses on sounds we hear internally and that we reproduce, as accurately as possible, through our own voice.
We listen, move, speak, and read with our ear. Body awareness, balance, motor coordination, muscle control, postural responses, sequencing, language skills, planning ahead, and problem solving grow stronger as we process the sounds that surround us.
THE OUT-OF-SYNC AUDITORY SENSE
An auditory processing problem often occurs along with SPD. However, this problem can also stand alone, as the result, perhaps, of ear infections or hearing loss.
With or without SPD, a child may hear adequately but process sounds slowly or inaccurately. She may have a problem modulating or discriminating sensations of sound. Or she may be dyspraxic and come to a standstill when she hears sounds, not knowing how or when to start or stop an activity. Her rhythm and timing is off, affecting how she moves, reads, and communicates.
Her language may suffer. Recalling what she wants to say, putting her thoughts in order, or getting the words out may be hard. She may have a problem pronouncing words clearly enough to be understood. She may lack awareness of how her mouth, lips, and tongue feel and work together. She may say “tool” instead of “school,” or “dese” instead of “these,” because of difficulty positioning the muscles necessary for articulation.
Sensory Modulation Disorders
AUDITORY OVERRESPONSIVITY—“OH, NO!”
For most of us, most of the time, when loud noises come at us, a muscle in the middle ear contracts to stifle the vibrations. This mechanism protects us from being overwhelmed or deafened. However, when we feel threatened (“Uh, oh!”) and go into fight/ flight/freeze mode, this little muscle does not clamp down. Instantly, keen attention to all sounds is imperative.
People whose auditory defensiveness keeps them constantly alert must listen to every sound. Easily distracted, some respond to ordinary noise with an infantile, whole-body startle. This state of ceaseless, on-edge alertness uses up energy, interferes with learning, and hamper
s language development and social interactions.
People on the autistic spectrum (and others, too, of course) often have auditory overresponsivity, or auditory defensiveness. Sounds that please others, such as chirping birds or rustling leaves, can make them feel as if their eardrums are being scraped.
HOW OVERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Auditory Overresponsivity
Before lunch, Brynna, a fifth-grader, rushes to the school bathroom. The flushing toilets and whirring hand dryers are loud, but these everyday sounds don’t bother her. When she hears loud, sudden noises such as screeching tires or fire alarms, she pays attention and winces. Otherwise, she briefly perks up her ears to unexpected sounds, such as books falling off a desk, and then ignores them. When Nelia, ten, gets home from school, she rushes to the bathroom. She never goes at school because the noise of the toilet hurts her ears. The flushing water is as deafening as Niagara Falls. Nelia also jumps out of her skin and claps her hands over her ears when a pencil hits the floor or a door clicks shut. Her oversensitivity to sounds makes everyone refer to her as “Nervous Nellie.”
With or without autism, the sensory avoider reacts strongly, swiftly, and negatively to loud, unexpected noises. He will alert to most sounds—even sounds that are too faint or high-pitched for most people to hear. When he hears sirens blaring, block towers tumbling, or people chewing, he may complain or cover his ears. Indeed, this child may worry incessantly about the possibility of loud noises, and that worry may affect his behavior.
If the metallic twang of guitar strings hurts, he may hang back from sing-alongs. If the sound of a balloon popping distresses him, he may refuse to go to birthday parties. If the rock concert promises a big sound, he may prefer an evening home alone. If he can’t get away from the hubbub, he may raise his own voice, hollering, “La-La-La-La!” to counteract noise, rather like fighting fire with fire.
The Out-of-Sync Child Page 18