AUDITORY UNDERRESPONSIVITY—“HO, HUM”
The “sensory disregarder” seems unaware of sounds that others hear and listen to. But is the child who seems unaware truly unaware? In many cases, we don’t know. Children with autism, for example, who cannot express themselves, clearly may sense more than we can detect merely by looking at them.
HOW UNDERRESPONSIVITY AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Auditory Underresponsivity
At the playground, kindergartners Asher and Frankie are playing with trucks at the base of the monkey bars. Another little boy, Jed, is climbing overhead and prepares to let go. He says, “Look out, look out!” Asher leaps nimbly out of the way, just in the nick of time. Frankie is crouching under the monkey bars, engrossed with his truck. He hears Jed cry, “Look out!”—but does not respond and continues his play. Jed lets go and lands nearby. Startled, Frankie whimpers, “Don’t do that.” Jed says, “I told you I was gonna jump, you baby.”
The child with underresponsivity to sound does not visibly respond to quiet sounds, soft voices and whispers that may be “under his radar.” Likewise, he does not seem to respond to ordinary sounds, voices, questions, and comments. And when he does respond, he may speak very softly, almost in a whisper.
SENSORY CRAVING—“MORE!”
The sensory craver loves crowds and places with noisy action like rodeos, car races, and parades. He welcomes loud noises and usually wants to turn the volume up. He may make his own noisy sounds, using his “outside voice” in the classroom and kitchen, and clapping and singing boisterously.
A Typical Child A Child with Sensory Craving
Thea, seven, is playing at Kaneesha’s. Thea covers her ears when her friend turns the TV way up. “Ouch! Let’s do something else,” Thea says. The girls decide to make Spoon Bells. They each take a yard-long string, tie a large spoon in the middle, wrap the string ends around their index fingers, and bring them to their ears. They lean forward and tap the dangling spoons on the kitchen counter, tables, and chairs. A gentle tap sends vibrations up the string to Thea’s ears. Gong! Just like a church bell! Kaneesha and her friend Thea cannot agree about the TV volume. Thea likes it low, and Kaneesha likes it loud enough to feel the vibrations through her chair. Instead of arguing, the girls make Spoon Bells and walk around the kitchen, banging their spoons against the counters and furniture. Kaneesha pulls out an oven rack and hits her spoon on it forcefully to get a big bang. Wow! She scrapes the spoon across the rungs. She likes the metallic reverberations. The racket is music to her ears.
AUDITORY DISCRIMINATION—“HUH?”
The child may have difficulty detecting likenesses and differences in words. She may find it hard to pick out or attend to the teacher’s voice without being distracted by background noises. Her receptive language may suffer: She may be a poor listener and struggle to read. She may seem noncompliant or may not follow directions well, because she cannot decode what was said. Her expressive language may be inadequate: She may have difficulty participating in conversations, answering questions, and putting her thoughts into writing.
HOW AUDITORY DISCRIMINATION AFFECTS A CHILD’S BEHAVIOR
A Typical Child A Child with Poor Auditory Discrimination
Aleah’s preschool teacher sings, “This old man, he played two, he played knick-knack on my…” She pauses and leans forward, inviting her four-year-old students to fill in the rhyme. Someone says, “Shoe!” Aleah says, “No, not shoe this time. Goo!” The teacher and most of the children laugh. “Goo” rhymes with “two,” so it meets the criterion, and it certainly is silly! “This old man, he played four, he played knick-knack on my.…” The teacher leans toward Leslie and invites her to supply a rhyming word. “Five!” Leslie says. “Tell me a word that sounds like ‘four,’” the teacher says. “Six!” Leslie says. Her difficulty with auditory discrimination and cohesion means she neither understands the task nor the joke. She just doesn’t get it.
A phenomenon often observed is that a child who ordinarily does not talk much or well will begin to speak once she gets moving. Indeed, when she runs or swings, she may suddenly shout, sing, or talk. As self-therapy, to start verbalizing her thoughts, she may jump up to walk around the room. Active movement primes the pump, and speech begins to flow.
The child with vestibular and language problems benefits greatly from therapy that simultaneously addresses both types of dysfunction. Speech-and-language therapists report that just putting the child in a swing during treatment can have remarkable results. Occupational therapists have found that when they treat a child for vestibular dysfunction, speech-and-language skills can improve along with balance, movement, and motor-planning skills. Other treatments include auditory therapy, such as Guy Berard’s auditory integration training (AIT), or the method developed by Alfred Tomatis that improves the rhythm of movement and of language. (See bibliography, p. 335.) Some improvements children experience with auditory training include:
Attention span and focus
Social interactions
Speech and motor control
Auditory discrimination and sensitivity
Musical expression
Self-esteem, mood, and motivation
Understanding spoken language
Reading, spelling, and handwriting
Bilateral coordination
Physical balance and posture
Other ways to help the schoolchild with auditory dysfunction include softening the sound in a noisy classroom, perhaps with a carpet; placing the child in a spot as far from bubbling fish tanks and doorways as possible; and using visual cues to help him supplement auditory information he may miss.
Determining the cause of a child’s hearing difficulties is important in order to treat it appropriately. When SPD is the root, a speech/language pathologist or an occupational therapist trained to provide sensory integration therapy is the logical choice. When SPD is not the cause of hearing problems, professionals who provide advice and treatment might include a pediatrician, an otologist (a medical doctor specializing in ear diseases) or an audiologist (a specialist in evaluating hearing disabilities).
HOW MOVEMENT AFFECTS A CHILD’S AUDITORY FUNCTION
A Typical Child A Child with Auditory Dysfunction
The fourth-graders can’t go outside for recess because it’s raining, so Hayley chatters with her friends as they work on a jigsaw puzzle. When math begins after recess, the kids can’t settle down. The teacher begins class with the “Hokey Pokey.” Shaking her arms, legs, and head, and turning herself about, Hayley begins to feel alert again. When the teacher asks her for the answer to a math problem, Hayley responds correctly. Caitlin misses recess on rainy days. Restless, she wanders around the room. The “Hokey Pokey” doesn’t help, as she can’t understand the directions. She feels sleepy when math begins. The teacher asks her an easy question. She can’t answer. The next day is sunny, and the kids go out. Caitlin swings the whole time. Later, the teacher asks her to answer another math problem. Caitlin gets it right. The teacher wonders why Caitlin is sometimes “on” and sometimes “off.”
CHARACTERISTICS OF AUDITORY DYSFUNCTION
These checklists will help you gauge whether your child has auditory 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 child with difficulty modulating auditory sensations may:
Be distressed by loud noises, including the sound of voices.
Be distressed by sudden noises, such as thunder, fire alarms, sirens, and balloons popping.
Be distressed by tinny or metallic sounds, such as those coming from a xylophone or from clinking silverware.
Be distressed by high-pitched sounds, such as those coming from whistles, violins, sopranos, and screeching chalk.
Be distressed by sounds that do not bother others, such as a toilet flushing, a distant church bell, or soft music.
Seek
sounds that would be loud or annoying to others.
With poor auditory discrimination, the child may:
Seem unaware of the source of sounds or may look all around to locate where they come from.
Have difficulty recognizing particular sounds, such as voices or cars coming down the street.
Have difficulty tracking a sound in the environment, such as footsteps.
Have difficulty recalling, repeating, and referring to words, phrases, conversations, song lyrics, or instructions, both right away (immediate memory) and later (deferred memory).
Have difficulty recognizing the difference between sounds, such as near or distant banging, angry or pleasant voices, or high or low notes.
Be unable to maintain attention to a voice, conversation, story, or sound without being distracted by other sounds.
Have difficulty associating new sounds to familiar sounds, or visual symbols (letters, numerals, musical notes) to their particular sounds.
Have difficulty hearing or reading jokes, verbal math problems, crossword puzzle definitions, or discussions, and understanding how all the information fits together into a coherent whole.
Have a poor sense of timing and rhythm when clapping, marching, singing, jumping rope, or playing rhythm band instruments.
The child may also have difficulty with receptive language, and may:
Have a problem discriminating similar sounding word sounds, especially consonants at ends of words, as in cap/cat, bad/bag, side/sign.
Have a short attention span for listening to stories or for reading.
Misinterpret questions and requests.
Be able to follow only one or two instructions in sequence.
Look to others before responding.
Frequently ask for repetition, or be less likely than others to ask for clarification of ambiguous directions or descriptions.
Have difficulty recognizing rhymes.
Have difficulty learning new languages.
The child may have difficulty with expressive language, and may:
Have been a late talker.
Have difficulty putting thoughts into spoken or written words.
Talk “off topic,” e.g., talk about her new shirt when others are discussing zoo animals or a soccer game.
Have difficulty “closing circles of communication,” i.e., responding to others’ questions and comments on demand.
Have difficulty correcting or revising what she has said so that others can understand.
Have a weak vocabulary.
Use immature sentence structure (poor grammar and syntax).
Have poor spelling skills.
Have a limited imagination in fantasy play.
Have difficulty making up rhymes.
Sing out of tune.
Have difficulty with reading, especially out loud.
Require more time than other children to respond to sounds and voices.
The child may have difficulty with speech and articulation, and may:
Be unable to speak clearly enough to be understood.
Have a flat, monotonous voice quality.
Speak very loudly or very softly.
Speak with a hoarse, husky, strident, weak, or breathy voice.
Speak hesitantly or without fluency and rhythm.
In general, the child may:
Be tired at the end of the day.
Have little motivation or interest in school work.
Have difficulty planning tasks and getting organized.
Be awkward and uncoordinated in movement.
Have poor timing and poor athletic skills.
Have low self-esteem.
Be shy and tend to withdraw from social scenes.
Improve the ability to speak while or after experiencing intense movement.
Part II of this book will give you specific, practical advice as you begin the process of evaluation, diagnosis, and treatment. You will also find many suggestions and activities to help your child at home and at school.
Part II
COPING WITH
SENSORY
PROCESSING
DISORDER
Chapter Eight
DIAGNOSIS AND TREATMENT
This chapter will help you learn to recognize and document your child’s out-of-sync behavior. It suggests when and how to seek a professional evaluation and diagnosis. It includes descriptions of various kinds of intervention, with emphasis on OT-SI, which is occupational therapy (OT) using a sensory integration (SI) framework.
A PARENT’S SEARCH FOR ANSWERS
A mother wrote me this letter:
“By the time Rob was two, I felt he had a special need, but I couldn’t figure out what it was. He required constant attention. Time-outs didn’t work because I couldn’t contain him. He was defiant, disobedient, disrespectful, and demanding. He was always busy, always talking (great verbal skills!), strong willed, contrary, and easily frustrated. I felt blessed to have Rob, and wouldn’t trade him for the world, of course, but he constantly tested and rejected me.
“What was the reason for his behavior? How could I regain control? What method of discipline would get through to him? If his behavior was an attempt to get my attention, how could I supply it in a way that would satisfy him? How could I help a high-energy child channel his energy in a positive direction? I was desperate for answers.
“I started seeking information from my pediatrician. He recommended a neurologist who tested Rob for seizures (he tested normal) and who didn’t think he had ADD. Next we saw a psychologist who said Rob was a normal, active, little boy. Then we tried an allergist because he craves milk, and then an ear-nose-throat doctor (ENT) because he seems tired a lot and snores. I thought he might have infected adenoids, but he doesn’t.
“Then we saw a child-development specialist who knew something about sensory problems. He didn’t do a formal evaluation but could tell that Rob has an immature, underreactive vestibular system with delays in auditory and visual processing. He gave us specific suggestions for activities to do at home, but they didn’t work well because Rob didn’t cooperate. Since home therapy wasn’t working, we then tested Rob for ADD (negative).
“Finally, a neighbor gave me the name of an OT who did a formal evaluation. At three and a half, he was diagnosed with Sensory Processing Disorder. It was a double relief to have Rob’s problem identified and to learn that therapy really helps! After four sessions with her, she feels that with a few months of therapy, Rob has good potential to benefit from OT and that his ‘nerve problem’ will be repaired, and then managing his behavior will be easier.
“The pediatrician feels the therapy won’t change anything and suggests using more discipline and seeing a child psychologist. But we have already begun to see results and want to continue the occupational therapy for as long as the OT feels it is necessary. I am hoping we are on the right track.
“This is so unlike anything I have ever been through. This is so hard for me. I am a very ‘up’ person with lots of friends who call me for advice, and for the first time in my adult life I need advice, big time! I’ve always worked hard to make our lives ‘perfect,’ but just getting through the day with Rob has been an accomplishment.
“We’re not done yet, but we’re making progress. Instead of feeling all alone and desperate, now I’m excited and hopeful. When I see Rob’s sweet, loving nature emerging, I feel certain we’ll restore harmony in our home.”
RECOGNIZING WHEN YOUR CHILD NEEDS PROFESSIONAL HELP
Ordinarily, growing older means that a child builds upon skills already acquired. A typical child develops the capacity to run after learning to walk, after learning to stand, after learning to creep.
For the out-of-sync child, however, growing older does not always mean getting better at many physical and intellectual tasks, because the basic foundation for efficiently organizing sensory information isn’t solid enough.
If growing older doesn’t help, what does? Early intervention! The most appropriate i
ntervention for Sensory Processing Disorder is OT-SI, which helps the child develop his nervous system.
Before receiving OT-SI or any other form of intervention, the child will need a professional evaluation and a diagnosis. How do you know if an evaluation is necessary?
Seven Rationalizations That Prevent Recognizing SPD
At least seven rationalizations prevent some people from recognizing SPD and thus seeking a diagnosis. Educators and therapists often hear these comments.
1) “Looks like ADHD, sounds like ADHD, must be ADHD.” Symptoms of SPD may look like symptoms of several other problems.
2) “Never heard of it, so it can’t be important.” Many pediatricians, teachers, and other early childhood experts are unfamiliar with SPD and unable to explain it to parents. Fortunately, it is beginning to be widely acknowledged as more research studies and books in layman’s terms reach the general public.
3) “Not my kid!” Even when parents do learn something about SPD, they may be reluctant to believe that it affects their child. People don’t go looking for answers if they are in denial that a problem exists.
4) “So what if he’s not a rocket scientist? We love him just the way he is.” Accepting a child “where he’s at” is great, but sometimes parents are too accepting. They may be satisfied with their child’s irregular development, even if their child is not.
5) “So what if she doesn’t do what other kids do? She’s advanced for her age.” Parents may think their child’s unchildlike behavior signifies that she’s “too smart” for playdough and playgrounds. However, every child needs to be able to play before she is able to succeed at school. The ability to read at the age of five doesn’t guarantee that she has the physical, social, and emotional readiness for kindergarten.
What looks like precocious behavior may, in fact, indicate neurological dysfunction. Johnny pulled himself to a stand in his crib at five months. At nine months, he walked—on tiptoes! His parents thought he was way ahead of other babies until they learned that his tactile defensiveness drove him to avoid touching the crib sheet and the ground.
The Out-of-Sync Child Page 19