The Out-of-Sync Child

by Carol Kranowitz

  The child may skip typical childhood experiences because she can’t do them. It’s illuminating to ask oneself what she avoids. The answer may be elusive, for parents may not realize how much moving, touching, and playing matter. This is a common scenario among families in which the child is the oldest or only one. Without another, more organized child to compare with the disorganized one, parents may be unfamiliar with age-appropriate skills.

  6) “He’s so smart, so what if he can’t tie his shoes?” Despite having SPD, the child may have many strengths. He may be a math whiz, a dinosaur expert, or a great storyteller. By contrast, the same child may be weak in self-help skills, sports, or handwriting.

  Often, the out-of-sync child develops one or two “splinter skills.” These are skills that the child works exceedingly hard to master, but they don’t help him generalize his learning to accomplish more complex skills.

  For example, one of my preschool students learned to play “Frère Jacques” on the xylophone. He was pleased as punch. Unfortunately, that was his only tune. He played it repeatedly and could not be persuaded to try “Old MacDonald,” another simple tune. Another child learned to ride a small bicycle at school—a great accomplishment. However, she had no concept of how to apply her skills to a slightly larger bike at home.

  When the child is adept in several areas, or achieves a splinter skill, parents, teachers, and pediatricians frequently believe that she has no definable problems. They think she’s “just lazy” about learning new skills.

  7) “He can do everything well, if he wants to.” The child may have good days, when he’s cooperative, calm, and competent, and bad days, when he’s furious, fidgety, and frustrated. Because SPD can manifest itself in different ways, at different times, it is easy to be lulled into false confidence that dysfunction is not the problem.

  Parents may believe that the child’s erratic behavior is a matter of choice. It isn’t. No child chooses to be disorganized, but the out-of-sync child may be chronically inconsistent in behavior.

  Three Valid Reasons to Seek Help

  Still uncertain whether to seek a diagnosis? If so, consider the following criteria.

  1) Does the problem get in the child’s way? The answer is yes if he struggles with “doing what comes naturally”: creeping, running, jumping, climbing, talking, listening, hugging, and playing. The answer is also yes if he has low self-esteem. Indeed, low self-esteem is a red flag of SPD. Sometimes the child will be referred to a mental health professional. But, if the underlying neurological problems are not addressed, the child develops only compensatory techniques, at most.

  2) Does the child’s problem get in other people’s way? Yes, if it causes behavior that may not bother the child but bothers everyone else. The child may annoy other children when he pushes, may vex his teacher when he fidgets, and may scare the bejeepers out of his parents when he’s reckless—without comprehending why they are always upset with him.

  Yes, if the child is an “angel at home,” where it’s safe, but a “devil on the street,” where it’s unpredictable and scary. Yes, if he’s an angel at school, where he manages to pull himself together, but a demon at home, where he falls apart at the end of the day. When his behavior differs dramatically in different situations, he is sending out signals of distress.

  3) Should you listen when a teacher, pediatrician, or friend suggests you seek help? Yes, if they have dealt with many children and can recognize disorganized behavior. While their advice may hurt, it may also confirm what you sense but have been unable to address. Think of it this way: If the gas station attendant says your car needs a tune-up because it isn’t functioning well, you would listen. How about a tune-up for your out-of-sync child?

  DOCUMENTING YOUR CHILD’S BEHAVIOR

  Parents know their child best but often can’t make sense of what they know. Perhaps you’re concerned about your child’s difficulties, which don’t fit into traditional medical categories of children’s illnesses or disabilities. Perhaps the pediatrician can’t identify the problem, either, and says, “Nothing is wrong. Everything will eventually turn out all right.”

  What should you do?

  First, trust your instincts, and then document your observations.

  Documentation is a critical part of the process of identifying and addressing your child’s needs. Anecdotal evidence is just as important as professional diagnosis. Jot down observations you have made at home and incidents teachers have noted at school. Then, armed with specific data, you will be better equipped to notice patterns and to describe your child’s difficulties to a doctor or therapist who is familiar with SPD.

  Remember Tommy, Vicki, and Paul? (See pp. 4–7.) Tommy’s problems are tactile; Vicki’s are vestibular; Paul’s are proprioceptive. (These imaginary children have obvious problems. In real life, dysfunction is not so clear-cut.)

  Below are charts that their parents prepared. The first chart for each child documents the “hard times”: situations that cause out-of-sync behavior. The second chart documents the “easy times”: situations in which Tommy, Vicki, and Paul function well. (Charts for Sebastian, the overactive and awkward sensory craver, would be similar.)

  You may wish to make charts, too, and fill them with clues to help you solve the mystery of your beautiful, but bewildering, child.

  Tommy’s Troubling Times (Tactile Dysfunction)

  Because no one seems able to help, Tommy’s parents decide to do some detective work. They begin to chart his most difficult moments, hoping to discover patterns that will offer clues about his behavior. Here is their chart:

  Behavior Date Time Circumstances

  Tantrum! Refused to get dressed. Oct. 10 8:30 am Says his socks are too tight and he hates his new turtleneck sweater.

  Inconsolable at school. Oct. 14 10:00 am Teacher said he was fine until it was time for art project (finger painting).

  Threw plate on kitchen floor. Oct. 22 Noon I thought he’d like cottage cheese (instead of yogurt) for a change. Wrong!

  Screamed in grocery store. Threw a grape at friendly old lady. Nov. 23 4:30 pm Day before Thanksgiving. Noisy, crowded store. Old lady (stranger) tousled his hair.

  Single-handedly destroyed toys at “Santa’s Workshop.” Dec. 18 2:00 pm Excited by toys in the department store and couldn’t keep his hands off them. Out of control, like a bull in a china shop.

  INTERPRETATION OF TOMMY’S TROUBLING TIMES

  Unrelated as the charted notations seem, they indicate a pattern of tactile dysfunction. Let’s look at the incidents, one by one.

  First incident: Tommy fusses over his clothes because he is uncomfortable in high collars and bumpy socks. He is not purposely ornery. He simply cannot explain why certain textures are irritating. His poorly regulated tactile system is the culprit, telling him on a subconscious level that his clothes are threatening his sense of well-being. His mother remarks, “The person who invents the truly seamless sock will make a fortune!”

  Second incident: Tommy is inconsolable at school, because of finger painting. The teacher, believing that she offers pleasurable activities to her students, is mystified and urges Tommy to participate. He hates the thought of wet, messy hands, feels like a failure, and wishes the teacher would leave him alone. The scene escalates into a very unhappy situation.

  Third incident: Tommy makes a scene at lunch. He has eating problems, for his mouth is overly sensitive to the food textures. If you remember the first time you put a raw oyster in your mouth, you can sympathize! Tommy will eat yogurt because it is familiar and safe. Lumpy cottage cheese, however, is not safe. Tommy can’t explain that his defensive tactile system is sending up alert signals, so he hurls down his plate.

  Fourth incident: In the supermarket, Tommy bops a friendly woman on the head with a grape. Why does he lash out, making his mother wish she could just abandon him and the Thanksgiving turkey and go home to weep? The answer is simple: To Tommy, the woman is a threat. She is unfamiliar, and she makes the “mistake” of
patting him on the head.

  For all of us, our heads are extra sensitive to unexpected, light touch. Most of us react instantly to light touch in order to protect the body parts we need for survival. Because Tommy is more sensitive than most, he reacts with what we might consider an excessive response.

  Fifth incident: Tommy tears into the toys at Santa’s Workshop. Whereas others his age may be satisfied to look at and maybe caress the toys, with a discriminative touch, Tommy “attacks” them. An aspect of his out-of-sync touch system requires him to manhandle objects in order to learn about them. Poor Tommy! He wreaks havoc in Santa’s Workshop because he wants to know (and, of course, own) all the toys.

  In summary, Tommy has tactile dysfunction, involving overresponsivity and poor discrimination.

  Tommy’s Terrific Times

  Noting Tommy’s out-of-sync behavior gives only half the picture. Tommy’s parents also chart his terrific times, when he is more positively in sync.

  Behavior Date Time Circumstances

  Fell asleep easily. Oct. 11 7:30 pm Asked for a backrub: “Daddy do it, not Mommy.” (Art was pleased; usually Tommy prefers me to his Dad.) “Down, not up!” Art rubbed his back hard with firm, downward strokes and gave ten tight bear hugs for more deep pressure. Then Tommy asked Art to put him to bed—a first!

  Enjoyed bath and again fell asleep easily. Oct. 12 7:30 pm Two good ideas: having Tommy help get the water temperature “just right” (lukewarm), and using Art’s rubbing technique, first with a washcloth, then with a sponge. “More, Mommy, more!” The rubbing relaxed him.

  Had a great day at school. Oct. 15 9:00 am–Noon After I told his teacher that he likes rubdowns, she tried the “People Sandwich” game. He was the “baloney,” squished between two gym mats. Loved it. Rest of the day went well.

  Ate lunch without complaint. Oct. 15 12:30 pm Gave him pureed soup—no lumps. He chowed it down and had a second bowl. Why did it take me so long to realize he’ll eat only smooth food?

  Actually enjoyed trip to grocery store. Nov. 30 3:00 pm Went to supermarket that has miniature carts for kids. He liked pushing one, loaded with potatoes and apples, and was a great helper. Good idea to take him when store isn’t crowded.

  Sat on kitchen floor and kept me company for an hour while I baked. Jan. 5 2:00 pm His teacher said he enjoyed handling dried beans in the big bin. (He avoids the bin when it has water or sand.) I filled a dishpan with peas, pinto beans, and lentils and gave him some measuring cups and a scoop. He busily measured and poured beans, chatting away. He said, “This is fun work.”

  INTERPRETATION OF TOMMY’S TERRIFIC TIMES

  First incident: Firm, predictable touch has always comforted Tommy. He asks for a back rub with downward strokes—the way hair grows. (Upward strokes “ruffle his feathers” and “rub him the wrong way.”) He prefers his father’s deep pressure to his mother’s gentler caresses. Firm, soothing pressure suppresses his overresponsivity and prepares him for sleep.

  Second incident: Tommy’s mother invites him to help adjust the water temperature before he gets in the bath. He likes having some control, rather than being plunged into water that is “too hot!” or “too cold!” Tonight, he climbs in willingly. Also, she takes a cue from her husband and rubs Tommy’s back and limbs firmly with a washcloth and sponge, instead of sprinkling him clean. He relaxes, and the result is another pleasant bedtime.

  Third incident: The teacher tries a deep-pressure activity at school, with much success. Tommy enjoys being pounded with “mustard” and crawled over by his classmates. Therapeutic and fun, the “People Sandwich” activity also helps him interact with his peers.

  Fourth incident: Tommy cannot tolerate lumps in his food. When his mother prepares soup with a smooth texture, he likes it.

  Fifth incident: Tommy likes pushing the little grocery cart. He can get a good grip on the smooth handlebar, which doesn’t irritate his hands. The deep muscle work of pushing something with resistance feels good. Also, Tommy’s mother is paying more attention to his fear of crowds. She notes that going to the store when it is quiet makes the outing enjoyable.

  Sixth incident: Tommy likes handling the dried beans because they aren’t sticky, and he becomes engrossed in his play. Comparing notes about his behavior, his mother and teacher can strategize ways to provide him with successful tactile experiences at home and school.

  Vicki’s Vicissitudes (Vestibular Dysfunction)

  Vicki’s parents take notes about their child’s inconsistent behavior:

  Behavior Date Time Circumstances

  Strolling to corner mailbox, stumbled and fell. Cried, “So tired. Carry me!” June 4 9:30 am After a long night’s sleep and good breakfast, why should she be so limp? But sometimes, by the end of the day, she’s raring to go!

  Refused to let me leave her at Ellen’s birthday party. Once the games began, she became wound up and uncontrollable. June 9 2:30 pm So excited about the party, until we arrived. The whole class was invited to play tag and relay races. I was the only mom who had to stay, and Vicki was the only child who didn’t play. When she finally left my side, the activities really wound her up. She was in everybody’s face, shouting, pushing, and running wildly. Everyone was in tears. We left early.

  Fell apart at the playground. Tantrum lasted twenty minutes. July 3 2:30 pm Yesterday she loved the playground; today she hated it. Same place, same time, same weather, but different child! All I did was spin her a few times on the tire swing. Usually, she loves the tire swing.

  When we pointed to the moon, she kept looking at our fingers rather than the sky. Sept. 4 9:30 pm Up later than usual. Other kids at neighborhood picnic excited about the bright moon and stars. Vicki didn’t understand what she was supposed to be looking at.

  INTERPRETATION OF VICKI’S VICISSITUDES

  First incident: Vicki’s early-morning fatigue is a symptom of low muscle tone; she has a loose and limp body. A short excursion to the corner mailbox requires more energy than she can muster at the moment. Also, her trunk is unstable, and she has poor postural responses, poor balance, and poor motor coordination. Her mother notes, however, that in the evening, Vicki is energetic after experiencing intense movement.

  Second incident: New situations distress Vicki. Difficulty controlling her movements causes her to be emotionally insecure, so she clings to her mother. Poor coordination and poor motor planning hinder her ability to socialize effectively with her classmates. Her need for vigorous movement is keen, but when she eventually joins in the games, she goes overboard, crashing and bumping into the other children.

  Third incident: Knowing that Vicki often enjoys the tire swing, her mother thinks she’ll enjoy it even more with a little help to make it spin faster. Vicki cannot tolerate the unexpected, passive movement, however. Vicki hates being on the tire swing when someone else moves it; she likes it only when she is in control.

  Fourth incident: Looking at the moon poses another problem. Vicki’s eye movements are not well coordinated. Because her eyes don’t work well together, she has poor eye-teaming and poor depth perception. She looks at her parents’ wagging fingers, within her visual range, and seems unable to gaze beyond her immediate space.

  In summary, Vicki is underresponsive to vestibular sensations. Associated problems are low muscle tone, dyspraxia and postural dysfunction, and poor ocular control.

  Vicki’s Victories

  Vicki’s parents also take notes about successful situations.

  INTERPRETATION OF VICKI’S VICTORIES

  First incident: Positioning herself upside down, feet in the air, is a form of self-therapy. Although this position seems odd, it helps regulate Vicki’s inefficient processing. Through her inner ear she is receiving useful information about the pull of gravity.

  Second incident: Vicki enjoys swinging in different ways for an unusually long time. When she decides how to move and for how long, she is actively engaging in self-therapy. Hanging upside down provides one kind of intense vestibular intake tha
t her brain craves. Swaying gently back and forth, a form of linear movement through space, is soothing. Spinning on the tire swing, a form of rotary movement, also helps regulate her vestibular system.

  The fact that she does not get dizzy when she spins indicates that her vestibular system is out of sync. Normally, prolonged spinning would make a person feel woozy, but it makes Vicki feel wonderful.

  After swinging, she is chatty and vivacious. The activities have aroused the language centers of her brain. Like all children, she has a lot to say; unlike most children, she often has trouble getting the words out. When she “primes the pump,” the words begin to flow.

  Third incident: Rocking from side to side is a form of linear motion called oscillation. Like swinging, it organizes Vicki’s vestibular system. She likes the jolting sensation when the board strikes the ground. The jolts arouse her in a positive way by sending extra messages to her joints and muscles. When she directs her own play, she plays with purpose and with good attention.

  Behavior Date Time Circumstances

  Spent 5 minutes standing on her head. Afterwards, was calm and attentive. June 6 8:00 pm Tried to get Vicki into bed to listen to a story, but she was revved up, walking in circles. Finally, she went to the corner and got into an upside-down position. I read the story and she listened quietly. Then she came back to earth, climbed into bed, and fell instantly asleep.

  At park, swung for forty-five minutes! Bubbly, bright, and talkative all afternoon. July 2 2:30 pm First, she lay across the swing, tummy down, and pushed with her toes. Second, she sat on the swing and asked me to push her for a very long time. Third, she spun herself around on the tire swing. She wasn’t dizzy, but I was, just watching!

  Tipped to and fro on a makeshift teeter-totter. Later, seemed more in sync than usual. July 12 2:30 pm Vicki joined other kids as they played on a teeter-totter they had made with a plywood board over railroad timber. She rocked from side to side and enjoyed the jolt whenever the edge of the board hit the ground. She had a lot of fun coming up with different ways to balance.