The Out-of-Sync Child

by Carol Kranowitz

  THE OCCUPATIONAL THERAPIST’S EVALUATION

  An occupational therapist will usually evaluate the child in her office. The evaluation is ordinarily a pleasant experience. While costs vary, expect to spend several hundred dollars. This will be money well spent, and it may be covered by health insurance.

  Here are some of the areas an OT investigates:

  Fine- and gross-motor developmental levels

  Visual-motor integration (doing puzzles or copying shapes)

  Visual discrimination

  Neuromuscular control (balance and posture)

  Responses to sensory stimulation (tactile, vestibular, and proprioceptive)

  Bilateral coordination

  Praxis (motor planning)

  Sensory processing is just one of several issues the OT is qualified to address. She may identify needs in other areas as well, such as attention deficit, language delay, or an auditory, visual, or emotional problem. If she finds that your child has a difficulty different from SPD, or that his needs are greater than her skills can serve, she may refer you to another professional.

  DIFFERENT THERAPIES, DIFFERENT APPROACHES

  After an evaluation, the next step is to arrange for treatment. The most beneficial treatment for SPD is occupational therapy using a sensory integration framework (OT-SI).

  Occupational Therapy

  Occupational therapy (abbreviated as OT) encompasses evaluation, assessment, treatment, and consultation. Occupational therapy is the use of purposeful activity to maximize the independence and the maintenance of health of an individual who is limited by a physical injury or illness, cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or learning disability, or an adverse environmental condition. For a child, purposeful activities include swinging, climbing, jumping, buttoning, drawing, and writing. Such activities are the child’s “occupation.”

  The specific goals of occupational therapy using a sensory integration (OT-SI) framework are to improve the person’s social participation, self-esteem, self-regulation and sensory-motor abilities.

  THE OCCUPATIONAL THERAPIST

  An occupational therapist (also abbreviated as OT) is a health professional who has received a baccalaureate or master’s degree after completing a course of study, plus internship experience, in the biological, physical, medical, and behavioral sciences. (After January 1, 2007, all new OT candidates will require a postbaccalaureate degree.) Coursework includes neurology, anatomy, orthopedics, psychology, and psychiatry.

  The OT may work with your child individually or in a group, at school, in a clinic, hospital, community mental health center, or your home. The ideal OT is one who specializes in pediatrics and who has received additional, postgraduate training in sensory integration theory and treatment.

  Under the guidance of a therapist, the child actively takes in movement and touch information in playful, meaningful, and natural ways that help his brain modulate these fundamental neural messages. The child responds favorably to SI treatment, because his nervous system is pliable and changeable. Therapy teaches the child to succeed—and he loves it!

  ACTIVITIES THE OT MAY PROVIDE

  Every child is different, so the sequence and kinds of activity that an occupational therapist provides for your child will be individualized. She will design a program based on his particular needs, going back in his system to where early skills have been mastered. Following his lead, she will guide him through activities that affect his central nervous system and challenge his ability to respond successfully to sensory stimuli in an organized way.

  For instance, your child may have difficulty jumping, climbing, pedaling tricycles, and getting dressed. These problems can’t be “fixed” by teaching him specifically how to jump, climb, pedal, and put on a jacket, when the underlying problem is SPD. He doesn’t need jumping lessons, but opportunities to integrate all sensations. With her appealing equipment and professional knowledge, a qualified therapist can weave art and science together to offer these opportunities.

  Here is a small sampling of activities that an OT may provide:

  • To reduce tactile defensiveness—having arms and legs rubbed with differently textured sponges and cloths

  • To improve tactile discrimination—finding hidden toys by manipulating a ball of therapeutic putty

  • To develop better body awareness and improve postural security—swinging prone in a special swing suspended from the ceiling, in order to experience specific movement sensations

  • To improve balance—lying or sitting on large, inflated, therapy balls

  • To improve bilateral coordination—using a rolling pin with both hands to bat at a ball hanging from the ceiling, while lying prone

  • To improve motor planning—moving through obstacle courses

  • To improve fine motor skills—playing with magnets to build up the muscles of the hand to stabilize loose joints

  • To improve extension against the pull of gravity—riding across the floor, or riding headfirst down a ramp, while lying prone on a scooter

  • To improve flexion—clinging to a cylindrical swing that is suspended from the ceiling

  • To reduce gravitational insecurity—swinging gently on a flat glider swing; jumping on a bounce pad

  • To improve ocular control and visual discrimination—playing games with beanbags, balloons, and suspended balls

  The most important factor that will determine the success of therapy is the child’s own inner drive to explore and learn from the environment. The child’s motivation to spin on a swing, to touch certain textures, or to be gently pressed between two gym mats tells the therapist what the child’s nervous system seeks.

  According to Dr. Ayres, “Sensations that make a child happy tend to be integrating.” When the child is actively involved in his own therapy, he becomes more organized, he has fun, and he feels in sync.

  Other Types of Therapy

  While the out-of-sync child will benefit most from occupational therapy, sometimes another highly specific type of therapy will also help. (While SPD is a neurological problem, most neurologists are not trained to evaluate it in children, and they do not provide SI therapy.)

  PHYSICAL THERAPY

  Physical therapy is a health profession devoted to improving an individual’s physical abilities. It involves activities that strengthen the child’s muscular control and motor coordination, especially of his large muscles. Sometimes using physical agents such as massage, whirlpool baths, or ultrasound, physical therapists help the child get his muscles ready for voluntary movement. Some physical therapists receive additional training in sensory integration theory and treatment. See www.apta.org.

  SPEECH-AND-LANGUAGE THERAPY

  Speech-and-language therapy includes activities designed to meet specific goals for the child. The child may need help with speech skills, such as pronouncing “L,” “K,” or “Sh” sounds; monitoring the pitch of his voice; and strengthening oral-motor control in the muscles of his mouth. He may also benefit from activities designed to expand his language skills, such as retelling stories, conversing, and playing games to develop memory and vocabulary. As many children with SPD are picky eaters, therapy with a speech pathologist trained in oral-motor and feeding issues may be very helpful. Indeed, when the child receives cotreatment simultaneously from an occupational therapist who has been trained in this area, optimal benefits of getting in the mouth occur. See www.asha.org.

  VISION THERAPY

  A developmental optometrist provides a complete evaluation of the visual system, determining not only that a person can see, but also how he sees. After the evaluation, the optometrist will provide the proper lens therapies or vision therapy (VT). VT includes sensory-motor and educational activities that strengthen eye-motor control, visual discrimination, and eye-hand coordination. Along with lenses or prisms, VT helps the child integrate visual information with input from other senses, such as hearing, touching, and moving. Th
is treatment often helps a child’s eyes and body function in sync and prevents learning-related visual problems. See www.optometrists.org, www.covd.org, www.pavevision.org, and www.oepf.org.

  AUDITORY TRAINING

  Auditory training is a method of sound stimulation designed to improve a person’s listening and communicative skills, learning capabilities, motor coordination, body awareness, and self-esteem. Various methods, including the methods developed by Alfred Tomatis, Guy Berard, Ron Minson, Sheila Frick, and Kate O’Brien Minson, use special headphones. During a course of several days, the child listens passively to music and voices filtered through the headphones, engages in specific visual and balance activities, and participates in active voice work. Therapy helps the ear to attend to and discriminate among sounds, the vestibular system to integrate sensory messages of balance and posture, and the person to become more focused, centered, and organized. See www.integratedlistening.com or www.vitallinks.net.

  CHIROPRACTIC

  Chiropractic is the philosophy, art, and science of detecting and correcting subluxation in the human body. Subluxation is a partial dislocation or abnormal movement of a bone in a joint. Chiropractic helps children with SPD by specifically addressing the structure and function of the nerves, muscles, and joints controlling posture and movement that influence our ability to interact with our environment. See www.chiroweb.com/find/children.html.

  CRANIOSACRAL THERAPY

  CranioSacral Therapy (CST) is a gentle method of evaluating and enhancing the function of the craniosacral system (the membranes and cerebrospinal fluid that protect the brain and spinal cord). CST involves light-touch manipulation of the bones in the skull, sacrum, and coccyx to correct an imbalance that can adversely affect the development of the brain and spinal cord and can result in sensory, motor, and neurological dysfunction. Developed by Dr. John Upledger, CST is used by a variety of health care professionals. See www.upledger.com.

  HIPPOTHERAPY

  Hippotherapy means “treatment with the help of the horse.” Occupational, physical, and speech therapists use the horse as a modality to improve the posture, movement, neuromotor function, and sensory processing of people with disabilities. The movement of the horse, with traditional therapy intervention, influences muscle tone, encourages muscle action, and improves vestibular reactions, sensory-motor integration, and midline postural control. See www.pathintl.org or www.americanhippotherapyassociation.org.

  MARTIAL ARTS

  For elementary school–aged and older children, martial arts, such as karate and tae kwon do, can be very therapeutic. (Dr. Larry Silver, who wrote the foreword to The Out-Of-Sync Child, often recommends martial arts for his clients with SPD.) See www.martialarts.about.com/cs/kids.

  NUTRITIONAL THERAPY

  Good nutrition is essential for development, efficient maintenance, and functioning, optimum activity level, and resistance to infection and disease. A nutritionist can help a person with nutritional deficiencies achieve balance in carbohydrates, fats, protein, vitamins, minerals, and water. See www.AutismNDI.com.

  PERCEPTUAL MOTOR THERAPY

  Perceptual motor therapy provides integrated movement experiences that remediate gross-motor, fine-motor, and visual discrimination problems. Activities, including sensory-input techniques, stimulate left/right brain communication to help the child interpret incoming information to the nervous system. Goals are to develop more mature patterns of response to specific stimuli, improve motor skills and balance, and stimulate alternate routes to memory and sequencing for those children who do not respond to the methods taught in the conventional classroom. See www.kidsmovingco.com.

  PSYCHOTHERAPY

  Psychotherapy is sometimes appropriate, particularly if the child is depressed or has behavior or self-image problems. (Psychotherapy deals with the effects of SPD but not the underlying causes.) Psychotherapies include behavioral therapy, to help the child deal with problematical symptoms and behaviors; family therapy, to help the child, parents, and siblings become a healthier unit; and play therapy, to promote the child’s social-emotional development. Therapists include clinical psychologists, licensed clinical social workers, and child psychiatrists. See www.icdl.org.

  BRINGING THERAPIST AND CHILD TOGETHER

  Before the first session with the OT (or other therapist), you will want to prepare your child. You can say, “Today you’ll meet someone who will help you get stronger. She has great toys and games to play. Her place is like a gym where you will do things that feel good. I think you’ll have lots of fun.”

  Emphasizing that therapy will be fun is important. Many children with Sensory Processing Disorder don’t have much fun. They wish they could but simply don’t know how.

  When you think and speak positively about therapy, you help make it work for your child. You reassure your child that this is not punishment or something to feel defensive about. The child may blame himself for being frequently clumsy or tired, saying, “I’m no good.” He needs frequent confirmation that he is good, and that therapy will make him even better.

  Whether treatment takes place in a busy clinic, at school, or in your very own basement, you will be involved, too. Part of the therapist’s job is to collaborate with parents to design activities that help the child function better at home. The therapist may also give suggestions to the teacher to modify the classroom environment.

  Because treatment will become a part of your child’s life, you and your child should get along well with the therapist. Goodness-of-fit is essential! If your child resists going for treatment, or if you lack confidence in the therapist, then something is amiss, and you should switch to another one, if possible. Treatment will be most successful when all the parties have a respectful and pleasant working relationship.

  Working with the therapist will take some time and effort, but your involvement is definitely worthwhile. The therapy itself may not last forever, but the results will last a lifetime.

  KEEPING A RECORD

  If you aren’t already keeping a running record of your child’s behavior and development, please begin one now! Your record should include:

  • Your own documented observations

  • Teachers’ comments and reports

  • Names, addresses, and telephone numbers of professionals you have consulted or intend to consult

  • Detailed, dated notes of consultations and telephone conversations with professionals

  • Written confirmation of information you have received orally

  • Specialists’ evaluations, diagnoses, and recommendations

  An orderly, chronological notebook is a valuable tool. It will help you see patterns that you may have missed. It will provide evidence of your child’s uneven development, should you need to prove at some point that your child requires special services. It will also help you feel more organized and in control.

  A professional diagnosis, along with therapy, should bring some relief. Meanwhile, life at home may improve when you follow some of the suggestions offered in the next chapter.

  Chapter Nine

  YOUR CHILD AT HOME

  Parents can make home life easier both for themselves and their child by introducing a balanced “sensory diet,” including activities that strengthen neurological development and improve self-help skills.

  A PARENT’S REVELATION

  When Tonya was three, she entered St. Columba’s. Reluctantly. She was fearful and limp. She spoke in a breathy voice, shrank from physical contact, and cried when it was time to go outdoors. However, she was very bright and loved stories, music, and dressing up.

  During the fall, we screened the three-year-olds for sensory processing disorder. Tonya’s results suggested a possibility of some dysfunction, but we weren’t sure. She might have been simply immature.

  While we usually observe late bloomers carefully before recommending occupational therapy, we decided to have a conference with Tonya’s parents. We felt we could promote Tonya’s social and physical dev
elopment if we could persuade them to improve her sensory diet.

  During the conference they listened politely to our suggestions to get Tonya outside every day, to give her more hands-on experiences, and to invite children over to play.

  “Well, those ideas won’t work,” her mother said. “Tonya hates being cold and messy. She dislikes going outside and playing with other kids. She just wants to be with the baby and me and listen to stories.” Rising to her feet, she added, “And that’s fine with us.” Unsatisfactorily for all of us, the conference ended.

  And so it went. Since the parents repeatedly resisted our suggestions, we decided to back off.

  Then, just as we stepped back, Tonya’s little sister took charge at home. This two-year-old began to clamor for changes in the family’s lifestyle. Sociable and energetic, she loved playing outside with the neighborhood children. Her mother found that the best way to gratify her was to take her daily to the playground. Of course, Tonya had to go, too.

  After Christmas vacation, we noticed a “new” Tonya. She was participating more and playing happily with other children. She laughed, spoke up, and even shouted. Her development amazed and delighted us.

  One day, her mother said, “I must tell you, I’ve had a revelation. We’ve been going to the park every day, even when it’s freezing. Tonya resisted at first, but now she asks to go. You had to tell me over and over again about a sensory diet, until I finally listened. Now I realize that for both girls, a sensory diet makes good sense and a huge difference!”

  A BALANCED SENSORY DIET

  A balanced sensory diet is a planned and scheduled activity program that a therapist develops to meet the needs of a specific child’s nervous system. Its purpose is to help the child become better regulated and more focused, adaptable, and skillful.