The Out-of-Sync Child

by Carol Kranowitz

  The Fall from the Ladder

  Perched on a ladder, you stretch to paint the ceiling. Your triune brain is totally involved: cerebrum, as you plan the next stroke; limbic system, as you smell the paint and remember your first painting experience with Dad; and reptilian complex, as you improve your “nest.”

  You tilt your chin up a little higher, and your inner ear sends messages to your brain stem about this change of neck and head position. The brain stem relays the vestibular information to your cerebellum, basal ganglia, thalamus, and cerebrum.

  Suddenly you feel dizzy, because your head is far off-center. You lose your balance, drop the paint can, and tumble to the floor.

  Your hypothalamus registers that you are hurt, afraid, and angry. It alerts your autonomic nervous system to increase your heart rate and to sweat.

  You lie in a heap. You can’t think about the spilling paint; when you feel endangered, your cerebrum shuts down and the reptilian brain takes over. Your instinct is self-preservation, so you wait until your reticular core calms you down. Regaining control, you realize that you are bruised but not broken. You arise and get busy.

  The Car Door Maneuver

  Your arms are full of packages and you must close the car door. Your parietal and occipital lobes exchange information to help you gauge your spatial relationship to the car and to plan and execute the maneuver.

  Motor neurons send messages through your cerebellum and spinal cord to muscles in your right leg. Excitatory neurons activate muscles on the back of your thigh, instructing them to flex. Inhibitory neurons activate muscles on the front of your thigh, instructing them to extend. Motor planning enables you to bend your knee and lift your right leg.

  Meanwhile, the opposite happens in your left leg, which straightens. You stabilize your body and keep your balance.

  Proprioceptors in your legs tell your brain what’s happening. You push your right foot against the car door and slam it shut.

  THE SENSORY PROCESSING MACHINE: SUMMARY

  This discussion of the “sensory processing machine” demonstrates the crucial interrelationship of the central nervous system and the senses. It also shows that all parts of the central nervous system must communicate in order to process senses.

  It is critical to understand that no matter how much advanced brain power a child has, intelligence alone is not sufficient for organized, daily functioning if the underlying senses are not in good working order. A child’s smooth development depends on smooth sensory processing.

  * If a person doesn’t engage in a wide range of sensory experiences, it becomes more difficult to use certain synaptic connections. For instance, when astronauts return to Earth after a few days, they have trouble reestablishing their sense of balance, because their gravity receptors were not stimulated in space.

  APPENDIX B: DR. AYRES’S FOUR LEVELS OF SENSORY INTEGRATION

  In her 1979 book, Sensory Integration and the Child, Dr. Ayres described the development of functional skills as “Four Levels of Integration.” As you read this summary, please refer to the building blocks illustration on page 67.

  LEVEL ONE (PRIMARY SENSORY SYSTEMS)

  The infant busily takes in sensory information, establishing the foundation for all future learning. While the visual, auditory, and other senses are operating, the primary “teachers” are skin (the tactile sense), gravity and movement (the vestibular sense), and muscles (the proprioceptive sense).

  Touch stimulation feels good on his skin and around his mouth (an extremely sensitive tactile receptor). He sucks with pleasure and enjoys being held and rocked. A strong feeling of attachment develops as a result of this sensory connection between mother and child. The baby learns that eating, cuddling, and being friendly provide positive feedback.

  Through his vestibular and proprioceptive senses, the baby receives information about his movement. He begins to regulate his eye movements, too. He blinks when a speck of dust approaches his eye. With his budding visual sense, he can see motionless objects nearby, as well as people and things moving around him. He anticipates and imitates his mother’s facial expressions. He learns to rely on the comings and goings of the people near him.

  Vestibular and proprioceptive senses also affect his posture and muscle tone. He tries new movements and, after some effort, succeeds. He lifts his head against gravity, then his shoulders, and, arching up with his weight on his hands and abdomen, he pivots on his stomach and looks around. He hears Mommy sing his name and turns to greet her. Moving in response to the environment is effective. The more he moves, the more confident he becomes.

  Vestibular sensations about gravity, coming through his inner ear, teach him that he is connected to the earth. He feels safe.

  LEVEL TWO (SENSORY-MOTOR SKILLS)

  Having processed basic senses at Level One, the toddler begins to develop body awareness. This is a mental picture of where body parts are, how they interrelate, and how they move. Visual feedback adds to a sense of self.

  Along with body awareness comes bilateral (two-sided) integration. This is the process that enables the child to use both sides of his body symmetrically, in a smooth, simultaneous, and coordinated way.

  Bilateral integration, a neurological process, is the foundation for bilateral coordination, a behavioral skill. Bilateral coordination is necessary for such interesting work as passing a rattle back and forth from hand to hand.

  A function of bilateral integration is lateralization, the process of establishing preference of one side of the brain for directing efficient movement on the opposite side of the body. As lateralization matures, the child begins to demonstrate a hand preference, uses his hands separately, and crosses the midline.

  Postural responses improve. The child can get into and stay in different positions. He develops neck stability and can raise his head and torso to look around.

  Neck stability helps the eyes hold steady so the child can gaze at whatever interests him. In turn, stabilization of the eyes helps the child improve motor control, for the more he uses his eyes to observe his surroundings, the more he coordinates his movements. With developing binocularity, or eye teaming, he looks where he is going and goes where he is looking.

  He begins to crawl, then creep. As he alternates his hands and legs, he uses both sides of his brain and stimulates bilateral coordination.

  His maturing tactile, vestibular, and proprioceptive senses promote praxis, or motor planning. He can figure out how to do something he has never done before, and then do it again. Rolling over, for example, requires motor planning the first few times, until the child has practiced it so often that he can roll over effortlessly.

  Practicing sensory-motor skills all day long means that the child’s activity level becomes better regulated. His attention span and emotional security increase because his sensations are becoming well organized. He can sit in his car seat for a ride to the grocery store. He can bang on the piano keys for a few minutes. He can fall asleep peacefully at the end of his busy day.

  LEVEL THREE (PERCEPTUAL-MOTOR SKILLS)

  As the child develops, so does cognitive understanding of the information that his senses take in. As sensory discrimination improves, his ability to interact with the external world broadens.

  Hearing (the auditory sense) becomes more refined. He can understand language and communicate through speech.

  Vision becomes more precise. He can interpret visual data more accurately. He understands spatial relationships and can discriminate where people and objects are and where he is in relation to them.

  Eye-hand coordination develops. Now the child can hold a crayon, draw a simple picture, catch a ball, and pour juice. Eye-hand coordination contributes to visual-motor integration, necessary for such tasks as putting together a string of pop beads, or fitting a jigsaw puzzle piece into place.

  Indeed, the child can do a jigsaw puzzle now—just for the fun of it—with purposeful, playful activity. When he picks up a jigsaw piece, it is his developing sen
sory processing that lets him see it, handle it, understand it, and fit it into the puzzle.

  As a preschooler, the child continues to develop and strengthen basic skills. Now he is ready for the top block—the end products of sensory processing, on Level Four.

  LEVEL FOUR (ACADEMIC READINESS)

  The end products of sensory integration are academic skills (including abstract thought and reasoning), complex motor skills, regulation of attention, organization of behavior, specialization of each side of the body and the brain, visualization, self-esteem, and self-control.

  These abilities become increasingly sophisticated. By kindergarten or first grade, the child’s brain is mature enough to specialize. Specialization (the process whereby one brain part becomes most efficient at a particular function) means that the child becomes more efficient and purposeful in his actions. His eyes and ears are prepared to take over as the primary “teachers.”

  He can suppress reflexive responses to unexpected touch sensations and his tactile discrimination improves. Outdoors on a wintry day, he can ignore the minor discomfort of an itchy wool hat and concentrate on making a snowball. He can tell the difference between a friendly pat and an aggressive punch.

  His proprioceptive sense, in tandem with his vestibular and tactile senses, strengthen his motor coordination. His gross-motor skills are smooth: He can jump and run and play with his pals.

  His fine-motor skills are good: He can button, zip, and spin a top. He consistently prefers to use one hand more than the other for tool use. He controls a pencil or crayon to make recognizable shapes and symbols.

  He can visualize past and future situations: yesterday’s ball game and tonight’s bath. Visualization helps him picture pretend and real images: make-believe monsters and Mommy’s reassuring face.

  He is socially competent, able to share ideas and toys, to be flexible when things don’t go his way, to empathize with others when things don’t go their way, to play by the rules, to be a reliable friend.

  The child will continue to process sensations throughout his life. As he encounters different situations and new challenges, he learns to make adaptations in meaningful ways. Feeling good about himself, he is ready for school and the big world.

  GLOSSARY

  Academic learning: The development of conceptual skills, such as learning to read words and multiply numbers, and to apply what one learns today to what one learned yesterday.

  Accommodation: The basic visual skill of focusing on objects at varying distances.

  Active touch: Using one’s hands, feet, and mouth to gather tactile information about objects in the environment.

  Activity level: The degree of one’s mental, emotional, or physical arousal. Activity level can be high, low, or in between.

  Acuity: The keen perception of a sight, sound or other sensation.

  Adaptive behavior: The ability to respond actively and purposefully to changing circumstances and new sensory experiences.

  Amygdala: The brain structure that processes smell sensations and produces memories with an emotional component.

  Arousal: A state of the nervous system ranging from sleep to awake, from low to high. The optimal state of arousal is the “just right” midpoint between boredom and anxiety, where we feel alert and calm.

  Articulation: The production of speech sounds.

  Attention-Deficit/Hyperactivity Disorder (ADHD): An umbrella term for a problem interfering with one’s ability to attend to and stay focused on meaningful tasks, control one’s impulses, and regulate one’s activity level. The main symptoms of this neurologically based disorder are hyperactivity, inattention (distractibility), and/or impulsivity.

  Audition: The ability to receive and apprehend sounds; hearing.

  Auditory discrimination: The ability to receive, identify, differentiate, understand, and respond to sounds.

  Association—Relating novel sound to familiar sound.

  Attention—Maintaining focus sufficiently to listen to voices and sounds.

  Cohesion—Uniting various ideas into a coherent whole and drawing inferences from what is said.

  Discrimination—Differentiating among sounds.

  Figure-ground—Distinguishing between sounds in the foreground and background.

  Localization—Identifying the source of a sound.

  Memory—Remembering what was said.

  Sequencing—Putting what was heard in order.

  Tracking—Following a sound as it moves.

  Auditory training: A method of sound stimulation designed to improve a person’s listening and communicative skills, learning capabilities, motor coordination, body awareness, and self-esteem.

  Autism: A lifelong neurological disability, usually appearing during the first three years of life, which severely impairs the person’s sensory processing, verbal and nonverbal communication, social interaction, imagination, problem-solving, and development.

  Autonomic nervous system: One of the three components of the nervous system; controls automatic, unconscious bodily functions, such as breathing, sweating, shivering, and digesting.

  Aversive response: A feeling of revulsion and repugnance toward a sensation, accompanied by an intense desire to avoid or turn away from it.

  Axon: A long fiber extending from the cell body of a neuron that carries impulses away from it to other neurons.

  Basal ganglia: The cluster of nerves in the brain that helps coordinate and modulate body movement.

  Basic visual skills: Unconscious mechanisms of sight.

  Behavior: Whatever one does, through actions, feelings, perceptions, thoughts, words, or movements, in response to stimulation.

  Bilateral coordination: The ability to use both sides of the body together in a smooth and simultaneous manner.

  Bilateral integration: The neurological process of integrating sensations from both body sides; the foundation for bilateral coordination.

  Binocularity (binocular vision; eye teaming): The basic eye-motor skill of forming a single visual image from two images that the eyes separately record.

  Bipolar Disorder: An illness involving mood shifts from high to low that affects perceptions, emotions, and behavior; probably caused by dysfunctioning electrical and chemical elements in the brain.

  Body awareness, body percept, or body scheme: The mental picture of one’s own body parts, where they are, how they interrelate, and how they move.

  Body position: The placement of one’s head, limbs, and trunk. Proprioception is the sense of body position.

  Brain: The portion of the CNS that receives sensory messages; integrates, modulates and organizes them; and sends out messages to produce motor, language, or emotional responses.

  Brain-behavior: Pertaining to the relationship of incoming sensory messages and outgoing motor, language, or emotional responses.

  Brain stem: A primitive brain part, which regulates elementary sensory-motor processes, such as breathing, swallowing, becoming aroused, and calming down.

  Central nervous system (CNS): The part of the nervous system, consisting of the brain and spinal cord, that coordinates the activity of the entire nervous system.

  Cerebellum: The brain part that directs accurate body movements and balance and processes all other types of sensation.

  Cerebral cortex: The outer layer of the cerebrum that coordinates higher nervous activity; also neocortex.

  Cerebral hemispheres: The two halves of the cerebrum, which continue sensory processing begun at lower levels of the CNS and direct voluntary behavior.

  Cerebrum: The front part of the brain where detailed processing of sensations occurs; the “thinking brain.”

  Compressed visual attention: Focusing on just one object at a time rather than seeing the whole picture.

  Cortical lobes: The four sections of the cerebral hemispheres devoted to processing vision, touch, proprioception, memory, hearing, speech, problem solving, voluntary movement, and emotions.

  Crossing the midline: Using a h
and, foot or eye on the opposite side of the body.

  Deep pressure (see Touch pressure).

  Defensive (or protective) system: The component of a sensory system that alerts one to real or potential danger and causes a self-protective response. This system is innate.

  Developmental delay: The acquisition of specific skills after the expected age.

  Diencephalon: The brain part serving as a relay station for incoming sensory information and outgoing motor responses.

  Discriminative system: The component of a sensory system that allows one to distinguish differences among and between stimuli. This system is not innate but develops with time and practice.

  Distractibility: The inability to fix one’s attention on any one stimulus.

  Down Syndrome: A congenital disorder, caused by an extra chromosome, that alters the typical development of the brain and body, causing mental retardation.

  Dysfunction in sensory integration (DSI): (see Sensory Processing Disorder.)

  Dyslexia: Severe difficulty in using or understanding language while listening, speaking, reading, writing, or spelling.

  Dyspraxia: Difficulty in conceptualizing, motor planning, sequencing, and carrying out unfamiliar actions in a skillful manner. (see Praxis.)

  Early intervention: Treatment or therapy to prevent problems or to improve a young child’s health and development, such as eyeglasses or ear tubes for medical problems, and speech/language therapy or occupational therapy for developmental problems.

  Emotional security: The sense that one is lovable and loved, that other people are trustworthy, and that one has the competence to function effectively in everyday life.

  Enuresis: Involuntary urination in a child five years or older when no physical abnormality exists.

  Essential fatty acids: Substances from fats that must be provided by foods because the body cannot make them, and yet must have them for health.