The "Out-of-Sync"
Child:
Sensory Processing Disorder
BY MEG ZWEIBACK, R.N., M.P.H.
© COPYRIGHT 2008 BY PARENTS'
PRESS
Dear Meg,
We have a delightful, high-energy 4-year-old boy. Jacob
has always been a handful, but we've never worried that there
was anything the matter we just figured that he was one
of those kids who had lots of energy and we take that into consideration.
This year, his preschool teacher, who loves him and thinks
he's delightful, funny and smart, asked us if we had thought
of having him evaluated for "sensory problems." She
says that compared to other kids his age, he has more trouble
settling down, and that he can't always do some of the fine motor
tasks that other kids his age can do.
We don't know if she's being overly cautious, and we're
not sure what she is talking about. Is this the new diagnosis
for preschoolers who don't always follow the rules, or should
we do something?
I don't know whether you need to be worried, but I will say
that a preschool teacher who loves your child is someone whose
observations should be given weight. At the same time, you may
want learn more about what she is noticing so that you can decide
on the next best steps.
Why don't you ask her to make a list of the specific behaviors
she sees that seem different from other boys his age? (Boys'
behavior at this age is often different from that of girls.)
Then compare what she tells you to what you see at home and in
other settings. That way, you can begin looking at what influences
affect Jacob's behavior. Noticing what helps him do well in each
setting will be the cornerstone for helping him do even better.
I think that your preschool teacher is describing a relatively
new way of thinking about how children respond to different types
of sensory input. In the past, we usually only thought about
sensory issues with children whose behavior and misbehavior was
extreme. Now we realize that children who have very mild variability
in their ability to process sensory stimulation can, at times,
have difficulty in some situations. We don't want to label or
diagnose children unnecessarily, but we do want to help kids
who may need a little extra consideration as we plan for their
busy days at school and at home. So here's a brief explanation
of sensory processing that will help you understand what the
teacher is saying to you.
Incidentally,sensory processing problems affect girls as well.
In the case of a girl Jacob's age, I'd suggest comparing her
behaviors with those of other 4-year-old girls. Again, that's
because entirely apart from sensory processing problems
boys' and girls' behaviors may differ at this age.
Your Child and Sensory Processing
Everyone learns and acts by using their senses: vision, hearing,
touch, balance, spatial awareness. We don't ordinarily notice
how we combine sensations we just do it.
Imagine yourself driving a car: You look all around with special
attention to what is directly ahead. You listen for unusual noises
such as sirens while ignoring ordinary sounds of traffic. You
feel your hands on the wheel and your foot on the gas and know
how much to turn or press down to get the car to do what you
want. You judge space and movement to decide when to merge lanes.
All of this happens at the same time, and most of us don't think
about it, even though it probably took us a while to integrate
all these sensations into our actions.
Sensory processing (sometimes called sensory integration)
is the neurological process of organizing the information we
get from our bodies and from the world around us for use in daily
life. Some sensory processing occurs developmentally; that is,
it becomes easier as out brains mature. (That's one reason we
don't teach an 8- or 12-year-old to drive!)
Young children gradually develop the ability to organize sensation.
However, some children have more difficulty than others processing
and organizing sensations. They have behaviors that are not common
for other children their age. A child with difficulties in sensory
processing may overreact or underreact to sensory stimulation
and behave inappropriately in situations where other children
the same age can behave well. The phrase "out of sync"
has been used to describe this condition in which a child is
not responding in an ordinary way to ordinary sensations.
Most children with sensory processing difficulties are healthy
and bright, and have competent parents. Their behavior may seem
mysterious to adults. These children must struggle to tolerate
ordinary sensations, to plan, organize, and predict their actions,
and to regulate their attention and activity levels. They are
too young to understand their own behavior, and they cannot learn
to manage it well unless the adults around them learn about how
to help them.
Although some children will have so many difficulties in their
behavior that they should be evaluated at a very young age and
get special treatment, many others have very mild symptoms in
only a few areas, and the issue of sensory processing may not
even be considered.
Parents often figure out how to begin helping a child on their
own and see great improvement. They learn to modify the environment
and expectations to help their child succeed. The first steps
always begin at home, since parents are the ones who see the
child in many situations and are often far more aware of the
range of behaviors that others see only sporadically.
These are the areas to think about in understanding your child's
responses to sensation:
Hypo and hypersensitivity. A child can be undersensitive
(hypo) or oversensitive (hyper) or a combination of the two.
Fatigue and hunger will worsen any child's ability to process
sensation, but the hyposensitive child may not feel hungry or
tired until he's starving or exhausted.
Movement. A child who is hyposensitive will seek more
stimulation in this area. Running, climbing, swinging, rocking
all will be present, and can be nonstop. The child may
be a risk-taker because of the need to push himself. "Daredevil"
behavior is common. However, the child may be able to sit and
focus very well, so the perception of "hyperactivity"
as in ADHD doesn't fit.
In contrast, the hypersensitive child may be bothered by any
activity that requires lots of movement or gross motor skills.
He may get very anxious about being in a situation where other
children are jumping, running, and climbing happily.
Touch. The hyposensitive child may be unaware of pain,
temperature, or how an object feels, and may seek more stimulation
by chewing, tasting or rubbing an object. He may overstuff his
mouth while eating and then gag on his food. He may want to touch
and manipulate everything he sees. He may love wrestling and
tickling and seek out these activities even when they are inappropriate.
Meanwhile, a child who is hypersensitive may be unable to
handle touch from others and may be upset by feeling certain
textures of clothing or food. Labels on clothing, tight shoes,
or heavy jackets may upset him. Pain may cause dramatic reactions
and lead to fears or phobias. The child may be extremely resistant
to washing his hair or face and may shrink from hugs or tickling.
A child may have both over- and under-reactions, or he may
be different on different days. (Since all young children learn
by touch and handling more than by listening or watching, this
characteristic may be developmental.)
Proprioception. This unfamiliar word means the ability
to perceive one's own position the unconscious sensation
of body movement necessary to balance, walk through a group of
people, avoid bumping into walls and furniture. This can apply
to large and small motor activities. A child with difficulty
in this area may bump into objects or people, break toys with
rough handling, or throw objects too hard. He may be unable to
master the twisting or stacking of small objects. He may be awkward
or clumsy. The child may kick or stomp to figure out where he
is in relation to furniture and floors. Manipulating objects
may be difficult because the feedback for the right amount of
pressure to use doesn't register.
Vision. A child may be hyposensitive and need to touch
objects to supplement his sight, even though his vision tests
fine. In contrast, the hypersensitive child will be distracted
or bothered by light, may dislike bright colors, and may avoid
looking at people's faces or making eye contact. An overly sensitive
child may need a completely dark room to be able to sleep.
Smell/taste. A hyposensitive child will be unaware
of bad odors. He may not be fussy about the taste of most food,
although textures can still be a problem. He may crave certain
tastes sweet and salty especially to get the stimulation
he seeks. Meanwhile, the hypersensitive child will notice differences
in foods and may be extremely discriminating and fussy about
what he will or won't eat.
Sounds. The hyposensitive child will seek out loud
noises, while a hypersensitive one will be bothered by loud noises
and may be distracted by or avoid noise that others don't notice
at all. He may put his hands over his ears and cry when he doesn't
like certain music or the noise of a crowd.
Self-regulation. A child may be unable to calm himself
once he is aroused. Other children may be able to get excited
and wild and then return to quiet behavior, but a child with
difficulty in this area will keep going. He doesn't appear to
be defiant or trying to test limits he just can't stop
unless an adult helps him calm down.
Because these sensory problems are confusing and unpredictable,
parents and teachers may react to the child as if the behavior
was intentional, and the primary response may occur after the
misbehavior. Since the child can't predict or control his behavior
without help before the situation occurs, the child and the adults
will be frustrated and probably angry. Because of this pattern,
the child with these sensory issues may be seen as having psychological
problems or Attention Deficit Disorder (ADD/ADHD). Parents may
be labeled as poor disciplinarians who are "unable to control
their child."
Finding Ways to Help
There are many ways to help children who have difficulty processing
sensations. The first step for parents is to observe their child
in a variety of settings and to notice when their child is doing
well. What is happening then? Most parents will begin to see
a relationship between environmental situations and the kind
of behavior they want to encourage and discourage. Those observations
point the way for the next steps.
Many children will be helped by a combination of a modified
environment, planning and preparing for challenging situations,
and learning self-soothing skills. If the area of sensory difficulty
is small and parents and teachers tune in to these issues, the
child will develop good coping skills and do very well. If a
child's sensory issues are more complex, it will help to have
an evaluation by an occupational therapist who has training in
sensory processing.
Treatment, whether it's mainly home and school-based or provided
with the assistance of an occupational therapist, helps the child
process all the senses so they can work together. Treatment helps
the child balance and integrate the "near senses"
the vestibular sense (inner ear) which processes information
on movement, gravity, and balance; the tactile sense (skin) which
processes touch; the proprioceptive sense (muscles, joints) which
processes information about body position and body parts
and the "far senses" (smell, taste, touch, sight, and
sound).
Many of the treatment activities are simply fun, and parents
will enjoy working with their child. These activities might include
water play, drawing in sand, using play dough and finger paints,
making music, blowing bubbles, gentle petting of stuffed animals
or pets, swaddling dolls or being swaddled, back rubs, going
up and down stairs, pushing and pulling, manipulating small toys
and objects, moving through an obstacle course, playground games,
balloon games, clapping, and tapping. And, of course, these are
all good activities for any child.
Resources
If any of these descriptions sound like your child, you may want
to read the excellent book, The Out-of-Sync Child: Recognizing
and Coping with Sensory Processing Disorder, Revised Edition
by Carol Stock Kranowitz and Lucy Jane Miller (Perigee Trade,
2006, $15.95 paperback). If Jacob's teacher hasn't read the book,
get her a copy. (The book describes children who have somewhat
complex sensory issues, but many parents will find the descriptions
very familiar, even if their own child's behavior is less pronounced.)
A companion book, The Out-of-Sync-Child Has Fun, Revised
Edition: Activities for Kids with Sensory Processing Disorder
by Carol Stock Kranowitz (Perigee Trade, 2006, $15.95 paperback;
also available as a Kindle Book via wireless delivery for $9.99 from
www.amazon.com) is also worth reading for practical ideas. Try
some of the suggestions, which are worthwhile for all children,
and see if the approach works for your child.
Then, if you think it would be helpful to go further, ask
the teacher and your child's pediatrician for suggestions about
the best places to have Jacob evaluated by an occupational therapist.
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