 |
||
|
The Out-Of-Sync Child: Recognizing and Coping With Sensory Integration Dysfunction Most preschoolers love the classes I teach involving music, movement, and dramatic play. Every day, small groups of 3-, 4-, and 5-year-olds come to my room to play, move, and learn. They happily pound on drums and xylophones, sing and clap, dance and spin. They shake beanbags, manipulate puppets, and enact fairy tales. They wave the parachute, play musical follow-the-leader games, and flow through obstacle courses. They swoop like kites, stomp like elephants, and melt like snowmen. Most children enjoy these activities because they have effective sensory integration -- the ability to organize sensory information for use in daily life. They take in sensations of touch, movement, sight, and sound coming from their bodies and the world around them, and they respond in a well-regulated way. Some children, however, such as Andrew, Ben, and Alice, do not enjoy coming to my classroom. Faced with the challenge of sensorimotor experiences, they become tense, unhappy, and confused. They refuse to participate in the activities, or do so inappropriately, and their behavior disrupts their classmates' fun. They are the children for whom this book is written. In my career as a teacher, since 1976, I have worked with more than 1000 young children. Outside of school, I have taught music classes for kindergartners in my home. I have choreographed children's dances for community performances. I have conducted dozens of musical birthday parties. I have been room mother, Cub Scout den leader, and team manager for my own sons' school and sports groups. Many years of working with children have taught me that all children like lively, interesting activities. They all want to join the fun -- yet some don't take part. Why not? Is it that they won't -- or that they can't? When I began teaching, the non-participants puzzled me. Why, I wondered, were these children so difficult to reach? Why did they seem to fall apart when it was time to join the fun? Why did Andrew have to buzz around the room's perimeter while his classmates, sitting on the rug, sang "The Wheels on the Bus"? Why did Ben tap, tap, tap his shoulders when the musical instructions were to tap, tap, tap his knees? Why did Alice flop onto her stomach, "too tired" to sit up and strike together two rhythm sticks? At first, these children annoyed me. They made me feel like a bad teacher. They also made me feel like a bad person when their inattention or disruptive behavior caused me to react negatively. Indeed, on one regrettable occasion, I told a child that turning away and covering his ears when I played the gui-tar was "just plain rude." That day I went home and wept. Every evening, while preparing dinner or engaging with my own sons, I would muse about these students. I couldn't get a handle on them. They had no identified special needs. They weren't unloved or dis-advantaged. Some seemed to misbehave on purpose, like sticking a foot out to trip a classmate, while others seemed to move without any purpose at all, in an aimless or listless manner. Little about their behavior could be classified, except for a shared inability to enjoy the activities that children traditionally relish. I wasn't the only one who was stumped. Karen Strimple (Director of St. Columba's Nursery School) and the other teachers were equally puz-zled by the same children. The children's parents were often concerned, especially when they compared their child's behavior to that of their other, more "together" offspring. And, if caring parents and teachers were frustrated, how must the children them-selves feel? They felt like failures. And we teachers felt that we were failing them. We knew we could do better. After all, since the 1970's, we had been mainstreaming into our regular school program a number of chil-dren with identified special needs. We were extremely successful with these children. Why were we less successful teaching certain "regular" kids with subtle, unidentified problems? We wanted an answer. The answer came from Lynn A. Balzer-Martin, PhD, OTR, a St. Columba's parent and a pediatric occupa-tional therapist. Since the 1970's, Lynn had been an educational con-sul-tant for our preschool mainstreaming program. Her primary work, however, was diagnosing and providing occupa-tional therapy for young children who had aca-demic and behavior prob-lems stemming from a neurological inefficiency called Sensory Integration Dysfunction. Few people recognize the term. The late A. Jean Ayres, PhD, an occupational therapist, was the first to describe it as a dysfunction resulting from inefficient neurological processing. In the 1950s and '60s, she formulated a theory of sensory integration dysfunction and led other occupational therapists in developing intervention strategies. Her book, Sensory Integration and The Child, presents a thorough explanation of this misunderstood problem and is required reading for anyone interested in grasping the technicalities of the subject. (See Recommended Books, Tapes and Videos.) It is important to recognize that sensory integration dysfunction, or SI dysfunction, is not a new problem. It is a new definition of an old problem. SI dysfunction is often subtle and can cause a bewildering variety of symptoms. Because their central nervous systems are ineffective in processing sensory information, children with this hidden difficulty have a hard time functioning in daily life. They may look fine and have superior intelligence, but may be awkward and clumsy, fearful and withdrawn, or hostile and aggressive. SI dysfunction can affect not only how they move and learn, but also how they behave, how they play and make friends, and especially how they feel about themselves. Most parents, educators, doctors and mental health professionals have difficulty in recognizing SI dysfunction. Because they don't recognize the problem, they may mistake a child's behavior, low self-esteem, or reluctance to participate in or-dinary childhood experiences for hyperactivity, learning disabilities, or emotional problems. Few people understand that bewildering behavior may stem from a poorly functioning nervous system. Dr. Lynn Balzer-Martin, like other students of Dr. Ayres' work, was trained to recognize SI dysfunction -- and to treat it. Her growing concern was that many of her clients were not sent to her for a diagnosis until well after they had run into trouble at school or at home, at the age of 6, 7, or 8. She was anxious to identify children at younger ages because the brain is most receptive to change while it is developing. Preschoolers, whose nervous systems are still developing rapidly, stand a good chance to benefit from therapeutic intervention. Lynn knew that if SI dysfunc-tion could be detected in 3, 4, or 5 year olds, these children could re-ceive indi-vidualized treatment that would prevent later social and academic impasses. The challenge was to find a way to identify preschoolers with SI dysfunction, because the available standardized tests are inappropriate for the "little guys." Lynn conceived of a quick, effective screening to see whether very young children had the neurological foundations necessary for developing into well-organized people. She asked us if we were interested. Were we interested?! Thus, everything came together at once. We wanted to learn more about our worrisome students. Lynn wanted to try out her screening idea. The Katharine P. Maddux Foundation, which already funded our flagship main-streaming program, was urging us to develop more projects de-signed to improve the physical, mental and emotional health of children and their families. Lynn's first goal was to educate us about sensory integration and then, with our help, to devise a screening program that would be developmentally suitable for preschoolers. The screening process would be fun for the children. It would be simple enough for many schools to duplicate. It would be short, yet thorough enough to enable educators to distinguish between basic imma-turity and possible SI dysfunction in young children. Most important, it would provide data that would encourage parents to seek early intervention for their children with an appropriate professional (such as an occupational therapist, physi-cal therapist, or sometimes a psychologist or speech/language pathologist). The purpose of early intervention is to help children function better -- even beauti-fully -- in their classrooms, in their homes, and in their daily lives. In 1987, with the support of the school community and with my eager assistance, Lynn instituted a program at St. Columba's Nursery School in which all 90 students undergo an annual screening. We began to guide identified children into early intervention therapy. And we began to see immediate, posi-tive, exhilarating results as these children's skills began to improve. Under Lynn's guidance, I studied and learned everything I could about the subject. I learned to screen the children and to compile data gleaned from teachers, parents, and direct observations. I learned to make sense of some children's mystifying behavior. As my knowledge increased, so did my teaching skills. I learned to help my co-teachers understand why these children marched to a different drummer. I gave workshops at other preschools and elementary schools to train educators to recognize signs of this subtle problem. I added activities in my class that promote healthy sensorimotor development for all children. I rejoiced in the strides that children such as Andrew, Ben and Alice made soon after they began occupational therapy. Incredibly, as they acquired more efficient sensorimotor skills, they relaxed, became more focused, and began to enjoy school. Now, when I went home at the end of the day, it wasn't to weep -- it was to celebrate! While my expertise grew, I learned that explaining sensory inte-gration to parents requires time and skill. When children have been screened at school and show clear evidence of dysfunction, Karen and I ask their parents to come in to school to observe them in the classroom and on the playground. Then we sit down for a private conference to discuss our observations. In these conferences, we describe sensory integration dysfunction and why we suspect it as a cause of their child's difficulties. We explain that the problem is treatable. We say that while older children and even adults can improve with treatment, it is early intervention that produces the most dramatic results. We try to allay parents' fears, assuring them that SI dysfunction does not suggest that their child is men-tally deficient, or that they are inadequate parents. We understand that parents are inevitably filled with anxi-ety, questions, and misapprehensions. Often, they dash to their pediatrician, who, unfamiliar with SI dysfunc-tion, may mistakenly dismiss it as a problem that the child will outgrow. We know that we raise more questions than it is possible to answer in a half-hour conference. Thus, this book was conceived to explain sensory integration and its counterpart, sensory integration dysfunction. I have attempted to make the explanations reader-friendly. They will introduce you to terms that early childhood professionals commonly use -- terms with which you need to become familiar. The information will help you understand your child, and that is the book's most important purpose. My hope is that once you grasp the subject, through the explanations and the examples of different types of children, you will be able to recognize the first signs of trouble in your own child. Then you will be prepared to provide the help your son or daughter needs to grow into a healthy, happy, and smoothly functioning adult. - Carol Stock Kranowitz |
|
