Introduction to The Out-Of-Sync Child: Recognizing and Coping With Sensory Processing Disorder, revised edition (Perigee, 2005)
For 25 years, I taught at St. Columba’s Nursery School in Washington, DC. Most preschoolers loved my classes involving music, movement, and dramatic play. Every day, small groups of three-, four-, and five-year-olds would come to my room to play, move, and learn. They happily pounded on drums and xylophones, sang and clapped, danced and twirled. They shook beanbags, manipulated puppets, and enacted fairy tales. They waved the parachute, played musical follow-the-leader games, and flowed through obstacle courses. They swooped like kites, stomped like elephants, and melted like snowmen.
Most children enjoy such activities because they have effective sensory processing—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, did not enjoy coming to my classroom. Faced with the challenge of sensory-motor experiences, they became tense, unhappy, and confused. They refused to participate in the activities, or did so ineffectively, and their behavior disrupted their classmates’ fun. They are the children for whom this book is written.
In my teaching career (1976-2001), I worked with more than one thousand young children. Outside of school, I taught music classes for kindergartners in my home. I choreographed children’s dances for community performances. I conducted dozens of musical birthday parties. I was room mother, Cub Scout den leader, and team manager for my own sons’ school and sports groups.
Many years of working with children 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 nonparticipants puzzled me. Why, I wondered, were these children so difficult to reach? Why did they fall apart when it was time to join the fun?
Why did Andrew 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 guitar 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 disadvantaged. 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 puzzled by the same children. The children’s parents were often concerned, especially when they compared their child’s behavior with that of their other, more “together” offspring. And, if caring parents and teachers were frustrated, how must the children themselves feel?
They felt like failures. And we teachers felt that we were failing them.
We knew we could do better. After all, since the 1970s, St. Columba’s had been mainstreaming into its regular school program a number of children 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 occupational therapist. Since the 1970s, Lynn had been an educational consultant for our mainstreaming program – called “inclusion,” today. Her primary work, however, was diagnosing and treating young children who had academic and behavior problems stemming from a neurological inefficiency – then called “sensory integration dysfunction.”
An occupational therapist, A. Jean Ayres, PhD, was the pioneer who first described the problem. About 50 years ago, Dr. Ayres 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 its technicalities.
Sensory integration dysfunction, now known as Sensory Processing Disorder (SPD), is not a new problem. It is a new definition of an old problem.
SPD can cause a bewildering variety of symptoms. When their central nervous systems are ineffective in processing sensory information, children 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. SPD 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.
Many parents, educators, doctors, and mental health professionals have difficulty recognizing SPD. When they don’t recognize the problem, they may mistake a child’s behavior, low self-esteem, or reluctance to participate in ordinary childhood experiences for hyperactivity, learning disabilities, or emotional problems. Unless they are educated about SPD, few people understand that bewildering behavior may stem from a poorly functioning nervous system.
Dr. Lynn Balzer-Martin, like other students of Dr. Ayres’s work, was trained to recognize and treat sensory problems. 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 ages of six, seven, or eight. 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 SPD could be detected in three-, four-, or five-year-olds, these children could receive individualized treatment that would prevent later social and academic impasses.
The challenge was to find a way to identify preschoolers with SPD, 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 mainstreaming program, was urging us to develop more projects designed to improve the physical, mental, and emotional health of children and their families.
Lynn’s first goal was to educate us about sensory processing 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 immaturity and possible SPD 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, physical therapist, or sometimes a psychologist or speech/language pathologist). The purpose of early intervention is to help children function better—even beautifully—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 in which all ninety students undergo an annual screening. We began to guide identified children into early intervention therapy. And we began to see immediate, positive, 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 sensory-motor 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 sensory-motor 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 SPD to parents requires time and skill. When children who were screened showed clear evidence of dysfunction, Karen and I asked their parents to come in to observe them in the classroom and on the playground. Then we would sit down for a private conference to discuss our observations.
In these conferences, we described Sensory Processing Disorder and why we suspected it as a cause of their child’s difficulties. We explained that the problem is treatable. We said that while older children and even adults can improve with treatment, early intervention produces the most dramatic results. We tried to allay parents’ fears, assuring them that SPD did not suggest that their child was mentally deficient, or that they were inadequate parents.
We understood that this information inevitably filled parents with anxiety, questions, and misapprehensions. Often, they dashed to their pediatrician, who, unfamiliar with SPD, mistakenly dismissed it as a problem that the child would outgrow.
We knew that we raised more questions than it was possible to answer in a half-hour conference.
Thus, this book was conceived to explain sensory processing and its counterpart, Sensory Processing Disorder, to parents, teachers, and other non-OTs who are new at this. This 2nd edition, seven years after the first, contains up-to-date information that may also help those who are already experienced in caring for children with other, more observable disabilities, many of which overlap with SPD.
I have attempted to make the explanations reader-friendly. They will remind or introduce you to terms that early childhood professionals commonly use—terms with which you need to be familiar.
Understanding SPD will allow you to understand your child (or student) better, and that is the book’s most important purpose. Then you will be prepared to provide the help the child needs to become as competent and confident as possible.