Published Summer 2010.

Picture Brian. While the other children are settling down to a workbook task, Brian rocks in his seat, whining, “Owwuu,” and rubbing his arm where a classmate grazed him en route to her chair. Abruptly, he stands and shoves his desk away from passing children.

The teacher frowns. “Sit down, stay put, and start working, Brian!”

He wriggles in his seat. “Um, what are we supposed to do?”

“Pay attention! Page 36, even-numbered questions.”

He gropes inside his messy desk, finally locates the workbook, and drops it. Retrieving it, he sags to the floor. He plops into the chair again, grips a pencil like a dagger, and starts writing — but presses so hard that the point breaks. He hurls the pencil across the room and screams, “I hate this!”

Brian is inattentive, impulsive, and fidgety. Does he have Attention Deficit Hyperactivity Disorder – or Sensory Processing Disorder? Recognizing the differences between these two disorders and providing appropriate treatment can greatly benefit children and adults like Brian.

Like ADHD, SPD is a neurological problem affecting behavior and learning. Unlike ADHD, SPD is not treated with medicine. Instead, occupational therapy using a sensory integration framework (“OT-SI”) helps most. This therapy addresses underlying difficulties in processing sensations that cause inattention and hyperactivity.

In The Out-of-Sync Child, I define SPD as the “difficulty in how the brain takes in, organizes, and uses sensory information, causing a person to have problems interacting effectively in the everyday environment.” Sensory stimulation – too much, too little, or the wrong kind – may cause poor motor coordination, incessant movement, attentional problems, and impulsive behavior as the person strives to get less, or more, sensory input.

Brian’s central nervous system inefficiently processes tactile sensations. The slightest touch overwhelms him. A “sensory avoider,” he is over-responsive and cannot regulate, or “modulate,” sensory input. Also, touch stimulation confuses him. A “sensory jumbler,” Brian cannot discriminate differences among sensations.

How does his SPD play out? Brian cannot interpret how objects feel when they contact his skin. His chair, desk contents, workbook, pencil, and classmates bother or befuddle him. Fidgeting and squirming, he pays a lot of attention to averting ordinary tactile sensations. Meanwhile, he pays scant attention to the teacher’s words or classroom rules.

Imagine Dana, a child who processes movement and balance sensations very slowly. This under-responsive child, or “sensory disregarder,” has difficulty starting or stopping an activity. With encouragement, she eventually settles into a swing, enjoying the movement that helps her nervous system get organized. However, Dana does not know when to stop. She swings and swings, inattentive to her own body-centered sensations screaming, “Enough!” 

Envision Jayson, a “sensory craver” who needs much more action than his peers. An impulsive “bumper and crasher,” he seeks intense, vigorous movement. Constantly, he rocks, climbs, gets upside-down, and gyrates, darting from one experience to another. He pays much attention to satisfying his craving for movement and little attention to his mother’s instructions or where he left his shoes.

Inattention . . . impulsivity . . . fidgetiness … constant movement … these are definitely symptoms of SPD.

Now consider this definition for Attention Deficit Disorder: a “neurological syndrome characterized by serious and persistent inattention and impulsivity. When constant, fidgety movement (hyperactivity) is an additional characteristic, the syndrome is called Attention Deficit Hyperactivity Disorder.”

Inattention … impulsivity … fidgetiness … constant movement. These are definitely symptoms of ADHD.

SPD and ADHD are certainly “look-alikes.” However, they are distinct disorders, and optimum treatment for the two problems is very different. Before jumping to conclusions (and to drug therapy), professionals, parents, and teachers should consider the whole child to thoughtfully determine the best support.

If the child is frequently, but not always, inattentive, it is useful to observe her behavior and ask: Where, when, and how often does her inattention occur? What is happening, or not happening, when she concentrates well? What is her “self-therapy”?

When overloaded, an over-responsive child needs less stimulation. How can we help? We can undo something! Over-the-counter first aid for this child might be decreasing the offending sensations. We can make the environment softer, dimmer, quieter, calmer.

Then, we can do something! Comfort her with “deep pressure,” such as a massage or bear hug. Create a retreat under the dining room table or in a classroom corner, with pillows and a sleeping bag to burrow into. Apply deep pressure on skin and muscles to get her organized and ready to participate and learn. Provide heavy-work activities: pushing a grocery cart, pulling a wagon, lifting weights, or carrying a book carton. Ensure daily outdoor play. (Movement always helps, so the more recess, the better.) Jog together around the block or playground. Offer 3 opportunities for gentle roughhousing. Give her a rolling pin for pressing dough, a shovel for digging, a bar for chinning, a hammock for swaying, a wad of gum for chewing, a trampoline for jumping.

When “underloaded,” an under-responsive or sensory-seeking child needs extra sensory stimulation. Again, we can do something! Provide sensory-motor experiences like those mentioned above. The under-responsive or seeking child needs them, too, in varying degrees, for similar activities may calm one type of child and invigorate or satisfy another.

Providing just the right sensory-motor input will certainly help a child with SPD. No surprise, sensory-motor input will also help the child with ADHD. Indeed, it will help everyone, because we all require frequent, daily sensory-motor experiences.

Not psychostimulants, but a sensory diet may be the best “medicine” for the child with attention problems. (An occupational therapist can develop an individualized sensory diet with appropriate touch and movement experiences.) An approach that excludes drugs and includes movement, deep pressure, and heavy work never hurts and often helps the inattentive child whose problem is not ADHD but developmentally delayed sensory processing.

 

References:

Ayres, A.J., PhD (2005). Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Los Angeles: Western Psychological Services.

Biel, L., & Peske, N. (2005). Raising a Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues. New York: Penguin.

Kranowitz, C. (2005). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder. New York: Perigee. Kranowitz, C. (2006). The Out-of-Sync Child Has Fun: Activities for Kids with Sensory Processing Disorder. New York: Perigee.

Kranowitz, C., & Newman, J. (2010). Growing an In-Sync Child. New York: Perigee.

Miller, L.J., PhD, with Fuller, D.A. (2006). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. New York: Putnam.

Smith, K.A., PhD, & Gouze, K.R., PhD (2004). The Sensory-Sensitive Child: Practical Solutions for Out-of-Bounds Behavior. New York: Harper Collins.

 

Published in Sensory Focus, Summer issue

An advertisement from an electric power company dropped through my mail slot today, shouting, BLACKOUT: Could It Happen Again? It got me thinking about survival skills. When an outage occurs and we can’t switch on the electric power, we must switch to our own power to get from place to place, prepare meals, communicate with others, and entertain ourselves.

Will we be prepared? Especially those among us with SPD and other physical challenges?

Alas, so much is done for us these days that we all are becoming “do-ees” instead of “do-ers.” Learned helplessness is everybody’s problem.

Consider automatic doors, electric can openers, battery-operated pencil sharpeners, Velcro fasteners, electronic keyboards, TV remotes, pre-sliced vegetables, and public restrooms’ sensor faucets. (Who’s the sensor? Not us!) These “smart” things are designed to make life easier and cleaner today — but they deny children opportunities to develop skills they will need tomorrow. Kids need steady practice using their sensory systems and engaging their bodies to push, pull, squeeze, rotate, twist, tie, zip, write, slice, chop, and perform other everyday actions. How smart is a device that renders us senseless?

Let’s not allow devices to extinguish our senses! We need our senses!

We need them, first, for survival. We must be at-the-ready to satisfy physical demands like hunger and to protect ourselves from potential threats. When we feel safe and that we will survive, we can relax and use our senses for a second vital purpose — that of discriminating what is happening around us.

Sensory discrimination helps us do and master important skills. The more important an activity is for survival, the more senses are involved. Because eating and making love are essential for life, they are the two human activities that engage all eight senses simultaneously. (Can you think of a third? Let me know.) In contrast, watching TV while lying on the couch uses only two senses — visual and auditory — and passively, at that.

Effective learning takes attention, time and practice. We learn to write after learning to scribble, to obey traffic rules on the road after riding bikes at the playground, and to pitch a baseball after tossing a beach ball. Many hands-on moments with regular faucets lead the way to turning an unfamiliar faucet handle with appropriate force, in the correct direction, and to the right extent … and then to turning the handle to “off” before walking away. (Can a sensor faucet teach all that?)

To develop and enhance our kids’ survival skills, let’s provide real, three dimensional, fun and functional experiences to get their bodies and brains in sync. Think of heavy work activities that use kid power, not electric or battery power. Think of action verbs, like push, pull, lift, carry, slice, chop, jump, climb, throw, catch, and so forth. The more kids do, the more they can do, and the more likely they will be to survive, superbly, when the lights go out.

 

HEAVY DUTY ACTIVITIES TO DEVELOP KID POWER

• HEAVE heavy, indestructible grocery items into the cart, such as bags of beans and potatoes, plastic bottles of water, cans of soup and iced tea, and so forth. The heavier, the better.
• HOIST grocery bags into the car, into the kitchen, onto the counter.
• LIFT the items out of the bags and stow them in the refrigerator and pantry.
• SLICE vegetables for a Circle Salad (see Box).
• CHOP vegetables for a Chopped Salad.
• TWIST a mill to grind pepper.
• GRATE a large, firm wedge of cheese using a box grater.
• PEEL carrots, cucumbers, potatoes.
• TUG the string, or ROTATE the handle, of a salad spinner to dry lettuce.
• TEAR lettuce leaves into bite-sized pieces.
• HUSK corn on the cob.
• VACUUM, SWEEP, SHOVEL, and RAKE.
• DRAG the hose to water the grass or wash the car.
• TUG the puppy around the block.
• CARRY the laundry basket upstairs.
• STAND UP without using hands.
• DO PUSH-UPS. • CLIMB STAIRS without leaning on the banister.

 

CIRCLE SALAD

For ages 7 and up (Note: Some children younger than 7 can handle a kitchen knife well, and some children — regardless of age — cannot. You know your child best, so please use your own judgment!)

What You Need
Sharp, round-tip kitchen knife Large cutting board Vegetables: • Yellow squash, zucchini, and peeled cucumbers (easy-to-slice for children with low tone, low stamina, or poor motor coordination) • Carrots, celery, unpeeled cucumbers, onions, scallions, radishes, grape tomatoes, and olives (requiring more motor-planning, strength or dexterity)

What You Do
1. Slice vegetables into circles.
2. Mingle all the pretty circles in a bowl and serve with your favorite dressing.

Helps Your Child Develop and Enhance …

• Motor planning (for using kitchen tools)
• Bilateral coordination (for using two hands in different ways to accomplish a task)
• Social relationships (for being part of a team and helping to feed a group)
• Can-do spirit (for trying new activities and perhaps new foods)
• Nutrition (for nourishing the body as well as the central nervous system)
• All eight sensory systems (even picky eaters who don’t engage their gustatory sense still use seven senses!)
  • Tactile — Hands manipulate the vegetables, developing touch discrimination and fine-motor skills
  • Proprioceptive — Hands, arms and upper body get into correct position to push the knife through the vegetables, developing appropriate force
  • Vestibular — Body is upright and stable, improving balance; muscles needed to handle the food and tool are engaged, improving muscle tone and stamina • Visual — Eyes see the vegetables, hands, and knife, improving visual discrimination and visual-motor coordination • Auditory — Ears hear the knife touching the board, improving auditory discrimination
  • Olfactory — Nose smells the vegetables, improving what the nose knows and stimulating the appetite
  • Gustatory — Mouth tastes the Circle Salad (let’s hope), increasing foods the child will eat
  • Interoceptive — Internal organs digest the food, improving general health

Ways to Make It More Challenging

• Slant the knife to slice ovals for an Ellipse Salad
• Cube the vegetables to make a Block Salad
• Use a melon baller to scoop little orbs of watermelon, cantaloupe, and honeydew for a Sphere Salad
• Celebrate holidays with color-coordinated vegetables (green peppers, parsnips and carrots for St. Patrick’s Day; broccoli, mushrooms and tomatoes for Columbus Day)

What to Look for

• The child holds the vegetables firmly and has good control of the knife
• The child slices the vegetables in somewhat regular circles
• The work stays on the cutting board
• The child is engaged and having fun

 

HARD WORK IS FUN

A preschool student of mine loved playing in the Housekeeping Corner. At home, this privileged boy had a nanny, housekeeper, and cook to serve him. At school, donning an apron, he served others. He swept, ironed, dressed the baby dolls, prepared imaginary meals like “Magic Soup,” and tidied up his own messes. One day, I said, “At our school, you are one of the hardest workers!” Laughing, this resourceful child said, “At my house, people who work hard have all the fun!”

Carol Kranowitz, author of The Out-of-Sync Child and co-author with Joye Newman of Growing an In-Sync Child and In-Sync Activity Cards, is working on a new book, The Out-of-Sync Child Grows Up.

Published in Sensory Focus magazine, Winter issue

If you are seeking information about SPD’s effect on children, you are in luck. An abundance of books is available to help parents, teachers, and other non-OTs learn to recognize SPD characteristics and support “out-of-sync” kids at home and school.

Alas, should you seek information about SPD’s effect as children mature, you will find fewer choices. Reader-friendly resources that describe “what happens next” are hard to write and hard to find.

Worrying and wondering, parents and teachers have many questions about their kids’ future. As children grow up:

• Do they grow out of SPD?
• Are they able to use their beautiful minds to flourish at school?
• Do they develop close friendships?
• Are they invited to birthday parties and social gatherings?
• Can they learn to enjoy games and sports?
• Can they manage noisy, odorous, madding places, such as the subway, the highway, the cafeteria, the dormitory?
• Will they ever eat like other people?
• Do they learn to date, procreate, and parent?
• Do they find meaningful work?
• Does it ever become okay to hug them?
• Will it be possible to take them to new places? Go to the beach, across a bridge, to the amusement park, up an escalator, on an airplane … to the dentist?
• Does everything turn out all right in the end?

Parents and teachers have asked me these questions since the publication of The Out-of-Sync Child in 1998. They yearn for reassurance that the children they care for will develop the sensory skills necessary to function in daily life.

I have yearned, in turn, to give an answer more satisfying than, “It all depends… I really don’t know.” I don’t know because, as an early childhood educator, my expertise is with young children. Also, I do not know because I do not have SPD. Well, maybe, just a little, when my hands are touching finger paints or bread dough. (Shudder.)

Because I don’t know first hand how SPD affects maturing people, I have sent information seekers to experts who do. Sharon Heller, a psychologist, has sensory over-responsivity and has written books about it for teens and adults. Hartley Steiner, mother of three teenage sons with SPD, has edited a compilation of memoirs from 48 adults.

Scholarly articles and research papers about SPD in adults are also available in journals, in OT Practice, in AOTA’s Sensory Integration Special Interest Section newsletters, and on the Internet. Moya Kinnealey is well known for her research in SPD with adults, and Teresa May-Benson and the late Jane Koomar reported on research studies in this area. Tina Champagne has published research with others and a book on using sensory integration strategies with adolescent, adult and geriatric populations in mental health settings. Paula Aquilla wrote an excellent article for S.I. Focus magazine about SPD in people of different ages.

These books and articles are helpful, and still we need more. Teenagers and adults must know that they are not alone, that they can learn new strategies, that others like them have learned to cope and improve their lives with direct one-to-one occupational therapy, and that the future is full of hope.

Thus, I decided to gather and interweave stories written by individuals who have lived with SPD all their lives and who are glad to tell us about the process. The title of the forthcoming book will be, The Out-of-Sync Child Grows Up: Coping with Sensory Processing Disorder in the Adolescent and Young Adult Years.

To whet your appetite, here are some examples of contributors’ thoughts:

I Was Finally Out of Jail
“When I learned about SPD around my 40th birthday I was shocked — so many years, so much suffering for me, and others! I felt like a victim, a person who was confined in jail for all those years without being at fault and suddenly was exonerated because they discovered I was innocent.” — Gina Betech

I Enjoy Helping Younger Kids
“I have been pleasantly surprised to discover that although I am still a teenager, I am having a real positive effect on kids even younger than I am. One of the things I have learned is that although children can learn from the guidance of adults, they will progress even more if someone around their own age assists them. Through my speeches, I have been able to directly speak to children and convince them about the merits of hard work so they can find their own voices. This is a reward unto itself.” — Alexander Fields-Lefkovic, author of books that promote exercise to kids with special needs

I Learned to Attend to Personal Hygiene
“Even after my nervous system became more relaxed to these sensations, my mind was still psychologically hardwired into avoiding them. I had to spend time working on removing my beliefs that these forms of stimuli would still be painful to me. Once I did, however, I was finally able to do the things I once could never bear! “After over three years of OT as an adult, I have finally gotten to a place where I am able to appreciate a daily shower, and brushing my teeth won’t send me over the edge.… and I am now able to begin reversing an awful trend in declining dental hygiene. Even if I never truly enjoy these things, being able to do them without them wreaking havoc on me and sending me into a state of overload has been amazing. “Occupational therapy honestly does have the potential to make dreams come true, and my story has been a living testament to that over the past few years.” — Dan Travis, college student who avoided the tactile sensations of soap and water tasks until OT helped him

I Help Others Understand
“I cried writing the email, unsure how I would come across, how they would react, and how it might change our relationships. Their reactions were heartwarming. When I showed up at my cousin’s celebration (disorders and diagnoses be damned), my uncle enveloped me in his arms. He didn’t need to speak a word; I know he understood. My aunt and cousins followed suit. “Two hours later, when I started feeling sensorily-taxed by the events, no one asked, ‘Why are you going? Why can’t you stay?’ Instead, we all teared up and hugged good-bye. They thanked me for the monstrosity that was my effort to participate that night. And that’s the thing. Most people don’t know how much you go through until you give them permission to understand.” — Rachel Schneider, after being diagnosed with SPD and deciding to inform her relatives prior to a cousin’s wedding

The stories collected so far cover many topics, from feelings to friendships, from strategies for avoiding certain sensations to strategies for adapting to other sensations, from childhood memories to future plans. Several topics reoccur, especially the misery of having an “invisible” and often undiagnosed or misdiagnosed disorder — and the jubilation when an occupational therapist made a correct diagnosis of SPD. The stories are vibrant, poignant, funny, determined, angry, resigned, tender, and grateful — the full gamut. Indeed, the contributors concur that their lifelong work to manage sensations has made their lives and relationships more precious than anyone would have predicted when they were out-of-sync children.

References

BOOKS
Fields-Lefkovic, Alexander. Get Strong! Have Fun! An Exercise Book for Kids (2007) and Get Stronger! Have More Fun! (2011). www.starservices.tv/products.html

Heller, Sharon, PhD (2003). Too Loud, Too Tight, Too Fast, Too Tight: What to Do if You Are Sensory Defensive in an Overstimulating World. New York: Harper.

———-—- . Uptight & Off Center: How SPD Creates Anxiety, Confusion & Other Mental Health Issues & What You Can Do about It. http://sharonheller.net/uptight-off-center.php

Steiner, Hartley. Sensational Journeys: 48 Personal Stories of SPD (2011). Arlington, Texas: Sensory World. www.SensoryWorld.com

ARTICLES
Aquilla, Paula, DO, BSc, OT (2007). Sensory processing across the ages. S.I. Focus magazine. www.SIfocus.com

Champagne, Tina, OTD, OTR/L, CCAP. Publications on “The Seclusion and Restraint Reduction Initiative” and using sensory strategies to benefit adolescents and adults in mental health settings. www.ot-innovations.com

Kinnealey, Moya, PhD, OTR/L. Research studies on SPD in adolescents and adults, available at www.SPDfoundation.net and other websites.

May-Benson, Teresa, ScD, OTR/L, and Koomar, Jane, PhD, OTR/L. Research studies in sensory processing in typical adults as well as in adults with SPD. www.thespiralfoundation.org/researchproj.html

Co-authored with Joye Newman and published in “TYC – Teaching Young Children/Preschool,” Vol. 6, No. 1, October/November 2012

Click to Download Article

Co-authored with Joye Newman and published
in “The Educational Therapist,” Vol. 33, No. 2, October 2012

Abstract:

With a strong foundation of smoothly functioning sensory, perceptual-motor, and visual systems, young children are likely to succeed at home, at school, and out and about.  Lacking these three components, which Carol Kranowitz and Joye Newman consider necessary building blocks for being “In-Sync,” children may falter and fall behind their peers.  By observing children’s sensory processing, affect, posture, motor coordination and other behaviors on the playground and in the classroom, teachers and therapists can take note of their developmental skills and can introduce fun and purposeful “In-Sync” activities into the school day that will give young students a head start and a leg up….

This article was excerpted from the book Growing an In-Sync Child, by arrangement with Perigee, a member of Penguin Group (USA) Inc., copyright (c) 2010 by Out-of-Sync Child, Inc., and Joye Newman. To obtain the article, become a member and subscribe to The Educational Therapist journal. To obtain the book, go to your local bookstore or purchase from Penguin.com.

Children who have sensory processing disorder find it hard to take in
the world around them.  By Cynthia Ramnarace
Kiwi Magazine: Growing Families the Natural and Organic Way, January/February 2009

At first, Lisa Copen thought her then-2-year-old son, Josh, was just a high-spirited boy. So when she had trouble keeping up with his endless running and jumping, Copen initially blamed her rheumatoid arthritis.
But as Josh got older, his symptoms became more pronounced.  In preschool he constantly leaned on other children and wanted to hold something in his hand at all times. During mealtimes he refused to eat anything but crunchy foods. “As a mom you think, ‘This
is just a phase’,” Copen says. “But then you’re around these mothers whose kids are eating tofu like it’s the best thing ever, and you start to wonder why your child is different.”

Copen searched for an answer. Autism screenings came back negative, and doctors advised against testing for ADHD until Josh was at least five. But when Copen read The Out-of-Sync Child, by Carol Kranowitz, she learned that kids with Sensory Processing Disorder (SPD) have difficulty organizing information from their senses into appropriate actions. Josh fit the description perfectly.

SPD is unrecognized by the American Psychiatric Association, despite the fact that it was first identified nearly 4o years ago. Today, occupational therapists receive training on the topic, and a movement is afoot to add SPD to the American Psychiatric Association’s diagnostic manual. Since many doctors (including Copen’s pediatrician) are not fully versed on the treatment of SPD, Josh goes to an occupational therapist to learn the skills he needs to cope with the disorder.
SPD can manifest itself in different ways. For kids who over-respond to sensational input, stimulation such as lights, noise and touch can be unbearable.  On the other hand, under-responsive children (like Josh) crave constant stimulation.

In general, kids with SPD display “unusual responses to touch and movement,” says Carol Kranowitz, author of The Out-of-Sync Child. According to Kranowitz, these symptoms usually appear early in life. “Some babies don’t like being touched,” she says.  “In other cases, the baby is into everything — he wants more touch and more movement. The child is often either avoiding movement or is only satisfied when moving.”

SPD can lead to motor and behavioral problems, failure in school, anxiety and depression.  “Kids with SPD have low self-confidence,” says Kranowitz. “They say things like, ‘I can’t do that’ or ‘I’m no good at that’ before they even try.”  But therapy can help these children succeed at simple activities such as playing on a playground. “The whole attitude improves,” Kranowitz says.  “Suddenly the child is saying, ‘I’m going to try that’ or ‘I’m good at that.’”
Treatment for SPD varies according to a child’s needs. Some kids go to occupational therapy in order to tolerate new foods or permit being touched by other people. For others, physical therapy helps improve balance and reduce clumsiness.

If parents suspect their child may have SPD, they should seek help right away. State departments of health offer early intervention services, and parents can find an SPD-trained therapist through the Sensory Processing Disorder Foundation, at www.spdfoundation.net.

SPD: A COMPLEX AFFLICTION
Sensory processing disorder affects how a person interprets information that’s delivered by the body’s senses. Here’s how the symptoms of SPD manifest themselves in various body systems.

THE TACTILE SYSTEM Some children are over-responsive to physical sensation and avoid being touched or touching new objects. Other kids want to touch everything — and with as much force as possible.

THE VESTIBULAR SYSTEM Children with SPD either love motion and are thrill-seekers who fidget constantly, or they dislike motion and may lose their balance easily and be generally clumsy.

THE PROPRIOCEPTIVE SYSTEM Children might deliberately crash into objects or constantly chew on pencils, shirt collars and toys.  It is difficult for them to plan the necessary steps to complete an action, such as putting on a shirt.

THE VISUAL SYSETM Eye-strain headaches are common, as is moving the head instead of the eyes when reading. These kids also have trouble repeating patterns, such as in a block tower, or stringing beads on a thread.

THE AUDITORY SYSTEM Everything from loud, sudden noises to soft background music can be distressing. SPD kids are also easily distracted by other sounds they hear while trying to participate in a conversation.