(2010) Revelation from a Paper Plate

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Published in S.I. Focus, Summer issue

Imagine coming to one of my “Getting Kids in Sync” presentations. You are here to learn new strategies for supporting children with SPD. At the door, you receive a warm welcome, a hefty handout, and two paper plates.

Get a cup of coffee and snack, but please, do not put food on the plates. We’ll use them in many different ways — just not for bagels and berries!

During our synergetic day, one activity is drawing on a paper plate. This activity requires some thought, so it comes immediately after a break. From years of teaching, I know you will think better if given opportunities to stretch and move every 10 minutes or so.

Tip: Human beings are born to move. Movement gets the body and brain in sync and makes learning easier. Want your child to be ready to learn? A few minutes devoted to a physical action, such as jumping or swinging, prepares him for the cognitive action of reasoning and problem-solving.

Once you all are refreshed and reseated, I say, “Please get one of your paper plates. Then I’ll give you an assignment.”

What? An assignment? Now you are alert and possibly on guard, because you don’t know what is expected. You may fumble as you search for the plate. Take your time. We’ll wait until everyone is ready.

Tip: Rushing a person to do a novel task is counterproductive. “Doing,” or “praxis,” takes practice. Want your child to taste success when trying a new task? Give her plenty of time to ideate (conceive of) what she needs to do, to do the necessary motor planning, and to carry out her motor plan. Practice leads to praxis!

Got your plate? Paying attention? Great!

I say, “On your plate, sketch an experience you had as a child that you like to think about, now that you are an adult. This memorable experience may have happened once, or many times.” As Robert Schumann’s Traumerai (Scenes from Childhood) plays in the background, you pick up your pen and begin to draw.

Tip: Instrumental music (especially by Mozart, Bach, Schumann or other classical composers) is conducive to reading and writing. Music with lyrics (i.e., songs or opera), however, competes with these verbal tasks. Want your child to improve her study skills? Encourage her to listen to quiet music without words.

After a minute, I stop the music and get your attention by blowing into a slide whistle. You alert to the sound as the whistle rapidly glides up and down a musical scale.

♬ Whooosh! Whooosh.

Tip: People with SPD or autism often have an affinity for music, drum beats, poetry, and chants. Rhythmic patterns help their brains get organized so they can pay attention. Want your child to listen to you? Sing it, strum it, clap it, or tap it!

When you are all ears, I say, “Briefly share your story with the person next to you — or with two other people, so everyone is included. This story-sharing can be a ‘twosie’ or a ‘threesie’ activity.”

Tip: People with SPD often feel isolated. Want your child to feel part of the family or group? In conversation or activity, be mindful about ways to include everyone.

The room is abuzz as you and your neighbor(s) describe wonderful childhood memories. You gesture, laugh, nod in understanding, and lean toward your new friends. After a few minutes of “speed stories,” you again hear the slide whistle’s glissando whooshing up and down to get your attention.

Now I say, “Let’s hear some of your stories. Someone, please volunteer to tell your story in a few sentences.”

You may think, “Is this a trick question? What might my story reveal about myself? It was just about climbing a tree…. Would others consider it silly?” You — and many others in the room — may freeze.

Tip: When your senses take in a sudden, unexpected message, you are instantly aroused and self-protective. Your brain integrates and organizes sensory messages to help you assess whether you are in danger — and whether to fight, to take flight or fright, or to freeze. Only when your senses tell you that you do not need to be defensive, can you relax and use your senses to discriminate what is going on around you. Want your child to be an active and discriminating learner? First make sure your child feels safe!

If no one in the hotel ballroom ventures to share a story, I’ll offer one of mine, such as raking with my family and then jumping and rolling in a pile of fragrant, crunchy, colorful autumn leaves.

Tip: Throughout the day, everyone needs the sensation of deep pressure to the skin, muscles and joints. Want to calm your over-responsive child … or to arouse your under-responsive child? Let her run and jump into a pile of leaves, hay or snow or onto a mound of cushions, or give her a “Squeezit” (bear hug) until her sensory system gets in sync.

My leaf-pile anecdote alleviates your worry. It’s okay, this story sharing is a safe activity, and soon hands go up. We hear stories about building dams in the creek, jumping from swings, rolling down hills, and bike riding with buddies. We hear about what you did with trampolines and tree stumps … roller skates and rowboats … brownies and mudpies … horses, hikes, and hopscotch.

After several memorable stories, I say, “Even without hearing every story, I know a few things about what you drew, because your experiences share many common qualities. Times may change, but children’s needs stay the same.”

Most of your drawn experiences were:

  • Outdoors. If your story was outside, I ask you to raise your hand and look around the room. You turn and see a forest of hands.
  • Sensory-rich. Most of your reminiscences involve active touch, movement, vision and hearing, and perhaps smelling and tasting, too. The more meaningful and memorable an experience, the more senses are integrated. (Because they are essential for survival, the two human activities that use all senses simultaneously are eating and lovemaking. Watching TV uses only vision and hearing.)
  • Safe. Even if the activity was very challenging, you felt secure enough to keep going. You had “inner drive” to satisfy your curiosity, reach beyond your grasp, try new moves, or vary the game to make it more complex. You climbed out further on the branch, bowled with your left hand, planted peach and cherry pits together to produce a mystery fruit, and so forth.
  • Social. You were probably with family or friends, all relatively dependable and predictable. No bullies, no spoilers —just cohorts. You were part of a team. You felt needed. (Even if reading was an extremely pleasurable pastime when you were a child, you probably have not drawn it on your plate. Being alone may have been pleasant, but participating in activities with others is more memorable.)
  • Untimed. The experiences were over when they were over — when you were satisfied, or went home for supper. No clock imposed an artificial ending to the activity.
  • Meaningful. You had some or much control of the situation, and you were learning or developing a new skill that you could generalize to other scenarios.
  • Desirable. You liked the experience so much that you wanted to repeat it.
  • Active. You were the doer — not the “do-ee” who passively allowed the experience to happen without your participation.
  • Not in the classroom. Let’s hope that as educators bring more sensory-motor experiences into the classroom, this will change!
  • Independent of electronic equipment. You were using kid power, not electric or battery power. You — not purchased, plugged-in games — were the source of your own entertainment.

What do you think your children will draw on their plates, 20 years hence? If we provide many sensory-rich opportunities to move and play (especially outdoors), we can ensure that their memories will be as meaningful as ours.

Thank you for coming to the presentation and for engaging in this paper plate activity. In a future article, we’ll consider more sensory-motor and perceptual-motor experiences with paper plates, designed to get you and your children actively moving, learning, and growing “in-sync.”

 

(2010) Two “Look-Alikes”: Sensory Processing Disorder and Attention Deficit Disorder

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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.

 

(2014) Focus on Survival Skills: When the Lights Go Out

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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.

(2013) The Out-of-Sync Child Grows Up

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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

(2009) Making Sense of the Senses by Cynthia Ramnarace

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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.

(2002) Wisdom from a Preschool Teacher

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Posted on Child.com, September

A mother tells me how excited she is about her toddler’s “educational” computer game. Just click the mouse and presto – one, two, three oranges bound into a bucket. Click again, and they reappear, one, two, three. Isn’t that a fabulous way to learn counting? What is my opinion, as a preschool teacher?

“How about giving him a bucket and three oranges?” I ask. “Then he can touch and hold them, smell them, toss them, and enjoy a real experience.”

“That seems so old-fashioned!” she says.

Old-fashioned is right! And often, old-fashioned is better. Times change, but children don’t. They still need the good old experiences that kids have always relished. They need to run and play outside, take risks, and try again when they stumble. And they still need thoughtful, available parents.

Want to raise a confident, competent child? The kind of kid who loves to learn and play? Who actively participates in the world around her? Who thinks independently while still considering others points of view? In 25 years of working with young children and their families, I’ve found these 10 tips most helpful for raising can-do kids.

#1 Provide concrete experiences. Children are sensory-motor learners. Sensory-motor means that sensations come in, and motor (movement) responses go out. Thus, playing with an orange engages most senses and encourages the child to try different motor responses. She can squeeze and sniff it, roll it across the floor or around in a pie pan, play catch with you, and maybe peel, section, and savor it. Many physical, hands-on activities like these nourish the brain.

You can enrich your child s play by providing meaningful sensory-motor experiences. For example, furnish footwear to play “Shoe Store.” Your child can: Sort shoes by shape, size, texture, and how they fasten(laces/Velcro/buckle). Sequence them (sneaker, pump, boot; sneaker, pump, boot). Seriate them according to size. Try them all on. Box and stack them. Be the “customer” and “salesperson.”

Hide the videos. Ban TV. Jane Healy, PhD, of Colorado, an educational psychologist and expert on brain development, advises that children sit before an electronic screen no longer than 30 minutes a day. Video time deprives children of the sensory-motor experiences that build healthy brains and bodies. A Chinese adage says: “I hear, and I forget. I see, and I remember. I do, and I understand.”

#2 Get physical with your child. “Everyone needs 12 hugs a day for optimum emotional health,” claims a wise colleague. Hugs are therapeutic – not only emotionally, but also physically. Research shows that at-risk infants who are cuddled are more likely to thrive than babies who are not. While you’re at it, roughhouse with your child – especially your girl! Baby girls arrive with the same physical requirements as boys. Every child needs to move through space.

So, get on all fours and play Horsey. Play Up and Over: hold her hands, let her scale your legs, and flip her over and down. Play Helicopter: hold her at the waist or underarms and swing her through the air.

Learning and active movement go together. For instance, the first time your child plays Horsey, she may feel unsteady. She must judge how to stay balanced, how hard to clench her knees, and how not to choke you! Subsequently, she’ll be more confident and relaxed because she has integrated countless body-brain connections. Someday, she ll generalize these lessons about balance and body position when she mounts a real pony or bicycle.

#3 Get his muscles moving. Fine, or small, muscles, which mature gradually, control the hands, fingers, toes, lips, tongue, and eyes. To encourage small muscle development, first you need to get your child’s big muscles working.

“Every child must organize large muscles before concentrating on complex small motor skills,” says Patricia Lemer, Executive Director of Developmental Delay Resources, a nonprofit organization dedicated to healthy alternatives for children with special needs. “Before sitting and writing, children require many opportunities to climb on ladders, toss balls, and paint broad strokes while standing at an easel.”

For little kids, think big: large Legos, foot-long trucks, life-size baby dolls, thick paintbrushes, chubby chalk and crayons. After preschoolers practice manipulating big toys and tools, they can graduate to smaller ones, such as Matchbox cars and watercolor brushes.

Get your child’s eyes roving. Play flashlight games, such as chasing each other’s beamed zigzags on darkened walls. Lob beach balls back and forth. Play tetherball and pingpong. Lie outside on summer nights and watch fireflies. Point out things in the distance. These visual exercises help young eyes track moving objects, change focus from far to near, and function as a team.

Get your child’s tongue wagging. Play mouth games with your baby: mimic the ways you curl, shake, and poke your tongue. Stretch your lips in great Os and wide grins. These games strengthen speaking skills.

#4 Encourage critical thinking. Wonder and hypothesize together. Why do melons float and potatoes sink? What may happen if we run out of gas? What snack will Grandma serve? Asking, “What do you think?” may elicit profound insights. Kids give thoughtful answers when we ask thoughtful questions.

Suppose your child is curious about a cartoon his schoolmates discuss. You’d prefer to read stories, but he wants to watch TV. Relent; in the long run, watching a short, mindless show is less damaging than feeling left out by classmates. Seize this opportunity to guide him into thinking critically. Critical thinkers are not complainers, but people who evaluate situations with discrimination and care.

Watch the show together. Later, ask questions: Would the hero make a nice friend? How does he treat less powerful characters? Does he have a plan, or just let stuff happen to him? When things go wrong, does he use his words to solve the problem? What helps him succeed – fancy equipment or his own wits?

Do not accept “Dunno.” Get an opinion!

#5 Let your child speak for herself. You and your daughter go to the ice cream parlor. The familiar clerk says, “Hi!” Your daughter freezes. Before you jump in with, “Say ‘hi’ to Mike,” give her time to respond. A child capable of speaking may simply need a few extra beats.

And suppose Mike inquires what flavor she wants today, and she just stands there. Don’t give the answer yourself; you may not know your child’s preference. You weren’t asked the question, anyway. Producing “language on demand” is a prerequisite for school success. A child must learn to respond to direct questions and to ask for what she wants. If you do the talking, the danger for your child is “earned helplessness.” Why should she make an effort, if you always take over? Model friendly conversation to encourage her to be responsive and considerate.

#6 Encourage good reading habits. A cartoon shows a boy holding a book. He regards his father, who is simultaneously using a laptop and watching television. The child says, “Daddy, can you read?” Take time to read. When you show an interest in books, you teach your child that reading is a lifetime pleasure. Let him catch you at it. Talk about what you are learning from the book.

A preschooler doesn’t need details about front-page news or the plots of best-sellers, but he can benefit from understanding that all kinds of challenges beset all kinds of folks. Children learn empathy from their parents. Discuss how problems may be overcome when people care about one another and work together.

#7 Champion chores. Children love and need heavy work. It activates the large muscles in the arms, legs, and torso; puts the brain in gear; and prepares them to pay attention to the surrounding world. The easier we make life for our kids, the harder their lives will be. Without sufficient motor activities, they may have low stamina, poor muscle tone, and scant experience in accomplishing simple tasks. Insufficient movement can also lead to poor sleep patterns and appetites.

Having your child help with chores is a great first step. He can rake leaves, shovel snow, dig in the garden, brush the dog, wash the car, push the stroller and vacuum cleaner, carry laundry upstairs, and haul nonbreakables (rice, plastic soda bottles, and cans) from grocery store to car and from car to kitchen.

Not enough heavy loads? Make some! Recycle those plastic bottles as Bottle Babies: fill them halfway with water, tinted with food coloring or tempura paint; tighten their caps; and hand them over. Outdoors, your child will lug them around, roll and kick them, hide them under the bushes, bury them in the sandbox, wrap them in blankets and pretend they are babies, and consider them a perfect toy.

#8 Make mealtime memorable. Sit down and share a daily meal. Dinner is best; breakfast will do. With you as a model for mealtime decorum, your child can learn self-help skills such as cutting and pouring, as well as more complex life skills such as patience, sharing, and participating in the give and take of conversation. Should conversation get stuck, ask each family member to relate one incident of the day. Or say, “Tell us something funny (confusing, scary, incredible) that happened today.” Make sure that everyone has a turn to listen and comment.

Food, like movement, is essential nutrition for growing bodies. Around the table, your child can also be nourished emotionally, so she feels a sense of belonging and learns to be mindful of the needs of others; socially, so she learns to function in a group; and cognitively, so she learns to meet challenges and plan solutions.

#9 Honor your child’s interests. Say your daughter is fond of earthworms. She rescues and carries them home in paper cups. And let’s say you hate worms. Before you say, “Yuck,” look at her face. Is she emotionally invested in these creatures? Curious and compassionate? Eager to share her thoughts with you?

This is bad? No, this is wonderful!

#10 Make fun a priority. Play helps children learn. It stretches the imagination, encourages thinking skills, strengthens motor coordination, and enhances social development. Our daily charge should be, “Have fun!” – not “Be good!” Fun, like manners, empathy, and the desire to read, begins at home. If you know and show how to have fun, chances are your child will, too. So…

  • Dress up for Hallowe’en.
  • Play make-believe games, like “I’m the kid and you’re the Mommy.”
  • Celebrate Backwards Day; eat dessert first.
  • Switch the initial sounds of words to create Spoonerisms, such as “Please heed the famster,” or, “Remember to toss your fleeth,” or “All ready for proccer sactice?” Because they are old enough to get it, preschoolers are tickled by such… nensonse.
  • Have Silly Contests. Who can crunch carrots the loudest? Blow the biggest bubbles? Invent a word to rhyme with “raccoon”? Stare into another’s eyes without laughing?
  • Make music together. Music restores order, improves communication, and is one of life’s greatest pleasures. Homemade rhythm instruments include spoons, pots and pans, oatmeal-box drums, pencil mallets, and cigar-box guitars (sturdy boxes encircled with rubber bands). Inexpensive kazoos and slide whistles can add hilarious melody. Beat a simple rhythm and invite your child to join in. Take turns following each other’s beat. Change from simple to complex, from slow to fast, from loud to soft. Making music is especially fun when you and your child actively make it happen.

Some of the most important skills your child needs at school come from lessons that begin at home. Try these 10 Can-Do Tips, and you will help get your child on the path to success.

 

(2001) Taking Care of Yourself When Your Child Has Special Needs

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Unpublished – Written for the now-defunct clubmom.com, August 2001

Before takeoff, you buckle your seatbelt and listen to the flight attendant review emergency procedures. You hear that if the oxygen masks drop, you should adjust your own before assisting your child. Likewise, if you are on a lifelong journey as a special mom, you must care for yourself so you can effectively care for your child.

Self-care, however, requires TLC (Time, Liberty, Cash), resources often in short supply. Kathy Vestermark, mother of four, cherishes time for herself. “I gain stamina to advocate effectively for my child with multiple disabilities when I take time to do those things that ensure my self-preservation. Easier said than done!” Kathy adds, “My husband often reminds me to do something for myself. It’s hard not to give endlessly to others – especially to my son. I worry that if I relax my efforts, so will he.”

Psychologist Griffin Doyle, PhD, comments, “Parenting a unique child is a most difficult adjustment.” Coloring the parents struggle often is their guilt about not possessing sufficient emotional resources to match their internal image of an ideal, all-courageous parent. “Parents who respect, admit, and work through their guilt or other agonizing feelings truly are caring for themselves,” he adds.

Also, self-care can be a priceless model of self-esteem for the child to emulate. Balancing your needs with your child’s is the ticket. Here are suggestions from moms who achieve this balance:

1) Exercise daily. Donna Keating, whose five-year-old daughter has sensory processing disorder, says, “Usually, moms assume the task physically and emotionally of the child. It zaps every part of you. Exercise is so essential to relieve everyday stresses. I stick to my work-out schedule and rarely feel guilty about taking time out for myself.”

2) Volunteer for groups that are needier than you. Sorting clothes at Goodwill or serving soup at a shelter, you may feel less self-pitiful.

3) Take classes. Nanette Bevan, mother of three boys, one with Down syndrome and one with spinal muscular atrophy, says, “Pay for a course and go.” Nanette crafts glass and silver jewelry. Learning new techniques or working in the studio, she is in the flow. She stops worrying about her sons’ problems and returns home refueled.

4) Listen to soothing music. The Mozart Effect recordings and Nourishing the Caregiver (available through www.SensoryWorld.com) are produced specifically to relieve stress and restore order. A loftier idea is to get the piano tuned and make music.

5) Talk to someone, besides your husband. If you talk only to him, Nanette advises, you ll probably keep bonking up against each other over the same issues. A sympathetic friend or relative can be a lifeline, especially if the person shares your sense of humor. Consulting a psychotherapist is also extremely worthwhile. Donna comments, “When your child has special needs, you spend every waking moment thinking and planning to stay ahead. Moms require quantities of support that a spouse, relative, or friend can’t easily provide. On days when the light at the end of the tunnel seems nowhere in sight, I find some relief networking with moms with similar children.”

To find a support group, visit websites related to your child’s disability. Many have message boards for sharing concerns, information, and even belly laughs.

6) Seek respite care for an afternoon, evening or weekend, at home or a licensed facility.Finding respite care is challenging. It can be cost prohibitive, and providers may be scarce. Perhaps your local government can guide you to grants to help you meet the costs. Groups that provide respite care, sometimes free, include:

• Local chapters of national organizations that offer Parents Night Out, such as Easter Seals (www.easter-seals.com)
• ARCH National Respite Network (919-490-5577 or www.archrespite.org/respitelocator)
• Campus Ministries or public service groups at colleges, where students may gladly volunteer to baby sit for kids as special as yours
• Hospitals and Red Cross chapters that train providers of children with special needs

7) Nurture good babysitters. Amy Cunningham, whose son’s visual dysfunction lowers his tolerance for new people and situations, advises, “Once you find good babysitters, woo them. Treat them like honored family members – and pay them well. Do whatever it takes to ensure their return.”

8) Barter time with similar parents of similar children. If you are single, maybe you can watch your child and other kids simultaneously. A babysitting co-op may also work well. To locate one, consult neighbors, community newspapers and bulletin boards.

9) Think positively. Amy says, “I take better care of myself, my son, and everyone else I love when I not only accept what is, but also acknowledge the secret, sweet, up side that makes my life seem divinely designed.”

When you find the time to care for yourself, you will see your family’s spirits soar. Buckle up, and let’s go!

 

(2000) How Does Sensory Processing Disorder Affect Learning?

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Posted on SPD Foundation’s website (May)

Sensory Processing Disorder (SPD) is not classified as a learning disability, but it can certainly hamper a child’s ability to learn. To illustrate, here are stories about two preschoolers whom I taught in my music and movement room at St. Columba’s Nursery School in Washington, DC.

Robin, 4, is over-responsive to touch sensations (she avoids them). Larry, 3-1/2, is under-responsive to movement (he craves it). Let’s look at these intelligent, healthy kids with an eye on how sensory issues are not only getting in their way now but may also interfere with learning and behavior in the future.

ROBIN

Robin has Sensory Over-Responsivity. She avoids being close to other children and shies away from adults, too. The possibility of being accidentally touched by them makes her extremely anxious. She also avoids messy play. Touching fingerpaints, mudpies, sand, playdough, glue, and bubbles makes her very uncomfortable–even threatened. Therefore, she scoots away from her preschool classmates when it’s time to sit on the rug for a story. She refuses to participate in art projects. She resists sitting at the science table. “I hate science,” she says, turning her back. “It’s yucky.” She avoids cooking and “gooking” activities in the classroom. At snack time, she becomes upset when a drop of juice spills on her skin or even on the table.

Robin likes to dance, but not if the game is Ring Around the Rosy, because she doesn’t want to hold hands in the circle. And not if the song is about whirling leaves, and the musical game is to hold a real leaf and twirl around the room with it. She likes to sing, knows all the words, has a good sense of rhythm, and enjoys chanting rhymes. But when offered rhythm instruments to accompany the song, she shoves them away. She crosses her arms and tightens her lips.

Now, rhythm instruments aren’t messy, are they? They’re not slimy or sticky or smelly. But Robin refrains from touching them, anyway. Unlike her curious classmates who are eager to explore objects in their environment, she just says “no” to picking things up and examining them. She disdains putting on dress-ups, playing with hand puppets, and drawing with crayons. Churning ice cream? Making snowballs? Picking up worms on the sidewalk? Washing doll babies? Pouring sand from one container to another? Finger painting in shaving cream? No way.

Robin is missing many concrete, hands-on experiences that are necessary for abstract learning later on. She is also missing making connections to other children. Tactile overresponsivity gets in Robin’s way, physically, socially, emotionally, and yes, cognitively, too. As she gets older, learning may become increasingly tough. If she hasn’t handled many different objects and toyed with many different textures, she may not understand concepts such as hard and soft, wet and dry, heavy and light, prickly and smooth, sticky and slippery, fragile and enduring. She may be mystified by challenges to estimate an object’s size and shape, weight, and density. She may struggle to make sense of math, science, and art. Expressing herself in words may be limited, because of her limited experiences and participation in the world around her.

For the moment, her teacher is aware of Robin’s tactile dysfunction and has found some ways to entice her into the play. For example, she invites Robin to come to the art table when only one or two children are working there, so Robin doesn’t feel crowded and anxious. She offers Robin individual finger mittens (snipped from vinyl gloves) to slip on her fingertips. She keeps a bucket of water nearby for Robin to rinse her hands immediately after she touches something objectionable. She lets Robin sit at the head of the snack table, so other children have less chance of grazing against her.

The teacher’s accommodations do help Robin for now. But what do you guess may happen when Robin goes to kindergarten and the great beyond? Will she be able to work in groups with other children, as expected? Will she be competent manipulating scissors, rulers, compasses and pencils? Will she function smoothly in the big, busy classroom?

LARRY

Larry is an impetuous daredevil. He does not appear to have much sense of how to protect himself. You might see him scrabbling up to the top rung of the jungle gym (where other kids know instinctively not to go) and leaping to the mulch below. Bam! He lands in a heap and scrambles to his feet, covered with mulch, grinning.

More, more, more.

Larry always needs more movement experiences and needs them to be more intense than other children’s. For instance, he craves rotary movement on the tire swing. Whereas twirling for a few minutes satisfies most children, Larry spins hard and fast for 20 or 30 minutes. Should his teacher invite him to play Duck-Duck-Goose or to go on a treasure hunt, he says, “No, thank you. I just want to spin.” Spinning is his favorite activity. The teacher respects his needs and lets him spin, although she worries that he is missing most of the activities that his classmates enjoy.

Off the tire swing, Larry runs everywhere, but stopping is hard. He trips and falls often. His teacher says, “Larry is like the Titanic. Throttles wide open, full steam ahead!” He frequently bumps and crashes into his schoolmates, pawing them to the ground for a bit of wrestling.

One day, The Gingerbread Man is the program du jour in my music and movement room. First, I tell the story on the felt board. During the story, the children shake jingle bells and sing, “Run, run, as fast as you can. You can’t catch me! I’m the Gingerbread Man!”

Larry is impatient: “Let’s go! Let’s go! Finish the story!” He doesn’t want to sit; he wants to run, run, as fast as he can.

His classroom teacher gently restrains him, applying the OT technique of deep pressure. She sits behind him, straddles her legs around him, squeezes his knees to his chest, and rocks him. The pressure and rhythmic motion are soothing. He closes his eyes and begins to tune in. Now he sings the Gingerbread Man’s theme song along with the other kids.

Meanwhile, I conclude the felt board story and show the children how the room is set up for the playlet. On the bare floor, all around the rug, a large circle of masking tape indicates the road. At one point on the road is a red paper stop sign. The idea is for the Gingerbread Man to run once around the rug and then halt on the stop sign. The other characters in the story will chase him, but never actually catch him.

As I point out the other props, the children watch attentively. They are so invested in the activity that they ignore Larry, who has wriggled away from his teacher’s embrace. While his classmates are learning how to enact the story, Larry places his forehead on the rug and pivots his body around his head.

Now each child gets to choose a part to enact: the Old Woman, the Cow, the Pig, the Fox, etc. Larry jumps up and clamors to be the Gingerbread Man. “I know this story,” he says eagerly. “My Mommy reads it to me all the time.”

Larry is a good listener, that I know. Even when he’s twirling or rocking, he can still pay attention to what is said or sung. But is he a good visual observer? Can he use his eyes to focus and attend? We’ll see.

The playlet begins. Larry knows the story and song… but not the significance of the red stop sign on the floor. He wants to participate… but can’t plan and carry out how he is supposed to act and what he is supposed to do. I repeat the information, and he says he understands… but he still has trouble stopping. I hold his hand and run beside him… but he still has trouble stopping. “Larry is doing it all wrong!” the Horse complains. “He’s messing us up!”

Larry is confused and unhappy. He falls in a heap on the rug. His classroom teacher sits nearby and rubs his back while the other children enact the story several times, until they’re satisfied.

Will Larry succeed in elementary school?