Alex is 6 years old. Unlike his peers he is lethargic, minimally verbally responsive to engagement, has difficulty making eye contact and hesitates entering into gross or fine- motor activities.
He seems shut down as if enshrouded in a fog that limits his ability to interact in his world.
Children like Alex are often under-responsive to tactile, proprioceptive/vestibular input, poor body in space perception and awkward motor abilities both gross and fine. In addition they are easy bullying targets by their classmates due to the above-mentioned characteristics.
They are often unpopular because their motor skills lag behind their peers due to the sensory issues that limit opportunities for learning motor skills.
This under-responsiveness within the vestibular system according to Ayres, can have far-reaching consequences. The neurological connections within the vestibular system reach into the visual system, impacting receptors in the eye, (tracking, reading and visual responsiveness), muscle tone (large and smaller eye muscles as well) and balance (postural security).
These children often have emotional deregulation as well, making them cry more easily and becoming withdrawn. Observed to be sluggish, apathetic, or clumsy social interactions often become painful. It is easy to understand why others might perceive these children to be self-absorbed and inattentive.
In a classroom these children are often the ones who stay in from recess “to finish their work”, when recess is exactly what they need to jump-start their sleeping sensory system.
What can be done to help this child within the occupational therapy setting and as the OT consults to the classroom teacher?
First explain to the teacher that this is an issue of sensory modulation not a behavioral choice on the part of the child. Without getting too technical outline that there are systems that modulate input that are skewed and this child is getting “static” in his interpretation system of incoming stimuli.
For the practicing OT I have briefly outlined (an over simplified) chart to help make this clearer. These descriptions are valid for all sensory irregularities.
|Thalamus||Acts as a relay between multiple subcortical/sensory organs areas and the cerebral cortex—It is part of the Limbic System
Think “Grand Central Station”
|Limbic System||Complex set of structure that is found on both sides of the Thalamus. Responsible for regulation of emotions. Amygdala (excitation) and the Hypothalamus (calming forces).|
|Reticular Formation||Arousal, attention, cardiac reflexes, awareness, motor functions (found in the central core of the brainstem). It creates a pattern of connectivity for convergence and divergence of sensory structures.|
This snapshot should help explain why the child looks a particular way and why often-frustrating behaviors are unintentional and need to be addressed by alternative and modified methods.
Classroom suggestions to help teachers address these issues and more effectively teach and reach these sensory under-responsive children (SUR).
|Behaviors||Suggestions for classroom teacher|
• Child seems to be in a continual state of “chaos”
• Language irregularities (expressive)
• Cannot easily elicit rapid fine motor skills
• Slow auditory processing
• Oral apraxia
• Visual spatial dysfunctions
|Be structured and present materials in small sections.
Have the child demonstrate what he is to do. Do not expect him to be able to verbalize the process.
Do not rush him, but do give him reasonable time limits.
Actually speak slower. Research has shown that children with auditory processing can synthesize information better when the speaker slows speech by just a few seconds
Present seat work with limited questions on each page.
• Obsessive tendencies
• Skewed perspective of situations
• Limited ability to anticipate areas that might need help and/or potential outcomes of a behavior.*
• Labile behavioral reactions*
|Provide a lot of structure preferably with 1 or 2-step repetitive processes.
Do not react to the child’s over-reaction, give time to calm and then return him to the task. Do not get into “fair and not fair” discussions.*
Check on his work, he may go off on a tangent and not know he is doing anything wrong.
• Abstract reasoning
• Low persistence with difficult or unfamiliar tasks
• Externalizing and internalizing affect appropriately
|Give break times between assignments—this could be walking around the room to collect papers, etc. Just let the child have definite breaks between transitions.
Give him choices within a task so that he has to decide what to do next. Limit choice initially to 2 selections.
Intervene when you see he is “stuck” on a task.
Help him differentiate between what are his thoughts, ideas and feelings and the actions of others. (social skills group could help here).
Remember that the SUR child cannot go “faster”, talk more, transition better, etc. just because he is encouraged to do so. But he can with the right strategies in place.
Susan N. Schriber Orloff, OTR/L, is the author of Learning Re-enabled, a guide for parents, teachers and therapists and Write Incredibly Now™ 12 hours to better handwriting. She is the Executive Director of Children’s Special Services, LLC, in Atlanta, GA. She can be reached on the Web at www.childrens-services.com or through her blog at LDMadeEAsy@blogspot.com. Her WIN™ program is available through YourTherapySource.com.