Wednesday, December 14, 2011

Thinking Outside the XBox {An Old Curmudgeon's Guide to Holiday Shopping}

Why don't I think electronic toys are a great choice for holiday gifts?  Let me count the ways...

Electronic toys are addictive, violent, and don't require or encourage creativity.

Children don't acquire critical skills like depth perception, hand eye coordination, problem solving, motor planning, joint stability, or balance while playing video games.

Electronic toys encourage isolation, not socialization.  They don't require making conversation or eye contact.  They don't teach social skills like turn taking, patience, or sportsmanship, they don't require the child to plan and strategize against a human opponent, and they require nothing in the way of negotiation or compromise.

Video games encourage hyperfocusing instead of fostering the development of flexible attention.  Flexible attention, the ability to concentrate on one thing while maintaining awareness of, and selectively responding to, everything else, is absolutely essential for success at school, the workplace, and in social situations.

Children who spend all their time sitting indoors playing on electronic toys are at risk for delays in their neurological development.  In order for a child to acquire a strong, stable, vigorous, healthy body with reliable balance and good vision and perception, he has to freely explore and interact with his physical environment, not sit staring at a screen for hours on end.  He needs  constant opportunities to move and use his body in all kinds of ways.  To be physically healthy and mentally and emotionally sane, he needs a great deal of regular activity out of doors so that he can breathe fresh air,  absorb the sunshine, and have contact with the natural world.

Why is this necessary?  An immature, inefficient nervous system that does not allow the child to respond to his world in a strong, healthy, flexible manner has a profound negative influence on learning and behavior, and sets the child up for being at risk for learning and behavioral problems.  A sedentary child is at risk for all kinds of health problems including obesity, and, later down the road, diabetes.

Recently, the mother of a little boy I have been treating decided to put away all of his electronic toys and to spend the time with him outside instead.  In combination with the work we are doing in the clinic to help him catch up neurologically, the change in his behavior and his ability to function in school was immediate and profound:  he went from being a serious behavior problem to being a class leader.

The best toys are ones that are open ended and encourage creativity and artistic expression, have problems to solve, and allow the child to develop and refine fine motor coordination by manipulating materials in three dimensions.

Some suggestions:

Art supplies are always a big hit with small children. Suggestions include but are not limited to rubber stamps, colored pencils, paint, sequins, glitter, feathers, pipe cleaners, stickers, construction paper, scissors that cut scalloped edges, modeling clay, Sculpey or Fimo, beads for stringing, scrapbooking supplies, a chalkboard easel with lots of colored chalk.

Crafts:  weaving potholders, woodworking, leather lacing, coppertooling, beading, perler beads, tessel tiles, suncatchers, kits for sewing your own puppet or stuffed animal.  For an older child, an introductory kit that teaches knitting or crocheting, or a little frame loom, can be an introduction to a meaningful pursuit that will last across the child's life span.

Games:  I particularly like Jenga, Connect Four, Operation, Tier Auf Tier, Scrabble, Boggle, and Monopoly for teaching social skills and fine motor coordination.

Musical Instruments:  Harmonicas, whistles, recorders, kazoos, drums, bells.  Toy stores or music stores usually have a great selection of inexpensive instruments.

Cooking:  A little chef's kit or set of children's baking ware can be a wonderful way to get a child interested in eating good food and cooking.

Outdoor fun:  The possibilities are infinite:  balls, skates, jump ropes, a scooter, a telescope for looking at the stars at night, some camping equipment and a promise to use it when it gets warm.

Indoor fun:  A little trampoline, a Sit N Spin, a Zoomball, a hula hoop.

What was your favorite book as a child?  Chances are the children in your life will enjoy it just as much, especially if you read it to them.

{Here is last year's post, with more suggestions.}

Wednesday, December 7, 2011

Battle Hymn of the Tiger Therapist, Verse Four

This series is divided into four parts.  The first, Battle Hymn of the Tiger Therapist, suggests that instead of automatically shielding children from the inevitable obstacles, failures, and disappointments that they will face in their lives, we instead teach them to be strong, resilient, and able to handle adversity.  The first step in this process is basing our actions and expectations  on the understanding that children are starting from a position of strength, not weakness. 

The second part, How to Achieve Planned Obsolescence, outlines strategies for teaching children how to be strong, resilient, flexible, independent, responsible, creative, and resourceful, think for themselves, and solve their own problems.  

The third part, Becoming Obsolete, Part II, discusses the value of a solid academic education, with an emphasis on the basics.  The rules of penmanship, arithmetic, spelling, phonics, punctuation, and grammar provide a stable foundation for everything that follows.  The rules of reading, writing and arithmetic are the academic equivalent of playing scales, and, like scales, should be practiced and drilled until they are completely automatic.  They ground the child's brain and body in order and logic. With this  secure base of skills and knowledge underlying and supporting his thought processes, the child's intellect is then free to to soar, unencumbered.

When a child can swiftly read and comprehend what is written in a book or on a blackboard, write rapidly and legibly, construct a grammatically correct sentence, and effortlessly add, subtract, divide, and multiply numbers without a calculator, he can freely and easily recall and formulate an opinion about what he reads, organize and express his thoughts and ideas elegantly and articulately in writing, and tackle complex math problems with zest and confidence.  

This last section is about providing the child with structure.  For a child to develop a strong, solid internal structure, from which springs his sense of discipline, his motivation to achieve and succeed, and his moral compass, his parents and teachers have to initially provide an external structure, composed of predictable rules and routine, which consistently contains him and forces him to consider how his actions affect those around him. 

Battle Hymn of the Tiger Therapist, Verse Four:

Act like a grownup.  You, the parent, are in charge. A family with small children should not be run as a democracy, but as a benevolent dictatorship.  Not everyone gets an equal say in the decision making; that is the privilege and the responsibility of the adults, who after all, are older, wiser, more experienced, have better judgment, and pay the bills.

Don't ask his permission to be the grownup.   Don't ask "OK?" at the end of the sentence when you tell him to do something or correct his behavior.  This undermines your authority.  Don't ask him if he "wants" to do something when he doesn't really have a choice.  Save yourself from arguments and oppositional behavior by just telling the child "It's time to brush your teeth" instead of asking him, "Do you want to brush your teeth?".

The adults lead, the children follow. Don't habitually make your child the center of attention.  The grownups should be the ones who make the rules and family decisions on behalf of everyone, and have the final say. Don't constantly seek the child's input about where to go on family outings, what to have for dinner, what to buy while you are shopping, etc.  Small children feel insecure when the grownups solicit their opinions before making decisions.  It makes them wonder why the adults can't manage.  They would prefer to play and let the grownups do the heavy lifting.

When the family's decision making continually revolves around the child's wishes, it conditions him to think that his wants and needs should always come first, before anyone else's.  This is not a healthy attitude to bring into mature relationships, and it won't get him very far in the world.

Have clear expectations, firm limits and high standards, and expect your child to adhere to them. Small children thrive with strong boundaries and clear expectations.  They want and need the grown ups to contain them, and to teach them, by rule and example, how to comport themselves.  Want to raise a strong, wise, compassionate leader?  Be a strong, wise, compassionate leader, and the child will model himself after you.  

Maintain control of your emotions.   Be mindful about what you do and do not respond to when a child is trying to wind you up.  Stay cool. Children instinctively understand that grownups who can't contain themselves can't contain them. For a child to feel secure, he needs to know that the grownups are calm, strong and in control of themselves.  Then he knows that the grown ups are stronger than he is and can keep him safe.

This book is very helpful if you are easily triggered and engage in unhealthy communication patterns with your child.

 Be an alpha dog. Lead your pack and command respect. Be "S/he Who Must Be Obeyed."  Don't allow your child to interrupt you when you're speaking, order you around, forget to say please or thank you, insist on getting his own way, or speak to you disrespectfully.   By being a person to whom respect must be shown, you are establishing a hierarchy and ensuring that the child's world is in its proper order.  This allows him to feel secure.

Don't give in to every whim and demand, and don't be afraid to stand your ground, set limits and to say no. There is a big difference between wanting to delight your child and give him pleasure with an occasional indulgence, and acceding to his every wish because you don't want to rock the boat, can't deal with a temper tantrum, or are afraid he won't love you when you say no. In the long run, he'll like you much better if you do say no. Children don't feel comfortable when their parents are too permissive.  It makes them feel neglected and insecure.  They  want to know that the grownups who are responsible for them are strong, know what's best, and can make appropriate decisions on their behalf and keep them from harm.

Love your child like crazy, but don't always be so easy to impress.  Don't continually tell a child he's smart, or special, or wonderful, and don't praise him for every little thing. That gets you less than nowhere.

Have regular bedtimes, mealtimes, and homework times.  Make your child's schedule as predictable as possible so that he is not using up his emotional reserves on coping with unexpected changes in his routine.  This is especially important if you have a sensory defensive child who has a tough time transitioning between activities.  {And I feel compelled to say it here, again: strictly limit computer and television time and keep your child active and out of doors.}

Insist on good manners.  People who exhibit good manners are well liked and get along with others.  People who lack social graces are operating at a disadvantage.   It's in your child's best interest for you to enforce good table manners, insist that thank you notes be written, and make sure that the child says please, thank you, and excuse me, does not interrupt when others are speaking, and can wait his turn.

If you have a special needs child, you must still set limits, insist on good behavior and good manners, and have high standards for achievement and comportment.  Always assume that your special needs child is strong, not weak.  Believe in him relentlessly, and he may surprise you. My young clients still amaze me all the time.

Teach a special needs child to lead with his strengths instead of focusing on his weaknesses.  Find a way to help him develop  the internal resources to meet a challenge thinking "I can!" instead of "I can't."  {Your child's OT can be very helpful here.}

If your child has a physical disability and must depend on others for his basic care, it is absolutely essential that he learn good manners.  When I lived in Berkeley, a city with a huge population of people  who live independently despite severe disabilities, I had many acquaintances and friends who used wheelchairs, and could not dress or toilet or feed themselves without total assistance.  Some were so lovely to be with, and had such exquisite manners, helping them felt more like a social call than work.  They had warm relationships with the people whom they hired to assist them at home with their personal care, and could count on them to stay for years.  Others were not so charming, and they had a difficult time being independent because they couldn't attract or maintain a high quality, reliable staff.  Manners in this case can make or break your child's ability to manage his care when you're not around.

Always, in the back of your mind, plan for the day when you're not around. 

Wednesday, November 30, 2011

Becoming Obsolete, Part II

Strategies for helping your child be independent and resourceful, and to maximize his ability to learn and to think critically.

The ability to learn and to think is grounded in movement.  As a baby begins to move through, and to explore, his environment, he develops his understanding of the world based on his physical relationship to everything and everyone around him.  Around the age of six, this understanding of the physical world deepens into reasoning and abstract thought.

In order to think critically and logically and to be available for learning, a child must have an organized body with a stable, reliable relationship with gravity, a mature, organized nervous system that allows the child to observe and respond to his world in a calm, flexible, reasoned, manner, and an organized brain that takes in and processes sensory information accurately.  The adults can help by making sure that he gets enough exercise and fresh air, sleeps well, eats a nutritious diet, and is accustomed to solving problems.

The child also must have a strong grounding in the basics of math, grammar, penmanship, and all of those other boring, old fashioned, outmoded necessities that modern education has decided to dispense with, having deemed them useless for the 21st century.  I vehemently disagree with discarding the basics.  They constitute the underpinnings of education, and without them, the acquisition of knowledge, and the ability to reason and think critically and logically, is compromised.

Think of learning to play an instrument.  To be able to make the most beautiful music, you have to spend a long time preparing.  You have to learn to sit and hold your body and instrument just so; you must practice hours and hours and hours of scales and fingering exercises with a metronome; learn to read and play musical notation fluently; follow time and key signatures; and translate the composers' instructions, which are traditionally in Italian. Only then will you be have the skills to get the music "up and off the notes."  If these technical abilities are not effortlessly in place when you play, you won't be able to express your musical ideas.  You will still be struggling with the mechanics.

Being a successful scholar requires the same preparation of the mind and the body to think, solve problems, and be creative.  To write the most elegant, articulate, persuasive essays and to be able to successfully tackle the most complex math problems, you have to have a strong, sturdy, healthy body to support the workings of your brain, your eyes, and your hands.  You have to have mastered and internalized the foundational rules of grammar, spelling, handwriting, and arithmetic so that they are securely  organizing and supporting your thought processes.  Without them, you can't easily solve problems, and you can't really fully formulate or express your ideas.

In order to make the most of his education and to function within both the academic world and the world outside, the child must have the basic rules of arithmetic solidly internalized and instantly accessible to him.  He should know his multiplication tables backwards and forwards, be able to add and subtract small numbers without a pencil and paper, do long division, add, subtract, multiply, and divide fractions, understand decimals, and be able to calculate percentages.  He should know how many feet are in a mile and how many ounces are in a quart.  Ideally the child should be as comfortable with metric measurements as well as Imperial.

If the child's school does not drill in the basics, like addition, subtraction, division, multiplication, fractions, decimals, spelling, punctuation, grammar, and handwriting, you'll either have to do it yourself or get the PTA to insist that the curriculum be revamped.  These skills are vitally important, no matter what the current educational philosophy dictates, and don't let anyone tell you anything different.  They discipline and organize the mind. They arm the child with the principles and rules he needs to rely on for knowing how to spell, write grammatically correct sentences, and for being sure that his numbers will always do what he tells them to do.

  The rules for grammar, spelling, punctuation and arithmetical computation are the building blocks for learning. If the child does not have the basics, combined with legible, rapid penmanship, {which also has its own rules that should be learned} solidly in place, his ability to understand higher level concepts, think critically, manipulate numbers reliably, and to fully express his ideas in writing will be severely diminished.  Disciplined, organized, logical work can only come from a disciplined, organized, logically trained mind.

There are so many articles flying around the web these days about handwriting.  Some people advocate for it to be dropped  completely from the educational curriculum and others insist that it still matters.

I am solidly in the latter camp.  I still use handwriting every single day of my life, and most people do too.  Today, for instance, I had half a dozen telephone conversations and took notes while I spoke during all of them, jotting down addresses, telephone numbers, dates of birth, license numbers, etc.  

Handwriting is essential to humans who live in a civilized world.  A child who cannot write down his thoughts, organize his work on the page, or express himself fluently in writing is at a serious disadvantage at school.  Handwriting trains the brain and is essential to developing hand-eye coordination.  Make sure your child has legible handwriting.  If your school does not teach it, buy the materials to do it at home, or hire a handwriting specialist to help you. 

Read to your child regularly.

See that your child knows how to use the library.

Teach your child how to tie his shoes and to tell time on an analog clock.

Homework:  frankly, I'm not a fan of homework.  From what I see at the clinic, there is far too much of it, and a lot of it is just busywork.  I was thrilled to hear that a very prestigious, very rigorous, very expensive prep school in New York had made it a policy to reduce homework for the lower grades.  

If your child has difficulty focusing, make sure that his homework time is preceded by vigorous exercise outdoors, a big drink of water, and a protein rich snack.  Break up the time into small, manageable segments and give him a quick movement break in between each one. 

 If your child has a hard time doing his homework by himself, by all means have him sit at the kitchen table and work while you are cooking dinner.  

More detailed suggestions about structuring homework here.

Not academic, but worthwhile:

Help your child find a hobby or pastime that involves solving problems, like woodworking, knitting, crochet, sewing, cooking, putting together wooden models, etc.

Send the child to camp in the summer where he will learn outdoor survival skills like swimming, hiking, building a fire, cooking over an open flame,  paddling a kayak or a canoe, archery,  setting up and tearing down a tent, tying knots, and foraging.

Give your child plenty of opportunities to prove to himself that he is smart, strong, flexible, and capable, by challenging him, keeping him active, providing him with problems to solve, not automatically removing every obstacle from his path, giving him responsibilities, and setting high standards.

Wednesday, November 16, 2011

How to Achieve Planned Obsolesence

My job as a therapist  and a teacher is to make myself obsolete, and so is a parent's.  We know we have succeeded when those who have depended on us for guidance, support, and help no longer need us, because we have provided them with the tools to be able to manage without us.

If you are a habitual reader of  advice columns, you have undoubtedly come across the same letter over and over again: aging parents whose children are still dependent on them long after they should have left the nest, draining them of their money, energy, and privacy. When I read those letters, I always wonder what the parents did to make their children so helpless. I suppose it's some combination of  overprotecting them and neglecting them.

It's a bittersweet reality that parents should start planning, from the moment the child is born, for the day that their child no longer needs them, and doing their best to make sure that it comes.

In order to survive and thrive in the world as a mature, responsible adult, a child has to develop sufficient inner resources to be able to handle himself at school and in the workplace, nurture his relationships, manage his money, and make sound choices about what he chooses to eat and drink and how he spends his leisure time.  This requires the adults to perform a constant balancing act between wanting to protect their child from pain, disappointment, and failure, and allowing the child to learn from his experience.

Some suggestions for helping a child become strong, self sufficient, and resilient:

Minimize the use of the stroller and let the child walk, or carry him on your hip.  Strollers promote passivity and isolation, and don't allow the child to develop trunk stability, dynamic balance, and head righting.  These are the essential physical underpinnings for vision, attention and learning.  Carrying a child on your hip allows you to talk to him while you carry him.  These conversations are crucial for the development of receptive and expressive language and social interaction skills. Put away your cell phone when you are with him and give him your undivided attention.

Never imprison a child in a playpen.  Playpens prevent children from developing and maturing their nervous systems and their intellects through movement and exploration.  Movement is the means by which a child develops his understanding about the world.  If a child is prevented from moving, he is also prevented from developing his ability to learn.

Always assume that your child is operating from a position of strength.  I can't tell you how many times I have started working with a child whom I privately thought was so impaired that I couldn't be of much assistance, only to be proven, yet again, that when it comes to young humans and their remarkable capacity for growth and change, no one can predict a thing.  Children possess resilience, intelligence, and energy in limitless abundance.  They are programmed in their DNA to achieve, and most of them will do whatever it takes, as long as they are not prevented from doing so, to drive their development forward.  When the adults work from this understanding, miracles happen.  Truly, there is nothing more motivating to a child than to be in the presence of a respected adult who sees greatness in him and demands it of him.

{If your child seems poorly motivated, he might benefit from occupational therapy  -- sensory integration therapists are specially trained to tap into a child's inner drive.}

Teach your child how to tolerate frustration.  Try not to step in every time a child gets frustrated or upset when he can't do something or can't manage his emotions.  Intervene only when absolutely necessary.  Be empathic and supportive, but encourage the child to solve his own problems. Being able self regulate and to struggle and stick with difficult tasks until they are mastered are essential life skills.   Without them, your child's chances of succeeding at school and work, and in his relationships, are compromised.  The most successful people are the ones whose temperaments allow them stay cool under pressure and to welcome a challenge.

Let your child fail.  This is hard, but necessary.  We all have to learn to cope with failure and to understand the limits of our abilities.  The late novelist Laurie Colwin wrote that in order to know true rapture, one must first earn it by having also experienced its opposite.  Failure and disappointment is an inevitable part of life. The child should know how to cope with it, and then be able to move on and look forward to, and appreciate, better times.

Don't micromanage the child's social interactions.  If you constantly intervene before he has a chance to work things out for himself, he won't be able to advocate for himself when you're not around.  Let children argue, lose their tempers with each other, call each other names, fight over toys, and vie with each other for dominance.  Stay out of it unless they ask you to mediate, and then help them come to consensus. Otherwise, restrain yourself from interfering unless you see that someone is about to get hurt or there is obvious bullying.

 Don't enable irresponsible behavior.  If your child doesn't do his homework, or forgets his lunch or his schoolbooks, let him sweat it out.  He'll have to deal with the consequences and will know better next time.

 Let him handle his own problems at school. Unless your child is being bullied or has an obviously incompetent teacher, or specifically asks for your help, let him manage his own affairs.  If he was assigned a bad grade, chances are he deserved it.  Instead of harassing his teacher to change his grade, help him come up with strategies to improve his performance.

Don't remove every obstacle from his path.  If you do, he won't be able to manage on his own. The more you can teach a child how to handle adversity, the stronger, more resilient, and better equipped he will be to face life's inevitable stumbling blocks.

Strictly limit recreational screen time.  A couple of hours on the weekend for TV and computer use is plenty.   Children should not be spending much time in front of screens.   Reading, making crafts, helping prepare meals and doing chores, playing games that promote eye hand coordination and improve social interaction skills, or riding a bicycle and playing outside with friends, are infinitely preferable to passively staring at a television or computer.

Have dinner together as a family. Ask the child about his day, and guide him to his own solutions for issues that come up at school and in his social life.

Assign chores and responsibilities so that your child understands about work, running a household, and what it means to have others depend on his contribution.

Teach your child how to manage his money.   It's never too early to learn to save, budget, and to think of others who are less fortunate.

Teach your child how to cook.  What better life skill could a young adult have than to be able to prepare healthy food for himself?  And who doesn't love a good cook?  This is an especially good strategy for picky eaters, who are more likely to eat food that they have helped prepare.

Next week I will outline some strategies and suggestions for academic achievement.

Wednesday, November 9, 2011

Battle Hymn of the Tiger Therapist

In her book The Battle Hymn of the Tiger Mother, Amy Chua outlined her methods for raising her two daughters, and they were extreme.  She never allowed them to watch television or go on sleepovers or playdates, drilled them incessantly on their academics, forced them to spend hours and hours practicing their musical instruments, locked them outside in the middle of winter for disobeying her, rejected handmade gifts that didn't  show sufficient effort, and threatened to break or give away their toys when they couldn't master their music lessons.

She wrote the book in hindsight, not to show the world how much better  Chinese methods of child rearing work in comparison to ours in the West, but as an apology to her children.

  One of her daughters knuckled under, became a concert level pianist, and was accepted to Harvard.  The other rebelled furiously at every step, eventually forcing Chua to reexamine her methods.

Much of what she recounts is disturbing; she really was over the top, and she knows it.  But here's where I think Chua gets it much, much righter than many of us do:  she starts from the assumption that her children are strong, smart, capable and resilient, and so expects and demands nothing less than their absolute best effort, always.  And they usually deliver.  In the end, her two daughters both grow up to be disciplined, intelligent, highly accomplished, articulate, and successful.

I once met an Aikido teacher from Australia who told me about an ongoing conflict at the martial arts school where he taught.  One of the other teachers was a former ballerina who had a different style than his.  She made it a point of pride to flip and throw her students very, very gently and never to hurt them or leave a mark.  He, on the other hand, sparred strongly, without apology.  

The ballerina scolded him that his students were getting bruised in his classes, but he didn't see that as a problem.  He knew that that his boys, who loved to feel and appear tough, would point to their black and blue marks proudly and brag to everyone who would listen, "I got this in Aikido!"

 I have no doubt that this man was a very popular and sought after teacher.  By not coddling or babying his students, he was giving them the message that they were tough, skilled martial artists, able to compete with him at his level.  

Who were your favorite teachers in school?  I had a few I adored.  They expected us to be bold, smart, persistent, and creative, forced us to stretch ourselves beyond our comfort zones, and held us to extremely high standards. They saw only the best in us, and by getting us to believe that we were capable of great things, got us to see it, too.

How do you want the world to view you?  As someone who is strong, resourceful, and resilient, or someone who needs pity and protection?

We want to think of ourselves, and to be thought of by others, as strong and capable, able to handle with ease and grace whatever life sends our way.

Being able to cope well with adversity is a critical life skill.  In order for a child to be able to navigate his life successfully,  he needs to have the opportunity to develop his strengths and learn to rely on himself along the way.

Little lessons learned early add up to big problems avoided later on.  When parents continually intervene between their child and the world, give in to the child's every whim, constantly make the child the center of attention, jump in and solve his problems for him, and never teach  the child how to cope with frustration, loss, and disappointment, when it's time for him to manage on his own, he will have no experiences or inner resources from which he can draw.

I recently watched a video of one of my teachers, Sheila Frick, treating a little boy with neurological delays.  She wanted to trigger his protective extension responses, which were absent, so she rocked him forward and back over a large ball. He hit his head on the mat over and over until he finally figured out that if he didn't want to get hurt, he'd better get his arms out in front of him.  One of the students in the class was horrified at her methods.  Sheila explained that it was far better  for him to bump his head with her and learn how to protect himself in the controlled atmosphere of the sensory gym than have a big fall on the playground later on and get a head injury.

Doesn't this make total sense?  This could be applied to life in general.  Learn how to cope early with the small things, and be prepared later on when you are inevitably faced with the big ones.

I worry about what we are teaching our children {and how we are shortchanging them} when we passively stroll and carry them everywhere instead of expecting them to walk, let them watch hours and hours of badly written television every day, give them toys that don't encourage any creativity or imagination, dumb down their literature, stop requiring them to learn cursive handwriting, don't insist that they write legibly or learn the rules of grammar, punctuation, and spelling,  give them calculators instead of drilling them in the basics of arithmetic, inflate their grades, pad them up with protective equipment for every outdoor activity, remove the merry go rounds, teeter totters, and monkey bars from the playground, eliminate recess and physical education, dismiss the teaching of art, music, and theater in schools as a frill, give them shoes with velcro closures instead of teaching them to tie their laces, make all their food "fun" {while draining it of any nutrition}  don't insist on good manners and respect for elders, don't set clear limits or impose consequences for bad behavior, ignore them while we are absorbed in our Ipads and cell phones, and tell every child in the entire soccer league that they are all the winner.

I see children who can't struggle with the simplest obstacle without giving up almost instantly.  They immediately look to someone else to solve their problems.  They can't advocate for themselves, or resolve conflicts, because they have been so passive and so coddled and protected their whole lives that they have never learned how to rely on or assert themselves.   Many of my little acquaintances have no empathy for others, because no one has ever demanded it of them.  They can't negotiate, come to consensus, or defend themselves effectively, because the adults have generally stepped in and handled things before they have had an opportunity to try.

One of the biggest jobs I have with many of the children I treat is retooling their self images. I'm not talking about employing verbal techniques for building the child's self esteem, which I think is a bad idea, anyway.   Imagine what a rude shock it is to always be told as a child that you are so very special and wonderful, and then to go out in the world as a young adult and discover that you are actually quite ordinary!  And that your boss and colleagues are most decidedly not aware of the deferential treatment that your elevated status confers!

Instead of telling the child he is strong, I have to show the child what he can do. When I give a child ample opportunities to prove to himself, over and over, that he can move past his small comfort zone, stretch himself, do something a little scary, tackle a challenge or obstacle and succeed, when he is confronted with something unfamiliar, he doesn't always think to himself, "I can't do that."

The more he understands that he can rely on himself to figure out a problem and come up with a successful solution, the stronger and more capable he will feel, and his behavior and performance will reflect that.

In my next post, I will outline some suggestions for helping a child grow up to be resilient, self reliant, capable, creative, and strong.

Wednesday, November 2, 2011

The Joy of Cooking

"Patriotism is the love of the food one ate as a child."  --  Lin Yutang.

I have a little boy on my caseload whose parents come from Jamaica.  They have a large extended family here in New York, and get together frequently.  A few weeks ago, I asked him what he did over the weekend, {hoping to hear that his parents had taken him outside to play, which, despite my constant nagging, it rarely occurs to them to do} and he mentioned a big family gathering at an aunt's home in Brooklyn.  "What did you eat?"  I asked, thinking of the marvelous coco bread, ackee and saltfish, callaloo, oxtail stew, jerk chicken and goat, escovitch fish, fried plantains,  pigeon peas and rice, and black cake I had enjoyed during my visit there.

 He had to stop and think for a minute.  "Pepperoni pizza and Kentucky Fried Chicken," he said, with an indifferent shrug.

Of all the ways in which we shortchange our children, feeding them bad food is one of the worst. And since everyone is entitled to my opinion, feeding them crappy takeout at family gatherings is a tragic, short-sighted mistake.  There could be legitimate reasons for ordering in, like everyone working all the time, but it seems to me that moving to another country and leaving your food and customs behind is the quickest way to disconnect a child from his ancestors and his cultural identity, prevent him from truly knowing his family, and to rob him of a large part of who he is.

Family gatherings are where the children learn that they belong to a tribe, encompassing their family, their religion, and their country of origin.   By eating the food and participating in the rituals of their tribe, they are an integral part of of their tribe's traditions and customs.  The customs and food of their tribe in turn become an integral part of who they are. After all, we are what we eat!

The wonderful experience of smelling and tasting all of the special food that the elders lovingly provision at those gatherings is what cements the child's feeling of belonging firmly in place.

I remember my grandmother, who died when I was 19, mostly by the food I ate at her home, and at our family gatherings,  for which she always prepared her specialties.   We didn't have a very close relationship  -- she was unfortunately not capable of much warmth  -- but she loved to feed us the intricate, slow cooked delicacies of her own childhood back in Yekatrinoslav: knishes, chopped liver with gribenes and schmaltz, blintzes, brisket, lokshen kugel, chicken soup with kneidlach, kreplach, latkes, delco, kichlach, scherben, and mandelbrot.

Every time I went to her home for a visit, she would make my favorites and package the leftovers for me to take back to the suburbs.  No matter how many knishes she sent back with me, the bag was usually empty by the time I got off the train.

Despite the often contentious relationship I had with my grandmother,  Jewish food, which I always associate with her, tastes like love, belonging, security, and family to me.  I can always count on my grandmother's recipes, many of which I now make, to comfort me when I'm blue. The tastes from my childhood, dishes that have been cooked and eaten by my forebears for hundreds of years, instantly remind me, with an immediacy that nothing else can, of my connection to something much, much larger than myself.

 What if my grandmother had fed me meat loaf, instant mashed potatoes, Campbell's soup, Jell-O, Hydrox sandwich cookies, and Hawaiian Punch?

Tradition, ritual, and the powerful sensory memory of the smells, tastes, and textures of the special foods we eat when we gather together are what anchor us to each other and our collective past, and ground us in the present, ensuring that we are well equipped to face whatever the future brings.

Feeling like a part of a tribe is a fundamental human need.  If a child doesn't feel a connection to his own people through its food, traditions and customs, he is apt to go off and form a connection to something else.

Although it's true that so many old country recipes are labor intensive and time consuming, cooking doesn't have to be elaborate to be delicious and fulfilling.  It just has to start with high quality ingredients, some decent pots and pans, and a few basic, easily mastered  techniques.

If you don't know how to cook, can someone show you a few things?  If you don't have any food traditions in your family,  can you arrange, perhaps with some other family members, to start some?  Perhaps great aunts or grandparents have recipes or food memories they can share.

 What can you do so that your child's family food memories are not of mass produced junk, but formed by your own rich history, customs, traditions, choices, and sensibilities,  lovingly produced in your own kitchen, by your own hands?

{Two beautifully written, deeply felt memoirs about family and food:  "Miriam's Kitchen" by Elizabeth Ehrlich, and "The Lost Ravioli Recipes of Hoboken" by Laura Schenone.}

Wednesday, October 26, 2011

A Life in the Balance

The way in which we perceive the world directly determines how we respond to it.  Here is the story of a little boy I started treating at the beginning of the school year.  He was uninterested in other people, lined up his toys instead of playing with them, and had almost no expressive language.  Despite how impaired he seemed initially, he made an immediate, remarkable turnaround when some simple improvements were made in his neurological and sensory functioning.

A few weeks ago, I started working with a really cute four year boy whom I could see was in trouble the moment he arrived for our first session.  He did not acknowledge my greeting, and ignored his mother's entreaty to look at me and say hello.

After passively allowing his mother to take off his shoes and jacket, he wandered into the treatment room, found some bean bags, dumped them onto the floor, and lined them up.  Before I could intervene, he had grabbed a toy tennis racket, positioned it just so on top of the precise row he had made, and stomped hard with both feet, damaging the playing surface.

  When his mother and I told him to stop, he completely ignored us.  I could see that he hardly knew I was in the room.  His mother said that this was typical behavior for him, and that despite being four he could not talk very well.   I quizzed her in depth about sensory issues, but she denied that she had ever seen any symptoms of defensiveness.

I tried to place him on all fours so I could test his postural reflexes, but he kept falling over and crawling away, back towards the line of bean bags.

He did let me put him on a large therapy ball, so I looked at his protective extension responses.  Protective extension means that when the body is falling, the arms and legs will automatically shoot out in order to protect the head.  His were absent.  When the ball rolled forward, his head hit the mat.  He was so shut down that he did not respond.

 Next, I set up the trampoline, and invited him to jump.  He tried, but could not maintain his balance while standing on it and kept falling over.  His mother held out her hands, and he jumped for a moment or two while holding on to her, then climbed off.

I put him on my back to see if he could hold on to me.  He could not.   When  I leaned to the side, he started to topple over. This meant that he was not righting himself in response to my movements, so the weight of his head was pulling him over sideways.

During the last few minutes of the session, I gave him some whistles to blow.  The sound was unbearably loud and shrill, so I made an exaggerated face, cringed, and covered my ears when he blew them.  To my surprise and delight, this made him laugh.  

Hooray!  He was in there!  I just had to figure out what was preventing him from being able to fully inhabit his body, explore his world freely, and want to interact with others.   Since his mother claimed that he was not tactile or auditory defensive, which is the first thing I always assume is causing the child to tune out the world, it had to be something else.  What could it be?

His balance!  What jumped out at me during our interactions was that this little boy had a very unreliable relationship with gravity.  He could not right his head, so his ability to keep upright when he tried to use his body was limited.  His legs and trunk were too weak to stabilize him effectively when he was on an unstable surface, and there was no reflex in his body to protect his head when he fell.

I also knew, from his lack of attention span, his clumsiness, and from his mother's report that he refused to do any prewriting or craft activities at school, that he couldn't see very well.  Poor vision is common in children with balance issues, partly because the vestibular nerve, which controls balance, also affects the movement of the eyes, and partly because the fine motor coordination of the eye muscles depends on a stable base of support from the spine. If a child is weak and unstable in his core musculature, his eyes will be weak as well.

Our eyes tell us where we are in relation to everything else, and if we don't have reliable vision, our behavior is going to reflect that.

No wonder he didn't want to play!  He could not trust his body to keep him from falling.   He could not rely on his eyes to tell him where he was in space. 

Our second and third sessions centered around deepening his breathing, developing protective extension, improving his balance, strengthening his trunk, legs, feet and toes, and stabilizing his eyes. Strongly rhythmic music helped organize and contain him and hold his attention while we played.

I also saw that he was quite easily startled, and that his heart would race at the slightest provocation.  This caused him to go directly into overdrive and become disorganized, so I focused some of our activities on training his nervous system not to set off alarm bells in response to ordinary, unthreatening experiences.

I asked his mother to buy a large therapy ball, and play some of our games with him at home.  I also suggested that her husband give him piggy back rides, dancing and bending over, so he that he could work on improving his head righting and strengthening his arms and legs.  She bought him some whistles and bubble toys.

When he came in for his fourth session,  he was like a different person.  It was amazing! Speaking in full sentences and making eye contact, he told me all of the games that he was looking forward to playing.  He was completely present, engaged, and motivated.  He played jokes on me, watching intently for my reactions, and laughed along with me.  His balance was so much better that he was able to play some really complicated games on the trampoline, catching bean bags while jumping at full speed, and aiming them at targets.

I've been seeing him now for about five weeks.  He has progressed from scribbling to drawing faces, stick figures, trees, and houses on the chalkboard.  He can have real back and forth conversations.   He no longer lines up his toys at home or in the clinic.  He displays a wicked sense of humor, and loves to make me laugh.  He has become much more affectionate with his mother, and has started to initiate conversations with the other mothers in the waiting room.  His parents took him to a family gathering recently, and everyone was astonished at how open, friendly, and talkative he had become.

Now that this child can rely on his body and eyes to give him accurate information about where he is in space, to keep him stable and strong against gravity, and not to startle at everything he encounters, he is ready and able to participate in, and enjoy, his life!

Wednesday, October 19, 2011

The Role of the Sensory Integration Therapist

A few weeks ago, a reader asked me how exercise could help a child who could not function at school.  Last week, I talked about how the sensory integration approach works.  This week, I thought I would continue the discussion by explaining what sensory integration therapy has to offer, and talking some more about how we go about accomplishing our objectives.

A sensory integration therapist's role, as I see it:

To improve motor planning and problem solving skills, which the child can then generalize to all learning.

To improve balance and equilibrium responses, so that the child has a reliable, dependable relationship with gravity.

To reduce or eliminate defensive, aversive responses to sensory experiences, so that the child is not bothered or distracted by sound, smell, touch, or light.

To improve neurological functioning by integrating the presence of primitive and postural reflex activity,  so that his movements are not dominated by the involuntary lowering of his muscle tone or involuntary flexor withdrawal when he tries to use his body.

To improve the child's ability to maintain the appropriate level of alertness and arousal for learning in a classroom setting.

To improve the child's ability to filter and discriminate sound.

To increase the length and flexibility of the child's attention span.

To maximize the child's ability to explore and interact with his environment freely and confidently.

To enable the child to self soothe, self regulate, tolerate frustration, solve problems, work independently, and socialize appropriately.

To provide the child with a strong, stable, resilient, flexible  body, and maximize fine and gross motor coordination and age appropriate skills acquisition.

To improve spatial awareness, visual perceptual, and visual motor functioning.

To give the child the inner resources to meet an unfamiliar challenge or obstacle with zest and confidence, by allowing him  to prove to himself, over and over, that he can solve problems and rely on himself.

In addition to these things, a sensory integration therapist can help the child function in class and on the playground by adapting his environment, providing him, his teachers and caretakers strategies to maintain his ability to be present and available for learning in class, prescribing a sensory diet, and by teaching life skills like shoe tying, using utensils, handwriting, telling time, bouncing, catching, and kicking a ball, jumping rope, and any necessary activity of daily living.

Why do sensory integration therapists use suspended equipment?

Children whose nervous systems have not matured along with their chronological ages behave differently than others.  They don't function well at school, because in some areas, they are developmentally behind the other children.  They can't consistently meet the grownups' expectations for comporting themselves, internalizing the rules of the classroom, or keeping up with the academic demands of school.  They can't sit quietly and do their work, they can't contain their impulses, they get into altercations, they talk out of turn, they can't get their work done in class, their work is messy and disorganized, they take up far too much of the grownups' attention.

 Or they do keep it together at school, but then can't manage their behavior once out of the public eye, having one meltdown after another at home.  Perhaps the child is obviously quite intelligent and capable, but in a classroom setting, seems lost and not very bright.

  Some of these children are driven to move and seek sensation, and will have a hard time sitting still.  They are constantly on the go, have a short attention span, and can't walk in a straight line because they have to spin themselves on every streetlight and jump on and off every curb that they pass.  They throw their bodies off of the highest walls they can find, crash into other people, give hugs like rabid bears, throw a ball a hundred miles an hour to someone standing two feet away, unintentionally break crayons and toys, and can't stay organized or get anything done in a chaotic atmosphere.

Others avoid interacting with things and people, sitting quietly, not bothering anyone, but not participating or learning, either.

For the first child, who needs a lot of intensity and endangers himself in order to get it, the suspended equipment can give it to him. With the therapist's direction, the swings can provide high intensity in a safe, controlled, contained way.   Over time, the child will stop seeking, because he no longer needs the huge amount of input to feel at ease in his body.  He also learns to control his impulses and solve problems, because if he does not slow down and think things through while interacting with the suspended equipment, he will fall.

For the avoidant child, working with a therapist on the suspended equipment is an efficient, highly effective way to improve motor planning, gain confidence and strength, and develop a good relationship with gravity.  The swings also affect the part of the inner ear responsible for alertness, so that over time, the child's ability to stay present is improved.

The therapist can also provide suggestions for making homework manageable and for navigating other problem areas in the child's life.

Wednesday, October 12, 2011

How Does Sensory Integration Therapy Work?

A reader left me a great question in the comments after I described a little girl who was struggling in her daily life. She asked how exercise could solve this child's problems.

A. Jean Ayres, who founded sensory integration therapy, was an occupational therapist and developmental psychologist whose work was based on the theory that learning problems and behavioral issues were caused by faulty processing of sensory information.

  According to Dr. Ayres, learning is a function of the brain.   If we improve the brain's ability to perceive, remember, motor plan, and solve problems, and to perceive sensory information correctly and respond to it accordingly, this skill can be generalized to all learning, including academic learning.  By having the child participate in specific movement experiences which integrate and strengthen an immature, inefficient nervous system, sensory integration therapy can, over time, correct the underlying issues that prevent the child from succeeding in school.

What we know, and how we learn, is through the brain. When we are babies, we train our brains to learn by moving through and exploring our environments.  As we sit up, turn over, reach for things, creep, crawl, cruise, and walk, we teach our bodies, and our eyes and hands as they work together, to do what we tell them to do.   We learn to discriminate, so that we can attend to what is important and  filter out what is not.  We learn to struggle for what we want to achieve, and not give up until we succeed.  We develop vision, balance,  core strength, equilibrium, hand eye coordination, and fine and gross motor control. We integrate the workings of the senses as they take in information, the brain as it perceives them, and the body as it acts on them, so that over time, the brain and body evolve into a unified, graceful, efficient whole.

Until a child is about six, virtually all learning, and all understanding, is based on his physical interaction with the environment.  This is why it's so important not to restrain children in playpens, strollers, and carseats, park them in front of televisions and computers, and force them to sit still.  It impedes their development.

As a sensory integration therapist, my concern is how the child's body is functioning.  When I evaluate a child, I am looking for how well the child responds to the demands I place on him and on his body.  This will give me direct insight into the child's difficulty functioning in the classroom.

How long can the child sit still and attend to the task at hand without losing focus?  Does he need frequent movement breaks?  Does he complain about fatigue, make conversation instead of engaging with the test materials, or otherwise try to divert my attention?  Does he lie on the table or rest his head in his hand when he is working? Does he rub his eyes?  Does his hand hurt because he is gripping his pencil too hard? Will his hands coordinate together when he cuts with scissors?

Can the child hold on to me if I put him on my back, or are his legs too weak to grip?  Does he move his head back to  midline if I lean to the side?  If I push him, will he fall, or do his core strength and equilibrium enable him to stay strongly upright?  If I place him over a large ball and tip him forward, do his arms shoot out to protect his head? Is he able to balance on one foot?    Can he run up and down stairs without using the rail for balance?

Does he startle and pull away when I touch him?  When I put him on all fours and turn his head, will he stay stable, or will his arms and back lose their tone and collapse?

When asked to do an unfamiliar task, can the child mentally form a motor plan and execute it without too much difficulty, or does he get lost and frustrated?

Can the child make eye contact with me?  Is he interested in pleasing me and in my reactions, or is he indifferent to me?  Does he have a sense of humor? Can he chat, or does he monologue?  What does he do if another child or therapist enters the testing area?

What is the child's breathing like?  Is he a picky eater? Can he sleep through the night?  How does he behave when he wakes up in the morning?  Does he have enough energy to get through the day?

Does the child get overly excited when he is stimulated, or does he shut down when confronted with intense or unfamiliar sensations?

Assessing how the child's body works, and how it habitually responds to the demands of daily life, is crucial to understanding what underlies the child's learning and  behavioral difficulties.  The body is the foundation for the brain.  If the foundation is shaky, and does not offer adequate support, the workings of the brain, and the eyes and hands, will suffer.

A child who is living in a body that falls out from under him when he wants to use it, won't do what he tells it, and doesn't keep him strongly,  sturdily, upright, is living in a body that does not support the work of his brain, eyes, and hands.  A body that won't keep him effortlessly upright when he sits in a chair or on the floor, won't keep him safe from falling while running on the playground or allow him to keep up in gym class, won't filter out background noise and movement, startles and flinches at the slightest provocation, won't correctly inform him about where he is in space, and constantly tells him that sounds are too loud, smells are disgusting, fruits and vegetables are yucky, paint, glue, and clay are nasty, and his clothes are tight and scratchy, is not a body that will allow him to navigate the complicated, demanding, exhausting world of school without a tremendous struggle.  His internal disorganization, weakness, unreliable sensory processing, and poor balance will be directly reflected in his behavior.  He will be either acting out, attempting to communicate his distress, or he will be tuned out, in an attempt to leave his body.  Neither one of these responses is appropriate for classroom participation, and  prevent him from being able to learn and to formulate and express his ideas.  A child who lives in this kind of body is "out of synch."

My job as a sensory integration therapist is to provide the child with a strong, stable, reliable, resilient body and a brain that perceives and responds accurately to the information conveyed by the child's senses.

In addition, I must educate his parents and his teachers about how to best support him, so that his environment is conducive to learning.

Wednesday, October 5, 2011

Peter Pan Was Wrong

 Here in America, we seem to have taken being sensitive to children's feelings into account to such an extreme that we have allowed them to take over.  Being kind and polite to small children is certainly important, but we have to be careful to maintain the role of the grown up while doing so.  It's not only all right for the grownups to assert their authority, it's crucial to a child's sense of security. 

It would be better for everyone if the grownups would just make the decisions and act on them instead of always seeking the children's input and approval. 

A few weeks ago I started seeing a little boy who was referred by his school for difficulty functioning in the classroom.  His IEP noted that he had a great deal of trouble transitioning between activities, and that he was very bossy and stubborn.

His father brought him to his first therapy session.  As is my custom, after we introduced ourselves and got our paperwork in order, I asked the father to come into the treatment room with us.

The little boy's father knelt down, assumed an expression of worry, concern, and apology, and asked his four year old boy, "Is it all right with you if daddy comes in?"

With that one short sentence, he had undermined my authority and let the little boy know who was really in control.

Not surprisingly, the child then proceeded to act exactly as if he was the one in charge of the therapy session.   He would not take off his shoes.  He would not lie on the mat.  He would not lie on the therapy ball. He would not jump on the trampoline. He would not kneel.  He would not go on all fours.

 He rudely informed me, after being told that I wanted to talk to his father for a bit, that I had exactly one minute to do so, then began counting so loudly that conversation was impossible.  When I instructed him to sit down in a chair, he asked, "Why should I?"  and proceeded to roll around on the floor.  He threw things across the room, and tried to break my toys.  After that first encounter, I was sweaty and exhausted.  I could see it was going to be a long, long year.

The next time he came to the clinic, he was accompanied by his mother, a very young, soft spoken British woman.  When I asked her to come with us into the treatment room, she held out her hand, said to the little boy, "Let's go!" and he promptly followed.  When we entered the treatment room, she said, "Shoes and socks off, diddums!" and off they came.  When it was time for him to lie down on the mat, she said, "Time to lie down on the mat!"  and he did.   He cooperated with all of the testing, played some games with me, and we all had a lot of fun.

Do you see what I'm getting at here?  This little boy's father, who is a loving parent and means well, thought that he was being polite and taking the child's feelings into account when he asked his son's permission to join us.  But what he didn't understand was that a four year old has hugely different emotional needs than he does.  A four year old doesn't really know what to feel about, or how to analyze, a lot of what swirls around him.  He just wants to feel safe, for the expectations for how he should conduct himself to be clear, and for the grownups to behave in a reasonable fashion.  When the grown ups want him to reassure them that they have his permission to be in charge, it's unsettling and confusing, to say the least.

When you continually ask a small child whether it's are all right with him for you to be the grown up by asking him if what the adults expect him to do is OK with him, what you don't get in return is a happy, secure child.  What you get instead is a child who continually acts out, because he being told, over and over, that he is more powerful than the grownups.  This makes him feel unsafe and insecure, and his actions will reflect that.  He will keep pushing and pushing, hoping that the grown ups will contain him, and because they have told him that he is in charge, he will respond accordingly by running the show.

I am here to tell you that your life will be easier if you stop checking in all the time and asking for the child's permission to take charge. The grownups are supposed to be in charge, and the children want it that way.  It's too confusing for them otherwise.  Children don't want to be the ones running the show! They don't want to have dominion over the adults.  They know that they are small, don't know best, and need protection and direction.  They want to be able to trust the grownups to be strong enough and smart enough to contain them, to make and act upon appropriate decisions on their behalf, and to keep them  safe from harm. {By the way, despite all evidence to the contrary, teenagers feel the same way.}

This mother, although she is so  young and soft spoken, has it just right.  She, not her son, is in the driver's seat.  When he is in her presence, he can relax and stop ordering everyone around.  He knows that in her own sweet, quiet way, she can contain him and keep his world in order, so he doesn't have to try to do it himself.

You can avoid a lot of fights, behavioral problems, and heartache if you follow a few simple rules when dealing with small children.  Be clear and reasonable in your expectations, don't ask a child if he wants to do something that he has to do, and don't ask if something is OK with him if he doesn't actually have a choice about it.  Don't say, "Do you want to brush your teeth?"  Don't say, "Brush your teeth, OK?" Say, "It's time to brush your teeth."

 Don't ask the child, "Is it OK if the doctor gives you a shot?"  If you think I'm being funny, I'm serious.  I once evaluated a six year old boy and told his father that he would benefit from a course of sensory integration therapy.  His father turned to him and asked him, " Would you like to come here for occupational therapy?"

How secure do you think this child feels if he knows he can't trust his father to be the grown up and make those kinds of decisions for him?  The adults should NOT be seeking the children's input for things about which they should have no say.  Going to therapy is not the child's decision to make.   Asking for his input tells him that the grownups can't or won't take care of him properly by making important decisions on his behalf.

The more you can order your child's world, be in charge of the decisions, keep it structured and predictable, and keep him contained, the more secure and happier he will be.

Wednesday, September 28, 2011

Look Before You Label

I would venture to guess that virtually every child with a diagnosis of ADHD is living in a body that doesn't support learning.  Before we label and medicate, we should assess and treat the impairments in the child's structural, metabolic and neurological functioning.

  We also need to be sensitive to what we are demanding of a child.  If we are constantly expecting the child to perform at a level that is higher than his neurological age, the child will fail over and over, and behavioral problems are certain to result.  This is also true of a sensory defensive child who simply can't cope well in a noisy, chaotic atmosphere.

Knowing what the child's life is like outside the classroom can also provide many clues as to what is preventing the child from being present, focused, and available for learning.

I have a little girl on my caseload who simply can't sit still.  She is a tiny four year old who is preternaturally articulate, bossy, demanding, and obstinate.  She knows exactly what she wants and what she doesn't want and is not shy at all about demanding it. She is constantly on the go, exploring her surroundings, opening drawers, rummaging through shelves, examining and manipulating every object she can reach.  It's a rare activity that can hold her attention for more than 30 seconds before she is up and off again.

Her SEIT {one on one teacher, assigned to special needs preschoolers in NYC} is very concerned about this little girl's lack of ability to function at school.  The child is extremely bright, but has no attention span for the activities the teachers choose for her, is not interested in learning or joining in, doesn't care about pleasing grownups, and won't align herself with the rules and expectations of the classroom.

The SEIT recommended to the child's parents that she be tested by a neurologist.  I know that she, and the school, believe that the little girl has ADHD.

It's very true that the child has attentional issues.  But what is behind them?  What is preventing her from meeting our expectations?

This child had a somewhat traumatic birth and was delivered by Csection.  She had a hard time feeding and didn't sleep very well.  She sat up on time, but when it came time to crawl, she got up and walked instead.  

Her mother owns a day care center, where she works long, hard hours, and when the little girl is not at her preschool, which is busy and noisy, she is at the day care, sharing her mother with the other children.  She's been in some sort of school since she was about two years old, and at the day care center since she was born.

 What I discovered during our first session was low muscle tone, poor balance, weakness in her trunk and legs, retained primitive reflex activity, impaired vestibular functioning, and tactile and auditory defensiveness.  Because she had not spent any time crawling, she had missed out on some key developmental experiences.  Consequently, her body is disorganized and weak.  Since crawling integrates the two sides of the brain, develops the vision, strengthens the neck and trunk, stabilizes the shoulders, and readies the hand for fine motor tasks, any child who does not crawl, or crawls for only a very short time, or crawls in an unusual way, is at risk for learning problems.

Low tone and trunk weakness make it difficult for this child to sit still. She doesn't have the effortless strength and stability in her spine and trunk that are required to support it.  Her impaired vestibular functioning drives her to move her body in order to stay present.   Auditory defensiveness prevents her from being able to concentrate in all the noise and chaos in the classroom. Her nervous system can't filter it out, and the incessant classroom chatter is bothersome and painful.   She doesn't like to allow people into her personal space, because it makes her anxious and uncomfortable.  Her clothing often bothers her, further distracting her. She is a highly picky eater, subsisting on white food, which causes her blood sugar to spike and drop.  She doesn't have good fine motor skills, which makes using a pencil or scissors a frustrating experience.

Like any four year old, she doesn't yet possess the internal organization or stability to learn to read and write, but her school includes them in their nursery school curriculum.  When the teachers insist that she engage in these tasks, which are at least three years beyond what she is capable of developmentally, she resists.

Children who are struggling with this combination of sensory defensiveness and physical weakness are not thriving in their school environments; they are merely surviving and coping.

  Many of the children I treat who live with sensory processing disorder crave a lot of solitude and quiet time in order to recharge their batteries, because they find daily life so stressful, but this child doesn't get it.  She goes directly from a noisy, chaotic school to a noisy, chaotic day care center, where she watches her mother nurturing many other children.  Then, when her  mother is finally done with work, she is exhausted.  She doesn't have much physical or emotional energy left in reserve to give to her daughter at that point, and she still has to take care of her home, so she parks the girl in front of the television while she prepares dinner and does housework.

In my clinical opinion, between school and day care, this child spends a great deal of her time in environments that are not suitable for her.  Consequently, she is overwhelmed, overloaded, and overstimulated much of the time.  The demands that are placed on her at school are too difficult for her at her developmental stage, which is far behind her chronological age.  She has no way of articulating to the grownups that she simply can't comply with their expectations, so she rebels and shuts down by getting up and walking away.

We need to give this child a stronger, more organized, less sensory defensive body, a better diet, much more time spent playing outside, a quieter, more structured classroom, a school curriculum that is more in line with her developmental abilities, less time in front of a TV, regular quiet time, and more quality time with her mother, before we label her with ADHD.