Monday, May 31, 2010

Ten Ideas For Building and Improving a Child's Attention Span

Since everyone is entitled to my opinion, I firmly believe that much of modern life is the culprit in a mass tendency here in the U.S.  to shortened attention spans, and not only in children.   Some things we can do:  eat better, turn off the electronic devices, get outside and play more, and return to the very human occupation of making things.  
1.  Make sure your child is getting plenty of time to play outdoors.  Studies show that there is a direct correlation between exercise, IQ, and school performance.  Remember, movement is what activates the brain!  I recommend to parents that they take their children to the playground for 20 minutes before dropping them off at school. If this is truly not possible, then have the child walk to school, or at least part of the way.  One friend plays a game of hide and go seek with her five year old on the way to school every morning.

2.  Children who have a hard time attending often are shallow or inefficient breathers.  Toys that encourage sustained exhalations are superb for improving respiratory function.  I like bubbles, blow darts, whistles, Blo-Pens, and inexpensive wind instruments, like ocarinas, harmonicas, and recorders.

3.  Brain Gym exercises for improving handwriting, like lazy8's  or  elephant 8's, are fun and easy to do before starting homework.  If your child has difficulty regulating his behavior at school,  doing hook-ups can be helpful before class starts.

4. Craft activities are the perfect means for encouraging a child to develop his tolerance for frustration, attention span, eye hand coordination, and problem solving skills.   Some ideas:  knitting,  weaving, {you can make a loom out of a piece of cardboard and give the child things like feathers and bark chips to weave into it, as well as yarn}, putting together and painting wooden models, suncatchers, perler beads, tile mosaics, felt stuffed animals or puppets to sew.  Check out this website, which sells lots of kits and supplies.

5.  Old fashioned board games not only require a good attention span, they develop sitting tolerance, and teach social skills like sportsmanship and turn taking.  Other good choices: jigsaw puzzles, word games, and card games that take some skill, like cribbage.

6.  Read to your child.  Start early, do it often.  I can't stress that enough.   Many children's books are mind numbingly boring, but a surprising number are not.  I love Dr. Seuss,  Maurice Sendak, Beatrice de Regniers, Crockett Johnson, and Russell Hoban, among others, for very young children.  And how about playing a little Mozart, Beethoven, or Bach on the CD player while you're at home with the kids?  You can borrow good classical recordings from the library and upload them to your computer.

7.  Invite your child to help you in the kitchen or in the garden.  Encourage him to take responsibility for things and make him feel like a true collaborator in your efforts together.  Help him to set high standards for his work.  How motivating this is!  An added bonus: picky eaters are much more likely to try things that they have had a hand in producing.

8.  Play catch, Twister, hide and go seek, statues, tag, touch football, soccer, and dodgeball  -- in other words,  gross  motor games that require a certain amount of coordination and motor planning.  Organize some games with the other children in the neighborhood.

9.  Try to limit battery operated toys that have lots of bells and whistles but don't invite much interaction, and substitute toys that require the child to employ fine motor skills and to use his imagination.  In the waiting room of sensory gym where I practice, there is an old fashioned wooden castle complete with moat and drawbridge with a lot of toy soldiers, warriors in armor on horseback,  and members of a royal family.  The children can't tear themselves away from it, and start inventing elaborate scenarios as soon as they pick up the first figure.   These magnetic scenes are wonderful for sparking creativity in young children, who can tell endless stories as they manipulate the figures.   Old fashioned building toys, like Tinkertoys, are good, too.

10. Don't jump in immediately every time your child experiences frustration, and resist the temptation to give in every time your child insists on having things his way.  Learning to tolerate frustration,  to be able to sit and struggle with something until it is mastered, to try again and again while keeping faith in your abilities,  or to be able to gracefully defer when necessary to the needs of others for the benefit of the group, is critical to the ability to succeed at life.

Wednesday, May 26, 2010

{This is Not} a Word From Our Sponsor

It's an unfortunate reality these days that our environment is toxic.  {I started this piece before the oil spill in the Gulf, and now it looks as if the spill is headed into the Atlantic Ocean.}  Our groundwater is becoming contaminated, our air is polluted, our wild caught fish {what's left of them} are full of mercury, our soil is full of chemicals, our food is full of additives and pesticides, our meat and farmed fish are shot full of antibiotics. This is tough for any immune system to have to cope with, but for a child who is immuno- compromised, it's a daily assault.

We have a whole crop of autistic spectrum children on our hands now that are highly environmentally sensitive to all kinds of common, unavoidable things: wheat, soy, corn, dairy, nuts, food additives, chemicals, pollen, dust, mites.  There is now a study correlating ADHD with pesticides.

For children who are living with these kinds of problems, it's important to try to make their home environments as poison free as possible. Here's something simple you can do to make your home less toxic and save tons of money at the same time: replace all of your cleaning solutions with baking soda and vinegar.

I started replacing the conventional cleaning products I'd been using all my life with baking soda and vinegar years ago, when my cat came to live with me. I didn't like the idea of him walking on a floor I'd cleaned with ammonia, and then licking his paws.

I can clean everything in my home with baking soda and vinegar. They are completely non toxic and super cheap, especially if you purchase them in bulk. I buy generic brands in huge sizes. A gallon of house brand white distilled vinegar costs two dollars and forty nine cents at my local market, and lasts for months. I decant it into a smaller bottle to make it easier to pour. Vinegar and baking soda are gentle on your hands, and you don't get sick from breathing the fumes. I'll never buy a commercial cleanser again.

Baking soda easily replaces abrasive cleansers in the kitchen and bathroom. I use it to clean the stove, the sink, the dish drainer, and the shelves of the refrigerator, and it works like a charm. It also cleans the bathtub and all of the bathroom fixtures quite efficiently, with the added bonus of not leaving any scratchy grit behind.

If you have greasy pots, a large handful of baking soda rubbed onto the surface will absorb the grease and shine them up, too.   Burn a pot?  Make a thick paste of baking soda and water, apply it liberally to the burned food, let it sit for a few days, and scrub with an abrasive sponge.  All gone!

I also use baking soda to clean plastic containers after I store something oily inside. Baking soda absorbs the grease right off of the plastic. A slug of vinegar into the soapy water will cut the grease in a sink full of dishes.

A few tablespoons of vinegar mixed with water in a spray bottle works perfectly to clean the refrigerator, kitchen cabinets, and mirrors.  {The smell dissipates quickly.}  You can toss a cup of it into the toilet to clean it. Let it sit for a few minutes, then scrub. You can use vinegar to get rid of mildew in the bathroom, too, by wiping down the tiles with it. Baking soda and vinegar will clean soap scum from a glass shower door without scratching. I use baking soda and vinegar to clean the litterbox, and they deodorize it nicely. Dump them in together, and they fizz up and make scrubbing bubbles for you.

Vinegar will remove many stains, such as mustard, jelly, and coffee, and, mixed in a bucket with some hot water, it will wash your no wax floor.

If you have a child with fragile health at home who lives with allergies and sensitivities, you can really make a difference by getting rid of chemical based cleaners and substituting these healthier options. There are some excellent books about cleaning house without using commercial cleansers. I have a copy of Organic Housekeeping by Ellen Sandbeck and refer to it from time to time when I have a question. A few weeks ago, I learned how to polish silver using salt and baking soda as a soak, then rubbing with more soda. I was very glad to know how to do that, as I had once made myself ill using commercial polish to clean a large quantity of silver.

If you do a Google search on "cleaning with vinegar" or "cleaning with baking soda" you'll get thousands of great ideas for cleaning your home without chemicals.

One more tip for keeping the house cleaner and toxin free: take off your shoes when you enter the house, and wear house shoes. I learned to do this when visiting friends in Europe. They keep their house shoes next to the front door, and when they come home, it's as automatic as hanging up their coats to change out of their street shoes. When my friend Birgit had a Boxing Day gathering in her home outside of Stuttgart, I was amused and delighted at the sight of all of her elegantly dressed guests sporting fuzzy bedroom slippers.  {And I'm sure the ladies were lots more comfortable in their slippers than in the high heels they left sitting next to the front door.}

My European friends' daughters and their playmates always packed their hausschuhe into their satchels when going on play dates after school. I'm so attuned to this now that the last time I visited them, I packed my house shoes in my carry on along with my toiletries. I was glad that I thought to do so, because my bag didn't arrive when I did, and their two hundred year old, drafty house has stone floors.

I've been wearing dedicated inside shoes for years, and it makes a huge difference in how often I have to vacuum and how hard I have to work to wash the floors. Shoes track in all kinds of things from the sidewalk, like lead from car exhaust and dog poop, that I would rather not have in my home. I keep a few extra pairs of house shoes around for guests, and no one seems to mind using them. I try to warn first time guests before they visit when I think of it.

As far as laundry detergents go, I would recommend an unscented one with a short list of ingredients. Skip the dryer sheets, which are full of chemicals.

As for personal products, I use Bert's Bees shampoo because it doesn't contain sodium laureth sulfate, a cheap foaming agent that is said to be an irritant. Whether SLES is harmful or not is up for debate, but I don't mind avoiding it. I also think that lotions absorbed by the skin should be as edible as possible, especially when used on children, so I use apricot oil or vegetable glycerin for moisturizing. I would also recommend avoiding highly perfumed bubbles or soaps for a special needs child.  I recommend bathing in Epsom salts; the salts draw toxins out of the body.

 What about sunscreen?  I don't have any product recommendations, but I do know that natural, chemical free screens exist and are worth tracking down, especially if they are being slathered liberally on very young children.

I think that the details, like reducing toxins in the home, making sure that the child is eating healthy food and getting enough sleep and exercise, can add up to a lot in making a special needs child's ability to cope much easier.

Monday, May 24, 2010

Lower Your Expectations

A few weeks ago I wrote a post I called Great Expectations, about how children love it when the adults in charge have high standards for them.  This post is about examining our expectations for very young children, and whether they are realistic.

Recently I got a call from a mother who was concerned about her four year old son, who was having tantrums and being oppositional much of the time.  He had OT services at school, but not sensory integration therapy.  She had heard that I was a sensory integration specialist and was hoping I would be able to help him with his behavioral issues.

I asked her about his schedule, mostly to figure out a treatment time, but as she elaborated, his problems became clear to me.  He went to school five days a week from nine in the morning until three thirty in the afternoon.  The ride in the schoolbus took an hour there and an hour back, so he was leaving home at eight and coming back at 4:30.  This meant that last winter, he was coming home at dusk or in the dark.

At school, he was participating in twice weekly sessions, 45 minutes each, of OT, PT, speech, and play therapy.  His mother had enrolled him in a couple of after school activities as well, thinking he could use the extra push. Gymnastics was one of them, and I forget the other.  I asked her how he liked his gymnastics class.  "He hates it!"  was her prompt response.

I said that it seemed like quite a long day, especially with the addition of two hours on the school bus. {I told her: I have to commute two hours every day on the subway and it's annoying and exhausting, even though I use the time to read or do paperwork, so I can only imagine how he feels.  He has to sit still for all that time, with nothing to occupy him, since he can't read  yet.}  I told her that I thought that all of those therapies and extracurricular activities added up to a lot of time for a four year old, especially a child with low tone and sensory issues, to have to be "on."  There was a long silence, and she said, "It's way too much, isn't it?"  

I said that I thought that it probably was, and asked if his time at school could be reduced.  She immediately answered that she was going to take him to school herself instead of putting him on the bus, decrease his time at school by a few hours every day, and cut back to four days a week.  She also said she would cancel all of his after school activities and give him more down time. 

I said that it sounded like an excellent plan, and that adding OT might be too much for him right now, so we should wait and see how he did with the new schedule.  I made some suggestions for things to do at home with him, including a strong recommendation that he be taken to the park every day to play on the swings, which he loved. We decided that we would not schedule OT for him until we saw how the new schedule was impacting his behavior.

I didn't hear anything after that, so I called her a couple of weeks later to ask how he was doing.  She said that a few days after she had decided to reduce his school time, instead of lying awake for a long time after he had been put down, he began to go right to sleep.  He was sleeping in his own bed for a solid ten hours a night, without waking up and crawling in with his parents.   He was getting up in the morning on his own, instead of having to be awakened, happy and refreshed, instead of cranky.  He had mostly stopped complaining about not wanting to go to school.

His mother had decided to use all of his new free time to take him to the park and on walks every day, and do fun things together, just the two of them, and as a family on the weekends.  She reported that his tantrums had stopped, and that she no longer needed any help for managing his behavior.

I wonder if this heavy scheduling and high expectations for such young children is limited only to large cosmopolitan cities, like Manhattan, where I live and practice, or if everyone is forgetting what is realistic for small children to be able to handle.

Since everyone is entitled to my opinion, if it were up to me, most three year olds would not be in school.  Many children, especially boys, don't have the emotional maturity to do well in a school setting at that age, and are not getting the movement opportunities there that they need for optimal development.  Everything a child knows about the world, until he is about six years old, comes from his physical relationship to it, so every time a child is required to sit still instead of moving his body and exploring, he is prevented from developing his strength, coordination, and visual skills, which are what support the ability to sit for long periods and attend, to write, and to solve problems.  Preferably after the age of six!

If your very young child, who spends much of his day in a highly structured environment, being expected to sit still much of the time and follow an elaborate set of rules, is being oppositional, seems anxious and stressed out, has a hard time sleeping, has uncontrollable tantrums, and just can't get it together, is it because too much is being expected of him at his young age?

Wednesday, May 19, 2010

Helping Children With Low Arousal

Arousal refers to our state or consciousness or awareness.  Someone who is in danger, or is moving at high speed, is in a high state of arousal, and someone who is about to fall asleep is in a low state of arousal.  Then there is everything in between. 

Many children with sensory issues have arousal problems, clocking in either too low or too high for whatever situation they happen to be in.  There is something about the way that their bodies take in and process sensory information that causes them to over respond to some things and under respond to others.  Their hearts start to race, their breathing quickens, and they go into instantaneous fight or flight in response to things that a more normally working nervous system would hardly register.  Or they don't respond to things that other nervous systems would have a hard time coping with: they can spin and spin and spin without ever getting dizzy, jump off of eight foot drops onto concrete and not feel any pain, and go on the scariest roller coasters without turning a hair.

Today I'll talk about children who are perpetually in a state of low arousal.  Interestingly, most children  with ADHD have this problem.  The reason they can't sit still is that they are trying to move enough  to activate their nervous systems in order to focus and to feel all right in their bodies.

Movement and intensity are what help low arousal.  Intensity can be supplied in many different ways, through each one of the senses.

To change arousal through the mouth:  Children love all of those ridiculously over the top sour candies because they are so arousing.  Warheads, Cry Babies, Tear Jerkers, Sour Straws,  Skittles,  Starburst, Pop Rocks and Lemonheads are first rate sensory therapy tools.  As much as I rail against it, junk food is brain food.  Why do you think all of those 7-11's carry such a big selection of candies and chips?   All that stuff to slurp and crunch and chew is exactly what you need to help you stay alert and focused when you're driving for hours and hours on a  monotonous stretch of highway.

Anything crunchy, that explodes with sound when you bite into it, is alerting.  Carrots, apples, popcorn, pretzels, and chips are an easy example.  Something strong tasting, like salsa or vinaigrette, to dip them into, is even better.  Popsicles, and anything frozen, are alerting.  Sometimes frozen peas can be a nice treat, eaten directly out of the bag.  I like to munch on frozen raspberries, especially in the summer. Cold fizzy drinks are alerting.  I recommend mixing plain seltzer with some cranberry or orange juice, or a squirt of lime.

You can often find interesting, strongly flavored treats in Asian markets.  You can  experiment with umeboshi plums, pickled, candied, and preserved ginger,  and other strongly flavored preserved fruits from Asian cultures.  There's a whole world of intensely sour Japanese hard candies as well.

Many of the children I treat are shallow breathers.  Chronic shallow breathing deprives the brain of oxygen and can cause a state of permanent low level anxiety.  The best way to improve this is to encourage the child to engage in activities that require prolonged, sustained exhalations.  A long exhale will cause the next inhale to be reflexively bigger and fuller.  This will help the child's body learn to breathe more deeply.

Whenever I see new whistles, bubble pipes, or blow toys, I always buy them.  I love blow darts, blow pens,  balloons, kazoos, razzers, and party noisemakers.  The best blow toys are ones that have a visual component, such as a moving part powered by the breath, or bubbles that slowly form at the end of the pipe.  The visual component is strengthening to the eyes because it encourages them to pull in close to watch.

Sometimes I'll get down on the floor with two straws and two pom poms and the child and I will blow the pom poms across the room in a race. 

Another reason for low arousal is sensory defensiveness.  If you are being bombarded by sound, smell, light, visual, and touch sensations that are irritating to your  system, you're going to want to leave your body when it becomes overwhelming, which it often does in school.  Schools tend to be highly noisy and chaotic.

Many children are in a low state of arousal because  their vestibular nerves, which regulate their levels of awareness based on the amount of movement they sense, have a very high threshold before they will activate. Movement activates the part of the brain responsible for arousal.  The more intense the better, but when you're inside, anything is better than nothing.  Some children like to spin, some like to jump, some like to turn upside down, some like to swing back and forth.

To change arousal through the vestibular system:  Some quick ideas:  spin in an office chair or a Sit and Spin, do jumping jacks or somersaults, wrestle, play a handclapping game, sing "Head Shoulders Knees and Toes" doing all the movements and making sure to bend all the way over,  or jump on a mini trampoline.  Sitting on a therapy ball while doing homework can be very helpful.  The child can bounce to his heart's content while he is working.

If your child is doing homework and having an impossible time focusing, just getting up and doing one of these for 30 seconds or so can be enough to give him five more minutes of concentration before he starts to flag.  I sometimes work with children at home on their handwriting, and when I see the child start to droop or lose the ability to follow me, we'll get up and quickly do one of these things, then sit right back down.  Little girls love handclapping games, and I add footwork as well to make it more interesting and challenging.  Here's an interesting article about how handclapping games can help improve coordination:

To change arousal through the visual sense: Light, or lack of it, can have a tremendous impact on arousal states.  Is your child sitting to do homework in a place with plenty of natural light?

To change arousal through hearing:  Music is a great way to rev up your engine.  What do you have on your iPod that you listen to at the gym?  Put on some high energy music  {I like "Thriller"} and dance around for a few minutes.  A wonderful choice that isn't so obvious is string band music for Irish, square or contra dancing.  The fiddles and banjos are so joyful, rhythmic,  and energetic sounding, they literally propel you into moving.

To change arousal through touch:  messy play, such as touching shaving cream, can be very alerting.  So can the simple act of running your hands along your legs while you are seated.

Do you sit in meetings fiddling with sugar packets, straws, and paper clips, doodling, knitting, drinking coffee or chewing gum?  That's how you help yourself stay present during those times when you are forced to sit still and listen without participating for long periods.  Why do teachers forbid children, who need them much, much more than we do, to employ similar strategies to help keep themselves alert?

For a child with low arousal issues, sitting still is a literal "no brainer,' since the cognitive area of the brain stops being able to function when the child is not moving.  Fidget toys, employed discreetly, can help a child stay focused in class.  A great fidget I learned to make at home: Take a good quality balloon, stick a funnel in it, pour in some cornstarch and some Elmer's glue, and knot it.  Squeeze and massage the balloon to mix the two, and you have a wonderful and inexpensive little "stress ball."   I also like to take a piece of clear, flexible fish tank tubing and slip it over the eraser end of a pencil to make a discreet chew toy.  {If your child is chewing constantly, however, he needs to move more, and would benefit from more time spent outside.} 

I tell parents to take the child to Party City or a local 99 cent store and look at the little prizes together, asking the child what he thinks would be good to keep in his pocket, and buying a small selection to try.  Stretchy animals and mini koosh balls are good. Many common objects, like paper clips, can be a good way to keep the hands busy and the mind alert.  Just make sure you run this by his teacher so whatever he uses doesn't get confiscated, and remind him to be discreet.  If he is also battling impulse control issues, you may want to limit things that can be shot across the room, like rubber bands.

Sitting on an inflatable cushion like Move N Sit or Disc o Sit during class helps.  Inflatable cushions allow the child to wiggle enough to stay activated while staying seated. If the teacher has observed that the child has a certain time of day that he really cannot manage, she can send him on an errand during that time.  Carrying a heavy box of books up some stairs is always a good choice, and he should stop at the water fountain while he's at it.

Brain Gym has some interesting techniques for improving brain function.  Here is one that you can teach your child to employ discreetly in class, called Brain Buttons:

Stretch your thumb and index fingers wide apart and place them into the slight indentations below the collar bone on either side of the breast bone.

Pulse lightly and rhythmically.  At the same time, press the other hand gently over the belly button.  Gently pulse and press for about two minutes.

To change arousal through smell:  strong scents, like peppermint, can be alerting.  I don't know much about aroma therapy.   This would be a very interesting area to explore.  I would use scents cautiously, since the olfactory nerve goes straight to one of the most primitive parts of the brain.

If your child has a hard time maintaining alertness in the afternoon, what is he eating for lunch?   Lean proteins and complex carbohydrates like whole grains, fruits and vegetables are the best choices to help a child make it through the day.

Salty foods can be dehydrating, which can make it hard to stay alert.  Remind your child to drink plenty of water at lunch.  And while you're at it, please make sure that breakfast contains some high quality protein.
Is your child getting enough sleep at night?  If he has a hard time falling asleep, that may be contributing to his arousal issues.  Is he getting enough exercise during the day to tire him out?

You can limit computer time before bed, be strict about bed time, and try a bath before bed with epsom salts.  Not only is it soothing and relaxing, helping the child transition to sleep, epsom salts can help draw toxins out of the body.

A very young child may  have a hard time falling asleep in a bedroom with too much visual stimulation.  If you think this may be contributing to sleep issues, make sure that closets are closed and the shelves are organized and tidy before bedtime.

There was a great article in the New York Times about how much better children performed in the afternoons after their schools changed recess to before lunch:

It might be worth looking into at the next PTA meeting.

In another post I'll talk about helping a child with high arousal bring his engine idling speed back down.

Monday, May 17, 2010

What is Arousal?

A term that sensory integration therapists tend to use a lot is "arousal." What does it mean when we're talking about a child, and why is it important?

Arousal is your level of alertness at any given moment. When you're lying in a hammock which is gently, slowly swaying back and forth in a warm, sweet breeze, and the birds are chirping, you can hear the sound of the surf in the background, and you're under the shade of a tree, you're very relaxed. Your arousal level is quite low, and you're about to drift off into sleep.

Now imagine yourself sitting in the first car of a roller coaster, you're at the top of the highest curve, about to head almost directly vertically downward.  Very high arousal there!

Then there's everything in between.  This is when we are engaged in an activity and still peripherally aware of what is going on around us so that we can respond to it when necessary.  For instance, think of sitting in the park, chatting with a friend while watching your children play.  You can easily flip your attention back and forth as required.

{Archie and Veronica fans: Jughead: low arousal. Laissez - faire attitude towards life, motivated by food and not much else. Happy to be left alone, no particular interest in the opposite sex or in achievement.

Moose: High arousal. Always taking everything the wrong way, spoiling for a fight. Too wound up to do well in class, but captain of the football team, where he gets to throw his weight around. Everyone walks around on eggshells when he's in the room, afraid to offend him and risk an out of control reaction.  His girlfriend's main function is to keep him on an even keel.}

Our arousal levels dictate how able we are to pay attention and respond appropriately to what is going on around us.

For most of us, our senses and internal chemistry work together seamlessly to maintain correct levels of alertness and arousal. When someone familiar touches us, our nervous systems don't interpret it as a threat.  When the phone rings, our hearts don't start to race.  When the family cat jumps unexpectedly on our laps, we don't scream and shoot up from our chairs.

And when we are sitting still, for example at a movie, we can stay alert enough to attend to what's happening on the screen. When we are at work, sitting in front of a computer all  day in artificial light, we can {mostly} stay focused on the task at hand, be alert and present at meetings, and accomplish everything we are supposed to do.

All these levels of alertness are important because they are necessary for survival.  When danger is imminent, high arousal and hyper vigilance are what allow us to defend ourselves successfully against predators.  Low arousal is what allows us to transition into sleep so that we can rest and repair our bodies.

We unconsciously do little subtle things all the time, like stretching, chewing gum, and doodling, to adjust our arousal levels  so that we stay in synch with what is happening around us.

Some of what we do, like drinking coffee, is alerting, and some things are self soothing, like twirling hair.  Some things can be either, like chewing gum, depending on the circumstances and how a particular nervous system takes it in and processes  the sensory information it provides.

Many of the children whom we see in occupational therapy for sensory issues tend to live at one extreme or another, functioning either too low or too high most of the time.  Any attempts to increase arousal will cause them to shoot straight into high gear.  They don't seem to have a lot of middle range available to them, which is what is required for most of the demands of modern urban life.

When a child has arousal difficulties, there may be many reasons why. One is chemical. The body's ability to manufacture and utilize neurotransmitters, which transmit information and facilitate communication between brain cells, is compromised. These chemicals are responsible for regulating, among other things, our attention, learning, memory, alertness, mood, and motivation.

Another reason that a child may have difficulty keeping his arousal levels up has to do with the body's ability maintain its upright stature against gravity. Many of the children I treat have low muscle tone. Their vestibular nerves, which talk to the extensor muscles, need a lot more stimulation before they will fire and activate the extensor system, so their extensor tone remains low unless they can move intensely, which they can't do when they're being expected to sit still. This means that they are struggling just to stay upright, which is very tiring. {These are the children who are completely frenetic the minute they get a chance to move, but as soon as they sit, they're lying all over their desks or falling out of their chairs.}  The vestibular nerve also talks directly to the part of the brain  responsible for managing our state of alertness and arousal, so if it's not activated properly, it's not doing its job of regulating the arousal centers in the brain.

If the child's senses are not taking in and interpreting things appropriately, he may be on high alert and stuck in a state of chronic fight or flight.

Have you ever been in such a stressful situation, like a horrible medical procedure or receiving terrible, life altering news, that you just left your body for awhile? A child who is sensitive to noise, light, or chaos, and has a hard time sitting up, is going to spend a lot of his school day being tuned out as one way of coping with things that are hard for him to deal with. These are the children who fall through the cracks, because they're not acting out. They're quiet about the fact that they're not present and unable to learn.

The paradoxical thing about ADHD is that since the children who have this disorder have a hard time keeping still, we think that their arousal levels are too high.   The opposite is generally true; the child is coping with arousal levels that are chronically too low to allow him to sit without his nervous system deactivating. A child who is perpetually on the go is a child who is doing whatever necessary, trying to move, mostly -- to activate his nervous system and increase his arousal. That's why stimulating drugs have such a powerful effect on attentional issues.  They increase arousal, and so they raise the brain's ability to attend.

One problem that children with arousal issues often have is the type of attention that is available to them.  They are either highly distractible and can't focus, or they become so overly focused on something that the entire world fades away and it's difficult to rouse them out of that state.  Again, this is problematic for functioning in school.  Something in the middle of those two extremes is what is required in a classroom.  The child should be able to attend to the lesson, but is not so lost to everything else around him that he is able to shift focus easily.  He needs to be able to concentrate on the task at hand while at the same time attend to what is going on around him.  For instance if he is concentrating on his work and the teacher makes an announcement, he should be able to look up briefly, take it in, and go back to what he is doing without having lost his train of thought or spending a lot of time spinning his wheels before he is able to return to the task at hand.

Helping the child learn to manage his body, and thus his arousal state, to live most of the time in  that in-between range is one of the goals of occupational therapy. This is what we call the "just right state for learning."

There is a wonderful program developed by occupational therapists called "How Does Your Engine Run?" that talks about this in great detail. The authors liken the body to a car engine. Where does yours tend to idle, low or high? If you think about the unconscious strategies you employ to help yourself during the day, you can get a sense of where you fall. People who mostly do things that are self soothing in nature tend to idle too high, while people who do things that are mostly alerting tend to idle too low. We all do a mix of these things, though, based on what we need at the moment.

Sensory integration therapy assists the child in maintaining a better arousal state in a variety of ways. We can improve the child's neurochemistry by doing things in the clinic that will increase the manufacture of dopamine and seratonin, the "feel good" neurotransmitters. We can strengthen up his extensor muscles, integrate postural reflexes, and improve the child's balance, which will help him sit for longer periods. We help the body learn to filter out extraneous information that is distracting to the child, by changing the way the inner ear and vestibular nerve process information, or by desensitizing the skin. We help the child become a better breather, so his oxygen levels are improved and anxiety is diminished. We can teach strategies for managing low arousal that the child can employ discreetly when needed. We can educate parents and teachers to recognize when the child is faltering and give him an opportunity to rev up his engine before he tunes out or acts out.

Building more movement and fresh air into the child's day will certainly help him maintain his arousal at appropriate levels. So will making sure that he gets enough sleep.  Hydration is important, as is a diet low in processed food and rich in protein.  Breathing well is critical.  If your child tends to be a shallow breather, his sympathetic nervous system {which is responsible for regulating the fight or flight response} will be too responsive, and make his heart race and flood his body with adrenaline at inappropriate times.

In another post I'll talk about some strategies I use to help children change their arousal levels  during clinic time and how they can begin to discreetly manage their arousal during class time.

Saturday, May 15, 2010

Guest Post

Jane  Tomkiewicz  discovered the Alexander Technique during her years performing on the downtown and worldbeat music scene.   Jane trained and certified at the American Center for the Alexander Technique (ACAT).  She has taught privately in  Manhattan since 1990, and has been teacher in residence at  the 92nd St. Y’s Harkness Dance Center since 1992.  She currently also teaches at the Feldenkrais Center of Park Slope and "the Art of Posture" at ACAT. Her teaching is also informed by Iyengar yoga and Buddhist philosophy and meditation.  She has worked with many people - performers and non-performers alike - from a great variety of professions and with a great variety of pain management and workplace efficiency or performance goals.  She served as the Executive Director of the American Center of the Alexander Technique from 1996-2008.  Her website is .  The following article appeared in PS 372's INCLUSIONS Spring newsletter in 1999.
A New Way to Look at Sitting up Straight
By Jane Tomkiewicz
Please sit up straight, dear!

Does your child slump while sitting at the computer, watching TV, doing homework, reading or at the dinner table?  Many parents are concerned about repeatedly having to remind a child to “Sit up straight!”.   Parents may be further discouraged that only moments after the reminder their child often returns to the previous slumping position.  Are children being disobedient?  Are they not being conscientious?  Why is sitting up so hard to do?
Our bodies are designed for movement and sustaining any single position can be challenging or fatiguing.  To meet this challenge growing bodies benefit from a great deal of movement and a great variety of movement patterns usually found in structured practice or sports or “free play”.  
City kids may not have the opportunity to simply run outside and play at will as some of us had in the days of yore.  Add to mix the fact that much of our new “entertainment” includes sedentary activities as computer games and television and you have the potential for a lot of slumping! 
But don’t fear.  Children’s postural habits have not yet set and there are ways parents can help give their children helpful directions about finding and maintaining a comfortable sitting posture.
Try the exercise below on your own before trying ti with your child.
Exploration #1Step #1) Please sit how you would sit if you were completely alone and no one was watching and you were not concerned in the least about sitting up straight. Please don’t be embarrassed if this is a slump – for the  majority of people it is.  Take a moment to tune into your sensory feedback – and notice whatever there is to notice about your position. How does it feel?  What feels good about it?  Is it a relief?  Where is the relief?  This could be called your “comfortable position”, your “collapsed position” or your “not straight” position. 
Step # 2) Now “sit up straight”.   Please try to notice and describe as specifically as possible what it is that you do to change your position. Some examples might be “I push my pelvis forward and then my whole body changes”.  Or “I push my chest forward.”  Or “I lift my chest up”.  Or “I lift my face up”. 
Step #3)  Go back and forth between those two positions several times really paying very close attention to whatever efforts you apply and whichever movements you do to make yourself straight.
Note: If there is no difference between these two positions give me a call – it could be you’re in naturally great shape – or you may need some assistance in moving between the different states.
Step #4) Lastly, please notice what it feels like to stay in your straight position for several minutes. Is it easy to maintain this position?   What do you have to do?  Where do you feel it?   Take a moment and jot down your sensory observations.

Many people go back and forth from a collapsed “c” shape curve to an overbracing pushed forward position.  This is the “knee jerk reaction” your child probably does when instructed by a parent, teacher or coach to sit up straight.  Is that what you do?  If so, please try one of the following alternatives to “sitting up straight”.
(illustration goes here…)
Exploration #2Step #5)  Return to your “not straight” position. 
Step #6) Take you hand and rub the muscles along the back of your neck.  To further help the muscles along the back of the neck ease up – nod your head a tiny bit forward and backward, forward and backward.  Now think of your head as a helium balloon and – in your imagination – see your whole head (the back as much as the front)  floating up to the ceiling.  As your head floats away – imagine your spine floating up after it. Imagine that your rib cage dangles off your spine and floats after them both. Your rib cage dangles and your waist falls back.   At the same time that your head, spine and rib cage float away, you feel your feet moving into the floor and your sit bones moving down into the chair.   
Step #6)  Imagine that the top of your head shines like a big flashlight.  See the light shining toward the ceiling.  Rub the muscles along the back of your neck to help them be easy.  Keep seeing the light on the top of your head shine skyward.  As you continue to shine out the top of you toward the sky, sense that another light shines out your navel to the wall behind you.   So your whole torso is “shining up” out your head and your waist shines back toward the wall behind you.  Without looking down, become aware of the contact of your pelvic bones with the seat of the chair. Think of light shining out your “sit” bones down out the seat of the
chair and down into the ground below you..

Whichever variation you choose (balloon or flashlight) continue to think these thoughts for a minute or two and at the end of that time notice how you feel. Has your position changed? Are you sitting differently? Are you sitting more straight? How does it feel to sit straight? Could you comfortably maintain this position?

If thinking these thoughts has resulted in you sitting in a straighter more easeful position, you may be surprised.  It may have been very different from how you normally would have straightened yourself up. It may have been much less physical work involving less pushing, heaving and bracing.

People often wonder how they feel so physically different with so little physical effort.  The answer is that the exercises in spatial thinking tricked muscles that were overworking (and therefore pulling bones closer together - increasing the three curves in your spine) into letting go. You feel different because you have let go of some overworking patterns that caused imbalances and got in the way of the reflexes and the good postural mechanism!   It’s hard to think one thing and do the opposite.
Young children naturally can be engaged to think of their heads as flashlights or balloons.  These ideas can even be worked into imaginary space personalities or other such creations. This kind of spatial thinking can be fun  - at the same time that it can be very  helpful – setting a tone that “good posture” and posture reminders from parents don’t have to be dreaded.  

Wednesday, May 12, 2010

Rainy Day Activities For Developing Fine Motor Skills

In a previous post, I talked about craft activities that promote fine motor control.  In this post, I'll talk about other activities and games that children can do to improve strength, pinch, and coordination in the thumb and fingers.

As we develop, the thumb and forefinger {the radial portion} separate out from the rest of the hand and perform the fine motor functions.   The pinkie, or ulnar, portion of the hand is responsible for strength, like using a hammer, and for sustained grasp, like holding a bag.

As the fingers strengthen, arches form in the palm.  If you pull your fingers and thumb in closely, you can see two distinct arches.  One forms along the knuckles that connect the fingers to the palm.  The other runs along the lengths of the fingers.  These two arches are what allow the palm to form a hollow cup so that we can hold things inside our hands.  They also permit strong tip to tip opposition of the fingers and thumb, which is essential for fine motor precision activities like picking up and manipulating very small objects between the thumb and forefinger.

If your child didn't spend a lot of time crawling, he may need to work on ways to strengthen his shoulders and separate out his thumb from the rest of his hand, which is part of what crawling accomplishes.  Wheelbarrow walking, push ups, and any activities that require the child to support his weight through his hands and shoulders are good.  I also like to tell parents to have the child lie on his belly and prop himself up on his elbows while drawing, putting together puzzles, etc. on the floor. This stabilizes the shoulders, which give the arms a good base of support, and strengthens the neck, which supports the eyes.

Scissors are a great way to strengthen the hand and fingers.  I like Fiskars child scissors. I teach the child to put his thumb through the  small loop and his third and fourth finger through the larger loop, wrapping the index finger around the blade, which allows for improved control.  I tell the child that cutting with scissors is like driving a car down the street.  The scissors is the car, the fingers are the passengers, and the index finger is the driver, and holds on to the steering wheel.  Make sure to drive in your lane!  Hold on to the wheel, don't crash!

I have a whole set of scissors with different blades on them that cut fancy shapes, like scallops and zigzags.  Those old fashioned activities like cutting out paper doll chains and snowflakes are a great way to spend a rainy afternoon.

 When I was a little girl, I used to love to cut strips of construction paper, tape them or paste them together, and make paper chains.  Or my mother would find a box of paper clips and we would make paper clip chains.  {Just avoid the colored ones, since they contain lead.}

Colorforms are good for developing tip to tip opposition and pinch.  This is also a calming activity for an over amped system.  Have the child make designs on a vertical surface, like a window, mirror, or the white board side of an easel.

Speaking of easels, I love them, and I love the chalk side the best.  If you have a very young child or a child with a dysfunctional pencil grasp, get rid of all of the markers and use the chalkboard side.  Break the chalk into small pieces so that he is forced to hold them between his thumb and forefinger. 

You can make your child the official junk mail shredder and give him all of the mail to cut up before it goes in the recycling.  Tearing paper is good for little fingers, too.

Picking up coins is a great way to develop pinch and separate out the two sides of the  hand.  Have the child pick up coins one at a time between his thumb and forefinger while stashing them in his palm.  If you have a family piggy bank or box for charity, he can be in charge of putting the coins in.

Lite Brite is superb for developing strong pinch.  You can use plain construction paper and play tic tac toe on it.

Operation is fun and motivating.  If it gets too frustrating it's easy to disconnect the buzzer.

Stacking games are great for developing mid range control in the hands and arms.  Jenga is always fun.  Recently, I was introduced to the game Tier Auf Tier, a stacking game from Europe, manufactured by Haba, that I thought was wonderful.  You take turns stacking wooden animals on top of an alligator.  I thought that the combination of skill and luck it required was a perfect balance, and so did my friend's five year old, when he won.

Connect Four teaches strategy and planning, and develops tip to tip opposition.  I try to make the children work to get diagonal winning connections, since developmentally they are the hardest.  This is a good game for a child who has perceptual issues and has difficulty writing diagonal letters like A, K, X, or Z.

If your child has weak hands and drops things out of them, he needs to work on forming those palmar arches.  Dice games are perfect for this.  Have the child cup them in both palms and shake them together.

I love Play-Doh, and I love all of the little factories and tools that come with it.  I especially love a set of extruders that you can buy from Dick Blick:  I sometimes see them in stores, as well.

 Rubber stamps are great for stabilizing the shoulders.  So are craft paper punches, often found in stationery stores.

Children love to use little tools.  You can use things you might already have, like tongs, a strawberry huller, a pickle grabber, Zoosticks,  and a meatball shaper, and have them pick up little objects or cotton balls and place them into a container.

Therapy putty is strengthening.  You can hide coins or beads in it and have the child dig them out, they can roll it into snakes and then snip it into little balls {to pick up with the tools}.

Pop beads are great for finger strength, and the kids love them.  I also like Rapper Snappers.  They can be connected together to form a tunnel for marbles to slide down.

Old fashioned games like marbles and jacks are wonderful for improving eye hand coordination.

Another great child's activity from Europe goes by various names like Nagelspiel and Tic Tac Toc.  It consists of wooden shapes with holes cut into them, a tiny hammer and a box of tiny nails.  You use the hammer to attach the pieces to a corkboard and make designs.

Readers, any other ideas?

Monday, May 10, 2010

McDonald Duck

I used to treat a little boy who, looking back, I think had a lot of undiagnosed food sensitivities. He would come into the clinic polishing off a snack of some highly processed food, {"Blue Berry Blast Go-Gurt" was a favorite,} then top it off with a stick of sugarless gum. He would then morph from a fairly reasonable little person, ready to play and have a good time, into an out of control, primitive bundle who became completely dysfunctional, hurling himself on the floor and kicking, as the additives and artificial sweeteners had their way with him.

At the end of the school year, the family went to Europe.  The child's father had been offered a wonderful teaching assignment, all expenses paid, at a great university in one of the most beautiful cities in the world.  His parents agonized over the decision to go, worried that their emotionally fragile son would have a stressful, terrible time of it where there was nothing familiar, no friends for playdates, he didn't speak a word of the language, and where he would be expected to comport himself perfectly in a very strict, regimented environment.  {European schools are generally quite, quite serious about these things and have a zero tolerance policy for out of synch behavior.}  I urged them to go, thinking that things would work themselves out and that they shouldn't deprive themselves of such a glorious opportunity.

When they returned, I heard that he had made a fantastic transition, almost instantly spoke the language like a native, did superbly at a very tough school, made friends, and thrived. His parents were grateful to me for all the work I had done to make this possible.  I accepted their thanks while secretly wondering whether this child's life was suddenly so much easier in Europe because he was eating much higher quality food.

Having spent quite a bit of time over there myself visiting friends who were raising young children, I can attest to the fact that  European children just don't consume junk in the same way that American kids do. When my friends were living with their two girls in Munich, their tiny daughters ate every stinky, strong cheese we grownups did.  They routinely polished off complicated, mustardy salads, dense, thickly seeded whole grain breads, sausages, soups and stews, potatoes in every form imaginable, exotic pastries, and plenty of fruits and vegetables. It would never have occurred to their mother to cook the children a separate meal. They ate what we did, and they cleaned their plates.  One day, I was taking care of the one and a half year old while her mother did errands and had lunch with the girls without a child on her hip.  After an afternoon of  peekaboo, horsie, and hide and go seek, she tugged my hand, said, "Brot! Kase!" and led me into the kitchen.  She wanted some brie, and a slice of moist, dark whole grain bread to spread it on.  No Kraft American Singles on Wonder Bread for this child.

Then they moved over here, and the kids, who were seven and four at the time, started demanding Cool Ranch Doritos and Pop-Tarts, since that's what their friends ate.  Their German born mother was justly horrified.

A few years ago, the 17 year old daughter of some friends who live outside of Stuttgart came to visit me for a couple of weeks.  We ate, among other things, asparagus roasted with chopped garlic and pine nuts, leek gratin, artichoke frittata, watercress, tatsoi, cranberry beans, Turkish yogurt with freeze dried blackberries, pistachio-mulberry granola, wild caught salmon topped with homemade pesto, aged Coach farm goat cheese, and rhubarb pie.   We went to the greenmarket and had fun choosing all kinds of curious things to cook and eat together.   I took her to my favorite restaurant in Manhattan, a Roman trattoria specializing in offal.  She was game for anything on the menu, and we had a stupendous dinner.  Another woman my age with a teenage girl sat at the table next to us. As I listened to the two of them combing the menu for something sufficiently familiar and plain sounding enough for the girl to try,  I felt proud of my team.

If it's not clear by now, I think that we do children a huge disservice by dumbing down their food.  I also think that allowing them to ingest large quantities of artificial sweeteners and additives is a dangerous mistake, and that the large corporations who manufacture a good portion of our food do not have our best interests at heart.  {Check those labels!  Even things that are not sugar free are suspect. I no longer buy Juicy Fruit or Bubblicious gum because they both now contain aspartame.}

Amazing things come about when people are introduced to the real thing.  Some of the time I spent in Europe was in the company of a Texan who had been raised on ersatz food, and was indifferent to the pleasures of eating.  He thought orange juice was Sunny Delite, salad dressing was Wishbone, beer was Budweiser, chocolate was Hershey's, coffee was Sanka, and cheese was Velveeta. Wine was for other people.  If I had not strongly insisted on proper meals in restaurants, and on eating local foods, our intake would have consisted mainly of Ritz crackers and Coca Cola, bought in supermarkets and eaten on a park bench.   What a pleasure it was for me to buy him a chunk of gianduja in Italy and watch his surprise and delight as he tasted it, to share a sandwich made with Cambembert and cornichons at a bar in Paris, to give him a taste of my salade frisée aux lardons  at an outdoor café in Nice,  a sip of my hefeweizen at the Hofbrau Munich, and have him flag down the waiter so he could order his own.

Once he tasted the high quality versions of things he had always disliked, he loved them.  He said to me many times after the trip was over that his best memories were of trying all of the delicious new foods everywhere we went.

One of the best things you can do for your family's overall health and functioning is to cook dinner and then sit down and eat it together.   I once read a book called The Surprising Power of Family Meals, in which the author quoted several studies that found that children who ate dinner with their families on a regular basis were much less likely to smoke, drink, or do drugs.

I love to cook, and find it absorbing and relaxing.  It's not as hard as you might think. Before there were all of these fancy cooking shows on the Food Network teaching you how to debone a chicken, form it into a roulade stuffed with a forcemeat of foie gras, ground pork, pistachio nuts, and cognac, truss it into a perfect oval and bake it en cocotte under a layer of homemade puff pastry, there were thousands of women routinely sticking chicken parts in a roasting pan with salt and pepper and maybe a little paprika, steaming some broccoli, and baking potatoes, without worrying whether Martha Stewart would turn up her nose at their efforts.  If you are not a cook, is there someone you know who would be willing to teach you how to put together a few easy things?

I'll end this plea to feed your children good food with an anecdote from the clinic.  As Dave Barry would say, I am not making this up:

Three year old girl:  "Mickey Mouse!"

Me: "Donald Duck!"

Three year old girl:  "Huh?  Who?  Donald?  Donald Duck....?  Who?


Wednesday, May 5, 2010

Helping Children With Modulation Issues

So many children come into to the clinic after a long day of school and go into overdrive as soon as they enter the sensory gym. They become disregulated and behave in a disorganized way almost immediately. They run around, throw things, hurl themselves on and off the equipment, scream, and literally bounce off of the walls. They can't contain their reactions for one more second after being forced to sit still in school all day. This is especially frustrating to watch when more and more schools are cutting out recess altogether, and many schools in Manhattan don't have adequate space for children to move during the school day.

I would love to be able to just let the child blow off steam and get a little crazy, but I have to share the gym with other practitioners, and our therapy sessions are all too brief, so I am forced to redirect. When I see this happening, I point out to the child that his body is getting out of control.   I either provide him with a safe activity that will give him the input he needs, or ask him what would help him gain control, offering choices like a trip to the bathroom, a piece of gum, a lollypop, or a drink of water. If there is a lot of activity in the waiting room, which bleeds into the gym area, I may suggest that we move someplace quieter in the clinic. Many children become disorganized when there is a lot of ambient sound, like voices, in the environment.

By having him participate in managing his responses, I am helping the child learn strategies to cope when there is no grown up to guide him.

Sensory integration therapy works to help the nervous system take in and process sensory information more reliably. Some of how we do this is by providing the intensity of input that the child requires. They work their bodies against gravity on suspended equipment, swinging, bouncing, spinning, jumping, and crashing. We playfully engage the child in experiences that help him overcome his overly negative emotional reactions to everyday situations, strengthen the eyes, and desensitize the skin, mouth, and ears.  By normalizing the way in which the body takes in and processes sensory information, we can begin to open up that middle range for a child who tends to live in perpetual low or high arousal.

Parents can help by making sure that the child's body is well supported. Everyone functions better when they have good nutrition and hydration, regular, structured, predictable routine, plenty of sleep, lots of opportunities for fresh air and exercise, enough down time, and a safe place to regroup when life becomes overwhelming. It's also helpful to know if the child is moving his bowels every day. Just as we don't feel great when we are constipated, neither does the child. A little system that is harboring waste and brewing toxins is not functioning optimally.

Children with modulation challenges are also constantly facing the consequences of failing to meet the expectations of others. Arranging family life so that he is not disappointing you all the time will help him maintain his confidence and not feel like a failure.

Honestly assessing what your child can and can't handle before scheduling activities will save you and your child from heartache. If you know that your child will melt down at a big family gathering, consider making only a brief appearance and leaving before things have a chance to get out of hand. A concert or an afternoon at a ballgame are not great choices for a child who becomes disorganized when his nervous system can't handle noise, lights, confusion, crowds, and being forced to sit still and be quiet for long periods while contending with all of the above.

I once got a phone call from the parents of a five year old girl who had a short attention span, was tactile defensive and very sensitive to sound. They had taken her and her older sister to see a Broadway musical and the little girl had acted out so badly that they had had to leave at intermission. I told her mother that the acting out was a distress signal. The little girl did not have the ability to tell them she was unable to cope any further, so she did what she had to do to let them know that she needed to get out of there.

It would have made more sense for one parent to take just the older daughter, who had a long attention span and did not have modulation problems. They could schedule a more appropriate activity that did not include contending with crowds, loud noises, and having to sit still for long periods in the dark, for the younger one.

If your young child is having a hard time participating in team sports, perhaps it's time to find him something else to do for the moment that is more suited to his needs and abilities. He may do better in a few years when he is older and can manage his reactions more successfully.

Or you may want to consider martial arts training, which many children enjoy. They thrive on the hierarchy and structure, especially with a firm, strict sensei at the helm, and the act of training itself is organizing, strengthening, and wonderful for improving coordination and focus.

If your child's body is telling him that he needs to move while he is doing his homework, telling him to sit still won't get either of you anywhere. He can do his homework while lying on the floor, standing up at an easel, or sitting on a therapy ball. He can go to the park for half an hour before starting his homework, or if that's not feasible, you can put on some upbeat rock and roll music and dance for a while before having to sit down. If your child can't sit still, it's because his body needs to move, and honoring that need will help him manage. You can even segment the homework into discrete time slots and provide movement breaks in between.

I just started working with a little boy whose nanny had complained bitterly to me about their nightly struggle with getting all of his homework done. I made some suggestions, she implemented them, and when they came for their second session, she was amazed at how much easier life was. She started taking him to the park directly after school and let him play for half an hour or so. At home, she gave him a nutritious snack, a drink of water, and some bubble gum to chew on while he got down to it. These simple changes, along with the Move N Sit cushion his parents had ordered, had reduced homework time down from two hours to 45 minutes. She also mentioned to me that she had noticed that I didn't respond to the usual delay tactics he employed, just urging him to refocus on the task at hand instead, and when she tried that instead of engaging in conversation, they didn't get sidetracked.

For the child who spends too much of his life in front of electronic devices, I suggest limiting computer time and television time. Computers make it hard to transition into sleep because they are too stimulating to the brain, and television, because... really, do I really need to tell you?

Send them outside to play instead, get out your stash of craft activities, put on some music and dance, bake some cookies or some bread together, or go to the library and get some books.

Monday, May 3, 2010

What is Modulation?

According to Webster, modulation means to regulate, according to measure or proportion.

In OT language, modulation is the ability to regulate behavior by taking in information from the environment, making correct judgments about it, and responding to it in an appropriate way.

Children with modulation issues are constantly struggling with their reactions, which are often not in proportion to the circumstances. Their nervous systems often do not allow them to respond to sensory information while remaining on an even keel. They tend to over react or under react, so they can't maintain their nervous systems in an easy state of equilibrium.

We all have individual ways of dealing with the world based on our unique perceptions, personalities, and internal chemistry. I remember a passage from the novel The Brimming Cup by Dorothy Canfield. A father in turn of the century rural Vermont, sitting upstairs in his office, is listening to his wife mediate an argument between two of their three children in the parlor. She is playing the piano while the children are singing. Their son, who is stolid and pragmatic, wants to sing "John Brown's Body Lies Amoulderin' in the Grave," while their daughter, who is sensitive and fanciful, finds both the lyrics and the tune too gruesome to bear. She begs her mother not to play it. Their mother says that since it's only fair that they each get their turn to sing what pleases them, her brother's wish should be honored. She then suggests that while they are singing the song, her daughter go sit on the back porch where she can't hear the lyrics, and since she has to pass the pantry on the way, she can slice herself a piece of cake to enjoy while she waits for them to finish.

Their father admires his wife's elegant way of acknowledging the differences in her children and making sure that their individual needs are respected and met, and reflects to himself how different in personality his children are: "Something that wouldn't cause Paul to turn a hair would just about flay the hide off of Ellie."

Modulation and behavior are based a feedback loop consisting of input, throughput, and output.

A steady stream of information about where we are in space, who and what we see, what we smell, what we hear, and what we feel comes to us through the eyes, ears, inner ear, nose, skin, muscles, joints, and tongue: Input. It is relayed to the brain, which evaluates it, attaching meaning and value to it: Throughput.

Our responses are the result of the brain's evaluation and perception of the information: Output.

A child with sensory issues is going to have ongoing difficulties with managing his output, because his input is not supplying him with correct information about what is happening in his environment. {Anyone who wears glasses and can't get out of bed in the morning before putting them on will know what this is like.} His system of throughput perceives things in a way that causes him to attach inappropriate meaning to his sensory experiences, so his responses are going to reflect that.

For example, the child with tactile defensiveness. His skin interprets light touch as a threat, a negative emotional reaction, so he may respond in a negative way, by lashing out at people who come into his personal space, wiping off kisses, and refusing hugs or eye contact. He will avoid touching certain textures which are upsetting to him, and because he is living in a fight or flight state, full of stress chemicals, he will have a hard time shifting his internal gears and being flexible. Many children with tactile defensiveness complain bitterly about things that most people would not even notice, like the tags in their clothing or the seams in their socks.

I once evaluated a little boy who could not walk to school in the mornings without breaking into tears over the tag in his shirt and the feel of the wind on his face as he walked through Central Park, often lying down on the sidewalk and refusing to continue. His behavior, or output, was dictated by the faulty throughput, which was informing him that these things were causing him harm.

A child with modulation issues tends to be either unresponsive or overly responsive, often a puzzling combination of both, and can escalate from a tuned out state to an out of control frenzy in a matter of seconds, completely bypassing the middle range. About 99 percent of modern life requires that we function somewhere in that middle range, so these children are very frequently at a disadvantage as they try to navigate all the demands and expectations of school and play.

The wiring in a sensory defensive child's brain is going to tell him that many things that we don't even register are dangerous, threatening, and painful, so his behavior is going to reflect that by being avoidant, cranky, and fearful. A child whose nervous system fails to register what is going on around him, or does not respond in a predictable way to a normal amount of information coming in, is going to reflect that in his behavior as well. He will appear to be tuned out of what is going on around him, or will seek out and try to provide himself with the sensory input he needs to stay regulated.

These children understandably have difficulty staying somewhere in the middle range, because it is so tricky for them to activate their nervous systems and keep themselves running smoothly. It reminds me of trying to start a car on a cold morning, with the engine endlessly turning and revving. The driver jiggles the key, carefully feeds it a bit of gas, the engine turns but doesn't engage. More jiggle, more gas... the engine turns and turns... the sparks fail to catch... more turn, more jiggle... nothing happening... then VROOM! All of a sudden, the engine is in full throttle.

Mostly what I see in the clinic are children whose nervous systems are under reactive to movement, and overly reactive to things like sound, smell, taste, and touch. For these children, it is hardly an exaggeration to say that a ride on a roller coaster is just about enough stimulation, while a light brush on the arm is too much.

In my next post I'll talk about ways we can help a child learn to modulate his reactions.