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Helping Hyperactive Kids-A Sensory Integration Approach Techniques and Tips for Parents and Professionals
By Lynn Horowitz Cecile Röst
Hunter House Inc., Publishers Copyright © 2004 Reed Business Information
All right reserved.
Chapter One Why This Book?
In this chapter, we introduce the basic approach of sensory integration (SI) and look at how it applies to hyperactive children. You may be wondering, for example, whether your child's hyperactive behavior is deliberate. Are there reasons for this disorder? How does SI processing take place? What does an SI evaluation include? What is SI therapy like? We will address these and related questions as we explain in an easily understandable manner the role of processing stimuli and its effects on a child's behavior.
To the Parents
This book was written to help you as a parent. If you are the parent of a hyperactive child, it is meant to serve as a resource and guide for you. We explain how the development of your child can be encouraged in a playful way, using the SI approach. We also discuss how parenting can become more enjoyable as you try some of the techniques in this book and experiment with viewing your child from a perspective that might be somewhat different from your current view.
Weoften hear questions such as, "Why does my child behave this way?" "Is it my fault?" "Have I done something wrong?"
Implicit in these questions is the suggestion that the answers will lead to an affirmation that the child's behavior has been caused by something the parent has or has not done. We have chosen to view this problem and its solution from a different angle. By considering the underlying causes of their children's behavior, parents can move away from self-recrimination and toward helping their children fulfill their individual potential.
Our purpose is to provide insight into the behavior of your child. We want to help you better understand your hyperactive child. This understanding can be of benefit to your child as well as to you as the parent and to any others who come into direct contact with these often challenging, high-energy children. Using the techniques described in this book, parents, helpers, and educators can find interaction with these special children more pleasurable.
Every child is unique and develops his or her own way of approaching the world. For this reason, this is not a recipe book. It is far more than just a collection of practical tips to help a hyperactive child process stimuli in a better way. By considering and applying the suggestions presented in this book, you will also gain a better understanding of the physiological processes involved in the development of hyperactive behaviors.
Dealing with Unconscious Behavior
The behavior of children who are, for example, very active, inattentive, impulsive, impatient, or very loud, is often deemed as suspect and considered inappropriate, even "bad." Companions, helpers, and parents often think these children have more conscious control over their behavior than they actually have. If your child is inattentive, you might say, "Kristin just won't pay attention" or "Matthew just wants to play; he's always on the go" or "Jeff is too lazy to pay attention." And yet Kristin, Matthew, and Jeff do want to pay attention-they just can't. Even if they try their hardest to do so, they just can't.
Sometimes a child's behavioral problem has a psychological or educational cause. In other cases, the child may have a problem processing certain stimuli. The problem may not be psychologically or educationally based, but rather the result of unconscious factors. SI-trained therapists can evaluate these factors and get to the root of the problem.
A Different Approach
The medical approach to children's behavioral problems involves prescribing medication as a way of helping children focus. Medication is generally administered in a dose that allows the child to concentrate well during school hours. This approach has become very popular, especially among parents who do not object to giving these medications to their children. Ritalin is the most frequently prescribed medical intervention in the United States and the Netherlands. In fact, for some children, medication can resolve certain aspects of the problem quite quickly.
As a result of many years of providing SI therapeutic intervention, we learned that each child has different needs. Some parents whose children are receiving medication also wish to obtain behavioral advice about how to improve their children's situation and behavior at home. In this case, SI therapy can be used as a supplemental form of treatment. Other parents want their children to have SI therapy instead of a medical intervention; in this case, SI therapy serves as a different approach. Either way, it is important to remember that your child's unique therapy needs must be met.
We use the letters SI to stand for sensory integration. This refers to the processing of information that our eyes, ears, skin, muscles, joints, mouth, nose, and sense of balance deliver to the brain. This processing takes place in various sensory systems. One example is the visual system. Besides the eyes, the visual system includes the optical nerves and their connections, as well as the part of the brain that processes visual information. The whole system is involved in the process of seeing.
Babies, toddlers, preschoolers, and young children are constantly busy discovering their own bodies and trying to figure out how to use them. Every nerve receives specific stimuli to process. But what is most amazing is that all the information from the different nerves is integrated so that an image can be produced in the brain. Our nerves work together to coordinate and correctly route the information. This cooperation is what we call sensory integration.
For example, imagine that Patrick wants to put on his hat. What has to happen?
* Patrick uses his eyes to look at the hat.
* Patrick uses his muscles and joints to feel exactly where his hat is.
* As he moves his arm up and toward his hat, his automatic balance reactions help him adjust.
* His sense of touch tells him he is holding the front of the hat with his fingers. * Muscles and joints detect that he has firmly clasped the hat in his fingers. He moves the hat upward and places it on his head (motor planning). * Patrick's sense of touch lets him know that the hat sits firmly on his head. * Muscles and joints in his neck register the difference in weight and adapt to the new situation. He has done it! He has put on his hat!
How your child learns to relate to his or her environment depends on your child's ability to absorb, process, and respond to environmental stimuli. For your child to develop optimal motor, emotional, and social skills, it is necessary for all the sensory systems to function well. It is important that all the information streaming in from different systems be coordinated and successfully integrated.
Sensory Integration Therapy
Sensory integration therapy, also known as SI therapy, is a method of treating children who have problems processing sensory stimuli, called sensory integration disorders. It focuses on improving the child's capacity for integrating sensory input. It is very important to treat a child with this type of disorder in a positive way.
Your child has to be encouraged to do what he or she is capable of doing and needs to be given just the right challenge." The therapist must be careful to organize the setting and material so your child feels a sense of accomplishment and can say, "I did it!" This feeling of success is an important first step in your child's ability to process sensory stimuli.
SI therapy can be useful in dealing with problems such as learning difficulties, motor problems, dyspraxia, behavioral difficulties, anxiety disorders, autism, hemiplegia (spastic muscles primarily on one side of the body), and whiplash. In this book, SI therapy is only described with respect to how it relates to hyperactive children. According to National Institute of Mental Health statistics from 2003, three to five percent of school-age children in the United States show signs of hyperactivity. Thus, if a classroom has twenty-five to thirty children, one child probably has ADHD. Altogether, this represents approximately two million children in America.
SI-trained therapists use a neurophysiologic approach to behavior that applies to and can improve hyperactivity and attention problems. This is a noninvasive first step for many parents, including those who do not want their children to use medication. SI-trained therapists see hyperactive behavior as an information-processing problem in the child's nervous system. They apply the neurophysiologic explanatory model to treatment provided by occupational, physical, and speech therapists. Therapists trained in SI usually use the testing batteries developed especially for these children by Dr. Ayres.
In our experience, some children benefit from the addition of a medical intervention, possibly a year after SI therapy has been initiated. Other children who are referred for SI therapy are already taking a drug for hyperactivity at the time they begin therapy. We usually see positive changes in these children when therapy is added to a medication regimen. Frequently, the child's medicine can be lessened and eventually stopped.
A Brief History of SI Therapy
One of the first breakthroughs in the treatment of hyperactive children took place when Dr. A. J. Ayres saw the connection between tactile defensiveness and hyperactivity. The term tactile defensiveness was coined by Dr. Ayres to refer to a reaction to touch. For example, one might experience an unexpected touch or being bumped unexpectedly as unpleasant or threatening, or one might be annoyed or react in a defensive fashion. The term touch aversion also refers to a negative experience of various tactile stimuli, but in this case, one experiences it as unpleasant and then actively avoids it. For example, one might react to the stimulus of clothing, textures, or even splashed water with either slight aggression or avoidance. We now make a distinction between the behaviors of aggression and avoidance. In each case, however, the negative energy with which one deals with a stimulus can be distracting and lead to distractibility and hyperactivity in general.
In the last decade, a scientific effort led by Dr. Lucy Jane Miller advocated for use of the name sensory processing disorders (SPD). One of the major goals of this campaign was to have this diagnosis accepted in the Diagnostic and Statistical Manual (DSM-IV), the guidebook that sets standards for diagnosis by the medical community worldwide. Miller recently published a book entitled Sensational Kids that has "sensory processing disorders" in its subtitle. In this book, we use the term sensory integration dysfunction. However, the trend in future years will likely be to use sensory processing disorders instead.
How We Process Stimuli
Sensory information, or stimuli, is the information in our direct environment that is perceived through the senses. We receive stimuli from sounds, light, and movement through our muscles and joints. What we eat and drink gives us sensations, or stimuli. We are actually bombarded with all types of stimuli day and night, and our nervous systems must respond to these stimuli (Figure 1.1), relegate them to the background, or chose to ignore them.
Not everyone reacts the same way to the same stimuli. What is important is what is reacted upon and what is not. The stimuli to which we react can be different for each individual. Each person has his or her own genetic makeup, which is responsible for that person's physical and psychological characteristics, which in turn shape the person's needs. For example, one person likes a darkened environment, while another person prefers a well-lit room. Some people concentrate better in a quiet environment and others concentrate better if music is playing. Within the extremes, all variations are possible.
From Stimuli to Reaction
Our neurological processes help us absorb, process, and react to the stimuli in our immediate environment (Figure 1.2). Information is received by the different senses and the central nervous system and is coordinated by the brain. The relevance of information and how it interacts with other information is defined in the brain. After organizing the information, the brain directs our body and our behavior. If the information is assembled properly within the brain, then our daily life tends to function smoothly. This helps establish the basis for good social skills.
Problems in Processing Stimuli
Sometimes children do not process stimuli well. Problems processing stimuli can manifest in various ways. Moreover, these ways of processing stimuli can vary from child to child. For example, one child might be very still while another might be very active, or one child might speak well and another might not. Or, problems processing stimuli might cause one child to move differently from the way other children move.
To get a sense of how this process works, imagine the nervous system as a tangle of electrical wires, interspersed with switches and connectors, and lit by lamps at the ends. In a calm child, only one of these lamps might light up for each stimulus. In a hyperactive child, the same stimulus might light up at least fifteen lamps. Because of this exaggerated reaction, the hyperactive child might not be able to analyze or organize his or her thoughts or keep them in balance. Inappropriate reactions to stimuli are called sensory integration dysfunction, or simply SI problems.
This book is about very active children. Some of these children are diagnosed with attention deficit hyperactivity disorder (ADHD) by doctors, psychologists, or psychiatrists upon examination. (ADHD is discussed in Chapter 2.) Outside of health-care circles, people in a child's environment sometimes offer informal diagnoses. Educators, for example, see and identify these children all the time, and their identification is based on the learning and social behaviors exhibited. SI-trained therapists, on the other hand, are trained to identify the underlying neurophysiologic basis for the behavior and to help the child's central nervous system function in a better fashion.
Environment: Where, with whom, and how do you live?
All children are part of the environments in which they live. The environment does not just refer to the parents, brothers and sisters, teachers, and other people with whom the child comes into contact. It also refers to how the child lives and to the kind of home in which he or she lives, sleeps, and plays. With what kind of toys does the child play? How much time is spent using the computer? Is he or she an only child or are there more children in the house?
Sensory Integration Diagnosis
When SI-trained therapists are invited to evaluate a child with problems, they have a battery of screenings, tests, and clinical observations from which to choose to help them make the decision about whether a child should have an intervention. Parents, caretakers, or teachers are the ones who frequently first identify the problem. In the next section we will discuss many of the behaviors that children with sensory-processing problems exhibit.
Dealing with Divergent Behavior
Adults generally have trouble dealing with a child who has problems processing stimuli and behaves in what adults consider to be a different way. They are definitely troubled by a child who is easily distracted, has no patience, is disorganized and impulsive, is always active, is very noisy, or in any other way disturbs adults in their daily activities. It can be difficult to understand that the child does not behave this way on purpose but is simply unable to behave in any other way.
If you understand this and learn to view your hyperactive child in a different way, you may notice that the child has a unique personality. It may also become apparent that your child has many positive characteristics, such as being friendly, spontaneous, always engaged and interesting, and always ready for an adventure. This perception can become the basis for dealing more effectively with your child's divergent behavior.
Excerpted from Helping Hyperactive Kids-A Sensory Integration Approach by Lynn Horowitz Cecile Röst Copyright © 2004 by Reed Business Information. Excerpted by permission.
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