The Out-of-Sync Child, Third Edition: Recognizing and Coping with Sensory Processing Differences

The Out-of-Sync Child, Third Edition: Recognizing and Coping with Sensory Processing Differences

The Out-of-Sync Child, Third Edition: Recognizing and Coping with Sensory Processing Differences

The Out-of-Sync Child, Third Edition: Recognizing and Coping with Sensory Processing Differences


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2022 Mom's Choice Gold Award Winner

The groundbreaking book that explains Sensory Processing Difference (SPD)—and presents a drug-free approach that offers hope for parents—now revised and updated.

Does your child exhibit...

Over-responsivity—or under-responsivity—to touch or movement? A child with SPD may be a "sensory avoider," withdrawing from touch, refusing to wear certain clothing, avoiding active games—or he may be a "sensory disregarder," needing a jump start to get moving.

Over-responsivity—or under-responsivity—to sounds, sights taste, or smell? She may cover her ears or eyes, be a picky eater, or seem oblivious to sensory cues.

Cravings for sensation? The "sensory craver" never gets enough of certain sensations, e.g., messy play, spicy food, noisy action, and perpetual movement.

Poor sensory discrimination? She may not sense the difference between objects or experiences—unaware of what she's holding unless she looks, and unable to sense when she's falling or how to catch herself.

Unusually high or low activity level? The child may be constantly on the go—wearing out everyone around him—or move slowly and tire easily, showing little interest in the world.

Problems with posture or motor coordination? He may slouch, move awkwardly, seem careless or accident-prone.

These are often the first clues to Sensory Processing Difference—a common but frequently misdiagnosed problem in which the central nervous system misinterprets messages from the senses. The Out-of-Sync Child offers comprehensive, clear information for parents and professionals—and a drug-free treatment approach for children.

This revised edition includes expanded information about SPD “look-alikes,” including Learning Disabilities, ADHD, and autism; about diagnosis and treatments; and about other topics.

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Product Details

ISBN-13: 9780593419410
Publisher: Penguin Publishing Group
Publication date: 04/19/2022
Series: The Out-of-Sync Child Series
Pages: 416
Sales rank: 89,437
Product dimensions: 5.10(w) x 7.90(h) x 1.00(d)

About the Author

Carol Stock Kranowitz, M.A., is the author of The Out-of-Sync Child Grows Up, The Out-of-Sync-Child, and The Out-of-Sync Child Has Fun. She is also the co-author on Growing an In-Sync Child with Joye Newman, M.A. She has been a preschool teacher for more than 25 years. She has developed an innovative program to screen young children for Sensory Processing Disorder, and writes and speaks regularly about the subject. She has an M.A. in Education and Human Development.

Read an Excerpt


Four Out-of-Sync Children at Home and School

NOTE: Mild sensory processing challenges are "differences." More pronounced challenges are "difficulties." Severe challenges are a "disorder." In this book, the "D" in the acronym SPD can stand for all three. (See "A Word about Words," page xxii.)

Surely you know a child who is oversensitive, clumsy, picky, fidgety, and out of sync. That child may be your son or daughter, your student or Scout, your nephew or neighbor . . . or the child you were, once upon a time.

That child may have sensory processing differences, difficulties, or disorder (SPD), a common, but misunderstood, problem that affects children's behavior, influencing the way they move, learn, communicate, relate to others, and feel about themselves. SPD can stand alone, or it can accompany other physical, cognitive, language, social, and emotional challenges.

To illustrate how SPD plays out, here are the stories of four out-of-sync children and the parents struggling to raise them. Perhaps you will recognize familiar signs in the child you know.

Whether sensory processing differences are major or minor, the child who is out of sync needs understanding and support, for no child can overcome the obstacles alone.


Tommy is the only son of two adoring parents. They waited a long time before having a child and rejoiced in his arrival. And when they finally got him in their hands, they got a handful.

The day after he was born, his wailing in the hospital nursery kept the other infants awake. Once he arrived home, he rarely slept through the night. Although he nursed well and grew rapidly, he adamantly rejected the introduction of solid food and vigorously resisted being weaned. He did not welcome cuddling; in fact, he seemed to hate it. He was a very fussy baby.

Today, Tommy is a fussy three-year-old. He is crying because his shoes are too tight, his socks too lumpy. He yanks them off and hurls them away.

To prevent a tantrum, his mother lets him wear bedroom slippers to school. She has learned that if it is not shoes and socks that bother him, it is inevitably something else that will trip him up during the day.

His parents bend over backward, but pleasing their healthy, attractive child is hard. Everything scares him or makes him miserable. His response to the world is "Oh, no!" He hates the playground, the beach, and the bathtub. He refuses to wear hats or mittens, even on the coldest days. Getting him to eat is a trial.

Arranging playdates with other children is a nightmare. Going to the barbershop is a disaster. Wherever they go, people turn away-or stare.

His teacher reports that he avoids painting and other messy activities. He fidgets at story time and does not pay attention. He lashes out at his classmates for no apparent reason. He is, however, the world's best block-builder, as long as he is not crowded.

Tommy's pediatrician tells his parents nothing is wrong with him, so they should stop worrying and just let him grow. His grandparents say he's spoiled and needs stricter discipline. Friends suggest going on a vacation without him.

Tommy's parents wonder if yielding to his whims is wise, but it is the only method that works. They are exhausted, frustrated, and stressed. They cannot understand why he is so different from other children.


Sweet Vicki, a pudgy first-grader, is often in a daze. Her response to the world buzzing around her seems to be "Wait, what?" She does not seem to see where she is going, so she bumps into furniture and stumbles on grass. When she tumbles, she is slow to extend her foot or hand to break the fall. She does not appear to hear ordinary sounds, either. Other six-year-olds may have developed the sense to stop, look, and listen, but Vicki is different. She needs a lot more sensory input than they do to catch on and catch up.

In addition, Vicki fatigues easily. A family outing or a trip to the playground quickly wears her out. She says with a sigh, "You go. I don't want to. I'm too pooped."

Because of her lethargy, her parents find that getting her out of bed, asking her to put on her coat, or maneuvering her into the car is an ordeal. She takes a long time to carry out simple, familiar movements. In every situation, it is as if she is saying, "What does that sensation mean? How am I supposed to use it?"

Nonetheless, she wants to be a ballerina when she grows up. Every day she sprawls in front of the TV to watch her favorite video, The Nutcracker. When her beloved Sugar Plum Fairies begin to dance, she hauls herself up to sway along with them. Her movements, however, do not match the musical rhythm or tempo. Ear-body coordination is not her forte.

Vicki begged for ballet lessons, but they have not been going well. She loves her purple tutu but cannot differentiate top from bottom and needs help to get into it. Once attired in tulle, tiara, and slippers, she plops down. She has no idea how to bend her knees in a pliŽ or stretch her leg in an arabesque. At dancing school, Vicki usually gets cold feet and clings like taffy to her mother's leg.

Vicki's parents disagree on the best way to handle her. Her father picks her up and puts her places-in bed, in the car, on a chair. He also dresses her, as she has trouble orienting her limbs to get into her clothes. He refers to her as his "little noodle."

Vicki's mother, on the other hand, believes Vicki will never learn to move with confidence, much less become a ballerina, if she does not learn independence. Her mother says, "I think she would stick to one spot all day if I let her."

Although Vicki lacks "oomph" and is definitely not a self-starter, certain kinds of movement will get her on her toes. She becomes livelier after getting into unusual positions-rocking forward and backward while on all fours, hanging over the edge of her bed upside-down, and swinging on her tummy. While she cannot yet pump, she loves to be pushed on the playground swing for a long time-and when she stops, she is never dizzy, as other children might be.

Being pushed passively arouses Vicki, as does actively pushing something heavy. Occasionally, she crams books into her doll carriage and shoves it around the house. She volunteers to push the grocery cart and carry bags into the house. She also enjoys pulling her big sister in a wagon. After pushing and pulling weighty loads, she has some energy for half an hour or so and then sinks back into her customary lethargy.

At school, Vicki mostly sits. Her teacher says, "Vicki has difficulty socializing and getting involved in classroom activities. It's like her batteries are low. She needs a jump start just to get going. Then she loses interest and gives up easily."

Vicki's behavior mystifies her parents. Their experiences with their two other active children have not prepared them to deal with her differences.


Paul is an extremely shy ten-year-old. He moves awkwardly, has poor posture and balance, and falls frequently. He lacks the know-how to play, and when he's in a group with other children, he usually watches dolefully or shuffles away. At their grandparents' house one Sunday afternoon, Paul's twelve-year-old cousin, Prescott, invites Paul to play marbles and shoot baskets with him. Paul gives the activities a halfhearted try, shrugs, and turns away. "I can't do that," he says. "Anyway, what's the point?"

Paul dislikes school. Sometimes he asks to stay home and his parents let him. He says he does not want to go to school because he's different from all the other kids. He says he is no good at anything, and everyone laughs at him.

Paul's teacher notes that he has a long attention span and an above-average reading ability. She wonders why a child with so much information to share becomes paralyzed when he has to write a paper. True, his handwriting is laborious, and his papers are crumpled and full of erasure holes. True, he has a "death grip" on pencils, fixes his elbow to his ribs, and sticks his tongue out when he writes. True, he often slips off the chair when he is concentrating hard on written work. His handwriting skills, she hopes, will improve with more practice. She says he just needs to get organized so that he can pay more attention to his assignments and do neater work.

His parents wonder why he is a misfit at school, because he has always fit right into their sedate lifestyle. Paul is a modest child, rarely seeking attention. He can spend hours slumped over his baseball cards, completely self-absorbed.

Paul's parents think he is the perfect child. They observe that he is different from other kids, who are loud and mischievous. He never makes trouble, although he is somewhat clumsy, often dropping dishes and breaking toys that require simple manipulation. But then his parents are somewhat clumsy, too, and have come to believe that physical prowess is unimportant. They are glad that their son is quiet, well-mannered, and bookish, just like them.

Something, however, is getting in his way. His parents have no idea what.


Sebastian, eight, fidgets constantly. At school, he riffles book pages, twiddles with markers, taps rulers, and snaps pencils. He clicks his teeth and chews his collar.

Sebastian's eyes dart, knees bounce, feet tap, and fingers flap his earlobes. He tips his desk chair way back and then brings it forward with a jolt. He squirms in his seat, sitting on his feet or squeezing his knees to his chest. He jumps out of his seat every chance he gets to sharpen his pencil or pitch a wadded paper toward the wastebasket.

His nonstop activity distracts his classmates and teacher. He used to twirl the lanyard with his latchkey around his finger. Once he let go accidentally and it whirled across the room and hit the window. Now he hands the lanyard over to his teacher every morning so it won't annoy or hurt anyone.

Every child seeks sensory stimulation, but Sebastian's craving for sensations is different. "More, more, more!" He is the child who has "gotta touch" and "gotta move," even when it should be clear that touching and moving at that moment is inappropriate.

One day the teacher is preparing a science lesson. She lays out white glue, laundry borax, and water-the ingredients to make a pliable substance called "stretchy gook." Sebastian is interested and hovers nearby, twitching his fingers and hopping from foot to foot. The teacher says, "Please don't touch a thing until the other kids join us," but he reaches forward and knocks over the bottle of glue, spilling it across the table.

"Sebastian! You did it again!" the teacher says.

"I didn't mean to!" Sebastian cries. He shakes his head vigorously and jumps up and down. "Oh," he moans, "why do I always get in trouble?"

"Oh," moans the teacher, mopping up the mess, "what shall I do with you?"

Why are Tommy, Vicki, Paul, and Sebastian out of sync? Their parents, teachers, and pediatricians do not know what to think.

The children have no identified disabilities, such as autism, cerebral palsy, or impaired eyesight. They seem to have everything going for them: they are healthy, intelligent, and dearly loved. Yet they struggle with the basic skills of managing their responses to ordinary sensations, of planning and organizing their actions, and of regulating their attention and activity levels.

Their common problem is SPD.

Table of Contents

Foreword to the Third Edition by Lucy Jane Miller, PhD, OTR, FAOTA xi

Acknowledgments xiii

Introduction xv

How to Use This Book xxiii

A Word About Words and That Pesky "D" in "SPD" xxv

Part 1 Recognizing Sensory Processing Differences

1 Four Out-of-Sync Children at Home and School 3

Tommy 4

Vicki 5

Paul 7

Sebastian 8

2 Does Your Child Have Sensory Processing Differences? 11

SPD: A Brief Definition 11

Common Symptoms of SPD 14

Self-Regulation Challenges 25

Who Has SPD? 36

Hope Is at Hand 38

3 Does Your Child Have Another Diagnosis? 42

What SPD Is Not: "Look-Alike" Symptoms (LD, ADHD, and ASD) 43

Other Conditions Involving SPD 57

More Look-Alikes and Overlappers 61

4 Understanding Sensory Processing-and What Can Go Amiss 63

The Senses 63

What Is Sensory Processing? 70

Sensory Processing Working as It Should 78

The Typical Development of Sensory Processing in Infants and Children 81

So, What About Sensory Processing Differences? 84

Possible Causes of SPD 94

Six Important Caveats 96

Comparison of Typical Sensory Processing and SPD 98

5 How to Tell if Your Child Has SPD in the Tactile Sense 99

Three Kindergartners at Circle Time 99

The Smoothly Functioning Tactile Sense 102

The Out-of-Sync Tactile Sense 105

How the Tactile Sense Affects Everyday Skills 112

Characteristics of Tactile Differences 123

6 How to Tell if Your Child Has SPD in the Vestibular Sense 132

Two First-Graders at the Amusement Park 132

The Smoothly Functioning Vestibular Sense 135

The Out-of-Sync Vestibular Sense 139

How the Vestibular Sense Affects Everyday Skills 147

Characteristics of Vestibular Differences 154

7 How to Tell if Your Child Has SPD in the Proprioceptive Sense 160

One Nine-Year-Old at the Swimming Pool 160

The Smoothly Functioning Proprioceptive Sense 163

The Out-of-Sync Proprioceptive Sense 166

How the Proprioceptive Sense Affects Everyday Skills 171

Characteristics of Proprioceptive Differences 176

8 How to Tell if Your Child Has SPD in the Visual Sense 180

Two Seventh-Graders at School 180

The Smoothly Functioning Visual Sense 183

The Out-of-Sync Visual Sense 191

Characteristics of Visual Differences 199

9 How to Tell if Your Child Has SPD in the Auditory Sense 204

A Third-Grader in Music Class 204

The Smoothly Functioning Auditory Sense 206

The Out-of-Sync Auditory Sense 211

Characteristics of Auditory Differences 218

Part 2 Coping with Sensory Processing Differences

10 Diagnosis and Treatment 225

A Parent's Search for Answers 225

Recognizing When Your Child Needs Professional Help 227

Documenting Your Child's Behavior 231

Diagnosing the Problem 245

Different Therapies, Different Approaches 255

Bringing Therapist and Child Together 263

Keeping a Record 264

11 Your Child at Home 266

A Parent's Revelation 266

A Sensory-Enriched Life 267

Promoting Healthy Sensory Processing at Home 270

12 Your Child at School 282

What a Difference Communication Makes! 282

If Only School Were More Like Home 283

Deciding Whom to Tell 286

A Good School-and-Child Match 287

Promoting Your Child's Success at School 289

Helping Children Become Better Organized 295

Adapting Your Own Behavior 299

13 Coping with Your Child's Emotions 301

A Typically Dreadful Morning 301

Other Experts' Advice 303

Dos and Don'ts for Coping 309

14 Looking at Your Child in a New Light 316

A Parent's Epiphany 316

Becoming Enlightened 318

A Parent's Encouraging Words 323

Appendix A The Sensory Processing Machine 327

Appendix B Dr. Ayres's Four Levels of Sensory Integration 341

Notes 347

Glossary 353

Index 367

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