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.

1 comment:

Jessica {The Novice Chef} said...

It is so interesting to learn all of this! Great post!