Monday, June 7, 2010

Is Your Child Sensory Defensive When He's Not at Home?

As a fairly new pediatric therapist practicing in a busy clinic in Brooklyn, I worked with a little girl for almost an entire school year before I found out, to my utter astonishment, that she had a diagnosis of PDD, a form of autism.  It wasn't on her IEP, and her mother, who had other seven children at home and was always in a tearing hurry to drop her off and pick her up, never said a word to me about it.

She had huge welts on the backs of her legs {which I never saw} from compulsively rubbing them on the furniture and scratching at them with her nails at school, a symptom of severe tactile defensiveness.  She was echolalic in class, meaning she repeated what others said to her instead of initiating her own conversation.  She exhibited many ritualized behaviors, could not make eye contact, and would speak only with her sisters at school, using a made up language.   She was such a highly picky eater that she would only eat a small handful of bland foods.

This was the child whom the school knew.  When she was with me in the clinic, however, she was open to try any game or activity I proposed, chatted with me about anything and everything, transitioned easily between activities, worked very hard on her handwriting and made exceptionally good progress, and was socially appropriate with the other therapists and children present.  We had a wonderful relationship, and her mother told me many times {always on the fly} how much this little girl looked forward to OT every week.

I would never in a million years have guessed that she was autistic.

A few weeks ago, in my post Look Homeward, Angel, I talked about children who are very nicely behaved out in public but behave like the spawn of Satan the minute they are behind closed doors at home.  

But what about if your child is the opposite?  What if you have a child whose behavior seems perfectly ordinary, maybe just a little overly sensitive to this or that, but his school or his soccer coach are reporting that he is struggling, and it comes as a complete surprise?

Most of the children who come to see me in the clinic have a clinical condition called sensory defensiveness.  This means that because of the way they are wired, many of the sensory experiences which we would consider neutral or would not even register at all are interpreted by their nervous systems as a threat.  

These children may be functioning adequately at home, because there is nothing in their home environments to trigger their defensive responses.  They may also appear to have perfectly appropriate responses in challenging environments when with their parents or a trusted adult.  For instance, I treat an absolutely adorable, highly intelligent little boy who is a pleasure to work with one on one in the clinic, but has such a hard time coping at school due to his extreme defensiveness that he requires an adult with him almost all of the time.  His behaviors are so problematic on the playground and during gym class that he is often in danger of harming his classmates or himself.  His parents were absolutely shocked when they read the school observation section of his evaluation, which outlined a steady series of outbursts, attacks on his classmates, and increasingly disorganized behaviors during the 90 minutes he was followed on a typical school day, because his behavior when he is not at school is so different.  He is the sweetest older brother to his baby sister imaginable.  He and his parents travel together around the busy streets of Manhattan without incident.   He is calm, focused, and organized, even on the subway, with all of its heat, noise, crowding, and movement.  

The difference is that when he is with his parents, he understands that they will protect him and make the world safe for him, and that nothing more than a little conversation will be required.  At school, he has to contend with all of the noise,  chaos, and unpredictability of small children without his parents' protection, while following an elaborate set of rules, having to sit cross legged on the floor for extended periods, socializing appropriately,  and applying himself to learning the day's lesson.  It's far more than he can currently handle.   

It's also entirely possible that your child has trained you and your spouse to respond to his sensory challenges in such a way that you have adapted to his needs and quirks without even realizing it.  Do you give several warnings about upcoming transitions, for example between play time and bath time, as a matter of course?  Do you find yourself withholding information about schedule changes lest your child become too anxious and bombard you with endless questions and complaints?

 Do you only buy your child seamless socks and the very softest clothing you can find, or put up with him insisting on wearing the same two or three pieces of clothing day after day?  Do you allow the child to subsist on white food because it's just easier than having a struggle at every meal?  Do you allow your child to wear a hat indoors and out because he likes to hide behind the brim?  Do you usually give him one brief set of instructions at a time, even if there is a lot to do, because you know if you give your child a complex multi step command, none of it will happen?  Do you avoid concerts, museums, classes, and other age appropriate cultural activities because your child doesn't like them?

If you are living with these things, you tend to become desensitized to them, and may not stop to analyze them until someone calls them to your attention and tells you that your child is having difficulty coping with his environment when he is away from you.

  All of us have our own peculiar sensory quirks.  For example, I have a friend who cuts the tags out of every piece of her clothing before she puts it on.   Another friend has to have a fan going in the bedroom, no matter the weather, because she can't fall asleep without some kind of white noise.  I myself won't leave the house without earplugs because I can't deal with screeching brakes on the subway,  and movies are always too loud for me.  Strong perfumes can have the curious effect of triggering a rage response in my body.  I once got into a screaming match with a colleague who habitually soaked herself in Eternity, a scent I find particularly noxious.

My sensory issues are entirely manageable.  I can have a full, fine life if I just remember my earplugs and walk quickly when I'm on the ground floor of Bloomingdale's. So can my friends, if they have a fan or a pair of scissors when they need one.   But what if your child's sensory issues are interfering with his ability to function at school, to play and explore his environment, and to socialize?

Children with sensory defensiveness issues have a difficult time managing their responses when they become overwhelmed.  Some children respond by leaving their bodies and shutting down when they are unable to cope.  These children may fall through the cracks because they are not bothering anyone.  Others respond by having outbursts or becoming out of control.  If your child seems perfectly reasonable most of the time but predictably acts out in certain situations, like gym class or or on the playground, chances are he's trying to tell you that he can't manage his responses because the environment is too much for him to handle.


Anonymous said...

This sounds like my 6 yr old son. He is perfectly reasonable most of the time at home. But at school he struggles enormously.
It is night and day.

So what can a mother do at home? I can't be his shadow for life? How/what are some techniques to help the child that struggles with sensory defensiveness? Besides the obvious, I've done all of that. Talking, role playing, etc. But this is bigger than him.

Loren Shlaes said...

Your son should be evaluated and treated by a pediatric occupational therapist specializing in sensory integration. The therapist can recommend an appropriate program to reduce sensory defensiveness and can work with his teachers to make his school experience more manageable by making accommodations when necessary.