Wednesday, June 9, 2010

Why Can't My Child Behave at School?

In my last post, I talked about the child whose sensory issues may not become completely apparent until he is forced to cope out in the world, away from his parents, and is failing to meet expectations at school.

Sensory defensive children often behave in ways that we don't understand. Things that we may not even notice {the sounds made by a refrigerator's motor or the hum of an air conditioner, the feel of an elastic waistband} or notice but perceive as neutral {another person sitting almost on top of us on the subway, eye contact with a stranger or new acquaintance} or think of as pleasurable { perfume, a kiss on the cheek, loud music} are interpreted by their nervous systems as noxious or viewed as threatening, and so their behavior is going to reflect that.  Your child may love you but wipe off your kisses. Or a child may like you but but may respond badly to your scent {which is why therapists and teachers should never wear perfume to work}.

Is it possible that your child is acting out as a result of being sensory defensive?  Here are some clues that may help you interpret some of his behaviors.

Visual defensiveness causes the child to be sensitive to light, and to dislike making eye contact.  He will be easily distracted by anything moving in the environment, because his nervous system is warning him that it may be a predator and he has to keep track of it in case it attacks.

Tactile defensiveness causes the child to dislike being touched, and to respond inappropriately when people come into his personal space by lashing out.  This can be a physical response, like biting, kicking, spitting, pushing, or hair pulling, or verbal, or both.  A tactile defensive child complains about his clothing being scratchy or too confining, hates having his hair combed or washed, objects to lotions and liquid soaps, is often a highly picky eater, gagging and choking on seemingly inoffensive smells and textures, and can have a rigid personality, unable to compromise and insisting on doing things only on his own terms.  He needs to have his world be predictable and ordered and doesn't deal well with surprises.  He has a hard time making eye contact, wipes off kisses, and has a hard time showing and receiving affection, especially to people outside of his close inner circle. Transitions are difficult for a tactile defensive child, and socializing can be quite a challenge.  

The auditory defensive child is often "tuned out," and doesn't appear to understand what is being said to him much of the time.  He often will not hear you when you speak to him.  He covers his ears and grits his teeth.   He hums or makes noises at inappropriate times.  He chews on everything he can find, becomes completely disorganized in noisy environments, and will lash out in surprising ways.  For example, I used to treat a little boy who would cause scenes at the dinner table every evening because he couldn't stand the sound of his family chewing.

Sensory defensiveness is often coupled with low muscle tone and delays in coordination, which means that the child is struggling with his balance and can't trust his motor planning abilities.  This makes the playground and gym class extra threatening.

Young children just don't have the verbal sophistication to tell anyone what's wrong.  They just know that they are being forced to spend time in environments that are a continual assault and that they are being required by the grown ups to do things that they can't do or are afraid to do.  Even a child who can kick a ball perfectly well when it is rolled to him by daddy in the park may be unable to do it on a real soccer field surrounded by running, screaming children.

If you have a child whose behavior is perfectly reasonable most of the time but has outbursts or temper tantrums at school or out in public, it's more than likely that either he is trying to figure out a way to get himself removed from an aversive situation or knows that he is going to be required to do something that he can't do or is afraid to try.  Who among us has not attempted to divert others' attention from our deficiencies, or has not left a party or a club because we couldn't handle the smoke and noise anymore and just wanted to go home?

Sometimes a defensive child simply can't contain his reactions.  I have been on many school observations over the years, and have seen this over and over.  A child who is perfectly capable of being calm, focused and goal oriented in a quiet atmosphere becomes horrifically disorganized in the noisy, chaotic atmosphere of the typical kindergarten classroom or gym class.   

I have seen countless boys who are charming and personable one on one, and a real delight to work with in the therapy clinic, but are simply unable, because of their sensitivity to noise, to participate in any meaningful way in their classrooms.  They become so completely disorganized due to their defensiveness that they can only run around in circles, kick things over, clown around and be silly, or kick, bite, and scratch their classmates.  They are trying to let the grownups know that they are not coping well in that environment and need to leave.  I once treated a little boy who would walk into his kindergarten class first thing every morning after a long, stressful ride on the school bus and tip his desk over.  This was a serious cry for help!

If your child doesn't have a mean bone in his body but is behaving poorly at school, being out of control and disruptive, it's time to take a look at what is driving his behavior.  When is it occurring, and what is he really trying to tell you? 

The best thing we can do for a child whose responses are so consistently aversive is to remove him from a situation that is causing him such distress.  Instead of forcing the child to tolerate a situation day after day that is obviously intolerable to him, if it's at all possible, find an environment that is better suited.  I once observed a child at school who was fine in the quiet atmosphere in the clinic but was disorganized and miserable in the chaos of his large classroom.  I told his parents he needed a quieter, less chaotic atmosphere.  Fortunately, they found him one and he did a lot better.

If your child is consistently acting out in gym class or in the noise of the cafeteria or on the playground, he's trying to tell you it's too noisy and chaotic for him.  What are some other options?  Would it be possible to work with the school to find an alternative for him {and the other children who are in his situation} for those times?

If this is not possible, you can try offering the child some earplugs.  Gum, or something to chew on, can help.  One of the reasons why a child may be so overly sensitive to noise is that the filtering and dampening mechanisms in the inner ear are not functioning correctly.   This is especially the case if the child has had recurrent ear infections.  Chewing can help the child by engaging the tensor timpani muscles, which dampen sound.  Intense spinning, if the child enjoys it, can also help.

  If your child is participating in occupational therapy, talk to his therapist about ways to reduce his auditory defensiveness.  She may be able to implement a therapeutic listening program specifically designed to reduce sound sensitivity.  

If your child is not in therapy, and is exhibiting some of these behaviors, I would strongly recommend an evaluation and treatment by a sensory integration therapist.  Sensory integration OT will teach the child to normalize the way he is processing sensory information, which will help him cope more successfully with the demands of school.


Anonymous said...

Thanks for your posts. I am an OT and I've just started working with children with Autism..I'll be spending more time reading your blog for sure!

annie said...

Thank you for your post. My child has been seeing an OT in school for sensory issues since 1st grade, he is now in third grade, and has done a complete nose dive since last year. He is withdrawn, refusing to participate, overly sensitive and emotional which leads the other children to ridicule him, he has poor self-esteem and is not socializing. I was basically told by an IEP team yesterday that that are throwing up their hands because they say they have tried everything. He is scheduled to see a meurologist in two weeks, and sees a psychologist every week. He is extremely bright and despite not doing schoolwaork, he is doing very well on tests. Where do I stand here, because they are telling me at this rate, he will not graduate to the 4th grade (and it's only October!)