When The Wheel Doesn't Squeak, But It Still Needs Grease

OH MY GOSH!!! HOW DID IT GET TO BE SEPTEMBER ALREADY???


Welcome back to my blog.  I had a lovely summer.  Most of the children I treat were on vacation, so I had lots of time to write articles!  I hope you had a nice one too  -- and I hope your children played outside every single day, and ate lots of delicious summer fruits and vegetables.


 I continue to have a few openings for both preschoolers and school age children in my pediatrics practice in Manhattan, so please email me if you are interested in having me work with your child.


I thought I would begin the school year with a timely topic:  recognizing those children who tend to escape our notice, because they're so quiet about their problems, and making sure they get the help and support they need before they fall too far behind.


The mother of a little boy I treat is just dreading the beginning of the school year.  She is very frustrated at having to deal with the bureaucracy of the public school he attends, which is refusing to provide him with any extra assistance, although he clearly has sensory issues.  The reason?  His method of dealing with his sensitivities, which are severe, is to shut down.  He is very quiet, never acts out, never makes the slightest bit of trouble for anyone, just folds himself up into a silent ball of misery at his desk and leaves his body.

No one ever suspected he had any issues until near the end of first grade, when someone noticed that he was way behind in reading, although he is very bright and has a strong work ethic.  The school put him in a short term intensive reading program, which helped catch him up to his classmates, but when the program ended he wasn't capable of continuing to keep up or to retain the gains he had made.

He was then evaluated by one of my colleagues, who found plenty of issues to treat, but told his mother that her child wouldn't qualify for services through the New York City Board of Education, since he didn't demonstrate any learning disabilities or delays in his visual motor or visual perceptual functioning.  His issues were purely sensory:  a high degree of auditory defensiveness, a chronic low arousal state, and depressed vestibular functioning.  His sensitivity to sound is so severe that his mother told me that he looks ill at the end of the school day  -- ghastly pale with red rimmed eyes.  He often can't manage to eat his lunch in the noise and chaos of the cafeteria, so on top of everything else, he has to cope with hunger and low blood sugar all afternoon.

Although this child is quite capable of learning, he has been so far prevented from demonstrating his true abilities because his sensory defensiveness, which dominates most of his responses to the noise, chaos, and confusion at school, makes learning and retaining information a huge challenge.

His mother was gearing herself up to talk to the school psychologist about making accommodations for him, like sitting him near the teacher, making sure he had movement breaks, and trying to get him a quiet place to eat his lunch.  She didn't think she would get very far.  It appeared, from the school's point of view, that if a child is not actively behaving in a way that disturbs the class, but sits quietly, there is no problem.  No problem means no need for an IEP, and so no special accommodations are required.  And certainly no mandate for occupational therapy.

If you have a quiet, withdrawn child who creates no problems other than functioning well behind his abilities, chances are good that he is sensory defensive, and his method of dealing with it, unlike a hyperactive child whose issues are so easy to pinpoint, is to disappear. In order to prevent a child who presents like this from slipping through the cracks, you're going to have to advocate for all of the things he will need, along with the added challenge of convincing the people in charge that there is a real issue here.

  Just like his classmates who act out, a withdrawn, low arousal child would benefit from sensory integration therapy.  At school, just like his brethren who can't keep still, he needs movement breaks, things to chew or suck on, sips of water, fidget toys, a seat near the teacher, an inflatable cushion to sit on, a pair of ear plugs, a slant board, and all of the accommodations that are made for the ones who are more obvious in demonstrating their distress.

How can we go about educating the system, and ourselves, to be more on the lookout for these children and provide them the help they deserve?