Wednesday, February 16, 2011

Auditory Defensiveness, the Hidden Behavior Problem

If your child is having tremendous difficulty comporting himself at school, is aggressive towards his classmates, can't participate in noisy classrooms, either going off by himself or  acting out, and in general behaves in ways that are difficult to comprehend when he is in a noisy environment,  the chances are very high that his ears are hurting him and that he has no way to let you know that he is suffering. 

Consider these scenarios, taken from my files:

1.  An exceptionally beautiful, creative little girl, who should be the most popular girl in school, but instead tends to keep to herself.  She does not interact or socialize with her classmates during lunch, gym, or recess.  While the other children are happily and noisily chatting and laughing with each other as they sit around a table and draw, cut, and color, she sits a bit off to the side, head down, and does what is required of her, but does not join in the conversation.  She refuses to accept any party or play date invitations on the weekends, preferring to spend her time alone in her bedroom with the door closed.

2.  A bright, handsome little boy who is labeled emotionally disturbed.  He cannot comport himself at school or in public.  He is verbally and physically aggressive, sarcastic, oppositional, and constantly spoiling for a fight.  His OT sessions the previous year with a different therapist were a disaster.  The therapist had to spend most of his treatment time trying to help him contain himself in the busy clinic.

{This year, he comes to OT at a time when he and the therapist work together alone.  He is affable, cooperative, and works hard.}

3.  A little boy who is the bane of his gym teacher's life.  Normally, he is a total delight to be around, charming, sweet, and funny.   He is a polite child who does well in school, but  his behavior in her class has everyone in an uproar.  He interrupts her frequently, is oppositional and rude, disrupts the games, and slugs his classmates.

4.  A little boy who always enters the gym {at 3:30, the busiest time of day in the clinic} making a face like an angry grizzly bear.  He won't make eye contact or say hello.   He does not respond to the therapist when she calls his name, but wanders around sulkily, arms crossed over his chest, picking up balls and toys and throwing them aimlessly.

When he does allow himself to interact, he says an emphatic no to every activity suggestion proposed to him, shaking his head and sticking out his lower lip.  At school, he is constantly getting in trouble for throwing things, talking out of turn, and being silly, especially during arts and crafts, when the teachers play music in the background, or when the children work in groups, building block structures together on a hard linoleum floor.

{A few weeks ago, he came at a time when he and the therapist were working alone.  He was cooperative, playful, motivated, and full of ideas about how to challenge himself.}

5.  A little boy is observed at school one day in his noisy, busy classroom.   The children work on the activities of their choice in small groups, sitting around small tables.  Instead of choosing an activity and being seated, he runs around the room, unable to sit still, follow directions, or to engage in purposeful activity.  He is constantly reprimanded for knocking the other children's projects off the tables.

{At the OT's suggestion, he was switched to a smaller, much more structured, quieter classroom, and immediately began to demonstrate goal directed behaviors.}

6.  A little girl whose parents experience her at home as supremely creative and intelligent, unusually physically coordinated and daring, feisty, funny, witty, and loving, comes home with this report card from her preschool:  Below average performance on most academic subjects.  Does not appear to understand what the teacher is saying and is frequently observed watching the other children for cues.  Cannot play games like Simon Says.  Sits by herself most of the time, chewing on her hair or on a sleeve.  Does not initiate any activities in a school where children are encouraged to be self directed.

7.  A charming, affectionate little boy who is the sweetest, most loving big brother imaginable to his baby sister, observed one rainy morning during indoor recess: He runs aimlessly around and around the periphery of the room.  He then picks up and starts throwing a Frisbee, aiming it directly at the backs of his classmates' heads.  When the Frisbee is confiscated, he picks up a plastic disc, runs up to his classmates, and whips the disc at them from behind, causing them to cry out in surprise and pain.  When this is taken away, he returns to running around and around in circles, until he finds a ball and begins to throw it into the center of the room, again carefully aiming it at his classmates' backs.

 His teachers report that when the children are lining up in the hallway, he will often suddenly tackle the child next to him and slam him up against a wall.

8.  A 43 year old man who suffers from severe anxiety.  He avoids parties and restaurants because it's too difficult for him to make conversation.  His wife reports that when they are sitting quietly at home, reading or watching television, he frequently turns to her and says, "What's that noise?"

9.  A very sweet, smart, friendly little boy who is reported as having a very flat facial expression at school, and who can never get his work done in class.  His teacher's policy is to allow the children to be self directed and do what they need and want to do during class time, as long they get their lessons learned and their assignments finished, so the classroom is noisy and busy during writing time.

10.  A bright, charming little boy who flat out refuses to eat lunch in the school cafeteria, no matter how hungry he may be.  His teachers think he is a bit dim, because he rarely participates in class.  He is consistently pale, mopey, and red eyed at the end of the day.

What do all of these people have in common?  They are all extremely sensitive to noise, and they can't cope in noisy environments.  Some of them respond by tuning out and shutting down, and some of them respond by acting out and doing anything they can think of in an effort to be removed.

If your child becomes disorganized, disruptive, oppositional, aggressive, or highly anxious in chaotic environments, becomes overwrought at live performances,  hums, covers his ears, grits or grinds his teeth, or chews on anything he can get his hands on, or or gets distracted by every voice and sound that crosses his path,  chances are good that his ears are not filtering and dampening noise effectively and that he is confused and even in pain as a result.

In my next post, I'll talk about auditory defensiveness, some of its causes, and what sensory based OT has to offer to an auditory defensive child  -- or grownup.


Brooke LaBouve said...

I've been reading for a while. I love your posts specifically because I have a little boy who is very rambunctious and silly. Nearly everytime we are talking to him about his outbursts (which they totally are) he hardly ever makes eye contact and mid conversation will ask me about other sounds such as the ice maker. He is only three, but I can tell that these things he is doing are not average. He is one of the sweetest little boys and extremely smart; although, at sometimes he pushes or hits his little brother out of nowhere. It is so hard for me not to lose my temper with him sometimes. We don't spank and sometimes he will throw himself on the floor before I can even get him to timeout. I have been researching some diets to try out and I'm not sure which would be good for him. Do you have any advice for my husband and I? Thanks so much!

Dr. Zachry said...

Love your blog! Lots of great information!

Anonymous said...

What would be your take on someone who gets physically ill in noisy & busy places (ball games, parties, etc.) and is highly susceptible to motion sickness? Would it more likely be auditory, visual, or both? Just curious what your OT perspective might be on such a problem.