Wednesday, May 25, 2011

You Talking to Me?

One of my favorite cartoons of all time, drawn by the incisive and hilarious Gary Larson, is called  What We Say to Dogs.
A man is pictured talking to his dog, saying, "Okay, Ginger, I've had it!  You stay out of the garbage!  Understand, Ginger?  You stay out of the garbage, or else.  I mean it, Ginger!"  Below, the artist depicts what the dog actually hears:  "GINGER blah blah blah GINGER blah blah blah GINGER."

Many of the children I treat are extreme sources of frustration for their parents and teachers {and, I confess, on occasion, their occupational therapist} because they don't appear to be listening,  or they don't respond when spoken to, or they don't follow directions.

Recently, I had a conversation about a little boy whom I had been asked to evaluate for handwriting problems.  His teacher told me that although he is not a behavior problem, she often feels that he is being disrespectful to her because when she speaks to him, he looks at her blankly or ignores her completely.

I had gone to observe him in school the day before and had walked into a classroom full of children working in groups of twos and threes.  There was quite a bit of chatter, and my friend was standing in the middle of the classroom when I arrived.  I watched as he wandered about aimlessly for several minutes until the teacher got up, walked over, and spoke directly to him.  She told him to choose a book and sit down.  He ambled over to the bookshelf and stood in front of it for quite a while.  She pulled out a couple of books and told him to choose one and sit.  He opened the book, but sat with it open in front of him while gazing around the room.

The teacher then asked the class to finish their discussions and to clean up the room.  My friend stood and began wandering around the room again, until the teacher got up, walked over to him, leaned down until their noses were almost touching, and gave him a specific task to do.

Later she told me that she had learned not to expect him to pay attention to what she was saying unless she was standing very close to him and made sure he was looking her right in the eye, and sometimes even then he would look at her with no comprehension or expression.

I stayed to watch my friend in his next class, which began as a highly structured lecture.  The teacher stood at the head of the class and spoke, then invited  discussion by asking a question and having the children raise their hands and answer one at a time.  My friend was entirely present and focused, and participated in the discussion.  After about twenty minutes, she brought out a project related to that day's lesson.  The children began to work on their individual assignments, which consisted of coloring and decorating posters.  The room, which had been very quiet, was now filled with the sound of chatter.  My friend picked up a marker, then began talking to the little girl sitting next to him and stopped working.  The teacher came over and sat next to him without saying a word.  He refocused on his project, and got back to work.

This teacher has observed that when the class is a tightly structured lecture, he is fine, but when the children are expected to work independently, he can only do so if she sits next to him, and that he can never work and talk at the same time.  She says that although he is one of the smartest students in the class, he is consistently at the bottom.

So what's going on here?  Why is this exceptionally bright little boy not able to function at school without constant adult redirection, and what is preventing him from being able to keep up with the academic demands of the classroom?
If we analyze his behavior patterns, what do we notice?

 He does fine when there is no background noise.  During the lecture, he was present and focused and participated in the discussion.  Whenever the children were split into groups and there was lots of noise and chatter, he couldn't function.

The reason he has always looked so blankly at the teacher when she speaks to him is that when she addresses him from across the classroom, she is generally trying to redirect him in a noisy atmosphere.  He is not able to pick out and attend to her voice from all of the other voices in the room.  His ears don't filter and distinguish foreground noise and pertinent auditory information {her voice directed towards him} from background noise {the sound of all the other children's voices in the room}.

Children with ears that don't filter and dampen sound efficiently tend to block out voices, since they can be painful to the eardrums.  So this boy may be in a state of chronic semi shutdown or  hyperfocus {in order to divorce himself enough from bothersome sensory input} in a noisy atmosphere.  This makes him  far less available for learning.  It also makes comprehending and following a string of instructions {take out your books, turn to chapter three, read the first four paragraphs, and answer the questions written on the board} very challenging.

He can't work and talk at the same time because in order to chat, he has to work extra hard to focus on his classmate's voice.  This takes up so much of his available brainpower that there is not enough cognitive energy left for the task.

When I talk about this with parents, I often hear, "My pediatrician has never said that there was anything wrong with my child's hearing."  It's not his ability to hear sound that's the problem.  It's the way the mechanism in his inner ear works to prepare sound for the brain and to protect the sensitive eardrum.  If this mechanism is not functioning correctly, the child's ability to make sense out of what he hears is diminished, and his ability to function in a noisy atmosphere is compromised.

A few quick fixes for this type of problem include being aware that the child does not function well in noisy environments, and having an alternative quiet space for him to write or study during the school day; gum or something to chew on, since chewing dampens sound, earplugs, or noise cancelling headphones.

I also strongly recommend that the child not be expected to do most of his learning through auditory teaching styles, but be given opportunities to process work visually and kinesthetically.

It's best to keep things short when speaking to the child.  Don't over explain, don't expect him to remember a long string of instructions, and don't expect him to be able to understand what others are telling him in a busy, noisy environment.

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