I'm sitting on a metal folding chair in the corner of a large, open room watching my son misbehave. I'm trying not to interfere. He is being tested by Rebecca, an occupational therapist, but he is not cooperating.
She demonstrates a sequence of foot stomps. He ignores her and asks if he can play on the mats in the center of the room. I wonder, "Does he understand what he is supposed to do?" Evan just laughs at us both and runs off.
I cringe. This is exactly why we're here: He won't follow directions. For weeks now, Susan, his Montessori preschool teacher, has been greeting me with a furrowed brow when I arrive to pick him up each afternoon. She catches me on the playground and, with increasing agitation, catalogues the ways in which Evan refuses to follow the routine, respond to direction or make any apparent attempt to stay out of trouble.
I am struck silent by these descriptions of Evan. As a child psychologist, I've heard parents of so-called oppositional children describe similar behavior, and I've made scores of recommendations about how to handle these kids at home and at school---how to set limits, define boundaries, support change. But, now my child is failing. Nothing is easy at our house. Everything is hard.
At home, my husband and I constantly argue with Evan about the simplest everyday things: getting dressed, washing his hands, picking up his toys, turning off the TV, taking a bath, brushing his teeth, going to sleep. He ignores us, then complains, whines, resists, falls on the floor, cries, or screams.
I knew the DSM-IV
forward and backward. This was not Depression, nor was it Anxiety or ADHD.
This is how we came to Rebecca. Cautiously. Skeptically, even. I knew that occupational therapists (OTs) sometimes worked collaboratively with psychologists; yet, in five years as a staff psychologist at one of the leading pediatric hospitals in the country and eight years in private practice, I had never met an OT. I had a vague notion that they helped babies with feeding problems, children with fine-motor delays and survivors of traumatic injury. What was an OT going to do for my precocious, uncooperative son?
In my first conversation with her, I sensed that Rebecca knew something about Evan that I didn't know.
She tested him on 17 different tasks that measured visual skills, coordination between the right and left sides of his body, balance, sensitivity to touch, accurate positioning of his body in space, imitation of movement and the ability to follow a sequence of instructions. Then she asked him to do things like move his finger from one spot on a map to another---without looking at the map---or to stand on one foot with his eyes closed. At first, he seemed to do pretty well. But when he was forced to rely on touch, balance and sensory information coming from his muscles and joints rather than from his eyes and his ears, he flat out failed.
According to Rebecca, Evan was not oppositional by nature. (And he had not been poorly parented.) He was at the end of his rope, trying to meet the behavioral expectations of a typical preschooler's world without the neurological equipment required. Trying---but failing---to please his parents, who were dragging him through his life oblivious to the challenges he faced every day.
For most of us, the delicate interaction between the brain and body known as sensory integration is nothing short of marvelous. It allows us to move purposefully through the world without being driven to distraction by the cacophony of sensory experience that bombards us each minute we are awake. It is how we can sit at a computer, concentrating on abstract ideas without thinking about how to position our body in the chair so that we don't fall on the floor, or when to ignore the sounds of the wind at the window and the barking dog and when to tune in to the ringing telephone or the crying child.
Rebecca talked to us about "sensory integrative dysfunction," a malfunction in the brain's translation of sensation into meaning and action. For example, the brain might not automatically recognize that pressure on the skin and muscles of the abdomen is coming from a too-tight waistband. It may not judge accurately whether the sensation is important or trivial, dangerous or benign and, therefore, may not respond logically or efficiently. It's like there is a traffic jam in the lower brain.
Children like Evan are not so fortunate. They vacillate between states of over- and under-stimulation and, as a result, often act in ways that are erratic and inconsistent. Everyday tasks---washing their hair or brushing their teeth---quickly overwhelm them. Complex tasks---learning to ride a bike or cleaning up a messy room---totally confound them. They become discouraged, irritable, whiny, explosive.
We started taking him to Rebecca for twice-a-week therapy sessions. She said that these sensorimotor challenges would build upon one another, gradually laying the neural pathways between body and brain that were necessary for more efficient sensory processing.
Within a few months, Evan stopped hating school. He started to recognize his own weaknesses, which made it easier for him to calm himself when he got upset, rather than exploding or disintegrating into a crying heap. When the din of the classroom became too intense and he started to get jumpy and loud, he asked for permission to take a break. And as his sensory processing became more efficient, he was able to focus on learning and enjoy its natural rewards.This blog is excerpted from “The Impossible Child."Read the full article here. >>Want to read more articles like this? Subscribe to Psychotherapy Networker Today!