Excerpts

FROM PART I - THE BASICS OF SPD

Part I of Sensational Kids tackles the pressing questions that arise when a child's behaviors at home and school signal that he or she is not interpreting sensation the way other children the same age do-questions such as What is Sensory Processing Disorder? What are the red flags I should watch for? Where do we go for the best treatment? What can we expect from treatment? Answers are provided with clear, easy-to-understand charts, illustrations, and checklists and enlivened with first-person stories collected by Dr. Miller during her years of working with sensational kids and their families.

From CHAPTER 1: What is Sensory Processing Disorder?

I am frustrated to the point of tears. It's so hard to see your child struggling, failing, trying again, failing again. I want to do everything I can to make things easier for my daughter so she'll be successful and feel good but I can't seem to find the right things-if there are any. When we are so exhausted from just getting through each day, it is nearly impossible to see what she needs and do something about it.

Yesterday, Emma said, "Mom, maybe I shouldn't have gotten born. My brain isn't like other people's. What's wrong with me?"

Contributed by Terri Reinhart and daughter Emma

When Emma Reinhart was born twelve weeks early, weighing barely two pounds, the Reinharts were warned that prematurity might result in some developmental delays. They were concerned, of course, but so encouraged by the way their little fighter overcame those touch-and-go early months that they just knew she'd triumph over whatever hurdles lay ahead. When Emma didn't act like other babies her age, they comforted themselves with the certainty that many preemies need some time to catch up.

But Emma didn't catch up. As time went by, she fell further and further behind her age mates. Once she stepped into the social whirl of preschool, the differences became painfully obvious. While other children played outside, Emma would stand behind a tree and watch, unable to join in. The most basic transitions-from one classroom to another, from one activity to the next-caused her to fall apart. At home, she had trouble taking baths, eating regular foods, even listening to her brother play his violin. Having her toenails cut was an ordeal.

The Reinharts' initial optimism gradually gave way to alarm. Something in Emma clearly wasn't working the way it should, but what was it? Emma was becoming more and more isolated, and she seemed so unhappy. Some observers hinted that the Reinharts' parenting style was to blame; others suggested Emma had been put in the "wrong" school. The pediatrician said the fearful preschooler might have an anxiety disorder or, at least, "failure to thrive." Terri and her husband Chris didn't believe any of the labels fit, but they didn't have a better one.

By the time I met the family, Emma was five years old and so defensive about every new sensation that we could not even test her in our specialized "spaceship" laboratory-a testing room specially designed to put sensational kids at ease. I interviewed the Reinharts about their daughter's history and development and discussed Emma's medical background with her pediatrician. When the multidisciplinary team at the clinic conducted a comprehensive evaluation, they concluded that the little girl had been right all along.

Emma's brain wasn't like other's people's. Emma had Sensory Processing Disorder.

Sensory processing and SPD

Sensory processing is a term that refers to the way the nervous system receives sensory messages and turns them into responses.

All of us are constantly managing sensory messages. Sight, sound, touch, taste, smell-the five familiar senses that let us hear the clock ticking in the background, feel the breeze blowing in the window, smell the cookies baking in the oven-come instantly to mind, but we're also constantly managing sensory messages from two less familiar sensory sources. Sometimes called the "hidden" senses, the proprioceptive and vestibular senses give us our perceptions of speed, movement, pressure on our joints and muscles, and the position of our bodies. It is your sense of vision that enables you to see the words on this page, your vestibular sense signaling that you are sitting upright while you read, and your proprioceptive sense letting you know how much resistance is needed to hold up the book.

Most of us are born with the ability to receive sensory messages and organize them effortlessly into the "right" behavioral and physiological responses. If that yummy cookie fragrance coming from the kitchen turns into the smell of something burning, we don't have to stop and think about what to do. We automatically translate the olfactory (smell) message into the behavioral response of dropping the book we were reading and rushing to the kitchen. At the same time, the nervous system produces a physiological response-an uptick in heart rate, a rise in blood pressure, the outbreak of a fine sweat.

Sensory Processing Disorder exists when sensory signals don't get organized into appropriate responses and a child's daily routines and activities are disrupted as a result. Let's say a boy is at play in the park when a ball careens toward his head. If the boy doesn't connect the ball with danger and duck or throw up an arm in self-defense, he could get hurt.

If this child consistently fails to organize similar messages, chances are he will have problems in other areas that rely on the same sensory and motor foundations. If the problem is that he can't plan the motor action of ducking, he could also struggle with putting on his socks or making his way through crowded spaces. If he sees the ball coming but can't judge how close it is, he may struggle with spacing letters and words . If he sees the ball and knows it's close but isn't alert enough to take action, it's probable that he'll miss a lot of other sensory messages important to such everyday activities as passing through a doorway or reaching for his milk glass at the table.

As problems like these recur in multiple areas, it would be easy for this boy to start feeling awkward, stupid, or just plain "different" because he couldn't do the simple things all the other kids could do so effortlessly. If other children began ridiculing him, he might have trouble making and keeping friends and feeling good about himself. His parents would become worried or frustrated. No matter what his gifts and strengths were, life would be hard. . . .

It's important to remember that all of us experience sensory problems occasionally, and some of us experience them regularly. For example, I am sensitive to labels against my skin, so I always cut them out of my clothes. This doesn't mean I have SPD. My label aversion is an isolated over-sensitivity that doesn't get in the way of my daily life. It would be quite another matter if I were a child so sensitive to the light touch of clothing that I resisted wearing shoes or refused to wear any clothes except one old, well-washed sweatsuit. Soon, my life would be affected at every level, from the most basic activities of getting dressed to the more complex ones of fitting in with classmates who wore "regular" kid clothes. I would undoubtedly have problems in other areas where the sense of touch was involved. In other words, I would be a child whose everyday activities and social interactions were being disrupted.

The hallmark of children with Sensory Processing Disorder is that their sensory difficulties are chronic and disrupt their everyday life. Children with SPD get "stuck." And no matter what strategies a determined parent uses-stickers on a chart, praise, discipline, or some technique another parent said worked magic for them-kids with SPD stay stuck. Parents of sensational kids often say it seems their children have no control over their bodies. Well . . . guess what? They don't. Children with SPD behave differently from typically developing children because their brains really are different.

The degree of difference varies, as it does with any condition. Some children are affected in only one sensory system; others in multiple systems. Symptoms of the same subtype may be severe enough to raise parents' alarm from birth or so mild that it takes years to recognize that something about their child's functioning isn't quite right. A great many children exhibit symptoms of SPD and another disorder, such as Autism or Attention Deficit Disorder (ADHD), a phenomenon that Chapter 12-Beyond the Types-will discuss in detail.

No matter where a child's symptoms fall on the continuum of severity, Sensory Processing Disorder needs to be identified as early as possible. When symptoms affect children but don't greatly affect people around them, it's easy for the problems to be missed. But Sensory Processing Disorder always deprives children of the sensory information and experience they need in order to learn and develop. Whether sensory issues are mild or severe, a child's social, emotional, motor, and academic development can be impaired without timely help in overcoming and/or adapting to the disorder.

FROM PART II - LIFE WITH SENSATIONAL KIDS

In five vivid story-chapters, Part II of Sensational Kids introduces readers to five children ranging in age from four to eight years old. One is a "typically developing child"; the others, sensational kids whose SPD illustrates one of the disorder's well-defined types or subtypes. In each of these chapters, Dr. Miller's insightful explanations and commentary are interwoven with the story of a single day in the child's life.

From CHAPTER 6: LaTanya, an over-responsive kindergartner

LaTanya Brown is a slender kindergartener who lives with her parents Tina and Martin and her boisterous seven-year-old brother Trey in an urban row house. Because they were already veteran parents when LaTanya was born, the Browns spotted the red flags quickly when LaTanya responded hysterically to a wide variety of sensations. They began searching for an explanation while their daughter was still a baby and, at four, LaTanya was correctly diagnosed with sensory over-responsivity. She attended six sessions of occupational therapy, the maximum the family's health insurance covered. LaTanya's parents continue to use the strategies they learned in OT with their daughter and occasionally schedule an appointment with the occupational therapist when LaTanya meets new challenges at different developmental stages.

At shortly after six a.m., the alarm clock that Tina and Martin Brown fondly call their "morning magic" begins its stealthy job of waking LaTanya. The clock's alarm is designed to start with a subtle, dawn-like light that brightens as slowly as a sunrise. Then aroma therapy scents release into the air. Next birds begin to chirp-just one or two at first and then a few more, until an entire chorus is singing cheerily. Finally music starts to play softly, growing louder as gradually as the light and bird songs did. When the Browns discovered the clock they were almost giddy with relief. At last! they thought. No more wake-up tantrums! Until then, tears and fears were inevitable unless one parent spent a good ten or fifteen minutes at LaTanya's side, gently easing her from sleep the way the clock now does.

On this particular morning, however, the clock is only halfway through its reliable magic when a loud BA-BOOM! Rat-a-tat-TAT! slices through the soft sounds. In the next bedroom, seven-year-old Trey has slammed his door shut and is playing a lively drum roll on the back of it. The thumps bring LaTanya's sleep to an abrupt end. Her eyes fly open and her hands jerk to cover her ears. A wail of terror follows.

The girl's mother dashes into the room. "LaTanya," Tina croons, resisting the urge to brush her daughter's tears away. "It's okay." Tina firmly pulls the wailing girl into the close, hard embrace the occupational therapist recommended for moments when LaTanya's sensory alarms were clanging. "It was just Trey closing his door. Everything's okay." After LaTanya calms a little, Tina releases her daughter and raises her own hands, palms toward the girl. "Push against my hands, honey. See if you can push Mama." This is an exercise LaTanya has done before. The little girl is still breathing unevenly but she places her hands against her mother's palms and pushes. "That's right," Tina encourages her. "Push hard."

It takes a few minutes for LaTanya to relax, but she eventually wipes her tears, gulps, "I'm okay now," and drops her hands. Tina resists the temptation to give her daughter a reassuring kiss on the forehead. Experience has taught Tina and Martin that when their daughter is in a state of over-arousal, the light touch of lips on her face has just the reverse effect they seek: instead of calming her, it agitates her. So Tina just gives LaTanya a final quick, firm hug and says, "Then up and at 'em, baby."

Before returning to dressing herself, Tina opens her son's door. "Trey!" she scolds. "You should know better than to make that racket when your sister's waking up. Hush now or we'll all be late and you'll miss the bus again."

LaTanya has a Sensory Modulation Disorder (SMD), which makes it hard for her to match the intensity of her responses to the intensity of the sensations she feels. LaTanya's SMD takes the form of sensory over-responsivity, which causes her to be more alert than most people. Even when she's asleep, LaTanya's "engine" is running too fast, the way a car's engine does when the idle is set too high. This causes sounds and other sensations to seem more intense to her than they would to a typically developing child. Even something as innocent as Trey slamming and drumming on his door jolts her into instant and complete alertness the way the a big BOOM coming from the furnace room of the house would alarm you or me.

LaTanya reacts dramatically because she is frightened. Her heart is racing and she's starting to sweat. These physiological manifestations of fear are as old as life itself, defensive reactions that are genetically programmed into our systems to let us know when we are in danger. The trouble with LaTanya's system is that it cannot filter sensations in a way that would allow her to come up with an appropriate response. She alerts to Trey's noisemaking even though there is no real danger. Once she discovers the real source-it's just her "bratty" big brother again-she's angry, fearful, and resentful. She hasn't been awake for five minutes, she's in the safest place she can possibly be-her own bed-and her sensory systems and emotions are already under assault.

Tina's strategy of calming her daughter with a firm hug followed by having LaTanya push against her hands demonstrates the use of two of the most effective sensory tools that therapists and parents have for soothing children with over-responsivity: deep pressure and proprioceptive stimulation. These tools utilize mechanical forces that are known to quiet the alarms tripped by over-responsivity.

Here's why they work: Perceived danger activates the parts of the brain responsible for arousal and emotions. Proprioceptive information (from the joints and muscles) and deep pressure (from the skin) travels to these areas, too, and can diminish the activity of the brain's neurons in these areas, overriding the danger signals. The effect is the one you may have experienced if you've ever taken a bite of ice cream so cold that it made your teeth hurt. The pain was a "danger" signal, but if you pressed your fingers hard against the throbbing area, you probably found the pain went away. That was because the deep pressure trumped the message of pain the sense of cold was sending. This is the same result Tina is after with her hard hug and her pushing exercise. And it works: LaTanya calms down.

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