Sync Stock Quotes

This child did not need to “change his behaviors.” We needed to understand his behaviors and what they suggested as the probable underlying reason for the behaviors. We needed to remember that behaviors are a message, a symptom—not a diagnosis.

Beyond serving as an inspiration to engineers, the group behavior of fireflies has broader significance for science as a whole. It represents one of the few tractable instances of a complex, self-organizing system, where millions of interactions occur simultaneously—when everyone changes the state of everyone else. Virtually all the major unsolved problems in science today have this intricate character. Consider the cascade of biochemical reactions in a single cell and their disruption when the cell turns cancerous; the booms and crashes of the stock market; the emergence of consciousness from the interplay of trillions of neurons in the brain; the origin of life from a meshwork of chemical reactions in the primordial soup. All these involve enormous numbers of players linked in complex webs. In every case, astonishing patterns emerge spontaneously. The richness of the world around us is due, in large part, to the miracle of self-organization.

More Activities to Develop Sensory-Motor Skills Sensory processing is the foundation for fine-motor skills, motor planning, and bilateral coordination. All these skills improve as the child tries the following activities that integrate the sensations. FINE-MOTOR SKILLS Flour Sifting—Spread newspaper on the kitchen floor and provide flour, scoop, and sifter. (A turn handle is easier to manipulate than a squeeze handle, but both develop fine-motor muscles in the hands.) Let the child scoop and sift. Stringing and Lacing—Provide shoelaces, lengths of yarn on plastic needles, or pipe cleaners, and buttons, macaroni, cereal “Os,” beads, spools, paper clips, and jingle bells. Making bracelets and necklaces develops eye-hand coordination, tactile discrimination, and bilateral coordination. Egg Carton Collections—The child may enjoy sorting shells, pinecones, pebbles, nuts, beans, beads, buttons, bottle caps, and other found objects and organizing them in the individual egg compartments. Household Tools—Picking up cereal pieces with tweezers; stretching rubber bands over a box to make a “guitar”; hanging napkins, doll clothes, and paper towels with clothespins; and smashing egg cartons with a mallet are activities that strengthen many skills.

Suggestions to Develop Self-Help Skills Self-help skills improve along with sensory processing. The following suggestions may make your child’s life easier—and yours, too! DRESSING • Buy or make a “dressing board” with a variety of snaps, zippers, buttons and buttonholes, hooks and eyes, buckles and shoelaces. • Provide things that are not her own clothes for the child to zip, button, and fasten, such as sleeping bags, backpacks, handbags, coin purses, lunch boxes, doll clothes, suitcases, and cosmetic cases. • Provide alluring dress-up clothes with zippers, buttons, buckles, and snaps. Oversized clothes are easiest to put on and take off. • Eliminate unnecessary choices in your child’s bureau and closet. Clothes that are inappropriate for the season and that jam the drawers are sources of frustration. • Put large hooks inside closet doors at the child’s eye level so he can hang up his own coat and pajamas. (Attach loops to coats and pajamas on the outside so they won’t irritate the skin.) • Supply cellophane bags for the child to slip her feet into before pulling on boots. The cellophane prevents shoes from getting stuck and makes the job much easier. • Let your child choose what to wear. If she gets overheated easily, let her go outdoors wearing several loose layers rather than a coat. If he complains that new clothes are stiff or scratchy, let him wear soft, worn clothes, even if they’re unfashionable. • Comfort is what matters. • Set out tomorrow’s clothes the night before. Encourage the child to dress himself. Allow for extra time, and be available to help. If necessary, help him into clothes but let him do the finishing touch: Start the coat zipper but let him zip it up, or button all but one of his buttons. Keep a stool handy so the child can see herself in the bathroom mirror. On the sink, keep a kid-sized hairbrush and toothbrush within arm’s reach. Even if she resists brushing teeth and hair, be firm. Some things in life are nonnegotiable.

the brain cannot do its most important job of organizing sensory messages.

Every child is occasionally out-of-sync. Careful diagnosis is imperative to determine which symptoms are related to sensory processing problems, and which are not.

In springtime when I lived at the White House, we used to plant what’s called a “three sisters” vegetable patch in our garden on the South Lawn, mixing a crop of corn, beans, and squash together in one place. This is a traditional Native American method for growing food in a resourceful way, one that’s been used for many hundreds of years and is based on the idea that each type of plant has something vital to offer the others: The corn grows tall and creates a natural pole for the bean plants to climb. The beans provide nitrogen, a nutrient that helps the other plants grow more efficiently, and the squash stays low to the ground, its large, spreading leaves helping to block weeds and keep the soil moist. The plants grow at different rates; the vegetables harvest at different times. But the mix provides a system of mutual protection and benefit—the tall and the small continually working together. It’s not just the corn, and not just the beans, but rather the corn and the beans and the squash combined that yield a healthy crop. The balance comes from the combination. I’ve started to think about both my life and our wider human community in these terms. We are here to share benefits and protection. Our balance rests upon this ideal, the richness of these combinations. If I begin to feel out of sync, if I’m feeling unsupported or overwhelmed, I try to take stock of what my garden holds, what I’ve planted and what I still need to mix in: What’s feeding my soil? What’s helping to block the weeds? Am I cultivating both the small and the tall?

Autism is a neurobiological disorder. The structures of the brains of people with autism are atypical. Research is pointing to differences in overall brain size and the numbers of certain cells; to abnormalities in the cerebellum that affect motor, sensory, language, cognitive and attention functions; and to altered genes that interfere with brain development. A new “underconnectivity theory” suggests that autism interferes with efficient integration, timing, and synchronization of brain activation patterns. Autism, or the umbrella term, Autistic Spectrum Disorders (ASD), is not one thing but many. Like SPD and LD, the term autism encompasses a wide array of symptoms. In broad terms, autism is a Pervasive Developmental Disorder (PDD) that affects verbal and nonverbal communication, social interaction, imagination, and problem-solving.

That most people with autism have some degree of SPD is a recognized fact. Understanding how sensory and motor problems complicate the child’s daily life is crucial for designing an appropriate intervention program. Parents must ensure that their child’s treatment program includes ample sensory-motor experiences and an individualized sensory diet.

For example, attending a noisy, crowded party can be overwhelming. Taking a bumpy airplane ride can overload your brain with rapid movement sensations. Lingering in bed with the flu can prevent you from receiving sufficient movement experiences and make you feel weak. Walking from a well-lit room into a dark closet can deprive your eyes of light and therefore your brain of visual sensations. Not being in control of oneself is very unpleasant, but an occasional disorganizing experience is normal. It is when the brain is so disorganized that a person has difficulty functioning in daily life that the person is diagnosed as having Sensory Processing Disorder.

Our senses give us the information we need to function in the world. Their first job is to help us survive. Their second job, after they assure us that we are safe, is to help us learn how to be active, social creatures. The senses receive information from stimuli both outside and inside our bodies. Every move we make, every bite we eat, every object we touch produces sensations. When we engage in any activity, we use several senses at the same time. The convergence of sensations—especially touch, body position, movement, sight, sound, and smell—is called intersensory integration. This process is key and tells us on the spot what is going on, where, why, and when it matters, and how we must use or respond to it. The more important the activity, the more senses we use. That is why we use all our senses simultaneously for two very important human activities: eating and procreating. Sometimes our senses inform us that something in our environment doesn’t feel right; we sense that we are in danger and so we respond defensively. For instance, should we feel a tarantula creeping down our neck, we would protect ourselves with a fight-or-flight response. Withdrawing from too much stimulation or from stimulation of the wrong kind is natural. Sometimes our senses inform us that all is well; we feel safe and satisfied and seek more of the same stimuli. For example, we are so pleased with the taste of one chocolate-covered raisin that we eat a handful. Sometimes, when we get bored, we go looking for more stimulation. For example, when we have mastered a skill, like ice skating in a straight line, we attempt a more complicated move, like a figure eight. To do their job well, so that we respond appropriately, the senses must work together. A well-balanced brain that is nourished with many sensations operates well, and when our brain operates smoothly, so do we. We have more senses than many people realize. Some sensations occur outside our bodies, and some inside.

According to Dr. Ayres, “Over 80 percent of the nervous system is involved in processing or organizing sensory input, and thus the brain is primarily a sensory processing machine.

A Variation of Dr. Ayres’s “Four Levels of Sensory Integration” By the time a child is ready for preschool, the blocks for complex skill development should be in place. What are these blocks? • Ability to modulate touch sensations through the skin, especially unexpected, light touch, and to discriminate among the physical properties of objects by touching them (tactile sense), • Ability to adjust one’s body to changes in gravity, and to feel comfortable moving through space (vestibular sense), • Ability to be aware of one’s body parts (proprioceptive sense), • Ability to use the two sides of the body in a cooperative manner (bilateral coordination), and • Ability to interact successfully with the physical environment; to plan, organize, and carry out a sequence of unfamiliar actions; to do what one needs and wants to do (praxis).

Sensory Processing Disorder is difficulty in the way the brain takes in, organizes and uses sensory information, causing a person to have problems interacting effectively in the everyday environment. Sensory stimulation may cause difficulty in one’s movement, emotions, attention, or adaptive responses. SPD is an umbrella term covering several distinct disorders that affect how the child uses his senses. Having SPD does not imply brain damage or disease, but rather what Dr. Ayres called “indigestion of the brain,” or a “traffic jam in the brain.” Here is what may happen: • The child’s CNS may not receive or detect sensory information. • The brain may not integrate, modulate, organize, and discriminate sensory messages efficiently. • The disorganized brain may send out inaccurate messages to direct the child’s actions. Deprived of the accurate feedback he needs to behave in a purposeful way, he may have problems in looking and listening, paying attention, interacting with people and objects, processing new information, remembering, and learning.

SNACK AND MEAL TIME Provide a chair that allows the child’s elbows to be at table height and feet to be flat on the floor. A stool or pillow may help. (Kids fidget less when they feel grounded.) Offer a variety of ways to eat food, e.g., eat pudding with a spoon, or scoop it up with fingers; use a spoon or a fork to eat corn kernels, or use both hands to munch corn on the cob; and spoon chicken broth, or lift the bowl to her mouth. Offer a variety of foods with different textures: lumpy, smooth, crunchy, chewy. Keep portions small, especially when introducing new foods. Let the child pour juice or milk into a cup. A tipless cup will help prevent accidents. The child who frequently overreaches or spills juice needs much practice. Encourage the child to handle snack-time or mealtime objects. Opening cracker packages, spreading peanut butter, and eating with utensils are good for proprioception, bilateral coordination, and fine-motor skills.

CHORES Together, make a list of chores he can do to help around the house: Make his bed, walk the dog, empty wastebaskets, take out trash, pull weeds, rake, shovel, sweep, vacuum, fold laundry, empty the dishwasher, set and clear the table. Let him know you need and appreciate him. Make a routine and stick to it. If the child is forgetful, make a chart and post it on the refrigerator. When he finishes a chore, let him stick a star on the chart. Reward him with a special privilege or outing when he accumulates several stars. Break chores down into small steps. Let her clear the table one plate at a time. (She doesn’t have to clear all the dishes.) BATHING Let the child help regulate the water temperature. Provide an assortment of bath toys, soaps, and scrubbers. Scrub the child with firm, downward strokes. Provide a large bath sheet for a tight wrap-up. SLEEPING Give your child notice: “Half an hour until bedtime!” or “You can draw for five more minutes.” Stick to a bedtime routine. Include stories and songs, a look at a sticker collection, a chat about today’s events or tomorrow’s plans, a back rub and snug tuck-in. Children with tactile defensiveness are very particular about clothing, so provide comfortable pajamas. Some like them loose, some like them tight; some like them silky, some don’t like them at all. Nobody likes them bumpy, scratchy, lacy, or with elasticized cuffs. Use percale or silk sheets for a smooth and bumpless bed. Let your child sleep with extra pillows and blankets, in a sleeping bag or bed tent, or on a waterbed. Life at home can improve with a sensory diet and attention to your child’s special needs, and life at school can improve as well.

Arousal, activity level, and attention are self-regulation problems that frequently coexist with SPD. • Unusually high arousal and activity level: The child may be always on the go, restless, and fidgety. He may move with short and nervous gestures, play or work aimlessly, be quick-tempered and excitable, and find it impossible to stay seated.

Regulatory Disorders SELF-REGULATION The child may have difficulty modulating (adjusting) his mood. He may be unable to “rev up,” or to calm down once aroused. He may become fussy easily. He may have difficulty with self-comforting after being hurt or upset. Delaying gratification and tolerating transitions from one activity to another may be hard. The child may perform unevenly: “with it” one day, “out of it” the next. Therapy, a “sensory diet” and nutritional supplements are some of the treatments that may help (see Chapter Nine

• Inattention: Perhaps because of sensory over- or underresponsiveness, the child may have a short attention span, even for activities he enjoys. He may be highly distractible, paying attention to everything except the task at hand. He may be disorganized and forgetful. • Impulsivity: To get or avoid sensory stimulation, the child may be heedlessly energetic and impetuous. She may lack self-control and be unable to stop after starting an activity. She may pour juice until it spills, run pell-mell into people, overturn toy bins, and talk out of turn.

SOCIAL AND EMOTIONAL FUNCTIONING Another coexisting regulatory problem may be how the child feels about himself and relates to other people. • Poor adaptability: The child may resist meeting new people, trying new games or toys or tasting different foods. He may have difficulty making transitions from one situation to another. The child may seem stubborn and uncooperative when it is time to leave the house, come for dinner, get into or out of the bathtub, or change from a reading to a math activity. Minor changes in routine will readily upset this child who does not “go with the flow.” • Attachment problem: The child may have separation anxiety and be clingy and fearful when apart from one or two “significant olders.” Or, she may physically avoid her parents, teachers, and others in her circle. • Frustration: Struggling to accomplish tasks that peers do easily, the child may give up quickly. He may be a perfectionist and become upset when art projects, dramatic play, or homework assignments are not going as well as he expects. • Difficulty with friendships: The child may be hard to get along with and have problems making and keeping friends. Insisting on dictating all the rules and being the winner, the best, or the first, he may be a poor game-player. He may need to control his surrounding territory, be in the “driver’s seat,” and have trouble sharing toys. • Poor communication: The child may have difficulty verbally in the way she articulates her speech, “gets the words out,” and writes. She may have difficulty expressing her thoughts, feelings, and needs, not only through words but also nonverbally through gestures, body language, and facial expressions. • Other emotional problems: He may be inflexible, irrational, and overly sensitive to change, stress, and hurt feelings. Demanding and needy, he may seek attention in negative ways. He may be angry or panicky for no obvious reason. He may be unhappy, believing and saying that he is dumb, crazy, no good, a loser, and a failure. Low self-esteem is one of the most telling symptoms of Sensory Processing Disorder. • Academic problems: The child may have difficulty learning new skills and concepts. Although bright, the child may be perceived as an underachiever.

Among the researchers’ findings is evidence that many children with SPD differ from children with ADHD in their responses to unexpected sensations, such as light touches, loud noises, flickering lights, strong smells, and being tilted backward in a chair. Children with ADHD tend to alert to these novel sensations and then, like most people, habituate—i.e., become easily accustomed—to them. Life goes on. Some children with SPD, however, may not alert to these everyday sensations. Life does not affect them much. Other children with SPD may be continually on alert and may not become accustomed to the sensations at all. Life affects them too much.

Outside the research laboratory, parents and teachers may notice other differences between SPD and ADHD. For instance, many children with SPD prefer the “same-old, same-old” in a familiar and predictable environment, while children with ADHD prefer novelty and diversion. Many children with SPD have poor motor coordination, while children with ADHD often shine in sports. Many children with SPD have adequate impulse control, unless bothered by sensations, while children with ADHD often have poor impulse control. Another difference is that medicine may help the child with ADHD, but medicine will not solve the problem of SPD. Therapy focusing on sensory integration and a sensory diet of purposeful activities help the child with SPD.

Perceptual motor therapy provides integrated movement experiences that remediate gross-motor, fine-motor, and visual discrimination problems. Activities, including sensory-input techniques, stimulate left/right brain communication to help the child interpret incoming information to the nervous system. Goals are to develop more mature patterns of response to specific stimuli, improve motor skills and balance, and stimulate alternate routes to memory and sequencing for those children who do not respond to the methods taught in the conventional classroom.

The Out-of-Sync Child Has Fun (Perigee, 2006), The Goodenoughs Get in Sync (Sensory World, 2010), Growing an In-Sync Child (Perigee, 2010), and In-Sync Activity Cards (Sensory World, 2012).

Activities to Develop the Tactile Sense Rub-a-Dub-Dub—Encourage the child to rub a variety of textures against her skin. Offer different kinds of soap (oatmeal soap, shaving cream, lotion soap) and scrubbers (loofah sponges, thick washcloths, foam pot-scrubbers, plastic brushes). Water Play—Fill the kitchen sink with sudsy water and unbreakable pitchers and bottles, turkey basters, sponges, eggbeaters, and toy water pumps. Or, fill a washtub with water and toys and set it on the grass. Pouring and measuring are educational and therapeutic, as well as high forms of entertainment. Water Painting—Give the child a bucket of water and paintbrush to paint the porch steps, the sidewalk, the fence, or her own body. Or, provide a squirt bottle filled with clean water (because the squirts often go in the child’s mouth). Finger Painting—Let the sensory craver wallow in this literally “sensational” activity. Encourage (but don’t force) the sensory avoider to stick a finger into the goop. For different tactile experiences, mix sand into the paint, or place a blob of shaving cream, peanut butter, or pudding on a plastic tray. Encourage him to draw shapes, letters, and numbers. If he “messes up,” he can erase the error with his hand and begin again. Finger Drawing—With your finger, “draw” a shape, letter, number, or design on the child’s back or hand. Ask the child to guess what it is and then to pass the design on to another person. Sand Play—In a sandbox, add small toys (cars, trucks, people, and dinosaurs), which the child can rearrange, bury, and rediscover. Instead of sand, use dried beans, rice, pasta, cornmeal, popcorn, and mud. Making mud pies and getting messy are therapeutic, too.

Feelie Box—Cut a hole in a shoebox lid. Place spools, buttons, blocks, coins, marbles, animals, and cars in the box. The child inserts a hand through the hole and tells you what toy she is touching. Or, ask her to reach in and feel for a button or car. Or, show her a toy and ask her to find one in the box that matches. These activities improve the child’s ability to discriminate objects without the use of vision. “Can You Describe It?”—Provide objects with different textures, temperatures, and weights. Ask her to tell you about an object she is touching. (If you can persuade her not to look at it, the game is more challenging.) Is the object round? Cool? Smooth? Soft? Heavy? Oral-Motor Activities—Licking stickers and pasting them down, blowing whistles and kazoos, blowing bubbles, drinking through straws or sports bottles, and chewing gum or rubber tubing may provide oral satisfaction. Hands-on Cooking—Have the child mix cookie dough, bread dough, or meat loaf in a shallow roasting pan (not a high-sided bowl). Science Activities—Touching worms and egg yolks, catching fireflies, collecting acorns and chestnuts, planting seeds, and digging in the garden provide interesting tactile experiences. Handling Pets—What could be more satisfying than stroking a cat, dog or rabbit? People Sandwich—Have the “salami” or “cheese” (your child) lie facedown on the “bread” (gym mat or couch cushion) with her head extended beyond the edge. With a “spreader” (sponge, pot scrubber, basting or vegetable brush, paintbrush, or washcloth) smear her arms, legs, and torso with pretend mustard, mayonnaise, relish, ketchup, etc. Use firm, downward strokes. Cover the child, from neck to toe, with another piece of “bread” (folded mat or second cushion). Now press firmly on the mat to squish out the excess mustard, so the child feels the deep, soothing pressure. You can even roll or crawl across your child; the mat will distribute your weight. Your child will be in heaven.

Activities to Develop the Vestibular System Rolling—Encourage your child to roll across the floor and down a grassy hill. Swinging—Encourage (but never force) the child to swing. Gentle, linear movement is calming. Fast, high swinging in an arc is more stimulating. If the child has gravitational insecurity, start him on a low swing so his feet can touch the ground, or hold him on your lap. Two adults can swing him in a blanket, too. Spinning—At the playground, let the child spin on the tire swing or merry-go-round. Indoors, offer a swivel chair or Sit ’n Spin. Monitor the spinning, as the child may become easily overstimulated. Don’t spin her without her permission! Sliding—How many ways can a child swoosh down a slide? Sitting up, lying down, frontwards, backwards, holding on to the sides, not holding on, with legs straddling the sides, etc. Riding Vehicles—Trikes, bikes, and scooters help children improve their balance, motor planning, and motor coordination. Walking on Unstable Surfaces—A sandy beach, a playground “clatter bridge,” a grassy meadow, and a waterbed are examples of shaky ground that require children to adjust their bodies as they move. Rocking—Provide a rocking chair for your child to get energized, organized, or tranquilized.

Riding, balancing, and walking on a seesaw. Balancing on a Teeter-Totter—Center a board over a railroad timber. (See The Out-of-Sync Child Has Fun for ideas.) Sitting on a T-stool—A T-stool helps improve balance, posture, and attention. (See The Out-of-Sync Child Has Fun for ideas.) Balancing on a Large Therapy Ball—Your child can lie on her stomach, on her back, or sit and bounce. Some balls have handles for bouncing up and lower (hippity-hopping). Tummy Down, Head Up—Have the child lie on her stomach. On the floor, she can rock to and fro to “Row, Row, Row Your Boat”; draw on paper while listening to music, using crayons, which require her to bear down to make a mark; and play with small toys. On a swing or therapy ball, she can “draw” on the ground or carpet with a stick; throw sponges into a basket; and bat a suspended ball with a cardboard tube. Jogging—Run around the block together!

Activities to Develop the Proprioceptive System Lifting and Carrying Heavy Loads—Have the child pick up and carry soft-drink bottles to the picnic; laundry baskets upstairs; or grocery bags, filled with nonbreakables, into the house. He can also lug a box of books, a bucket of blocks, or a pail of water from one spot to another. Pushing and Pulling—Have the child push or drag grocery bags from door to kitchen. Let him push the stroller, vacuum, rake, shove heavy boxes, tow a friend on a sled, or pull a loaded wagon. Hard muscular work jazzes up the muscles. Hanging by the Arms—Mount a chinning bar in a doorway, or take your child to the park to hang from the monkey bars. When she suspends her weight from her hands, her stretching muscles send sensory messages to her brain. When she shifts from hand to hand as she travels underneath the monkey bars, she is developing upper-body strength. Hermit Crab—Place a large bag of rice or beans on the child’s back and let her move around with a heavy “shell” on her back. Joint Squeeze—Put one hand on the child’s forearm and the other on his upper arm; slowly press toward and away from his elbow. Repeat at his knee and shoulder. Press down on his head. Straighten and bend his fingers, wrists, elbows, knees, ankles, and toes. These extension and flexion techniques provide traction and compression to his joints and are effective when he’s stuck in tight spaces, such as church pews, movie theaters, cars, trains, and especially airplanes where the air pressure changes. Body Squeeze—Sit on the floor behind your child, straddling him with your legs. Put your arms around his knees, draw them toward his chest, and squeeze hard. Holding tight, rock him forward and back.

Bear Hugs—Everyone needs twelve hugs a day. Pouring—Let the child pour sand, beans, or water from one container to another. Opening Doors—Is this hard? Then your child needs practice! Take the time to let her do it all by herself. Back-to-Back Standing Up—Position two children on the floor, back to back. Ask them to “dig their feet into the floor” and to stand up together by pressing against each other’s back. Bulldozer—One child sits in a large cardboard box or on a folded gym mat, and another child pushes the load across the floor, using his head, shoulders, back, or feet to make it move. Arm Wrestling—If you are stronger than your child, please let him win once in a while.

Activities to Develop the Auditory System Simplify your language. Speak slowly, shorten your comments, abbreviate instructions, and repeat what you have said. Reinforce verbal messages with gestural communication: facial expressions, hand movements, and body language. Talk to your child while she dresses, eats, or bathes, to teach her words and concepts, such as nouns (sunglasses, casserole), body parts (thumb, buttocks), prepositions (around, through), adjectives (juicy, soapy), time (yesterday, later), categories (vegetables/fruits), actions (zip, scrub), and emotions (pleased, sorry). Share your own thoughts. Model good speech and communication skills. Even if the child has trouble responding verbally, she may understand what you say. Take the time to let your child respond to your words and express his thoughts. Don’t interrupt, rush, or pressure him to talk. Be an active listener. Pay attention. Look your child in the eye when she speaks. Show her that her thoughts interest you. Help your child communicate more clearly. If you catch one word, say, “Tell me more about the truck.” If you can’t catch his meaning, have him show you by gesturing. Reward her comments with smiles, hugs, and verbal praise, such as, “That’s a great idea!” Your positive feedback will encourage her to strive to communicate. (Don’t say, “Good talking,” which means little to the child and implies that all you care about is words, rather than the message the child is trying to get across.) Use rhythm and beat to improve the child’s memory. Give directions or teach facts with a “piggyback song,” substituting your words to a familiar tune. Example: To the tune of “Mary Had a Little Lamb,” sing, “Now it’s time to wash your face, Brush your teeth, comb your hair, Now it’s time to put on clothes, So start with underwear!” Encourage your child to pantomime while listening to stories and poems, or to music without words. Read to your child every day!

Activities to Develop the Visual System Making Shapes—Let your child draw or form shapes, letters, and numbers in different materials, such as playdough, finger paint, shaving cream, soap foam, sand, clay, string, pudding, or pizza dough. Mazes and Dot-to-Dot Activities—Draw mazes on paper, the sidewalk, or the beach. Have the child follow the mazes with his finger, a toy car, a crayon, a marker, or chalk. On graph paper, make dot-to-dot patterns for the child to follow. Peg Board—Have the child reproduce your design or make his own. Cutting Activities—Provide paper and scissors and have your child cut fringe and strips. Draw curved lines on the paper for her to cut. Cutting playdough is fun, too. Tracking Activities—Lie on your backs outside and watch birds or airplanes, just moving your eyes while keeping your heads still. Jigsaw Puzzles! Block Building!!

Office and Classroom Tools—Have the child cut with scissors; use a stapler and hole puncher; draw with crayons and chalk; paint with brushes, feathers, sticks, and eyedroppers; squeeze glue onto paper in letters or designs, sprinkle sparkles on the glue, and shake off the excess; and wrap boxes with brown paper, tape, and string. MOTOR PLANNING Jumping from a Table—Place a gym mat beside a low table and encourage the child to jump. After each landing, stick tape on the mat to mark the spot. Encourage the child to jump farther each time. Walking Like Animals—Encourage the child to lumber like a bear, on all fours; a crab, from side to side on all fours; a turtle, creeping; a snake, crawling; an inchworm, by stretching flat and pulling her knees toward her chest; an ostrich, while grasping her ankles; a duck, squatting; a frog, squatting and jumping; a kangaroo or bunny, jumping; a lame dog, with an “injured” leg; a gorilla, bending her knees; a horse, galloping. Playground Games—Remember Simon Says, Ring-Around-the-Rosy, The Hokey-Pokey, London Bridge, Shoo Fly, and Mother, May I? Insy-Outsy—Teach the child to get in and out of clothes, the front door, and the car. With a little help, the child may become able to perform these tasks independently, even if it takes a long time!

BILATERAL COORDINATION Ball Catch—Toss a large beach ball gently to the child from a short distance. As he becomes more competent, use a smaller ball and step farther away. Ball Whack—Have the child hold a baseball bat, rolling pin, broomstick, book, cardboard tube, or ruler in both hands. Remind her to keep her feet still. Toss her a big ball. As she swings, her body will rotate, as her arms cross the midline. Two-Handed Tetherball—Suspend a sponge ball at the child’s eye level from a string attached to a wide doorframe. Let your child choose different “bats.” Have her count how many hits she makes without missing. Try four-handed tetherball, in which you play, too. Balloon Fun—Using both hands together, the child bounces or tosses up a balloon and catches it. He can keep it afloat by whacking it with open hands or batting it repeatedly with hands clasped together in one large “fist.” Rolling-Pin Fun—Provide the child with a cylindrical block or a rolling pin without handles, so he presses down with his opened hands. Have him roll real dough, playdough, crackers, clay—or mud! Body Rhythms—While you chant or sing, clap, and tap different body parts and have your child imitate your motions. Tip your head from side to side, wave your arms overhead, shake icky sticky glue off your hands, pound your chest, slap your hips, bend from side to side, hunch and relax your shoulders, stamp your feet, and hop from foot to foot. Use both hands together or alternately.

Eggbeater Fun—Give your child an eggbeater to whip up soapsuds or mix up a bowl of birdseed, or of uncooked beans and rice. Marble Painting—Line a tray or cookie sheet with paper. Put a few dabs of finger paint in the center of the paper. Provide a marble to roll through the paint to make a design. Great wrapping paper! Ribbon Dancing—Attach ribbons, streamers, or scarves to the ends of a dowel. Holding the dowel with both hands, the child swirls the ribbons overhead, from side to side, and up and down. (No dowel? Give him a ribbon for each hand.) This activity also improves visual-motor coordination. Two-Sided Activities—Encourage the child to jump rope, swim, bike, hike, row, paddle, and do morning calisthenics.

The child who feels uncomfortable in his own skin may have poor motor planning, or dyspraxia. He may move awkwardly and have difficulty planning and organizing his movements. Thus, he may shun the very activities that would improve his praxis.

In addition, the child with poor tactile awareness in his mouth, lips, tongue, and jaw may have a sensory-based motor problem called oral apraxia, which affects his ability to produce and sequence sounds necessary for speech.

The vestibular system tells us about up and down and whether we are upright or not. It tells us where our heads and bodies are in relation to the earth’s surface. It sends sensory messages about balance and movement from the neck, eyes, and body to the CNS for processing and then helps generate muscle tone so we can move smoothly and efficiently. This sense tells us whether we are moving or standing still, and whether objects are moving or motionless in relation to our body. It also informs us what direction we are going in, and how fast we are going. This is extremely useful information should we need to make a fast getaway! Indeed, the fundamental functions of fight, flight, and foraging for food depend on accurate information from the vestibular system. Dr. Ayres writes that the “system has basic survival value at one of the most primitive levels, and such significance is reflected in its role in sensory integration.” The receptors for vestibular sensations are hair cells in the inner ear, which is like a “vestibule” for sensory messages to pass through. The inner-ear receptors work something like a carpenter’s level. They register every movement we make and every change in head position—even the most subtle. Some inner-ear structures receive information about where our head and body are in space when we are motionless, or move slowly, or tilt our head in any linear direction—forward, backward, or to the side. As an example of how this works, stand up in an ordinary biped, or two-footed, position. Now, close your eyes and tip your head way to the right. With your eyes closed, resume your upright posture. Open your eyes. Are you upright again, where you want to be? Your vestibular system did its job. Other structures in the inner ear receive information about the direction and speed of our head and body when we move rapidly in space, on the diagonal or in circles. Stand up and turn around in a circle or two. Do you feel a little dizzy? You should. Your vestibular system tells you instantly when you have had enough of this rotary stimulation. You will probably regain your balance in a moment. What stimulates these inner ear receptors? Gravity! According to Dr. Ayres, gravity is “the most constant and universal force in our lives.” It rules every move we make. Throughout evolution, we have been refining our responses to gravitational pull. Our ancient ancestors, the first fish, developed gravity receptors, on either side of their heads, for three purposes: 1) to keep upright, 2) to provide a sense of their own motions so they could move efficiently, and 3) to detect potentially threatening movements of other creatures through the vibrations of ripples in the water. Millions of years later, we still have gravity receptors to serve the same purposes—except now vibrations come through air rather than water.

Nature designed our vestibular receptors to be extremely sensitive. Indeed, our need to know where we are in relation to the earth is more compelling than our need for food, for tactile comfort, or even for a mother-child bond.

Bilateral (from the Latin for “both sides”) coordination means that we can use both sides of the body to cooperate as a team. A well-regulated vestibular system helps us to integrate sensory messages from both sides of our body. By the age of three or four, a child should be crossing the midline. For the child who avoids crossing the midline, coordinating both body sides may be difficult. When she paints at an easel, she may switch the brush from one hand to the other at the midway point separating her right and left sides. She may appear not to have established a hand preference, sometimes using her left and sometimes her right to eat, draw, write, or throw. It may also be hard to survey a scene or to track a moving object visually without stopping at the midline to blink and refocus. The child with poor bilateral coordination may have trouble using both feet together to jump from a ledge, or both hands together to catch a ball or play clapping games. She may have difficulty coordinating her hands to hold a paper while she cuts, or to stabilize the paper with one hand while she writes with the other. Poor bilateral coordination, a sensory-based motor disorder, is often misinterpreted as a learning disability such as dyslexia. In fact, this difficulty can lead to learning or behavior problems, but it does not ordinarily mean that a child is lacking in intelligence or academic ability.

An occupational therapist will usually evaluate the child in her office. The evaluation is ordinarily a pleasant experience. While costs vary, expect to spend several hundred dollars. This will be money well spent, and it may be covered by health insurance. Here are some of the areas an OT investigates: Fine- and gross-motor developmental levels Visual-motor integration (doing puzzles or copying shapes) Visual discrimination Neuromuscular control (balance and posture) Responses to sensory stimulation (tactile, vestibular, and proprioceptive) Bilateral coordination Praxis (motor planning)

Sometimes, your child may function well, and other times, she will resist going to school, spill her milk, and fall. Expect inconsistency. When she stumbles, try to be understanding. Break challenges into small pieces. Encourage her to achieve one goal at a time to feel the satisfaction of a series of little successes. Remember that you have had years of experience in learning to deal with the world, and that the child has not.

Discipline When the child loses control, avoid punishment. Loss of self-control is scary enough; punishment adds guilt and shame. Comment on the child’s negative behavior, not on the child: “Your yelling makes me angry,” rather than “You infuriate me!” Help the child find a quiet space, away from sensory overload, as a technique to regain self-control. Let him decide the length of the time-out, if possible. Set limits, to make a child feel secure. Pick one battle at a time to help him develop self-control and appropriate behavior. Be firm about the limits you set. Show him that his feelings won’t change the outcome; a rule is a rule. “I know you’re mad because you want to play with the puppy, but it is suppertime.” Discipline consistently. Use gestures and empathy to explain why you are disciplining him. (Discipline means to teach or instruct, not punish.) After you tell him what you are going to do, then do it. Determine appropriate consequences for misbehavior. A natural consequence is best, because it is reasonable, factual, and you don’t impose it: “If you skip breakfast, you will be hungry.” A logical consequence, in which the child is responsible for the outcome of his behavior, is second best: “If you throw food, you must mop it up.” An applied consequence, in which the punishment doesn’t exactly fit the crime, is useful when nothing else works: “If you spit on the baby, you may not play with your friends,” or “If you hit me, you may not watch TV.” Reward appropriate behavior with approval.

Do build on the child’s strengths: “You are such a good cook! Help me remember what we need for our meat loaf recipe. Then, you can mix it.” Or, “You have energy to spare. Could you run over to Mrs. Johnson’s house and get a magazine she has for me?” Think “ability,” not “disability.” Do build on the child’s interests: “Your collection of rocks is growing fast. Let’s read some books about rocks. We can make a list of the different kinds you have found.” Your interest and support will encourage the child to learn more and do more. Do suggest small, manageable goals to strengthen your child’s abilities: “How about if you walk with me just as far as the mailbox? You can drop the letter in. Then I’ll carry you piggy-back, all the way home.” Or, “You can take just one dish at a time to clear the table. We aren’t in a hurry.” Do encourage self-help skills: To avoid “learned helplessness,” sponsor your child’s independence. “I know it’s hard to tie your shoes, but each time you do it, it will get easier.” Stress how capable she is, and how much faith you have in her, to build her self-esteem and autonomy. Show her you have expectations that she can help herself. Do let your child engage in appropriate self-therapy: If your child craves spinning, let him spin on the tire swing as long as he wants. If he likes to jump on the bed, get him a trampoline, or put a mattress on the floor. If he likes to hang upside down, install a chinning bar in his bedroom doorway. If he insists on wearing boots every day, let him wear boots. If he frequently puts inedible objects into his mouth, give him chewing gum. If he can’t sit still, give him opportunities to move and balance, such as sitting on a beach ball while he listens to music or a story. He will seek sensations that nourish his hungry brain, so help him find safe ways to do so. Do offer new sensory experiences: “This lavender soap is lovely. Want to smell it?” Or, “Turnips crunch like apples but taste different. Want a bite?” Do touch your child, in ways that the child can tolerate and enjoy: “I’ll rub your back with this sponge. Hard or gently?” Or, “Do you know what three hand squeezes mean, like this? I-Love-You!

Do encourage movement: “Let’s swing our arms to the beat of this music. I always feel better when I stretch, don’t you?” Movement always improves sensory processing. Do encourage the child to try a new movement experience: “If you’re interested in that swing, I’ll help you get on.” Children with dyspraxia may enjoy new movement experiences but need help figuring out how to initiate them. Do offer your physical and emotional support: “I’m interested in that swing. Want to try it with me? You can sit on my lap, and we’ll swing together.” The child who is fearful of movement may agree to swing at the playground if he has the security of a loving lap. (Stop if he resists.) Do allow your child to experience unhappiness, frustration, or anger: “Wow, it really hurts when you don’t get picked for the team.” Acknowledging his feelings allows him to deal with them, whereas rushing in to make it better every time he’s hurt prevents him from learning to cope with negative emotions. Do provide appropriate outlets for negative emotions: Make it possible to vent pent-up feelings. Give her a ball or a bucketful of wet sponges to hurl against the fence. Designate a “screaming space” (her room, the basement, or garage) where she can go to pound her chest and shout. Do reinforce what is good about your child’s feelings and actions, even when something goes wrong: “You didn’t mean for the egg to miss the bowl. Cracking eggs takes practice. I’m glad you want to learn. Try again.” Help her assess her experience positively by talking over what she did right and what she may do better the next time. How wonderful to hear that an adult is sympathetic, rather than judgmental! Do praise: “I noticed that you fed and walked the dog. Thanks for being so responsible.” Reward the child for goodness, empathy, and being mindful of the needs of others. “You are a wonderful friend,” or “You make animals feel safe.” Do give the child a sense of control: “If you choose bed now, we’ll have time for a long story. If you choose to play longer, we won’t have time for a story. You decide.” Or, “I’m ready to go to the shoe store whenever you are. Tell me when you’re ready to leave.” Impress on the child that others don’t have to make every decision that affects him. Do set reasonable limits: To become civilized, every child needs limits. “It’s okay to be angry but not okay to hurt someone. We do not pinch.

Do recall how you behaved as a child: Maybe your child is just like you once were. (The apple doesn’t fall far from the tree!) Ask yourself what you would have liked to make your childhood easier and more pleasurable. More trips to the playground, free time, or cuddling? Fewer demands? Lower expectations? Try saying, “When I was a kid and life got rough, I liked to climb trees. How about you?” Do respect your child’s needs, even if they seem unusual: “You sure do like a tight tuck-in! There, now you’re as snug as a bug in a rug.” Or, “I’ll stand in front of you while we’re on the escalator. I won’t let you fall.” Do respect your child’s fears, even if they seem senseless: “I see that your ball bounced near those big kids. I’ll go with you. Let’s hold hands.” Your reassurances will help her trust others. Do say “I love you”: Assure your child that you accept and value who she is. You cannot say “I love you” too often! Do follow your instincts: Your instincts will tell you that everyone needs to touch and be touchable, to move and be movable. If your child’s responses seem atypical, ask questions, get information, and follow up with appropriate action. Do listen when others express concerns: When teachers or caregivers suggest that your child’s behavior is unusual, you may react with denial or anger. But remember that they see your child away from home, among many other children. Their perspective is worth considering. Do educate yourself about typical child development: Read. Take parent education classes. Learn about invariable stages of human development, as well as variable temperaments and learning styles. It’s comforting to know that a wide variety of behaviors falls within the normal range. Then, you’ll find it easier to differentiate between typical and atypical behavior. Sometimes a cigar is just a cigar, and a six-year-old is just a six-year-old! Do seek professional help: SPD is a problem that a child can’t overcome alone. Parents and teachers can’t “cure” a child, just as a child can’t cure himself. Early intervention is crucial. Do keep your cool: When your child drives you crazy, collect your thoughts before responding, especially if you are angry, upset, or unpleasantly surprised. A child who is out of control needs the calm reassurance of someone who is in control. She needs a grown-up. Do take care of yourself: When you’re having a hard day, take a break! Hire a babysitter and go for a walk, read a book, take a bath, dine out, make love. Nobody can be expected to give another person undivided attention, and still cope.

With the most complex brain in the animal kingdom, humans have the most complex nervous system. Its main task is to process sensations. The nervous system has three main parts, working in harmony. One is the peripheral nervous system, running through organs and muscles, such as the eyes, ears, and limbs. The second part is the autonomic nervous system, controlling involuntary functions of heart rate, breathing, digestion, and reproduction. The third part is the central nervous system (CNS), consisting of countless neurons, a spinal cord, and a brain.

hippocampus (Greek for “sea horse,” which it resembles)

revisions in this second edition of The Out-of-Sync Child reflect Dr. Miller’s work. Her wonderful book, Sensational Kids: Hope and Help for Children with Sensory Processing Disorder (Perigee, 2007), explains the terminology in detail.