Overcoming Behavioral Issues: Sensory Processing Disorder (How is Patrick affected?)

As I mentioned on my last post, Patrick was evaluated by an Occupational Therapist, who tested not only his fine and gross motor skills, but also his Sensory Processing Skills. Patrick's evaluation displayed scores in "Some Problems" range with Touch and Body Awareness; "Typical" performance range with Social Participation; and "Definite Dysfunction" with Vision, Hearing, Balance and Planning and Ideas.

Vision and Hearing.
I will start by addressing these areas, particularly "hearing", because it was the first problem we discovered. Since Patrick was only a few months of age, we noticed he was extremely sensitive to loud and unexpected noises. We know some babies are afraid of the vacuum cleaner, for example, but Patrick used to cry totally freak out to noises like the faucet on the bathtub, a blender, doorbell, music or TV that are unexpectedly turned on, animal sounds, and even stuffed animals noises, among many other things. As Patrick grew older, his tolerance to some of these noises got better, however, his over-responsiveness to certain unexpected loud sounds continued and began to concern us.

He was also very afraid of small, fast-moving objects and animals. We thought maybe it was because of his eye disorder. Patrick's eye condition (Ocular Motor Apraxia) make him have difficulty tracking objects moving horizontally. Imagine one year old Patrick seating on the floor, then suddenly a dog comes barking and moving around. Patrick not only can't run away (or even crawl -due to low muscle tone), his eyes also have difficulty tracking the dog's movements. So what does Patrick do? He gets afraid of being attacked without being able to defend himself, so he starts having a panic attack. Perhaps baby Patrick believed stuffed animals could voluntarily move, and that's why he used to be afraid of them, too. This is how my husband and I made sense of the situation, but we didn't know how to help him avoid getting panicked.

When he was almost 3 years old, we talked to his OT about all of this and she was a life saver. We used to grab the doggy (or whatever was making him afraid) and be like "look, it's fine, it won't do anything to you, look, I'm petting it, you can pet it too! Which she told us was an absolute mistake. The thing is, Patrick is in panic mode, his mind is so far away that he won't reason to "it won't harm you". So the OT said we should not force the child to confront his fear right on the spot. Instead we needed to respect his fear, and say "bye talking bear, byeee" and put it away. Eventually he associated the "bye" with taking the scary things away, and so he began to say "bye" on his own to things he didn't want. All we had to do was to listen to his "bye" which in other words meant "take that scary thing away from me" and so we did just that.

It made a whole world of difference. He could be in control of the situation, and he knew we would respect his wishes. If we went to the Zoo, he would be so excited walking towards the animals, but at a certain point he would say "bye elephant" and we just knew we were getting too close to them, so we would stop right there. Any step closer could mean total Panic. We knew it, and he knew it. So we would just admire them from the distance and move onto other animals. As he grows he gets more familiar with them and the distances get reduced. He is just very cautious all the time, but warms up to anything eventually.

Touch and Body Awareness
It took a long time for Patrick to stop mouthing toys and other objects. He was waaay passed that stage, but he continued doing it. Eventually he replaced the objects with his thumbs, and so now he likes to put each thumb all the way back to each set of molars and chews on them while he is watching TV or trying to fall asleep. He is often sticking out his tongue or pushing his lower teeth with it. We know now that it's all about seeking that sensory input in his mouth. We use chewy tubs and seem to help.

He puts a lot of pressure when drawing, and often times doesn't realize the strength in which he pushes, opens, pulls or moves things. He grasps objects so tightly it is difficult to use the object. His hands are always making a fist, not because he is ready to hit someone, but it's just the way he moves around.

His body in general is sensory seeker. He loves standing under the shower just to feel the water in his body. He doesn't sleep unless he has a somewhat heavy blanket on him. Ball pits are his f-a-v-o-r-i-t-e thing in the world. He loves throwing things (and he has amazing aim) so we have plenty of soft balls that he can throw around the house and a jump-o-lene where he can just throw himself and get the deep pressure he wants. Robbie is a tough little guy and his dad of course loves playing rough with them so thankfully Patrick gets ways of satisfying these sensory needs. He loves to be hugged tight, too, and this is definitely my favorite part. =)

Balance and Motion
The vestibular system (located in the inner ear) is in charge of several things such as postural control, perception of body movements in space, gravity, attention, bilateral coordination, ability to cope with stress and auditory-language among other things. His balance and coordination aren't perfect. Heights, uneven surfaces, narrow paths, stairs... all these make him move with extreme caution. He bumps onto things and people often. Patrick can't ride a kiddie bike, and I can already tell it's going to take years before he is able to master that skill. He is much more sensitive and adverse to vestibular input than other kids. This sensitivity contributes to avoidance and hesitation with daily activities that involve vestibular input.

Sometimes it feels like Patrick isn't 100% aware of where his body parts are. If I tell Patrick to touch his cheek, he has no problem doing it. But if I touch my cheek, and ask him to imitate me just by watching me, he may touch the lip, or the forehead, and may take him a couple tries before he touches successfully the cheek. And if I were to cross my left hand all the way to right cheek... well, forget it, he is just going to raise one hand, then the other one, and touch his hair, then try with the other hand, then start all over...

Planning and Ideas
The difficulty in performing the tasks mentioned above are affected also by his struggles with planning and improvising. Patrick often fails to complete tasks with multiple steps and has trouble coming up with new ideas during play or other activities.  Motor planning plays a huge role in the way he approaches things and places. I know he struggles with this. He is not able to put on shoes or dress himself or to even take off his jeans without some sort of help. At first I thought it was just related to his low tone which caused fine and gross motor delays, but now I know it's mostly due to his difficulty planning.

Just to put an example, for awhile I had the Pack 'n Play filled with small plastic balls, so the kids could use it as a ball pit. One day, Robbie (15-18 months old) placed a stool next to the Pack 'n Play, he climbed on to it, and then he climbed into the Pack 'n Play. I was amazed that he had already figured out a way to get in without help, while Patrick (3 1/2 years old) hadn't all that time. On top of this, when Patrick tried to imitate Robbie, he got stuck climbing into the Pack 'n Play. I saw how difficult it was for him to decide which leg had to move first and how, and then what arm goes next... For Robbie there was no thinking, once he was on the stool, it took him a second to jump in. But with Patrick, the movements aren't spontaneous. He has to think it through, and then he struggles coming up with the plan and coordinating his own body to accomplish said plan.

Social Participation
I addressed Patrick's social skills on this post. There isn't much to add other than he recently had few episodes of being very uncomfortable in closed spaces with a lot of people. He also seems to be bothered by routine changes, sometimes with things so simple like placing my purse on the couch instead of the table where I usually put it, or his dad sitting on the right side of the sectional sofa instead of the left side, where he usually sits when we watch a movie. Not sure if these are social participation-related, but one thing I know is that two weeks ago he was having a really rough time being "out there" because of situations like these. He was having meltdowns almost every day and it was difficult on me to see him going through it. I know I was supposed to talk about it on this post, but this is already long enough that I will have to leave it for next week.

Enjoy your weekend!