Chad has been known to me since he was a toddler and his older sister would come to OT and he would wait in the Clinic area with his mom. Having had the opportunity to observe him casually over time, it was not a surprise to me that he was also now participating in an OT program.
What did surprise me was the report from school that he was the “meanest” and the “worst” child they have ever had in their (public) school.
Sensory sensitive to movement with poor figure-ground discrimination, Chad is easily confused in large classrooms. The noise the movement, the rapid changes from one task to another are very unsettling for him to the point of frustration.
Dr. David Burns, a noted psychiatrist and author of the book “Feeling Good” (Avon Books 2000) clearly delineates the path to anger. First comes frustration, then the inability to understand what is causing the frustration, the fear (of the unknown), rigidity of thought, decreased reasoning and then anger.
This is easy to see when the road map to acting out is given the “AAA” treatment. Unfortunately, children do not have the life experiences to “re-route” themselves, so it is up to the adults around them to model these pathways.
Too many classrooms today run on “because I said so” mentality. This is counterproductive for children with sensory issues that already do not process or organize information in typical patterns. Getting reasonable explanations of what, when, why and how to do assigned tasks helps considerably with these children in helping them complete with accuracy required assignments.
It is also beneficial for the teacher (parent, OT, etc.) to let the child know in a gentle manner that this is one of those “new route” times.
This happened recently with Chad. In a conference with both Chad, his mother, his older sister and his math tutor Chad listened and participated appropriately most of the time. The first part of the conversation was Chad providing us with information about what upsets him.
The list was exhaustive but clearly outlined the build up process from frustration to anger:
- Gets the assignment but didn’t understand the directions
- He asks the teacher but the teacher asks a peer to re-explain it to him
- He is still confused but afraid to ask again—thinking the classmate will think he is “stupid”
- So he does the best he can and gets it wrong and the teacher accuses him of not listening” and “not doing his best” (this is last fall back response is a major pet peeve of mine)
- He gets upset and cries and then can’t stop and is sent to the principals office for being “disruptive”
- He gets angry because he feels he is being punished unjustly…and then…
And this cycle repeats itself everyday. Enthusiastic about learning and simultaneously experiencing diminished self-esteem because he “can’t ever seem to get it right”. He also reported experiencing rejection (by both the teacher and the students) and fear of interaction.
Chad should be receiving in school OT 2X a week for 30 minutes each, but the OT quit and services have been sporadic and with various fill in OT’s.
We talked about Chad getting a fidget such as one of these squishy balls where the eyeball pops out but stay attached to the ball and when he feels the frustration building just squish the ball he can do this in his desk away from the eyes of his classmates or keep it in his pocket, etc.
One of those times came up for him during our conference. I told him (he was squishing a balled up damp paper ball) that this was one of those “squish” moments, and just gently taking his hand, he self-calmed and the conversations went on without missing a beat.
Now let’s go back to the dysfunctional road to anger and see if we can re-work it:
|The issue||The behavioral shift|
|1. Gets the assignment but didn’t understand the directions||1. Chad can read it over 2x and highlight exact areas of confusion|
|2. He asks the teacher but the teacher asks a peer to re-explain it to him||2. Prearrange via condition on the IEP that Chad and his teacher will have a system by which she answers his questions directly and not a fellow student.|
|3. He is still confused but afraid to ask again—thinking the classmate will think he is “stupid”||3. If he is still confused he should put the issues that confuse him most on separate pieces of paper.It is also important to reinforce with Chad that he is engaging in a form of “fortune telling” and “mind reading”. He does NOT really know what the other children are thinking and emphasize that most likely they are thinking about themselves; just like he thinks most about himself!|
|4. So he does the best he can and gets it wrong and the teacher accuses him of not listening” and “not doing his best” (this is last fall back response is a major pet peeve of mine)||4. Have the attending OT explain clearly about sensory modulation and that right now this is a skill Chad is learning and as with any new skill there will be days where he “gets it” and days where he needs to “practice some more”.|
|5. He gets upset and cries and then can’t stop and is sent to the principals office for being “disruptive”||5. It should not get to this point but if it does, then ask Chad if he needs some time in the bathroom to “cry it out”—this should be done discretely and not as a classroom announcement. Chad responds extremely well when he feels safe. At times like these the teacher can pull up a chair next to him, take his hand and just keep on giving the lesson. Human touch has been verified and the most healing of all touch and using it for external (teacher OT instigated) calming can be extremely effective.|
|6. He gets angry because he feels he is being punished unjustly…and then…7. P…..O….W!!||6/7. This doesn’t happen, and by slowly working back up this pattern it will over time extinguish itself.|
What has been happening with Chad is that his amygdala has consistently been hijacked by irrational thinking that has led him to incorrect conclusions that in turn provided him with dysfunctional action choices.
Occupational therapy should be focused on his thought processes as well as increasing his tolerance of extraneous background noises and movements. Additionally, OT should help Chad establish fallback action choices that will be acceptable to the school still provide him with both self-calming and relief from frustration. In addition to squishing the eyeball-ball, having a pre-made list of behavior choices he can flip through (3×5 spiral pad) so that he can get in the habit of doing something else before reacting, etc.
Over-reaction to everyday stimulations in typical classrooms can be addressed through structured games and activities that have these distractors built in to them.
Sensory sensitive children are reacting because of one of two reasons; either they see and hear everything blasting away, or they hear and see everything muffled as behind a thick curtain. Either way the “environmental message” is not getting delivered properly resulting in what seems to be, upon superficial glance, intentional, but what is probably a child in survival mode.
It is the job of occupational therapists in addition to treating the child, to differentiate and explain these actions and reactions to the teacher so that the child can be understood and not blamed; motivated instead of being labeled “mean”.
Susan N. Schriber Orloff, OTR/L is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA. She can be reached through her website at www.childrens-services.com or at firstname.lastname@example.org