"Ho-hum"

The Out of Sync Child explicates the nebulous condition referred to as "sensory processing disorder" ("SPD"). By way of background, sensory processing disorder is not an official diagnosis. Lucy Jane Miller, an authority on the topic, explains:

It's hard to get funding for research because it's not in the DSM, but we can't get in the DSM without the research. It's a catch-22.

The Out of Sync Child sets forth the three general profiles of children with SPD:

1. Sensory Overresponsivity: The Sensory Avoider - "Oh, no!"
2. Sensory Seeking: The Sensory Craver - "More, more!"
3. Sensory Underresponsivity: The Sensory Disregarder - "Ho, hum"

Brad fits the "ho, hum" profile (described in detail below), almost to a tee:

The child reacts less intensely to sensations than do typically developing children. This sensory disregarder needs a lot of stimulation just to achieve ordinary arousal or alertness. His response to the world is "Ho, hum."

The child may be withdrawn and difficult to engage. Or, he may be so gifted and creative that he does not notice sensory stimuli because he is self-absorbed and preoccupied with intellectual pursuits. Determining the underlying cause of a child's problem is essential, and a therapist's art and science are required to figure it out.

The sensory disregarder may apper to be a "space cadet" or "out to lunch." He may be passive, lack initiative and unable to get going. He may tire easily and seem sleepy, and as a baby, he may have slept and slept and slept.

Source: The Out of Sync Child, p. 72

Underresponders often have sensory-based postural disorder, described below:

Postural Disorder causes the child to have poor posture. She may have low musle tone and be "loose and floppy." She slouches while sitting or standing and slumps over the desk and dining room table. This droopy child is beseiged by the "gravity monster." The reason may be the inefficient sensory processing of vestibular and proprioceptive sensations about where her body is in space and what it is doing.

According to Dr. Ayres, "The major symptoms manifested by children with this type of dysfunction....are related to the fact that man is a bilateral and symmetrical being." When a child has not developed a sense of two-sidedness, Postural Disorder may interfere with nature's plan, which is to keep upright and ready to spring into action, using both sides of the body together or separately as needed.

The child may have a problem with bilateral integration, the neurological process of connecting sensations from both sides of the body. The result is poor bilateral coordination, the ability to use both sides of the body together. For instance, she may struggle to gallop, skip, or pedal a bicycle.

She may have difficulties positioning her body and maintaining her equilibrium. Getting into different positions, such as kneeling or stretching to her tiptoes, without tipping over may also be a challenge.

Often the child will have poor ocular (eye movement) control, affecting binocularity - the use of both eyes together as a team. This will hinder depth perception, body movement, motor planning, and reaching for objects.

Source: The Out of Sync Child (pgs. 75, 76).

Brad presents with the symptoms of postural disorder, although I did not notice them until a skilled occupational therapist brought them to my attention. He has weak trunk strength and he's floppy. However, these symptoms have decreased with therapy. (He receives occupational therapy three times per week, and we do daily exercises.) He still drools. No sign of pedaling, although he is only 2.5 years old, so that may not be significant. His bilateral coordination is weak, as evident when he completes a puzzle or the shape-sorter.

As an aside, perhaps the apple doesn't fall far from the tree. I have terrible depth perception, and low muscle tone. (Of course, I haven't been to the gym in a decade but that's a different story.) However, what ever sensory issues I have never interfered with acquisition of language, as I believe Brad's issues are.

So I think the "ho-hum" label is a keeper for Brad. After all, I've never been one to avoid a label or the doctors/therapists that apply it.

Is your child "ho-hum"?

Brad on film.

Brad's SLP is filming him today. She's taking a class on Floortime, and he's her case study. We're just happy to help her in any way we can, after all she's done for Brad.

Progress Report, By the Numbers

Brad at 24 months
Per Early Intervention -

Receptive communication: 10 months
Expressive communication: 14 months

Brad at 31 months
Per Mullen Scales of Early Learning, administered by Brad's developmental pediatrician -

Receptive communication: 30 months
Expressive communication: 35 months

Bottom line
Receptive language: 20 months improvement over 7 months.
Expressive language: 21 months improvement over 7 months.

(Wow!)

Brad having a conversation.

Stability of PDD-NOS, Part II: Analysis

Peer-reviewed, published research indicates that children diagnosed with autism spectrum disorder at an early age can later go on to lose the diagnosis. For example, this study reported that 19% moved off the spectrum. The abstract lists three possible reasons for such movement:

1) True improvement based on maturation,
2) Intervention, or
3) Over-diagnosis at age 2.

The merits of these reasons is the source of much debate. In this regard, let's examine the public remarks of Professor Camarata, the controversial doctor whose research provides support to Einstein Syndrome author Thomas Sowell and shock jock Michael Savage. In a published article, he states:

The broader question is how one can tell if a child has mental retardation, autism or other pervasive developmental disorder, or language disorder-or will simply "grow out" of the problem. [Emphasis mine.]

Camarata doesn't appear to allow for the possibility that an individual can have a pervasive developmental disorder and grow out of the diagnosis. He phrases it as an either/or proposition.

But when we consider these studies in the aggregate, is it even plausible to source all of this movement off the spectrum to "over-diagnosis at age 2" or misdiagnosis. After all, each of these children were formally diagnosed (probably videotaped), and the results of the research were peer-reviewed. Is it even plausible that the researchers conducting the studies were guilty of sloppy diagnostics?

This blogger believes that the first reason - true improvement based on maturation - is the likely source of movement off the spectrum. I believe that the subjects legitimately met the DSM-IV criteria for PDD-NOS at age 2, and later grew out of the diagnosis. This belief is corroberated by the research, as well as my anecdotal experience.

Edited 09/24/2009