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Should
You Request a Sensory Integration Evaluation for Your Child Adopted from
an Institution?
By Harriet McCarthy
When to seek an sensory integration evaluation
for your adopted child.
There are some who feel that every child coming from an institutionalized
background would benefit from a Sensory Integration evaluation by a certified
Occupational Therapist. I agree with them. My understanding of this need
comes from my on-the-job training with my two sensory disordered Russian
boys, from books, medical periodicals, and on-line classes which explore
the effects of childhood trauma. It also comes from a wealth of anecdotal
information shared on the PEP-List (Parent Education and Preparedness)
at our EEAC website.
An evaluation for sensory issues is as important as an evaluation for
developmental issues in newly arrived children, and I have always recommended
a scheduled appointment with a Developmental Pediatrician be made as soon
as possible. An additional evaluation by an occupational therapist trained
in sensory issues is well worth the modest price and a little more of
your time.
The more I learn about trauma, abandonment, institutionalism, neglect,
abuse, helplessness, hopelessness, rejection, malnutrition, and prematurity
- and what their effects are on a child's brain - the more I understand
why so many of our PI (post institutionalized) children have mild to grave,
often pervasive sensory issues. These abnormalities present themselves
as hearing problems such as central auditory processing disorder, vision
problems like amblyopia and partial blindness, or oral sensory issues
which cause feeding and swallowing problems or lack of proper sucking
and chewing skills. A child may have an over sensitivity or under sensitivity
to smells which can cause reactions ranging from an overactive gag reflex
to the refusal to eat. It is sensory problems that cause the difficulties
with tactile sensations -some children crave too much and crash, twirl,
press, or spin into everyone and everything - some children avoid it and
refuse to be touched at all, acting-out inappropriately or recoiling in
panic when someone or something gets too close.
Misdirected sensory cues cause a number of problems. They can keep a child
from sitting or standing still, prevent a child from understanding what
you are saying to them, cause speech abnormalities, gross and fine motor
problems, dyslexia and learning disabilities, and passive, regressive,
or aggressive behavior. They may cause eating problems, which keep a child
from ingesting enough nourishment, or cause them to gorge on anything
and everything. They cause sleep and toileting disturbances. Quite frequently,
processing problems aren't simply one-dimensional but multi-layered, affecting
several dynamics of a child's perception.
All this sensory disorganization has to do with the brain's chemicals,
the hormones they produce, and the effects of those hormones on the child’s
ability or inability to accurately process the sensory input of touch,
movement, taste, sound, smell, and sight. In an institutional setting,
many, if not most of these sensory components, are missing or diminished.
Orphanages are quiet places. Often the light is very dim and auditory
and visual stimulation is at a minimum. Children don't get the opportunities
for enough movement or touch. There is very little variety in diet, much
of it is soft, and often there is barely enough food to keep a child adequately
nourished. Extra-large holes in bottle nipples speed up the feeding process,
but never allow the development of good sucking skills. Interaction between
children and/or between children and caretakers is minimal. Beyond the
orphanage window is a very small, circumscribed, unchanging picture of
a world waiting to be explored by children who have no opportunity to
do so. Normal cycles of need aren't rewarded with comfort. Lack of stimulation
in all these sensory areas interrupts production of the beneficial hormones
needed for a state of calm - hormones which are released when children
feel a mother's gentle touch, see the warmth and approbation of her smile,
or sense the safety of her fierce protectiveness. Instead, high levels
of stress hormones flood the brains of these confined children who have
rotating caretakers, causing different neural development than that which
is normally seen in healthy, nurtured children. The deficits and atrophy
these high stress hormone levels create cause a child's perceptions to
be processed in a distorted manner. Under these circumstances, it is easy
to understand why a child would be very frightened, confused, or overstimulated
after institutional care.
The good news is that the brains of most children from institutional settings
are plastic enough throughout childhood to be healed and made whole, even
when considerable damage has taken place. It takes work. Most of the time
it takes some therapy and early intervention. It always takes time, patience,
gentleness, kindness, and understanding. First, we must learn to recognize
a sensory disordered and frightened child when we see one. New parents
need to learn how to calm that frightened child, and that child must learn
to accept a state of being calm within his or her new surroundings. Once
a state of fairly normal equilibrium is reached, stress hormones sufficiently
reduced, and the fight or flight response moderated to low levels, young
brains will begin to perceive the world differently - less threatening
and more bearable. With time, the appropriate stimulation and retraining,
these children can begin to process sensory input in normal or near normal
ways, and the potential for a happy and complete life for that child is
possible.
Consequently, if you are wondering at all about an Occupational Therapy
evaluation, get one. Because these sensory changes happen deep inside
the brain, they are invisible to the outside world except for the effects
of their devastation. These abnormal processing issues are often very
subtle. It takes a trained expert to see and evaluate them correctly.
Although there are many excellent resources on the subject of sensory
integration, and parents are certainly encouraged to learn all that they
can, this is not a do-it-yourself project for you and your child. What
looks absurdly simple in the orchestrated play of the Occupational Therapy
setting is actually the end result of an extremely complex discipline
which takes many years and a specialized degree to master. The competent
occupational therapist can and will give you ideas for a sensory “diet”
to work with at home, but the direction and focus of the therapy will
be accomplished best within a clinical setting.
If you suspect your child may have sensory issues, the earlier you have
an expert evaluate your child, the better off he or she will be, and the
sooner you and the therapist can start to reverse any damage that may
already exist. A multi-sensory evaluation is another issue to consider
seriously along with all those medical and dental exams, all those tests,
re-tests and re-inoculations. Have your child evaluated by a good Occupational
Therapist trained in Sensory Integration theory and therapy techniques.
It may ultimately make life much easier for you, your child, and for your
entire family.
Copyright © 2001 By Harriet McCarthy. All rights reserved.
Harriet McCarthy was the list administrator
of the PEP L list for parents who have adopted from Eastern Europe to discuss
the issues involved in parenting post-institutionalized children. She is
the mother of three children adopted from Eastern Europe. |
