Posts made in November 2010

Autism/PDD or a Sensory Issue: suggestions for making a clinical decision

Autism as a sensory issue is very tricky, so many things over lap and intertwine. The classic indicators seem to almost be the same.

In fact, I really hold to the opinion, that the two diagnoses are irrevocably meshed.

Having said that , however, there nonetheless remains a need to differentiate between these two distinct issues.

The two lists offered here are to help illustrate just how careful we need to be in suggesting parents further investigate clinically observed behaviors. I also suggest that clinicians use these lists as informal checklists as part of their parent in-take process or in the course of therapy as needed.  I advise making this into one list but keeping the items separated, and then note which items from the two categories are most noted.

The suggested items* for each issue is listed below: (*complied from various sources)

Sensory Integrative issues may be characterized by:

  1. Either be in constant motion or fatigue easily or go back and forth between the two.
  2. Withdraw when being touched.
  3. Refuse to eat certain foods because of how the foods feel when chewed.
  4. Be oversensitive to odors.
  5. Be hypersensitive to certain fabrics and only wear clothes that are soft or those they find pleasing.
  6. Dislike getting his or her hands dirty.
  7. Be uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator.
  8. Have difficulty calming him or her after exercise or after becoming upset.
  9. Jump, swing, and spin excessively.
  10. Appear clumsy, trip easily, or have poor balance; odd posture
  11. Social skill issues/authority issues.
  12. Tantrums
  13. Overly sensitive to criticism
  14. Either always on the go or very sedentary
  15. Memory difficulties and/or problems following directions
  16. Have difficulty handling small objects such as buttons or snaps.
  17. Be overly sensitive to sound. Vacuum cleaners, lawn mowers, hair dryers, leaf blowers, or sirens may upset your child.
  18. Lack creativity and variety in play. For instance, your child may play with the same toys in the same manner over and over or prefer only to watch TV or videos.

While Autism and or PDD issues may be characterized by:

  1. Insistence on sameness; resistance to change
  2. Difficulty in expressing needs; uses gestures or pointing instead of words
  3. Repeating words or phrases in place of normal, responsive language
  4. Laughing, crying, showing distress for reasons not apparent to others
  5. Prefers to be alone; aloof manner
  6. Tantrums
  7. Difficulty in mixing with others
  8. May not want to cuddle or be cuddled
  9. Little or no eye contact
  10. Unresponsive to normal teaching methods
  11. Sustained odd play
  12. Spins objects
  13. Inappropriate attachments to objects
  14. Apparent over-sensitivity or under-sensitivity to pain
  15. No real fears of danger
  16. Noticeable physical over-activity or extreme under-activity
  17. Uneven gross/fine motor skills
  18. Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

And, as illustrated here, it is easy to see, especially in very young child (ages 2-6) how these behaviors can be dismissed as “they’re young, they’ll grow out of it.” And making broad statements, suggestions of referrals to other sources, etc.,  may be very frightening to parents, especially if they have been trying to tell themselves that the nagging feelings they have been experiencing is due to being an “over-protective mother”.

A psychologist who refers to my practice once counseled me about informing parents of issues with their children. She said, “…the first person to tell them gets shot, the second shoved and the third gets listened to. Try to be number 3.”

In our position as occupational therapists, we are often put in the role of being “number one”. Being the resource person in the schools, the first referral source of pediatrician, the person known in the community for what we do, etc. puts us in the precarious position of saying first to a parent, “there is something that needs to be investigated”.  I hope that the use of these lists when converted into a check- list will help guide both our families and us in the quest to provide empathic quality care.

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 or at GOOD for your Brain!!

Doodling:  bane to teachers—a boost to the brain

I went to “teacher school”; even was one for a while.  And I have to say unequivocally that there was no information about how a child learns—just what they should learn.

I guess that is why I became an occupational therapist.  I needed to know what was going on “inside” not just the outside—looks as they say, can be deceiving.

And so it is the case of “doodlers”.  Admonished for “not paying attention” they are often made to feel belittled and self-conscious about something they really do on “auto-pilot”.

Recent research has shown that doodling actually helps learning!!  The child may not look like he or she is paying attention but science says otherwise.   In findings published in Applied Cognitive Psychology (2009) test subjects who doodled while listening to recorded messages had a 29% better recall than those who didn’t.

The article goes no to state that, “If someone is doing a boring task, like listening to a dull telephone conversation, they may start to daydream,” study researcher Professor Jackie Andrade, of the School of Psychology at the University of Plymouth, said in a news release issued by the journal’s publisher. “Daydreaming distracts them from the task, resulting in poorer performance. A simple task, like doodling, may be sufficient to stop daydreaming without affecting performance on the main task.”

Various articles on associative memory contend that doodling can boost retention up to 50% for immediate recall.  In other articles there is information that doodling actually helps the learner “opt-IN” to discussions by enhancing recall invigorating multiple neural pathways.

Science is giving a new slant on doodlers, fidgeters, and, Heaven forbid—whisperers!!  Reprimands from teachers (and even bosses) may soon be a thing of shame to them NOT to the “culprit”.  “Pay attention”, “Are you listening, I will not repeat myself” and “Am I bothering you?” and similar phrases are more than inappropriate, demeaning and harsh—they scientifically wrong.

TIME Magazine (Feb. 2009) states a study that defines the benefits of doodling very simply.  It prevents daydreaming.  Daydreaming tends to trigger the brain to recruit other networks that shift your attention to other things so you cannot focus on the tasks at hand. Doodling does just the opposite; it keeps the motor running so the brain can focus. And historically we have had some rather impressive doodlers:  Winston Churchill, John F. Kennedy, Franklin D Roosevelt, John Keats and Bill Gates to name a few.

Other studies support that doodlers tend to be more organized than their non-doodler counterparts. Doodling, it is reported, actually helps clear the mind by relieving stress and aiding in relaxation. So what is the problem?  Obviously with the people that doodling seems to upset. (Teachers??)  “Paying attention” in class usually means sitting up straight, feet on the floor, not touching anyone else and eyes on your work or the teacher.

Research has a different slant on doodling. Similar to the analysis of dreams, the inspection of doodles can actually create a better understanding of how a mind works. It is the connection between the conscious and unconscious and that is where we learn. Rather than a distraction, doodling can assist in triggering many major routes for us to store information into long-term memory.

Margaret Livingstone, a Harvard University neurophysiologist writes in her book, “Vision and Art: the Biology of Seeing” that art is a “spin-off” of our brains visual system and this connection cues neurons.  Not only does it help us pay attention, it also helps our mind wander into unimagined areas stimulating associative thinking aiding in symbolic expression.

What is known about doodling is that it increases arousal in the brain and forces it to use up just enough energy to STOP it from daydreaming.  Doodling seems to stimulate the right side of the brain that mediates visualizations (reading and writing) leaving the left side (information gathering) to relax and absorb information more readily.  Both sides together allow the person to synthesize the total concept being presented.

Encouraging doodling may be a route to increasing attention in class.  Wouldn’t it be amazing if  “Increase doodling while listening” became an IEP goal?

Susan N. Schriber Orloff, OTR/L, is the author of Learning Re-enabled, a guide for parents, teachers and therapists and Write Incredibly Now™ 12 hours to better handwriting.  She is the Executive Director of Children’s Special Services, LLC, in Atlanta, GA. She can be reached on the Web at  Her WIN™ program is available through

How to pick a preschool and why

For some very young children, preschool is NOT the answer.  Some kids just belong at home a little longer.

Now as an “always” working mother, I more than “get” that you have to go to work and the kids have to be somewhere and not everyone can afford in-home care.

But keep in mind that the early learning experience can have long-range impact on the young child. Because this is often the first time that they have been away from home without a parent, finding the right experience is crucial.

Choices for this are often chosen for reasons ranging from: geographical convenience, social (this is where my friends take their children), religious, cost, physical appearance.

While all of these issues are important the list needs to also include:

  1. Experience of the teachers
  2. School certifications
  3. Philosophy of the school
  4. Size of the classrooms
  5. Number of classes per age group (are there smaller classes for children that might need modifications in the general program)
  6. On-going continuing education for the teachers
  7. Frame of reference for age/class specific curriculums
  8. Structure of the school (level of classroom structure and flexibility, is it experiential, etc.)
  9. Classroom facilities
  10. Extra-curricular experiences available (foreign language)
  11. Outside consultants (OT/Speech, Nutritionist, psychologist)
  12. Accommodations and modifications for the child with early learning needs

These issues become even more important when you are selecting a school for a child with special learning concerns.  This is where the occupational therapist is often engaged to help the parent make specific decisions that are essential for a successful early learning experience.

Helping find the right place is two-fold: it must fit the child and it must fit the parents.

Evaluating the home philosophy is as important as the evaluation of the child.   A child from a family that is “democratic” may not do well in a structured school. And conversely a child from a very structured home may be lost in a loosely defined atmosphere.

If your child has been asked to leave a preschool setting the first impulse is to be defensive. But step back a minute and think, “was this really a good match?” Usually the answer will be “no”.  Figure out why before picking the next setting.  

Maybe some testing might help you get to the right decision.  Or maybe an alternative setting might be just the “ticket”.  For more information log onto “The Modified Developmental Preschool” at