Post #3 in category. We recommend reading posts in numerical order.
Early sensorimotor responses in infancy are largely automatic, quick, reflexive and bound to the present moment. They are more related to survival than to understanding. Only when these sensations are stored, compared, and integrated with other experiences do they become flexible enough to support language, reasoning, learning and intentional action.
Infant and early childhood sensations are immediate and can be powerful. Sensory and emotional regulation and higher cognition reach downward, shaping what is felt by the child, and how it is perceived and interpreted. This top-down influence is one of the primary tools we use in helping children learn to move, attend and act with purpose.
Sensation and Movement
The infant’s earliest movements are governed by reflex, grasping, sucking, turning toward touch or sound. These inborn reflexes are scaffolds, “clothes hangers” on which later more voluntary actions are hung. For movement to become intentional, the child must develop appropriate arousal and sensory attention to relevant stimuli and persons, and to reliable proprioceptive feedback. Sound, sight, touch, feelings and motivations are woven together into coherent meaning and purposeful actions.
Ian was three years old when he was first observed during a Parallel Assessment process. He had been previously diagnosed with PDD. When his mother called his name, he did not turn. When food was placed near him, he did not reach for it. According to his parents, he was not able to do things other children far younger had already mastered. He was passive, did not pay attention and had few coordinated movements. Because of this, he was always spoon-fed. His parents assumed he was incapable of feeding himself.
Some families avoid encouraging self-feeding not only because of perceived incapacity, but because of the mess, hands, face, clothes, floor, walls. Others hurry the process, wanting meals to be efficient. For families of children with disabilities, there is often an urge to provide total care, as an expression of sympathy, of love, duty, and a lack of belief. “He needs us for everything.” “We will do everything we can to protect this child so he does not suffer.”
Ian did not respond to adult speech. He did not orient when his name was called. His hearing and auditory discrimination had never been properly assessed. He had never been seen by a developmental pediatrician or pediatric neurologist. His parents were told by their family physician, “there was no cure, and he would probably always remain an infant.” His family saw so little progress over the last few years that they assumed he was not able to learn or to progress further.
Ian remained strikingly passive in most exploration, interpersonal or self-help activities. One of his new mediators observed Ian and his parents for a while and then began sitting on the floor near him, gently inviting him to move toward her, helping him to sit in her lap.
Then, several sessions later, helping him to climb over her outstretched legs to reach the other side, helping him to learn the movements involved, to connect with this safe and encouraging mediator, to understand and to follow requests, to learn that he could overcome obstacles, that he could indicate he needed help, and then together they could succeed. These were not exercises in obedience, but invitations into attention, purposeful movement, into shared space and into a shared relationship.
Regulation and Avoidance
Neurotypical infants are not helpless sponges of sensation. They come equipped with ways to regulate what enters their nervous system. They close their eyes, turn away, avert their gaze, cover their ears, stiffen, pull back, or avoid touch. These are not signs of defiance but of self-protection. Some children show reduced vigilance. They do not respond to sounds or voices; they turn their faces and bodies away. They appear passive. When avoidance fails, distress appears, crying, anger, and sometimes aggression. This is especially true for infants with low tolerance for stimulation.
During Ian’s ongoing Parallel Assessment, careful attention was paid to:
- His baseline level of arousal and alertness, usually quiet, still.
- How modifiable was his arousal, attention and intentional action with proper mediation?
- What are his current sensory processing skills, preferences and biases: auditory, visual, tactile?
- His current motor skills: balance, range of motion, strength, endurance, coordination, functional mobility?
- Ian appeared to ignore or to avoid sensory input. Did not scan his environment. Did not explore. Did not respond to verbal requests. Why?
- He indicated he was hungry or thirsty by crying, squirming and becoming fussy and stiff.
- He seemed extremely passive and withdrawn? Little sense of agency.
- He showed no signs of social referencing or shared attention.
Several hypotheses were considered. Was he healthy? Perhaps sensory input did not arrive clearly. Maybe certain sensations were not pleasant or rewarding, or not meaningful, or even painful. Maybe his sensory connection to his world was chaotic, distorted, disorganized, or too intense or too weak. Were there hypersensitivities to light touch, to bright light, to sudden or loud sounds, to certain pitches, to fast-moving objects, dizziness, or balance challenges? Some children dislike hugs. Some pull away when others enter their personal space. Some cannot tolerate “in-your-face” interactions. Maybe there were disruptions in functional connections between his sensory input and his motor responses. Maybe unformed, ineffective infant reflexes did not serve as essential prerequisites for more intentional actions? What initial goals should be targeted?
Goals and Domain Interaction
A complete medical evaluation with a skilled developmental pediatric neurologist was scheduled.
In the meantime, a major goal emerged: to increase Ian’s thresholds of tolerance for different kinds of stimulation. Sensory thresholds are not uniform. A child may tolerate spinning objects but not human gaze. Some children have extremely low tolerance for human stimulation, including direct eye contact, but very much enjoy having weighted balls rolled across their arms, back, legs or even stomach. Some cannot tolerate light touch, but crave deep, heavy pressure. We had to see what Ian tolerated, what he liked and what he did not like.
Sensorimotor regulation is never merely physical. How arousal is managed affects emotional states, excitement, tension, anxiety. Daniel Stern wrote that mothers try to expand their infant’s tolerance for arousal, stretching their world gently. Not toward a perfect constant state, but toward flexibility, the growing ability to adjust to self, to others, and to their environment.
Parallel Assessment for Ian included a close study of context. Which environments, interactions, and adult styles created tolerable stimulation? Which allowed and encouraged more communication, collaboration, and learning? Which environments, opportunities and mediation taught Ian how he could better regulate his own sensory world?
With trusted and sensitive mediators, some neurodivergent children with sensory defensiveness even enjoy a certain amount of rough play, being swung, lifted, and turned upside down. The question is not what is “normal,” but what is tolerable, meaningful, and growth-producing for this child.
After three weeks of daily interventions, Ian allowed, and even smiled and laughed, and did not want to stop these rough-play activities with the one trusted mediator who had begun by slowly, sensitively learning who Ian was and what he could be.
From barely being able to sit in her lap or crawl over her legs, to joyous rough physical play and purposeful crawling and “cruising” (side-step walking, supporting himself with furniture) to reach a desired object on a shelf, in two months.
The Adult’s Role
Parallel Assessment examined the match between the child’s stimulation level and the mediator’s style. Some adults were overly responsive, overly animated, overly controlling, constantly redirecting, and constantly interrupting what the child was already attending to. They were well-intentioned. They tried too hard to capture Ian’s attention, to teach, to help. But when the adult’s needs become the measure rather than the child’s felt experience, Ian’s attention, collaboration and learning suffered.
The best judge of Ian’s over- or under-stimulation was his response and non-verbal communication. His facial expressions, his slight gestures. Was Ian interested and engaged with what his adult mediators were doing or trying to do? Was Ian enjoying the activities, the social connection, the feedback? Was Ian trying, persisting, attempting to overcome obstacles? Did it seem like his mediator was over-mediating or under-mediating? Did the mediator believe in the child? Did they underestimate him? Were they confused about what to do and how to do it? Were they desperate or frustrated?
In Ian’s case, some mediators repeatedly overstimulated him. They called his name again and again: “Ian, Ian, look, look here.” They made silly noises, exaggerated smiles, spoke faster and louder, moved closer as he withdrew, escalating enthusiasm the more he avoided them. Some mediators took phony deep breaths to trick Ian into thinking something important was happening.
In an almost obsessive way, some of his mediators, teachers, therapists, repeatedly said, “Ian, Ian, Look. Good job, good job. Good job Ian,” even when Ian made no attempt at an action and turned away from them. Some adult mediators became louder, faster, closer, more determined, more in his face, more desperate, precisely what he could not tolerate.
His mother often held him from behind like a puppet, moving his legs with hers as they walked, thinking she could walk for him. But by this time Ian could walk, but it was unsteady and not always where or when she wanted. She increased her volume and commands when he resisted. She often put a spoonful of pudding in his mouth while they were trying to walk together to reinforce her directions.
When children stare into space, appear aloof, have seizures, or engage in self-stimulation, adults may feel compelled to over-engage, to over-encourage, or to pull the child back from their behaviors by force of voice, command, touch or force.
Many of Ian’s mediators tended to be either overly or under sensitive to Ian’s feelings or current skills level, or levels of understanding or willingness to cooperate. They often began teaching at too high a level without first co-constructing the necessary prerequisite feelings, motivations, behaviors, understandings and communication.
Ian’s parents, grandparents, teachers, and therapists were desperate for his progress. Their intentions were good. But they lacked tools for making interactions slower, safer, more interesting, more pleasurable. They struggled to create the right atmosphere, to select the right joint activities, to judge Ian’s current comfortable time on task, preferred proximity with his mediators, or pace. They did not yet understand or feel how their actions and the current environment were perceived by Ian.
There was too little patience, too little planning around prerequisites for relationship building, unsuccessful motivations using meaningless, pressured verbal commands, stereotyped verbal cues and food reinforcers, and too little real connection and collaboration. Too often, Ian’s signs of distress were missed until he had already crossed his tolerable limits.
One mediator truly learned to read him. This mediator adjusted herself, her pace, her voice, her distance, her expectations, her plans so she could enter Ian’s world, so he could enter hers. Through this quality interpersonal relationship, this partnership in development, Ian began to grow, to engage, to thrive.
His progress showed what was possible and suggested what might have been achieved if his entire team had learned to see Ian not only by what Ian did, but by who Ian was and who he could become. And to see themselves and their mediated relationship with Ian and make the appropriate changes.
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