Does this sound like Sensory Integration Disorder?

[jlo]

Hello,

I previously posted a question here ("How to handle toddler's phobia of other children?")a while back. Thank you for your reply.

Since that time, my 3.5-year-old son, who had seemingly developed a serious phobia of other children when he was 9 months old, was given a PPD-NOS dx by a child psychologist in May. At the time, I felt that there were some aspects of PPD that fit my son, especially the social deficit areas, but in many other ways, not really. He has no "obsessions"--he has things he likes to do (examples are to play football or pretend to drive our cars), but he is able to make transitions between activities with no real problems. His speech eval came back advanced for his age. He suddenly is very interested in numbers and letters and is teaching himself to read short words and learn numbers beyond 100 (completely self-motivated, although we do read to him a lot). He is very social (appropriately so) with adults and older kids. He has good imagination and pretend play. He's potty trained. He's doing great in so many areas. In fact, a 2nd psychologist that we saw this month is not at all convinced of the PPD dx.

So what's the problem? He is still almost paralyzed with fear when it comes to certain social situations. We enrolled him in a music therapy class and a social skills class with 3 other little boys when he got the PPD dx. These were the first times he had been separated from us in a classroom setting, and he has been doing well--still shy, but making better eye contact and initiating questions to the other kids sometimes. However, if the kids are playing in the gym (running around him), he really seems overwhelmed. He also cries very hard every time his baby sister cries, and also when he hears a child crying out or angry in public he gets very upset. He worries excessively that his sister will cry, and so he spends time trying to make her laugh. When she's happy, he like to be around her, so I don't think it is a sibling/manipulative thing, esp. since he has been this way for 3 years.

We had a few OT sessions, but the OT seemed at kind of a loss as to what to do, since he seemed fine every time we were at her office. We have been doing therapeutic listening, and it seems to be helping a bit. I guess my question is: could this be SID rather than PPD? Some other things that make me think this are: he hates tags in his clothes; when he was younger he like to roll around in blankets and crash into things like sofa cushions; he was extremely sensitive to sunlight as a younger child. If he is visually and/or auditorily hypersensitive, what else can we do? It is really hard to imagine him being able to be in a regular (noisy) preschool class next year, which we would like to be able to do, and although he has so many strengths, it is still very hard to go anywhere in public that has other children (i.e., almost anywhere) without having it end in hysterics.

Thank you for your thoughts.

[Kevin Kennedy, Ph.D.]

His symptoms are not typical of most children with PDD, though there is avery wide spectrum covered by that disorder. And the two don't have to be mutually exclusive. It does sound like he displays some tactile defensiveness and some auditory sensitivity. These possibilities would have to be pinned down via an OT evaluation (which can be difficult at such a young age). The social skills class, and almost any structured small-group experiences, will be useful. Often the best remedy is literally practice - that is, the opportunity to be around peers in a relatively quiet and non-threatening situation.

[CSkill]

I agree very much with the earlier comment. I'm also curious about his speech, because his ability to communicate goes along with these and other developmental issues. Does he have a comparable vocabulary to other children around his age, and how does he communicate his needs and feelings to you?
His developement of some social skills is a good indicator of future progess. His progress in potty training & reading are also convincing of future progressions. From your description, he sounds very sensitive in many areas. I would focus on this. Expose him gradually and keep it slow and comfortable.
I hope this helps.

[jlo]

Thank you for the comments. My son's speech developed normally, with words, phrases, and sentences coming right on time. When we had him evaluated in the spring (at the time he got his dx), we weren't really worried about his speech. Then after the dx, we started to wonder if maybe something was wrong, because he would repeat phrases and parts of videos and books that he liked. Hoever, it was nearly always in the context of "playing pretend"--for example, when he wanted to be the Cat in the Hat--and his spontaneous speech was fine. Over the summer, his speech and thought processes seemed to blossom even more, so he seems right on target. Around other kids though, he is very quiet and has had to be encouraged to use a "big boy voice" in class.

If you don't mind, a quick follow-up on behavior management...At home, if he cries when the baby cries, we've been leading him to the "calm-down chair" and telling him that when he has calmed down, he can get down by himself. Nothing punitive--I don't want to make him feel bad if he really can't help getting scared. We've just started being consistent with that, so we'll see if it decreases the crying. I don't think he can help his initial fear reaction, but sometimes he's still carrying on when the baby stopped crying 5 minutes ago. It gets a little purposeful, in my opinion. Out in public, though, I'm at a loss. I feel like I am constantly having to manage his environment, because I can't control how quickly other parents can get their kids to stop yelling or crying, and once my son starts crying, he will just go on and on. Any ideas on how to handle this? It seems like a tantrum; should I treat it as such? He doesn't do this in any other area of his life--he's pretty well-behaved.

[CSkill]

The "calm down" chair sounds like an appropriate action.  It also sounds like you have a great handle on the sitations at home. It is quite relevant how you mentioned the specific places his behaviors are exhibited. A requisite of managing behavior for children in educational settings is narrowing down the problem to when and where it occurs. Then, perhaps, you can figure out why its happening at all. It sounds as though you have these components uncovered. You seem to notice the antecedents to the tantrums/crying fits (Is that how you would desribe them?) The reason I wondered about his speech development, namely his ability to communicate his feelings, is that I wonder what would happen if you simply asked him (perhaps right after the fact, when you got home, etc.)WHY he got so upset. For example, "I notice you heard those kids screaming across the hall. It seemed to make you very upset. Why?"
I wonder what his response would be. In addition, when you remove him from the problematic situation, how long does it take for him to "come back"? Is he ever consolable?
Your son seems to have many endearing and promising qualities. I wish you the best.
Again, I hope this helps.