As I watched this, several images played through my mind like a silent movie: Steven licking the glass on the sliding window...Steven placing his hands over his ears and pressing hard, leading us to believe he could hear aversive frequencies we did not...Steven crawling into tight spaces and remaining there for several minutes until we prompted him to come out...Steven pulling the heavy blue beanbag chair on top of himself, ensuring that every part of his body was covered...Steven attempting to push his head into my knees as I faced him in our two small chairs during instruction...Steven placing his Koosh ball in his mouth, biting down on it, and tugging hard until sometimes it snapped...
The whisper stole up into my consciousness: Steven was seeking specific input from these behaviors. His body clearly needed something. Providing Steven with opportunities to receive these sensory inputs might allow us to reach him again, to pull him up from the abyss to interact with us on common ground. I knew that Steven saw an occupational therapist at a clinic once a week. I arranged to observe him there, so I could give the whisper fuel, make it louder, convince it to tell me what I needed to know.
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Two hours after I set foot in the OT clinic, my whisper had built such volume that it practically screamed at me. I had watched Steven bounce hard on a trampoline while the therapist held his hands and jerked his body up and down in a manner that appeared very rough. To my amazement, Steven was laughing hysterically, and made nearly continuous eye contact with her during this activity. I observed as she conducted joint compressions by firmly gripping Steven's ankle and pushing up into his hip. When it was time for Steven to sit at the table, she placed weighted bean bags across Steven's lap as he searched for trains in a bean bin. He attended for 4 minutes, which was twice as long as our sittings at home.
The most important lesson I learned that day completely contradicted something I had known for years: instead of having five senses, as I had been taught in grade school, we had more! These additional sensory processes shed light on Steven's behaviors:
Tactile Sense: relates to the body's sense of touch. Some children are under-responsive to tactile inputs and may appear to have a very high tolerance to pain. Other children are over-responsive to tactile inputs and may avoid certain textures, resist haircuts, (as Steven did), and become very irritated by clothing tags. Could an atypical sensory system be the reason Steven constantly removed his shoes and socks? His tiny feet were often dirty, and dotted by bruises, scrapes...even a splinter.
Vestibular Sense: involves our sense of movement and gravity. Some children over-react to vestibular input, making swinging or jumping on a trampoline feel scary and aversive. Steven appeared to have an under-reactive vestibular system: he was constantly in motion! Running, jumping, climbing to the very top of the jungle gym...Steven often didn't stop until he fell asleep in his high chair, his sticky fist still grasping the Top Ramen noodles he selectively ate.
Proprioceptive Sense: refers to a person's subconscious awareness of body position. Children with impairments in this sense often appear clumsy and lack fine motor precision. Steven's behavior was inherently disorganized. He was a messy eater, and often failed to get his food into his mouth. Instead, it ended up on the floor, stuck to his chin, or worse, matted into his hair! Steven was also unable to use an appropriate grasp on a marker. Perhaps deficits in this area also explained his desire to squeeze his body into tight spaces...he craved the pressure.
This information would prove vital to my future work with Steven. My whisper, now informed by occupational therapy research, directed me to give him what his body craved. I felt that sometimes he felt as though his skin crawled with an aversive prickle which distracted him from learning and interaction. If I administered the antidote to this affliction, perhaps I would reach him once more, and achieve the elusive connection that I was becoming so addicted to.
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I closed the door to the small downstairs bedroom that served as our therapy room. Steven had bounded ahead of me, and had slid down the carpet-covered stairs on his bottom, all the while shrieking like a banshee. "Eeeeeeee!" It was his happy, albeit over-stimulated sound. As I set up the first activity, I watched as Steven climbed onto the bed, and began to jump on the mattress, hands flapping, hair flying, he jumped harder and harder until I had to stop him.
He protested by whining and trying to evade me, but I caught him in my arms and hauled him to me. I sat on the floor, and sat him in front of me, with his back to my chest. Then, the soft rustle of my whisper directed me to wrap my arms around Steven, and curl his body into a ball. With his back still to me, I gripped his knees, pulled his whole body into mine and lifted him off the ground. I squeezed him, almost too hard, I felt. After 10 seconds, I felt a nearly imperceptible change in his energy level. I immediately released him and then...I waited. Steven took my hands and placed them on his knees, encouraging me to squeeze him again. "More?" I asked. I squeezed again, felt his body give an internal sigh of relief, and then let go. Steven did not move. I felt that I should direct him to the table and observe whether his calmer state improved his accuracy on the current program. As I moved to stand up, I was rewarded once more by the little boy who repeatedly vanished and re-appeared at the whim of his autism.
Steven was looking straight into my eyes. He tugged at my hand and placed it on his knee. Then he brought his chubby toddler hands up into an unmistakable gesture: "More".
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