Meeting Learning Challenges: Working With Children Who Have Perceptual Problems

By Stanley I. Greenspan MD | January , 2000

Perceptual problems aren't ordinarily associated with lowered intelligence. Offer children with perceptual problems practice in areas where they are vulnerable.

I'm concerned about a child in my kindergarten class. While he's warm and affectionate and eager to please, he's not always responsive to directions. His hearing has been tested and found to be OK. It seems odd, though, that while he often doesn't tune in when spoken to, he's super sensitive to high- and lowpitched sounds. For example, when the fire bell rings, he becomes terribly frightened. What could the problem be, and what can I do to help? It can be puzzling for teachers and parents when a child's response to sensations seems so inconsistent. I'll bet it takes several shouts to get this boy's attention, even though he seems unduly sensitive to loud, high-frequency sounds like fire bells, motorized sounds like vacuum cleaners, or high-pitched sounds like violins. Children with auditory perceptual problems have trouble modulating sound-they tune out some frequencies and overreact to others. For a child like this, a cat's meow may seem like a lion's roar. This type of impairment does not show up on ordinary hearing tests because the sound is passing through the child's ear and into the brain. The problem is in the way the child experiences and reacts to it. Another symptom associated with auditory processing problems is trouble sequencing and following a series of directions. While the child is likely to understand it if you say, "Now you have to stand up," he might get confused when your instructions are more complex: "Please stand up now, get in line, wait for me to open the door, and then march slowly out the door into the playground without pushing anyone." Children with processing problems are so easily overloaded with auditory perceptual stimuli that they can't hold a complex sequence of directions in mind. Unfortunately, young children with perceptual problems often appear less bright than they really are because of their difficulty registering words and holding complex instructions in mind. Without a proper intervention program, they may have trouble keeping up in school as they get older. It's important to remember that these problems are not ordinarily associated with a lowered level of intelligence. In fact, a child can be quite bright, a great abstract and creative thinker, and still have problems in perceptual areas. It would be wise to have this child undergo a thorough pediatric exam, including a speech, hearing, and neurological evaluation, to rule out other problems. If it is an auditory processing problem, he'd benefit from seeing a speech pathologist or occupational therapist. Practice Sequencing Short of sending the child to a specialist, there are many simple things teachers can do to help a child who is having trouble with auditory perception. One of them is to give the child extra practice sequencing information. The key is making the practice fun, exciting, and meaningful, so that it doesn't feel like work to the child. Say the child's name is Johnny. As your class gets ready to go outside, turn to him and say: "We're going to go out on the playground, but first, Johnny, I need you to stand up and put up the sign on the wall that says we're out on the playground. Then I want you to go and open the door for everybody and put the stopper behind the door so the door stays open. OK?" Johnny feels honored that he's being called on to do such an important task, and he's eager to go outside, so he's motivated. Even if parts of your instruction have to be repeated, little Johnny is getting the extra practice he needs following directions. You can build sequencing into pretend play and story time too. When setting up for a tea party, ask the child to decide what items he needs to buy, then have him go to the pretend store to buy them. When reading, discuss the story's events. For example, if a character in a book is going to buy a red apple a bicycle, and a new dog, stop momentarily to say: "Gee, if you were going to the store to get those three things, which would you want most? And which would you like second best and third best?"

Holding a Child's Attention Let's return to the problem of sensory modulation-this child's inclination to either overreact or underreact to sound. One way to help him register sound better, especially the human voice, is to animate your voice more. Ask a question as if you really expect an answer. If you fail to see the gleam of recognition in the child's eye that means "I'm getting it," put more energy into it. Experiment with the rhythm, frequency, and tone of your voice. While some children prefer a slow and lower register, others respond more to a high one. If changing the tone of your voice doesn't work, try getting involved in the activity he's using to distract himself. If he's fidgeting with a toy, join in by holding your hand out and saying, "Could I see that too?" If he continues to ignore you, gently put your hand on his and say, "Could we look at that together?" Now the child is bound to respond, either by indicating a "yes" or "no," or by pulling the toy away. Either way, you've gotten his attention. Minimizing Distractions For a child who is oversensitive to high or low-frequency sounds, your job is to protect him from being overwhelmed. If the school has bells that ring at the beginning and end of each day, help a child anticipate the noise by looking at the clock and saying: "Oh, what's going to happen soon? The bell's going to ring. Who wants to hold their ears?" In addition to helping the child recognize the source of his upset, you can show him how to cope with it by talking about it or engaging in soothing relaxation games. Sometimes, when you know that an unpleasant motorized sound is going to start, a child might enjoying listening to music, if it has a rhythm, tone, and frequency he finds relaxing. Related Problem In addition to auditory perception impairment, some children suffer from a parallel problem: visual perceptual impairment. These children might be overwhelmed by bright lights or too much color, or they might be underwhelmed by them; that is, it takes a lot of visual stimulation to get them to look at you or an object. They might also have problems with visual modulation or tracking. Here, as with auditory impairments, the key to helping a child is to offer her practice opportunities in areas where she is vulnerable. Begin by observing how the child uses her vision. How good is she at finding or tracking things? How is her sense of direction? How reactive is she to bright lights or colors? Once you have a sense of her strengths and weaknesses, you can work with her; for example, dim the lights if she's overreactive to them, or play tracking games with her. It's important to help the child see her uniqueness in perceiving auditory and visual stimuli in a very positive way. Children like to work on improving their skills, as long as the skills aren't labeled negatively. It is also important for teachers and parents to realize that young children can overcome these perceptual problems once we understand their underlying processing difficulties and work with them.