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The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction
By Carol Stock Kranowitz, M.A. New York: Skylight Press, 1998, 322 pages, $14.00.
Carol Stock Kranowitz is a music and movement teacher for pre-school children who noticed that some of her students became anxious and unhappy when presented with the seemingly fun activities that their classmates enjoyed. They appeared to not be listening to directions, disrupted the class by acting inappropriately, or refused to participate. She was unable to understand their distress and felt frustrated with the children as well as with her own teaching abilities. Once educated about Sensory Integration Dysfunction, she realized that the children were not intentionally being uncooperative; their nervous systems were not correctly processing sensory input, therefore not allowing them to act appropriately. “SI Dysfunction can affect not only how they move and learn, but also how they behave, how they play and make friends, and especially how they feel about themselves” (p. xxii). She wrote The Out-of-Sync Child for parents who feel the same frustration with their children, as well as for professionals or anyone else working with an “out-of-sync” child. Kranowitz states in her introduction that the book’s primary purpose is to “help you understand your child” (p. xxv).
The book’s definition of Sensory Integration (SI) Dysfunction is “the inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior” (p. 292). Kranowitz both describes the dysfunction in detail and gives three brief stories of hypothetical children suffering from it, to which she refers back in later chapters of the book. SI Dysfunction affects a child’s tactile sense (touch), vestibular sense (balance and movement), and proprioceptive sense (body awareness and body position). The author describes each in detail, allocating an entire chapter for each to help the reader decide with which the child has difficulty.
She provides checklists of common symptoms and behavior problems for each, which the reader can check off accordingly. She also tells the reader what SI Dysfunction is not, as it is easy to confuse the dysfunction with other difficulties such as learning disabilities. Possible causes are listed briefly, but the book’s focus is much less on etiology than on education and practical use at home and school. An explanation of the typical development of SI is included to illustrate how SI Dysfunction deviates from that.
This book is a wonderful resource for parents or professionals who feel that their children meet the criteria for SI Dysfunction. Kranowitz writes in a clear language free from confusing scientific terms. She assumes that the parent knows nothing and provides a comprehensive manual for them, while at the same time not speaking condescendingly. The book can be used as a kind of workbook or record for the parents, as it contains checklists of common behaviors that parents and teachers can complete. While the book clearly outlines what SI Dysfunction is and is not, it does not stop there. Explanations of possible therapies are provided for those not familiar in order to prepare them for what to expect. Kranowitz encourages the parents to keep a record of their children’s behaviors, gives examples, and provides template sheets to use. Another very useful section of the book is a description of activities that the child can do at home, which takes up a generous twenty-six pages of the book. For the parents who would appreciate additional resources, there is a list of recommended reading, as well as information on catalogues, clinics, organizations, and websites pertaining to SI Dysfunction. A glossary and an appendix explaining the workings of the nervous system in easy-to-understand language are also provided to keep the book user-friendly and non-threatening.
Since the language is very conversational and devoid of complex scientific terms, adults with a basic high school education will find the book easy to comprehend. This book is not recommended for children to read because they are not the intended audience. The book’s focus is on educating the parents, teachers, and other professionals who work with children with SI Dysfunction. Psychotherapists who work with children may prescribe this book to the parents whose children are affected by SI Dysfunction and/or the teachers of these children. They can assign chapters of the book for parents to read in order to understand the disorder and how it affects their children. The parents may also be asked to complete checklists and keep records about their children’s behavior to bring back to the psychotherapist to discuss and find solutions or modifications. The psychotherapist could use the descriptions of activities as homework for the parents to try with their children and report back on. The psychotherapists may also self-prescribe the book to educate themselves if they work with such children. They may read certain chapters to gain knowledge and use the activities for ideas for their sessions with the children.
The book has many strengths in the above-mentioned checklists of behaviors, lists of activities, and other resources. Another strength is the frequent use of anecdotes of children with normal SI contrasted with children with SI Dysfunction. The reader is able to better understand the common behaviors of the dysfunction through these examples. One such anecdote describes a “normal” reaction of a child having his hair brushed and face washed and tolerating it, as compared to a child with SI Dysfunction going through the same experience who “pushes his father away and cries, ‘You’re hurting me!’” (p. 72). The reader may recognize behaviors similar to those of his or her own child.
A possible criticism of the book could be that its focus is on young children roughly under the age of ten. This can be explained by the fact that the hallmark signs of SI Dysfunction often show up by age three or four and are noticed especially as the children begin attending school. The author does note, however, that the same therapies can be effective for older children and even adults who are not diagnosed earlier. The background information on the dysfunction would still be applicable, though the at-home activities would be inappropriate for a more mature child.
Kranowitz puts a positive spin on the book and also provides hope to the parents and other readers by emphasizing the strengths and not the weaknesses of the child. She reminds the reader that however frustrating it is that the child is not acting in the desired way, it is not because the child will not do it, but because he or she is unable to. She devotes an entire chapter to “Coping with Your Child’s Emotions” in order to promote empathy and understanding. The final chapter is entitled, “Looking at Your Child in a New Light,” which helps parents to accept their children’s difficulties and also to “give your child credit for being so bright that he has figured out how to avoid making a fool of himself when he knows he can’t meet others’ expectations” (p. 253). The author’s empathy does not extend solely to the children; she also realizes the frustration and guilt of the parents, reminding them that this dysfunction is not caused by poor parenting and that they are helping their child just by reading the book.
Overall, this book is an excellent comprehensive guide to Sensory Integration Dysfunction, clearly explaining all aspects of it, how to identify it, and how to treat it. It provides parents and other readers all the needed resources in one place and encourages its use as a workbook through checklists and record forms. It is highly recommended to anyone who has or works with a child with SI Dysfunction.