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White Noise

Symptoms

Chavy is a well-behaved, precocious third-grader. Chavy’s mother is concerned about Chavy because she does not react to instructions appropriately. Unless Chavy’s mother focuses exclusively on Chavy and gives her specific directions, Chavy appears to shut down and ignore everything she hears.  For example, if Chavy’s mother wants everyone to get into the car she will call out instructions to all her children. “Everyone, put on your shoes and go out to the car!” The other kids will comply; Chavy will continue her activity and appear to ignore the instructions or be “spaced out.” Chavy’s teacher similarly reports that Chavy will ignore instructions in the classroom, especially if the classroom is noisy or other distractions are present.  This is especially noticeable when the teacher is attempting to settle the class down and begin teaching at the start of the day. Chavy’s classroom includes a window facing the street, and whenever noise from the street filters into the room during class time, Chavy appears to shut down.

Assessment

Our assessment is that Chavy is not able to process information from multiple sources simultaneously.

Children with typical development can sift through multisensory stimuli to react to and concentrate only on the important information. For example, if the teacher is speaking at the front of the class and some students are whispering at the back of the classroom, a student can typically ignore the whispering and focus on the teacher.

Chavy lacks the ability to prioritize the important sensory input (foreground noise from the teacher) and tune out the unimportant sensory input (the background noise from the students).  All the noise overwhelms her, and unable to make sense of what is going on around her, she simply shuts down.

Solution

Chavy had to learn to tolerate and integrate the degree of sensory input she would typically experience and make sense of it. To build this ability, we created situations where Chavy received sensory input from multiple sources simultaneously. First, the therapist brushed Chavy’s hands with a sensory brush, identifying the activity by saying, “Now we’re brushing your hands.” Then she asked Chavy to sing the alphabet. Finally, she brushed Chavy’s hands while Chavy sang the alphabet, saying, “Now you are saying the alphabet while feeling the brush.”

Chavy learned to recognize multiple stimuli simultaneously and to identify each as distinct experiences. As Chavy progressed, we added additional simultaneous stimuli so that Chavy was doing tasks that challenged all five of her sensory systems: vestibular, auditory, proprioceptive, tactile and visual.

Once her neural networks were strengthened to the point where she could identify several forms of input at the same time, the next step was to prioritize which stimulus to pay attention to and which to ignore. Instead of becoming paralyzed and overwhelmed, Chavy learned to zero in on the important stimuli and disregard the rest.

Chavy’s ability to perform in the classroom improved tremendously. Now when Chavy’s mother calls all the kids for supper, Chavy is the first to sit down at the table.


You can submit questions via email at therapythoughtsnj@gmail.com. To schedule an appointment call 732-813-HAND today or visit our website www.thetherapyplacenj.org for more info.
Names and details have been changed. This case study may be amalgamation of different patients or symptoms. The purpose of this article is to educate about conditions that may be treated with occupational therapy.