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Tuesday, 1 October 2013

Life can be tough for a child with difficulties

I have been fine tuning one of the parent evening lectures that I give to parents of children with gross and fine movement difficulties and I thought that it would be good to share some of the ideas on the blog page. My main passion about what I do is that I believe that knowledge and understanding of a child’s difficulties is the first and most important step towards helping them meet their difficulties with dignity, self-assurance and belief in themselves.  Not only is educating the parents and teachers important, but also teaching the child about themselves and how they learn and why they might find things trickier than others is key to maintaining their sense of self esteem. Life for a child with difficulties is tough and I don’t believe that we should pretend that those difficulties are not there.

So, what can be challenging for a child with a learning or movement difficulty? Sitting in class, writing, eating, getting dressed, playing in the playground are just a few things. Some children find one area particularly tricky and others find all areas a challenge. Every child is different and the environment that they are brought up in can affect what areas they find most challenging or the easiest.

Whilst sitting at their desk or on the floor, some children tend to: Have slumped posture, lean on others, lie down, wiggle, fall over or hold their head in their hands. The reason for these reactions could be that the child has a low resting state of the muscles and less resistance in their connective tissue structures. This presents as “low tone” which means that the muscles are less ready to contract and the surrounding connective tissue does not provide enough resistance for the muscle to work against. As a result the child may look floppy and loose.  A child with bendy joints often has this kind of “low tone” due to the lack of inherent stiffness in their connective tissue. This affects how well they control their muscles and as a result may often have decreased postural control (core control), which makes it hard to maintain a standing or seated position for an extended amount of time.  It is most difficult to maintain a posture when children are still. Some children need to keep moving in order to use the moving muscles to provide their postural support and stability, rather than their core or inner muscles.  Movement also helps increase the level of brain activity which send more messages to the floppy muscles to be stable. As you can imagine all of this activity takes up a lot of energy, which is why sitting still can be harder for many children than running a race.

Why is Writing Challenging?
In the same way that low muscle tone and postural control affects sitting, so does it affect writing, as we all need to sit upright, maintain our posture or even just stay seated in our desk in order to write. Similarly, if a child leans on their arms or cheek to provide their support, it creates a very tricky position to write from. If you don’t have a stable and controlled base of support, it is very difficult to hold your pencil effectively. It reminds me of a concept my science teacher taught me about fulcrums and levers. If you don’t have a secure fulcrum, your lever will collapse. (Imagine your shoulder blade muscles as your fulcrum and your arm and fingers as the levers). Finally, children with learning difficulties often rely too much on their vision and less on their sensations and ability to integrate their senses. Therefore they can focus more on the pencil than on the writing. Or, they cannot rely on the feel of the pencil in their hand and therefore can hold too tightly or too softly. This is exaggerated by the lack of shoulder control so they often press down too hard on the page or conversely, too softly. Once again, we have a scenario of a lot of energy being used up in order to perform a simple task, with most of the child’s attention being taken up with the background of writing rather than the writing itself. As a result, the child can become exhausted, bored, fidgety, deflated or frustrated with writing and all of these emotions can play out in a number of ways in the classroom.

The continued challenges that children with difficulties have with daily activities like dressing & eating and academic performance can impact on a child’s self-esteem. They can become withdrawn and shy or act out abrasively or aggressively around their peers. It is common for a child with a learning or academic difficulty to experience difficulties with physical activities as well (such as hopping, skipping, coordination, ball games, running) and as a result they do not include themselves in playground activities. This can further exacerbate the social difficulties these children have. They can become frustrated and upset with themselves or even embarrassed and the resulting social issues have the most impact on a child’s feelings of who they are and what they are worth.

I will write my next blog about instilling a sense of self efficacy in these children-parents, coaches, therapists and teachers: we all have a role to play!