Many parents and professionals are confused about unusual behaviors, generally referred to as “stims,” which are usually associated with autism. These “stims,” in fact, exist to varying degrees with many children and adults, some of whom have various developmental issues and some of whom are considered “typical.” During the past year, many parents of typical children have become concerned their child may fit into the autism spectrum, and a surprising number of normal adults are wondering if they fit into the spectrum as well. That being said, there are many children being permitted—and even encouraged—to engage in what are actually Debilitating Sensory Addictions (DSAs) which do need to be addressed. It’s important to understand what is, and is not, of concern.

Over ten years ago I coined the term DSA, or Debilitating Sensory Addictions, to identify most of what was being referred to as “stims” in children on the autism spectrum. These included developmentally harmful sensory behaviors which may occur in a broad range of children with developmental issues. I incorporated debilitating into the term to indicate that these behaviors are in fact debilitating, as in undermining and impairing development. In addition, these behaviors are addictive. The more the individual engages in the behavior, the stronger the addiction to the behavior becomes, and the more inclined they become to developing sensory and other addictions. The foundation of these behaviors is sensory dysfunction or delayed/underdeveloped sensory function. 

Debilitating Sensory Addictions, although primarily seen in children on the autism spectrum, exist within the broad range of children with delayed development. This is particularly true for those with significant sensory issues. DSAs begin as a form of self-soothing or self-arousal behaviors. They originate around a “broken,” underdeveloped, or abnormal sensory channel and/or a lack of ability or opportunity to engage and interact appropriately with their environment, people, or toys. This was seen very graphically visiting state institutions for those with developmental issues back in the sixties and early seventies. The institutions were filled with “autistic” individuals who had entered after having been labeled or identified as having Down syndrome, cerebral palsy, or brain injuries, etc. The DSAs exhibited by these institutionalized children were often much more extreme than what we observe today in even the most severely involved autistic children. These children were, sadly, models of what can develop in permitted and untreated DSAs. 

DSAs can involve any and all sensory channels and can incorporate more than one at a time. The most common DSAs involve vision and hearing. The most prevalent visual issues, in both children on the spectrum and others with developmental issues, is the delayed or slow development of central vision. Peripheral vision is the first vision that develops in all children. Peripheral vision picks up edges and movement. Most people know that babies are attracted to black and white images with sharp edges and to things that move.* These are things that they can see as opposed to things involving their central, or detail, vision. Most young children are far sighted, meaning they do not see things that are up close well. As they use this central vision more and more it generally improves. If, however, this development is delayed, the central vision may not improve. Delays to central vision development can occur when a child learns to play with their peripheral vision in such a way as to become aroused by this play. This can include waving their hands and objects in front of their eyes or lining up objects and flipping pages. It can also include, once they become mobile, moving around a room looking at the edges of the walls, ceiling, and floor, as well as other objects.

Often the first thing that is apparent with a child on the spectrum is the lack of eye contact. The reality is that it goes way beyond lack of eye contact, to not actually looking directly at many things, since they look peripherally. If you watch a typical person as they look around their environment, you will notice—unless they are thinking—that they look directly at faces or objects of significance. This is as opposed to a child or individual with hyper-peripheral vision and hypo-central vision who rarely look directly at anything and instead look rather absent, which they often are.

One of the common characteristics of those “on the spectrum” is the apparent inability to read expressions. I would propose that many, if not most, of those on the spectrum with this issue simply have underdeveloped central vision. They have learned to look at the periphery of the face (the hair that is sticking up or the edge of the ear), rather than the face itself. If you are not looking at the face, you are not seeing or reading the expression on the face.

DSAs related to hearing or auditory processing issues involve manipulating sound, from producing repetitive sounds with toys, to simply tapping or banging, to various forms of vocal repetitions of sounds, words, phrases, or songs. Also included is covering or batting at the ears to block or modify sounds. 

As mentioned, all sensory channels can be involved in DSAs and can involve more than one sensory channel at a time. As an example, children can engage in hand/mouth DSAs that involve the senses of taste, touch, smell, and in some cases even hearing, all simultaneously. The DSAs involving many sensory channels are often the most difficult to resolve.

We can often equate the degree of DSAs and the degree to which individuals are or are not present with the global degree of developmental delay or the placement on the spectrum

One of the significant effects of DSAs is the child’s lack of connection to their environment or to being present. We incorrectly equate learning almost exclusively with being taught, but the reality is that most of what we learn—and what permits us to interact with our environment and the people in it—relates to the degree to which we are simply present. Those engaged in DSAs are to varying degrees not present.

Perseveration—stuck on repeat

A subtle form of DSAs involves perseveration. Perseveration involves wanting, needing, and essentially being addicted to specific input. Videos, commercials, books, and songs all have the potential of becoming perseverative addictions, or DSAs. If permitted, children will watch the same video over and over, or the same piece of a video over and over,** or want to hear the same book or song over and over. They do this to the point at which they have it memorized and beyond, because they are literally addicted to it. This type of DSA is of particular concern because the child can eventually watch the video, recite the line, or play the song in their head over and over; and although not displaying an overt DSA, they are simply not present. Many parents who are trying to get their child’s attention feel as though their child’s mind is someplace else. This is because their child’s mind is somewhere else; they are watching their video clip or repeating their sound bite in their mind. They are not present.

The greater the DSAs, the less present and connected are the individuals and the greater the impact on global development

The role of neuroplasticity is very relevant to DSAs. Essentially all development occurs because of neuroplasticity, which essentially means that the input the brain receives and how we use our brains determines how our brains become wired and develop. To trigger neuroplasticity, the more specific the input (stimulation) and the greater the frequency, intensity, and duration of the input (stimulation), the greater the impact on the brain and thus the more the brain is trained or developed in that direction. Typically, we perceive learning and stimulation as a good thing and work to utilize the components of neuroplasticity to maximize learning. If, however, we look at DSAs, they tend to occur with very repetitious specificity–high frequency, often with great intensity and extended duration—the model that changes the brain. Unfortunately, in the case of DSAs the change is all negative; it triggers neuroplasticity, but with harmful outcomes. If the DSA involves a “broken” undeveloped sensory channel, it tends to perpetuate and unfortunately strengthen what is “broken” and simultaneously wire the brain for more addictive behaviors. If the brain is focused on this intense input, it simultaneously diminishes the “normal” appropriate input that leads to “normal” development.

Sensory/developmental imbalance and sequential processing

In typical development, changes across the sensory and functional areas are balanced. DSAs and sensory issues tend not to be balanced, meaning unequal. As such, the overall development is imbalanced. A very significant related factor is found in auditory and visual sequential processing. This refers to the number of sequential pieces we can hear or see. This is typically measured in digit spans. If I said a number sequence to you at one second intervals, such as 5-2- 7- 3- 9-0-8 and if you could repeat it, that would give you an auditory digit span of seven, which is normal for most adults. This would be a measure of your auditory processing, or short-term memory, which equates with how much you process of what is said to you. Hearing a list of numbers and repeating them backwards, a reverse auditory digit span, would be a measure of your working memory, which is now being referred to as the new IQ and is the foundation of executive function. Executive function is what permits us to have self -control, inhibit inappropriate behaviors, plan, organize, set goals, problem solve, prioritize–all functions that are challenging for many on the spectrum. Typically, auditory sequential processing develops at about ¾ of a digit a year from birth to about 9 years of age. For most children this growth of processing—including short term and working memory—expands simply by people talking to the child and the child being present and listening. If the child is not present, it significantly impairs this development with global impact, affecting all aspects of typical development, most notably the ability to understand language, to think in words, to develop language, and to think conceptually. 

Essentially, we think in either words or pictures. Thinking in words is called conceptualization and thinking in pictures is called visualization. Because of not being present and other issues, many children with DSAs do not develop auditory processing well and lag behind, often dramatically, in learning to think well in words. Simultaneously, the ability to think in pictures, to visualize, keeps getting stronger, creating a greater and greater imbalance. This is often the root cause of the lack of language development and maturity in children on the spectrum. Often behavior outbursts occur because what is happening in real time does not fit the picture in the child’s mind, and their inability to think in words inhibits their ability to think their way through the situation.

Stim is short for stimulation—a misnomer

We generally perceive stimulation as a good thing, and perhaps, therefore, many tend to think of stims as being good and to be permitted, if not encouraged. But, as stated previously, stims/DSAs are providing the brain with negative input which is detrimental to development. DSAs deprive the individual the means to engage and interact with their environment and produce “bad” brain wiring. My grandfather liked to use the saying “Call an ace an ace.” If we are going to address and fix debilitating sensory additions, let’s start by calling them what they are: DSAs.

Attention, inattention, distraction, and fidgeting—good, bad or ???

What is fidgeting? I correlate fidgeting with the issue of DSA’s obstructing the individual’s ability to be present. If a child or adult is actively engaged in behaviors to varying degrees that prevent them from being present, then I would classify the behavior as a DSA. There is a disturbing tendency to see many (and tragically in some cases, most) children as needing more sensory input. Quite to the contrary. The reality is the need to teach the child, and their brain, to focus, to filter, and to ignore extraneous, disruptive input. To believe that many children in a classroom need additional sensory stimulation is ludicrous. Twenty plus children are in a classroom, with all of them breathing, moving, squirming, mumbling, and talking, while other children move down the hallways, trucks go past outside, and planes flying overhead. All the while, they are supposed to be attending to their teacher or their work. The problem is not children being deprived of sensory input; it’s children being overloaded by sensory input and learning how to tune it out, not tune into it. The more distractions, the tougher it is for the child to learn how to filter and attend. When you were going to school, would you have had a better time attending to your work in a library or in the gym during a basketball game? The few who need a thing to occupy part of their brain while they are learning to filter and focus does not justify teaching others to be distracted and dependent and even addicted to inappropriate actions or mechanisms.

For a small percentage of children and adults, the intention and function of a behavior, such as tapping a foot or a finger to help maintain focus, could be considered a short term needed mechanism, although identifying and addressing the underlying issue or issues is to be preferred. The need for fidgeting may exist because of some residual sensory deficit, such as hyper-peripheral visual distractions or residual figure ground issues; but if the result is better attention and the individual being more present, then, while not to be encouraged, it is fine. Fidgets can also be the reflection of being “wired” from a poor or individually inappropriate diet, from present anxiety or nervousness, or from a residual behavior resulting from previous anxiety. Sometimes it might not even have any direct sensory association at all. But encouraging otherwise typically developing children to adopt such behaviors is counter to healthy normal development.

It is vital to look at all these actions and behaviors that have been lumped together as stims from the perspective of the individual. Most of these behaviors have underlying sensory issues which need to be identified and developed. If understood as addictions, it becomes obvious that we need to do all that we can in order to reduce and eliminate them as much as possible. This process typically involves redirection, elimination of any tools that facilitate DSAs, and appropriate engagement for as much of the waking day as possible. If one of the net results of DSAs is prevention of the individual from being present and engaged, then we need to do everything we can to keep them present and engaged. Sensory channels that are underdeveloped, or which have developed improperly, need to be treated. If sequential processing, short-term memory, working memory, and executive function work together to be the foundation which permits us to learn, develop, to think, and function in society, we need to actively and specifically work to develop these incredibly important functions.

Every person is unique. One of the things I taught both of my sons when they were young and perceptive enough to be able to observe the differences between and oddities of their friends and classmates, was that if you met someone and you did not think they were “weird,” it only meant you didn’t know them well enough. We are all “weird” if you look closely enough, which is rather synonymous with different and unique. That is a good thing and bodes well for the perpetuation of our species. Often labels and terms can cause more harm than good. When we can be definitive, we need to be. When we can identify issues as specific to the individual, we need to. Lumping children together with similar symptoms, and often perceiving these symptoms as pervasive, tends to imply that these symptoms are just part of who and what they are and thus to accept it. Having worked with thousands of individuals with DSAs over fifty years, the most important lesson learned is that each child is unique and complex—and needs to be perceived as such. Doing so is the first important step in helping them do and be what their innate potential would permit them to be. Understanding these associated pieces which are distinctive to the individual leads to creating the necessary tools and the ability to treat each child appropriately so that we can unlock their innate potential.

The children have unlimited potential. Our lack of knowledge and the application of that knowledge is the causative factor which limits the outcomes.

*Some children on the spectrum demonstrate an exceptional ability to identify numbers, letters, and words and even to be able to read at an early age, which appears to be the result 

of an early attraction to the edges of numbers and letters. 

** YouTube has made some children on the spectrum tablet navigation experts, as they are driven to pursue their addictions to specific videos.

Reprinted by permission of The NACD Foundation, Volume 36 No.1, 2023 ©NACD

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by Bob Doman

Who would have thought that one of the potentially most harmful “tools” available to our children was something as educational and entertaining as YouTube? For many children and young adults with developmental issues, it is.

Our work at the National Association for Child Development involves working with the whole child and all aspects of their development. From sleep and diet, to reading and cognition, to social function and behavior, to how they spend their day and how they entertain themselves. Our job is essentially to see where all the pieces are, how they are fitting together or not, and how to work with the family and the child to maximize the child’s function and potential.

We work internationally with the full range of children. From those with severe brain injuries, to those on the autism spectrum, to genetic issues such as Down syndrome, to learning and attention problems, as well as “typical” and talented children. Working with this broad range of children provides us with an opportunity to gain many insights, not the least of which are what tools can be used to our benefit or that can become harmful. For many children, particularly, but not exclusively those with developmental issues, YouTube can have a negative to devastating effect on their global function, wellbeing, and development.

When the iPad first came out, I heralded it, and still do, as both a tremendous developmental and educational tool and source of entertainment. For many children with developmental issues, we finally had an instrument that served as an entire portable toy box and toolbox, an instrument that taught them everything from cause and effect and how to isolate and use their index finger, to how to speak (NACD Apraxia apps) and to think (NACD Cognition Coach apps), therapeutic videos, and an almost endless list of educational and entertaining content and access to a world’s worth of information.

For many parents of our lower functioning children, having something that their child could engage with all by themselves was a godsend. Not many children are going to sit by themselves and entertain themselves putting rings on a post. With the tens of thousands of apps for young children, it was a fairly easy task to find apps that the child enjoyed and to follow a progression of apps that push and follow the child’s development. For an educator and a developmentalist, the iPad and subsequent tablets are certainly some of the greatest inventions ever.

One of the amazing effects of the iPad was how quickly children learned how to use it, and not only use it, but navigate and control it. I have been amazed to watch children with severe handicaps and typical kids as young as two and three navigate and find everything they want on their device, often better than their parents. This facility of children to navigate has, however, created some unintended issues.

For many children one of the favorite and most preferred functions of the iPad is to use it as a vehicle to watch YouTube videos. How some children who can’t even read are able to navigate and find specific videos is rather amazing, but many do it and they do it well.

I first became aware of the issue with YouTube with our children on the autism spectrum. Many of these children have a tendency to get stuck on specific things, with videos being at the top of the list and with music coming in a close second. For more than forty years, I have been hearing parents tell me that their autistic child would watch the same video over and over. Not over and over like four or five times, but over and over like many hundreds of times. I was also hearing of children who, if they had control of a VCR or disc player, would keep rewinding and watching little snippets of the video over and over. What we came to realize was that the children memorized these videos or snippets and would get a huge endorphin rush every time what they anticipated happening did in fact happen. Quite simply, they became addicted to the video or their favorite parts of the video. Why else watch it over and over and over again? In some cases, the addiction was so strong that there was nothing, including eating, that the child would voluntarily do over feeding their video addiction. As it turns out, the iPad and YouTube provided the perfect pairing for creating and feeding the children’s addictions.

One of the issues for many children on the autism spectrum is lack of eye contact and not being present. For many of these children their ability to visualize, think in pictures, is exceptional; and if they become addicted to a video or a specific event, they can “watch” that event over and over again in their mind. If you are visualizing, thinking in pictures, you cannot really simultaneously process what you see well enough to engage in the moment, in the real world properly or to be entirely present. As an example imagine (but don’t really do it) driving on a freeway in rush hour traffic and computing something like 379 plus 86 in your head. Most of you to complete this task would need to picture, or visualize, the numbers to do the computation. Guess what you wouldn’t be doing while completing the problem? Would you believe watching the road. The more mental ammunition these children have to visualize, often the less present and engaged they are. This issue has become exacerbated for many children because of YouTube.

YouTube is the perfect vehicle for these children. It offers an endless variety of short videos that the child can easily locate, stop, go back to their “spot,” and revisit as often as needed. Many of these kids also find related videos easily as well. One of the favorite subjects for some of the children on the spectrum is roller coasters. This has to do with the imbalance between their central and peripheral vision and an attraction to movement and edges, which roller coasters abound in. Some of the children become amazingly talented at finding roller coaster videos, of which there is an almost endless supply on YouTube. The biggest video culprit isn’t roller coasters, however, it’s music videos.

When children watch the same thing over and over, or listen to the same song over and over, or even want the same book read to them over and over, we refer to it as perseveration. (See video below.) In addition, the perseverative child will perseverate with thoughts that lead to perseverative behaviors or actions that involve the senses, often leading to DSAs—Debilitating Sensory Addictive behaviors, or “stims,” all of which are harmful.

We tend erroneously to believe that most of what we know we were “taught,” but in truth most of what our brain processes and what we learn from our world, we learn simply by being present and aware. If a child spends hours a day watching the same YouTube videos over and over and then spends great chunks of the day not really being present, but watching the same videos in their mind, then they are not present, not learning, not engaging in life, and not developing as they should.

In school it is often the quiet child who doesn’t make waves or get into trouble that gets ignored. Unfortunately, many of these children and young adults who are off getting their YouTube fix fit into the same category. Parents and caregivers are happy that these children and adults on the spectrum, or with Down syndrome, or other issues that tend to slow down and misdirect development are quiet, happy, and occupied. Tragically we have seen many children and young adults left to their own devices—pun intended—become more and more addicted to their videos, with a resulting slowing down of their development or even regressing.

Parents, beware. Excessive screen time can be a significant problem—excessive perseverative screen time can be a disaster.

Here are a couple of links to assist you in restricting access to YouTube or other apps:

• https://www.imore.com/how-restrict-siri-airdrop-and-carplay-parental-restrictions-iphone-and-ipad
• https://www.guidingtech.com/block-youtube-screen-time-iphone-ipad/
• https://support.apple.com/en-us/HT201304

Of note, fortunately I have yet to hear of any children perseverating on any of my many YouTube videos. They’re safe and educational, not fodder for perseveration, I hope!

Reprinted by permission of The NACD Foundation, Volume 33 No. 7, 2020 ©NACD

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It is hard to believe that my involvement with NACD started back in 1992, over 25 years ago.  With that said I have had the pleasure of watching many young children grow up to be highly capable adults. Some of these wonderful families are in regular contact while other times I am totally floored, when a voice from the past reaches out after many years. This last month, I heard from a wonderful Mom that I had lost contact with. I worked with her son and his brothers many years ago and am so pleased to hear that Christopher has such a wonderfully fulfilling adult life. For you moms that just need to hear that there is a wonderful future within reach, enjoy this article that Ana Grosshauser shares with us.
—Lyn Waldeck, NACD Developmentalist

What a miracle and wondrous gift to receive our firstborn child! As most new parents and family, we were thrilled! Here was a perfectly formed and beautiful child who seemed so content and peaceful.

Little did we know that this peacefulness and contentment would change so quickly.

From the second day he was born, Christopher cried almost constantly. It was difficult to console him. Breastfeeding was a challenge for him, and so was the bottle. At three weeks of age, he was diagnosed with his first ear infection. This was the beginning of three and a half years of back to back ear infections and antibiotics. Christopher was constantly fussy and crying. He never slept through the night, nor would he nap during the day. Besides the ear infections, Christopher often had bronchitis and pneumonia. He would want to be held, but then felt uncomfortable being held. It was not easy to console him. He usually had to be marched before he would settle down.

Additionally, the vaccinations seemed to make things worse. He reacted with high fever and rashes, and he cried incessantly. As a precaution, his pediatrician decided to give him a second round of vaccinations. This wreaked enormous havoc on his little body. Christopher was miserable and very sick and continued to cry incessantly. As a new mother, my heart was broken; it seemed almost impossible to make our little one smile.

The first few years passed. He babbled and said few words. At three years of age, he had a minimal vocabulary. By the time he was four years of age, the ear infections and the bronchitis/pneumonia episodes finally began to diminish. But now there were learning issues to address.

At age three, Christopher was placed in Project Launch and later, the Early Childhood programs of the school district. He was mainstreamed in the first and second grades with special aides, but there were obvious difficulties in learning, especially with the open classrooms, and the decision was made to homeschool him.

Various evaluators within the school district diagnosed Christopher as having Pervasive Developmental Disorder. In the meantime, Christopher was also taken to an independent neuropsychologist and audiologist who disputed the PDD label, and claimed instead that the difficulty in learning was the result of all the years of ear infections. She gave him a different label of ADHD and pointed me in the direction of an allergist.

Christopher was then taken to several doctors to evaluate him for allergies. Eventually he went to a Chinese doctor and homeopath for several years to treat him for candida, vaccinations, lead poisoning, allergies, and for over-usage of antibiotics.

Christopher was also taken to a DAN (Defeat Autism Now) nutritionist who put him on a strict diet. He also prescribed chelation.

At around age 7, Christopher began having facial tics. These began with the mouth. Later on, they became eye tics. Several years later, the self-stimming became more prominent. There was a lot of spinning, finger and hand flapping, and arm waving. The loud clapping began; often times it would be done right next to my ears! He made up a word and said it a million times a day. He’d “scribble” in the air with his finger. The stimming would change from one thing to another, and they included mouth noises, snapping till his fingers bled, talking to himself, and so forth. At this age, Christopher seemed to almost never get sick. But it was obvious that other things were going wrong.

The OCD developed. Christopher developed an obsession with the computer and his games. He could never go anywhere without caring a container full of computer game boxes. He had the same obsession with photographs. He would line them up and cover the entire family room floor with photos.

In the meantime, the homeschooling continued, but there were constant problems with inattentiveness, hyperactivity, poor short-term memory, auditory processing, sensory integration dysfunction, and manipulative behavior, among other things. The biggest challenge was that Christopher seemed to have very little curiosity or desire to learn about the world around him.

And then, one day, all of this turned around when one of the specialists seeing Christopher recommended that we look into NACD.

After researching their website, I eagerly made an appointment to take Christopher in for an evaluation. Words cannot express the excitement that I felt to FINALLY be given a ray of hope for our child. After trying so many different avenues of doctors and therapies, we were able to implement something that made complete and total sense!

With great fascination, I learned all about the neurological organization of the brain. What a relief to have the support of an astonishingly intelligent and caring group of individuals, and to know that they truly cared, along with his parents, about our child’s success! Following the program meant an enormous amount of commitment on my part, and I found it to be a huge blessing to be able to include this in our homeschooling program. This simply became such a wonderful way of life for us.

We learned so much!! How exciting it was to know that we were working towards building new connections for the brain cells! How encouraging to realize that sensory and motor pathways could be created with the proper stimulation of frequency, intensity, and duration! It made a lot more sense to me to be able to do this within the home every day instead of driving all over creation to visit various doctors and therapists.

One of the most important details that I learned was to do away with the labels and diagnoses. I personally had received about five different diagnoses for Christopher from as many well-meaning professionals. The leaders of NACD reminded me that these diagnoses didn’t matter. What was most important was building up strengths in all the different areas of development. It didn’t matter if a child had special needs, developmental delays, or special gifts. Each one had the ability to grow by leaps and bounds.

I was ecstatic to receive the support of NACD. For many years I had gone round and round in circles and felt frequently overwhelmed. It was so encouraging to feel so understood, and to have their support in writing up the program and lesson plans.

It took months and years of hard work, and we knew that Christopher’s brain was going through many positive changes. He eventually was able to establish his natural dominance. He could be touched without screaming with pain. He was able to master long digit spans easily. He became more pleased with himself and proud of his newfound abilities.

Where once he had great difficulty focusing, he was able to listen more, remembering details, as with directions. His stimming behavior diminished and eventually disappeared completely.

Discovering and learning the NACD philosophy, and then implementing it within our family was the pivotal, most important event in our lives. It has had such a tremendous and positive impact on me and my entire family. I am extremely grateful to this organization, and I carry enormous respect and gratitude for the caring individuals who help run it.

Today, Christopher is a wonderful, well-adjusted 29-year-old young man. He lives a simple life, still at home with his mom, and works part-time at Randall’s. He has an immense love for music and carries close to 50,000 songs on his iPod. Those who know him describe him as extremely friendly and talkative. He is pure joy and love. He has enormous confidence in himself and is almost always happy. He is a beautiful soul.

One day recently, his father had taken him out to eat. Christopher was in his usual happy-go-lucky mood, and his dad was having a bad day. Curiously, his father asked him, “Son, why is it you are ALWAYS so happy??” Christopher looked at him with a smile and simply said, “Because I CHOOSE to be happy!”

We are convinced that he has been sent here to teach all of us around him about love and compassion, patience and tolerance, and happiness! This, to us, his family, is the greatest measure of success.

NACD Newsletter, April 2018 ©NACD

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At 2 ½ our son Evan rarely gave us any eye-contact, and did not communicate outside of dragging one of us to the kitchen when he was hungry, repeating phrases he heard on TV, or echoing what we said to him. He could play by himself beautifully for hours, but would throw huge tantrums if we tried to interrupt him. We knew something was wrong, but it was still difficult to hear the Autism diagnosis. Thankfully, it wasn’t long before we were introduced to NACD. We started on program one month before Evan’s third birthday.

We soon discovered that virtually everything our son did was a stim (DSA – Debilitating Sensory Addiction). He could line up cars, trains, and blocks with laser precision. One of the first things we learned was that not only was he not learning anything from his “play,” but allowing him to continue with it was destructive. Following our first evaluation, as Evan napped, we purged many of his toys. When he awoke, we started our battle with stimming. However he was not to be easily deterred. If he couldn’t stim with his cars, he would line up drink coasters or kitchen chairs, or he’d watch Kleenex tissue float down to the floor. We knew our work was cut out for us, but with our new program in hand, we now had a plan of attack.

Affirmation of our decision to work with NACD came soon after. Within our first two weeks of doing program (badly at that), Evan grabbed a spatula off the kitchen counter and was running around flapping it and watching it out of the corner of his eye. I picked him up, plopped him in my lap, and started making faces at him. He looked at me with a clarity in his eyes I had never seen before and said, “Eyes, nose, mouth,” touching my face as he spoke. This was the first time he had ever spontaneously put three words together, and the first time he ever labeled anything. I was shocked and thrilled at the same time. He got down out of my lap and started stimming with something else, but my husband and I knew that we had made a crack in the shell that kept Evan from participating in our world.

Something we recognized very quickly was that this was going to be a full time job. We couldn’t just do program in the evenings after work and expect to overcome Autism. I quit my job and made it my full-time occupation to work with Evan. We have never regretted that decision.
The NACD approach is very challenging. As a parent you may not feel qualified to be doing all the therapy required, nor might you feel physically able to do all that is asked of you. But it quickly became apparent that the more we stopped and redirected his stimming, the more he could think and learn. It was exhausting work, but incredibly rewarding, as Evan began to break out of his pretend world and join us.

We have been tremendously blessed to have access to a group of professionals who didn’t look at our son and see a label—they saw his potential. They had high expectations for Evan to do very well in every area of his development, and that pushed us, as a family, to achieve the goals they set.

Evan has gone from a very disengaged child to a 5th grader who loves to read, is on grade level or better in all subjects, skis, swims, has a brown belt in karate, and plays on a middle school basketball team. He loves to make others laugh, play (and argue) with his brother, and is protective of his little sister. We are still working, and still have some challenging areas (social interactions are still difficult at times), but we have full confidence that we will conquer this last obstacle. Evan is a bright boy with a lot to offer. We are thankful to NACD for giving us a way to unlock his mind.

NACD Newsletter, Volume 5 Issue 1, 2012 ©NACD

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With Christmas right around the corner, we are all trying to figure how to get gifts that are really worth getting for our children. When it comes to larger ticket items, it is hard to beat an iPad for usefulness and continued relevance. This is not a gadget that will get put away, but rather a device that can continue to be altered to fit changing needs, changing attention spans, and changing processing levels. This is why we like it so much.

It is hard to beat a device that can review modular math in a way that is actually fun and can also review algebra operations in a way that is pretty fun as well. It can also review telling time or making change, as well as quiz math fact—all in a way that looks a lot like play. With this device we can do language photos, receptive language cards, math fact review, math process reviews, analogies for SAT review, and Critical Reading for the SAT, as well as animal flashcards that are real photos and make the sound of each animal, bird songs, white noise to help your child sleep, a virtual piano keyboard, number tracing, Science flashcards for middle school and elementary school students, virtual tours of European cities, star charts that show your own bit of the universe, and more, and more, and more. It can coach your child until he or she is ready for a 5K.

I have to admit that I was a skeptic, being more of a Barrel-of-Monkeys person myself. I am not generally a lover of electronic devices for my kids or for yours. The huge benefit here is that the children love the device, and I can keep changing it to fit the child’s needs. So if I start out teaching the child to talk and to identify common things, I can use apps for that. Then if I am trying to help the child string more words together, I can use apps for that. Then as I’m teaching the child to read, I can use apps for that. As I add math concepts, I can use apps for that. If I follow this child all the way up to college, there will continue to be apps I can use that will both help and entertain the child, while we reach our goals.

Now the other handy thing is that you, the parent, can have your own folder with apps to make you happy. There are workout apps, recipe apps, flight tracking apps, and a great word dictionary app that I keep on hand. So it isn’t all Angry Birds (although there are quite a few parents out there who have that one).

To use it to the best advantage, change the apps frequently. Many of them are free, and others are often a dollar. We recommend adding new apps and hiding some old ones each week. You will see your child pay renewed attention to this new input. Kid Calc and a few others may stay on for a while, but many can be circulated in and out of use. Interact with your child and the iPad. This will help ensure that your child is not stimming on an app and is interacting with it appropriately. It also helps to ensure that you are getting the most out of the app.

As technology advances there seem to be many new and high-intensity learning opportunities coming our way. Where was all of this fun stuff when I was trying to get my kids to remember math facts? Be that as it may, I am delighted to see it arrive now. So whether your child needs help to pronounce a long “e” sound or help to get high scores on the SAT, this may really help.

There will always be a place for barrels of monkeys and little wind-up horses in the life of children. We still need balls to bounce and slides to climb, books to read, and pencils.

As a supplement to learning, however, this iPad is hard to beat.

NACD Newsletter, Volume 4 Issue 6, 2011 ©NACD

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At 2 years old John was officially diagnosed with autism. We began the typical battery of therapies including speech, occupation and applied behavior analysis (ABA). Some gains were made, but still our hope for any type of normal life was dismal. In the fall of 2003, at the age of 3, we were introduced to NACD. Bob Doman assessed John at that time and found his developmental level to be that of an 18-month old child. Some of his most interfering symptoms included constant visual and auditory “stimming”, sound sensitivity, oral sensitivity, poor quality and limited quantity of speech, low muscle tone in his arms, and difficulty with fine motor skills such as holding a crayon.

The first thing we noticed when we received our initial NACD program was that it encompassed activities from many of the disciplines that we had been already been doing with John, such as deep pressure techniques in occupational therapy and oral motor exercises from speech therapy. However, we quickly recognized that the NACD program was much more comprehensive and intensive. It started to make sense that 30 minutes of speech therapy once or twice a week by a therapist that didn’t know John very well would not bring the desired results. The idea that short, frequent activities provided throughout the day by us, his mom and dad, would make a big impact on his developmental progress. Our family determined we would make whatever time and effort sacrifices were necessary to accomplish his prescribed NACD Program each day. We noticed progress right away. For the first time since diagnosis, we felt back in control of our child’s care and saw a glimmer of hope for his future.

Within two months of starting his NACD Program, John became potty trained. He was able to sit long enough to play a board game, such as Candy Land. He began riding a tricycle. We could finally brush his teeth without a big hassle. He was attending a special education preschool and within a month the school decided he was doing well enough to go to a regular education class and be mainstreamed with the assistance of an aide.

Six months into the NACD Program, John began to play imaginatively, his visual stimming was decreased. He also began treatment with a medical doctor to address some underlying physiological issues, who tested him for food allergies, immune dysfunction, and metal toxicity, all of which were positive. With the medical issues addressed we noticed that John was even more receptive to his NACD therapies, and his progress became accelerated.

In August 2004, just 10 months after starting with NACD, we happily said goodbye to our in-home ABA program, feeling John’s needs could best be met through attending pre-school and continuing his NACD Program. He was riding a bike with training wheels and attending an art class with typically developing peers. He began to be able to button things. By the time he was 4 ½ years old, he was reading simple primary reader books. His coordination and eye contact continued to improved, and we were delighted by his constant asking of “why” questions. We all cheered when the training wheels came off his bike and we watched him ride off on his own in May 2005. He also became quite a swimmer about this time.

In August 2006 we sent John off to Kindergarten. He had an aide in the class, but by the middle of the school year, she informed us that he didn’t really need her help anymore. Not only was he meeting the kindergarten standards, he was exceeding them, with his math and reading at the second grade level. He was attending a Karate class with typically developing peers, and participated in Tee ball. At the end of Kindergarten, we met with the school and agreed John would go to first grade without a classroom aide.

By first grade teacher marveled, along with us, how John has returned from the tough roads he has journeyed. His teacher told us that if she left a note for a substitute teacher, saying that one of her students had been diagnosed with autism, John would be the 17th choice out of the 20 kids in his class! Today he is in 5th grade. He attends 6th grade math class and is on the Dean’s List at school. He has friends at school, plays the piano, and participates in Boy Scouts and a Rocket Club. He aspires to attend MIT’s school of Engineering “Because it is the Best”.

We credit John’s recovery to NACD and his medical doctor. We feel blessed to have found this help, and also acknowledge John’s own hard work. NACD has helped to change the course of his life. The reminders of his diagnosis are gradually fading from our everyday lives to an occasional incidence. We recognize he has continued challenges, but also celebrate his gifts and talents and look forward to helping him grow and develop. His last NACD evaluation from 11/07 says “Doing Fantastic”. We agree with that and feel his future is bright.

Reprinted by permission of Journal of The NACD Foundation, Volume 24, No. 3, 2011 ©NACD

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Printed in the Autism
Health and Wellness Magazine
Volume 1 Issue 3 – Autumn 2009

Bob Doman has been working with autism since the late 1960’s and was part of the team that first discovered the connection between sensory dysfunction and autism. Bob has been instrumental in establishing the foundation for today’s understanding of neurodevelopment and those within the autism spectrum.

Understanding and remediating neurodevelopmental issues of those within the autism spectrum is critical if we are going to provide these individuals with an opportunity to overcome their debilitating developmental issues and to function within “typical” or “normal” limits. The underlying neurodevelopmental issues associated with autism are often not addressed. And when they are addressed, it is often only in part or with inadequate or inappropriate interventions. A thorough understanding of all of the related pieces is necessary if a comprehensive and effective strategy is to be created and implemented.

Most neurodevelopmental issues will not simply go away. Teaching new skills or utilizing aggressive medical or nutritional intervention without addressing the underlying issues may change some function; but if the neurodevelopmental foundation is not established, results are going to be limited at best. And sadly, some of the more aggressive treatments may actually be harmful and cause regression. The predominant view that most children within the spectrum have only limited potential and cannot overcome their issues reflects the overall misunderstanding of the problem. There is a lack of attention to the uniqueness of each individual and a general misperception that we are dealing with a specific disease that will ultimately be cured or eradicated through pharmaceutical or medical intervention. Autism is not polio or chickenpox; you can’t catch it. It is neurologically based, regardless of the initial cause. I am sure we will ultimately see that there are many causes, and like other developmental problems, that there is neither a single cause nor a single solution. The disease model is leading many parents, researchers, and practitioners in the wrong direction. Those within the spectrum are unique individuals, each with their own set of issues and underlying problems, who should not be perceived as having a disease. Those who are and were within the spectrum cover a broad range of ability and disability. Included within the autism spectrum are those who have been “cured,” who are no longer identifiable as having a problem, to savants such as “The Rainman,” Kim Peek, or Daniel Tammet, to those individuals who are so involved and dysfunctional that they cannot be safely maintained in anything other than a very protected, restrictive, and controlled environment.

Discovering, understanding, and learning how to address the unique underlying neurodevelopmental issues has been an effort of a lifetime and a dynamic process. Each insight opens more doors, assists in the understanding of these unique minds, and leads to better results.

Although each child is unique, we have discovered some neurodevelopmental issues that are expressed in varying degrees in virtually every individual on the spectrum. Successful intervention necessitates an understanding of and attention to these fairly universal neurodevelopmental components, including:

Neurology and physiology are interrelated. That which is impacting the child’s physical function impacts their neurological function. Most children on the spectrum are extremely physiologically sensitive. Diets, medications, supplements, and interventions need to be applied with a gentle scientific hand, measuring and evaluating the effects of each specific component with an understanding that generally many interrelated aspects of physiological function are involved. Aggressive intervention often creates another problem. Also, as the neurological function and efficiency improves, so does the physiology–the child becomes healthier and less physiologically sensitive. Intervention needs to by applied gently, with the goal of producing overall health and wellness.

The brain develops if it receives specific, appropriate input through the sensory channels. Specific auditory, visual, and tactile input stimulates the brain and triggers neuro-growth that physically changes the brain and its function. This process is called neuroplasticity. In autism the primary issue is sensory dysfunction. The brain does not correctly process sensory input, thus interfering with the typical neurodevelopment and triggering what is now being referred to as negative plasticity. Function determines structure; how you use your brain determines how it develops. Normalization of all these sensory channels establishes the foundation upon which typical neurodevelopment can occur.

Abnormal sensory function coupled with low sequential processing generally leads to what I have coined as DSAs—Debilitating Sensory Addictions. Generally DSAs are referred to as “stims,” or self-stimulatory behaviors. The reality of DSAs is that the child is playing with what is improperly developed or “broken” in a sensory channel. For example, under-developed central vision and enhanced peripheral vision trigger DSAs that involve the child fixating on the movement or edges of objects. This behavior becomes additive, with the brain responding exactly as it does to a drug or any other addiction. It thus results in the creation of a more addictive brain, which further delays the development of the central vision, the component of our vision primarily responsible for learning, and focuses the brain on fulfilling the addiction. These DSAs often involve many, if not all, sensory channels; and they often dramatically disrupt and corrupt typical development.

Complexity of thought, conceptual thought, language, and global neurological and developmental maturity are critically linked. For those within the spectrum, the developmental delay produced from the sensory dysfunction creates both neurodevelopmental delay and an imbalance affecting these critical functions. The delay is in the development of sequential processing. Sequential processing is the ability to take in a series or sequence of auditory or visual information and to then hold those pieces together and manipulate them. This ability is that which permits us to learn and think. The primary global neurodevelopmental difference between a typical child of one, two, three, four, or five years of age is the difference between their abilities to process information sequentially. Delaying the development of sequential processing delays critical aspects of the child’s total development. Delays in auditory and language development create an imbalance between the ability to think in pictures (i.e. visualization–typically very strong in those with autism) and the ability to think in words (i.e. conceptualization–generally significantly delayed in this population). This imbalance, if not addressed, can and often does have a devastating effect on the ability to process, understand, and utilize language, as well as the ability to think conceptually, thus impacting global function.

A comprehensive treatment regime for children with autism and those on the spectrum involves creating specific neurodevelopmental programs for each child. These programs and treatment protocols must address health and wellness, sensory issues (visual, tactile, auditory, olfactory and taste), processing problems (auditory and visual), lack of development of and imbalance in visualization and conceptualization, fine and gross motor function, cognitive and academic function, and speech and language, as well as behavioral and social issues. We tackle these issues by designing a very child-specific, holistic, coordinated Targeted Developmental Intervention (TDI)® program. A TDI program is created after we thoroughly review the child’s history and conduct an in-depth developmental and educational assessment.

The work we do at NACD with children with autism has changed the previous notions that they are unable to progress and learn, or that the only effective treatments are behavior modification programs and skill-based training programs. NACD does not see children on the autism spectrum as being unreachable. We respect them for who they are and believe that they, like any child, are capable of attaining their innate potential and that they deserve the opportunity to do so.

Reprinted by permission of The NACD Foundation, Volume 22 No. 10, 2009 ©NACD

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I really don’t know what to do. My son continues to stim off of traffic lights. What would this problem be related to? How do I fix it? His language has actually improved quite a bit over the last couple of years of home school, and his processing is in normal range. (6 conceptual objects, 7 or 8 auditory digits, 7 or 8 visual digits) We went to an amusement park today, and as we sat at the picnic table, all he wanted to do was look at the traffic (even though he was sitting by friends). When I was able to engage him with conversation, he was appropriate, asking me what my favorite ride was. But once the conversation ended, he was back to looking at traffic. Every time we drive in the car, he obsesses over looking at the traffic lights (even with pinholes on). What can I do?

Thanks,
Natalie
(14-yr-old son with high functioning autism)

Dear Natalie,

At your son’s level of function, the things he perseverates on are not really still DSAB (Debilitating Sensory Addictive Behaviors), or “stims,” per se. These behaviors probably had a sensory origination but now are likely more of an unusual interest. At this point his interest in traffic lights is not a sensory problem, and if he can be distracted and can direct his attention to other things, it probably is no longer really addictive either.

The concern at this stage is more that it is inappropriate and might stigmatize him or make him appear “weird”. I would suggest that you continue to assist him in expanding and varying his interests. This will help him have more appropriate topics to discuss with friends and family.

On a practical level, you can make a list of age-appropriate and edifying subjects/topics for him to research. As the world around him becomes more interesting, traffic lights should become less interesting – particularly if he understands how “odd” it can look to others.

Ideally, you’d like him to develop the awareness and capacity to self-regulate in this area, but you also don’t want to hyper-focus on it so he considers it a defining characteristic instead of merely an annoying habit. At present, continue to calmly redirect his attention away from the traffic lights with meaningful conversations. Also continue to work on improving his auditory and visual processing, which will help him develop higher levels of thinking, speaking, and relating with the world.

Thanks for the question.

Bob

NACD Newsletter, Volume 1 Issue 5, 2008 ©NACD

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TV/Videos and The Preschool Child

For over twenty-five years, the National Association for Child Development (NACD) has had the opportunity to serve a large, international caseload of children covering the entire functional spectrum. Our work with innovating ways to accelerate the development of children with profound developmental issues (such as brain injury, autism and Down syndrome) has provided us with significant insight into the development and education of typical and highly capable children as well. Because NACD trains parents to work directly with their own children, we are privy to the structure of the child’s day, diet, and free time activities as well as their developmental, educational and therapeutic input and opportunities. Our unique position has afforded us the opportunity to find out, quite simply, what works.

We have found that carefully selected television programs, commercially available videos, and individually designed videos can be powerful tools for advancing the development of preschool children across the spectrum—from the severely developmentally delayed to the highly capable and gifted.

Using Television to Develop Visual Function

Our years of working on ways to improve visual function have yielded a number of techniques of visual stimulation. Many of these techniques have proven to be helpful not only in the development of vision but also as educational tools. One of these techniques involves the use of television. Below we offer a brief explanation of some fundamentals of child development, and specifically visual development—including some common problems that occur—to provide a framework for understanding how and why television, properly used, can be an important tool for helping even very young children develop and learn.

To develop well a child needs to follow a specific path and to move through the normal developmental steps fairly rapidly. At each stage of development there are specific things that the brain is learning to do. The brain will tend to keep working at a stage until the next piece starts to kick in. Staying too long in one stage is not a good thing. In normal development we see all children start off life as visualizers, meaning that they think in pictures not words. They think in pictures because words have no meaning. In normal development the ability to process language starts kicking in within six months or so, and the child begins to think in both pictures (visualizing) and words (conceptualizing). If it all happens as it should, language starts to develop, and we end up with a good balance between the ability to think in pictures and the ability to think in words.

Vision develops essentially the same way in all children although at different rates. The peripheral vision develops first, followed by the central (macular) vision. You avoid running into doorframes with your peripheral vision; you see detail, and learn, with your central vision. When reading a book, you are using your central vision. When looking at someone across a table, you see their face in detail using your central vision while the rest of the room is slightly blurred because only the small circumference of that face fits within your central visual field. One good way to recognize your central versus peripheral vision is to recall the after-effect of a flashbulb going off in your face. Your macula, the area responsible for your central vision, is located in a small spot on your retina, and it is very photo/light sensitive. When that flashbulb goes off it temporally bleaches out your macula so that you lose your central vision. The spots you see are actually temporary blind spots where your central vision should be. The development of your central/macular vision is very important to many aspects of learning and overall development. Many of the problems exhibited by children diagnosed with developmental delays result from the lack of properly developed central vision.

Problems with Visual Function in Autistic Children

One of the most common characteristics of autistic children is the lack of development of the central vision. Autistic children do not make good eye contact—not because they don’t like you, but because when they look directly at you they can’t see you. Autistic children typically havehyper (enhanced) peripheral vision and hypo (diminished) central vision. Therefore, they experience the visual world more through their peripheral vision and less clearly or not at all through their central vision. They display this lack of visual development in another characteristic commonly associated with many autistic children: They don’t watch television. Many will stand directly in front of a TV and bounce or display excitement in other ways, but they are not “watching” the TV, they are “stimming” with the TV. Essentially what the child is doing is engaging in a form of repetitive sensory play that amounts to “playing with what is broken” in their vision (i.e., their vision is not functioning properly because the central vision is undeveloped, therefore they are playing with—and reinforcing—their peripheral vision only).

The Danger of Stimming—“Debilitating Sensory Addictive Behavior”

There are many forms of repetitive sensory play, and all fall under the informal heading of “stimming,” short for self-stimulating behavior. NACD has developed new terminology for this behavior, which we call “Debilitating Sensory Addictive Behavior,” because of the addictive nature of the behavior and how detrimental it is to development and even to the structure of the brain itself.

Children can engage in Debilitating Sensory Addictive Behavior with any “broken” or underdeveloped sensory channel. Engaging in these repetitive behaviors actually becomes addictive, much like an addiction to a drug. As the child engages in the behavior his brain produces endorphins—which are feel-good chemicals that can become as addictive as narcotics. The more a child engages in the behavior, the more endorphins are produced, and the stronger the addiction becomes. Unfortunately, not only is the child becoming addicted to a useless behavior, he is reinforcing what is already wrong with his sensory system. As described above, kids stimming with television are strengthening their peripheral vision and failing to develop the central vision.

Autistic children (and other children with visual delays) learn a variety of ways to “stim” with their peripheral vision. They often become adept at spinning objects or flipping anything that is not nailed down in an effort to get their “fix.” NACD has discovered, however, that although the TV typically provides an autistic child with an opportunity to “stim,” the TV can also be utilized very specifically as a tool to develop the central vision. Developing the central vision is the key to normalizing the vision so that learning—rather than stimming—can occur. TV is, in fact, such a great tool for the development of central vision that if it did not already exist as an instrument for entertainment we would have had to create it as a therapeutic tool.

Early Stimulation of the Central/Macular Vision is Crucial to the Development of Children within the First Two Years of Life

As mentioned earlier, all children’s vision develops pretty much in the same sequence. Peripheral vision first, followed by central vision. Typical babies begin life using their peripheral vision; then, as they receive specific opportunities/stimulation to use their central vision, it develops as well. (It is no accident that nature’s survival system for babies is designed to place them eight to twelve inches from their mother’s face when being fed and held.)

A typical baby deprived of specific opportunities/stimulation will be slow to develop their central vision, and if they are very deprived of these opportunities they are in danger of becoming globally developmentally delayed. To some degree all babies “stim” simply because early on it is the only thing they can do. If they fail to develop the global neurological maturity needed to engage in exploratory or play behaviors, they become increasingly adept at stimming, and their development slows or stops. Early stimulation of the central/macular vision is crucial to the development of children within the first two years of life.

How Reading to Your Child Stimulates Development: Vision, Language, Sequential Processing

It is often said that if you can’t do anything else with your baby, read to them. As most parents discover, “reading” to babies and very young children involves not so much reading text as it does looking at picture books with them, pointing to or directing their vision to specific pictures (or, if you will, teaching them to use their central vision). The closer something is to a child, the more the child’s central vision is engaged and the less peripheral distraction there is.

No one questions the importance of reading to children, but it is important to look at the development that occurs throughout the process. When you read to your child there are the obvious psychological/bonding /nurturing benefits. There are also very significant auditory benefits. Essentially, we use reading to teach children a “foreign” language—their first language. Initially we point to a single object and name it “puppy,” then we expand the information as the child’s receptive language skills develop, and it becomes “black puppy,” then “little black puppy.” We proceed along, matching visual information (the pictures) to the auditory cues (the words). In so doing we are not only teaching language, we are also developing a vitally important neurological function—we are developing the child’s ability to take in and manipulate pieces of auditory and visual information in a sequence. This ability to process information is called “sequential processing.”

NACD Innovates Methods of Developing Sequential Processing

At NACD we have been investigating and working on methodologies to build and develop auditory and visual sequential processing, as these are the basic components that give us access to our innate intelligence. (NACD has actually started an international initiative to raise the sequential processing skills of people all over the world through a program called “The Project 9 +/-2.”) We have found the act of reading to a young child—or showing a child pictures and naming them—achieves a vital step in the developmental process.

Stimulating Central Vision

How much does a young child learn from a book or picture card twelve to eighteen inches from their eyes as opposed to things placed further away around the room? NACD’s findings suggest that a young child learns a lot from things placed at the distance of a book being read, and much less from things across the room. When we bring a book up to a child we are pulling it into their central visual field. At twelve inches the child may be seeing a significant part of the page in detail, and with the peripheral field being limited it is relatively easy for the child to attend and to see the image. If you held a book out ten feet and had the child look at it, you would find the child’s attention would generally be much shorter and more difficult to hold because, at that distance, the child would have difficulty locating the image within his central visual field. This is because when attempting to see a small object held at a ten-foot distance, perhaps 95% of the child’s visual field would be peripheral, not central. Remember, peripheral vision develops before central vision, so for young children, particularly those under two years of age, their focus is constantly pulled to those things around the periphery. In other words, they are “visually distracted” or “distractible.” The more visually distracted the child is, the less she will pay attention to visual cues, thus the less attention she will pay to the information being “taught,” and the less stimulation and development of the central/macular vision will occur.

Will My Child Learn More in Preschool than at Home?

At NACD we have been privileged to work with some of the most motivated and informed parents in the world. All of the families we work with—be they parents of children with significant developmental issues or parents of “typical” children—wish to help their children achieve their innate potential. They come to us because they want to assume the primary responsibility for their child’s development and education. They want the best for their children and use schools and outside services only as an adjunct to what they do at home with their children. For many of these exceptional families one of their first big decisions is if and when to start their children in daycare or preschool situations.

Ultimately the answer comes down to the needs and resources of the family. But, one of the questions asked more often than not is, “Is my preschool child going to learn more at a school than at home?” The younger the child, the simpler the answer because the younger the child the more they need direct, one-on-one contact and interaction. The younger the child, the more specific the developmental/educational input needs to be. In general, nothing beats one-on-one teaching. Teaching one child at a time permits the input to be designed to fit the individual; it also permits virtually immediate modification of the input in response to the child. Most parents are not even aware of how often and how rapidly they modify what they are doing with their child when they are interacting one-on-one. For example, if you observe a parent looking at a book with their child you will see the parent constantly responding to the child’s cues. If the parent picked a book with more text than the child can process, you will see the parent start to simplify the story or even start just pointing at the pictures and talking about them; they may even put the book away and get another or go to something else altogether, naturally and spontaneously modifying the input to fit the child. The further you get from the 1:1 teacher to student ratio, the more difficult it becomes to provide children with the specific, appropriate input needed to stimulate their brains and maximize their developmental progress.

The Significance of the Learning Environment

There are tremendous differences in the quality of preschool learning environments.
Preschool children are distractible and have short attention spans. It comes with the territory. Preschoolers have short attention spans because their sequential processing skills have not yet developed to where they can process a lot of associated pieces of information. They can move from this to that, taking in little pieces and chunks of information, but they cannot attend to one subject for a long time if their processing is not up to the task.

The significance of the learning environment cannot be overstated for children at this age. The more distractions there are in the environment, the more difficult it is for young children to filter out the extraneous input and focus their attention, even if there is something in the environment that is appropriate to their learning level. How many adults would attempt to study new information in an environment containing the distractions that exist in a room full of preschool children and a lot of “fun stuff?”

Many parents ask about putting their children in schools and situations with other children so that they can learn from the other children. NACD recommends parents be very selective about such situations. The better organized and structured the environment is, and the fewer visual and auditory distractions in the environment, the better the odds are that any child will in fact learn something specific and appropriate.

Learning Occurs when Specific Input is Provided with Sufficient Frequency, Intensity and Duration—Random Input is Distracting

In any given environment a child will generally learn that which is being presented with the greatest intensity. Imagine a room with fifteen or twenty children where a few are playing in a sand box, a couple are looking at books, a few more are painting, a group are huddled around a teacher reading to them, and one is throwing a humongous tantrum because he can’t have the truck he wants. Guess what is being presented with the greatest intensity—and guess what is being learned? The reality is that for most preschool-aged children in a room with many other kids, a myriad of toys, and a lot going on, it is very difficult for them to learn what we would like them to learn. Learning/development occurs when we provide the brain with specific appropriate input, and the input must be provided with sufficient frequency, intensity and duration. Random input is distracting, and random extraneous input does not stimulate neurological development or the learning process.

Using Video Tapes to Teach

I have been known to tell parents to save their money and not send their child to the preschool, but to go to the preschool and videotape a child doing the things they would like their child to learn. Video tape a child climbing the slide, doing the monkey bars, riding the trike, drawing a circle, taking off their coat—doing any of the things they would like their child to learn from another child—then let their child watch it at home.

I used to do a lot of all-day seminars. We would start off with my speaking throughout the morning, then take a lunch break, and, because we had a lot of information to give the attendees in a day, we would show a video of me speaking during lunch. After lunch, we would follow up with me speaking live throughout the afternoon. A lot of me! After we had done a number of these seminars I started to watch the attendees during the lunch break, and it became evident that they paid better attention to me on the video than when I was standing in front of them. The videos were no great production—they were simply a talking head, my talking head, the same head they had been hearing all morning—but the audience seemed more focused and less distracted watching me on TV than when I was standing in front of them. Once we recognized this phenomenon, our first thought was that our society is in big trouble because we have become so trained to watch the tube that these adults were simply reflecting that training. (To some degree that may be true—I don’t think too many people would argue that the use of audiovisual media has been abused, particularly with children, and that the majority of the content is garbage.) But the answer was not so simple as that. We wanted to understand what was going on in the brain that would make people pay more attention to a person on TV than to the same person standing live before them. One of the questions we asked ourselves in order to find the explanation was, “Who does notwatch television, and why not?”

Well, experience had shown us that many autistic children do not “watch” television; little babies do not watch television; many children with obvious visual issues do not watch television; many children with globally low developmental function do not watch television; and, except for brief moments on Animal Planet, my dogs don’t watch television. And what do all of these examples of individuals who do not watch TV have in common? They all have poor or underdeveloped central/macular vision.

As we looked further into this and explored the development of attention to television in our children, we came to the realization that television provides a unique form of visual stimulation. The images on television can only be perceived using central/macular vision; one cannot process the information on the screen with peripheral vision. Children with poor or underdeveloped macular vision do not attend to television because they cannot see it; the image provides them with no meaningful information.

NACD Discovers TV Can Be a Powerful Tool for Visual Therapy and More

We decided if we needed to develop central/macular vision then perhaps we needed a specific instrument that required the use of that vision—the TV. We started having parents sit in darkened rooms about two or three feet from the TV, with their “blind” or visually impaired, or autistic, or delayed, or simply young children, and we “taught” them to watch TV. For content we used whatever we felt would best attract the individual child’s attention. We used a lot of homemade videos of everything from Mom talking directly to the child to videos of themselves or siblings, to spinning objects and black and white shapes. We incorporated their favorite music and voices and in general used whatever we felt might attract their attention. In the vast majority of cases the children would first glance at the TV and then, generally, over a relatively short period start attending for longer and longer periods of time. Within a short time the children did start to attend to the television and develop their central vision. They then began to make eye contact, and look at books and pictures better, and in fact do all the things they should be doing with their central vision to learn about their environment. In autistic children we saw a significant decrease in the visual sensory play (Debilitating Sensory Addictive Behaviors) and a corresponding improvement in their overall function.

Not only were we discovering that the children’s visual function was improving, but because of the content we were using, the auditory and language skills were developing as well. Once we had the children attending to the TV, we started to experiment with content, and many of the programs we designed for families began containing various therapeutic and educational videos.

TV Screen Holds Visual Attention, Helps Brain Tune Out Peripheral Distractions

So, back to my mesmerized audience, why did they attend so well to the talking head on TV? We found the answer, once again, by working with our clients. As we began to use therapeutic videos, we were happy to see that many children learned exceptionally well using the methodology, but we were surprised to find that many parents were having the same experience I had at my seminars. The children were often attending better and learning better from the videos than when the family was actually presenting the information live! We were learning that not only is television a great tool for developing central vision in children, but it really is an outstanding educational tool.

Observing our audiences’ and clients’ responses taught us that television—and computer—screens provide stronger macular input than other images. As I am writing this article my vision is focused upon my computer screen. The screen offers such strong macular stimuli that my brain almost entirely tunes out the peripheral field. If I look up from my screen to my coffee cup, for example, not only do I see the cup, but also my vision gets pulled out to everything else that is cluttering up my desk because the cup does not have the same power as the computer does to hold my central vision. Now, when I switch off my computer screen and look across my office to a twelve-inch television (not turned on) that is sitting on my credenza, my vision is pulled to the books, pictures and various memorabilia I have on my shelves. The TV before it is turned on has no more—and probably less—power to hold my attention than most anything else. But, turn the television on and everything else goes away. If I turn the TV off again and look at the credenza, most everything there has the same ability to attract or detract from my visual attention. We can safely assume that for a young child who is just developing their central vision, the peripheral distraction they have to deal with is significantly more compelling than mine.

Videos are Powerful Learning Tools—Content Counts

As NACD learned to use therapeutic and educational videos, we encouraged families to make their own videos. These included close-ups of Mom saying words and emphasizing the various sounds heard in the English language; showing objects and naming them; filming animals and naming them; modeling directions being followed; modeling progressions in expressive language; modeling self-help skills; showing children how to crawl, ride a bike, and do long division. We have found this kind of video to be an excellent tool for stimulating development and teaching knowledge and skills.

In recent years, commercially prepared videos and DVD’s have been developed specifically for babies and young children. Some are really good, and some not so good. If the content is good—that is, it is teaching the child to identify a letter or a number, or to differentiate between a cow and a horse, or modeling appropriate actions and behaviors, that is all fine. I believe commercial producers are just beginning to scratch the surface relative to content, and they have a long way to go before they really understand the best ways to present the information. However, the tool exists, and it is powerful.

It is important for parents to understand that videos can be an extremely useful tool in the education of young children, but they should be selected carefully and used judiciously. There certainly can be too much of a good thing. And, any amount of a bad thing is too much! I personally find most children’s television programming to be horrendous. In the language of computers, “Garbage in—garbage out.” Content counts.

I also find that parents are spending far too little time interacting with their children. It seems our society subtly pressures parents to abdicate the responsibility for their child’s development and education to the “professionals.” I personally do not perceive most daycare and preschool programs as a good thing. So few of them recognize or provide an optimal environment for neurological development and learning. In our current culture they are a necessary reality for many families in which both parents need to work. However, we must not kid ourselves into thinking that having a two-year-old spend eight hours a day in preschool/daycare is a good substitute for quality time spent with parents. When it comes to helping young children learn and grow, the more one-on-one interaction the better.

Informed Parental Involvement is the Key to Good Child Development

I often comment that those of us who function reasonably well are lucky accidents, and those who don’t are not so lucky. The reason I feel this way is that most parents do not have much of a clue as to what pieces need to come together for their children to end up having their neurological act together, and, unfortunately, it appears most professionals do not either.

We can continue to throw more money at education, increase the hours children spend in school, and develop yet more reading and math programs that are not significantly different than the thousand that preceded them, but until we get back to parents taking a primary role in teaching their children, and acknowledge the necessity of providing individual attention and an environment that nurtures neurological development, we are going to continue to see our children fail to achieve their innate potentials.

To stimulate a brain—to teach a child—we need to provide specific, developmentally appropriate input. If we provide a child with appropriate input in an appropriate environment, not only will learning occur but the brain will learn how to process more information better. It is up to parents to make sure that information is of a quality that enhances the physical, intellectual, emotional and spiritual growth of our children. Parents who do so are their children’s heroes, and the children of such parents are our society’s hope for the future.

Reprinted from the Journal of The NACD Foundation (formerly The National Academy for Child Development)

Reprinted by permission of The NACD Foundation, Volume 19 No. 5, 2006 ©NACD

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On April 19, 1983 we heard these words from a doctor, “I believe your newborn son has Down’s Syndrome. I encourage you to take him home from the hospital, but he probably won’t be able to go to school, run, read or write.” Those words were very sobering concerning our son’s prognosis. They were also words we chose not to believe. We would not put a limit on our son’s abilities. We did take our son, Gregory, home and began an incredible journey that has been filled with ups and “down’s” that have not stopped.

We were determined to research everything we could find to help our son. Over the next few years Gregory experienced medical problems such as a heart defect, a serious, mixed seizure disorder that was uncontrollable, gastro problems, respiratory problems, chronic infections, surgeries, unable to regulate body temperature, etc. Gregory had various speech therapists, physical therapists, occupational therapists, seven different schools (public, private and home), medical specialists of every sort, behavioral psychologists, alternative treatments, supplements, etc. We began to notice that Gregory wouldn’t establish eye contact, didn’t want to be touched in some places and would scream as if in pain when we brushed his teeth, and not feel any pain in other areas of his body. He would yell if he heard different sounds such as a hair dryer, the ocean, music, or a vacuum cleaner. It became increasingly difficult to take him anywhere publicly like a store, church, movie theatre, etc. He would usually end up in a corner moaning and covering his head. So we didn’t go out much at all. He didn’t express emotion and was banging his head and doing other self-abusive behaviors. He was demonstrating all kinds of self-stimulating behaviors and not developing speech. His coordination was poor. Then came the diagnosis of autism.

As the years progressed, the labels and diagnosis’ poured in. Our hope was diminishing and the answers were running out. It was now 1993 and Gregory was 10 years old with only a small amount of improvement, but little did we know that everything was about to change. We had heard about sensory integrative therapy and felt Greg would benefit from it. We found a therapist who taught us how to do it. We began seeing improvement. The therapist had just recently returned from visiting a Dr. Berard, who had trained her in how to do auditory integrative therapy. We tried it and what an amazing result for Gregory. Following the first few sessions of therapy, he started talking. The first word he spoke was “yes”.

In 1995, a friend introduced us to National Association for Child Development and on February 22nd of that year we took Gregory for his first evaluation with Bob Doman. We were at first cynical, fearful, and not sure what we could learn after “all we had been through”. That day forever changed Gregory’s life and ours for the better. It turned out to be the answer to many years of prayers. A home program was set up to address Gregory’s tactile problems, his dominance issues, his unusual behaviors, his language difficulties, mobility problems, auditory problems, etc. Mr. Doman even made us aware of a thyroid problem that had been undiagnosed in Gregory. That initial evaluation accomplished a lot more that a home program. For the first time in 12 years we had someone else helping us prioritize Gregory’s needs. We no longer needed to run all over going from therapist to therapist. We could stay home and do the program. It saved us money, time and a whole lot of energy. There was hope again. We could relax and spend time enjoying our son instead of always researching and seeking endlessly for answers because NACD did that for us. NACD spent the last twenty years researching and developing new treatment techniques. So many of the pieces that others are trying to fit together NACD has already put together. The folks at National Association for Child Development were nice, friendly and helpful, unlike so many professionals we had dealt with in the past. Anytime we had a question, they had suggestions and were always looking for new ideas and alternatives. We have been acquainted with terms like proprioception, auditory enhancement training, The Listening Program, trigeminal stimulation, hyperacute, etc. There was a lot we needed to learn and NACD was been kind enough to teach us. The best part was that the program worked!

Greg will be 18 years old on April 19, 2001. Thanks to NACD he has a full and enjoyable life. He competes statewide in horse shows entering categories of barrel racing, showmanship, equitation and trail. He competes in track and field events, bowling and baseball. He enjoys showing off his numerous trophies and ribbons. He is a forever Star “Trekkie” and loves lightening (studying, observing it, and collecting photos). He enjoys drawing, going out to eat, shopping, etc. He has mastered all of his Nintendo games and has now conquered the computer. One of his many hobbies involves trains (HO, wooden, etc.). He has been honored at banquets and has the best of manners and is very socially appropriate. He reads and writes. Greg has a winning smile and demonstrates a full range of appropriate emotions. He no longer has difficulty with sounds and is the best of our 5 children at vacuuming. We have to stay for hours at the beach because we can’t get him out of the water. His ability to regulate his body temperature even improved which enables him to participate in more outdoor activities. He is seizure free and has a cold maybe once a year. He is healthy and strong. Greg’s area of greatest need continues to be his auditory processing and speech, but we are still working and not placing limits on him. We are now looking at vocational training opportunities and hopefully one day an independent living arrangement. There’s not enough thanks or money in the world to express our appreciation for what The National Association for Child Development has done for our family.

We are not a wealthy family and we have had to come up with creative financing ideas such as garage sales, donations, etc. to pay for the program. It has been worth every penny. NACD works hard to keep the costs down. We have 3 adopted children who are presently on the NACD program. Our state adoption workers were so impressed with Greg’s program and progress, that they made the cost of the NACD evaluations part of the children’s adoption package. They are benefiting greatly. We are looking forward to the next few years so we can share their achievements with you, also.

With sincerest appreciation, Bill and Donna Ortt

This is a humorous paper I wrote in trying to deal with the frustrations of stopping Gregory’s self-stimulating behaviors. This dealt specifically with his obsession of playing with string. In re-reading it, I am amazed at how far he has come. Years ago, it felt like we would be dealing with these behaviors the rest of his life. It took a lot of persistence and work, but it is rare today to see Greg do any of the old behaviors. He is a kind, calm, socially functioning person who has a lot to offer society and his family. He gained these tools from NACD. “Thank you” can’t begin to express how we feel. Keep up the good work. The work you are doing is impacting so many lives for the better. With warmest regards, Donna Ortt.

GREGORY’S RESOURCE MANUAL
A Guide for Replacement Behaviors

(In other words, what do you do when Bob Doman tells your mom, “Don’t let him do stimulating behaviors, like playing with string.”)

Dedicated to Greg’s mom for her untiring efforts in extinguishing his stimulating behaviors, like play with string.

If you find yourself in the position of being without a string for one reason or another, here is a list of alternatives that work quite nicely. They have all been extensively field tested and will serve as a replacement for string.

1. Find a woven rug that is off the beaten path. Try to locate a snag in the rug. If none can be located make your own. Slowly, so as not to damage the weave, pull the snag until it is approximately 42″ in length. The next part is a little tricky. Locate scissors or a knife to cut the length off at the rug. If you cannot locate an instrument to cut, then continue the pull until the section of the weave runs out. Of course, this method leaves a more obvious mark on the rug. Hopefully, it will be hours before it is discovered.
2. Since this idea only works for a short time, here is a second one to try. When someone pulls out gift wrapping paper, this is your cue. With this idea you can hit two birds with one stone. After the person finishes wrapping the gift they usually use RIBBON!! When their attention is diverted, grab the rest of the ribbon and RUN! There are a number of good hiding places to store your treasure: under your pillow, inside your dump truck, tied around toys, wadded in your pocket, etc. You can think of your own places, too. Now for part two. Grab the TAPE! It is a great alternative when all string has been purged from your environment. You can use tape anywhere and everywhere and it stays where you put it. It will stay on the floor, on your linens, on your toys, on mirrors and windows, on your books and cassettes, it even hides well on toy trains. It can take your parents weeks to find all the places. But beware, this idea usually provokes an outburst from them. When this happens, just use your tape to tape their door shut. You don’t have anything to lose at this point.
3. By now you should be getting the hang of this. Let us move on to more sophisticated alternatives. These alternatives are more deceptive to the casual eye. Hopefully, this deception will provide you more hours of entertainment without being discovered. Nonchalantly, remove lint from the your clothing or others apparel. This gives the appearance of being helpful. It is also small enough to palm when parents are looking.
4. Another great idea is RUBBERBANDS! Who would have thought a rubber band could have so many uses and appear so harmless. I did!! They can be cut in different lengths. They come in various colors, shapes, and sizes. They are so versatile. They offer more than just plain strings. Rubber bands are also easy to acquire anywhere: doctors’ offices, schools, desks, off the morning newspaper, on the ground, office supply stores, and most public places.
5. Keep your eyes open for helium balloons. Have you figured out why yet? That’s right! The tail or ribbon on the balloons can last you for weeks. Your parents won’t be any wise. They thought the ribbon was thrown away with the deflated balloons.
6. If these ideas fail, you can try some riskier solutions. Notice that at the bottom of your or pants there is a hem put in with thread. Grab an end and carefully start pulling. With any luck you can pull off a few inches without losing your entire hem and becoming obvious.
7. You should be getting the idea of alternative replacements for string in your home. Try some of your own ideas. It would be interesting to have a report from you on your ideas and how they worked. We must stick together to protect our self-stimulating behaviors that provide us with hours of entertainment and escape

Reprinted by permission of The NACD Foundation, Volume 14 No. 2, 2001 ©NACD

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