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

The post Debilitating Sensory Addictions (DSAs): Stimming & Fidgeting appeared first on NACD International | The National Association for Child Development.

In an effort to help our NACD families and others maximize their efforts and make the most out of the time they have to work with their children, it is incredibly important to keep reminding everyone about the significance of intensity.

The foundation of what we do at NACD is designing very targeted individualized programs that are created to help provide the maximum results, relative to the time invested. The significance of being targeted is that we stimulate and change the brain when we apply specific, organized, targeted input with the necessary frequency, intensity, and duration. Random input is just noise to the brain; disorganized input is irrelevant to the brain; and any input that is not received by the brain with intensity never happened.

We understand that intensity, the most important of the Super 3 (frequency, intensity, and duration), is not entirely a reflection of how loud or strong or exciting we are when working with our kids. The big factor is what the intensity is with which they are processing the input. Have you ever seen someone fall asleep at a party or in a movie theater or sporting event? These are all intense environments; but if that person is asleep, it has zero intensity for their brains—it didn’t happen. I recall the question I heard way back when in school—“if a tree falls in the forest and there is no one there to hear it, did it make a sound?” It’s not about you, it’s about them. Back to the folks at the party-how about if they are not asleep, but just dozing? Or, they just had a fight with their significant other and are running through the last argument in their mind one more time, or have a song stuck in their head that keeps going around and around. How much did all that “intensity” that is going on impact them? Probably not much. Ultimately intensity is based on how the individual is receiving/processing the input.

I have always related intensity and impact on a scale of 1-10. If something goes into a brain with the intensity of 9 or 10, learning is virtually instantaneous. Drop it down to 7-8 and we need a fair amount of frequency and duration to change the brain. If the intensity is only a 6, we need a lot of frequency and duration—many times per day and lots of days, weeks, or months. At a 5 we are in for a very long haul. And below a 5, we are better off taking a nap.

Let’s look at some of the things that affect intensity, starting with physiological issues. Diet is one of the things we talk about with all parents. I won’t get into the specifics of diet in this article but suffice it to say that if you feed your kids pancakes with syrup for breakfast, just send them back to bed and forget about school. Sleep is another foundational issue, and doing what is needed for both you and your child to get enough sleep is very important. So before we go any further, let’s see where we are. If what you are trying to put into your child’s brain is super exciting to them and they love it, they ate some good protein, had a great night’s sleep, and feel wonderful, you might get them to an 8. Trying to input something they might like but don’t love, drop to a 7; not a wonderful breakfast, drop to a 6; and then you were up with them for half of the night, we just dropped to a 5, and perhaps you are both getting ready for a nap.

Just yesterday I had a talk with a very nice family, great, concerned parents who have a teenage son on the autism spectrum. He has had a few small seizures that did not appear to have any residual effect and is on two different anti-convulsive medications. His doctors have also put him on two additional drugs that are used for schizophrenia and irritability. When I look at this boy, he looks like he is about to fall over with his eyes open. He’s at a 2-3 for intensity, and if you work hard, you can push him briefly to a 4, and on rare occasion to a 5. Under the circumstances we hope to maintain what function he has until these medications that all slow his brain down can be altered or eliminated.

Drugs that are used for seizure control and behavior and attention control are slowing down the brain. As a side note, the neurologists and neurosurgeons that I worked with almost 50 years ago were aware that the vast majority of seizures actually caused no harm, and my clinical observations over all of these years verify it; but we still have neurologists who see their mission as stopping all seizures, regardless of the fact that they are medicating the child to the point where there can be virtually no development. I’ve been happy to hear that after 50 years, there are a few neurologists acknowledging that not all seizures spell the end of the world and are being much more conservative with the medications. And fortunately there are new very promising alternatives to the drugs.

Diet, sleep, health, exercise, or the lack of, and medications all have an effect on the brain, your child’s ability to process information, and thus to be stimulated and develop.

I have a confession to make. I do not get regular organized exercise. I played sports, and I played them hard. I have almost always lived where I had a good size piece of land and always loved working outside and work hard. I enjoy walks and hikes, but a daily exercise routine—never. It’s a good thing your child has parents and helpers to help structure their days, establish priorities for them, and to motivate them and make things fun. Perhaps if I had some great fun personal trainer who came and got me at a specific time each day and praised my success, I might exercise. I probably would also need to add a 25^th hour to every day. As adults we are responsible for ourselves. We can choose to eat well, exercise, whatever; however we are also responsible for our children, and it is our responsibility to see that our children eat well, get their sleep, and do all the other things needed to help them develop well. Even the smartest child isn’t wise. We need to make the choices for them and keep them heading in the right direction. Side note: How many of you give your pets more nutritious diets than your kids?

The younger the children, the easier it is to make things fun and increase the intensity. I constantly hear that little Johnny is bored with this or that or he doesn’t like it. The reality is that it’s not about the activity, it’s about the environment of the activity and how it is presented. Remember Tom Sawyer and how he got the kids to paint the fence for him? Create the right atmosphere, and you can get your kids to have a ball cleaning toilets. If something doesn’t hurt, you can create an atmosphere that makes whatever you are doing fun, and if something hurts, stop doing it because something is wrong. If you can’t get your intensity or their intensity above a 5, what should you do? You should go take a nap and come back to it later with good intensity.

One of the most common issues I see when watching program implementation is a lack of intensity when a child gets something right or does something well. I can observe someone working on processing, and the difference in the response when the child gets something right or wrong is almost indistinguishable. Often when reviewing program implementation videos, we have to pay close attention to see if a child got something correct or not because we can’t tell the difference from watching the reaction of the parent or caregiver.

Children of most any age will respond to your positive attitude and words of praise. If older children need something more to get their intensity up to adequate numbers, then explore some form of a positive token economy, where achievement as a reflection of their trying and doing something with sufficient intensity to impact their brains can purchase special privileges and such. But always let your child know that you are proud of them for their efforts and achievements. Don’t reward compliance that does not equate with intensity. Reward achievement even if you have to initially make it a bit easier for them so that they can experience success.

One of the most common killers of intensity is duration. Many of the activities we give children have a duration of only a minute or two, and the duration we give is a maximum. Maximum, not minimum. More often than not, more turns a positive into a negative. We encourage parents to, if at all possible, end an activity on a high note. Parents tend to continue an activity until the child has had it, and it turns negative. The result of that is the next time you go to do that activity the child recalls it as a negative, not a positive. Imagine giving your child the forbidden fruit—ice cream. You give them just a spoon or two and they love it and you stop. They want more. Now imagine that you gave your child a couple more of spoons of ice cream—still loving it—and then you gave them a small bowl. They’re still loving it, but not quite so much. Then make them eat a large bowl, having to force them to eat it over the course of an hour; and to really make it fun, make them eat more and more until they throw up. That would sure teach them to love ice cream. When should you have stopped? We have the ability to turn most anything that can be positive and fun into a negative. Remember: it’s all about intensity.

The big secret to success is intensity—the intensity with which your child takes in the input you are providing.

Intensity is not only foundational, it is mandatory: Get it?

 

Anything that adversely affects your child physiologically has a negative impact on intensity: Get it?

 

Any mediation that affects your child’s brain is likely to have a negative impact on their intensity: Get it?

 

What you do can affect your child’s intensity, but ultimately, it’s a matter of doing what works to create intensity in them: Get it?

 

Too much of a good thing is a bad thing; stop while you are ahead: Get it?

 

If your intensity or your child’s falls below a 5 and you can’t raise it, take a nap: Get it?

 

To be successful we need to provide your child with specific targeted input with sufficient frequency, intensity, and duration: Got it?

 

Good!

Reprinted by permission of The NACD Foundation, Volume 31 No. 8, 2018 ©NACD

The post Intensity: Get It – Got It – Good! appeared first on NACD International | The National Association for Child Development.

I just returned from an outstanding trip to Sydney, Australia. I worked with some great folks and evaluated many kids whose potential I can’t wait to help unlock. I also met with some great open-minded folks at the University of Sydney to discuss a research project with our Simply Smarter System and creating NACD courses for their continuing education programs.

You might surmise from the title of this article that it has something to do with brains; but what is the link to Norfolk pines and what is a Norfolk pine?

I have always thought that the little Norfolk pines that I would see in grocery stores around Christmas, overlooking the glitter they often put on them, were rather exotic and interesting. I had never had the time, opportunity, or actual inclination to investigate them; but I still found them to be curious little 18” plants, particularly since they were a species of pine tree. However, upon recent investigation, I discovered why I thought they were curious pines– they are not actually pine trees at all. Okay, lest you think I am having some kind of senior moment and running off on a tangent, let me start trying to connect some dots.

While visiting Sydney we spent a weekend at Manly Beach, just outside of Sydney. Shortly after arriving, we went out to check out the sights. The beach and the area were really spectacular. We admired the beautiful sandy beach, watched the surfers, and started appraising the dozens of tempting restaurants. But some of the most prominent features of the area were these very spectacular, exotic hundred-plus-foot high evergreens that were everywhere. My son, Laird, wondered aloud what kind of trees they were, and I realized that I recognized them as huge specimens of those little plants with glitter–Norfolk pines. I decided that when I got home I needed to go find one of the 18-inch versions for my house and another for Laird and his wife to commemorate our trip to Australia.

Fast-forward a couple of weeks. I’m back in the mountains of Utah, where we have many “real” pines and evergreens. I was home watching the news and dozing a bit when a commercial came on. I rarely pay any attention to commercials, with the exception of the occasional Jaguar commercial, and I really didn’t pay any attention to this one either, or so I thought. But actually, my brain did. Something in my peripheral vision caught my brain’s attention. I stopped the commercial and rewound it. I still couldn’t tell you what they were trying to sell, or why my brain said, “Hey, there was just something of significance;” but after I rewound the commercial, I discovered that in one very fleeting scene, as they were rapidly flashing across an office, there sitting on a shelf was a little potted Norfolk pine. But why did my brain react to that little piece of apparently-irrelevant data, when my sort-of-conscious brain was trying to contemplate what was behind Hillary Clinton’s missing email? The answer is simple: it could, so it did.

Did you ever buy a new car and suddenly start seeing them everywhere? Did a few hundred thousand of them get produced and sold overnight, or did they just start occupying a more significant place in your brain? Could it be that as our brains add more and more importance to these pieces of information, and as we make more and more associations, particularly personal associations, that our brains, like magnets, gather more and more associated pieces? Could it also be that what we know, what is in our long-term memory, provides relevance and helps to determine what we do and do not perceive? That our short-term and working memories dictate how many of those pieces we can sequence and associate, thus determine how large and meaningful our world is? How connected we are to it? How tuned in we are, how significant it all is? How much we are learning?

Yes it could be, and I believe it does.

There is this great connection and loop between our short-term memory, our working memory, and our long-term memory. Our short-term memory determines how many sequential pieces of information we can process. Starting with a newborn, that number is zero and builds based on input/opportunity. The foundation of our working memory is our short-term memory. Our working memory refers to how many pieces we can manipulate and determines our complexity of thought. Together we call our short-term memory and working memory our processing power. What we process goes toward, and perhaps into, our long-term memory, based on the frequency, intensity and duration of the input and what is already in there. Our knowledge base determines what we actually process. And the more we process and the more we put into our brains, the more we stimulate the brain, the more we trigger neuroplasticity, grow connections, build networks, and literally grow our brains. The more we know, the more relevance new input has, the more our brains pay attention to it, and the more we take in, the better we process–it’s a loop. The brain is really very cool. The more you put into long-term memory, the more it can actually hold and the more it has in it, the more new input it attracts.

The significance of this is that what we teach our child impacts the development of the short-term and working memory. If it is relevant and associated information, then it gets into long-term memory, and then in turn it adds relevance to additional new information and builds everything even further.

The degree to which we impact the development of a child’s brain and build their neurological foundation (short-term memory, working memory, and long-term memory) is largely a reflection of how targeted our input is.

Targeted input means that it is specific to the child, as reflected by how well it fits their present level of processing and what they already have in their long-term memory. To help you understand this, put yourself into these two different scenarios:

Bad Scenario–You are in college, a freshman English Literature major. Things got screwed up and they placed you in some kind of crazy blow-your-mind advanced math class with a bunch of seniors. You hadn’t taken math since your junior year in high school and then hadn’t gone past Algebra II, which you hated. Saying that everything that went on in this class was over your head is an incredible understatement. The only things you would take from the class were a significantly lowered self-image, verification that you really stink at math, and a lower GPA. In this scenario the odds are that you had no real frame of reference for the material, nothing for your brain to associate/connect with; so what you had in your long-term memory did you no good at all. If you can, imagine a blackboard covered with formulas and figures that you need to process visually. Odds are that being an English Lit Major you are much better at processing auditory sequential information than visual, and that your visual processing probably was not up to the task. Net result: no increase in your auditory or visual short-term or working memory, and nothing added to your long-term memory other than a confirmation of your hatred for math. Neuroplasticity triggered—minimal. Brain change or growth—minimal.

Good Scenario–You are still a freshman English Lit. major. You get invited to a small private dinner party at your favorite professor’s house to meet your favorite author. You have read everything this author has written, and you know your professor’s views on her work. At dinner, in this very intimate evening where you are treated as a peer, you have the opportunity to discuss this author’s novels and short stories and her new project. You take in every word as though it had the intensity of a bolt of lightening. Each bit you take in immediately associates with many hundreds and perhaps thousands of other related and associated bits and chunks of information. This was a targeted educational experience. Because it was so targeted for you, the strong auditory learner and conceptualizer who loves literature and who knew and loved the author and her work, your brain was changed. The experience added to your long-term memory/knowledge base, which in turn would then affect your brain’s ability to process future associated input. The targeted, and thus intense, input would have actually helped build your processing ability as well. Neuroplasticity triggered—immense. Brain change and growth—huge. These are moments you would perhaps recall for a lifetime.

What are the implications of all of this?

What affects, stimulates, and develops our brains is very specific and unique to each of us. We need targeted individualized educational opportunities to encourage neuro-development. The more individualized our education, the more it actually constitutes an opportunity. Random disassociated input does little to really change the brain. Sequential associated information makes an impression on the brain.

How much we take in and learn and what gets into long-term memory is a refection of the strength of our neurological base, our short-term memory, working memory, and long-term memory. We needed targeted individualized opportunities to build our processing power, utilizing specific processing brain development activities, such as the Simply Smarter System, NACD Cognition Coach apps, and 1:1 processing activities.

What we know of our world affects our processing and memory. It appears that our brain pays attention to what it can identify, what has meaning, and particularly to what it can name and the degree to which it can name it. Observing many thousands of children and trying to crawl into their brains, it appears that our brains do constantly react to, rehearse, and review based on opportunity. Simply being able to name those things that are in our daily world, I believe, helps build and develop our processing and helps keep information in our long-term memory.

The more we learn, the more we can learn. Knowledge, information in long-term memory, produces more knowledge and increases what goes into long-term memory. As we learn and add to our long term memory, the more significant more things become, and the more our brains attention to and learn. Picture your long-term memory as a magnet, a magnet that grows and gets stronger with every new thing that it pulls in. The more you put in, the “smarter” you get, and the easier it is to get even smarter.

What develops changes, and that which changes can be developed. If those involved with child development and education really understood this, this could be a game changer for everyone. What develops changes. Every child begins life not being able to even give meaning to a sound or an image, but learns and changes based on opportunity. Short-term memory develops. Working memory develops. Everything that develops through opportunity can be accelerated with more and better opportunities. And you can teach an old dog new tricks—if you try.

I did find some little Norfolk pines. We have them in our homes, and I have no doubt that our memories of our trip to Australia will remain much longer now that we have our trees.

Just a little P.S.: I’m presently in Los Angeles. I used to live here and I’ve been coming here regularly since the 70s. You will never guess what I was seeing all over the place this evening as I drove through rush hour traffic in Laurel Canyon. Norfolk pines! How amazing it is that during all those years my brain never determined that they were worth acknowledging. Once my brain could put a name to them and had established associations, they became significant. I think that’s very cool.

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Stimulation is vital to our brain’s efficiency. It is the regular and proper stimulation of our brain through our five senses that permits us to be able to function on a relatively steady, even keel most of the time as our brain relates us to what is happening around us. Proper stimulation leads to the proliferation of more and more connections between brain cells creating more efficient pathways of brain function.

But what happens to the brain’s efficiency when the brain is deprived of proper stimulation? Sensory deprivation studies show us that sudden and nearly complete deprivation of stimulation through the five senses can lead to dramatic changes in the brain’s efficiency with a partial loss of memory, a lowering of the I.Q., personality changes including withdrawal, hallucinations, and in some people even an abnormal electroencephalogram, a picture not unlike what is seen in the mentally ill patient who becomes withdrawn and hallucinates.

The bright side of such studies on sensory deprivation is that they teach us that the adverse effects of deprivation can be reversed if the deprivation is stopped and the brain properly stimulated. It is important that we realize such problems are reversible with proper stimulation.

Let’s look at some chronic or longer lasting forms of sensory deprivation. Sadly, this country’s recent history provides a number of examples of just such deprivation with its sometimes tragic results. Captured U.S. soldiers fighting in Korea were subjected to a prolonged period of isolation by their captors. During such isolation they were forced to listen to propaganda. Their brains, dulled by prolonged isolation, were vulnerable to the propaganda to the degree that when a truce was declared and prisoners exchanged, many U.S. soldiers refused to return home. Later after being taken out of isolation and permitted the normal stimulating effects of an active environment, their brains’ efficiency improved to the point that most of them wanted to, and finally did, return home.

The Pueblo incident and the sad effects of isolation on Captain Bucher and his crew should have taught us that none of us would be immune to the adverse effects on the brain of other forms of sensory deprivation. For example, the cerebral palsy child whose body is restricted by braces and a wheelchair is deprived of some of his most needed forms of stimulation, that which comes from uninhibited movement providing the brain with tactile, vestibular, and proprioceptive feedback stimulation from the body extremities, the muscles, and the joints. Adult head injury patients and stroke patients are also frequently subjected to the same restrictive environment depriving their brains of desperately needed stimulation. Being confined to the non-stimulating environment of the nursing home dulls the patient’s brain, adding to any disorganization and confusion produced by the brain injury itself. Sedatives and tranquilizers often prescribed for such patients add to their mental confusion making it even more difficult for the patient to properly relate to his surroundings and causes deeper and deeper withdrawal.

A classic example of a withdrawn child is the Autistic child. In treating the many Autistic children seen by NACD, we find one of the frequent observations is that many such children have turned off one or more of their senses, thus creating their own isolation from which we must shake them. To a lesser degree, the child who daydreams in class is temporarily turning off the world, contributing to a possible future learning disorder. The normal child who turns off his parents and teacher may be developing a behavior problem. Schools and homes together are turning many children off to learning.

NACD, with its evaluation of a client’s brain efficiency using the Developmental Profile, is aware of any shortcoming in sensory intake and is able to provide an individualized program of sensory stimulation designed to prevent or overcome any associated problems thereby broadening the brain’s horizons.

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

Reprinted by permission of The NACD Foundation, Volume 5 No. 3, 1984 ©NACD

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The level of function achieved by an individual is a reflection of the stimulation and opportunities afforded the individual by his environment.

Injury to the brain disrupts the brain’s ability to receive, process, store, and utilize information, leading to neurological dysorganization. Our ability to stimulate a dysorganized child is reflected in the child’s growth and development, or lack of such.

It is said that one learns from his failures. At one point in my career, I had the opportunity to learn from some of the most magnificent of human beings I am sure I will ever meet. These people, these children, were the living, breathing (though not always satisfactorily) failures of the entire profession dealing with hurt children.

In 1971 my position was that of Clinical Director of United Cerebral Palsy of Delaware County, Pennsylvania. This old Victorian building, located on a hill surrounded by four acres of rolling grounds, was the site of my education. U.C.P. also ran the George Crothers Memorial School a few miles away where I had spent the previous three years developing some of my educational and behavioral principles and techniques. As Clinical Director, I was responsible for the team of therapists and therapy programs carried out with each of the children in the school, as well as the academic programs.

My learning experience as Clinical Director began on my first day in my new position. This experience, as well as many others, arrived in the form of a problem. This particular problem involved a severely brain-injured child named Dawn. Dawn had just entered her teenage years and was a lovely, blonde, warm, loving, and happy child. Dawn also only weighed about thirty pounds. On a good day she could move some facial muscles, and turn her head slightly. Dawn’s immediate problem was that she had stopped breathing on several occasions. On that particular day, the staff was afraid to touch her for fear that it would happen again. They all felt that Dawn should be taken home until she was breathing better. Or until…

I already knew Dawn’s history because I had spent hours reviewing the children’s charts prior to my first day as Director. Reviewing histories of severely brain-injured children and their families is always a sobering experience, but Dawn’s had been one not to forget. Dawn had been born a brain-injured child. Her parents eventually found their way to the Institutes for the Achievement of Human Potential, where she had received a full program, and had made fantastic progress. At five, Dawn could walk, looked beautiful, seemed healthy, and was obviously on her way toward becoming “normal.” Evidently, all miracles are not meant to be, because after working so hard and doing so well, Dawn fell victim to encephalitis. Not once, but twice, leaving her severely brain injured. The program was tried again, but this time without much success. She then made the tour of surgeons and specialists, finally arriving at U.C.P. for what was termed a maintenance program. A maintenance program meant failure. Not the child’s failure, for Dawn never failed, but our failure—the world’s failure. When everything the world knows has been tried without success, there is nothing to do but try to maintain the child’s condition, and wait. And hope that you, or someone, will find something to help the child.

On the particular day while Dawn was having the difficulty, I was fortunate, because the Medical Director was in the building examining children. The founder and Medical Director of U.C.P. was also a co-founder and Medical Director of the Institutes for the Achievement of Human Potential, the founder and Director of the Center for Neurological Rehabilitation, the holder of many awards and certificates, and one of the few physiatrists (a physician with specialization and certification in physical medicine and rehabilitation) in the nation. He was also my father and my mentor.

That day when I presented the Medical Director with the problem, I received a reply which I have heard in various forms many times since. “Dawn is a severely brain-injured child. With what we know today, she is one of the few which we are failing, and when we fail a severely hurt child, they do die. They cannot breathe, they cannot digest or properly metabolize their food, their circulation is poor, and their sensory channels are often so involved that they cannot even perceive the world in which they live. They die, because they starve. Their brains are starved for information. They need stimulation.” When a child is doing poorly, she doesn’t need less, she needs more; and it was our job to see that Dawn received it.

I spent most the rest of that day on the floor with Dawn. At first she was white as a sheet, and her breathing was so irregular and shallow that it could have easily stopped completely if Dawn had let it. She didn’t. For perhaps the first half hour, I just sat and watched her struggle to breathe, her tiny body rigid and her blue eyes closed in a half sleep, half coma. After that, I started to whisper to her and gently stroked and squeezed her arms and legs, without receiving any signs of response. Then I rubbed and squeezed harder. I turned on sound-effect records of jets and trains; turned on all the lights; turned off all the lights; put the most horrible odors I could find under her nose, and the most obnoxious tastes into her mouth. I rolled her, and turned her and whispered softly into her ear. Gradually, her color got a little better and her breathing became deeper. I could see some flicker of recognition in her eyes. Toward the end of the day her mouth twitched and her eyes opened. This time bright and alert, she broke out with the most beautiful smile I have ever seen—and a long healthy moan.

Five or six times a day after that I would come down to see Dawn and we would talk, or at least I would talk, and Dawn would react with a combination of sounds and expressions that could communicate all her feelings.

I learned a lot from Dawn. She gave real meaning to many of the concepts that my father and uncle had developed and utilized to develop a treatment philosophy for brain-injured children. Dawn taught me that even the most severely involved child can be bright. In fact, very bright. Dawn taught me the fantastic need for stimulation to sustain life itself. But perhaps most of all, she taught me that within those incredible bodies lie real people. Loving, giving human beings that could give so much without even speaking a word. Real people that we must never give up on, and for whom we must always search for new answers.

That night after spending the day with Dawn, I stayed awake, designing a program and designing a new environment for Dawn, as well as other children in her group, and for our children in preschool programs.

Designing a program for severely brain-injured children in a clinical or school setting is extremely difficult. At maximum, there are six hours a day, and five or six days a week to work with a child, which is not enough time for a severely involved child. A severely brain-injured child should be worked with virtually every waking moment, seven days a week, every day of the year. In a clinical setting there is the problem of staff. Staff which must be paid. At U.C.P., I had three children for each staff member on a good day, when there were also volunteers, and five children per staff member on a bad day. The children we were working with could not provide their own stimulation. If left alone for two minutes, they would fall into an almost sleep-like state. With a maximum of six hours per day, we could not afford to waste even a minute of their time.

The next morning I called a staff meeting and made an announcement. No child shall be without stimulation for a single minute, from the time he enters the building until he leaves. Within a week, what had been rather normal looking clinical rooms, were transformed into maximum sensory environments. The floors became a series of ramps and platforms covered with padded mats and textured carpets, as well as vinyl surfaces. Mounted on two walls and the ceiling of each stimulation room was the most exotic light show equipment I could find, so we could produce vivid moving visual images in every corner of the room. We also mounted slide projectors which were synchronized with tape recorders that played into cordless head phones, so we could supply different auditory stimulation to different children at the same time, while allowing them movement throughout the room. Each room also had dozens of sponge balls scattered around the floor which the staff would throw toward, and at the children. In addition, two staff members would constantly move throughout the room changing body position, increasing movement, masking, stimulating taste and smell, and, in general, creating as much disturbance as humanly possible. This is where the children would stay when they were not being taken into one of the many individual therapy rooms where they received their specific individual programs in mobility, language, vision, auditory competence, manual competence, tactility, or academics. The children thrived in this new environment, and progressed at a rate that amazed me.

The stimulation provided to the children in these high stimulation environments was great enough to get through even the poorest sensory channel.

The children were being provided with specific stimulation delivered with the greatest frequency, intensity, and duration possible within the economic and social parameters afforded.Dawn and I remained together for almost four years. Four years in which we had little to offer her except love and attention. No new miracles were found for her. During those four years, Dawn progressed ever so slowly. There was significant progress, but she had a long way to go. Her breathing became fairly stable. Her awareness improved about 1000 percent. Her eyes and face were alert and sparking. She became less spastic and developed some controlled movements of her arms and legs. She developed a great sense of humor and without a doubt understood everything said around her. During those years we employed the combined expertise of our team of therapists, our medical staff, and whatever could be picked up from the literature. Dawn made progress, but it wasn’t sufficient, for Dawn was still dependent upon the intense stimulation of the center environment to keep her going.

Children like Dawn are either turned on or turned off. When they are turned off, everything turns off. The brain virtually shuts down. It is an over simplification, but you are essentially either learning or forgetting. That is, if you are being stimulated you are learning; if you are not being stimulated, you begin to lose what knowledge you have. The brain never remains static. In a very real sense, if you don’t use it, you lose it.

Appropriate Education

In Pennsylvania in the early seventies, we at U.C.P. worked hard at getting the first “Right to Education” law enacted. Prior to the enactment of the Right to Education, children who were classified below the level of “educable” were denied access to public education funds. Programs such as we had were either funded privately, paid for by the family, or through specific government H.E.W. grants. We saw the acceptance of the Right to Education as a giant step forward for our children with severe problems. With enactment of the new law, all children were entitled to an “appropriate education.” The problem developed with the word “appropriate.”

Having succeeded in getting state education monies for our children, we then came face to face with government controls and guidelines, and a basic dispute as to what constituted an appropriate educational experience for a severely brain-injured child. The traditional care for such children was, and still is, defined as custodial. Custodial care involves changing diapers, feeding, and very minimal therapy. Therapy which rarely exceeded range of motion. Range of motion is moving or ranging the joints in an attempt to avoid contractures. Specific sensory stimulation, per se, does not fit into traditional custodial care. In fact, traditional custodial care generally produces a sensorially deprived environment.

What constitutes an appropriate opportunity for any child? How much is enough? How much is too much? How much can we expect the government institutions to do for us?

The Pennsylvania Department of Education moved into U.C.P. with their funding, guidelines, and restrictions. Guidelines and restrictions with which I was in direct opposition. These restrictions restricted the type and degree of stimulation and opportunities which could be provided for children in a state-run school. I lost my battle with the traditionalists. Our school thus became like the others. I could not see my role as running another school for the state, and I resigned my position. A few months later, while on a trip to Barcelona, where I was working as part of a team which visited Spain every three months to design in- home stimulation programs for their brain-injured children, I received a call from the States telling me that Dawn had died. Within six months after having received an “appropriate” education, Dawn and another child from that original group of six were dead.

Stimulation

As stated earlier, the level of function achieved by an individual is a reflection of the stimulation and opportunities afforded the individual by his or her environment.

Brain injury is in the brain. The goal of treatment must be either the creation of function where none exists, or improvement of function where it is delayed or inhibited.

Stimulation “excites” the brain. What does excitement of the brain produce? Functional activity. What is functional activity? Breathing, metabolizing food, walking, talking, reading, etc.

The goal of treatment is to produce functional activity.

Stimulation which is produced in the sufficient frequency, intensity, and duration excites the brain, improves the organization of the brain, and permits increased functional activity.

Bio-Responsive Multi-Sensory Environment

In its efforts to assist a full range of children, NACD has designed an environment which is to be utilized within our facilities for that segment of our clients who are at the lower end of the continuum of function. The comatose, semicomatose, or severely brain-injured child is difficult to assist because of the extent of their injuries, their medical complications, and the extreme difficulty involved in providing such children with sensory input which is specific enough and intense enough to stimulate and organize their brain.

The Multi-Sensory Environment is patterned after the environments designed several years ago for Dawn and for our preschool children. This environment consists of specific intense visual, auditory, and kinesthetic stimuli that is of such intensity so as to be perceived by children with only the lowest level of function. Such an environment with its built-in controls will also be utilized for “normal” infants as well, permitting us to provide for their specific developmental needs.

Greatly enhancing the usefulness of the Multi-Sensory Environment is the application of bio-monitoring and biofeedback equipment. Such equipment permits the utilization of the sensory environment as a bio-responsive, Multi-Sensory Environment. Bio-responsiveness refers to environmental response to biological or physiological action. Bio-monitoring is possible for all of our bodily functions—the electrical activity of our brain, our respiration, circulation, even the tension within our muscles. By monitoring the child’s reactions to various input, we can determine just what input is stimulating the child’s brain, and what is not. Such knowledge will greatly enhance our effectiveness in designing sensory programs for the severely involved child.

Biofeedback, as a branch of treatment and rehabilitation, is relatively new. Even in its infancy, biofeedback technology has proven useful in such areas as the control of seizures, improving circulation, and changing muscle tone. Biofeedback essentially provides us with instantaneous feedback as to what our body is doing, thus permitting us to exert influences over these basic functions that were otherwise unresponsive. This feedback normally is provided by instruments which give us visual feedback (lights going on and off) or auditory feedback (tonal changes or clicks). For the young child or severely involved child, such feedback is meaningless. However, if such feedback permits the child to control the entire intense sensory environment—with intensive visual input and intensive auditory input, as well as the very surface upon which the child lies—we will, hopefully, be able to teach the child to reproduce these movements.

The Right Direction

As parents, we cannot accept limitations placed upon our children’s development. Appropriate opportunities cannot be legislated, and perhaps can never be realized within the confines of a government supported educational system. The economics are just not right. Working together and supporting each other, we can increase the opportunities available for all of our children. The primary responsibility for a child’s education and development must lie with the parents. The National Association for Child Development was established upon the premise that if any of our children are going to have the opportunity to come closer to realizing their full potential, the parents would have to be actively involved in that process of development.

NACD, as an organization of parents and volunteers, is striving to utilize all available resources to gain what expertise is available, and is dedicated to the research and development of new avenues within which to assist our children.

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

Reprinted by permission of The NACD Foundation, Volume 1 No. 1, 1980 ©NACD

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