Ruth | Integrated Learning Therapy

immature differentiation balance problems ATNR vestibular-cerebellar functioning

Ruth is in Grade 0. She is a friendly girl of average build who seems eager to please, but finds it difficult to comply with instructions. She is easily distracted and is constantly fidgeting or moving on her chair. Her teacher and parents are concerned about her school behavior and lack of ‘school readiness’ and also very concerned about her habit of masturbating openly during rest time in the afternoons.

Ruth’s diet is already controlled because of her allergies and an earlier operation to her small intestine. She is not allowed to eat lots of sweets and chocolates and drinks at least 4 glasses of water per day. She is not taking any supplements, so an essential fatty acid was recommended.

The evaluation revealed problems with her vestibular system, muscle tone, proprioception, kinesthesia and interhemispheric integration. She also shows immature differentiation. Differentiation should develop before lateralization, which means she doesn’t have an internal map or external map of space and cannot distinguish left and right.

Eye movements are very jerky, and she finds them very difficult to do with her eyes taking strain during tracking. During the convergence exercise her eyes could not stay with the focal point and often lost it. She shows cross-dominance, having a dominant left eye but dominant right hand, foot and ear.

Aberrant primitive reflexes that are present must be inhibited, for example the ATNR, which causes balance problems, difficulty crossing midline, oculomotor problems with poor ocular pursuit movements, visual and spatial perception. Audition is also a problem, but can be addressed more later after basic systems have improved.

She was given a programme of activities to follow to address these concerns. To address her differentiation problems and also to help distract her from masturbating, her practitioner devised an additional activity: her mother made her a necklace of string with two beads on it. She wears it during the day during school and when watching TV in the afternoons and is encouraged to ‘fiddle’ with the beads. When she lies down to rest at school, both hands should be occupied with the exercise.

After 10 days, Ruth showed remarkable improvement. She wasn’t masturbating as much anymore and could sit still. She loved the exercises so much that she woke her mother up on the Saturday and Sunday to do the exercises.

Ruth was re-evaluated eight weeks later and her practitioner was pleasantly surprised by the reports and results of a re-evaluation. She could sit still and didn’t fidget any more. She had completely stopped masturbating and no longer needed to fiddle with her fingers. She was generally more confident in herself, her balance and coordination had improved and she was crossing the midline more naturally. Proprioception and kinesthesia showed improvement and overflow of movement was reduced, showing better differentiation.

There were also major shifts as far as aberrant reflexes were concerned. She seemed to have integrated the STNR and showed greatly reduced signs of an ATNR. Her visual tracking was less jerky than before, and although she was still losing a focal point, this happened less often. With the improvement in vestibular-cerebellar functioning, it was decided to send her to a Developmental Optometrist for possible visual therapy.

Internalising the knowledge of left and right showed some improvement but needed more work.

Ruth continues with the programme and is helped enthusiastically by her mother who is thrilled with the results.

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Martin Doherty, writing for The Conversation, says that at the age of about four, children reach important milestones in brain development.

One of these is a huge improvement in understanding others’ thoughts and feelings. This is the start of empathy. Another is in spatial thinking—understanding how objects are positioned and related. This is the beginning of the ability to read maps.

Martin and his colleague, Catherine Sayer, conducted a study with 175 two to five-year-olds to explore how children are able to use scale models to figure out where something is in the real world. At about four, children are able to use a scale model of a room to work out where something is. We thought that this might result from children’s understanding of how one thing can represent something else. But we actually found that four-year-olds’ ability to use scale models came from their spatial abilities.

At the same age, children start to understand that someone’s behaviour is due to what that person believes, not necessarily what is really the case. This has interesting consequences.

If you’ve played hide-and-seek with young children, you may have noticed that they aren’t always very good at it. They love the ritual of looking in all the wrong places first, but beforehand they may tell you where they are going to hide, hide in the same place every time, or not be especially hidden.

After their fourth birthday, they get much better at hide and seek. They understand that the seeker looks in the wrong places because they don’t know where the hider is.

At about three to four children also start to tell lies. They realize they can make someone believe something that isn’t true.

Understanding symbols

Martin’s earlier research with fellow psychologist Josef Perner suggests that four-year-olds don’t just start to understand how others’ minds work. Figuring this out is part of the development of an understanding of “representation”—that symbols, like thoughts, words, or pictures, can be used to stand for something else.

Children start to think about how words relate to objects. This means, for instance, knowing that “animal” can refer to something you already have a name for, such as “rabbit”. This might help children learn the new word.

Their ability to use a understand the components of pictures also improves around this age. Very young children use a lot of trial and error to complete a jigsaw, picking up random pieces to see if they fit. By the time they are about four years old, they start to use the picture as a guide, trying to connect lines and match bits of colour, while checking the guide picture on the box lid.

Developmental experiments

Another ability children develop at around four is using scale models. A classic set of developmental experiments involved a model of a regular household room. The real room had typical furniture—sofa, table, cupboard and so on—and the model had miniature versions laid out in the same way.

Children were shown where something was hidden in the model and told to find an object hidden in “the same place” in the room. Children of around four can find the object using the identical layouts. If shown a sticker under a particular chair in the model room, for example, they can go straight to the “same” chair in the other room. This is the fundamental understanding required to read maps.

Adults see scale models and maps as representations. Maps represent a town or a country. A scale model of, say, the Eiffel Tower represents the real thing. At first, Martin suspected children’s ability to use scale models is more evidence of understanding representation at this age.

He was wrong. Instead, the researchers found that this ability is based on a development in children’s spatial abilities that also occurs at about four. This is the ability to think about spaces and where objects are within them. Spatial abilities help with maths skills, and good spatial ability is linked to an interest in science, technology, engineering and mathematics.

Their experiment was simple. They compared the model room task with a test of understanding how representation works. The two abilities develop around the same age, but they found they were not related. Children who could do one task couldn’t necessarily do the other.

They also had a test of purely spatial ability. Children who passed the model room task also passed the spatial task. So it looks like the model room task relied on children‘s spatial thinking.

They don’t yet know why two important but apparently unrelated abilities arise at the same time. Perhaps it’s related to changes in the growing brain at this interesting age.

Provided by The Conversation.

Image supplied by Freepik.