Emily is a pretty 8 year old, who is again clowning in her class. Her teacher is frustrated and confused.
Emily arrived at school this morning, well-organized and enthusiastic. Through the first two hours of the school day she performed well on the different tasks at her desk. When she was asked to stand up and read a sentence from her journal, her behavior changed dramatically. She first joked with two classmates. Then she "read" silly words that she hadn't written down.Only she thought it was funny.
Emily has been slow to read, in contrast with her other, quite advanced abilities. But her reading and writing abilities are now catching up.
When her teacher tried to help her settle down, she seemed confused and unable to go on. Through-out the rest of the day, she seemed "spacey" (her teacher's words) and withdrawn.
This has happened before in similar circumstances. When Emily returns to school tomorrow, her learning and behavior will likely be entirely appropriate and predictable.
Emily has a true learning disorder that handicaps as much as 10 percent of the children in a regular classroom. This relatively unrecognized and un-named learning problem has been termed "central integrative disorder" and "disorganization under stress" in England and other Western countries.
It causes students to feel helpless and unable to use their good intelligence when they are expected to perform. Children with CID are usually intelligent children who have another learning problem in the areas of language acquisition, reading and memory.
In the United States, it diagnostically resides within a broader class of difficulties called cognitive integration difficulties.
These children's responses to stress are one of three qualities of interruption of predictable and normal cognition: speeding up, freezing or disorganization and confusion. With younger children, these responses are usually manifested in their behavior, with out-of-control movement, blank expression and long pauses, or poor coordination and stumbling. With older children (third grade and older), the manifestations are typically experienced "inside" with thinking and judgment being handicapped.
In most cases, the stressors that trigger disorganization are events or conditions that may make other children feel uncomfortable but not seriously handicap functioning. For children with CID, however, until they are helped, being rushed, too much noise, competition, risk, test-taking and performing in front of a group truly handicap or paralyze functioning.
Children report "going blank," "my ears getting foggy and I can't hear so well," "not being able to collect my thoughts" and "I know all the pieces, but I can't put them together." Underachievement, clowning and withdrawal are the most frequent results.
One parent often admits having had the same problem when he was younger.
While many children feel tense and temporarily blocked when they are under pressure, only a few (one or two in a classroom of 20) actually struggle with this handicapping problem. Under stress, children with central integrative disorder undergo a dramatic interruption in their thinking that does not clear quickly. It may last for several minutes or up to several hours before recovery takes place. The youngster may appear spacey, bored, oppositional, teary, embarrassed or just confused. Once the interruption and subsequent change in mental processing has come about, academic performance is very much compromised.
This constitutionally based disorder is typically evident in some form as early as infancy. It may show itself as inability to remain engaged with a parent, hyper-sensitivities followed by feeding or sleep disorders and motor delays and clumsiness.
Since clinical research was presented by the internationally renowned psychiatrist and pediatrician, Dr. Reginald Lourie, at meetings of the American Academy of Neuroscience 15 years ago, there is still not a definitive diagnostic examination for children who struggle with vulnerabilities to stress that trigger these responses.
Even so, it seems that vulnerabilities to stress and their resultant effects reside closer to the domains of learning disabilities and neurology than they do emotional disturbance. It is for this reason that psychological help that has been most effective has to be more like remediation and teaching, rather than conventional psychotherapy.
We have found that directness about what we think happens "inside" is welcomed by children who disorganize under stress. They seem relieved to learn that other children share their problem. Subsequently, the psychologist or teacher helps the child diagram (usually on paper, with pictures) the stressors that trigger freezing or disorganization.
The child is helped to describe her experience, which usually includes feeling helpless, out-of-control and misunderstood. The remediation carefully describes the freezing, speeding up or disorganization.
Then two kinds of strategies are formulated. One group that prevents the disorganizing response from happening is experimented with. The other one includes strategies that help the child recover from the reaction and to resume, as quickly as possible, the sequence of thinking and problem solving that was interrupted by the stressful condition.
Our work with children in Seattle and Washington, D.C., is providing promising results as we rethink and re-create remediation strategies.