A 5-year-old boy in my pre-k class has cerebral palsy. His right side is weaker than his left, and his right arm is rigid. He recently acquired a brace for his right leg, and he walks in a kind of bumpy way. He can't really run, and his speech is not always clear. He has difficulty drawing and writing too. Since he is getting a lot of physical, speech, and occupational therapy, these physical handicaps don't worry me as much as his social limitations. He's a sweet boy who sometimes looks a bit sad. Occasionally he seems kind of lost. How can I help him feel more a part of the group?
I'm glad that your first priority for this boy is his social and emotional development. Because of their physical limitations, children with physical challenges often have social challenges as well. It's much harder for them to move through the six core experiences necessary for healthy emotional, social, and intellectual development-harder, but still do-able. Let's consider each of those six essential milestones for a physically challenged child.
Milestones for Healthy Development
The first core experience for infants is learning to focus and attend. That involves coordinating what a baby sees with what he hears. Naturally, he wants to look towards the voice of mommy. But that might require turning his head, which can be hard for a child with low muscle tone, stiff muscles, or if the child has a weakness or rigidity on one side. So, the simple matter of learning to focus and pay attention is the first challenge.
For the second milestone, learning to engage another person, it's necessary not only to look and listen, but also to respond with great big smiles and enticing glances to woo parents into a loving relationship. That can be even more difficult for a child who can't turn, move easily, reach up with his arms as though to get a hug, or show big, smiling facial expressions.
The third milestone, becoming purposeful and intentional, involves exchanging different emotional expressions and interactions — taking toys that are offered, and handing them back, all while making gleeful sounds. But that is difficult, too, if you can't move your arms or grasp something offered to you. So the physical challenges may make it harder to master two-way communication and to learn an important lesson in logic ("If I drop this, she will pick it up") and a lesson in mastery ("I can make things happen").
Then we come to the fourth milestone — combining many skills in order to solve a problem. For example, taking Mommy by the hand and walking her to the toy area, pointing to the toy you want, and climbing up on Mommy's lap to reach it. Obviously, if you have severe motor problems, all those actions are going to be difficult to perform. So again, it's tough to conclude that you can make things happen.
When it comes to the fifth stage, which involves using ideas creatively, much depends on being able to engage in pretend play. This may be picking up a dolly, talking to it, and organizing a tea party-all of which involves complicated motor behavior.
The sixth stage involves building bridges between ideas. Here, we're talking about back and forth dialogues through pretend play and games such as musical chairs or ring-around-the-rosy. Obviously, it's difficult to get involved in such typical 3- and 4-year-old activities when your motor system isn't as much under your control as you might wish.
Drawing on a Child's Capacities
So, we see that the motor system is an enormous contributor to all of the six fundamental abilities. And the challenges for a child with a motor delay go way beyond having a hard time writing or running, jumping, and skipping. All of these are surface problems compared to the task of enabling a child to master intellectual, social, and emotional development, despite his motor limitations.
But here is where the good news comes in. Once we know that this is our task, we can draw on many of the child's different capacities. As important as the motor system is, it is not the only capacity, and we can often harness even limited motor ability. So let's take a child like the one in your class who has weaknesses on one side of his body but control over some muscles. He has one arm that's working well, so he can reach for things and show you what he wants. He can probably be very imaginative with pretend play. Even without a good functioning arm, the child can use ideas to tell others what to do verbally, or with signals. In this way, he can learn to be purposeful.
It's vital to use all of the child's operating senses and abilities. This may include receptive- and expressive-language skills and the ability to see, smell, hear, and move certain body parts.
What You Can Do
Like many others in his situation, this little boy apparently does not feel that he can make things happen. That could lead him to regress into passivity or escape into his own private world when the going gets rough. Another child in his situation might have temper tantrums. But if you, as the teacher, can work around the limitations of his muscles and create situations that allow him to explore his own assertiveness, you will be helping him enormously. You might:
- Pair him up with another (carefully chosen) child and find activities in which the boy with motor problems can be an assertive play partner. Although his speech is not always clear, he does have verbal skills to draw on.
- Use a tape recorder for children to "write" stories. The challenged child can get pleasure from creating alongside his peers.
- Another child can help him with motor skills while playing board games. Your little guy can say what move he wants to make and then duplicate it with another board piece kept near him where he won't knock over other pieces on the board. This will give him a sense of control he wouldn't have if he were just using his voice to play or worse, did not play at all.
- Create social games in which this child does not have to be just a passive follower. Outdoors, if this child can't participate in a kickball game, and if there is an aid available, you can create another little play area where you encourage interaction in a sandbox. Encourage the children there to create a drama with toys, using their voices, rather than their bodies. Here, again, you are helping the physically challenged child to practice the skills he does have, including his all-important thinking skills, as well as his limited motor skills.
Teachers and parents should not be inhibited about expecting things of a child with physical challenges. Quite to the contrary, they should capitalize on every opportunity to allow the child a sense of accomplishment. An occupational therapist or physical therapist can be very helpful in modeling more ways to do that. Teachers, parents, and outside experts all have the same goal — enabling the child to become a creative, assertive, can-do, and social young person.
- The Challenging Child by Stanley I. Greenspan, M.D. with Jacqueline Salmon (Perseus, 1996; $15)
- The Child With Special Needs by Stanley I. Greenspan, M.D., and Serena Wieder, Ph.D. (Addison Wesley, 1998; $28)
- The Growth of the Mind: And the Endangered Origins of Intelligence by Stanley I. Greenspan, M.D., and Beryl Lieff Benderly (Perseus, 1998; $17.50)