A four-year-old in my class is rather clumsy and can't keep up with the others. Instead of joining in or initiating pretend play, he aimlessly pushes a truck back and forth, touches a doll, bangs a drum, or hammers one toy with another, awkwardly moving from task to task with no apparent purpose. How can I help him?
Almost everything children do in the early years of life involves their motor system, whether it's pretend play or giving Mommy a hug and a kiss. Coming over from the other side of the room to do that requires looking at Mommy, seeing where she is, coordinating walking, reaching her, and finally climbing up her legs to plant a nice big kiss on her cheek: six different but related motor-behavior patterns. Whether we are talking about a chase game, holding on to a toy the child wants to play with, or greeting another child, a series of interrelated motor actions is required. The young girl or boy who has poor muscle tone, is very poorly coordinated, or can't put together a series of actions that most children take for granted may have a very hard time.
Of course, some children will be a little stronger in the gross-motor area, such as running, jumping, skipping, and hopping but at a loss in the fine-motor area. Others may be just the opposite - rather strong in the fine-motor area, able to pick up little pieces of cereal but unable to throw or catch a ball. And still others have relative difficulty in both areas. Language is yet another cause for concern because it involves a lot of coordinated motor action. Some children actually have a difficult time making meaningful sounds because they can't coordinate the motor movements in the mouth.
Having trouble in one area doesn't necessarily mean a child will have trouble in another, though there are some children who have difficulties in all, including eating. For those children, it's exhausting just to chew food, so they may avoid those foods that are hard to chew:
Providing Opportunities for Improvement
There are two hints for helping a child with any of these motor problems. First, draw on the child's own interests. Second, start simple and provide gradually increasing opportunities for mastery so that the child can succeed about 70 to 80 percent of the time. Slowly but constantly make the challenges more difficult.
Physical and occupational therapists may be very important allies in your effort, especially if the child has severe motor problems and some asymmetry (weakness or strength on one side of the body). But even without the assistance of the physical or occupational therapist, the teacher or parent who's trying to help a child enjoy pretend play can look at what the child does naturally.
Let's say the child is banging a car but can't seem to move the car along. Start by giving that banging some meaning so the child can use it as a first step. Banging on the car might open the door - out comes dolly! Now the child's banging has become purposeful and intentional: "Where do you think dolly is going?" And for a child who's able to understand purposeful play but just can't do the motor part of it, this supports her growing use of ideas or imagination. That also inspires the child to want to do more.
From the banging, you might go to pulling. Bang the door and then see if the child can pull the door open a little bit. Now it's a two-step action that may lead to the child's putting the dolly back in the car and eventually moving the car along, which can be broken down into giving the car a shove and then holding the car and moving it along with an even rhythm. So, the key is to add steps to the previous accomplishment, one small step at a time. Each one provides a sense of mastery and builds on something the child already can do.
Setting Up for Success
Some children need support for their arms or legs. Giving support around the elbow will help a child who can't stabilize that joint well. Occupational and physical therapists often work behind the child, trying to position the muscles in such a way that she can turn over or reach for something. It's also very, very important to have somebody in front of the child, enticing her to do something desirable with the movement that she's being helped to make. You'll want to have that orange or that dolly in your hand so there's something she's reaching for. That makes the whole action purposeful and meaningful. Then she will try to do it again, and, eventually, she'll learn to do it on her own. Moving the child's limbs, without any real purpose except to show her she can do it, isn't as effective.
Recognize each child's strengths and weaknesses in order to orchestrate interactions that help each child move up the developmental ladder. The child with poor motor planning can do simple motor movements. For example, in a simple game in which there is an obstacle course, children navigate the obstacle course together, but one child does something very simple, such as banging or pushing, while another child climbs, pushes, and throws. Still, they master the course as a team.
Simon Sez is another good game to play: Start with simple things like "Clap your hands," then give more complicated instructions: "Touch your nose." "Touch your eyes." "Touch your ears:" Eventually, you could say, "Clap your hands and then tap your knee" or "Touch your nose, your ears, and your sides." Songs with fingerplays can be very useful too. Again, start simple and then get more complicated so the child masters the activity and enjoys it.
One more hint, especially for parents: The key to helping a child with low muscle tone and/or motor problems is to encourage him to be assertive. Of course, he prefers to have things done for him because they're so hard to do. What's more, it's understandably often very, very painful to watch him struggle. But, again, start simple. If there is a toy between you and your child and you're inclined to pick it up and hand it to him, or if he comes over to you to be picked up and doesn't quite get his hands into the position of gesturing to be picked up, wait just a split second more - until he gets his hands all the way up, looks perplexed, and motions a second time: "Hey, pick me up!" That child has gotten 200 percent more practice at being purposeful and intentional. A parent who is near the toy can deliberately be a bit lazy, perhaps saying, "Oh, I can't get to it! Can you help me?" And the child may take 10 seconds to reach down and just barely grab the toy, hold it up, and give it to Mommy. All the while, Mommy is giving lots of verbal and gestural encouragement with her body posture, her hand motions, and her sounds. She's cheering for her child's assertiveness from the sidelines as opposed to doing something for him.
An Important Note
We did a little study with children who had severe motor problems. They started out six to eight months behind their peers at only 16 and 17 months of age. First, we had the parents as involved as they wanted to be, doing a lot of things for their children, such as moving their hands during our assigned activities. The second time we did the exercise, we told them, "You can't touch the children, but you can give them a lot of vocal and gestural support." The children's motor skills moved up an average of three to four months, a 50 percent improvement, just by the children's being encouraged to be assertive and do it themselves