It has taken us awhile to really get a handle on ‘the cumulative effect’. When it comes to SPD, understanding this is oh-so-important if you want a somewhat peaceful and pleasant day.
So what exactly is the cumulative effect? Rather than explain it myself, I’m going to turn to an explanation that is provided in the book Sensational Kids: Hope and Help for Children with Sensory Processing Disorders by Lucy Jane Miller (which, as I’ve mentioned before, is a fantastic first read for those who want to understand SPD).
A typically developing child gets a sensory message such as the big bang of Trey slamming his door, figures out the cause, and lets it go. In children with sensory-processing problems, this ability to let go of past messages sometimes appears to be impaired, leading to a “backlog” of sensation that accumulates until it overwhelms the child’s coping skills. Think of a child like LaTanya [or Maddy] as a busy office worker who has an in-basket but no out-basket. She finishes an assignment but, even after it’s done, the assignment sheet stays in the in-basket. Every time she completes another assignment, the in-basket gets fuller. Eventually she grows frustrated and finds it harder to complete new work because the pile of old work is growing precarious and she has to spend a lot of energy just making sure it doesn’t spill. At last, there’s one assignment too many. It doesn’t have to be an important assignment; it’s just the proverbial “last straw” that brings down the whole mountain. It is believed that the cumulative effect of undisposed sensory messages is what causes children with SPD to eventually fall apart over triggering events that are minor.
You can link to this section of the book here.
Now, the cumulative effect causes the child to “fall apart” as you read above. This is often commonly referred to as the meltdown. A meltdown is not a temper tantrum. Let me repeat that: A meltdown is not a temper tantrum. Simply put, a tantrum is a manipulation attempt by a child when he does not get his own way. A meltdown is a result of over-or-under-stimulation. When a meltdown is taking place, the child loses complete control and awareness. In our experience, when Maddy has a meltdown, not only can she not calm herself down, we can’t calm her down either.
Before we understood that Maddy’s “fits” were meltdowns, Eric and I used to announce to one another at the start of one: “Game over,” you know, to warn the other. At the time, it just seemed like extreme stubbornness. If we gave Maddy cold, chunky pear and she was expecting warm, puréed avocado – game over! Not only would she not eat the pear, she would not eat at all, even the avocado she was expecting. Beyond that, she would cry for the next hour or two no matter what we did. In fact, at times it would ruin her entire day.
Everything had become such a guessing game, and Eric and I were walking on eggshells trying not to upset Maddy. We had a policy: If baby is happy, don’t look, talk, move, or even breath near her. I’m being dead serious. If Maddy was sitting on your lap completely happy, and you moved and placed her on your other knee – game over!
The one thing I was struggling with, was how in the world could Maddy have a meltdown from an accumulation of sensations if she has low registration. There are a couple of answers to that. First, although she’s under responsive to vestibular and proprioception, she’s over responsive to the tactile sense. Additionally, our OTs explained to us that with low registration, it is still more stressful for Maddy trying to register and interpret her senses. Too much stress = accumulation = meltdown.
So, how do we deal with the cumulative effect? We are working on developing a sensory diet for Madeleine with our OTs. We already have a huge list of things we can (and do) do with her daily. Some of them help Maddy meet some of her sensory cravings, some are helping to desensitize her to sensations, and some are used to calm her. We always use our calming techniques before we do something that we know will be difficult for Maddy.
What we’ve learned is that the most important time to do Maddy’s sensory diet is when she is happy. This is so, so important, because once she’s unhappy it takes one hundred times the effort to get her back into a calm, happy place. We learned this hard lesson once after a family gathering at Eric’s parents. Maddy was so happy and pleasant, and so we just let her be. Big mistake! The next day she was monster Maddy…. and not in this cute way:
Of course, that was our last ‘cumulative effect’ mistake. I promptly asked our OTs what gave, and they explained to me our error (thank goodness for Kora and Jamie – we’d be lost without them!).
So, what does this all mean? It means it’s exhausting meeting Maddy’s sensory needs to prevent a meltdown since she’s still at an age that she needs a lot of support from me. But, it’s less tiring than dealing with monster Maddy day-in-and-day-out. And, when we do have a meltdown, I have that much more energy to deal with it because it’s not every day, all day long anymore.
What am I most looking forward to? Maddy learning to speak so that one day she will finally be able to verbalize what her needs are and what is irritating to her. Until then, it’s still a bit of a guessing game. But we’re making progress, slowly but surely.