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Modulation Disorders
Disorders of modulation are first seen in infancy and early childhood. The disorders are characterized by:
an inability to integrate behavior in terms of physiological, sensory, attentional, motor or affective processes;
coupled with
an inability to organize a calm, alert, psycho-emotionally positive state.
The operational definition includes a distinct behavioral pattern coupled with a sensory, sensory-motor or organizational processing difficulty. The classification suggests two major types, each with 2 distinct subtypes.
Poorly modulated responses may show themselves in the following domains:
- Physiological or state repertoire
- Gross motor activity
- Fine motor activity
- Attentional organization
- Affective organization
The child with a modulation disorder will demonstrate both a sensory, sensory-motor, or processing difficulty and one or more behavioral symptoms.
Processing difficulties that may be demonstrated include:
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Over or under-reactivity to high or low-pitched noises
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Over or under-reactivity to new or striking visual images
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Tactile defensiveness
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Oral defensiveness
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Under-reactivity to touch or pain
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Gravitational insecurity
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Under or over-reactivity to odors
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Under or over-reactivity to temperature
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Poor muscle tone and muscle stability
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Qualitative deficits in motor planning
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Qualitative deficits in ability to modify motor activity
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Qualitative deficits in fine motor skills
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Qualitative deficits in articulation capacity
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Qualitative deficits in visual-spatial processing capacities
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Qualitative deficits in capacity to attend and focus
Behavioral difficulties that may be demonstrated include:
Type 1: Hypersensitive
Subtype A: Fearful and Cautious
Behavioral patterns include excessive cautiousness, inhibition and/or fearfulness. In early infancy these patterns are manifested by a restricted range of exploration and assertive, dislike of changes in routine, and a tendency to be frightened and clinging in new situations. The young fearful and cautious child's behavior is characterized by excessive fears and/or worries and by shyness in new experiences.
Occasionally, the child behaves impulsively when overloaded. The child tends to be easily upset, cannot soothe himself readily, and cannot quickly recover from frustration or disappointment.
Caregiver patterns that enhance flexibility and assertiveness in fearful and cautious children involve empathy paired with supportive encouragement to explore new experiences; and gentle, but firm limits. Inconsistent and overprotective caregiver patterns intensify these children's difficulties.
Subtype B: Negative and Defiant
Behavioral patterns are negativistic, stubborn, controlling, and defiant. The child often does the opposite of what is requested or expected. The child has difficulty in making transitions, and prefers repetition, absence of change, or change at a slow pace. Infants tend to be fussy, difficult, and resistant to changes. Preschoolers tend to be negative, angry, defiant and stubborn, as well as compulsive and perfectionistic. However, these children can evidence joyful, flexible behavior at certain times.
Caregiver patterns that enhance flexibility involve soothing support of slow, gradual change and avoidance of power struggles. Caregiver patterns that are intrusive, overstimulating, or punitive tend to intensify these children's negative and defiant patterns.
Type 2: Under-reactive
Subtype A: Withdrawn and Difficult to Engage
Behavioral patterns include seeming disinterest in exploring relationships or even challenging games or objects. Children may appear apathetic, easily exhausted, and withdrawn. High affective tone and saliency are required to attract their interest, attention, and emotional engagement. Infants may appear delayed or depressed. Preschoolers may evidence diminished verbal dialogue. Behavior and play may only present a limited range of ideas.
Caregiver patterns that provide intense interactive input and foster initiative tend to help underreactive withdrawn children engage. In contrast, caregiver patterns that are low-key, "laid back", or depressive tend to intensify these children's patterns of withdrawal.
Subtype B: Self-Absorbed
Behavioral patterns of self-absorbed children include creativity and imagination, combined with a tendency for the child to tune into his or her own sensations, thoughts, and emotions, rather than being tuned into and attentive to communications from other people. Infants may become interested in objects through solitary exploration rather than in the context of interaction. Children may appear inattentive, easily distracted or preoccupied, especially when not pulled into a task or interaction.
Preschoolers tend to escape into fantasy in the presence of external challenges such as competition with a peer or a demanding preschool activity.
Caregiver patterns that tune in to the child's communications and encourage a good balance between fantasy and reality help these children remain grounded in external reality.
Modifying the caregiver style to match the need of the child is an important key to successful treatment and parenting of the child with a modulation disorder. It is also helpful to remember that the neurobehavior being demonstrated is not really so much of a choice, but rather a biochemical predisposition to respond in a particular behavioral pattern
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