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Monday, November 26, 2018

Children with Sensory Processing Disorders and Hand Preference

Excerpt from From Flapping to Function: A Parent's Guide to Autism and Hand Skills. 

Most typically developing children show a preference for one hand or the other by the time they enter kindergarten, although it is not abnormal to develop hand dominance as late as six or seven years of age.
  •     Hand dominance is the result of brain specialization so that the hand opposite the dominant brain hemisphere develops great skill. 
  Children develop coordination between the right and left sides of the body when the right and left halves of their brain- called the brain hemispheres- are communicating efficiently.  Many children with Sensory Processing Disorders (SPD), especially those with dyspraxia, have difficulty with coordinating the two sides of their body, especially to perform complex tasks such as braiding hair or knitting. Because the right and left halves of their brain may not communicate well, these children may develop hand dominance (right-or left-handedness) at an older age than is typical, or not at all.  

Let's take a brief look at the relationship between brain hemispheres and hand dominance. Each hemisphere controls the opposite side of the body-the left hemisphere controls the right side, and vice versa. One hemisphere of the brain is typically dominant and people develop greater skill on the body side opposite the dominant hemisphere. Thus, someone with a dominant right hemisphere is typically left-handed. Most people are right-handed, have greater skill on the right side of the body and have a dominant left hemisphere. 

The person reaching for pictures in the top photograph demonstrates a  right hand preference because she consistently uses it to reach across her midline and to perform skilled tasks such as fitting shapes into form boards.  She also tends to avoid using her non-dominant left hand unless she really must-another characteristic sometimes seen in people with SPD. 

  • Midline  is an imaginary line that runs down the center of the body, dividing it into left and right halves or sides.  
The term hand preference is sometimes used to mean hand dominance. However, hand dominance is the result of brain specialization. This means that certain skills- like language- develop in one hemisphere rather than the other and that one hemisphere becomes dominant with the opposite side of the body becoming more skilled. 

  • The term hand preference is sometimes used to mean hand dominance. 

The preferred or dominant hand is often stronger, as well as more skilled at performing tasks such as controlling pens, scissors, tweezers or a sewing needle. 

There are other reasons why a child may prefer one hand over the other. For example, Thomas may be left-handed but use his right hand to cut because he was given right-handed scissors or he imitated his right-handed teacher.  Some children switch hands when one hand gets tired or when they are searching for a more comfortable way to grasp a tool. Modifying tasks may help them to use their dominant hand consistently. For example a fat piece of chalk that is easier to grasp may reduce hand switching due to fatigue.  

It is important to develop hand dominance because using the same hand consistently for specific  tasks helps develop proficiency. Try writing with your non-preferred hand and you can see what I mean! 

Some children develop what is called crossed or mixed dominance. This means that they use different hands for specific skills. For example, Claude became adept at using his right hand to write and his left hand to throw a ball. This was not a problem because he practiced each skill consistently with the same hand. Thus, he became very good at throwing with the left hand and writing with the right.  

Many children with SPD  also avoid reaching across midline, or even bringing their hands together at midline.  Learn why this is an important skill to develop in my post...  The Importance of Crossing Midline for Children with Sensory Processing Disorders

Children with poor coordination between the right and left sides of the body may also have difficulty using their hands together to stabilize materials and to discriminate right from left.

The following videos demonstrate a few strategies to
  • promote right left side coordination
  • promote crossing midline
  • learn to discriminate right and left  
  • develop an awareness of which hand feels stronger, more coordinated and comfortable  
Velcro bottles are difficult to use unless stabilized with one hand, usually the non-preferred hand.  Pulling Velcro objects off backings requires force and using force provides proprioceptive sensory stimulation to muscles and joints. Encourage your child to use the same hand consistently to remove the objects and the other hand to stabilize.

Source: Velcro Bottles for Individuals with Developmental Disabilities by RecyclingOT

As this video demonstrates, children pull using force and using force provides sensory stimulation. Ask your child to think about which hand is stronger while pulling and which hand gets tired more quickly.

Source: Sensory Pull Bottle Helps Children with Autism or sensory Processing Disorders by RecyclingOT

Talk to your child about the "worker hand" and the "helper hand" and refer to them as either right or left respectively. Position materials so that they cross midline to retrieve them with the hand identified as the more comfortable "worker hand".  

Don't forget to make Developing Hand Skills Fun !

Source: Recycling Occupational Therapist demonstrates Fidget Spinner by RecyclingOT

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