American Action Fund for Blind Children and Adults
Future Reflections       Fall 2019      ORIENTATION AND MOBILITY

(back) (contents) (next)

Rocking Revisited

by Elaine McHugh

From the Editor: People sometimes ask me where I find the articles that appear in Future Reflections. Some come from presentations at NFB conventions and seminars, and some are reprinted from other Federation publications. Many articles are submitted by blind adults, professionals in the blindness field, and parents of blind children. Others grow out of conversations I've had with people who have compelling stories to share. This article by Elaine McHugh came from a most unexpected source—my fiftieth college reunion!

When Elaine and I were classmates at Oberlin College, she was headed for a career in the field of modern dance. As often happens, however, her life took some surprising turns. Her work in dance and choreography led her to teach adapted physical activity to children and adults with disabilities. She also became an orientation and mobility instructor. This article draws upon her doctoral research, in which she investigated rocking behavior in blind children.

I can't remember how I decided to conduct my doctoral research on rocking, but as it turned out, the topic perfectly suited my interests and expertise. Rocking is an area of concern for many parents and teachers, and I am pleased to have this opportunity to review my findings and to look at more recent research.

As a parent or teacher of blind children, you have probably heard many negative comments about rocking. The following statements are typical.

• Rocking is inappropriate behavior, and it has to be stopped.
• Rocking prevents a blind person from fitting in, finding a job, and making friends.
• Rocking reflects poorly on all blind people.
• Many blind people have not been educated about the drawbacks of rocking.
• Rocking is a bad habit that persists in adults because it was never addressed in childhood.
• If blind people understood how sighted people react to rocking, they would stop.

However, other perspectives may seem less harsh and judgmental.

• Some sighted people also have stereotypies (repetitive mannerisms or behaviors), that include rocking, twirling the hair, or swinging a leg.
• Rocking provides vestibular stimulation and is self-soothing.
• Rocking is a normal part of development for everyone.
• Rocking reflects a need to move when freedom of movement has been limited or curtailed.

Previous Research

Before I conducted my doctoral study, my review of the scholarly literature made it clear that rocking is part of normal development. Some research—including the two studies that I conducted—gives us clues about possible causes and control of this behavior.

Formal research has established the following points:

1. Rocking appears in typically developing sighted children during transitions between motor milestones, such as the time just prior to creeping on all fours.
2. Rocking is delayed in onset and/or persists beyond the expected period in some children with disabilities.
3. The tendency to rock may be related to factors such as activity level or restriction of activity, cognitive delays, institutionalization, and/or environmental deprivation.
4. Sometimes interventions to control rocking behavior are successful, and sometimes they are not. 

The First Study

My dissertation was based on a qualitative study. I studied four blind children ranging in age from ten to thirteen who rocked persistently. All were congenitally totally blind due to retinopathy of prematurity (ROP). All of them had average or above-average intelligence, and they were all mainstreamed in school. I observed the children at school, at home, and in various other settings. I also interviewed their parents, teachers, and therapists, as well as a few school staff members, peers, and siblings. I did motor tests to determine the children's fitness, motor skills, balance, and coordination, and I looked at their school records and other reports.

I found that the participants had a number of factors in common, suggesting that the combination of prematurity and ROP may present some unique developmental and neurological challenges. Due to their medical fragility in the first months of life, all of the children had experienced surgeries and long periods of immobility. Lengthy hospital stays deprived them of the cuddling and playful handling that is part of life for most infants.

Even after the children came home from the hospital, their movement experiences were limited. Over the years they had few opportunities for free and vigorous movement, leading to poor fitness and other motor delays. These delays, in turn, most likely affected the number, range, and quality of the children's later movement experiences. Due to their low skill levels, perceptual-motor delays, and poor fitness, the children had little incentive to move about. In other words, they were caught in a vicious cycle!

The children in the study rocked throughout their waking hours. They rocked while they were waiting or listening. They rocked when they were conversing, eating, reading silently and reading aloud, engaging in class discussions, typing, using a calculator or abacus, putting on their shoes, telling a story, or reciting poetry. Their rocking occurred in classrooms, gyms, cafeterias, hallways, and cars. The children rocked at home, during mobility lessons, on the playground, on field trips, at church, and in child care.

Parents, teachers, and others made concerted efforts to control the children's rocking, but the behavior proved extremely resistant. The children experienced some of these attempts as very frustrating, and so did the parents and professionals.

For the two older children in the study, rocking was less frequent and less intense than it was for the younger children. This finding suggests that age or maturity may be factors in the reduction of rocking. It's not known what it is about getting older that seems to make a difference, but social awareness and self-management may increase with age. In addition, cumulative efforts by others to reduce the behavior eventually may have an impact.

Interestingly, the study participant who showed the most control over her rocking also had the greatest opportunities for vigorous physical activity. She jumped on a trampoline in the backyard, swam in the family pool, and rollerbladed with her three siblings in the family's large driveway. This observation supports the idea that vigorous physical activity can help reduce rocking.

Parents and teachers reported that all of the children seemed to crave movement. A PE teacher said that one child "almost wanted to explode with energy." Another teacher said, "She just wants to be active; unless she's moving, the game hasn't started."

All of the children had had early intervention services that involved physical activity. Nevertheless, at the time of the study their opportunities for vigorous movement were very limited. Although the children all attended physical education classes at the time of the study, these classes did not provide vigorous movement on a daily basis.

The Physical Activity Guidelines for Americans, issued by the U.S. Department of Health and Human Services, recommend that children and adolescents ages six to seventeen should have sixty minutes or more of moderate to vigorous physical activity on a daily basis. Throughout my years of professional experience training and observing physical educators, I have found that this recommendation is rarely met, even in some high-quality PE school programs.

Although sighted children probably don't move enough during the course of the school day, I suspect that they find more opportunities for movement than their blind classmates do. When I reviewed a videotape of one blind student in his classroom, I made a startling observation. Throughout the period captured by the video, the blind child's peers were up and down frequently. They moved around the classroom to get materials, sharpen pencils, or talk to the teacher. Meanwhile, the child I was observing remained in his seat, rocking gently. This observation suggested that the blind children did not experience even the low levels of incidental movement that are common for sighted children in the classroom. They may have grown accustomed to teachers or aides bringing them the materials they needed and coming to them to answer questions about class assignments.

The Second Study

In a second study, a colleague and I conducted research at a sports camp for children with visual impairments. We gathered information on fifty-two children through questionnaires, observations, and parent interviews. Fifteen of the children were reported as rocking persistently, either currently or in the past. This study allowed us to compare the children on a variety of factors. We looked at the developmental histories of those who rocked and those who did not. We compared those who had ROP with those whose visual impairments had other causes, and we compared children who had a range of degrees of vision loss.

Our research corroborated the findings of previous studies. It showed that rocking seems to occur in association with a pattern of developmental factors, although the pattern can vary from child to child. As we found in my previous study, extended hospital stays and early medical complications often resulted in severe restrictions of movement and parental handling. "He was pinned down so much," one parent reported, "especially because of these eye surgeries." Many of the children were connected from birth to machines, tubes, and wires that prevented free movement for weeks or months at a time.

The parents generally reported that rocking began early and proved resistant to efforts to control it, although for a few children it declined over time. Teachers were often the first to identify rocking as inappropriate and to insist on controlling the behavior. Some evidence suggested that involvement of the children or teens themselves was important in modifying rocking.

Eight of the fifteen children who rocked were congenitally totally blind, and the other seven had congenital low vision. Nine of the fifteen had ROP. The histories of the children whose impairments had other causes revealed some of the same factors seen in the children with ROP. These factors included congenital vision loss, extended time in the hospital after birth, and multiple medical complications early in life. The children who did not rock shared a number of factors, including normal birth weight, little or no time in the hospital after birth, the absence of surgeries during infancy, and visual impairment that occurred after eleven months of age. Interestingly, two pairs of siblings attended the camp. The differences in their histories helped to explain why one sibling from each pair rocked and the other did not. Differences in birth weight, time spent in the hospital after birth, and early medical problems seemed to be important factors.

Finally, we found a few children who did not fit the outcome we would have predicted from their histories. These children showed that the presence or absence of rocking may be influenced by some factors that we didn't discover. 
 
Like the children in my first study, the children who rocked seemed to have an insatiable need for movement. "It is very difficult to get him just to stand still next to you," one teacher told me. "He always has to be in motion." Another reported, "I can just see that he is going to burst while he is sitting there . . . trying to contain himself."

Research done by others in recent years supports the findings above and adds some important information. Some investigators substantiated that extent of vision loss and sensory processing deficits play a role in determining the number and type of stereotypies a child demonstrates. Several researchers conclude that stereotypic movements such as rocking help the child maintain an optimal level of stimulation. They believe that the challenge for parents and professionals is to identify the function for a particular child in order to facilitate socially appropriate behaviors that achieve the same result.
 
Some writers in NFB publications have expressed strong beliefs that rocking should be controlled in order to promote social acceptance. Others held ideas that coincide with my findings and those of other investigators. For example, some point out that rocking communicates sensory needs that have to be met. One parent described redirecting her young child to engage in singing and movement activities whenever rocking appeared. Another writer recommended teaching children who rock about behaviors that other children do when they have to sit still. She also urged providing adequate physical activity, with adaptations that allow the blind child to play successfully and appropriately with peers. 

Research shows that rocking relates to complex interactions between medical history, visual status, and environmental factors. An increased need for specific sensory input seems to result in the persistence of movements such as rocking that provide vestibular and kinesthetic stimulation. As a child grows, available resources and interventions need to provide sufficient movement opportunities. Such opportunities may preclude or reduce persistent rocking.

Findings from the literature on behavioral change support the idea that individuals themselves must take charge of controlling unwanted behaviors to effect meaningful change. One adult who rocked when she was young reported that she took control after a teacher whom she greatly admired expressed disappointment with her for rocking during a public presentation. She also reported that she had several rocking-chairs in her house. She had found a way to rock that was considered socially acceptable.

Decisions about how to address a child's rocking should be based on research findings, and as much as possible should avoid punitive or judgmental responses. As children grow older, they should be involved directly in any decision about how to address the behavior. Without the child's involvement, interventions are unlikely to succeed. 

As I reviewed the NFB literature, I discovered a quote from Joe Cutter that perfectly captures my underlying philosophy. He wrote, "For blind children, as for all children, the freedom to move, to be self-amused, and to experience the joy of movement is fundamental to being human."

References

Cutter, J. (2007). As quoted in "Teaching Orientation and Mobility to Students with Visual Impairments and Additional Disabilities," by M. N. Chamberlain and D. Mackenstadt. Future Reflections, 2008.

Fazzi, E., Lanners, J., Danova, S., Ferrarri-Ginevra, O., Gheza, C., Luparia, A., Balottin, U., and Lanzi, G. (1999). "Stereotyped Behaviors in Blind Children." Brain Development, 21 (8), 522-528.

Gal, E. and Dyck, M. J. (2009). "Stereotyped Movements among Children Who Are Visually Impaired." Journal of Visual Impairment & Blindness, 103 (11), 82-95.

Gal, E., Dyck, M. J., and Passamore, A. (2010). "Relationships between Stereotyped Movements and Sensory Processing Disorders in Children with and without Developmental or Sensory Disorders." American Journal of Occupational Therapy, 64 (3) 453-461.

Gosch, A., Brambring, M., Gennat, H., and Rohlmann, A. (1997). "Longitudinal Study of Neuropsychological Outcome in Blind Extremely-low-birthweight Children." Developmental Medicine and Child Neurology, 39 (5), 297-304.

Hashash, S. (2011). "Student Viewpoints." Future Reflections, 30 (4)

McHugh, B. E. and Pyfer, J. (1999). "The Development of Rocking among Children Who Are Blind." Journal of Visual Impairment & Blindness, 93 (2), 82-95.

McHugh, Barbara Elaine. Texas Woman's University, ProQuest Dissertations Publishing, 1995. 9615490.

McHugh, E. and Lieberman, L. J. (2003). "The Impact of Developmental Factors on Stereotypic Rocking among Children with Visual Impairments." Journal of Visual Impairment & Blindness, 97 (8), 453-474.

Miss Whozit. (2016). "Ask Miss Whozit." Braille Monitor, 59 (7).

Prost, D. (1997). "Parents: The True Teachers." Future Reflections, 16 (3).

Ross, D. B. and Koenig, A. J. (1991). "A Cognitive Approach to Reducing Stereotypic Head Rocking." Journal of Visual Impairment & Blindness, 85 (1), 17-19.

Stevens, J. (2011). "Vestibular Stimulation." Future Reflections, 30 (1). Reprinted with permission from Wonderbaby Newsletter, April 2010, www.wonderbaby.org.

Willoughby, D. M. (1994). "Fitting In Socially." Future Reflections, 13 (3). Reprinted from A Handbook for Itinerant and Resource Teachers of Blind and Visually Impaired Students, by D. Willoughby and S. Duffy. Baltimore: National Federation of the Blind, 1989.

(back) (contents) (next)