why add sensory processing disorder to the DSM-V?

Published March 22, 2010 by Nancy

Three Reasons

1. Most children with behavioral issues get sent to psychiatrists and psychologists. Psychiatrists and psychologists are only allowed to diagnose conditions listed in the DSM. Ergo, if it ain’t there, they can’t diagnose it. As a result, most children with SPD never get properly identified. They get drugs instead of occupational therapy and neurofeedback therapy.
2. Since ADHD is the condition which most closely resembled SPD, that is the diagnosis most of these children get. ‘Cause that’s the one in the ADHD. (You have to marvel at the psychology profession’s inability to see beyond the covers of the DSM to the greater world, but that’s the way it is.)
3. Kids with SPD who are told they have ADHD get put on stimulants, same as ADHD kids. For SPD kids, ritalin has very disturbing side effects, including psychotic episodes and paranoia. Just FYI most kids with SPD also have anxiety issues, AND stimulants are contraindicated for kids with anxiety issues because they make the anxiety worse. These kids should never be given stimulant therapy.

Resistance to  Change

If you took the DSM for its word, you’d think the brain was completely separate from the body. The DSM scrupulously avoids cross-contamination with any body diseases and conditions.

But we know that the brain and body are all one long enchilada, and we can’t do something to one end without having an effect on the other.

SPD is a condition of this brain-body connection. Which means it is an affront to the whole idea of the DSM.

So time for a new DSM, one that glues the head back on the body and acknowledges that those little ripples of electricity that flit along the neurons and dendrites, up and down, left to right and back, may have more to do with the body than the brain ever wants to admit.

tics and video games

Published November 4, 2009 by Nancy

Do you notice that your kid’s tics are worse when playing video games?

Like, far worse?

For some kids, the computer/console is the only place where they do tic. But then afterward, they can tic for hours or even days.

Something’s going on there.

Science says tics are caused by the number of neurons floating around in the basal ganglia area of the brain. The basal ganglia is part of the brain’s brakes. In tic disorders, the brakes leak.

Greater use of the prefrontal cortex (the executive control centre) can help regulate the basal ganglia.

Meanwhile, neuroscience links tics to the sensorimotor rhythms (SMR), a brainwave pattern deep in the brain (hypothalamus area) that regulates the senses and muscles. When SMR is too low, the kid’s brain can’t control movement, interpret sensory information, or get a grip on anxiety.

Higher beta brainwaves can help restore balance.

So what do video games do?

For sure, they increase agitation. The more intense the concentration on the game, the more the kid gets sucked right into it. They lose touch with reality as they become one with the game.

Their beta brainwaves decrease.

Their use of their prefrontal cortex decreases.

Somehow the video game activity makes the brakes leak.

But is it the screen, or the video game?

Is it the light or the visuals from the screen interacting with the brain’s neurons, or is it the action and intensity of the game interfering with normal function?

This is an important question.

We know flickering lights can cause all kinds of brain disturbances. But what about nonflicker screens? Can light do it too?

Or does the brain go into a different mode when concentrating on a screen?

We also know that intense activities raise adrenaline, which cuts off a lot of the regular neurochemicals in the brain.

But are all games culprits? What about mild, low-action games like RuneScape? What about educational games?

Is it the act of gaming that does it, or just certain kinds of activity?

Watch this video of a boy ticking in front of his computer.

He’s very honest. And keep in mind that all he is doing is typing and reading on the computer (not playing a game).

Try making a video like this. It could help define exactly what is going on with your kid.

If the games are the cause:

Then you should expect to see tics during

• computer game playing
• Nintendo/Wii game playing
• Gameboy (handheld) game playing

But you should not see it for

• computer reading
• computer typing
• computer video watching
• TV watching

If the screen is the cause:

Then you should expect to see tics during

• computer reading
• computer typing
• computer video-watching
• computer game-playing
• Nintendo/Wii games
• TV watching

But you should not see it for

• Gameboy (handheld) game play (because they don’t have much of a screen)

Remember: tics wax and wane.

For a couple of weeks, there can be lots of tics. Then for a month, there might be none.

It is a good idea to record what changed when the tics reappear. But don’t be discouraged if you can’t pinpoint a cause.

Other things you can do

1. Help your kid become aware when he/she is ticking.

Making a video can help, but it will be distressing, so get full consent first. You can also put up a mirror beside the screen so your kid can check every now and then.

2. Help your kid identify how he/she feels about tics.

You need to help him/her frame it as “no biggie,” just as something to work on. Frustration, embarrassment, and shame are not allies in solving this issue.

3. If computers or games are the big trigger, then you need to make a decision together on how to handle it.

One option is putting the equipment away for six weeks in exchange for other activities.

Good luck on that one. Many ticky kids don’t have outside activities or even a lot of friends.

Another option is a timer limiting exposure, following by a relaxation exercise to blow out any pent-up tension.

4. Get checked out for allergies.

Many parents have reported that pollen, milk, corn, and wheat seem to trigger tic episodes.

Some parents are convinced that mercury exposure is a cause of tics. I am no expert here. Studies in Denmark have shown that tic disorders are on the rise along with autism and hyperactivity disorders. So there is some kind of environmental thing going on, we just don’t know quite what it is.

5. For mild facial tics, devise an alternative tic for the kid to use instead of the real one.

This is a central concept in Habit Reversal Therapy.

If the tic is a grimace, make the alt tic a yawn. Encourage the kid to replace the real tic with the alt tic as it is happening.

This helps increase awareness, gives a measure of control, and helps extinguish the tic.

new book out!

Published June 16, 2009 by Nancy

It’s been a very busy month. Heck, I had a book to put to press!

But it’s done now, it’s out, and it’s making its way around the world.

The second edition of The Sensory Team Handbook is similar to the first edition. But the pictures have some professional touches, the fonts have been simplified for easier reading, and the last three chapters have been rewritten for better focus.

It’s available at Amazon.com, and soon Amazon.ca and Amazon.co.uk. Some bookstores are carrying it too. And I’ve sent some free giveaways to several sensory processing disorder and Asperger Syndrome conferences coming up in the next few months. So who knows, you might be able to get a free one.

If you’re interested, follow the link on the side to see the trailer.

Thanks to the people who have commented while I have been otherwise occupied. It helps to remind me that yes, I do have a blog.

Today I will go back in time (you can do that in WordPress!) and post some pages from the book.

autism acceptance conferences

Published April 17, 2009 by Nancy

The Autism Acceptance Project is hosting a conference! The University of San Diego is holding the Summer Autism Institute, June 24-26. Contact the project for more details.

Also, Nova Scotia just held an autism conference. The Provincial Autism Centre and the Autistic Self-Advocacy Council hosted its first ever conference for people with autism in Halifax on April 2, World Autism Awareness Day.

progress

Published February 4, 2009 by Nancy

The drama over our nonfunctional washing machine appears to have drawn to a close.

Taking video of said washer in action and threatening to put it up on YouTube did the trick.

Keep in mind that nothing short of that did.

Anyway, they hauled away the washer this past weekend. I am supposed to get a cheque in the mail sometime soon.

What’s most interesting about this whole episode isn’t the near-disaster state of affairs at Sears. Nor the shoddy offshore quality of the new line of washers.

It was our response.

Number one: We didn’t take them to a lawyer.

We took them to the Internet. Faster, cheaper, and it lasts forever. Anybody can do it. Nobody has to quiver before the might of a big company anymore.

Number two: We didn’t buy a new washer to replace this one.

Over the past few weeks, we discovered that we don’t need one. Nobody needs one.

There are these places called “laundromats,” and there’s one lovely clean one right around the corner from our house. They have double-, triple-, and sex-tuple sized washers that do the job in 20 minutes.

20 minutes to do five loads of laundry. In two washers.

At home, we hang up some of it, and put the rest in our double-size dryer, and presto, a week’s laundry done within an hour.

No more Saturdays spent waiting for a 60-minute cycle to end.

How much water is this method saving? How much electricity? And how much of our valuable time?

In the old days (and in many poor countries today), women used to gather by the river to wash clothes together. It was a social time. Laundromats are good for that too.

Our culture has been told that we need labour-saving appliances in our homes. But here is a middle-class family of four going back to the old way. It makes more sense.

Number three: Long-term relationships are worth more than big names.

We decided to get a replacement washer from a used appliance shop that sold us our first washer, dryer, fridge, and stove. Andre still works there. In fact, he fixed our freezer and old dryer a couple of times. We know him well.

That is why we bought from him.

The washer is a good five years old, but in good shape and very clean. Andre gives a one-year guarantee, same as the big shops. Except that he’s not going to screw us around or wait till we show him the YouTube video. We have a relationship with him. It’s valuable to him, and it’s valuable to us.

policy

Published February 1, 2009 by Nancy

At the store, I demanded a refund for my nonfunctioning washer. It was still under warranty.

The “customer service” clerk hardly looked up. She said that the warranty was good just for repairs.

I demanded a refund because the repairs had not worked.

She said, “I’m sorry, that’s our policy.”

What does it mean when a “customer service” clerk says “that’s our policy”?

It means: Go away.

It means: I am not paid to care.

It means: I hate this job.

Seth Godin would say it’s because they have no ownership of the problem and no relationship with the customer.

No relationship = no customer.

I replied to her: “It’s my policy not to accept someone telling me it’s their policy.”

We stood staring stupidly at each other.

solving tantrums

Published February 1, 2009 by Nancy

Tantrums. Wild, out of control, unprovoked, unexplainable. They quickly work up to hyperventilating, which leads to even wilder out-of-control behaviour.

Toddlers and preschoolers with sensory issues can’t deal with all the sensory distress they put up with in a day. They can’t filter it all out. It’s like being stuck with pins all day.

I’m not sure what it was that prompted me one day to approach him with crackers. He was huddled, terrified and shrieking, in his bed. I wasn’t even sure he would recognize them or be able to hold them, let alone eat them.

But he took them, like a drowning person reaching for a buoyline. I watched him munch, almost frantically, his eyes still wide, his breathing harsh.

By the end of the second cracker, he had calmed down quite a bit. Enough for him to start regaining control.

There is a lesson here. For sensory kids, too much of the wrong sensation can push them over the edge. Then the wildness of their own reaction becomes even more to handle, which starts to snowball.

But the right sensation can right them again.

Here are some suggestions. But keep in mind: these vary from kid to kid.

1. Crunchy or chewy foods: The rhythmic chewing works the jaw muscles, which stimulate the inner ear, and also stimulates the mouth’s senses of taste, texture, and smell. By simultaneously stimulating many senses at once, these handy mouth tools short-circuit sensory overload.

2. Sucking from a straw: Similarly to the crunching and chewing foods, sucking short-circuits sensory overload, and the rhythmic suck-and-swallow calms all the senses.

3. Music: 1950s rock ‘n roll music is very stimulating. The strong rhythm and energetic sound can cut through a sensory overload tantrum. Once the kid is shocked out of the tantrum, provide something to drink.

4. Wrestling: A full-body workout with a parent may allow the kid to work out the frustration. Be aware that the kid must give permission first; otherwise, she may think she is being attacked. A milder alternative is any kind of rhythmic movement, such as patting the shoulder, rocking, moving the hands up and down, or moving the legs in a gentle flutter-kick pattern.

talent and change

Published January 4, 2009 by Nancy

Before computers, writing a book used to be an extraordinary thing — because you had to write it by hand.

Today, writing a book is easy. All you need is a computer and lots of time. It may not be a particularly good book in the end, but it’s a book.

Before computers, only very talented writers attempted writing a book. Publishers had it good — they could pick and choose from a small pile of pretty darn good manuscripts.

Today, publishers are deluged with manuscripts. Publishing has become more competitive, so only quick money-makers get published.

Before the internet, publishers had a monopoly over the printed word. You needed a printing press to make a book or newspaper.

Today, anybody can publish a book. All you need is some software and a copy shop. Or you can publish it electronically for downloads.

Today, you could say that anybody can become a writer.

Today, you could also say that everybody is a writer.

neurofeedback update for November

Published November 20, 2008 by Nancy

We are hardly doing any neurofeedback training now. Just on weekends, but we’re getting lazy.

The problem is that he’s doing so well in day-to-day life that it’s hard to think about training.

The heart-rate variability training seems to have done its job. There is a lot less worrying and agitation. We still try to do five minutes each night, but we forget a lot of the time.

We still do the neurofeedback training on the weekends, but just a short session. His motivation level is low now.

At school, he has gotten on top of the homework load and is organizing himself to get the work done before he comes home. Socially, things have improved too.

So it’s time to think about phasing him off the rest of his meds.

what is sensory processing disorder?

Published November 7, 2008 by Nancy

Sensory processing disorder comes by many names. The other popular one is sensory integration disorder.

It’s a neurological condition to do with the connection between the brain and the body parts — specifically, the senses. The brain has difficulty processing information from the senses.

Hence the name.

As kids grow and develop, the nerve pathways between the seven senses and the brain have to grow and develop too. Delays, disruptions, and neurological confusion in those nerve pathways garble the messages , and the brain either can’t respond or responds incorrectly.

“What seven senses? I know of just five.”

The five “outer” senses are vision, hearing, taste, smell, and touch. They give the brain information about the outside world.

There are also two “inner” senses that give the brain information about what’s happening inside the body:

• the proprioceptive sense: information about muscles, joints, ligaments, strength, etc.
• the vestibular sense: information about balance and gravity

Of the seven senses, the two inner senses and the touch sense seem to cause the most problems.

“I’ve never heard of it.”

That’s not too surprising. Many doctors, pediatricians, and psychologists don’t believe in it. It hasn’t really hit the media yet either.

Kids with sensory issues often have other issues. So professionals tend to lump the sensory problems in with another diagnosis. Kids with ADHD, Asperger’s, Tourette’s, and many learning disabilities tend to have sensory development issues as well.

For some, sensory problems are the major cause of their difficulties. For others, they’re just part of the package.

“What does it look like?”

Sensory difficulties come in two types: hyposensitivity (lack of sensitivity) or hypersensitivity (extreme sensitivity). A kid can (and often does) have a combination of hypo- and hypersensitive senses.

Each of these descriptions fits one hypo- or hypersensitive sense. So the symptoms are a ragbag of contradictory behaviours:

• bouncy and fidgety, unable to sit still
• wild and uncontrollable
• fearful of movement
• falls a lot, drops things a lot
• unco-0rdinated, ungraceful
• irritable about touch, taste, noise, and bright lights
• fearful of anything new
• unable to see detail
• touches people too much
• recoils from touch

See what I mean?

That’s why a professional needs to assess the kid to determine what (if anything) needs work.

“So what do we do?”

The primary treatment is activity programming, developed by an occupational therapist who specializes in sensory difficulties. The activities gently work the problem areas until the nerve pathways are strong.

The earlier the start, the better.

The prognosis is very good. Kids who work on the sensory difficulties get better at dealing with them. Some eliminate their difficulties entirely.