Polyvagal Theory, Sensory Challenge and Gut Emotions

Have you heard about Dr. Stephen Porges' Polyvagal Theory? The theory, already 20 years old,  replaces our old notions of how the sympathetic (fight/flight) and parasympathetic nervous systems (rest and recuperation) help to keep us calm, alert and safe. The area covered by Polyvagal Theory is huge. It impacts the way we understand our nervous system, senses, emotions, social self and behaviors. We see diagnoses like autism, sensory modulation disorder, borderline personality and others, in a new light.

Polyvagal Theory claims that the nervous system employs a hierarchy of strategies to both regulate itself and to keep us safe in the face of danger. In fact, it's all about staying safe.

Our "highest" level strategy is a mechanism Porges calls social engagement. It is a phenomenal system - connecting the social muscles of the face (eyes, mouth and middle ear) with the heart. You knew that your heart came alive with social interaction, and it's true! This system is regulated through a myelinated branch of the vagus nerve. In evolutionary terms, this is our most evolved strategy (mammals only) for keeping ourselves safe. We use this all the time to clear up misunderstandings, get help, plead for forgiveness, and so on.

The next mechanism, or strategy, is fight or flight. It's regulated by the sympathetic nervous system. This system is our fall-back strategy when social engagement isn't a good fit. (Think of seeing someone sneaking up on you!) Note that freeze is not a part of fight or flight.

Our freeze option is primal and is a remnant of our reptilian past. Freeze is a great strategy for turtles and lizards, but it's usually a bad idea for humans - think of fainting. Therefore, we typically use it last, when social engagement and fight/flight aren't going to work for us. But there are good uses for freeze. During severe injury, it shuts us down and turns off our registration of pain. We also make use of it during sex, and it helps women regulate pain and response to pain during labor.

Now these systems appear to work in tandem. The social engagement system puts the brakes on the other (fight, flight, freeze) strategies, thus keeping our heart and body active while we work through a situation. The social engagement system will release the brakes to engage a different response to the environment (i.e. running) if engagement doesn't help to get us into a safe situation.

What Can Go Wrong
We want our nervous system to operate using the social exchange most of the time. It is our most evolved way of being. It is restful and healthy because it allows our gut and other organs to do their job uninterrupted.

However, some of us are programmed from an early age to work from a fight/flight mode. Think of people who are sensory sensitive and recoil from sound, touch, smell or taste. Think of people with autism (in this case, the face to heart connection is not working). Think of people with borderline personality, depression and perhaps other disorders, too. When we are not able to work from our social engagement strategy, then we revert to a modified fight/flight strategy, which puts us in high alert. If we use too much of the fight/flight or freeze strategies, we may end up with gut issues because the gut comes to a halt and we stop digesting food during fight/flight activation.

The Polyvagal Theory has gained great acceptance over the years as pieces of it are shown to hold under laboratory findings. From a psychological viewpoint, it provides us with a rich understanding of self-regulation in the body. From a sensory processing viewpoint, it informs our understanding of sensory modulation.

If you are unfamiliar with the topic, check out the many articles on Dr.Porges' website. The most comprehensive article is The Polyvagal Perspective, and it is published here on the NIH Public Access site. It contains the physiological underpinnings of the theory as well as perspectives on  development, emotions, trauma and many other topics. There is a short video of it here.

Sensory Connection
Two researchers looked at a biological marker of the social exchange system, RSA, in typical children and in children with sensory modulation issues. RSA is the measure of high-frequency fluctuation in the heart between heart beats. It is a window into the social exchange system. The researchers found that children with sensory modulation issues have a lower level of RSA than their peers, meaning that these children are better prepared to put the breaks on social strategies and instead use fight-or-flight strategies.

As part of the study, the children were (each in turn) given a sensory challenge. The chairs they were seated on tilted backwards unexpectedly. The level of RSA was monitored in each child throughout the incident. The RSA of typical children dropped quickly and then stayed low for a short time. The children with poor sensory modulation skills had a very brief drop of RSA and a quick rebound to their RSA baseline.

This implies that children with sensory modulation symptoms use different strategies to handle safety-related situations than their peers. At this time, it is harder to draw greater conclusions since we do not have an easy-access window into the fight/flight system or the freeze system. With time, we'll get a better understanding of this. The article can be found here.

Emotions
Perhaps the most interesting new work making use of the Polyvagal Theory is the work of A. D. (Bud) Craig. Mapping our emotions, this is what he found. (Read about it here.)

Emotions arise from feelings in our organs and gut. The feelings are sent via the vagus nerve to the Anterior Insular Cortex (AIC) in the brain. (There's a lot going on in the vagus nerve - think of it as a cable with lots of separate wires.) The AIC captures feelings over time  and stores them as snapshots of feelings. This is our working emotional memory. These feelings are massaged and integrated with the social exchange to give us both an emotional response to the world around us as well as a safety-driven strategy.

Think of this: I am relaxing in a lounge chair on the beach. I feel safe. Suddenly, a beach ball hits me. My fight or flight instinct kicks in and the sympathetic nervous system stops everything that's happening (i.e. digestion) in my organs and gut. The gut passes the feeling of stoppage as "alarm" to the brain. This translates in the brain to fear and my body is set in motion. I quickly turn and see it's a ball and that a child is nearby and smiling at me. My social engagement strategy puts the breaks on my fight/flight response and also calms my heart. I smile at the child. This sends a sense of relief to my gut and it in turn sends a "warm" feeling to the AIC. My heart is still pounding from the surprise, but my response is guided by compassion.

In the above scenario, we specifically looked at a situation with a challenge to safety. But in fact, we spend much of our time worrying about safety. Unless I am completely safe, listening to quiet music in a locked room, I will most likely have safety challenges to respond to. The challenge may be from the scary book I am reading, or from the sense of anxiety I feel when I drop a spoon on the floor. Almost any activity will involve the combined interaction of the various strategies. The bottom line: we are constantly adjusting ourselves to meet the world. Polyvagal Theory gives us a look at how this works.

This is pretty complex stuff - and the theory is still in flux. It changes with each new study that looks at the implications of Polyvagal Theory on our response to the world. It is going to impact research greatly in the years ahead. As I mentioned at the beginning, Polyvagal Theory adds a new dimension to how we see autism, sensory issues and other disorders and will, I think, inform our interventions for those disorders in a big way.

References:

1. Porges, S. W. (2008, February). The Polyvagal Perspective. NIH Public Access, PMC1868418
2.  Schaaf, R. C., Benevides, T., Blanche, E. I., Brett-Green, B. A., Burke, J. P., Cohn, E.S., Koomar, J., Lane, S. J., Miller, L. J., May-Benson, T.A., Parham, D., Reynolds, S., Schoen, S. A.  Parasympathetic Functions in children with sensory processing disorder. Front Integr Neurosci. 2010; 4: 4. Published online 2010 March 9. doi: 10.3389/fnint.2010.00004
3.  Craig, A. D. (2009). Emotional moments across time: A possible neural basis for time perception in the anterior insula. Philosophical Transactions of the Royal Society of London. 364,1933-1942.

Criteria for Screening SMD with the Sensory Profile

The time over the holidays is when I typically read everything I can get my hands on as a way of updating my workshop and keeping current in general. I sometimes run across elusive information such as this item.

Here is the criteria that Dr. Miller and her colleagues use to determine whether a child has Sensory Modulation Disorder (SMD). They screen using the Short Sensory Profile and if ...

1. Total Test score of less than 3.0 SD (standard deviations) below the mean; or
2. Less than 2.5 SD below the mean on two or more subtests; or
3. Less than 4.0 SD below the mean on one subtest

.... then the child has SMD.

That leaves it to you to figure out the means using the manual :((( ..... or come back in a few weeks and I'll have it here. :)))

Update, January 9, 2013:  I have not been able to locate published values for 2.5 SD and 4.0 SD of each of the SSP sections. It is a difficult mathematical exercise to produce the numbers without all of the data. So let's estimate some of these numbers for 2.5 SD. I will have to beg off estimating 4 SD at this time - it's a pretty tricky calculation.

The numbers for 1-2 SD and 2-3 SD are on p.66 of the Sensory Profile Manual. By the way, I am going to estimate 2.5 SD somewhat conservatively.

Estimates	2.5 SD	3 SD
Tactile Sensitivity	16	6
Taste/Smell Sensitivity	7	3
Movement Sensitivity	6	2
Underresponsive/Seeks Sensitivity	15	6
Auditory Filtering	12	5
Low Energy/Weak	14	5
Visual/Auditory Sensitivity	10	4
Total Score	89	37

Scoring examples:
1. If a child has a tactile sensitivity score of 16, he is 2.5 standard deviations (SD) below the mean. If he has a score of 2 on movement sensitivity, he is 3 SD below the mean. Since he has 2 scores of 2.5 SD or lower, he qualifies for a diagnosis of SMD.

2. If a girl's total score is 37 or less, she is 3 SD below the norm and qualifies for the SMD diagnoses.

Teresa

Reference:

1.       Miller L. J., Reisman J. E., McIntosh D. N., Simon J. (2001). An ecological model of sensory modulation: performance of children with fragile X syndrome, autistic disorder, attention-deficit/hyperactivity disorder, and sensory modulation dysfunction. In Understanding the Nature of Sensory Integration With Diverse Populations, Smith S. Roley, Blanche E. I., Schaaf R. C., editors. , eds (San Antonio, TX, The Psychological Corporation; ), pp. 57–88.

2012 Journal Tidbits - Autism

Here are some study findings from the Journal of Autism and Developmental Disorders - one of my favorite journals - that struck me as worth sharing. By the way, you have until Dec. 31st (2012) to browse this journal for free on line.

 1. Is picky eating due to sensory issues or due to food rigidity?
This article suggests that some picky eating problems are due entirely to rigidity in the child's food selection patterns. Treatment in this case is motivational. A child is told they will try a certain food. They are offered a choice of reinforcers (rewards). If they eat the food, they receive the reinforcer. They are also rewarded with accolades.  If they do not eat the food, they do not get the reinforcer.

When trying a new food, the authors followed a hierarchical pattern similar to Kay Toomey’s SOS Approach method:

1. Touches the food
2. Puts food to the lips,
3. Bites the food, bites
4. Puts in mouth but does not swallow
5. Chews but does not swallow
6. Swallows reluctantly
7. Accepts food without signs of displeasure.

After18 weeks, children were spontaneously requesting the new foods they had tried. The three children in the study, Ken, Robbie and Daniel accepted 5, 9 and 8 new foods respectively at the completion of the 22 week study.

Source: Koegel, R. L., Bharoocha, A. A., Ribnick, C. B.,Ribnick, R. C., Bucio, M. O., Fredeen, R. M., et al. (2012). Using individualizedreinforcers and hierarchical exposure to increase food flexibility in childrenwith autism spectrum. J Autism Dev Disord, 1574-1581.

  
2. What causes self-injurious behaviors in autism? The seven risk factors for self-injurious behaviors are 1) poor sensory processing, 2) low cognitive skills, 3) poor language / communication skills 4) poor social function, 5) age (18 mo. - 19 yrs.), 6) rigid behaviors and 7) gender. However, these factors account for just 29% of the self-injury cases seen, with sensory being the greatest factor of these (5-7%). The authors hypothesize that chronic pain and psychosocial factors may play a large factor in the remaining 71%. Clearly, there is more work to be done.

Source: Duerden, E. G., Szatmari, P., & Roberts, S. W.(2012). Toward a better understanding of self injurious behaviors in childrenand adolescents with autism specturm disorders. J Autism Dev Disord,2515-2518.

3. Is there a relationship between anxiety and repetitive behaviors? Yes, repetitive behaviors appear to be a cause of anxiety. "It is possible that, for some individuals, interventions focused on a reduction of behaviors, promoting flexibility and reducing repetitive play may consequently reduce anxiety." See the next article for more on this.

Source: Rodgers, J., Glod, M., Connolly, B., & McConachie,H. (2012). The relationship between anxiety and repetitive behaviors in autismspectrum disorder. J Autism Dev Disord, 2404-2409.

4. Are there interventions for quieting repetitive behaviors? Yes, if the child's behavior can consistently be triggered. For example, give a child with autism six cars, he will line them up. That behavior is triggerable and can be replaced with functional behavior. How about if the behavior is not triggerable? That's a harder problem. Not only do we not have interventions, we are not doing the research to look for them.

Sources:

1.  Boyd, B. A., McDonough, S. G., Rupp, B., Khan, F.,& Bodfish, J. W. (2011). Effects of a family-implemented treatment on therepetitive behaviors of children with autism. J Autism Dev Disorders,1330-1341.
2.  Boyd, B. A., McDonough, S. G., F., & Bodfish, J.W. (2012). Evidence-based behavioral interventions for repetitive behaviors in autism.J Autism Dev Disorders, 1236-1248.

5. Do children with autism also qualify for anxiety disorder? Yes, the diagnoses overlap often in children and young people (40-45%). Specifically, in children with high functioning autism, anxiety should be treated (medicine or stress reduction techniques) as a way of supporting other methods of increasing social skills.

Source: White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits and loneliness in youth with autism spectrum disorders. J Autism and Dev Disord, 1006-1013.

Aromatherapy and Essential Oils

A recent study (1, 2) showed that essential oils reduce blood pressure and heart rate - but only if they are used for 15 - 60 minutes at a time. There is evidence that they reduce heart rate, but they can cause other issues (asthma, for example) in longer doses.

Aromatherapy is often touted to help reduce anxiety. The National Institute of Cancer (NCI) says this about it:

A large body of literature has been published on the effects of odors on the human brain and emotions. ... Such studies have consistently shown that odors can produce specific effects on human neuropsychological and autonomic function and that odors can influence mood, perceived health, and arousal. These studies suggest that odors may have therapeutic applications in the context of stressful and adverse psychological conditions.

The NCI (3) looked at a research done with cancer patients using aromatherapy to treat anxiety and other symptoms of cancer. The studies, which included children, show that aroma therapy can be effective - and especially when combined with massage. Here are some of the results. The full results are here.

• Chamomile combined with massage appears to work well.
• Smelling and tasting orange helped with physical symptoms of cancer treatment in children. There was no report on its effect on anxiety.
• Various essential oils (selected by patient) appear to reduce anxiety.
• Bergamat did not work and in fact, increased anxiety in children.
• Lavender did not appear to work as a relaxant in these studies. By the way, there is some evidence that exposure to lavender in boys and men can enlarge mammary glands.

As noted above, essential oils should be used for only 15 - 60 minutes at a time.
 
For more information on essensial oils and aromatherapy go to:

• The National Cancer Institute: Aromatherapy and Essential Oils
• A Brief History of Aromatherapy
•  Llewellyn's Complete Formulary of Magical Oils by Celeste Rayne Heldstab - A fun, but not evidence-based source of information.

References:

1. Chuang K-J, Chen H-W, Liu I-J, et al. The effect of essential oil on heart rate and blood pressure among solus por aqua workers. Eur J Prevent Cardiol, 2012 DOI: 10.1177/2047487312469474 
2. A synopsis of the above article is at ScienceDaily: Mind&Body:  http://www.sciencedaily.com/releases/2012/11/121129093419.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29
3. Study with cancer patients:  http://www.cancer.gov/cancertopics/pdq/cam/aromatherapy/healthprofessional/page7

Autism and Fear

Researchers at Bringham Young University showed that children with autism hang on to the association of fear for a particular object long after other children have let it go. In a series of trials, children were given a puff of air in the face after seeing a yellow card. All of the children registered fear when shown a yellow card. At some point the card associated with the puff of air was switched to a differerent color. Typical children figured this out quickly and soon lost their distrust of the yellow card. Children with autism continued to be fearful of the yellow card long after the others. The length of time they stayed fearful was related to the severity of thier autism diagnosis.

The authors conclude that this heightened sense of fear ("anxiety", in their words) is not just associated with autism but is an integral part of it.

References:
1. Synopsis can be found at Science Daily: Mind and Brain

2. Mikle South, Tiffani Newton, Paul D. Chamberlain. Delayed Reversal Learning and Association With Repetitive Behavior in Autism Spectrum Disorders. Autism Research, 2012; DOI: 10.1002/aur.1255

Do you REALLY think he has Asperger's?

Check out New York Magazine article, Are You On It?  .... If so, you're in good company.  From Asperger's to "Asperger's", how the spectrum became quite so all-inclusive about ? Finally someone shaking a finger at those who would lightly diagnose husbands, colleagues, politicians or themselves with the disorder.

iLs Pillow Insert

Just received an email about a new sleep product from iLs that helps with auditory sensitivity. It is priced at $295 and available for purchase by parents. It is described as follows:
 
 The iLs Pillow delivers processed music through a vibration which is carried by the body (our bones are great conductors). The music travels internally to the bony area surrounding the inner ear, and is audible only by the user. It is used to de-senstitize those with auditory sensitivity, reduce anxiety and improve sleep.

Patterns of Early Development in Autism

Follow this link to a short article on the normal development cycle for a child with autism. In fact, there are two development cycles - one for children with an early diagnosis of autism (14 months) and the other for children who are typically identified between 24 - 36 months of age.
 
References:

1. Rebecca J. Landa, Alden L. Gross, Elizabeth A. Stuart, Ashley Faherty. Developmental Trajectories in Children With and Without Autism Spectrum Disorders: The First 3 Years. Child Development, 2012; DOI: 10.1111/j.1467-8624.2012.01870.

 

2. http://www.sciencedaily.com/releases/2012/10/121030062401.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

Sally Rogers and the Early Start Denver Model

Here is short article about Sally Rogers' Early Start Denver Model (ESDM). Children with autism who are not typcially diagnosed until age 2.5 can stagnate and miss fertile developmental opportunities. In fact, we know how to diagnose at much earlier ages (there are at least two methods for making a diagnosis at 6 months) and so have a window of opportunity to work with children at a much earlier age.

Dr. Rogers  and her colleagues have developed an intense program that combines Play, Behavioral Therapy and Relationship Therapy to help children make gains at 18 months. Her team at the Mind Institute in Sacramento is seeing tremendous results that include  speach gains. In fact, 90-95% of children  coming through the Mind Institute's program begin speaking at age 3 - 3.5. 

Here is the transcript of a PBS interview with Dr. Rogers.

Do Weighted Vests Work? Two Studies

Last year, two widely different studies published in AJOT (American Journal of OT) looked at the effectiveness of a weighted vest in increasing the on-task behavior in children with poor attention. One study showed an effective protocol, the other showed a protocol that did not work.  Let's look at the methods used in the studies.

What didn’t work

In study 1, by Collins and Dworkin, children wore a standard commercial vest (based on the size of the child) for 15 or more minutes (the length of an activity). Filming of the child’s behavior was started after a 5 minute adjustment period. The recording was 10 minutes long. A total of 9 sessions were recorded over a period of 3-6 weeks.   To make that clear, each child wore a weighted vest for approximately 15 minutes on each of 9 days. They did not wear a weighted vest at other times. The authors report that their weighted vest protocol did not improve attention to task. By the way, these children were typical children in elementary school. No further information is given about them including whether or not they were known to have sensory issues or had been diagnosed with ADHD.

What appears to work

Study 2, by Fertel-Daly, et. al., had children with autism ages 2-4 in a pre-school program wear similar vests for 2 hours on and then two hours off. Children wore the vests 3 days a week. They were given 3 weeks of this protocol to adjust to the vests prior to filming behaviors. All participants had an increase in attention. The smallest child had the best increase, suggesting that the ratio of the child’s body weight to the weight in the vest made a difference. Teachers noted that the level of aggression and self-stimming behaviors were noticeably reduced at the end of the study. The children's attention skills improved overall by the end of the study and did not return to baseline once the vest was discontinued.

Conclusions that Need Re-Validation

1.       The art of “how much weight to use in a vest” says that 5-10%  of the child's bodyweight works best. In study 2, the smallest girl used weight equal to 4% of her body weight – and it worked. Other students who had less vest weight still had good results, but not as good.

2.       Vests are more effective when used consistently over time. Even 3 days a week is effective, but the gains increase as the weeks go by.

3.       The method of 2 hours on and 2 hours off appears to work. A vest that is worn for 15 minutes (as needed) is not effective.

4.       The weighted vests  appear to help pre-schoolers with autism. Would it help elementary children with autism?

5.   Children with autism tend to have sensory issues. It makes sense that a vest (a sensory solution) was successful for them.  Would it also work for a small child with ADHD?

 

6.  In the second study, the children's attention skills improved - and did not return to baseline. What would happen if the protocol were continued? Would the children lose those symptoms?

So many questions, so few answers. Ah, to have a large group, long term study!

 

References

1.       Collins, A., & Dworkin, R. J. (2011). Pilot study of the effectiveness of weighted vests. American Journal of Occupational Therapy, 65, 688–694.

2.       Fertel-Daly, D., Bedell, G., & Hinojosa, J. (2001). Effects of a weighted vest on attention to task and self-stimulatory behaviors in preschoolers with pervasive developmental disorders. American Journal of Occupational Therapy, 55, 629–640.

In the News ...

Here are a couple of interesting news items you may have missed. I found these on the Science Daily news service over the weekend.

Second-Hand Smoking Affects Neurodevelopment in Babies
How does it affect the baby? ..."poor physiological, sensory, motor and attention responses". Read it - it's an eyeful.

Disorder of Neuronal Circuits in Autism Is Reversible, New Study Suggests
Scientists have found an impaired set of circuitry affecting many symptoms of autism and have reversed the problem in mice. This gives hope that we may be able to do the same in humans once we are better at pinpointing brain chemical therapy to a given small region. A breakthrough in that technique was also reported last week.

You can subscribe to email delivery of ScienceDaily at this site. They also have an RSS Newsfeed.

AJOT Issue on Autism

You might want to check out this month's edition of the American Journal of Occupational Therapy (AJOT) - which is devoted to autism. Here are some highlights from the articles:

• Modifying sound and light in a classroom for students with autism by insulating walls with sound absorbing Owens Corning Basement on Finishing System (TM) and replacing fluorescents with area-based halogen lighting decreased the act-out behaviors of 4 teens (ages 13-20) who use the room.
• Yoga for children with autism is shown to be a good intervention for kids on the spectrum - we already knew that, but it's great to see it verified.
• Also, several articles look at the incidence of sensory issues (oral motor, auditory processing and proprioception) in children with autism as opposed to that in typically developing children.

EFT Post Update

Here is an update to the original EFT post of a few weeks ago.

The Emotional Freedom Technique is an easy way to deprogram the brain of emotional garbage. The basic idea is that you tap on acupressure meridians while bringing up difficult emotions or memories followed by saying positive things (affirmations) about yourself. The claim is that the emotions disappear and the memories become neutral. The evidence says that it is effective and my own quick experimentation with it has sold me on it. Bad memories were indeed neutralized. It felt a bit like magic.

There are a number of YouTubes that demonstrate the method, including how to do this with a child. You will want to read The EFT Manual by Gary Craig before you try it. And by all means, don't do it on others if you are not professionally capable of handling the situations you could get into. There are lots of workshops out there that can give you a hands-on approach to learning it.

Here are the basic steps:

1. Name an emotion you are feeling.

2. Create an affirmation:

      But even though I am (emotion), I deeply and completely accept myself.

      Example: Even though I am angry, I deeply and completely accept myself.

3. Tap side of palm while saying affirmation.

4. Tap head, face and other points while saying emotion.

5. As you move to the wrists, say the affirmation again. 

6. Do steps 3-5 for several rounds until the emotion eases.


Doing EFT on the memory of an emotional incident
1. Name the memory (i.e. “fight with Sarah on the playground”).

2. Create an affirmation (as before).

3. Tap through the name of the memory until the child can say it without emotional reaction.

Now very slowly begin to play a part of the memory. Stop and tap until you are comfortable with it, then continue on with each section of the memory in the same fashion. You do not have to do the entire memory in one setting – break it up and do what is comfortable for you. Long or highly emotional memories will take a while. 

Older memories may have layers and layers of thoughts and emotions connected to them. Perhaps the child gets through one aspect (embarrassment of the situation) only for another aspect (fear of Sarah) to show up next.

 There is so much more to learn, but this is enough to experiment with. Remember – read the book, watch the YouTubes, practice on yourself and see how it works for you.

Using Ease for Behavior & Flight/Fright

Here is a way to help a child with poor self-regulation (think of a wiggly, inattentive sensory child with or without autism or of a child who is alarmed by loud noise). The type of therapy I'm describing is a lite-version of sound therapy and can be done at home or at school over a period of several weeks. The product is called EASE and is modulated music on a CD (there are a variety of CDs). It is available to parents and therapists at Vision-Audio.com.

Protocol
As a protocol, the child listens to music 2x/day for 20-30 minutes, 5-7 days per week. Separate the 2 daily sessions by 3 hours or more. The volume should be set low - that is, no higher than what is needed for the child to comfortably hear the music.

Try not to use the disks too close to bedtime as the music may be alerting. Use each disk for about 2 weeks. You can rotate the disks in and out of a long-term schedule, or do a few weeks of music and then more later as needed.
 Always do a 5-minute test before starting a program. Have the child listen to music for 5 minutes, then wait 24 hours before doing any more. If there are any emotional outbursts, mood changes, or unusual behaviors during that time, do not continue therapy unless you are well-versed in sound therapy and know your way around this.  

Do not do sound therapy if the child has a history of seizures, depression, mania, bipolar disorder, or some type of psychosis – including hearing voices.

Purchasing Equipment

Purchase Ease 1 or 2 for starters and then if it appears to be working, purchase additional disks. Ease 3 is typically used for children with attachment issues. Ease 4 has especially good 3-D auditory enhancement properties. There are many disks available.

You will want to buy good headphones. Do not use Bose - they filter out the modulated music sounds. Two good choices are Sony 7506 (about $100) and the relatively childproof Sennheiser HD 500A (about $150). Both are available from on-line sources. Get a good CD Player with random-access play. I like the Sony's that are available for about $25. Putting the player in random-access mode will help keep the music from getting boring. Make sure that Mega Bass is OFF. It is harmful to ears.

By the way, Vision-Audio also has 3-D video games which can help with auditory and visual sensory integration.  There is also a very powerful iPod app available to therapists to use with clients.

ADHD Alternative to Meds

Here is some infromation for parents looking for alternatives to ADHD meds.

Dr. Weil, the alternative medicine guru cites a study in Australia (1) that compares the results of taking methylphenidates such as Ritalen and Concerta versus a supplement of omega-3 fish oil and omega-6 in the form of evening primrose oil. The omega-3 and omega-6 supplements showed the best results. Dr. Weil's blog post is here.

There is a recent book on the topic by Dr. Sandy Newman: ADHD Without Drugs. Dr. Newman recommends that the child also take a multivitamin and a probiotic daily to help keep the gut healthy.

Dr. Weil also says to "be sure to rule out hearing or vision problems, allergies, thyroid disorders, depression, or even boredom in a gifted child" before resorting to medication. Here is a link to his blog on ADHD.  

1. Sinn, N. & Bryan, J. Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD. Journal of Developmental & Behavioral Pediatrics: April 2007 - Volume 28 - Issue 2 - pp 82-91

Be Different

Just finished reading John Elder Robinson's latest book, Be Different: Adventures of a Free-Range Aspergian with Practical Advice for Aspergians, Misfits, Families & Teachers . Loved it, loved his advice for people with Asperger's. He discusses everything from emotions to sensory issues to friendships to being different - which is the point of the book: it's okay to be different. He says that being Aspergian (his term) is a gift to be utilized. He tells others to channel their narrow interests into their life's work - as he has very successfully done.

He says that there are simple solutions to many of the issues that Aspergian's have. For example, he is a business owner and deals with people a lot, so he decided to beef up his social skills by reading Emily Post's Guide to Manners and Dale Carnegie's How to wn Friends and Influence People. Makes sense. So does the book.

Drumming as Timing Therapy

I've discussed the importance of timing therapy in other posts. It can improved executive functioning, coordination, sensory processing, social skills and increases IQ. What better way is there to do it than drumming? The important thing is that the movements need to be done with precision - otherwise there is little gain other than rudimentory timing skills.

Here is a fabulous YouTube of kids with special needs drumming. It comes from TamboRhythms.

EFT - The Emotional Freedom Technique

The Emotional Freedom Technique is an easy way to deprogram the brain of emotional garbage. The basic idea is that you tap on accupresure merideans while bringing up difficult emotions or memories followed by saying positive things (affirmations) about yourself. They claim that the emotions disappear and the memories become neutral. The evidence says that it is effective and my own quick experimentation with it sold me on it. Bad memories were indeed neutralized. It felt a bit like magic.

There are a number of YouTubes that demonstrate the method, including how to do this with a child. You will want to read The EFT Manual by Gary Craig before you try it. And by all means, don't do it on others if you are not professionally capable of handling the situations you could get into. There are lots of workshops out there that can give you a hands-on approach to learning it.

Gary Craig's web site is EFTUniverse.com.

Martha Herbert, M.D. and "The Autism Revolution"

Dr. Martha Herbert's new book, The Autism Revolution is a gift to those of us trying to understand what the mish-mash of research results in the area of autism really mean. She talks about autism as a whole-body disorder that includes the mind. It's "a collection of problems that can be addressed and many that can be solved."

MeMoves

MeMoves is an engaging exercise for small or large groups. Its developers describe it as "a kind of Western t’ai chi or yoga set to music". Children watch and imitate images of slow rhythmic movement and in the process get calm and improve attention skills. In children with autism it fascilitates the function of the mirror neurons.

The original product is a DVD with a variety of moves and costs $59. Watch the children below work to it.



There is also a MeMoves app for iPhone which helps with calming and focus, but without the whole-body movements. It is $10.




I've heard this described as a timing program - but I'm going to disagree with that. It is rhythmic, and the children are doing coordinated movement, but in what I've seen thus far, the stress is on calming and attention rather than on precise timing. In any event, it appears to be a great product! Find out more at ThinkingMoves.com

Sensory Check Lists

I often get asked about a sensory check list for parents. I like the Sensory Processing Disorder Checklist from SPD Foundation because it looks at function, covers all ages and looks at modulation. Another list I like a lot is the Sense and Self-Regulation Checklist by Dr. Louise Silva. It was published in the Jan/Feb 2012 issue of AJOT, and is also available Dr. Silva's web site.

The gold standard for sensory questionnaires is the Sensory Profile with the Sensory Processing Measure being very good, as well. Both of these are standardized on large populations and available commercially from Pearson's and WPSpublishing respectively.

How about assessments? There is the SIPT, but it does not cover modulation. I am waiting for the Sensory Scales from SPD Foundation to be completed. They have standardized the SOR (sensory over responsivity) section on a few hundred children across the US, but have much work to do on the rest of the tool. By the way, the SOR section is being actively used by researchers.

SPD Conference

I am at the Sensory Processing Disorder Conference in Boston. Day 1 is for parents and others who want a crash course in all things sensory. Days 2 and 3 have sessions cover new research.

Diane Henry, author of Tools for Tots, Tools for Teens, etc. was the primary lecturer for Day 1. Her books and workshops are excellent with tons of good tips for helping children of all ages to self-regulate using sensory strategies.

We also heard a lecture by Doreit Bialer covering the A SECRET method of identifying sensory strategies for a particular child taking the child's emotional state, culture, relationships and environment into consideration. Ms. Bialer talked about a child who displayed chaotic behaviors in a grocery store. His mother changed this behavior by giving him responsibilities during shopping. He helped create the (picture) gorcery list, took it to the store, pushed the cart and deposited pictures into a bag once the grocery items were placed in the cart. His mother scaffolded these activities by working first with small lists and shopping in very small stores and then increasing the challenge with time.

HowdaHUG

In our "goodie bags" were both practical and fun items. My favorites include a very cool seat called HowdaHug that cradles and rocks a child. This is very light, very portable and comes in a variety of sizes. We also received a set of Soft Seamless Underwear for children who have difficulty wearing clothes. The cloth in the underwear is thick, soft (of course) and would provide good proprioception if a slightly smaller size was purchased. The garment has no elastic.

Sleep and Dental for Autism

Autism Speaks has published two guides that parents will want to download.

The first covers sleep habits and discusses bedtime routine (including sample PEX-style cards), sensory concerns (light, sound, tactile and temperature), the amount of sleep needed (children with autism appear to need less sleep), and strategies for problem sleepers. There is a wealth of good information in 8 pages.  Autism Speaks Sleep Tips

The second guide is a toolkit for dental professionals. It provides practical strategies for doing dental work on children with autism. Included topics are sensory strategies, picture schedules and social stories. There are handouts for dental workers to provide to parents regarding chemicals and procedures. The appendix contains parent medical checklists and parent handouts regarding the nature of amalgams and flouride. Autism Speaks Dental Tool Kit

Update on Winter Depression and Melatonin and Lights

Two years ago I wrote about using low dose melatonin to help chase the winter blues. (See that post here.) There is a bit of an art to this method. Someone told me that you are supposed to use the melatonin for a few weeks in the autumn and then stop. I looked for a reference to cite on this, but found none. However, it made sense to me, so I decided to try it this year.

Starting in early November, I took about 3 drops of liquid 25 mg. melatonin in a glass of water (also tried under the tongue, which seemed to be fine, too) once a day for about 3 weeks. Research shows that there are two times of the day it will work. For most people, the dose is to be taken in the early afternoon. For others (that's me), it is taken in the morning. I would get up at 7:00 and take the melatonin at 9:00.

I did nothing else until early January when the light was beginning to increase a tad. At that time, I started getting a bit of brain fog, so I purchased a 10,000 lumen light and began sitting with it for 15 minutes in the morning. It has worked very well. I notice that my brain goes into a bit of hibernation if I miss a few days running, but otherwise, the brain is working well. BYW, I have tried using lights without melatonin in past years, but it didn't seem to be enough. And the article cited below says that melatonin alone may not be enough either.

To get more information, read the short summary on the NIMH website: posted in May 2006 Summary from the National Institute of Mental Health (NIMH): http://www.nimh.nih.gov/science-news/2006/properly-timed-light-melatonin-lift-winter-depression-by-syncing-rhythms.shtml

Ease App on Fox News

A quick note about the EASE listening therapy app from Vision-Audio.com.  Fox News did a segment on the product. It can be seen at:

http://www.foxnews.com/health/2012/02/05/solution-for-sensory-disorders/

Coaching Cards

Check out the Parent Coach Cards available at www.ParentCoachCards.com. There are 20 cards on a ring. Each card has a lively illustration on a topic such as flexibility, reactivity, organization skills, impulsive speech, and other ADHD-related behaviors.

The back side of each card contains text that parents can read to help coach their child on avoiding the problem behavior. The cards are set up for on-the-spot usage. A parent can grab a card, show it to the child and read text such as: "Finding your brakes means using your 'thinking side' to control your energy."

There is also first-person text for the child to read. Within that text are a number of 1-liners such as "I need my 'thinking side' even when I'm having fun", that can be used for quick reminders.

An associated coloring book is also available for sale on the site and on Amazon.com.



Sensory Vs Behavior Approach

There is a bit of unnecessary tension between the fields of applied behavior analysis and sensory therapy. There needn't be. Both approaches have tons of research. Sometimes there is an overlap in the type of therapy one might consider for a given situation. Excellent! Both types of therapists can give a problem a "go". I am grateful to have colleagues to refer difficult cases to and am glad to help their clients, as well.

I've compiled, what I contend, are a list of truisms regarding the scope and overlap of these two types of therapies.

1. Yes, there is such a thing as sensory processing disorder. Yes, there is evidence. Do sensory interventions work? In many cases, yes. See the many, many papers written.

2. No, sensory techniques do not solve all sensory issues. Sometimes a child has developed negative habits and a behaviorist can provide the best therapy. In fact, for truly challenging problems, a behaviorist approach can be a God-send.

3. A behavior approach can be the therapy of choice for feeding problems - even those with textures and tastes. Why? Sometimes the child just needs to get past the weirdness of texture and tastes. There is a rule of 13 tastings. When a child tries a food (that they don't hate) 13 times, they acclimate to it. This is especially important for children who are at risk for failure-to-thrive due to feeding issues.

4. Using one of the BIG sensory therapies such as Therapressure™ (Wilbarger Protocol), sound therapy or a strictly followed sensory diet can change the life of a child with sensitivity (hyper-reactivity) to sensory input. These children suffer - we need to help them

5. "ABA"-based therapies have helped many children with autism to attend to lessons in a regular-education classroom. This can be a life-changer for a child.

6. Movement and other sensory-style breaks throughout the day help all children to attend better in class. This can help all children achieve higher grades.

7. New medical research is uncovering unusual issues in children with autism that affect their behavior. Treating a medical issue with sensory or aba-style therapies can be a waste of time.

That's the short list. What other things might you add?

DSM V and Autism

If you want to see what is happening with the DSM V revisions (Psychiatrist's Diagnostic Manual) for autism, check out their website. I was very skeptical prior to looking at the changes because I did not want (and still do not want) to see the Asberger's label go away, but aside from that, I like the way that they have streamlined it to feel like a spectrum. I get a nice visual of its dynamics, seeing severe move to moderate move to high functioning move to off of the label. I see enough children make headway along that path moving slowly but steadily into better space with our therapies, to make that spectrum visual real. As for whether or not it will work, time will tell. There is still time to provide input to the DSM V committee for those of you who want to do so.

By the way, the new language for sensory modulation symptoms for autism is in that definition. They included all three types of modulation problems: hyper-reactive (over-responsive or over sensitive), hypo-reactive (under-responsive or under sensitive) and craving (seeking). This is a huge win and a first step for Dr. Lucy Jane Miller and her colleagues. Sensory modulation does not exist as it's own disorder yet in the DSM. Presumably, that is step two.