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Psychology and the child with Sensory Processing Disorder: Misdiagnosis, Mother-Blaming and the Manipulative Child

By: Dr. Jennifer Jo Brout
Submitted: 2007-05-21 19:25:54
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Frustrated Families

The first day of “Introductory Family Counseling” a wise professor stared at her students and said “Your primary goal is to not make things worse”. It is ironic that while I was in graduate school studying how to be a therapist, I was also desperately searching for a therapist to help my daughter manage her sensory integration problems.As I consulted psychologists and psychiatrists alike, I wondered if there were any clinicians who even understood what Sensory Processing Disorder (SPD) was! My daughter received Occupational Therapy to remediate her symptoms, yet her personality and our family dynamics were already negatively impacted by the disorder.Were there any mental health professionals with something to offer beyond ineffective treatment plans and medications that didn’t work? Was there anyone “out there” who would understand that I was not simply “giving in” to my daughter’s “manipulations” because I was a browbeaten MOTHER lacking any savvy?

Although her other senses were affected, extreme over-reactivity to auditory stimuli caused my otherwise sociable, empathic sweet-natured little girl to be unpredictably moody and explosive.During toddlerhood and early childhood she threw tantrums that lasted for many hours, way beyond that which was typical for her age. She was extremely clingy, and often appeared sad. Background noises that most people didn’t notice set her off into rages. When she was six years old she looked at me desperately and said, “When I hear bad noises I feel like I am turning into the Incredible Hulk”. Then she intently inquired, “Mommy can you fix my brain?” This moment defined the extent to which my daughter was suffering, and how negatively her self-image had been impacted by SPD. What little girl should envision herself as a huge green out of control mutant?Occupational Therapy was helping her symptoms, but she needed psychological support as well (and so did the rest of our family).

Like me, many parents are disheartened as they progress through a bevy of mental health professionals who have limited competence in treating the emotional, behavioral, and familial complications related to the disorder. A main cause in this knowledge gap is that SPD is not yet in the diagnostic manual used by psychiatrists and psychologists (which is only revised every ten years or so).[1]Some psychologists “believe in SPD”, while others do not. Often psychologists are well intended but overlook sensory processing problems as causal or transactional in behavior. Others understand what SPD is but they do not know how to help manage the disorder. It is encouraging that mental health professionals are more frequently referring patients to Occupational Therapists who treat the disorder through sensory integration therapy.Yet, while Occupational Therapists seem to have an understanding of the psychological complications of SPD, many mental health clinicians do not. Just as psychologists should not treat the symptoms of SPD through Occupational Therapy, Occupational Therapists should not be expected to be psychotherapists or family counselors.

The Worst Kept Secret in Mental Health Recently, the definition of SPD has been published and includes three categories with different subtypes (Miller, L.J. et al, 2007).Sensory Over-Responsivity is a particularly relevant subtype to psychologists due to its high correlation with “fight or flight” reactions that appear as behavior problems in children.

To study Sensory Over-Responsivity Miller and colleagues at KID Foundation used physiological measures to compare how children with SPD vs. typically developing children react to a variety of sensory stimuli in a laboratory paradigm. They found that children with Sensory Over-Responsivity perceive harmless sensory stimuli as noxious. Long past the time that the brains of typically developing children realize that the stimuli are not worth attending to, the brains of children with sensory issues are still processing the stimuli and trying to figure out if the sensations are dangerous. That is, in response to stimuli which others would consider pleasing or neutral, children with Sensory Over-Responsivity alert as if their body was responding to a serious survival threat. Physiological evidence demonstrated that their sympathetic nervous system readied for “fight or flight”. Normally, when a threat passes the parasympathetic nervous system puts the breaks on the “fight or flight” reaction. It is necessary for our arousal level to increase if danger is suspected and then decrease when we find out we are not in danger. Nature designed us to be hyper-vigilant and over-aroused when a threat is real (not because our system misinterprets sensory information). Imagine if every day you were unpredictably bombarded with sounds, smells and touch that others didn’t notice or even enjoyed. Imagine if songs on the radio, the smell of pizza wafting from the oven, or another individual kindly putting a hand on your shoulder propelled your system into a “fight or flight” state. Think how this would impact your mood, your concentration, and your personality!

What can a parent do? How can a parent mediate Sensory Over-Responsivity within family life?

With Occupational Therapy and as your child grows older he or she will be able to implement greater control over his behavioral reactions to his physiological responses. Parents are often concerned that they will send a message to their over-responsive child that they condone out of control or aggressive behavior.How do you keep your child calm, or regulated, without sending the wrong messages?Regulation (calming the child so that he she is not overaroused and agitated) is the first priority. To accomplish this, you must allow yourself to dismiss much of what you have been told about parenting, by mental health professionals and others, because it does not apply to children with Sensory Processing Disorder.Your child has a brain that over-reacts to sensory stimuli and which has difficulty calming down.

Regulate, Reason and Reassure

Regulate: Identify the source of the sensory over-responsivity, focus the problem on the child’s “brain”, and shift the focus from any resulting behaviors.For example if your school-age child has just hit his sister because she made a noise that set him off, rather than react punitively shift his focus to “calming down.” Within the confines of the child’s developmental level, explain that a particular noise set him off and his brain is making him feel out of control. As a child develops greater linguistic and cognitive skill this process becomes easier. However, even younger children with limited language skills can be calmed (or regulated) by utilizing physiologically based techniques that are available through consultation with an Occupational Therapist. No formula exists for treating a child since every child is unique; thus consultation with a professional is critical to learn what works for your child. However, some of the techniques are logical and similar to what we naturally do with young children when they are upset.

Reason: Later, perhaps even hours later, review the incident with your child focusing on his thought processes.For example, you might ask, “What were you thinking right before you exploded?”If he cannot identify the source of his reactivity try to suggest possibilities. For example you might say, “Was it your sister’s whistling that bothered you?”Make sure to identify the sound by name and explain to your child that the noise upset his brain, not his sister (she did not purposefully make the noise in order to disturb him). Also, point out that even though he could not control his reaction, his behavior hurt his sister’s feelings. When you see that he understands this, then ask him to apologize to her. For younger children, you will have to go through this process with relative simplicity and brevity. You may feel frustrated and as if you are not making progress. However, with consistency your child will understand your message and will also learn that when he or she feels out of control, calming down is the first step! Remember, this is a process that works reciprocally with your child’s development. It is not an over-night panacea!

Reassure: Your child does not like feeling out of control. He does not like the fact that he just hurt his sister, even if he does not seem remorseful. Reassure him that over time he will gain control over his brain, and that you will help him. Let him know that you expect him to try as hard as he can but protect his self-esteem and self-image by framing the problem as though it were “a work in progress”. Repairing damaged self-esteem and poor self-image is much more difficult than reshaping a child’s misconstrued ideas about the antecedents and consequences of behavior.In other words, it is easier to undo some poor behavior habits that may result along the way than it is to rebuild a child’s view of him or herself in relation to the world. No child should see themselves as a huge out of control green mutant being that repels others!

Within the family dynamics, the over-responsive child probably feels victimized by the overwhelming sensory stimuli generated by family members. However, siblings are also likely to feel victimized having often been the object of the over-responsive child’s mood swings and/or aggression. Therefore, let siblings know that they are not responsible for these problems and that you are doing everything you can to help for your over-responsive child. The child’s behavior is not only about his or her actions and consequences. Interpersonal relationships are at stake; Sensory Processing Disorder affects family functioning.

Finally, it is important to realize that you are not alone. Yours is not the only family affected by Sensory Processing Disorder and your child is not the first to be accused of being manipulative! There are many other parents who understand very well what you are going through and there is research to support that Sensory Processing Disorder is brain-based rather than a behavior problem. Connect with other parents through KID Foundation (they list support groups all over the country) and don’t be afraid to use what you know to advocate for your child. It isn’t always easy but many parents have done it and so can you!

Tips for finding a psychologist for SPD family related issues

- Ask your Occupational Therapist if they know a psychologist or counselor who understands SPD

- Join a local support group so that you can benefit from referrals from nearby parents (www.KIDFoundation.org lists parent groups all over the U.S.)

- Choose a psychologist who is willing to read books and research articles about SPD and consult with your Occupational Therapist

- Access the many available books and articles on Sensory Processing Disorder. Many are written for parents, others for educators and psychologists and some for scientists. Carol Kranowitz and Lucy Jane Miller are both Occupational Therapists/authors whose books are particularly helpful to parents and professionals alike.

- Ask the mental health clinician how they feel about SPD? Is it a “real” disorder? Are they willing to attribute your child’s moody or explosive behavior to SPD alone without confounding diagnosis such as Oppositional Defiant Disorder?

- Trust your instincts. If a mental health professional recommends an intervention that makes you uncomfortable, or seems contrary to what you know about SPD and over-responsivity, voice your opinion and when necessary, move on to a different practitioner. Jennifer Jo Brout, Ed.M., Psy.D. is a psychologist focused on Sensory Processing Disorders and their application to mental health. She earned an Ed.M. in School Psychology from Columbia University and a Psy.D in School/Clinical Child Psychology from Albert Einstein College of Medicine. Working as a child advocate she continues to spearhead evidenced-based research projects in order to address various aspects of sensory processing/regulatory disorders. Dr. Brout is currently involved with projects at the KID Foundation Research Institute (the leading authority on Sensory Processing Disorders) Duke University, and in association with audiologists and private clinicians throughout the country.

In 2006, Dr. Brout launched Positive Solutions of New York, LLC to support research in psychological conditions, developmental disorders, and learning difficulties related to sensory processing/regulatory disorders through various creative and public service projects. Prior to forming her company, Dr. Brout worked with KID Foundation where she co-chaired an advocacy effort to include SPD in the revision of the Diagnostic and Statistical Manual used by mental health practitioners (DSM-V). She has also held fundraisers in support of KID Foundation and currently serves on their Board of Directors.

Dr. Brout, the mother of twelve-year-old triplets, is also on the Advisory Board of Mothers of Supertwins (M.O.S.T), a non-profit organization dedicated to supporting and researching multiple birth children/families. She writes a quarterly column, Ask the School Psychologist for M.O.S.T. which addresses the concerns of parents of school-age multiple-birth children.

Dr. Brout is currently working on an anthology, The Mother Load with a collection of mothers and colleagues sharing issues, solutions and encouragement for mothers raising children with special needs.

Article source: Expert Articles