Wednesday, November 28, 2007

Intervention for adults who have sensory processing disorders

I received this email today, and I thought it was a great question:

I am an adult who has Sensory Integration problems that were diagnosed three years ago. I also have central auditory processing disorder and was recently diagnosed with Asperger's. I have had some OT in the past for the SI difficulties, and was wondering if you knew of services for adults with these problems.


Sensory integration refers to an 'unseen' process that has not yet been clinically defined - people have suggested that it may be a neurochemical problem, or perhaps a neuromigrational problem, or perhaps something else entirely. However, occupational therapists are claiming that it is SOMETHING that has to do with neurological processing - a lot of current research is looking at sympathetic and parasympathetic sensory processing of information.

There are also some occupational therapists who claim that the prevalence of SPD can be as high as 5% (in the 'normal' population), and I have seen this number posted around the Internet, but have not been successful in finding any source documentation for this claim. The prevalence may be higher in populations of people who have other developmental disabilities.

So you see the problem here is that we have a relatively undefined problem that is occuring with a relatively undefined prevalence - and there does not seem to be face validity to the concept that 5% of all adults are walking around with some kind of sensory processing problem. The problem seems to be notable in children but why does it seem to mediate with age/maturity? Is it likely that if there was some structural neurological problem that it would all just 'disappear' with age?

Now I don't doubt that some people process sensory information differently than other people. I also don't doubt that people have different learning styles and different neuropsychological profiles that cause them to have strengths and needs in relation to their abilities. I am not sure that these all represent some distinct clinical disorder.

I spent quite a bit of time researching sensory processing abilities of adults, and I even spent some effort in trying to link sensory processing patterns with known neurophysiologic patterns of hypersensitivity (complex regional pain syndrome). I found that adults who had complex regional pain problems all had differences in the way that they processed sensory information but that those differences were not in the directions that one might expect (toward hypersensitivity, for example).

Yes, I am guilty of not attempting to publish my own doctoral work (perhaps I will someday, with a larger sample). Very little else has been published about adult sensory processing disorder. For as little as we know about sensory processing problems in children, we know even less about whether or not this is an issue that carries through to adulthood.

Now I know that I will undoubtedly get emails from some people who are 'treating' adult SPD and they will provide evidence that they learned about it from a video or from some newsletter that is not peer-reviewed. I will state in advance that I can't consider these as adequate resources of information.

So for people who receive this 'diagnosis' I encourage them to sit with their occupational therapist and discuss what the functional problems are that are interfering with daily life functioning. I would encourage people to use tried and true (and evidence based) interventions relating to anxiety control, situational coping, and stress management. Simple behavioral techniques can provide structure and sameness that can help ameliorate problems with sensory modulation. Education about activity participation and organization/planning around potential 'triggers' or 'stressors' also seems to be pragmatic and functional.

Please note that none of these interventions denies the presence of anyone's sensory processing disorder. Rather, I am just encouraging the use of rational intervention that is time limited, functionally based, and directly oriented to the individual's problems.

I would also strongly discourage anyone from trying unproven 'sensory' interventions that involve 'brushing' or 'deep pressure protocols,' 'therapeutic listening,' 'Brain Gym,' or whatever else happens to be popular at the moment.

I am interested in anyone else's ideas on this topic, and will graciously publish all comments in full.

Friday, November 16, 2007

the genesis of class warfare

When we see people who need occupational therapy they have to be understood in more than organic terms. That may seem obvious to some but I know it is not obvious to all. I know that it is not obvious to all because so much of clinical practice looks like it is oriented toward the organic or biological level.

People are more than the sum of their parts, of course - and that is why I find it so important to let my anthropologist out for a walk.

I was reviewing these 'field notes' from some time I spent teaching at a college - and I wondered how different the intervention plans would be if they both came to an occupational therapy clinic with similar injuries or needs:

Penny and Natalie are moving in two different directions. I watched their trajectories intersect for a couple months and it provided a lot material to think about.

Let me start by saying that they don't even know each other. But they are the same age - having both just turned 21. Natalie will graduate in a year from a professional college program and Penny will still be working as a housekeeper at the college.

Natalie celebrated in the typical college way. Her friends made her wear a t-shirt all day that announced her birthday and they got her rip-roaring drunk to celebrate the occasion. Standard 21 year old college fare.

Penny didn't celebrate her birthday other than to have her mother watch the baby. Penny is a single mom, and so is not able to go out much with friends. Most of them have moved on anyway - they just don't have much in common with her now that she is a mom. Besides all this, her friends don't go out much anymore anyway - don't want to get into any fights with those students. Students are always talking down to townies.

Natalie dropped an essay on my desk today, hoping that it would meet approval for her acceptance into an Honor Society. This would be good on her resume, she posits.

Penny came and emptied my garbage can, standing in the same place that Natalie stood in, and told me how her baby's father couldn't be trusted, that he abuses drugs, that he just lost his job, and that she hates having to comply with handing over her daughter to him for court ordered (supervised) visitation.

Penny barely graduated from high school and was in special education classes. She tells me now that she needs help to do the math for her checkbook and that long division is beyond her comprehension. She thought about becoming a nursing aide but could not read well enough to understand those complicated medical terms.

Natalie studies for her classes. Based on her grades, she is having difficulty with those complicated medical terms too.

When Natalie comes back to the dorms after celebrating on a Friday night, Penny cleans up behind her.

Penny does not know Natalie, and so holds no direct animosity toward her. But those college students sometimes throw paper towels into the toilets and this backs them up. Penny made a sign and hung it up on the bathroom doors. It says:


Do not


Paper Towels

in the

The Janitorial Staff

Thanks You.

I sit and stare at that sign every day, and I can't get over how very much it represents.

on botany and telling the truth

I got email from a parent today asking me how to answer some difficult questions from her son. I told her that it was ok for parents to 'make up a story' for the short term if the real issue at question was too developmentally complex for the child to comprehend. Parents have a lifetime to be honest with their children, and sometimes it is ok to hold the truth for just a little while. The truth is hard for children to understand, sometimes.

I admit that I have a long history of 'telling stories' to children. I do this for fun, and to sometimes promote a fantastic world to them. The world is so much more fun when it is also fantastic. So although I 'stretch' the truth I also know that you reap what you sow (in so many ways). I know this intuitively.

This is something that I always keep in mind, hopefully in the forefront, as I go about the daily tasks associated with raising and also in working with young children. But inevitably, kids ask difficult questions and it is sometimes easier to answer obtusely rather than provide a real answer. Parents will know when they have to 'come clean' and make an adjustment in approach.

Case in point: My youngest, Casey, always wanted to know where things came from. For a very long time the brief answer "God made it" was quite satisfying to her - but that changed.

After a while the questions became a little more probing, as in "How did God make that?" Hm, this can start to get a little tricky.

Popular culture provides many easy outs that are reinforced by others without my having to make sure that everyone has the same story. So telling her that the moon was made of green cheese is something that I can count on others reinforcing (likely with a wistful smile).

One day she asked me where rabbits come from and I provided my pat answer "From God" and this was clearly not enough. "No Daddy, I mean HOW does He make them?" So I took her to her "secret garden" in our back yard and showed her the pussy willow tree and said, "God grows them on that tree."

Well she thought I was out of my mind, but the next spring I took her to that tree again and showed her all of the 'baby bunnies' that were growing on the tree. She was sold, and I immediately had a new way of explaining where things come from.

So for a long time when she asked me where something comes from (and if I was too pressed for time to give a proper answer), I told her that it grows on trees.

When she turned 6 I decided that I had to start being a little careful about telling her this as it may cause her some social embarrassment or ridicule from her peers. She truly believed that God grew many things on trees.

Why was this such a problem? One day, after coming home from McDonalds, I watched her quietly step into the secret garden with her Happy Meal bag and a shovel from the garage.
She was planting the seeds from the hamburger bun into the ground.

Why should I complain? She just wanted to reap what she was sowing.

Just like her Dad was.

So it is important to tell the truth to kids, eventually.

Thursday, November 01, 2007

ABC Therapeutics pictures

As promised, here are a few pictures of our new space... this is the desk I am currently sitting at and making this entry. It belongs to the receptionist but I have temporarily taken over until I get my own office out of boxes.

This is one of the gross motor areas. Phase II of our building project will add an additional gross motor gym, as well as an outdoor play area and bike path. With over an acre to develop we are having a lot of fun developing ideas!

We especially love the interior design that makes it feel so open and fun for swings!

Here is Danielle Green, a Level II student from Quinnipiac College, working with one of our friends in the fine motor treatment area!

...and of course we always have time for fun at ABC Therapeutics! Here is a nice picture of our two Halloween ladybugs!