Helping a Child with Sensory Overload

Podcast Transcript

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time.

In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, let's talk Little Health.

Did you know that research shows one in six children experience sensory challenge significant enough to affect their daily life? I'm Richard So, a pediatrician at Cleveland Clinic Children's. And today, we're talking about sensory processing. We'll explain why something as small as a clothing tag or as common as a loud room can feel physically overwhelming and why even neurotypical children can struggle with sensory overload. Joining me today is Alison Blakeley. She's an occupational therapist at Cleveland Clinic Children's. Welcome to Little Health. Please tell us a little bit about yourself.

Allison Blakeley:

First and foremost, thank you for having me, Dr. So, I appreciate it. I have been an occupational therapist for 12 years. My specialty areas are working with children with sensory dysregulation challenges, specifically those with autism and in pediatric mental health. Fun fact about me, this is actually my second career. My first career was actually in the graphic arts and in art education and what I've learned in that field, I apply every day into my journey as an occupational therapist.

Dr. Richard So:

In the interest for those people in the audience who don't know what an occupational therapist is or what diseases or problems they treat, could you please tell us a little bit?

Allison Blakeley:

Absolutely. So an occupational therapist, our main aspect and main goal is to develop skillsets in a child's development in order for them to be functional in everyday age appropriate developmental milestones. So that could be we need to teach a child how to brush their teeth or dress themselves, but we also work on fine motor aspects related to handwriting, cutting, visual perceptual skills, visual memory, form constancy, things of that nature.

We also work on a big one as we're gonna talk about today is sensory processing and learning how the balance of those different sensory systems can affect an overall child's ability to function within their everyday lives. So we do a lot of different things. As an occupational therapist, we work with a variety of diagnoses such as those with cerebral palsy, genetic conditions, mental health conditions such as anxiety, or OCD, oppositional defiant disorder. Autism obviously is a huge one. So we work with a variety of children from different backgrounds.

Dr. Richard So:

That's a lot of variety of different kinds of patients. When I think about sensory processing, we talk about our different senses. It could be sight, it could be smell, it could be taste, it could be touch and there's also just that gut feeling of something doesn't feel right and that's like, our senses. What problems do you see most commonly and what do you like to see?

Allison Blakeley:

So the problems that I see most commonly, and that's a really loaded question when it comes to sensories because we have such a variation on how children respond to different sensory input within their environment.

Dr. Richard So:

Yeah. One of the common ones that I, we see in the pediatric offices that is a little bit hard for me is that my kid doesn't like to wear these pajamas. They're very texture. They only like these pajamas, they'll only wear these socks, you know? And I tell them to, "Hey, give them two different choices. Say those ones are dirty." But I think a lot of parents are afraid to give in to their kids. That's like one of the motives that we have in our podcast, and just parents are afraid to make any type of changes that might make their kids uncomfortable.

Allison Blakeley:

Absolutely. And that is, you know, it's a very sensitive thing for parents to encounter with their children and that goes into teaching the parent about sensory regulation, specifically what we call in the circumstance that you just described, a child that is an over-responder. They perceive perhaps in that situation, tactile input from different clothings where they wanna wear specific things so many times during the day because those types of textures actually feel really comfortable to them where other textures to them could feel really noxious. So there is this oversensitivity that their tactile sensory system is receiving that is making it difficult for them to explore different types of clothing, but not even just clothing other tactile sensation experiences as well.

Dr. Richard So:

What do you tell the parents whose kids are tantruming, you know, they gotta rush out the door, they gotta go to school, they gotta drop off the kid at daycare. You know, what do you tell them?

Allison Blakeley:

I tell them a lot of times that we need to be proactive in order to be prepped for, you know, when something is reactive.

Dr. Richard So:

So more preparation.

Allison Blakeley:

Yes. So a lot it goes into we need to have some sort of sensory input in the morning as part of their routine. We need to have visual schedules set up so they can follow different visuals in order for them to sequence events because when you're in a state of fight or flight or you're uncomfortable, it's really hard to register sometimes through sound what your parent is telling you. So coming up with different sensory activities in the morning in conjunction with what kind of cue systems are gona help your child process information is really important.

Dr. Richard So:

So what you're saying is, is that you try and prevent the tantrum from even happening and It's what I've been telling them in the office is maybe the night before you set out a different pair of clothes. You know, do you tell them like, "Hey, the ones that you like are dirty, you can get sick," because that's what I say in the office.

Allison Blakeley:

Yeah. So that one is a little bit more tricky because you have these kiddos that really hyper fixate and what makes them feel comfortable and through different fun sensory activities outside of that would be a really great way in order to bond with your child as far as exploring what different types of textures and clothing could we explore. And that's where the proactive aspect comes in because then you could explore those different textures while incorporating other sensory input to counteract that tactile desensitization. So it's one of those things where you don't want to flood the child in a situation like that. You want to make it fun and explorative and be proactive just like you're telling the parents.

Dr. Richard So:

So I'm kind of picky about my clothes. I like the way certain feels. You know, when we talk about sensory processing, what makes their sensory overactive? Is it part of the brain that's just like, "Hey, this doesn't feel good. I don't like it, " which leads to like emotional dysregulation. And what do you do?

Allison Blakeley:

So in that circumstance, it's where a couple things. We have to look at sensory as a dynamic basis of support. So a lot of times when you have those tactile over responders like we're talking about, we have to work on slow gradual exposure to desensitization. Like I said, you don't want to flood the child because it can sense them into a sensory meltdown. The other thing that we have to look at too is, is there another sensory system that's not functioning properly?

Dr. Richard So:

A lot of times they go hand in hand.

Allison Blakeley:

Yes, yes. So that's where another sensory system may be under responsive where they're seeking and they're looking for other different input in that sensory system, your perpeoceptive system, your deep pressure system is on overdrive because the other sensory system is overstimulated.

Dr. Richard So:

Give me an example of what you would.

Allison Blakeley:

So an example related to what I was just talking about would be let's talk about a picky eater. Okay. A picky eater is a great example. So when we have a picky eater that comes to the table, they don't wanna touch anything. If you can't touch it, you don't wanna put it into your mouth. But these tactile kiddos that are over-responders, sometimes they also have an under-responsive vestibular or propeoceptive system, so your body awareness system and your movement and balance system. And these are the kiddos that don't want to sit at the table. They're running around, they're wiggly in their chair and they have a hard time just grounding themselves at the table.

Now, if these two systems are dysregulated, it's gonna throw another sensory system off and it could put them into an over-responsive state. So that's where we have to come up with different sensory activities to prep the child before they come to the table, deep pressure activities, movement activities and that's gonna also help balance that tactile system because you're getting all of these other, what I call happy chemicals in the brain, your dopamine and your serotonin to prepare the body.

So when you are presented with something that's challenging, that's tactile averting, for example, from food or a picky eater, it's gona help balance those systems out.

Dr. Richard So:

Yeah. We had a podcast on picky eaters. It's actually doing pretty well, but, you know, I think visually they see it and then they just see disgust. I'm not gona get into too much details in the picky eaters because we talked to that in another episode, but do you ever blindfold them? It's like, "Hey, you can't see it, but does it smell good?" Or, but then their taste might be bad because we all know is that if you taste something maybe 20% they might like.

Allison Blakeley:

That's a really good point. Do you exclude a sensory system for another one to balance out?

Dr. Richard So:

If something is hyper. I'm just based on what you were saying.

Allison Blakeley:

Yeah. So I mean, that makes complete sense. I think it, and it's hard because every child's different, but we have to look at the child holistically because it's not just picky eating where this happens. It can happen with a lot of different sensory experience, like an auditory experience where they find something really sensitive from their environment, just depending on the decibel or their frequency or what they're hearing can throw them off as well. So it's really about what I like to call exercising the different sensory systems and either desensitizing or feeding the sensory nutrition the body needs in order to find a more balanced regulation system to be more functional.

Dr. Richard So:

Gotcha. So we covered a little bit of our senses moving through today, but let's talk about some other sensory issues or processing issues, for example, ADHD.

Allison Blakeley:

So I work with a lot of children with ADHD and sensory processing and the one thing that I always tell parents right off the bat is these kiddos are commonly what we call under-responders because they are constantly seeking input in order to feel grounded. The other aspect about ADHD that we know is that their brain doesn't produce as much dopamine as a neurotypical brain. They're constantly looking for this conflict seeking aspect to feed their body and how do we do that? We do that through crashing and running around in circles or we can do it on swings and throwing all kinds of really intense input. We can swing from a trapeze and crash and that's the intensity that these kiddos need as far as their sensory input in order to feel grounded and regulated. I know that seems like a lot, but that's the sensory nutrition that their body needs in order to be optimally functional.

Dr. Richard So:

Wow, what a great explanation of that they're seeking it because they're lacking some type of neurotransmitter or brain chemical. Wow, that's probably why some of the treatments include some medications. What do you do for them? You know, I get the IEP where the kid can get the bouncy ball. I can see that. But one that kind of bothers me sometimes is like fidget spinners. You know? What are your thoughts on those for those kids, you know, because then they distract all the other kids and everybody wants one.

Allison Blakeley:

Right. And so I would love to have a research study on fidget spinners, to be honest with you, to see the effect on specific diagnoses. When it comes to ADHD, I always believe that they are just their high cravers. They want robust input to feed the body what it needs. Does the tactile system help with some of that intensity? It can because tactile is one of our base systems that helps us regulate. However, those kiddos, I typically advocate if at all possible for the school to implement some sort of sensory breaks within their individual education plan or their 504. So they're receiving that sensory input that they need in order to process, to attend, to problem self, to sequence, to socialize better with their peers or not interrupt them. So if there's a way that we can feed the intensity of a child's body with ADHD throughout the day, it's going to help them overall functionally.

That emotional brain's gonna be more balanced and for that functional brain.

Dr. Richard So:

Do you think all the kids with ADHD should be referred to occupational therapists or just some of the worst ones?

Allison Blakeley:

I think if it's affecting function.

Dr. Richard So:

Define function to everybody.

Allison Blakeley:

Function would be your higher executive functioning processes. If they're having a hard time learning, if they are having a hard time processing new information and retaining it in the brain so it can output to be able to perform different academic skillsets, social skill sets, everyday life activities at home where they may be impairing their safety, a referral to occupational therapy to really look at those different sensory systems to help not only the child, but the parent also feel at ease as well is a great recommendation.

Dr. Richard So:

So you said you work a lot with pediatricians, other therapists, you know, do you ever refer like, "Hey, I think there, there's something more going on with this child. He might need speech, he might need a psychologist." 'Cause like I think a lot of people with ADHD, there's a lot of confusion where is it, I can't focus because I'm nervous or I just can't focus and now I'm nervous.

Allison Blakeley:

Absolutely. So I actually work with one-on-one with a psychiatrist, her name is Dr. Molly Wimbiscus and we actually have a service line where we work specifically with children with ADHD, anxiety, and pediatric mental health conditions. And I do have a lot of kiddos that come to me that are on medicine, but it's nice because we have that relationship where it's easier to refer out to a psychiatrist or a psychologist to look at different things. And there are moments where I do see higher cognitive things going on where I need to refer out to a speech therapist, but what it really comes down to is, is speech going to be effective if they're emotionally dysregulated?

If that emotional part of the brain is not balanced, is it going to affect their higher cognitive processes? You can send them to speech that's great, but if we're not regulated and we're not teaching them how to regulate themselves or teaching the parent how to help them build coping strategies, it's going to be really challenging.

Dr. Richard So:

Yeah. Talk to me a little bit about more coping strategies and how you help manage a kid with emotional dysregulation. They could be nervous.

Allison Blakeley:

So for emotional dysregulation, one of the sensory systems that I tap into immensely that there's a lot more research going on and there's more going on in the field of occupational therapy and I love the sensory system is the interoception system.

Dr. Richard So:

Not familiar. Interos.

Allison Blakeley:

Interoception. Yes.

Dr. Richard So:

Okay.

Allison Blakeley:

So this is actually our eighth sensory system and this is the sensory system where we have organs that provide us feedback, just two different things, where it can give us organ feedback, is something hot or cold, or if we are tired, are we awake, are we hungry, are we thirsty? But the other aspect of what it does is it signals body cues to send to that emotional part of the brain to equate to an emotional response.

So an example would be if you have itchy eyes or runny nose and a sore head, you're probably feeling sick. Now, if you have tight fists, your skin is starting to get red and flush and your head is feeling really dizzy and disorganized, you might be feeling nervous or anxious. So what a lot of times I do is we work on the interoception system through fun exploration activities to understand that my body is actually registering cues that are telling me I'm about to go into a state of where I'm overstimulated or I'm worried or I'm nervous.

And it's, it's a really fun way to explore that, but it does take time because you're teaching the body how to register and exercise it in a different way for, so they have a better understanding of what is going on in their body.

Dr. Richard So:

If you're worried that sensory struggles are impacting your child's daily life, please reach out to your pediatrician to discuss your concerns. To schedule an appointment with Cleveland Clinic Children's, please call 216.444.KIDS, that's K-I-D-S, or 216.444.5437.

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the Little Health Tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.