30.09.2016 Our Kids

The Sensory Processing Dilemma of Our Age

Dr Anthony Balint, a GP working in youth mental health support, sees an emerging crisis affecting our young people

Have you seen these children?

They may be restless and reckless, physically and emotionally. They don’t seem to listen and they may be into everything. Their parents are running after them saying ‘don’t do that!’ or ‘come here’. They get upset easily, hate change, don’t want to be told anything and may end up like their parents, crying in frustration. Or else they may be withdrawn, not engaged, more comfortable with solitary play.

They don’t sleep well and are fussy eaters, being very particular about foods - specifically tastes, textures and even the way the food is placed on the plate. They hate changes in routine, can be sensitive to particular smells and to being touched or to the texture of materials and clothes, sometimes not wanting to be dressed, sensitive to noises (loud noises or particular noises), temperature (too hot or too cold) or bright lights and colours.

Many of these children appear to develop normally until around 18 months to two years of age. Nothing may be apparent until starting kindy, preschool or later in school.

From early on they can feel lost in the playgroup or the classroom, get distracted easily by other children or by random things and may end up wandering around, talking and disturbing the other children.

They can’t readily follow or retain instructions or directions, especially if a number of directions are given concurrently. Even if they have understood, a moment later they may have forgotten what they were meant to be doing. They may often say ‘huh?’ or ‘what?’ Things need to be repeated; they need more time to respond and to take things in.

It can be hard to remember and recall information or tasks needing to be done. As they grow older, they may develop helpful techniques. They may need to write things down, to make lists or to use sticky notes, reminders and prompts.

There can be difficulty with reading, writing and spelling. Word and letter sounds can be confusing. Words and letters or lines may jump or move around on the page. They may need to follow with a finger or mouth the words. Letters and words or numbers may be written out of sequence. Their pen grip may be awkward and their writing messy.

Social difficulties

These children can find it hard to relate to other children or adults.

They can have difficulty reading social cues, and may be prone to being ostracised and can experience bullying.

They can be socially awkward, stand too close or too far away and be unaware of or puzzled by the behaviour of others. They may prefer to be alone. They also may be didactic, overly literal and pedantic; ‘the little professor’, or acting out; “the class clown”, a talker, a wanderer, or the quiet, good child hoping that no one notices them.

They can often get frustrated with others and with themselves. Anger may become more of an issue and tantrums are not unusual.

They may be physically clumsy, with balance and coordination issues. Ball skills or riding a bike may be a challenge. Even though they may have mastered such skills, later on they may suddenly be forgotten. Team sports may be difficult. Many are not inclined to be sporty. They may be excluded from playground groups.

As they grow up they can become even more frustrated and lose motivation to try. Unannounced changes in routine can provoke unexpected lack of cooperation, despair or anger. Impulsivity can be an issue, and may result in reckless, poorly thought out actions.

Often unwell

They may have frequent visits to the doctor, with coughs, colds and fever and ear infections. There may be various allergies, hay fever or asthma. They do not appear to be robust, healthy children and they may catch whatever is going around. They may have disorders of digestion and bowel function, with tummy aches, constipation and/or diarrhoea and various food sensitivities.

Sometimes there are food cravings such as salt, sugar, spreads on bread, chocolate, milk, package cereals or other processed foods.

Truth can be a casualty. They actually may not have a clear sense of what is reality and what isn’t, so in saying “No, I didn’t do that” it may actually be what they really believe to be true.

On the spectrum

It can be hard to find a diagnostic category for all this. It is more a spectrum of symptoms.

Each child or young adult may have his or her own particular difficulties. These behaviour and learning difficulties have traditionally been considered to be part of the Autism Spectrum. They were originally considered to be separate difficulties, such as dyslexia (reading), dysgraphia (writing), dyscalculia (maths), dyspraxia (organisation and routine), ADD (attention deficit disorder), ADHD (attention deficit disorder with restlessness and hyperactivity), Irlen’s syndrome (Visual Processing Difficulty), Oppositional Defiant Disorder, Conduct (or Impulse) Control Disorder, Asperger’s Syndrome and Autism, which may be high or low functioning.

Sensory Information Processing Difficulty

A new one is Sluggish Cognitive Tempo (SCT).

This is just another aspect of Sensory Information Processing Difficulty. This personal view of the autism spectrum differs from the latest system of classification, but I find it is more closely allied to my clinical experience of how these symptoms manifest.

Sensory Information Processing Difficulty is common to all of them.

Autism, although it is now steadily increasing in prevalence, is still relatively uncommon in comparison to the rest of these learning and behaviour issues. There is obviously a spectrum of difficulties, with the “milder” ones tending to be many times more common. There may be mainly one or two particular difficulties, with the other ones being less prominent. It is usually a broad spectrum of difficulties, for which I use the term ‘minor autism spectrum difficulty’. Sensory Information Processing Difficulty is common to all of them.

Secondary schooling challenges

As youngsters come into their teenage years it becomes harder for them to cope with the more complex school setting and a confronting and confusing social milieu.

Secondary school is much more demanding than primary school, and grows more challenging each year. It is a new and changing learning situation, where there is an expectation of more competent and efficient learning and an expectation to make a significant contribution to the class learning environment. This can be confronting for someone who is already falling behind, and is already having trouble understanding what is being asked of them. And if they manage to survive secondary school, university or employment can be a huge challenge.

Social groups and friendships tend to become more complex, and there is social media to contend with. There may be a tendency to isolate, to stay in their bedroom and do screen time until all hours, procrastinating over schoolwork that needs to be done. They may tend to prefer to be indoors. It may feel safer there, and the visual information format of the screen may be easier to cope with.

Adolescence is a time for working out ‘who am I?’ This conceptual work is doubly hard if you haven’t been able to process information capably while growing up.

It is much harder to have a sense of oneself and to make sense of others when you have a distorted perception of the outside world.

‘I don’t know who I am’, ‘I don’t know what I want’, ‘There’s nowhere I fit in’. These are common feelings for all teens, but it can be especially fraught for those with sensory processing difficulties. Anger and frustration can cause problems in relation to others or themselves. Self harm can occur and, like illicit substances or medicines, can bring temporary relief. Perhaps by hurting oneself, you know you are real. Symptoms of depression and anxiety are common, as well as chronic tiredness. It is hard work trying to keep up, and there is often a sense of continually trying to make up for lost ground.

Anxiety an issue

Anxiety is much more common in young people now. If you have had difficulty getting an accurate picture of the world, it can become a dangerous, unpredictable place. Suicidal thoughts and fantasies are not unusual.

Anxiety is much more common in young people now.

These young people may feel a great need to try to control everything and everyone in their environment. This can manifest as anxiety, obsessive thoughts and behaviour and overthinking to the point of paranoia about what others may be thinking or saying about them, or about events, past or recent. This may even extend to hearing internal self critical or judgmental voices. Things may need to be in a particular order or sequence, and disorder can be very unsettling. Trusting others is a huge issue.

Trying out substances such as marijuana and alcohol, or other drugs, can be tempting. It can provide temporary relief, even providing a sense of ‘now I know who I am’, but of course this proves to be an illusion.

Substance use will usually worsen the already impaired information processing, and can have a tendency to aggravate any pre-existing symptoms of anxiety, paranoia, self critical voices, suicidal thoughts and depression.

Impulsivity and mood swings can even mimic Bipolar Disorder symptoms.

Later on, they may be diagnosed as having a mental health problem, such as Anxiety, Depression, Bipolar Disorder, Obsessive Compulsive Disorder, Dysfunctional Personality Disorder, Drug Dependency or Psychosis. A significant proportion of young people with these diagnoses can turn out to have had significant prior processing problems that could have led to the development of many of these troubling symptoms.

Problems with auditory processing

The commonest sensory processing difficulty is with accessing, sorting, understanding and recalling verbal information. This is termed Auditory Processing Difficulty (APD) and is also known as Central Auditory Processing Difficulty (CAPD). It is present to some degree in all of the above behaviour and learning issues. As I have noted, here may also be issues with Visual Processing, and with any of the other sensory systems.

Functional audiometric assessment can occasionally be helpful. There are specific audiometric changes in APD. There is computer software that can measure the speed of information processing and recall, and also can measure the ability to remember sequences among other things. These assessments can be used to measure progress, but the best measure to rely on is how well the person is managing day to day. If there is a clear history of processing difficulty, and hearing is normal, there is no particular advantage in having an audiological assessment.

The clinician, educator or others who may be involved in the lives of these young people can develop an awareness of its prevalence and the common features of Sensory Information Processing Difficulty, and can have a suspicion that this could explain their difficulties.

Otherwise, they can remain a forgotten tribe. As students they are often labelled as lazy, wilful, difficult, weird, or troublemakers. They get left behind in learning; they act up and get repeatedly sent out of the classroom, suspended or expelled; or they may get by for a while being quiet and good, copying and following someone else, until that device is no longer sustainable and it catches up with them.

This awareness can be especially important in dealing with the older young person with mental health issues or substance use problems. One can ask the relevant questions about sensory processing difficulties, in particular relating to a much earlier age.

Impact on mental health

Currently in my work as a GP in a centre for youth mental health support I am finding that approximately 75% of the young people that I see have a history of having been affected by significant sensory processing issues from an early age, predating their mental health problems.

Of course, anyone with a history of trauma, anxiety or depression will have difficulties with attention, focus and concentration, so it is helpful to ascertain how effective learning and information access was for them before mental health problems manifested in their lives.

Medications for anxiety and depression can sometimes complicate things. They may not be particularly effective in the longer term for people with sensory processing difficulties. They may tend to worsen their processing ability, and the young person may complain that they can’t think clearly and that their brain is thick and fuzzy. Side effects appear to be more common and it can sometimes be harder to integrate the positive changes that could be accessed in counselling and developing useful strategies.

Wasted potential

Sensory processing difficulty has a huge effect on a young person’s self esteem. Many of these young people struggle valiantly but steadily fall behind in learning, social relationships and life in general. It is a tragic waste of potential and ability. The worst part is that they tend to blame themselves, and become self critical and then feel that they must be stupid. In fact, they are highly intelligent but score badly in IQ tests due to the testing structure and to time constraints.

In my experience, sensory processing difficulty and the associated minor spectrum features is now exceedingly common. It could be termed an epidemic.

Rainbow and Indigo children

These young people have been called “rainbow” or “indigo” children. It is often true that they have extra qualities. They may be extra sensitive in some ways, sometimes being quite intuitive. However, the difficulties seem to outweigh the advantages. Perhaps they are showing us that there is a need for all our systems to change. Medical, educational, social, employment and political systems do not work well for these young people and adults.

Following is a checklist that may be helpful. It is just a guide - each person will have some features that are particularly relevant for them. What one is trying to do is to build a functional picture rather than to compile a diagnostic score.

Checklist for Auditory and Associated Sensory Information Processing Difficulties

Hard to follow verbal instructions or directions

Hard to recall what was said just now or a while before

Things often need to be repeated or said slowly

Response time may be prolonged

Need to go over things many times to absorb it

Need to write things down, make lists, diagrams, and use sticky notes

Say ‘what?’ or ‘huh?’ frequently

Noises are too loud or too soft. Loud noises can be painful

May speak too loudly or too softly, echoes or noises in ears

Misunderstand what is meant, can be pedantic

Particularly hard to concentrate, hear or focus with background noise or activity

Easily distracted

Restless, fidgety, tapping

Hard to hear with background noise

More difficult to think and respond when put on the spot

Get frustrated and angry with learning difficulties, often with oneself

Lose motivation, easily discouraged by tasks, tend to procrastinate

Brain feels fuzzy, foggy. Daydream or zone out. Have a short attention span

Reading, writing or spelling difficulty

Difficulty with reading comprehension or recall

Difficulty with numbers and sequences

Tend to be a ‘hands on’ learner, easier to learn by doing it oneself than being shown

Better at creative pursuits

Hard to adapt to unexpected changes

May have balance or co-ordination issues

Speech and comprehension difficulty, confusing some sounds and words, words may come out wrong

Socially awkward, difficulty working out social cues or situations

Forget routine daily tasks

Tired out, exhausted

Self critical voices, obsessive thinking, especially about what other people are thinking about them

Things have to be a certain way, eg how food is on the plate, or how room is arranged

Other sensory issues and sensitivities; tastes (aversions and cravings), textures (clothing, foods), certain smells

Impulsive actions

Dr Anthony Balint currently works in adolescent and young adult mental health in Fremantle, Western Australia.

Acknowledgement

I am indebted to Laila Toutounji, Neurodevelopmental Therapist, of Yarra Junction Victoria, for her insight, broad experience and her clear understanding of this area of health and education.

DrAnthony Balint

Dr Anthony Balint currently works in adolescent and young adult mental health in Fremantle, Western Australia.

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