The Sensory System: Part 2 of A Neurorelational Look at Anxiety in 4 Parts

This is the second of a four part series that looks at ways anxiety might originate in each of our four brain systems [1].

Part 2: Anxiety from The Sensory System

[Note: In this post, diagnosis titles will be used to describe the extremes of sensory system distress. Extremes are used for the purpose of clarity and do not represent most of the children to whom these ideas apply.]

The sensory system is often overlooked in identifying sources of stress and ways to soothe stress. When a sensory-defensive child enters a new situation and is bombarded with novel stimuli, the results of this system's response can be seen in behavior.

The Red Zone [1] (sympathetic nervous system) stress response prompts fight or flight and is well represented by children with ADHD and Explosive Disorder. With ADHD, novel sensory stimuli is one cause for regulation difficulties, making the child restless and unable to be still. This restlessness is at one end of the Red Zone spectrum, while exploding in rage is at the other.

The most extreme response to sensory stimuli is Blue [1], represented by the Autism diagnosis. Too much novel stimuli makes the autistic child retreat into an inner world. This recoiling from stimuli dramatically reduces the child's exposure to speech patterns, social cues and body awareness [2], delaying related skills such as talking, relating to others, and fine and gross motor skills respectively[3].

The third toxic stress response is the Combo Zone [1] (simultaneous Red and Blue Zone responses). A diagnosis of Oppositional Defiance Disorder characterizes this type of response when relationship distress is added to already-present sensory distress. When adults respond to stressed children using a top-down approach to discipline, children either subdue their Red Zone behaviors by adding Blue parasympathetic pressure, or they animate their shut-down Blue Zone state using a Red, fight or flight response. These Combo Zone responses are anxiety or fear driven, and occur both when adults are permissive and the child is put into the top position in the relationship where they feel insecure [4], and when adults assume the top authoritarian position. (April's post and May's Free Alta Class will address top-down versus egalitarian relationships and how they create and remove stress respectively.)

There is a difference between sensory processing, or understanding sensory information coming in, and sensory modulation, the ability to filter out or dampen the information in order to tolerate it or to be able to focus on just one thing. Sensory defensiveness is mainly caused by the inability to modulate stimuli to the degree that it can be tolerated. [5] When children cannot modulate information, it becomes overwhelming. Their attention recoils away from it, making learning about it difficult. When novel stimuli is avoided, it does not get processed, and so it remains novel.

Stephen Porges, author of the polyvagal theory [6], identified a breakthrough cause of sensory system challenges in modulating stimuli. He found that when the stapedius, or middle inner ear muscle is weak, it fails to dampen sounds, keeping them amplified. The stapedius muscle is #7 in the photo above. The smallest human muscle, the stapedius pulls on the stapes (also called the stirrup bone shown as #3 above, this is the lightest named human bone), preventing it from moving too much. Limiting the stapes' movement dampens its vibrations [7].

A weak stapedius not only fails to dampen sounds, it also causes the brain to pick up lower tones that cue the threat response system in the brain. (Think of thunder, a predator's roar, and stampedes.) Having sensory defensiveness from a weak stapedius might lower tolerance in other senses as well; in other words, having too much coming in through the audial sense might make vision, touch, taste and everything else feel like too much, too.

Strengthening the stapedius muscle both dampens sounds and enables the brain to hear higher pitched sounds, which cue a safety response in the brain. (Think of bird chatter, which signals to other animals that all is well. When bird calls out a warning, a flock becomes silent [8].) Low sounds take less of a center stage in terms of attention, and sounds in general become more tolerable.

To strengthen this muscle, Porges developed the Safe and Sound Protocol, an iLs listening system available through Alta that takes an hour a day, for five days, to complete. After the five days of use, people are found to have a marked reduction in anxiety [9].

In addition to irritating the nervous system, sensory stimuli can soothe it as well. Recently in a preschool, I watched a child many consider to be defiant (I will call her Danielle) at clean-up time. She began to clear a table of its contents, but noticed an easel all set up with paper and paints.

"I'm going to paint a fast picture!" she said abruptly, picked up a paintbrush, and spread the color green over the white paper.

"Hmm. You are painting a picture at clean-up time," I say with as little judgement and as much curiosity as I can manage.

"Yes," she answered decidedly.

Children instinctively seek out the approval of their caregivers. Disapproval is potentially deadly for children from a survival perspective. To the reptilian brain, defiance means that they must risk potential neglect. Only significant stress can prompt a child to put their developmental needs above adult approval.

I thought back to Danielle's experiences over the last hour. Bradley had told her that she was not his friend. "Dennis is my friend. You are not." Later, when Teacher Jody passed out the clean-up assignments, Danielle was heartbroken. "But I wanted to clean up with Clementine!" Teacher Jody had told her that you get what you get. Danielle threw a fit.

"Danielle, are you painting to help yourself feel better after not getting to clean up with Clementine?" (Children at four years old do not usually answer a question like this. They tend to need silence to process the connection between how they feel and what they do. Danielle is precocious.)

"Yes."

"Is it helping?"

"A little!" She put the brush back in its pain container and ran off to clean her section.

Play and art therapists use a sensory activity like painting to help children and adults enter their subconscious. Perhaps Danielle knew instinctively that a little cognitive rest and the pleasure of rich color would give her some joy. Whenever we can insert even a little joy into a child's experience, we are propelling their brain development. Impressed that Danielle found a way to help herself develop joy using a sensory activity, I was reminded that human behaviors in general can in some way be seen as movements toward a developmental ideal.

The External Senses

Audial - Audial-defensive children tend to cover their ears for loud noises or feel particularly peeved about background noise when watching a show. They may be quite loud themselves, however, as theirs are sounds they can control. Children soothed by this sense may enjoy music, nature sounds or white noise when upset or trying to get to sleep.

Visual - too much visual stimulation is found in malls and grocery stores, and a lot of faces in one room, such as in classroom, can be a trigger. Children soothed by this sense like painting and reading picture books.

Tactile - Where a light touch may feel irritating to a child, a deep squeeze can be calming. Children with tactile-defensiveness may feel stifled when receiving a cuddle they cannot control versus giving one that they can.

Olfactory - Smells can trigger a stress response or soothe a child through aromatherapy.

Gustatory - Gustatory-defensive children abhor strong or certain flavors, while many are soothed by putting non-flavored (and non-food) items in their mouths.

The Internal Senses

Vestibular - Sensitive to receptors found in inner ear, these children may have a wonky relationship with gravity, speed and direction, and may be particularly focused on avoiding or experimenting with these things. This sense is the first sense to develop and is stimulated by movement, the most effective way to soothe a screaming child.

Proprioceptive - Children who have sensitivity to receptors in joints, muscles & tendons may have difficulty with body posture (too limp or too stiff), motor planning, and feeling feedback from pressure. Closely related to the tactile sense, often children are soothed by holding something in a fist, walking on tip-toes, wearing weighted vests or blankets, or being pushed on a swing.

Interoceptive - This senses the body’s involuntary processes such as digestion (hunger & bowel movements), thermostat (knowing whether one is cold or hot), and immune response (feeling pain). A child does not realize that hunger is the cause of distress, eating can be a soothing experience.

In addition to the feedback that comes from bodily organs, children can be highly sensitive to the emotions and energy of others as well as their own. When emotions/energy is intense, it can cause a child to become dysregulated or anxious; when it is too low, it can create the same response. To soothe a child, match your energy or emotion to theirs, and then gradually modulate to a more neutral level.

References:

1. Lillas, Connie; Janiece Turnbull. Infant/child Mental Health, Early Intervention, and Relationship-based Therapies: A Neurorelational Framework for Interdisciplinary Practice. Norton Series on Interpersonal Neurobiology, 2009.

2. Baniel, Anat. Kids Beyond Limits: The Anat Baniel Method for Awakening the Brain and Transforming the Life of Your Child with Special Needs. Random House, 2012.

3. Perry, Bruce D; Maya Szalavitz. Born for Love: Why Empathy Is Essential--and Endangered. William Morrow Paperbacks, 2011.

4. Crittenden, Pat. Attachment and Family Therapy. Open University Press, 2014.

5. Koziol, Leonard F.; Budding; Deborah Ely; Dana Chidekel (June 1, 2011). "Sensory Integration, Sensory Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings". Cerebellum by Springer Science+Business Media, LLC

6. Porges, Stephen. The Polyvagal Theory: Neuropsychological Foundations of Emotions, Attachment, Communication and Regulation. Norton Series on Interpersonal Neurobiology, 2011.

7. Wikipedia article on stapedius, Retrieved March 23, 2018 from https://en.wikipedia.org/wiki/Stapedius_muscle

8. Young, Jon. What the Robin Knows: How Birds Reveal the Secrets of the Natural World. Mariner Books, 2013.

9. "Safe and Sound Protocol (SSP): A Portal to Social Engagement" by Integrative Learning Systems, Retrieved March 23, 2017 from http://integratedlistening.com/ssp-safe-sound-protocol/