How Sensory Integration Dysfunction can lead to Emotional and Behavior Problems Later in Childhood 

In our clinic, we see children as young as 3 or 4 years old beginning to show signs of emotional disorders that are typically seen in children who come from chaotic or abusive families.  But these children come from homes with loving, attuned and responsive parents, plenty of attention, and no history of abandonment, trauma or abuse.  They have well-adjusted siblings.  Parents do everything they can think of to try to help their child – they are far from being distant or neglectful.

Yet these children can be angry at the world, moody, explosive, defiant, inflexible – what many refer to as “emotionally disturbed.” They have difficulty in most or all of their relationships and can be extremely unhappy children, despite having the same advantages as their siblings or any other “successful child.”

Most professionals in the field of mental health, seeing no obvious signs of cognitive or language impairment, will look for signs of abandonment, trauma or abuse, or some form of “deprivation of early empathic care.”  They look for pathological parenting or life experience in other words.  In the worst cases, because professionals may not have experience with Sensory Integration Disorders in early childhood, they may blame the parents and suspect they are not getting the “whole story.”

That part is true – they are not getting the whole story.  The story has to do with how the brain develops in infancy, and the relationship between the sensory, “motor” and emotional parts of the brain to the thinking parts of the brain.

Neurology, Trust and Attachment Security

To paraphrase the late Stanley Greenspan, MD (Greenspan & Weider, 2009), the first developmental achievement or milestone of the newborn is to be able to be calm and interested in the world.  Babies are not born this way – they have to learn how to calm or “soothe” so they can feel comfortable enough to be interested and happy to be in the world.

Newborns have no ability to do this on their own.  They cannot calm themselves down and they get distressed when they are awake and someone or something isn’t around to provide just the right type of stimulation or calming.

Babies experience distress as a normal part of life.  They get hungry, wet, tired, overstimulated, understimulated – there are lots of reasons.  Someone must help them, or their distress will continue to escalate, and if this goes on for long periods and often enough, the brain can suffer catastrophic damage.  Babies can be fed and cleaned in a custodial way, as happens in some orphanages or disturbed families, but there is no relationship between the baby’s needs and the timing of these functions, and stimulation can be too much or too little.  In some cases where only custodial care is provided, babies can still die or “fail to thrive.”  Some will survive, but at great cost to their development, and often with lifetime consequences.

Attuned Parenting

Attuned parenting, or “attunement” refers to the sensitive and responsive nature of meeting a child’s needs.  The attuned Parent responds to the child’s distress in a sensitive way.  The special type of sensitivity that characterizes attunement is based on the Caregiver’s ability to respond quickly enough, and to be able to “read” the baby’s signals.  After all, newborns and infants cannot tell you what they need.  They require someone that cares enough and pays attention in ways that allow them to “learn the baby.”  In the beginning, this can be quite difficult, because babies don’t develop different sounding cries until later.  Therefore, to be an “attuned Caregiver,” you must first be able to figure out the source of the baby’s distress and, you must also be able to do something to relieve the baby’s distress.

In comparison to infants of other species, the human child’s needs are enormously complex.  Sure, it’s pretty easy to figure out if the baby is hungry or wet or uncomfortable, and in those cases, it’s also pretty easy to know how to help.  Those are just the biological basics.

The baby’s sensory and emotional needs are a different matter altogether.  Each baby is different.  Anyone with more than one kid can tell you that.  But all babies need the right amount of stimulation to keep them happy and interested.  Too little, and the baby’s distress comes from not getting enough.  Too much, and the baby’s distress comes from being overwhelmed or overstimulated.  And here, we’re only talking about how much.

Babies also need the right types of stimulation at the right time.  Sometimes they need to be held or bounced or rocked gently.  Sometimes, they need social stimulation such as talking to them, cooing, singing, or smiling and emoting back and forth in a process called “mirroring.”

Parents spend hundreds of hours with their newborns in face-to-face emoting, which all children desperately need for healthy emotional and neurological development thereafter.  It is called “mirroring,” because whether or not they are aware of it (they usually don’t think about it), Parents mirror the expressions of their newborns.  When the baby smiles – they smile.  When the baby belches, they make an “oops” face.  When the baby frowns or shows distress on her face, the attuned Parent has an empathic face.  The Parent therefore is like a mirror of the child’s internal feelings, as they are expressed on the baby’s face.

Emotionally healthy individuals do this in their relationships with others in some way or to some level for the rest of their lives, but at this stage – face-to-face emoting and mirroring is not only the most important form of communication – it is the primary one and the foundation for most further emotional development.  Importantly, it is not mirroring if the parent does not sensitively stay tuned to the baby’s ongoing and changing emotional states and signals.  There must be a certain ongoing synchrony between both the baby’s and the Parent’s internal, subjective, emotional states in order for it to be called “attunement.”

Mutual, Interactive and Dynamic Regulation

Later on, as the baby gets better control of his facial muscles and can produce more stable facial expressions, the mirroring process becomes more of a two-way street.  Now, it isn’t just the parent following the child’s lead.  The baby can follow the Parent’s lead.  The baby can now smile because Mommy or Daddy smiles.  If the parent shows distress, the baby can reflect this.  Each partner now has a “regulatory effect” on the other.  They are responding and changing each other’s emotional states in a “contingent” (I smile then you smile; you frown then I frown) way.  This is what is meant by mutual regulation or “co-regulation.”

Now let us go a little more deeply into what regulation is.  Basically, regulation is the process in which systems achieve stability and control.  Other terms such as balance or homeostasis apply.  We experience good regulation with feeling good (or at least OK), and “dysregulation” as feeling uncomfortable.  Good regulation can exist when we are awake or asleep.  Dysregulation can cause too much waking or too much sleeping, and any number of imbalances.

Our body systems, including our emotional and mental ones, undergo regulation.  We self-regulate by taking care of our needs for nutrition, elimination, stimulation etc.  We regulate each other by performing actions that affect those states in other people.  When people’s actions regulate other people’s actions – we have co-regulation.  The discussion here so far has had to do with the characteristic regulatory needs of newborns and infants in the context of a simple “dyad” with one infant and one parent.  As life progresses, regulation takes on multiple layers of complexity that require the building of ever more complex foundations from this point.  The children that come to the clinic that are labeled “emotionally disturbed” or “autistic” or something else, experience problems with regulation at some level.

The particular types of cases that we are talking about here involve children that had serious trouble with the earliest forms of regulation.  They may have outgrown some of the most obvious forms of infantile chronic distress from Sensory Integration Dysfunction (SID), but the psychological residue remains very present.

Before we get into what that “psychological residue” looks like and how it relates to SID, we should first understand the neurological mechanisms of regulation.

Firstly, the brain and the rest of the body are two parts of the same thing.  Information travels constantly back and forth through all of the parts.  Until we are skilled enough to perform “mind over matter,” the brain and the rest of the body share all aspects of regulation.

Of course, the brain has a special role.  We can exist without arms or legs, but not without a brain.  The brain in fact coordinates the rest of the body’s systems more than any other system regulates the body.

What the Brain Does

The brain does remarkable few things, but in remarkably complex and varied ways.  It interprets what comes into the body in the form of one type of energy or another (e.g., light and from the body as sensation and turns it into perception.  Light waves are eventually “perceived” as vision; sound waves as hearing; chemicals as smell and taste; position or “vestibulation” by virtue of the position of liquid inside the ear; touch by virtue of contact with nerves in the skin; proprioception (the sense of pressure or torque) by virtue of special neurons that sense stretching or compressing, temperature and so on.  The brain also receives input about internal states of hunger, pain, comfort/discomfort, etc.  These constitute the “input” functions of the brain, which end up, once interpreted by several, hierarchically organized sets of neural circuitry - as perception.

The brain also coordinates reactions or movement, which psychologists and medical people call “motor.”  This constitutes the “output” functions of the brain.  “Thought” or thinking is also a motor or output function of the brain, because thoughts are merely movements that we experience inside our heads.

Then there is “attention/memory,” which I combine here because when properly understood, attention and memory are versions of the same thing.  Attention is extremely temporary recall of information, and we usually refer to memory as longer versions of information recall.  When attention is focused on something, whatever it is that we’re attending to activates neural pathways that frame the most current and momentary window of perception.  What we call memory isn’t really like storage – it is more like reactivation of circuits that were first in attention.  Memory is merely reactivation of those pathways back into attention.  I explain how this works in other articles.  For our purposes here (highly simplified), attention/memory is ‘output in search of input.’

So we have basically three things the brain does: input/perception; output/motor and thought, and; attention/memory.  The brain may only do three things, but of course, it does it in enormously varied, complex and exquisite ways.

Synchrony

One of the things that make us human is the power of our brains to coordinate all of the varied input, output and attention/memory mechanisms simultaneously and in parallel fashion.  This is an enormous feat, and we don’t always do it on all levels.  For instance, when we learn a new complex movement such as a dance or driving a car, we can lose track of our surroundings and cut off many other channels of perception and thinking.  When we strain to make out some form of input such as a sound, we are still.

But normally, as we move through the world, our position changes in relation to the objects around us; our weight and balance shift constantly; we maintain trains of thought and execute steps and make the adjustments necessary along the way.  We recall memories (reactivate circuits first formed in attention) to guide our forward thinking.  In other words, input, output, and attention/memory must constantly inform and update each other in order for us to be ‘synced up’ with ourselves and the rest of the world.

The Out of Sync Child

Carol Kranowitz (Kranowitz, 1986) coined this term in her book of the same name about Sensory Processing Dysfunction.  In this paper, I emphasize more than she does the neurological, emotional and behavioral consequences of the disorder later on in childhood and in life in hopes that parents and clinicians may recognize how the psychological and relationship impairments they see actually emanate from developmental, rather than parental pathology.

I cannot describe SID better than Kranowitz, so I quote and paraphrase from her book…

Despite having “…no identified disabilities… [and] they’re healthy, intelligent and loved…they struggle with the basic skills of tolerating ordinary sensations; of planning and organizing their actions; and of regulating their attention and activity levels.”

Kranowitz describes SID briefly as “…the inability to process information through the senses … [which is] …the result of inefficient neurological processing.”  “When a glitch occurs, the brain cannot analyze, organize, and connect – or integrate – sensory messages.  The result of SI Dysfunction is that the child cannot respond to sensory information to behave in a meaningful way, consistent way.  He may also have difficulty using sensory information to plan and organize what he needs to do.”

She describes problems on three different levels: perceptual/input related: difficulties with reading and deciphering patterns in the environment that enable us to find order and a sense of predictability and to get the ‘big picture;’ motor or output related: the child is inflexible and unable to change her behavior or stop herself, and/or; with “facilitation:” “the neurological process that promotes connections between sensory intake and behavioral output.”

Kranowitz connects SID to the emotional and subjective experiences of growing up with it…

“The brain-behavior connection is very strong.  Because the child with SI Dysfunction has a disorganized brain, many aspects of his behavior are disorganized.  His overall development is disorderly and his participation in childhood experiences is spotty, reluctant, or inept.”

I highly recommend reading “The Out of Sync Child.”  It is a seminal contribution to our understanding not only of SI Dysfunction, but also of other disorders that it can lead to such as learning disabilities, autism spectrum and related disorders, mood regulation disorders, etc., as well as the more attachment-related and psychiatric disorders I emphasize here.  Her book is dedicated to understanding the nature and treatment of SI Dysfunction, and she has followed up with various activity books and videos useful for parents and professionals.

“The Out of Sync Child” was originally published in 1986, but since then, neuroscience has developed an enormous body of evidence and a consensus about something called “central coherence” (Frith, 2003) (sometimes called “perception binding” – but central coherence encompasses a lot more) and how the brain organizes information that validates what Kranowitz was saying long before.

Basically, the brain/body sends messages in feedforward and feedback loops to its multitudes of subsystems, in a constant and ongoing (dynamical systems) manner to maintain a coherent and unified experience in the world.  The central nervous system, which coordinates most of it, is made up of hundreds of thousands of circuits that perform separate dedicated functions and that combine with others to perform ever more complex and integrated functions.  For instance, the brain has circuits that may only process a single color; others that see the edges of an object; others that process the motion of it; others that compute its distance or orientation, etc.  These combine to provide a singular visual perception of the object – the visual perception being several steps higher on the hierarchy of perception than its subcomponent circuitry.  Once an object is recognized, other hierarchies of may perceive its function, modulate it so that it does not distort or overwhelm other systems in the brain, record the changes made to it, put it in a context (combine it eventually with other sensory and motor information), etc.  While this description nowhere near does justice to its true complexity, it is apparent that rapid coordinating and updating of each system is vital.

Central coherence has to do with the efficiency of communication and the coalescence between the myriad circuits of the central nervous system.  This is an amazing feat, given that the disparate parts of the brain process different forms of information at different speeds and send their messages across varied distances – and yet still have to function in conditions of constant change.  They say that the brain is a dynamical (multivariate, constantly changing) system that is always on the edge of chaos (the complete breakdown of coherence among the parts).  When each part changes the others have to readjust to maintain synchrony.

And it is not difficult to imagine how “glitches” as Kranowitz calls them can cause disruptions in the larger hierarchies if not the entire system.  The fluidity of simultaneous perception (input) and motor/thought (output) is easily disrupted.  Imagine trying to walk down stairs if the visual system is slow to process depth perception.  Imagine trying to catch a ball or get out of the way of someone walking towards you if your ability to perceive motion is slow.  Imagine talking to someone when your ability to process their words was much slower than your vision.

The Disturbing Nature of being Out of Sync

Not all newborn nervous systems are ready for prime time.  Due to hyper-connection (too much), hypo-connection (too little) or other problems with encoding, modulating and synchronizing one set or level of brain circuitry with another, the infant experiences difficulties managing sensory input – including the feedback he gets from his own movement.  In other words, the baby can be highly disturbed by not being able to filter out or modulate (control registration levels) of input, or the baby may have trouble registering input in order to know how she feels or what is happening.

Babies know when they don’t feel right, and when they don’t they cry out in distress.  This is their natural response.  They don’t know it, but it brings about helping responses in others – that is what it is supposed to do.  Healthy and attuned Caregivers are very “activated” emotionally by a baby’s distress, and have an urgent need to do something about it.  Hence, both parties, baby and Caregiver, experience distress until the baby is relieved or regulated.

As mentioned, in a healthy infant/Parent or Caregiver dyad, this process of regulation, distress and regulation occurs cyclically on a regular basis and is a necessary process for maturing the nervous system.  The baby begins to internalize the process of the autonomic nervous system going up (sympathetic response) and going down (parasympathetic).  Over time, the repeated process creates emotional security and an association between feeling distress, and the presence of a Caregiver being associated with relief and trust.

But what if the baby’s nervous system can’t be relieved? What if the caregiver can’t figure out what is wrong?  Or worse, what if the Caregiver’s actions – even though well meaning – serve to make the baby’s problems worse?  What types of associations do you think the baby will make between feeling distress and the presence of others?  It could be that the baby learns to fear that when he or she feels distress, others will probably make it worse.  As the baby develops abilities to think and assess situations in toddlerhood and early childhood, it can lead to chronic and inchoate feelings of being misunderstood.  As Carol Kranowitz describes, children that experience difficulties with coordinating their responses will also act on impulses or behave in ways that are “too much” or “not enough” and become blamed unfairly – worsening this sense of trust that others understand.

Clinical Example 1

A 12 year old boy demonstrates extreme insecurity, especially regarding his mother.  He expresses it by being extremely clingy around her.  He insists on sleeping in her bed.  He follows her around constantly and always wants to know where she is.  He won’t let her close the door when she goes to the bathroom.  He continues to have serious emotional breakdowns when he has to separate from her, although he tries to act more grown up when in public. 

I got to know this mother.  She was very warm and attuned, and the boy’s older brother and sister were very emotionally healthy, secure, and well behaved.  There was no history of forced separation (as say in hospitalization or loss of a parent’s love), any trauma, abuse or neglect – none of the conditions traditionally associated with creating such insecure attachment.  Both parents were very competent and loving.

So I asked about his early childhood and infancy.  “Oh that first year was awful” remarked his mother.  He would have these long fits of [inconsolable] crying and it seemed there was nothing I could do to help him.  In fact, whatever I tried made it worse.

I asked how the situation resolved.  “I finally figured out – after a year, that it was the refrigerator motor that bothered him.  When it went on, he’d cry.  When it went off – he stopped.”

Think about this.  This mother was always very concerned.  She asked for help and no one could help her.  There was nothing physically wrong with her baby.

This baby went through a year’s worth of un-consoled distress.  At the time when genes in his nervous system were calibrating on the environment for purposes of setting up internal arousal and calming mechanisms – he was constantly overloaded with adrenaline and cortisol.  He was overloaded.  He was ‘drinking out of a sensory fire hose.’

Now think about this.  What do mothers normally do to “soothe” their babies?  They pick them up, bounce them, hold them tightly, sing, talk and coo, rub their backs, etc.  In other words – they provide more sensory input.  A baby that is already overloaded can become further agitated by the mother’s well-meaning actions.  What is she to do – leave him there?  What types of psychological and emotional associations are both parties in the dyad forming?  The baby can come to fear help, and the mother can fear helping.

Clinical Example 2

Sometimes, the opposite can happen.  The baby can only be soothed by the most primitive sensory input – skin-to-skin contact and swaddling.  For generations, we have known that wrapping babies up tightly can help them calm.  Firm touch and holding or swaddling can activate the parasympathetic nervous system (we want hugs and to be held tightly when we experience extreme distress too!). 

In this example, this 9 year old – highly intelligent boy presented as very angry and defiant.  He had been kicked out his school for assaulting children and adults, and he seemed to express no remorse about it.  When interviewed, his mother reported that he could not be calm unless he was on her chest.  The warmth of her body and her heartbeat were the only things that could make him feel OK – for 2 full years!  He couldn’t sleep without her and he was otherwise inconsolable.  At 9 years old, he still couldn’t regulate his arousal.  He was very impulsive and highly reactive to his surroundings.  He was very verbal and obviously very smart, but he couldn’t stick with anything for very long.  Because of his reactive nature, he always got in trouble for impulsive acts like hitting or running away. 

As I got to know him, I found that deep down; he really wanted to be good and to please others.  He just couldn’t fit in and he experienced being in trouble far more than others.  Since he could talk so well and engage in apparently logical reasoning, adults assumed he should “know better” and behave better. 

These are examples of children whose early life experiences were preoccupied with defending themselves against the sensory world and trying to feel OK.  The energy they spent on this made them edgy and irritable and prone to meltdowns.  ‘States’ of arousal eventually become ‘traits.’  Moreover preoccupation with defending themselves against unpredictable and destabilizing stimuli came at the expense of other types of learning experiences that would have taught, or at least allowed them ways to stay calm, in control, and in an optimal state for paying attention and learning.  They missed learning and social experiences that would give them a sense of competence and success.

Because of this they became consumed with feelings (perhaps buried deep below their awareness), that they were never going to be OK.  They continued to experience meltdowns that embarrassed and ashamed them in front of others.  Peers and siblings noticed and judged them harshly or even feared their tempers.  Getting in trouble with adults and other kids and being rejected and avoided by peers only confirmed their doubts.

Oh, they knew the drill.  After getting in trouble for having a tantrum or hitting or breaking something for the umpteenth time, they know what adults need to hear.  The intervening adult (often a parent), has a sound of weary frustration – of ‘here we go again’ and ‘will you ever learn?’ and ‘what is exactly wrong with you anyway?’ attitude that this child has become very sensitized to.

Adult: (Admonishing, frustration-weary tone; disdainful even) “What should you have done?”
Child: [Pick one] “Kept my hands to myself” “Ask permission” “Tell the Teacher” “Watch where I’m going

This is often followed by “consequences” that are supposed to teach the child not to make the same mistake again.  Or they are dismissed and ridiculed… “It’s just a tag on your shirt.  What is your problem?  You’re just trying to be difficult.”

The saddest part is that these kids want to do well.  At least at first – for their first several years and maybe beyond.  They go out on that playground and they promise themselves, “I am not going to hit anyone today.”  “I’m not going to have a tantrum.”

But someone reaches across them to get a toy and they react reflexively and hit.  Sand gets in their shoes and they explode.  They have too much fun, get too excited, and then they are hyperstimulated and out of control.

They’re wired so tightly.  Those constant rushes of adrenaline in infancy have wired their nervous system to go from 0 to 60 in one second flat.  The adrenaline also stays in their system longer than others (their parasympathetic nervous system is underdeveloped for their needs) so they cannot stop – even when they want to.   The repeated states of fight, freeze or flight have now become ‘most likely responses’ or traits.  They avoid experiences that might make them more resilient or better at self-control and eventually, they are behind in the ability to think before acting and they run through all of the stop signs.  The other kid says, “Stop” and they can’t.  The parent tries to help – and the kid escalates.

The child asks later, “Why didn’t you stop me?”  You respond – “I tried, but you wouldn’t let me.”  Sometimes, trying to stop this child is like stepping in front of a bus.

Back to the Brain

There are good reasons for your child’s current characteristic reactions and ways of handling emotions, even if they have outgrown the obvious signs of sensory processing issues and inconsolability they exhibited earlier on.

This is because the brain is an ‘experience-dependent’ organ.  It requires experience with light and color in order to learn how to see it.  It requires experience with sound in order to learn how to hear, odors in order to learn how to smell and so on.  Each sense requires exposure to its specific stimuli in order to ‘wire up.’  This is called an ‘epigenetic’ process or ‘epigenesis.’

Our DNA only provides us with our genetic potential, not our genetic destiny.  From prenatality to about 2 years old, our brains actually make new neurons (neurogenesis).  By 2 years of age then, all of the cables are provided that we will need for the rest of our lives.  Experience decides which cables to keep, which ones to develop and branch and connect further, and which ones are not needed.

Throughout our lifespan, the brain decides to use the wiring that is already there, and discards a lot of the rest.  Experiences tell us what pathways we will need, which ways to connect them together and use and, which ones to discard or “prune.”  If our brains did not do this (a process called “apoptosis” or “programmed cell death), we would wind up with noisy, inefficiently over-wired brains).  We keep what we need.  This is the reason for instance that people can learn languages well and have perfect accents if they learned the language as children.  In childhood, genes turn on and off pathways that process specific sounds.  If those sounds weren’t in the language you learned as a child – you’ll probably speak with a foreign accent if you learn the language later on.  You never learned to hear the deep subtleties of sound that you are predisposed to learn as children.

Sensory and mood regulation systems work in the same way.  They utilize specific pathways that help us go up and down with our arousal.  Genes turn on and off and pathways are forged by the experiences the brain/body experiences.  Early experiences (and very likely in-utero experiences as well) shape the pathways that will later connect to other systems like the megasystems of pathways that create feelings, emotions, communication and thinking.

I thought it was neurochemistry.  Isn’t that why doctors prescribe medicines for these problems?

Well, it’s about both, because the brain’s pathways also produce the neurochemical messengers that decide where messages go, what thresholds need to be crossed before they will pass along a message, and whether or not to keep using a given pathway.

“Behavioral medicines” – those that influence our moods and behavior, work by changing these thresholds one way or another.  While medicines can be very helpful and lifesaving in some cases, the problem with chemical intervention is that it works on many more pathways than the ones we want them to.  This is why medicines can cause side effects.

Another problem is that medicines really only produce temporary changes.  Indeed, they may allow a child to be more “available” for learning and/or therapy.  Learning and behavioral therapy (therapies that work by interaction between a Therapist and a Patient) create new pathways and may allow the brain to eventually discard some of the problematic old ones.  Another process that actually involves learning is “neurofeedback,” which also changes the wiring of the brain.  Once the wiring is healthier, the neurochemistry is healthier.  This is why it is always best to use learning as the primary force of change, rather than simply medicine.

How Sensory Processing Disorder can predispose a child to emotional problems later on

In order to understand this, we should look at two broad areas: how early experiences affect thinking as thinking becomes part of the child’s mental toolkit, and; how a child’s social experiences – pervasively impacted by SID, can affect their psychological and emotional well-being growing up (I’ve alluded to some of this already).

The Emotional Lava Lamp

From before birth, to neonatality, to infancy, toddlerhood and childhood and beyond, our brains go through the same sequences, different only by degree and type as we go through life.  On the ground floor, we have sensation.  In-utero and neonatal experience teaches the brain to recognize and differentiate sensations.  The primary cables and epigenetic foundations are formed for sensation earliest in life, but we continue to refine our “senses” as we go through life.  For instance, we may be overwhelmed at first by the sensation produced by “hot” pepper.  Taste temporarily highjacks all other systems and one’s conscious attention.  Many of us learn to modulate that sensation to one degree or another, and “acquire a taste” for it.  We’re no longer overwhelmed by reasonable amounts of it, and we may learn to be able to tell one kind of hot pepper from another.  We might do that at any age.

But a sensation – at least neurologically, is mainly a message to the brain that something is there.  The body’s sensors have detected something. It may or may not be important enough to enter conscious attention.  Perception helps us understand what it is.  Perception is the brain’s interpretation of the sensation.  Perception gives us the feeling of what happens as Antonio Damasio, the renowned Neuroscientist and neuroscience popularizer might put it (Damasio, 2000).  Emotions are perceptions of sensations going on in the body and the body’s neurochemical and messengering actions going on.  We perceive a certain wavelength of light as red; a certain molecular structure as the taste of sweetness or a type of odor; changes in infrared radiation as hot or cold, and so on.  We know that dogs do not perceive color but can differentiate and perceive odors much better than we can, and that insects can see more colors than we can, but may not have any awareness or perception of the sensations that light produces in them.  So every animal is different.

Conception is at the top.  Conception is a deep, layered and complex form of perception.  Conception allows us to make associations and to organize perceptions into categories.  Most “higher mammals” can do this.  We are only superior in terms of the degree and scope of our conceptual abilities.  We can label our feelings and we can purposefully communicate our feelings and experiences to others.  We can pick which ones to share and which ones we will [try to] conceal.  We can choose what to respond to, when to respond and how.  We can choose not to respond, which is something even our closest primate relatives have a problem doing.

You can imagine this (and to some degree it is true), that the brain is layered from the bottom to the top in this hierarchy.  While this is almost cartoonishly oversimplified, the bottom deals with sensation, the middle with perception, and the outer layers with conception.  Perhaps the biggest problem with this oversimplification is that it ignores the very real and important fact that our concepts affect the way our senses and perceptions work.  This is why we are affected by optical illusions and that picky eaters can be genuinely disgusted by peas.  Did I mention that shrimps and lobsters are giant sea bugs that if they were found on land might make them unpalatable?  Do you like to eat bacteria?  I do – in some cheeses, breads and wines.

In neonatal development, sensations are just coming into focus.  One of the first motor accomplishments necessary is for the baby to learn how to focus her cornea, because without being able to do that, the most important social stimulus in the world – Mother’s face, is just a blurry set of blobs.  In the first two years, perceptions are forming and memories are being encoded – without language being primarily involved.  Later on, language has a lot to do with how we organize, remember and manage our emotions, but in the first two years, the foundations of all emotional life thereafter are being laid down before language is really useful.

We now understand that emotions are not secondary to language or thinking – they are out in front, in the middle and behind those systems.  Emotions are now recognized as the primary organizers of the brain and no sensation, perception or conception exists without some involvement of emotional pathways.

With sensory integration or sensory processing dysfunction, the neonate/infant/toddler experiences sensations, perceptions (emotions) that lay down pathways and epigenetic instructions that function as records of early life.

As life proceeds, thinking and language develop on top of these layers or experience that were not encoded by linguistic (language) or cognitive (thinking) systems.  These human systems are there to interpret feelings even further and to share them with other parts of our minds and the minds of other people.  Human “thinking” pathways evolved to find causes for things.  When it can’t find the real cause, the thinking brain will make one up.  This is why the Neurolinguist Steven Pinker (Pinker, 2009) has called the cerebral cortex the “[BS]manufacturer.”  Writers like Neurologist Oliver Sacks (Sacks, 1998)and Neuroscientist Vilayanur Ramachandran (Ramachandran, Blakeslee, & Sacks, 1999) describe strange phenomena of patients where the subconscious emotional layers of the brain and the ‘so called’ thinking outer layers are confusing each other and yielding very strange sensations and perceptions of sensory or motor stimuli.

And that is the point.  The inchoate anger, blame, and irritable negative feelings of many children with emotional, behavioral and/or psychiatric disorders do not have to do with the misdeeds of their parents.  They have much to do with their cerebral cortices looking for someone or something to blame for the way they feel and act.

This is why I call this the emotional lava lamp.  Emotions that percolate up to the cerebral cortex from the roiling sea of sensory distorted pathways and memories and expectations underneath manifest as predilections of disturbed thinking and moods.  These pathways have hidden triggers – triggers that were formed before language and thinking pathways were formed to retrieve them.  They are there, but they have very round-about ways of finding their way to the surface, and when they do, the thinking brain has to find a reason and will usually make one up that, well sort of – fits.  “School sucks because it is boring and the Teachers are all stupid.”  “My parents took my cell phone from me at 3 am (not because the texting was keeping me up and is entirely inappropriate anyway), but because they are mean and they don’t love me.”  This is the same kid that might have scored in the Superior Range on the IQ test.

I wrote this article because many parents need to hear this and many professionals need to know this so they can begin to treat the real problem instead of looking for parent pathology that was never there.  If there was maltreatment – it was nature, not nurture.

Adapting – Psychologically
The Emotionally Disturbing Effects of Growing up with SID

How does a 9 year old explain to his friends that he still has [public] meltdowns like a 2 year old?  How can a 4 year old that can hold a conversation like a 7 year old explain to you why he just smashed his little brother’s head into a wall because his little brother touched his blocks?  Why would a 14 year old attack his parents because they would not go out and get another cell phone battery at 1:30 am?  These kids “know better” don’t they?

How can anyone preserve a sense of well-being under such conditions of repeated failure?  How can someone with high intelligence and no excuses (good parents and plenty of chances) manage to preserve the ability to move forward in life?

There are several phenotypical responses that we see.  These responses are the result of the child’s unique neurological issues, the environmental experiences they’ve had, their temperament and cognitive ability and a host of other factors, but they tend to fall into several predictable patterns:

Withdrawal and Depression/Risk Aversion

One way is to simply withdraw.  It is easier to avoid circumstances that could be fun, but that they know carry the risk of potential breakdown and public humiliation.  They learn to play alone and to stick to the familiar.  They trust fewer people and increasingly restrict their lives.  They are consumed with shame and doubt.  They may even avoid parents and family that see them as spoiled.  Their parents also can become isolated, because there are others that see the child that way.  Parents regularly get recommendations to spank and punish the problem away.  Many parents have already tried that, and not only did it not work, it further eroded what little trust the child had left and made the parent feel even more like a failure.

Aggressive; Defiant; Externalized and “Owning it”

Some kids don’t want to go away.  But how do they explain their behavior.  “Why did you hit?”  “Uh, I meant to…yeah, that’s it.  I meant to do it and I’ll do it again.”  Psychologically, it is easier to tell yourself that you are in control of your behavior than to face the fact that maybe you’re not.  Instead of collapsing into a heap, they aggress.

Younger children are also magical thinkers.  ‘The reason I hit that other kid was because he touched my toy.’  They begin to blame others.  They blame their parents for not being able to prevent this from happening to them (after all – it feels out of control; it feels that it is happening to them and they do not have control.  And to a large extent – a young child doesn’t really have the capacity to stop).  When a shirt itches too much and it triggers a hard-wired explosive response – the child blames the parent and punishes them – no matter how loving, patient and attuned that parent tries to be.  “You put that shirt on me.  You should have known it was gonna itch.  It’s your fault.”

Inflexible; Controlling

Living with a nervous system that can fail at any time and result in catastrophic meltdown leads one to avoid uncertainty.  These kids want to know everything before it happens.  Parents preview upcoming events extensively.  They play alone or they play with younger children so they can be in control of events.  No surprises.  Surprises require quick processing and fluid adapting – and this is exactly what this child wants to avoid.

Clingy

This may seem paradoxical.  The child that could not be soothed has now become insecurely attached to a parent – usually the mother.  This is the same mother that during infancy, well meaning – still blew up the child every time she tried to help.  Now, he clings to her for dear life.  Why?

One reason is that no one else is going to stick around unconditionally.  Our species seems to be hard-wired to expect our mothers to put up with us no matter what.  We will work hard to stay in control for periods of time when we are around peers and others that will reject us – but we let it all hang out with our mothers.  “Why am I the punching bag?” mothers ask.  “Who else would it be?” seems to be the answer.

Angry/Ambivalent

By any stretch of the imagination – this life circumstance is incredibly unfair.  Not only is the sensory world disturbingly uncomfortable and potentially unraveling, impulses and losses of control lead to repeated humiliation, shame, rejection, punishment, and finally erosion of self-esteem and growing self-doubt.  The future is not something to look forward to.  It just seems to get worse.  No one understands and people are starting to hate me.  Other kids think I’m crazy.  I don’t want to go back to school.  I don’t want to go to parties anymore.  I can’t do fun stuff.

Here again, who’s going to sit around and take the brunt of the anger?  Parents – especially mothers.  Perhaps a few caring and understanding professionals committed to help – if you can find them.  Most just blame (see the October 10, 2011 story in the Los Angeles Times[1]), and the child risks being constantly punished, restricted, or even expelled from school.

Other Maladaptations

Punishment works – in the short term.  “Knock it off or I’ll give you something to cry about!”  This is like squeezing a balloon.   Suppress one behavior and it pops up as another.  The anger goes underground and becomes internalized.  The behavior of the moment will stop – in the presence of the punisher – that is a cardinal rule of how punishment works.  And punishment, in order to remain effective – usually has to be continually escalated.  And when you’ve gone as far as you can morally handle – then what do you do?

What happens with suppression is that the behavior goes underground and resurfaces in damaging ways.  Some kids will seek punishing or degrading experiences or self-mutilate to mask their pain.  Others will turn to drugs to manage their feelings.  There are few good outcomes to punishment as an approach to this problem.

Rewards for good behavior can be even worse.  These kids are notorious for ripping up their sticker charts.  They want to be good, but they fail because their nervous systems are like minefields.  It’s like asking someone to stop hiccupping – for a reward.  Carol Kranowitz describes these children as having “indigestion of the brain.”  It is a physical, physiological problem.  There aren’t enough stickers to make this stop.  And fairly soon, these kids can smell a naïve professional with a sticker chart in her hand – and rarely is the outcome very good.  These kids need professionals that know what they’re doing and that do not assume that what works with other kids will work with these kids.

What you’ll never hear

Please – if there is any professional or parent out there that has heard their child or adolescent say, “I experience emotions that really have their roots in infancy and my history with sensorimotor processing dysfunction and the reason I came for counseling is because I want to stop blaming my the people that love and care for me unfairly…” please let me know.

What you typically hear

I usually want to know what the child thinks when he comes to the clinic.  I want to know the child’s perception of why he was brought to counseling.

Those of us that work with children know that the children themselves usually don’t know why they are in counseling or what counseling really is or is supposed to accomplish.  This is a fundamental difference between working with children – who usually do not come voluntarily, and adults that seek out psychotherapeutic help.  Adults have some sense of their failure or they want to know why everyone else fails them, and they often have a perception of the impact their moods and behavior has in their lives.

The answers I get from children when I ask them why they think their parents or school brought them in often reveal their psychological adaptation to their reality.  Often, the answer is “I don’t know,” which can be in large part true, and in many cases – not true.  Some will say, “Because they think I’m crazy” “I’m crazy” “I’m bad” “I hit people” “I don’t want to go to school” “I’m stupid” “The other kids won’t play with me” “They don’t like me” etc.

Advice to Professionals

Mental health professionals that work with children have brains that work like everyone else’s.  They tend to see what they expect to see.  The have their own professional development experiences that shape their thinking.

My own strange professional journey is like the bowling ball going down the bowling alley with the bumpers in the gutters, bouncing back and forth between behavioral and developmental and psychodynamic orientations.  On my way, I’ve had both the privilege or working with professionals from many schools of thought, and the intense annoyance of dealing professionals that are religiously tied to one school of thought.  This accounts for my orthodox agnosticism, and perhaps my immodest claim to be able to write this article.

Those with behavioral orientations look at the child’s experiences and the learning that resulted.  They will often miss the sensory and neurological underpinnings of the problem, and wrongly assume that these children come from pathological environments. They do not usually take early developmental histories and rarely ask questions about early sensory and arousal/mood regulation.  They usually do ask about early behaviors and how the parents handled them, and yes, parents often end up mishandling the behaviors.

But far too often, I have seen parents blamed unfairly by professionals that do not understand the peculiar evolution from SID to Emotional or Psychiatric disturbances of later childhood.  This is especially true if they work in clinics that deal with children diagnosed with Conduct Disorders, Oppositional Defiance, or in schools where kids are lumped together in a category called “emotionally disturbed.”  The cerebral cortices of these professionals will manufacture parent pathology that wasn’t there in the beginning.   Parent pathology may indeed form later on as the result of living with these children and being punished constantly by their kids and the professionals whose “help” they seek.  Some have had their children manipulate the system and have called child abuse hotlines to report abuse – just to punish their parents for taking their cell phones.  Imagine trying to keep loving a child through that.  What is amazing to me is how emotionally healthy and resilient many parents are – especially when around professionals that are not in the act of blaming them.

Professionals with developmental orientations will recognize and deal with the sensory issues – but they often don’t see these kids.  They see the kids with autism and developmental delays.  Counseling is not their “go to” intervention.  The “talking cure” is not their specialty.  They may attribute too much to neurology and sensory development, and work that angle – if they ever get to treat a child diagnosed with Conduct Disorder or Emotional Disturbance.  Or, they may use Applied Behavior Analytic (ABA) treatments, which I think can be totally inappropriate.

School professionals can take an “either/or” orientation.  Either these children are emotional disturbed (connoting parent/environmental pathology, or perhaps organic psychiatric pathology such as ADHD, Schizophrenic, Bipolar or Obsessive/Compulsive disorder), or, they are autistic and they’re thought to belong in the autism classroom – where their patterns of thinking and feeling rarely come under study or treatment.  The former is more often the case, because the child that curses and accuses and speaks above his age level is probably not headed for the autism classroom.  Asperger’s Syndrome is now widely recognized, and many can be misdiagnosed with AS.  All of the above diagnoses can share a history of SID, but the evolutionary outcome is different.  These kids are experiencing sociopathy.  And unfortunately, the pervasive influence of ABA in Special Education precludes the necessary psychodynamic orientation I think is necessary in treating these children.

For professionals, I recommend what I consider to be a definitive book on Conduct Disorders that recognizes the interaction between children’s sensory makeup and temperament and that of parents written by Pauline Kernberg and Saralea Chazan. (Kernberg & Chazan, 1991).

Conclusion

This article was meant to provide background and understanding, mainly to prevent good parents from being blamed for childhood conditions that are otherwise typically caused by pathological environments, parenting and child maltreatment.

I will follow up on Treatment Recommendations from experts that I believe have the appropriate understanding of both the neurodevelopmental, psychodynamic, and environmental complexities of the issue.

Sources:

Damasio, A. (2000). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. Mariner Books.

Frith, U. (2003). Autism: Explaining the Enigma (Cognitive Development) (2 ed.). Wiley-Blackwell.

Greenspan, S., & Weider, S. (2009). Engaging Autism: Using the Floor Time Approach to Help Children Relate, Communicate, and Think. Da Capo Lifelong Books.

Kernberg, P., & Chazan, S. (1991). Children with Conduct Disorders. USA: Basic Books.

Kranowitz, C. (1986). The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction. New York, N.Y.: Perigree.

Pinker, S. (2009). How the Mind Works (Reissue edition ed.). W. W. Norton & Company.

Ramachandran, V. S., Blakeslee, S., & Sacks, O. (1999). Phantoms in the Brain: Probing the Mysteries of the Human Mind . Harper Perennial .

Roan, S. (2011, October 10). Child Mental Disorders: New diagnosis or another dilemma. Los Angeles Times.

Sacks, O. (1998). The Man Who Mistook His Wife For A Hat: And Other Clinical Tales . Touchstone.

 

 

 

 

 



[1]   Child mental disorders: New diagnosis or another dilemma?  A proposed new diagnosis for outbursts and tantrums sparks debate in the psychiatric community. Would it help parents desperate for answers, or just add to the confusion?

Read more at… http://www.latimes.com/health/la-he-child-temper-20111010,0,3234089.story