Mental Health Disorder or a Sensory Processing Challenge?

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“Angela” was such a puzzle to her parents and teachers alike. In first grade, she struggled to stay in her seat, and teachers constantly reprimanded her for not listening to instructions. At home, her parents often felt confused by her constant need for movement and habit of jumping off tables and countertops. Her teacher secretly wondered whether her parents were setting enough limits, or whether lax parenting was to blame. At the same time, her parents secretly wondered if Angela might have ADHD or hyperactivity.

Each year as children return to school, parents anxiously await news about their transitions. Some children, like Angela, experience a rough start. But Angela was lucky.  Her public school has a “student success team” (SST) whose goal is to support early difficulties as soon as possible.

Two months into the school year, the SST met with Angela’s parents. During the meeting, an occupational therapist asked many questions and came up with a potential explanation for her difficult behaviors.  After spending a few hours with Angela, she surmised that the child experienced challenges in body awareness, and that her constant movement was her body’s way of coping. When she jumped around, feedback to her system of “proprioception” (input to the muscles and joints) allowed her to feel where her body was in relation to people or objects around her. She urged the team to consider that her actions most likely reflected a need coming from signals in her developing brain and body, rather than intentional misbehavior. This is considered a “bottom-up” rather than a “top-down” perspective on the causes of children’s behaviors.

Angela’s occupational therapist was trained in a developmental relationship-based approach to supporting childhood challenges. Such approaches prioritize an understanding of the child’s individual differences within the context of warm and caring relationships. So, when the occupational therapist observed Angela in class she asked these questions:

 What factors might be affecting a child’s ability to have calm, focused and alert attention in her body and mind?

 What impact does this have on a child’s “occupations” such as engaging in the classroom and playing with peers?

In Angela’s case, her need to move and problems with sustained attention were already affecting relationships at home and at school.  Her parents and teacher had formulated their own reasons for the behaviors. And they were wrong. Angela’s behaviors stemmed from neither poor parenting nor ADHD.  Rather, they reflected differences in the way she processed sensory information.

The profound shift in thinking about her behaviors led to a plan for supports at school and at home. She received occupational therapy at a local clinic once a week for several months. At school, her teacher gave her opportunities for frequent “movement breaks” and recruited her to help her move around heavy objects, calming her body’s need for input to her muscles and joints, and making her feel important at the same time. At home, she helped her mom carry grocery bags, and she enrolled her in a creative dance class. With the team’s help her parents suddenly had more compassion and less worry, allowing them to enjoy their daughter more. As for Angela, the support strategies led to increased focus and attention, and to a successful school year. When her parents and teachers considered options other than intentional misbehavior, everything changed for the better.

If you are wondering about sensory processing contributions to challenging behaviors, here are some things to consider:

  1. Explore below the surface of behaviors. Think of behaviors as the tip of the iceberg, and all the potential reasons for the behaviors as the larger chunk underneath. For children, underlying reasons for certain behaviors may include sensory processing differences which cause challenges in physiological regulation (feeling calm in mind and body), often leading to emotional distress for both the child and the parent.
  2. Give children the benefit of the doubt. While our first reaction may be to explain a behavior as willful disobedience, we need to understand that children also have an innate desire to please.
  3. Prioritize loving relationships as the foundation for regulation of emotions and behaviors. Warm, positive emotions support all learning and development.
  4. Seek a professional consultation from a qualified occupational therapist if you feel your child might have sensory processing challenges impacting his ability to be in control of his actions and emotions. Click here for more information about sensory issues that may require therapy, including sensory processing disorders. Lucy Jane Miller’s Star Center for Sensory Processing Disorders is the leading worldwide resource for research in this area.

Again and again in my practice, I have observed empathic, loving parents and professionals attempt to reason in vain with children about behaviors that stem from causes beyond their awareness or comprehension.

When we shift the lens to include mindful compassion and an appreciation of each child’s unique differences, new doors open. To be sure, the underlying causes for children’s behaviors are complex, so we should not simplify our explanations, but entertain a wide range of causal underpinnings, including childhood trauma.  I describe these  pathways in a “developmental iceberg” model in my new book for providers. With this fresh approach to challenging behaviors, parents and professionals alike can understand and support children when they need us most. Let’s  move from deficit-based checklists to a more compassionate understanding of why children do what they do.

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