Sensory Processing Difficulties.

Although the sensory system is very complex and its correct development is vital, this post is only able to provide a brief guide. I will however highlight the major problems, which children who suffer brain injury face in the developmental areas of vision, hearing and touch.

We take in information about our environment through our senses. This is something, which we cannot help but do. The amount of sensory information our brains are processing at any one moment is phenomenal. As I sit here typing for instance, I am aware of several sensory stimuli. Visually I see the computer keyboard, with the letters printed on the keys; I can see my hands, the desk, the computer screen and more. In my peripheral vision, I am aware of the window, my dog, the sofa and other items in the room. Auditorially (hearing), I can hear the kettle beginning to boil, I hear my fingers tapping on the keys of the keyboard and I hear my cat mewing. In terms of touch (tactility), I can feel the keys of the keyboard; feel the wooden floor beneath my feet etc. These are merely the things of which I am aware and these sensory stimuli are all being processed simultaneously, in a fraction of a second.

As an example of this processing, consider the complexity of my typing this text, which hopefully you are reading with enjoyment! The front part of my brain (the frontal cortex) is sending out messages to the motor parts of my brain (the motor cortex), which control my hands,

instructing it which keys on the keyboard I need to hit next in order for the written words on this page to make sense. The motor cortex then instructs the hands to move in order to hit those keys. Parts of the brain known as the basal ganglia and cerebellum then become involved in

order to attempt to execute the necessary movements of the hands in a fluent and accurate manner. When the movements have been executed, feedback signals are then sent back to the frontal cortex, via the ‘cerebellum’ and ‘basal ganglia’ to inform it how successful the hands

were at hitting the correct keys on the keyboard and whether the movements were accurate and fluent. If necessary, the frontal cortex then issues new instructions, to correct any errors.

In a healthy, uninjured brain, this grossly oversimplified description of events all takes place within a fraction of a second whilst the brain simultaneously takes care of many other complex tasks. It is a phenomenal feat.

Also, consider how the brain decodes the various sounds we call language and how it regulates its own attention. Imagine you are sitting in your lounge holding a conversation with a visiting friend. There you are, happily chatting away; - you are attending to your friend’s voice

so that your auditory system is able to process the constant stream of noise, which we call speech. Your brain is able to take this constant stream of sound, break it down into recognisable chunks and attribute meaning to it so that you understand what it is your friend is saying. At

the same time, your brain is tuning out extraneous sounds in the background, such as traffic passing outside your window, so that you are able to focus on the task at hand. Your brain does all of this and much more, (this again is actually a gross oversimplification), with the

minimum of effort, without you even being conscious of the processes involved.

Now consider a brain, which is not healthy; - a brain, which has suffered injury and try to imagine the chaos, which might ensue for a child whose sensory processing system has been impaired. Imagine this child’s ability to ‘tune out’ noises, which he does not wish to pay attention to, has been impaired. What havoc would that child experience?

I believe that the sensory problems, which are faced by brain-injured children can be assigned to five categories, which we shall discuss later. Fundamentally it seems to me that many brain-injured children experience difficulties in correctly modulating incoming sensory information, their sensory system processing incoming stimuli in a distorted manner.’ I have applied these theories (which are all supported by evidence), to differing patterns of brain-injury: - And there are many patterns of brain-injury to which they can be applied! A particular pattern rarely has absolute, identifiable boundaries and symptoms from another. There is often a great deal of ‘overlap’ in the symptoms which differing patterns of brain-injury display. Allow me to explain.

A good example is my proposition that cerebral palsy, autism and ADHD are not distinct separable conditions, but are a continuum; they are overlapping expressions of brain–injury and consequently it is possible to have some symptoms of autism, or ADHD within what is termed cerebral palsy. It is also possible to have some symptoms of cerebral palsy within what is known as autism or ADHD.

I can already hear the howls of indignation over the fact that I have referred to autism as brain-injury! Have you not seen all the recent evidence, they will say, which points to the cause of autism as being genetic? Yes, I have seen this evidence and I accept that some forms

of autism have genetic causes. However, I have seen too many children with brain-injuries, who display amongst their repertoire of symptoms, many autistic qualities. Thus, I cannot ignore the fact that some forms of autism also have environmental causes. In other words, they are produced by brain-injury. I am also aware that genes can only express themselves in the correct environmental conditions!

It was Delacato in the 1970’s, who first claimed that children suffer distortions of sensory processing, separating them into the categories of ‘hyper-sensory,’ hypo-sensory’ and white noise. I have managed to identify five categories of sensory difficulties, which children display,

(other researchers may find more!) and I see these as symptoms of a malfunctioning ‘tuning mechanism’ in the brain. This ‘tuning’ mechanism is the structure which enables us to ‘tune out’ background interference when we wish to selectively attend to something in particular; it also enables us to ‘tune in’ to another stimulus when we are attending to something completely different. It is the same mechanism of the brain, which allows us to listen to what our friend is saying to us, even when we are standing in the midst of heavy traffic on a busy road. It is this mechanism that allows us, even though we are in conversation in a crowded room, to hear our name being spoken by someone else across that room. It is this mechanism, which allows a mother to sleep though various loud, night-time noises such as her husband snoring, or an aeroplane passing overhead and yet the instant her new baby stirs, she is woken. It is a remarkable feature of the human brain and it seems to be the responsibility of three structures operating cooperatively; - these are the ascending reticular activating formation, the thalamus and the limbic system.

Having made such a bold claim, allow me to furnish you with the evidence to support it. The three structures just mentioned receive sensory information from the sense organs and relay the information to specific areas of the cortex. The thalamus in particular is responsible

for controlling the general excitability of the cortex (whether that excitability tunes the cortex up to be overexcited, tunes it down to be under excited, or tunes it inwardly to selectively attend to it’s own internal sensory world.) (Carlson, 2007). The performance of these neurological structures, or in the case of our children, their distorted performance seems to be at the root of the sensory problems our children face.

I would label the five categories of sensory distortion, which I have witnessed in brain-injured children as follows: -

1. Sensory over-amplification. The particular sensory modality, (vision, hearing, touch, etc) can become oversensitive to stimuli from the environment. It is my belief that in this case, the thalamus, limbic system and reticular formation, which are acting as the brain’s ‘tuning

system’ are malfunctioning and are not effectively regulating the level of incoming sensory stimuli. Indeed, in this case they would appear to be acting to over-excite the cortex, which would have the effect of amplifying the sensory stimuli. This could possibly cause the child to

overreact, or to withdraw into himself as a defensive strategy from a world, which in sensory terms is simply overwhelming.

2. Sensory under-amplification. The particular sensory modality can appear to become under sensitive to incoming stimuli from the environment. In this case, I believe the thalamus and other two brain structures, acting as the tuning system, are acting to under-excite the cortex, which is having the effect of appearing to dampen down incoming sensory stimuli. This could influence the child to act as though he cannot see, hear or feel; - he may be deficient in this way, in one or more sensory modalities.

3. Internally focussed sensory tuning. In this case, the particular sensory modality appears to be ‘inwardly tuned.’. In this case the three brain structures, acting as the brain’s tuning system are exciting the cortex to attend to sensory information of the sensory system’s own making, or from within the child’s own body. Consequently, the child may have difficulties perceiving the ‘outside’ sensory world through this haze of internal stimulation. We see this effect ourselves in the visual aura of a migraine, or when we have 'pins and needles.'

4. Wide spectrum tuning. In this case, the three neurological structures are exciting the cortex and attempting to tune its attention to many incoming stimuli simultaneously. They seem unable to filter out background noise, sights, etc in order to allow the child to focus on one aspect of the environment. For this child, the world is absolute chaos and again, he often withdraws into himself.

5. Narrow spectrum tuning. In this case, the neurological structures are only exciting the cortex selectively, allowing the cortex to attend to limited, isolated sensory stimuli. This child may often seem ‘over-focussed’ on one particular aspect of his environment. He can for instance, become intensely interested with a spinning top or the particular features of one toy and will not play with anything else, to the point of seeming obsession. For this child, it appears his sensory tuning system is focussed too narrowly and he cannot spread his attention to incorporate several features of his environment simultaneously.

Can these problems be addressed? Yes they can. As part of its programme for children with sensory processing issues, Snowdrop creates an individually tailored 'adapted sensory environment' for the child to encourage his sensory system to begin to process stimuli on a much more normal level. Are we experiencing success with children who have sensory processing problems? Yes we are.

Anyone requiring more information should contact info@snowdrop.cc

References.

Beck, A. T., and Guthrie, T. (1956). Psychological significance of visual auras: Study of three cases with brain damage and seizures. Psychosomatic Medicin, Vol XVIII, no 2,

Carlson, N. R. (2007). Physiology of Behavior. London. Allyn and Bacon.

Haist, F., Adamo, M., Westerfield, W., Courchesne,E., and Townsend, J., (2005). The functional neuroanatomy of spatial attention in autistic spectrum disorder. Developmental Neuropsychology, 27, 3, 425-458.

Mulleners, W. M., Chronicle, E. P., Palmer, J, E., Koehler, P. J., and Vredeveld, J. W. (2001), Suppression of perception in migraine: Evidence for reduced inhibition in the visual cortex, Neurology, January 23, 2001; 56(2): 178 - 183.

Yang, T., and Maunsell, J. H. R.. (2004) The effect of perceptual learning on neuronal responses in monkey visual area V4. Journal of Neuroscience, 24, 1617 – 1626.

A Mother's Touch.

When a baby with neurological problems is born into a family and he / she is brought home, we know that normal patterns of interaction between baby and parents can break down.  This is no fault of the parents, but is merely the consequence of the stress of the situation in which they find themselves.  Unfortunately, this can have negative consequences for many areas of development, especially in terms of language and communication development.  This is why a Snowdrop programme, which stimulates communication development always includes 'back to basics' activities to overcome these issues and to stimulate brain development.

UCI child neurologist and neuroscientist Dr. Tallie Z. Baram has found that maternal care and other sensory input triggers activity in a baby's developing brain that improves cognitive function and builds resilience to stress.

For an infant, a mother's touch provides a feeling of security, comfort and love. But research at UC Irvine is showing that it does much more.

UCI child neurologist and neuroscientist Dr. Tallie Z. Baram has found that caressing and other sensory input can trigger activity in a baby's brain which can make a remarkable difference to the development of the child.

The finding contributes to growing knowledge about epigenetics, the study of how environmental factors can reprogram the expression of genes.

In a study published earlier this year in The Journal of Neuroscience, Baram and colleagues identified how sensory stimuli from maternal care can modify genes that control a key messenger of stress called corticotropin-releasing hormone.

In earlier work, Baram helped discover that excessive amounts of CRH in the brain's primary learning and memory center led to the disintegration of dendritic spines, branchlike structures on neurons. Dendritic spines facilitate the sending and receiving of messages among brain cells and the collection and storage of memories.

"Communication among brain cells is the foundation of cognitive processes such as learning and memory," says Baram, the Danette Shepard Chair in Neurological Sciences. "In several brain disorders where learning and similar thought processes are abnormal, dendritic spines have been found to be reduced in density or poorly developed.

"Because an infant's brain is still building connections in these communication zones, large blasts or long-term amounts of stress can permanently limit full development, increasing the risk of anxiety, depression and dementia later in life."

Her most recent study describes for the first time the cellular pathways of the epigenetic process by which maternal care reduces the expression of CRH in the hypothalamus. Detecting sensory input, DNA in brain cells in this stress-sensitive region activates a neuron-restrictive silencer factor, which limits CRH. Without the interference of excess stress-triggered CRH, neural dendrites in the hippocampus can fully develop, which leads to stress resilience.

"What's noteworthy about this study is that it reveals that brain structure is influenced by the environment early in life, and especially by maternal care," says Baram, whose research on early-life factors in neural development has fundamentally altered the understanding of disorders such as epilepsy.

"There has been a belief that the brain is hardwired - that once it's established, it's that way for life," she says. " But we're seeing that the brain is actually 'softwired - that changes in stimuli alter the wiring - and that it's not predestined to be a certain way."

It is upon this plasticity that the conventions of the Snowdrop programme are based!

 

Infants trained to concentrate benefit academically.

This is why the Snowdrop programme builds attentional abilities through processes such as training children to focus eye contact, partake in 'intensive interaction' and to build 'proto-conversations'  Regulation of attentional resources is an essential part of the developmental process.

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Although parents may have a hard time believing it, even infants can be trained to improve their concentration skills. What's more, training babies in this way leads to improvements on other, unrelated tasks.

The findings reported online on September 1 in Current Biology, a Cell Press publication, are in contrast to reports in adults showing that training at one task generally doesn't translate into improved performance on other, substantially different tasks. They also may have important implications for improving success in school, particularly for those children at risk of poor outcomes, the researchers say.

"Research suggests that differences in attentional control abilities emerge early in development and that children with better attentional control subsequently learn better in academic settings," said Sam Wass of the Centre for Brain and Cognitive Development at Birkbeck, University of London. "The connection is an intuitively obvious one: the better a child is at concentrating on one object, such as a book, and ignoring distractions, for instance people moving around a room, the better that child is going to learn. We show that attentional control abilities can be trained at a much earlier age than had previously been thought possible."

The researchers trained 11-month-old infants to direct their gaze toward images they observed on a computer screen. For example, in one task, a butterfly flew only as long as the babies kept their eyes on it while other distracting elements appeared on screen. Infants visited the lab five times over the course of 15 days. Half of the 42 babies took part in training, while the other half watched TV. Each child was tested for cognitive abilities at the beginning and end of the study.

Trained infants rapidly improved their ability to focus their attention for longer periods and to shift their attention from one point to another. They also showed improvements in their ability to spot patterns and small but significant changes in their spontaneous looking behavior while playing with toys.

"Our results appeared to show an improved ability to alter the frequency of eye movements in response to context," Wass said. "In the real world, sometimes we want to be able to focus on one object of interest and ignore distractions, and sometimes we want to be able to shift the focus of our attention rapidly around a room—for example, for language learning in social situations. This flexibility in the allocation of attention appeared to improve after training."

The fact that the babies' improvements in concentration transferred to a range of tasks supports the notion that there is greater plasticity in the unspecialized infant brain.

"In other words, if we want to substantially alter cognitive development, it may be that the earlier we start, the better," Wass said.

There is one caveat: It remains unclear whether babies' developing and "trainable" brains might tend to lose newfound skills just as readily as they gain them.

Autism. - It's all in the wiring plan.

As has been thought for many years now, it seems that parts of the brains of children with autism are wired differently.  That doesn't have to mean that the wiring pattern has to be permanent though.  The environment is the most powerful developmental force and we know that the brain can change its wiring diagram in response to environmental stimulation.  That is what the Snowdrop programme is all about.

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STANFORD, Calif. - Researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital have used a novel method for analyzing brain-scan data to distinguish children with autism from typically developing children. Their discovery reveals that the gray matter in a network of brain regions known to affect social communication and self-related thoughts has a distinct organization in people with autism. The findings will be published online Sept. 2 in Biological Psychiatry.

While autism diagnoses are now based entirely on clinical observations and a battery of psychiatric and educational tests, researchers have been making advances toward identifying anatomical features in the brain that would help to determine whether a person is autistic.

"The new findings give a uniquely comprehensive view of brain organization in children with autism and uncover a relationship between the severity of brain-structure differences and the severity of autism symptoms," said Vinod Menon, PhD, a professor of psychiatry and behavioral sciences and of neurology and neurological sciences, who led the research.

"We are getting closer to being able to use brain-imaging technology to help in the diagnosis and treatment of individuals with autism," said child psychiatrist Antonio Hardan, MD, who is the study's other senior author and an associate professor of psychiatry and behavioral sciences at Stanford. Hardan treats patients with autism at Packard Children's.

Brain scans are not likely to completely replace traditional methods of autism diagnosis, which rely on behavioral assessments, Hardan added, but they may eventually aid diagnosis in toddlers.

Autism occurs in about one in every 110 children. It is a disabling developmental disorder that impairs a child's language skills, social interactions and the ability to sense how one is perceived by others.

The study compared MRI data from 24 autistic children aged 8 to 18 with scan data from 24 age-matched, typically developing children. The data was collected at the University of Pittsburgh.

"We jumped at the results," Menon said. "Our approach allows us to examine the structure of the autistic brain in a more meaningful manner." The new findings expand scientists' basic knowledge of the core brain deficits in autism, he added.

The analysis method, called "multivariate searchlight classification," divided the brain with a three-dimensional grid, then examined one cube of the brain at a time, and identified regions in which the pattern of gray matter volume could be used to discriminate between children with autism and typically developing children.

Instead of comparing the sizes of individual brain structures, as prior studies have done, the new analysis generated something akin to a topographical map of the entire brain. The scientists essentially mapped the autistic brain's distinct cliffs and valleys, uncovering subtle differences in the physical organization of the gray matter.

Such analysis may be a more useful approach than previous tacks. Earlier studies, for instance, suggested that people with autism may have larger brains in toddlerhood or have a large defect in one brain structure. This study took a different approach and discovered several autism-associated differences in the Default Mode Network, a set of brain structures important for social communication and self-related thoughts. Specific structures that differed included the posterior cingulate cortex, the medial prefrontal cortex and the medial temporal lobes. These findings align well with recent theoretical and functional MRI studies of the autistic brain, which also point to differences in the Default Mode Network, Menon said.

Once Menon and his team had found where the differences in autistic brains were located, they were able to use their analysis to classify whether individual children in the study had autism. They used a subset of their data to "train" the mathematical algorithm, then ran the remaining brain scans through the algorithm to classify the children.

"We could discriminate between typically developing and autistic children with 92 percent accuracy on the basis of gray matter volume in the posterior cingulate cortex," said Lucina Uddin, PhD, the study's first author. Uddin is an instructor in psychiatry and behavioral sciences at Stanford.

In addition, the children with the most severe communication deficits, as measured on a standard behavioral scale for diagnosing individuals with autism, had the biggest brain structure differences. Severe impairments in social behavior and repetitive behavior also showed a trend toward association with more severe brain differences.

Menon and his team plan to repeat the study in younger children and to extend it to larger groups of subjects. If the results are upheld, the new method offers the possibility of several applications in autism diagnosis and treatment. For instance, brain scans might eventually help distinguish autism from other behavioral disorders such as attention deficit hyperactivity disorder, or might predict whether high-risk children, such as those with autistic siblings, will go on to develop autism themselves. Brain scanning might also be able to predict what type of deficits will occur in a child with a new autism diagnosis, allowing clinicians to target their treatments to a child's predicted deficits.

"Scans would likely be used alongside clinical expertise, giving that extra hint from the brain data," Uddin said.

When such integrated assessments are possible, the researchers hope they will allow clinicians to build detailed profiles of each patient. "We hope we'll eventually be able to tell parents, 'Your child will probably respond to this treatment, or your child is unlikely to respond to that treatment,'" Hardan said. "In my mind, that's the future."

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Other Stanford scientists who collaborated on the project were research scientist Srikanth Ryali, PhD; postdoctoral scholar Tianwen Chen, PhD; and research assistants Christina Young and Amirah Khouzam. Nancy Minshew, MD, from the University of Pittsburgh, also contributed to the project.

The research was supported by funding from the Singer Foundation, the Stanford Institute for Neuro-Innovation & Translational Neurosciences, the National Institute of Child Health & Human Development, the National Institute of Deafness & Other Communication Disorders, the National Institute of Mental Health, the National Institute of Neurological Disorders & Stroke and the National Science Foundation. Uddin was also supported by a postdoctoral fellowship from the Stanford University Autism Working Group. Additional information about the Department of Psychiatry and Behavioral Sciences, which also supported this work, is available at http://psychiatry.stanford.edu/

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Celebrating its 20th anniversary in 2011, Lucile Packard Children's Hospital is annually ranked as one of the nation's best pediatric hospitals by U.S. News & World Report, and is the only San Francisco Bay Area children's hospital with programs ranked in the U.S. News Top Ten. The 311-bed hospital is devoted to the care of children and expectant mothers, and provides pediatric and obstetric medical and surgical services in association with the Stanford University School of Medicine. Packard Children's offers patients locally, regionally and nationally a full range of health-care programs and services, from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit www.lpch.org.

David. A Case Study from the Snowdrop Programme.

David is a little boy who literally could not stop.  When I first saw him in the village hall just a year ago, he simply ran and ran until he was exhausted.  He was so overactive and unpredictable in his behaviour that mum and dad did not take him out much, simply because they couldn’t control him.  He also had terrific sensory processing problems.  If anyone sang, or clapped, or whistled, David would overreact wildly as if terrified or as if he was in pain.  In addition to this, upon examination, he was very oversensitive to tactile stimulation in all his limbs.  Also David never slept for more than an hour. At two and a half years of age, mum and dad were obviously keen to try to calm him down in preparation for entry to nursery.

On my first assessment of David, I spent most of the morning chasing him to try to pin him down long enough to perform various tests / observations, which isn’t an unusual situation in itself as I find myself in such a pursuit of various children, but David’s level of activity was bizarre.  Finally after much chasing and wrestling, my work was done and mum just looked at me and said, “what on earth can we do?”

The programme which I instituted was based upon the ‘opponent threshold theory’ – The research which supported this theory seemed to suggest that in some children in order to reduce the level of activity of a particular neurotransmitter system, it was necessary to stimulate that system beyond a certain threshold of activity.  The programme activities were designed to do precisely this.  The repetitions of those activities would serve as a basis for stimulating brain plasticity, - encouraging the brain to make new connections within this normal framework of activity.

Now mum and dad are the type of people who will readily admit that they go away and hibernate.  Although they still regularly see me to this day, they take the programme and go away never to be heard from for the next four months.  This is fine, the last thing I would wish to do is to impose myself upon anyone’s privacy.  So the next time I heard from them was four months later when they made the appointment for their reassessment.  I was a little dubious because I thought mum sounded a little cagey on the telephone and I was thinking that maybe very little progress had been made.

The Friday morning of their first reassessment arrived and I waited nervously for them to enter the village hall.  I was expecting to have to chase David down again and had joked with Janet, my wife that I had a lassoo in my bag.   I was overjoyed when David walked in holding his mum and dad’s hand.  Just looking at him you could tell he had lost that ‘frantic’ overactivity.  He came to the table, took a tesco bag of his mum and emptied his Mr Men books onto the table.  This child who four months earlier had not produced any language which I could recognise then proceeded to tell me the titles of the books.  He was making good eye – contact, paying appropriate attention to me and was just so much calmer.

Dad said that when they left after their initial assessment four months earlier, he had been sceptical about the programme and what benefit it would have, but that all of that scepticism melted away when they got home and after one particular activity David had just immediately calmed down.  He slept for several hours that first night for the first time in months and with the addition of a weighted blanket, was now sleeping consistently well.  His auditory processing problems had also dissipated to the point where mum no longer had to dive for the remote control to change channel every time there was singing on the TV.

David still has problems and I still see him to this day, but these problems are now minor compared to a year ago and we are steadily making inroads into them.  He now speaks in four word sentences, mum and dad can take him out and his learning abilities are progressing nicely now he isn’t being hindered by lack of sleep, an inability to attend and sensory processing problems which were simply preventing the correct environmental information from being processed in the brain.  David is heading in the right direction and will have no difficulty in being accepted into a mainstream nursery and school.