What you need to know about sensory processing disorders [PODCAST]

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“Understanding and recognizing sensory processing issues may help improve functioning and quality of life for many individuals, starting with children in school. While many are preparing for back to school, it is important for parents, teachers, health care providers, guardians, and policymakers to be aware that millions need funding to get the care they need to succeed.”

Lisa Yeh is a psychiatrist.

She shares her story and discusses her KevinMD article, “Let’s address the needs of millions of students with sensory processing disorders.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we welcome back Lisa Yeh. She’s a psychiatrist, and her KevinMD article is titled “Let’s address the needs of millions of students with sensory processing disorders.” Lisa, welcome back to the show.

Lisa Yeh: Thank you so much for having me back. It’s a pleasure to be able to talk with you again and with your listeners. So I wanted to start off with a little bit about who I am. I am a psychiatrist, and I’m also a child and adolescent psychiatrist. I am the medical director of an autism center at Rush University Medical Center in Chicago, and for almost 30 years now, I’ve really been working with children with autism and any kind of neurodevelopmental disability. I started off at Children’s Memorial Hospital, which is now called Lurie’s Hospital, and from there I moved into Illinois Masonic Hospital, which is also in Chicago, at the Pediatric Developmental Center. Then since 2018, I’ve been part of the Rush University Medical Center family.

Kevin Pho: So take us through a typical day of what you do. What are some common cases and common treatments that you would do in the exam room?

Lisa Yeh: Since I predominantly work with people who have autism, I specialize in people who actually have more difficulty and significant impact from their autism, but I also see a range of people who have higher cognitive and higher verbal abilities. The clinic that I work in is a lifespan clinic, so we see people from zero to whenever. My youngest child right now is two years old, and my oldest is 76 years old. So I can see the impact of things over a lifespan, and I am very aware of how important it is to get early types of treatment and early recognition of things, and, if it wasn’t done at all, of just how much it impacts them in adulthood and their ability to function, whether it’s in some sort of a job, in their relationships, or even in day programs or residential treatment, anywhere that the adults are going into. So it’s making sure that we recognize early on some of the issues that are going on.

I also do a lot of training for medical students, residents in psychiatry, and developmental pediatricians, as well as fellows in child and adolescent psychiatry. One of the things that I see is that there is this difficulty in separating out sensory issues from autism. Everyone thinks that if you have a sensory issue, it must be autism or some other sort of neurodevelopmental disability, but that’s not the case. There are people without autism, or without a neurodevelopmental disability or any type of disability, who also have a sensory issue, and it is really important that we don’t forget those kids who have those issues.

Kevin Pho: So give us a definition of a sensory processing disorder.

Lisa Yeh: What a sensory processing disorder is: We have five senses, and there’s either a heightened sense of one of those five senses, so sight, smell, touch, hearing, things like that, or they have a lower sense of it. So they can be either what we call hyperaroused, which is a heightened sense of it, or in hypoarousal, which is that lower sense of it.

What happens is that if they’re hyperaroused, certain noises may just set them off, and they get really agitated by it. For non-autistic individuals, one of the things that people might see is that they think their parents are yelling at them, and their parents aren’t yelling at them. They think that somebody has a really mean tone with them when they don’t have a mean tone with them. They’re just super sensitive to those little nuances of our tones, so they misinterpret them in a way. Other types of things are that they can’t sit in circle time in school or be in the middle of a line, and they seem to get really out of sorts by that. Or sometimes, I’ll say, the lights are too bright in the school, or sometimes, even in the offices, they just can’t stand the typing of the computers or something like that. For people without any sensory issues, that doesn’t seem like it should be an issue, but people are getting agitated because of even slight increases in sensory things.

For the hypoarousal, those low-arousal types of people, they need sensory input, something strong, to help perk them up. One of the things that I do is that I specialize in looking at whether people have autism or not, this kind of confirmation of the diagnosis. A lot of the kids who come in have symptomatology that looks like they have autism: They don’t have good eye contact, they are not communicating very well, they don’t really know how to make friends, and they’re not enjoying all that kind of back-and-forth type of relationship as much. But when I see them, they look really low-arousal; they look low-energy. If I give them input, so I have them jump around or I have them run around, then they look at me, and they perk up, and they interact, and they do what they should be doing in a non-autistic way. So that is one of the things: These kinds of kids are sometimes just passed off as having autism or some other type of disability, and really what they have is a sensory issue, and they just need that kind of input to perk them up and get them engaged in the world.

Kevin Pho: So you talk more about this in your KevinMD article titled “Let’s address the needs of millions of students with sensory processing disorders.” Now, for the parents out there, how can they tell whether to bring their children in for a potential sensory processing disorder? How would they present? What are some of the things that they should look out for?

Lisa Yeh: If they’re concerned about those social communication things, that the kids seem really low-energy, that they’re not really getting things done, and that they don’t seem to be looking at them or making lots of eye contact with them, I would say look at whether, if you can just have them do it, they enjoy sports like basketball, swimming, or yoga, things that have lots of input and activity level, and whether that makes them look more excited and happier, but when they’re not doing it, they don’t seem to be connecting with people. I would say to ask their regular doctors to do an evaluation for that. There are some screeners that they can do. There’s the Short Sensory Profile, which just takes a few minutes to do, or they can refer them for an evaluation through occupational therapy.

For those who are more hyperaroused and hypersensitive to things, these are the kids that I tend to see are more reactionary. They get upset over something that doesn’t seem like it should be getting them that upset. A lot of times, these are very dysregulated ADHD kids who seem to get really super angry about something, and you can’t figure out why they’re getting angry about it. So if the parents think about it, when we have a high arousal level, it’s over the top already. If they had a normal arousal level, a little bit of something getting them upset would still be well within the range of manageable, but if they are already hyperaroused and over the top, that little bit puts them over the top even more. So they seem really reactionary. Those are the types of kids where oftentimes clinicians will say, “Oh, we just need to medicate them because they have a mood disorder,” that type of thing, and really what it could be is that they have a sensory issue. That can then be evaluated to see if that’s the case, because then we don’t necessarily need to go toward medications to help with that, and sometimes we can really help kids learn how to self-regulate.

Other things that we may see are that kids bump into people. I see a lot of parents yelling at their kids, “Stop bumping into me,” or “Don’t bump into that.” That may be a sign that there might be something going on, that they’re trying to naturally get their own sensory input, because bumping, pounding, and breaking things actually is sensory input that helps regulate their sensory system. So sometimes these kids look like they’re doing negative behaviors when all they’re trying to do is help calm down that sensory system for themselves.

Other things that we may see are really disrupted sleep. They just move around a lot in their sleep and just can’t seem to settle, or they need tons of weight on them to be able to settle and sleep, or they are really sensitive to temperatures and they can’t sleep because of the temperature. Sometimes those types of kids may also have a sensory issue, and that can be looked at, because there are some sensory soothing things that we can do before bedtime to help soothe them, and once again, we don’t necessarily need to give medications for that.

Kevin Pho: So if they present to you in the exam room, give us a spectrum of some of the things that you would do for them. How effective are these treatments?

Lisa Yeh: When I start to suspect that there could be some sensory types of things, I will do that Short Sensory Profile for them. What it asks is: Are they having sensitivities to noise? Do they ever cover up their ears? It could be things more typical, like fireworks, school alarms, things like that, but they tend to do it over the top of what we would normally expect. Or sometimes sensory kids really like to make tons of noise, but they can’t tolerate anyone else’s noise, and that’s the other type of thing that I’ll ask about, because sometimes they’ll say, “Oh, no, they don’t have a sensory issue. They have the TV on so loud, and they speak so loud.” But they can’t tolerate it when I speak or when we play music or the TV is on or their sibling is talking or anything like that. So we can see them doing their own really loud noise, but they can’t tolerate anyone else’s noise, and I ask about that type of thing.

I’ll ask if they’re sensitive to smells at all, or to touch. Do they seem to get more heightened and agitated then? Can they stand in line? If they’re younger, can they do circle time? Do they get upset and agitated when there are more people in the room? So I go through those types of things, and then in an exam, I’ll try out a few types of sensory input. For instance, like I was saying, I may have the kids jump around a lot or have the kids run. The chair in my office is one of those typical office chairs that you can swing around, so sometimes I’ll bounce them in that chair or swing them around in that chair and see if that helps settle them for a bit. So with some of these really dysregulated kids in my office, I’ll try to see: If I give them some sensory input, can they sit for a while? Are they able to look at me and talk to me better? Are they less agitated? Do they seem more comfortable? A lot of times they feel a little bit out of sorts when I’m seeing them, so let’s see what happens when I give them that kind of sensory input.

Kevin Pho: So what proportion of the kids who are initially dysregulated are treatable and can eventually lead normal lives?

Lisa Yeh: Well, I think if we recognize what those sensory issues are, a lot of them improve significantly when they have the appropriate sensory input. Also keep in mind that as kids develop, their sensory needs may change developmentally, and so they may need sensory input. Sometimes I’ll hear parents say, “Oh, it used to work, but now it no longer works.” It just means that their sensory needs have changed, and you just need to go back and get another evaluation. But I would say that for the majority of the kids that I see, there is some improvement. Sometimes it’s significant, sometimes it’s night and day, and sometimes it’s just a mildly better sense for themselves, but I do see an impact for the vast majority of the kids that I see.

I particularly see that when they’re non-autistic, because their world is very different, and it is easier for them then to be seen in the way that they’re working. So I think the supports out there improve for that, whereas unfortunately, with a lot of my autistic patients, people tend to just say, “Oh, that’s just autism.” So even though they recognize that they have sensory stuff, they don’t necessarily do all of the kinds of supports that they need, because they just say it’s autism, and then they forget to do that. But with the non-autistic individuals, once they figure that out, people really support it and work on it and help them improve. So I do see that it really changes a lot of kids’ lives, especially with friendships, because these dysregulated kids don’t necessarily have those boundaries, and they’re too impulsive, potentially because they have ADHD as well. Then other kids start to avoid them. Other kids don’t want to be around them. They rough-play too much, and some of the other kids can’t get involved with them. So it improves their ability to socialize and make good friends, and it helps them with their self-esteem, if we are addressing the needs that they have.

Kevin Pho: We’re talking to Lisa Yeh. She’s a psychiatrist, and we’re talking about her KevinMD article, “Let’s address the needs of millions of students with sensory processing disorders.” Lisa, what are some of your take-home messages that you want to leave with the KevinMD audience?

Lisa Yeh: I think it’s really important that parents in particular are really aware of some of these possible sensory issues that their kids could be having, and that they are paying attention. Oftentimes these kids get medicated, and it’s just not quite right, or they’re on multiple medications. Start thinking about this as a possibility. Bring it up with your child’s doctor, and maybe even talk to the school teachers and see what they may have noticed in the classroom, to start getting information about whether this could be a true issue for your child.

As far as adults go, I would have to say that if you’re noticing that it’s hard for you to keep a job, or it’s hard for you to be in the workplace because there are too many people in the room, or you feel uncomfortable with the lighting in your office, or you feel really out of sorts, think about this as a possibility as well, and go get an evaluation. Like I said, occupational therapy can do the evaluation for it. Not all occupational therapists are able to do this evaluation, so make sure that you are going to one who is trained to recognize this and then get a treatment plan for what might be helpful for you.

Kevin Pho: Lisa, thank you so much for sharing your time and insight. Thanks again for being on the show.

Lisa Yeh: Thank you.

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