Richard Jacobs:  Hello. This is Richard Jacobs with the future tech and future tech health podcasts. I have Lindsey Biel, she’s an occupational therapist and author of a couple of books. One is “Sensory Processing Challenges, Effective Clinical Work with Kids and Teens” and another one, she’s the co-author of “Raising a Sensory Smart Child”, which is a forward by Temple Grandin. So Lindsay, thanks for coming. How are you doing today?

Lindsey Biel:  My pleasure. I’m so happy to be here. I’m great, thanks.

Richard Jacobs:  Well good. Well, tell me about your work, dealing with kids’ sensitivity to stimuli, what’s that about?

Lindsey Biel: Okay. Well, I am an occupational therapist and I work with kids, adolescents and young adults in their homes and schools on a variety of issues, that affect their participation and learning and playing and socializing. And that includes fine motor skills, gross motor skills, visual perceptual skills, self-help and self-regulatory skills, and perhaps most important importantly or fundamentally underlying sensory processing skills, which kind of formed the foundation for all the other skills. And so a lot of kids with, what I call neurotypically developing children have sensory sensitivities that impact their everyday lives. You know, sensory sensitivities kind of are on a continuum from like the little quirky things that all toddlers have on the likes and dislikes, the preferences and intolerances that we as adults also have. Those are kind of at the mildest end and I wouldn’t even call that a disorder. It can range all the way from there to a more significant and ultimately disabling to some degree, sensory problems that we see a lot in autism and developmental disabilities and so on. And what these look like, depending on where you fall on that sensitivity spectrum, it could be extreme sensitivity to certain textures of clothing. I’ve worked with children who will only wear like one pair of leggings and one t-shirt. Anything else is intolerable for them. They can’t handle, seems in their socks. Certain sounds are really painful to their ears and it’s not necessarily because it comes in too loudly. It’s just the frequency of the sound. Like a hairdryer or a vacuum cleaner is just exquisitely painful to their super-sensitive hearing. A lot of these kids have an unusually high or unusually low threshold for pain. They may be able to see and hear fluorescent lights as they flicker on and off. I actually can see that myself. So, it’s always this extreme sensitivity. It can fall anywhere on that spectrum. A lot of the kids that I work with have very low muscle tone and muscle tone refers to the state of the muscle when it’s at rest versus muscle strength, which is the state of the muscle when it’s in use. So when a child is at rest, just sort of sitting in a classroom chair, for example, they sort of melt into gravity and ended up being those kids that are like sprawled all over the table or rolling around on the floor during circle time. A lot of the kids that I work with move awkwardly or they seem kind of clumsy or accident prone because they’re not getting good feedback from the muscles and joints of their bodies.

Richard Jacobs:  Quick question. What do you think is the underlying cause of these sensitive to certain stimuli sounds or other things or, like you said, being floppy and flopping all over the place and having accidents like that going down?

Lindsey Biel: Okay. So most of us first learn about the world through our senses, right? A little baby moves through space, sees things, hears things, uses their body and learns the limits of their body and the outside world. And it’s a process. Sensory processing is how we transform those bits of information into like messages that we know how to act on. Now some people because of how their nervous system is wired, meaning their brain and their body, they don’t take in and use that information in quite the same way. And there’s lots of science behind this where they’re finding that there’s a difference in structure and function of, I’m going to get a little technical here, in the white matter brain tracks in the back of the brain, the posterior part of the brain where the activity is different, the brain fibers are working in a different way. So the connectivity in parts of the brain isn’t happening in a typical way. There are also differences in the sympathetic and parasympathetic nervous system. So it’s kind of to oversimplify. It’s a difference in wiring. So it’s not faulty wiring, it’s just a difference in wiring. So some people end up being hypersensitive, over-reactive to all kinds of sensory stimuli. Other people are under-reactive or hypo-reactive to some of that stimuli. And some people are mixed. It depends on how well they’ve slept, how well they’ve eaten, how much stress they’re under.

Richard Jacobs: Well, what do you call it when someone has a, I guess the light version of this, what is a pet peeve? And a strong version of it is someone who yells and screams when they have certain stimuli or let’s say they cover their head or just, I don’t know, they freak out. Are there words to characterize the levels of the spectrum of response to stimuli?

Lindsey Biel: Well, you know, it becomes a disorder when it interferes with daily function. So if I’m in a restaurant that’s really noisy and I can’t hear the person I’m with, I get kind of annoyed and grouchy and I may stop talking so much, I may just give up on that. That’s just like common every day versus someone who hears a loud or unexpected sound and screams and freaks out. I guess we could talk about, you know, human experience, just daily life experience, and its extremes. So, mild common versus at the more extreme dysfunctional disordered.

Richard Jacobs: Well I guess in my experience, I have pet peeves. Everyone does. Like I hate whispering. People make fun of me for it and my wife hates computerized voices and I make fun of her for that. So I guess society probably isn’t very nice to people about their pet peeves and when it escalates to a higher level, my guess is that they’ll say what’s wrong with that person and be judgmental. So it’s probably unfortunately not an easy thing to deal with for anybody at any level, especially if it’s pretty impactful.

Lindsey Biel: That’s right. And as adults, we’ve learned how to find a partner, who doesn’t whisper, for example, who knows who respects our quirks and a job where whispering is not an issue on the job. You know, we’re able to create a life for ourselves where we can manage our pet peeves for the most part. But for a kid, those pet peeves, there’s a lot of bullying, a lot of teasing that goes on. We all know this from our own childhood. And of course the more sensitive the child is, the more prone they are to difficulties like that. I have pet peeves too. I can’t stand fluorescent light. It makes me crazy and as the author of two books and I’ve been in this field for over 20 years, I teach a lot of workshops and people now know when I go back to teach a workshop that they need to make sure there are no fluorescent lights going right into my eyes or I’ll get a headache. So it’s like we learn how to communicate our likes and dislikes and work around them, hopefully.

Richard Jacobs:  So with teens and kids, what kind of interventions can you make or we can you do to help the kid to understand what’s going on and that there’s nothing wrong with them. It’s just how they’re unique and how do you help them?

Lindsey Biel: I love that question because that’s what it’s all about. And that’s what parents and therapists and teachers need to be doing. I’m going to give you an image and the image is of going to a picnic with a paper plate in your hand and you go and you take a hot dog and you put that on your plate and you get some potato chips and put that on your plate. Then you take some, coleslaw, put that on your plate, everything’s fine. But then you take some potato salad, you put it on your plate and your whole plate falls apart. And that’s what our nervous systems are like, right. So as a therapist, teachers, and parents, we all need to figure out just how much we can put on a person’s paper plate, their nervous system before they’re going to fall apart. And at the same time as a therapist, I need to start building a stronger paper plate. And that means how do I do that? Right? It starts with an assessment. I need to figure out what is going on with that person, what are their strengths, what are their challenges, what’s going on? And I do that through a professional assessment. I do have screening tools on the sensory smarts website. If people want to take a look at those, print them out, build them out for your kid, for yourself. They’re not standardized, so this is not something that is scorable, but it’ll give you an idea if there is indeed something going on and what it might point to. So once I know what’s going on with a child, I can customize a treatment plan and that may be reducing some of the stuff I’m putting onto their plate. That might mean having them, for example, wear sound reducing headphones, noise-reducing headphones and in crowded, noisy situations like going to the shopping mall is intolerable for a lot of people. I can’t stand it, so taking that intense sound off their plate and if you have hypersensitive hearing, if you put sound-reducing headphones on, all it does is reduces the sound to a normal noise level and I’m using that word normal a little bit. I don’t like the word normal, but a typical as expected noise level,

Richard Jacobs:  For that person it’s normal.

Lindsey Biel: Right. So also a great thing is the vibes hi-fi headphones, sorry, earplugs. That again gives you the full range of sound but just reduces the volume level and that becomes more bearable for a person. So this is taking stuff off the plate at the same time. I want to make that paper plate stronger and I’m going to do what’s called a therapeutic listening program and that would be having the person listened to specially engineered music, two times a day. Let me simplify it. The same way you would exercise weak arms, right? The muscles in your arms by doing exercises. I’m going to exercise the muscles inside the ear so that the person’s more able to, strongly manage, a wider range of sounds. I’m going to do both and do that across the board in all settings.

Richard Jacobs:  So, do people have different sensitivities that come out only at different stress levels?

Lindsey Biel:  Yeah, I mean, stress is a huge factor in sensory issues. Often a child will do wonderfully well one on one at home, right? They’re doing fine. They can do everything but put them in a classroom setting and they really have a hard time or take a child to a busy birthday celebration and they have a hard time. So if a child is upset, I mean, we know from our own life experience, if you’re upset about something, everything is going to be more extreme like dealing with a problem at work, your coping skills just go, you know, way south when you’re stressed out about other things. So stress is a very important trigger for a lot of these sensory issues. And when we think about stress, stress generates neurotransmitters in the brain and body making it much harder to stay calm and well-regulated in order to tolerate things.

Richard Jacobs: What about if a child or a teen has certain stresses, if they’re not addressed, does that predispose them to have more, or having other problem? So is it important to deal with this?

Lindsey Biel:  Untreated stress is toxic, really toxic. We know that long-term stress can result in physical exhaustion, poor sleep, poor learning, and poor coping skills. So yeah, we need to deal with stress. Absolutely. It makes everything worse.

Richard Jacobs:  Okay. This is important because it’ll cascade all kinds of other health problems, even though they seem unreasonable or silly or inexplicable or any other number of things to outside observers of a teen or child’s behavior.

Lindsey Biel:  That’s right. That’s right.

Richard Jacobs: Is it very difficult to intervene? I mean, does it depend on the case? So there are certain kinds of irresistant to help or is it just thinking and evaluating and trying to understand what’s going on with this person?

Lindsey Biel: Yeah, you’re talking about sensory issues. I mean, again, it’s a spectrum. So a lot of kids do grow out of their sensory sensitivities, especially with understanding help. They do kind of, you know, move on and their nervous systems mature and evolve. Other people have lifelong sensory issues and it becomes more a matter of knowing, I really feel horrible if I don’t go to the gym. If I don’t get a lot of body awareness input and vestibular movement input into my body, I’m going to have a lousy day. So you learn how to meet your own needs as self-awareness develops. So my goal, especially with older children is to be like, I feel terrible right now. What’s going on? What’s happening in my body and what tools do I know I can go to? What am I go-to strategies for feeling better? Right. It’s all about self-knowledge. Now someone with autism may have more extreme difficulties throughout the lifespan and hopefully, they too have gotten good intervention and powerful tools they can use to feel better. So some people outgrow it, some people do not.

Richard Jacobs:  How do you see that parents view sensory issues? Do they just fear that something’s wrong with their child or their child has, did they fear just, an autism diagnosis for instance? Or do they just dismiss it or what kind of reactions have you seen and looked at? What’s the range of them from parents?

Lindsey Biel: Well, it’s interesting. I have a couple of thoughts on that. The first one is I have to address the autism thing head on. When a parent goes to the Internet, it’s like touch sensitivity or sound sensitivity, inevitably autism comes up because it’s the most extreme version, we see the most extreme sensory issues in autism generally speaking. Just because a child has sensory processing difficulties, most certainly does not mean that they have autism, but if a person has autism, they most likely do have sensory issues. So parents are terrified when their child is, biting their hand or flapping their hands or running around in circles or even lining up toy cars, it’s like, Oh, this must be autism, you know, and some helpful in law or neighbor is like, Oh, I think your child is autistic or they look it up on one of the parent chat-boards. There’s a lot more to autism. There are deficits in communication and the ability to share interests. So there’s a lot more to autism than the sensory issues. Now, parents, they get the hypersensitive child. They can recognize that as a problem, the hypo-sensitive, the sort of under-stimulated child that is sometimes harder for parents to recognize what it is. Like if you’re a child is holding her hands over, ears screaming, it’s too loud. Get me out of here. That’s a pretty clear message. But for the child who just kind of zones out, who tunes out or shuts down, that’s much more difficult for a parent to recognize. So, they have a hard time with that and what kids do when they’re under sensitive, they’ll tend to, because they want to engage or rev themselves up and because their nervous system is functioning so poorly, they start to look like hyperactive kids because then they become hyper-motoric. They can’t stop moving once they get started and that just speaks to a really poorly functioning nervous system. What I do also see is a lot of parents who see their child and start to do some research and think, oh, he’s really doing poorly in school. It must be sensory or he’s not behaving the way I expect him to. It must be sensory. Sometimes that sensory processing disorder diagnosis feels more palatable for a parent then perhaps an autism diagnosis. So you know, sometimes the parents are eager to obtain that diagnosis. And when they really should be looking at anxiety and autism, there are also interrelated. I know it’s very confusing for parents. This is why getting a professional evaluation is essential. That will help to clarify what’s going on, what needs to be explored further.

Richard Jacobs:  What about when the teen and kids are in public schools, do the public school system seem to help or do they just want to come in and do like an autism diagnosis, they misdiagnosis or they just say, oh, it’s ADHD and let’s give the kid medicine. I mean, how does a school interact typically in a good or a bad way?

Lindsey Biel:  Well, the school should not be doing any diagnosis. Right. So, the way to get a proper diagnose is really outside of the school system, the school may have a child psychologist that they work with and so they may get diagnosed that way. I do recommend to parents if possible to go to a developmental pediatrician outside of the school system and find out what’s going on, get a psycho-educational evaluation so that parents and educators can find out exactly what’s going on and what the child’s learning strengths and challenges are and then meet that. Unfortunately, insurance companies and schools are positioned. The way things are set up right now is if you have an autism diagnosis, the door opens to a huge amount of services in terms of getting a lot of occupational therapy covered, physical therapy covered and most especially, um, educational support covered. So, it all depends on the school. I can’t speak nationwide about what’s going on with schools.

Richard Jacobs:  Well, very good. So, what’s the best way for parents and for people that feel like they interact with someone that has sensory issues to find out more? Where can they get your books? Where can they contact you if they want to?

Lindsey Biel: Okay. Well, parents, you can go to sensorysmarts.com. You will find a downloadable sensory checklist. You’ll find a lot of information about sensory difficulties as well as strategies. Some of the best techniques for working with schools right there on the website for free. You’ll also find a load of webcast and magazine articles. Nothing touches what’s in my books and you can find both of my books in most bookstores as well as on Amazon and other online booksellers. You can just, you know, follow the links on the sensory smarts website, the book-length to get that information. You can also follow me on Facebook, on the Raising a Sensory Smart Child or sensory processing challenges page. And if you have any questions, want to get in touch with me directly, you can email me at info@sensorysmarts.com. Got to put an “S” at the end of it so it’ll get to me and I’d be happy to speak.

Richard Jacobs:  Okay, well Lindsay, thanks for coming on the podcast. I appreciate it.

Lindsey Biel:  My pleasure. Thanks for having me. Bye