I had the great pleasure of interviewing Dr. Rex Birkmire today, a psychiatrist who works a great deal with children that have sensory processing disorder. He has a nursing degree from the University of Virginia, and completed his training at the Cleveland Clinic. He then attended medical school in Cleveland and completed his residency/fellowship at Harvard. He continued to work there as the Co-Director of Psychiatry and the Law. He now has two private practice clinics in Orlando and Jacksonville, Florida.

Dr. Birkmire first became aware of sensory processing disorder when a Hispanic mother of two girls came into his office asking him to be open to her daughters’ being diagnosed with a condition called Sensory Integration Disorder. He listened to her list of symptoms in interest and decided to further research this information. Once he looked into this condition more, he was able to reach out to the parents of four other boys in his practice, and provide them with information in order for them to get help. He recommended they start by reading the Out-Of-Sync Child book, by Carol Stock-Kranowitz.

Dr. Birkmire now classifies Sensory Processing Disorder as a “neuro syndrome” in which 50-80% of the treatment is Occupational Therapy for sensory processing treatment. Children that come into his office have moderate to severe symptoms, enough for the parents to feel they need to see a psychiatrist. Common symptoms include: not sleeping, mood problems, anxiety and behavioral problems. Dr. Birkmire has the parents complete a 10-page questionnaire, with one page that solely looks at sensory symptoms. In his experience about 80% have insomnia, 80-90% have attention issues, almost 100% have anxiety, and 70-90% have a mood disorder (like depression or bipolar disorder). He often uses 1-2 medications to stabilize these children so they are better prepared to start occupational therapy services to address their sensory processing difficulties, and so the family is less stressed in the meantime. He spoke about the powerful use of Seroquel used as a mood stabilizer and a support to help children be able to sleep.

Dr. Birkmire is certainly in the minority at this time for being a psychiatrist that understands and treats sensory processing disorder. He stated that the assertive doctors and the doctors that have kids with SPD are the ones who understand it at this time.

Dr. Birkmire is working on an internet-based book that will address the history of sensory processing disorder and it getting recognition in the medical community, reimbursement for this disorder and the neurology of this disorder. This will be an excellent resource for other medical professionals, so we should all look forward to it’s release!

If you are a struggling parent out there looking for guidance, Dr. Birkmire recommends: searching the internet for information; interviewing specialists you think may be helpful to your child and making sure they have additional experience in treating SPD; as well as finding a support group in your area as you are not alone!

Please tune in to this episode if you would like to hear more on this topic from Dr. Birkmire, and some of his success stories with treating children that have sensory processing disorder!

He can be reached at: www.gobbh.com or by calling Birkmire Behavioral Health at 407-332-6506. You can also find his seminars online at www.sensoryresources.com for which he is currently presenting 1-day seminars in tandem with Carol Stock-Kranowitz.

Thank you Dr. Birkmire, you are an amazing wealth of information on Sensory Processing Disorder and a great asset to the field of medicine!

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One of the biggest challenges we face these days are hidden sensitivities or allergies to our environment as our immune systems aren’t what they used to be.

Do you remember being a child and playing outside for hours at a time until the street lights came on? Riding bikes, playing hide and seek, getting dirty without the stress of time limits or homework? It rings a bell for me!

Now days we have children who are more intelligent and who are acting out more, with a growing list of behavioral symptoms reported by their parents and teachers. Parents then have the big task of figuring out what to do about these behaviors. Our job is to figure out the root cause.

When children come into our office for an evaluation, we discuss their development, starting from birth. It often comes up that our clients were irritable as an infant. If they were fussy after eating, had abdominal discomfort and/or needed to switch formulas (often from milk to soy, and then to other hypoallergenic formulas if needed), then they seem to fit into what I call “the allergy category”. If they constantly needed to be moving (held, bounced, rocked, or driven in the car) or left alone to calm in a quiet or dark place, then they seem to fit into “the sensory category”.

A history of ear infections and chronic congestion are other alerting symptoms that are in my allergy category. These concerns in particular can turn into sensory as well as speech and language disturbances. When the muscles of the middle ear (that sit next to the ear drum) are affected by fluid or scar tissue, then these muscles are not able to do their job well- to protect our ears from sounds! Then you see children who respond to loud sounds as a threat, or deep tones (like vacuum cleaners, blenders, public toilets flushing and hairdryers). This can be addressed by occupational therapists using auditory integration training programs to exercise the ear muscles back into shape. Speech and language development can also be affected as children can not be expected to hear and speak clearly if they perceive sounds and words from behind a fluid filled ear, as if they were hearing people talk underwater. Sometimes these symptoms are apparent when a child shows visible signs of congestion, a frequently runny or congested nose, or signs of ear pain. These symptoms should always be discussed with your child’s doctor. They should also see an Ear, Nose and Throat physician if these symptoms persist.

Children who are often irritable, don’t like being touched, or who are sensitive to certain types of clothing can appear to have tactile hypersensitivity. This is when the brainstem sends too many alerting messages to the brain, causing the person to react in a negative or distressed manner. A sensory integrative treatment approach would be useful here unless these children have a history of eczema, dry skin, rashes or hives, which now places them into my allergy category. I have seen children with these symptoms improve dramatically, if not completely, when milk and sugar are avoided in their diet (for at least 2 weeks as a trial period). They are often sensitive to chemicals on their skin as well, including chlorine from unfiltered water and swimming pools, pesticides sprayed inside our homes and on our grass/playgrounds, bleach products used for cleaning, antibacterial products, soaps, air fresheners, polyester blends of clothing and laundry detergents (just to name a few)!

The behavioral responses seen in children can look the same here when their sensory symptoms are assessed without considering their medical history.

There is yet another group of symptoms that fit into my allergy category that are not considered medical allergies, but chemical sensitivities. These are food dyes (especially red dye #40), artificial ingredients (like sweeteners) and preservatives. We can find these ingredients in almost every product in the grocery store that is packaged and found on a shelf. Children who have sensitive nervous systems react to these ingredients by being hyperactive, impulsive, distractible, overly silly and/or more emotionally reactive. They often have a harder time calming down and may have a strong desire to consume these foods. From a sensory perspective their behaviors can be the same as a child who has a sensory modulation disorder. This is a condition in which the brainstem cannot regulate incoming sensory information. We won’t know the root cause until we can see how their behaviors change when these children are on a strict diet that excludes these artificial ingredients. If this applies to your child then try to live by the motto “if I can’t pronounce the ingredient, then my child should not be eating it”.

The most helpful suggestions I’ve seen work successfully in our office are:

1. Replace the use of harsh cleaners with natural or organic cleaning products. Baking soda and vinegar are great and inexpensive household cleaners.
2. Try to buy organic foods whenever possible, to avoid ingesting chemicals and pesticides that have been sprayed on our produce and wheat before processed.
3. Wheat and dairy products should be avoided when congestion/ear infections are present, dark circles under the eyes are seen or when the child’s stomach protrudes.
4. Continue to substitute milk products if your child was sensitive to them as an infant. You may see that they are tolerated without a strong digestive response as they get older, but they seem to have other symptoms that arise such as being constipated, irritable, hard to wake up or more reactive, behaviorally.
5. Watch your child’s intake of sugar if they are hyperactive or distractible. Natural sugars from fruit or raw sugar will not cause such extreme behavioral changes as the artificial sweeteners and sugar-free products that flood our grocery stores. Monitor your child’s activity level based on the foods eaten.
6. Children who are on a good multi-vitamin and an omega fatty acid supplement appear to have better nervous system support for self-control, good behaviors and better attention for learning.
7. Children who eat protein in the morning seem to do better with controlling their behaviors and attending longer throughout the school day. Sugary breakfasts work in the opposite direction. When I have clients that are sensitive to sugar, I can tell what kind of breakfast they ate within a few minutes of working with them. Eggs with cheese, protein drinks and lunch meat roll ups are some of the safe foods I hear about that are eaten for breakfast.

I will be sure to interview a variety of experts on this topic in upcoming podcast shows.  Best of luck on your venture to good health and sensory processing!

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Feeling stressed? Not knowing what to expect or what to do when your child’s been recommended to start occupational therapy services? This episode is for all those parents and family members who are new to the world of sensory processing disorder. This can be a very overwhelming time, so I am going to share the most common questions I receive at my office, from new families inquiring about sensory therapy.

How long will my child need therapy?

It’s very hard to say how long a child needs sensory integration treatment, as all children and all people for that matter are made differently. In general, children usually require a few months at minimum to a few years to improve their sensory processing, and then any developmental skills that may have been delayed along the way.

How long does it take to see progress?

It should really take a few days to a few weeks to see improvements in your child’s sensory processing if he or she is starting therapy with problems in attention, calming and behavioral control (to name a few). You should see rapid progress in the first few months as you are learning what to do and what not to do from your occupational therapist in your child’s treatment sessions. After this general time frame, it’s expected that your child’s skills and performance will plateau some, but continue to slowly improve over time at a steady rate.

Is this something we always have to keep doing or will my child get better?

No! Children should be able to improve the maturity of their nervous system for greater sensory processing that stays with them for life. The goal of therapy is to improve your child’s processing so he or she can perform, and get through life in a functional manner. The goal is not for every child to leave therapy having the same skills, or fitting into the same box, so to speak. Once your child can blend in with other kids the same age (for handwriting, behavioral control, balance, attention, etc…) they may be done with therapy. Sometimes these children will fall apart more often with big life changes, when they are sick or when they are going through a growth spurt, but don’t worry, this typically passes when your child overcomes this obstacle. During these times of stress, it’s best to reincorporate some of the home activities your therapist recommended to you when your child was going to weekly therapy appointments. Children that are naturally hyper, full of energy or always stressed may continue to require age-appropriate activities completed at home or in the community, such as: always keeping your child in a physical sport (in order to have an outlet).

What do sessions look like?

Occupational therapy sessions with a focus on sensory integration treatments look like play! They are fun and motivating for the child, because the child guides the session based on his or her interests and internal body needs. There are some exceptions to this which may include times when children have behavioral or motor planning difficulties and they need more guidance and concrete directions throughout their sessions. Regardless, the child’s needs are still taken into consideration and the children that need this therapy, almost always want it, crave it, don’t want to leave and always want to come back! This includes kids that have very short attention spans and kids that are always fussy or throwing fits at home.

What is my role as a parent?

Okay parents, your job is to participate by coming into the sessions to watch, learn what the therapist does and why, learn what to do at home and to ask questions! True sensory integrative therapy is hard for many people to learn and understand, and it’s especially hard to explain to others. It looks like play, but the theory behind it is based on neurological processing and how different sensations are processed in the brain stem and interpreted in the brain.

How do I explain this to family and friends?

Be patient and ask your family and friends to be patient too. Again, it takes time to understand how all this play-based therapy helps your child get through the day in a pleasant manner and have the coordination skills he or she needs to keep up with peers at any age. Have your family come to a few sessions to ask questions and observe. The parent who doesn’t typically bring the child must also come to a few sessions at minimum to understand what on earth is going on and what their role is specifically in helping their child. If a nanny or babysitter takes the child to therapy or if sessions are completed at school as a convenience, then both parents need to make a big effort to show up on occasions, to get the full benefit of therapy. There are some good books out that explain sensory processing disorder, here are just a few, which all cost around $10.00 each:

-“Sensational Kids” by Lucy Jane Miller

-“The Out-of-Sync Child” by Carol Stock-Kranowitz

-“Answers to Questions Teachers Ask About Sensory Integration- by Jane Koomar

-“Raising A Sensory Smart Child”-by Lindsay Biel

What do I do about telling my child’s teacher and school?

Only tell people what you are comfortable with sharing. Consider everyone to be on a need-to-know basis. If you child is not doing well in school, behaviorally or academically, then it’s likely in your best interest to share this information with the school, so they know you are working hard to resolve these issues and that you are not living happily on your own island of denial. If your child thrives in school and becomes the Tasmanian Devil at home, then use your discretion in sharing information. Also, if your child use to have tremendous difficulties and is now starting school or starting a new school, try not to give them a long dark history of what you’ve been through to get to this point, so they do not have a negative image of your child before they get to build their own, unbiased opinion. You will be amazed at how well your child can do!

Be very encouraged, as there’s lots of hope for your child! Don’t give up and don’t let your child’s sensory symptoms go untreated if they are burdensome now, as life can be so much better for your whole family, if your child can get help now.

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Children with major behavioral problems or outbursts are easily identified as needing help. Where they get help is all relative to what services are provided and promoted well in town. Then there are many children who are not as easily identified as having processing difficulties due to the subtle or inconsistent nature of their symptoms. Whether your child’s symptoms are obvious or not so obvious, this episode is for you! Last week I talked about the common symptoms seen in children ranging from infancy to the 4 to 5 year old range.This episode is a continuation of last week’s topic, with a large list of symptoms that may be seen in children who are old enough to sit at a desk to learn.Symptoms seen in the school-aged population can be much more extensive since the expectations increase here for learning and paying attention.  This is not an “all inclusive” or definitive list, but it should help you figure out if your child would benefit from further testing.

If a group of these symptoms stand out to you, or if even one symptom stands out strongly to you, I recommend taking this list to your pediatrician and talking to him or her about your concerns. You can also contact a local occupational therapist who has additional sensory training and ask them questions, to see if a full evaluation would be warranted. You can listen to this podcast episode, to get more detailed information and explanations of symptoms in this wide age range.

Occupational Therapy School-Aged Checklist:

• Has trouble with cutting or tracing activities
• Has difficulty reading or copying from the blackboard (slow or labored)
• Has difficulty spacing letters as they are written
• Reverses letters more often than his/her peers
• Sometimes reads words backwards
• Eyes tire easily; frustrated with writing and/or reading
• Does not have normal hand dominance, or solid skill with either hand
• Gets right and left confused often
• Hyperactive, distractible, or poor attention span
• Has trouble holding his head up while sitting
• Becomes tired easily
• Frequently fidgets and/or shifts body position while seated in a chair
• Is not really good at sports or does not enjoy them
• Has difficulty with eye-hand coordination tasks
• Plays too rough; takes excessive risks during play
• Gets confused with directions or forgets
• Often stands too close to other people or bumps into them
• Moves too slowly or too quickly
• Becomes anxious when feet leave the ground
• Has an unnatural fear of falling or fear of heights
• Does not enjoy, or really craves movement activities such as exploring playground equipment
• Dislikes or craves rough-housing, somersaults, rolling on the floor or jumping
• Is threatened when other people move him
• Constantly touches or leans on people/objects
• Has not learned to do many self-help activities
• Has trouble putting on clothes, using buttons or zippers and putting on shoes
• Distressed with the feeling of certain clothes, tags, socks/shoes, hair washing &/or tooth brushing routines
• Picky eater; dislikes certain tastes or textures of food
• Craves certain foods; frequently mouths non-food items (i.e.- chews on shirt or pencils often)
• Does things in an inefficient way
• Appears weak or has low muscle tone
• Is accident-prone/clumsy (i.e.- spilling/tripping)
• Needs more protection than other children
• Is more emotionally sensitive; feelings are easily hurt; expresses not being liked by self or others
• Cannot tolerate upsets in plans or expectations
• Bruises, bumps and cuts seem to hurt more than they do with other children
• Is often stubborn or uncooperative; has frequent tantrums, meltdowns or emotional outbursts
• Has a strong need to be in control and a hard time accommodating others (peers /adults)
• Has a shortage of skills; has to practice each skill over and over
• Has trouble with pencil control; messy written work
• Lacks confidence with performance-based activities (i.e.- writing, playing games)
• Is slow or hesitant to learn new games or skills
• Has trouble with cutting or tracing activities
• Has difficulty reading or copying from the blackboard (slow or labored)
• Has difficulty spacing letters as they are written
• Reverses letters more often than his/her peers
• Sometimes reads words backwards
• Eyes tire easily; frustrated with writing and/or reading
• Does not have normal hand dominance, or solid skill with either hand
• Gets right and left confused often
• Hyperactive, distractible, or poor attention span
• Has trouble holding his head up while sitting
• Becomes tired easily
• Frequently fidgets and/or shifts body position while seated in a chair
• Is not really good at sports or does not enjoy them
• Has difficulty with eye-hand coordination tasks
• Plays too rough; takes excessive risks during play
• Gets confused with directions or forgets
• Often stands too close to other people or bumps into them
• Moves too slowly or too quickly
• Becomes anxious when feet leave the ground
• Has an unnatural fear of falling or fear of heights
• Does not enjoy, or really craves movement activities such as exploring playground equipment
• Dislikes or craves rough-housing, somersaults, rolling on the floor or jumping
• Is threatened when other people move him
• Constantly touches or leans on people/objects
• Has not learned to do many self-help activities
• Has trouble putting on clothes, using buttons or zippers and putting on shoes
• Distressed with the feeling of certain clothes, tags, socks/shoes, hair washing &/or tooth brushing routines
• Picky eater; dislikes certain tastes or textures of food
• Craves certain foods; frequently mouths non-food items (i.e.- chews on shirt or pencils often)
• Does things in an inefficient way
• Appears weak or has low muscle tone
• Is accident-prone/clumsy (i.e.- spilling/tripping)
• Needs more protection than other children
• Is more emotionally sensitive; feelings are easily hurt; expresses not being liked by self or others
• Cannot tolerate upsets in plans or expectations
• Bruises, bumps and cuts seem to hurt more than they do with other children
• Is often stubborn or uncooperative; has frequent tantrums, meltdowns or emotional outbursts
• Has a strong need to be in control and a hard time accommodating others (peers /adults)
• Has a shortage of skills; has to practice each skill over and over
• Has trouble with pencil control; messy written work
• Lacks confidence with performance-based activities (i.e.- writing, playing games)
• Is slow or hesitant to learn new games or skills

Please feel free to contact our office if you have any questions related to the above symptoms. Our office staff would be happy to assist you in determining the need for an occupational therapy evaluation.

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