Vol. 12, No. 3, 2006 Page 6
Physicians treating children who experience frequent episodes of explosive rage should investigate the possibility that sensory issues play a role, according to a recent case report.
Physician Michael Cheng and occupational therapist Jennifer Boggett-Carsjens treated a nine-year-old diagnosed as having bipolar disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, and nonverbal learning disability. Because of his daily rage attacks, the boy had been placed in a special education classroom where teachers noted that a wide range of triggers—noisy rooms, being touched by others, etc.—could precipitate violent attacks.
Cheng and Boggett-Carsjens taught the boy sensory modulation techniques and coping strategies, and planned multiple ways to reduce the amount of sensory input he received (for instance, by giving him earplugs and headphones with music to mask outside noise). They report that within weeks, he was calmer and more focused. He finished the school year in a regular classroom, began getting good grades, and received an award for being the most improved student. The next year, he entered a gifted program where he excelled.
"Since affect regulation is a higher order function," the authors say, "it makes intuitive sense that problems with affect regulation may result from problems with earlier developmental stages, such as sensory processing." Such problems, they note, can manifest as anger, sadness, hyperactivity, or distractibility. They note that children with behavior problems due to sensory issues often exhibit a "good days and bad days" pattern, because it is the cumulative emotional overload from either hypersensitivity or hyposensitivity that eventually triggers outbursts.
"Consider sensory processing disorders in the explosive child: case report and review," Michael Cheng and Jennifer Boggett-Carsjens, Canadian Child and Adolescent Psychiatry Review, Vol. 14, No. 2, May 2005; and "Making sense of things: An overview of sensory processing and regulation," presentation by Michael Cheng to Crossroads, May 20, 2005. Address for either: Michael Cheng, Children's Hospital of Eastern Ontario, McArthur Site, Suite 200, 311 McArthur Avenue, Ottawa, Ontario, K1L 8M3, Canada.