Wednesday, May 19, 2010

Helping Children With Low Arousal

Arousal refers to our state or consciousness or awareness.  Someone who is in danger, or is moving at high speed, is in a high state of arousal, and someone who is about to fall asleep is in a low state of arousal.  Then there is everything in between. 

Many children with sensory issues have arousal problems, clocking in either too low or too high for whatever situation they happen to be in.  There is something about the way that their bodies take in and process sensory information that causes them to over respond to some things and under respond to others.  Their hearts start to race, their breathing quickens, and they go into instantaneous fight or flight in response to things that a more normally working nervous system would hardly register.  Or they don't respond to things that other nervous systems would have a hard time coping with: they can spin and spin and spin without ever getting dizzy, jump off of eight foot drops onto concrete and not feel any pain, and go on the scariest roller coasters without turning a hair.

Today I'll talk about children who are perpetually in a state of low arousal.  Interestingly, most children  with ADHD have this problem.  The reason they can't sit still is that they are trying to move enough  to activate their nervous systems in order to focus and to feel all right in their bodies.

Movement and intensity are what help low arousal.  Intensity can be supplied in many different ways, through each one of the senses.

To change arousal through the mouth:  Children love all of those ridiculously over the top sour candies because they are so arousing.  Warheads, Cry Babies, Tear Jerkers, Sour Straws,  Skittles,  Starburst, Pop Rocks and Lemonheads are first rate sensory therapy tools.  As much as I rail against it, junk food is brain food.  Why do you think all of those 7-11's carry such a big selection of candies and chips?   All that stuff to slurp and crunch and chew is exactly what you need to help you stay alert and focused when you're driving for hours and hours on a  monotonous stretch of highway.

Anything crunchy, that explodes with sound when you bite into it, is alerting.  Carrots, apples, popcorn, pretzels, and chips are an easy example.  Something strong tasting, like salsa or vinaigrette, to dip them into, is even better.  Popsicles, and anything frozen, are alerting.  Sometimes frozen peas can be a nice treat, eaten directly out of the bag.  I like to munch on frozen raspberries, especially in the summer. Cold fizzy drinks are alerting.  I recommend mixing plain seltzer with some cranberry or orange juice, or a squirt of lime.

You can often find interesting, strongly flavored treats in Asian markets.  You can  experiment with umeboshi plums, pickled, candied, and preserved ginger,  and other strongly flavored preserved fruits from Asian cultures.  There's a whole world of intensely sour Japanese hard candies as well.

Many of the children I treat are shallow breathers.  Chronic shallow breathing deprives the brain of oxygen and can cause a state of permanent low level anxiety.  The best way to improve this is to encourage the child to engage in activities that require prolonged, sustained exhalations.  A long exhale will cause the next inhale to be reflexively bigger and fuller.  This will help the child's body learn to breathe more deeply.

Whenever I see new whistles, bubble pipes, or blow toys, I always buy them.  I love blow darts, blow pens,  balloons, kazoos, razzers, and party noisemakers.  The best blow toys are ones that have a visual component, such as a moving part powered by the breath, or bubbles that slowly form at the end of the pipe.  The visual component is strengthening to the eyes because it encourages them to pull in close to watch.

Sometimes I'll get down on the floor with two straws and two pom poms and the child and I will blow the pom poms across the room in a race. 

Another reason for low arousal is sensory defensiveness.  If you are being bombarded by sound, smell, light, visual, and touch sensations that are irritating to your  system, you're going to want to leave your body when it becomes overwhelming, which it often does in school.  Schools tend to be highly noisy and chaotic.

Many children are in a low state of arousal because  their vestibular nerves, which regulate their levels of awareness based on the amount of movement they sense, have a very high threshold before they will activate. Movement activates the part of the brain responsible for arousal.  The more intense the better, but when you're inside, anything is better than nothing.  Some children like to spin, some like to jump, some like to turn upside down, some like to swing back and forth.

To change arousal through the vestibular system:  Some quick ideas:  spin in an office chair or a Sit and Spin, do jumping jacks or somersaults, wrestle, play a handclapping game, sing "Head Shoulders Knees and Toes" doing all the movements and making sure to bend all the way over,  or jump on a mini trampoline.  Sitting on a therapy ball while doing homework can be very helpful.  The child can bounce to his heart's content while he is working.

If your child is doing homework and having an impossible time focusing, just getting up and doing one of these for 30 seconds or so can be enough to give him five more minutes of concentration before he starts to flag.  I sometimes work with children at home on their handwriting, and when I see the child start to droop or lose the ability to follow me, we'll get up and quickly do one of these things, then sit right back down.  Little girls love handclapping games, and I add footwork as well to make it more interesting and challenging.  Here's an interesting article about how handclapping games can help improve coordination:

To change arousal through the visual sense: Light, or lack of it, can have a tremendous impact on arousal states.  Is your child sitting to do homework in a place with plenty of natural light?

To change arousal through hearing:  Music is a great way to rev up your engine.  What do you have on your iPod that you listen to at the gym?  Put on some high energy music  {I like "Thriller"} and dance around for a few minutes.  A wonderful choice that isn't so obvious is string band music for Irish, square or contra dancing.  The fiddles and banjos are so joyful, rhythmic,  and energetic sounding, they literally propel you into moving.

To change arousal through touch:  messy play, such as touching shaving cream, can be very alerting.  So can the simple act of running your hands along your legs while you are seated.

Do you sit in meetings fiddling with sugar packets, straws, and paper clips, doodling, knitting, drinking coffee or chewing gum?  That's how you help yourself stay present during those times when you are forced to sit still and listen without participating for long periods.  Why do teachers forbid children, who need them much, much more than we do, to employ similar strategies to help keep themselves alert?

For a child with low arousal issues, sitting still is a literal "no brainer,' since the cognitive area of the brain stops being able to function when the child is not moving.  Fidget toys, employed discreetly, can help a child stay focused in class.  A great fidget I learned to make at home: Take a good quality balloon, stick a funnel in it, pour in some cornstarch and some Elmer's glue, and knot it.  Squeeze and massage the balloon to mix the two, and you have a wonderful and inexpensive little "stress ball."   I also like to take a piece of clear, flexible fish tank tubing and slip it over the eraser end of a pencil to make a discreet chew toy.  {If your child is chewing constantly, however, he needs to move more, and would benefit from more time spent outside.} 

I tell parents to take the child to Party City or a local 99 cent store and look at the little prizes together, asking the child what he thinks would be good to keep in his pocket, and buying a small selection to try.  Stretchy animals and mini koosh balls are good. Many common objects, like paper clips, can be a good way to keep the hands busy and the mind alert.  Just make sure you run this by his teacher so whatever he uses doesn't get confiscated, and remind him to be discreet.  If he is also battling impulse control issues, you may want to limit things that can be shot across the room, like rubber bands.

Sitting on an inflatable cushion like Move N Sit or Disc o Sit during class helps.  Inflatable cushions allow the child to wiggle enough to stay activated while staying seated. If the teacher has observed that the child has a certain time of day that he really cannot manage, she can send him on an errand during that time.  Carrying a heavy box of books up some stairs is always a good choice, and he should stop at the water fountain while he's at it.

Brain Gym has some interesting techniques for improving brain function.  Here is one that you can teach your child to employ discreetly in class, called Brain Buttons:

Stretch your thumb and index fingers wide apart and place them into the slight indentations below the collar bone on either side of the breast bone.

Pulse lightly and rhythmically.  At the same time, press the other hand gently over the belly button.  Gently pulse and press for about two minutes.

To change arousal through smell:  strong scents, like peppermint, can be alerting.  I don't know much about aroma therapy.   This would be a very interesting area to explore.  I would use scents cautiously, since the olfactory nerve goes straight to one of the most primitive parts of the brain.

If your child has a hard time maintaining alertness in the afternoon, what is he eating for lunch?   Lean proteins and complex carbohydrates like whole grains, fruits and vegetables are the best choices to help a child make it through the day.

Salty foods can be dehydrating, which can make it hard to stay alert.  Remind your child to drink plenty of water at lunch.  And while you're at it, please make sure that breakfast contains some high quality protein.
Is your child getting enough sleep at night?  If he has a hard time falling asleep, that may be contributing to his arousal issues.  Is he getting enough exercise during the day to tire him out?

You can limit computer time before bed, be strict about bed time, and try a bath before bed with epsom salts.  Not only is it soothing and relaxing, helping the child transition to sleep, epsom salts can help draw toxins out of the body.

A very young child may  have a hard time falling asleep in a bedroom with too much visual stimulation.  If you think this may be contributing to sleep issues, make sure that closets are closed and the shelves are organized and tidy before bedtime.

There was a great article in the New York Times about how much better children performed in the afternoons after their schools changed recess to before lunch:

It might be worth looking into at the next PTA meeting.

In another post I'll talk about helping a child with high arousal bring his engine idling speed back down.


Anonymous said...

This is exactly what I was looking for today.....something for an introduction about a low arousal student and something shorter that THE OUT OF SYNC CHILD.......(for now.)

Madelyn Griffith-Haynie said...

I found this EXCELLENT article on an Autism Board on Pinterest and am highly impressed (will be repinning with an endorsement). I will also backlink it to my intro article on sensory processing and will ping you when it goes live.

I don't have kids (and work only with ADD/EFD spectrum adults, including TBI), but I would send any child with Executive Functioning struggles to you in a heartbeat, on the strength of this article alone (including the generosity of your sharing, with links to other info). Thank you. I'll bet you see wonderful improvements in your patients.

As you may already know, many therapists, even those who work with children, are not fully versed in the over/under arousal implications of sensory processing to cognition. It's heartening to read a blog post that covers the bases. I love it that you underscored the importance of hydration and oxygen.

Unfortunately, getting adults to "play" (or breath!) is a bit tougher, even when you can explain why they need to do it. Even so, I will be adapting some of your suggestions for my clients, almost all of which struggle with a prefrontal cortex that is under-aroused. Far too often, an inability to activate has been labeled "self-sabotage" or "procrastination," when something very different is at base.

If ALL kids could have the benefit of therapists like you, by the time they were adults all but the lowest functioning would probably be doing well enough that coaching would truly be optional, as it is for the neuro-typical population -- and many would be able to manage without medication. I'll be back!

(Madelyn Griffith-Haynie - ADDandSoMuchMore dot com)
- ADD Coach Training Field founder; ADD Coaching co-founder -
"It takes a village to educate a world!"