Monday, May 17, 2010

What is Arousal?

A term that sensory integration therapists tend to use a lot is "arousal." What does it mean when we're talking about a child, and why is it important?

Arousal is your level of alertness at any given moment. When you're lying in a hammock which is gently, slowly swaying back and forth in a warm, sweet breeze, and the birds are chirping, you can hear the sound of the surf in the background, and you're under the shade of a tree, you're very relaxed. Your arousal level is quite low, and you're about to drift off into sleep.

Now imagine yourself sitting in the first car of a roller coaster, you're at the top of the highest curve, about to head almost directly vertically downward.  Very high arousal there!

Then there's everything in between.  This is when we are engaged in an activity and still peripherally aware of what is going on around us so that we can respond to it when necessary.  For instance, think of sitting in the park, chatting with a friend while watching your children play.  You can easily flip your attention back and forth as required.

{Archie and Veronica fans: Jughead: low arousal. Laissez - faire attitude towards life, motivated by food and not much else. Happy to be left alone, no particular interest in the opposite sex or in achievement.

Moose: High arousal. Always taking everything the wrong way, spoiling for a fight. Too wound up to do well in class, but captain of the football team, where he gets to throw his weight around. Everyone walks around on eggshells when he's in the room, afraid to offend him and risk an out of control reaction.  His girlfriend's main function is to keep him on an even keel.}

Our arousal levels dictate how able we are to pay attention and respond appropriately to what is going on around us.

For most of us, our senses and internal chemistry work together seamlessly to maintain correct levels of alertness and arousal. When someone familiar touches us, our nervous systems don't interpret it as a threat.  When the phone rings, our hearts don't start to race.  When the family cat jumps unexpectedly on our laps, we don't scream and shoot up from our chairs.

And when we are sitting still, for example at a movie, we can stay alert enough to attend to what's happening on the screen. When we are at work, sitting in front of a computer all  day in artificial light, we can {mostly} stay focused on the task at hand, be alert and present at meetings, and accomplish everything we are supposed to do.

All these levels of alertness are important because they are necessary for survival.  When danger is imminent, high arousal and hyper vigilance are what allow us to defend ourselves successfully against predators.  Low arousal is what allows us to transition into sleep so that we can rest and repair our bodies.

We unconsciously do little subtle things all the time, like stretching, chewing gum, and doodling, to adjust our arousal levels  so that we stay in synch with what is happening around us.

Some of what we do, like drinking coffee, is alerting, and some things are self soothing, like twirling hair.  Some things can be either, like chewing gum, depending on the circumstances and how a particular nervous system takes it in and processes  the sensory information it provides.

Many of the children whom we see in occupational therapy for sensory issues tend to live at one extreme or another, functioning either too low or too high most of the time.  Any attempts to increase arousal will cause them to shoot straight into high gear.  They don't seem to have a lot of middle range available to them, which is what is required for most of the demands of modern urban life.

When a child has arousal difficulties, there may be many reasons why. One is chemical. The body's ability to manufacture and utilize neurotransmitters, which transmit information and facilitate communication between brain cells, is compromised. These chemicals are responsible for regulating, among other things, our attention, learning, memory, alertness, mood, and motivation.

Another reason that a child may have difficulty keeping his arousal levels up has to do with the body's ability maintain its upright stature against gravity. Many of the children I treat have low muscle tone. Their vestibular nerves, which talk to the extensor muscles, need a lot more stimulation before they will fire and activate the extensor system, so their extensor tone remains low unless they can move intensely, which they can't do when they're being expected to sit still. This means that they are struggling just to stay upright, which is very tiring. {These are the children who are completely frenetic the minute they get a chance to move, but as soon as they sit, they're lying all over their desks or falling out of their chairs.}  The vestibular nerve also talks directly to the part of the brain  responsible for managing our state of alertness and arousal, so if it's not activated properly, it's not doing its job of regulating the arousal centers in the brain.

If the child's senses are not taking in and interpreting things appropriately, he may be on high alert and stuck in a state of chronic fight or flight.

Have you ever been in such a stressful situation, like a horrible medical procedure or receiving terrible, life altering news, that you just left your body for awhile? A child who is sensitive to noise, light, or chaos, and has a hard time sitting up, is going to spend a lot of his school day being tuned out as one way of coping with things that are hard for him to deal with. These are the children who fall through the cracks, because they're not acting out. They're quiet about the fact that they're not present and unable to learn.

The paradoxical thing about ADHD is that since the children who have this disorder have a hard time keeping still, we think that their arousal levels are too high.   The opposite is generally true; the child is coping with arousal levels that are chronically too low to allow him to sit without his nervous system deactivating. A child who is perpetually on the go is a child who is doing whatever necessary, trying to move, mostly -- to activate his nervous system and increase his arousal. That's why stimulating drugs have such a powerful effect on attentional issues.  They increase arousal, and so they raise the brain's ability to attend.

One problem that children with arousal issues often have is the type of attention that is available to them.  They are either highly distractible and can't focus, or they become so overly focused on something that the entire world fades away and it's difficult to rouse them out of that state.  Again, this is problematic for functioning in school.  Something in the middle of those two extremes is what is required in a classroom.  The child should be able to attend to the lesson, but is not so lost to everything else around him that he is able to shift focus easily.  He needs to be able to concentrate on the task at hand while at the same time attend to what is going on around him.  For instance if he is concentrating on his work and the teacher makes an announcement, he should be able to look up briefly, take it in, and go back to what he is doing without having lost his train of thought or spending a lot of time spinning his wheels before he is able to return to the task at hand.

Helping the child learn to manage his body, and thus his arousal state, to live most of the time in  that in-between range is one of the goals of occupational therapy. This is what we call the "just right state for learning."

There is a wonderful program developed by occupational therapists called "How Does Your Engine Run?" that talks about this in great detail. The authors liken the body to a car engine. Where does yours tend to idle, low or high? If you think about the unconscious strategies you employ to help yourself during the day, you can get a sense of where you fall. People who mostly do things that are self soothing in nature tend to idle too high, while people who do things that are mostly alerting tend to idle too low. We all do a mix of these things, though, based on what we need at the moment.

Sensory integration therapy assists the child in maintaining a better arousal state in a variety of ways. We can improve the child's neurochemistry by doing things in the clinic that will increase the manufacture of dopamine and seratonin, the "feel good" neurotransmitters. We can strengthen up his extensor muscles, integrate postural reflexes, and improve the child's balance, which will help him sit for longer periods. We help the body learn to filter out extraneous information that is distracting to the child, by changing the way the inner ear and vestibular nerve process information, or by desensitizing the skin. We help the child become a better breather, so his oxygen levels are improved and anxiety is diminished. We can teach strategies for managing low arousal that the child can employ discreetly when needed. We can educate parents and teachers to recognize when the child is faltering and give him an opportunity to rev up his engine before he tunes out or acts out.

Building more movement and fresh air into the child's day will certainly help him maintain his arousal at appropriate levels. So will making sure that he gets enough sleep.  Hydration is important, as is a diet low in processed food and rich in protein.  Breathing well is critical.  If your child tends to be a shallow breather, his sympathetic nervous system {which is responsible for regulating the fight or flight response} will be too responsive, and make his heart race and flood his body with adrenaline at inappropriate times.

In another post I'll talk about some strategies I use to help children change their arousal levels  during clinic time and how they can begin to discreetly manage their arousal during class time.


Kalashree said...

It was a very helpful post. :)

Mary Gallagher said...

Thank you! So helpful to me as a student in my first fieldwork placement! Feeling very lost and overwhelmed... You really broke it down and explained this aspect very well!