Greg Fritz, MD (Host 1): Hello and welcome back to Mindcast: Healthy Mind, Healthy Child, a podcast from the children's mental health experts at Bradley Hospital. I'm your host, Greg Fritz. And I'm joined by my new co-host, Dr. Tanuja Gandhi. On the podcast today is Nicholas Donohue, an occupational therapist at the COASST program here at Bradley. Nick is here to explain more about sensory strategies and how they can support regulation.

Tanuja Gandhi, MD (Host 2): Thanks, Greg, and welcome, Nick. As a psychiatrist, we work alongside and collaborate with you and other occupational therapists on the team to create regulation strategies for our patients. Sometimes when a child has difficulty responding to sensory inputs, it could be a sign of sensory processing disorders. This means that they may be averse to inputs such as sound, touch, light, taste, or smell. Often, we may have a patient that can't stand a certain smell, or perhaps the feeling of certain clothes bothers them to the point where they cannot focus on anything else. Often we know the trigger, but identifying strategies to help the child regulate is much more specialized. And today, we're looking forward to diving in and learning more about how these strategies are developed and implemented. So, let's get started.

Nicholas Donohue: Thanks so much for having me. I'm excited to talk with you both about how OT helps our patients and also strategies for anyone needing some support to regulate their body and their emotions. I'm an occupational therapist here at Bradley and work primarily in our outpatient clinic, the CVS COASST Clinic. However, I also work in our Children's Partial Program as well as the Bradley Center Program.

Host 1: So, sensory overload or feeling overwhelmed are terms that are now mainstream. We use them all the time. But will you help us and our listeners understand sensory processing disorder specifically?

Nicholas Donohue: Sure. Sensory processing disorder is a complex disorder. It affects our brain and the nervous system of our developing children and also adults. Many of us know the basic main five senses, such as taste, touch, sight, smell, and sound. However, there are other senses such as muscle force, knowing where our head is in space, and understanding those signals inside our body and the signals our internal organs send us.

We all have sensory preferences, which support our mood and how we feel. Some sensations go unnoticed by some people, and those same senses may also bother a person, such as the sight, the smell, taste, or those other sensory inputs I mentioned.

Host 1: So, what are the symptoms that you might typically see in children who have trouble regulating their emotions and feelings?

Nicholas Donohue: Yeah. All children have different symptoms and they might act differently when they're dysregulated. Depending on what the trigger is or what they're having a hard time with, you'll likely see a different reaction. When dysregulated, some children may have an outburst and seek movement or physical contact, while other children might just shut down and appear frozen.

Host 2: We all have sensory preferences, just like you're saying, to support our mood and how we feel. And many of us use music, exercise, candles, or even essential oils to assist how we feel. You know, we know that each child is unique and different. So, I imagine assessment is important to identify what would be calming or alerting for a person. Could you please explain how you do that?

Nicholas Donohue: Yeah, what might be calming for one individual might be alerting for another person. As occupational therapists, we use a variety of assessment tools, such as parent surveys, as well as clinical observations, to help guide an intervention plan. To identify when it might be a good time to use a tool, we use a couple of different programs. One program we often use is called the ALERT program, as well as the Zones of Regulation. And these programs help to use analogies such as feeling too slow, just right, or too fast, as well as the Zones uses terms as the blue zone, the green zone, yellow zone, and red zone. And we help to develop in each of those areas for that child. We then help to collaborate with that child to identify, you know, is this a good tool to use when you're in the blue zone? Or is this a good tool to use when you're in the yellow zone? And how can we help get you back to just right or feeling in that green zone?

Host 1: It's so interesting. Can you talk a little bit about weighted blankets and their benefits? They've become very popular over the last few years, but it would be great to hear from you how to choose one and what the potential benefits are.

Nicholas Donohue: Weighted blankets have become extremely popular, here at Bradley as well as in the community. Weighted blankets work by providing deep pressure or heavy input for that individual. And for many people, they find that calming. Not for everybody, for most people. Typically, we'll recommend a blanket that's around 5-10% of a person's body weight, meaning if you were 200 pounds, we would recommend one that is 20 pounds.

An additional factor to consider when looking at weighted blankets is how easy it is to clean, right? We all don't want something that's more difficult to clean. Some will have a wipeable cover, which is great. And then if not, some will have a removable cover, that you can put in the washing machine and then dry and then put it back onto the blanket, just to make it more easy for yourself and for the child.

Host 1: What's their price range? just out of curiosity.

Nicholas Donohue: They vary greatly in price depending on the brand. I've seen some as cheap as $20 for a weighted blanket up to hundreds of dollars.

Host 1: Really?

Nicholas Donohue: There are different factors why the price might change depending where it is. Back when I was in college, it was much harder to get weighted blankets and they were much more expensive. We used to make our own with Ziploc bags and rice and duct tape. Now, you can easily order them on Amazon, have it at your next door for the same day, walmart, Target, many major shopping centers. Here, for some of those more wipeable covers and things, we have different vendors. But yeah, they can really vary in price.

Host 2: Yeah, it's interesting you say that because in the inpatient units, we've often heard how children enjoy or feel benefited from weighted blankets, and then there's this whole deal to find out where to find them. And then, you find out it's just available in Target or Walmart. It's not like the unicorn it used to be once upon a time.

Nicholas Donohue: Yeah, as well as there are tons of different sensory tools out there. Probably a very often question I get is how much does this cost and where can I find it? And, you know, talk to an occupational therapist, talk to one of us. We'd be happy to kind of help show you, you know, why one product might be better than another and any precautions or reasons why we might recommend one over another and why we might suggest one store over another.

Host 1: So, how can an occupational therapist help with sensory processing disorder?

Nicholas Donohue: There's many things an occupational therapist would do with that. Like I had said earlier, the first step is really assessing and evaluating the individual and getting to know them, and what their sensory preferences are. We have our "typical" way of sensory processing, but each individual is so different and something that might be calming for one person might be an alerting for other. And, you know, we might have a theoretical scientific reason of why we would think a tool might be calming for them, but for that individual, it might not be.

For example, many people find the sense of lavender calming. To me, it is extremely alerting. I hate the scent of it. And there are things out there that, you know, really support that lavender is a calming tool, but for me, it is not. So, that evaluation assessing part and getting to know that person is an essential key. And then, using those tools throughout their day, whether that be in a school setting, at a home setting, in a clinic setting, in the hospital, to really help identify when there would be good times to use tools and how that can help them. It's not an easy process, but occupational therapists can really assist in the person's daily living to help live life to the fullest.

Host 2: Is it possible that children have unique sensory needs but still don't have a sensory processing disorder?

Nicholas Donohue: Absolutely. We all have our own sensory preferences. Like I had said earlier, there may be a certain scent that really bothers a person or a scent or taste that causes a person to gag. That doesn't mean they necessarily have a disorder, it just may be a preference. And sometimes it's just Identifying those preferences and sometimes either just staying away from them as much as you can or finding an alternative. But just because you have a preference or something that you like or don't like doesn't constitute always having a disorder.

Host 2: Very helpful. Reminds me of how some people enjoy loud music, but the same loud music can be very triggering for some individuals.

Nicholas Donohue: Absolutely. Some people use a certain type of music to help them wake up or when they're feeling sad or something that is very alerting to me would be, say, metal music. But I've worked with many individuals that say metal music and loud music helps them to feel calm. So, it's really getting to know that person, and how it can help them.

Host 2: Thank you. That's so helpful. I know that understanding and embracing the unique sensory experiences of kids is crucial towards fostering their well-being in a holistic manner, both emotional and physical well-being. It's important to note that each child is an individual with their own sensory preferences and challenges. And what we're learning from you, Nick, today is by exploring sensory strategies and creating a supportive environment, we can help children thrive and navigate the world around them. That's the ultimate goal for all of us as caregivers and treatment providers at the end of the day.

So, if you found today's episode insightful, check out our other podcasts at www.bradleyhospital.org/podcast. For all our listeners here, until the next time, take care and keep nurturing those bright minds.

Host 1: And thanks very much for being here, Nick. And thanks to our listeners for tuning in today. We appreciate every one of you. Until next time, this is Mindcast: Healthy Mind, Healthy Child.