THE SENSORY, ATTACHMENT & TRAUMA TANGLE:

MAKING SENSE OF THE INTERPLAYStephanie Zimmerman, LMFT

Zimmerman Marriage & Family Therapy Inc.The Resilience Counseling Group

A Sensory

Experience

SENSORY PROCESSING & THE BRAIN

THE 7 SENSORY SYSTEMSVisual

Tactile

Gustatory

Olfactory

Vestibular

Pro- pioception

Auditory

–Jean Ayres, 1972

“Sensory Integration is the ability to organize sensory information

for use.”

SIGNS OF HEALTHY SENSORY INTEGRATION

• Appropriate attention

• Self-regulation skills

• Positive self-esteem and self-confidence

• Appropriate skills for learning and playing

• Play that is varied and creative

Normal sensory and motor development are connected and dependent on each other

and develop both through the internal processes of the

individual and the external processes of the caregiver

CLASSIC SIGNS OF SPD: THERE ARE NONE

SENSORY PROCESSING DISORDER: INEFFICIENT ORGANIZATION AND USE OF

SENSORY INFORMATION RESULTING IN FUNCTIONAL LIMITATION

A WALK IN HIS SHOES…

SOR depends on various personal and con-textual factors. SOR prevents people frommaking effective functional responses.Difficulties are particularly evident in newsituations and during transitions. Theintrapersonal range of responses may appearas willful behavior, seemingly illogical andinconsistent.

However, the atypical responsesobserved are not willful; they are automatic,unconscious physiologic reactions to sensa-tion. More intense responses generallyoccur if the stimulation is unexpectedrather than self-generated. In addition, sen-sory input often has a summative effect;thus, a sudden exaggerated response mayoccur to a seeming trivial event because ofthe accumulated events of the day. Behav-iors in SOR range from active, negative,impulsive, or aggressive responses to morepassive withdrawal or avoidance of sensa-tion. Sympathetic nervous system activa-tion is a marker of SOR (Miller et al.,1999), which may result in exaggeratedfight, flight, fright, or freeze responses(Ayres, 1972a). Emotional responsesinclude irritability, moodiness, inconsola-bility, or poor socialization. People withSOR are often rigid and controlling. SORmay occur in combination with other sen-sory modulation disorders (e.g., sensoryseeking, sensory overresponsivity in vestibu-lar and proprioceptive systems) and is oftenobserved concomitantly with sensorydiscrimination disorder (SDD), dyspraxia,or both.

SMD Subtype 2: Sensory Underresponsi-vity (SUR). People with SUR disregard, ordo not respond to, sensory stimuli in their

environments. They appear not to detectincoming sensory information. This lack ofinitial awareness may lead to apathy,lethargy, and a seeming lack of inner driveto initiate socialization and exploration.However, in SUR, inaction is not due to alack of motivation but rather to a failure tonotice the possibilities for action. A failureto respond to pain (e.g., bumps, falls, cuts)or extreme temperatures (hot or cold) istypical. Behavior of people with SOR isoften described as withdrawn, difficult toengage, inattentive, or self-absorbed. Com-pensatory strategies may lead to procrasti-nation, and people with SUR are oftenlabeled “lazy” or “unmotivated.”

Commonly, SUR is not detected ininfancy or toddlerhood. The child may beconsidered a “good baby” or “easy child”because few demands are made on care-givers. However, because people with SURneed high-intensity salient input to becomeinvolved in a task or interaction, when chil-dren are older, the necessary arousal level toparticipate across contexts may not be avail-able. Reports of inconsistency are common(e.g., the child’s behavior is acceptable athome but not at school). SUR occurring intactile and proprioceptive systems usuallyleads to poor tactile discrimination and apoor body scheme with clumsiness. Thus,people with SUR often have concomitantSDD, dyspraxia, or both.

SMD Subtype 3: Sensory Seeking/Craving (SS). People with SS crave anunusual amount or type of sensory inputand seem to have an insatiable desire forsensation. They energetically engage inactions that add more intense sensations to

their bodies in many modalities (e.g., spicyfood, loud noises, visually stimulatingobjects, constant spinning). Invasive SSbehaviors can influence social interactionswith peers (e.g., other people are crowdedand touched, physical boundaries are notobserved). Active SS often leads to sociallyunacceptable or unsafe behavior, includingconstant moving, “crashing and bashing,”“bumping and jumping,” impulsiveness,carelessness, restlessness, and overexpressionof affection. The actions of these peopleoften are interpreted as demanding orattention-seeking behavior.

Some degree of sensory-seeking behav-ior is typical in children as they learn,explore, and master new challenges; how-ever, children and adults who meet criteriafor SS are extreme in their quest for sensoryinput. When unable to meet sensory needs,children may become explosive and aggres-sive. They are frequently labeled “trouble-maker,” “risk-taker,” “bad,” and “danger-ous” and expelled from preschool.Disciplinary trouble in elementary school isalso common. Extreme SS can disruptattention so profoundly that learning iscompromised or activities of daily living aredifficult to complete.

SS may also occur to obtain enhancedinput when reduced perception of sensationoccurs. For example, if a child cannot feelhis zipper well, he may play with the zipperover and over until he has adequate percep-tions of the feel and movement of the zip-per so that he can complete a zipping task.

SS often occurs as the person tries toincrease his or her arousal level. For thosewith SS, the need for constant stimulationis difficult to fulfill, particularly in environ-ments where quiet behavior is expected.Unfortunately, obtaining additional sensorystimulation, if unstructured, may increasethe overall state of arousal, resulting in evenmore disorganized behavior. Specific,directed types of sensory input, however,can have an organizing or self-regulatoryeffect. Some children with SOR will engagein SS behaviors as an attempt at self-regulation (e.g., stereotypy in a child withautism). A challenge is that overactive andimpulsive symptoms in SS can easily beconfused with (and often co-occur with)attention deficit hyperactivity disorder(ADHD).

The American Journal of Occupational Therapy 137

Figure 1. A proposed new nosology for sensory processing disorder.

SENSORY PROCESSING DISORDER (SPD)

Sensory ModulationDisorder (SMD)

Sensory-Based MotorDisorder (SBMD)

Sensory DiscriminationDisorder (SDD)

SOR SUR SS Dyspraxia Postural DisordersVisualAuditoryTactileVestibularProprioceptionTaste/Smell

SOR = sensory overresponsivity.SUR = sensory underresponsivity.SS = sensory seeking/craving.

Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., Osten, E. T. (2007). Concept Evolution in Sensory Integration: A Proposed Nosology for Diagnosis. The American Journal of Occupational Therapy, 61 (2), 137.

ATTACHMENT AS A SENSORY SATURATED PROCESS

ATTACHMENT…is the bond between the parent and the child. It creates for

the child an idea or a model for how he/she can experience and

relate to others

ATTACHMENT PLAYS A VITAL ROLE…

• as it is a basic human need• creates a safe haven• establishes trust• in the development of the brain• in self-regulation• in creating core beliefs• in developing morality• in creating resilience

The reciprocal relationship relies on the baby’s ability to communicate needs, as well as the parents ability to accurately read their baby’s signals and respond in a timely and sensitive

way.

Virtually all children create a strong attachment by about 12 months of age, this attachment just varies in quality and can vary

from caregiver to caregiver.

SECURE ATTACHMENT PATTERN

If a parent is reliably emotionally available and sensitively responsive, infants will develop

positive expectations and confidence in the parent which results in a Secure Attachment

pattern.

Insecure Attachment

Secure Attachment

ATTACHMENT SPECTRUM

Insecure Attachment

Secure Attachment

Avoidant/Dismissive Attachment

Ambivalent/Preoccupied Attachment

AVOIDANT/DISMISSIVE ATTACHMENT PATTERN

Insecure Attachment

Secure Attachment

Avoidant/Dismissive Attachment

Ambivalent/Preoccupied Attachment

AMBIVALENT/PREOCCUPIED ATTACHMENT PATTERN

Insecure Attachment

Secure Attachment

Avoidant/Dismissive Attachment

Ambivalent/Preoccupied Attachment

DISORGANIZED ATTACHMENT PATTERN

PARENTS ATTACHMENT WOUNDS

A parent will naturally pass on what he/she has been given unless there is an intentional shift towards an earned secure attachment

TRAUMA

WINDOW OF TOLERANCE

• Hyperarrousal

• Hypoarrousal

• Dissociation

Hyperarrousal may look like chronic hypervigilance, emotional tantrums, anxiety, preoccupation with a relationship, rejection sensitivity, over responses to

perceived threats

HYPERARROUSAL

Hypoarrousal may look like flat affect, numbness, disconnected feelings, passive-agressiveness.

HYPOARROUSAL

• I’m in a fog

• I’m in a dream

• I’m disconnected from my body

• I’m zoned out/numbed out

• I’m floating

• I’m a robot

• I’m split apart

• There is stuff I can’t remember

DISSOCIATION MAY LOOK LIKE…

NEGATIVE MEMORIES HOLD MORE WEIGHT

Trauma

Sensory

Attachment

THE TRIAD

RESILIENCY

Social support provides buffering that reduces stress hormones and prevents fear learning

–Louis Cozolino

“The experience of our own bodies becomes the model for our connection,

understanding, and empathy in relationship with others.”

WHAT IS YOUR CHILD’S SENSORY DIET NEEDS

•Movement generally alerts

•Deep pressure/heavy work (proprioception) is universally organizing

•Oral outlets are calming

IN GENERAL…

THE WORK OF SENSORY INTEGRATION IS FOR A TRAINED OCCUPATIONAL THERAPIST BUT THE WORK OF COREGULATION,

USING SENSORY BASED TREATMENT, IS ESSENTIAL FOR

PYSCHOTHERAPISTS AND PARENTS

REFERRALS FOR OCCUPATIONAL THERAPY HELP IMPROVE A CHILD’S

SKILLS FOR THE JOB OF LIVING. SO IF A CHILD HAS A HARD TIME WITH THEIR OCCUPATION (SELF-

CARE, PLAY, EDUCATION, COMMUNITY INTEGRATION)

PROVIDE/REQUEST A REFERRAL

SETTING UP A HOME TO BE SENSORY SENSITIVE

SETTING UP AN OFFICE TO WORK ON A SENSORY

LEVEL

ATTUNEMENT…

is the process of being aware of your own inner experience while being able to notice and connect with the inner experience of the person in front of

you.

ATTUNEMENT DEFICIT

You can’t create attachment cognitively. It is created somatically and interpersonally within a felt sense of safety over

time

MODEL FOR YOUR CHILDREN

FIND A TRAUMA TREATMENT MODEL THAT WORKS FOR YOU

AND HEAL YOUR PAST WOUNDS TO CREATE A

BETTER FUTURE

WORKING WITH THE SCHOOL & OTHER PLACES OF CONNECTION FOR

THE CHILD

engage & be curious

REFERENCESAron, E. (2002). The Highly Sensitive Child: Helping our children thrive when the world overwhelms them. New York: Three Rivers Press.

Bunim, J. (2013). Breakthrough Study Reveals Biological Basis for Sensory Processing Disorders in Kids. Retrieved from: http://www.ucsf.edu/news/2013/07/107316/breakthrough-study-reveals-biological-basis-sensory-processing-disorders-kidsi.

Huges, D., Koomar, J. Safe Place DVD: Parenting Strategies for Facilitating Attachment and Sensory Regulation.

Huntington, A. Sensory Integration: Developmental Foundations for Interaction and Play. Advanced Child Development Course: Family and Play Therapy Center

Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., Osten, E. T. (2007). Concept Evolution in Sensory Integration: A Proposed Nosology for Diagnosis. The American Journal of Occupational Therapy, 61 (2), 137.

Orlans, M., Levy, T. (2006). Healing Parents: Helping Wounded Children to Love and Trust. Washington: Child Welfare League of America.

Parnell, L. (2013). Attachment focused EMDR: Healing Relational Trauma. New York: W.W. Norton & Company.

Karen, R. (1994). Becoming Attached: First Relationships and How They Shape Our Capacity to Love. New York: Oxford University Press.

Kennedy, J., Lane, S. J. (2014). The Role of Tactile Sensation in the Neurodevelopment of Affective and Social Function. The American Occupational Therapy Association, Inc. 37 (1)

Koomar, J. A. (2009). Trauma-and Attachment-Informed Sensory Integration Assessment and Intervention. The American Occupation Therapy Association, Inc. 32(4).

Kranowitz, C., Miller, L.J. (2006). The Out-of-Sync Child. New York: The Berkley Publishing Group.

Siegel, D., Hartzell, M. (2003). Parenting from the Inside Out. New York: Penguin Group Inc.

Smith, K., Gouze, K. (2004). The Sensory-Sensitive Child: Practical Solutions for Out of Bounds Behavior. New York: Harper.

Zaccagnino, M., & Cuisine, M. (2013). EMDR and parenting: A clinical case. Journal of EMDR Practice and Research, 7(3), 154-166.

Helpful Websites: http://asensorylife.com/index.html

http://www.sensory-processing-disorder.com

http://www.otawatertown.com/?topic=Root

http://drgabormate.com/topic/parenting-childhood-development/

http://theinspiredtreehouse.com

http://www.lifeskills4kids.com.au

Booklet with usable tools for parents: http://www.falkirk.gov.uk/services/social-care/disabilities/docs/young-people/Making%20Sense%20of%20Sensory%20Behaviour.pdf?v=201507131117

LEARNING OBJECTIVES

1. attendee will be able to list and describe the 7 senses and the 3 prongs of sensory processing

2. attendee will be able to describe attachment as a sensory process

3. attendee will be able to describe the triad approach of treatment

4. attendee will be able to state at least 2 practical skills/exercises for the clinical or the parent

QUESTIONNAIRE FOR PARENTS:HTTP://SPDFOUNDATION.NET/ABOUT-SENSORY-PROCESSING-DISORDER/

KIDSKORNER/

ASSESSMENT TOOLS FOR PYSCHOTHERAPISTS:

1. SENSORY PROCESSING MEASURE BY DIANNE PARHAM AND COLLEAGUES

2. SENSORY PROFILE BY WINNIE DUNN AND HER TEAM