A Fireside Chat with Dr. Goh: Part 5 of 5
In this last video in our fireside chat series, Dr. Goh answers questions from parents about how to help children who experience sound hypersensitivities (00:57), what medical therapies might help children who elope (04:44), how to best manage obsessive-compulsive symptoms (07:38) including what Cranial Electrotherapy Stimulation is and how it can help (09:18), and Dr. Goh's thoughts on the most promising therapy for autism (10:10).
Transcript from the Video:
Welcome to our fifth and final fireside chat. The past few months have been unlike anything we’ve ever seen before. With so much going on in our world, I hope that our team at Cortica can be a source of strength, support, knowledge, and guidance to you and your family.
Let’s get started.
One parent asked: “Our son hears noises that bother him, then at the same time he makes louder noises to block the noises he hears. If he is concentrating on something and there is noise around him it doesn't seem to bother him, but when he is not concentrating on something, then the noise will bother him. How do we help him with this issue?”
Hypersensitivity to certain sounds is something that many people experience – not just those with autism. Think about sounds that might bother you, like nails on a chalkboard or the very noxious high-pitched sound a microphone can make. Individuals with autism or other developmental conditions can sometimes be more sensitive to routine noises in the environment. One coping strategy that some individuals adopt is to make their own noises as a way of blocking out the unpleasant noises. We also know that the way our brains process and experience sensory stimuli from the environment – whether the stimuli are auditory (things we hear), visual (things we see), tactile (things we touch), or other types of sensory stimuli – is modulated by what else is happening in our brains. So, this parent observes that when the child is concentrating on something, the noise doesn’t seem to bother him. I think that many of us can think of times when we are concentrating on something, and that deep concentration means that we don’t notice other things in our environment, like someone speaking to us or other sounds or things that are happening around us.
One of the most important teaching points I make when working with parents, children, or other professionals is that how the brain processes certain types of information is influenced by what else is happening. So, what this example illustrates so nicely is that sensory processing in the brain is influenced by the context of what else is occurring in the brain. In this case, what is occurring that is modulating sensory processing is cognitive engagement. So, one strategy that we use a lot in our work is to provide a child with learning opportunities that are very engaging cognitively; this often has a very positive effect on the child’s sensory processing and their level of regulation.
So, for the question, "how do we help someone who has hypersensitivity to certain sounds," there are many possible answers.
It sometimes helps, in the beginning, to minimize exposure to those sounds that are excessively noxious. Reducing exposure can help to reduce the overall stress that someone is experiencing from their environment and make them more available, open, and able to learn. Controlled, predictable exposure to sounds (at a level that is tolerable) can help to reduce sensitivity over time.
Careful use of exposure to music can sometimes help; this can be done with a music therapist or occupational therapist and might involve the professional guiding the use of music in specific ways, and sometimes that may include a music-based listening program.
There are some medications that modulate the nervous system and reduce the hyper-response to certain sensory stimuli.
Building skills in other areas – whether sensory, motor, cognitive, language, or social-emotional – can also have a beneficial effect. As the brain acquires new skills, its ability to process sound and other types of stimuli can often improve. For this reason, all types of therapies, including music therapy, occupational therapy, physical therapy, speech-language therapy, ABA, counseling, social skills groups, and other therapies all have the potential to have a beneficial effect if they are helping the child to build new skills.
One parent asked: “What are potential biomedical reasons for elopement? Are there any nutritional changes, supplements, probiotics, or therapies that may help specifically to target wandering that could be secondary to medical causes?”
The term “elopement” is one that is sometimes used to describe when an individual leaves a location that they are expected to stay in. Because elopement might mean different things to different people, we don’t generally use that term, and instead will simply say that a child has a behavior that involves leaving the space where they are being asked to stay. This could be their therapy room, their home, their classroom, or any other space that they might wander, walk, or run away from. It could be leaving their parent when in the community.
There can be many different reasons for this. When we think about what's happening at the physiological level, I find it helpful to think in terms of two categories.
One is what we sometimes refer to, when we're thinking about neurology, as a fast pathway in the brain – where the brain is responding in almost a reflex manner, without conscious thought or planning.
The other would involve slower pathways in the brain – where the brain perceives the environment, processes that information, and then consciously considers different alternatives for how to respond. This might involve planning, strategizing, weighing expectations of others, considering the consequences of different actions, and so forth.
For many children, the behavior of leaving the location where they are supposed to remain is happening because of activation of a fast, reflex pathway. When children can access and utilize slower pathways – that involve the frontal lobes of the brain – they can make more deliberate and less impulsive actions. As far as what nutritional changes, supplements, medications, or other therapies could help with that, many different options have the potential to help. A wide range of therapies that help to reduce impulsivity and improve executive function, for example, have the potential to help. There are too many to list here, and what will work for a particular individual depends a lot on their unique biological makeup. For some individuals, nutritional supplements or medications that affect different neurotransmitters in the brain can be extremely beneficial. Please give us a call if you’d like to talk more with one of our medical providers on what we think would be the best approach for your child.
Another parent asked: “If a child exhibits high levels of OCD, what treatments are effective?”
Obsessive-Compulsive Disorder (OCD) is one type of anxiety disorder. Obsessions are defined as thoughts and fears that are excessive and persistent. Compulsions are repetitive behaviors that are connected to obsessions. Individuals have the urge to carry out certain behaviors as a result of the persistent thoughts that they experience. Those repetitive behaviors are referred to as compulsions. Obsessive-compulsive symptoms can be present on their own, or they can be present in individuals who have other underlying conditions, like autism or other neurodevelopmental conditions. We may not always know whether a child has obsessions and whether the repetitive behaviors represent compulsions or not, but there are a lot of treatments that can help to reduce obsessions, compulsions, and the anxiety that underlies them, if we think this is what the individual is experiencing.
Treatments for obsessive-compulsive symptoms overlap a great deal with treatments for anxiety. There are many different medications that can help, including a class of medications called selective serotonin reuptake inhibitors. There are nutritional supplements that can reduce anxiety, and can help in that way – these include supplements such as magnesium, glycine, L-theanine, 5-hydroxytryptophan, and L-tryptophan. There are also neuromodulatory device therapies that might help. One of these is a therapy called Cranial Electrotherapy Stimulation (CES), which involves the application of a small microcurrent through electrodes applied to the ears. The stimulation can affect the vagus nerve, which is a major nerve in the body that can help to reduce the body’s physiological stress response. Another major category of therapy for obsessive-compulsive symptoms is psychotherapy, where, with the help of a psychotherapist or counselor, an individual can develop strategies to reduce obsessions and compulsions. If you’d like to learn more about any of these therapies, please reach out to us to speak with a member of our medical team.
I’d like to close this session – and our fireside chat series – with this question from a parent: “What do you think is the most promising therapy for autism that all parents should know?”
Although it would be nice for there to be a single answer to this very important question, the answer depends, in my view, on what subtype of autism a child has. The universe of autism research and autism treatment has been focused for many years now on trying to characterize autism subtypes. One subtype that has been better characterized in recent years involves significant disturbance to the function of mitochondria. For this subtype, there is a medication called Suramin that is being studied by my colleague Dr. Bob Naviaux at UCSD, which holds tremendous promise for autism therapy. As we’re waiting for more promising therapies like this one to be studied further, there continue to be so many promising therapies that are already available to us. I hope you’ll partner with our team at Cortica to explore all of these therapies in an organized, methodical way so that we can bring the best treatments we have to offer to your child to help them reach their greatest potential.
