Superdotação, Asperger (TEA) e Dupla Excepcionalidade por Claudia Hakim

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terça-feira, 11 de setembro de 2018

Transtorno de integração sensorial (hiperexcitabilidade ou hipersensibilidade sensorial) e superdotação : artigo a respeito do tema e meus comentários sobre ele

Neuroscience of Giftedness: Greater Sensory Sensitivity

Most parents of gifted children won’t be surprised that research supports what they can see for themselves: gifted children are highly sensitive to their environment and react with heightened emotional and behavioral responses, more so than do children of average intelligence.1 In fact, in the world of giftedness, the term “overexcitabilities” frequently comes up. Based on work by Kazimierz Dabrowski, a Polish psychiatrist and psychologist, the term itself is something of a misnomer, implying that the brain is reacting more intensely to a specific stimulus. In actuality, the neurological reactions simply have more going on. This is in line with Dabrowski’s original (translated) term, superstimulabilities.2 (In the interest of accuracy and precision, we’ll be using “superstimulabilities” in this article.)
Limited research exists on sensory sensitivities specific to the gifted brain which show the actual process of stimulation and what is happening to cause the gifted brain to react, but the work that does appear to be related is intriguing. One study showed enhanced auditory response in exactly the way that we think the auditory superstimulability might look.3 Additional research shows that gifted children hear sound faster (earlier peak latency) and louder (amplitude) than non-gifted children.4While this study concentrated solely on auditory processing, it is not a stretch to consider that this study might also pave the way to validate the experience of many gifted individuals (think: sock seams!). How else might this impact the daily experiences of a gifted child with those superstimulabilities? What seems “normal” to them may be different from the experiences of others. Skeptical adults may expect gifted children to go about the same activities as other children who do not have this obstacle to confront, leaving the gifted child in pain, discomfort, or exhaustion. They may learn to mistrust their own senses after being told repeatedly that what they feel is not real.
According to Liu et al, “The enhanced neural function of the intellectually gifted children might be due to more spatially and temporally coordinated neural network, faster neural processing speed and more efficient neural activation functions.”5 This explains the “more happening” in addition to the “more intense” aspect. Liu et al found that gifted children exhibited an increase in amplitude and duration signals in the auditory cortex compared to neurotypical kids. They also showed earlier peak signals in the auditory cortex compared to age-matched children with average intelligence. Additionally, gifted children showed an enhanced neural network for auditory sensory processing. Essentially, gifted kids are more likely to hear faster, louder, and longer than children who are not gifted. While the research doesn't address this specifically, it seems likely that some of the need that many gifted adults have to isolate themselves stems less from introversion than from the fact that they may not outgrow these superstimulabilities. Instead, they simply learn to manage them.
Given this, it is not surprising that many gifted children have received diagnoses of Sensory Processing Disorder (SPD). Neuroscientist A. Jean Ayres, PhD, likened SPD to a neurological "traffic jam" that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly.6The child responds to input in a hyper- or hypo-sensitive response. For example, the mechanics of their ears may work just fine but the message gets scrambled between that input and its receipt by the brain. While a variety of auditory processing disorder types exist, ultimately this may be due to an over-response or it can be a superstimulability. Many parents wonder whether SPD and Overexciteabilities or superstimulabilities are one and the same. Ultimately, they do appear to align. Beyond semantics, equally or even more important questions are how does it impact the child and how best to approach it? It may be discomfiting for the adults and inconvenient for the parents, but the actual experience of a life lived out of synchronicity with one’s peers—and the mismatch in expectations that results—will affect the day-to-day and long-term capabilities and even mental health of the child if it isn’t mitigated or accommodated. Ultimately, superstimulabilities are simply another of the many asynchronies with which gifted children and adults must cope.
Sensory perception is very much an individual experience. For some gifted people, their brain may perceive a noise as louder than other people do, while other gifted people’s brains may perceive a more typical volume but respond more intensely. In either case, the gifted person experiences a superstimulatory response which may interfere with other neurological processes or which may elicit a fight-or-flight reaction. Though the behaviors displayed may appear to be oppositional or pathological, they are not. Rather, they are reasonable reactions to real superstimulation—even if they are not the same reactions that the adults in the room are experiencing or expecting.
Another example of a superstimulability is smell, which can be overpowering and may even have physical ramifications. Also known as hyperosmia, it could explain the child who refuses to use a particular cleaning product or clean up after a pet for fear of vomiting.7 The parent may get very frustrated with the child who is then deemed irresponsible or defiant, not understanding that the child may want to do what they have been told to do, yet be unable at that time to follow through. The child with superstimulabilities is more likely to melt down from frustration resulting from conflicting messages in their brain (“cooperate” versus “don’t do it or you’ll puke”). They may develop anxiety because they never know when they will feel attacked either by the sensory input (which can hurt!) or by the misunderstanding of an adult who gets angry at them for what they cannot control.
Other sensory obstacles reported by parents include children whose heightened sense of smell makes it difficult to eat in the cafeteria at school, auditory superstimulabilities that make movies too loud, and vestibular responses that interfere with the ability to enjoy amusement parks, boat rides, and zip lines. These gifted childrenand adultsmay develop avoidance behaviors to protect themselves, but which undermine their own goals and desires. For example, a child with asynchronous vestibular perception may decline to attend a party for fear of being asked to dance, or a child with a strong creativity streak may decline to participate in an art class on the off-chance that the project may involve textiles with textures they find intolerable to touch. These may seem minor, but result in a sense of isolation and ostracism by others who read into it anything—that perhaps the child is a snob, “overdramatic,” or simply won’t behave appropriately (i.e., as expected)but a sense of self-preservation. Unfortunately, while adulthood allows for more control over situations where these are concerns, it doesn’t remove the sense of being an outsider that the college student or young professional feels who is unable to join their colleagues in the kind of bonding and networking experiences that may be critical to their aspects of their adult lives.
If a child is struggling with enhanced auditory, sense of smell, or any other superstimulability—bright lights, too much text in a small space, scratchy clothes—the amount of energy used to cope takes away from the ability to learn and to interact. It’s exhausting. At times, the only thing to do is to push through and allow the time needed for recovery. Conversely, the child may be unaware that they are experiencing something differently to others—as they have nothing to compare it to—and doesn’t know to speak up—as they don’t have the words to express how they feel. The impact these superstimulabilities have on families is significant and can be costly. Parents of children with these issues may feel frustrated at the cost of specific foods that their child can eat, the clothing which they find painless and comfortable, or the number of activities which their child begins but drops partway through due to high-pitched lighting, insufficient downtime, overwhelming auditory input, or adults and other children who are less than accepting of differences. It’s not unusual, either, for a child to be bullied by the uninformed, or to try hard to just deal with it only to result in a total meltdown in a public setting.8
Understanding these issues is paramount; so is getting emotional support. Advocating for your child’s needs in a world of grouping by age, averages, and expectations can be challenging. Realizing your child may not share your love of riding on rollercoasters or attending live performances may be disappointing. Facing the disapproval or judgment of others who say you are coddling your child, or who claim a diagnosis is an excuse rather than an explanation, makes holding your ground require more effort. We all hope our loved ones will rally to the cause, but sometimes we have to seek out a different kind of support. Numerous online communities offer such support; you don’t have to go it alone. Sensory challenges do not always require professional intervention. They do, however, require compassion and a willingness to work with the child to make the world a less scary place.9
The combination of superstimulabilities and emotional sensitivity can seem explosive at times. In order to support gifted children, it’s helpful for adults to acknowledge the challenges the child is facing. The first step in advocacy is an accurate assessment, often in the form of an evaluation from an occupational therapist (OT) or audiologist who can help explain what is happening to your child and offer support in finding the balance between sensory integration treatment, mitigation, and accommodations, so your child understands that they have appropriate options and plans for dealing with their superstimulatible bodies.
Parents of gifted children are always having to choose their battles. But sensory issues require parents to think long term so that the sensory overstimulation doesn’t result in insurmountable obstacles for the child’s future. Some of the things that adults can do to help support gifted children with superstimulabilities include arranging to choose a different project, making social plans in a less overwhelming setting, or simply allowing breaks from input as needed. Additionally, balancing development on all levels with treatment is important. Over time the gifted child may be better able to self-advocate, given the appropriate, safe opportunity to do so. These skills will, of course, continue to serve them well as adults.
Meus comentários a respeito do artigo que eu lhes trouxe : 

Eu tenho superdotação e possuo hipersensibilidade sensorial. Fico muito incomodada com barulhos e sons altos, locais cheios  de gente e alguns cheiros me incomodam, mas num nível tolerável (que apesar de eu ficar irritada, consigo suportar, mas que quando ocorre, me tira o foco do que estou fazendo ou me deixa irritada onde estou). Mas, isto não me causa prejuízos, no dia a dia. Só me deixa mais irritada. 

Meu sistema vestibular também é super sensível. 

O artigo em referência não traz amostra de pessoas que foram submetidas à alguma pesquisa, para os autores chegarem à conclusão que chegarem, o que já me deixa desconfiada do viés pelos autores, que foi atribuído em prol da superdotação e que eventuais patologias seriam decorrentes dela. 

Os autores tentam negar que superdotados possam ter problemas de integração sensorial e atribuem a hipersensibilidade sensorial como se fosse algo normal da superdotação, quando não é sempre que ocorre. 

Nos casos em que ela, eventualmente, ocorre, eu acho que ela pode, sim, ser um traço de TEA ou a pessoa estar dentro do espectro e não ter tido este diagnóstico; pode ser uma comorbidade de TDAH ou uma transtorno de integração sensorial que a pessoa tem com superdotação. O que não concordo é os autores induzirem que o transtorno de integração sensorial seria uma característica inerente da SD, tal como Dabrowsky fez a apologia (e da qual eu discordo). 

Se for um mero incômodo sensorial, como é o meu caso, aprendemos a conviver com isso. Porém, se os prejuízos forem intensos e frequentes, já se trata de um transtorno de integração sensorial  e deve ser tratado como tal. Além disso, também deve ser investigado se além da "Superdotacao", a pessoa não tem TEA (ou apenas traços de TEA - transtorno do espectro autista), ou TDAH, o que também justifica a sua ocorrência. 

O que não concordo é considerar como se a hipersensibilidade sensorial fosse algo inerente e uma característica da própria superdotação (como o artigo quis induzir) e não ser vista como uma patologia, quando os níveis são frequentes e intensos.

Podemos até pensar que os superdotados sejam mais vulneráveis aos transtornos de integração sensorial; mais predispostos a eles, mas não desconsidera-los como uma patologia, se os sintomas causam prejuízos intensos e frequentes e, se isto ocorrer, devem ser tratados com terapeuta ocupacional ou ser procurado um otorrino ou fonoaudióloga. Mais do que jogar toda a "responsabilidade" da hipersensibilidade sensorial na superdotação (que também pode ter sido mal diagnosticada ou ter sub identificada uma dupla excepcionalidade além desta), é importante tratar do incômodo ou patologia que a pessoa apresenta sem usar a superdotação como uma desculpa "nobre" para o que pode ser um transtorno.

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