Thursday, April 3, 2014

Deep Pressure Stimulation for anxiety, ADHD, insomnia, or autism

Someone was telling me last week about a snug sweater that is available for your pet dog or cat, which is intended to soothe anxiety or phobic behaviour!  Here is an informational site for a business selling this:
The whole idea made me smile!   Maybe it’s gimmicky, but what if there’s something to this?

I think the idea is very simple, that pleasant, hug-like tactile stimuli can be emotionally comforting.  As with other sensory stimulus treatments for mental health symptoms, why not try tactile things?  We have, for example, bright light therapy, calming audio recordings, and aromatherapy, each of which have a reasonable evidence base.  Of course, there is massage therapy, but usually this would consist of  brief, fairly expensive sessions which would rarely be practical to arrange daily or continuously.  
Here are the results of my survey of this issue:
For children with autism or attention problems, there are weighted compression vests available on the market, which are supposed to help cognition, comfort, and behaviour.  These are simply vests which weigh about 10% of body weight:   This 2014 study in an occupational therapy journal showed significant improvement in ADHD symptoms in 110 children, average age 9 years.  The study had a randomized, crossover design, with subjects putting on the vest and immediately doing a CPT test.  The subjects were scored according to the CPT test result, and according to observations of behaviour during the trial.   Symptom improvement attributable to the vest was quite significant: about 20% improvement in being on-task, 50% reduction in fidgeting, and 20% reduction in CPT omission errors.  In this study, the 4 weighted vest subjects had 18-25 % improvement in on-task behaviour, also 3 of the 4 children asked to wear it more!  In this review article, they found insufficient evidence to recommend weighted vests. But most of the studies reviewed were looking at very young children (under 5) with autism.  It is of greater interest to me to look at the use of this strategy for older children and adults with anxiety or attention problems. 

This study showed that swaddling babies reduces the pain response to a blood test needle, compared to control.  
Temple Grandin is a famous autistic woman, with a BA in psychology and a PhD in animal science, who has been very open about her personal history; she has become an authority in the area of providing safe, ethical care and comfort to agricultural animals.    These are links to Grandin’s 1992 paper in Journal of Child and Adolescent Psychopharmacology in which she describes her own very beneficial experience of a device she built (“the squeeze machine”) which she used daily for many years.
She found this machine to be comforting, and to even improve her subsequent ability to tolerate other types of sensory and interpersonal stimuli as an adult.

Here is a very recent article with Grandin as co-author:  This is a case study of a woman with bipolar disorder who reported some benefit from deep pressure techniques.  Other adjuncts in this case were use of a squeeze ball, chewing gum, lightly tinted glasses, and a soft brush to rub against the skin. I'm a bit surprised this got published, though, since it seems they didn't really use any one technique systematically. 

Weighted blankets are another idea along these lines.  Here is a website selling items like this:   I see the weights are up to 20 pounds for a larger blanket, again with a recommendation of about 10% body weight.    It seems like a home-made version of this wouldn’t be too hard to make, or at least to experiment with.  The material used for the extra weight is often simply small, smooth stones.  
Sleeping in a mummy bag (a type of sleeping bag used for camping) is another similar idea.   

So, in summary, deep pressure stimuli of this sort could be worth a try to treat ADHD, anxiety, insomnia, or tactile hypersensitivity, with very little risk.  I suspect one could get an idea of results and tolerability quite quickly.  A key idea, that Grandin emphasizes, is that the stimulus should always be fully under your control, so it would be useful I think to be able to adjust the weight, and to remove it very easily.