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MD: Anyone have information or comments about the use of low dose of clonidine in a 22 month old female child with intractible crying? Normal EKG. Family history of fragile X.

JL: One might try a referral to occupational therapy before considering medicating. With a history of fraX in the family, some over-reactivity to sensory input might be a basis for the inconsolability. There are OT practitioners who are well versed in dealing with these sensory processing disorders.

MD2: I agree that an OT evaluation by someone experienced with regulatory type otherwise known as sensory integration problems is a very good idea prior to medication.

MD3: How does one integrate sensory? On several occasions I inquired OT folks with various levels of education about neurological and neurodevelopmental basis of sensory-motor integration and usually got gibber or blank stare. And I am skeptical of the technique claiming deep structural neurological changes via infrequent short exercises. Akin to fixing hardware with software. BTW, I would be reluctant treating this child with meds stronger than...

JL: I am more comfortable using the terms sensory processing or sensory modulation rather than sensory integration, which has received historically a bad rap and elicits somewhat emotional responses from some professionals. I would not go so far out on a limb regarding "deep structural changes," preferring instead to conceptualize the process as an organizing one, functional in nature rather than structural. These sensory processing or sensory modulation disorders often take the form of a hyper-responsiveness to non-noxious stimuli or, alternatively, an under-reactivity to sensation. Greenspan conceptualizes these disorders as regulatory in nature.

Sensory and motor strategies can calm or arouse the nervous system as needed. Slow linear movement, e.g., calms and soothes while fast rotary input alterts and excites. There may be times, especially with younger children when these strategies might be considered before medicating, and a referral to a trained OT would be in order.

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