Transcript for
Working with children with high sensitivity

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m joined by Rachel Samson, a clinical psychologist in private practice, to talk about the trait of sensitivity and what this means for children’s mental health and wellbeing. Rachel has specialist training in schema therapy and attachment-focused interventions and was involved in developing an expanded model of schema therapy for people with high sensitivity and stronger emotional reactivity. In this episode, we discuss the trait of high sensitivity, how it relates to temperament and the important role that attachment plays in supporting a highly sensitive child. Rachel also shares some suggestions around what practitioners can do to start to support highly sensitive children in their work.

Sophie Guy [00:00:51] Hi, Rachel, and welcome to the Emerging Minds podcast.

Rachel Samson [00:00:55] Thank you for have inviting me to have this conversation.

Sophie Guy [00:00:58] We’re here today to have a conversation about the trait of sensitivity and what this looks like in children and how it relates to their mental health and wellbeing, and I’ve been wanting to meet you and have this conversation for a while, actually, as a highly sensitive person myself who grew up without anyone close to me recognising this and giving me that guidance about how to be in the world, it’s something that I feel particularly passionate about bringing greater awareness to. And I have also this sense that maybe the numbers of children identified as highly sensitive are growing, maybe partly through an increasing awareness of the trait, but also that there are more highly sensitive children being born, you know, for probably complex and multifaceted reasons. So I wanted to start off with Rachel, if you could tell us a little bit about your background and how you came to specialise in working with sensitivity.

Rachel Samson [00:01:56] Absolutely. I’m a clinical psychologist and I run a private psychology practice in South Australia with my colleague, Dr Erin Bullus, who’s also been on an Emerging Minds podcast episode. And our clinic has two main focuses, so we provide attachment-focused interventions to families and individuals to support them in developing more healthy and secure relationships that really support their mental health and optimal development. And the other focus being working with neurodivergent families and individuals. So people who identify as highly sensitive, autistic and/or gifted to support their emotional wellbeing. I’ve always had a really deep interest in parent child attachment and specifically how early relationships shape our development. So right after being registered as a psychologist, I started to train in different attachment-focused therapies. So these are interventions designed to really improve the quality of the relationship between parents and their children and also therapies that helped adults process painful childhood experiences, learn to have healthy relationships with adults. So, for example, one of the therapies that I trained in was schema therapy, and I also travelled abroad to train in the assessment of parent-child attachment and parenting styles. At the same time, I was really fascinated in temperament, particularly the type of sensitivity which, like you, was something that I identify with myself and I notice was a common trait in many of the clients that I was seeing in my practice, both kids and adults. So I was particularly interested in the intersection between our early attachment experiences in childhood and our temperament, really how some people seemed to be more sensitive to their childhood than others. That was something that was really fascinating for me.

[00:04:08] So in around I think 2014, I attended a schema therapy conference in Istanbul where I attended a colleague’s workshop on temperament, and it was talking about how we can leverage sensitivity in therapy or parenting to really improve people’s wellbeing and development. And that was at the time a fairly new idea to me. So over the next few years, I began to focus more on that area in my clinical work and training, and that eventually led me to collaborate with Dr Jeffrey Young, the developer of schema therapy, and another colleague, Dr George Lockwood, to develop an expanded model of schema therapy for highly sensitive and emotionally reactive adult clients. [OK]. And over the past few years, I’ve been writing and lecturing on attachment and sensitivity and their importance in parenting and therapy, and that’s kind of brought us to the conversation we’re having today.

Sophie Guy [00:05:08] Thank you. I kind of want to jump into how attachment and sensitivity relate, but I might come back to that. And instead, I think it’d be helpful early on to ask you what is high sensitivity? How do you define it and what does it mean for a person to be highly sensitive?

Rachel Samson [00:05:26] I think before we define high sensitivity, might be helpful for us to, I guess, define temperament, and then look at the trait of sensitivity. So Dr Elaine Aron coined the scientific term Sensory Processing Sensitivity, which is just a fancy way of saying sensitivity, and she defines that as a heritable and evolutionarily conserved temperament trait like introversion or agreeableness or conscientiousness. Like introversion, we all sit somewhen on the sensitivity continuum from low to high. And when we talk about temperament, we’re referring to the biologically-based individual differences in people’s reactivity and our self-regulation, and it’s something that’s influenced over time by our genes, our development and our life experiences. But it’s present from birth, and these traits are also seen in a range of other species. So when we say reactivity, we mean our disposition towards our emotional and motor reactions and our attention. So it’s things like how quickly do we become fearful, withdrawing or self-protective if we’re in a scary or stressful situation, how quickly we might become frustrated if things don’t go our way or we can’t achieve a goal, and how intense our reactions to stressful situations are.

Rachel Samson [00:06:59] And then when we say self-regulation, we’re talking about the coping methods and processes that we use to regulate how reactive we are and how we adapt to situations and people so they’re like our tendency to either approach or withdraw from a situation, whether we direct our attention to something or away from it, and the effort that we use to influence our thoughts, emotions and behaviour and our temperament is present from birth, but it’s constantly being shaped by the quality of parenting that we receive as we’re growing up. And the most simple way to think about temperament, if we boil it down, is that it’s really the biological core of our personality. So if we then jump back to what is sensitivity, the trait of sensitivity is referring to how responsive a person is to their environment. So how strongly we react to things that happen in our environment.

Sophie Guy [00:08:01] Mm hmm. OK, that’s quite simple when you put it like that. And so what does it mean for a child to be highly sensitive? What what is this going to look like?

Rachel Samson [00:08:13] So when we start talking about high sensitivity, again, going back to that continuum of sensitivity, research shows that about 29 percent of people are low on sensitivity, around 40 percent are moderately sensitive so somewhere in the middle, and about 31 percent are highly sensitive. So someone who falls into that higher range would be termed a highly sensitive person or a highly sensitive child. And that would be someone who has a really heightened awareness of their environment and is really responsive to their environment, so reacting strongly to certain situations and experiences. And these just kind of stem from a really highly reactive and receptive central nervous system, which is something that’s been confirmed through several FMRI studies. [OK]. So the rates are actually similar across species. So it suggests that high sensitivity is a naturally occurring variation in genetics and not a flaw or disorder of any kind. It’s actually thought that high sensitivity has survival advantages. So being more tuned in to your environment and more responsive to your environment means that you’re more able to detect and respond to opportunities like food or alliances, but also danger like predators and competitors, so alike in a highly sensitive child or adult to the canary in the coal mine, they’re kind of capable of providing advance warning of danger or opportunity before it’s detected by the majority of the group. And in her book, The Highly Sensitive Child, Elaine Aron describes the highly sensitive child as a living smoke alarm. They let everyone know if there’s a bit of smoke anywhere. So in terms of how we recognise it, there’s four main characteristics associated with high sensitivity, a greater capacity for noticing subtleties in the environment, so really noticing details and small changes, a deeper cognitive processing of physical, social and emotional information, much greater emotional reactivity to positive and negative information and higher empathy, and I think that’s probably one of the traits that is most often associated with high sensitivity. We think of highly sensitive kids and adults as being really emotionally reactive or the characteristic is the tendency to be more easily overstimulated. So because highly sensitive people have a much lower threshold for registering and responding to input coming in from the environment, there’s much more coming in and getting processed by the nervous system. So it makes sense that highly sensitive kids and adults are much more prone to becoming overstimulated or stressed or overwhelmed.

Sophie Guy [00:11:23] And when you say it’s primarily sensitivity to the environment, is it generally a heightened sensitivity to everything in the environment or does it vary in certain things? The more, children are more sensitive to it than others?

Rachel Samson [00:11:38] Yeah, that’s a really good question. So environments are not just physical environments like the spice or even things like food and caffeine and medication, but it’s also the social environment. So I think that family dynamics, other people’s moods, crowds and as you said, sensory stimuli as well so auditory, tactile, visual, also internal experiences, that’s also an environment. So our thoughts, emotions, bodily sensations such as hunger or pain, pretty much everything.

Sophie Guy [00:12:14] OK. And I want to ask you how it is distinguished from, say, sensory processing disorder, something that’s a disorder, are they, they must be quite related?

Rachel Samson [00:12:26] Yeah, there’s a lot of overlap between sensory processing disorder and autism spectrum conditions. And one of the main overlapping areas is these differences in sensory processing and also very, stronger emotional reactions is something that that we see across all of those different conditions and experiences. The difference at this stage, the thinking is around the impact that it has on a person’s wellbeing, but at this stage, sensitivity is considered a naturally occurring temperament trait and in good conditions it’s a real advantage and helps people to flourish above and beyond people who are less sensitive, whereas it tends to be in stressful conditions that highly sensitive people are more prone to to struggle. Whereas the thinking, at least at this point in time, is that sensory processing disorder and autism spectrum conditions are impacting a person’s daily functioning and their wellbeing. And it’s a more permanent difference that they experience, whereas high sensitivity is something that is, I guess, changeable, and the impact really differs depending on the environment that the person is in. But in our thinking in our clinic is that all of these different conditions fall under the banner of neurodiversity and they all represent natural variations in human genetics. So whilst at the moment sensory processing disorder and autism spectrum conditions are pathologised and attract the label of disorder, our hope is that one day we will just see all of these variations as naturally occurring and possibly even serving some kind of evolutionary function. But it’s not the dominant view at the moment, unfortunately.

Sophie Guy [00:14:34] Yeah, OK. And the next thing I wanted to ask you is about, you know, how how can this understanding of high sensitivity help us to better support children’s wellbeing and how does it relate to mental health?

Rachel Samson [00:14:51] So I think it’s essential for parents and practitioners to understand high sensitivity in kids because the research shows that children are more strongly affected by their environment for better and for worse. So what the research shows very clearly is that if highly sensitive children are not in supportive environments, they are disproportionately at risk of experiencing mental health problems like anxiety and depression, behavioural problems and also chronic illnesses. But in supporting environments, sensitive kids are actually less likely than other children to develop mental health problems, and they can even outperform their less sensitive peers and experience greater emotional wellbeing and greater social competence. So this is something that’s known as differential susceptibility to the environment. Some people are more affected by their environment for better and for worse, and they’re able to take in more of the good, but they’re also more affected by adverse and stressful conditions.

Sophie Guy [00:15:59] So is there research showing that is there that in those good supportive environments that children, people with high sensitivity can tend to do even better than average?

Rachel Samson [00:16:08] Yes, there is. This may be a time to mention some really fascinating research that’s been done in the United States with rhesus macaque monkeys. And the findings of this research has also been replicated in a similar kind of human studies as well. But what the researchers did was selectively breed highly reactive rhesus macaque infants, and they fostered the infants within the first four days of their life to unrelated adult females who became their mothers. And they were pre-selected to be the unusually nurturing in their attachment behaviours to their infants or less, but still within the normal range of maternal care. And then the selectively bred infants were reared by their respective foster mothers for the first six months of life, and then they moved out into the larger social groups. And what they found was that during the fostering, the infants with normal reactivity, so those who were not highly reactive showed relatively normal patterns of development. There were no real marked differences between those who were fostered with the really nurturing females or the females who showed less nurturing parenting. When they looked at what was happening with the highly reactive infants, they found dramatic differences as a result of the type of parenting the reactive or sensitive infants received. So what they found was that the highly reactive infants that were foster-reared by the less-nurturing females showed deficits in their early exploration behaviour and really exaggerated behavioural reactions to even minor stress in their environment. Whereas the highly sensitive infants that were fostered with the nurturing females actually appeared to be more confident than all of the other infants, including the infants that were less reactive to begin with. So it’s really amazing, it’s incredible research. So they found that those infants who were highly reactive and had the nurturing mother moved away from their mother earlier, they required less body clinging,  they moved around and explore their environment more than the other infants, and they displayed much less disturbance during weaning than the highly reactive infants with the less nurturing mothers, but also the normally reactive or less sensitive infants that were raised by either mother. And so what the researchers concluded was that those reactive infants had actually developed an unusually secure relationship to their mother. And then when they went to do follow up studies and they moved the monkeys out into the larger social groups, they actually found marked optimum outcomes for the highly reactive monkeys who had those secure attachment to their mothers. They became especially competent at recruiting and retaining all the group members as allies in response to difficult social situations. And they subsequently rose to and maintain top positions in the groups dominance hierarchy, whereas sadly, the highly reactive infants who had been fostered to the less nurturing females developed less secure attachment and actually tended to drop to the very bottom of the social hierarchy. And then lastly, that the less reactive infants, so the normally reactive infants were not strongly affected by the highly nurturing or the less nurturing mothering, and they maintained position somewhere in the middle of the social hierarchy, regardless of the type of parenting that received.

Sophie Guy [00:20:03] I always feel sad when I hear about these studies inflicted on animals. But that’s really interesting, really interesting.

Rachel Samson [00:20:10] I agree, yeah, unfortunately psychology has a very poor history for animal studies.

Sophie Guy [00:20:17] Yes. So I’m still curious to dig a little more into how to sort of make sense of thinking about sensitivity alongside wellbeing and mental health. And I guess I’m thinking maybe for practitioners who are listening to this who aren’t very familiar with temperament trait of sensitivity and why it might be important to know about this and how it can sort of feed into thinking and supporting children’s wellbeing.

Rachel Samson [00:20:45] Yeah, I think firstly, it’s really important for practitioners working with children and families to increase their own awareness and knowledge of differential susceptibility and the trait of high sensitivity, so really we can provide education and knowledge to families. I think our job is two-fold, we need to be good at assessing and identifying children who are highly sensitive and then we need to support parents, families and other significant adults in children’s lives to practise sensitive parenting, to provide a highly supportive environment for their sensitive children. So I think we need to appreciate that as many as one in three people may be highly sensitive, which means the likelihood of professionals working with highly sensitive kids or adults is very high. So we also know that highly sensitive children and adults are disproportionately at risk of experiencing psychological issues. So they’re more likely to seek and engage with mental health services than less sensitive individuals. It’s important that researchers and practitioners can understand what constitutes a negative or positive environment for a particular child so that effective interventions can be developed and implemented with, with families and in the community.

Sophie Guy [00:22:12] And what does that look like? Could you give a sense of how you would go about assessing the environment and sort of what is supportive and maybe not so supportive?

Rachel Samson [00:22:22] So there’s various tools, validated self report and parent report scales that are freely available on Dr Elaine Aron’s website. And they can be used by practitioners or even parents to assess where a child or an adult sits in terms of sensitivity. And also through interview with parents, often parents will come to therapy saying that they’re noticing certain things in their child, these characteristics and reactions. And so that can sometimes be a clue for practitioners, that sensitivity may be part of the picture, but in general, I think all children really require their caregivers to attuned to their temperament than neurotype needs preferences in order to flourish and highly sensitive children need it even more, which is to say that they really need caregivers who are attuned to their needs and preferences and respond sensitively. And if that happens, they’re likely to do better than when the adults in their lives don’t tune in or respond to what they need. So I think one of the things that’s supportive for a highly sensitive child is firstly understanding and appreciating their sensitivity and then really paying attention to what they respond positively to and what they respond negatively to. So especially in the early years of life, children depend on their caregivers and the adults in their world to regulate their level of arousal and stimulation, to prevent them from becoming overwhelmed, stressed, overstimulated. So as adults, we really need to be paying attention to what is overstimulating child, what helps them to come and really supporting them in that way, because especially for young children, they don’t have the capacity to do that for themselves. So that’s one of the things that practitioners can support parents to to do for their children. Highly sensitive children also require patience, so there are some kids who are more impulsive, who kind of act first and think later, whereas highly sensitive children often have a tendency to pause and check their environment or an activity before they’re comfortable enough to go into it. So as adults, we must be careful that we don’t push sensitive kids into situations they’re not ready for, or this just puts them at risk of becoming overstimulated and emotionally dysregulated. It’s not that children can just adapt to, we’re talking about children’s neurobiology, their wiring, so children can’t easily adapt to these expectations that that might be there from adults. It’s really our job as the adults, as the practitioners, the parent, to as much as we can accommodate the child’s needs and not push them into situations that they aren’t ready for.

Sophie Guy [00:25:23] And what sorts of things might a parent be saying if before perhaps have gotten to an understanding that their child is perhaps highly sensitive and they come and see a practitioner? What sorts of things the parents say and what are they noticing?

Rachel Samson [00:25:42] If we have a look at the highly sensitive child’s scale, which is a parent report that was based on some of the most common reports that parents make about their highly sensitive kids. So it’s things like, my child startles easily, they complain about scratchy clothing, seams in their socks or labels against the skin, they don’t usually enjoy big surprises, they use big words for their age, they notice the slightest unusual odour, it’s hard to get to sleep after an exciting day, they don’t do well with big changes, they ask questions, notice the distress of others sensitive to pain, bothered by noisy places and feel things deeply. So they’re just a few of the options that are in the scale, but in my experience, one of the things that parents most commonly report is that their children have big emotional reactions and big meltdowns to things, and it is more intense than perhaps their peers or their siblings. And so parents who may be the first child was not sensitive then have a second child who is really sensitive. And I think what is going on with this child, this is so different to my first child. There must be something wrong. And what it actually might be is that the child has a much more reactive nervous system, and so they react more strongly to things than their sibling, than their friends and other kids their age. So that’s a really common thing that parents come up with and also separation anxiety is also quite common in sensitive kids. If they have that soothing and nurturing that was found in the study with macque monkeys, but also in the research that’s been done with sensitive kids, then they internalise that and they start to feel more confident. And if they know that when they get freaked out or nervous that their parent will be there as a secure base that they can go to to comfort them and regulate them, they have much more confidence that they can go out in the world and explore. And so then we see the bright side of sensitivity where that can be very confident. But if parents maybe aren’t yet aware of the trait, they may be pushing the child to be independent and to not be clingy. And that’s just going to send the child’s anxiety higher and make them even more clingy. So sometimes parents will come in and saying, my child is struggling to separate, they’re anxious about going to school, bedtime is a big problem, they don’t want to separate at bedtime. And so that will be another thing that parents will commonly say is of concern for them.

Sophie Guy [00:28:35] OK, and then so if a family or parent comes to see a practitioner and perhaps things have already started to not go well because of maybe not recognising high sensitivity in their child, what sorts of things are supportive and how can how can practitioners and parents start to support their highly sensitive child to start to flourish?

Rachel Samson [00:29:00] It depends partly on the parents own attachment history. So parents who themselves have a secure attachment history and grew up with parents who were responsive may only need some basic education about high sensitivity. And they are very willing and able then to respond to their child’s sensitivity once they know this isn’t a disorder, this isn’t a flaw or a problem, and this is what you can do to support your child. You know, you can be more nurturing and patient, allow them to be clingy until they feel confident. That can sometimes be enough and things can improve very, very quickly. The research shows that highly sensitive children are much more responsive to intervention than less sensitive children. And so even very short interventions can be extremely helpful when parents are really open and keen to engage. Then we have a second group of families where parents have grown up with an insecure attachment history themselves. They didn’t have their emotional needs met as children, and so they don’t have a template for responding sensitively to their children. And that’s when intervention will need to be more intensive and maybe a more long-term process. And in that situation, we would be working closely with parents and supporting them in how to learn to tune into their child’s signals. So is the child signalling that they need comfort and closeness and help to organise their feelings? Or are they signalling that they’re wanting to move away from parent to play and explore? And for parents who who didn’t have that security when they grew up, it can be very hard to read their child. And so that’s something that we would, as practitioners, be supporting them to do. And then as the parents gain confidence in being able to read their child’s needs and this signalling, we then see that the child starts to become more secure and then the anxiety tends to go down. But if there is already an anxiety disorder or a mood disorder, then then we would also need to do some maybe some therapy with the child as well around that, depending on the child’s age. But to be honest, most of the therapy with children is with parents because children are so strongly affected by their family. I think it’s best practise to always work with parents and there’s some work you do one on one with kids, but most of the work is usually caregivers.

Sophie Guy [00:31:49] OK, so you mentioned before this idea of sensitive parenting. Could you just talk a little bit about what what do you mean by sensitive parenting and how does that relate to children who have high sensitivity?

Rachel Samson [00:32:01] Yeah, so when we talk about, I guess, optimal parenting and children’s needs, there are two main categories of needs that children have. They have attachment needs, which is their need for regulating their feelings, they need soothing and comfort and really helped organise their feelings when they’re distressed. So the parent’s role when children are emotionally triggered or emotionally activated is to help them regulate those emotions and come back to a state of calm. And that helps children to feel very secure when they’re feeling, you know, am I emotionally distressed or overstimulated and so sensitive parenting is reading the cues that the child is saying, I’m upset. I’m overwhelmed. Help me organise my feelings. And a parent will then go in and, you know, they may provide touch or it might be soothing words, validation. If the child is verbal, it’s saying things like, it’s OK that you’re upset. You’re having a big feeling at the moment. You’re really angry or you’re sad. And that’s OK. I’m right here with you. With a smaller child or a non-verbal child, it might be rocking touch, quietening the room, those kinds of things. And then what happens is that once those attachment needs are met, usually what kicks in is what’s called the exploration system. And then the child will signal that they’re ready to play or explore their environment. And so then sensitive parenting would be reading that, that’s where the child is at, and then at that point, they need support to play and to explore their environment. And so that’s things like setting up the room in a way structuring so that they can play successfully, being there as they try new things so that they feel confident. And the important thing for sensitive kids is that that might look a little bit different to what it looks like for other kids. So, as I said before, sensitive kids may need to pause and check before they’re ready to go into play or to explore new activity. And so parents would need to read the signs. My child is not ready yet. They’re needing a little bit longer to process the situation. And so it’s just supporting them with that and being with them until they feel confident and until they give the signal that they’re ready to engage or they’re ready to play. And then on the other side of it, you know, highly sensitive children are more emotionally reactive. So they do need a lot more emotional support and coaching, so parents will often spend a lot of time with their kids talking through feelings, validating their feelings and letting sensitive kids know that it’s OK to have these big reactions and that, yes, they may feel more upset about things than other kids, but they will probably also experience joy more deeply as well. So it’s just the kids across the full range of their needs. And the important part is that the parent, as much as possible, is tuning into the child’s signals. And that is a hallmark of sensitive parenting.

Sophie Guy [00:35:22] Great, thank you for that. And then any sort of final thoughts about what would be helpful for practitioners to take away that they could maybe start to apply to their work with children and families?

Rachel Samson [00:35:35] Learning more about differential susceptibility, the research that shows that we’re all affected differently by our environment is really important. And then I think specifically learning more about the trait of sensitivity, given that it is so common, is really important just for people to be more aware of what to look out for in their clients and families and when they’re conceptualising some of the issues that might be going on for a family. And then I also think that for anyone working in the space with children or families, getting trained in attachment-focused interventions is so essential, you know, this huge body of research that our early relationships have an incredible influence on our mental health as adults. So I think if we want to improve the mental health of Australian children, but also future generations, then we really do need to target the parent-child relationship as a focus of our intervention. So anything people can do to upskill in attachment-focused interventions I think is hugely beneficial.

Sophie Guy [00:36:49] OK, well thank you is a quite a high level conversation, really quite broad and I can tell it’s so rich, but we’ll leave it there for today. And thank you so much for joining me and sharing your wisdom, Rachel.

Rachel Samson [00:37:05] It’s been my pleasure. Thank you for inviting me to have this conversation.

Narrator [00:37:11] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds, the National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.