No One Knows What The Cerebellum Does, Listening Therapy As A Tool & Socially Influenced Learning

Raise your hand if you were taught in school that the cerebellum’s main responsibility is to coordinate movement 🙋🏻‍♀️.

If you’ve taken any advanced courses in sensory processing disorder, you know that movement coordination is probably not the entire story.

This article lays out the history of what we know about the cerebellum and how recent research has shown cerebellar problems to be highly associated with disorders such as autism and schizophrenia.

Looking back, it doesn’t make a lot of sense for such a big part of the brain to have a small role in cognition. We know now that every part of the brain works together with every other part. We just don’t know enough yet to know how or why those pieces fit together to make a cohesive personality.

Scientists have begun to map the cerebellum using functional MRI technology and have been able to locate areas that influence or control many functional skills such as:

• motor planning
• divided attention
• resolution of conflicting sensory information
• visual letter recognition
• visual working memory
• mental math
• verbal fluency
• word comprehension
• autobiographical recall
• emotional processing
• language processing
• word comprehension
• rapid eye movements

Despite these advances in neuroscience, though, we still don’t know exactly what the overall role of the cerebellum is.

I think about articles like this a lot when I’m trying to explain sensory processing disorder to families.

We, as health care professionals, are really good at reducing every observable behavior to a specific brain region or function.

But the reality is we still don’t have a good idea about what’s causing a lot of deficits and behaviors that we see in therapy. I mean, we still don’t know what the cerebellum actually does.

Over the years I have spent an exorbitant amount of money on training and equipment for various listening programs. I even hired a “mentor” to guide me through choosing the right music for the right child using a program she was paid to lecture about.

What I found was that many kids hated wearing the headphones, hated the music, or both. And I’ve never had a patient show any real progress that I could relate to a listening protocol.

I have many colleagues, who I greatly respect, who have noticed changes in their patients that they could relate directly to the listening programs they use. I’m definitely open to the possibility those programs work for some kiddos.

No tool is going to work for everyone, and I admit I may be too skeptical of the approach for it to actually be successful for me. I just don’t buy into passive stimulation as a treatment tool.

Yes, I know listening is an active process. But hearing and listening are two different things, and it’s often difficult to determine which process is happening under those headphones.

Still, I’m open-minded. I’d love to find that magic tool that changes a child’s life. I am completely sold on using music as a tool in therapy, just not as a protocol.

I ran across this article that appeared to be a study about hypersensitivity in children with autism. While I was disappointed with the discussion of treatments, I did learn a lot.

The article describes two pathways for auditory processing: the classical pathway and the non-classical pathway. The classical pathway starts at the 8th cranial nerve (the vestibulocochlear nerve) and connects to the auditory centers of the cortex.

The non-classical pathway also starts with the 8th cranial nerve, but it ends up in the limbic system. In young children, the non-classical pathway seems to be more well-developed.

This makes sense because toddlers have very little cortical control over their behavior and emotions – that comes with age.

Toddlers tend to react strongly to loud noises, and this tendency fades as they get more cortical control.

It’s likely that since children with developmental disabilities tend to demonstrate widespread neurological immaturity the non-classical pathway activation could persist for a much longer period of time. This could explain why a 10 year old with autism may still have tantrums when he hears loud noises.

The authors of this article cite evidence regarding the effectiveness of systematic desensitization for children with auditory hypersensitivity. The problem with that approach is that the child has to be cooperative with the systematic desensitization, which is a big ask.

They suggest listening therapies as a first line of treatment, as those approaches are passive and allow the child to become more accustomed to listening to sounds without major emotional breakdowns.

I guess this could work as an introductory strategy for children who show hypersensitivity to most sounds. But it’s still a passive approach, and neural plasticity depends on active participation.

The article didn’t convince me to jump back into the world of listening protocols, but it does give a good deal of insight into why auditory hypersensitivity might exist. It’s worth a read. You can read it here.

If there’s one thing many of our patients can’t do, it’s learn from social experiences. But why is that? There are lots of theories including mirror neuron dysfunction, lack of attention and lack of theory of mind.

This article explains how “direct learning” and “socially influenced learning” may work, and a disruption in these neuro circuits may offer a better explanation of why many of the children we treat have such difficulty learning from others.

Direct learning is your ability to learn from your own actions and expectations. For example, let’s consider what happens when you meet a new patient for the first time.

• You start out with expectations about how the patient may look and/or behave given what you’ve seen on the referral. You may have also formed opinions based on what you’ve heard about the patient from other therapists or teachers.
• Without realizing it, you create an idea of what the patient is like and begin to plan how to interact with him based on that mental “short cut”.
• When you meet the patient, if he’s exactly like you expected he would be, you carry on as you normally would. There’s no need to change your behavior because your expectation was correct. Your original plans and ideas are reinforced.
• If the patient is nothing like you expected, you have to re-think how you are going to interact with him. You adjust your future expectations based on your current experience. You are learning directly from your own judgement mistakes.

Socially influenced learning is similar, but involves adjusting your behavior based on the behavior of others. Let’s continue with the above scenario, only this time you are co-evaluating the new patient with a speech therapist.

• You have expectations about the patient based on what you’ve already heard. Let’s say you are expecting him to be oppositional and defiant.
• You evaluate the child and decide that he definitely demonstrates defiance with certain activities.
• After the co-evaluation, you consult with the speech therapist to share your observations.
• The speech therapist’s impression of the child was that he was very mild mannered and compliant. She saw no evidence of defiance.
• Now you have a decision to make. How does the speech therapist’s impression influence yours? Was he really defiant or were you just being biased? Did the speech therapist miss things you saw?
• Your ultimate first impression of the child will likely include what you learned from the speech therapist. If you have a lot of respect for that therapist, you are likely to learn from her opinion and adjust yours accordingly. This is socially influenced learning, AKA peer pressure.
• If you don’t have a lot of respect for that therapist, you’re likely to stick with your original opinion and write therapy goals that support your first impression instead.

Interestingly, direct learning, and to some extent social learning, are governed by the prefrontal cortex circuitry which isn’t fully developed until your mid-twenties. And we know that most of our kiddos have immature functioning in that area compared to their typical peers.

A disruption in these learning circuits may explain why some of our patients have such difficulty learning from their friends.