Go with the flow: Sensory strategies for transitions and getting to reflex integration: Blog #7

decorative sensory motor mindset picture

If you are a therapist, you most likely see at least one kid who goes a million miles per hour. They can slow down but their focus is inconsistent and you are left with your hair frazzled wondering if you are getting any “therapy” done.

You may have lots of therapy tools but what are they worth if the kid is never in one spot long enough for you to use them.

These few weeks I have been applying some sensory techniques that have been helpful in getting these kids to participate in less-preferred hands-on therapy techniques.

I will use an example of one of the trickiest kids currently on my caseload.

He is in 2-3rd grade and if he had a setting it would be fast.

I will refer him to Taz because he reminded me of the Tazmanian Devil (a cartoon character from an old TV show who had SO MUCH energy that he was portrayed as a tornado when he moved).

tazmanian devil looney tunes

Taz’s case has many behavior and sensory elements mixed together with unintegrated reflexes.

He is super smart—above grade level for math—and has a HUGE loving heart.

When we first worked together, he refused to do many of my suggested activities. Instead, he played with a few toys and ran around the clinic. He also loved to spin super-fast on our suspended trapezes.  Taz processed sensory information differently than the majority of people. He pulled away from most touch. If I tried to do firm and gentle compressions with my hands on his arms or legs, he often responded as if I was hurting him or said “that feels weird!”

Many OTs use terms such as “sensory-seeking” and “sensory-avoiding” to describe types of children with sensory processing difficulties.

A common school of thought is that if a child was sensory-avoiding, they would benefit from having environments that were less stimulating. The opposite was said of children that were sensory-seeking.

The problem with labeling a child as either sensory seeking or avoiding is that often people display a mixture of behaviors.

For example, I have known many children who both craved touch—often excessively touching others—but were explosive if they were unexpectedly touched.

Typical of many kids with difficulties processing touch input, Taz was often fine with sensory input when he was in control of it. You can read more about touch processing in this blog.

Taz did not fit into either category of sensory-seeking or sensory-avoiding. Simply giving him deep pressure input with my hands at the beginning of the session was not working for him.

Instead of labeling a child as sensory seeker or avoider, I have found better results with a different approach.

 Inspired by an OT teacher named Julia Harper I will share some questions that may be helpful when working with children like Taz.

Considering Taz’s behavior, I asked myself what activities he preferred? Those were definitely running back and forth between rooms, swinging and spinning on swings, and hanging from a trapeze.

The big question is: “Is what they are wanting “rhythmic or arrhythmic?” You could also ask if it is “predictable or unpredictable.”

 Although many things that he did seemed erratic on the surface level, he was actually doing things that were repetitive and gave him predictable results.

One session when I gave him the choice between being in either of two rooms, he ran back and forth between each room for 5 minutes (perhaps it was longer).

When I mistakenly forced him to choose by blocking the entrance of one room with my body, he had a HUGE meltdown.

He screamed at his mom insisting that he be taken home. It took another 15 minutes for him to recover in the waiting room before he could come out and play.

What was my mistake? I interrupted his rhythm, his groove.

One technique that I use with children who are engaging in a repetitive behavior is to join in. I imitate what they are doing. Sometimes this is just enough to get them to snap out of their cycle.

I feel cheesy when I say that you should “go with the flow”, but it is really a constant lesson with the kids I work with. Often you have to move into a pattern with the kids before they can transition into something else.

Dr. Masgutova used one of these techniques for a child in her book You Are A Winner. The book talks about working with child survivors of a tragic train accident.

One child was repeating the same phrase for hours “We were riding with my grandparents and an explosion happened and my grandmother had fire in her hair.”

To help him, Dr. Masgutova repeated what was saying to acknowledge him. She also helped him move in a figure 8 movement (lazy 8s). *You can read more on this in the free book(Co-written by Pamela Curlee our guest speaker on March 28th). 

Eventually Dr. Masgutova altered his phrase to “You were riding with your grandfather and grandmother, and now, look, you are here in this room with me.”

The boy stopped repeating the same phrase and said, “Yes, now I am here.”

Back to Taz! He was seeking lots of repetitive and predictable activities he could control. I helped him get more of this input by encouraging him to do more of the same activity and doing it with him.  

This not only improved my connection with him in that moment – it improved his ability to transition to new activities such as reflex integration techniques.

In addition, I included lots of high impact deep pressure activities. For example, if he was jumping into crash pads, I asked him how many crashes he wanted to do and counted down with him.

The input was rhythmic and repeated. He enjoyed connecting with me and doing them WITH me especially if I added imaginative play to the activity.

Eventually near the end of the session, he was allowing me to work on reflexes such as his hyperactive foot tendon guard. (This reflex can predispose children to being in a a state of fight and flight.)

I have another child I have been seeing who has been enjoying mostly arhythmic input. He is the kid who seems to notice every small detail in the room and is very easily distracted. I shall refer to him as Joey.

Joey tried to convince me that the reflex integration work was making him worse, even though his mom and I could see improvements from just a few sessions.

Mostly, I think he just did not want to pause when there were so many fun things in our clinic to play with.

In our last session, he loved activities with directional changes and intense unpredictable touch such as pillow fights.

In between these types of activities, he was much more willing to do reflex integration techniques with me.

Note: You can definitely overdo these activities with some kids but you can always follow up with more heavy work and deep pressure touch to get their energy levels back down.

There may be times when children have more need for rocking and repetitive movements just as there may be times when they would like to engage in less predictable and arrhythmic movements instead.

As an example, this week at our clinic I have noticed one child feeling sleep-deprived. He loved wild shaking in hammocks in the sessions before but that day, he declined this activity and we stuck to linear swinging in our warm-ups.  

Let me know what you observe with your clients this coming week. Do you notice more rhythmic or arrhythmic patterns in their preferred play?

What shifts do you notice when you join in with their style of play?

In April I will be sharing more of my rhythmic and arrhythmic sensory strategies and how to create a sensory diet with children so you can get them to participate better in therapy and at home. 

Does this sound good to you?  Comment below!

There are just a few more days till Pamela Curlee speaks on reflex integration on March 28th. I’m sure you are RSVP’d but if you haven’t yet you can do so below.