“Early trauma is stored in the body via the senses, this is why therapy through the senses is effective.”
Smith, K BPD and SI 2004
Occupational Therapists are ideally placed to work through play and via the senses to promote the development of healthy neurological pathways and structures; impacting the development of sensory motor skills and abilities that underpin our ability to move, learn, play, develop, communicate, think and process emotions.
Sensory integration is integral to the process of healthy development ‘when the functions of the brain are whole and balanced, body movements are highly adaptive, learning is easy and good behaviour is a natural outcome’
They can do this with clients who are very young, or those who are adults with childhood trauma, who often find talking therapies very hard to engage with as the trauma memories are stored before language has developed, so are instead stored in the body and via the senses.
These young people do need trauma-informed schools, but this is not enough! The problem with whole school approaches to trauma is that for these children whole school strategies are not individualised and personalised and as such, are not specifically targeted. Specialist assessment and intervention is needed for these young people to reduce the impact of trauma on their young plastic brains, still in development.
Postgraduate education in Ayres’ Sensory Integration theory and practice alongside undergraduate education in infant and child development means that occupational therapists are ideally placed to address the sensory-motor needs of looked after children who have often been subjected to trauma in utero and early childhood.
Ayres’ Sensory Integration is a theory that suggests that brain “maturation is the process of the unfolding of genetic coding in conjunction with the interaction of the individual with the physical and social environment. As a result of experience, there are changes in the nervous system.”
Spitzer and Roley 1996
Sensory qualities of the environment can positively or negatively interact with function and development.
Schneider et al, 200
Occupational Therapists working in this area are able to use a discreet but comprehensive range of skills and resources within their scope of practice to offer direct one to one sensory integration – based intervention. These may be with the individual child, while also supporting foster and adoptive families, and typically includes parent participation in therapy. Occupational therapists will also offer parent and family education and work alongside schools and other organisations via a consultation model, offering education, in-service training, supervision for staff.
“Adopted children who have suffered traumatic early experiences are “barely surviving” in the current high-pressure school environment and need greater support if they are to have an equal chance of success, a charity has said.
They are falling behind in their studies because they are struggling to cope emotionally with the demands of the current education system which “prizes exam results at the expense of wellbeing”, according to a report from Adoption UK.”
The development of Occupational Therapy care pathways for children, adolescents and adults with trauma is increasing, as the role of Occupational Therapists in this area is increasingly being recognised.
‘Sensory Integration sorts, orders and eventually puts all the sensory inputs together into whole brain function.’
What emerges from this process is increasingly complex behaviour, the adaptive response and occupational engagement.
Allen, Delport and Smith 2011
You can read more about work in this area by following these links:
1. May–Benson, T. A. (2016). A Sensory Integrative Intervention Perspective to
Trauma–Informed Care. OTA The Koomar Center White Paper. Newton,
3. Werner, K. (2016) “Occupational Therapy’s Role in Addressing the Sensory Processing Needs of Young Children with Trauma History” Entry-Level OTD Capstones. 8. http://commons.pacificu.edu/otde/8[accessed Jul 01 2018]
In my time as a special needs parent, I’ve had a variety of responses to telling people my child has special needs. Some responses have been great, others have left me crying all the way home. Literally. Some have opened up conversations, others have shut them down. I know that those people who have not been so helpful have just been looking for the right thing to say and found the wrong one. So here are some cues to think about what you’re saying. Remember when the parent says the “we think (s)he might have….” Or “(s)he’s got…” they are very vulnerable. They will have cried and fretted and lost sleep over the information they are giving you and they will be at some stage of processing that information. If they are giving you that information, they either need you to change the way you are interacting with their child, or they need to talk about it. Choose your words carefully to open up the conversation and hear what they’re trying to tell you.
Please don’t say: “(s)he seems fine to me”. I know you’re trying to be reassuring, but by saying this, you imply that you are more able to identify the child’s developmental needs than the parents and the professionals working with the child. It pretty much shuts the conversation down, but if it continues, you force the parent into the role of pointing out their child’s deficits while you defend them. This is not a natural way of things, the parent spends enough time pointing out their child’s deficits with professionals, you need to enable them to big their child up and point out what a wonderful person they are.
Say instead: “I hadn’t noticed. What’s going on?” By saying “I hadn’t noticed”, you can reassure the parent that it isn’t that obvious, but also put yourself not the parent in the position of the person who needs educating about the child. You open up the conversation, and you give the parent the choice about how much information to give you, they might just tell you a load of assessments and appointments or they might tell you what the child is struggling with. It’s up to them.
Please don’t say “I couldn’t do it” the truth is you could. Of course, you could and a whole lot more, if that was what your child needed. Don’t point out how lucky you are that you don’t have to. The parent might well be wondering whether they can do it, and how long they can keep doing it for, they need you to reassure them that they can keep going.
Say instead “I really admire the way you’re doing it” This way, you’re complimenting the parent, you’re recognising how hard they’re working but you’re not sowing that seed of doubt that they might not be able to keep going.
Also, say “how can I help you do it?” they probably won’t know, but they’ll really appreciate being asked. It might be as simple as “watch my child while I have a pee in peace”. Do that. Then offer to do that again, don’t wait to be asked.
Please don’t say “(s)he’ll catch up” (s)he might well not. People were telling me this when the doctors were telling me she might well steadily regress. It wasn’t reassuring, it was frustrating. Again, it puts you in the position of the expert over the parent and professionals and the parent in the role of pointing out the deficits. Parents do not want to point out their child’s deficits, please don’t make them do it. Please don’t encourage the parent to compare their child to typically developing children, the only person a child needs comparing to, to track their learning is themselves.
Say instead “what does (s)he really love doing?” Give the parent a chance to gush about their kid, what they love, how much fun they are etc. Most parents will leap at this chance, it’s so refreshing after appointment after appointment telling professionals what their child can’t do.
Please don’t say “is there a cure?”The child may well not need a cure, they’re probably not ill. If the child is ill and there is no cure, they really won’t want to keep repeating that and if they know there is a cure, they’ll be doing it. Trust me, they will have researched treatment options very thoroughly.
Say instead “what are you thinking about for the future?” Again, keep it open. The parent might be trying really hard not to think about the future, they might well be taking one day at a time or they might be able to think of nothing else. They can choose how to interpret “the future” in your question and might tell you about getting them to eat just one more type of food or school support options, or they might be racing ahead to adulthood prospects.
Please don’t say “have you tried…?”again, you’re putting yourself in the role of expert with this one and the parent in the role of person to be taught how to raise their child. Unless you’re really actually a professional expert in what you’re suggesting, and you’ve spent time really interacting with the child, please just don’t.
Say instead “what do you think might help?” A parent who thinks their child has some additional needs will have done very thorough research, trust me. Give them time to talk about what they’ve learned. They might say “nothing” and then you’ll feel really awkward. Live with that, they feel awkward a lot of the time. They’ll probably tell you things that have been suggested and why they think/ don’t think that’s any good. Listen.
Please don’t say “you won’t want to come” Don’t presume, parenting a child with additional needs is isolating and exhausting. They might say no. Don’t be offended if they do but give them that option.
Say instead “I know (s)he finds this difficult, but I wanted to invite you in case you think they’d like it” Invite the child, acknowledge that it might be hard for them and they might want to say “no” and that’s OK, but make sure they know you want them there and you value time with them.
Please don’t say too much in front of the child.Remember they may well understand more than they can say and for any child seeing their parent upset is confusing and frightening.
Say instead “how am I best to communicate with him/her?” Then get down on the floor and do it. Playing with a child, talking with them on their level and really getting to know them is the biggest compliment you can pay the child and the parent.
My biggest advice if someone is telling you their child seems to have additional needs or a developmental difficulty is to listen to them, make them feel validated, treat them as the expert on their own child and don’t belittle their experiences. Your role is not to fix the child, you can’t do that. Your role is to support the parent, build their confidence and to be their friend.
On our courses, we teach staff from CAMHS and adult/older adult mental health services how to use Ayres’ Sensory Integration to inform care including for those who have had early trauma.
On our in-house courses, we regularly teach mixed staff teams including Mental Health Nurses and Healthcare Assistants, CPN’s, OT’s, PT’s, SLT’s and Therapy Support Staff, Complementary Therapists, Psychologists and Psychiatrists. Working with staff teams from forensic, secure, acute and longer stay units, our lecturers help teams to develop and implement sensory informed care pathways. This includes working with sensory providers to develop secure safe sensory rooms for safe self-regulation and sensory-rich movement activities suitable for secure and forensic environments, where ligature risks mean traditional swings and other equipment cannot be used.
The use of Ayres’ Sensory Integration to support health and well-being has grown across the UK and Ireland.
The research and evidence base is expanding across the globe, with more clinical audits and studies being published that report that Ayres’ Sensory Integration is
promoting participation in everyday life
increasing clients ability to engage with others, with therapy
this means that there are significant reductions in
days in secure or acute care
the use of PRN medication
the need for the use of physical support aka TMAV
We’d like to thank Tina Champagne for pointing us in the direction of this resource which fits so neatly alongside the resources and tools we teach on our courses.
Tina is a colleague and critical friend of ASI WISE – having started her journey into sensory integration in parallel to our journey here in the UK where we were focussing on improving participation in care and daily life, addressing development of skills and occupations including self care to reduce self harm and use of PRN medication. We finally met in 2004 at a first conference about ASI in MH in Cornwall, UK.
Her work in addressing the use of chemical (mace) and mechanical (cuffs) restraints in the US helped transform their mental health care and she wrote several chapters in this free online resource about developmental trauma and practical ways to institute trauma-informed care.
Resources for Eliminating Control and Restraint aka Therapeutic Manage of Aggression and Violence
As I read the recent article “14 Phrases Kids Said That Were Code Words for ‘I’m Anxious“ from The Mighty, It felt familiar – like I had met every one of these responses to anxiety and not just from children.
“What’s wrong with me?”… “I’m tired.” … “Can’t we stay home?”
“I don’t feel well.”
Anxiety affects so many people and they are not all confident naming and talking about it. Some may know they are anxious but be embarrassed about telling people, for others, it may be that long-term anxiety is new to them and they haven’t really grasped that the physical symptoms are related to their anxiety.
So how does anxiety play out in real life and how can we help?
The elderly lady who has had a reduction in her mobility now feels sick when she goes in the car (but her doctors can’t find anything physically that would cause this), may not understand that her body and brain has become accustomed to less movement and so is less able to integrate vestibular stimulation with other sensory stimulation hence she feels sick now avoids leaving her chair for fear of some as yet unidentified illness but is embarrassed to say she feels scared. Her fears about illness then generate yet more anxiety symptoms e.g. Feeling sick racing heart and more, confirming that she really has got some mystery illness that the doctors are missing, so she avoids leaving her chair whenever she can. This leads to a further loss of integration between her senses as she is not moving much (vestibular) and she is not using her muscles much (proprioception) and will eventually lead to loss of function.
Or that friend who is always tired or busy when you want to go out (there might be other reasons) and cancels at the last minute. But to be honest, as a mother to a lovely but anxious young lady it is the young people who concern me most
My concern for young people is driven by the knowledge that the young brain is primed to learn (Jenson 2015)… And learn it will – either good things or less good things, so if like the elderly lady the young teen avoids activities there is a good chance that these coping strategies will become an ingrained life pattern.
So what can we do to help?
First get to know the symptoms of anxiety there are numerous self-help books and Web pages e.g. The NHS Web site, Web MD, mind etc.
Second help the young person to choose activities that are likely to reduce anxiety… From a sensory integration perspective, these are likely to be ones that involve heavy muscle work and muscle stretch (proprioception) and ones that make the young person think like Martial arts, dance, rock climbing gymnastics etc. Will be better than just proprioception alone. We do dance and acrobatics.
Consider 1 to 1 tuition if they need to gain skills to catch up with their peers… But if you do this it’s good to plan to reintegrate the young person into group lessons… So that they can deal with social anxieties. We went to a group lesson and it was clear my daughter had a lot to learn so we had a year of individual lessons (and still supplement the group lessons with the occasional individual lesson). But then we went to group lessons, it took half a term but now she is enjoying doing acrobatics duets which brings me to my next point.
Make sure the young person attends regularly and on time for a good chunk of time…..
Be prepared for ongoing anxiety and be firm that they go… My daughter frequently tells me on the way home “oh sensory mum you’re right I do feel better.“
Try to avoid surprises… We have a wall planner for the term and all activities are written on it… And I have noticed my daughter (and I am) much calmer knowing what needs to be done and when.
Discuss and consider professional help… Some Ayres’ Sensory Integration trained occupational therapists use other techniques in conjunction with their sensory integrative therapy, others will work alongside mental health professionals and for some people, Ayres’ Sensory Integration therapy will be enough on its own.
You may also decide to work through a self-help book and this can be a good option… But if in doubt always consult with your GP or/and any other health professional who is working the young person.
So what about those adults… Its a little different to the young people but listening and understanding or trying to understand is a good first step. Giving them information about sensory integration and mental health issues can also be helpful. Then asking them what they want you to do and staying in touch with them even if it’s difficult. And always remember it’s never too late for someone to get help.
Reference The teenage brain by Frances Evans Jenson. L
In 2010 Shelley Lane published a study that concluded that 54% of children with ADHD have sensory over-responsivity. In 2014 Shimizu, Bueno and Miranda compared 37 children with and 37 children without ADHD using the Sensory Profile to see if there was any relationship between sensory processing difficulties and presenting behaviours in children with ADHD.
They compared the ADHD groups Sensory Profile scores to behavioural symptoms assessed using the Child Behaviour Check List and the Behavioural Teacher Rating Scale.
The study results suggest children with ADHD have more difficulties (than those without ADHD) processing and modulating sensory input. They also have more behavioural and emotional responses (11/14 sections and 6/9 factors). The Sensory Profile scores moderately negatively correlated with scores on the Child Behaviour Check List and the Behavioural Teacher Rating Scale.
Their study shows us that children with ADHD may present with sensory processing impairments, which are possibly contributing to inappropriate responses and that in future, we need to know more if we are using Ayres’ Sensory Integration to help and support young people with ADHD.