Safety First

Stephen Porges' Polyvagal Theory

 

Abraham Maslow's Hierarchy of Needs

Bruce Perry's Neurosequential Model of Therapeutics

 

Circle of Security

Neuroception is a term coined by Dr. Stephen Porges that identifies the underlying sense that is operating in the background at all times in all humans that scans the environment looking for cues that indicate whether a situation, or the people in it, are safe, dangerous, or life-threatening. If a child or caregiver does not feel safe in any given situation, healing and progress cannot be attained. However, many children have faulty neuroception, especially those with developmental trauma or neurodevelopental differences. They often experience themselves and others as subjectively frightening when there is no objective or immediate threat present. Unfortunately, the longer this occurs, the harder it is for the child to break out of the stress responses of fight, flight, freeze, and fawn, and therefore they get stuck in this maladaptive yet subconscious pattern of relating to the world. My goal is to help your child to feel safe in their body, their relationships, and their environment so that all other intervention will be maximally accessible and effective. Children and families will only take risks when they feel safe.

Play is the Way

Stanley Greenspan's DIR/Floortime Approach

 

A. Jean Ayres

 

Jean Piaget

Lev Vygotsky

 

Maria Montessori

Fred Rogers

Fred Rogers stated, "Play is often talked about as if it were a relief from serious learning. But for children, play IS serious learning. Play is really the work of childhood." From an occupational therapy perspective, he was spot on. Play is the primary occupation of childhood. It is how children learn about the themselves and the world around them. Unfortunately, in our present culture of achievement, and the valuation of cognitive skills as being of primary importance, we have done our children a disservice by focusing on isolated skill acqusition as opposed to helping to support them in interacting meaningfully and spontaneously with their envionment, family, and peers. When we utilize play to intervene in a child's life, we are accessing the many inherent benefits of play for their development. We promote curiosity, risk-taking, ideation and planning, making connections between prior and current experiences, and we offer children a way to get what their brains and bodies most need in the moment. My goal is to help you, as the parent or primary caregiver, become your child's best play partner in all of your daily activities. 

Regulate to Relate

Greg Santucci's Model of Child Engagement

 

Stanley Greenspan's DIR/Floortime Approach

Bruce Perry's Neurosequential Model of Therapeutics

A. Jean Ayres

Stephen Porges' Polyvagal Theory

After helping a child achieve a felt sense of safety, the next step in the order of operations of intervention, according to Greg Santucci's Model of Child Engagement and Bruce Perry's Neurosequential Model of Therapeutics (NMT), is to help them regulate their autonomic nervous system, which will, in turn, help them regulate their emotions and behavior. I focus on co-regulation with parents and caregivers, because co-regulation necessarily precedes self-regulation in the population of children with which I work. In addition, all people rely on co-regulation with trustred friends and family at various times to help them maintain an optimal state of arousal. In order for co-regulation to be effective, however, at least one of the individuals needs to be able to achieve regulation. As the adult, that is our responsibility. Arousal state is contagious, whether positively or negatively, so my job, as the therapist or coach, is to help you, as the parent or primary caregiver, to first become aware of your own arousal state throughout the day as you interact with your child, and then to start to help you to be able to achieve and maintain a regulated state so that you may help your child do the same. In therapy I am doing the same with your child and helping them to experience longer periods of time in a regulated state, which is where all connection, relationship, and learning occurs.

Parents are Primary/Caregivers are Key

Dan Siegel and Tina Bryson

 

Richard Solomon's PLAY Project

John Bowlby's Attachment Theory

Circle of Security

Bessel Van Der Kolk

Kids Do Well if They Can

Ross Greene

In his model, Collaborative Problem Solving, Ross Greene discusses his overarching belief that "kids do well if they can." He suggests, and I agree, that motivation, or the desire to do well, is not the problem underlying most children's challenges. It's not a matter of will, it's a matter of skill. That is, when children are struggling physically, emotionally, socially, or behaviorally, it is not because they do not have a desire to be successful. It is because they don't have the ability to be successful. Our jobs as the adults in their lives is to figure out what is keeping them from having the ability to be successful, and then help them to overcome those challenges. My job, as the occupational therapist and developmental coach, is to help you, the primary caregiver, discover what those challenges are, and learn the approaches and methods to implement the changes in a way that respects your child's individual needs, and your family's access, resources, and routines. 

Connections Over Compliance

Karyn Purvis (TBRI)

 

Lori Desautels

Following achievement of a regulated brain state, connection with a trusted adult is the next step in any neurodevelopmentally-respectful, relational intervention. Humans are social beings and children are no exception. They use social engagement with others for feelings of safety and security that enable them to venture out into unchartered territory and to take risks. If we approach children from a position of power with an expectation of compliance, we are directing our interventions too high and jeopardizing establishing a therapeutic rapport with the child that will contribute to improved outcomes. This concept follows along with the gentle approach that I ascribe to, which priortizes the therapeutic relationship over blind obedience to cultural standards that impose conformity to arbitrary and largely unattainable standards of normalcy. 

All Behavior is Communication

Mona Delahooke

The field of neuroscience has shed much-needed light on the need for there to be a tremendous paradigm shift in the way parents and professionals view the observable, surface-level behaviors of children. While these behaviors can certainly be challenging for the child and caregivers, alike, they have historically been erroneously attributed to willful disobedience on the part of the child. In other cases, it is assumed to be evidence of a lack of initiative or motivation. In yet other situations, the child is deemed to be attention-seeking or manipulative. The projection of such adult psychology onto children has done extensive harm to the psychological well-being of children and adolescents. The question has been "what is wrong with you?" for far too long. It is time to change the question to "what happened to you?" or "what is happening to you?" that is causing you to have these distressful behavioral manifestations. It is then our jobs, as the adult helpers in these children's lives, to help them overcome those barriers that are preventing them from feeling safe and being successful in their daily activities. 

Firm Foundations for Solid Success

Williams and Shellenbarger

Lucy Jane Miller

A. Jean Ayres

Sally Goddard

It is generally accepted that development proceeds in predictable hierarchical or sequential patterns. These include such things as starting from the head and moving downward toward the feet (i.e., learning head control before learning to walk); starting from the core and moving outward (i.e., developing trunk control before coordinated arm movements); and moving from general to specific (i.e., learning to pick up a ball with two hands before picking up a piece of cereal with the thumb and fingertip). For many infants and children, some of the foundational bases of support such as head control, trunk control, core strength, shoulder stability, etc., have not fully developed and continue to impact their ability to successfully complete higher level coordination skills. In addition, because these children are working so hard to compensate for these gaps in their develoment, they are using up valuable energy and effort that is no longer available for the cognitive and regulatory demands being placed on them. Many children also haven't developed a good awareness of their own bodies and feel disoriented and disorganized in them, which can produce anxiety and frustration and further contribute to dysregulation. As an OT, it is my job to help find those cracks in the foundations of your child's development and help fill them in, so that your child can feel solidly grounded in their body and free up their effort and energy to truly enjoy and succeed at the other activities that are meaningful in their lives, such as play, recreation, and learning.