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Pediatric Occupational Therapy and
Parent Coaching Services
What We Believe
Safety First
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 neurodevelopmental 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. Our 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
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. Our 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
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. We focus on co-regulation with parents and caregivers, because co-regulation necessarily precedes self-regulation in the population of children with which we 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 our 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 We are 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.
Caregivers are Key
Trauma expert, Bessel Van Der Kolk, has stated, "the parent-child connection is the most powerful mental health intervention known to mankind." We also know from attachment theory that having a secure attachment with a parent or primary caregiver is essential for a child to confidently explore their world, apart from their caregiver, knowing that they can return to the stable relationship for connection and support as needed. In addition, the field of early intervention has recognized that involving the family in intervention is crucial due to the rapid brain development that occurs in the first five years of life. Parents and other caregivers are the ones who spend the most time with the child, and therefore have the most opportunity to affect change. As such, we encourage caregivers to be directly involved in their child's therapy both in the clinic whether through in-room or out-of room observation and when appropriate, direct participation. We encourage this engaement in the home as well. Gina also offers separate, individualized neurodevelopmental parent/caregiver coaching outside of therapy sessions and as a stand-alone service. This is all done to ensure maximal understanding of treatment concepts and methods, and to offer support to you, as she recognizes how difficult it can be to confidently implement a therapeutic intervention on your own at home. She wants to help ease that burden by being accessible and available to walk alongside you in that journey.
Kids Do Well if They Can
In his model, Collaborative & Proactive Solutions, Ross Greene discusses his overarching belief that "kids do well if they can." He suggests, and we 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. Our job, as the occupational therapist or parent 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.
All Behavior is Communication
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.
Connections Over Compliance
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 we ascribe to, which priortizes the therapeutic relationship over blind obedience to cultural standards that impose conformity to arbitrary and largely unattainable standards of normalcy.
Firm Foundations for Solid Success
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 occupational therapists, it is our 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.