Let the Band Play On!

Charlie is four years old and I have been working with him for 15 months now. He is one of the children I see who was prenatally exposed to methamphetamine (and possibly alcohol).

This means that like many other children with prenatal exposure, he has some major challenges, including poor impulse control, aggressiveness, resistance to limits, problems understanding social cues, and difficulty tolerating frustration.

What this often looks like is Charlie pushing his younger brother over, kicking his sister, yelling at everyone around him (myself included), and throwing things at us before attempting to run out of the room and down the stairs.

Children use their senses to form emotional bonds with others. Together with his father, we've incorporated a number of ways to help Charlie "regulate," or soothe himself so that he can return to a calmer, more organized state and ultimately be able to relate appropriately to another person.

In addition to weekly occupational therapy sessions, where Charlie can roll, tumble, swing, jump, and so forth, we have incorporated music into our play, which also helps him to feel better.

This week, Charlie and his sister collected toy instruments including a drum, a horn, and an accordian from the cabinet in our play room and decided that they would form a band. Each family member was assigned an instrument, including dad on the tambourine.

Charlie led the band in playing various songs such as "Twinkle Twinkle Little Star," and directed everyone to join in and sing. The play at that moment was remarkably joyful and robust. Everyone seemed to be having a good time, a smiling Charlie included. And, he was able to stay focused, calm, and organized for a much longer period of time than is usual for him.

As he continued in this activity with his family during this particular session, it was plain that what Charlie was experiencing with them was a sense of competency, togetherness, and simple fun.

So let the band play on!

A Note: I play a lot of different CD's during sessions with Charlie. A new one that we are enjoying a lot is Dan Zanes and Friends' Spanish language "Nueva York!" For lots of singing and fun, please check it out -- my personal favorite on the CD is "Pollito," which is a great way for kids and grownups alike to learn some new Spanish words.

The Miracle of Occupational Therapy

A year ago, we were very fortunate to have wonderful USC-trained pediatric occupational therapist (OT) come to our clinic to start an OT program.

This is unusual in a traditional mental health setting such as ours, as OT is typically used for children with issues such as autism and feeding and eating problems.

Occupational therapy is essentially focused on helping a person to engage in meaningful and purposeful activities throughout his or her daily life. For a child, this would cover areas such as playing, learning, and engaging in relationships. A child can have difficulties with any of these areas for emotional or biological reasons, such as the trauma of loss or problems with brain development.

Since the arrival of OT at our clinic and its use with a number of the children I see with mental health and behavioral issues, the way I think about how to treat the young children who come into our clinic has changed dramatically.

Now, in addition to looking at what's happening in the family, the school, the child's relationships, the child's developmental history, and losses and separations, I also think about what is going on with the child's ability to self-soothe and manage incoming stimuli. This stimuli may include sound, touch, taste, movement, and pressure. I consider how we can use this additional sensory-related information to help the child to feel better emotionally.

For example, if a child is calmed by a rocking movement and the deep pressure of massage on the arms and back, then I encourage parents to use this at home, especially if the child becomes upset or tantrums. We might also use this in session.

I believe strongly that OT has the potential to help children with emotional problems to learn how to manage their feelings better. Through helping them manage their sensory experiences, we provide them with the miraculous beginnings of being able to handle difficult feeling states.

Sensory Awareness: Looking At the Whole Picture

As human beings, we are hopefully constantly learning and experiencing new things, which we can then incorporate into our senses of who we are and how we move through the world.

The same can be said for child therapists. Every day we have contact with children and parents in the clinical setting means the chance for a moment of learning. It can mean another opportunity for a eye-opening and unexpected experience, which can then enrich the work we do moving forward.

The way that I work as a child therapist has changed and evolved tremendously in the past year. I attribute this in large part to the learning that I’ve been doing about the brain, the central nervous system, and sensory issues.

This past year, we were fortunate to have an occupational therapist come to our clinic, set up an OT program, and help us to incorporate an understanding of these areas -- including how a child regulates, or manages, his or her sensory input (sound, touch, gravity, taste, balance). Our occupational therapist taught me to understand the deep influence this has on a child’s emotions and behaviors.

Take 4-year-old Dylan. He is constantly moving, running, bumping into furniture, climbing up on the table, and jumping off things like the arms of the sofa. If he lands on his head, he just gets up again without seeming hurt at all. He has a very hard time following directions. He also gets frustrated very easily and quickly, to the point of catastrophe – and then, inevitably, there’s a meltdown. We (the caring grownups) then have to help scoop it all up and put back together into the shape of a little boy.

Using a traditional mental health model, Dylan’s symptoms could very easily be chalked up to ADHD. That’s Attention-Deficit Hyperactivity Disorder. For Dylan, the subtype that would apply to him would be “Predominantly Hyperactive-Impulsive Type.” The parent might be coached to provide increased structure and routine at home, use repetition, or use behavioral charts (which might include one sticker for every episode of “good” behavior, as outlined on the chart) and rewards.

I’m not saying any of that is bad or wrong. It’s just not looking at the whole picture. I’m not saying it’s not doing enough. I’m saying we could be doing more.

The whole picture, if you look at Dylan from a sensory perspective, would include consideration of the fact that Dylan is sensory seeking and sensory craving. He wants movement. He wants pressure against his body, the bottom of his feet. He wants to touch a lot of different textures.

Dylan wants the inner-ear stimulation of swinging which allows him to feel calmer. He wants the deep pressure of a hug from grandma that makes him feel more organized and allows him to actually pay attention when she asks him to put his shoes on. And, Dylan wants all of this now.

So, I’ve learned, why not give him what he needs if it helps him to actually feel better and prevent a tantrum or another “catastrophe?”

I’ve incorporated this way of thinking into my work and collaborated with Dylan’s grandmother to give him the stimulation that he needs. If she sees that Dylan is becoming frustrated and upset (or “dysregulated”), she can now recognize it and give him some calming pressure, like squeezing his arms, or giving him a big bear hug while also reassuring him.

And, it works!

I’m just touching on the tip of the iceberg here about looking at the whole picture. I'll be talking more about sensory integration, regulation issues, inner motivation, and ways to help a child improve the way he deals with people and the world outside of himself.