Autism Discussion Page Helping your child regulate! Many of our children have disorganized nervous systems that are always seeking out sensory stimulation to try and calm and organized it. Yesterday I saw a 13 year old, nonverbal young lady at our sensory clinic who is one such child. She was a charming girl, with a warm smile. She could not sit still, or focus on any one activity more than a minute without having to get up, literally bounce around the room, jumping, stumping her feet, and clapping her hands together with strong force. She was not upset, just could not stay regulated. She appeared happy and enjoyed attention, but simply could not regulate. She would continually seek out strong proprioceptive stimulation (pressure and resistance to her joints, and tendons). She could not control this. We could engage her for approximately a minute before she had to do her “running around”. Instead of sitting, she would squat with her knees and back compressed to add stretching of her joints. As strong as this sensory input was, it was a much improved adjustment to what she was displaying four years ago when she was constantly pinching, slapping, and biting herself and others. Now, her sensory seeking is less intrusive since she has substituted strong hand clapping with the jumping to provide the sensory input. This girl was very charming in that she smiled a lot and loved to share emotion with us. As active as she was, when we offered her our hands, she would stop briefly, take our hands, smile and bring face close to ours. Then within 10 seconds she was back to jumping and clapping. Since she was seeking strong proprioceptive input (resistance into her joints by jumping and clapping) I decided to do some sensory motor interaction that provided joint input. We sat on the floor together, facing each other, holding hands with outreached arms, and rocking back and forth, in a “row, row, row your boat” fashion. This allowed us to pull and stretch our arms and shoulders, which provides strong sensory input. She referenced my face the entire time, smiled, and seems to enjoy both the sensory input, plus the emotion sharing from my animate facial expressions. She was allowing me to regulate her, by engaging in a “we-do” (back and forth) activity together. She could only handle this for about two minutes, before she needed to get up and do her bouncing, jumping, and handclapping. During these times I would also calming clap with her. Next, I provided her compressions into her legs by doing a rhythmic pattern of pressing her folded legs up and in toward her chest, which we call leg presses. She relaxed to this while calmly referencing my face. She was experiencing what it felt like to have another person help her feel relaxed. During this time she was referencing my face to share the experience. Calming, soothing input that came from someone else. Nice warm smile, and good inviting eye contact. For most of her young life, this girl has always loved to sift sand through her fingers, or transfer small objects from one hand to another in self stimulatory fashion. At home she will do this throughout the day, for only a minute or so, and then back to bouncing, jumping, and clapping. When she goes anywhere the group of small objects goes with her. She had them on the floor at the clinic. Frequently throughout our session, after bouncing and clapping, she would return back to her collection of objects and briefly squat and stim with them. Mom related that she does not usually let others engage in this stemming with her. She will resist if others try and intrude in this play. However, this was one activity she felt safe and competent, so I wanted try using it to engage her. I sat down in front of her, stated how much fun that seemed, and show great excitement in her transferring these small toys back and forth a couple of times, from one hand than the other, than back to the floor. Each pattern was the same, pick them up, transfer them back and forth and then let them slide back to the floor. When she picked them up again, I reached out my hand and said “my turn!” She looked up at me but did not give me the items. Once she let them drop back to the floor, I gently cupped my hands around them and slowly picked them up in my hands while saying “my turn.” I quietly chanted, in a sing song voice, “back and forth, back and forth”, as I transferred the items from one palm to the other, twice, and then laid them gently back down on the floor. Next I stated quietly “your turn!” with an animated facial expression. She looked up at me and smiled, taking the items and repeating the pattern. Once she laid them back on the floor, I would again state “my turn!”, pick up the items, and repeated my pattern “back and forth, back and forth, back to the floor.” She was a little nervous at first, but calmed quickly once she understood the interactive pattern. During this play, she became calm, relaxed, and engaged with me for probably about ten minutes. She went from the squatting to sitting quietly and did not get up to bounce, jump, and clap. She was calm, alert, and regulated, feeling what it was like to be “engaged” and letting someone else “pace” and regulate her. After every few turns, I would reach my hands out, she would place her hands softly into mine, and I would gently bring her hands up to my face as we smiled warmly at each other. It was a calm, gentle, and engaging, reciprocal play around her self stimulatory preference. She was relaxed and regulated, following my lead and pacing herself to stay engaged. She was smiling, referencing my face to share emotion, and calmly following my lead at that point. She felt “safe, accepted, and competent” sharing the experience with me. At that moment she did not need to bounce, jump, and clap her hands to stay regulated. She went ten minutes while engaged in a calm, regulatory pattern with another person. She is not capable of regulating herself yet, but was feeling safe allowing someone else to “pace” it for her. For her to eventually learn to self regulate, she will first need to allow others to help her regulate. All children, usually at a much earlier age (first year of life), need to first let others regulate them, before learning to self regulate. They learn to regulate themselves, by allowing others to help them regulate. If the young child with autism is too overwhelmed to allow the parent to regulate them, then they will struggle with ever being able to regulate themselves. Hence, at the age of 13, this young lady is not able to do. How did I do this? Three main tools! I used her sensory preferences (proprioception) to engage her, used my hands, face, and words to help her feel safe, and built a calming, regulatory pattern around her favorite activity. I initially helped her feel safe by giving her proprioception through rowing and leg presses together, then engaged in reciprocal, back and forth, repetitive play around her object play. I used soft words (sing song chant), gentle facial animation, warm smile, and gentle touch (holding hands and bring hands to my face) to relax her. I also used repetitive, rhythmic, back and forth pattern of toy play to create “we-do” engagement whereby she followed my lead to “pace” her to stay regulated. This is the beginning stages of learning to allow others to help you calm, organize, and stay regulated. She was “feeling” what it was like to be engaged, connected, and regulated with another person. A great feeling to experience, for both of us. The lesson here is (1) identify what stimulation helps your child feel calm and organized, (2) first follow your child’s lead by engaging in their preferred activity (even if it is self stimming), and then (3) slowly build a calm, soothing regulatory pattern (rhythmic, repetitive, back and forth) around that activity, where the child is following your lead to “pace” herself and stay regulated. Use your words (often sing song chatting), touch (if not defensive), and facial expressions to pull them into feeling “safe, accepted, and competent” following your lead. Help them feel regulate and engaged “through you”, by doing “with you.”
Posted on: Thu, 27 Jun 2013 04:37:46 +0000
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