When therapists talk about "regulation" they are referring to sensory regulation. This is best understood as one's ability to adjust or regulate one's level of arousal to meet the demands of their immediate environment. Children often have difficulty with self-regulation, which is usually the result of a disorganized nervous system. By participating in activities that provide sensory input to assist with organizing their nervous systems, children learn about how their bodies work and become better equipped to control their bodies to meet the demands of their environments.
For a person with a disorganized nervous system, heavy work can provide very organizing input. This works by activating pressure receptors in the big joints (ankles, knees, hips, wrists, elbows, shoulders, and jaw) and forcing the brain to coordinate the body's movements in order to accomplish the task at hand. Resistance in the form of heavy objects and/or gravity plus the use of both sides of the body together is the key to heavy work. The following are suggestions for simple ways to incorporate heavy work into your lives.
- animal walks (bear crawl, crawling, snake, crab walk, hop like a rabbit, tip toe like a quiet mouse, frog jumps)
- wheelbarrow walking
- climbing up and over big furniture
- jumping and crashing onto a cushion
- crawling underneath furniture
- crawling through a tunnel
- hanging by arms on a chin-up bar or a rope
- going for a walk - long enough that child is visibly tired at the end (or up a hill)
- moving heavy objects to a rhythm (rolling a ball and counting or singing)
- lying on their tummy to roll a ball back and forth with a grown up
- hold onto a rope while a grown up drags the child across the floor by pulling the other end of the rope (or any variation of this game - the more friction between the child and the floor, the better)
- pulling a dump truck/wheelbarrow with a heavy object in it across the grass with a rope
- kneeling or standing and pushing the heavy object across the grass
- wearing 1 or 2 lbs ankle and/or wrist weights while doing any type of movement activity, dancing etc.
* Make sure to make play purposeful and structured (with a firm end point). If playing with a ball let child know he will do X # of throws before the next activity. If going for a walk go from point A to point B. If jumping and crashing make sure to do X # of jumps. You can use a timer to establish a firm end point to a task (make sure to let him know the timer is set or even press the start button on it so he feels like he has control over the activity).
* Have the child articulate as much as they can using descriptive language about the activity - describe what they’re doing, how it feels, how they have to move their bodies, have them explain the objective of the game or the details of their environment, etc. This will stimulate the language center of the brain and enhance the connections between movement and language.
Deep Pressure organizes the body similarly to the way that heavy work does and can be very calming and organizing. Even, rhythmic, and firm pressure applied to the body sends signals to the brain via pressure receptors in the skin. Deep pressure provides the input needed for a disorganized nervous system to organize more effectively by increasing the person's sense of proprioception (the sense of where their body is in space). Sometimes deep pressure can be a passive activity for the child (meaning that the input is provided to the child by a grown up). During deep pressure activities, make sure to work towards the child actively participating in and engaging with you during the activities. The end goal of helping a child become more organized is to facilitate self-regulation, which in this case refers to the child providing deep pressure to themselves independently and appropriately.
- deep tissue massage (make sure to focus on both sides of the body evenly)
- stretch child's legs and hips (like a runner stretches) while he is lying on his stomach or his back
- firmly squeeze child's feet and/or hands
- interlace your fingers with child's and squeezing firmly and rhythmically
- steamrolling child with a therapy ball
- bounce child on top of a therapy ball with a steady rhythm (either seated or on their stomach)
- make a burrito with the child and use your bodyweight to apply pressure (roll child up in a large pillow, yoga mat or beanbag and apply firm pressure)
- use a vibrating massager all over their limbs and back and along the jawline (avoid the front torso/stomach area)
other organizing activities
- eating crunchy food (apples, pretzels, carrots)
- drinking a thick drink with a straw (smoothie or shake)
- using a water bottle with a bite valve (Camelbak type that they have to suck hard on to get liquid out)
- blow bubbles in a drink
- blow bubbles in a the air
- playing in a sand box
- take a warm bubble bath with epsom salt and some type of aromatic element (scented bath salts, scented bubbles, scented bath oil)
When therapists talk about transitions, the are referring to either the beginning or end of a task or the act of changing from one task/place to another. Transitions can also refer to a change in routine, expected or unexpected. Transitions naturally require us to change gears or directions and can often upset habits or routine that we take comfort in. Many people experience anxiety and fear during transition periods. By planning ahead, providing structure and warning for upcoming transitions and giving people the tools they need to cope with the discomfort they experience during transitions, the fear and anxiety can be decreased significantly and make transitions much more pleasant for everyone around them. Here are some tips to make transitions a bit easier.
- Make sure to make play purposeful and structured (with a firm end point). If playing with a ball let child know he will do X # of throws before the next activity. If going for a walk go from point A to point B. If jumping and crashing make sure to do X # of jumps. You can use a timer to establish a firm end point to a task (make sure to let him know the timer is set or even press the start button on it so he feels like he has control over the activity).
- By setting clear boundaries for these activities, the child will learn to anticipate the end of the task and will have an easier time transitioning between activities. He should not be allowed to negotiate the terms of the activity once it has begun. If he says he’s done and refuses to continue, then finish the task with him hand-over-hand. The task MUST be completed before moving on to another one.
- If the child is hesitant about transitioning from place to place, asking him to hop like bunny to the car or tip toe like a mouse will likely make the transition much smoother (these are just examples - feel free to be creative with the movements that you choose). This makes the transition period active and playful, instead of it just being a span of time during which the child has to somehow figure out how to change gears on his own.
- If your child doesn't want to clean up, make the clean up process into a game - throw the cars into the basket, race to see who can wipe the table clean fastest, time how long they take to clean up, or sing a silly song while cleaning up. Make sure to praise them for cleaning up when they are finished.
- “First -Then” statements can be very useful for children with difficulty transitioning. For example, “first ball, then snack” to help him get past an obstacle or task he doesn’t like to do or is hesitating to participate in. If he doesn’t do the first thing on his own, then do it with him and give him the second thing afterwards. This will help to establish the pattern and teach him how it works.
- Make lists, or picture schedules, and limit the list to 3 items at a time initially. Let the child help make the list by writing, drawing, or dictating to you and let them cross off or check each item as they are completed.
- Teach children about "oops days" or "oops activities". If a schedule changes suddenly, or it's field day at school and their normal routine is upset, you can refer to these as "oops" activities, or "oops" days. By using one word like "oops" for everything, children will begin to take comfort in the sameness between the "oops" activities just because they are called the same thing. This will help them to learn to cope with those "oops" moments because they access the same skill set/strategies for each "oops" moment they experience.