BONUS for Members this week: Key points video plus extended podcast content

Keith Landherr is our guest on this week’s podcast to talk about how emotional regulation is the driver for sensory integration. Keith has 25 years experience as an Occupational Therapist and is the founder and director of Little Buddies Pediatric Therapy, Incorporated just outside of Vancouver, British Columbia. He is a DIR Floortime Trainer and is currently a PhD student in the Fielding Graduate School’s Infant and Child Development Program. He was trained by Dr. Stanley Greenspan himself.

Four and a half years ago I blogged about my top 10 take-aways from my family’s visit to The Floortime Center and #1 was that emotional regulation is as or more important than sensory integration. Jake Greenspan explained to us that emotion has to be the driver for sensory work that is done. That is, emotional attunement together with sensory work helps regulate the sensory system. Keith commented on that blog post and when I was going back over my website, I realized I needed to do a podcast about this topic, so I invited Keith to discuss it in more detail.

Co-regulation is the Driver for Sensory Integration

by Affect Autism | affectautism.com

The Start of a Floortime Journey 

Keith shares that when he wrote that comment it was around the same time that he opened his clinic where he could finally really just do Floortime and completely Floortime, so he appreciated Affect Autism. Whenever any of his mentors from the Interdisciplinary Council on Development and Learning (ICDL) mentors would go out west to give talks, they would be in Seattle but never across the border in Vancouver, so Affect Autism was a way to have access to helpful reminders and training tips to inform Keith’s practice.

Keith remembered a story about a class he took with Dr. Stanley Greenspan who did conference calls. Keith was working at an occupational therapy clinic one Saturday morning during class when a child ran in from another therapy room to escape the therapist doing non-Floortime therapy he wasn’t enjoying. Keith simply suggested the child tell the therapist what he wanted to do and it all worked out. Meanwhile, Keith didn’t realize he hadn’t muted his phone and the class was listening to the whole conversation, so he was horrified. But Dr. Greenspan said, “This is exactly what we’re talking about: connecting to the child, taking their lead, and using positive affect to turn the situation around.

Dr. Ira Glovinsky later told Keith that that moment was so powerful and it really made Keith feel that he was heading in the right direction. To connect in the moment with the child despite others who might say, “You can’t do that all the time. We have to do this or that” or “you’re just coddling them“. What it is saying to the child is, “I’m going to mirror your emotional state and take it as something that’s meaningful, even if it’s not a pleasant experience for me.” It helps the child calm down and think that someone understands what they’re feeling, or at least is kind of getting it if not completely getting it, Keith explains. This allows them to move away from fight or flight and be present with you.

This allows a child to move away from fight or flight and be present with you. When we’re stressed, we regress, Keith says. So if we remove that stress, a child can show us their better selves because they’re not fearful of what’s going to happen next. Keith recalled being a young therapist where he would be cruising along with a child only for the supervising therapist to insist he use a different methodology. Keith would oblige and the child would lose trust in him. By the time Keith went back to a developmental approach, the child took ‘forever’ to trust him again. It made Keith really disappointed in himself for listening to the therapist who thought the behavioural technique would be better.

The Sensory System and Motor Planning

Next, Keith described the snowballing process by which children with motor planning challenges experience fear when they realize that not being able to do something disappoints or scares a parent. The mother might be showing the child how to use a spoon to feed themselves and the child throws the spoon to instead show what they can do, which gets the engagement they seek and moves away from the focus of “I can’t do something“. Nobody likes being shown what they cannot do. Their fear that it’s going to happen again is making it more likely that it will happen again and the gap widens, Keith explains.

Sensory Integration

Keith explained Armando Bertone’s research out of McGill University that found if someone has a sensitivity to one sense, like sound, then by increasing the input into another sense, like vision, you can decrease the intensity of the sound. 

Keith is just fascinated that the science is starting to catch up with this sensory integration theory that happened because someone was really observant and saw the cause and effect of sensation on kids.

I shared that TV Ontario recently showed an amazing documentary about the senses. Keith brought up incredible research out of the University of Wisconsin-Madison about using the tongue to see through sensors.

Keith says it’s really incredible and echoes what Jane Ayres, the pioneer of sensory integration theory, says about how the brain has this amazing ability to take sensation and use all of the different senses to fact check each other.

She discovered that if you created one type of sensory input, it could dampen another type of input if it was too much. You could also intensify it in a prescribed way–although Keith says that you would never know it’s prescribed if you saw him at work because it’s supposed to just look like you’re having fun!

He can experiment with proprioceptive input to see which children needed that, or others for whom it was too much for. He’s had behavioural consultants say to him, “Of course they love coming to see you. You have a swing!” Keith says they don’t realize that moving for children who are vestibularly insecure is like hell.

The reason they have this expensive equipment is that it allows for all kinds of movement in different directions without talking about it, to take the processing part out. He just plays while working on that. Taking the language out allows it to be a bottom-up experience so they focus in on the sensation to attune to it in their bodies so they have that connection to be able to just stay up or to create an action in the environment.

His job is to give them the environment to have these experiences without having to think about the language processing part, especially if you have a lot of auditory sensitivity.

I wanted to add to that the take away about sensory integration vs emotional regulation that I hope can be helpful. I know that Stanley had many conversations about this with many OT’s and other professional over the years. I too had conversations with him about this in my courses with him which has helped me to develop my perspective. I think of emotional regulation and sensory integration as having an important working relationship.

Sensory integration changes begin with emotional support and co-regulation which brings about a more regulated state that allows sensory integration skills to begin to develop so sensory experiences can be processed in a more meaningful and efficient manner. One will always find it harder to have emotional regulation if you have sensory integration challenges but by acknowledging their sensory challenges we help children regulate, connect and thrive.

I had advanced training in sensory integration before I began my DIR journey but the relationship piece that DIR brings into the picture was the glue that allowed my clients to make and maintain gains in their sensory processing skills. I have always believed that the practice of providing sensory integration treatments without the emotional supports that the children requires to be not only ineffective but damaging as well. We need to support their emotional well being as they are exposed to controlled challenging sensory experiences until they can make sense of them. Emotional regulation and sensory integration must be facilitated at the same time in order for real change to occur.

The real key is that the two are interdependent and you can work on both by focusing on the co-regulation experience as you introduce sensory input. This creates relationship bonds between children and the rest of us that are then getting stronger because this pre-language attunement is really “everything”. Stanley once said, “Self-regulation isn’t just something… it is everything.” We can’t be regulated without both emotional and sensory security.

Thanks for you great work!

Keith Landherr on September 13, 2016

Keith shared a heart-warming story about a past client whose child hugged his mother for the first time. This was a child who was so tactile sensitive they did the Wilbarger brushing technique that really helped him. But Keith stresses it was that the child knew that he was the one making him feel better and that he was showing this technique to his mother. That emotional connection was key.

Seeking the “why” behind the behaviour

If a child comes in to Keith’s clinic and throws a chair, Keith thinks, “Wow, something is really hard for you.” It must be something that’s really necessary because we all want people to like us. Keith really attunes to the child and understands that by throwing, it will show what they can do that is strong and powerful, and stops Keith from asking them to do something they can’t do–which they already know.

I paused to share that on the day of the podcast recording it was Anti-Bullying Day, which is why I had on my pink sweater, and that this would be a great focus of the day–to understand why a bully resorts to bullying. If we could attune and prevent bullying by helping the bully, we wouldn’t need to alienate the bully and resort to teaching and talking about kindness which doesn’t really solve the problem. Keith adds that the root cause is typically trauma, and often multi-generational trauma. We may have less sympathy for some of the trauma than for other trauma but it is trauma.

Attuning to the child’s emotional experience

Keith described how mothers mirror the faces of their babies, but if you try to do facial expressions for the babies before they make the expression, it only works with about 5% of babies. Mirror neurons are formed because as the children make faces and we mirror them, they see the cause and effect they have which gives them confidence. Somewhere along the line, Keith continues, we decide to teach them instead. He says he’ll instruct parents to return to that mirroring of their child. So if you put on music and they make a movement, imitate that movement.

Getting them attuned to that ground-up experience is different than the demand of “Here, I’ve shown you my idea, now copy my movement“. So when we think of a child who has an unpleasant reaction to something, you can have parents who are so upset about it versus parents who say, “just push them through it and they’ll be fine“. Instead, Keith says, when we see our children have a reaction to something, and we can see what it is too, we can show the same reaction to it as them to show understanding and empathy.

What parents can do

Attune and acknowledge Keith gives an example of a high-pitched air filter in his office that a child had an aversion to. Keith recognized that and said, “Oh it sounds really loud today” and turned it down. The other therapist commented that it was like Keith was reading his mind, but he what he did was tune in to what the sensation was that was overwhelming the child. What helped was that he, himself, had the same aversion as a child but now is able to drown it out. Similarly if the room is too busy he can say to a child, “Oh yeah, this room is too busy. Should we wait here or do you want to go in?

Don’t force the child Rather than saying, “Oh it will be fine, just go in“, this shows the child that you are not scared, you’re not going to push them in the room, but you get that they are having an experience. By doing that, the emotional regulation is happening, and the child’s ability to re-evaluate the sensory information starts happening too. Then every time the child has a calmer experience around a sensory experience, even if it is noxious, it becomes less aversive. The emotional part that comes up saying “This is anxious” or “fearful“, it calms down and it’s less likely that you’re going to go into fight or flight. When Mommy says, “I see it too” it at least doesn’t get worse.

Problem solve I gave the example of my child who seeks sensation in many ways but does not like getting stuff on his hands such as marker while he’s scribbling or drawing on the white board. I suggested that I would acknowledge that emotional experience by mirroring it, “Oh no! Yuck! We got marker on our finger!” and rush to clean it off, or if playing with gooey slime or finger paints, slowly try again with affect, saying, “Eww! I didn’t like that but I’m going to try again really quick” as I touch the paint to give them that safe experimentation with something they’re uncomfortable with. Keith says he would actually get out some wet wipes before starting the activity and just say, “I know you don’t like getting marker on your fingers. Let’s just keep these wipes here in case we need them” so the problem is solved in advance and he is reassured.

Give competing sensory input Keith said that when he would use shaving cream as paint with children and they didn’t like getting it on themselves, he would act right away saying “Eww, I can’t believe that happened“. He would at the same time give the child proprioceptive input as he was wiping it off, so their bones are getting the input to pay attention to, which helps calm the child. The next time they start to get into that pattern again, the intensity goes down.

Relate it to your own sensory experiences I noted that when my son was a baby and restless, I instinctually squeezed his little chubby thighs and that seemed to calm him down. Keith said it’s why people give bear hugs, too. The input is calming. Similarly, when people have cocktails at a wedding reception, getting up and dancing helps bring them back into their bodies. Movement is giving their bodies the input it requires.

Complete your sensory processing profile  When practitioners are trained in Floortime, one of the first exercises is to complete your own profile to be able to empathize with children’s sensory processing profiles. We all can relate to a picky wool sweater or having a stick in your sock that you need to get out. 

Anticipate and mirror Keith says that there’s some recent functional MRI brain research that shows when we’re about to execute a motor plan, our sensory system changes its state to get front-loaded for the action. So if we don’t ‘go where they go’, their sensory system won’t have the same adjustment. If we can anticipate that and move in a way or interact with them or the environment in a way that we think their sensory system is, they’re less likely to have the aversive experience to the same degree, and they’ll feel more successful.

Keith says this is all so fascinating because it shows scientifically why what we do in Floortime works. Attuning right down to the sensory system letting a child know that you see they’ve taken in this sensation, you wonder how it feels for them, you’re not telling them what to do and you’re just letting them feel it while letting them know that you understand what they’re feeling. It’s so cool and so powerful, Keith adds.

Our goal is for our children to feel in control of their body. None of us knows where our child will go or what they will do. We can just support them on the journey towards being all they can be. We want to allow them to have choice and agency, which is hard to do if someone doesn’t understand their sensory system.

Motor Planning Questionnaire for Parents

For parents with concerns about their child’s motor planning, Keith suggests this free resource: The Developmental Coordination Disorder Questionnaire (DCDQ) that captures 94% of children who have motor planning challenges that parents can complete and then score themselves.

Thank you, Keith for the great discussion on why sensory integration in and of itself may not be helpful. It’s the emotional regulation piece that accompanies it that drives the progress. If you enjoyed it and learned something please feel free to share this post on Facebook or Twitter, and please share any related experiences, comments or questions in the Comments section below.  

Until next week… here’s to affecting autism through playful interactions!

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