The Impact of Vestibular Processing on Development

by Affect Autism

This Week’s Guest

A returning, frequent guest, Occupational Therapist Maude Le Roux joins us this week to discuss the impact of vestibular processing on the functional emotional developmental capacities (FEDCs), the ‘developmental ladder‘ in the Developmental, Individual differences, Relationship-based (DIR) Model, or DIR/Floortime. Maude has run her practice, A Total Approach, in Glen Mills, PA, just outside Philadelphia, for over 20 years where I’ve brought my son many times. We haven’t been since before the pandemic and he keeps asking when he’s going back to ‘school camp’. Maude has also operated her own online academy for over three years now.

Bonus Insights

Vestibular Processing

We focus on the first six developmental capacities (FEDCs) in DIR/Floortime, or the foundation of development that we work on in the DIR Model. Vestibular processing affects these FEDCs. It is how our body moves. Maude explains how it’s when a baby starts to lift their head against gravity. The receptors for the movement system are in the inner ear. They are fully mature by the time we’re born, she explains, and it stays the same size throughout life. It’s integral to help mobilize to you want to move and be a part of what life gives you. It’s crucial, Maude stresses.

Maude continues that in Occupational Therapist (OT) lingo, they ask if a child can move against gravity, how much pull they have against gravity, or how much can they sustain a move against gravity. If a child is in school paying attention to the teacher and they start to shift in their seat and fidget is the anti-gravity response, or the vestibular system. Many of our kids need to move. I gave the example of my son’s Individual differences (the ‘I’ in DIR/Floortime) where his profile is generally understimulated and that he needs to move to stay regulated.

The vestibular system is a very cool system, Maude offers. It’s like the pivotal point where all the systems move around. It’s the only system that feeds back into itself. All the other sensory systems hook up to something else, but this one is like the grounding agent of sensory integration, she explains. It’s so important to look at all of these manifestations such as the child who wants to move around all the time. 

The vestibular system can have an impact on both your autonomic nervous system, which is part of your peripheral nervous system, and your central nervous system. When we think about the vestibular system of a ‘sensory seeking’ child who wants and needs to move all of the time, you’re looking at the autonomic nervous system, which is driven by your arousal level.

Adaptive, Not Maladaptive Responses

If a child feels they need more information from the environment to stay alert, they need to move all the time. It’s not necessarily maladaptive, Maude explains. A child’s behavioural response has in the past been seen as an inappropriate, maladaptive response. Maude would like the term to be changed to adaptive response behaviour. 

When we look at it as maladaptive behaviour, we think we need to change it. But if we think about it as adaptive behaviour, we wonder why the child needs to adapt to the environment on that day. Usually it’s because they have an inner piece that is not in synch with something. It’s coming from somewhere. It’s not random, and it’s not willful. It’s coming from a place of adaptation.

Maybe the child doesn’t really understand where their body is in space, Maude suggests. In the first two developmental capacities, body awareness if a big piece. If you close your eyes and can’t figure out where your body is situated, it makes you feel so insecure, which drives the child to seek movement in order to feel more secure. It’s not so efficient, though, Maude explains. That’s why you can have a child swing non stop and that need is not satisfied, because you do need the connection to get that just-right balance in the autonomic nervous system.

The vestibular system doesn’t even need to have a problem for a child to be a sensory seeker, Maude asserts. It could be that another system is not coming into place and the vestibular system is trying to get it to act up. The vestibular system is the catalyst to access visual, auditory, proprioceptive input. Maude adds to the podcast with OT Keith Landherr where we talked about co-regulation being the driver for sensory integration with this point that co-regulating brings in the vision, the auditory, etc. This is where DIR is so pristinely beautiful, Maude exclaims.

Everyone looks at the high sensory seeker mover child saying we need to give them vestibular, and it’s true, but not for the reason of vestibular, but for the reason of activating the connection to the other systems.

Maude Le Roux, Floortime Occupational Therapist

Sensory Systems Need to Work Together

Once Maude started to switch her Sensory Integration therapy to DIR therapy, she got the sensory integration anyway because natural play enhances the natural way of integration. In the inner ear mechanism with up and down or side-to-side movement, you get a connection to the auditory system which impacts the first two developmental capacities, FEDC 1 and FEDC 2. The vestibular and auditory system together is about 80% of the brain’s energy, Maude explains. She adds that it’s just one cranial nerve (cranial nerve #8), which impacts the sensory integration of the child.

It means that if you can’t hear the teacher, you can move to hear them better. Neuroanatomically, you can’t separate the vestibular and auditory systems, Maude explains, and they also share the same cranial nerve to the prefrontal cortex to analyze information. Many children with an autism diagnosis only listen to every third syllable of what we’re speaking, Maude says. It creates auditory issues. If you can’t hear someone clearly but can move to hear better, you want the child to be able to move–especially for children who struggle with verbal communication. How much do they need to move in order for the auditory system to come alive, she asks.

This is why Maude uses Tomatis sound therapy. The way that my son spoke gave Maude a clue into what he was hearing. In Season 2 of We chose play, I describe the intervention at A Total Approach where my son spent two-week intensives a number of times over 6 years at Maude’s clinic receiving Tomatis, Occupational Therapy, Speech Therapy, Floortime, and other remediation interventions such as Interactive Metronome and ReadOn. Maude and I also did a podcast about Remediation versus Accommodation where Maude talked about accommodating children, including allowing kids to sit on a ball in class so they can bounce, as well as the above-mentioned remediations.

I also added that the vestibular system that we are discussing is the same system involved when people get vertigo, where the room spins around and you throw up and feel awful until a physiotherapist does movements with you so the crystals in your ear settle back in place. Maude says they have a number of concussion and brain injury clients where vertigo can be a big factor.

If we think about FEDC 2 (Enagaging and Relating) to FEDC 3 (Intentionality and Two-Way Communication), the occular motor control is building on top of the motor control, Maude explains. If the occular motor system is not working with the vestibular system, you can get dizziness, but our kids can’t tell us about it because they may not have the usual experience to compare it to. They might need to move a lot because their vision needs to catch up. The vestibular system needs to help with adaptation, she explains.

It’s why little kids can’t ride a bike without training wheels yet, I offered, and gave the example of when Maude say a video of my son finally riding a bike (with training wheels on it) a few years ago. She commented on how happy she was that he didn’t need to look down at the ground while riding, indicating to her that he had integrated the sense of riding the bike with his vision.

Integrating to Separate

You need integration to use separateness in the visual system, Maude explains. It’s only when the foundation is integrated that you can use the system freely. Each system needs to carry information in an appropriate way, then they can work together. So when we think about joint attention and engaging the child with us in an activity at FEDC 2, Maude explains, a big component of the vestibular system is with postural control. We think of the tummy muscles as our flexor muscles and our back muscles as our extensor muscles–which is entirely fed by the vestibular system. 

The Superman position is to test that extensory power which will help you stay sedentary, Maude explains. If you don’t have the balance between them, you fatigue much earlier so you see them slumping or ‘W’ sitting, or they need something to touch when sitting in a circle or touching the walls as they walk down the hall. It helps understand the core so you can get grounded in your core, Maude says. The high movers could need momentum to maintain their play, she states.

There is a difference between core strength and the balance between the system to maintain postural control. Your flexor has to be in balance with your extensor. Your vestibular has to be in balance with your visual system. Your vestibular has to be in balance with your auditory system. There’s also touch and proprioceptive system. This made me think of a recent article that suggested that balancing on one leg predicts life longevity!

Sensory and Emotional Processing are Intertwined

Integrating before separating is a topic I have heard a lot from Dr. Gordon Neufeld’s work. He says that if you don’t have the attachment with your primary caregiver, you cannot successfully individuate. He talks about the need for attachment as greater than hunger or sleep and says you wouldn’t starve your child or deprive them of sleep.

It’s the same process Maude is talking about here. Dr. Neufeld also talks about how children process one emotion at a time before they can feel more than one at the same time when the prefrontal cortex can mix emotions.

Maude follows a lot of attachment and trauma research and works in these areas and a lot of these pieces come back to the sensory integration. These issues affect the entire emotional system, she says. There is an area of the brain stem that is where the external information meets the internal information. If that’s in synch, we have balance for integration, she explains.

Visual processing

Maude says that if you see your child wanting to play with things only that they see in their environment, that is a compensation. They’re trying to get some visual ideas from somewhere, but maybe the connection is not completely full yet to make that visual system come alive in imagination and visualization which you need for the fourth developmental capacity (FEDC 4) and up. Maude says that we’ll have to do a separate podcast on the complication of vision.

My son has had vision tests and his vision is fine, but it’s the way the brain perceives the vision that has some issues. A developmental optometrist checks depth perception, peripheral vision, etc. My son was suppressing the sight in one eye and only using the stronger eye. He was given vision exercies and was given glasses which helped him use both eyes at the same time.

But if your child is not feeling that balance with their own systems, Maude continues, it creates a sensory-physical insecurity which drives the emotional insecurity. So, many children who have a sensory integration developmental delay struggle to increase their emotional capacities because their sensory systems are driving an experience that feels uncomfortable.

Our brain stores our experiences all the time, even from in utero, Maude explains. The way it’s stored is by an emotional association. If your emotional system is struggling because your sensory system is struggling, it’s going to be challenging to move into the fourth developmental capacity, she states.

Combining Sensory Integration with DIR/Floortime

There’s more than one adaptive response, Maude asserts: There’s the sensory adaptive response and an emotional adaptive response. You can work on the sensory integration first, yes, but it also takes some time for the child to trust the new body emotionally in order to not reinvent the ugly experiences from before, she explains. When Maude began working on emotional processing in Floortime much earlier at her clinic, they had a much faster response than when starting with sensory integration, then adding in Floortime later.

Greenspan’s big revelation was using emotion to promote development. DIR/Floortime focuses on emotional experiences of the child. The cerebellum is the key piece in the brain for vestibular and it is linked to emotional experience, Maude explains. When you change the vestibular, you change the emotional response. I had asked Maude before about cerebellum exercises, and I’m hearing now that it’s not just about doing the exercises, but about doing Floortime with them.

Parents have Relationship

The power that parents have is so great, Maude says. In your hands lie some of the biggest tools that therapists can never have. Maude has to attune to the child, whereas the parent already has the emotional connection. And Maude stresses that if you find yourself doing an activity and have to forfeit the Relationship to do the activity, don’t do it. Context is everything. The Relationship provides that safety net within which you can do other things with the child’s trust. Our children need the emotional security that only a parent can give.

Maude Suggests Vestibular Activities to Do with your Child
  • FEDC 1 Activities (no matter the age of the child) Heavy wrestling play, tug of war, pillow fights, etc. Have fun! These things are impactful on the body. It touches on the proprioceptive system that tells your body how it’s moving through space. Maude gave an example of having Friday night family fun night including games that involve tackling and playing with each other. Lie on the floor with socks on and wrestle to see who can get whose socks off first, for example, is a game Maude learned from Occupational Therapist, Sheila Frick.
  • FEDC 3 and 4 Activities Hopping, skipping, jumping, playing on a playground, hanging, etc.
  • FEDC 5 and 6 Activities Vestibular comes together with the emotional experience in these capacities. Here, do good old Floortime play, including a lot of role-playing

Questions? Contact us, or go to the Comments section below.

This week’s PRACTICE TIP:

This week let’s look at our child’s behaviour with a lens of curiosity about their sensory processing.

For example: Does your child constantly move? Do you find that they are more likely to move when they lose the ability to regulate and attend? Does moving help them with their visual or auditory processing?

Thank you to Maude Le Roux for enlightening us about the vestibular system and the importance of its functioning for functional emotional development. I hope that you learned something valuable and will share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below.

Until next time, here’s to choosing play and experiencing joy everyday!

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