So many times children are referred to occupational therapy because they are having problems with self-regulation. Some people are OVER responsive to information – becoming easily overwhelmed leading to emotional meltdowns. Others are UNDER responsive, needing so much more information to just notice it – they seem bored, spaced out and aren’t available to take in new information. And yet others need so much more information that they will do anything to seek it out, and the seeking interferes with accessing what’s happening around them in that moment. The difficulty with self-regulation is it is one of those murky problems that has such a wide variety of symptoms and related behaviors; progress often feels like one step forward and two steps back. In all instances the person is not able to remain available for comfortable interaction with the materials, items and people in the environment around them.
Having studied and worked with kiddos that have “regulation difficulties” over the years I’ve used a variety of tools. Some of those are what we call top down strategies, they require cognitive problem solving to use different strategies to change their own state of regulation. The Alert Program and Zones of Regulation are examples of these top down strategies. Sensory Integration theory utilizes a bottom up or body based strategy that allows input through the body to influence the nervous system and change a person’s state of regulation. By filling up the body’s needs or changing the environment to reduce the impact of environmental sensations we allow the nervous system to regulate.
In recent years I’ve found that all of the above tools have some effect, but they aren’t treating the underlying cause of sensory regulation problems– they are treating the symptoms. The behaviors that we observe are symptoms of a nervous system which is not effectively dealing with perceived threats from the environment.
Individuals who have difficulty regulating their arousal level are often described as being in a fight or flight response. This is a physiological response to a perceived threat or harmful event. This response is triggered by the Moro Reflex. If our Moro Reflex does not become fully integrated, we easily move into that fight or flight response at what seems to be very slight threats. An individual might become very angry and have an over reaction, or they may engage in avoidant behaviors, trying to get away from the situation.
A similar response would be to freeze – to not engage, or respond. These individuals often look like they have low arousal; they aren’t paying attention to what’s going on around them. In reality, their nervous system is feeling threatened and going into a different physiological state brought on by the Fear Paralysis Reflex. This reflex protects us by having us stop, almost like a opossum playing dead, until the threat is gone. It should integrate by the 3rd year of life, and when it doesn’t our nervous system will rely on this inadequate response as a coping strategy.
More and more I find that the “on the go”, hyperactive individual keeps moving because they don’t have core stability – the Spinal Galant Reflex and/or the Spinal Perez Reflex aren’t integrated properly. These spinal reflexes are responsible for the development of our proprioceptive system, coordination of our legs and body core, postural control and attention. When they are interfering our body stays in motion to compensate for the lack of coordinated stability.
All of these reflexes are processed in the Brainstem or Diencepholon, meaning our brain processes all of the sensory information and forms a physiologic response before the information even reaches the Cerebral Cortex where we can “think” about the threat level of the information. By normalizing the responses of these reflexes, we are teaching the nervous system to respond to input in an ordinary way; allowing the nervous system to remain in a relaxed/ready state instead of a hyper alert state. This is the beauty of working with reflexes; we are effecting lasting change in the nervous system that translates into improved regulation. We are no longer just addressing the symptoms; we are getting at the cause of the problem.