Tag Archives: regulation

How Speech-Language and Occupational Therapies Work Together

By: Danielle Maglinte, MAT, MS, CCC-SLP

Ryan - webYoung children go through many developmental stages before they begin talking. One of the first stages of development is shared attention. In a baby, shared attention looks like the baby turning her head toward mom when she hears mom’s voice or a baby looking into dad’s eyes when dad talks to the baby. As children get a little older, shared attention looks like mom holding up a toy, the child looking at the toy, then looking back at mom and smiling. The next step in developing shared attention is dad looking at or pointing to a toy, the child looks where dad looks or points, then he looks back to dad. These steps towards developing shared attention typically happen within the first 12 months of a child’s life.

When a young child reaches a stage of shared attention where they can follow a caregiver’s point and they can shift their gaze between the caregiver and the object, they start to develop back-and-forth communication. At first, this looks like a child reaching for an object to tell the caregiver “I want that.”

As back-and-forth communication with gestures continues to develop, the child starts to vocalize. In the beginning, these vocalizations are mostly babbling. As parents talk back when the child babbles, these vocalizations turn into jargon where a child sounds like they are speaking in sentences but not actually saying words. Some parents comment that it sounds like the child is speaking in another language. Over time, the child’s vocalizations are shaped into short, simple words, such as mama, dada, and baba for bottle. Children with speech delays often demonstrate limited shared attention. Working to develop strong shared attention will help a child learning to communicate.

One challenge for some children with speech delays is that they need to maintain a calm, regulated state so that they are available for interactions and can share attention with another person. Read more about self-regulation from OT Maureen here.

15_JJAzariahIf a child is focused on seeking sensory input, they may not have the ability to focus on social interactions, developing shared attention and speech with caregivers. Occupational therapy can help figure out activities and ways we can include these activities in everyday life so that a child can remain in a calm, regulated state so that she is available for social interactions. This may look like a child with limited eye contact running away and looking back to see if you are chasing him or a child who is quiet asking for “more” when you stop pushing the swing.

When a child stays regulated for longer periods of time, she will be available for interactions so that she can continue to develop strong shared attention, and move on to using gestures and speech to communicate. By working together, speech-language therapists and occupational therapists can help a family find activities, such as climbing, playing chase, swinging, and swimming  or others that help a child with speech delays stay regulated and available to develop shared attention and communication skills.

To learn more about speech-language and multi-discipline therapy at Easterseals DuPage & Fox Valley visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/speech-language-therapy.html. 

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Sensory Regulation, What Is It?

By Maureen Karwowski, OT

As I sit at my desk typing this blog on my laptop, I am regulated enough to focus on this task.  I am able to filter out the sounds of the lights buzzing, my coworkers typing, the feeling of my clothing, and the light coming in from the window beside me.  I will admit that some times I am able to do this, and not others.  For a child with sensory processing challenges, the interpretation and responses to the  sensory experiences I described can be ineffective.  These ineffective responses can impact a child’s overall regulation and can affect many areas of development.  It is estimated 01_Mason Esquivelthat 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).

I have worked with many children with sensory processing challenges as a pediatric occupational therapist.  I know from my work that every person presents with their own unique sensory profile.  Since every child is so unique, I am required to closely assess each client to be sure that I understand where their challenges are and what I can do to assist them.  A skilled occupational therapist will use a variety of assessments, some are standardized evaluations, and others are from observations of the child.  A thorough assessment will address three areas of sensory processing: sensory regulation, sensory modulation, and sensory discrimination.  Today’s topic is sensory regulation.

Sensory regulation refers to a person’s ability to keep their arousal at the right level for the situation.  Adequate self-regulation is essential to the development of attention, regulation of sleep/wake cycles, control of emotions, as well as the daily transitions that make up a child’s routine.  Sensory regulation is necessary for social interactions and learning.

One of my clients, who has significant challenges with this skill described a story about how at school, he loves to run around on the playground at recess.  He told me that the problem is that all of the other kids can slow down after recess, line up and then go back into school.

“I get so revved up that I can’t control myself anymore.”10_Logan

His teachers stated that he ran into the building, bumping into other kids at times, and did not respond to verbal directions.  This is a great example of how regulation issues can impact transitions and school.  This story ends well for this little boy.  His mother and I worked together and identified what were the factors that were impacting his regulation challenges.  For this boy, he was sensitive to movement and visual input.  He was correct in his statement that running around on the playground “revved” him up.  In occupational therapy sessions, and at home with his parents, we worked to address his challenges with movement and with visual input.  This in turn assisted him with his transition from running around to lining up to go back inside the school much easier.  We also worked on using some “tools” to help him with this transition, such as being given an earlier warning than the other kids from the teacher, he blew the whistle which gave him a chance to take a deep breath, and was in charge of carrying the bin of recess equipment into school which gave him some heavy work.

We all have strategies that assist us in keeping our arousal level where they need to be.  People chew gum, drink coffee, fiddle with objects, all in an effort to keep alert.  We also have strategies to calm ourselves down such as deep breaths, working out, knitting, herbal tea.  It is very important for children with sensory regulation challenges that we identify what are the regulating strategies that they can use to assist them.  Something as simple as chair pushups, sucking on a piece of candy, squeezing a stress ball, or rocking in a rocking chair can be useful.  It is important to customize these strategies to your child, as everyone responds differently.

I find that my occupational therapy sessions are the most effective when the parents and I are working together to identify the child’s sensory processing challenges and how those challenges are impacting daily life.

Stay tuned, as my next blog post will discuss sensory modulation.  Sensory modulation is the amount of sensitivity a person experiences towards a sensory experience.

For more information about Easter Seals DuPage & Fox Valley please visit EasterSealsDFVR.org.