The Right Eyes

Today, Little Bear has been seen by another psychologist. This came about because the last time we saw an Educational Psychologist, I became very irate and had to resist the strong urge to tell him he didn’t know his arse from his elbow. You may remember this ranty post which tells you all about it: Conversations

Thankfully, the Bear’s school were none too impressed either and volunteered to pay for a private psychologist to ensure a non-biased, useful report. I know that I have moaned at times, about the school, but things have come a long way. I feel a real gratitude towards them that they genuinely care, about Little Bear and us, and that they are willing to be creative and do things differently if that’s what’s required. In these times of dwindling budgets, I’m well aware that many schools wouldn’t have funded such an assessment.

It isn’t just that, but by inviting a knowledgeable stranger into the school, they were laying themselves bare to observation and potential criticism. They took that risk because they want to do the best they can for our son and they are willing to make changes to their practice if advised. There is something about us having these shared vulnerabilities and this shared desire to ensure he reaches his full potential and is as happy as he can be, that makes me a little emotional. I think (I hope) that we have reached that much longed for status of Having A Good Working Relationship. And also Mutual Respect. I hope so, because I do feel like giving them a collective hug.

So, having got the right professional across the threshold, how was it?

Other than the times someone from our post-adoption support service has come into school meetings, this was the first time that somebody with an evident knowledge of trauma and attachment has observed Little Bear and seen what I see. There is a palpable relief in that. It isn’t in my mind; I haven’t concocted his needs; I’m not exaggerating. A knowledgeable stranger has come in and is sitting at the table I have sat at many times before and is observing things and recommending things that I have previously talked about, at that very table. She’s more convincing than me because she’s a psychologist and she certainly couldn’t be accused of being a neurotic mother, but even so, it makes me feel a little vindicated.

It’s refreshing. It’s also reassuring and hopeful. It means that instead of things being okay for Little Bear, maybe there is hope of them being the best they could be. I probably haven’t aimed that high for a while – just hoping we could avoid abject failure. School are willing and keen and they like the Psychologist and she is passionate and full of useful ideas. Surely this is the most hopeful our status has been so far?

I complained in my blog about the incompetent Ed Psych, that I knew more about trauma than he did and I’m sure that’s true. (Incidentally, today’s Psychologist said almost the polar opposite of everything he said. One has to laugh). I’ve written about  Being an Expert Parent and how our children necessitate us being so. I have always been a little reluctant about it though, so when a professional appears who is undoubtedly more knowledgeable than me and more experienced than me and I can learn from them, it’s brilliant. There is a surprising relief in it, that allows me to relax a bit, so I can attend the meeting as a Mum, not some sort of parent/professional hybrid trying to do several things at once. It makes me realise how exhausting navigating such meetings can be and how much of my emotional energy is eaten up week to week, trying to make sure Little Bear has what he needs in every area of his life, unwittingly filling the gaps left by others lacking in knowledge. Perhaps I can relax a little about his education now because between the psychologist and the school, I think they’ve got this.

It also highlights how rarely I’m in a situation with a professional who is knowledgeable enough to give advice about Little Bear’s needs. This shouldn’t be the case – that a professional who is trauma-informed is a rarity. Any professional coming to advise on children with developmental trauma should be suitably trained and aware. It is wrong that we find ourselves in a situation where the only way of getting that expertise is to pay for it, especially as childhood trauma is so prevalent.

Anyhow, with the right eyes on Little Bear, what did we learn?

There are some real positives about how things are currently being done. The Psychologist commented how lovely it was that Little Bear’s teacher and his TA are both willing to be physically affectionate with him and allow him to snuggle close to them. His teacher (a man), calls him ‘mate’ a lot and gives him reassuring pats on the back or arm. In this day and age where figures of authority have to be so careful about touching children, and some establishments have become so wary that they don’t touch children at all instead keeping some kind of unnatural and cold distance, it is heartening that the Bear’s school feel able to react to him naturally and to provide him with the physical comfort/connection he needs.

There are also real positives in terms of a multi-sensory curriculum and learning being fun. Little Bear is largely happy in the classroom and his trusting relationship with both members of staff is evident to a new onlooker. These things are reassuring.

What is more concerning is that Little Bear was not observed to be regulated at any point during the morning-long observation. I’m not surprised though. We achieve periods of regulation at home but that’s because we work really hard at it and we have spent three and half years getting tuned in and figuring out what works. I can see that without a trained eye, it would be difficult to figure out the underlying causes (often linked to Interoception in my opinion). I am still very much trying to untangle Little Bear’s sensory needs and that is with Sensory Integration training under my belt and a lot of time to puzzle. I can fully understand how, without the training or the experience, school would struggle to interpret and manage these aspects of Little Bear’s needs. The good thing is that today’s visit has brought them better understanding and the report will bring many practical suggestions for ‘sensory snacks’ to hopefully improve regulation across the day. I’m excited to read the ideas and maybe steal some for home too.

Little Bear was also observed to be anxious, hyper-vigilant and attachment-seeking in the classroom. Staff were observed to be inconsistent in making Little Bear adhere to the rules and at times punished possible self-regulatory behaviour. The big take home message for school was to ask themselves, ‘what is Little Bear showing us with this behaviour?’ ‘What is he showing us he needs?’ ‘What can we do to make him more comfortable/reduce his anxiety?’ instead of saying, ‘how can we stamp out this unwanted behaviour?’

The take home messages for me were more questions to ask of myself: ‘Are we doing enough to meet Little Bear’s sensory needs?’; ‘Should I get somebody else to assess him in this area?’; ‘Do we make appropriate accommodations for his sensory needs, particularly at mealtimes?’ I do find myself saying “sit down properly” a lot more than I probably should.

We talked a lot about difficulties with executive function and employing strategies to support that, such as visual supports, timers and short sharp bursts of learning, interspersed with sensory snacks. We talked about positive feedback, a proper meet and greet, a better transition for the end of lunchtime and closer supervision if unstructured play is leading to difficulties.

One of the main reasons we initially sought psychological input was due to the upcoming need to re-apply for funding for Little Bear. Today’s Psychologist was strongly of the opinion that Little Bear’s supportive adult should not be removed from him – he needs her support to get going with tasks and frequent check-ins to help him complete them. He cannot learn without adult support currently – an opinion we also hold strongly and one of the key reasons I got so frustrated with the LA Ed Psych who thought we should be working towards independence. The fact that today’s Psychologist independently and without any vested interest, drew this opinion is a great outcome and will hopefully add significant weight to our case for funding. I would love to say I’m not worried about that but I am because there are a few wider things also happening, relating to staffing at school and some problems with our back-up plan, should the funding application be rejected. There is always something to worry about it seems, but, today, I’m going to bed hopeful that now Little Bear has been seen through the right eyes, we might be on the right track to him getting the right support.

Advertisements
The Right Eyes

Hangry

This little infographic shows the typical process we experience when we’re hungry:

Hungry

And this little infographic shows how hunger turns to hanger and how easily the state of hungriness can lead to escalation in our house (and I suspect we’re not alone):

Hanger

I love hangryness, its a real joy.

I’ve previously written about Interoception  and Adopted Children & Eating Issues and Demand Avoidance if you’d like more info than the little bits here that you will no doubt need to squint at (it does look pretty though).

I’m assuming that time and working on interoception are going to help with this. I also need to remember to leave Little Bear a tray of healthy snacks outside of his bedroom door for when he wakes up at the crack of sparrows and none of us are ready to leap out of bed and make him some breakfast. On the occasions when I’ve remembered, it seems to have worked well in terms of pre-empting some of the issues above. Anticipating hunger and regular snacking and routine mealtimes do seem to keep things as calm and even as possible (though don’t actually take away the underlying issues). If anybody else has any clever tricks, I’d love to hear them.

Hangry

Working on Interoception

Back in March I wrote this blog: Interoception   At the time, I promised I would have a go at working on interoception with Little Bear at home and I would report back about how we got on. Another random Twitter chat has prompted me to do that this week so here we are!

I began Mission Interoception by buying this book because I struggled to find any practical information on the internet:

IMG_1098

It is quite informative but it is also very expensive for what it is. I was expecting a sturdy text book for the £24 I paid, not a thin novel sized book which I was able to read in one sitting. Although the content is quite helpful, I didn’t find it revelatory. The basic premise of interoception remains the same as I thought before: we need to get children more tuned-in to things that are happening inside of them. In order to do that, we need to get them thinking and talking about what’s inside. A key part of interoceptive therapy seems to be describing how different parts of the body are feeling and this is where we ran into a bit of trouble. Little Bear has well-documented speech and language difficulties and it soon became clear that coming up with lots of different adjectives to describe parts of his body he doesn’t really know are there is fairly challenging. In fairness, if I make myself think of how to describe my stomach for example, when I’m hungry, I’m not sure how many adjectives I can really come up with either. Working on interoception has several pre-requisites I’ve discovered and good language skills are one.

The book gives quite a few different activities to do but they are essentially all just different ways of making a child think about a specific body part (a grown up points at different bits with a light sabre/ you draw a picture of your child & point at different bits of the picture etc.). As with most things, I picked the bits I liked the most or thought would be the most fun or the most practical and we had a go.

The book suggests that a good starting activity is to draw around your child (who will be lying on a large piece of paper – wallpaper or lining paper is ideal), get them to help you mark their different organs on their body map and then talk to them about how different ones feel in turn. We enjoyed the drawing around each other part – I roped Big Bear in too to make it a bit more fun:

IMG_1110

 It was at the stage of marking the organs on the map that I realised there was another pre-requisite skill that we were slightly lacking. Your child kind of needs to know what’s inside of them. Not complex anatomy but stomach, lungs, heart, brain, bladder, bowel are all fairly crucial to this. Little Bear seemed to find the drawing around each other part quite overstimulating so between that and not really knowing about the organs, he quickly lost attention for the task. If you were hoping for the kind of blog post where everything goes swimmingly and I resolve my child’s difficulties overnight, you have come to the wrong place.

My conclusion after this was to shelve direct work on interoception for a while so that we could fill in some anatomy blanks. Little Bear’s birthday was around this time and always wanting to get something a bit educational in amongst the fun stuff I had got him this:

IMG_0412

 I found this a much better way to think about insides with Little Bear. The model is good because you can take the transparent plastic ‘skin’ off then ‘dissect’ the man with the tools provided. There is a labelled sheet with blank spaces for you to match the 3D organs up with their pictures. It felt quite a bit more rock’n’roll than drawing on the paper which meant it grabbed my boys’ attention more and they engaged with it better. Over time I linked the items they were removing from the unfortunate plastic man to their own body parts. Sometimes I would hold a bit up and ask if anyone knew where it was on their own bodies. We began to talk about what the bits did and how they worked. We re-visited this task every so often to re-inforce the information.

 Alongside this, the book I bought advocates working on interoception ‘on the fly’ i.e. just at random while out and about, not solely during an interoception task. It also suggests trying to apply interoceptive learning at points of dysregulation, though it points out this is difficult. I realised I was guilty of identifying out loud that Little Bear was hungry or needed the toilet but I wasn’t really arming him with the skills to identify this himself. I tried to add in a bit of interoception on the fly at these points. For example, I might say, “We need to get up now; its breakfast time. How is your tummy feeling?” Little Bear might struggle with the vocabulary so I would sometimes give him a choice of possible descriptions e.g. is it full or empty? If his tummy rumbled, that was brilliant and an opportunity I tried to seize. The first time I tried it, I said, “What was that noise?” and Little Bear very earnestly replied that it was a bear. I suspect he knew full-well what it was but it is possible, with my interoception hat on, that he couldn’t identify that the noise was coming from inside of him.

Over the last months I have tried to tune him into these little signals, as well as things like how his behaviour changes when he needs the loo or is hungry. I describe the changes I see to him and try to get him to feel them e.g. “You are talking really fast and jiggling up and down. I wonder if that could be because you need the toilet? How is your bladder/bowel feeling?” I might put my finger on his tummy to help him focus on the right place.

I think the most significant thing we can now (sometimes) manage is getting Little Bear to pause, even for a few seconds, to consider his body. I can’t pretend it works every time or that when he pauses he can read the signals but certainly sometimes he is now able to stop and try to tune in. This doesn’t sound like much but I think that interoception is something that takes a long time to change. We are chipping away at it and maybe in a year’s time I’ll notice bigger changes.

One thing that has changed is that Little Bear has become aware of his heart and how fast his heart is beating. We haven’t targeted this directly so I do think it’s a sign of improved overall interoception. The fact that Little Bear is able to lie still and be quiet enough to notice his own heart beat feels like a positive step in the right direction. He can use his breathing to slow it down and notices when it speeds up, neither of which he could do before. He seems to have gained this awareness by himself, perhaps as a result of being more aware of where his heart is and what it does. I have seized on this where possible to link the changes in his heart rate with his feelings/emotions, especially when he feels angry. I have explained why I encourage him to do his ‘Ronaldo breathing’ at these points.

A couple of times, Little Bear has been getting grumpy and heading for meltdown when he has managed to say, “Mum, I think I’m grumpy because I’m hungry”. This is brilliant and obviously I have fed him straight away. It’s far from consistent though and I would say that the majority of the time it is still down to Grizzly or I to interpret his behaviour to figure out things like hunger or needing the loo.

With regards toileting, this is the area we have had least success with in terms of interoception. The majority of the time Little Bear doesn’t seem to know he needs a wee until he is wet and then sometimes he isn’t always aware. This is the area that would make the biggest difference to him but I wonder if there is a hierarchy within interoception, with some body parts being more difficult to tune into than others.

Overall, I would say we are making progress but it is slow and steady. I guess it might be quicker if I chose to focus all my efforts on interoception for a 6 week period and did a little every day. It is hard to give it that level of focus though when we have so many other areas that also require our attention.

On a related but slightly tangential note, I have noticed significant improvements in Little Bear’s sensory seeking behaviours recently. I suspect it is since he has had his Our Gym Bar Invention. Initially he used it all the time, for lengthy periods – mainly hanging upside down – but he rarely uses it now. I wonder whether he has had sufficient proprioceptive and vestibular stimulation that he has been able to re-organise those brain systems. It was particularly noticeable during the summer holidays because there were quite a lot of days when he didn’t do any vigorous exercise, just walking, and he was absolutely fine. That could never have happened even a few months ago. Every day he needed a good run around or swim or bike ride or to climb something or we would have been in for trouble. I can genuinely say that has changed which fills me with hope that sensory diets do work. We still see dysregulation but it’s less physical than it was.

My belief is that interoceptive work will be effective too but it’s a long game. Perhaps if I’m still blogging in a year’s time I could give you another update then.

 

 

 

 

 

 

 

 

 

Working on Interoception

Our Gym Bar Invention

You know your child has some sensory needs when you have one of these in your house:

 IMG_1573

 It is not exactly an off-the-shelf product; it is several products that we have combined to create a gym for Little Bear. The basic product is a Pull Up Mate pull-up bar. We got that first because Little Bear was spending quite a lot of time hanging from things. There are not many things in your average household that are safe to hang from though and he tended to resort to the side of his cabin bed which we weren’t too keen on. We decided a free-standing pull-up bar would be safer and we chose this one because it seemed the sturdiest available.

The bar is height-adjustable and we started off with it being half the size it is in the pictures. Little Bear loved it and soon came up with several different moves: hanging, swinging, doing roly-polys in the air, hanging vertically upside down, hanging from the bar like a sloth and moving hand over hand along it, from one side of it to the other. I guess all the moves were giving him both proprioceptive and vestibular feedback, which he seeks.

The only thing I had to be careful of was that Little Bear couldn’t identify when he was getting tired or had satisfied his sensory needs and would just keeping swinging and hanging for ages and ages, tipping himself into over-stimulated territory (see Interoception for more on why this might have been happening). To begin with he would get more and more excited and he would need one of us to tell him to stop and do something else. I do think that has improved with time though and although we do still need to step-in, Little Bear is getting better at identifying when he needs to stop. He is also calmer when he is on the gym and is now using it more functionally to regulate himself. We’ve noticed that when he is generally dysregulated, there are fewer times when he prowls about the house looking for trouble. Now, he tends to go to his gym instead which is certainly preferable.

When it was Little Bear’s birthday we didn’t really know what to get him so we ended up getting some additional bits and bobs to make his gym more exciting. In order for that to work we had to make it full height. We have added a rope ladder, which could be tied onto the bottom bar but Little Bear likes it loose; two hoops and a swing.

 It is fair to say it made his day and was a better present for him than a traditional toy. He quickly invented some new moves including climbing up the frame itself in a star fish shape and then jumping to hold onto the top bar. I frequently have to close my eyes because he does things you would never think possible and even Grizzly gets a bit of a fright sometimes. However he is very lithe and strong and these things seem to come naturally. He is very good at having enough points of contact and at landing safely.

Little Bear also likes to climb up and through the ladder; to do roly-polys on the hoops; turn himself upside down from the hoops and create sequences of moves from one piece of apparatus to another. He often challenges the rest of us to copy his moves but none of us are capable!

When other children visit they are very attracted to the gym too but it is definitely quite over-stimulating for Little Bear if there is more than just him on it (its fine if Big Bear plays).

Another crucial addition with the birthday package was the crash mat, for obvious reasons! It’s one of the fold up gym ones – there is a lot of choice on Amazon. Little Bear also likes this as a place to have a little lie down, I found him there watching TV the other day.

IMG_1572

The only other safety factor to consider is the weight of the child using the gym. The pull-up bar itself is suitable for adults up to 110kg but obviously it isn’t really designed for people swinging around on it. Little Bear doesn’t weigh much so it copes with him fine but it does tip a little if Big Bear goes on the swing or ladder. We are going to add some tent weights to the bottom bars for a bit of extra stability but in general I do think the whole thing is more suited to someone on the lighter end of the scale.

Although it looks like a thing of torture and is not what you would expect to find in someone’s conservatory, we are very pleased with it as a purchase. It wouldn’t be for everyone and it does take up quite a bit of space but I wanted to share what can be done. We had been looking at these types of thing (see below) but they are huge and I don’t really know who could accommodate one in their house whereas our smaller DIY attempt works well for Little Bear and would be equally as good outside during the summer.

IMG_1579

The whole process has made us realise how talented Little Bear is in the gymnastic department. He doesn’t currently attend lessons as he would struggle with waiting to take his turn and with listening. I’d be interested to hear if anyone has tried 1:1 gym lessons or anything similar that we should consider.

 

 

Our Gym Bar Invention

Pets, Children & Why We’re Not Getting a Dog

We keep thinking about getting a dog. We have favourite dog breeds and have even thought about dog names. We are not getting one though, unless I actually want to have a nervous breakdown, which I don’t, so we are not getting one. Not in the foreseeable future anyhow.

It is not as though we haven’t got any pets. We have two cats, outside fish, inside fish and up until fairly recently we had three hens (they got old, don’t worry, it isn’t a grizzly fox story).

The cats are good pets for Little Bear. The cats are quite straightforward with clear boundaries; if they are happy they show you with purring, if they’re not they show you with a scratch. They literally never get over-excited, I don’t think cats can be bothered, and if Little Bear is too rough or over-exuberant with them, they either walk away or give him a nip. Obviously I don’t want him to be nipped or scratched but it is a natural consequence of not treating the cat properly and has led to him being very gentle with them. He has learned that if he is nice to the cats, they will reward him with cuddles and sleep on his bed. Whenever that happens I always tell Little Bear how much they love him, otherwise they wouldn’t want to be in his bedroom or on his bed and that makes him feel good.

IMG_8902

Little Bear has started to get involved with feeding them and knows when they’re hungry. He is also good at keeping them company on the way to the vets. He is less pleased when the little cat goes on a killing spree and brings all sorts of half-maimed creatures into the house but he has helped to catch a live mouse on more than one occasion and has also tidied up dead birds (I don’t make him do that, obviously, but he likes to help). The cats have taught both boys a lot about life, nature and responsibility.

The fish are quite entertaining to look at but I have to admit they are the least exciting of all our pets for children. Little Bear enjoyed building the pond though and enjoyed keeping it ice-free over the cold spell we just had. He likes to feed the inside and outside fish and helps to clean out the tank. Pets definitely provide opportunities for helping and feeling successful.

Our hens have been our most fear-inducing pets, though only ever in other people’s children, not in our own. It has always been a bit of a surprise to folk when they have come across them in our back garden as we live in a typical cul-de-sac, with a not-very-big garden and you don’t really expect to find them there. We have fenced off part of the garden at the side and the hens are generally free range in that bit. Children have to go in there to get to the trampoline though which is what causes the consternation.

We already had the hens when Little Bear came home and he was pretty interested in them from the beginning. I have some lovely photos of him holding one of them and also him inside the hen house with them all outside! I was pretty impressed with him that at the age of three he was brave enough to get hold off one (they were friendly but you did risk a whip from a wing if you didn’t hold them firmly enough). The look on his little face of pride and happiness is just lovely.

IMG_2982

Little Bear has learned quite a lot from the hens. When he first arrived I don’t think he’d ever seen an egg before and he certainly didn’t know that hens lay them. The first time he was left alone with the freshly laid eggs, he threw them all on the ground and trampled them. I often talk about the incident in my workshops and I genuinely think it was because he didn’t understand the context. He didn’t understand that the hens had laid the eggs, that we could take them inside and cook them or that we could eat them. I think he just thought “they look interesting” and explored them on a sensory level.

Funnily enough Little Bear is a good little helper in the kitchen these days and whenever we are baking or making pancakes, he is always in charge of the egg part.

Little Bear has always enjoyed a practical task and would often help Grizzly to hose out the hen house or to re-fill the feed or water or just give the hens some treats. Our last hen, Yoko, recently became poorly and it was obvious she was going to die. It was during the Beast From The East so we brought her inside and she sat in a washing up bowl by the back door for several days while we gave her ‘end of life care’ (the poor thing had lost her ability to move about). Both boys were good at sitting with her and stroking her. Big Bear even suggested she might want to watch You-Tube on his I Pad!

I think that having her inside and letting her go naturally was helpful for the boys who could get a bit used to what was happening and were not shocked when she did die (though the three of us did stand there for quite some time staring at her, trying to decide whether she was breathing or not. It’s harder to tell than you’d think!).

Having pets has certainly brought another dimension to our lives and I do think the boys have gained from it. They have developed empathy, caring and the practical ability to look after something.

I could see us with a dog: I could see the boys would get a lot from one too. Only we just can’t get one. It’s a bad idea.

Little Bear LOVES dogs. I don’t think I’ve ever met a child who loves dogs quite as much as him. When he was smaller he would just run at them, whether he knew them or not and would be desperate to get his hands on them. We have had A LOT of chats about not knowing whether dogs are friendly or not and that you must ask their owner first before you can touch them. Little Bear has learned the rule well but it has not stopped him from gate-crashing stranger’s picnics to make a furry friend or trying to wrestle a lead from someone so he can walk their dog. Once, we were in the country park near to home and I happened to turn around just at the instant Little Bear had over exuberantly scooped up a Dachshund and was dangling it face first above the ground, the poor thing no doubt scared out of its wits. Another time we met a Chow Chow on the high street and within three seconds of being acquainted with it, Little Bear popped his hand in its mouth, probably as he was intrigued by its dark tongue. Dark tongue or no, you can’t go round sticking your hand into random dog’s mouths.

My brother has a dog. She is only about a year old, massive and EXTREMELY bouncy. She is a Tigger of a dog. She is very friendly and has no malice in her whatsoever. She never growls and loves the children. However, and it’s a big however, she has some issues with regulation. She basically can’t regulate herself and hence can be poor at listening, unruly and very, very excitable.

Before we go to see the dog, Little Bear and I always have a little chat. I remind him that if he runs and jumps at her, she will jump up at him. I remind him that if he wants her to be calm, he needs to be quiet and calm and move about slowly. Little Bear knows all this and can tell me the rules. I believe he has every intention of sticking to them.

When we arrive, the dog will be beside herself because some new people have appeared and not only that but some of them are tiny people and that’s way more exciting. Her tail will be wagging with such vigour that she’s knocking things over and she will be being held by her grown-ups to stop her from jumping at everyone’s faces. As she is considerably bigger than Little Bear on her hind legs there is a very real possibility that she will knock him flying. Little Bear doesn’t mind one jot and is just as keen to get to her. What usually ensues is a tangle of human and dog, lots of licks and possibly an accidental scratch.

Already, Little Bear has forgotten the rules. Then mayhem breaks out. The more times the dog licks him or stands on him or knocks him over, the more excited Little Bear gets. The more excited and loud and fast Little Bear gets, the more excited the dog gets so the more she leaps about like a lamb and the more Little Bear laughs and falls over, the more the dog tries to bury under him and the more it tickles and the more he laughs. The dog and the boy reach fever pitch within the first 5 minutes of meeting each other.

Now, if that lasted for half an hour and then everybody calmed down I could deal with it. But it doesn’t. You wouldn’t think it humanly possibly but Little Bear at least, remains at fever pitch the entire time he is with the dog. We once managed 24 whole hours at my brother’s house before Grizzly and I couldn’t bear the dysregulation any longer. People say, “but they’d get used to each other, they’d calm down after a bit” but they wouldn’t. Little Bear doesn’t get any calmer and Grizzly and I find it really hard because what everyone is seeing is Little Bear at his worst. He is completely out of control. He has lost his ability to listen and he cannot be controlled either by us or by himself. He is as dysregulated as he can get. It means that when we try to get everyone to sit quietly and watch TV or let the dog have a nap, Little Bear is not physically capable at that moment in time of leaving her alone or of being quiet or of sitting still. It means he seems very disobedient and is constantly told off.

Having written about Interoception recently, I do wonder if that is the root cause. I read that part of being under-responsive to interoceptive feedback is that you don’t know when you’re getting over-excited or when you need a break. Little Bear certainly doesn’t when he is with the dog and last time, he was absolutely exhausted when we got him home, having come down from his adrenaline-fuelled high.

Obviously if we did get a dog Little Bear would love it but you can see why it feels risky. We would do our research and get a calm breed but a puppy is a puppy and all will be excitable to some degree. We wouldn’t be able to rely on Little Bear sticking to any sort of rule about leaving the dog alone for five minutes or not playing with it roughly and I do wonder how on earth we’d be able to train it properly in those circumstances. The very worst outcome for Little Bear would be us getting a dog then having to send it back, something we are, for obvious reasons, keen to avoid.

It feels a little mean, saying our child can’t have the thing he would love most in the world but until his regulation is improved, it’s too risky. I know there is a lot written about the benefits of dogs for adopted children but I wondered whether anyone else experiences the issues we do?

I think we’ll stick to cats and hens for now. Easter is just around the corner, the perfect time to welcome some new chicks…

IMG_2985

 

Pets, Children & Why We’re Not Getting a Dog

Interoception

When I went on Sensory Integration training (admittedly about ten years ago) we were taught that there are seven senses: all the ones you usually think of (taste, touch, sight, smell, hearing) plus proprioception and the vestibular system.

Proprioception is the sense of knowing where your body is in space and is stimulated by things like deep pressure, heavy work and vibration.

The vestibular system is in your inner ear and is the sense that helps you battle gravity. It is stimulated by movement, especially spinning or being upside down, and is the sense that causes travel sickness. If anybody has experienced Labyrinthitis they will have experienced their vestibular system on overdrive! Grizzly had it so badly that he literally didn’t know whether he was the right way up or not and couldn’t get out bed for several weeks or even move his head.

I think about Sensory Integration (SI) quite a lot when it comes to Little Bear and I’ve previously written about it a little in Too fast, too hard, too loud. The basic premise of SI is that everybody has a sensory system and we are integrating sensory stimulation all of the time. Everybody’s system is different and what we can cope with/ what we need in terms of sensory stimulation in order to be comfortable in our bodies will differ too. Little Bear certainly seeks proprioceptive and vestibular input which has led to us having a free standing pull up bar in the playroom so he can climb and hang as he needs, instead of seeking similar input in a more dangerous fashion (like clipping his belt loop to the bed and hanging from there. Full marks for ingenuity but a little too dangerous for my liking).

However, a couple of articles have caught my eye recently which have suggested my SI knowledge is a bit out of date. Current thinking is that there are in fact 8 senses: all the ones I mentioned plus something called Interoception. I have done some digging to figure out what it is and why it might be important for our children and thought it may be useful to share.

Interoception is a bit like proprioception but from the inside. It is the sense of knowing how things are within our bodies. It includes things like being aware of our heart beat and whether it has sped up or slowed down; being aware of our digestive system – are we hungry/are we full/do we feel sick; is our temperature ok – are we too cold or too hot; awareness of blood sugar – are we getting shaky and a bit low on fuel; awareness of our bowel and bladder – are they full/ do they need emptying; do we have pain anywhere.

I’m imagining it like there is a telephone system between our internal organs and our brain. The lines of communication need to be kept open so that if our heart is beating faster, it can “ring” the brain which can then take measures either to ignore that or suggest for you to sit down and rest for a bit. Or you might have a full bladder. The bladder would call and tell the brain to make you aware you needed a wee and you would go to the toilet. It’s all good and very effective when working properly but there are lots of things that can get in the way.

IMG_1077

Studies of infants have suggested that interoception develops very early, perhaps in the first few months of life and might be stimulated by things such as their parent stroking their cheek or rubbing their back – which are pleasant sensations that might ease internal states. One study showed that being stroked on the face led to a decrease in heart rate in 9 month olds. I read something else which stated that infants “associate interoceptive signals of warmth and satiety with their caregiver’s face, which in turn drives attachment behaviour”.

From the limited evidence, you can see that a child who has been neglected (hasn’t received physical comfort) or who has had multiple caregivers (seen many carers faces), might not develop typical interoceptive skills. There is already evidence to say that children who have suffered physical abuse grow up to have altered pain sensations. One article I read suggested that investigating the impact of adverse childhood experiences on interoception is a big area which requires loads more research.

Even if we don’t fully understand all the reasons why a child may end up with a faulty interoception system, we do know that they can and that they may be under-responsive, over-responsive or seeking of interoceptive input. Being over-reactive to bodily signals such as heart rate, butterflies and muscle tension has been associated with anxiety and depression. I suppose that is the equivalent in my analogy of the brain being phoned constantly for every internal twinge or tickle instead of just for the big ones.

Being seeking or under-responsive to feelings of a full tummy has been linked to eating disorders. In this example the brain isn’t getting the call when the tummy is full or the brain starts to panic when there aren’t calls so stimulates the body to continue eating. Something about the feeling of fullness is desirable. I think the converse could also happen – being empty being the more desirable feeling.

If children struggle with interoception, they can find it difficult to know whether it is something inside or outside of them that is causing discomfort, leading to dysregulation or an unusual response. I think hunger is a really good example as Little Bear definitely struggles to identify when he’s hungry (hangry!) and will tend to get irritable and aggressive with anything and everything rather than identifying his tummy is empty and that he needs to eat.

Some researchers think that interoception could underpin many psychopathologies and could be a lot more crucial than we yet realise. One thing they do agree on is that being able to recognise and respond to your internal states (interoceptive feedback) is a crucial skill for recognising your own emotions, learning and good decision-making. Poor interoception tends to be linked to risk-taking behaviours such as drug-taking, promiscuity and alcohol abuse in later life. Could this be because these things tend to heighten sensation, giving the brain the feedback it needs but doesn’t usually get?

As emotions such as anger, nervousness, and excitement have a physical impact on the body, as well a neurological one, we can see how interoception also has an involvement with our emotional development. In fact interoception is crucial in helping us to identify which emotions we are feeling from the signals our bodies are giving us.

It turns out that interoception is a much more complex and wide-ranging sense than you would initially think.

So what about Little Bear? What I have learned that is of use to him?

Well, according to SPD Star “it’s only when all of the other senses are regulated and in check that our body is quiet enough to listen to what those internal signals are telling our brain”. In other words, most children who experience SI challenges are likely to experience some interoceptive differences and they won’t be resolved until their other sensory needs are being met. Let’s hope that hanging bar is doing its job then.

I have identified that when it comes to the interoceptive sense, Little Bear is under-reactive. I have already mentioned that he would neglect to eat without adult support but perhaps the biggest thing I’ve learned is that he is probably under-reactive in the bowel/bladder department too. I have talked about his Continence Issues previously but this information shines a new light on them. It seems very likely that the phone line between Little Bear’s bowel/ bladder and brain is a bit faulty. When the bowel/bladder start to fill up, the message does not immediately get passed to his brain. It is only when they are full to capacity and the red warning light should be going off that Little Bear’s brain gets the signal to tell him to go to the loo. By that stage he often needs to run and sometimes he inevitably doesn’t make it. The theory certainly fits with the behaviour we observe.

I like this as a way of explaining why he’s not consistently dry, it makes sense. As with most aspects of SI it also means there is hope and that with the right approach he should be able to make progress.

I have found it more difficult to find specific advice about how exactly to work on interoception, other than to speak to an OT or get a sensory diet written. However, what I have gleaned is that you basically want to get the brain more tuned into the signals from the organs/ muscles and Mindfulness is mentioned quite a bit in the literature. I guess that makes sense – quietening everything down so that you can hear the internal whispers that you would otherwise miss. Once you are more tuned into those signals, your brain should get better at listening out for them.

Some of the things we already do at home seem to be appropriate for improving this sense. Things like when Little Bear is hungry, I will draw his attention to the rumbling sounds from his tummy and explain what they mean. Sometimes he will say he has tummy ache and I’ll know from the coincident hyperactivity that he needs the toilet. Since reading about interoception I am getting more conscious of not just herding him to the loo but trying to encourage him to feel that tummy ache and identifying it as the feeling of needing the toilet and explaining that when you feel that sensation, you know you need the loo. This sort of cause and effect doesn’t always come naturally to our children anyway and sometimes they do need us to state things that seem obvious to us (it isn’t obvious to them otherwise they would be able to act on the sensations).

Apparently regularly prompting a child to go to the loo helps them to get used to the sensation of an empty bladder and to experience the contrast with a full bladder which should help to develop their interoception over time. Using technology such as vibrating watches is a helpful way of keeping on top of their interoceptive challenges a bit more independently, as well as teaching them strategies such as going to the toilet during every break whether they think they need it or not.

As with most things adoption related, this isn’t a quick fix. It takes time and getting other sensory needs under control first.

I can see improvements in Little Bear’s interoception system though. He was certainly under-responsive to pain when we first met him and though he still has a high pain threshold (a few more than average phone calls from the injured area to the brain before a response happens) he does now respond to knocks and bumps in a much more typical way. He will cry and come for a rub where previously he could have banged his head on a solid object and not even broken step or let out a yelp. The toileting and hunger issues have improved too, but in a stepwise fashion, where we still have some steps to go.

Interestingly, while being hyper-aware of your own heart rate can go hand in hand with anxiety, some children enjoy the sensation of a heavily beating heart and actively seek this – driving them to exercise – and consequently they become very fit. I’m not sure if this applies to Little Bear but I’m not sure that it doesn’t either as he certainly likes running about/ bouncing/ hanging etc. and is developing into an impressive sportsman.

As with most differences, a differently developed interoception system brings its challenges but also its unexpected silver linings.

 

 

*If you want to know more about interoception, this is a particularly comprehensive article:

https://www.sciencedirect.com/science/article/pii/S187892931630127X

 

**This blog is based on my own reading. If you think I’ve missed something or not quite explained something properly please let me know.

 

 

 

 

Interoception