A Therapeutic Week

It’s funny how you can have periods of time where everything feels difficult or like you aren’t making headway, then several positive things happen at once, making you feel as though you are taking a bigger than average leap forward.

A big positive last week, came in the form of a meeting I had with Little Bear’s teacher. We needed to update his SEN targets, both because they were due but also as part of our funding application. The teacher could have just written them by himself and wafted them under my nose to sign. However, he didn’t, inviting me to meet with him and write the targets together. We pored over the recent psychology report (see The Right Eyes ), agreeing how to group the advice into targets and how to apply the advice, in real terms, in the classroom. It felt truly collaborative, as though my knowledge as a parent was respected and even, dare I say it, valued.

Part of the reason I sound a bit disbelieving about this is not only because this level of collaboration is so tricky to attain but also because this is the same teacher I wrote Dear Teacher about, earlier in the year. I put our improved relationship down to perseverance on my part, an open mind and willingness to listen on his and probably a few of the things I wrote about in Stop. Collaborate & Listen.  It’s reassuring that these things do (can?) pay off in the end.

Irrespective of what has gone into achieving it, the outcome for Little Bear is surely more favourable, now that we are all working to the same advice? As most of the advice is around emotional, behavioural and sensory supports, the final targets did have a very therapeutic feel about them. And it’s reassuring that he’s getting a lot of that sort of support all day at school as well as at home.

The meeting also led to a second therapeutic development: a sensory/calm box. It was one of the recommendations from the psychologist, although she said ‘sensory box’ and I slightly took it in my own direction. I maintain that Little Bear’s sensory presentation is complex and often when he appears to need more movement, he actually needs help to calm. So far, this is something we have struggled with and I have found difficult to get right for him. Little Bear’s TA is very good at knowing when he needs a movement break and taking him outside to bounce a basketball or have a little kick about. However, it’s the times when he needs some comfort/ soothing to calm that we all struggle with. This is where I saw the sensory box coming in and half-inched it as more of a ‘soothing box’. We have managed to establish, after longer than you might think, that Little Bear finds fluffy things soothing so I mainly went for tactile items in the box – things to squeeze, stroke etc. I did add a kaleidoscope for a bit of calm visual distraction and also some photos of us in case he needed the reassurance of seeing us during the school day. Here’s the box before Little Bear decorated it and we added the personal bits:

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I found that The Works was a great shop to go to for little squeezy things and much cheaper than if you look for ‘sensory toys’ on Amazon. I also got the wooden box from there, which is the ideal size and personalise-able – something Little Bear really enjoyed.

Early feedback suggests the box does offer him comfort at school, which I’m really pleased about – could that be another sensory hole plugged? There have been some issues with him not wanting his access to it to end, but hopefully they will be solved with a bit more structure and a sand timer.

A fluffy beanbag, a fluffy blanket and jackets/zippers with fluffy linings inside have all brought comfort at home over recent months so maybe we have finally hit on the right modality for soothing? I hope so. It certainly feels more effective than letting him run wild and over-stimulating himself.

The third and final therapeutic development has come in the form of massage. I’m not too sure how this came about, although I know someone has mentioned it to me previously as a good approach but I can’t exactly remember who. Somehow, Little Bear has started asking for a massage at bedtime. It has felt like an exercise in trust, communication and consent, as well as an intrinsically soothing exercise. I’m careful to ensure Little Bear is in control of the massage and that I listen carefully to him and heed his requests. He has got quite specific in expressing what he wants e.g. ‘rub my leg but not the back of my knee’, ‘more firmly please – not as hard as this but harder than this,’ (while poking my arm to show me). It feels imperative that I adhere to his boundaries in this way – not just because I clearly should respect anybody in that way, but to strengthen our bond, and as a reference point for his own behaviour e.g. when he’s holding onto my hair and refusing to let go, I can say, ‘when I give you a massage and you say, that’s enough, or not my toes, I always stop. When I ask you to let go of my hair, you should listen to me, like I listen to you’. It has also given the opportunity for me to clarify the rules on ‘private places’ i.e. ‘no, I won’t massage there, it’s a private place, nobody is allowed to touch you there’.

And even more than all that, it feels like we’re doing something fundamental: repairing gaps in Little Bear’s development.

Although Little Bear has always been affectionate, this feels different – as though he is allowing himself to be vulnerable. It has made me think about the early months when he pushed us away at bedtime, not wanting goodnight cuddles or kisses. I remember trying to respond playfully – pretending I had lost him in the bed, patting the bedsheets to try to find him. I’d mainly pat the bed but occasionally get his feet and pretend I thought they were his head. He found this funny and over time, would ask me to play the game until we eventually, after a long time, got to the point of me patting his head or chest and eventually planting a sneaky kiss. The contrast between that – me earning his trust one baby step at a time – and him asking for a massage, feels vast.

I’m reminded that we’ve come a long way – we really have.

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A Therapeutic Week

Sensory trial and error

One of the biggest priorities at our house these days is helping Little Bear with his regulation. It has always been an issue but I think because other things have settled down, it has come more to the fore. I have been experimenting with various sensory hacks to see what works and which ones we can use routinely to improve things in our daily lives. Here are some things we have recently tried and how we have got on:

Regulation at the table

Little Bear has always struggled with sitting still. He’s fine on a sofa and can sit for quite a while but finds sitting at the kitchen table for mealtimes particularly tricky. He is better on our wooden bench than on any of the chairs but still tends to kneel up and change position a lot and get down a lot. I have been trying to engage Little Bear in his own regulation more so I recently asked him why he moves about so much. I had no idea if he’d have enough insight to be able to tell me but it seemed worth a try. He said he didn’t like being too low down. We then experimented with putting various items on the bench to make him higher and a bit more comfortable. Several were no good or too unstable but in the end we settled on a beanbag. We can tuck it through the gap in the back of the bench so it stays in place and Little Bear has given it his seal of approval.

I have to say it has been pretty miraculous in its efficacy. Little Bear is certainly able to sit still for much longer with it and doesn’t change his position half as much. Crucially Little Bear prefers it and goes looking for it if I have taken it off the bench for any reason. My feeling is that children will show us when we are getting the sensory input right for them and this hack is ticking all the boxes. I have been considering a wiggle and sit cushion for a while but I don’t think we need one, the beanbag is perfect.

Regulation when out and about

This is the biggest challenge for us and one I would really like to come up with a solution for. We generally notice Little Bear’s difficulties with regulation when we go on a day trip somewhere or go somewhere new. I guess there might be an element of anxiety underlying the behaviour and we certainly feel Interoception has an impact. We are continuing to work on that but it is not a quick fix and I don’t think we are ready to feedback about how it’s all going just yet (but I will when we’ve made more headway). In the meantime, we have been experimenting with things that help in the instant of dysregulation, while we are waiting for longer term solutions to work.

If we are having a dysregulated day out, Little Bear continually seeks movement, which can be unsafe depending where we are. Often we let him run where we can or swing or climb to his heart’s content. I realised on a recent day out though that all the movement doesn’t actually seem to help, if anything, it gets Little Bear more and more dysregulated. Therefore I hypothesised; we needed to add in more calming elements, rather than encouraging the seeking elements.

I remembered that we used to use a rucksack for that purpose so we have re-introduced it. On the first attempt it didn’t go particularly well as the straps were a bit loose and kept coming down Little Bear’s shoulders which annoyed him. The next time we tried a different bag which has a little chest clip to keep it in place. It was a mixed outcome. We could certainly tell the difference in Little Bear’s behaviour – the weighted bag did calm him and stopped the running and swinging almost completely. I would say this was a fabulous outcome apart from one crucial factor: Little Bear doesn’t like wearing it. I don’t want him to think it’s a punishment of some sort and the fact he doesn’t like it makes me think we haven’t quite got it right sensory-wise. I suppose we need to experiment with the weight of the bag; how long he wears it for etc. I know that when I was taught about weighted blankets, the rule of thumb was always to remove them after 20 minutes as otherwise the body modulates to the weight being there and the effects cease. However I have played around a bit with just letting Little Bear wear the bag for a bit then taking it off but I feel as though the effect goes with the bag and as soon as it goes, he’s back to seeking movement again.

I also wonder if there is another way to give him ongoing proprioceptive input that doesn’t involve wearing a bag? I know you can get pressure jackets but I feel as though he would be too hot. Please make suggestions if you have any as we are certainly in the market for trying something else.

Regulation at bedtime

Little Bear has one of those heavy cuddly toys that is filled with sand, I think it’s a large newt and I have been experimenting with that lying on him to help him calm at bedtime. Again I would say it works a little but then he chucks it on the floor!

In the winter if Little Bear can’t get to sleep, we have a heavy knitted blanket that he sometimes likes me to put over the duvet on top of him which works well. It is generally the sensory approaches that Little Bear is collaborative in that work the best. He will tell me when he does or doesn’t want the blanket and I assume that relates to when he does or doesn’t need it.

I have noticed recently that he has a big fluffy blanket on his bed at the moment and he likes to get all cosy inside that, especially if he hasn’t got his top on. I feel as though it would be quite an unpleasant sensation but it obviously works for him. Looking at how children self-soothe can be a key way of discovering sensory hacks that work. Little Bear still has comfort blankets in bed. They are muslin squares and it is the label that he likes – he strokes his lips with it which seems to soothe and calm him. I can’t think of anything worse and he often tests it out on me knowing full-well that it will make me squeal in discomfort. I suppose it’s a good way into talking about how everyone’s sensory needs are different!

I am now wondering whether proprioception is the best avenue for calming for Little Bear or whether the right kind of tactile stimulation would work better for him. How would we go about providing that whilst walking around a zoo or museum I wonder?

This has definitely been a post with more questions than answers (apart from beanbags, they are an answer) so I apologise for that but if anyone has any clever solutions I’d love to hear them.

Sensory trial and error