Making Sense

Risky Play

Anita Bundy, ScD, OT/L, FAOTA, FOTARA is a professor and head of the occupational therapy department at Colorado State University. She has conducted decades of experiments and research in Risky Play. Listen as Dr. Bundy shares both the benefits of risk-taking in play and the developmental costs of being risk-averse.
The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.
 
Resources Mentioned In this episode:
Anita Bundy’s bio page, publications and awards at Colorado State University: https://www.chhs.colostate.edu/bio-page/anita-bundy-1189/
Sydney Playground Project: https://www.sydneyplaygroundproject.com/
Revised Knox Preschool Play Scale: https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_604
Test of Playfulness (Bundy): https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_299
Neumann, Eva: The Elements of Play https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_604
Gregory Bateson's concept of “metacommunication”: https://www.sciencedirect.com/science/article/abs/pii/0732118X9190042K
David Ball: Playgrounds - risks, benefits and choices: https://eprints.mdx.ac.uk/4990/1/crr02426.pd
Tim Gill: The Benefits of Children's Engagement with Nature: A Systematic Literature Review: https://www.jstor.org/stable/10.7721/chilyoutenvi.24.2.0010
Ellen Beate Hansen Sandseter: https://scholar.google.com/citations?user=vxKzmO8AAAAJ&hl=en&oi=ao
The Play Outside UBC Lab, led by Dr. Mariana Brussoni: https://playoutsideubc.ca/
 
Episode transcript: 
Carrie Schmitt  I'm joined today by Dr. Anita Bundy. She's an occupational therapist, and thank you so much for being here today, I would love for you to tell us a little bit about yourself.
 
Dr. Anita Bundy  My pleasure to be here. Thank you, Carrie. I am currently the department head in occupational therapy at Colorado State University. And I've been engaged in labor you search for a long time now,
 
Carrie Schmitt  I saw that was an area of interest and research among your many distinctions and awards, and all of the important work that you've done in our field. And when I asked you one of the topics you might be interested in talking about today, you mentioned risky play. And so I was able to, you're able to share some articles with me and I was able to go and look up some of your research, I would love to hear the pathway, maybe or some of the things that you've found early in your research or curiosities about play that led you to study risky play as a research category. And you've done some really important findings on the topic.
 
Dr. Anita Bundy  Well, I started studying play as part of my doctoral work. And I was, I was interested in the notion that therapists had and I think still have, but that maybe not as strongly now that if we helped children to develop skills, those skills would automatically be transferred into their everyday life. And so I was interested in that I was interested in studying the relationship and and I chose to study the relationship between motor skills, and am I needed something functional, that children would do, and I was interested in, you know, graduating in my own lifetime, and I wanted children to be willing to participate. And so I chose play. And so honestly, play was, for me, at that point, a matter of convenience. And so I did my doctoral study. And as I, I observed, a number of children playing. And as I did, I actually became quite fascinated with, with the play part of it with watching children who had some kinds of difficulties. And I had one child in particular, who will always stay with me, and he was a child who had a lot of sensory integrative issues. And he, he was playing outdoors, and I was watching him play outdoors. And he was really terribly, terribly boring to watch out towards he, he was climbing up the slide and going down the slide. And this, this child was sort of he was more than six, he was somewhere between six and eight. But he climbed up beside me like down the slide, and I left the slide went down the slide, and he just did that for ever. And these two other children who were on the playground with him at the same time, they came over and said, Would you like to play with us? Now, of course, what they wanted, they were this was in the days when you had merry go rounds on on playgrounds, and they wanted him to push. But they didn't say that they asked him if he would like to play in. And this would have been a child who probably not very many children, asked him to play. And his response to those two boys was No, I'm busy. And he was busy going up and down the slide. So and I watched him do that for like 15 minutes, and he did nothing else. And so then I, we also watched the children indoors, and I wasn't scoring his play observation indoors, because different people scored them outdoors versus indoors. But I was there when he was playing indoors. And he was like a completely different child. He was he was near Thanksgiving. And he was directing all the other children to make a Thanksgiving dinner. So they had a shoe, which they had turned into a turkey. And he was he was just completely in charge of that whole place situation. And so so I just became very fascinated with the idea that that well, of course, did sensory integration affect his play. It absolutely did. But it didn't keep him from playing. And in fact, he was a great player in in certain circumstances, and that, of course, was not being captured the standardized assessments that we were using of his play. So that's how I got that's how I got into play research. And when I finished that, I finished my doctoral work i i started thinking I used to preschool play scale, to observe play. And I realized at some point that I did the preschool Play School scale was about the skills that children use when they play. It was not really about the play itself, which is how that child was not being captured very well by standardized assessment. And so I thought, well, I'll never do that, again, I'll find a test that really looks at play itself. But there really weren't, aren't very many of those kinds of assessments around. Most assessments really do look at the skills that children use when they play. And so I, I got engaged with several colleagues in developing the test of playfulness to look at the actual interactions that children had not so much what they did not so much the activity or the skills they use. But although the skills are a piece of it, but more about the transaction that was play itself. And so I worked on that for quite a long time. And then I went to Sydney, to work and work for the University of Sydney. And I was interested in doing research with play. And I was interested in something that that somebody would fund, because play research isn't really, I had a lot of funders list. And I gathered a group of colleagues around me who were interested in play in the way that I was interested in it. And so they were, this was a really interdisciplinary group. So we had a human geographer, pediatric exercise science person as a child psychologist. And we that was the core group that that started out. And so we sat down and thought, what would what would we like to do that would inform all of our disciplines, and would be, would actually capture play in the way that we wanted to do that. And so that we started something called the Sydney playground project, which was, which actually was using play as a medium to in the beginning to to promote children's physical activity. But we were very clear that what we what we were doing, what we were going to promote would be play itself. So it wasn't going to be remarkably just put, you know, there's many, many ways that that researchers use to promote physical activity. But we didn't want to do any of those things. We didn't want to draw lines on the playground, we didn't want to leave sporting goods equipment around, we didn't want to do any of that stuff. We wanted to actually promote play in groups of children. So we started out with a, a cluster randomized trial in regular mainstream schools. And we were funded by the government by the Australian government to do this project. And we put recycled materials on the playground. And a whole series of playgrounds. And it was really easy to get the kids to play the play the kids, you know, they love this stuff. They thought it was just great. It had it had no obvious play value. So it was things like tires. And so I don't know, pool noodles. And we had a whole we had a series of seven different criteria that had to be met for us to put these materials on the playground. And we changed them periodically, we added to them. And so you know, barrels, all kinds of different things that we just got from places and put on the playground. And it was really easy. The kids loved it. In fact, it was so popular that school, school principals started doing things like rostering children to the playground and answer them recycled materials when they were on the playground. So you had to use only first and second graders, for example, were allowed to use it on a certain day. And so that was that did kind of muck up the research a little bit because nobody bothered to tell us that they were doing that. But the children loved it. But the adults, the adults didn't love it so much. The adults were convinced that something terrible was going to happen to the children that they were going to get hurt. And so I mean, for example, we use pool noodles. We gave children pool noodles. And you can imagine that the first thing kids do when they have pool noodles is they start playing with them like their swords. And I was on the playground one day when a teacher said to me, you've taken the pool noodle. So I was like, Oh, yeah. She said yes. A child when she named the child, he came in the other day from recess and he had a graze on his nose. And I could just imagine him going home and his mother would be just livid that he had a brace on his nose and I thought Yeah, right. Others probably saying yeah, what happened to you nose, Yeah, I got hit by noodle, you know.
 
Dr. Anita Bundy  So anyway, we added to our city playground project risk reframing workshop. So we put parents and teachers in the same room and we gave them a series of activities to do they are mostly talking about things and among them you know, what did you do what could you not wait to get to when He left school as a child. And those things were almost always dangerous play risky play, if you will. They were water, they were trees, they were, they were going downhill fast on bicycles or in carts or whatever. And they almost always ended with the same sentences like we were, we would never let kids do that today. And so I started to I heard that so often that I started asking parents will Were your parents negligent? Because there were never any adults and they stood, it was always only the children. And so I started asking them, were your parents negligent? And should they have been there? Or did you learn something that you might not have learned? If you had if they had been there? And they would think about that and talk about that. And almost always, they would come back and say, you know, we've learned to take responsibility. We learned to think, can I do this? And not just Can I do this? But Can my little brother do this? Because often it was siblings playing together? And so you'd have to think, well, will he be safe doing that? And they said, you know, if a parent had been there, we wouldn't have thought about it, the parents would have said, Yes, you can do that, or no, you can't do that. And you could almost see the penny drop with, with these folks, when they start to think that it's like, oh, wow, went through our children learn to do this. When did they learn to take responsibility for their actions, so, so that, while I don't necessarily think that we, the stuff that we put on the playground was very risky, adults, that the teachers thought it was risky, and they were very afraid that parents would think it was risky, and something that happened to the child, and then they would be blamed for it. So that sort of got me intrigued with this idea of risk reframing and risky play, and what are the benefits of risky play? And how do we promote it? And there are a group of researchers around the world who are interested in this phenomenon of risky play. So I've sort of joined a relatively small group of people, although it's a growing group of people who are interested in risky play. And, you know, I would say that, that for me, it's because I'm an occupational therapist, and my colleagues are not, I'm interested in in more than risky play, I'm interested in being able to take risks in everyday life, and manageable risks in everyday life and the benefits of that, and what are the what are the problems if you don't take any risks? So I think that this issue is not just with children in play, but it's also with, with folks with disability, it's the same with old people. And, you know, at all cost, everyone seems to want to keep people safe. And and we don't seem to think very much about what are the consequences of never allowing people to step outside their comfort zone?
 
Carrie Schmitt  Thank you for sharing that progression. Because I heard so many interesting things in there that I'd love to unpack this idea of trying to measure play skill, when what we really needed to do was look more at the ingredients of play, like what characterizes play, not what does it play skill like? And that seemed to answering some of those questions seem to lead you ultimately, in kind of organically to exposing children to things that adults suddenly decided were potentially risky, which then led you to think about risk assessment. And because of your background, and because of who you are professionally, you started to have some questions around the developmental trajectory, almost of like, what happens if we don't experience some of these essential ingredients of play? That is voluntary, that is pro social, right? That's it, you know, it is played for play sake, it's intrinsically motivated. And then risky play, you could maybe pile on some ingredients, like you mentioned, inherently near risky substances like water. So I'd love to unpack that a little bit like what are some of the ingredients that you're looking for that characterize play? What are some of the ingredients that you look for that would characterize risky play? And how have you figured that those ingredients ended up being kind of essential for risk assessment and for the development of daily comfort with risks? And maybe if they don't, if those ingredients aren't available if those ingredients aren't part of the play, what are we at risk of not developing?
 
Dr. Anita Bundy  When I was doing my doctoral work, and my, my supervisor said to me, Well, of course, you will have to define play. And I sort of thought that was a kind of silly statement, because everyone knows one play is. And then I started down very seriously looking into play literature. And I realized that not an awful lot of play literature starts with the same sense. And that is no one has ever successfully defined play. And I think that is because people from all sorts of professions are interested in play. You know, biologists are interested in play, and sociologists and anthropologists and, and all sorts of people are interested in play, but I think occupational therapists have, are interested in the phenomenon of play itself. And so I started looking for good definitions of that would fit occupational therapists. And I actually borrowed a definition from a woman named Eva Newman, who wrote who wrote a book, and it was her doctoral work called The Elements of play. And she offered a really, I think, a lovely, well, I turned it into a graphic, but she offered a really nice conceptualization of play. And she said, you know, play is not, it's not in contrast with work. So first of all, we need to get that off the table that play is in contrast, with non play, and play and non play are a continuum. It's not that something is either play, or it's non play. And she said, there are three elements that contribute to play. And those things are also on continuous. So they're present to a greater or lesser extent, it's not an either or they either are or they aren't. It's a continuum. And it's, I'd started to think about it like, like a scale with weights that you could move, and you could offset. If one of those elements was not so much present, then you could offset it with one of the other elements. And she said those elements were intrinsic motivation, that's relative intrinsic motivation. I'm doing this or the player is doing it really, because they want to do it, relative to internal control. So the player feels like they have control over some control over the situation. But so who am I playing with? What am I playing something about how it's going to come out, but you can never have total control, you don't want total control, because then it becomes boring. So there has to be a little bit of a little bit of play in it, but you but you need to feel as though you're in charge. And at the very least, a player can say I'm taking my choice and going home now I don't want to play anymore. So they have to retain at least that much control. And then the third element that Newman talked about was the suspension of reality. So she said, the player had the right to decide how close to objective reality a particular play transaction would be. And of course, the best you know, the the most common examples of suspension of reality are pretend, pretend it's probably the most common one. But that but I think there are probably other ways of suspending reality. So it's, it's breaking the rules a little bit. It's so it's mischief. I think it's a kind of suspension of reality. And, you know, there are other examples as well. And so I borrowed Newman's conceptualization of play, and I added to that the work of Gregory Bateson, and he was interested in framing, he was interested in the queues. In particular, he started out being interested in the cues that even animals would give. So he was interested in medic metacognition, that a meta communication. And he was interested in whether nonhumans who who weren't speaking could actually communicate in other ways. Now, of course, you remember this quite a long time ago. And he talked about monkeys on Monkey Island, and how they would be running around chasing each other grabbing each other's tails, growling, fighting. And if you just said that made that description and said to someone, what are they doing? Probably people would say they were fighting. But the monkeys didn't think they were fighting. The people who are watching didn't think that they were fighting. So somehow, those monkeys were able to give out cues it said this is not for real. This is just pretending this is just play. And so occasionally, of course, you know, a monkey would buy too hard or and then you know you you know what happens then? And you know, the play stops, because then he doesn't play anymore. So I added that little bit to my conceptualization, of play and playfulness.
 
Carrie Schmitt  You were beginning your research at a time where lay hadn't been defined and described quite as much as that is in current literature. And maybe hadn't, we hadn't captured or defined it, as well as maybe some of the literature has now. So I love the amalgamation of like those two ideas, because it's what is play, and when does play stop to like that I can take my things and go home is control. But then if I take it too far, it's no longer playful. And there's social consequence to that. And that marries really well with this idea of risky play. Because when, when it is playful, and when we're taking risk, let's say around water, but then the risk was too great. There seems to be a message that sent to our system that helps us with future risk assessment. And that is something that we wonder if it's missing, when we don't allow risky play, and then it might have consequences that we don't fully understand. So I'd love for you to talk a little bit about that. What stops us from taking risks? And maybe it's the adults in the room? And then what, how do we benefit? We take a risk, and it goes a little too far.
 
Dr. Anita Bundy  Well, what stops us I mean, I do think for very young children, it is often adults who stopped them now some children are not stoppable, some children are going to take risks no matter what you do. But that when the children hear repeatedly, the message, you can't do that you're going to get hurt, don't do that. I think they many children, probably not all, but many children internalize that and and learn or learn is the right word, but but begin to feel that they are not capable. And so they stop trying to take risks. And so what are the consequences of that I think what those parents were saying in risky framing, that the children don't learn what their limits are, and, and they don't learn what they're capable of, or maybe what they're not capable of. And of course, children will sometimes cross the line. I mean, if you're learning where your limits are, you will sometimes crossed those limits, and you will sometimes get hurt. And we're not hoping that children have serious injuries. But if you went through life without ever having a bruise, or a scrape or a cut, you know, that just means you haven't done, you haven't done all you're capable of doing. Now, the term risky play came from the work of a woman, an early childhood educator named LMB at East San center. And she's, she's someone that I'm working with now, in my project in Norway, and we're looking at virtual reality and, and risk risky play. So I think in the long run, and this is me, this is just conjecture, really, is that, you know, we have started to see a whole group of university students, for example, who are extremely anxious they have, and I think they've been held to an unreasonable standard all their lives, you know, they have, they're always supposed to be perfect. And everything they do is right, and they never do anything wrong. And, and so I think that's, that's not a realistic standard. But then when they get to university, and they've been that way all their lives, they've always been the top of that class. And they, you know, they've been above average and everything. Well, of course, that isn't going to be maintained forever. And so they become terribly anxious. And then we see another group of children who they're not children anymore, but youth who go off to university, for example, they've never been independent, they've never had to, to determine their own routines, their own schedules, and they go off to university and they become just wild children, you know, for a Navy for only a short period of time, but because they've never been, they've never had the opportunity to test their limits and to go to a certain level of risk. They just don't know how to handle that.
 
Carrie Schmitt  I like that both of those examples give a different perspective on limitations. So in one example, there were the students who have always been top of the class top of the heap, right, and now they're finding themselves running up against their human limitations, and is making them anxious and then in the other example, the people maybe never got to two test their limits or take risks within the context of their development. And so when the, you know, supervising adults are no longer there on a daily, they decide that it's probably a good time to test their limits. And it both both examples, talk about limits and limitations. And that, inherently, the ability or being allowed to take risks in the context of play, and maybe with lesser stakes, because they're three, or five or seven, would be the ideal time to let them test limits, because when they're testing their limits, it's maybe jumping out of a tree where their arm could get broken, but they probably won't die, versus when they go to university. And they test their limits, and it's involving substances or something where their life could be more at risk. So that's a really interesting. So really interesting observation that now we're looking at the outcomes of maybe not being allowed to take those risks and seeing we need to maybe think about how we're allowing kids to play. What are some of the obstacles to that you have found? Or what are some of the common concerns you hear from caregivers? Why not? Why not let them play in a risky way?
 
Dr. Anita Bundy  Well, I think it depends on who you are. But very commonly, why not let a child play, many parents or teachers will say, I would let my own child do that. But I won't let other children do it. I don't know what they're capable of, I don't want if someone's at my house, and I'm watching them, and they get hurt, I will, I'm afraid that I will be blamed. And teachers, similarly would say, if a child on my watch gets hurt in some way out, I could lose my job, which course is not realistic, and it's probably not going to happen. And we're not talking about head injuries, we're talking about, you know, very minor injuries. But so I think that's one thing that that keeps people keeps adults from allowing children to, to engage in risky play that the fear that they will, they will be thought to be a bad parent or a bad teacher or, or not good enough to supervise someone else's children. I think that's probably the biggest reason why adults don't now don't let children take risks and get involved in risky play. And of course, I mean, the over if you ask people why they don't let them by they don't let their children do particular kinds of risky play. The most common thing, the most common fear is that children will be abducted. And that's almost universal, that there's a fear that if I let my child go out and play out of my sight or out of an adult, a supervising adults site, then they could be abducted.
 
Carrie Schmitt  Yeah, as as an ingredient for rescue play, or part of the definition of rescue play is that there's not adults present, right. So allowing your child to go out and explore in groups by themselves. I, as a parent that resonates with me, I grew up in the late 70s and early 80s, when, you know, there was a lot of talk about abduction. And I also have four children of my own, and three of the four children had what I would call very little self preservation. As toddlers, they love risk, and they loved risky play. And when you said that, about knowing their capabilities that rang true to me, because I knew that they could land it if they jumped off something so high. But my friends would panic, because I would let them do that. But one of my children in particular, I would tell like a babysitter, for example, you know, if you think he might, he will, like there is not going to be a stop. So don't like if you know, if he's standing on the top of an 18 foot tower, he will jump he just would he didn't really have that, you know, self preservation kind of button. And so my sisters and I both share that, that a lot of our children take really big risks, but I knew their capabilities. Like I knew a lot of times he could jump from six or seven feet and landed and I'd say don't jump, you'll get hurt. And he would jump and say see, I didn't get hurt. And he was testing his limits. Like I'm i He knew confidently he could jump six feet and land it and it was me being worried and landed. So all Have that really resonated with me both as a parent and as you know, someone who grew up at a time when media exposure to the terrible things that happen, really made, made our generation maybe a little too insistent on supervision and, you know, really shortened, you know, our tolerance of allowing them to be unsupervised and explore.
 
Dr. Anita Bundy  Yeah. You know, I think children are remarkably good at knowing their limits. You know, I've watched so many children and playgrounds in other places now. And for the most part, I mean, an occasional there's occasionally a child will go past where, you know, they, they shouldn't have done that. But for the most part, they are remarkably good at knowing their limits. And you know, we did the city playground project for more than a decade. And in that time, we had one accident that required some kind of care. It was a child, it was actually a child with autism. And he stacked no crates on top of each other, and I don't know, like, four of them and got up on top and fell off and broke his arm. And he, he, they had the school, of course, had to call his mother. And the child when he got up off the ground said, I knew I shouldn't do that. And when they called his mother, she said he did no, he shouldn't do that. He did something like that once before he broke the other arm. So so but for the most part, I mean, in more than a decade, and countless children and countless schools. That was the only accident that we had, and it wasn't I mean, even then the parents, they weren't distressed and the child was in distress, like, Oops, I shouldn't have done that. And yes, he has a broken arm. But as you said, he's not going to die from a broken arm. So.
 
Carrie Schmitt  I'm interested about that child, you mentioned that he had a diagnosis of autism. Have you looked at any research for children with neurodevelopmental or motor developmental differences and limitations around play?
 
Dr. Anita Bundy  What half of the Sydney playground project was done with children with autism? And they were it was a programs that were substantially separate or and one of the schools was, it was a mainstream school, but it had a substantially separate program for children who had mostly autism, and could be autism and intellectual disability. And, yeah, I mean, I think I mean, I just even think back on my own practice, and I remember, you know, being really afraid that a child would, something bad would happen to them. I remember thinking, I have no, I'm sure we wouldn't be doing this today. But I remember taking a child to a fair that we had, we had like three or four of the kids were there. And this little boy had Athetoid cerebral palsy, and he wanted it the worst way to ride by himself in one of the sort of cars that goes on a track. And I was really scared to death, the left. And the guy who was running the car said, just let him do it. I mean, if something happens, we can always stop these covers. And by the time he was done, he was he had fallen all the way down inside of the character, he couldn't see a thing. But he did it all himself. And he was so excited that he had done that himself. And I mean, I think that's, it's really important. I just can't imagine being someone who, for all of your life are never allowed to do anything. That's even mildly risky, because you could get hurt. And that message that I'm not capable of doing anything is such a strong and horrible message to give to children and the children and send me a playground project, we found that one of the one of the programs that we were involved with was a program that really they talked about recess as being play lessons. And they if a child was on the playground for more than like, two minutes without engaging a play, then an adult would go and engage the child in play. And our students started coming back and saying, you know, we don't think that those kids know their other kids on the playground. They wait for an adult to come up and engage them in doing something. And that was in contrast with the program with children where it was a mainstream school, and the children were just expected To do a lot, and they did, they, and they benefited a lot from the playground project, much more than the children in the in the school where they did play lessons. And you know, they were really proud of the fact that they were promoting play. And when you think about it, you know, at first blush, promoting play should have been a desirable thing. And parents really wanted their child to go to this school, but actually turned out that they weren't really promoting play, they were promoting dependence, adults.
 
Carrie Schmitt  Interesting, the, which you mentioned about the roller coaster. And you know, the child has cerebral palsy, the joy attained through independence and autonomy. And then the, the example on the playground of play lessons, where we teach them just wait two minutes, and an adult will engage you. Right. So it's like a dependence on adults, again. And so I wonder about that, again, as an ingredient for play and for risky play, is autonomy is body agency, and, you know, maybe allowing them to stand there for a little while until they can figure out how to move their body for play. So interesting. I love this topic. If people are interested in this topic, I've captured some of the names that you mentioned, so that they could maybe look up some of the the authors that you referenced, and I'll definitely include them in the show notes. But is there any voice that you really like in this space, or any particular research that you think is interesting that they could look up?
 
Dr. Anita Bundy  There's a lot of Sydney playground project, research that's been published, I think all of the work that lnbf a Zen Center has done is really fascinating work. You know, in Norway, there are an awful lot of outdoor preschools. And her a lot of her work has been done in those outdoor preschools, Mariana Gressoney, who's choosing entry, she began as an injury prevention person at the University of British Columbia, her work is really, really interesting. There's folks in the UK who've done quite a lot of looking at risk benefit analyses. So David ball, if you just Google risky play, you'll get a relatively small group, Tim Gill is the name I was trying to think of Team gills, a person from the UK who's done a lot of work in risky play. So there's, you know, there's sort of a kind of a core group of people that you'll find if you just Google was kidnapped?
 
Carrie Schmitt  Yes, thank you. And of course, that's in addition to looking you up on the Colorado State University website, because I, you're obviously very well versed in this a little published. And if anybody's interested in seeing your work, all your publications are listed there as well. I always like to end our conversations, asking a question and that question is, at Star, we place a really high value on curiosity, and recognize that over time, things change and things evolve. And the science leads us to unexpected places. So we have to be humble, and our willingness to follow the science and it often requires us to change our minds about something. So I'm just curious about maybe something that you once believe that you've changed your mind about?
 
Dr. Anita Bundy  Well, I think play in general, is something that I changed my mind about. You know, I probably started out like, many, many people of my generation, and even since me, thinking that play was what you do when you're done with everything else. No, it's sort of a spare time and whoever has any of that. So it's no, it's not a very important thing. And I have come to see that it is it's a hugely important thing. And I've also changed my beliefs, and I think I alluded to this earlier is that I've changed my beliefs about what is our role as a professional, and as an occupational therapist, trying to help people to lead the life they want to lead. And I think that I have changed my beliefs about that a lot. It's not my life, it's someone else's life. And they have a right to take risks and in fact, pretty much their entire life will be a risk. So if you don't, if you don't embrace risk, you're not going to do very much and what a sad way to live your life. It's our I believe it is our responsibility to help people prepare to take risk and and I'm not no I'm not thinking that, that somebody, a parent's going to open the door and say bye See ya. You know, I think you do help children to prepare to take risks. And that's really important. And I think as OTS Our job is to help people prepare to take risks.
 
Carrie Schmitt  Yeah, thank you. That's a really important message and a call to action, maybe for other occupational therapists to think about the ways that we help our clients prepare for risk and maybe teach parents if you're in the pediatric space, how they themselves could work on their tolerance for risk or how they themselves can prepare their children through modeling and modeling what we might do or even just helping them and parent education.
 
Dr. Anita Bundy  If you take play seriously, it will cause you a lot of problem as the therapist, the more seriously you take it, the more the more it will cause you a problem. And it's a problem worth embracing.
 
Carrie Schmitt  I love that. It's a problem worth embracing. That's great. Thank you so much, not just for being here today, but for the important work that you've done in your career. I'm sure have enjoyed looking at your work and and I haven't learned a tremendous amount. So thank you for for modeling, what it looks like to follow a curiosity and to contribute to the body of work around it and a really purposeful, meaningful way. So I really appreciate it.
 
Dr. Anita Bundy  You're very welcome. Thank you for showcasing this work.
Calls-to-action:
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A Family Nurse Practitioner and mom shares her personal and professional encounters with ADHD and SPD

Family Nurse Practitioner and Parent, Holly Healy offers both personal and professional insights into sensory differences. She recognizes the way that traits of ADHD and SPD present similarly and offers insight into her process as a parent of a child with sensory differences and her work as a diagnostician.
The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.
 
Resources Mentioned In this episode:
Ahn R. R., Miller L. J., Milberger S., McIntosh D. N. Prevalence of parents' perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy. 2004;58(3):287–293. doi: 10.5014/ajot.58.3.287
Chang, Y.-S., Gratiot, M., Owen, J. P., Brandes-Aitken, A., Desai, S. S., Hill, S. S., Arnett, A. B., Harris, J., Marco, E. J., & Mukherjee, P. (2016). White matter microstructure is associated with auditory and tactile processing in children with and without sensory processing disorder. Frontiers in Neuroanatomy, 9. https://doi.org/10.3389/fnana.2015.00169
Ghanizadeh A. Sensory processing problems in children with ADHD, a systematic review. Psychiatry Investig. 2011 Jun;8(2):89-94. doi: 10.4306/pi.2011.8.2.89
Kranowitz, C. S., Wylie, T. J., & Turnquist, T. H. (2006). The out-of-sync child has fun: Activities for kids with sensory processing disorder. Perigee Book.
Miller, L. J., Fuller, D. A., & Roetenberg, J. (2014). Sensational kids: Hope and help for children with sensory processing disorder (SPD). Penguin Group.
National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scales for Diagnosing ADHD: https://www.nichq.org/sites/default/files/resource-file/NICHQ-Vanderbilt-Asses sment-Scales.pdf
School-Based Intensive Education: https://sensoryhealth.org/basic/school-based-intensive-star-for-school
STAR article: Is It Sensory Processing Disorder or ADHD?: https://sensoryhealth.org/node/1114
Unyte formerly Integrated Listening Systems (iLs): https://integratedlistening.com/
Wood, J. K. (2020). Sensory processing disorder: Implications for primary care nurse practitioners. The Journal for Nurse Practitioners, 16(7), 514–516. https://doi.org/10.1016/j.nurpra.2020.03.022
 
Episode transcript: Transcript of the episode’s audio
Carrie Schmitt  I'm happy to be joined today by one of STAR's Board Members, Holly Healy. Holly, thank you for being here. I was wondering if you would introduce yourself.
 
Holly Healy  Sure. Thanks for having me. My name is Holly Healy and I have been a board member for two years now. I'm also a family nurse practitioner, and I practice in pediatrics for the past 17 years.
 
Carrie Schmitt  So I'm really excited to have this conversation because I think you could really help other family nurse practitioners, pediatricians, who also are on the frontlines of encountering people who are coming with concerning behaviors or some school reports that they can't make sense of. So tell me a little bit about how you got connected with the STAR Institute?
 
Holly Healy  Sure, I'd love to. So when my oldest who is now 11, was around four or five, we started to notice some behavioral differences with her and a lot of dysregulation, so it manifested in behavioral outbursts, and just really difficulty with sleep. And so we went to a counselor to try to figure it out, because we kept saying, well, she's anxious, she's anxious. So the counselor handed me, Lucy Jane Miller's book, and my husband and I read it together. And it was like a revelation. And we thought, this is her. This is this exactly explains, you know, what is going on. And so I read as much information as I could, and we got her into OT, we started changing things at home. And we didn't see a lot of progress at first. And so reading the book, I realized in going on the website, I realized, oh, there are trained OTs, by star, that have gone through a mentorship program. So when we finally kept hitting several walls, you know, with our OT treatment, I drove her four miles to the closest OT, who had been mentored by Starr and took her to Asheville, North Carolina, and we met with this amazing therapist, and the first thing she told me was, you know, we see things differently, we have a different lens in which we see children. With sensory processing disorder, she took two hours, and it changed our lives. And so from there, we launched into implementing a sensory diet every day, we got her into chiropractor, we got her into vision therapy, and then we also got her into horseback riding. So we learned that this wasn't just a once a week, go to OT, you know, and it was more this is, you know, this is part of like your life, this is how you need to change things daily. And, you know, it wasn't drastic, it was just small changes, and how we would view how does she need to start her day off, you know, it may not be what normal kids do to start their days. And so I also got myself certified with at the time it was called integrated listening systems, they've changed now to unite. So I got myself certified, and we put her through the focus program that I did, and got her started on the dream pads. So we just really implemented everything because we were honestly desperate to get her to a happy place. And, but also, I just, I'm a big fan of just learning information. And with her OT, I could never go back into the room. I didn't know what, what they were doing and how he could help her. So with with that particular visit, I stayed with them the whole time with this therapist that was trained by Starr and I was like, Oh, my goodness, this is fascinating, because I had so many questions that I could never really get answered, because the traditional treatment is I'm going to take your child back for an hour, I'll be back. And I'll give you two minutes to let you know what we did. And then I'll see you next week. So it was it was transforming. And so I then implemented it more into my practice. And I started to see children differently, that we're coming in with struggles, and I started to just completely change my perspective on how to help parents, from my own personal experience, and then just educating myself. So that's why I wanted to be a board member to just so I could help. From my perspective as a parent and a professional, help the you know, the organization, get get the word out, you know, how can we make this? How can we make everybody more aware of how to how to integrate it.
 
Carrie Schmitt  Thank you for sharing that a couple of things jumped out at me. One is, I'm thinking it's Dr. Miller's book, sensational kids. Yes. Okay. Yeah. So we'll put all of this in our show notes. So if you're listening and you're interested in reading This book, sensational kids hope and help for children with sensory processing disorder, you know, that has been transformative for people who are otherwise unaware of sensory processing differences, to read that book and know that this is its own diagnostic category, right, it's not listed in the DSM. Right now the Diagnostic and Statistical Manual, it we have had efforts to get sensory processing differences or disorder, you know, classified as such, yet the science is telling us it truly exists. And one of the other things that you pointed out was that in that book, Dr. Miller shares, the development of the Star model. Model is a different approach to occupational therapy intervention for children with sensory processing differences. And one of the key features of our model is that it is fully relational, and that all of our intervention includes one or both parents in every session. And then every fifth or sixth session is parents only. So it's parent education focused, we're in, we recognize that you're the expert in your child, and we have a sensory lens, and we could guide you to adapt your lifestyle, to the new understanding of who your child is through that sensory lens. And it sounds like that's exactly what happened for you, this occupational therapist said, I'm going to put this sensory lens on, tell you what I see about your daughter. And then here are some lifestyle changes that would support improved regulation in her system. And then you as the expert went out and resourced all of those things, and implemented them with the support of a sensory trained occupational therapist. So I loved that. That's
 
Holly Healy  Yeah, and she gave us you know, some exercises to get started. And then I thought, I used this out of sync child has fun it was it has a bunch of activities in it. So what I did, and this might help parents, you know, it has some great information, I think I got the flashcards to one of the symposiums. But every every morning, I would wake up early, and I would just piece together, okay, this is what I'm going to do today. Because my daughter is a, she's a heavy into the heavy work, she was, you know, her ot really say, give her the heavy work. So I'd put together, you know, some things that would give me about 15 minutes every day of, you know, of activities for her to do says she could start her day off, right. So it's really just, you know, for parents, it's just taking the time to sit down, put together some activities, which I find fun, because I'm active too. And then just making sure each morning that your your child starts off, like getting their system regulated, it's like adults that need to take a run every morning, you know, before they can, you know, function. So it's, um, it was really great to realize this is a daily thing, not just once a week.
 
Carrie Schmitt  Yeah, right. And to recognize that as children, oftentimes, we don't have the agency or even the knowledge to know her body needs. And as adults we do. And so we all have sensory processing differences. And we all have designed our lifestyles to support them. So I always to parents, like you might wake up with music or your spouse wakes up with a blaring alarm, right. And those sensory differences, because you figured out, this one is more supportive of your regulation to wake up, you may shower at night, somebody else might shower in the morning, like you're doing some people wake up, hit the ground and go for a run, because that's what regulates their nervous system, and they find that supports them to have high levels of performance after at work, or at school, or whatever it is. And so we design our lives in a way that supports our sensory system. And so to then turn and apply that to your daughter recognizing, oh, the heavy work activities, which are push pull, climb, you know, closed chain exercises, like wall squats, or playing like those can be super supportive of regulating our nervous systems. And so you designed for that, to increase her performance and then sent her off to school probably.
 
Holly Healy  Yeah, yeah, you're exactly right. And it's great now that she's 11 We started this at five. So now she'll say, like, the other night, she just wasn't doing well. And so she said, Can I have my weighted blanket? And can we play my music? And I thought, this is fantastic because it took six years, you know, but with that is so much brain growth of that awareness. Like I know now what I need, you know, so are progressive relaxation. I'll do some time she loves it. So she'll say can you do that? It's, you know, to a five or six year old, they're not gonna really have that awareness to know what they need. So they're going to either act out or regress. But you know, some someone like her at her age, they get to this, like, more awareness of like, I'm feeling this way, therefore, I can do this, you know. So
 
Carrie Schmitt  I love that. Advocacy, right, like a beautiful development of self advocacy. I had a teen client one time, and I said, what, you know, what brings you to a star. And she said, something has always been different about my system. She was exceptionally bright, at really high performing school and found knowledge to be really informed, like really helpful to her like, not just from a regulatory standpoint, but it was something that she actively sought out. So she went to the library, and started researching about her own system, found Dr. Miller's book on sensational kids. Wow, read it, took it home to her parents and said, Take me here. Ah, that is fantastic. And other self advocacy story, right? Like, you know, she was able to recognize in herself the differences, and then ask for, you know, a sensory based intervention. Tell me a little bit about this remote, a family nurse practitioner standpoint, what are you seeing in your practice, in terms of awareness around sensory processing differences, or some diagnoses that seem to overlap? Or maybe are missed diagnoses that are good with sensory processing differences?
 
Holly Healy  Yeah, I'd love to speak to that. So. And you're right, what we typically put in as a diagnosis is I think it's sensory processing difficulties, what it ends up, you know, so you're right, it's very hard sometimes. Because when I see that on a patient's chart, it's just makes me wonder, you know, kind of what we're what we're dealing with, because oftentimes, they'll see other diagnoses at the same time, like behavioral concerns or difficulty sleeping. So what has been most alarming to me over the past few years is that I feel the overdiagnosis of ad ADHD. And it's really been hard because in every provider will will definitely understand this, you get 10 minutes to see a patient. And within that 10 minutes, you can hear bits and pieces of what's going on. But you don't really get the whole picture. And so we have, of course, these very reputable and valid scales that we use for diagnosis, but I was doing some research and looking back through the Vanderbilt scale, which is what we use for ADHD diagnoses. And you know, so many of the questions that are asked have everything to do with sensory and are oftentimes I grab Alyssa J. Miller's book, and I'm reading what are some symptoms that we see with SPD? And then they literally coincide with so much of these questions on the Vanderbilt and as a provider, you love your you love your scales, you know, you love to say, Oh, wonderful, she scored this this she has ADHD with some type of inattentiveness, you know, so we're gonna go ahead, we're going to treat with this, rather than saying, Oh, I noticed you answered a lot of these questions that had to do with behavior, can we? You know, can we talk more about that? Like, is there to notice a trend? Is it always in the mornings? Is it? You know, do you notice that it happens after they've been going to their gymnastics class for an hour. So it really, it's really been difficult for me to see how often kids are now just placed in this silo of this is your disorder. This is your treatment, let's start you on medicine. And I've taken an approach where I won't prescribe, I actually send them to an occupational therapist, and they actually see them back several times before we even go down that avenue. And I had a wonderful fourth grader who she was struggling in one of her classes, and the teacher had, you know, reached out and said, I think she has attention problems. And the mom was really open to me just seen her for a while first before going down that avenue of medication. And I think it was our sixth visit. We did a lot of work together. She come in, I was able to get 20 minutes with her. And I said, you know, about the fifth visit. I told them I'd really love for her to get evaluated for her vision, her developmental vision, not can she see she 2020 And they came back the next week and they said, oh my goodness, like she's having a really hard time with how she's, how her eyes are tracking and we're going to start therapy and the teacher made a couple modifications and everything was drastically improved. And it just took it took time it just and I know it's hard for provider's, because time is just so hard right now with the way our healthcare is set up. But if you just take the time to look at the big picture of the child, you can see that it's not we just look so much at the behavior, not what's behind it, and, and how we can really, you know, help them. And so it's, it's something I struggle with. Because I do see it so often it's, it's, what are the symptoms, here's my diagnosis, and here's my treatment, it's all like A, B, and C, but these kids kids are not, they're not black and white, the key you can't go A, B and C with kids, you have to really, really look at what is going on. And I always observe, tell me what your days like, how are the parents reacting? Are they regulated, that makes a big difference. So I kind of look at the whole holistic picture of what's going on how much activity they get, what calms them, what makes them, you know, overstimulated, so that I can really try my best to help the parents understand that it may not be just just this diagnosis that we, you know, have you fill out in the pit and teachers fill out and you know, we give it a number and we go with it. It's it's so much more than that. So I've tried really hard to educate parents, they send them to the Star website, I send them on to the books. And then I also talk a lot about what are some things they can change in their home? Like, what can they buy? I have sensory swings in my house, we have a whole room set up with a trampoline and balls and balance boards, and, you know, what are some small things they can do every day? To help to help their child to?
 
Carrie Schmitt  Yeah, I love that you brought up a couple of things. One is diagnosis. And then one is intervention based. In terms of diagnosis, you know, as you mentioned, there's a lot of challenges with practitioners having the time. You know, there's an article that will we'll put in the the notes as well, um, that an occupational therapist actually wrote for nurse practitioners. The author is Jessica wood, and it was published in the journal for nurse practitioners. And it was educating yourself about sensory processing differences in order to help families differentiate. Because we know that there's some studies say up to 11% of children, ages four to 17 have ADHD. And then we have a prevalence study for sensory processing difficulties, which would suggest that five to 16% of children in the general population without any other diagnoses have sensory processing difficulties. And so if we visualize a Venn diagram, there's definitely overlap. And potentially, you. If you do have a diagnosis of ADHD, you do have a likelihood of having some sensory processing features of that right. And so about 40% of children with ADHD also have SPD. But it's really important for practitioners and for parents alike to recognize that while there is overlap in that Venn diagram, ADHD and SPD in brain studies are differentiated, they are different. They are their own differences and disorders. And so one has a neuro ADHD has a neurotransmitter basis. And so a lot of times kids do react well, if they have truly have ADHD to medication, because it is changing the way their brain neurotransmitters function. But if they have, you know, sensory processing difficulties or disorders, we the brain studies are showing that there's actually a difference in their white matter. And so electrical impulses are not reaching the portion of their brain that is responsible for sensory integration. And then there is the overlap, right. And so to take the time to tease it apart to say, you know, maybe this is ADHD with a sensory processing feature, or maybe this is sensory processing difficulties on its own. And they actually do have in our society, a different treatment approach to each. And so I understand that when sometimes people just want the diagnosis, right, like, yeah, it feels like the easy thing to matter to processing differences are not as easy to measure. We leave the office with a diagnosis and a plan and that for some people feels easier than it does to take the lowest level approach. Let's tease it apart. RT, we have some information that they might be struggling with some of the, you know, some of the things we captured on the Vanderbilt assessment scales, maybe these could also very likely be contributed to sensory processing differences. So what maybe what scale? Could we add for sensory processing awareness? Could you visit an occupational therapist? Who's trying to do processing? To your point? Could you try the approaches, which are all natural, used in sensory processing intervention, which are the sensory based bottom up approaches? And if you find that those are helpful, that might be giving us more information to look more closely at the sensory processing features that you're describing? Because if they're effective, it is likely that there's a sensory processing component to, to this complex behavior, whatever it is.
 
Holly Healy  Yeah, yeah, I totally agree. And that's where the OT Can, can be so helpful with that bottom up approach, because that's how they would approach this, you know, and really help the parents understand that some of that top down approach just isn't always the answer. And we need to help these kids understand that they are still loved, no matter what their behavior is, we have to our job as providers, parents, practitioners, to let them know that they're not different, they're not. There's nothing wrong with them. And I think, you know, to your point, that overlap of other sensory processing add is, is really evident. So I love that you said that, and I and I also see such an overlap with self esteem, and this diagnosis of ADHD. And you know, with that, then comes, perhaps an increased prevalence of depression among some of these kids, because then they realize, I have a label, I have a diagnosis and different and, you know, my youngest was diagnosed with it, and kindergarten, and the teacher sat her by herself, and just literally thought this is this is the way we're going to handle it, we're going to sit her by herself, and then we're going to put her on a wiggle seat, and then she's going to get her work done. And it was horrifying, to see how it affected her self esteem. And all she wanted to do was sit with her friends, and to a six year old, you know, how does that How did she interpret being Senate, you know, being told she has to sit by herself. So it I found a new school where she was in she is currently accepted for, for who she is. And if she has to get up and move around, it's, it's welcomed, and she doesn't sit by herself. She sits with her friends, and she's allowed to be more tactile, which is how she learns. And she's doing amazing. So it's more, you know, let's meet them where they are to help them succeed, no matter how diverse they are, you know.
 
Carrie Schmitt  Yes, you know, and teachers again, or another person who might be on the front line of this right, recognizing some behaviors. And so we have a passionate STAR about educating with a school based approach, right, or school based focus. Because again, like if teachers are given the sensory lens, they may look at the behavior and be like, Oh, this is interesting, while they are trying to manage 25 and 30 kids and they do need, you know, classroom management approaches. A lot of times the bottom up approach, the sensory based interventions can be used for multiple students at a time and increased regulation across the classroom, not just for the child that might need it. And I find that the children who need it, oftentimes self select into alternative seating options that are tied to the likes of their chair, the, you know, headphones, or your plugs for sensory over responsivity being mindful of where they're sitting, so that they feel safe in their environment. And so all of that is you were educated enough to advocate for your child. And so, you know, that's, that's a wonderful gift. But hopefully some of this conversation would help somebody sitting at home listening, whether they're apparent whether a teacher, whether they're a practitioner, to say, oh, what could we try, like what approaches could increase success and decrease the likelihood of impact on the mental health, self esteem, right child? I actually had a dad one day I was sitting across from him. And we know that there are hereditary components to both of these diagnoses, ADHD and sensory processing difficulties or disorders. And whether that's you know, it could also be Korean hairy needle right as well, there are some studies around that. But he said, Oh, that's what's going on. This is how I was when I was little, like he made that connection. Oh, now I'm making the connection between what you're telling me and how I was as a little. And my teacher put me in a cardboard box. Oh, my goodness. So this is, you know, he's probably in his 40s. But they realized his attention differences. And their solution was to place an entire refrigerator box over his desk today. And I just, I got tears in my eyes, I just thought talk about feeling othered Yes, context of the classroom, like what would happen to your self esteem if your teacher put you in a cardboard box every day. And, you know, I mean, the teacher was, you know, asked to manage a classroom of multiple kids and thought that it would be helpful, right, you know, really help them. And there was something about it that allowed him to focus, but it wasn't the approach that would support you know, I don't know, healthy social mood. Yes. But you know, all that to say like, there are approaches that support a healthy reception of attention and sensory differences within the classroom, that support integration, that support the children to develop healthy self esteem in the context of their education, which they spend an enormous amount of time at school. So how important for them to function well, and to feel good about their contributions.
 
Holly Healy  And I love I love I love that story, in a sense, because he was literally placed in a cardboard box, but figure that figuratively, he was placed in a cardboard box. And a lot of these kids are just don't have silos the right word, but they're just placed separately, and it's just not the way we should be approaching it. And as accepting as we are now as our society is becoming more accepting of diversity, and embracing people for their gender, their, you know, their pronouns, I feel like this is another example of how we need to move towards embracing the diversity of, of people's sensory needs to and so I've changed my language, even at home. And even when I talk to patients and parents, I'll say, You don't tell my kids, you know, I'm feeling not feeling centered. And I use that word a lot, because I know it's kind of a yoga phrase, it's a practice, but, you know, I'll say, I'm gonna go just onto my yoga mat for 10 minutes, and I'll be back so that I can feel more present. So I've changed my, my verbiage and my vocabulary around my kids. So they know. They understand that that's important. And so I've found my youngest, who's almost seven, she'll give her one of her yoga mats, and she'll, she'll disappear sometimes if she's getting upset over something, and I'll find her up there doing yoga, because she's learned like, Okay, I'm gonna go, like, calm myself down. And that's accepted. That's okay. So I'm hoping that with, with all this transformation of acceptance of diversity in our world, that we can see a sensory place in that too, because I think it's just so you know, so important. No, no more cardboard boxes, you know, should be allowed, it should definitely be, you know, John's a little bit he's getting out of his seat sounds like he needs to maybe go do some a couple jumping jacks, I love using crab and down dog, you know, for kids, like, I think he just needs to do a couple things and then come back. So it's just, you know, that awareness of that diversity, too, I think is so important for teachers to see.
 
Carrie Schmitt  I could see that yoga poses in particular, would be something that would be really helpful to recenter and reregulate children who might, you know, to your point either need a little bit more movement, or might need some proprioceptive activation at their joints. And so you have a specialty also in yoga, and you utilize that specialty at the preschool level. So tell me a little bit about that.
 
Holly Healy  Yeah, so I've practice for 25 years myself, and that's, that's my regulation personally. So I practice every day. And I know I'm, I know I love certain poses, personally, that help regulate me. So I teach at a wonderful preschool where the director is very well well versed in, in sensory processing. And so I think that if I if she wanted, I'd be there every day, but I do go in and I teach two year olds up until pre K, transitional kindergarten yoga classes and I, I always do sensory components into my class that they love. And so there's some sort of texture that I bring in. So it might be like for my class on Monday, I cut my daughter's two, two up into these squares because there's a really beautiful texture. And so I'll I'll drape it over the kids kind of fan them with it. So I bring in that we do the movement, a lot of down dog because kids love being upside down. It's wonderful. And I let them be free to move their body and figure out what they need. Because kids need different things. And, and I always close with them in what's called shavasana, which is the, the pose that you it's a resting pose at the end of class, and I do a spray, I have a beautiful room spray that's lemon flavored, and they love it, they say, oh, did you bring the spray. And so they have this, they end with this beautiful sent, and I take their legs and I I kind of rock them side to side because I know that movement is also good. So I'm getting that kind of input for them of movement. And then I kind of rest their feet at a I basically flex them out and then push them a little bit into the ground. So they get that grounding, feeling at the end too. So I integrate it. And I had this wonderful three year old I think who I was just teaching the class and she was doing great. And she was, you know, I could tell she was she would separate herself from the class, she kind of sat aside. But she participated the whole class and I didn't think anything of it, she she loved it. So at the end of class, the teachers came up to me, and they were in tears. They said she'd never participates in anything. In the classroom. She's really anxious. She's very cautious. She doesn't like the loud noises and all the you know, some of the activities that involve a lot of things, she has a difficult time participating. But in this class, she was amazing. So they, they were so excited because they could go home and tell the mom, hey, listen, you know, you know, your daughter did wonderful in yoga, here's things that she really loved. And they were so excited because I think they were trying to help her. They didn't know what approach to take. So I told them, I said, well integrate some movement when you start your class. And instead of coming in sitting down and doing something, maybe move first and, you know, kind of go from there. So it was really, it was really great to see.
 
Carrie Schmitt  I love that story. I you know, in this conversation, we've talked a lot about intervention approaches and how they differ based on diagnoses. And so we've also talked about, you know, neurodiversity, in terms of everybody's brain is different. Like we have biodiversity, we have neurodiversity, and we affirm that and respect that. And we're hoping to see that spread widely. That there's an acceptance that every brain is beautiful, right? That we come as we are. And so all that to say, you know, ADHD is a real neurotransmitter difference in the brain. And we honor that, and the intervention approaches we have so far, our medication, and then some behavior management techniques, and then sensory processing differences or difficulties disorder is itself also a real thing. Differences in the brain, show us that their brain imaging and the treatment approach for that is the bottom up, approach, the sensory based approach, and what yoga is, is both. And so if you're listening, and you do have a, you know, diagnosis of either or have an overlap, the yogic approach integrates bottom up and by bottom up, I'm being that body sensation and movements are the entry point. And the end result is self regulation, hopefully, to better performance and in whatever you want to achieve. And by top down, we mean that it's cognitively accordingly originated, right. So we use, mediated, I guess might be a good word. And we use cognition to focus our attention oftentimes, and it results in meaning making an understanding and yoga is both right we have the movement of our body and our putting our body in different positions. And then queuing to use our cognition to attend to, to our bodies and and make meaning of it and the result is self regulation. So yeah, I love that as kind of, maybe the wrap up of our conversation today because it marries who you are as a practitioner, and then your passion for differentiating and recognizing through a sensory lens that we can and serve the people that come to us with some challenges by taking the low slow approach by teasing apart, what's behind and underneath the behavior that's on the outside, and that that approach that you practice meets everybody where they are an honors or diversity. Yes, that is perfectly perfectly but I couldn't, could not agree more. That's wonderful. Well, to wrap up, I always ask the same question. So we have a really high value on Curiosity here at Star, we recognize that our thinking needs to evolve as the science evolves. And to do that we try to stay humble and follow the science to find out what we're learning. To do that, sometimes we have to change our minds about something. So I was wondering if you could think of an example of something maybe you once believed, that your thinking has evolved in or that you've changed your mind about?
 
Holly Healy  That is such a wonderful question. And I, I mean, I think I could speak all day about this, I think, you know, as a parent, when your child has any sort of diagnosis, you feel, there's just one road to take, you know, so for example, my child has an ear infection, we're gonna get treatment, and we'll be better. But it's really not a one road approach or children are not. They're still multi dimensional. And I think what I have learned is, it is so important to look at them from all aspects and take that bottom up approach and not just focus on the behavior. And it's so easy for providers and parents to focus on the behavior without saying why. And so I've learned the importance of why and the importance of looking at the child, my own children and other children I treat and the children in my yoga classes as more of a holistic sensory lens and how we can approach them through different avenues through different roads. Don't just take one road, take many, many roads. And I can't urge parents enough to really, you know, tap into your own sensory self, and I think it will help them so much to understand their children as well, too. I love that. Thank you.
 
Carrie Schmitt  Thank you for the work that you do. Thank you for serving on our board. Absolutely. Thank you for the work that you do as a family practitioner, and for being such a beautiful advocate for sensory health and wellness in the clients and patients that you serve. So and your own family. Family you We really appreciate it.
 
Holly Healy  Thank you. Thank you so much for having me.
 
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Reaching for Sustainable Behavioral Shifts: A Look Inside the Applied Educational Neuroscience Framework

Join Dr. Lori Desautels to explore how trauma and adversity impact the developing brain and body and show up in the challenging behaviors we sometimes see. Learn about mitigating the effects of trauma in our schools and communities while building resiliency and a secure sense of belonging through a relational approach to discipline. Discover practices that meet our children, youth, and adults in their brain and body states and cultivate their social, emotional, and cognitive well-being.
The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.Resources Mentioned In this episode:
Lori Desautels, Ph.D. resources: https://revelationsineducation.com/resources/?v=4096ee8eef7d
Deb Dana, LCSW: https://www.rhythmofregulation.com/about
Dr. Bruce Perry: https://www.bdperry.com/
Dr. Albert Wong: https://www.dralbertwong.com/
Dr. Stephen Porges: https://www.stephenporges.com/
Polyvagal graph from Dr Lori Desautels and Deb Dana, LCSW: https://twitter.com/desautels_phd/status/1391564089479114752?lang=en
Angela Davis quote: https://gustavus.edu/gwss/events/angeladavisflier.pdf
 
Episode transcript: Carrie Schmitt I'm joined today by Dr. Lori Desautels. I was hoping that you could introduce yourself to the listeners today. And tell us just tell us a little bit about your background and where you are today. Lori Desautels Thank you, Carrie. And first of all, thank you for having me join in this really critical discussion. And so, I am an assistant professor at Butler University in Indianapolis. And I also am working with schools, organization, districts across the world right now, helping teachers, social workers, counselors, administrators, to really delve underneath behaviors. And to understand that the nervous system is really showing up every single time, we see challenging behavior from a child or an adolescent, or a colleague. So I've developed a framework that's evolving, it's continually changing. It's called applied Educational Neuroscience. And it really is about the adult nervous system, and how contagious emotions are. So we know that as a parent, I'm a mom also have three young adult children. But this is not just about me, as a professor, or as a school counselor, or as an educator, I carry in to my work, my lived experiences, what I have embodied. So the very first pillar at this work, we really take a deep dive into our own nervous systems. We know that behavior management is about adults, it's just not about kids. And this is a big shift for educators and for parents, to really begin to understand as the science. So well researched, and the literature share with us in this time. This framework also looks at co regulation, which is at the heart, it's at the core of this new lens for discipline. We take also a deep dive into touch points, which we term as those micro moments of connection that happen all day long, and most and what we sometimes misunderstand is that those touch points are nonverbal. So children and adolescents and any of us, when we are experiencing elevated or chronic stress, when our stress response systems are activated, we really are not listening to language or words, we're really tapping into nonverbal. And then the fourth pillar of the framework is really what I'm excited to share about often today. And that is we are teaching our children, little like four or five years old, in our adolescents and the adults, we're learning together about our nervous systems. So we're really moving away from always talking about behaviors, and looking at how our sensory and nervous systems are driving the behaviors that are indicators. They're just really signals that were rough, you know, or that we're feeling some steadiness or some groundedness. So that's, that's really what that's the work that I'm doing right now.
Carrie Schmitt Oh, that's wonderful. I'm super excited to unpack that a little bit. Because I think, at the start Institute, we often encounter clients who come to us, because there is a behavior that the parents are encountering, the teacher is encountering, and that they're trying to make sense of, we are equipped with sensory lenses, right, because of our education around sensation and how sensation underlies a lot of our nervous system capacities. And so I immediately heard as you started the conversation around behaviors, and what behavior can teach us about what's going on with other people, but the twist that I heard was, what does behavior or our inclination to manage that behavior? Tell us about our own nervous systems? So talk to me a little bit about that. Lori Desautels Well, it's it's really a big shift in this time for adults, whether we are parenting whether we are caregiving, whether we are teaching anyone who sits beside Children and Youth, we need to begin to understand how our nervous systems are so contagious. And we can unintentionally escalate a child, or an adolescent, or our own children, by not tuning in, and being aware of our own nervous system states. And this is critical, because in our school, over the past couple of years during kind of during COVID, and kind of as we move through this global pandemic, all of us have been impacted by the trauma of this pandemic. And in the reason I bring that up, is because our bodies become hijacked by this sensory fragment, or the fractures that happen when we are confronted with significant or chronic adversity and trauma. And so, when we walk into a classroom, when we walk into, you know, our schools, we carry that with us, and our children and adolescents pick up on the autonomic state of our nervous systems. So we are seeing a significant correlation of high discipline referrals from educators that are also coming in in a very elevated and activated stress response state. And our discipline data in our schools really tells the story of our autonomic nervous system state. So when you see an teacher and administrator, a social worker, or a counselor, a bus driver of food service provider appear professional, when any of us are feeling so dysregulated, we can, again, unintentionally, really escalate everybody around us. And we misunderstand that that behavior is communicating a sensory or nervous system need, it's really a physiological challenge. It's not a behavioral challenge.
Carrie Schmitt I'm so fascinated by how you're reframing this, and I think it's going to be pretty new to a lot of people. You work in a school system. And when you see high discipline referrals, one of the questions you're asking, is the adult in the situation regulated? And I think our system is built to say, what's wrong with the child's behavior? So what how do we, as adults take responsibility for our nervous system? Are there tools as a school counselor, as you know, a PhD scientist that you are like, what is it that you think, helps us? Is there a tool that helps us to understand our own nervous system state, so that we can come into these situations regulated with the capacity to also we'll talk about this later. But I think this is a good segue into lend our nervous system to the children that need the CO regulation, right? Because their behaviors are behaviors, they're communicating something, they're communicating something about their own nervous system. And oftentimes, as adults, we're called upon to lend our regulation to them, so that some co-regulation can occur. In the absence of an adult with a regulated nervous system. And a child with a dysregulated nervous system. We're getting discipline and behavioral referrals. Is that di summed that up correctly? Lori Desautels Yeah, pretty much. Yes. And this is true for Fs parent. So I really want to make the you know, as we speak about this framework, during the podcast, it says much about me at the mom as it is a professional and I want to also be clear that it's not very realistic to you know, to think about I must be regulated, I must be regulated. The goal is to recognize and be aware when we are dysregulated that is the first step that is a practice that we really want to bring awareness to the adults that worked with children and youth. It you know, we are human beings we're living you know, physiological organisms system that bro Read and live in rhythms and we, you know, move through our autonomic nervous system states all day long. That's, you know, there. That's the beauty of this, but, but we just really want to be very clear that it is so critical to be aware and to have that. Just that ability to tune into ourselves, and what's interesting in the western part of the world, when we come into the world, as infants, it's almost as if we're socialized out of our bodies, it feels like our heads go one way and our bodies go the other way. We're very cognitive, we're very language oriented. we problem solve, we talk about cognition in schools right now, the big hot topic, which is shocking, still, since coming through a pandemic is learning loss. And what we misunderstand is that it's that the language of the nervous system is sensation. And we are feeling and sensing creatures who think we are not thinking creatures who feel and sense. So our biology is all about sensing safety in our environments than seeing the rat or sensing conditions or experiences that are unfamiliar. So it really, we've moved away from the natural evolution of our nervous systems. And then language of the lower, like the brainstem, and the nervous system is all about conversation. So one of the tools that we share with adults than we share with students is to start to become aware of those sensations. And our children understand that we we talk about words like tingly, edgy, teary, flat, stuck. And we're moving away from those feeling words, as we really focus on those sensation words, because I know when I'm hot, I know when my ears are buzzing. I know when my heart is beating fast. I know when I'm sweaty, those are sensations that are informing us that our bodies hold this beautiful communication system that knows how to find a home, that knows how to get home that knows how to find homeostasis, which is that that balance. So this is really critical work as much for adults, as it is for children. So this is not a program. This is not something that we do to kid. This is not something that has a Bach or a script. It's it's not, it's not just about children and adolescents, it is as much about the adult as it is youth. Carrie Schmitt That's a message of inclusivity. To me, that we are asking all humans, yeah, in every environment, to us the sense data that they have, right, to contribute to the to the collective. And what you're saying, which is super important, and is often overlooked, as you mentioned in the Western world, is how vital sensation is and tuning into our internal sensation. You know, in our world, we would call that interoception, or sensation that arises from within our bodies, and laid down our over reliance on both cognition and extra receptive sensory information. Because I notice in periods of dysregulation in children who experience chronic dysregulation that could be from a trauma history, it could be from other issues, right, that have contributed to this. Oftentimes, they over rely on extra receptive sensory data. So you know, things that happen from outside of us noises, lights, movement, and lose track of or haven't learned the awareness that you were mentioning, how do we tune into our sensation without judgment or emotion, and just notice what is happening within our bodies? And that's the first step as you mentioned, if we have an awareness of that we understand what's happening in our nervous system. And then that awareness helps us to understand do we need to take action, do we not right? Do we need a behavior or an action that supports our nervous system? And what is that behavior action? And so What you're saying is every person you're teaching every person for you and your work environment at school, for you, as a parent in your in your home, to learn the integration, learn the mind body integration, learn the awareness, learn to pay attention to sensation without judgment. Does that sound like what you were saying?
Lori Desautels Absolutely, it does. And one of the things that, you know, I want to add to this is that it feels empowering. And it feels relieving to children, to know that there's nothing wrong with me, and I not a bad kid. And, and I mean, all ages, it really feels good to us as adults to know that, when we start to feel hot, when we start to sweat, when we start when we can feel our heartbeat to know that this is much more than anxiety, this is much more than a panic attack, this is much more than or if I am experiencing heaviness, or I just don't have the energy to get up and do another day, I don't want to just quickly label that as depression. You know, we understand that anxiety is oftentimes energy that needs to be released, and it just doesn't have an outlet, you know, that anxiety is that energy that, you know, maybe has been stagnant in our bodies. And it just sometimes will come out in times that, you know, start unless, you know, and, and so this is really important because we traditionally have pathologized. And we have given classification and rulings to behavior disorders. And this is something that I am working towards every single day is that we've, you know, when you label a child emotionally disturbed or behavior disordered, or other health impaired, or even add Attention Deficit Disorder, it these aren't disorders, you know, this is this is really kind of a re ordering, a nervous system architecture, brain architecture. So we know that the nervous system have plasticity, it is experience dependent. So we form perceptual maps of the world, based on our embodied experiences. And so nothing, you know, Nothing comes from nothing. I mean, it's like if a child grows up in an environment where there is a lot of chaos, or if the environment feels overwhelming, or if the environment feels frightening, then our nervous system adapts to those experiences. So that child may pull in, they may begin to retreat, they may begin to shut down, out of protection, out of survival. That's called a survival drive. And so as that child moves through school and turns into an adolescent and a young adult, oftentimes, we are on autopilot, we revert back to that survival drive, because that's what we have known. That's what we have used, and we don't need it anymore. I love what therapist Deb Dana share, she says sometimes we activate those survival drives that no longer serve us. And so that's, we share that with our students, you know that you know, you're safe in this classroom right now. You know, and we're here for each other, and we're working together, and your body, if you're feeling threatened, or if your heart's beating fat. Again, if your heads fuzzy, if your ears are burning, then that's that's a good thing, because we know that your body is working to protect you. But it doesn't need to right now it thinks it needs to. But one of the things that I want to share carry is that when trauma happens to a child, or to any of us, but or when our sensory systems are overwhelmed, that experience is often not time stamped in the midbrain region. So we can have something happen at six years old, or a 10 years old, or two years old that we don't have explicit declarative memory, but we have body memory, which is implicit memory, and it feels as if it's happening. Right now 20 years later, and it's true for us as adults, and there's nothing in the body that says, you're okay, Laurie that happened in 1980. Today is today. So this is really important. And that's why it's frustrating for me to see so many children and adolescents punished and disciplined for the implicit body memories that get triggered. And all we do is just see the behavior. But we're not looking under the behavior, and we're not getting out in front of the behavior. Carrie Schmitt So helping that our own selves and other people, demystify, that sensation is information. And it its primary function really is protection and survival. And so thank our system for the information and normalize it, I think that's the piece that's missing that you're working on in the schools that we're working on at the star Institute. Just because your system over responded to that loud noise that happens that happens to other people, How often have I said in, you know, in the context of education, and in the context of therapy, that doesn't work for your body? That's all we know, right? It's, we're not placing a judgment, that loud noise didn't work for your body, it gave you some information, you know, and we're going to work with that information. Same with parents and learning about their own sensory profiles. Let's sit down and do an adult sensory profile as an adult and learn how sensation impacts you. Right, and how it impacts your nervous system. The thing I think that we're, that we're talking a little bit around, and that I think is kind of the next logical place to go with this is how do we establish this felt sense of safety, so that when we incur it, when we incur or recognize sensation in our own bodies, we can thank it for its information and for the survival that it's helping us to accomplish. And then take the next step in, I think that your work, as you mentioned, in like the third pillar, values, highly values, relationship and connection, oftentimes, that's where a traumatic experience occurs, is in relationship and then a broken connection. And that's where the repair occurs is in a tuned relationship and positive relation in, you know, positive attuned relationship. Lori Desautels Yeah, absolutely. And there is, you know, we know that we are also social creatures, and we can't survive without each other. And so, Dr. Bruce Perry talks about this so beautifully, is that many of our children come into our schools with relational poverty, they just they don't have the trust, they don't have the connections that they need for nervous development. And for many of our children and adolescents, school, can be their place of felt safety, but it can also be a place of adversity, and trauma, where, you know, they're not feeling safe, and they're not feeling connected. So I want to be respectful. Looking at both ends of that. And so when we think about touch point, it's, you know, as an educator, or as a clinician or therapist, we can't have a robust, you know, deep, rich relationship with 150 students. I mean, that's, you know, if your caseload is if that's not what we're talking about, but we're talking about this relational reciprocity, where we are creating a culture where our children feel seen and heard, and felt in our presence. And I love this, this it's called the magic of resonance. And Dr. Albert Wong talks about this and, and he says, you know, there's just nothing that feels better to a human being than to feel seen and heard, and, and to be felt by another. It just, it's, it's, it's really just miraculous. So and though, but those relationships take time. So there are practices that we are integrating into our classrooms and into small group therapy, one on one or whole class where we're learning together. So that begins with checking in with our nervous systems tracking our nervous system state, I would have done that, as a mom, we would have, we're using work. What I love is the polyvagal graph from Dr. Steven Porges. His work. So, Deb, Dana, and I revisited that graph, and we augmented it a couple of years ago, year and a half ago. And so this is a way for families, or classrooms, for all of us to check in with our nervous system. And if we are functioning, you know, in our prefrontal cortex, and we can feel some steadiness and some groundedness, then, you know, we track that, and if we get triggered or activated, and we move into that sympathetic pathway of the autonomic nervous system, which is traditionally known as fight flight, that we noticed that, and we track that, and, and again, then if we, human beings have this autonomic state, that is our state of disconnection, and it is that traditionally known as freeze, but more accurately expressed as immobilized or collapsed. And in polyvagal theory, we call that dorsal vagal, a dorsal vagal state, where we just shut down we retreat. And we, we see that a lot in our homes and in our schools with our children that might have high absences, not you know, they're failing grit, there's their grades, they're failing school, they have their hoods over their head all day, they're, you know, they're just retreating. And that's what we also called internalizing pain. And so, by, by tracking those Nervous System States, is really helpful for all of us to notice patterns to notice, you know, like, what were the sensory experiences that happened right before, during after was, you know, what, what was happening around us what was happening, like happening internally, or relationally. So that's a practice that we use, that we're integrating in our schools every day, it's tracking lots of different ways to do that. Carrie Schmitt Thank you for bringing both ends of the spectrum to this conversation, a lot of times, our conversations end up focusing on the problematic behaviors that drive kids to get referred, you know, to the office, or don't allow them to stay in the classroom. But that free state gets left out of the conversation a lot. And we don't often reach out to the kids who are in that state, and that dorsal vagal, freeze, state because their behaviors don't look as problematic or affect others, maybe as often as the people who are in sympathetic kind of overdrive or acting out. Yet, what we know is the education piece that you're bringing up, checking in with our nervous system, tracking, sensation, nervous system response, and a tune resonant relationship reaches both those both of those examples, both of those ends of the spectrum, both of the kids in those examples. So there are some things that you know, that we tend to implement for kids who are acting out what we tend to stop thinking about or don't implement for the kids that are in the frozen state. So let's talk practically, about the the nervous system education that you're doing the practices that reach everyone, no matter where their nervous system is at the moment, if that makes sense. Lori Desautels Absolutely. So in my work is specifically in the schools. So we are, first of all, helping educators to understand that our procedures and routines and transition, they're already in place at the teacher at the social worker, as a counselor as an administrator. That's a significant cultural piece of, of a school. So the practices with regard to checking in with our nervous system, those practices of identifying sensation, like am I flap Am I feeling teary? Is there a mic open and mic flowing? Our kids write or draw their sensations on they use color line shapes So that's all a part of our procedures and routines. And we ask the staff to do this. So before we have a staff meeting, before we have a department meeting, before we start the day, our staff and students have an opportunity to check in with either their autonomic nervous system state, or they can draw and use color in lines and shapes to identify a sensation. So we have a lot of practices, different ones, that really are a part of our procedure. So we're not asking educators, anyone to do anything more, it's being intentional about the procedures and the routines and the transition intentionality is huge. Yes. Carrie Schmitt I think the teachers listening will really appreciate what you're saying, we asked a lot of our educators. And so when we come in with a message, and we're teaching, you know, something that we've learned from neuroscience, or from, you know, occupational therapy, or whatever it is, when we ask them to add one more thing to what they're already being asked, it doesn't feel fair. But when you're saying is, let's just build it into the culture, let's just build it into the routine, and let's build it into the teacher routine as well, because then it benefits them as well. So it's not just okay, we need you to do one more thing to benefit your students. This is let's build something into our school into our culture that benefits teachers and students alike, administrators, you know, all the way down to whatever the youngest person in the school is. And so I love that because it's practices that are intentional, that are not adding tasks, but additive to the lived experience.
Lori DesautelsThey are and they're also helping our children and youth to access the cortex. And this is critical, because if you're not functioning from this medial prefrontal cortex, then you can't have strong working memory, you're not able to have sustained attention, problem solving, emotionally regulating. And, and this is why this is what happens when we don't take the time, and attune and attend and, and are intentional with helping our kids to get to the Quartet. You know, it's it's an and as many of us walk in to work, and we're not in the Quartet, you know, we just had a rough morning that kids were throwing up, the pet is lost, you know, the tires flat, we can't pay our bills, you know, we are no different than our children that we sit beside. So oftentimes we walk in to a classroom and we're functioning from the mid and lower brain, we're in fight flight, or we are in shutdown. Carrie Schmitt No, I think it's your point is so great, because neuroscience is teaching us when we are in sympathetic activation or high levels of arousal, we are unable to access our prefrontal cortex. So our executive functions go away while they're there, but they're just not available to us. And so if we see another adult or a child who is unable to problem solve in the moment, what that tells us is that they're unable to access that for some reason, and the reason typically is some sort of nervous system activation reason. So what say you have a checking in you have a tracking, say there is an identification that there is nervous system activation, or a big emotion is, is is being drawn. Are there also intentional practices built in? That are regulatory practices? Yes. Lori Desautels So many of the practices are regulatory practices. And the key is not to wait for a crisis, and used regulatory practice. Traditionally, as parents, as educators, we are reactionary, we're focused on consequences. We're focused on if the consequences aren't painful enough or uncomfortable enough, then the behavior will not change. And this is providing our students with these regulatory practices that we call anchors out in front of the behavior, getting out in front of the behavior, getting out in front of a crisis, and we practice those, you know, those are in our school. We have the tier one, tier two and tier three of response to intervention or response to instruction, RTI, and these are tier won practices meaning that these regulatory practices, strengthening connections through touch points, that's a tier one practice that's for all students. And that's a part of our procedures and routines. Now some of our children will need a little more intensity, they might need a little more frequency of these practices. But we now understand that we're not talking about this group of kids or that group of students, or, you know, this, this group, I mean, it's really a tier one practice. But the key is, you know, getting out in front of that behavior. And that's why our procedures are so important. And we provide our children and our adolescents with these anchors, whether it is chewing on ice, whether it is listening to the music, whether it is coloring, journaling, creating their sensation through art, whether it is holding a hand warmer, you know, there are so many anchors, sensory regulatory practices that we provide for our students based on surveys that we get them that they kind of like ordering off the menu, and, and then app, they can choose three or four, try them out. But we practice those in neutral times, we practice those so that they're more acceptable when there is a rupture. And, and that's true for all of us. You know, it's if we wait until we have some anxiety to put on our, you know, tennis shoes and go for a walk, we'll never do it. But if we get into the habit of a five minute 10 minute walk, even when we're feeling steady, that practice is more accessible to us. Carrie Schmitt I love Yeah, I love how proactive that is, it's also, again, very inclusive, all of us are going to explore what works for our nervous system, and identify it in a neutral state. So that when our nervous system does need it, and we're not accessing our problem solving, or executive function, we have already established some a menu of ideas that work for our nervous system, because I often recognize, as you mentioned, we wait until we have a crisis. And then we try to implement regulatory strategies that may or may not have been practiced before. And we're asking the child to choose when we recognize they've lost access to their problem solving and executive functions. And so we're saying, We'll do you want this or this, we'll do you want this or this, we we and we in our minds, no, that's not available to them. And yet here we are adding to their dysregulation by asking them to make a decision in sympathetic activation. How much agency two is built into this, I'm going to learn about my nervous system, I'm going to understand what works for my nervous system, I'm going to have a whole menu of things that I know regulate my nervous system, so that I'm a caring adult might recognize dysregulation and offer me my menu. Like that is such a beautiful, really juxtaposition to let's wait until they're in crisis, forced the decision on them, right? Or isolate them, you know, from what they need most.
Lori Desautels That's right. That's right. And so that is that is really at the heart of this shift in how we perceive behaviors, and also exploring and re examining our discipline protocols, in our homes, in our schools and in our communities. Carrie Schmitt Thank you for putting that onus on us as adults as well to take accountability for our own nervous systems and how we contribute to the environments that we enter by bringing our own nervous system dysregulation sometimes into the nervous into it. Recognizing that the tools that we're saying are effective for students are also effective for us. That going into the our work environment, recognizing and having an awareness of our nervous system dysregulation. Go seek out that attuned resonant relationship. As a regulatory strategy, check in with yourself. You know, use the intentional practices that you've mentioned that your that your school environment uses. Those things could also be practices we could all take to our home and work environments. Lori Desautels Absolutely. Carrie SchmittSo I think I'll just try to summarize, really quickly a little bit of our conversation. And I think a lot of the common ground between your lived experience of of Educational Neuroscience and kind of the star Institute model of, you know, understanding nervous systems, in particular through sensory lens, which we, we both highly value as contributing to all of our nervous system, activation and brain power, the mind body connection being so powerful. Hear your examples of education, and practices, take positive bodily sensation, add the special ingredient of a tuned resonant relationship, and deliver a really hopeful message of rewiring our brains through neuroplasticity. Recognizing that that can contradict previous negative multi sensory experiences, like a traumatic experience is a good example, which we brought up today, our relationship rupture, something like that, we can contradict that, with the positive bodily experience, the practice of checking in and tracking the special ingredient of attuned resident relationship. And the result we hope is, and we've seen in practice, leads to regulation of the nervous system, which affects both our availability to our environment, and our emotions state helps us to take sensory data from outside our body and inside our body and respond in kind to it right with the right amount of response or modulation. And what we have there is an embodied cognitive response to our environment. Lori Desautels Yeah, absolutely. And I, and I also want to be very clear that it's not just the brain that has neuroplasticity, our nervous systems, old neuroplasticity. And a couple of years ago, I wouldn't have said that, but, you know, the research is showing that, you know, we have these, this beautiful communication system between the body and the brain. And those afferent projections go 80% of them, our body to the brain. And only 20% of those projections are efferent going from the brain down to the body. Carrie Schmitt Thank you for bringing up that, um, by directionality of our nervous systems. And the hope that is in this message. And that is that our entire nervous system can be impacted positively and rewired positively and the result can be us being able to show up in the world in a different way for other people to contribute to the collective. And that is true for adults and children, which is something we didn't used to think was true, right that we didn't think neuroplasticity lasted through the lifetime, and through the lifespan. But your work is showing us that it does. And so thank you for for that work. One of the things we really, really highly value at STAR is curiosity, and intellectual humility. And one of the practices that intellectual humility calls for is following the science and sometimes changing our minds about something or just being open to having our thoughts evolve on a topic. So tell me, what's one thing that maybe you once believed that your thinking has evolved on, or something you've changed your mind about? Lori Desautels Well, for me that the response is very clear and succinct and easy to reach. And that is that I have really changed the way I define and view and perceive behaviors. I wish I had known what I know today as a young because what we label oppositional, defiant, aggressive. What we label as oftentimes violent, or just manipulative. Is is there's so much more to that behavior, as we've talked about today. So, I know I will continue to learn, and I will continue to understand that yes, the behavior is an important signal. It's important cue I'm not going to eat Ignore the behavior. But I love the quote from Angela Davis. I shared it at the star symposium. And she defines radical as pulling things up by the root. And so that's how I see my change in in how I'm viewing and perceiving behaviors. It's a radical change, actually. And it's been evolving for a long time, it takes time. But we were just kind of picking it the leaves. And we still are in our schools and in our homes and communities, we are still opting for compliance, and obedience. And we're not really reaching for that sustainable behavioral shift that produces that sustainable mental and emotional well being. Carrie Schmitt I wonder, practically speaking. You referenced wish that you wish you had known what you know, now, when you were a young mom, and I'm thinking about parents listening, I'm thinking about teachers listening, when they see a behavior that is not okay with them, or is not safe for their child or for the people around them? Can you think of like what one question maybe they could ask themselves to help get to that next layer of thinking of like the root? Or the cause? Or the what's underneath this behavior? Like, what's one question when you, as a school counselor are pulled in to say we have this behavior? What's like one of the questions that pops up into your mind? Lori Desautels Well, it's the first question, and it's the initial question. And that is, am I in my holding a nervous system state that can capture a sense of emotional availability, so that I can drain off and share my nervous system with that child who needs it in that moment? Carrie Schmitt Wow. Yep, thank you for saying that. That's it. To me, that's a paradigm shift. To turn it back to myself and my own nervous system is something I think that's really unique. And something that will, as Angela Davis is, you mentioned her quote, help us pull something out by the route, is by turning the question back to ourselves and not over relying on other people to change their behavior to make our life easier. So thank you for saying that. I think that's a real paradigm shift. Thanks for the work that you're doing. Thank you for sharing it with us. We were lucky enough to have you at our 2022 STAR Institute symposium this year. And so that is initially how you and I connected. And I got to hear a lot of your thoughts and works, which prompted me to ask you to come on and share it with a broader audience. So I really appreciate your willingness to do this. And for your continued work. Where can people find you and find out more about your work? Lori Desautels So I have a website that is very, it's filled with resources, very interactive, and it's revelations in education.com. Carrie Schmitt And we'll link all all the names you mentioned today, all of the your website, any resource that we mentioned today, I will find it and I will link it in the show notes. So if anybody's listening, it is interested in that. All of that will be in the show notes for today. So thank you again so much for being here and for for sharing your work with our audience. I appreciate that. Lori Desautels Thank you, Carrie.
 
 
Calls-to-action:
Learn more about The STAR Institute by visiting https://sensoryhealth.org/ where you can subscribe to our email list and find out more about our educational offerings 
Find us on YouTube at STAR Institute https://www.youtube.com/channel/UCFVd3oVz4icMcZAZDwvHwBA?vie w_as=public
Find us on Instagram @starinstitute
Contact Lori Desautels, Ph.D. at https://revelationsineducation.com/contact-us/?v=4096ee8eef7d
Find the host, Carrie Schmitt, on Instagram @carrieschmittotd

A Family’s Journey to Sensory Health

Parents of two boys with sensory differences discuss the experience of diagnosis and their pathway to building a sensory lifestyle for their family.
Episode Guests: Jerade and Maria Tipton
The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.Resources Mentioned In this episode:
STAR Institute: https://sensoryhealth.org/
Occupational Therapist trained in sensory processing through the STAR Insititute: https://sensoryhealth.org/treatment-directory
Episode transcript: 
Carrie Schmitt 
I'm joined today by Jerade and Maria Tipton. Jerade and Maria are the first couple and parents that we've had on the podcast. So I would invite you guys to tell us a little bit about yourselves, your meaningful occupations, who you are, what you do in the world and who your family is.
 
Maria Tipton 
I'm Maria Tipton, and I am a military spouse. I am a mom of two amazing boys. They're seven and nine. And I am also a corporate attorney. I also volunteer as President of the Board of Directors at STAR Institute, which is a passion of mine.
 
Jerade Tipton 
As you mentioned, my name is Jerade Tipton, but yeah, I'm a career military professional. And so you know, I guess ever since I left high school, I guess you could say in my life is a life of service, both our country as well as my family. And that's what my primary energies and devotion is to.
 
Carrie Schmitt 
Well, thank you so much for your service. So Maria, you and I connected at the star symposium, we were connecting and talking a little bit about some of the ways that the presentations had resonated with us. And your perspective as the president of our board, but also apparent, to me was such a unique perspective. And so we decided to regroup and record a conversation where you could talk about maybe your journey to connecting the star and a little bit about your family and your personal experience with sensory processing. Okay, so we started our journey. In August of 2016, when my oldest son was I had a limited verbal vocabulary, I would say, and so we were seeking speech therapy. And in the course of that, we referred to occupational therapy as well. And so that kind of opened up a whole new world I had never heard, I've heard of occupational therapy, but never experienced it, especially on a pediatric level. And so
 
Maria Tipton 
I think back in 2016, when we received diagnosis, you know, you hear it was very deficit language, you know, as development, significant developmental delay. And at that point, I saw myself as a mom and an attorney, by trade. And so to take him to therapy three times a week, we had amazing therapists, but it was an approach where I had the therapist take him and do the therapy, and then I came home, and I wasn't really involved. And we then subsequently had a military move, and had to set all that up again, and we had a lot of trouble finding a right fit for our family. And through that course, I found an amazing occupational therapist, I kind of call her like our family ot because she brought me in the sessions really empowered me as a mother. And the sales progression grew exponentially because of that, I started taking classes that were for occupational therapist, but as a mother and doing a lot of home carryover with him. And I came across the star Institute, and because of his sensory needs, and it was just always such a resource for me, because there were Facebook Lives and webinars that I could take. And so I kind of had taken those during that time. And then when we were stationed in Georgia, the symposium was there in 2018. And I was like, I really want to go, like, I want to go to the parents seminar, I want to go to the symposium and so I was able to attend. And that was really life changing for me, because it I learned so much from all of the sessions, you know, at that point, there was a session on interoception was something that I hadn't heard about before, and you know, just kind of tools in things that I could utilize with our own family. And from there, I think, you know, everything just kept what is called like a flow, I think like it continued with him and he is just, you know, just such a well put together nine year old little boy with, you know, just really enjoying life. And so that kind of along with it is is our journey there's there's more to it in terms of we have a second child to that. And because we had gone on this journey with our car. First we recognize some, some things where he may need some intervention. And so that has has helped him as well.
 
Carrie Schmitt 
Jerade, from your perspective, you are taking your military service, you're probably a leader in your roles. And Maria is communicating to you that she's a little concerned about your first child. And then she's when you start down this path. Tell, tell me a little bit about that from your perspective.
 
Jerade Tipton 
Um, so when we started this, you know, it's one of those things is that I guess, it's different perspectives. Maria picked on it. We had a discussion about it. And I said, I know you're, yeah, you're right. He's, I would think he would be using more words and speaking more than I thought, Okay. I'm not really, you know, at what age? Does he become more intelligible in terms of when he's talking to his parents and things of that nature? And, you know, I do remember I thought is interesting when he was, we were living here. And we were downtown, I think old Colorado City. And, you know, a lot of noises and stuff like that, that a motorcycle that went by and Samuels response to that, that really caught me off guard, because he was just totally distraught about it. You know? And then when we started piecing all this together, I really remember that situation, like, yeah, maybe there's something going on here. And the fact is that, this he's getting a lot of inputs, and he's just not knowing how to, to work with those. I do know, I'll be honest, as Father, I was like, Okay, this was nice, like, hey, we'll get him wedding season people and he'll be he'll be fine. And what I realize is, it's not a one and done deal here. With this, it takes persistence. It takes perseverance, and acceptance to understand like, hey, my son has is working through this issue. And this is not going to be a quick fix. This is not gonna say, Hey, sit down with this person for a couple of weeks and do that. No, he's been he's been working through this. And he's now nine. And so part of it is just understanding like, it takes work, okay, it takes work on a parent's part takes work on the child's part, and also trying to develop that support network for that child. You know, it's funny, as kids, we don't really, we're very, I guess, narrow viewed as children, okay, get my life, I'm a child, you know, it's all this stuff around me. And they don't really understand. I know, when he gets older, he'll understand about how much work he had to put in. Maria has done a great job of trying to explain to him as he you know, every year he gets older, hey, this is this is where you were, this is where you're at, where you're at. And this is the work you still need to put in. So that we can kind of like, I guess, normalize that with him. And also allow him to accept that, you know, my biggest fear is you always your biggest fear is your child struggling. And that was my biggest concern. When she first we first started talking about it. Nobody wants to challenge struggle. You know, I'll be honest, my first responses by a broken heart. And I was worried and about him, and fearful. I was like, How are how are we gonna get through all this stuff, and I had to give it to my wife. I'll be honest, you know, what's military is very demanding. She put all her time and effort into chasing everything down.
 
Carrie Schmitt 
First, I'm gonna say thank you for sharing that. Because I think from a parent's perspective, the last thing you want is for your child to struggle, a little bit about how you carry that forward, like Maria was telling me Jared that like as a leader, now, you have given a hand up to people behind you to say like, it's okay, if your child struggles, you can set up these services. And it sounds like Maria, you also have modeled that for other moms, maybe in your situation like, this is how you set up services in the context of the military or in the context of a military move.
 
Jerade Tipton 
Yeah, I've, you know, been in positions with, with co workers and, you know, a military very tight community and share things. And, you know, I've had members share things and like, the struggles and stuff like that, and like, I was better able to relate to that situation was those those members that come and talk to me about that, and I was me, unfortunately, as always, I Hey, we have been through this. And I would always recommend them recommend they talk to my wife. So you know, and we had one situation in which we were able to help someone. And that means a lot. Even if you just help one person it means a lot that we're able to because we've experienced it we will share your experiences with this individual. And then this is how we move down the path. Okay, in support and hope and hopefully providing a better life for your child.
 
Carrie Schmitt 
But what I hear is that you as parents said, This is who he is, I mean, love, and we accept Him, and we're gonna just do whatever it is to make a great life for him.
 
Jerade Tipton 
Yes,
 
Maria Tipton 
Yes, I think, absolutely. And, you know, when I hear Virginia speak, like, it's just like, I wish that I had these words when this first came on, because I still revert back to, you know, you're gonna revert back to the language that you heard at diagnosis. And so sometimes I go back to that, but you know, I, in talks, you know, she calls it asynchronous development, you know, everybody, one, everybody develops differently. And but it was, it was such a significant delay, in our case, that it caused problems just with daily life. And that's not always the case. But I think part of it also is removing that stigma of seeking services, because there's, there are people and professionals out there that can help get that to where a child feels, basically, I always just say, Are they comfortable in their body, because that may mean many different things. But if they're uncomfortable, you were experiencing meltdowns multiple times a day, not being able to participate in, you know, play, you know, the occupations of childhood in an enjoyable manner. And so, I've always been very open about our journey. And I think, because I don't want there shouldn't be a stigma associated with it. And sometimes it feels that way. Maybe, especially when you're a first time parent, and you've never really experienced like the this world maybe where you need additional services. And so that's why I've always shared it like in groups, I'm, I'm in with other other parents and even within the military, and sometimes when you're starting, it feels really lonely, because you're like, What do I even do? Like, where do i Where's step one, and, and it felt that way for me when I first started, and I was very fortunate to meet several people that helped me along the way, and I just kind of want to pass that on as well.
 
Jerade Tipton 
Yeah, as you said, a lot of their specific incidents are brought to us all home to me. I got home from work. And our son was just having, he was having a rough day, he's had a complete meltdown. And I had to go down and I had to get down on his level, and hold him and put my arms around him because he was nothing was working. And he was upset. And he You can tell he was angry and in it, and I put my arm around him and has held him. And he's struggling. And so that, that brings it home to you. And also and as I mentioned, it reinforces your commitment to your job. So it also helped me to kind of put my myself in his shoes, to understand what he's going through. Because he's just, he doesn't know how to communicate that point. And it's the frustration, I could feel the frustration from him. And so bit of a bonding experience, but also it brought it home to me as well.
 
Carrie Schmitt 
And that's beautiful. And it's something that you know, at the start is the two plates, a super high value on parent coaching. And at the very beginning, it's like just join them. Just join them where they are get on the floor. Right? Just look in their eyes and tell them You understand, right that you're you're here and that you're not afraid of whatever their big emotion is, and you wrap your arms around them, and you're with them. And so that's such a beautiful example. I think that will hit home with a lot of parents who maybe have a child that they're not sure what's going on. But they're seeing some concerning signs, whether it's big behaviors, or maybe it's even meltdowns. So talk to talk to those parents a little bit about what are some of the things that like Jarrett's example of getting on the floor, what are some of the things that maybe are your go twos, or some even some different way that you think about the big reaction to the motorcycle, the meltdowns, the frustration that builds in your children, if you have any tools, any tips, any hints, any resources that you turn to, when you have those experiences as parents?
 
Maria Tipton 
You know, I think when you have that, if you haven't already I always say you know, get an evaluation from a qualified occupational therapist because every child's makeup and sensory needs are different and they can let you know if this is something where they may need intervention and then they can help develop a sensory diet but really it is the sensory diet. I mean that a child may need like one you know one of our children really loves swinging a lot like in big gross motor, and where as our other may need You know, some quiet time and like lights out and just kind of reading in a little notebook like, you know, they're like going back and forth, and a body sock and like, you know, and so I think that each child is is so is so different. But once you get to really understand their needs, and then you just make that part of daily, I think when we were back when we were having the big meltdowns and things, a lot of the sensory diet stuff wasn't really we weren't really, we didn't really know. But we didn't know that we could dislike co regulate, like give them whatever, you know, your child likes, like some children may not like to be hugged. But if they do, give them a big hug, or, you know, if you don't have that sensory diet developed yet, like we hadn't at that time, what do they what comforts them in and do that and then seek the professional assistance.
 
Carrie Schmitt 
I love the message of like, know your child and find out what works for them. Like there was something in you Gera that knew that your son needed you to get on the floor with them?
 
Jerade Tipton 
That was a basic situation, because I was like, What do I do here? And my fallback was just hold him, just put your arms around him. Okay. And, and one that one, it is to show you care. And also to show that as a parent, you're relating to them and are not alone. Notice my biggest fear is that he's going through this singular, in his mind a singular situation with multiple inputs going on. And I'm like, what is the one thing I can do? And I went for the simplest thing, and in no way calm him down. But it also, it pulled me into the situation, I'd be honest, it kind of spurred as spurred my journey. He really did. That's when I, you know, you kind of like you get complete buy in on this in the success of your child. And also with all the meeting all the needs they may have at that time.
 
Carrie Schmitt 
I think that brings up an interesting topic, and that is that sometimes one parent just proportionately experiences, some of the, the fallout from sensory processing differences. So the other parent comes in and feels like I don't know what to do, and I'm not as experienced here. And so the importance of, of communicating and have the buy in of both parents to support the progress. To be okay with not knowing, but just kind of jumping in and saying what can I do?
 
Jerade Tipton 
True, it's also opened mine, I'll be honest, Maria had brought when we're going through this process with our sons, Maria brought a lot of things to me. And what I realized is that I had to kind of take the right term, I had to take my own biases. Okay, everybody has their own biases about certain things. And some things you don't know. You don't really notice. I think the term they use metacognition, and that's where you realize, okay, what are my biases? I became a more of a person to recognize that because we're braced up, I was like, Are you sure we really need to do that? I don't know about that, you know? So what it did is it It drove me to have more of an open mind. And then to also think about, okay, why, why am I not so supportive of this one, therapy, or this one thing that needs to happen, or something like this, or this additional diagnosis that's been added on top of all these other diagnosis is, is to keep an open mind. And to realize that any effort you make is only for the benefit of a job.
 
Carrie Schmitt 
That's really lovely. Jerade, I know you have to go because you're working Midnight's. And so you're so gracious to be here, before you go to go to work tonight. But one of the questions that I always ask at the end of the podcast, and I'd love to get your answer before you have to gomis that we play such a high value on Curiosity at star that as the science evolves, and as we learn new things, a lot of times we have to admit our humility, that we don't know everything, but that we're willing to learn. And that means sometimes we have to change our minds. And so what's something that you maybe once thought or believed that you've changed your mind about?
 
Jerade Tipton 
Mine was, I kind of mentioned it earlier was that hey, this is a, this would be a quick fix. It's not a quick fix. I was like, Okay, we'll just do this. And we did, maybe we'll do this for a couple of months, and then they'll be you know, right as rain and everything. That's not true. I don't wear mine and that this again, is this is a it's a progress, it's progress, and it's a journey, and that you must share that journey with your child. For them to be the most successful down the road.
 
Carrie Schmitt 
As beautiful thank you. And Maria and I think we're going continue talking. But it does sound like, as you mentioned earlier, that you have gone on a journey towards joy and that you see in your sons, that they're living full and joyful lives. And so I just want to, you know, just complement that humility that you answer that question with and that you've lived that, to honor that you've lived that.
 
Jerade Tipton 
Thank you very much. And I appreciate you providing the time for us to talk.
 
Carrie Schmitt 
Yes, thanks for being here, I appreciate it. Let's jump back in, I want to make sure that we come full circle with recognizing your son had significant speech delays, you started on the path of getting therapeutic intervention. But I'd love to make sure we capture a little bit about not just the resources that you were able to collect and build a team around him, but how he's doing, you know, what they look like and how successful he is now.
 
Maria Tipton 
One thing I failed to mention is we did have a developmental pediatrician, our initial visit, and she interviewed Jerade and I and said, Okay, um, you know, Samuel is a child that he's going to be a teenager, and I know, you guys as parents, because we had to have like, a two hour, you know, meeting or whatever they need a medical appointment, to, like, he's gonna not even know there was anything at that point, you're like, what is like I don't, I'm just learning everything. And it's really hard. Like, it was hard to see him struggle. But we're, I feel like we're there. And we're there early. But it is definitely possible with, you know, just to basically every child's journey is going to be different. And I just wanted my children to feel comfortable in their body to be able to attend to their daily life. But what happened was pretty successful, says success. I'm not saying the word right. But he was, you know, he was meeting ot goals in a year goal or six year goals in six months. And then he was dismissed from his IEP. And that freed up to where we could send him to school. And that was also just like, that was one of the big moments where like, we knew his, his development was coming to a point where he was progressing. And then really, I think, within the past two years, it has, he's just a, he's just himself, like, he knows what he likes. He feels comfortable. He makes friends very easy, like very social. Like that was one of the things at the very beginning that we were always so concerned about. And then like, when he started kindergarten, I like walked in school, like maybe three months later at a Halloween party. And like Samuel was saying hi to like, a third and fourth grader, like as like you is this child, like, I was so happy. But it was also like this exponentially kind of more, but I also think that it makes those little things like so much more special, because I know, like all the steps he had to take to be able to be that, that that person you like he he's just comfortable in his body. That's to say, but he's very competent. And yeah, I couldn't be happier. You know, I did have to step away from my career for a few years because we wanted to do intensive intervention. And I knew I would go back and I was able to, and I think that's also another like, sign like he, like my children are, are great. They can attend to daily life, and I don't, I don't need to take them to therapy and be able to do that, like carryover everyday that we were doing.
 
Carrie Schmitt 
Yeah, that's so important to bring up to, I think like for parents listening, take us a little bit more on the trajectory of three years old, does not have the speech and language, some red flags are going up. Is that the time that you see the developmental pediatrician?
 
Maria Tipton 
Yes. And we hadn't recognized sensory honestly, it was a great thing that we went for speech and that therapy place had an occupational therapist. So it was like, let me take the evaluation.
 
Carrie Schmitt 
Which is something parents might pick up on because sometimes I think speech in the early intervention model can be the thing that brings families to therapeutic intervention. Because the milestones can be pretty concrete, and practitioners can whether you take them to the pediatrician, the developmental period Nutrition a nurse practitioner, a lot of times the questions around speech can be pretty clearly yes or no. And so that can be your entry point into therapy. And then the speech language pathologist can say, you know, I think maybe we could use a an occupational therapy opinion.
 
Maria Tipton 
Yes.
 
Carrie Schmitt 
Sometimes I think they could be the professionals that say, have you seen a developmental pediatrician.
 
Maria Tipton 
And we had an amazing pediatrician at that time, who said, Hey, let's go ahead and get you on a schedule for a developmental pediatrician. And so, luckily, there was one in the area that didn't have a two year wait, a lot of a lot of places, you can't even find one, right. And so we went through that process. And we, and I think it was a good point that one of our one of our caregivers said, and I just kind of loved it. And she was just like, Samuel is Samuel, like, it doesn't matter what it diagnosis or label is like. And I was like, That's true like that, we wanted the diagnosis for insurance like, and that never defined our son, or either one of their sense. And it's hard to like, say that, Oh, this is a diagnosis or whatever. But that doesn't matter what's on paper that's just for the professional medical community. And it's for insurance purposes, it got us the insurance coverage that we needed to do intensive therapy. And I think that that's important for parents to kind of like if you can wrap your mind around that, like that's a label that is given based on a set of criteria, but your child is so much more than that set of criteria.
 
Carrie Schmitt 
Thank you for saying that. Because I think the diagnosis piece can be very hard and very emotional for parents. And so I love the way you said, you know, Samuel is Samuel, their child is their child. If the diagnosis can get your child the services, they need to live a fuller life to live a more joyful life, then as a parent, use them, right, like use that to get the services that your child needs, but don't get too hung up on the label.
 
Maria Tipton 
Yeah, exactly. I would agree. You know, I think another point, I kind of want to make too is that like, you know, it, it takes, it takes a while, like you're gonna get evaluations. And every time you like I had, unfortunately, fortunately, and unfortunately, like the military is great. That's our life. But the unfortunate part is that I had to fill out that paperwork, so many times, I had to fill it out. And it's very disheartening to have to list the negative qualities when you know that that's not really what you want to see your child as, like, I always loved the question like, like, what's the unique attribute of your child? Or what do you like about them the most, but then you have to list all this other stuff. And then you get evaluations every six months to a year for the insurance, and it like, has all this negative things in it. And that was always hard for me like to get every time I read through those. So
 
Carrie Schmitt 
Thanks for saying that. Because I think that's also something practitioners can take away that we are sending out paperwork, and you know, using that paperwork to inform what evaluation tools you might want to use. But it's really, really important to make sure that we're using string space light language, in our evaluation in our Parent report measures, in our interview of the parents as well, not too only use deficit language, or only use deficit metrics. And when you and I spoke around the time of symposium, one of the things we were talking about is how, how important it is to on the front page of the evaluation captures some of the most wonderful, unique things about the child because the parents are faced with reading reports, maybe annually, maybe every six months that hopefully are capturing progress, but also use deficit based metrics. And so if we could make sure that we're capturing who that child is, what makes them unique, what strengths they have, that are going to support progress, how much easier that report is for you as a parent to digest.
 
Maria Tipton 
Absolutely. You know, and the flipside is, we also have a gifted, he's gifted so like we see so much of that shine, like shine to that there's other things that go along with being gifted, but, you know, like, there's world we're all and I guess it's, let's see, we're all neurodiverse and so that's something that I learned during this process like you know, what is normal? There's everybody has different qualities about them. And so, and we're not going to fit, no one fits a mold. And and it's like those, those unique attributes that you really, like find those even if it's like, a really hard time, like, what is it that is so unique, like, when he was really younger, just like he's, like, so lovable like, now I love his love of learning. Like he's, he takes it to a different level on different things like he knows every country and I'm like, Okay, I didn't, I'm sad to admit like, I don't know that country like, like little small, not not big ones. But
 
Carrie Schmitt 
That's so great. So, you know, to hear even that end of the spectrum, where he was unable to even communicate with you for a while you got involved with intervention and developmental pediatrician said, Just wait, just wait, he's gonna tell you, right, like, Wait till he's a teenager, he won't even know what you've done, because he's gonna, he's gonna be okay. And that message of hope. And now you're telling me he not only learned to communicate, but he is identified as gifted. So he was able to communicate enough to even complete assessments, that we're capturing his intellectual strengths, as well. And so there's so much hope there. For parents who are in the trenches and worried will they ever speak? Will they ever communicate? Will we ever find that special interest, like knowing every country in the world.
 
Maria Tipton 
And you know, and I do want to speak to you because I have a, I have a nephew, who is autistic. And he, he communicates in a different way. He's not verbal, he, he can communicate with his parents very well. But his, you know, his trajectory will be totally different. So I also want to say like, I'm very grateful. So you will develop to who he is. But even, like, if he was, if he was made to be different than that, I would, we would have accepted that and don't like, I just don't want parents to think Oh, everything's, well maybe be like, what you may personally picture like, as what would be like, the end goal, like, you know, meet them where they are. And then like, just recognize and like, celebrate, like, we used to do little celebrations for, like meeting different things that he he wanted to do. And it that's going to look different, the end is going to look different for every family. And our son also has apraxia of speech. And it is amazing that he is where he's at most people would never know. And like sometimes people will say, Do you think he needs some speech therapy? And I'm kind of, well, we've been in speech therapy for six years. And I'm also now that he is nine, I we have a lot more open conversations. And because he's in a school setting, you know, kids may bully because of based on how speeches, it's not. You know, it's not as, as conversational as maybe me like talking, you know, like, there's still ours, there's other things, but I kind of tell him, I say, Well, I mean, I have apraxia of speech, everybody has challenges, and I've worked really hard. So what's your problem? Like, just to advocate for himself? And I, I really hope that that like all all kids can do that and be like, Hey, this is what's going on with me and, you know, be comfortable with where they are.
 
Carrie Schmitt 
I love that. And we were talking earlier about like, oh, how do we capture and highlight their strengths. And you're even saying, like, doesn't communication is what was important to you. And for your nephew, it's nonverbal, but he's bonded and communicating really well with and communicating his wants his needs, and things to the people that love him. And just as you celebrate your son's accomplishments, because he's worked so hard on his individual accomplishments, you know him well enough to know, he worked really hard at that I'm going to celebrate it. It's not always going to look the same for every child, what that accomplishment is, to your point, like, we have expectations, and it's going to look this way, and then this is going to happen, and then this is going to happen. But to stop and just be in awe of what they accomplish. It can be the smallest thing that nobody else would even notice. But you noticed, oh my gosh, he just said hello to kids that are like three or four years older than him. Like that's a huge accomplishment for him. You know, nobody knows the work that went into that. So to know your child to celebrate every little thing that you can, that they worked really hard for.
 
Maria Tipton 
I think that we tell them you've worked really hard so you can you had to work really hard to do some things that just others take for granted. So like remember that and you can do whatever you want to do.
 
Carrie Schmitt 
I like that. And it sounds like at this age, there's even an opportunity for some agency around that, like, what work do you want to do? Like, what are you wanting to focus on right now, if you wanted to get back into intervention, if you want to take a break from intervention, trying to follow their lead a little bit, tell me a little bit about how that developed for your family.
 
Maria Tipton 
Um, so we, we graduate, like graduated, our oldest from therapy, when we moved back to the springs and 2019. And took a break from that. And then we did like a refresher like the, like, basically a little after COVID hit and ended that. And then we let him decide to end that. And he's, we're going to be good with it until he says he wants to maybe if he ever feels that he needs it. And then when in terms of like speech, we did take a break, and he may restart it, like in the near future, but we're going to also let him decide and take ownership of like, do you think that you want to go to speech therapy? Or are you? Or do you think that you're, you're good, where you're at, like, he's done it for so long that he gets to make that decision. And with our youngest, he does, he does have occupational therapy once a week, and we set up a whole sensory gym for them. So I feel like, you know, they're good, they like they go to school, but they can come home and do their whatever they want in that, that sensory gym with their like, or swings. And, you know, I mean, it's kind of like when you start to get into, like, every child has like this, like, you know, they have, have all these fun things. Like I'm like, I definitely didn't have that. But they're able to meet whatever needs they may have. And now I think our youngest will probably say, like, give another six months, and then he'll be fine to just, you know, kind of progress out of therapy. Tell us more about your sensory gym. Like if parents are curious about that. How did you start setting that up? And like, what did you just kind of follow what you knew was good for them. You mentioned like one of your sons loves to swing, you mentioned that another one kind of likes, like a body sock or some you know, restricted kind of pushing and pulling kind of movement. So tell us a little bit about what you have in your gym and kind of how that grew. And when we are in Georgia, we have basically the best PT in the world. She was also neurodevelopment and si trained and like, just had did this for 30 years and had her own physical therapy clinic. And so she brought me in it within like, had the boys like use me and part of the therapy or like sent me snippets, but a lot of it was her gym. And she was like, I think that he could really benefit from a steamroller, my youngest could benefit from a steamroller. And I was like, what is that, and Georgia had family funds available for certain medical equipment that your kids needed, which included certain things and I was like, man, we would have really had bought that. But we didn't really kind of know like, and we like once we had got it, it was such a life changer. But it really was like, therapist directed in terms of like, these are things that would really help their bodies. And then and so when we moved here, we purchased our house, and I was like, I really want to put sweets. But I think my husband was like what, and I did it then he was like, Okay, this is like really good. Like, I got the buy it after I did it and then ask for, you know, for forgiveness later but, and I started taking like I started like looking at online basically at what, what kids used. And then I also asked our therapists, like, what do you think would be good for them. And the military have like a small grant that I was able to use. And then we invested some money and getting like, you know, the mats that they need to have that and we have to crash pads. And you know, they can run and jump on and then follow the swing on and so they have a few swings, they can switch up. And I think like that really has just allowed them to feel really great. Yeah, we have an occupational therapist, that's amazing now and she comes to our home. So it's really nice to have that. So she teaches us like how to use it with like meet the needs at that point of what's needed. And then it has allowed us to, you know, kind of more graduate from like professional therapy, a lot like a lot of professional therapy. They can just do it on their own, now.
 
Carrie Schmitt 
You mentioned early on that you started recognizing the importance of carryover and this is like carryover to the nth degree. Right, like if I have this lifestyle and these things in my home, and if I asked my providers, what should I get? And how should I use it, that the carryover is really supported and maybe leads to needing less appointments and things like that?
 
Maria Tipton 
Absolutely. And you can do it like, you know, you can make one that's not, you know, super elaborate, just have a couple of things that they really need. But I think taking direction from your therapy, like the therapist and your children like, are the two most important pieces to that.
 
Carrie Schmitt 
I love the evolution to the different phases, like when they first started, you needed to go three times a week, until you could build kind of a base of understanding for yourself what their challenges were and how to carry over. But you've mentioned a couple different things. One is that there was a time when you were going to therapies every day, you mentioned an intensive model, you've mentioned now, being able to take breaks from therapy, have a therapist come to your home, like there's all different ways and ways that this might happen. For other people as well, it might not always look like driving to a therapy clinic five days a week, which is super time intensive and finance intensive, and surely, emotionally intensive, as well. So talk a little bit about that. Like, there's all different types of ways to experience intervention, I love for you to talk about the model where you went once or twice a week, and then what the difference is, between that and like an intensive experience.
 
Maria Tipton 
You know, we did the once or twice a week after we moved back here. And then SEMA was in full, full time kindergarten, and I think that he was at a point where that was beneficial. And, and I think the difference is that it's not all encompassing. At that point, like you and you can get the services that you need, I think we did the intensive very early because from what you know, my research is that early intervention, like you know, so much, it pays off in dividends later, and you get so much you so much benefit from it. And so that's why we did that, when they were so young, I think the two days a week is good, like, if you're you know, especially if you have if you have school aged children, or, you know, it also is, is cost and time prohibitive for most people to be able to do that, like, you know, we decided to take that like, I'm not going to work in that to step off our, our table in terms of like how we were going to live our lives, but we made that decision, but the two times a week can help so much. And I think that like there are other there are therapy clinics that offer like short intensives. So you could maybe like you know, take a couple weeks vacation and do that. And then go back to your one to two days a week. And then going from the one to two days to like just one day is was just kind of like I wanted to make sure that we maintained where we're at. And because we had so much work, I wanted to make sure that was good and drifting away, like with none is that I think that I have enough knowledge and my child has enough knowledge about himself that and, and we have the tools, so he doesn't have to have that intervention anymore.
 
Carrie Schmitt 
I like that you're saying like kind of live in the season and see what your kid needs in that season. And when you were in an early intervention, age range of your children, and we're studying what therapy could look like. And you were with your spouse able to say like, maybe I'll stop working and we'll go for this intensive approach. The STAR Institute does have an intensive model. And what that looks like very practically for parents who are listening is that the children would come to star once, depending on their age, sometimes twice a day, for a period of time, that's more like three to six weeks instead of once a week for six months. But there's also a place for the one to two times a week, depending on the season of life you're in. If you're working on a specific goal or really want to accomplish something, sometimes the intensive model can help get you there quicker. But if you're looking to maintain sometimes the once a week model can be really helpful to you. One thing I heard that impacted you the most in experiencing all the different ways you've experienced intervention was being included as a parent. So tell me a little bit I know you've had both experiences were, you were not in the clinic, and then you've had the experience that you've been in the clinic and tell me a little bit about those experiences.
 
Maria Tipton 
You know, and I have thought about that a lot. And I was like you do you meet the child where they are, but you also kind of meet the parent where they are, because sometimes you might be overwhelmed. And a parent just cannot, like, you know, be present there. I think, for me, it was very empowering when our that our OT in Georgia, and she brought me in, in the session that just had me sit on a couch, and kind of watch what was going on and then sent, she actually sent the SOAP Notes home with me, which is the occupational therapy notes from the session. And, like, I just kind of collected him and she had given me things like resources and that kind of stuff. Yeah, she was just kind of, I think she was kind of meet me where I was at. And then, like, a few months, and I started talking to her and like, you know, then I started doing the more at home, like Korea where she'd say do this, and that would be like, okay, and then I like wasn't going to go to the STAR symposium because I can learn a lot and do that at home. Because, um, you know, the, the therapist hasn't like, even in an intensive model three, three hours a week was what like one therapist would do, but I'm with my children, the remainder of the time. And so that's how she included me, our, our physical therapist was amazing. She, she would either have me watch, or like she even had like, my, one of my, my youngest, like, swing me around, and like kind of use me as like, therapeutic heavy work. And then she would catch her on video, and then text me and give a little snippet like, you know, this is what, like we were working on. And like, this is how it helped Gabrielle and then that would remind me and I could look back on my phone at any time. But you know, because like, especially a mom of two that were toddlers, like, I could look at that and say, Okay, well, maybe we can replicate that like, and she would use like things that you would have at your home or give you suggestions. So, um, you know, it was just really empowering. And like, I enjoyed going to those sessions, there was a period of time even with her where it was like, okay, he does better now without me being in there. But having had several sessions or months, there was so great to gain that knowledge as a mom, and then he went off and did it on his own.
 
Carrie Schmitt  I love the word that used empowering. Because it really, if you meet the parent, where they're at, they're going to feel empowered. And it's such an important piece of it, it doesn't have to look one way. Right? It can look, however, the parent and the therapist, you know, decide it's going to look and you know, you can say sometimes I think he's going to do better without me today. Or you can say, Hey, I'd love to come in, you know? And could you videotape some ideas for me. So from both a parent perspective, and from an intervention in this perspective, all of that sounds great. I think there's something to be learned for everybody there. I feel like I could talk to you about this forever, because I just appreciate your perspective so much. And I appreciate the way that you went all in, you found out about this for your children and got curious about what it could mean for them. But then you started just learning and learning learning and that ended up going to say classes and go to the symposium and then you just followed your curiosity and your passion. And here you are. With, you know, your boys being seven and nine now back at work full time, which at one time didn't feel like it was going to be available to you, and serving as president of the board of directors at the star Institute. So it's just such an inspiring story of going from a really concerned mom to a place where you have knowledge and tools that have really, really impacted your family and now you're turning around and sharing it with other people. So that's super inspiring to me, and I know so many people listening will feel that.
 
Maria Tipton  Thank you.
 
Carrie Schmitt  So let's, um, I want to ask you the same question that I got to ask Jerade earlier, in terms of what something that you once believed, that you've changed your mind about.
 
Maria Tipton  And probably like Jerade I've kind of touched on this a little bit earlier. And but I would say like a a good involved parent knows their child best. You know, you spend more time than any medical professional or therapist with them. And I learned that you really have to advocate and fine find the fit for your child if it's a good fit or an ill fit and like refuse those ill fitted relationships like you would a normal friendship. There was a time when I was like, I just want him to be in therapy and we were. In a place that really was, he was regressing, it was such an ill fit. It doesn't necessarily always speak to the therapist, but it's that relationship because your child may need a different therapist for whatever reason, especially if there's these additional needs, like maybe it's just not messing in whatever way, but don't be afraid to be like, Okay, I need to step away and find a good fit. And that may mean not having therapy for a couple of months, or a month or whatever, you know, but really advocate and get involved in know that know, the professionals that are seeing your child and kind of just pick up on if, if they're progressing like you would hope. Or if they're regressing in, there's going to be regression, even in good therapy, but overall.
 
Carrie Schmitt  Thank you for saying that. Because I do think that's one thing I like to give parents permission to do is a be the expert in their child, and be, have a voice in whether or not this is a good fit, and build a team around your child that has all the ingredients of good relationship that are gonna support your child's progression and know that it's okay to say, this isn't a good fit, we're gonna go find some something that is a good fit. So thank you for saying that. I really appreciate that. Well, thank you so much for all that you do for STAR and on the Board of Directors, but also in the way that you share the message of sensory processing and sensory health and wellness.That the way that you turn around to other people and offer your story as a beacon of hope to them, and as an inspiration to them, that you poured into your family. And the result is that you learned a tremendous amount about who they are and can love them better as who they are. So it's very, very important for parents and interventionists. I like to hear these personal stories instead of well. I appreciate your vulnerability and sharing it today.
 
Maria Tipton  Thank you, Carrie. I really appreciate your time.
Calls-to-action:
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The Role of Occupational Therapy in Trauma Informed and Responsive Care: An OT’s Personal Story

According to the Administration for Children and Families (n.d.), nearly 500,000 children and youth are currently in the foster care system in the United States. Caregivers and professionals who work with children in the foster care system must have an understanding of and tools to provide trauma-responsive and trauma-informed care. Listen as occupational therapist and foster parent, Rachel Ashcraft, shares her personal and professional path to providing this care.
Episode Guest: Rachel Ashcraft, MS, OTR/L
The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.Resources Mentioned In this episode:
University of Alabama, Birmingham Department of Occupational Therapy: https://www.uab.edu/shp/ot/
Rachel’s non-profit: Foster the Future Alabama: https://www.fosterthefuturealabama.org/
STAR Education: https://sensoryhealth.org/landing-page/education
Trust Based Relational Intervention ™ https://child.tcu.edu/about-us/tbri/#sthash.STk9qfIR.dpbs
Occupational Therapy Practice Framework: https://research.aota.org/ajot/article-abstract/74/Supplement_2/7412410010p1/8382/Occupational-Therapy-Practice-Framework-Domain-and?redirectedFrom=fulltext
Dr. Deb Hinerfeld: https://debihinerfeld.com/curriculum-vitae/
Dr. Amy Lynch: https://cph.temple.edu/about/faculty-staff/amy-k-lynch-tuf83028
Drs. Ryan Lavalley and Khalilah Johnson’s podcast: https://podcasts.apple.com/us/podcast/dr-thots/id1557659719
Dr. Alaa Abou-Arab: https://www.linkedin.com/in/alaaabou-arab/
Disrupt OT: https://www.disruptot.org/
Resmaa Menakem: https://www.resmaa.com/
SAMHSA Principles of Trauma Informed Care: https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf
Making Sense Podcast on Anti-black racism in the Autism Pathway: https://podcasts.apple.com/us/podcast/5-concrete-action-steps-for-clinicians-t o-take-in-response/id1559608909?i=1000551993824 What Happened to you by Dr. Bruce Perry & Oprah: https://www.bdperry.com/
The Neurosequentail Model of Therapeutics (NMT) by Dr. Bruce Perry: https://www.bdperry.com/clincal-work
Episode transcript:
Carrie Schmitt Join Today by Rachel Ashcraft, she's an occupational therapist and assistant professor at the University of Alabama, Birmingham. Thanks for being here today. Could you tell everyone a little bit about yourself? Hey, everyone,
 
Rachel Ashcraft  I'm so excited to be here. I'm Rachel, I'm assistant professor, as she said, at the University of Alabama in Birmingham. And my main focus and work that I do is within the realm of trauma responsive and trauma informed practices, and then really looking at what that means for us in the occupational therapy world and kind of how to take that lens and put it to what we do.
 
Carrie Schmitt  In your personal story, you were an occupational therapist practicing in pediatrics. And then you and your husband made a decision that took you down the road of getting interested in this trauma informed and trauma responsive work, do you mind sharing a little bit about.
 
Rachel Ashcraft  I love to Yeah, so I was a fairly new practitioner, and I was working in a pediatric outpatient clinic with a sensory focus. And just doing the day to day regular work, they're learning how to be a new clinician, you know, just kind of learning the ropes of everything, when my husband and I became aware of a really big need in our community within our foster care system. So we have learned that a lot of the kids in our county, we're not even having homes to go to. So I think at one point, it was like, there was maybe over 400 kids in care and just our specific county and like less than 40 homes, for them to even potentially go to, and most of those were full. And so kids were really ending up in places that were not ideal, just because there's nowhere for them to go. And so we've really felt kind of a burden of injustice just in the sense that we did have capacity to open our home up to open our family up to to take in not just these kids, but also to partner with their families, in the hopes of them being able to be reunified, because that's really the goal of foster care is for the children and the family to be able to stay together. And so we really felt like that was something that we could do. And so each day that we weren't doing this thing that we knew that we could do just really started to feel really like we were doing an injustice in our community by not showing up for that for that group. And so that's what happened, we became foster parents. And as that was happening, we had in the span of five years, we've had 24 Kids come through our house, as infants all the way through 17. So it was just a really kind of different way to enter that experience. Just even in just like, my season of life just being where I was kind of late 20s started my career. And now I'm trying to figure out how to help these kids and these families. What I felt like I noticed was that kids were coming into my home that were unable to do things that I expected them to be able to do that. Not that they should have based on their life experiences, but my lens, I was expecting them to be able to do things that they really wasn't a fair ask for them. So things like I distinctly remember, a child that couldn't had no idea how to take a shower. And so and they're really too old for me to be in there with them. Right? So trying to figure out how do I help this child learn how to take a shower in a way that's appropriate, but also honors, whatever experiences they've had that have been harmful and traumatic surrounding that space, you know, in their life. And just, all these different occupations were happening. And I was thinking these kids just don't, aren't getting help, you know, for what they need. And I wasn't even thinking of it from a really sensory health lens, or trauma informed lens. Like I really didn't even know enough at the time to be to be thinking that way. I was just thinking. I'm in a profession that helps people learn how to do the things they want me to do. And here's a group of kids that has no opportunity to do the things they want me to do. And that is wrong. And I really just started feeling like the same sense of kind of injustice about our profession, that we weren't stepping up for this group of kids and these families in our culture. In the same way. We my husband and I were feeling you know, we're really doing an injustice. If we don't step up for these kids and bring them into our home. I started feeling that same like professional injustice of why are we as occupational therapy practitioners, not showing up for these kids and not really kind of seeing what we need to do to help them be able to participate. And so that kind of started me down this path, where as I learned more i I was able to understand what the barriers were in the foster care system and started trying to figure out how to eliminate some of those barriers that ended up in me creating a nonprofit actually, with the mission of reducing systemic injustice and access to care that kids in Alabama's foster system experience. But it also ended up in me doing things like going to the star mentorship program and learning more about sensory health, you know, and then as I did that, I was able to bring that back to the kids I was working with and think about, oh, gosh, like, I've learned all these, like subtypes and all this stuff about sensory health from starts to two. And now I'm seeing these very specific expressions of those patterns, but in ways that have to be really gently met in a trauma informed way, so that we're not harming these kids. And so that we're really valuing safe relationship and everything we do, which I know is what you know, the star model does already. So that started to be a really good fit for me. And then I started learning more about trauma informed models and got trained in trust based relational intervention, you know, and started really bringing that perspective to what I was doing. And then what happened is I started realizing like, it's not just the foster care community, but it's trauma is this whole bigger conversation that actually impacts all of us. And it impacts at these individual levels, but also all the way systemically. And it's just so broad and started really realizing that's how all our practice should be, you know, for everybody is really looking through that lens. And so I've just kind of continued to do work down that path over the last 1015 years. And that's kind of where I've ended up today, really, as an advocate for what I believe is that we should all be using trauma responsive, and trauma informed practices, and everything we do with everybody will be interact with. But it's been kind of a journey to get there.
 
Carrie Schmitt  I love the almost organic way your journey happened. Going back to kind of this the origin story of your involvement in the foster system and your recognition of injustice that you felt called to remedy. You had training in development, training in occupation, and then you received into your home, children who were at an age where you would have thought someone had already taught them some of the life skills, daily occupations. And it sounds like your very first realization was that you are uniquely trained to recognize, you know, developmental differences or skills that haven't been learned, and then teach them. And yet, suddenly, you realized what the root of the impact of some of their histories was having and how their histories might have contributed to, and are still contributing to barriers to learning those skills. Does that sound right?
 
Rachel Ashcraft  Well, that's exactly right. And, I mean, again, I have to emphasize I was such a new practitioner, when I first kind of came to this. So I really didn't know if I was way out of line and saying like, occupational therapy has a role in foster care, occupational therapy has a role on trauma. I, I didn't know that other people were even considering this topic. And at the time, there, there weren't that many people who were. And I remember one day, I just, it would have been the occupational therapy third framework, Third Edition, I just printed our framework, which is, you know, our document that kind of outlines from the videotape perspective, this is what our scope is right? And I just went through and I wish I had kept that document because I highlighted every part of it that I felt like applied to foster care specifically, and was like, Is this our scope? Right? Like, do we have a place in this field of practice? And the whole thing was marked up and I was like, No, I think we did. You know, I think we do have have a space in that and then the only way that I really ended up getting connected with other people who also believed that who were doing work on it but just in different parts of the country is our State Association Conference, and they had advertised this like pediatric track they were gonna have and somebody backed out, you know that happen? It's like they've advertised, we're gonna have this pediatric session, and the person didn't, you know, for whatever reason they couldn't come. And so they called me a little bit in, you know, in a panic, and they're like, We know you work in a kid's clinic, can you come up with something, you know, to present? And I was like, well, it's gonna be different. I said, because here's the deal, like, all I'm thinking about right now is foster care and OT, and this idea of trauma, keep reading about, and I'm just really thinking about that. And it's basically going to be about how we need to do better as a profession. So like, if you want to lecture, that's what I'm gonna talk about, because that's what's on my mind. They're like, sure, whatever. Thank you for coming, you know. And so that's the presentation I did. And I really just talked about how we have a responsibility to step up specifically for the foster care community, and that our profession wasn't doing enough. Well, it just so happened that at that conference, it was actually it was Debbie Heiner filled, she was on the Volunteer Leadership Development Committee at AOTA. And she heard that presentation, and connected me with a group of people at AOTA that were on a community of practice, and doing like, pediatric mental health. And so they connected me with them. And then it just so happened that I met Dr. Amy Lynch through that, who was really passionate also about trauma work, and had been doing it for many more years than me, and I just didn't know her. And so we were able to connect, and we've been doing work collaboratively together ever since. So I always say like, sometimes it's just showing up and putting yourself out there you know, to was like part of how I even was able to learn more, because I was able to meet these other people with a similar passion that that we're doing this work, but in someone in Miami, someone in California, someone in Pennsylvania, you know, and we were able to kind of come together and push the profession a little bit forward, that in ways that I couldn't have done by myself.
 
Carrie Schmitt  I think it's so important for younger practitioners to hear that message. Oftentimes, the change comes from following an interest, a passion and a curiosity. And then connecting with other people who share that interest, that passion, that curiosity. One of the terms that keeps coming to mind when you're speaking because it was like, first I had my occupational therapy lens on then I had my foster care lens on, then I realized there was a sensory basis. Right. And so I put my sensory lens on, you know, and then I realized, oh, trauma is, you know, trauma traumatic experiences, AB underlying, and interrupting a lot of developmental milestones a trajectory in the brain and things. So you put your trauma informed, or trauma responsive care, that the humility that it takes to keep pivoting, I think is something that also keeps jumping out at me, just keep going, just keep learning the next thing, just keep accepting an invitation to speak at that conference, to meet this community of practice, to connect with Dr. Amy Lynch, to take it, you know, just taking.
 
Rachel Ashcraft  Take that next step, and also to be okay with the not knowing right, and to really embrace for me and even still so much as about how much I still have to learn and being excited about that. And being open to that and staying curious about things. You know, I think about to kind of this idea of being curious about things, and then if I can backtrack and kind of apply it within trauma. You know, a lot of the literature in trauma informed care has come out of, you know, historically based work in psychology, and in neurobiology, and going back several decades, which means it was a lot done by primarily white men, right? If we go back and look at kind of what the research is, historically, right, so when they first were looking at aces, this idea of adverse childhood experiences, the first study was in this fairly predominantly white homogenous group done by you know, researchers without using a lens, it's looking more at holistic perspectives, considering systemic and justices things like that, right. So the first the first data that came out of that was all about those just like individual traumas that people experienced as a child. So whether it was child abuse or you know, physical abuse or how household dysfunction or something like that it was these very like individual things that over time as more and more justice occurred within academic spaces within research spaces, and that's not at all to say that that's been achieved. But as more and more voices were at least allowed in, more and more research was able to be done that expanded that concept to understand not just what this looks like in majority Western white spaces, but what does this look like in all spaces and in global spaces, and when we look at the global majority, racially, when we start looking at systemic and justices that occur, and there are some things that were wrong, you know, there are some things as a group that have really expanded and come to understand a lot of interventions that we need to be doing have to look at systemic injustice. Before we even get to some of the more individual things, and how are we also participants in that system? And are we doing the work we need to do to make sure we're not re traumatizing individuals. But I guess I say all that to say like staying curious, because so much of that has come out of pushes for more justice and more equity in the way we even consider even in the way we ask questions, you know, and who's invited to the table for those questions? And who's doing that research. And I've learned so much now from, you know, the people who are doing trauma and trauma work in spaces where they're looking at intersectionality, right, between different identities and how those things impact people and how systems of oppression impact people and not just these individual experiences to tell.
 
Carrie Schmitt  Tell us for people who are listening and interested in curious about taking their curiosity on this topic or the little maybe that they already know, and integrating some of this intersectionality some of the bigger justice issues, who are a couple of voices that you are listening to in this space that we could be exposed to that we could go look at their work.
 
Rachel Ashcraft  The three four, I would say in occupational therapy that have pretty accessible online platforms are Dr. Kalia Johnson, and Dr. Ryan Lavalle. They have a podcast called Doctor thoughts. But I listened to them a lot and they have a lot of really great conversations surrounding just justice and accountability for our profession to which is has just been really helpful to have a lot of fun conversations too. So I like to listen to their voices. Dr. Alaa Abu Arif also is someone who has a online presence. He's an occupational therapy therapist in California, he wrote a chapter in the trauma textbook on racism and has brings a really I find a really helpful perspective has research has been on bias within the within the occupational therapy profession. So looking at explicit and implicit bias, specifically within OT, which is is an enlightening and hard work. That is important work that he's been doing. And then Sheila with disruptive T is out in the California area as well. And that's she has a social media presence, disruptive T and then also a website. And they do like training events and free events that you can go where she has different speakers of different identities speak and talk. And so those are some of the OT voices I'm really listening to. I'm really inspired by the work of Reza and then I come he does a lot of work within like somatic experiences of trauma specifically related to racial trauma. He wrote the book, my grandmother's hands. And so if anyone's familiar with that book, I find it I found it really helpful. One thing that, that I noticed is that in this conversation surrounding trauma, is SAMSA has put together six principles of trauma-informed care. And I think of those almost in my mind as like a gatekeeper of, if you're not doing those six principles, then you're not really doing it. Right. So like people will say I'm doing trauma-informed care different people mean different things when they say that right? And there's actually been a movement kind of away from that term. Some because people mean different things when they say that and some people are not doing this the work to make sure they're not re-traumatize Seeing people in this kind of systemic consideration. But the sixth principle of trauma-informed care, according to SAMSA is consideration of gender cultural, historical trauma. So the idea being if you're not including that, it doesn't matter if you're doing the other five, you know, and so what I find is a lot of the models that have come out over the years, they might have the first five, but they don't really address like, How are you holding those practitioners accountable to not engaging in other systems of bias? Your presenters in season two talked about when they did the anti black black experiences that autistic children have? I don't remember the name of that
 
Carrie Schmitt  Anti black racism in some pathway?
 
Rachel Ashcraft  Yes, So.
 
Carrie Schmitt  You were just missing all the barriers to particularly they're looking at the population of black children and their caregivers who are seeking acknowledgment of symptoms that might end up in the diagnostic pathway. And the barriers they encountered was what their research was around.
 
Rachel Ashcraft  Yes. So when I was listening to that, I was thinking of how that applies to the kids I see. Even if the autistic diagnosis isn't the conversation on the table, but definitely for that as well. But with kids who've experienced trauma, those kids are more likely to be labeled as a behavior, you know, a behavior problem than a child who's experienced harm, and you see, like racism and things like that start to scaffold within that community as well. I was just thinking, that's the perfect example. How are you holding professionals accountable to not engaging in that bias? That actually is a trauma to people as well, you know, so that conversation goes so deep.
 
Carrie Schmitt  Thank you for referencing that. Because one of the things I loved about their research was that they really helped to point us in the direction of taking action, meaningful action, to make change. And I hear that and your drive to that you have recognized some injustices you use experience, you know, had an experience where you were trying to seek services for the foster children in your care and encountering barriers, and started asking questions and came up against some systematic issues, right. And then your strong sense of justice brought you forward into and called you to action. So I do love kind of the intersection of those two conversations, I keep going back to some curiosity around people who don't understand even the basic issues surrounding trauma. So we started this conversation talking about foster children, children in foster care who entered your home. For some people, it might be obvious that those children might have encountered trauma in their lives that were impacting then impacted in their brain or developmentally impacted them. I also heard you say that as occupational therapists, we have a place both in caring for people in foster care, but that we're often encountering individuals with trauma histories that might not be advertised or might not be obvious to us. So in your case, a child was temporarily removed from their care system caregivers, placed, hopefully temporarily in your home until circumstances would allow reunification. And so there was a relationship that was temporarily hopefully impacted. But we recognize in that, that when relationships are interrupted and a child needs to leave an environment that they were previously in that that might be experienced, as traumatic to their little systems. Absolutely. But let's dive into that a little bit. Like what like maybe defining trauma, okay. What is it about maybe children and foster care that make them a little bit more vulnerable but also So how do we take that to every client who walks through the door, who might not have a history of needing foster care? So we don't, you know, taking it outside of the context of fostering, but may have also experienced, you know, trauma in their young lives.
 
Rachel Ashcraft  Yeah. Okay. I love this question. So the idea of trauma is really that trauma has occurred, whenever there's an event, or a series of events in someone's life, that makes them feel unsafe, or where they actually are unsafe, and in an extreme way, in a way that's going to carry lasting effects for their physical, mental, social, cognitive, spiritual well being. So it's not just oh, I had something stressful happen, I'm okay, it's this, this thing happened, or this series of things happens. And I am not the same anymore, because that happened. So what we know that's very interesting is that actually, the impact of trauma of an event like that that can happen starts as early as in utero, and then can permeate. Of course, you can experience an event like that at any point in your life. But an experience of in utero could even be if the mother is in our personal violence situation, or in a situation where there's extreme stress where the there's even physical harm, the stress and trauma of that mother will actually be passed hormonally on to the infant and the infant's brain as it's developing will wire for harm, the brain will wire to protect itself from harm. And so the way that can even look when we're talking about sensory health is an infant in development in a like fetal development stage in utero. Who mother is at physical harm risk, that infant May, and we see patterns of this, it doesn't mean it will always happen. But we do see patterns that infant's brain and sensory system may wire where they dissociate from pain from depression, that might turn out to be an individual who seeks a lot of proprioceptive input or is under responsive to proprioceptive input, who does not register pain, right? Who then engages in the sensory experiences that they're seeking out to meet their sensory needs, in ways that may not make sense to others. But when you understand how their brain wired, it makes a lot of sense. Not just one example. But then at any point in life, you can have these experiences for which are forever altered. But if those experiences happen from in utero, till 25, the brain is still developing, right? So anytime there's experiences during that period of someone's life, it just means that the impact has the potential to be that more significant, because the wiring of the brain will shape to adapt for that. And so what we'll see is we'll see differences in people's sensory needs, we'll see differences in what situations they do or don't feel safe around though, you'll see differences in how they engage socially what relationships feel like to them. Because the brain has wired to adapt for survival. And so if if someone's brain is wired to adapt for survival, then that's going to be the response they go to first, even in situations that may not seem like it makes sense for that.
 
Carrie Schmitt  When you're speaking. I love that you're highlighting that we are all sensory beings, that experiences with a negative valance in which we lose our agency and our safety, hmm. are traumatic experiences. Yes. And so we recognize in sensory work. When a system experiences a sensation, as threatening, and it activates their sympathetic nervous system, and they experience that over and over and over, that that can be a traumatic experience. I think trauma thankfully, is in our vernacular and is in the collective consciousness now, but it does seem like something that can be overplayed and can be misunderstood, or only understood. As one thing, which is incredibly traumatic events, like a war experience for a soldier. And so understanding trauma on a continuum, I think is super helpful for practitioners, that when we encounter people to your point, who may have stored implicit memory in their body as and negative sensory experience in which they lost agency in which they lost their sense of safety or trust, in which they didn't have adequate resources to respond in the moment, that reconnecting with their body can feel.
 
Rachel Ashcraft  To them, yeah, into them.
 
Carrie Schmitt  And so you had mentioned that we might see that people detach a little bit from their body as a protective mechanism, because of their history. And when we detach from our body, when we detach from our agency, when we detach from the ways that we can act in the world, sometimes that shows up in not accomplishing developmental tasks that you might otherwise expect that child to do. And so we should always question if there seems to be some some interruption or some task that is on there unable to accomplish. What underlies that? And, you know, is there potentially a sensorimotor experience that underlies it? Even if it's not labeled a trauma, right? Was there something that they experienced in their bodies, that was a threat that disrupted their agency that disrupted their their sense of trusting themselves or trusting other people?
 
Rachel Ashcraft  Yeah, I think that's such a good point. And this, I love that idea of you're saying that we're all sensory beings. And really, whenever your safety is violated, that is experienced as a trauma by our bodies, and by our brains. Bruce Perry, who has done a ton of work, although I would recommend if to any readers that haven't already read what happened to you, by Bruce Perry. Also, the audiobook is very good, because it's an interview between him and Oprah. And they read it. So it's very, it's an engaging, listen. But he has the model in an t that some people may have heard of before, but he talks about the brain in the way of, of it processing where you have to be regulated within your brain, and then you can have relationship, and then then you can reason, right, so you have to regulate be regulated, you have to feel safe in your body, before you can really access that higher level reasoning. And so what we know is that, like you were just saying these kind of like, classic traumas, I guess you would say, of these things that we would all recognize, like if a child's abused a certain way, we're all going to agree that that's a trauma, right? So there's these things that are so big, so egregious things that if they happen multiple times, or you have these kinds of scaffolding of experiences, that no one's neurology is really going to come out regulated, right? Like, in the literature, we see four aces as kind of a tip point where you start to see kind of a snowball effect of poor outcomes. Basically, it's almost like once you get to that point, very few people have the capacity to come out kind of without some kind of impact. But what we can't say is the flip of that, is that, oh, well, if this one thing happened, it shouldn't have been as traumatic as so and so's XYZ experience because the response is entirely about how the body and the brain regulates with that. And then we can take that approach and consider this idea of sensory health, and how some people's bodies themselves are traumatized by environments that do are experienced as unsafe, you know, or people experience being in their body as unsafe, you know, and so then that's where I think this meshing of a trauma informed approach with a really like affirming sensory health approach really makes sense. Because it's not really about labeling levels of trauma. It's not really about saying, you even have to know every detail of what happened in somebody's story, but it's about affirming that until you're regulated, you don't get to be to your fullest self, and that everybody deserves to be regulated, and everybody deserves to be their fullest self. And so if you can bring that lens to it, then we start being able to have compassion for our clients, but also for ourselves also, for our co workers. Also for, you know, everyone involved in a system, if we're able to come with that lens of, we all have a past, that might impact our regulation. And when our regulation doesn't feel when our isn't there, and we're not feeling safe. We don't we don't have the opportunities to be who we fully want to be, and that we all deserve that.
 
Carrie Schmitt  Thank you. Because I think that is a message that any practitioner can take, any person can take into relationship, any parent can take into their home foster parent or their parent. When we prioritize regulation, nervous system regulation, our own and those that were charged with their care, build upon that with a tuned relationship, established sense of safety in their environment, and within the context of that relationship, then so much more as possible, right in embodied cognitive experiences. But those embodied cognitive experiences rely on information that helps us prioritize regulation and relationship. And so thank you for bringing that kind of full circle. I feel like we could talk on and on and on. And we might have to do like a part two, because I know there's so many people out there, both occupational therapy practitioners, but also people involved in the foster system that could really benefit from what you're learning. So maybe we'll have to see about having further conversation. I do want to ask, though, like, we've been talking a lot about how you and your life have followed passions, how you have followed curiosity, how you have sought to stay humble intellectually, so that you could learn from what the literature is teaching you what other practitioners are learning. So what is one thing that you can think of that you used to believe that now your either your thinking has really evolved on? Or you've kind of changed your mind about?
 
Rachel Ashcraft Yeah. So I think the first thing would be really this idea of understanding, understanding systemic harm, and my role in it, you know, and really being open to questioning where have I participated in that? Where have I been hurt people and didn't realize it, you know, whether it was from, you know, ableist, thinking, you know, or just not understanding the full picture of racism within our profession, right, and what my responsibility is for that. But I think one thing that I've really used to believe that was wrong, is I graduated school. And the time when we really talked about what we really didn't talk about neurodiversity. In that paradigm, we talked about disability in ways that were that kind of like, not affirming, I guess, I would say, you know, not neuro neurologically affirming of everyone's experience, right. And so I was taught really, under this whole idea of, of, I mean, what I would really consider ableist around, like the Autistic community, specifically, and really just had some wrong thinking about that, and kind of what my role was in that, and this idea of that being something to be sad about, or something that needed to be fixed, instead of understanding that like, really, I needed to be fixed, right. And the approach I brought to the table is what was sad, and understanding that like, really, where have I caused trauma by not understanding a neuro, you know, a really neuro affirming way of being and embracing sensory health as a spectrum that we all have, right, and understanding that and so I think, really, the work that's come out of the star center, and specifically, Virginia Spielmann, a lot of her work that she's done has been so helpful and instructive to me and you know, I think I hope that that my language around that and that my practice around that sounds really different than it did when I first graduated school and had learned some things that I just don't agree with anymore, and I hope that I keep learning and keep doing better, you know.
 
Carrie Schmitt  Thank you. It's really inspirational. And I think it is a call to action for all of us practitioners to try to examine where we hold knowledge or biases in our own practice, that are not serving us or the people that we are encountering. So thank you for modeling, learning and unlearning. The hardest work of all learning, right? No, thank you for being willing to go first, to show you know to do some of that work and then to turn around and share it with your students at UAB, which I think is, you know, going to change the way that we educate occupational therapy practitioners for the better, which is super important. Well, thank you so much for being here today. If people want to connect with you or with your work, where would they find you?
 
Rachel Ashcraft  You can find me on Instagram at Rachel underscore Ashcraft underscore OT, or on Twitter at Rach underscore Ashcraft. Nine or you're welcome to email me as well. If you want to look me up on the UAB website, my email is there as well. So
 
Carrie Schmitt  Great. Well, thank you so much. I really appreciate your being here today.
Rachel Ashcraft  Yeah, I appreciate you having me.
 
Calls-to-action:
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Find out more about Rachel Ashcraft, MOT:
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Rach_Ashcraft9 on Twitter
https://www.cicerotherapies.com/team/rachel-ashcraft-2/
https://www.linkedin.com/in/rachel-ashcraft-31484a201/
Find the host, Carrie Schmitt, on Instagram @carrieschmittotd

Making Sense Season 3 is Sponsored by Summit Sensory Gym

Making Sense Season 3 is Sponsored by Our Community Partner Summit Sensory GymAre you an occupational or physical therapist struggling to excite your patients with different therapeutic activities, or even worse are finding that your therapists and more importantly your patients are tired of the same old therapy? If you're like most practices are organizations, acquiring new patient referrals and converting them into ongoing patients is often very expensive and time consuming.
This fact was proven in a recently completed survey of 500 patients. The outcomes of the survey showed patients are 18% more likely to cancel or no show their therapy session if they expected the therapy session to be a repeat of a previous session or lack any excitement. Have you ever wondered if there was a way to reduce patient cancellations and amplify a patient's therapy experience? Well, we've got some good news. This doesn't have to be the case with your practice or organization. Introducing Summit Sensory Gym, the industry leader in freestanding sensory therapy gym structures.
Summit Sensory Gym is passionate about creating unexpected adventures through our multifunctional gym packed with all the therapeutic benefits you've always desired for your patients. Our freestanding sensory gym structures encourage patients to explore and learn fundamental lessons by inspiring imagination, adventure and learning.
Whether you're looking to replace an existing therapy structure or design a custom sensory gym for your new facility, our commercial gym equipment, accessories and design capabilities will not disappoint. Summit Sensory Gym is fully equipped to take your visions of the perfect therapeutic gym structure and turn them into reality. Our time proven process finally calibrates these dreams into innovative, functional and life changing therapeutic assets that will help the lives of those we care for most.
As the industry leader, we are proud to be the STAR Institute Community Partner. For a limited time Summit Sensory Gym is offering a $300 shipping credit for all sensory gym purchases. To learn more about Summit Sensory Gym, please visit us at summitsensory.com or give us a call at 720-457-5500.

The Shift to Neurodiversity-affirming Psychological Assessment

The concept of neurodiversity is credited to a sociologist named Judy Singer. Neurodiversity recognizes and pays respect to the diversity of human minds, and the infinite variation in neurocognitive functioning within our species (Walker, 2014). Today, listen in as two clinical psychologists, Dr. Courtney McDonnell and Dr. Jared Kilmer, discuss what a neurodiversity affirming assessment pathway could look like.
 
Episode guests: Courtney McDonnell, Psy.D. & Jared Kilmer, PhD
 
Resources Mentioned In this episode:​
Game to Grow: https://gametogrow.org/
Personality Assessment Inventory (PAI): https://www.parinc.com/Products/Pkey/287
Ritvo Autism Asperger Diagnoistic Scale, Revised (RAADS-R): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134766/
Neurodiverse affirming therapists Facebook group: https://www.facebook.com/groups/2219847184963504/about/
Dr. Joel H. Schwartz: https://www.psychologytoday.com/us/therapists/joel-h-schwartz-torrance-ca/161994
MIGDAS-2: Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Editionhttps://www.wpspublish.com/migdas-2-monteiro-interview-guidelines-for-diagnosing-the-autism-spectrum-second-edition?utm_term=migdas&utm_campaign=Search+%7C+Autism&utm_source=adwords&utm_medium=ppc&hsa_net=adwords&hsa_tgt=kwd-331660223516&hsa_ad=376185522396&hsa_acc=6243382947&hsa_grp=71450949288&hsa_mt=p&hsa_cam=1687564772&hsa_kw=migdas&hsa_ver=3&hsa_src=g&gclid=CjwKCAiAxJSPBhAoEiwAeO_fP4K9m73E7GIkPMECCPpN6NuznTdqsAxCElhIq0AC1xu0L9kCL03Q2RoCnhkQAvD_BwE
How to ADHD on YouTube: https://www.youtube.com/c/HowtoADHD
Walker, N. (September 2014). Neurodiversity: Some basic terms and definitions. http://neurocosmopolitanism.com/neurodiversity-some-basic-terms-definitions/
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Evidentiary support for Occupational Therapy’s Role in Empowering the Occupation of Caregiver in those caring for Autistic Loved Ones

Evidence-based practice is vital to focus the OT lens and voice in the autism community.  Occupational therapists are in a position to recognize the importance of the occupation of caregiver and provide evidence-based support in intervention when working with all clients. Today, we focus this conversation on autism intervention science.  Listen as this conversation unpacks the value of research in guiding us towards essential ingredients in support of caregiver agency with a focus on the parent-child dyad.
 
Episode guest: Carrie Alvarado, Ph.D., OTR
 
Resources Mentioned In this episode:​
Autism Community Network https://www.acn-sa.org/
Developmental, Individual Difference, Relationship-based Model training (DIRFloortime® model https://profectum.org/training-programs/training-2/
Green, J., & Garg, S. (2018). Annual research review: The State of Autism Intervention Science: Progress, target psychological and biological mechanisms and future prospects. Journal of Child Psychology and Psychiatry, 59(4), 424–443. https://doi.org/10.1111/jcpp.12892
Pediatric Autism Communication Therapy https://www.pacttraining.co.uk/
Profectum Foundation https://profectum.org/
 
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5 Concrete Action Steps for Clinicians to Take in Response to Anti-black Racism in the Autism Clinical Pathway

The clinical pathway for Autism services is complex. Anti-black racism within that pathway is well-established in the literature.  This pervasive, systemic racism affects every step of the pathway from early caregiver concerns to accessing intervention.  This conversation begins with raising awareness around this issue and ends with five action steps clinicians can take to respond to the anti-black racism in the autism clinical pathway.
Episode guest: Aksheya Sridhar, M.A. and Diondra Straiton, M.A
Resources Mentioned In this episode:​
Beagan, B. L. (2021). Commentary on racism in occupational science. Journal of Occupational Science, 28(3), 410–413. https://doi.org/10.1080/14427591.2020.1833682
Farias, L., & Simaan, J. (2020). Introduction to the Anti-Racism Virtual Issue of the Journal of Occupational Science. Journal of Occupational Science, 27(s1), 454–459. https://doi.org/10.1080/14427591.2020.1824567@rocc20.2020.27.issue-s1
Grenier, M.-L. (2020). Cultural competency and the reproduction of White supremacy in occupational therapy education. Health Education Journal, 79(6), 633–644. https://doi.org/10.1177/0017896920902515
Kronenberg, F. (2020). Commentary on JOS Editorial Board’s Anti-Racism Pledge. Journal of Occupational Science, 27(s1), 398–403. https://doi.org/10.1080/14427591.2020.1827483
Primary Care Clinical Pathway for Autism Screening and Referral: https://www.chop.edu/clinical-pathway/autism-screening-and-referral-clinical-pathway
Project Impact: https://www.project-impact.org/
Straiton, D., & Sridhar, A. (2021). Short report: Call to action for autism clinicians in response to anti-black racism. Autism, 136236132110436. https://doi.org/10.1177/13623613211043643
Straiton & Sridhar resource website: https://autismlab.psy.msu.edu/resources/anti-racism-resources/
 
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The role of Pre-conscious Sensory Processing in Embodied Occupation

Occupational therapists recognize the importance of occupation to well-being. This episode explores the essential contribution of sensation to the way occupation is expressed in humans. From socio-cultural experiences to sensory habits, listen as Drs. Bailliard and Schmitt explore occupation with a wide lens. Episode guest: Antoine Bailliard, Ph.D., OTR/LResources Mentioned In this episode:​
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001
Atzil, S., Gao, W., Fradkin, I. et al. Growing a social brain. Nat Hum Behav 2, 624–636 (2018). https://doi.org/10.1038/s41562-018-0384-6
Dr. Bailliard’s Keynote at Colorado State University: https://www.chhs.colostate.edu/ot/outreach-and-engagement/ot-knowledge-exchange/ot-knowledge-exchange-keynote-speaker/
Bailliard, A.L (2013). The Embodied Sensory Experiences of Latino Migrants to Smalltown, North Carolina. Journal of Occupational Science, 20(2), 120-130. DOI: 10.1080/14427591.2013.774931
Bailliard, A.L., Carroll, A., & Dallman, A.R. (2018). The Inescapable Corporeality of Occupation: Integrating Merleau-Ponty into the Study of Occupation. Journal of Occupational Science, 25(2), 222-233. DOI: 10.1080/14427591.2017.1397536
Clear, J. (2019). Atomic habits an Easy & proven way to build Good Habits & Break Bad Ones. Penguin Audio, an imprint of the Penguin Random House Audio Publishing Group.
John Dewey: https://plato.stanford.edu/entries/dewey/
Frank Kronenberg: https://www.researchgate.net/profile/Frank-Kronenberg
Lisa Feldman Barrett: https://lisafeldmanbarrett.com/
Maurice Merleau-Ponty: https://plato.stanford.edu/entries/merleau-ponty/
Pierre Bourdieu: https://www.britannica.com/biography/Pierre-Bourdieu
Van der Kolk, B.A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
 
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