Thursday Apr 06, 2023

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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