Most of us learn sensory modulation as a volume dial: turn some inputs up, turn others down. This episode keeps that starting point and then blows it open. The brain is running many dials at once, and underneath all of them sits a single question, am I safe? We trace modulation from neuroception up through the whole cascade of arousal, emotion and social engagement, and land on why regulation is the foundation everything else is built on.
We pick up the thread we left at the end of last episode and dive into sensory modulation, with the upfront caveat that it is a huge, genuinely confusing topic that takes years to settle. We start where most of us start, the volume dial of turning inputs up and down, and the engine-idle metaphor from the Alert Program. Then Tracy complicates it productively: the brain is not one dial but many, dialling up a voice while dialling down hunger, clothing, and the fact that it is dialling at all. That deeper question of what state we should be in is what modulation actually governs.
From there we connect modulation to state, arousal and neuroception. Tracy walks the full cascade, from the sensory evaluation of safe versus threat, through reflex arcs, autonomic activation, emotion and the social brain, up to the prefrontal cortex, and explains why the old linear under- and over-responsive continuum is giving way to a double-valence model in the newer sensory integration texts. We finish on the clinical heart of it: the L-shaped arousal graph Michelle and Tracy use to map state and the window of tolerance, and why treatment means bumping those edges adaptively to widen the window. Part 2 will take this into intervention planning.
Lightly edited for readability. Speaker labels and chapter markers match the published episode.
Cory: Hello, welcome back, episode five. Here we are. Hi Tracy, hi Michelle, how are you guys?
Tracy: Good, Cory. Hello, Trace. I am so good, great to be back again, you guys, and ready to have another fun conversation with you.
Cory: We are going to jump into modulation. We started to talk about it a little at the end of the last episode. I just want to let everybody know this is such a big topic, and it was really confusing for me initially. So be okay with the process. It might not all make sense, and I am still learning about this seven years in. It will come to you as it comes, and as you pull this stuff together, just keep coming at it. This conversation lets you be part of that.
Michelle: Every time you talk about it, you add another little piece, so I do not think we will ever be done, and the science is moving so fast that we are not going to shut the file on this. We are going to keep coming at modulation, and kids, and how it gets impacted, continually.
Cory: So I am going to put together my words around this concept, knowing the way I have put it together is probably more basic than it actually is, but that gives us a way to talk about it, and we can refine it. When I think about sensory modulation, I go back to my initial traffic-jam-in-the-brain and volume-dial idea. Jen was the first person to introduce me to that concept. So I always think about the nervous system’s ability to turn the volume up, or enhance certain inputs, and its ability to turn the volume down, or dampen, inhibit and reduce other inputs. That function lets the nervous system organise and pay attention to what matters, though that is a dicey word, because if the brain is in a different state, different things matter. So it is being able to dial up and dial down to match the situation or the environment. That is how I have put it together, but there is so much to it.
Michelle: Cory, that is how I think about it as well, probably from Jen too, and that is how I explain it to families and educators. It is still a really accessible way for parents and kids to understand it for themselves.
Cory: For me it is now, well, what are the mechanisms behind that? The brain’s ability to do that is complicated, so understanding the how and the why of how it gets organised lets you intervene, support the function, and know when it is getting disrupted, and separate that out from everything else. If I just say the child cannot match the environment or the demand, you have to separate whether that is a modulation issue or a postural issue, because there are so many ways a child might not be able to match the demand in front of them. So let us talk about modulation. What do you think, Tracy?
Tracy: I love it. Starting with that basic concept of dialling up and dialling down is a great place to start, but then the brain is not one single dial.
Tracy: Maybe the first place to start is to shift into the idea that if you are trying to dial in to paying attention, maybe to our voices right now, or to a teacher’s voice in a classroom, or to my friend’s voice on the playground, what that means is you are actually dialling up their voice while you are dialling down the hunger you have because you have not eaten lunch, or dialling down the feeling of your clothes because they were itching you. So the brain is doing this simultaneous dialling up and dialling down of multiple functions. And the harder it works at that, the more the brain is also having to dial up and down the fact that it is dialling up and down, which is deep and hard to explain. So that is actually what modulation is: the deeper question of what state we should be in right now. Sometimes we use that word state as a descriptor of the regulatory how, how you are showing up, how you are present in the world. So when I say state, we are going to connect sensory modulation and state together, and that is a big leap, a leap of neurological faith. So when I say state, what does that mean to you in relation to sensory modulation?
Michelle: I think about it in terms of state of regulation. Before we get neurological, I explain it like a car having a basic engine idle speed. A Ferrari, when it idles, revs higher and has capacity for more intensity and power, whereas a Toyota Corolla, or a Mazda, which is actually my car preference, we have no sponsors, idles lower. Bodies are the same: we have an idle-speed state, and it can change so we can match what we are required to do internally and externally. So I go from a base idle speed, and I move my state up when I am about to do a podcast, and then in the middle of the podcast I might put my gears down, into first gear, ready to pay attention and really think about what I am doing here now.
Cory: I have a very similar thought about it. I do not always use the car analogy, but it is a helpful way to think about it, because pushing a pedal down to increase speed feels similar to the nervous system’s ability to ramp up, to increase the arousal or state where there is more activity and energy, more heightened, a readiness. I am not even thinking about going too far yet, just your ability during the day to shift and match your own state. I think about state as the reflection of the nervous system’s ability to match the environment. If I need to read, I cannot be too revved up, I need to shift my state down. If I have a lot of energy, I might need to do ten big bounces on the lounge, or burpees, or ten pikes, like in cheerleading where you jump up and touch your toes in front of you, and then I am ready to settle into the pillows. But that is just me, because my baseline, my idle speed, my base state, is different from other people’s.
Michelle: I think the window-of-tolerance and idle-speed idea comes from Dan Siegel and Pat Ogden’s model of modulation, and people talk about it with different terms.
Cory: That is the other thing, there are so many different terms for the same thing.
Tracy: So we danced from sensory modulation, to the word state, and connected state to the window of tolerance and arousal theory. State in relation to arousal is that idle speed when you are ready to go, whatever ready is for you, a certain energy, and that energy has a quality of activation to deactivation. That is individually different based on personality and temperament, but also on the environment, relationships and context. If you needed to drive on a challenging, bumpy, skinny mountain road, you would not choose the Lamborghini, the fast fancy car, because you would be more dangerous. In a parking lot, every vehicle idles at a different speed and has different capacities, and we match our safety and our experience and our adventurousness to the possibility. That is what arousal and the window of tolerance are about, and sensory modulation is one source of the dialling up and dialling down of that. If you only have a really fast car but have to drive on a scary road, you can use your brake a lot, put it in a low gear, control those factors, if you know how to regulate the car. If you know how to regulate your system, your brain, you can manage lots of scenarios. But sensory modulation problems limit those control factors. If your little nervous system does not manage this well, you do not know how to use the brake, or the accelerator, or you only have full on and full off, without the ability to grade and control it. So that is one critical component of state: what is my resting idleness, and what is my ability to ramp up or ramp down, push the brake or push the go, and move between those places?
Cory: I love it. I realised when you first asked us how we put state and sensory modulation together, I did not actually answer the sensory modulation part, but you did it beautifully. In terms of the ramping up and down, we as occupational therapists think about how sensory inputs support the ramping up or down. Is that how state and sensory modulation come together, that the modulation piece is so critical to state because input shifts the nervous system’s ability to go up or down, or vice versa?
Michelle: Or vice versa, that if you are not integrating sensory input, you cannot adjust your modulation.
Cory: Yes, if you are not integrating sensory input, you cannot modulate your state. I know it is more complicated than just sensory modulation, it is not only sensory input that shifts state, but that is what we are going to talk about today. Is that right?
Tracy: That is exactly right. The other thing the sensory modulation function does, and it draws from detail, so it draws out of sensory discrimination, is that it tells you, when you get into the car to go, when you enter an experience or an interaction, is your seatbelt on? Do you feel snug, secure, bounded by space? Do you feel a sense of, I am here, I have arrived, I am present and I am safe? If the answer to those questions is yes, yes, here you are, yes you are safe, yes you can engage, then it can dial up and dial down. So the sensory modulation function tells you, am I safe or not, am I engageable or not? If yes, proceed with the go or the no-go. If no, it tells you, you do not have the freedom to go here, you do not have the freedom to start and stop, and we are going to start making those decisions for you, because we have to protect you and keep you safe.
Tracy: So sensory modulation informs the go, no-go of the modulation circuitry, but the very first question it answers is the safety question.
Cory: Is that through the limbic system? The sensory input coming in through the reticular activating system, up into the limbic system? I know some people may not know these terms, so take it as you like and ignore them if you want. Is it through the reticular activating system up into the limbic system, and into the immediate, how is that happening?
Michelle: And then to the frontal cortex. Is there still cortex involvement too?
Cory: How is that happening? Information is coming into the nervous system, and then it is getting evaluated somehow for threat or safety, right?
Tracy: That is exactly right. The first key word there is evaluated. The information gets evaluated, first for, is this a good thing or not a good thing, a soft, touchy thing I want to experience, or a threatening, spiky thing I do not want to experience? On the first level, that is a sensory question. Then it gets processed. If the answer is, this is not safe, then there is immobilisation across the circuitry. It actually starts in the reflex arcs, not even in the brain, all the way down in the body, where you are turned on to be faster, to move away, to withdraw, to have a reflex that withdraws from the hot thing, the spiky thing, the uncomfortable thing. So it mobilises your phasic muscle activation and moves you away from the source of threat. Then in your brain it mobilises the activations and energies that protect you. It moves through the reticular and arousal systems, but right away it starts to interact with the diencephalon, these deep circuits related to the autonomic nervous system, and that autonomic activation shifts you out of engagement and into protection. It activates that fear, fight or flight responding. If the threat is really significant, if the thing you saw or touched was a humongous threat, it might freeze you or shut you down. So you get this mobilisation or demobilisation in the autonomic nervous system, and then an emotional response, and that emotionality recruits the social circuitry, which makes you wonder, is there a person here to keep me safe, what would my mum do, who else can I think about to help me problem-solve? So right away the social brain, and then the prefrontal cortex, also get involved in problem-solving. That is a cascade right up the hierarchy of layers of the nervous system, and it happens a little bit in parallel and a little bit sequentially. So look at that, we went from the peripheral all the way through the central nervous system, talking about sensory processing as well as arousal, emotional, autonomic and social processing. It is big. That is why, when we say state, it is not one thing, it is humongous. So I am wondering what questions that brings up for you guys.
Michelle: When we did that dance across, in trying to get my head around all of this I have read different authors, and there are a whole lot of different languages and concepts about different elements. What we know is that the brain is really integrated. Traditionally we have thought of the brain in different parts, the idea of the triune brain or the hierarchy of the brain, and it is easy to tease it all apart and put it together like a Lego box, but the brain does not work like that, it is much more fluid and integrated. So I wonder, the idea you just raised about the body’s feeling of safety or not, I know Stephen Porges’s polyvagal theory talks about neuroception. When you mentioned the senses evaluating whether they are safe or not, is that the same concept Porges is talking about with neuroception, and the cascade you described, where if it is evaluated as a threat you get that cascade of the autonomic nervous system, the sympathetic activation and the mobilisation? That sounds like polyvagal theory and neuroception, is that right?
Tracy: That is exactly right. Here is where there is an interesting and important layering of information, and also a bit of a disconnect. In the traditional, not so much the Ayres sensory integration theory, because Dr Ayres defined sensory modulation as the ability of the nervous system to maintain harmony across all of these functions from a sensory foundation.
Michelle: I have got goosebumps, that is so lovely and so neurologically correct.
Tracy: It is cool, right? It is this ability of the nervous system to do all of what we started to talk about at the very beginning, but there are lots of dials, not one, and those dials are all responding to keeping the person in a state of adaptation. The foundation of adaptation is neuroception. Porges’s concept of neuroception is that the nervous system has the ability, on a sensory, interoceptive, very deep level, to discern whether something is safe or not, whether there is safety or protection available, and if you are in a state of threat, to relatively dial up or dial down, activate or deactivate. So neuroception is this double-balanced function of safety-threat versus activation-deactivation, and that concept of a double balance is critically important. Even though it is a Porges concept, and not everyone talks about it from a Porges viewpoint, from a classic neuroscience perspective we know those two valences exist at the level of every single cell, through the whole system, and into the whole way the brain produces behaviour. So we have neuroception as a base. But in the OT literature there has been a funny disconnect, not from an Ayres perspective, but in the broader sensory processing literature.
Tracy: There has been this discussion about how things are either under- or over-responsive, hypo- or hyper-responding, and that became a linear continuum where you are either under or over. But it does not interact with that double valence. So under and over is not a very helpful concept, and actually in the new Sensory Integration: Theory and Practice textbooks there is a real movement away from this simple linear continuum, which I have been waiting for for a couple of decades, so I am really excited.
Michelle: It better aligns with the actual neuroscience and neurobiology, the mechanism.
Cory: That was my question, actually. When you talked about the child who sticks their hand on the spiky thing, part of that reflex arc, I was thinking, what about those kids when it is not spiky, but they react as if what they touched is that spiky thing? Traditionally people would say they are over-responders, but there are instances where that child will not react that way. That makes so much sense, because if they are on that second valence, more activated into threat, they might react more to that potential input than they would in a state of safety. So that is why it makes more sense that you might get this inability to tolerate certain things amped up if you are in a perceived threat state.
Michelle: Tracy, refining the literature, I think I already said Pat Ogden and Dan Siegel are involved in this too, with the window of tolerance, which looks a bit different but seems to align. I am wondering about the concept of arousal, because is that the same as state? Are those words used interchangeably, or is arousal more like reactivity at a cellular and neuronal level? How do we define that term, and is it used interchangeably in the neuroscience with alertness, or state?
Tracy: It is a really important question, and honestly, for almost a year and a half I have been working on a big science paper with several other people, and one of the problems has been that we cannot come to enough consensus about what arousal is, because it depends on where you read it. So it is quite a complicated question. In our OT literature, our dear colleagues Mary Sue Williams and Sherry Shellenberger put together the Alert Program, How Does Your Engine Run?, back in the 1990s, used all over the world with a lot of efficacy. It uses that simple car-engine metaphor, back to the beginning of our episode: your basic engine idle, and once you start to engage and participate, is your engine matching just right, or a little too low or too fast? So on some level we can think about arousal that way, a match of energy that is about right for the situation, or a little too high or too low. That is the baseline of arousal, which either runs a little low, a little high, or tends to run just the way it should, and running just right is not a steady state, it is adjusting. Sometimes I am going 50 miles an hour because it is a highway and I should, and sometimes 10 miles an hour because I am in a school zone and want to be super careful. So just-right does not mean one thing, it means I adjust and match what is going on around me. That is the simplest way to think about arousal, but within it you have all these dials. To go 10 miles an hour in the school zone, I have to dial down my thinking about stress at work, my grocery list and my weekend, so I can pay attention that the children do not get run over. My attention has to dial in to my arousal state if I am going to be a good driver. Or say I have never driven a stick shift before, so now I am dialling into my attention to not run over the children, go the right speed, and control my limb as I shift gears. The brain is working harder, and the more it has to think about shifting gears, the harder it is to keep it at 10 miles per hour, because of the simultaneous processing. So state is actually all of that, and that is why it is so complicated.
Michelle: And taking a leap, some of our kiddos, and us, on a hectic day when you have lots going on, might say, I am going to avoid the schools today, that was too hard on my brain, too taxing, too much of my attention and energy to manage safely. I am going around the schools today. That is what we see kids do when they are having a tricky time managing their state: they get sticky about where they go and what they do, they want to avoid the tricky times and take an alternate route, or get lots of rules, I will go past the school but we cannot have the music on, nobody talking, and I am not going to change gears, I am just going to idle past in second and hope the light does not change.
Tracy: That is exactly right. What you just did, Michelle, was connect the whole conversation to the higher-level capacity that sensory modulation fuels, which is what we call self-regulation. Self-regulation is that adaptability we all have to make those decisions, ooh, that is not comfortable, I am just not going to do that. But in a nervous system that does not function well, that is not a volitional decision, it happens to you. My nervous system is so overloaded by sound that I cannot leave my house.
Michelle: So you cannot come up with an adaptive strategy to work around the discomfort of loud sound.
Cory: Can I come back to separating state from arousal? In the driving example, is arousal just how able I am to move my attention and hold myself where I need to be paying attention? I needed to notice it changed to 40 km/h because it is a school zone, and if I can do that, I am managing my arousal in that moment, despite stresses about picking up my child. Whereas state, let me see if I can put it together: now you have amped the task up, I have to drive my manual car, there is a crossing guard, I have to stop, I have not driven a stick before and I have to change gears. So the arousal piece is that I could stay with the task, but now that there is simultaneous processing of multiple things, my state has shifted up. How should I put that together?
Tracy: I think that is how you put it together, but part of it is that we try to put 18 different processes into one word, so it falls a little short. When we train therapists to do clinical reasoning on this, we start with the base of neuroception, what do those valences look like, and then what does that window of arousal look like around that. When you start to bump into the edges of functioning, what is the impact on all the arousal functions? The arousal functions are what we are alluding to: attention, action regulation, managing the stick shift and figuring out how hard or soft to push the brake. But there are others, emotionality and affective processing are highly involved, and again those autonomic functions. We call those the A’s of infancy, and there are these A functions all related to regulatory capacity, informed by sensory modulation. Then you have that arousal state that is not just arousal, it is all the A’s together. So arousal is one, and state is all.
Cory: Got it. Does that help? I think it might. So in one moment you were talking about the optimal range of arousal. If I have good capacities to tolerate a number of things at once, I can maintain an optimal range of arousal with a lot of load. Whereas once I hit the edges of my optimal, if I get too activated and there is too much load, I am shifting into a different state of nervous system. Is that right?
Tracy: Then you are not as adaptive, so the system starts to tell you, wait a second, you need to reduce stimulation. Maybe the sensation is too much, so if you dial down the sensation, maybe you can hang in there with your arousal. Or maybe you dial down your language processing, or your attention, or one of the other A’s. It is a very dynamic, complicated process. What happens with our kids is that in an optimal state of arousal everything works: their sensory responses look great, their safety and engagement look awesome, their attention is good, their affect is great, their action regulation is spot on. This system works as a constraint, a narrowing window, which is why we call it the window of tolerance. As that window narrows, it is more likely you bump the edges, and as our kids bump the edges, you see inattention, hyperactivity, action dysregulation, fear, fight or flight, antsiness and agitation, discomfort in their own skin, over-responding to every little sound, hiding, seeking comfort, dodging out of situations, all kinds of coping, because the window got narrow and they cannot handle it. As the window opens up, you see a return to adaptability. As it narrows, you see chaos, rigidity, a lack of flow, integration and regulation, so we just say dysregulation. But dysregulation is not one thing, it is that whole cacophony, a lack of integration. Dan Siegel talks about how the flow of integration gives you regulation, and regulation gives you integration, a back-and-forth relationship, and that is why we end up treating it, because we are treating problems of integration.
Michelle: That is so wonderful, Tracy. There is so much to get our heads around. When I have a kiddo in the clinic, the first thing I do, and I do it when I look at everyone in the world now, is that concept from STEPPSI where I literally draw an L. Up the vertical axis is the state, so I look at whether they have a lower state of regulation and draw a line across down low. When a kiddo comes in, that is what I am looking at, what state, and not just one time, but over the course of a few sessions, because it is variable, some kiddos are lower because of a new environment, but I am tracking their base state. Then I look at their sensation, specifically their processing and modulation of sensation, how they process sound, taste, smell, vestibular and proprioceptive input, noticing what they might be defensive of, auditory defensive for example, which cues them not to be safe. Then I look at their range of tolerance, that window, and I literally draw two dotted lines across, this is their window of tolerance, they are really narrow, and I note that auditory or tactile input is a cue for them to feel not safe, a threat, which activates that defensive pattern, and their particular profile is to mobilise into a flee state and run. So each new child, and really every session, I am checking state, sensory modulation, and what is adaptive and what might push them out of being adaptive. Is that how you do it on a practical level?
Tracy: That is so exactly spot on, and that is clinical reasoning around sensory modulation and regulation in a nutshell. That is what we have on the left-hand side of the handout, an opportunity to use a sketchpad to draw that L-shaped bar graph that captures arousal state across time, how wide or narrow the window of tolerance is, where it is located, and what happens when the kid bumps those edges. The interesting thing is that we have assessments for problems of adaptation, like anxiety or attention, and we can get a sense of over- and under-responding, defensive responding and variable responding on some tools, but there is no comprehensive assessment that tells us all we need to know. So the only way is what you are doing, drawing it out, gathering that information, and tracking it across time and circumstance to get a sense of the dynamics of this complicated system. So as you have done that, Michelle, how did it change your clinical practice to insert that process into your thinking?
Michelle: It is the information that lets me, in the moment, decide what to do. From moment to moment I am gathering this massive info bank about what is supporting the child and what might be a signal of threat. When that happens, I notice, oh, that was a little flee, a mobiliser response. Were my eyebrows too big, was my laugh too big, did I play too big? I mark down what the impact was, what the input was that was dysregulating, and then I note the things that signal safety for them, so I can help them recover. For example, if they have affect dysregulation, I might lower myself, have a softer face and speak with prosody, signalling safety, helping them know I am ready for them to return, so when they are ready they come back. It helps me work out what state they are in and what we can do in the session. If their state is a bit fragile and dysregulated, I really work on regulation first, using the things I know support their regulation so they come back into a better state. As time goes by, when I want to expand their tolerance, I bump up to the edge of that top window with some support, so they hit it, feel it a bit, but hopefully come back into that regulated state, widening it over time.
Tracy: That is so beautifully described, and it is essential, because treatment requires that we bump into those edges adaptively, and that we resource the child to have an adaptive response to those edges. That is how you build resiliency, and how you build and expand the window of tolerance. If you do not have an image of what you are doing in treatment, you end up doing very formulaic treatment that does not really build capacity. I love that you are doing that, and Cory, you do the same. I have seen you treat, and you are so present with the children, but I can see you almost picturing that window of tolerance.
Cory: A hundred per cent. So many things come to mind. There is the modulation piece of the actual sensations coming in, but as soon as you think about whether the child perceives they are in a safe space or that this is too much, it is fascinating how much that changes what they can process and organise. If you picture that graph, you can see their range narrow depending on what is going on and what demand you put on the child. If I am doing a task and I have loaded up the motor system, or given them too much language, I see it narrow down, and I see them mobilise away, or they are no longer adaptive. That was the cool thing you said, Tracy, we hit the edges adaptively, which brought up that idea of a volitional response rather than reactive, because that is what we are looking for. All the time these kids are reactively responding rather than hitting the edge and having an adaptive, volitional response, they are just controlled by the nervous system. So that is the treatment, and it is hard to explain to a parent, so I am always using that graph to help explain the concept, because in treatment it requires such a sophisticated ability to go with what you see in the moment, but have the knowledge around why you are seeing it.
Michelle: I explain this to anybody who will listen, because it helps decide what you are going to do. Parents can start to see their child through this lens and make decisions about whether to even have a big, hello, how was your day, darling, when the child jumps in the car. If you see their state is really activated, body upright, face stern, no eye contact, you can see they are loaded, so talking about how was your day, your maths assignment, we have to go to the shops for avocados, is going to be a source of stress, so you choose not to do that if you can.
Cory: If the window is already narrow, do not add any more load. That makes me think about what Tracy says all the time, regulation is the basis for everything. If you are not regulated, you cannot really add anything more. Sometimes I am trying to highlight that to parents so they know what I am trying to do, because I need to get them regulated first, I cannot ask any more of them at that point because they are not in that state, not in that range.
Michelle: Sometimes it takes multiple sessions to work out what that actually is. Is it a fort, where they literally have a safe nest and a physical sense of safety? Is it music? Is it affect? Is it no task at all other than rhythm? Is it visual containment, do I have to get into a small space with this child? Because we are greedy, and we know this neurological change only happens once they are regulated, but then to expand them we have to start challenging them. So once I feel I have their recipe for perceiving safety, and I know what all their dials are, then I start, with all due respect, messing with them. If I know auditory input is difficult, I will start amping it up when I see them regulated, providing all the cues of safety, layering that on, while adding the source and helping them be adaptive.
Tracy: Precisely. I love it, you guys. I am so proud.
Michelle: You taught me all this, Tracy. I have spent, oh my gosh, I do not want to tell you how many hundreds of dollars on books. It is so hard to get your head around this work theoretically, and then to align it, because the language is different depending on whether it is neuroscience or psychology, so to merge them and bring them into the OT language. There have been some early people, like the How Does Your Engine Run? team, I probably got the car idea from them, so I am sorry if I did not credit them. And you, Tracy, have allowed me to make sense of that in the OT sense, and add in all the elements we know so well, sensation, motor planning, relationship. So thank you, Tracy, and all the forerunners, for making this so accessible for OT.
Cory: Listeners did not know this, but that bar graph chart Tracy does, mapping out a child’s state, their window, and how they bump the edges and what narrows it, she has been doing for how long, Tracy? Since the nineties?
Tracy: In STEPPSI, Julie Wilbarger first made this graph back in 1991. That was just an arousal graph related to sensory processing, really sensory response and recovery, which is on some level the definition of modulation. We included it in STEPPSI when we were figuring out how to treat sensory modulation disorders, we said you have to make this graph to figure out your clinical reasoning, because there is no assessment, so this is our only way forward. Then a few years later the window of tolerance became a concept in the psychology and psychiatry literature from Dan Siegel and Pat Ogden in 2006. They popularised it, but it really comes from the Yerkes-Dodson principle, which goes all the way back to the early 1900s. So these are not new concepts, but the way we conceptualise them in our OT literature really takes sensory modulation to a whole new level, and that is what we need for treatment, because it is not just the sensation, it is sensation for the purpose of regulation, and regulation for the purpose of adaptive self-regulation.
Michelle: Thanks so much, Tracy, I learn something every time we talk about this. We will wrap up now, because we could go on for hours. We will come at this in the next episode with more practical application and extend it into intervention planning. My takeaway today is that in trying to get our heads around a phenomenon, we dive in and look at it quite isolated and separately, but like all the other systems in the brain, sensory modulation is really very integrated and connected, a part of regulation, and these things do not stand alone.
Cory: Mine, from today, was that I had never really separated state from arousal before, and even thinking about arousal, knowing now that there are so many pieces and how complicated it is. I knew that already, but it really highlighted it for me, so my key takeaway is that I am going to go and dig into that, because it is complex and I want to get my head around how these elements are all different.
Michelle: That is it for me today. That was another beauty, Trace, thank you.
Tracy: Thank you so much for the great conversation, you guys, and I look forward to deepening it next time. See you then. Bye.
And that’s a wrap on today’s episode of Spirited Conversations. We hope this sparks something for you, whether it’s a new clinical idea, a fresh perspective, or just the reminder that you are definitely not alone in this work. If this conversation resonated, we would love for you to share it with anyone on their own learning journey. You can find information about the podcast on our website, and you can join us in the courses and communities the Developmental FX team have put together at developmentalfx.org. And if you’re enjoying listening, please subscribe or leave a review, it genuinely helps more people find us. Until next time, keep the conversations spirited!