Part 2 goes back to the sensory base of modulation and asks how it actually works, and why it breaks down. We follow inhibition and facilitation from single cells up to behaviour, unpack why some nervous systems never quite habituate to the passing car, and move into the practical: co-regulation, the R’s of regulation, re-storying a child’s experience, and the STEPPSI framework for turning all of it into a plan.
We pick up sensory modulation from the sensory base this time. Tracy frames it as the nervous system’s constant dialling up of what is salient and dialling down of what is competing, and follows that through inhibition and facilitation from the cellular level all the way up to behaviour. The key idea is that modulation never works in a vacuum: it is organised top-down by state and by the safety question, which is why the same sound can feel comforting after coffee and unbearable straight after a nap.
From there we get into why modulation breaks down. For some kids the habituation does not stick, so the fifteenth passing car lands like the first, and the circuit never learns to organise an adaptive response. We move into the clinical work: reading ever-subtler cues of state change, co-regulating, and being masterfully in control of our own reactions so we do not flood the child. Tracy walks the R’s of regulation across the major models, recover, relate and reason, and the work of Perry, Siegel, Deb Dana, Dan Hughes and Jane Koomar, then the power of re-storying a child’s experience. We finish on STEPPSI, the planning tool Tracy co-developed, for tying sensation, task, environment, predictability, self-regulation and interaction into one clear plan.
Lightly edited for readability. Speaker labels and chapter markers match the published episode.
Michelle: Hello, welcome to episode six. Hello Cory, hi Trace, great to see you.
Tracy: Hi Tracy, great to be with you guys.
Michelle: We get so excited, this is such a joy for us. Last episode we examined sensory modulation and regulation, and danced across both those concepts. Today is really about recapping sensory modulation and then springboarding forward, because it was such a big topic we thought we would break it up, probably over more than two episodes.
Cory: Oh yeah, down the track for sure. I feel like we could have a whole month dedicated to it.
Tracy: We could come back to it over and over from different perspectives. What I was aware of after our last episode was that, from an occupational therapy standpoint, we entered this space around sensory modulation from a pure sensory integrative framework, and then the way it unfolded, it connects into all of that regulatory circuitry. So I think it would be fun to think back to the sensory base of it and dive into that a bit more.
Michelle: That sounds good. It is so intertwined, and I think we maybe better understand the sensory modulation part, which is why I am so eager to get to the connection to regulation. But let us go back to sensory modulation.
Cory: I am curious about how the mechanism of modulating sensation actually occurs. Is that too deep a topic for today?
Tracy: It is not too deep for us, because we love deep, we are deep seekers on some level. I should have worn my vestibular labyrinth earrings. So, the concept of sensory modulation. We talked last time about how Dr Ayres described this harmony within the system. Harmony, like in a vocal performance or an orchestra, is the dialling up and dialling down of the different tonal qualities. So sensory modulation refers to the neuronal capacity to turn up and turn down the sensory mechanisms, turning up the focal feature, what is salient, and turning down the things competing with it that are not assisting. It is this simultaneous turning up and turning down, and we use a lot of different words for it. Sometimes you hear inhibition and facilitation.
Cory: That is what I often see in the literature, those two terms.
Tracy: What starts to be interesting is that, especially the word inhibition, inhibition happens in the cells, in the peripheral cells and the central nervous system cells, but inhibition is also something we can see in behaviour. So we jump from the cellular level all the way to behaviour. A lot of the time in the regulation processes we see in children, they struggle with inhibition or inhibitory control, and sometimes that relates directly back to what is happening at the cellular level in sensory processing, where the child cannot inhibit. A sound comes in, and instead of whooshing in and whooshing out, it comes in and stays, too focal. So that is a place where there is both clarity and some confusion, because we are jumping between levels of analysis, from what is happening in sensory processing into what is happening in behaviour.
Cory: I just had a thought. If the sound is coming into the cochlear labyrinth and moving up, activating the tympanic membrane and the little hair cells, and you do not have inhibition, are you saying the action potentials go on for too long, or how does that work?
Tracy: That can happen, but not because of what is happening in the periphery. Sensory modulation is summed within that whole regulatory circuit, all the way across the systems, from the brainstem up the hierarchy into the frontal cortex, and inhibition is actually organised from the top down. When you are trying to exquisitely tune in to something, that desire to tune in organises, from the top down, the filtering, the slowing down, and the parsing out of what you are trying to take in. The top down tells the peripheral system, do more of this or less of that. So the modulation happening in the auditory mechanism is not happening in isolation from the rest of that circuitry. That is why this is interesting: sensory modulation never operates in a vacuum, it operates as part of the rest of that circuit, which is telling it why you are trying to take in that sound, why it is important to your nervous system. And the question of why ticks all the way back to that safety issue. If the sound you are taking in is meaningful, relevant and safe, it feels good to take in, not too loud, not an irritating pitch, the information is interesting and you want more of it, so you dial up. But you do not just dial up, you also dial down the stuff competing. So sensory modulation is the harmony, the constant adjusting of up and down that brings the just-right information into the system, which then becomes discriminative information, the actual detail, what the music is about. The discrimination system and the modulation circuitry always work in partnership, but modulation is just the dialling up and down based on, do I want that in my system, and if so, do I want it richly, with nuance, with colour, with the affective tone of the information? If I want it, I allow it in. If I want to protect myself, I dampen it and move away. And that interacts with your state, because if you are just waking from a nap, your sound system is in a sleepier state and is not ready to listen to a lecture. If you have had your coffee and your run and you are ready to go, your state dials to a level of alertness that lets you take in a different quality. So in the morning, music sounds differently comforting to your system than it does later in the day.
Cory: How interesting.
Michelle: That is fascinating. I have two things in my mind, Tracy. What about the nervous systems that do not change their state so readily? I change my state and feel exactly those examples you mentioned, and go with the flow through the day. But what about children with autism, or trauma, where their state is perhaps higher, or perhaps lower? They are the ones we see coming in who have a difficult time, which brings in the second concept of attention: their state is heightened, so they are less able to attend to something even if it is compelling, and they keep getting pulled off by the car going past, or the bright light, or the phone ringing outside. So it is the state that comes first, is that right?
Tracy: That is exactly right, and your description is spot on, Michelle. For kids where these mechanisms do not work well, sensory modulation is in the foreground instead of the background. What sensory modulation should do for you is help you orient and organise in space and time, so you just know, I am in a room near the road, and when cars go by I do not need to worry. That is because we can take sensation and make meaning from it. For kids who struggle with sensory processing, regardless of their cognitive and language levels, that information-making is sticky. They know the car might pass, but when it passes, the loudness or the tenor of that sound is something they have to orient to, because the inhibition mechanism does not work well for them. So it does not learn, I know the car, now I can ignore it. That ignore, or habituation, mechanism is often really altered for these kids, it does not exercise well. If we think of a sensory modulation circuit as a muscle, you lift weights, and now you can pick up your heavy can of beans without effort because you exercised that muscle, and tomorrow it is easy because you already exercised it. But with sensory modulation problems, it is like the exercise does not stick. That is the habituation problem. I hear the car go by and I over-orient to it, maybe I startle, over-respond or defensively respond, and then that neuronal circuit does not learn from the experience. So the next time the car goes by, it is like the first time, and again, and again. Over-responding tells you the circuit is not regulating up and down, facilitating and inhibiting in a way that learns to habituate and organise the response adaptively, so it is more adaptive next time. That is exactly why this is a sensory integrative problem, because it does not organise that adaptive response.
Cory: I have a question. When you talk about inhibiting or facilitating, I picture a single nerve cell with many other cells connected to it, some whose job is to make it quiet and some to make it activate. I am wondering, if you have a sensory modulation difficulty, so you are not habituating or learning, is it because the cells that say be quiet, or the neuromodulators that say be quiet, are not there, or the neuromodulators are not being released? Do we know the mechanism, and where should inhibition come from?
Tracy: I love the question, and it is a hard one to answer, partly because it sits in the context of state again. There are mechanisms whereby the neighbourhood of neurons processing sound, in this case, has forces that say, okay neighbourhood, you are going to work together cooperatively to respond, and these are the partners that will help you. It is this building of the neighbourhood through Hebbian circuitry, and it gets really complicated. This is why it gets tricky to simplify, and it is okay for us to stumble through it, because this is the reality of why this circuitry is so complicated. Basically, if the state and context around that neighbourhood tells the modulation circuitry in the cell, you should be upregulating right now because this human is trying to attend, so help them attend, then it is more likely to do so. What happens for our kids with neurodevelopmental problems is that the whole rest of the circuitry is also out of balance, so it is not getting enough information to know why it should modulate. So it relates back to what we talked about last episode, that all those other regulatory functions are telling the sensory modulation system what to do, and the sensory modulation system is telling the rest of the regulation system what to do. It is a bidirectional thing.
Michelle: So if you have multiple senses that are really primary, touch, auditory and vestibular, and all the neighbourhoods are saying, be on alert, because I am not quite sure I am safe here, then you have multiple neighbourhoods getting ready for something that might upset the apple cart. So you have that heightened state.
Cory: I was going to say the state, because if you are feeling unsafe you have the state shift, which puts all the neighbourhood security guards on alert. Whoa everybody, watch out for any incoming input, maybe somebody is going to rob the houses. So as soon as the state goes up and the alert goes out to the neighbourhoods, everyone is more on edge about what is coming, and maybe cannot prioritise one thing over another, just paying attention to everything. Whereas if the message goes out, no threat detected, chill, everybody is good, then everyone can decide, maybe I will go out and play in the park today.
Tracy: That is exactly right. Neurons that fire together wire together, and what happens in our kiddos who are struggling is that today it fires in this pattern, tomorrow in that pattern, the next moment in a different pattern. So you cannot strengthen the circuitry, because you do not have consistency, or you have consistency around the wrong function, around protection, or around being excited about every little thing that comes along. So it is this neighbourhood of neurons that need to fire together consistently in the same state over and over. One of the things we do in treatment is create a consistent state for consistent responding, so the nervous system starts to say, when this happens, I am safe and I should respond this way, over and over, until it locks in. Once that happens, you get a general state of modulation that supports regulation.
Michelle: Tracy, last episode I spoke about how I practically put that together, where I literally draw out the state of regulation, the window of tolerance, how wide or narrow it is, the things interrupting that state, the things that support it, how quickly they habituate and under what conditions, and where they do not habituate and it takes a lot of effort and refined thinking and support to return them to that optimum state. What I am curious about now is strategies for how we build that tolerance and habituation, because in real life, back at school or home, they do not have the time, the equipment, or the refined skills we have the luxury of in the clinic one-on-one. So how do we start to think about regulation, and have a frame of reference that guides the next steps?
Tracy: To get to that level of practicality, the handout we have shared is a good foundational start. The first thing you do is the theorising, drawing your picture of what you think you are working on, and if you can translate that for the family or school, it gives them something tangible to hang on to. If a child is not habituating every time the car goes by, you could draw that out: cars driving by on the bottom axis, and every time, a large response that does not recover back down. From depicting that, you wonder with the teacher or parent, how do you help the child settle away from that, instead of just saying, we are not listening to cars, realising their nervous system has now gotten a full charge of carness. How do we help their little nervous system say, I am not interested in the car, I am interested in this book? How do we make the book as relevant and salient as the car? You cannot coach them if you do not have a working theory of the modulation problem, so drawing it creates clarity and bridges what is happening in the brain to what is happening in behaviour. We make a hypothesis, sometimes we are wrong, but mostly we are pretty right, so we know what we are trying to grab onto and affect.
Cory: That is fascinating. In drawing the chart, as you see the child’s nervous system respond to certain inputs, the chart reflects how intense the response is and how well the nervous system can inhibit it, which gives you a sense of what you do in session to help that recovery. And Michelle, you know this in and out, some kids you can go in and actively engage with to pull them back into a more organised state, you co-regulate them. We have not talked about that, but you become soft, you represent safety, so the relationship represents safety and brings them back. Whereas other kids cannot have a bar of you, you cannot even look at them, they are like, get away from me, I cannot do relationship right now. That piece helps you know where to go for this child in the recovery and habituation. I do not know all these R words, Tracy, or the theories they come from, but I just talked about relating, so what about some of the other ones, should we go through them together?
Tracy: What we put in that middle column is a suggestion of some key concepts out there, and you did such a beautiful job of dancing through them, Cory. The first R you mentioned was recover. If a child’s nervous system is over-responding or defensively responding, or their state is mismatched upward from where they optimally function, you might be working on downregulation. For some kids, recovery is recovering upwards. We need a really clear model of where we are headed and what will organise their little nervous system. There are a lot of different people who theorise about regulation. Bruce Perry has a model very well described in his Neurosequential Model, and his is sequential: you regulate before you relate, then move into reasoning and rationality. Almost every regulation model has reasoning and rationale at the end, so the cortex comes last.
Michelle: The cortex is lost until then.
Tracy: Yeah, and that follows the triune brain model, that you cannot access reason until you are more regulated. We can go back to Dan Siegel’s Flip Your Lid model, a really popular construction you can watch YouTube videos about: if a child is dysregulated they flip their lid and operate in a more primitive way. But for some kids to put their lid back down, they cannot access relationship to do that, so relate may not be the first place to start, though it is never in the absence of relationship. You soften the safety and access for them, move yourself into a space that lets them access safety, regulation and comfort. Or if the child accesses safety through activity, you go there with them. So it is about attuning to what they need. Deb Dana has a set of R models. Dan Hughes, whom I respect greatly, worked a lot with Jane Koomar, a close mentor of mine, and they created a particular model for children with more trauma-based issues that does not even have the R in it, it is called the Safe Place model. You have to pick a model based on what this child’s nervous system needs, and that takes a lot of knowing. So the point today is to point people to that middle column and say, be on purpose about this. Decide what works to regulate this child, what works in terms of relationship, and how you will proceed through it, and be consistent, because we are trying to exercise a neural circuit and have to do that with consistency. We describe it to the teachers, parents, siblings, the nanny, and sometimes the dog, so the child comes into regulation over and over through relationship. Which one is more focal is a nuanced clinical decision, so be patient learning it, but be on purpose.
Michelle: I had the pleasure of working with some kiddos who taught me so much, because relationship is probably our intuitive go-to if you are an OT and a people person, and then, learning more about sensation, we build in rhythm and sound. Those were my go-tos. Then I started working with some kids where that was not right, where even me saying hello as they entered, or facing them with a big happy smile, was too much. That forced me to rethink what I was cueing, because I felt I was cueing approach and safety. Even when I toned myself down, averted my eyes, did not say hello, and just did a little sideways hey after they had been in the room five minutes, I had to go to those other theories you mentioned, Tracy, because that did not fit for me. I felt, how can you not say hello? But in dampening myself down, I felt I was not using relationship, when in fact I just needed to wait until they showed me the cues of approach and safety, and then signal I was ready in a much more subtle way than I had got away with before. After coming at it for a while, learning through these kiddos, I now put all that down and feel okay that I do not always go in with relationship first, or even rhythm and sensation. It has given me a freedom to just watch what signals safety and approach for them, and hang onto that, as subtle and nuanced as it is.
Cory: That is probably because it is integrated a bit more for you now, Michelle. When you were talking, it made me think of the time it has taken me to tune in to the cue of state change and dysregulation, oh, you have shifted, now you are activated, now you are not perceiving safety. Early on I would miss that until it was quite big, until the child was running away. Now I can pick up on so many more refined cues, a subtler version rather than a whole-body running away, even pupil dilation, or a slight freeze in the body, or a look of overwhelm for a second, and I can catch them so much quicker. The other thing along the same lines is figuring out how to be masterfully in control of myself, because my natural reaction, if a child does something they have not done before and it is so exciting, is to go, yes, that is so exciting. So now I temper my reaction, because I would overwhelm their ears. You feel it in your body and want to show them, but you have to stop some of those innate things so you do not flood the child and disrupt what you have just got. The kids have taught me to be massively in control of myself in sessions, because you might innately want to go one way, but the child in front of you needs something different. Tracy, I can see you holding your hand to your heart. Is recognising what I am talking about, just noticing the state shift, is that what recognise is?
Tracy: Yes, absolutely, for yourself as the co-regulator, embodying that in a co-occupational way with the child, and then helping them eventually start to recognise what they need, which is such a beautiful gift. Listening to the two of you, I have just been putting my hand on my heart to take in the beauty of your clinical work. What it brought me to in this moment is that we use the terms regulation and dysregulation almost as if they are an either-or, but really we should shift it and say we are continually always regulating and continually always relating. When a child starts to struggle a little, it does not mean they are getting dysregulated, it means they are working harder to regulate. Even their so-called dysregulation is showing us how hard they are working to find that homeostasis and harmony. So it is deep stuff, and you are so gorgeous in the way you do your work.
Michelle: That is so lovely of you to say. We do work at it, but it is our keenness to support the kiddo in front of us, particularly when they are having a tricky time, so that we are not adding to the stress, not a source of stress for them. So when I think about the last of the R’s, Trace, I was interested in the re-story part. I do not know lots about that one. What I try to do in the clinic pretty early on, if I know a child has challenges with state, is set up places of safety, and this came from you, the idea of a nest or a base where they can go when they need time to settle and come back. They might have a little toy or an oral motor chewy in there, but it is a contained space, if that works for them. And, again from you, I cue, let me know when you are ready, so they come back and I help them approach me. I am wondering if re-story is where I might say, oh, I wonder if that noise was too loud for you, did that give you a fright, did that make your body run over there, and then, when you felt calmer, you had a chew on your chewy or took some breaths, and then you came back to play because you are ready now. Is re-story trying to make sense of what just happened for them?
Tracy: Absolutely, that is exactly what it is, and it can be profound, because you are re-storying their lived experience in that moment, but you can also be re-storying on a bigger level: there is nothing wrong with you, your nervous system does this, it over-responds, and here is how you feel safe, and how smart are you to take care of yourself. Sometimes we are re-storying something other people have coded as maladaptive, naughty, annoying or bothersome, and helping the child feel understood and see how we help them see the world. Sometimes we re-story for ourselves, because the child pushes our buttons and we have to say, what is that about? Sometimes we help the parent or teacher re-story that the child is not being naughty but is really working hard to cope. And sometimes we re-story to help a child find grit, dig in, and find their power. There is all kinds of beauty in that, it is a real part of the nuance of the work.
Michelle: That is powerful. I got goosebumps, because this is where you change the script of, oh they are just attention-seeking, or just trying to get out of maths, and allow another, ideally more true, story of what is happening. I like to say to kiddos, oh my gosh, your body took over and ran you over there, just to make it that the body did that, you are still gorgeous and still wanted to play, but your body responded this way.
Cory: And the highlighting of, wow, how smart is your body, in knowing that was too much, and your body took over and needed to go away, and I am really glad you are back, are you ready to play? Is that how re-storying works, Trace?
Tracy: Absolutely.
Michelle: It has such a compassionate, kind underpinning. It is another way they can befriend and think nicely about what is happening to them, kind of automatically.
Cory: And know that the body has an inherent knowing of what I need. Not just, my body took over, but, I actually needed to do that for myself.
Michelle: What we need to make sure of, though, is that it is not just a long, inefficient timeout. You give them a different adaptive strategy. And we can slide into that now, Tracy, because the last column on that image in the show notes is the STEPPSI, so we are setting it up so they are not just marking time, not just in a fled, activated state running around randomly, but efficiently cueing them, I wonder if these are the things that help your body, so we can support families and teachers to do that co-regulation piece. Did you want to talk about STEPPSI, since you made it, Tracy?
Tracy: What I love about STEPPSI, which Julie Wilbarger, Sharon Trunell and I put together back in the mid-1990s, is that it is a mnemonic. We analysed hundreds of hours of videotape of master clinicians treating, categorised what they were doing, and came up with the basic categories clinicians use in a treatment session, and also in parent coaching, home programs and school supports. So you take the theory of the child from the left column and go through and ask, what are the sensory and motor supports, the task supports, the environmental supports, the predictability, the self-regulation, and the interactional or relationship-based supports? You really nut out the elements that are going to work. For some children we use all of them, for others we focus on a few, and we tie it to how we are trying to help this kid in their active regulating process, so the nervous system gets what it needs to make sense of the world and organise the adaptive response. We support the sensory system in a particular way, toward what is missing. When we do trainings on STEPPSI, we go through each element in a lot of detail. What I love is that it is a mnemonic, so you can be observing a child who has run across the room and is scattered, and if you are a little stuck, and it is okay to admit we sometimes get stumped, you can inform your intuition by going through STEPPSI, we have added the extra P for playfulness because it is so critical, and asking, what is missing, what am I doing in each one? Just like tuning the strings of a guitar, you tune the STEPPSI, what else can I do to enhance the situation so the child can come into regulation and use that regulated state adaptively, to play, engage, master something, and find that gorgeous mastery drive that pulls it all together. It is a really beautiful tool, and it has been amazing to watch people take off with it.
Cory: You just described what Michelle did before, with having that space for the child. You are literally using the environment, reducing the amount of sensation and the demand on the systems to interpret it, because they come down to a more confined space.
Michelle: What I look for is the elements of a more contained space, so I consider that the environmental support, bring the space down. Sometimes that has a deep-pressure quality, under the mats, or in Lycra tubes where they squeeze in, because deep pressure is an inhibitor. Sometimes, if kids are okay in their vestibular system and there is no trauma around darkness, I will put a roof on it. Initially I make this space with the child, when they are in a regulated state we make a fort or nest or cubby, and they choose whether to repeat it. In offering it and seeing if it serves a purpose, they will repeat it, hey mum, could we make a nest at home? So my cue is following the child’s lead: did that help them? If it does, they repeat it, and it does not matter if it is built or not each session, they cue into, that environment serves me.
Cory: Even in the environment piece, there is the predictability of having that to go to, and the sensations the space offers, so many aspects.
Michelle: And it turns a mobilised flee response, oh, this is too much, I need to get out of here, into something more adaptive. In time I am like, oh, you are not ready, tell me when you are ready, so they know what is happening to them, and it is not just running around the room without me, it is, yeah, you are doing that when you are dysregulated, so even that feels purposeful. Sometimes they do it just to recover between activities, a little discomfort I would not necessarily spot as a big dysregulation, just a gap, I need to pause, Michelle, that I would not have picked even looking for nuanced signs. So it gives them a legitimate breather in a productive, self-directed way.
Cory: And there are other ways we use these proactively in sessions, to set a child up. If you are trying to maintain them in their optimal and you know these things work, you proactively set the room up. You know rhythm organises them, so you straight away pop a Quickshifts track on, or, if you are not trained in Quickshifts, use a certain music, or start with a rhythmical game, or something that is not the biggest challenge, to maintain that state and perceived safety, before you move into something more challenging that they have to hold and stay adaptive through. There are so many ways. Since we are talking about modulation, maybe I will talk about sensations. Michelle alluded to deep pressure being, most of the time, a rule of thumb for regulating, organising and inhibitory, dampening or organising for the nervous system. So I have started working in more proprioceptive quality to what kids are doing, because often they are moving through space in a way that is not very organised, seeking out movement, and I try to organise that with a little more proprioceptive input, or a change in head position, so they are not just moving through space upright but working against gravity. It is a fine line between what is motivating and playful, the P, and what is too hard, because you are trying to organise the sensations so they stay in the state and become more adaptive in a task. Michelle, what do you think about when keeping kids in that, through a sensation- and modulation-based perspective?
Michelle: I really look at what they modulate well, because not all the senses have modulation challenges, and some are modulated more strongly than others. I tend to bump into the auditory and tactile defensiveness profile more, so I will avoid those and use, say, intense vestibular input, whatever that is for each child, rotary or an inversion, as a setup, and then start to interdisperse the sensory element they have more challenge perceiving and modulating well. So I come at the trickier part after I have got them set up, from a sensation and a relationship perspective, and then I give that challenge, or start to address the piece that is not modulating well.
Cory: And you always embed that in the task. You do not just start poking them, or play around with sound randomly, it is within the activity, if I make myself a bit louder, can you still stay? Because if that disrupts you every single time a kid runs up, you cannot play with any children, so you organise them and then create the challenge around the actual thing that is interrupting their life and participation.
Tracy: That is right. The clinical reasoning you are demonstrating is so heartwarming, because for every single child, every little nervous system, it is a different formula and profile. What STEPPSI lets you do is sort that, create a clear plan, analyse what you are doing, think it through, and take the data, what is happening here, to establish what happens when we bump edges, how we organise that, what is organising and what is disorganising to the nervous system, and how we broaden the window of tolerance so it handles normal, typical life experience. That is what we are going for. You both just demonstrated the utility of it and how it deepens your work.
Michelle: I do not know how you make sense of the complexity without these models. There are multiple, but everything we have discussed over the last episode and this one, sensory modulation, state, the regulation elements, and Stuart Shanker, who I am not sure we have mentioned, goes into much more detail on some of the other areas that are dysregulated, breaking down biology, for example. So that has been a useful tool, and then it is, what am I going to do with all that information, how do we make sense of it for the child and others? This makes my heart sing, because it is life-changing for people sometimes, just taking them through this process and being able to make sense of what seemed like really disconnected pieces, behaviours the kids show somewhat randomly, they do this sometimes but not all the time, at church but not at school, at grandma’s but not at mum’s. All this information pulls the pieces together into a framework that helps them understand there is some connection across these seemingly random instances. That is my biggest takeaway.
Cory: My key takeaway today is that it dawned on me that nobody else in our professional sphere is looking at sensory modulation, we as occupational therapists are the ones who bring this to the table. So it is so important that we get our heads around this concept, really work at understanding it and how it cascades into the rest of these kids’ lives, and do the work, because nobody else is doing the work around this specific piece. So go and dive into this and love it and get your head around it, because no one else is going to do it.
Tracy: I want to reinforce what you are saying, Cory: we have to do this work, and we have the tools. The STEPPSI tool is really gorgeous to support this, and it supports the child in the treatment session, supports you in coaching parents and educators, and is solidly the way forward. What a joy to share it in this forum.
Michelle: Thanks, Trace, so much. I really want to thank you, because you have done a lot of work in this area, specifically with STEPPSI, and also the Spirit framework, which really encompasses and lets us think about sensory modulation too. So thanks, Tracy, for all your work for our OT profession in this area. Great session. See you everybody, bye.
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