What do our senses have to do with early development? I spoke with a pediatric occupational therapist who breaks it down.
In this episode, Ayelet sits down with pediatric occupational therapist, parenting coach, educator, and author Jill Loftus. Jill is focused on enabling and empowering children and families, and is also the founder of Honest Occupational Therapy. Jill and Ayelet discuss the term “sensory processing,” how we all do it differently, and how that spectrum might affect different people in different ways. Jill explains the difference between a tantrum and a sensory meltdown, and offers 5 great tips to help families with young children when it comes to “sensory overload” – especially during stressful times like the holiday season, when life can break from routine.
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Ayelet: Welcome to episode 45 of the Strength In Words podcast! Today, I’m speaking with Jill Loftus, a pediatric occupational therapist, parent coach and author focused on enabling and empowering children and families. Her experience ranges from working in the schools, homes and clinics and in the community in San Diego, New York, and currently, in Denver. Jill started Honest Occupational Therapy to motivate children, families and educators to develop the skills they need to perform everyday tasks and be successful – the heart of Occupational Therapy. Welcome, Jill!
Jill: Thank you, Ayelet, it’s so nice to be here!
Ayelet: So, I’ve asked you on the show today to speak a little bit about the sensory system, sensory processing, and really what that is, and how we can best support sensory development in our infants and toddlers. First, I’d love to just hear a little bit about you and what brought you into the kind of work that you’re doing today.
Jill: Sure. So, I’ve been an OT in pediatrics for almost 20 years, and I can’t believe that I’m saying that, because I don’t feel that old! But, I’ve always had a passion for children, I love watching them play and talk, and from my very first days as an OT that’s what I’ve been doing, I’ve always worked in pediatrics. And I love working with families, and I also enjoy sharing all this information that we have to offer… just getting it out there, helping families make life a little bit easier in so many different areas. It’s great, and I’m still very passionate about it after all this time. So, yeah! My major area that I base my work on is the Sensory Integration Theory. And, I know it sounds a little bit scary, we’re talking about theories, and “blah blah blah,” but I’m going to try to make it really easy for you guys to understand, and realize that sensory is truly the foundation. If we looked at development as a pyramid, sensory and the nervous system would be at the bottom of that pyramid, and all those other skills would kind of go up all the way to the top, you know, with just how we get through our day.
Ayelet: Nice, great way to think about it. So, let’s see, can you give us an overview of some of the basic information about that sensory system and what happens, also, when it’s overloaded.
Jill: Yes, yes. So, we have been taught from very early on that we have 5 senses. And, ironically enough, I was just in a preschool classroom a couple of weeks ago and they were talking about this, and I was like, “we should really be teaching them that we have three hidden senses!” And this is, I think really, so interesting, and to me these three senses are really the true foundation of how our bodies work. I’m gonna share with you that piece of information today.
So, the first system is called the vestibular system. And it’s just a fancy word for how your body experiences movement. So, inside our ears, there are these little ear canals, and they have fluid in them, and they move around, it flows back and forth. And then, there are these hair cells that dip down in there, and they send signals to our brain. So, when you’re riding in a car, when you’re doing a forward roll, when you’re sitting in a chair, when you’re doing any sort of movement, you’re getting signals to your brain about what you’re doing. Sometimes, those messages can get messed up. They can be hyper-sensitive, so, you might have to move all the time. They might be under-responsive, meaning kids who get, like, car sick or don’t really like having their feet off the ground. And then you have just slow processors, so imagine that information is creeping, and then they respond to everything a little bit later than they’re supposed to. So, that’s a really important sense to develop, and it’s one of the first senses to develop when we’re itty-bitty.
The second sense is called your proprioception system, and, again, big fancy word, but all it really means is it’s the response of your muscles and tendons around your joints. So, things like crawling and running and opening and closing doors, and using utensils during mealtimes and using pencils… all of that requires proprioception, or how you’re feeling that information coming to your body. For children who are hyper-sensitive to that, they’re kind of flitting all around, they’re clumsy, they’re not noticing what’s going on, and then kids who are low in that area are pushing super hard like, opening the door like “booom” – you know, like, busting in. Or, they’re drawing holes through their paper, because their system is low and they think they’re doing it properly, but they’re not. And the thing with kids is that they have no previous understanding about how things should be. This is what they know, this is how they’re acting. So, we need to pick up on these kinds of red flags, or types of behavior, so that we can help them.
The last one is kind of new on the scene, it’s called interoception, and that’s our inner body sense. So, kids who have a hard time potty training, kids who maybe never ask for water or for food, or kids who are insatiable – need to be drinking water, need to be eating all the time. Heart rate… all those inner senses: that’s interoception. So again, when you have kids who are really hyper about it, they are unaware. They’re the ones who are playing all the time, not really checking in with their bodies, and then you have the ones who are lower, who are kind of like, this is what I need all the time, all the time. So, these senses, truly, to me, are really, really important. And sensory processing, the pure definition of it, is how we take in, process, and give an adaptive response to our environment. So, 20% of the population has sensory processing disorder. Disorder is kind of a scary word, I think, to a lot of people, based on the history of special needs and all of that, it has this negative connotation. With sensory processing disorder, disorder means, truly, a disordering. So, the information is coming in through our senses, and it’s a neurological disordering of the information. So, a siren goes off, and to one person, it’s just a siren. To another person, it is so horribly loud and terrifying that they have a really negative response. And then there are people who don’t even know it’s going on. I hope that that’s clear and I really want people to understand that it’s… we probably all have sensory processing disorder to some degree.
Ayelet: Right, because from what it sounds like, and I think this is maybe a good way to think about it, is, like anything else, it’s a spectrum. A perfectly managed sensory system right in the middle, right? But then you have a hyper-sensitive and hypo-sensitive, all in the higher and lower end. So, at any given moment, and probably depending on also the kinds of input that a child or a person is given, and their level of tiredness and hunger as well… those are all things that are going to influence especially a young infant, who experiences this sensorama world all the time, and then, say, a toddler, who is probably trying to manage emotions and all of the other regulatory things.
Jill: I love that you brought up the spectrum, and I think that’s a really awesome way of understanding it, and we can have a mild reaction, a moderate reaction, and a severe reaction. And a severe reaction is when it truly interferes with your daily routine. Your child is unable to put the clothes on and get out the door in an appropriate amount of time, that means that there is something going on there.
Ayelet: Which, in and of itself, is a spectrum, right? Because most toddlers have a hard time getting out the door.
Jill: Right! And that’s when you would reach out to an OT. Well, before I go into why you should want to work with an OT, I just want to say, also, with a spectrum, not only can it be mild, moderate and severe, but it can also happen in one or all of those sensory systems. So, you could have a really severe response to auditory stuff, but then you could have like, your taste buds, you know, like you could just have very bland food, or whatever. So it can really be all over the place. And that’s what I think a lot of the frustration is with parents, because they think, you know, they look at a checklist and they’re like, “they don’t have everything!” – they don’t need to have everything. It’s truly about: is it impacting your life so incredibly that it’s just so frustrating and you don’t know what to do. And that’s when you reach out to an OT! Because we can help you sort through all of that, give you clear answers as to “is this truly sensory processing?” Not only do we help with the sensory processing, but we’re looking at gross motor milestones, like crawling, sitting up, walking, running, jumping, your posture… we’re looking at your fine motor skills, how you’re playing with toys, how you’re using crayons and markers with drawing and coloring, how you’re using utensils at mealtime, how you’re manipulating zippers, buttons, snaps, getting dressed, all those kinds of things. So we really, truly look at the whole child. And, just like the word “disorder,” I want people to understand that occupational therapists are not synonymous with special needs children. We can really, truly help anyone, you know, whether you have a disability or not, because of our training and because of our knowledge and the resources we have, we can just answer your questions! If you’re a parent, you probably have a lot of questions.
Ayelet: Guess what? That’s why you’re here today! Jill: Yeah! Hey! Exactly! So, it’s always great to reach out, like, why be like “I wish I knew that back then!” Yeah! Get an answer, stop worrying, like, you have enough to do as parents.
Ayelet: Exactly. Thank you, Jill!
Jill: You’re welcome!
Ayelet: So, let’s hear a little bit about what are some of the vital differences between a tantrum and a sensory meltdown? Because, as we mentioned before briefly, sometimes we see that real… those needs not being met, and that can look really scary or really intense for a child from the outside.
Jill: Right. And I love what you just said, which is needs are not being met. And that is truly what a tantrum is. So, really quickly, before I get into the differences of a tantrum and a sensory meltdown, I wanted to share that I’m also a parenting coach, and I’ve been working with my very good friend Melissa Schwartz who is a parenting coach for highly sensitive children. And we are in the final stages of our book, which is gonna be released this spring. And, it’s called, “Under The Hood: The Inner Workings of Children.” And what we do is we talk about the differences between high sensitivity, sensory processing disorder, and then we talk about these kinds of things, like, how do you my child’s having a tantrum and a meltdown and all of that? And really briefly, high sensitivity is a genetic trait, in 20% of the population. It’s been studied in all different species, even animals. And sensory processing, like I said earlier, is a neurological disordering of information. So, that word “sensitivity” and “sensory” kind of get confused, and again, we’re trying to make it clear for parents and anyone working with children, when you should see certain things like this. And there can be an overlap! Your kid could have both of those things. So now we’re going to talk about the real information! So, a tantrum is like, what you said. It’s a learned behavior as a result of built up stress. And a sensory meltdown is a neurological response to something that’s happening.
Tantrums can, in a way, be stopped, even when they’re in that like, ooooh, in the middle of Target, you know, having their meltdown. But, with sensory meltdowns, this could go on for a really long period of time. And we might not be able to control the environment and what’s going on, or even figure out what that trigger was, until several days later, as to why that happened. So, first, let’s talk a little more about tantrums. So we have manipulative tantrums that usually start off pretty innocently, you know, and most of the time, we’re unconsciously contributing to this tantrum. It can be because we’re probably being inconsistent with our rules, routines and boundaries.
So, the example I love giving here is, you have a rule in your house about not jumping on the couch. And the kid keeps standing up and, you’re like, “listen, the rule is, we’re not jumping on the couch.” And they get up, and up, and up, and after the 10th time, you’re finally like, “Ok fine, jump on the couch.” And you go through this all the time. But if you’re not standing firm on what you want your rules, routines and boundaries to be, this can happen all the time, and kids know how to poke at us, and act like that. So, you know, they’re say no to us, or they’ll whine and say, “why can’t I jump on the couch, uuuuh” you know. So, we really want to make sure we’re being consistent, and that their wants and needs are being met consistently throughout the day.
Ayelet: Well, and also, I think just to add to that, it is also their job as toddlers to test whether or not there is a rule that is consistent across all people, setting, contexts, environments, all of those things. So, if the rule in the house is not to jump on the couch, then they’re going to try and figure that out with mom or with dad, and in the morning or in the afternoon, and, maybe if I can’t jump on the couch, maybe I can jump on this chair, right? So, they’re trying to figure out the rules of the world. That is what they are supposed to be doing – it’s infuriating and it makes us crazy, but it is also developmentally appropriate!
Jill: Absolutely – and that’s what I was just going to say, it’s very common for toddlers, even into the kindergarten, early elementary years to do this, to figure out what’s going on. That’s an awesome point. The other tantrum is a stress tantrum. So, it might seem like these tantrums also come out of nowhere, but it can be built up. You know, changes in life, right? New baby, moving, starting a new school. You having a stressful day at work, constantly, you know, bringing that home. You know, like, we experience stress tantrums as adults, I think. Even though we might not yell and kick and scream on the floor, we sometimes kind of lose it, you know, we have a hard time regulating. So, some of the best ways to help kids going through stress tantrums is to kind of tune into what is going on, and to maybe figure out what some of those signs would be before they get to that point. It’s a little bit different than those manipulative – you’re approaching it from a different perspective than a manipulative tantrum. So, those are the two, I think, major tantrum areas. And, do you have any other questions or comments about that? Because I’m gonna move on to the sensory meltdown.
Ayelet: I think that’s pretty clear, I mean, I think the manipulative is sort of the testing behavior, and then the stress is more… it’s because they’re experiencing something that is enhancing or making them more, I guess you could say sensitive to something that’s happening.
Jill: Yeah. And I think a lot of times it’s hard like when you have multiple children, or like when you have a new baby, and they’re like, “but the older one didn’t do that, this didn’t happen with them.” And that’s hard, because you’ve gotta parent in a different way for all of your kids because they have something called “temperament,” which is like our hard-wiring and it’s something you’re born with. So you could have like a really chill kid the first time, and then you can have a kid who’s off the freakin’ wall the second time, and what one situation might send one of them into a tantrum, the other one’s gonna look at the one on the floor and be like, “why are you so upset?”
Ayelet: “What’s wrong with that guy?”
Jill: So, yeah, it can be very challenging. So now, sensory meltdowns – and I like saying “sensory meltdowns” together, not just meltdowns – because it is because of a sensory overload experience. Again, just like we talked about with the spectrums and just like we mentioned with kids being different, there can be different tipping points for these kids. So what that means is their central nervous system has been overwhelmed by something, and it’s misinterpreted in their body. It can be that the lights are humming, it could be a fire alarm went off in the store, it could be that the store is super crowded. It could be there’s a smell in the restaurant. I think a lot of parents of sensory kids try to really think about these things, and go into proper environments, but you can’t… you don’t live in a bubble, and it can’t always be controlled. So, this is what can happen sometimes. I think with the sensory meltdowns, the difference between a tantrum and a meltdown is with tantrums, there’s a point where you can kind of go in there as an adult and work through it, and give some comfort in trying to get through this and kind of rationalize with the kid and go through that.
Ayelet: Or even just acknowledge that it’s happening, sometimes that’s enough. But…
Jill: Yes. But with a sensory meltdown, that sometimes – and most times – seems like that’s not possible in that moment. By letting the child kind of go through it, we have to wait to intervene, because we might actually cause more stress in that moment, I think, by coming in there, than just waiting until we see signs of calm behavior to process that. So I think that that’s also a big difference between the two things that we see. You know, I love what you said, too, about the tantrum – even just sitting next to your child, who might be crying, and just hugging them and loving them, you know, they can feel that, too. Sometimes with a sensory meltdown, you really want to be safe, you know, you might not want to get near your kid, they might be very upset, and you don’t want you or them or anyone else to get hurt in that moment because it can be just so, so overwhelming for them. So, again, you just wanna kinda wait. So, I think that kind of leads into, maybe, we’re coming into this holiday time, and a lot of times it’s stressful for everyone (regardless of where you are on that spectrum!) – you know, lots of holiday time, lots of food, lots of things to schedule, all of that.
Ayelet: I’m hoping that these tips can probably apply to the grown-ups, as well.
Jill: Yeah, I think everyone can benefit from some of these tips. So, I send out a weekly newsletter and I basically always do 5 tips for whatever topic it is. And in this one, I’m going to provide you with 5 tips to maintain your sanity during the holidays! Yay!
So I think the first one, truly, is our self-regulation: adult self-regulation. If you’re overwhelmed, if you’re stressed out, if you’re feeling not yourself, your kids are gonna pick up on that. And they’re gonna be a mess – because you’re the model! You’re the one who’s energetically, physically, you know, all of that, showing them how they should be getting through this time. So, I know it’s really hard, but really being that good self-model, even if you do things like, check in and be like, “I need to take a deep breath right now – let’s just all take a deep breath right now!” It’s ok for you to leave the room and take a break! You know, that’s a great strategy that you can teach your kids, is how to self-regulate, and how to calm down appropriately.
Ayelet: Yeah – that acknowledgement of “everyone needs this.” I tend to use the phrase, “I think I need to hit the reset button.”
Jill: Yes! That’s great. I mean, I know that there’s a strategy out there like “red, yellow, green, blue,” you know, colors might work really well, especially with those younger kids, because we tend to associate red with, like, stopping; yellow is like, “I’m kinda getting there, I’m feeling like I’m gonna freak out a little bit,” green is like, “thumbs up, good to go,” and blue is like, “tired, lethargic.” So, you know, there’s lots of different strategies out there – and you can even say it, too! You could be like, “I feel green this morning! I’m ready to go!” So, I think again, that first one, adult regulation is really important.
The second one is for those kids who do have sensory processing disorder, a lot of times, their occupational therapist will provide them with a sensory diet. And, really briefly, a sensory diet is a set of activities that a child should be doing throughout the day to help them maintain what we call ‘an optimal level of functioning.’ So, truly this could work for any child. So, parents are already amazing! You’re doing so many activities with your kids, but you’re not thinking about, like, behind the scenes sensory things that are going on, but if you have this great, like, “in the morning we’re gonna go to the playground for 30 minutes, and then we’re gonna come home and…” you know, not overwhelmingly, but just providing a nice balance of some movement activities, some activities like play-doh or shaving cream or sensory bins, those kinds of things.
Ayelet: That tactile stuff.
Jill: Tactile – that would be incredible, and really, kind of, providing them with a way to satiate their self-regulation skills. There’s plenty of examples online, and if you do work with an OT, definitely talk about it, and, it’s a living breathing thing. Like, we’re not always the same person – what will work one day won’t work the other day. So it’s nice to have a bag of tricks and some back ups to try to say, like, ‘hmm, I notice this behavior’s happening a lot at the same time, but this isn’t working, maybe I need something else to kind of fill it in.
The third one is I would really encourage all of us to watch our diet during this time. It’s obviously a season for lots of snacks and… over eating and all the sugar… and there’s so much research out there that tells us that sugar and dyes and all of that kind of stuff really impacts our bodies – and these little bodies! – you know, so hard, and there is a brain-body connection, so what our gut experiences, our brain experiences. And, you know, we always go with, “oh, now they’re gonna be all crazy after sugar!” Yeah! They are! Because, they’re digesting it and it’s connected. So, you know, let them have the treats, but watch the amount that they’re having. You don’t have to take it away, but just, in moderation.
Ayelet: Everything in moderation.
Jill: Yeah. The fourth one is, because a lot of these kids might be out of school, and I know from working in the schools that lots of the classrooms now have a visual schedule up on the board. So the kids start to really get routinized and understand that I come in, I put my backpack away, I wash my hands and go to circle, we have snack – all of those kinds of things. And it’s there, because after a while, we start talking, and it’s like, “blah, blah, blah, whatever.” So, especially since some of these kids might be out of school, you might just want to create a visual schedule at home. That can kind of remind them, and they might even be excited, because they’re so used to what it’s going to be! Not that every day of your holiday has to be the same, but just let them know what’s coming, like, “oh we’re gonna wake up, we’re gonna have breakfast, we’re gonna go on a play date with Joe, then we’re gonna come home…” however you want it to look. Or, “we’re getting on an airplane, we’re going to Florida,” all of that stuff.
Ayelet: Yeah. That preparation for transitions that are less familiar or less regular, even. Or in an unfamiliar environment to give some stability, to give some routine. Because, we all know that those daily routines, those caregiving routines, those play routines are what help to regulate both ourselves and our children, and help them to anticipate what’s coming next and deal with transitions, so that’s so important, I think, Jill, because when we are out of that, it becomes naturally dysregulating for all of us, it’s a tough… we don’t know where our bodies and our brains are supposed to be, and we have lots of different kinds of input from, you know, family and everything! So, yes. Excellent point.
Jill: Yes. And you know, there’s lots of ways you can do this. You can use a dry erase board, you know, one of those small ones and take it with you. You can probably find apps on your phone or, you know, find pictures and print those out. Also, keep in mind how old your kid is and how much they can truly handle in relation to that schedule. So, for some kids, it needs to be within that activity. So, meaning, like, we’re gonna get up, brush our teeth and get dressed. And that’s all you’re telling them. And then you’re gonna tell them the next chunk of what’s going on. For older kids, you can probably put the whole day down, and let’s check it off as it happens. You know, we’re gonna do our morning routine, we’re going to the playground, we’re going on a playdate, we’re gonna take a nap… and then they just know what’s expected. And I think we would see a lot less tantrums and just – like you said – a lot more stability within a, really, outrageous time.
Ayelet: And, to reiterate, this is really important, even for an infant, say, a 9, 10, 11-month old… we don’t think, sometimes, about how (because they can’t tell us with words) how outside of themselves things are happening, but it’s so important – we can just say those things. And like you said, just, “ok, look, we’re at Grandma’s house tonight, but we’re gonna wake up, and we’re gonna do this and that, and let’s do it!” And when you just put words to what you’re doing, or sing a song about it, or whatever it is, or look at a picture of where we’re going, it’s so helpful.
Jill: So helpful! And with that said, with the word part, I love encouraging parents to read books about anything that’s coming up about change. So, reading books about holidays or going on vacation, or anything that’s going to be happening, it’s so helpful for you as an adult, because then you have a reference. So, again, we talk, talk, talk, talk, and they’re like whatever – and you can be like, “remember in the story when Bobby went to his grandma’s house? How did he feel?” So, you have more tools as a parent to help your kid through something that’s new or unexpected, and those kinds of feelings. Yeah. So the last one I want to share is to kind of say no to crowds, large groups, those kinds of things that may be truly overwhelming. Even if you go over to a family’s house and, kind of going back to the infant – you know, passing around the baby, who’s holding the baby, those kinds of sensory information can really start to amp up a little baby, who you might see crying, and just not ok, falling asleep, whatever.
Ayelet: And back to that – that is that “hyper” and “hypo,” right? Crying, crying, it’s too much, or just shutting down, falling asleep. That is opposite sides of that sensory spectrum. That child is experiencing way too much and is crying, or is experiencing way too much and is shutting down.
Jill: Exactly. So, I know for me, like I can handle family for like a couple hours, and then I truly need to be by myself. I need a glass of wine, I need some TV, I need to have some down time. And I think we truly need to attune to our children in that way. We need to know before they start doing that, that it’s time to go. Because, in that moment, when they’re melting down, it’s just, it doesn’t serve anyone. Just to be mindful.
Ayelet: That’s great, Jill. Great tips. All five of those are great, great tips. Ok so, we are going to take just a very quick break to hear a word from our sponsors, and then we’ll hear more about some of your favorite resources, that would be great.
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Ayelet: Ok Jill, what are some of your other favorite resources for parents who may be interested in learning more about sensory development and sensory processing. You mentioned your upcoming book, and I can’t wait to link to that once we have that.
Jill: Yeah. So that is SPSD Kids is the company, and then the book is “Under the Hood: the Inner-Workings of Children,” and that will be released in early Spring of 2018. And there will be a link on my website, so a great resources is honestot.com! Sign up for our weekly newsletter, we go all over the board as far as topics. I love having guest bloggers, I’ve had quite a few speech therapists, chiropractors, massage therapists, anyone in the community that can help to foster child development, I’m in. Some of the other resources, here in Denver is the STAR Center, which is a world-renowned resource for sensory processing disorder. Lucy Jane Miller founded it, and she is one of the most amazing women, just does so much research and support for families all over the world, so you can check out that website.
There’s some great books out there that kind of talk about sensory processing – “The Out-of-Sync Child,” by Carol Kranowitz is a good one. “Raising A Sensory-Smart Child” by Lindsay Biel is another good resource. It really just depends on what kind of learner you are. I can’t say that there are any good videos that kind of break it down, you know, it’s… it’s a tricky topic, you know, and it can get easily overwhelming because, I think, of that science-based stuff, so, trying to make it fun and exciting can be a little bit tricky!
Ayelet: Well, I think we’ve done a pretty decent job of it today!
Jill: I think we did, too!
Ayelet: So, thanks so much, Jill, and thanks to all of our Community LAB members who are listening here live. We are going to continue the discussion and open up for a Q&A session so that if we haven’t done a full job, we can continue on – and so we’ll do that in just a minute. And, for everyone listening at home or on the go, thanks so much for joining us, and we will see you next time!