Wednesday, September 8, 2010

Why Did My Child's Behavior Get Worse After He Started OT?

When you prime the pump, the first thing that comes out is mud.  If your child's behavior gets worse before it gets better after he starts therapy, actually, you're probably on the right track.  

Sometimes when a child starts sensory integration OT, things happen that you don't expect.  It's important to remember that big changes in a child's nervous system are going to manifest in all kinds of behaviors, and many of them are unfortunately not adorable.  Often, a child who is plagued by defensiveness, and has been hanging on by a thread, tuning out, and shutting down, will be able to let go enough after a good OT session to allow himself to know how he's really been feeling.  This will allow him to move through it and let it go.  {In other words, he'll have a meltdown.}

This is particularly the case if you have a child with a very high pain threshold.  A child who does not register pain is a child who is very shut down, and when he ceases to be shut down, anything can happen.  Meltdowns, regressions, and unpredictable, disorganized behaviors are all very common and to be expected when a child begins sensory integration therapy.

If your therapist has recommended starting several direct interventions, for instance, therapeutic brushing, music therapy, and sensory gym all at once, changes in behavior are inevitable.  We are bombarding the child with intensity in an effort to get his nervous system to shift the way it takes in and processes information, and a few bad bumps along the way are part of the process.  It's not a good idea to request the OT to back off, even if things seem out of control at the moment.  The more intensity, the stronger the intervention, the more effective and lasting the changes.  Hang in there!

Many children, after their first time in the sensory gym, especially those who avoid movement, may be strung out and exhausted.  They may cry, be disorganized, look pale and have no energy, or just want to skip dinner and go to bed. This is normal. If your child has a good relationship with his therapist and has had an enjoyable session, working hard, having fun, and challenging himself, but then has a strong emotional reaction afterward, remember that it's all part of the process and please don't ask her to change the program.  Again, the sensory defensive child has been suppressing a lot of misery.  It has to go somewhere as it exits the body.  And remember, he's doing it where it's safe to let it go.  Wouldn't you rather have him do it at home, in private, than out in public?

On the other hand, if the reaction is not emotional but physical, that's something the OT definitely needs to know.  If your child spends the evening throwing up, sweating and shaking, or has a terrible headache after his time in the sensory gym, that's a sign that there was more input than he could handle during the session, and you should definitely let the therapist know so that she can scale back accordingly.  But if he's just cranky, disorganized, or has a meltdown, think of the therapy as a big broom that is sweeping out much of the misery, negativity, and discomfort that the child has been holding.  It's very uncomfortable to live with sensory defensiveness and try to maintain some semblance of good behavior when you're coping with the noise, chaos, and demands of school every day, which are perceived as an assault.  It's a relief to acknowledge it and let it go, but small children lack the emotional or verbal sophistication to tell us what is happening inside or to titrate it in any way, and can only cry and let themselves lose control as a response.

Children who are wrapped up in their sensory defensiveness are people whose true personalities and abilities have yet to emerge.  I have a few little boys in my practice at the moment who started out being timid, avoidant, compliant, passive little creatures, who suddenly have started becoming sassy, assertive, fiercely independent, and frankly mischievous.  In other words, they are behaving exactly like six year old boys!  It takes some getting used to, to be sure.  Personally, I find it delightful and enjoy it, because it means that I'm being an effective therapist!  Try to roll with it.  Although the former child may have been easier to live with, it's the latter qualities that are going to help him cope the most successfully with that cold, cruel world out there.

I heard a funny story from one of my teachers, Sheila Frick, who was one of the founders of an OT camp for special needs kids.  After one little boy came home from his session, his mother called her, furious.  Her passive, avoidant, lumpish ten year old had woken up early the morning after he returned, gotten himself out of bed,  dressed himself, eaten a bowl of cereal, and ridden his bike down the road to visit a friend.  She was baffled and frightened at this sudden, unexpected change in him and wasn't sure how to interpret the fact that he had gone off by himself.  He had behaved exactly like any ten year old boy on a summer day, but she wasn't anticipating such a different child than the one she had sent to camp a week earlier, and didn't know how to respond to the new paradigm.

If you are having genuine difficulty coping with your child's changes and feel your buttons getting pushed on a regular basis as he becomes more assertive and independent during therapy, I can recommend an excellent book, Parenting From the Inside Out.   We all have our triggers and blind spots, and this book teaches us how to recognize the source of our negative emotional responses to our interactions with our children, and how to repattern our dysfunctional communication patterns.  If your reactions to the child's changes are problematic, however, a few sessions with a counselor might be in order.

If you have experienced dramatic, unexpected changes in your child's behavior after OT intervention, I would be very interested in hearing about it in the comments.


Stephanie said...

Thank you, Loren for posting this! Brandon (4yo) has been going to OT and speech therapy all summer. A few weeks ago, it was like someone turned up the volume on all his coping behaviors. He had been yawning on occasion and hopping or spinning once in a while. Well, he started yawning constantly, widely, like a fish out of water. Toe-walking joined hopping and the whining and clingy behaviors were off the charts. It took me an hour one day to get him outside (along with my 16mo, Evey). We went for a walk and he whimpered and draped himself on me as we slowly walked around the block. By the end of the week, I thought I was going to lose my mind.

I figured something like what you described might be happening, so we would face the storm head-on. I began brushing, deep pressure, and joint compression before naps and bedtime and bought a scooter. It helped. Today is his first day of school, so... we'll see.

Thanks for letting me know this is what's supposed to happen!

dancilhoney said...

Very informative, I will certainly persevere with your techniques. child behavior

Anonymous said...

My daughter was very shut down before therapy. For the last few days I have been working at home with her brushing her every 2 hours and doing joint compressions coctailed with LOTs of interaction. I have noticed that I can keep her attention for 10x longer now but with that I have been worried as well. She has went from a pretty quiet little girl with rare meltdowns to a little girl who gets frustrated mroe easily because she is trying to do stuff she can't figure out....for instance putting a necklace on a toy. She just cannnot figure out how to put the necklace over its head. This has cause intense meltdowns and I have been worried I am pushing too hard or doing something else wrong. The other plus is that her vocab has went from about 15 words to 40 in 3 days. Am I on the right track and how do I ease the meldowns, nothing works!!

Loren Shlaes said...

It sounds as if you are on the right track. I wouldn't change what you are doing. Intensity is the key here and the meltdowns won't last forever -- although you may have to put up with them for a few more weeks.

You can try stepping in before she gets too frustrated and see if that helps. More time outside running around will help. Children who are physically tired are too tired to tantrum!

Let her feel her feelings. She's been very unhappy and the brushing is connecting her with her body and allowing her to look outside herself a bit. She doesn't know how to interact with the world quite yet and doesn't have the patience or sophistication to regulate her emotions or to cope with failure.

You may want to read about Floor Time by Stanley Greenspan. He recommends constant intensive interactions in order to engage a withdrawn child's emotions. He's written many good books. I recommend Engaging Autism. Even if your daughter is not autistic there is plenty of great advice and information about how to help an emotionally disengaged and shut down child.

Good luck!

Hadeel said...

Hello, am a speech therapiest from Amman ,Jordan. Iam really thankful for finding your blog, i in Jordan we dont have many expierianced OT. howeverm ,am helping an autism 6 year old girl who started OT therapy since one month , since she started therapy she become more hyperactive ,her hands flapping is worse her eye contact is also worse, that actually is affecting speech sessions. I would be gratful if you helpe me to know whats going on .....