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.