April 7, 2014
In case you haven’t seen the movie “Frozen”, it tells the story of a princess who lives her life afraid that her powers will be discovered. Like Elsa, many of our clients are frozen in a state of anxiety and fear. Their anxiety doesn’t have a specific cause, but rather stems from the fact that they have difficulty with self-regulation; the process by which our brain attains, changes, and maintains our emotional state so that it matches the environment and the task. When we can’t efficiently self-regulate, the brain and body move in to a state of up-regulation, which is associated with anxiety, fear, panic, sympathetic nervous system dominance and flight/fright/fight reaction.
There is a typical development of self-regulation1 and we expect to have to help babies with this process. It’s why we swaddle, rock, pat and sing to soothe them. But we also expect that as babies grow, they will begin to be able to accomplish more and more of this by themselves. This progression is actually a reflection of what is happening in the brain. When we are born we have the greatest number of neurons we will ever have, but the least amount of organization. As we grow, these neurons fire and wire together, creating organized pathways in the brain. These pathways allow for the efficient processing of sensory information, which leads to increased self-regulation skills.
However, many things can interfere with our ability to self-regulate. Motor challenges, sensory processing disorders, attachment disorders2, acute and chronic pain can all disrupt the process of developing/accessing efficient self-regulation. This leaves our clients in a state of increased emotional arousal (=up-regulation), unable to maintain that “just right state” where emotional arousal is matched to the task and the environment.
It is important for us to recognize when a client is up-regulated because this state interferes with both postural control3 and learning4. Unless we can assist our clients with down-regulation, they will have more difficulty mastering any skill, whether it be sitting independently, standing on one foot or riding a bike.
Finding the strategies that assist each client is a problem-solving process, because no two brains are exactly alike. We can help our clients and families by educating them regarding the connections between self-regulation, postural control and balance. And we can problem solve with them to find which strategies work in which situations. We can also scaffold in these strategies for improved self-regulation under our work on postural control and functional motor skills. Then, like Elsa, our clients can learn to take control of their anxiety and Let It Go.
When a client comes in to your clinic, the following signs can alert you to the fact that they are in an a state of increased emotional arousal:
* dilated pupils
* reddening at the tops of the ears
* breath holding
* difficulty self-calming
* retained Moro reflex
If you have a client that is up-regulated, the following may help:
* dimming the lights
* working in a quiet room with soft colours and minimal clutter
* using a calm, quiet voice
* slow movement
* integrating the Moro reflex
* deep breathing/blowing activities (with a neutral rib cage and pelvic alignment5, of course)
For more information, check out my new online course on self-regulation, anxiety and postural control from my presentation at the 2014 APTA Combined Sections Meeting.
1. Oetter P, Richter E, Frick S. M.O.R.E. Integrating the mouth with sensory and postural functions. PDP Press, Hugo Minnesota, 1995.
2. Crittenden PM. Raising Parents. Attachment, parenting and child safety. Willan Publishing, Portland Oregon, 2008
3. Stins JF, Ledebt A, Emck C, Van Dokkem EH, Beek PJ. Patterns of postural sway in highly anxious children. Beh Brain Funct. 2009; 5:42. doi 10.1186/1744-9081-5-42.
4. Barthel K. Mental health, sensory processing and challenging behaviours. Niagara Falls, 2009.
5. Mannell S, Wiebe J. Applying the evidence: core stability in a child with challenges. Part 1 and 2. 2013, APTA CSM, San Diego, CA.
Great blog, Shelley! This is my son to a T. We are so happy to have found you. In two treatments, we have already seen a big difference in how he handles himself both at home and at school. We are grateful for your expertise and even more grateful that you are so close to home!