Today’s blog post was submitted by Lara Mather. Lara is an OT working in Hillcrest, KZN and is excited to start her ASI® journey on SASIC 1 and 2 this year. Thank you Lara!
“Home is not a place, it’s a feeling”- Cecilia Ahern
Growing up, Ouma buttermilk rusks were the solvent of all of life’s problems. Not feeling well- have a plain rusk. Got your heart broken- nothing a rusk dunked in tea can’t fix. Sunday blues- here come the rusks! Our Ouma rusks tasted like home.
A recent post on social media by Kath Smith from ASI Wise spoke to the sensory experience of eating a rusk, which got me thinking- is it the rusk, or is the sensory input provided by the crunching and the chewing of the rusk that brings about calmness and serenity that all of life’s problems have now been solved (1)? Is the feeling of “home” in fact an experience that brings about self-regulation? Some literal food for thought!
Upon reading Kath’s post, I realized that as South Africans, we have many unique sensory experiences that the rest of the world may only occasionally encounter, ranging from the squawking hadedahs at 5am to the smell of a neighbour’s freshly lit braai wafting over the wall. Without even giving it a second thought, we often find ourselves seeking or even to some degree avoiding these sensory experiences in order to meet the demands of everyday life and keep ourselves regulated.
Over the years, South African drivers have built up a notorious name for themselves. A peak hour traffic jam is a perfect example. Picture this- cars jam packed bumper to bumper across all four lanes, moving at snails’ pace. Whilst most are law abiding citizens, we always have exceptions to the rule. For those select few a traffic jam automatically means making a beeline for the emergency lane. On a day when I have to encounter a situation like this, the constant stop, start, emergency breaking, hooting back and forth, I feel myself becoming completely unhinged and dysregulated and the day hasn’t even begun yet! A cup of something warm (Rooibos tea!) in hand often allows for much needed sensory input, bringing about a calm state in which I can function optimally. Each sip just feels like home.
South African’s are pretty adaptable beings- 14 years of load shedding really does that to you! One minute it’s light, and the next you are plunged into complete darkness- a completely unique sensory experience of its own! As inconvenient as the two-hour periods can be, they bring about an unusual calmness and serenity- no bright lights, no blaring TV’s, just the darkness. The hustle and bustle seems to grind to a halt and for a rare moment I can actually process my thoughts. A part of me is grateful for these forced moments of “down time” where I can remove myself from the sensory overload that is daily life. It gives me time with my family, who usually gather in one room waiting the two hours out together. It’s laughing, giggles, life advice and just general “togetherness” that we otherwise would probably never get. It’s home. Who would have thought that load shedding allowed for self-regulation? Who would have thought that load shedding felt like home?
Growing up in Durban meant that almost every home on our street proudly displayed their ever-blooming Jasmine that crept over fences and released the most beautiful scent. The sweet scent was identifiable from a couple of streets away, signifying that home was near. It only occurred to me recently that every single one of my perfumes contain Jasmine as an ingredient. Am I unconsciously self-regulating? A spritz and spray in the morning brings about the familiar scent that is grounding, familiar and calming- it smells like coming home.
Our beautiful country offers a myriad of unique sensory experiences that I could go on and on describing, from our incredible beaches to our midday electrical storms amidst mountains that seem to stretch far beyond what the eye can see. Each one holds a significant meaning for every one of us, helping us to centre ourselves and begin again. We encounter these unique sensory experiences every single day and we cope; we cope through engaging in small acts and experiences that allow us to self-regulate and bring us back on track. Home is not a place. Home is a sensory experience.
1.Smith K. Thank you Rusk and Co! [Internet]. 2021 January 25 [cited 2021 February 14]
Written by Karen Powell
Happy New Year to you! To inspire you to have fun despite the pandemic level challenges we might be facing this year, we revisit the foundation and importance of play, and how it relates to the work we do.
Play and Discovery
In 2007 the American Academy of Pediatrics (AAP) published Clinical Reports on the importance of play. Since then, newer research has provided additional evidence of the critical importance of play in “facilitating parent engagement; promoting safe, stable and nurturing relationships; encouraging the development of numerous competencies, including executive functioning skills; and improving life course trajectories” (1).
Living in the midst of a pandemic reminds us that fostering healthy relationships with those in your social bubble is vital, not only to further promote and encourage the healthy development of children, but also as a means to manage the underlying stress, for parents and children alike.
As occupational therapists (OT’s) we are well aware that an increasing societal awareness on school readiness has led to programmes which promote earlier academic results, even as early as preschool, with a corresponding decrease in playful learning (1). The new Clinical Report, The Power of Play: A Pediatric Role in Enhancing Development in Young Children (2) by the AAP is very exciting, as it not only provides encouragement to paediatricians for the prescription of play, but provides research and evidence for what we as paediatric occupational therapists know to be true.
This article holds so much value. You can learn from it, share it, motivate your therapy and causes. The full article is available here for your own review, but below are a few thought summaries to whet your appetite, perhaps a form of “highlight reel” of those issues most relevant to our area of expertise.
Relating to infant play:
- “Caregiver infant interaction is the earliest form of play, known as attunement, but it is quickly followed by other activities that also involve taking of turns. These serve-and-return behaviours promote self-regulation and impulse control in children and form a strong foundation for understanding their interaction with adults” (2).
- “By 9 months of age, mutual regulation is manifested in the way infants use their parents for social referencing” (3, 4).
- “Uncontrollable crying as a response to stress in a 1-year old is replaced as the child reaches 2 to 3 years of age with the use of words to self-soothe, building on caregivers scaffolding their emotional responses” (2).
Relating to didactic learning:
- “Early learning combines playful discovery with the development of social-emotional skills” (2). Children learn by playing with toys and looking at those around them. Explicit instructions, however, limit a child’s creativity. It is argued that we should let children learn through observation and active engagement rather than passive memorisation or direct instruction (2). “Successful programs are those that encourage playful learning, in which children are actively involved in meaningful discovery” (2).
- Panksepp (5) went so far as to suggest that play deprivation is associated with the increasing prevalence of attention-deficit/hyperactivity disorder (6).
Relating to Sensory Integration, Outdoor Play and Risk
- “Outdoor play provides the opportunity to improve sensory integration skills. Viewed in this light, school recess becomes an essential part of a child’s day (7). It is not surprising that countries that offer more recess to younger children see greater academic success among the children as they mature (7,8).”
- “Physical activity is associated with decreases in concurrent depressive symptoms” (9). [Outdoor] play decreases stress, fatigue, injury and depression and increases range of motion, agility, coordination, balance and flexibility (10).
- “Rough and tumble play…enables children to take risks in a relatively safe environment, which fosters the acquisition of skills needed for communication, negotiation, and emotional balance, and encourages the development of emotional intelligence. It enables risk-taking and encourages the development of empathy because children are guided not to inflict harm on others” (11, 12, 13). “The goal is not to eliminate risk” (14).
Relating to scaffolding:
- “A Russian psychologist, Vyygotsky, recognized that learning occurs when children actively engage in practical activities within a supportive social context. He was interested in what he called the ‘zone of proximal development’, which consists of mastering skills that a child could not do alone but could do with minimal assistance (15). In the zone of proximal development, the ‘how’ of learning occurs through a reiterative process called scaffolding, in which new skills are built on previous skills and are facilitated by a supportive social environment” (2).
- “According to Vygotsky (15), the most meaningful learning occurs in a social context, where learning is scaffolded by the teacher into meaningful contexts that resonate with children’s active engagement and previous experiences. Scaffolding is part of guided play; caregivers are needed to provide the appropriate amount of input and guidance for children to develop optimal skills” (2).
Relating to stress:
- “Play and stress are closely linked. High amounts of play are associated with low levels of cortisol, suggesting either that play reduces stress or that unstressed animals play more” (16).
- “Children need to develop a variety of skill sets to …manage toxic stress. Toxic stress can disrupt the development of executive function and the learning of prosocial behaviour. Play supports the formation of the safe, stable, and nurturing relationships with all caregivers that children need to thrive. The mutual joy and shared communication and attunement that parents and children can experience during play regulate the body’s stress response.”
- “Play also activates norepinephrine, which facilitates learning at synapses and improves brain plasticity” (2).
- “Play, especially when accompanied by nurturing caregiving, may indirectly affect brain functioning by modulating or buffering adversity and by reducing toxic stress to levels that are more compatible with coping and resilience” (17,18).
Perhaps we should not overlook the importance of teaching parents to play with their children. Play is not something facilitated only by the OT once a week in sessions, but is a vital part of every day. Barriers to play with caregivers need to be removed so that children can experience more effective play interactions on a daily basis.
But it’s not all about the kids. Play is great for adults too, and we can use this information to motivate parents to set aside uninterrupted play time with those in their charge.
- “Parents learn to see the world from their child’s perspective and are likely to communicate more effectively with their child, even appreciating and sharing their child’s sense of humour and individuality” (2).
- “To be passionately and totally immersed in an activity…and to experience intense joy” (2).
- “Positive parenting experiences result in decreases in parental experiences of stress and enhancement in the parent-child relationship” (19, 20, 21).
“Play is not frivolous; it is brain building. Play has been shown to have both direct and indirect effects on brain structure and functioning. Play leads to changes at the molecular (epigenetic), cellular (neuronal connectivity, and behavioural levels (socioemotional and executive functioning skills) that promote learning and adaptive and/or prosocial behaviour” (2).
Wishing all SAISI members a playful 2021, for all the right reasons!
- Ginsburg KR; American Academy of Pediatrics Committee on Communications; American Academy of Communications on Psychosocial Aspects of Child and Family Health. The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Paediatrics. 2007; 119 (1): 182-191.
- Yorgman M, Gardner A, Hutchinson J, Hirsh-Pasek K, Golinkoff RM. Clinical Report: Guidance for the Clinician in Rendering Pediatric Care. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018; 412 (3): 1-18.
- Campos JJ, Klinnert MD, Source JF, Emde RN, Svejda M. Emotions as behaviour regulators: social referencing in infancy. In: Plutchik R, Kellerman H, eds. Emotion: Theory, Research and Experience. Vol 2. New York, NY: Academic Press; 1983: 57-86.
- Sorce JF, Emde RN, Campos JJ, Klinnert MD. Maternal emotional signalling: its effect on the visual cliff behaviour of 1-year-olds. Dev Psychol. 1985; 21 (1): 195-200.
- Panksepp J. Can PLAY diminish ADHD and facilitate the construction of the social brain? J Can Acad Child Adolesc Psychiatry. 2007; 16(2): 57-66.
- Christakis DA. Rethinking attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016; 170 (2): 109-110.
- Murray R, Ramstetter C; Council on School Health; American Academy of Pediatrics. The crucial role of recess in school. Pediatrics. 2013; 131(1): 183-188.
- Pelligrini AD, Holmes RM. The role of recess in primary school. In: Singer D, Golinkoff R, Hirsh-Pasek, K eds. Play = Learning: How Play Motivates and Enhances Children’s Cognitive and Socio-Emotional Growth. New York, NY: Oxford University Press; 2006.
- Korczak DJ, Madigan S, Colasanto M. Children’s physical activity and depression: a meta-analysis. Pediatrics. 2017; 139(4): e20162266.
- Goldstein J. Play in children’s development, health and well-being: technology and play. In: Pellegrini DA, ed. Oxford Handbook of the Development of Play. New York, NY: Oxford University Press; 2011.
- Burghardt GM. The Genesis of Animal Play: Testing the Limits, 1st ed. Cambridge, MA: MIT Press; 2005.
- Pellis SM, Pellis VC, Bell HC. The function of play in the development of the social brain. Am J Play, 2010; 2: 278-296.
- Pellis Sm, Pellis VC. Play fighting of rats in comparative perspective: a schema for neurobehavioral analyses. Neurosci Biobehav Rev. 1998; 23(1): 87-101.
- Barry E. In British playgrounds, bringing in risk to build resilience. New York Times. March 10, 2018. Available at: https://nytimes.com/2018/03/10/world/europe/britain-playgrounds-risk.html . Accessed April 27, 2018
- Vygotsky LS. Play and its role in the mental development of the child. In: Bruner J, Jolly A, Sylva K, eds. Play. New York, NY: Basic Books; 1976: 609-618.
- Wang S, Aamodt S. Welcome to Your Child’s Brain: How the Mind Grows from Conception to College. New York, NY: Bloomsbury USA; 2011.
- Siviy SM. Effects of pre-pubertal social experiences on the responsiveness of juvenile rats to predator odors. Neurosci Behav Rev. 2008; 32(7): 1249-1258.
- Garner AS, Shonkoff JP, Siegel BS, et al; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. Early childhood adversity, toxic stress, and the role of the paediatrician: translating developmental science into lifelong health. Pediatrics. 2012; 129(1). Available at: www.paediatrics.org/cgi/content/full/129/1/e224
- Berkule SB, Cates CB, Dreyer BP, et al. Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care. Clin Pediatr (Phila). 2014; 53(5): 460-469.
- Weisleder A, Cates CB, Dreyer BP, et al. Reading is not just for language: promoting cognitive stimulation also enhances sosioemotional development. In: Pediatric Academic Societies Annual Conference; April 30 – May 4, 2016; Baltimore, MD.
- Cates CB, Weisleder A, Dreyer BP, et al. Leveraging healthcare to promote responsive parenting: impacts of the Video Interaction Project on parenting stress. J Child Fam Stud. 2016; 25(3): 827-835.
Today’s post was submitted by Liani Austin. Liani works in private practice at Therapy Factory and has two beautiful children. She loves guiding concerned parents and educators, so that children can reach their full potential by means of a sensory integration approach.
“Knowledge is power.” We are all familiar with this quote from Frances Bacon, an English philosopher born in 1561. Interestingly, Francis is best known for his promotion of the scientific method, reveals a quick Wikipedia search.
Science. Evidence. Facts. Research. These come to mind first. But what about philosophy? Dreams. Hope. Goals. Expansion. Improvement. These two terms, seemingly on the opposite ends of the spectrum, yet gently and subtly connected by the human brain.
I believe occupational therapists are some of the kindest, wisest souls on planet earth. The everyday “Mother Teresa’s and Florence Nightingale’s” of the world. Most of us are naturally drawn into the philosophical side of life, in which we can (as clichéd as it sounds) express our deep yearning to help others. Perhaps waking up at night, fretting about the child who is falling apart at school. Or blinking away tears when triggered by a song in the car and feeling the pain of your stroke patient whose whole world came tumbling down today.
“If you don’t move forwards, you move backwards” (author unknown). I eventually learned this as I navigated my way through my early days as an occupational therapist. Now I have to be honest, studying occupational therapy straight after giving it my all for years at school, felt like it took its toll on my learning tank. I remember the feeling of freedom during my community service days. Relief that filled my heart when I returned home after a rewarding day at the hospital and plopping down onto the couch instead of opening a textbook. I was a little bit over studying… There, I’ve said it.
So when the HPCSA implemented stricter measures on tracking CPD and everyone around me was being “audited”, I rolled my eyes in despair. But I complied and made sure to go on a few courses, workshops and seminars.
It happened slowly, but one day, I suddenly realised, that what I had previously rolled my eyes at, became part of the highlights of my year: attending seminars, learning, and best of all, the feeling of complete inspiration afterwards. I wasn’t necessarily able to explain perfectly in words what I had learnt, but I could feel it in my hands and heart during therapy the next day. It made me a better OT.
When SAISI put forward the awesome idea of structured journal clubs, I jumped at the opportunity when I was invited by Stefanie Kruger. The name of our journal club in Pretoria East? “Sensory Inspiration”. How fitting!
I love meeting therapists in the area, putting smiles to names, and my favourite part of journal club is the bits of discussion and brainstorming in between. We share ideas,so that next time we will look at a situation from a different angle. Not even Covid-19 lockdown could deter us as we continued our monthly meetups online via Zoom.
I’m sure everyone has their individual favourite topics, and for me my ears prick when we discuss articles about sensory modulation and linking this to behaviour. A few standout articles for me were:
- Atypical Sensory Modulation and Psychological Distress in the General Population, Bar-Shalita & Cermak (2016).
- Sensory Integration Therapies for Children With Developmental and Behavioral Disorders, Zimmer & Desch (2012).
- Sensory Over-Responsivity as an Added Dimension in ADHD, Lane & Reynolds (2019).
No one has ever failed (or not that I know of in any case) the quick multiple-choice questionnaire completed after each article discussion.
Journal clubs are an easy and cost-effective way, to not only get loads of CPD points, but also to keep up with the latest research, especially in the field of Sensory Integration. Plus, we stay connected to our colleagues. After all, isn’t a journal club really like a book club (with or without wine)? We make friends, we chat, we listen, we connect. Oh yes, and we learn!
Time to sign up. Free to SAISI members.
What you need: 3 like-minded SAISI members / 6 hours per year / you can meet in person or over zoom.
What you get: earn up to 18 CPD points for the year / time to reflect with colleagues / expand yourself as and ASI ®️ therapist
Contact the SAISI office email@example.com
Bar-Shalita, T & Cermak, SA 2016, ‘Atypical Sensory Modulation and Psychological Distress in the General Population’, American Journal of Occupational Therapy, vol.70, 7004250010. (http://dx.doi.org/10.5014/ajot.2016.018648)
Zimmer, M &Desch, L 2012, ‘Sensory Integration Therapies for Children With Developmental and Behavioural Disorders’, Section on complementary and integrative medicine and disorders council on children with disabilities pediatrics, vol. 129, no. 10. (http://pediatrics.aappublications.org/content/129/6/1186)
Lane, SJ & Reynolds, S 2019, ‘Sensory Over-Responsivity as an Added Dimension in ADHD’, Frontiers in Integrative Neuroscience, vol. 13, article 40.
And just like that we bid farewell to 2020. SAISI board would like to thank you for your ongoing support and engagement through what has been a very challenging year. For some the challenges were health-related, for others financial, emotional, or personal. We see you and we acknowledge how our members have made the most of the situation and supported each other through it.
The year with its ever-changing restrictions has also challenged us, especially technically. Both younger and older members have felt the the push to improve their tech skills. It has been a year of firsts, including:
- First online board meeting in June
- First online SASIC 4 course
- First webinar series to support members through all the changes, and
- Whatsapp groups for member support
I think the overarching theme of the year has been one of support. We can all agree that SAISI members have pulled together, helped each other, shared ideas, sourced PPE and equipment, supported each other when the rules and restrictions didn’t seem fair. While all the messages and mails may have been overwhelming, I feel there has been a shift in our profession, from competition to collaboration. What a wonderful acknowledgment of the kindness of our fellow OT’s, knowing that we pull together when it counts, for the good of our clients and each other.
Wishing you all a very blessed festive season with your families, wherever that may be. Though you might not be able to go to the beach or see all the family members that you miss, we know that as resourceful OT’s you will make the most of the difficult situation.
Sit back for a while, recharge with your families and pat yourself on the back for surviving the year. Be thankful for all the good that has come out of the year. Acknowledge those who helped you through it. Look for an opportunity to give back.
We have lots to share with you when we come back in 2021!
Today’s blog is written by Stefanie Kruger, private practitioner at Simply Senseable, and SAISI board member, who decided to conduct some of her own research into the loss of “OT-ness” in this year of the pandemic.
Vanilla essence is a delectable scent. It infuses anything it is mixed with, whether it is a milkshake, cookie dough, tea or soap, with that unique vanilla flavour. However, a spoonful on its own is rather bitter. For any young baker, that is often a surprising discovery: the secret of balance on a very concrete level. By adding “just the right amount” (not too much, and not too little) to the other ingredients, one would get the desired flavour. On a more abstract level, the term ‘‘essence” can be defined as the intrinsic nature or indispensable quality of something, especially something abstract, which determines its character. This may be the reason why it is so hard to describe the exact character or essence of hands-on occupational therapy, especially when we have a passion for the Ayres Sensory Integration (ASI®) approach. What is that indispensable, often intangible, quality or abstract “thing” (or probably mixture of things) that we miss when we cannot see our clients in person? It is that special something-ness that is so hard to compensate for over a screen e.g. for those who provide therapeutic support via a telehealth platform as well as those who did not see clients at all during lockdown earlier this year.
Perhaps we can also ask similar questions when it comes to presenting or attending training sessions or webinars over a virtual platform. However, for the purpose of this blog we will focus on hands-on OT intervention with a special interest in ASI®. That could be another topic for another blog 😊
As OT’s with a special interest in ASI®, we are all familiar with concepts such as the art and science of intervention, as well as the requirements according to the Fidelity Measure (Ayres 1972, 2005; Parham et al 2011). It is interesting that about half of the process criteria of the Fidelity Measure pertain to therapy as play and the therapist as a skilled playmate, the promoter of play as well the person responsible for being able to create the just-right challenge and developing a therapeutic alliance (Bundy and Lane 2020). By using this playful approach in intervention, the therapist often infuses imaginative play and creative themes so that the child loses track of time and effort. It allows the child to become engaged in challenging activities that might not otherwise be possible (Schaaf and Smith Roley 2006).
It is evident that play is the essence of childhood, and of ASI® intervention. Play is intrinsically motivating, it relies in on the child’s inner drive, and allows the child to be and feel in control. Play, in the context of intervention, involves a careful balance of freedom of rules and the constraints of reality, with some subtle and unobtrusive structuring and framing by the therapist. Being playful with children and watching them flourish through play with us, is what makes our work so enjoyable, satisfying and effective. Providing structure and support for adaptive responses is one of the key issues for collaboration in activity choice and for the therapist to create that just-right challenge (Bundy and Lane 2020).
What gives an OT-session that unique character, or OT-ness which makes activities in a “real-life” session different than over a screen?
When we think about the idea or concept of an OT-session, and how to use different pieces of equipment, one of the terms that comes to mind is affordances. This implies knowledge of objects, actions, and appropriate object-action interactions. Dr Teresa May Benson mentioned that praxis has to do with our library of motor possibilities: when we make an adaptive response, we put a new book into our library to interact with the rest of the library. She further added that action-semantic fields link with the total experience of a sensory-motor input, and that we encode these books in our library as pictures (generic images) and not just with words. Arnheim (1966) stated that his mind in its “ordinary operations, is a fairly complex picture gallery, not of finished paintings, but of impressionistic notes”. When we think about the characteristics of a cat, we can describe its body parts, diet and perhaps its habits. But what are the action-semantic fields and encoded images, which give a cat, its total experience of cat-ness? We could probably add that our perception is based on our interactions and previous experiences with a cat. (Based on workshops notes presented by Dr Teresa May-Benson 2015: Assessment and intervention for ideation and praxis).
Thank you to everyone who completed the online questionnaire for this blog. We received 56 responses of which 78.6% presented telehealth sessions this year. It truly was amazing to tap into the wisdom of this crowd in an attempt to capture what the “essence of OT-ness” is from our personal experience. It was even more exciting to find the supporting evidence to support our perceptions with up-to-date literature.
- From your perspective, what did you miss the most by not being able to see your clients face-to-face? (irrespective if you did telehealth sessions or not):
Human connection, personal interaction, touch, being hands-on, sharing in the small joys and successes, subtle support and adaptations within activities, gauging the child’s non-verbal cues, therapeutic relationship, tangibility of working in real-time and space, spontaneity, natural flow of a session (being more flexible e.g. in terms of planning and preparation), being able to control / manage the environment and equipment within.
- In your opinion, the “essence of OT-ness” is a:
Physical therapeutic space (50%)
Having a variety of equipment available (44.6%)
Click on the link to open the chart: Chart 1
Being together in the moment, combination of who we are and what we know, adaptability, balance between art and science, facilitating problem solving as it happens
- Which statements describe the “essence of OT-ness” the best?
The following options were given and the results are indicated in the bar graph below (click on link to open):
- Sharing space (e.g. not necessarily in conversation, but just “being” together or doing something meaningful together)
- In-tune with the client’s needs in the here-and-now (e.g. able to subtly adjust grading quickly in the moment or as needed)
- Intuition (e.g. able to read non-verbal cues and support client’s needs such as emotional and sensory regulation)
- The joy of having fun together
- Dynamic exchange of ideas and trying out different things
- The satisfaction of seeing the client succeed (ability to scaffold, tweak and adjust challenges)
- Empathy for the client (e.g. when something goes wrong or not according to plan)
- The freedom of being creative within a session while still keeping goal-setting in mind
- Spontaneity (e.g. the flow of a conversation, or within activities)
- Types of activities and grading that can be presented by the therapist (e.g. not limited by what parents have at home)
It is indeed fascinating to see that the following items were the top five (5) descriptions of the essence of OT-ness from the 56 responses that were received:
- Intuition (98.2%)
- In-tune with clients’ needs (85.7%)
- Satisfaction of seeing the client succeed (80.4%)
- The freedom of being creative within a session (75%)
- Spontaneity and the flow within the session (62.5%)
- Describe the “essence of OT-ness” in one word, phrase or sentence:
Fun, play, adaptable, collaborative, flow, small moments of joy, engage, connect, synchrony, empowering, meaningful, creative, available to child, intuition with skill, the feeling of sharing space and time, therapeutic use of self.
Finding balance between the art and science of OT – creating a sensational palette
The most effective intervention reflects a partnership between art and science, where the relationship is fluid. Science is explicitly concerned with knowledge and theory, and crucial for clinical reasoning, effective goal-setting and targeted intervention. Science allows us to situate a session in the proper constructs of ASI® theory. Art on the other hand is more intuitive, almost ethereal. Art is fluid, and allows for that “ever-adapting activity required to meet the moment-to-moment needs of a child”. “The artist’s mission may not ever by reduced to words or rationally understood, but its invisible magnetizing presence will infuse an artist’s work completely” (Alex Grey 1998 in Bundy and Lane 2020).
Peloquin (1989) indicated that art is the soul of occupational therapy practice. (Bundy and Lane 2020). Peloquin (2005) further stated that effective practice is artistry and science together “Grains of sand and waves of sea together make seaside. Seaside would not be if one were gone” (Bundy and Lane 2020).
Let us go forth in the ever-evolving future and strive to balance the science and art of OT intervention, so we as therapists, as well as the people we work with, may experience the soul of OT in its totality.
Ayres AJ. Sensory integration and learning disorders: Western Psychological Services; 1972.
Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005
Bundy, A., and Lane, S.: Sensory integration theory and practice 3rd edition (FA Davis 2020)
May-Benson TA, Blanche E, Schaaf R. A theoretical model of ideation. Understanding the nature of sensory integration with diverse populations. 2001:163-81
Parham, L. Diane, Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., Cohn, E. S., Mailloux, Z., Miller, L. J. and Schaaf, R. C. (2011) Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration Intervention American Journal of Occupational Therapy, 65, 134 – 142
Roley SS, Blanche EI, Schaaf RC. Understanding the nature of sensory integration with diverse populations: Pro-Ed; 2001.
Schaaf RC, Mailloux Z. Clinician’s guide for implementing ayres sensory integration: Promoting participation for children with autism. Bethesda, md.: American occupational therapy association. linda. linneanet. fi/F. 2015.
Schaaf RC, Roley SS. Sensory integration: Applying clinical reasoning to practice with diverse populations: PRO-ED, Incorporated; 2006.
Can busy, paediatric and adult OT’s, ASI® practitioners with big caseloads, and overworked practice owners “re-imagine doing”, or “not doing”?
The pandemic has left us in a strange kind of in-between. Lockdown started on 27 March 2020 in the most extreme form. Some of our privileges and routines had already been stopped in the week prior to the president’s big announcement, but then. life. stopped. We all took a big pause, challenged by the time to do less, have access to less, socialise less. As weeks became months, we became used to uncertainty, waiting week on week for new and updated rules. Gradually, some restrictions were lifted. But here we sit now, in Level 1. In between. Lockdown is not over. There was no lockdown “off” switch.
Many of us as OT’s spend our days helping clients and patients get back to being busy, after life or disability or illness has interrupted their daily normal. Many of us had our “usefulness” challenged when our outpatient clients disappeared overnight. Some needed to take a break and rest. Others found themselves faced with a whole range of new challenges – to keep earning an income, to save a clinic, to maintain contact, to address urgent client needs. Where did you find yourself? Did you have a chance to think, or did you settle into a new kind of hustle?
This week The Daily Maverick (24 October 2020) had an article by Yvonne Jooste, challenging the notion that the “hustle culture” we subscribe to might not be best for our health. Jooste weighs up the benefits of switching one form of hustle pre-lockdown, for another at home. This article really struck a chord and seemed to be published somewhat coincidentally in line with World OT Day on 27 October. While some people needed to be busy to stay sane, others felt the pressured through online social channels that they weren’t doing enough.
“Although routine, productivity and work may help some people alleviate their anxiety during the coronavirus crisis, feeling guilty because you are not designing an app, doing a course in digital marketing, starting a business or writing some of the best plays ever written, will only be detrimental to your health and wellbeing. Many of us will oscillate between fear and anxiousness, optimism, sadness and searching for comfort. We will need to address our needs whatever they may be and take care of ourselves, nothing more.”
As I read through her article it challenged me as an OT to make sure that my goals and objectives for my clients are always according to their priorities. Not mine. Not society’s. Not our perhaps unhealthy culture’s.
Hustle culture refers constant working. It means devoting as much of your day as possible to working, or hustling. Hustle culture implies that the more you work, the more celebrated you are. It interferes with basic sensible health needs such as meals, sleep, exercise and family time. Hustle culture breeds a toxic sense of competition.
Many occupational therapists are caught up in this irony. While wanting the best for clients, supposedly subscribing to a mindset of life balance, they get caught up in one of two frantic races – the entrepreneurial one, or the service model. Occupational therapy personalities come in all shapes and sizes, but many a final year student, lecturer, therapist or board member has worked, chased or served to the point of burnout.
“Several authors have suggested strategies to resist hustle culture and its effects, such as burnout and depression. Suggestions range from doing nothing, to finding more meaningful pursuits, to focusing on relationships, family and passions.” (Jooste)
Jooste goes on to say “Hustle culture, apart from ignoring vast systemic inequalities in part created by modern ideas of progress and individualism (some people have no option but to hustle and is it possible to hustle when your basic human needs are not being met?), it also reduces life to getting and spending. There is no time left for sadness, reflection, slowness, and activities imbued with love – values much needed in a time of crisis.”
The pause of life as we know it in 2020, forced us to rethink our careers, our values and our goals. While some OT’s were able to lean into that pause and learn from it, others felt threatened by the loss of momentum. Addicted to busyness? Which side were you on? Admitting that you’re addicted to the transactional nature of a getting-and-spending culture seems so counter-intuitive to the generally accepted stereotype that OT’s are caring individuals who want to “help other people”.
And here is the crux, for us OT’s who have been challenged to “re-imagine doing”:
“We must challenge the notion of development at all stages of life, and imagine the course of life differently than through speed or milestones.” – Vincenzo di Nicola (psychiatrist) in writing a manifesto for Slow Thought. “This requires practices that have no object, no measurable result “that allow us to live more fully in an a-temporal present, freed from the burden of an imperfect past or the futile promise of a redemptive future”. In other words, do whatever sings to you, Jooste says. I love that.
For a profession built on activities, participation, just-right challenges and growth, these edgy words push our clinical reasoning to new heights. We have to really re-imagine. Reframe our thoughts and beliefs. That means taking the creative process and walking the path of our thoughts not once, but twice, with enough courage to believe that we might come to a different conclusion the second time around.
What is optimal for the child’s development in the midst of a pandemic?
How do I view technology and screen time in a socially-distanced world?
How does school-readiness look in 2020?
How has Covid-19 affected mental health – of those with known issues and those who are being confronted with anxiety and depression for the first time?
Which part of my practice offering adds value to my clients when they might’ve lost their income?
How do re-invent myself to build new momentum when this has passed?
What is urgent while “normal life” is paused?
What is most important for me now?
How will things look for my family in an uncertain 2021?
And, who needs OT now?
There is no finite answer. Each OT and each client will have walked their own path through 2020. It is vital however, that we each acknowledge that we will emerge changed. And that we need to re-imagine whatever it is that we’re going to be doing.
Happy World OT day on 27 October 2020 to all the phenomenal occupational therapists who are part of our community! We value your contributions to your families, your workplace and your society.
Today’s post was written by Stefanie Kruger, and first published on her website, Simply Senseable, after which she updated it for SAISI’s blog. Thank you Stefanie for reminding us to always look at the broader context!
This past year presented many events or situations that challenged our ability to adapt. The verb “adapt” can be defined as the ability to adjust someone (including oneself), or something to different conditions, a new environment; to fit, change or modify to suit a new or different purpose. In order to keep on growing and learning, we must be internally driven to actively participate in a purposeful activity, so that we can build on previous experience and gradually expand our skills repertoire and ability to adapt. Integration of sensations is critical so that we can react to the sensations from our bodies and environment in a meaningful way.
In her 1978 Eleanor Clarke Slagle Lecture, occupational therapy as a “science of adaptive responses” was proposed by Lorna Jean King. The adjustments made by an individual in the ongoing process of interacting with the environment were referred to as individual adaptation. Inherent in individual adaptation are adaptive responses, characterized by King as active, goal directed, integrated and self-reinforcing. The adaptive response is considered on a continuum of sequential and interdependent relationships to other human responses that serve an adaptive function. Authentic occupational therapy practice is concerned with eliciting an adaptive response, implying an action towards an external demand. King further suggested that Ayres’s phrase “eliciting an adaptive response” succinctly sums up what occupational therapists do (Kleinman and Bulkley, 1982).
Dr Jean Ayres was the first to recognize the role of sensory integrative processes in functional behaviour. She proposed that the manner in which a child’s central nervous system is able to process, integrate, and respond to sensation, influences the child’s cognitive, motor, emotional, regulatory, and adaptive behaviour. If the child’s integration of sensation is ineffective, the resulting responses are less than optimal, and may lead to a range of difficulties which may impact participation in daily life activities (Watling et.al., 2018).
In the context of occupational therapists with a special interest in Ayres Sensory Integration®, we are often dealing with terms and concepts such as adaptive responses and adaptive behaviour.
Ayres defined an adaptive response as an appropriate action in which an individual responds successfully or makes an adjustment to an environmental demand (Ayres 1979). It is a measure of the individual’s ability to cope with and successfully meet an environmental challenge (Roley et.al. 2001). The effectiveness of an adaptive response depends on the accuracy of our sensory perception and sensory feedback from our bodies. Adaptive responses imply that we are, or that we can do things, a little easier, better or more spontaneous than before. The tie between motivation and challenge is clear (Bundy and Lane 2020).
Ayres further added the term “adaptive behaviour” and differentiated between lower- and higher-level adaptive behaviours according to their complexity. A less complex adaptive response implies that the environment imposes itself on the individual. In a more complex adaptive behaviour, the individual initiates the interaction when he/she recognizes an invitation from the environment to act on it. Promotion of long-term adaptive behaviours leads to a healthy life due to the expanding repertoire of skills that enable people to achieve their goals in their own environment. Long-term goals leading to health through adaptive behaviours need to include assisting the individual to develop repertoires of nourishing occupations that help them maintain their optimal level of arousal, provide a sense of well-being and enable them to achieve their goals in society. Developing such a repertoire, the characteristics of the experience, the nature of the occupations and the temporal aspects of activities need to be considered. The characteristics of occupations that provide a sense of well-being include being enjoyable, intrinsically motivated and orientated towards the process, rather than the product should be considered. (Roley et.al. 2001)
In a therapy session, adaptive responses can be facilitated by means of creating the “just-right challenge”, not too easy, and not too difficult, bearing in mind the child’s unique level of skill (including strengths and vulnerable areas). The child has to exert some effort to get it right, in other words, a little out of their comfort zone. Some of the key issues in sensory integration therapy are that the child is in control as much as possible, the child is allowed to collaborate in activity choices during the course of a session, that activities are presented in the context of play and that there is a therapeutic alliance between the child and the therapist (Ayres 1972; Parham et al 2011). Shaping the just-right challenge can be difficult, as there may be some anxiety involved when having to perform a task at peak. Ayres indicated that these moments are “optimum-for-growth”. They allow a child to experience a sense of mastery over his/her environment, and are often embedded in moments of fun and moments of failure (Bundy and Lane 2020). An artful therapist has mastered the skill of finding the balance between when and how much support to give, and when to step back a little. Unlike in real life, a child in a therapy session is physically and emotionally safe to explore and make mistakes.
In life, individuals have to face challenges that are presented by their environment or people in their environment, without taking into considering each individual’s capabilities or emotional state, which can sometimes be a stretch too far. Some might be more effective than others, seeing that the environment in life is not necessarily adapted to suit the individual’s needs or skill level. However, an informed person can assist someone else in achieving success, and experiencing a sense of mastery over his/her environment by making subtle changes to an activity, breaking tasks down into smaller steps, or providing a little bit of support, until the individual (child or adult) can do things successfully on his/her own.
Adaptive responses can be observed on different levels (Smith Roley, Blanche and Schaaf 2001):
- Motor adaptive responses can easily be observed e.g. being able to hold on while swinging, or while being pulled/pushed, being able to maintain balance on a moving surface, being able to throw a ball into a basket, riding a bicycle over obstacles without falling off, being able to run and kick a ball, getting dressed independently, eating with utensils, or independent toilet routines.
- Organisation of behaviour in time and space can be observed when planning and packing for a holiday, or sports game the next day or the coming weekend.
- Emotional adaptive responses can be observed when someone is able to remain calm in a stressful situation. For a child it might be having fun without the presence of a primary caregiver at a playgroup or birthday party. For older children or adults, it might be coping with slightly less sleep, or dealing effectively with unpredictable change, or going to an unfamiliar place to do something without knowing exactly what is expected.
- Physiological adaptive responses can occur on an autonomic nervous system level which are not so easy to observe e.g. improved respiration and heart rates, digestive functions and sleep/wake cycles.
Remember that we all make mistakes, but we try to learn from them. Please reassure children that it is OK to make a mistake, things do not have to be perfect or work out perfectly the first time. Guide them through possible frustrations by finding alternative solutions so that they can approach something differently to achieve success. There is more than one way to do something.
An important achievement for each family is to just try our best everyday, taking one day at a time. Today’s best may not be the same as yesterday’s or tomorrow’s best, and that is OK. Participating in movement activities, getting some fresh air and vitamin D from the sunshine is wonderful for everyone.
When attempting new activities, remember that each child is different in terms of interests, age and skills, so we have to make sure that we present them with a challenge that is not too easy, nor too hard for them, but just right – so that they can exert some effort and achieve success. And ultimately, have fun!
- Ayres AJ. Sensory integration and learning disorders: Western Psychological Services; 1972.
- Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005.
- Bundy, A., and Lane, S.: Sensory integration theory and practice 3rd edition (FA Davis 2020)
- King LJ: Toward a science of adaptive responses-1978 Eleanor Clarke Slagle Lecture. Am J Occup Ther 32:42943/,1978
- Kleinman M., Bulkley B. (1982) Some Implications of a Science of Adaptive Responses. American Journal of Occupational Therapy January 1982 vol 36 nr 1.
- Mailloux, Z., & Miller-Kuhaneck, H. (2014). From the Desk of the Guest Editors—Evolution of a theory: How measurement has shaped Ayres Sensory Integration®. American Journal of Occupational Therapy, 68, 495–499. http://dx.doi.org/10.5014/ajot.2014.013656
- Occupational therapy practice framework: Domain and process (3rd edition). American Journal of Occupational Therapy. 2017; 68(Supplement_1): S1-S48.
- Parham, L. Diane, Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., Cohn, E. S., Mailloux, Z., Miller, L. J. and Schaaf, R. C. (2011) Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration Intervention American Journal of Occupational Therapy, 65, 134 – 142
- Schaaf RC, Mailloux Z. Clinician’s guide for implementing Ayres sensory integration: Promoting participation for children with autism. Bethesda: American occupational therapy association. linda. linneanet. fi/F. 2015.
- Schaaf, R. Smith Roley, S. (2006) Sensory Integration: Applying clinical reasoning to practice with diverse population. Psychorp.
- Smith Roley, E. Blanche, & R. Schaaf (2001), Understanding the Nature of Sensory Integration in Diverse Populations. USA: Therapy Skill Builders.
Thank you to Elize Janse van Rensburg for sharing your thoughts with us today! Elize is the vice chairperson of SAISI, lecturer on SASIC3, owner of a a private practice in Bloemfontein as well as co-founder of Built to Bloom.
The year 2020 has been a year of many firsts for SAISI – from supporting members through lockdown regulations, hosting webinars and taking the first steps in telehealth in occupational therapy/sensory integration in South Africa, to hosting the very first online treatment course. If there is one thing that this year has taught us, it is that where there is a will, there is a way! And a will there was to make SASIC4 happen despite the unpredictability that has become part of our daily realities.
Preparations for the first online treatment course started months ahead of time and the team put in a formidable effort. Preparations started with ensuring that SAISI’s courses would still align with the standards set by the International Council for Education in Ayres Sensory Integration (ICEASI) in an online teaching format. While ICEASI’s standards require face-to-face contact for treatment courses, some of the requirements were altered amidst the global COVID-19 pandemic. Additional mentorship was added, and all course participants will attend at least three hours of face-to-face mentoring with an ASI® trained therapist following the course.
The SASIC4 lecturing team worked tirelessly to review and revise lecturing material under the leadership of Carina Taylor. Since treatment demonstrations could not be done “live”, the wealth of treatment videos collected during SASIC4 courses over the last few years provided invaluable learning opportunities. Marié Greyling must be saluted for the hours, days, weeks, months of work that she put into reviewing, selecting and editing videos for the online course. These have made all the difference and was evident in the feedback received from participants. In the words of one participant: “Using pre-recorded videos was an absolute plus as we could revisit sessions and learn factors or reasoning as they paused and spoke over them.”
Preparations for the course also included sending physical course packs to participants consisting of course notes, worksheets for practical sessions, some treats from SAISI, and lovely gifts from various “virtual exhibitors”.
The lecturing team consisted of Annamarie van Jaarsveld as course leader, and Marié Greyling as co-lecturer. Learning from these two masters of the science was captivating and inspiring! Elize Janse van Rensburg supported the team as course coordinator, seeing to the technical aspects and ensuring that the lecturers were well nourished and hydrated at all times. And, as always, Aletta Kietzman was keeping it all together in the background, surprising the team and participants with a beautiful personalised landing page each morning with memories captured from the previous day.
Participants and lecturers alike were apprehensive about the online environment, internet connectivity problems, load shedding issues, and all the “tech gremlins” that could potentially hamper the course. However, the “tech gremlins” (mostly) stayed away, and there were only minor glitches with quick recovery time and no significant impact on the course itself – for which all parties involved were very grateful. But as the COVID-19 saying goes… “Zoom fatigue is real”! For more than forty peadiatric occupational therapists, who are collectively much more comfortable crawling around on munch mats or cocooning in a spandex swing, spending almost forty hours in front of a screen in one week was quite a challenge – physically and mentally (this also goes for the lecturing team!). On the other hand, for many being in the comfort of their own homes was a big advantage that aided in combating the “con’s” of the online course format.
The lecturing team worked together from Annamarie’s beautiful home in Bloemfontein. Visits from the local wildlife was a daily occurrence, and the “lecturing Zoom room” was one with a view which definitely helped to combat the Zoom fatigue. A big thank you to Annamarie for availing her house for the week. The lecturing team’s favourite session, however, was when they got to ‘play’ during the equipment practical on the Thursday afternoon. In the absence of children to demonstrate object affordances, Marié and Annamarie played their hearts out to make up for it. From hanging on to the bottom of a bolster swing, to playing with a “bilateral stocking bat”, it was indeed fun!
Feedback from the course was overwhelmingly positive and while many participants would have preferred a face-to-face course, the online format undoubtedly allowed for rich learning experiences. We take many lessons from this experience going forward, and we know that these lessons will help in SAISI’s continuous striving to doing it better every time!
Today’s post is written by Karen Powell, private practitioner for infants, toddlers and children and SAISI board member.
“Life is neither static nor unchanging. With no individuality, there can be no change, no adaptation and, in an inherently changing world, any species unable to adapt is also doomed.”
― Jean M. Auel
While 2020 brought immeasurable change to the lives of health care practitioners, it could be argued that it brought even more to the lives of those on the cusp of completing their degrees. If the words “unprecedented” and “uncertain” were appropriate to be used in every news broadcast, then they were surely applicable to the students stuck at home who needed to complete their practical hours so that they could graduate at the end of the year.
Well necessity is the mother of all invention. And when the World Health Organisation (WHO) approved telehealth for use by occupational therapists as a result of the pandemic it opened the door for students to be trained in those same methods. After all, aren’t we preparing them for the real world, the one caught in a pandemic? Aren’t we training them to do what we do, and if we are able to assist families on a virtual platform, then they can too?
Under the guidance of Helga Lister and Stefanie Kruger, the University of Pretoria took on the challenge. As part of their community work hours, students would work under the supervision of therapists in private practice, treating children with a variety of diagnoses on virtual platforms.
I think it is fair to say that everyone was anxious and stressed. While some therapists and families were already quite well-versed in the telehealth processes, others were taking it on for the first time. There were so many things to consider, amongst others:
- Training of lecturers, therapists and students in new methods
- Accessibility to suitable platforms
- Connectivity, transfer speeds and access to data
- Coordinating the timetables of three or four individuals
- Finding quiet and private work space
- Limited access to resources
- Confidentiality and Non-disclosure Agreements
- Sharing of reports and videos
- Building therapeutic relationships over screens, and
- “Handling” children when you can’t use all the tricks you’re used to
There were also many new things to learn, including how to:
- Get and keep a child’s attention when you’re just a face on a screen
- Set up gross motor activities via “remote control”
- Handle printing and material costs
- Involve parents in the therapy, to be your hands on the other side, and
- Use what you’ve got available.
The students were up for the challenge. Thankfully, most of the therapists had been through various training webinars during lock down and had built up a big collection of resources that they were able to share with the students. The recorded SAISI telehealth webinars, as well as resources, activity suggestions and spreadsheets shared on the Whatsapp support groups proved invaluable. Therapists, lecturers and students also met via weekly webinars to train in the use of telehealth and discuss challenges, and a Whatsapp group for the therapists supported them along the way.
The students embarked on a 6-week long practical. Their sessions had to fit around outings to their community placements and they had to adjust to the programmes of the therapists and the children’s families. Not only that, but parents were also juggling changing return-to-school plans and their own work-from-home issues, sick family members and PUI’s in their companies.
Then enter another curveball: load-shedding. Always unpredictable, could be upgraded at any moment, always inconvenient. These students had to have back up activities, back up schedules and back-ups for their back-ups.
I think it’s fair to say that although in feedback they mentioned how stressful it was, they did not show it, always handling themselves professionally and overcoming obstacles with grace and maturity. The students were grateful for the opportunity, and for the most part feedback was upbeat and encouraging.
The first community block ended last week and I would like to commend all involved on a job well done. It struck me while completing the final work habits report that the COVID-19 crisis is not all negative. It has bred a new type of student – a more adaptable, flexible and throw-anything-at-me kind of professional. These young occupational therapists are going to fly through their community service years, knowing that nothing can stand in their way as they pursue their dream career.
“The measure of intelligence is the ability to change.”
― Albert Einstein
This week’s post was written by mental health OT and SAISI board member, Tharina Annandale.
Let me introduce you to my nine-year-old boy. He loves rugby and any form of rough play. He speaks loudly, likes to listen to loud music and never stops “running”. I always say that he started “running” at nine months. Yes, he started walking at nine months and hasn’t stopped “running” since, (or so it seems to a sensory sensitive mother).
He is a sensory seeker and does sports every day of the week. If he could play rugby every Saturday, he would be “in heaven”!
During the COVID-19 lock down my nine-year-old became unbelievably rebellious. Doing homework with him was such a nightmare. According to him, he “couldn’t do Maths without his friends”. I realized that he got his energy from social interaction and found it very frustrating to be limited by other people. He kept on verbalizing how angry he was with the headmaster of his school and even the president of the country! He was getting more and more irrational every day. I started wondering whether he did not have an anxiety disorder.
During the middle of lock down I had reached my limit. Having a sensory sensitive system and being in the presence of a sensory seeker, that did not want to leave my side or even allow me to attend virtual meetings, started to get to me. I realized that I had to do something, whether it was pushing the legal boundaries or not. The thing is, he was not satisfied with any craft activities and even started neglecting his pets. Although we have a large yard, he verbalized that he “was in a prison”. It was time for desperate measures!
I contacted someone that gave one-to-one horse riding lessons and I contacted his rugby coach. They both agreed to help him with an hour session a week. After two weeks his behaviour started getting better and even his school work improved. His participation in homework, knowing that he would go horse riding on Wednesdays and would play rugby on a Friday afternoons, made a huge difference in his and my life.
The value of activity can never be underestimated. Taking someone out of a constant social environment twice a week contributes to their mental health. Even to the mental health of the sensory sensitive mother the sensory seeking child!