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.