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“Treat the cause, not the symptom.” 

That will always be our approach at Kaleidoscope OT!

I have personally worked with a number of children who have a difficult time engaging with others, performing academically, or overcoming maladaptive behaviors.

A common starting point in my search for the root cause of the problem: primitive reflexes (which I talked about in my last post – link ). You’ll remember from that last post that more than half (65%) of healthy preschool-aged children have some level of retained primitive reflexes, which can affect them physically, emotionally, academically, or socially!

In the next couple of posts, we’ll be sharing what the specific primary primitive reflexes are, when they should be integrated, and the possible effects on children if they are retained!

Primitive reflexes can be broken into three categories: 1) The Moro Reflex (multisensory), 2) primitive reflexes of position, and 3) the primitive tactile reflexes. Today, we’ll focus on the first.

THE MORO REFLEX

What is it and when does it disappear? We’ve all seen the Moro reflex. It occurs when an infant is startled and behaves as if she is falling – a sharp inhale and a shooting out of her arms. This is the first reflex to develop in utero and is known as the earliest form of “fight or flight” response. It exists for the survival of the infant, and is the only reflex that that can be triggered by all of the senses. An activated Moro reflex – along with the sympathetic nervous system – produces increased heart rate, breathing, and raised blood pressure, together with crying to get the attention from caregivers what the child needs for help.

Typically, this reflex begins to fade away within 2-4 months after birth, however, in extreme cases of danger, it may be triggered in later life and be considered normal.

What if the reflex is retained? Since the Moro reflex can be triggered by each sense, if it is retained there can be profound challenges later in childhood among all sensory systems. And because it is so foundational to development, the child who retains this reflex is constantly “on guard” and very easily overreacts to a situation or sensory input. Below is a list of other possible symptoms of a retained Moro reflex.

• Vestibular hypersensitivity (knowing where your head is in space): motion sickness, poor coordination (i.e. hand/eye movements) and poor balance.
• Touch hypersensitivity: a child may be startled by unexpected touch or easily feel that there is an invasion of body space.
• Visual hypersensitivity: visual perceptual issues, poor reaction to light, eyes become tired under fluorescent lighting, photosensitivity, immature eye movements and slow reaction to fast-approaching objects (such as a ball being thrown for him to catch).
• Auditory hypersensitivity: difficulty discriminating between sounds or shutting out background noise.
• Physiological and emotional effects: Shy, fearful, poor at peer relationships, and coping with affection or aggressive, excitable, difficulty reading body language of others and be dominating. A child with a retained Moro does not enjoy change and has a very difficult time adapting to it (especially those changes where he perceives he has no control).
• Biochemical effects of a Moro leads to an increased production stress hormones, cortisol and adrenaline, designed to increase sensitivity and reactivity. These hormones also assist the body’s defense against infection and allergy. However, if a child has a retained Moro, there may be a decrease in the efficacy of the immune responses. This means a child with a retained Moro reflex is more susceptible to suffer from allergies, pick up colds, and possibly have food or additive sensitivities. In addition, his glucose metabolism acts fast resulting in sudden onset of fatigue and mood swings.

If you see an item above present in your child, it does not necessarily mean they have a retained Moro reflex. If you read through the list, however, and see a few areas that trip an alarm and cause you to say: “Yes! That sounds like my child!” then it would be a great idea to get their Moro reflex (and possibly others) tested! Over the course of the next couple blogs we will cover position and primitive tactile reflexes! A lot more information to come that may be very relevant to you and your child! Keep tracking with us!

-Christiana Cooper, OTR/L

References:

Goddard S. Reflexes, Learning, and Behavior: A Window Into the Child’s Mind. Fern Ridge Pres. 2005., ed 2.

It’s one of the best moments in life: holding your brand new baby for the first time. That baby automatically knows how to nurse, how clasp their tiny hands around your index finger, and are oh so cute sleeping on their back with their one arm sticking straight out.

Did you know those are all reflexes a baby is born with to ensure immediate survival and to prepare them for voluntary actions later in life? They are called primitive reflexes. These reflexes are important in utero, present in infancy, and should be gone by the child’s first birthday.

If these primitive reflexes are present beyond age 1, though, they can manifest themselves in problematic ways down the road (i.e. the child’s perception of the world around them, their reactions to it, and their ability to perform tasks within it). These reflexes are difficult to detect later in life, however, as they don’t show up as they did in infancy. If your child struggles with gross or fine motor coordination, sensory processing, attention, cognition, emotional regulation, or anxiety, the underlying cause MAY be retained primitive reflexes!

In a recent study of 35 preschool aged children, it was noted that:

• Over half (65%) had retained primitive reflexes at least at a residual level
• Eleven percent of them had no retained primitive reflexes
• From the study, the researchers indicated that 9% of the children were significantly delayed in their development due to retained primitive reflexes, 29% were somewhat delayed, 59% had “normal” development, and 3% had “very good” development.
  (Gieysztor, Choińska, Paprocka-Borowicz, 2016).

This study found a significant percentage of healthy preschool children struggled with the effects of retained primitive reflexes! Could this also be true of your child?

Our encouragement: if you see symptoms (poor social behaviors, academic performance, balance, posture, hand function, etc.) in your child and are concerned, understand that the issue could be something deeper. Occupational therapy can treat the root problem, then outward symptoms can be addressed.

Keep an eye out for our next post, which will delve into each primary primitive reflex, its purpose, and its possible effects on someone if it remains uninhibited. If you are concerned, we invite you to reach out for an over-the-phone consultation and to learn how our services could benefit your child!

 

References: 

Gieysztor E, Choińska A, Paprocka-Borowicz M. Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of Medical Science. 2016;14(1):167-173. doi:10.5114/aoms.2016.60503.

Goddard S. Reflexes, Learning, and Behavior: A Window Into the Child’s Mind. Fern Ridge Pres. 2005., ed 2. 

The school year is underway, and my mind is on those students in every elementary school, every middle school, and every high school who are struggling in one way or another. Perhaps their challenge is academic, perhaps behavioral or social. Or maybe they struggle with basic daily activities (getting dressed, brushing teeth, etc.). Children and teens with these challenges walk the halls of every school. Maybe it sounds like your student, or one you know.

What we established in part 1 of this post is that these issues may very well have underlying causes, and until they are addressed, students, parents, and teachers will all be frustrated.

We shared with you the Pyramid of Learning (go back and see), showing that before academic learning can take place, several other elements must be present – the most vital of which are the Hidden Senses. In this post, we’ll unpack these senses for you!

Vestibular Processing

The vestibular system is our sense of movement and balance. The inner ear contains the receptors which are activated when our head moves and changes positions in regards to gravity.  Along with the visual and auditory systems, it tells us about our position in space.

Essentially, the vestibular system informs us if we are moving – and if so, what direction and how quickly.  It is the system primarily responsible for keeping us in balance, responding to gravity and alerting us to know which way is up.  The vestibular system is also important because it communicates with our muscles to keep our posture upright and helps to integrate the two sides of our bodies so they can work seamlessly together. In addition, the vestibular system coordinates the working together of the head, neck and eye movements.

• Signs of an over-responsive vestibular sense: withdrawing from others; being overwhelmed by movement; quick to become dizzy; afraid to leave the ground (swinging or playing on playground equipment);poor balance/clumsy; and difficulty with hand-eye coordination (i.e. catching a ball).
• Signs of an under-responsive vestibular sense: difficulty sitting/standing still (i.e. they are always on-the-go); seeking out movements such as jumping, spinning, etc.

 

Proprioceptive Processing

Where the vestibular system is activated by receptors in the inner ear, the proprioceptive system is activated by various receptors throughout our muscles, joints, ligaments, and tendons. As a result, these receptors provide our bodies with feedback pertaining to the following: the force necessary for a muscle to use to perform a task (i.e. writing not too hard and not too soft), knowing where a specific part of our body is in space (without seeing it), and the feedback needed to perform both fine (small) and gross (large) movements/activities. The same receptors are also responsible for providing our brain with constant feedback which is crucial for obtaining postural tone and balance.

A child that has proprioceptive challenges may present with signs such as writing too hard/too soft, chewing and biting objects, wanting deep pressure (i.e. tight clothes, purposefully jumping or crashing into things), pushing, playing rough, poor motor planning and body awareness (i.e. bumps into people and objects, difficulty riding a bike), and poor postural controls (i.e. slumps, must rest head on desk while working).

Now What?

It is easy to see how a child with these underlying difficulties can become frustrated with school and feel defeated. With the right help, they can begin to behave at an age-appropriate level and perform academically. But first, they need to be taught strategies to help their bodies become regulated so they are at an optimal sensory state to learn.

Below is a basic guide of common terms regarding sensory processing disorder and signs. It is a very complex subject, but we are here to help! Please reach out to kot.christiana@gmail.com or call (540) 324-5330 for more information, to have your questions answered, or to set an appointment!

 

As a parent or a teacher have you ever asked:

“Why is my student struggling in school?”
“Why are they having a hard time making friends?”
“Why can’t they follow simple directions?”

Ever been told that your child is acting out in class? Distractible? Unmotivated?

It’s easy to feel defeated. Maybe you have talked to your child until you were blue in the face about their behavior, but they just don’t seem to be able to make the changes needed to succeed at school.

We expect so much of children. We have in our minds that – at a certain age – they should be able to sit for X amount of hours, without fidgeting, and comprehend all that they are being taught. They can hear and see the teacher, so why are they not performing well?

The Hidden Senses

Everyone knows there are 5 basic senses: tasting (gustatory), smelling (olfactory), touching (tactile), seeing (visual), and hearing (auditory).  These senses allow us to take in and learn about the world around us!

Many are not aware that we also have two hidden senses that affect an individual’s ability to perform age-appropriate daily functions: the vestibular and proprioceptive senses. These systems are foundational components of one’s ability to learn and perform at an age-appropriate level.

Below is Williams and Shellenberger’s Pyramid of Learning (1996). You’ll see that academic learning is at the top of the pyramid and beneath it: all the foundational elements that – when present – allow academic learning to take place. Absolutely foundational to learning – see the bottom of the pyramid – is the child’s ability to handle sensory input appropriately!

Dr. A. Jean Ayres Ph.D., OTR, the founder of the Sensory Integration approach for therapy stated:

“When sensations flow into a well-organized or integrated manner, the brain can use those sensations to form perceptions, behavior, and learning. When [this process] is disorganized…it will affect many things in life.”

Certain students have challenges processing incoming sensory information from the 7 senses we just discussed, making it difficult for them to participate in their everyday tasks (school, play, etc.). It’s in cases like these that Occupational Therapy becomes incredibly valuable. Kaleidoscope OT is here to help children with such difficulties – to help them succeed in their daily tasks, help them behave appropriately in each environment, and to improve their interactions with others.

Until a child is able to take in and respond to sensations appropriately, the parent, caregiver, teacher, and child will all become frustrated and feel defeated! We cannot expect a child to learn multiplication and division when they are missing key building blocks to learning.

In our next post, we’ll unpack – in great detail – these hidden senses that are so foundational to learning!

There is an experience that countless people share across our country. It is happening with increasing frequency, and today, it happened to me.

Today, my son’s speech therapist informed me that from now to the end of the year, our insurance will only cover 10 more visits. Although, medically necessary to receive speech 2-3x/ week based on his evaluation he is only given a total of 30 visits/per year. Now I am forced to decide: do I scale back the frequency of his appointments to once a week for 10 weeks? Or, for the sake of consistency and repetition, do I continue twice a week for just 5 more weeks?

Regardless, unless I pay-out-of-pocket he will be without therapy for months! I got a sinking feeling in my gut when I got this news. Our son had just started making progress! Without continual and proper intervention, that progress will stall (at best) and likely – to a degree – be lost.

What if there was a better alternative?

• What if you – the parent – dictated your child’s care rather than a third-party insurance company?
• What if you were able to have more high-quality treatments because insurance and the red-tape were not dictating your therapists’ time, energy, and availability to put thought and quality time into each of your child’s sessions?
• What if insurance did not dictate what services your child would or would not qualify for?
• What if YOU and your child’s therapist collaborated TOGETHER to identify the areas needed for intervention regardless of diagnoses, etc?

Imagine your child’s therapist working alongside you – partnering with you – instead of some third-party payer who doesn’t really know your child and their needs?

Benefits of the cash-based model

Client benefits:

• Below is a small graph that shows that out-of-pocket costs are on the rise and consumers are required to payer higher deductibles. With this in mind, maybe it is time to consider the added benefits of self-pay?

Looking at these graphs maybe your question changes from “Do you take my health insurance?” to “Who do I trust to provide me with the best quality for my money?” This is when a cash-based model may be beneficial to you. Below are more reasons you may benefit.

• Cost effective care- Therapists are highly trained and skilled for their field. If you already have a high deductible then it is worth paying cash for thorough evaluations and treatments.
• Accessibility- Anyone insured or not is able to come to my practice. Also, because cash-pay practices tend to have fewer clients you can be seen sooner than a typical practice and the sooner you can be seen the better! In addition, I will even say, “hello” to you and get to know you rather than just asking for your insurance card and handing you a stack of papers to fill out.
• No hidden fees- A cash-based practice will be able to tell you exactly what you owe rather than sending forms into insurance and wondering what they will actually cover. However, you will be provided with a superbill and can submit it to your insurance company for possible reimbursement (check with your provider on how this works with your individual plan). In addition, because we are not submitting to insurance we do not charge you for that administrative cost. You are paying ONLY for the therapy services being received!

Benefits for the Therapist:

• Freedom to provide services I see are most beneficial and not restrained by red-tape of insurance companies
• Less burnout because I will not be spending hours on the phone with insurance companies trying to get services provided for you that are medically necessary. At the same time, making sure I am getting paid by them for my services. In addition there is the headache and stress of trying to keep up with their ever-changing regulations.
• Focus is more on quality than quantity. Often times, therapists can feel like they are factory workers seeing clients for 30 minutes back to back. If you don’t have breaks between clients when can you think through treating the next person? With children, especially, they often need at least an hour for therapy for it to be beneficial. Often times, they need to get their sensory systems organized before they can start on other smaller tasks such as fine motor activities etc.

I hope you find this post educational as more and more therapy offices, specialists, and primary care physicians are heading in this direction! Please reach out if you have any questions.