Cora is newly 3, and by the time her mom reached out to me, she had a full therapy team in place. Cora was already receiving Speech, ABA, and OT, but her mom still needed more tools for the moments that happen at home, between sessions, when there's no one else in the room to help.
Here's what her mom highlighted on the intake form:
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Takes Cora over 20 minutes to find the “right” pair of socks to wear
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She loves to play outside, but if anything sticky or dirty touches her, it’s over.
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Really struggles with feeling comfortable in big crowds or around new people, so birthday parties and shopping is hard.
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Hairbrushing has been a constant daily battle, but she recently got her hair cut, which has made it easier.
Her mom described it to me this way:
"It's not even a big thing. It's a sock. It's dirt on her hands. But she goes from zero to completely overwhelmed in about four seconds, and I don't know what to do with her at that moment."
She ended her intake form by spelling out what she’s looking for loud and clear: “How can I help her improve her frustration tolerance?”
My initial thoughts:
My first thought after reading this was that I wanted to help her mom reframe what frustration tolerance is and rethink the behaviors. Because from this brief intake information, it doesn’t seem like frustration tolerance is the main culprit here.
All the challenges Cora’s mom listed seemed to have the same thread of an underlying sensory sensitivity. Because she was already in OT, I assumed the therapist would have talked to her about this, but that didn’t seem to be the case.
Now there’s the big elephant in the room: Cora's language delay. When a child has the words, they can tell you they're frustrated or overwhelmed, ask for help, or even just narrate what's happening in their body. Cora doesn't have full access to that yet. So when something goes wrong, she doesn't have a reliable way to express it or move through it. So, her nervous system does what it needs to do to take care of her: it creates an alerting behavior to try to get her needs met.
This is what I mean when I talk about a skills gap. It's the distance between what a child is expected to do and what their nervous system and skill set can currently manage. For Cora, we already knew that communication was stretching that skills gap, but I wanted to learn more and get the full picture. If there were other skills that were missing or not fully developed, and those skills were central to being successful, it would make the reasoning behind her behavior very clear.
Coming up:
Over the next three weeks, we're going to dig into three pieces of Cora's story:
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How her behavior was actually communicating sensory overwhelm, not just frustration tolerance
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Low lift ways to shift Cora’s regulation throughout the day
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Understanding the link between sensory processing, communication delays and emotional regulation
If any of this sounds familiar, stay tuned, you're in the right place.
Disclaimer: These case studies are inspired by real-life clients I have worked with, with permission from their parents to share. Some aspects of the case are authentic, and other details are added to include more variability for our discussions. None of the strategies and advice here substitutes medical advice, diagnosis or intervention with an Occupational Therapist.
New to the world of sensory differences and don’t know where to start? I got you! My SPD 101 crash course for parents will catch you up to speed with the need-to-knows about sensory processing, including some strategies you can try today and which providers to work with for more targeted support. [Click here to learn more about SPD 101]
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