Eadie's family had just moved to Canada from the US as she turned 7, entering 1st grade.
The main areas of need that were presented included:
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General dysregulation (mostly at home; at school, she was just fine)
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Signs of perfectionism/anxiety
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"Underperforming" at school based on teacher's reports, but not matching up to what parents were seeing at home (they were always told she was gifted, but somehow was reading below grade level at school)
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Sensory seeking to the point that she becomes more dysregulated
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Waking up in the middle of the night, never seeming to get good enough sleep
I was pleasantly surprised when Eadie's mom shared that she was not only already receiving OT services, but she was enrolled in a weekly outdoor, nature-based OT program. If you've never heard of nature-based OT, you need to! The entire therapy process takes place right outside, in nature (literally in the woods, forest, etc.). There are already incredible sensory benefits from just being outside, but when you're guided by the brain of an OT, the possibilities are endless (more on this in part 4). She was enjoying her time there, and the therapists were very communicative about her progress in terms of her comfort with participation.
What Eadie's parents still sought help with was the following:
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They wanted a better understanding of her regulation patterns: how to know what kinds of movements or activities are helpful to lean into vs. what to discourage
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They were noticing signs of anxiety/perfectionism and wanted to know if a different kind of OT would be helpful, and how to best integrate that
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They needed help communicating with and advocating to the school to find out more about why she was "underperforming" in class, but seemed to be just fine at home
My Initial Thoughts
I was curious about the discrepancy being seen at school with Eadie's work performance. My first thought was that this had to be related to the difference between US and Canadian coursework, but I wasn't certain. Perhaps it just had to do with the overall anxiety and overwhelm of going through a huge life transition in general, adding to the cognitive stress of a new grade level in a new country. I also wanted to know more about Eadie's participation in OT: what she was working on there, and what areas her parents felt they wanted to explore more.
Up Next
Follow along with Eadie's story for the next 3 weeks as we dive into:
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Eadie's sensory profile — taking a closer look at the input she seeks and learning how to meet her needs without causing more dysregulation
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What exactly is going on at school, and any recommendations for learning supports
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What Eadie can do about her anxiety, sensory needs, and perfectionism, and whether or not nature-based OT is still a good option for her
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.
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