I worked with Henry and his parents over a series of 4 calls. The main goal of our work together was to create a set of accommodations and sensory strategies that would help them all have smoother evenings and weekends, which were the times when Henry seemed to be the most dysregulated.
Henry’s mom was a dream client in every sense of the word. She was kind, proactive, on board to try anything, and very detailed in the intake form. Too much information doesn’t exist in my book. I want to know it all. Here are some direct excerpts from Henry’s initial intake form, and a peek at what we’ll be talking about over the next few weeks.
Transitions: Any activity that requires moving through different areas (bathroom to bedroom for sleep, bedroom to bathroom to kitchen to get ready for school, car to bathroom to classroom at school, etc.) feels like I’m herding sheep, and it often infuses him with wild energy and distraction.
Getting wet: He refuses to wash hands. Reasons include others’ presence in the bathroom at school, lifting hands to dry (hates when the water drips down his arm), and high-flow faucets (when it sprays his shirt). As for bathing, he is very worried about and upset by getting water in his eyes, ears, and nose. He often resists baths and will not shower. Hair-washing is irregular, and face-washing is nearly non-existent.
Tactile Seeking: Sometimes I need a break from being touched, and conflict arises when I set boundaries. He needs this type of support to regulate, and I want to help him find alternatives to my skin :)
Sleep: It’s difficult for his body to get comfortable, he moves restlessly in his sleep and requires parental support to settle
Fine motor: He demonstrates great fine motor skills in play (e.g. Legos) but has a loose grip and tires easily.
My initial thoughts
After reading the intake form, my first thought was that he seems to have mixed thresholds- seeking some proprioception and deep tactile input from cuddling while being overly sensitive and avoidant of wet tactile input like from bathing and washing hands.
I suspect that these mixed thresholds have some impact on his winding down for sleep, because in order to fall into a state of sleep, your nervous system needs to feel cozy. And by cozy, I mean, not starving for more sensory input and not overstimulated from too much. It’s a delicate balance, and I had a hunch that Henry was teetering on the edge. The good news is, implementing a sensory diet to help his afternoon dysregulation might also carry over into helping him fall asleep faster.
As for the weak pencil grip, it’s also likely that this was related to his sensory processing differences- his proprioceptive processing, specifically. It’s hard to say without knowing more, but when there are sensory processing differences, it’s not uncommon to see impacts on motor functioning as well.
We’ll tease all of this apart over the next few weeks! Make sure my emails are landing directly in your inbox and not in the spam folder, so you don’t miss an email. And if you think a friend would want in on this series, please send them over to the subscribe page at www.theotbutterfly.com/subscribe
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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