If you looked at the definition of “marches to the beat of her own drum”, you’d see a photo of 6 year old Lena. You could bet money that at any time during the day, you’d see her climbing, hanging, jumping, laughing uncontrollably, making potty jokes, or doing anything but what was just asked of her.
Morning routines, after school, free play, bedtime, really any time of the day was a prime time to see Lena avoiding transitions. She relies heavily on movement to regulate, and on a good day, it really helps her stay organized and connected. But sometimes, it seemed to backfire.
She did have some identified diagnoses: Pediatric Feeding Disorder, SPD, Anxiety, Autism, and Language Disorder. Her parents had already tried so many strategies and were very active and open to anything that could help. They’ve done feeding therapy since she was one, OT and speech on and off for years, and have built a home full of sensory supports. And yet, in the months leading up to our coaching calls, things were getting worse. Transitions were met with full on resistance. Instructions were completely ignored. Regulation tools that once helped—like the gymnastics bar before bed—started to lead to bigger problems, like more hyper activity and difficulty ending.
They know Lena isn’t being “defiant.” They’ve already identified that hunger, fatigue, and sensory needs play a role. They’ve tried timers, warnings, visual schedules, games, and lowering demands. Sometimes it helps. Sometimes it doesn’t. And they’re left wondering how to support her nervous system without every day feeling unpredictable or revolving around avoiding the next meltdown.
Lena’s parents were looking for support in the following areas (among others, not listed here):
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Ongoing resistance to transitions and instructions, especially during morning and bedtime routines
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How to find balance in Lena’s favorite regulation swings so they don’t backfire and cause additional problems
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Understanding Lena’s interoception, especially hunger and bathroom cues, and how missed body signals can impact regulation
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How to create more predictable and consistent routines when Lena seems to dictate daily life based on her regulation
My initial thoughts
Because Lena already had identified diagnoses and years of therapy, I knew that her parents would already be aware of and familiar with conversations around neurodivergence and dysregulation. They mentioned trying so many of the strategies that are the gold standard for neurodivergent kids, but said they weren’t working. So I knew I had to come to the table with more creative ideas and strategies that they hadn’t heard of yet, or help them reframe or adjust some of the strategies they were already relying on.
Hearing Lena’s mom describe how she gets stuck on her regulation tools (like a lycra swing and the gymnastics bar) especially before bed started making me wonder about how high her sensory threshold was, and if there was a more efficient and effective way to have her meet it.
I was also very interested to learn more about her interoception processing. On the intake form, her mom reported,
“I still struggle with knowing what to feed her every day and when. She doesn’t feel or report hunger like typical children so she’ll continue to play”
And she also struggles with listening to her bowel and bladder cues. I really think this was going to be the biggest driving factor (and current barrier) for regulation.
Stay tuned
In the next three newsletters, we’ll take a closer look at what’s driving Lena’s resistance and dysregulation, and how to support her nervous system without removing all structure or relying on constant crisis management. We’ll talk about:
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Why transitions and instructions are such a trigger for Lena—and how to reduce resistance without giving up boundaries
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How regulation tools like movement can help or backfire, and how to add structure so they stay supportive
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How interoception (or lack of body cues) impacts behavior, especially around hunger, bathroom needs, and bedtime
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How to provide daily routines without activating Lena’s stress cycle
We’ll get started next week talking about those back to back, demanding transitions!
PS, don’t forget, you can always catch up on previous case studies here.
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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