March 01, 2018
Self-Regulation: What Is It? And What Does Sensory Processing Have To Do With It?
Betty Paris, PT, M.Ed., C/NDT and Carolyn Murray-Slutsky, MS OTR, C/NDT
Self-regulation involves monitoring and controlling one's own feelings, emotions and behavior. It necessitates the ability to block out irrelevant stimuli, control impulses and persist in tasks. Sensory processing is foundational. It is the ability to take in cues from within our body and from the environment, process them accurately, and prioritize what to focus on in order to perform daily activities.
Sensory Modulation Disorder (SMD) and Its Effects on Self-Regulation
Sensory modulation disorder (SMD) refers to difficulty regulating responses to sensory stimulation due to an underlying sensory processing disorder. Three subtypes have been proposed: sensory over-responsive, in which the child responds too much, for too long, or shows a strong response to stimuli of weak intensity; sensory under-responsive, in which the child responds too little, or needs extremely strong stimulation to become aware of the stimulus; and sensory seeking/craving, where the child responds with intense searching for more or stronger stimulation (Miller, Nielsen, Schoen, & Brett-Green, 2009). Self-regulation, attention and arousal are linked to SMD both behaviorally and physiologically. When a child is well-regulated, he adapts to changes in the environment, has a level of arousal and attention appropriate to the task, blocks out irrelevant information, attends to relevant information, and responds appropriately in direct proportion to the input. Behaviorally, sensory modulation thus refers to the observable ability of a child to produce "responses that match the demands and expectations of the environment" (Lane, 2002).
A child with sensory under-responsivity may have difficulty perceiving, processing and attaching meaning to sensory events of daily life. A child with sensory over-responsivity may be overly sensitive to sounds, tastes, smells, touch, movement and even clothing. He or she may appear anxious and fearful, avoiding sensory events or daily life activities. Helping children become better regulated enables them to adapt better to environmental demands; be more tolerant and flexible; willingly engage, process, and learn; have better attention, focus and behavioral regulation; and engage with more purpose. Often, the first step is helping the child move into the calm-alert state, the window of optimal arousal. Looking at the child's arousal levels, we gain insight into the child's modulation. This helps us identify strategies that can move the child into the calm-alert window, a state of better regulation and modulation.
Intervention to Aid Sensory Modulation and Self-Regulation
Help for a child with SMD involves several considerations and types of intervention. Ayres, 1979, posited that modulation is the act of balancing excitatory and inhibitory inputs in the central nervous system (CNS) and responding to only those that are relevant. Sensory cues from the external environment can challenge a child with a sensory processing disorder and impact the child's attention, focus, tolerance and performance. Engineering the environment is an easy start. For the over-responsive child and sensory seeking/craving, you want to decrease clutter and minimize noise and other distractions to promote attention to salient components within the physical setting and activity (Murray-Slutsky & Paris, 2005, 2014); decrease a child's stress and anxiety; and promote better internal sensory modulation and self-regulation. For all children with SMD, providing structure to the physical space and the tasks, such as well-defined areas for eating, homework and play, is an important first step to aiding sensory modulation and self-regulation. Some may also need a quiet space such as the Cuddle Swing or a tent for their bed.
A next step in aiding the child is inclusion of physical activities and opportunities to meet the sensory needs. Proprioceptive, tactile and vestibular inputs have been identified as helping aid the child in the development of self-regulation, whether in treatment, included in sensory diets, or simply used at school or home. Repetitive, regular-paced rhythmic activities and songs are organizing activities.
Proprioceptive activities are calming and organizing and include climbing activities:
* Playground equipment
* Resistive activities
* Rope ladder
* Cargo net
* Wall climbing
* Climbing through a resistive tunnel
Vestibular activities can be either calming or arousing.
* Calming vestibular activities include:
o Slow rocking in a chair
o Cuddle Swing or Airwalker Swing
o Slow rolling in a barrel
* Arousing vestibular activities should also be organizing and include:
o Rhythmic, organized jumping on a trampoline or bounce pad
o Jump & Play Island
o Trapeze Bar
o Frog Swing
o Sling Seat Swing
o Tube Swing
Further steps might include sensory diets. These activities and interventions must be chosen to meet the needs of the individual. The end result of an effective program for a person with SMD should be a more relaxed, contented and focused individual who is able to participate in activities, tolerates change in the environment and in his/her schedule, and is ready to learn and assimilate new information.