by Toni Heron, Senior Occupational Therapy Consultant, Take Two – Berry Street
Berry Street’s Take Two service has recently undertaken a three-year Occupational Therapy research study assessing the sensory processing patterns of the children and young people we work with. The results are partially what we expected, but there were some surprising findings also.
We’re in the process of getting our results ready to publish, but I wanted to share some key findings.
Take Two works with children who have experienced abuse and neglect. We work with the child, their carers and families but also with systems around the child such as their kinder or school. We help the adults understand the child and how their past experiences are now impacting their behaviours through a specialist trauma lens. If the adults in the child’s life can help them feel safe, the child is more able to learn to regulate their minds, body and behaviour.
Abused and neglected children often need somatic or sensory support to help them process their traumatic experiences, alongside their psychological therapies. The children referred to us need help learning to manage their bodies, as well as their minds.
What is Developmental Trauma?
If children haven’t had their basic needs met and they didn’t receive the nurture they required, they have probably missed significant developmental experiences. This can mean they miss child development milestones such as learning to walk, use a knife and fork or throw a ball. This means that their development may be skewed, with some areas less developed than others. Their developmental age may be much younger than their birth age. They may have a chronological age of 10 years but be functioning emotionally, socially, physically and cognitively like a 5-year-old.
We call this developmental trauma. In the case of most children seen by Take Two they have multiple instances of trauma, so it’s complex developmental trauma.
Developmental trauma can be associated with physical, sensory, language and communication delays, as well as cognitive and emotional issues.
When young people are referred to us, they often struggle to control their bodies. They might be stuck in a flight, fight or freeze distress response. They’ve previously learned they must behave this way to keep themselves safe and alive. Now they’re in safer environments, they need help to get out of that survival response.
Hyper-arousal and hypo-arousal – what’s the difference?
If a child gets stuck in a flight or fight response, they might become hyper-aroused. This could be in response to either neglect or abuse.
These are the children and young people who look like they:
- cannot relax and have problems sleeping
- are constantly alert to any perceived danger (even when none exists)
- have frequently elevated heart rates and dilated pupils
- have clenched fists or fidget constantly
- are easily agitated
- have a low tolerance for frustration
- move around quickly, can be restless and panic easily
- are anxious, not able to sit still or concentrate.
They are keeping themselves ready to fight or run away when they feel scared to escape from danger or threat. Unfortunately, many of them feel threatened even when they are in safe environments because they have frequently experienced things quickly shifting, and the people they love becoming unsafe to be around very quickly.
These children’s bodies and brains are so dysregulated they may become aggressive or run out of a classroom if asked to sit still or do a task they don’t know how to do. At home they may get very distressed if asked to do something they haven’t done before ─ such as sit at the table to eat dinner. They may get angry and aggressive when asked to stop one activity and do something else, and the reaction can be very intense.
Sometimes adults describe these children as those that ‘act out’ and are really worried about their self-destructive behaviours.
Activities that can help:
Short bursts of rhythmic heavy muscle work for a few minutes at a time can settle a someone’s nervous systems down. Simple activities include:
- going for a walk
- slow, deep breathing
- counting to 5 repeatedly
- punching arms alternately into a pillow
- bottles with a suck-swallow function helps to calm children down (it’s harder work then just swallowing on its own and it slows swallowing and breathing rates down).
Some other simple exercises can also help calm our minds and bodies down include:
- wall pushups – do 5 times (this compresses the shoulder and elbow joints)
- press palms together – 5 times (this compresses the shoulders and wrist joints).
Hypo-arousal (the ‘non-sensing’ children)
The lesser known response is those children who freeze when they feel they are in danger or are overwhelmed by what is happening around them. These children often appear hypo-aroused. This could be in response to neglect and/or abuse.
These children often:
- don’t seek help, warmth, food or comfort (because previously they have not been responded to or had their needs met)
- appear to completely zone out or withdraw
- feel disconnected from their own bodies
- have glazed-over eyes and may not cry when hurt
- don’t notice they’ve wet or soiled themselves
- have matted hair or dirty hands and don’t seem to care
- feel numb to physical pain
- look bored, unresponsive or even floppy.
Sometimes adults describe these children as ‘withdrawn’. They’re often perceived as the quiet, ‘invisible’ kids who don’t cause any problems. They might be the babies who don’t cry, toddlers who don’t throw developmentally-normal tantrums or children who sit quietly on their own in the playground.
I prefer to call them the ‘non-sensing’ children. It’s important we don’t ignore their pain and trauma just because they’re not ‘acting out’.
Activities that are soothing, relational and nurturing can help these children and might include:
- stroking a pet
- smelling a favourite aromatherapy oil in a room spray or body spray
- chewing a favourite crunchy food
- curling up in a beanbag and listening to favourite music on headphones
- having a warm bath or shower
- hugging a pillow or weighted soft toy.
An adult (who the child trusts) can help by:
- brushing the child’s hair
- talking softly and calmly or hugging and rocking them if they like that
- reading them a story.
The Take Two research project
We’ve recently completed a three-year occupational therapy research project. I provided other Take Two clinicians with secondary consults and specialist occupational therapy sensory processing assessments to supplement their therapeutic work with children who have experienced complex developmental trauma.
I chose to focus specifically on the narrow field of sensory processing because we know that trauma directly impacts the way children process sensory input. At the start of the trial I searched for published research based on similar cohorts of children. I found that very little exists.
Based on that lack of comparative research, I expected to find that the children Take Two works with would be more hyper-aroused than their peers.
We used various measures and tools as part of the project, including three of Winnie Dunn’s Sensory Profile™ 2 standardised assessments of a child’s sensory processing patterns. We assessed about 100 children across our service.
Take Two will be publishing the results, but I wanted to preview a couple of the findings.
So, what did we find?
1. There were significantly higher rates of hyper-aroused children in Take Two’s client group (compared to the population).
2. A significant number of children in the Take Two client group are also more hypo-aroused. This means we are working with many ‘non-sensing’ children.
3. If you map children and young people on a spectrum of arousal, Take Two’s client group sit on the extremes of that spectrum when compared to the rest of the population.
1. These findings are likely replicated in other children who have experienced complex developmental trauma.
2. Upon understanding a child’s sensory processing pattern, an Occupational Therapist can suggest ways to moderate or manage that arousal level with sensory activities.
3. Occupational Therapists can play a critical role in helping children process their past trauma.
4. The results highlight that abuse matters, but neglect matters just as much. A ‘non-sensing’ child is likely to be traumatised and in pain but may not be able to say so.
Take Two is a Victoria-wide outreach service provided by Berry Street on behalf of the Victorian Department of Health and Human Services. The service is recognised all over the world as a leading model of how best to support children and young people who have experienced complex developmental trauma.
Take Two can provide specialist clinical consultancy services to other organisations. Contact us for more information.