As an occupational therapist for 18 years, I wanted to talk about a topic that’s really near and dear to my heart and that is helping to support the “behavior” or the regulation needs of my clients. I am very familiar with the traditional behavior management approaches–I’ve seen a lot of people use them over the years—and they do not work (and are many times unkind!).
An analogy that comes to mind with these traditional approaches is that of an iceberg. Typically we only see the exposed part of an iceberg–the part that is above the surface of the water. Like the exposed part of the iceberg, these traditional behavior approaches focus on the behaviors that we observe–the actions we can see above the surface of a person. Many times people will label these observable behaviors as attention-seeking, pathological avoidance, oppositional, defiant, lazy or rude. Although these terms are reflective of what we see on the surface, they’re often extremely inaccurate.
Just like an iceberg, there is far more beneath the surface of a person. So when our labels are reflective of what we think we see on the surface, it represents a disregard to the underlying causes that could be contributing to the participation difficulties. Staying on the surface leads to a drastic misunderstanding of a person and their experience.
In order to successfully support the behavior or the regulation needs of our clients, we need to take the time to see beneath the surface. What is going on underneath or within that person that is causing them to do the things that we observe on the surface? If we can get better at understanding, at seeing beneath the surface, we will be more effective at supporting our clients in a kinder, more effective way.
So how do we do that? Read on to find out….
5 Keys to Supporting Behavior Regulation
Over the course of many years, my colleagues and I have come up with five keys to being better at supporting the behavior regulation needs of your clients, students and children.
Key 1 – Take the Time to Build Each Relationship
Key 1 is all about building positive relationships and working to understand the ‘whys’ behind what it is we see on the surface. So throwing out what we think to be true based on our observations, why we consider that person doing what it is we see. Getting rid of that and really trying to understand the person from their unique experience and perspective.
There has been some interesting research in the autism field where non-autistic people have deficits in understanding the perspective and experience of an autistic person. And I believe that if we were to look in other fields outside of autism, the same would be true for many people. For example, in people that might not have experienced trauma, they likely do not have the ability to truly understand the perspective of a person that might have experienced trauma. Or maybe a person that doesn’t have an anxiety disorder might misunderstand the experience of a person that does have an anxiety disorder and so forth. And so we really need to get better at understanding our client’s unique experiences and doing so through positive relationship building. Striving to be an ally for our clients and not presuming to understand why what we see on the surface is what we think is going on. We really need to get better at asking the right questions and figuring out the whys.
Key 2 – Meet sensory needs
For many of our dysregulated learners, they have unmet sensory needs. They might be sensitive to sensory experiences in the environment and are not sure how to adapt the environment to best meet their own needs. Or they may be unsure of what coping or sensory strategies they can use to help maximize their participation. That’s why we need to get to know each individual’s unique sensory needs and how we can better meet them in a supportive and proactive way. Avoiding a reactive approach and waiting to that point when the person is extremely dysregulated. At that point in time, yes, we need to be a support, but at that point in time, it’s too late to do much else. A meltdown is not a teachable moment. We need to be using these sensory strategies and meeting sensory needs proactively ahead of time in order to prevent the level of dysregulation or the frequency of dysregulation that many of our learners experience.
Key 3 – Predictability and Use of Visual Supports
Many of our dysregulated learners have a really hard time with making predictions. They feel that the world is so uncertain and dysregulating. If you have a hard time knowing what to expect, this can be of course, very, very dysregulating. So anything that we can do to make their world more predictable is good. There are many different strategies, but visual supports can be a big help for people that find the world to be uncertain. So providing them with visual supports like a visual schedule, showing them what is going to happen next so that increases the predictability of their daily life can help with regulation.
Key 4 – Communication Supports
Even for some of our most talkative learners, when dysregulation strikes, when anxiety is high, overwhelm is high, their ability to communicate can be very low. So we really need to think about how we get better at providing communication supports for all learners. What strategies can they use when they start to get dysregulated to communicate to others what they need? One of the things we can do before dysregulation happens is to come up with a plan of what exactly they want to happen so that they don’t have to communicate their needs during the actual dysregulation moment. Because at that point in time, their ability to communicate is probably very much affected.
Key 5 – Interoception and promoting feel-good emotions
Lastly, if you know my work, you know what interoception is. It is that sense within our bodies that allows us to notice our body signals like a racing heart or a growling stomach or tense muscles or hot skin and noticing these body signals are clues to our emotions. Many people really struggle with their interoceptive sense and noticing their body signals or giving meaning to their body signals. So if we are going to support a person in helping them build independent regulation skills, we need to address their interoception and help them to discover their own unique interoception experiences and what their body feels like during various emotions, so that they can be better in tune with their emotions, which leads to greater levels of self-regulation.