Making Sense – Details, episodes & analysis

Anita Bundy, ScD, OT/L, FAOTA, FOTARA is a professor and head of the occupational therapy department at Colorado State University. She has conducted decades of experiments and research in Risky Play. Listen as Dr. Bundy shares both the benefits of risk-taking in play and the developmental costs of being risk-averse.

The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.

Resources Mentioned In this episode:

• Anita Bundy’s bio page, publications and awards at Colorado State University: https://www.chhs.colostate.edu/bio-page/anita-bundy-1189/
• Sydney Playground Project: https://www.sydneyplaygroundproject.com/
• Revised Knox Preschool Play Scale: https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_604
• Test of Playfulness (Bundy): https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_299
• Neumann, Eva: The Elements of Play https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1698-3_604
• Gregory Bateson's concept of “metacommunication”: https://www.sciencedirect.com/science/article/abs/pii/0732118X9190042K
• David Ball: Playgrounds - risks, benefits and choices: https://eprints.mdx.ac.uk/4990/1/crr02426.pd
• Tim Gill: The Benefits of Children's Engagement with Nature: A Systematic Literature Review: https://www.jstor.org/stable/10.7721/chilyoutenvi.24.2.0010
• Ellen Beate Hansen Sandseter: https://scholar.google.com/citations?user=vxKzmO8AAAAJ&hl=en&oi=ao
• The Play Outside UBC Lab, led by Dr. Mariana Brussoni: https://playoutsideubc.ca/

Episode transcript: 

Carrie Schmitt  I'm joined today by Dr. Anita Bundy. She's an occupational therapist, and thank you so much for being here today, I would love for you to tell us a little bit about yourself.

Dr. Anita Bundy  My pleasure to be here. Thank you, Carrie. I am currently the department head in occupational therapy at Colorado State University. And I've been engaged in labor you search for a long time now,

Carrie Schmitt  I saw that was an area of interest and research among your many distinctions and awards, and all of the important work that you've done in our field. And when I asked you one of the topics you might be interested in talking about today, you mentioned risky play. And so I was able to, you're able to share some articles with me and I was able to go and look up some of your research, I would love to hear the pathway, maybe or some of the things that you've found early in your research or curiosities about play that led you to study risky play as a research category. And you've done some really important findings on the topic.

Dr. Anita Bundy  Well, I started studying play as part of my doctoral work. And I was, I was interested in the notion that therapists had and I think still have, but that maybe not as strongly now that if we helped children to develop skills, those skills would automatically be transferred into their everyday life. And so I was interested in that I was interested in studying the relationship and and I chose to study the relationship between motor skills, and am I needed something functional, that children would do, and I was interested in, you know, graduating in my own lifetime, and I wanted children to be willing to participate. And so I chose play. And so honestly, play was, for me, at that point, a matter of convenience. And so I did my doctoral study. And as I, I observed, a number of children playing. And as I did, I actually became quite fascinated with, with the play part of it with watching children who had some kinds of difficulties. And I had one child in particular, who will always stay with me, and he was a child who had a lot of sensory integrative issues. And he, he was playing outdoors, and I was watching him play outdoors. And he was really terribly, terribly boring to watch out towards he, he was climbing up the slide and going down the slide. And this, this child was sort of he was more than six, he was somewhere between six and eight. But he climbed up beside me like down the slide, and I left the slide went down the slide, and he just did that for ever. And these two other children who were on the playground with him at the same time, they came over and said, Would you like to play with us? Now, of course, what they wanted, they were this was in the days when you had merry go rounds on on playgrounds, and they wanted him to push. But they didn't say that they asked him if he would like to play in. And this would have been a child who probably not very many children, asked him to play. And his response to those two boys was No, I'm busy. And he was busy going up and down the slide. So and I watched him do that for like 15 minutes, and he did nothing else. And so then I, we also watched the children indoors, and I wasn't scoring his play observation indoors, because different people scored them outdoors versus indoors. But I was there when he was playing indoors. And he was like a completely different child. He was he was near Thanksgiving. And he was directing all the other children to make a Thanksgiving dinner. So they had a shoe, which they had turned into a turkey. And he was he was just completely in charge of that whole place situation. And so so I just became very fascinated with the idea that that well, of course, did sensory integration affect his play. It absolutely did. But it didn't keep him from playing. And in fact, he was a great player in in certain circumstances, and that, of course, was not being captured the standardized assessments that we were using of his play. So that's how I got that's how I got into play research. And when I finished that, I finished my doctoral work i i started thinking I used to preschool play scale, to observe play. And I realized at some point that I did the preschool Play School scale was about the skills that children use when they play. It was not really about the play itself, which is how that child was not being captured very well by standardized assessment. And so I thought, well, I'll never do that, again, I'll find a test that really looks at play itself. But there really weren't, aren't very many of those kinds of assessments around. Most assessments really do look at the skills that children use when they play. And so I, I got engaged with several colleagues in developing the test of playfulness to look at the actual interactions that children had not so much what they did not so much the activity or the skills they use. But although the skills are a piece of it, but more about the transaction that was play itself. And so I worked on that for quite a long time. And then I went to Sydney, to work and work for the University of Sydney. And I was interested in doing research with play. And I was interested in something that that somebody would fund, because play research isn't really, I had a lot of funders list. And I gathered a group of colleagues around me who were interested in play in the way that I was interested in it. And so they were, this was a really interdisciplinary group. So we had a human geographer, pediatric exercise science person as a child psychologist. And we that was the core group that that started out. And so we sat down and thought, what would what would we like to do that would inform all of our disciplines, and would be, would actually capture play in the way that we wanted to do that. And so that we started something called the Sydney playground project, which was, which actually was using play as a medium to in the beginning to to promote children's physical activity. But we were very clear that what we what we were doing, what we were going to promote would be play itself. So it wasn't going to be remarkably just put, you know, there's many, many ways that that researchers use to promote physical activity. But we didn't want to do any of those things. We didn't want to draw lines on the playground, we didn't want to leave sporting goods equipment around, we didn't want to do any of that stuff. We wanted to actually promote play in groups of children. So we started out with a, a cluster randomized trial in regular mainstream schools. And we were funded by the government by the Australian government to do this project. And we put recycled materials on the playground. And a whole series of playgrounds. And it was really easy to get the kids to play the play the kids, you know, they love this stuff. They thought it was just great. It had it had no obvious play value. So it was things like tires. And so I don't know, pool noodles. And we had a whole we had a series of seven different criteria that had to be met for us to put these materials on the playground. And we changed them periodically, we added to them. And so you know, barrels, all kinds of different things that we just got from places and put on the playground. And it was really easy. The kids loved it. In fact, it was so popular that school, school principals started doing things like rostering children to the playground and answer them recycled materials when they were on the playground. So you had to use only first and second graders, for example, were allowed to use it on a certain day. And so that was that did kind of muck up the research a little bit because nobody bothered to tell us that they were doing that. But the children loved it. But the adults, the adults didn't love it so much. The adults were convinced that something terrible was going to happen to the children that they were going to get hurt. And so I mean, for example, we use pool noodles. We gave children pool noodles. And you can imagine that the first thing kids do when they have pool noodles is they start playing with them like their swords. And I was on the playground one day when a teacher said to me, you've taken the pool noodle. So I was like, Oh, yeah. She said yes. A child when she named the child, he came in the other day from recess and he had a graze on his nose. And I could just imagine him going home and his mother would be just livid that he had a brace on his nose and I thought Yeah, right. Others probably saying yeah, what happened to you nose, Yeah, I got hit by noodle, you know.

Dr. Anita Bundy  So anyway, we added to our city playground project risk reframing workshop. So we put parents and teachers in the same room and we gave them a series of activities to do they are mostly talking about things and among them you know, what did you do what could you not wait to get to when He left school as a child. And those things were almost always dangerous play risky play, if you will. They were water, they were trees, they were, they were going downhill fast on bicycles or in carts or whatever. And they almost always ended with the same sentences like we were, we would never let kids do that today. And so I started to I heard that so often that I started asking parents will Were your parents negligent? Because there were never any adults and they stood, it was always only the children. And so I started asking them, were your parents negligent? And should they have been there? Or did you learn something that you might not have learned? If you had if they had been there? And they would think about that and talk about that. And almost always, they would come back and say, you know, we've learned to take responsibility. We learned to think, can I do this? And not just Can I do this? But Can my little brother do this? Because often it was siblings playing together? And so you'd have to think, well, will he be safe doing that? And they said, you know, if a parent had been there, we wouldn't have thought about it, the parents would have said, Yes, you can do that, or no, you can't do that. And you could almost see the penny drop with, with these folks, when they start to think that it's like, oh, wow, went through our children learn to do this. When did they learn to take responsibility for their actions, so, so that, while I don't necessarily think that we, the stuff that we put on the playground was very risky, adults, that the teachers thought it was risky, and they were very afraid that parents would think it was risky, and something that happened to the child, and then they would be blamed for it. So that sort of got me intrigued with this idea of risk reframing and risky play, and what are the benefits of risky play? And how do we promote it? And there are a group of researchers around the world who are interested in this phenomenon of risky play. So I've sort of joined a relatively small group of people, although it's a growing group of people who are interested in risky play. And, you know, I would say that, that for me, it's because I'm an occupational therapist, and my colleagues are not, I'm interested in in more than risky play, I'm interested in being able to take risks in everyday life, and manageable risks in everyday life and the benefits of that, and what are the what are the problems if you don't take any risks? So I think that this issue is not just with children in play, but it's also with, with folks with disability, it's the same with old people. And, you know, at all cost, everyone seems to want to keep people safe. And and we don't seem to think very much about what are the consequences of never allowing people to step outside their comfort zone?

Carrie Schmitt  Thank you for sharing that progression. Because I heard so many interesting things in there that I'd love to unpack this idea of trying to measure play skill, when what we really needed to do was look more at the ingredients of play, like what characterizes play, not what does it play skill like? And that seemed to answering some of those questions seem to lead you ultimately, in kind of organically to exposing children to things that adults suddenly decided were potentially risky, which then led you to think about risk assessment. And because of your background, and because of who you are professionally, you started to have some questions around the developmental trajectory, almost of like, what happens if we don't experience some of these essential ingredients of play? That is voluntary, that is pro social, right? That's it, you know, it is played for play sake, it's intrinsically motivated. And then risky play, you could maybe pile on some ingredients, like you mentioned, inherently near risky substances like water. So I'd love to unpack that a little bit like what are some of the ingredients that you're looking for that characterize play? What are some of the ingredients that you look for that would characterize risky play? And how have you figured that those ingredients ended up being kind of essential for risk assessment and for the development of daily comfort with risks? And maybe if they don't, if those ingredients aren't available if those ingredients aren't part of the play, what are we at risk of not developing?

Dr. Anita Bundy  When I was doing my doctoral work, and my, my supervisor said to me, Well, of course, you will have to define play. And I sort of thought that was a kind of silly statement, because everyone knows one play is. And then I started down very seriously looking into play literature. And I realized that not an awful lot of play literature starts with the same sense. And that is no one has ever successfully defined play. And I think that is because people from all sorts of professions are interested in play. You know, biologists are interested in play, and sociologists and anthropologists and, and all sorts of people are interested in play, but I think occupational therapists have, are interested in the phenomenon of play itself. And so I started looking for good definitions of that would fit occupational therapists. And I actually borrowed a definition from a woman named Eva Newman, who wrote who wrote a book, and it was her doctoral work called The Elements of play. And she offered a really, I think, a lovely, well, I turned it into a graphic, but she offered a really nice conceptualization of play. And she said, you know, play is not, it's not in contrast with work. So first of all, we need to get that off the table that play is in contrast, with non play, and play and non play are a continuum. It's not that something is either play, or it's non play. And she said, there are three elements that contribute to play. And those things are also on continuous. So they're present to a greater or lesser extent, it's not an either or they either are or they aren't. It's a continuum. And it's, I'd started to think about it like, like a scale with weights that you could move, and you could offset. If one of those elements was not so much present, then you could offset it with one of the other elements. And she said those elements were intrinsic motivation, that's relative intrinsic motivation. I'm doing this or the player is doing it really, because they want to do it, relative to internal control. So the player feels like they have control over some control over the situation. But so who am I playing with? What am I playing something about how it's going to come out, but you can never have total control, you don't want total control, because then it becomes boring. So there has to be a little bit of a little bit of play in it, but you but you need to feel as though you're in charge. And at the very least, a player can say I'm taking my choice and going home now I don't want to play anymore. So they have to retain at least that much control. And then the third element that Newman talked about was the suspension of reality. So she said, the player had the right to decide how close to objective reality a particular play transaction would be. And of course, the best you know, the the most common examples of suspension of reality are pretend, pretend it's probably the most common one. But that but I think there are probably other ways of suspending reality. So it's, it's breaking the rules a little bit. It's so it's mischief. I think it's a kind of suspension of reality. And, you know, there are other examples as well. And so I borrowed Newman's conceptualization of play, and I added to that the work of Gregory Bateson, and he was interested in framing, he was interested in the queues. In particular, he started out being interested in the cues that even animals would give. So he was interested in medic metacognition, that a meta communication. And he was interested in whether nonhumans who who weren't speaking could actually communicate in other ways. Now, of course, you remember this quite a long time ago. And he talked about monkeys on Monkey Island, and how they would be running around chasing each other grabbing each other's tails, growling, fighting. And if you just said that made that description and said to someone, what are they doing? Probably people would say they were fighting. But the monkeys didn't think they were fighting. The people who are watching didn't think that they were fighting. So somehow, those monkeys were able to give out cues it said this is not for real. This is just pretending this is just play. And so occasionally, of course, you know, a monkey would buy too hard or and then you know you you know what happens then? And you know, the play stops, because then he doesn't play anymore. So I added that little bit to my conceptualization, of play and playfulness.

Carrie Schmitt  You were beginning your research at a time where lay hadn't been defined and described quite as much as that is in current literature. And maybe hadn't, we hadn't captured or defined it, as well as maybe some of the literature has now. So I love the amalgamation of like those two ideas, because it's what is play, and when does play stop to like that I can take my things and go home is control. But then if I take it too far, it's no longer playful. And there's social consequence to that. And that marries really well with this idea of risky play. Because when, when it is playful, and when we're taking risk, let's say around water, but then the risk was too great. There seems to be a message that sent to our system that helps us with future risk assessment. And that is something that we wonder if it's missing, when we don't allow risky play, and then it might have consequences that we don't fully understand. So I'd love for you to talk a little bit about that. What stops us from taking risks? And maybe it's the adults in the room? And then what, how do we benefit? We take a risk, and it goes a little too far.

Dr. Anita Bundy  Well, what stops us I mean, I do think for very young children, it is often adults who stopped them now some children are not stoppable, some children are going to take risks no matter what you do. But that when the children hear repeatedly, the message, you can't do that you're going to get hurt, don't do that. I think they many children, probably not all, but many children internalize that and and learn or learn is the right word, but but begin to feel that they are not capable. And so they stop trying to take risks. And so what are the consequences of that I think what those parents were saying in risky framing, that the children don't learn what their limits are, and, and they don't learn what they're capable of, or maybe what they're not capable of. And of course, children will sometimes cross the line. I mean, if you're learning where your limits are, you will sometimes crossed those limits, and you will sometimes get hurt. And we're not hoping that children have serious injuries. But if you went through life without ever having a bruise, or a scrape or a cut, you know, that just means you haven't done, you haven't done all you're capable of doing. Now, the term risky play came from the work of a woman, an early childhood educator named LMB at East San center. And she's, she's someone that I'm working with now, in my project in Norway, and we're looking at virtual reality and, and risk risky play. So I think in the long run, and this is me, this is just conjecture, really, is that, you know, we have started to see a whole group of university students, for example, who are extremely anxious they have, and I think they've been held to an unreasonable standard all their lives, you know, they have, they're always supposed to be perfect. And everything they do is right, and they never do anything wrong. And, and so I think that's, that's not a realistic standard. But then when they get to university, and they've been that way all their lives, they've always been the top of that class. And they, you know, they've been above average and everything. Well, of course, that isn't going to be maintained forever. And so they become terribly anxious. And then we see another group of children who they're not children anymore, but youth who go off to university, for example, they've never been independent, they've never had to, to determine their own routines, their own schedules, and they go off to university and they become just wild children, you know, for a Navy for only a short period of time, but because they've never been, they've never had the opportunity to test their limits and to go to a certain level of risk. They just don't know how to handle that.

Carrie Schmitt  I like that both of those examples give a different perspective on limitations. So in one example, there were the students who have always been top of the class top of the heap, right, and now they're finding themselves running up against their human limitations, and is making them anxious and then in the other example, the people maybe never got to two test their limits or take risks within the context of their development. And so when the, you know, supervising adults are no longer there on a daily, they decide that it's probably a good time to test their limits. And it both both examples, talk about limits and limitations. And that, inherently, the ability or being allowed to take risks in the context of play, and maybe with lesser stakes, because they're three, or five or seven, would be the ideal time to let them test limits, because when they're testing their limits, it's maybe jumping out of a tree where their arm could get broken, but they probably won't die, versus when they go to university. And they test their limits, and it's involving substances or something where their life could be more at risk. So that's a really interesting. So really interesting observation that now we're looking at the outcomes of maybe not being allowed to take those risks and seeing we need to maybe think about how we're allowing kids to play. What are some of the obstacles to that you have found? Or what are some of the common concerns you hear from caregivers? Why not? Why not let them play in a risky way?

Dr. Anita Bundy  Well, I think it depends on who you are. But very commonly, why not let a child play, many parents or teachers will say, I would let my own child do that. But I won't let other children do it. I don't know what they're capable of, I don't want if someone's at my house, and I'm watching them, and they get hurt, I will, I'm afraid that I will be blamed. And teachers, similarly would say, if a child on my watch gets hurt in some way out, I could lose my job, which course is not realistic, and it's probably not going to happen. And we're not talking about head injuries, we're talking about, you know, very minor injuries. But so I think that's one thing that that keeps people keeps adults from allowing children to, to engage in risky play that the fear that they will, they will be thought to be a bad parent or a bad teacher or, or not good enough to supervise someone else's children. I think that's probably the biggest reason why adults don't now don't let children take risks and get involved in risky play. And of course, I mean, the over if you ask people why they don't let them by they don't let their children do particular kinds of risky play. The most common thing, the most common fear is that children will be abducted. And that's almost universal, that there's a fear that if I let my child go out and play out of my sight or out of an adult, a supervising adults site, then they could be abducted.

Carrie Schmitt  Yeah, as as an ingredient for rescue play, or part of the definition of rescue play is that there's not adults present, right. So allowing your child to go out and explore in groups by themselves. I, as a parent that resonates with me, I grew up in the late 70s and early 80s, when, you know, there was a lot of talk about abduction. And I also have four children of my own, and three of the four children had what I would call very little self preservation. As toddlers, they love risk, and they loved risky play. And when you said that, about knowing their capabilities that rang true to me, because I knew that they could land it if they jumped off something so high. But my friends would panic, because I would let them do that. But one of my children in particular, I would tell like a babysitter, for example, you know, if you think he might, he will, like there is not going to be a stop. So don't like if you know, if he's standing on the top of an 18 foot tower, he will jump he just would he didn't really have that, you know, self preservation kind of button. And so my sisters and I both share that, that a lot of our children take really big risks, but I knew their capabilities. Like I knew a lot of times he could jump from six or seven feet and landed and I'd say don't jump, you'll get hurt. And he would jump and say see, I didn't get hurt. And he was testing his limits. Like I'm i He knew confidently he could jump six feet and land it and it was me being worried and landed. So all Have that really resonated with me both as a parent and as you know, someone who grew up at a time when media exposure to the terrible things that happen, really made, made our generation maybe a little too insistent on supervision and, you know, really shortened, you know, our tolerance of allowing them to be unsupervised and explore.

Dr. Anita Bundy  Yeah. You know, I think children are remarkably good at knowing their limits. You know, I've watched so many children and playgrounds in other places now. And for the most part, I mean, an occasional there's occasionally a child will go past where, you know, they, they shouldn't have done that. But for the most part, they are remarkably good at knowing their limits. And you know, we did the city playground project for more than a decade. And in that time, we had one accident that required some kind of care. It was a child, it was actually a child with autism. And he stacked no crates on top of each other, and I don't know, like, four of them and got up on top and fell off and broke his arm. And he, he, they had the school, of course, had to call his mother. And the child when he got up off the ground said, I knew I shouldn't do that. And when they called his mother, she said he did no, he shouldn't do that. He did something like that once before he broke the other arm. So so but for the most part, I mean, in more than a decade, and countless children and countless schools. That was the only accident that we had, and it wasn't I mean, even then the parents, they weren't distressed and the child was in distress, like, Oops, I shouldn't have done that. And yes, he has a broken arm. But as you said, he's not going to die from a broken arm. So.

Carrie Schmitt  I'm interested about that child, you mentioned that he had a diagnosis of autism. Have you looked at any research for children with neurodevelopmental or motor developmental differences and limitations around play?

Dr. Anita Bundy  What half of the Sydney playground project was done with children with autism? And they were it was a programs that were substantially separate or and one of the schools was, it was a mainstream school, but it had a substantially separate program for children who had mostly autism, and could be autism and intellectual disability. And, yeah, I mean, I think I mean, I just even think back on my own practice, and I remember, you know, being really afraid that a child would, something bad would happen to them. I remember thinking, I have no, I'm sure we wouldn't be doing this today. But I remember taking a child to a fair that we had, we had like three or four of the kids were there. And this little boy had Athetoid cerebral palsy, and he wanted it the worst way to ride by himself in one of the sort of cars that goes on a track. And I was really scared to death, the left. And the guy who was running the car said, just let him do it. I mean, if something happens, we can always stop these covers. And by the time he was done, he was he had fallen all the way down inside of the character, he couldn't see a thing. But he did it all himself. And he was so excited that he had done that himself. And I mean, I think that's, it's really important. I just can't imagine being someone who, for all of your life are never allowed to do anything. That's even mildly risky, because you could get hurt. And that message that I'm not capable of doing anything is such a strong and horrible message to give to children and the children and send me a playground project, we found that one of the one of the programs that we were involved with was a program that really they talked about recess as being play lessons. And they if a child was on the playground for more than like, two minutes without engaging a play, then an adult would go and engage the child in play. And our students started coming back and saying, you know, we don't think that those kids know their other kids on the playground. They wait for an adult to come up and engage them in doing something. And that was in contrast with the program with children where it was a mainstream school, and the children were just expected To do a lot, and they did, they, and they benefited a lot from the playground project, much more than the children in the in the school where they did play lessons. And you know, they were really proud of the fact that they were promoting play. And when you think about it, you know, at first blush, promoting play should have been a desirable thing. And parents really wanted their child to go to this school, but actually turned out that they weren't really promoting play, they were promoting dependence, adults.

Carrie Schmitt  Interesting, the, which you mentioned about the roller coaster. And you know, the child has cerebral palsy, the joy attained through independence and autonomy. And then the, the example on the playground of play lessons, where we teach them just wait two minutes, and an adult will engage you. Right. So it's like a dependence on adults, again. And so I wonder about that, again, as an ingredient for play and for risky play, is autonomy is body agency, and, you know, maybe allowing them to stand there for a little while until they can figure out how to move their body for play. So interesting. I love this topic. If people are interested in this topic, I've captured some of the names that you mentioned, so that they could maybe look up some of the the authors that you referenced, and I'll definitely include them in the show notes. But is there any voice that you really like in this space, or any particular research that you think is interesting that they could look up?

Dr. Anita Bundy  There's a lot of Sydney playground project, research that's been published, I think all of the work that lnbf a Zen Center has done is really fascinating work. You know, in Norway, there are an awful lot of outdoor preschools. And her a lot of her work has been done in those outdoor preschools, Mariana Gressoney, who's choosing entry, she began as an injury prevention person at the University of British Columbia, her work is really, really interesting. There's folks in the UK who've done quite a lot of looking at risk benefit analyses. So David ball, if you just Google risky play, you'll get a relatively small group, Tim Gill is the name I was trying to think of Team gills, a person from the UK who's done a lot of work in risky play. So there's, you know, there's sort of a kind of a core group of people that you'll find if you just Google was kidnapped?

Carrie Schmitt  Yes, thank you. And of course, that's in addition to looking you up on the Colorado State University website, because I, you're obviously very well versed in this a little published. And if anybody's interested in seeing your work, all your publications are listed there as well. I always like to end our conversations, asking a question and that question is, at Star, we place a really high value on curiosity, and recognize that over time, things change and things evolve. And the science leads us to unexpected places. So we have to be humble, and our willingness to follow the science and it often requires us to change our minds about something. So I'm just curious about maybe something that you once believe that you've changed your mind about?

Dr. Anita Bundy  Well, I think play in general, is something that I changed my mind about. You know, I probably started out like, many, many people of my generation, and even since me, thinking that play was what you do when you're done with everything else. No, it's sort of a spare time and whoever has any of that. So it's no, it's not a very important thing. And I have come to see that it is it's a hugely important thing. And I've also changed my beliefs, and I think I alluded to this earlier is that I've changed my beliefs about what is our role as a professional, and as an occupational therapist, trying to help people to lead the life they want to lead. And I think that I have changed my beliefs about that a lot. It's not my life, it's someone else's life. And they have a right to take risks and in fact, pretty much their entire life will be a risk. So if you don't, if you don't embrace risk, you're not going to do very much and what a sad way to live your life. It's our I believe it is our responsibility to help people prepare to take risk and and I'm not no I'm not thinking that, that somebody, a parent's going to open the door and say bye See ya. You know, I think you do help children to prepare to take risks. And that's really important. And I think as OTS Our job is to help people prepare to take risks.

Carrie Schmitt  Yeah, thank you. That's a really important message and a call to action, maybe for other occupational therapists to think about the ways that we help our clients prepare for risk and maybe teach parents if you're in the pediatric space, how they themselves could work on their tolerance for risk or how they themselves can prepare their children through modeling and modeling what we might do or even just helping them and parent education.

Dr. Anita Bundy  If you take play seriously, it will cause you a lot of problem as the therapist, the more seriously you take it, the more the more it will cause you a problem. And it's a problem worth embracing.

Carrie Schmitt  I love that. It's a problem worth embracing. That's great. Thank you so much, not just for being here today, but for the important work that you've done in your career. I'm sure have enjoyed looking at your work and and I haven't learned a tremendous amount. So thank you for for modeling, what it looks like to follow a curiosity and to contribute to the body of work around it and a really purposeful, meaningful way. So I really appreciate it.

Dr. Anita Bundy  You're very welcome. Thank you for showcasing this work.

Calls-to-action:

• Learn more about STAR Institute by visiting https://sensoryhealth.org/ where you can subscribe to our email list and find out more about our educational offerings
• Find us on YouTube at STAR Institute https://www.youtube.com/channel/UCFVd3oVz4icMcZAZDwvHwBA?vie w_as=public
• Find us on Instagram @starinstitute
• Find out more about Dr. Anita Bundy: https://www.chhs.colostate.edu/bio-page/anita-bundy-1189/
• Find the host, Carrie Schmitt, on Instagram @carrieschmittotd

Family Nurse Practitioner and Parent, Holly Healy offers both personal and professional insights into sensory differences. She recognizes the way that traits of ADHD and SPD present similarly and offers insight into her process as a parent of a child with sensory differences and her work as a diagnostician.

The views expressed in the following presentation are those of the presenter(s) and do not necessarily reflect those of STAR Institute.

Resources Mentioned In this episode:

• Ahn R. R., Miller L. J., Milberger S., McIntosh D. N. Prevalence of parents' perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy. 2004;58(3):287–293. doi: 10.5014/ajot.58.3.287
• Chang, Y.-S., Gratiot, M., Owen, J. P., Brandes-Aitken, A., Desai, S. S., Hill, S. S., Arnett, A. B., Harris, J., Marco, E. J., & Mukherjee, P. (2016). White matter microstructure is associated with auditory and tactile processing in children with and without sensory processing disorder. Frontiers in Neuroanatomy, 9. https://doi.org/10.3389/fnana.2015.00169
• Ghanizadeh A. Sensory processing problems in children with ADHD, a systematic review. Psychiatry Investig. 2011 Jun;8(2):89-94. doi: 10.4306/pi.2011.8.2.89
• Kranowitz, C. S., Wylie, T. J., & Turnquist, T. H. (2006). The out-of-sync child has fun: Activities for kids with sensory processing disorder. Perigee Book.
• Miller, L. J., Fuller, D. A., & Roetenberg, J. (2014). Sensational kids: Hope and help for children with sensory processing disorder (SPD). Penguin Group.
• National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scales for Diagnosing ADHD: https://www.nichq.org/sites/default/files/resource-file/NICHQ-Vanderbilt-Asses sment-Scales.pdf
• School-Based Intensive Education: https://sensoryhealth.org/basic/school-based-intensive-star-for-school
• STAR article: Is It Sensory Processing Disorder or ADHD?: https://sensoryhealth.org/node/1114
• Unyte formerly Integrated Listening Systems (iLs): https://integratedlistening.com/
• Wood, J. K. (2020). Sensory processing disorder: Implications for primary care nurse practitioners. The Journal for Nurse Practitioners, 16(7), 514–516. https://doi.org/10.1016/j.nurpra.2020.03.022

Episode transcript: Transcript of the episode’s audio

Carrie Schmitt  I'm happy to be joined today by one of STAR's Board Members, Holly Healy. Holly, thank you for being here. I was wondering if you would introduce yourself.

Holly Healy  Sure. Thanks for having me. My name is Holly Healy and I have been a board member for two years now. I'm also a family nurse practitioner, and I practice in pediatrics for the past 17 years.

Carrie Schmitt  So I'm really excited to have this conversation because I think you could really help other family nurse practitioners, pediatricians, who also are on the frontlines of encountering people who are coming with concerning behaviors or some school reports that they can't make sense of. So tell me a little bit about how you got connected with the STAR Institute?

Holly Healy  Sure, I'd love to. So when my oldest who is now 11, was around four or five, we started to notice some behavioral differences with her and a lot of dysregulation, so it manifested in behavioral outbursts, and just really difficulty with sleep. And so we went to a counselor to try to figure it out, because we kept saying, well, she's anxious, she's anxious. So the counselor handed me, Lucy Jane Miller's book, and my husband and I read it together. And it was like a revelation. And we thought, this is her. This is this exactly explains, you know, what is going on. And so I read as much information as I could, and we got her into OT, we started changing things at home. And we didn't see a lot of progress at first. And so reading the book, I realized in going on the website, I realized, oh, there are trained OTs, by star, that have gone through a mentorship program. So when we finally kept hitting several walls, you know, with our OT treatment, I drove her four miles to the closest OT, who had been mentored by Starr and took her to Asheville, North Carolina, and we met with this amazing therapist, and the first thing she told me was, you know, we see things differently, we have a different lens in which we see children. With sensory processing disorder, she took two hours, and it changed our lives. And so from there, we launched into implementing a sensory diet every day, we got her into chiropractor, we got her into vision therapy, and then we also got her into horseback riding. So we learned that this wasn't just a once a week, go to OT, you know, and it was more this is, you know, this is part of like your life, this is how you need to change things daily. And, you know, it wasn't drastic, it was just small changes, and how we would view how does she need to start her day off, you know, it may not be what normal kids do to start their days. And so I also got myself certified with at the time it was called integrated listening systems, they've changed now to unite. So I got myself certified, and we put her through the focus program that I did, and got her started on the dream pads. So we just really implemented everything because we were honestly desperate to get her to a happy place. And, but also, I just, I'm a big fan of just learning information. And with her OT, I could never go back into the room. I didn't know what, what they were doing and how he could help her. So with with that particular visit, I stayed with them the whole time with this therapist that was trained by Starr and I was like, Oh, my goodness, this is fascinating, because I had so many questions that I could never really get answered, because the traditional treatment is I'm going to take your child back for an hour, I'll be back. And I'll give you two minutes to let you know what we did. And then I'll see you next week. So it was it was transforming. And so I then implemented it more into my practice. And I started to see children differently, that we're coming in with struggles, and I started to just completely change my perspective on how to help parents, from my own personal experience, and then just educating myself. So that's why I wanted to be a board member to just so I could help. From my perspective as a parent and a professional, help the you know, the organization, get get the word out, you know, how can we make this? How can we make everybody more aware of how to how to integrate it.

Carrie Schmitt  Thank you for sharing that a couple of things jumped out at me. One is, I'm thinking it's Dr. Miller's book, sensational kids. Yes. Okay. Yeah. So we'll put all of this in our show notes. So if you're listening and you're interested in reading This book, sensational kids hope and help for children with sensory processing disorder, you know, that has been transformative for people who are otherwise unaware of sensory processing differences, to read that book and know that this is its own diagnostic category, right, it's not listed in the DSM. Right now the Diagnostic and Statistical Manual, it we have had efforts to get sensory processing differences or disorder, you know, classified as such, yet the science is telling us it truly exists. And one of the other things that you pointed out was that in that book, Dr. Miller shares, the development of the Star model. Model is a different approach to occupational therapy intervention for children with sensory processing differences. And one of the key features of our model is that it is fully relational, and that all of our intervention includes one or both parents in every session. And then every fifth or sixth session is parents only. So it's parent education focused, we're in, we recognize that you're the expert in your child, and we have a sensory lens, and we could guide you to adapt your lifestyle, to the new understanding of who your child is through that sensory lens. And it sounds like that's exactly what happened for you, this occupational therapist said, I'm going to put this sensory lens on, tell you what I see about your daughter. And then here are some lifestyle changes that would support improved regulation in her system. And then you as the expert went out and resourced all of those things, and implemented them with the support of a sensory trained occupational therapist. So I loved that. That's

Holly Healy  Yeah, and she gave us you know, some exercises to get started. And then I thought, I used this out of sync child has fun it was it has a bunch of activities in it. So what I did, and this might help parents, you know, it has some great information, I think I got the flashcards to one of the symposiums. But every every morning, I would wake up early, and I would just piece together, okay, this is what I'm going to do today. Because my daughter is a, she's a heavy into the heavy work, she was, you know, her ot really say, give her the heavy work. So I'd put together, you know, some things that would give me about 15 minutes every day of, you know, of activities for her to do says she could start her day off, right. So it's really just, you know, for parents, it's just taking the time to sit down, put together some activities, which I find fun, because I'm active too. And then just making sure each morning that your your child starts off, like getting their system regulated, it's like adults that need to take a run every morning, you know, before they can, you know, function. So it's, um, it was really great to realize this is a daily thing, not just once a week.

Carrie Schmitt  Yeah, right. And to recognize that as children, oftentimes, we don't have the agency or even the knowledge to know her body needs. And as adults we do. And so we all have sensory processing differences. And we all have designed our lifestyles to support them. So I always to parents, like you might wake up with music or your spouse wakes up with a blaring alarm, right. And those sensory differences, because you figured out, this one is more supportive of your regulation to wake up, you may shower at night, somebody else might shower in the morning, like you're doing some people wake up, hit the ground and go for a run, because that's what regulates their nervous system, and they find that supports them to have high levels of performance after at work, or at school, or whatever it is. And so we design our lives in a way that supports our sensory system. And so to then turn and apply that to your daughter recognizing, oh, the heavy work activities, which are push pull, climb, you know, closed chain exercises, like wall squats, or playing like those can be super supportive of regulating our nervous systems. And so you designed for that, to increase her performance and then sent her off to school probably.

Holly Healy  Yeah, yeah, you're exactly right. And it's great now that she's 11 We started this at five. So now she'll say, like, the other night, she just wasn't doing well. And so she said, Can I have my weighted blanket? And can we play my music? And I thought, this is fantastic because it took six years, you know, but with that is so much brain growth of that awareness. Like I know now what I need, you know, so are progressive relaxation. I'll do some time she loves it. So she'll say can you do that? It's, you know, to a five or six year old, they're not gonna really have that awareness to know what they need. So they're going to either act out or regress. But you know, some someone like her at her age, they get to this, like, more awareness of like, I'm feeling this way, therefore, I can do this, you know. So

Carrie Schmitt  I love that. Advocacy, right, like a beautiful development of self advocacy. I had a teen client one time, and I said, what, you know, what brings you to a star. And she said, something has always been different about my system. She was exceptionally bright, at really high performing school and found knowledge to be really informed, like really helpful to her like, not just from a regulatory standpoint, but it was something that she actively sought out. So she went to the library, and started researching about her own system, found Dr. Miller's book on sensational kids. Wow, read it, took it home to her parents and said, Take me here. Ah, that is fantastic. And other self advocacy story, right? Like, you know, she was able to recognize in herself the differences, and then ask for, you know, a sensory based intervention. Tell me a little bit about this remote, a family nurse practitioner standpoint, what are you seeing in your practice, in terms of awareness around sensory processing differences, or some diagnoses that seem to overlap? Or maybe are missed diagnoses that are good with sensory processing differences?

Holly Healy  Yeah, I'd love to speak to that. So. And you're right, what we typically put in as a diagnosis is I think it's sensory processing difficulties, what it ends up, you know, so you're right, it's very hard sometimes. Because when I see that on a patient's chart, it's just makes me wonder, you know, kind of what we're what we're dealing with, because oftentimes, they'll see other diagnoses at the same time, like behavioral concerns or difficulty sleeping. So what has been most alarming to me over the past few years is that I feel the overdiagnosis of ad ADHD. And it's really been hard because in every provider will will definitely understand this, you get 10 minutes to see a patient. And within that 10 minutes, you can hear bits and pieces of what's going on. But you don't really get the whole picture. And so we have, of course, these very reputable and valid scales that we use for diagnosis, but I was doing some research and looking back through the Vanderbilt scale, which is what we use for ADHD diagnoses. And you know, so many of the questions that are asked have everything to do with sensory and are oftentimes I grab Alyssa J. Miller's book, and I'm reading what are some symptoms that we see with SPD? And then they literally coincide with so much of these questions on the Vanderbilt and as a provider, you love your you love your scales, you know, you love to say, Oh, wonderful, she scored this this she has ADHD with some type of inattentiveness, you know, so we're gonna go ahead, we're going to treat with this, rather than saying, Oh, I noticed you answered a lot of these questions that had to do with behavior, can we? You know, can we talk more about that? Like, is there to notice a trend? Is it always in the mornings? Is it? You know, do you notice that it happens after they've been going to their gymnastics class for an hour. So it really, it's really been difficult for me to see how often kids are now just placed in this silo of this is your disorder. This is your treatment, let's start you on medicine. And I've taken an approach where I won't prescribe, I actually send them to an occupational therapist, and they actually see them back several times before we even go down that avenue. And I had a wonderful fourth grader who she was struggling in one of her classes, and the teacher had, you know, reached out and said, I think she has attention problems. And the mom was really open to me just seen her for a while first before going down that avenue of medication. And I think it was our sixth visit. We did a lot of work together. She come in, I was able to get 20 minutes with her. And I said, you know, about the fifth visit. I told them I'd really love for her to get evaluated for her vision, her developmental vision, not can she see she 2020 And they came back the next week and they said, oh my goodness, like she's having a really hard time with how she's, how her eyes are tracking and we're going to start therapy and the teacher made a couple modifications and everything was drastically improved. And it just took it took time it just and I know it's hard for provider's, because time is just so hard right now with the way our healthcare is set up. But if you just take the time to look at the big picture of the child, you can see that it's not we just look so much at the behavior, not what's behind it, and, and how we can really, you know, help them. And so it's, it's something I struggle with. Because I do see it so often it's, it's, what are the symptoms, here's my diagnosis, and here's my treatment, it's all like A, B, and C, but these kids kids are not, they're not black and white, the key you can't go A, B and C with kids, you have to really, really look at what is going on. And I always observe, tell me what your days like, how are the parents reacting? Are they regulated, that makes a big difference. So I kind of look at the whole holistic picture of what's going on how much activity they get, what calms them, what makes them, you know, overstimulated, so that I can really try my best to help the parents understand that it may not be just just this diagnosis that we, you know, have you fill out in the pit and teachers fill out and you know, we give it a number and we go with it. It's it's so much more than that. So I've tried really hard to educate parents, they send them to the Star website, I send them on to the books. And then I also talk a lot about what are some things they can change in their home? Like, what can they buy? I have sensory swings in my house, we have a whole room set up with a trampoline and balls and balance boards, and, you know, what are some small things they can do every day? To help to help their child to?

Carrie Schmitt  Yeah, I love that you brought up a couple of things. One is diagnosis. And then one is intervention based. In terms of diagnosis, you know, as you mentioned, there's a lot of challenges with practitioners having the time. You know, there's an article that will we'll put in the the notes as well, um, that an occupational therapist actually wrote for nurse practitioners. The author is Jessica wood, and it was published in the journal for nurse practitioners. And it was educating yourself about sensory processing differences in order to help families differentiate. Because we know that there's some studies say up to 11% of children, ages four to 17 have ADHD. And then we have a prevalence study for sensory processing difficulties, which would suggest that five to 16% of children in the general population without any other diagnoses have sensory processing difficulties. And so if we visualize a Venn diagram, there's definitely overlap. And potentially, you. If you do have a diagnosis of ADHD, you do have a likelihood of having some sensory processing features of that right. And so about 40% of children with ADHD also have SPD. But it's really important for practitioners and for parents alike to recognize that while there is overlap in that Venn diagram, ADHD and SPD in brain studies are differentiated, they are different. They are their own differences and disorders. And so one has a neuro ADHD has a neurotransmitter basis. And so a lot of times kids do react well, if they have truly have ADHD to medication, because it is changing the way their brain neurotransmitters function. But if they have, you know, sensory processing difficulties or disorders, we the brain studies are showing that there's actually a difference in their white matter. And so electrical impulses are not reaching the portion of their brain that is responsible for sensory integration. And then there is the overlap, right. And so to take the time to tease it apart to say, you know, maybe this is ADHD with a sensory processing feature, or maybe this is sensory processing difficulties on its own. And they actually do have in our society, a different treatment approach to each. And so I understand that when sometimes people just want the diagnosis, right, like, yeah, it feels like the easy thing to matter to processing differences are not as easy to measure. We leave the office with a diagnosis and a plan and that for some people feels easier than it does to take the lowest level approach. Let's tease it apart. RT, we have some information that they might be struggling with some of the, you know, some of the things we captured on the Vanderbilt assessment scales, maybe these could also very likely be contributed to sensory processing differences. So what maybe what scale? Could we add for sensory processing awareness? Could you visit an occupational therapist? Who's trying to do processing? To your point? Could you try the approaches, which are all natural, used in sensory processing intervention, which are the sensory based bottom up approaches? And if you find that those are helpful, that might be giving us more information to look more closely at the sensory processing features that you're describing? Because if they're effective, it is likely that there's a sensory processing component to, to this complex behavior, whatever it is.

Holly Healy  Yeah, yeah, I totally agree. And that's where the OT Can, can be so helpful with that bottom up approach, because that's how they would approach this, you know, and really help the parents understand that some of that top down approach just isn't always the answer. And we need to help these kids understand that they are still loved, no matter what their behavior is, we have to our job as providers, parents, practitioners, to let them know that they're not different, they're not. There's nothing wrong with them. And I think, you know, to your point, that overlap of other sensory processing add is, is really evident. So I love that you said that, and I and I also see such an overlap with self esteem, and this diagnosis of ADHD. And you know, with that, then comes, perhaps an increased prevalence of depression among some of these kids, because then they realize, I have a label, I have a diagnosis and different and, you know, my youngest was diagnosed with it, and kindergarten, and the teacher sat her by herself, and just literally thought this is this is the way we're going to handle it, we're going to sit her by herself, and then we're going to put her on a wiggle seat, and then she's going to get her work done. And it was horrifying, to see how it affected her self esteem. And all she wanted to do was sit with her friends, and to a six year old, you know, how does that How did she interpret being Senate, you know, being told she has to sit by herself. So it I found a new school where she was in she is currently accepted for, for who she is. And if she has to get up and move around, it's, it's welcomed, and she doesn't sit by herself. She sits with her friends, and she's allowed to be more tactile, which is how she learns. And she's doing amazing. So it's more, you know, let's meet them where they are to help them succeed, no matter how diverse they are, you know.

Carrie Schmitt  Yes, you know, and teachers again, or another person who might be on the front line of this right, recognizing some behaviors. And so we have a passionate STAR about educating with a school based approach, right, or school based focus. Because again, like if teachers are given the sensory lens, they may look at the behavior and be like, Oh, this is interesting, while they are trying to manage 25 and 30 kids and they do need, you know, classroom management approaches. A lot of times the bottom up approach, the sensory based interventions can be used for multiple students at a time and increased regulation across the classroom, not just for the child that might need it. And I find that the children who need it, oftentimes self select into alternative seating options that are tied to the likes of their chair, the, you know, headphones, or your plugs for sensory over responsivity being mindful of where they're sitting, so that they feel safe in their environment. And so all of that is you were educated enough to advocate for your child. And so, you know, that's, that's a wonderful gift. But hopefully some of this conversation would help somebody sitting at home listening, whether they're apparent whether a teacher, whether they're a practitioner, to say, oh, what could we try, like what approaches could increase success and decrease the likelihood of impact on the mental health, self esteem, right child? I actually had a dad one day I was sitting across from him. And we know that there are hereditary components to both of these diagnoses, ADHD and sensory processing difficulties or disorders. And whether that's you know, it could also be Korean hairy needle right as well, there are some studies around that. But he said, Oh, that's what's going on. This is how I was when I was little, like he made that connection. Oh, now I'm making the connection between what you're telling me and how I was as a little. And my teacher put me in a cardboard box. Oh, my goodness. So this is, you know, he's probably in his 40s. But they realized his attention differences. And their solution was to place an entire refrigerator box over his desk today. And I just, I got tears in my eyes, I just thought talk about feeling othered Yes, context of the classroom, like what would happen to your self esteem if your teacher put you in a cardboard box every day. And, you know, I mean, the teacher was, you know, asked to manage a classroom of multiple kids and thought that it would be helpful, right, you know, really help them. And there was something about it that allowed him to focus, but it wasn't the approach that would support you know, I don't know, healthy social mood. Yes. But you know, all that to say like, there are approaches that support a healthy reception of attention and sensory differences within the classroom, that support integration, that support the children to develop healthy self esteem in the context of their education, which they spend an enormous amount of time at school. So how important for them to function well, and to feel good about their contributions.

Holly Healy   And I love I love I love that story, in a sense, because he was literally placed in a cardboard box, but figure that figuratively, he was placed in a cardboard box. And a lot of these kids are just don't have silos the right word, but they're just placed separately, and it's just not the way we should be approaching it. And as accepting as we are now as our society is becoming more accepting of diversity, and embracing people for their gender, their, you know, their pronouns, I feel like this is another example of how we need to move towards embracing the diversity of, of people's sensory needs to and so I've changed my language, even at home. And even when I talk to patients and parents, I'll say, You don't tell my kids, you know, I'm feeling not feeling centered. And I use that word a lot, because I know it's kind of a yoga phrase, it's a practice, but, you know, I'll say, I'm gonna go just onto my yoga mat for 10 minutes, and I'll be back so that I can feel more present. So I've changed my, my verbiage and my vocabulary around my kids. So they know. They understand that that's important. And so I've found my youngest, who's almost seven, she'll give her one of her yoga mats, and she'll, she'll disappear sometimes if she's getting upset over something, and I'll find her up there doing yoga, because she's learned like, Okay, I'm gonna go, like, calm myself down. And that's accepted. That's okay. So I'm hoping that with, with all this transformation of acceptance of diversity in our world, that we can see a sensory place in that too, because I think it's just so you know, so important. No, no more cardboard boxes, you know, should be allowed, it should definitely be, you know, John's a little bit he's getting out of his seat sounds like he needs to maybe go do some a couple jumping jacks, I love using crab and down dog, you know, for kids, like, I think he just needs to do a couple things and then come back. So it's just, you know, that awareness of that diversity, too, I think is so important for teachers to see.

Carrie Schmitt  I could see that yoga poses in particular, would be something that would be really helpful to recenter and reregulate children who might, you know, to your point either need a little bit more movement, or might need some proprioceptive activation at their joints. And so you have a specialty also in yoga, and you utilize that specialty at the preschool level. So tell me a little bit about that.

Holly Healy  Yeah, so I've practice for 25 years myself, and that's, that's my regulation personally. So I practice every day. And I know I'm, I know I love certain poses, personally, that help regulate me. So I teach at a wonderful preschool where the director is very well well versed in, in sensory processing. And so I think that if I if she wanted, I'd be there every day, but I do go in and I teach two year olds up until pre K, transitional kindergarten yoga classes and I, I always do sensory components into my class that they love. And so there's some sort of texture that I bring in. So it might be like for my class on Monday, I cut my daughter's two, two up into these squares because there's a really beautiful texture. And so I'll I'll drape it over the kids kind of fan them with it. So I bring in that we do the movement, a lot of down dog because kids love being upside down. It's wonderful. And I let them be free to move their body and figure out what they need. Because kids need different things. And, and I always close with them in what's called shavasana, which is the, the pose that you it's a resting pose at the end of class, and I do a spray, I have a beautiful room spray that's lemon flavored, and they love it, they say, oh, did you bring the spray. And so they have this, they end with this beautiful sent, and I take their legs and I I kind of rock them side to side because I know that movement is also good. So I'm getting that kind of input for them of movement. And then I kind of rest their feet at a I basically flex them out and then push them a little bit into the ground. So they get that grounding, feeling at the end too. So I integrate it. And I had this wonderful three year old I think who I was just teaching the class and she was doing great. And she was, you know, I could tell she was she would separate herself from the class, she kind of sat aside. But she participated the whole class and I didn't think anything of it, she she loved it. So at the end of class, the teachers came up to me, and they were in tears. They said she'd never participates in anything. In the classroom. She's really anxious. She's very cautious. She doesn't like the loud noises and all the you know, some of the activities that involve a lot of things, she has a difficult time participating. But in this class, she was amazing. So they, they were so excited because they could go home and tell the mom, hey, listen, you know, you know, your daughter did wonderful in yoga, here's things that she really loved. And they were so excited because I think they were trying to help her. They didn't know what approach to take. So I told them, I said, well integrate some movement when you start your class. And instead of coming in sitting down and doing something, maybe move first and, you know, kind of go from there. So it was really, it was really great to see.

Carrie Schmitt  I love that story. I you know, in this conversation, we've talked a lot about intervention approaches and how they differ based on diagnoses. And so we've also talked about, you know, neurodiversity, in terms of everybody's brain is different. Like we have biodiversity, we have neurodiversity, and we affirm that and respect that. And we're hoping to see that spread widely. That there's an acceptance that every brain is beautiful, right? That we come as we are. And so all that to say, you know, ADHD is a real neurotransmitter difference in the brain. And we honor that, and the intervention approaches we have so far, our medication, and then some behavior management techniques, and then sensory processing differences or difficulties disorder is itself also a real thing. Differences in the brain, show us that their brain imaging and the treatment approach for that is the bottom up, approach, the sensory based approach, and what yoga is, is both. And so if you're listening, and you do have a, you know, diagnosis of either or have an overlap, the yogic approach integrates bottom up and by bottom up, I'm being that body sensation and movements are the entry point. And the end result is self regulation, hopefully, to better performance and in whatever you want to achieve. And by top down, we mean that it's cognitively accordingly originated, right. So we use, mediated, I guess might be a good word. And we use cognition to focus our attention oftentimes, and it results in meaning making an understanding and yoga is both right we have the movement of our body and our putting our body in different positions. And then queuing to use our cognition to attend to, to our bodies and and make meaning of it and the result is self regulation. So yeah, I love that as kind of, maybe the wrap up of our conversation today because it marries who you are as a practitioner, and then your passion for differentiating and recognizing through a sensory lens that we can and serve the people that come to us with some challenges by taking the low slow approach by teasing apart, what's behind and underneath the behavior that's on the outside, and that that approach that you practice meets everybody where they are an honors or diversity. Yes, that is perfectly perfectly but I couldn't, could not agree more. That's wonderful. Well, to wrap up, I always ask the same question. So we have a really high value on Curiosity here at Star, we recognize that our thinking needs to evolve as the science evolves. And to do that we try to stay humble and follow the science to find out what we're learning. To do that, sometimes we have to change our minds about something. So I was wondering if you could think of an example of something maybe you once believed, that your thinking has evolved in or that you've changed your mind about?

Holly Healy  That is such a wonderful question. And I, I mean, I think I could speak all day about this, I think, you know, as a parent, when your child has any sort of diagnosis, you feel, there's just one road to take, you know, so for example, my child has an ear infection, we're gonna get treatment, and we'll be better. But it's really not a one road approach or children are not. They're still multi dimensional. And I think what I have learned is, it is so important to look at them from all aspects and take that bottom up approach and not just focus on the behavior. And it's so easy for providers and parents to focus on the behavior without saying why. And so I've learned the importance of why and the importance of looking at the child, my own children and other children I treat and the children in my yoga classes as more of a holistic sensory lens and how we can approach them through different avenues through different roads. Don't just take one road, take many, many roads. And I can't urge parents enough to really, you know, tap into your own sensory self, and I think it will help them so much to understand their children as well, too. I love that. Thank you.

Carrie Schmitt  Thank you for the work that you do. Thank you for serving on our board. Absolutely. Thank you for the work that you do as a family practitioner, and for being such a beautiful advocate for sensory health and wellness in the clients and patients that you serve. So and your own family. Family you We really appreciate it.

Holly Healy  Thank you. Thank you so much for having me.

Calls-to-action:

• Learn more about The STAR Institute by visiting https://sensoryhealth.org/ where you can subscribe to our email list and find out more about our educational offerings
• Find us on YouTube at STAR Institute https://www.youtube.com/channel/UCFVd3oVz4icMcZAZDwvHwBA?vie w_as=public
• Find us on Instagram @starinstitute
• Learn more about Holly Healy at https://www.linkedin.com/in/holly-healy-8a529b1a/ https://sensoryhealth.org/basic/board-of-directors
• Find the host, Carrie Schmitt, on Instagram @carrieschmittotd

Calm Strips is the proud sponsor of Season 2 of Making Season.

Calm Strips began as a small piece of blue tape wrapped on the founder’s finger. He looked a bit silly wearing the tape, not to mention he had a lone sticky finger at the end of the day. So, then came the idea to create something that you could stick anywhere and take everywhere you may need a little bit of calm. The Calm Strips' mission is to further destigmatize the need for support and help and their dedication to this mission is unwavering.

To learn more about Calm Strips and to purchase your strips today, visit www.calmstrips.com. Save 20% on your order for $20 or more with promo code CALMSTAR20.

Play is a child’s occupation and has a profound impact on attachment and neuro-development. Therapeutic and developmental experiences benefit from a deeper understanding of the importance and impact of play. Today, Carrie Schmitt and Mim Ochsenbein unpack The Interpersonal Neurobiology of Play by highlighting and defining Play, while considering both the impact of play on brain development and the way that play in the context of relationship is powerful for driving development. 

Resources Mentioned In this episode:​

• Brown, S. L., & Vaughan, C. C. (2010). Play: How it shapes the brain, opens the imagination, and invigorates the soul. Avery.
• De Waal, F (2019). Mama's last hug: Animal emotions and what they tell us about ourselves. W. W. Norton & Company.
• Kestly, T. (2014). The interpersonal neurobiology of play : Brain-building interventions for emotional well-being (First ed., Norton series on interpersonal neurobiology). New York: W.W. Norton & Company.
• Stephen Porges on Polyvagal Theory:  https://www.stephenporges.com/
• Dan Siegel on Interpersonal Neurobiology: https://m.drdansiegel.com/about/interpersonal_neurobiology/
• Yogman, M., Garner, A., Hutchinson, J., Hirsh-Pasek, K., & Golinkoff, R. M. (2018). The power of play: A pediatric role in enhancing development in young children. Pediatrics, 142(3). https://doi.org/10.1542/peds.2018-2058

SPONSORED BY CALM STRIPS

To learn more about Calm Strips and to purchase your strips today, visit www.calmstrips.com. Save 20% on your order for $20 or more with promo code CALMSTAR20.

The vestibular system is critically involved in integrating sensory signals from inside our bodies (interoception) with sensory signals from outside ourselves (exteroception). There is a large body of work showing that our sense of self stems from multisensory integration. Today, guest Lisa Porter, PhD, OTD, OTR/Land Carrie Schmitt, OTR/L unravel the important role of the vestibular system in our sense of self. From the role, vestibular sensation plays in modulating sensory processing to vestibular sensations contribution to safety and perspective taking, listen to Lisa and Carrie discuss the impact of this important sensory system. 

Resources mentioned in this episode:​

• Kestly, T. (2014). The interpersonal neurobiology of play: Brain-building interventions for emotional well-being (First ed., Norton series on interpersonal neurobiology). New York: W.W. Norton & Company.
• Lopez C. (2015). Making Sense of the Body: the Role of Vestibular Signals. Multisensory Research, 28(5-6), 525–557. https://doi.org/10.1163/22134808-00002490
• Polkinghorne, D. E. (1996). Transformative narratives: From victimic to agentic life plots. American journal of occupational therapy, 50(4), 299-305.
• Porges, S. (2019). Brain-body connection may ease autistic people’s social problems. https://www.spectrumnews.org/opinion/viewpoint/brain-body-connection-may-ease-autistic-peoples-social-problems/
• Dan Siegel on Interpersonal Neurobiology: https://m.drdansiegel.com/about/interpersonal_neurobiology/

Find Lisa Porter at https://sensorykidsot.com/

Motor development is essentially psychological. In this conversation, Carrie Schmitt, OTR/L and Renee Allen, MS, OTR/L discuss the idea that motor development informed by sensation allows us to act on the world in the context of culture and relationship and ultimately enables skill acquisition across both motor and psychological milestones. Using clinical examples, they unpack what motor development challenges can tell us about a child’s sensory and psychological development.

Resources mentioned in this episode:​

• Adolph, Karen E, & Hoch, Justine E. (2019). Motor Development: Embodied, Embedded, Enculturated, and Enabling. Annual Review of Psychology, 70(1), 141-164.
• Bialer, D., & Miller, L.J. (2011). No longer A SECRET: Unique common strategies for children with sensory or motor challenges. Sensory World.

Sensory differences have a profound impact on learning. Colleen Whiting is our faculty specialist on school-based practice. Today, Carrie Schmitt and Colleen Whiting discuss an article highlighting a study aimed at capturing parent and teacher perspectives on how sensory differences affect learning and life at school. This conversation covers topics such as the current day impact of distance learning, sensory profiles mismatches, sense of agency, and what specific strategies work to support students with sensory differences. Parents and school-based therapists alike will benefit from this discussion. 

Resources Mentioned In this episode:​

• Bialer, D., & Miller, L.J. (2011). No longer A SECRET: Unique common strategies for children with sensory or motor challenges. Sensory World. 
• Jones, E.K., Hanley, M., & Riby, D.M. (2020). Distraction, distress and diversity: Exploring the impact of sensory processing differences on learning and school life for pupils with autism spectrum disorders. Research in Autism Spectrum Disorders, 72, 101515.
• Miller-Kuhaneck, H. & Kelleher, J. (2018). The classroom sensory environment assessment as an educational tool for teachers. Journal of Occupational Therapy Schools & Early Intervention. 10.1080/19411243.2018.1432442.
• Miller, Lucy Jane, Anzalone, Marie E, Lane, Shelly J, Cermak, Sharon A, & Osten, Elizabeth T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy, 61(2), 135-140.
• Piller, A., & Pfeiffer, B. (2016). The sensory environment and participation of preschool children with autism Spectrum disorder. OTJR Occupation Participation Health, 36(3), 103–111.
• Short Child Occupational Profile (SCOPE): https://www.moho.uic.edu/productDetails.aspx?aid=9 

Find more about the school-based course Colleen Whiting designed at https://www.sensoryhealth.org/basic/school-based-intensive-for-occupational-therapy-practitioners

In pediatric occupational therapy, play is often used as a therapeutic medium. Today Carrie Schmitt and Michele Parkins discuss how the ways in which we play can include emotion regulation alongside sensory motor regulation. They explore the concept of psychosensory experiences tying in temperament as it manifests in play and how this guides therapeutic play aligning with sensory modulation, discrimination and sensory motor development.

Resources Mentioned in this episode:​

• Foley, G. (2017). Play as regulation: Promoting self-regulation through play. Top Language Disorders 37(3), 241-258. doi:10.1097/TLD0000000000000129
• Miller, Lucy Jane, Anzalone, Marie E, Lane, Shelly J, Cermak, Sharon A, & Osten, Elizabeth T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. The American Journal of Occupational Therapy, 61(2), 135-140.

Find Michele Parkins’ new webinar HERE. 

Executive Director Virginia Spielmann and Carrie Schmitt introduce the STAR Institute for Sensory Processing’s podcast and discuss how a podcast is a wonderful medium to further the vision and mission of STAR Institute. In addition, they discuss the cornerstones of the Occupational Therapy Practice Framework (OTPF-4) highlighting the OT’s unique ability to integrate macro and micro viewpoints into our practice. Listen in and hear how we plan to use this season of the podcast to share research to practice translation through our unique perspective on sensory integration, relationship, and regulation. 

STAR Institute is a 501(c)3 organization, for more information and to donate please visit www.sensoryhealth.org.

Resources:

• American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001
• Appiah, K. A. (2011). The honor code: How moral revolutions happen. Norton & Company.
• Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. https://doi.org/10.1258/jrsm.2011.110180
• O'Rourke, P. (2011). The significance of reflective supervision for infant mental health work. Infant Mental Health Journal, 32(2), 165-173.

STAR Institute. (n.d.). Vision, Mission, & History. https://www.sensoryhealth.org/basic/vision-mission-history

TRANSCRIPTION - READ HERE

This Making Sense podcast season is dedicated to the memory of Janet Wright. Who was Janet you ask? Janet was an incredibly enthusiastic occupational therapist who loved what she did. More importantly, she was always striving to further her education and was passionate about bringing that knowledge to her patients, parents, peers, and most especially OT students.

STAR Institute is a 501(c)3 organization, for more information and to donate please visit www.sensoryhealth.org.