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The Unregulated ChildThe Unregulated ChildThe Unregulated ChildThe Unregulated ChildImpact on Emotional Development Impact on Emotional Development

and Adjustment to Schooland Adjustment to School

Framework for observing emotional Framework for observing emotional development in peersdevelopment in peers

The quality of the child’s interactions with The quality of the child’s interactions with others whether it is with their parent or a others whether it is with their parent or a peer is an important source of information peer is an important source of information about the child’s socialabout the child’s social--emotionalemotionalabout the child s socialabout the child s social emotional emotional functioning. functioning. It is through relationships with others that It is through relationships with others that the child’s social and cognitive the child’s social and cognitive development is fostered. development is fostered.

Social categories in the school Social categories in the school settingsetting

Popular: positive relationshipsPopular: positive relationshipsControversial: closed circle of friendsControversial: closed circle of friendsIsolated: ignored by classmates, Isolated: ignored by classmates,

i l di l duninvolveduninvolvedRejected: consistently subjected to Rejected: consistently subjected to ridicule, bullying, harassment by ridicule, bullying, harassment by classmatesclassmates

Typical problems seen in children Typical problems seen in children with socialwith social--emotional problemsemotional problems

Sensory modulation: overstimulated, Sensory modulation: overstimulated, overwhelmed easily by sensory stimulation overwhelmed easily by sensory stimulation experienced in groups. experienced in groups. Pattern of avoidance withdrawalPattern of avoidance withdrawalPattern of avoidance, withdrawal, Pattern of avoidance, withdrawal, overreactivity, or failure to orient. overreactivity, or failure to orient. Poor processing of facial expressions, Poor processing of facial expressions, gestures, and voice tone impacts social gestures, and voice tone impacts social skillsskills

Auditory processing: poor modulation of Auditory processing: poor modulation of voice volume.voice volume.Unable to filter sounds in environmentUnable to filter sounds in environmentO ti l t d i th t lik hO ti l t d i th t lik hOverstimulated in rooms that are like echo Overstimulated in rooms that are like echo chamberschambersDifficulty listening to directions and can Difficulty listening to directions and can only focus if visual componentonly focus if visual component

Tactile Problems: Difficulty tolerating Tactile Problems: Difficulty tolerating proximity of peers with response of proximity of peers with response of shutting down, withdrawal, acting out, shutting down, withdrawal, acting out, getting aggressive or wish to escapegetting aggressive or wish to escapegetting aggressive, or wish to escape. getting aggressive, or wish to escape. Some children crave touch and may lean Some children crave touch and may lean on peers, touching others impulsively.on peers, touching others impulsively.

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Vestibular processing problems: UnderVestibular processing problems: Under--reactive children may move constantly, reactive children may move constantly, climb or run when inappropriate, seem to climb or run when inappropriate, seem to be hyperactivebe hyperactivebe hyperactive.be hyperactive.Those with gravitational insecurity or fear Those with gravitational insecurity or fear of movement may be fearful of being of movement may be fearful of being bumped or pushed and steer clear of bumped or pushed and steer clear of others and avoid sports.others and avoid sports.

Motor planning: Child may be fearful of Motor planning: Child may be fearful of trying new things, have difficulty making trying new things, have difficulty making transitions, and sequencing actions. transitions, and sequencing actions. High need for structure may be disruptiveHigh need for structure may be disruptiveHigh need for structure, may be disruptive High need for structure, may be disruptive or destructive, and easily frustrated with or destructive, and easily frustrated with poor impulse control. poor impulse control. Difficulties understanding and organizing Difficulties understanding and organizing gestural and facial communication. gestural and facial communication.

Body regulation: often become somatic Body regulation: often become somatic or unregulated in body so that it disrupts or unregulated in body so that it disrupts ability to remain in a group. ability to remain in a group. May impact eating so that child won’t eatMay impact eating so that child won’t eatMay impact eating so that child won t eat May impact eating so that child won t eat at school. at school. Child may use somatic complaints to avoid Child may use somatic complaints to avoid group or school activities. group or school activities.

Attentional problems: impulsivity, Attentional problems: impulsivity, inattention, hyperactivity, and inattention, hyperactivity, and disorganization result in need for high disorganization result in need for high structure, distractionstructure, distraction--free settings, and free settings, and prompting.prompting.Children with impulsivity tend to answer Children with impulsivity tend to answer questions before they have been asked, questions before they have been asked, have trouble waiting turn, and interrupt have trouble waiting turn, and interrupt others.others.

Inattention may cause child to have Inattention may cause child to have trouble attending to details, to make trouble attending to details, to make careless errors, and to have problems careless errors, and to have problems organizing themselves especially inorganizing themselves especially inorganizing themselves, especially in organizing themselves, especially in sequenced activities.sequenced activities.Some children may be overlySome children may be overly--focused on focused on certain sensory channels or thoughts.certain sensory channels or thoughts.

Mood regulation problems: These children Mood regulation problems: These children have behavioral outbursts and can’t have behavioral outbursts and can’t remain calm or organized in group remain calm or organized in group settingssettingssettings. settings. Many of these children become irritated Many of these children become irritated and agitated by proximity of peers, and agitated by proximity of peers, difficulties accommodating to group difficulties accommodating to group agenda, and not doing things their way.agenda, and not doing things their way.

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Pragmatic language, communication, Pragmatic language, communication, executive functioning, and memory: executive functioning, and memory: problems in any of these areas impact problems in any of these areas impact social functioning especially reciprocitysocial functioning especially reciprocitysocial functioning, especially reciprocity, social functioning, especially reciprocity, reading social cues, knowing when to reading social cues, knowing when to listen and wait in natural conversation, and listen and wait in natural conversation, and how to sequence verbalizations and how to sequence verbalizations and actions in interactive play. actions in interactive play.

Framework for working with Framework for working with children in classroom or group children in classroom or group

settingssettingsThree primary levels of emotional development: Three primary levels of emotional development: engagement and attachment to othersengagement and attachment to othersIntentional organized behaviors including Intentional organized behaviors including reciprocity, purposeful communication, reciprocity, purposeful communication, yyunderstanding of causal relationships, and selfunderstanding of causal relationships, and self--initiated organized behaviors.initiated organized behaviors.Representational capacity, elaboration and Representational capacity, elaboration and differentiation: labeling feelings and emotions differentiation: labeling feelings and emotions and elaborating on them. and elaborating on them.

Treatment of socialTreatment of social--emotional emotional problems should include the problems should include the

following:following:SelfSelf--regulation: selfregulation: self--soothing, mood soothing, mood regulation, sustained attention, modulating regulation, sustained attention, modulating activity level, and reactivity to sensory activity level, and reactivity to sensory experiencesexperiencesexperiencesexperiencesSensorimotor processing, motor planning, Sensorimotor processing, motor planning, and communication: organizing facial, and communication: organizing facial, motor and gestural responses for eye motor and gestural responses for eye contact and communicationcontact and communication

Interactive capacities: attachment to others, Interactive capacities: attachment to others, social referencing, and ability to organize social referencing, and ability to organize reciprocal interactionsreciprocal interactionsMastery and motivation: exploration of Mastery and motivation: exploration of yyenvironment, capacity to organize play with environment, capacity to organize play with peerspeersSymbolic thinking: representing symbolic Symbolic thinking: representing symbolic thoughts, feelings, and emotional ideas that thoughts, feelings, and emotional ideas that underlie relationships and concept of self.underlie relationships and concept of self.

Integrating sensory integration and Integrating sensory integration and emotional needs of children in emotional needs of children in

classroom settingsclassroom settingsUnderstanding the challenges for children Understanding the challenges for children with social skills and emotional needs:with social skills and emotional needs:What is the contribution of the following:What is the contribution of the following:S ti it d iS ti it d iSensory reactivity and processingSensory reactivity and processingAttention and arousalAttention and arousalMotor planning and organization of Motor planning and organization of responsesresponsesChild’s interactive and cognitive styleChild’s interactive and cognitive style

Functional developmental capacities:Functional developmental capacities:SelfSelf--regulation: sensory reactivity, arousal, regulation: sensory reactivity, arousal, and shared attentionand shared attentionEngagement with others: warm andEngagement with others: warm andEngagement with others: warm and Engagement with others: warm and trusting relationshipstrusting relationshipsReciprocity: initiate and respond to social Reciprocity: initiate and respond to social communication with gesturescommunication with gesturesComplex gestural communication and Complex gestural communication and problem solving: chains of interactionsproblem solving: chains of interactions

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Emotional ideas: labeling feelingsEmotional ideas: labeling feelingsEmotional thinking: logical connections Emotional thinking: logical connections between feelings and consequences; between feelings and consequences; dealing with uncomfortable feelings likedealing with uncomfortable feelings likedealing with uncomfortable feelings like dealing with uncomfortable feelings like aggression, competition, poor selfaggression, competition, poor self--esteemesteemProblem solving, social reasoning, and Problem solving, social reasoning, and mindfulnessmindfulness-- awareness of other and their awareness of other and their perspectiveperspective

Steps for supporting emotional Steps for supporting emotional development and appropriate development and appropriate

social skillssocial skills1. Develop basic interactive capacities:1. Develop basic interactive capacities:Is the child ready for a classroom or group Is the child ready for a classroom or group setting or do they need dyadic intervention setting or do they need dyadic intervention first? Is it with an adult or another peer first? Is it with an adult or another peer pp(mediated by a therapist)?(mediated by a therapist)?Work towards building a warm, trusting Work towards building a warm, trusting relationship in which shared attention, relationship in which shared attention, interaction, and communication occur on interaction, and communication occur on child’s terms.child’s terms.

Before a child can tune into other Before a child can tune into other children’s agenda, they may first need to children’s agenda, they may first need to have an adult tune into their interests.have an adult tune into their interests.Work on the child’s ability to take in andWork on the child’s ability to take in andWork on the child s ability to take in and Work on the child s ability to take in and process sensory stimulation for short process sensory stimulation for short periods of time in busy play environments periods of time in busy play environments (i.e., watching first, activity that structures (i.e., watching first, activity that structures how to engage). how to engage).

2. Identify and empathize with the child’s 2. Identify and empathize with the child’s point of view and their feelings. Build their point of view and their feelings. Build their selfself--esteem.esteem.Find out why the child is behaving the way Find out why the child is behaving the way y g yy g yhe is, how his action fits into his overall he is, how his action fits into his overall view of the world. view of the world. Empathize with, rather than criticizing what Empathize with, rather than criticizing what the child is doing (i.e., destructive the child is doing (i.e., destructive behaviorbehavior–– doesn’t’ know what to do). doesn’t’ know what to do).

Appreciate the child for who he is.Appreciate the child for who he is.Give the child opportunities to take pride in Give the child opportunities to take pride in things they are good at. things they are good at.

3. Develop problem solving skills:3. Develop problem solving skills:Listen to the child’s perspective, then give Listen to the child’s perspective, then give them your point of view.them your point of view.D ’t k h t th hild iD ’t k h t th hild iDon’t assume you know what the child is Don’t assume you know what the child is thinking or feeling.thinking or feeling.Make sure that they, not you, do most of Make sure that they, not you, do most of talking.talking.

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The goal is to help the child learn how to The goal is to help the child learn how to be logical in their interactions, to anticipate be logical in their interactions, to anticipate and solve challenges.and solve challenges.Help the child to anticipate the feelings Help the child to anticipate the feelings p p gp p gthat they are likely to have (Draw comic that they are likely to have (Draw comic strip, act it out).strip, act it out).Once child understands and verbalizes Once child understands and verbalizes how they feel, they can gain more how they feel, they can gain more flexibility in coping with the situation. flexibility in coping with the situation.

4. Break social challenges into small 4. Break social challenges into small components:components:Give the child little successes to feel good Give the child little successes to feel good aboutaboutaboutaboutFind creative, enjoyable ways to challenge Find creative, enjoyable ways to challenge the child to practice what is hard.the child to practice what is hard.

5. Provide rules and boundaries for social 5. Provide rules and boundaries for social behaviors:behaviors:Discipline should be gentle and respectful, Discipline should be gentle and respectful, but also firmbut also firmbut also firm.but also firm.There should be rules in small groups that There should be rules in small groups that help the child (i.e., inside voice, friendly help the child (i.e., inside voice, friendly touch)touch)

Breaking the challenges into small Breaking the challenges into small stepssteps

1. Build the child’s self1. Build the child’s self--regulatory capacities:regulatory capacities:Establish a rhythm and shape to classroom Establish a rhythm and shape to classroom experiences or therapy sessions so that there is experiences or therapy sessions so that there is predictability. Example: Share, main activity, predictability. Example: Share, main activity, p y p yp y p ysnack and story. snack and story. Try to read the child’s cues and redirect either Try to read the child’s cues and redirect either the individual or group activity for inner the individual or group activity for inner organization. organization.

SelfSelf--regulation is essential not only for the regulation is essential not only for the individual, but also the group. It builds individual, but also the group. It builds group cohesion and attachment of group group cohesion and attachment of group members to one another and the leaders.members to one another and the leaders.Examples: dim lights for shadow puppets. Examples: dim lights for shadow puppets. Music and rhythm work: drum circle Music and rhythm work: drum circle Use of enclosures Use of enclosures –– puppet theatre puppet theatre Use of proprioceptive inputUse of proprioceptive input-- clay, resistive clay, resistive toystoys

2. Enhance the child’s ability to read social 2. Enhance the child’s ability to read social cues. Build capacities to organize clear cues. Build capacities to organize clear facial, gestural, and verbal signals.facial, gestural, and verbal signals.Work on reading and communicatingWork on reading and communicatingWork on reading and communicating Work on reading and communicating social cues through mutliple sensory social cues through mutliple sensory channelschannels–– movement in space, tactilemovement in space, tactile--proprioceptive, visual, and auditory proprioceptive, visual, and auditory channels.channels.

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Help the child to imitate and understand Help the child to imitate and understand the meaning of social cuesthe meaning of social cuesEnhance backEnhance back--andand--forth interchanges, forth interchanges, shared attention and controlshared attention and controlshared attention, and control.shared attention, and control.Stress the relationship dynamics Stress the relationship dynamics underlying the processunderlying the process–– to feel a to feel a connection and attachment with others. connection and attachment with others.

Example of activities:Example of activities:Stop and start activities (obstacle course, relay Stop and start activities (obstacle course, relay races)races)Structured games like charades, truth or dareStructured games like charades, truth or dareStructured games like charades, truth or dareStructured games like charades, truth or dareDraw or write something on specific topic then Draw or write something on specific topic then “go fishing” and guess who did it“go fishing” and guess who did itUse of play money to buy stickers or toy pieces Use of play money to buy stickers or toy pieces to make a projectto make a projectCootie catchers, then share with one another.Cootie catchers, then share with one another.

3. Develop the child’s representational 3. Develop the child’s representational capacities and emotional thinking.capacities and emotional thinking.Observe the children to identify emotional Observe the children to identify emotional themes of importance to themthemes of importance to themthemes of importance to them.themes of importance to them.Provide safe and healthy ways to express Provide safe and healthy ways to express these emotional themes in a group.these emotional themes in a group.Use combination of openUse combination of open--ended projective ended projective techniques along with semitechniques along with semi--structured. structured.

Sometimes it is important for the activities Sometimes it is important for the activities to focus on the individual within a group, to focus on the individual within a group, other times for the activities to be group other times for the activities to be group focused (team work)focused (team work)Pleasure and excitement activities: Pleasure and excitement activities: Treasure hunt; space travelers, paper Treasure hunt; space travelers, paper airplanes, addairplanes, add--on stories, puppets, on stories, puppets, transport confetti thru obstacles without transport confetti thru obstacles without letting troll capture it. letting troll capture it.

Assertiveness/control: King or queen for a Assertiveness/control: King or queen for a day; building forts; role play problems like day; building forts; role play problems like being teased; leader for day jobbeing teased; leader for day jobCloseness/dependency vsCloseness/dependency vsCloseness/dependency vs. Closeness/dependency vs. autonomy/individuation: Children have to autonomy/individuation: Children have to band together and problem solve situation band together and problem solve situation (leader is hungry troll in cave with (leader is hungry troll in cave with treasure)treasure)

Fear/anger/sadness: Mask making; play Fear/anger/sadness: Mask making; play out stories with fears (monster in house, out stories with fears (monster in house, dogs running up to them, talking in front of dogs running up to them, talking in front of group)group)group)group)

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Setting up small, structured groupsSetting up small, structured groups

Define purpose and goals of group. (OT, Define purpose and goals of group. (OT, speech, social skills, or educationally speech, social skills, or educationally oriented)oriented)Screen children carefullyScreen children carefullyScreen children carefullyScreen children carefullyChildren are less mature in a groupChildren are less mature in a groupImportance of acceptance and nurturance Importance of acceptance and nurturance in a safe environmentin a safe environment

Never plan or encourage competition. Never plan or encourage competition. Provide food and developmentally Provide food and developmentally appropriate nurturing.appropriate nurturing.Tit t t f t tTit t t f t t l ll lTitrate amount of structureTitrate amount of structure–– clear rules clear rules about group (safe play, how disruptive about group (safe play, how disruptive behavior will be handled, etc.)behavior will be handled, etc.)

Working with the parentsWorking with the parents

Provide feedback through handoutsProvide feedback through handoutsVerbal feedback faceVerbal feedback face--toto--face in parent face in parent conferencesconferencesE t d ti iti th t b i t t dE t d ti iti th t b i t t dEasy to do activities that can be integrated Easy to do activities that can be integrated into their daily lifeinto their daily lifeEliciting their concerns on an ongoing Eliciting their concerns on an ongoing basisbasisSupporting them when they need itSupporting them when they need it

Structuring a typical groupStructuring a typical group

Talking and listening for short periods of Talking and listening for short periods of time: Share topics about things child is time: Share topics about things child is proud of, something that happened to proud of, something that happened to them a social problem picturesthem a social problem picturesthem, a social problem, pictures. them, a social problem, pictures. Provide fidgets or something to doodle on Provide fidgets or something to doodle on while talking and listening. Sitting on while talking and listening. Sitting on inflatable cushions for some children.inflatable cushions for some children.

Planning structured activities: Think about Planning structured activities: Think about how much sharing, waiting, and how much sharing, waiting, and competition are required and what competition are required and what developmental demands are placed on thedevelopmental demands are placed on thedevelopmental demands are placed on the developmental demands are placed on the children for language, praxis, and motor children for language, praxis, and motor skills. skills. Anticipate what could go wrong. It will!Anticipate what could go wrong. It will!Plan backPlan back--up activities.up activities.

Getting startedGetting started

How many teachers or therapists are needed. How many teachers or therapists are needed. 33--4 children to 1 therapist; Group size should 4 children to 1 therapist; Group size should not exceed 6not exceed 6--8 children.8 children.What physical setting and supplies are needed? What physical setting and supplies are needed? p y g ppp y g ppProvide physical and visual boundaries for Provide physical and visual boundaries for distractiondistraction--free setting. If using large OT room, free setting. If using large OT room, plan first, discuss rules of room and activity plan first, discuss rules of room and activity before entering space.before entering space.

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Group composition: Best not to have too Group composition: Best not to have too many children of any one diagnosismany children of any one diagnosis––oppositional defiant, ADHD, Aspergers, oppositional defiant, ADHD, Aspergers, etcetcetc. etc. You need role models for the children to You need role models for the children to work from. work from.

General Principles for working in General Principles for working in groupsgroups

Provide structure and safety but remain Provide structure and safety but remain flexible in the structure.flexible in the structure.Have a protocol for handling conflictsHave a protocol for handling conflicts––rotate who is first; what to do if a child rotate who is first; what to do if a child ;;bullies another; what to do if a child falls bullies another; what to do if a child falls apart.apart.Provide opportunities for leadership to Provide opportunities for leadership to evolve for the childrenevolve for the children-- first in line, leader first in line, leader of day, helperof day, helper

Importance of assertiveness, initiative, and Importance of assertiveness, initiative, and oppositional behavior to group processoppositional behavior to group process–– it it means they are developing cohesion and means they are developing cohesion and independence. independence. Gradually increase demands on the group Gradually increase demands on the group to plan for future activities, to to plan for future activities, to communicate with each other without adult communicate with each other without adult intermediaries, and to discuss and resolve intermediaries, and to discuss and resolve conflicts among one another. conflicts among one another.