SSP and co-regulation from family helps 1st grader increase awareness and emotional regulation

About the Provider

Name: Allison Hunt
Discipline/Credentials: Occupational therapist (OTR/L)
Modalities: Safe and Sound Protocol (SSP), Sensory Processing/Integration, trained yoga teacher

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Client Background

Name: Matthew (pseudonym)
Age and Gender: Seven-year-old boy
Program Delivered: Safe and Sound Protocol (SSP) (SSP Core and Balance, Hours 1 through 5)

Matthew is diagnosed with attention deficit hyperactivity disorder (ADHD). An only child, he lives at home with his mother, his father, and their two cats. His SSP provider, Allison Hunt, describes Matthew as a very friendly child with excitement for life. He is currently in the first grade and has been participating in occupational therapy (OT) services for about a year and a half.

Matthew had completed the SSP once before, after which his parents reported seeing great results. About a year later, they requested support from Allison due to increased difficulties with emotional regulation. Before this second round of the SSP Core, Matthew struggled with attention, strong reactions to small problems, limited body and safety awareness, and a limited window of tolerance, quickly “flipping his lid and showing big emotional reactions.” When frustrated, he would often throw items or use negative self-talk aloud and, at times, it would take him an hour to return to feeling calm or move on from what had upset him.

One notable change was that he had become increasingly anxious about being late to school or other outings. He would become very irritable hours before an outing, including school, where he had difficulty taking turns, controlling his impulses to interrupt during class, letting go of an idea, and sustaining attention like his peers.

In summary, Matthew’s parents sought Allison’s help to address the following:

• Limited body and safety awareness
• Limited core and upper extremity strength
• Limited hand-eye coordination and ball skills
• Handwriting skills
• Limited attention and organization skills
• Limited emotional regulation and self-calming skills
• Sensory seeking, which impacted his ability to participate in daily life activities with independence

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Implementation of the SSP

The SSP Core was delivered to Matthew in his home with headphones. His mother was present while listening as he engaged in Legos, sensory bins, a calming corner, drawing and tracing. The plan was to complete 30 minutes of listening per day, with email check-ins with the provider to modify the plan as needed. Due to poor emotional regulation, the program was titrated to 15 minutes per day for hours 4 and 5 of the SSP Core program. The Balance program commenced two weeks after his completion of the SSP Core. SSP Balance is played aloud on a speaker during Matthew’s bath time three times per week for 30 minutes.

His mother was educated on the signs to look out for that would indicate that the listening plan needed to be modified. Heavy work activities were demonstrated in previous treatment sessions and recommended during listening breaks and throughout the days of listening. Deep pressure was also recommended as the child shows great regulation benefits, and he often sought this input from his mother and other sources.

Response

Matthew showed great improvement during and after completing the SSP Core. His mother reported an increased window of tolerance and ability to be flexible with the weekend schedule after listening to just one hour of the music.

Two weeks after completing the five hours of SSP Core, Matthew’s mother reported that his handwriting had become much more legible, and he could take his time to erase and form his letters more legibly. He began to seek out coloring on his own at home, an activity that he would previously avoid or show no interest in. He showed improved frustration tolerance; he was able to remain calm and social with a peer when his mother was five minutes late to pick him up. Before the SSP, he would have been having a full meltdown if this had happened and likely would have had trouble returning to a calm state until up to an hour after arriving home.

“His mom was quite shocked at how well he handled this!” Allison shared.

Additionally, Matthew showed an improved ability to recognize his emotions and body sensations, and began to initiate calming strategies from previous OT sessions, such as humming breaths or seeking out a weighted blanket. His ball skills improved, as he was more successful in catching the ball during baseball practice. He began to join his peers in the monkey bars at school, an activity he prior would state he was not able to do, and continued building his skills on the monkey bars without using negative self-talk or becoming upset when it felt difficult.

Discussion

Matthew has become a leader in peer sessions, sharing the regulation tools that help him and using positive self-talk to encourage himself and others.

His parents continue to report how well the SSP helps their child, and they plan to complete the SSP with Matthew on an ongoing basis as the provider recommends.

Having Matthew complete the SSP with his mother provided a great opportunity for co-regulation support and safety. Continuous collaboration and check-ins between his mother and the therapist were crucial to support the “just right” amount of SSP for his nervous system. Matthew’s mom was attentive and connected to his nervous system and the signs that alerted them of when he may need less music. This supported him in having a listening experience that “stretched” his nervous system without adding “stress.”

“Collaboration with the parent supports the ability to allow the family to complete the music at home without the therapist needing to worry whether the music being provided is too much or too fast for the client’s unique system,” Allison said. “Parent education, attunement, and connection with therapist are very important for this approach and success.”