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 In Anxiety, Autism, Blog, Focus System, Safe and Sound Protocol (SSP), Trauma
This article is not intended to be medical advice or to replace the advice of a trained and licensed medical provider. 

As a pediatric occupational therapist, I work with children who are taking medication for various reasons, such as attention challenges, anxiety or seizure control, and various nutritional needs. Often, parents will ask for my recommendations regarding medication: Should they start? Should they stop? Will my therapies prevent the need for medication?

I always suggest that parents discuss decisions involving medication with their child’s doctor(s). However, I also think it’s helpful when providers are informed about the various impact of medications on outcomes of therapy or any interventions we include in therapy, including the Safe and Sound Protocol (SSP).

When thinking about factors that could influence outcomes or delivery of the SSP, including medications, I often consult existing literature, talk to parents and discuss with my clients’ medical providers. While more research is needed about the impact of medication on delivery and outcomes of SSP, we do have preliminary evidence from the Indiana University School of Medicine that in some situations, certain medications may impact outcomes of SSP more than others. 

This study examined 17 children who participated in one month of the SSP. Parents rated their children before and after SSP using a parent-report questionnaire (BBC Sensory Scales), the data from which was then blindly divided into comparison groups. Non-medication and medication group outcomes were then compared, which revealed:

  • There was a significant difference in response to the SSP between the two groups
  • Children not taking medication showed improvement in symptoms of hypersensitivity (overreactive) and hyposensitivity (underreactive) 
  • Within the medication group specifically and compared to children not taking medication: 
    • The SSP showed less impact for children taking non-stimulant neurotransmitter-altering medication (such as Seratonin Re-uptake Inhibitors)
    • Children taking non-neurotransmitter-altering medication were the only ones in the medication group that showed significant improvement in hypersensitivities

Despite some limitations (such as sample size, size of comparison groups and being specific to pediatrics only), it’s promising to think that researchers are beginning to identify patterns of response to the SSP based on medication use, and I’m pleased that research is getting as specific as to identify the type of medication that might impact outcomes in addition to directions for future research. 

As additional research becomes available, providers may find it valuable to consider new information alongside any training and their own clinical reasoning when determining SSP delivery. It’s also essential for parents to have open, ongoing communication with providers so together, they can make informed decisions that are best for each individual client. 

Case Example: Eddie

I’m currently working with a six-year-old autistic client—we’ll call him Eddie—who has anxiety and a history of developmental trauma. Eddie completed multiple rounds of the SSP and is now completing the Focus System program. After Eddie’s second round of SSP, his auditory sensitivity went away. He was able to be around barking dogs, go into public spaces, and feels comfortable enough to flush toilets, which he had avoided and refused to do for years. 

Over time, it became clear that despite no longer being sensitive to noise, Eddie’s level of anxiety was increasing (as evidenced by increased instances of yelling when he did not get his way, school avoidance, and daily emotional and behavioral outbursts). For this reason, his psychiatrist changed his medications at the same time we opted to repeat the SSP, and with this third repetition, it took longer for Eddie to show improvements.

I’m happy to report, however, that Eddie is no longer having daily outbursts, his sound sensitivities have not returned, and he is engaging in activities that were previously impossible for him, such as group gymnastics classes, community recreation classes and using bathrooms! Occupational therapy and SSP plus the Focus System seem to be working for Eddie, despite the medication change. 

As formal research and evidence-based guidelines regarding medications and the SSP are in development, having knowledge of medications alone allows us to:

  1. Support parents in making informed decisions about therapy
  2. More accurately interpret our clients’ response(s) to the intervention
  3. More accurately evaluate the outcomes of therapy or the SSP. 

As a certified SSP provider, it’s important to consider the implications of medication, because the SSP and some medications are designed to impact the nervous system. Having a better understanding of the medications my clients are taking and the reasons for which they are taking them, along with common side effects, helps me make confident delivery decisions about proceeding with the SSP. To learn more about specific medications, you can use the American Academy of Pediatrics (AAP) online Drug Search tool or have a conversation with the client’s doctor and family.

Building relationships and connecting with the medical providers with whom your clients are working as part of your therapy plan is always recommended. The SSP is intended to be used within the context of an overall intervention plan and medications are one part of that. In my experience, using discipline-specific assessment tools, good pre-during-post measures of symptoms and function, and interdisciplinary collaboration is an excellent way to incorporate medications into my clinical reasoning for SSP delivery. 


About Kelly

Kelly Beins is an Occupational Therapist with over 27 years of experience working in a variety of settings and roles with all ages and most specifically with children and families. Kelly has an extensive clinical background combining OT and sensory integration with behavioral health interventions. She received her specialty certification in Sensory Integration in 2005 and became a Unyte practitioner in 2011.

Discover more case examples and clinical insights!
Polyvagal Theory and Sensory Processing: Influencing Behavior Through an O.T. Lens, featuring Kelly Beins

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