Wednesday 23 May 2012

Timing of sensory integration and reflex integration/inhibition

Continuing our discussions about retained reflexes and overall development, here are some observations and questions from Deb and Nick related to the work they have been doing with their son through RDI and through the BIRD programme.


Your discussions on the blog have been very interesting and have come at a time when we have been trying to assimilate our thoughts on the relationship between interventions to address retained reflexes, Sensory Integration Therapy and the RDI approach.

In October 2008 our son completed a course of sensory integration therapy. Through this we learnt how different types and amounts of movements can stimulate his different sensory systems and affect his level of functioning and behaviour in a given situation. We came to better understand what types of movement and sensation  we need to 'feed' our son 'in the moment' to help him with his sensory processing and integration to help him in terms of  his concentration / attention, posture, physical regulation, gross and fine motor skills etc. We see short lived improvements in these areas – enough to make a positive difference so that he can more fully participate or be more competent in an activity at that time - but this does not result in him being able to sustain these improvements over time without further/ regular feeding.

In April 2011 we commenced Reflexive Rehabilitation Development programme under the direction of B.I.R.D. The initial assessment concluded that our son (who was 7yrs 4 months at that time) had retained all of the primitive reflexes that they test for i.e.  babinski, asymmetrical tonic neck reflex, spinal gallant and the symmetrical tonic neck reflex. A year on, May 2012, at his latest assessment it was found that the asymmetrical tonic neck reflex and the spinal gallant reflex are now inhibited completely. The babinski reflex is residual in the left foot only, and we are commencing new exercises to work on inhibiting the symmetrical tonic neck reflex.

In January 2012 we commenced RDI programme and have just completed the initial education module.

Like Kimberley we too have considered the importance of timing, and this has led us to conclude that to get the best outcomes from an RDI approach, the work on retained reflexes has to happen first or be happening, if at all possible, doesn't it?  And what about sensory integration difficulties  - exercises to address these difficulties -  they need to be part and parcel of everyday life don't they.?

We are wondering what the relationship is between retained reflexes and sensory integration difficulties. They must be inextricably linked / interwoven. Can you possibly have one without the other? We are assuming you can't, and that work on retained reflexes and work on sensory integration difficulties have to go together.

But they are different aren't they?  Why do some therapists advocate sensory integration therapy and not do any work on retained reflexes, and other therapists lead with work on the retained reflexes and don't mention sensory integration therapy? How can this be?

Finally, for now anyhow, do you think our sons sensory integration and processing will improve and be more sustained, with the need for less 'feeding', once all his retained reflexes have been inhibited?

from Deb and Nick

The question about the difference between sensory integration and reflex integration and inhibition is one that I too have been pondering since this discussion started.  I'm hoping that Claire  and others can give us the benefit of their wisdom on that one!

Wednesday 16 May 2012

Promoting positive behaviour and emotional regulation in autism: The 'Nurtured Heart Approach'

Clearly I am going through a phase of making like a bus……you wait for ages (for another blog post) and then two come along at once………….

I have recently learned, from RDI colleagues Dema and Libby (thank you ladies) a little about ‘The Nurtured Heart’ approach and was inspired to share it with you.  It has the same sort of philosophy of promoting and spotlighting positive interaction and behaviour as ‘Gentle Teaching’, which Brendan outlined in a guest blog post here.

Libby describes the ‘Nurtured Heart’ approach as an ‘effective balanced approach to parenting kids who struggle with emotional regulation and behavioural challenges. It takes the relationship between the parent and child into account and allows parents to positively impact behaviour by being proactive rather than reactive.’

I can certainly testify to my own emotional regulation being a major obstacle (reactive) when I am trying to support a child who presents as being verbally oppositional, persistently negative or aggressive.  We know of course that these behaviours are a manifestation of a child not coping with uncertainty or struggling with emotional regulation and/or to manage negative episodic memories…….but when you are ‘in the moment’ with those behaviours and they are occurring regularly, it can be very challenging indeed.

Here is a checklist from the Nurtured Heart approach to help parents channel their energies into positive feedback and avoid the negativity trap.

10 Ways to Propel Your Challenging Child to Greatness!! by Howard Glasser, MA Author of Transforming the Difficult Child: The Nurtured Heart Approach and All Children Flourishing: Igniting the Greatness of Our Children

1. Resist the trap of accidentally energizing negativity! It happens all the time in subtle ways.  We accidentally celebrate negativity when we give it our time, energy and relationship. In that way we are sending are child the message that we are willing to celebrate “non-greatness” because that is accidentally what we are most present for.

2. Realize that all the less energetic words or approval like “good job,” “way to go,” and “thank you” and such, do not begin to touch the realm of greatness. They energetically barely scratch the surface compared to the energy we give to what’s wrong.  We need to go to the level of “radical appreciation” in order to leave a lasting impression of the greatness we wish to cultivate.

3. Greatness is a choice and for our children to eventually choose greatness on their own we need to “choose” to see greatness and bring it into the realm of things we discern, recognize and appreciated.

4. “Catching a child being good” will not serve you in propelling greatness. There is a much better lens which is “creating” greatness by the way we choose to take advantage of the moments of the day and mirror back what we see, detailing the great qualities the child is showing by the choices he is making in the moment.

5. Children led to feel like they are great by the way we reflect and attribute greatness, come to act-out greatness. This is a much better way of acting out.

6. Instead of giving discussions, lectures, admonishments, warnings, threats, etc. when a rule is being broken, give the energized lectures and appreciation many times a day when rules are NOT being broken. Be willing to flip the switch on your energy 180 degrees.

7. Make these moments super-energized by feeling the gratefulness and emotion that is authentically there. After all, if you have a child who is very disrespectful, then the truth is that when the disrespect ISN’T happening, it is glorious and wonderful.

8. See these moments of following the rules as your child making a great choice because the truth is that your child could be breaking the rules and the great news is that she isn’t at this moment. It isn’t just happening. She is choosing to follow the rules.

9. By doing this you are making yourself the energetic prize. Your connection and relationship is the gift of your giving, so if a rule is broken, just say reset and momentarily remove YOU—the prize. When the rule is no longer being broken, even seconds later, make it your mission to stay in the truth of that next moment and be willing to celebrate that choice of your child having stopped the problem.

10. By celebrate, I do not mean giving things and money, I simply mean giving of yourself. Giving of yourself means opening up the treasure trove of your heart and letting the words of appreciation flow.

I happened to be confronted with quite a tricky emotional regulation situation as Philip and I went for a walk earlier tonight.  It wasn’t connected to rules but to choices.  I was mindful of the above points and made a conscious effort not to get wound up and frustrated, and to give as much positive feedback as possible.  It took a while, but eventually, after dismissing several options (my 'reactive' flashpoints), Philip was able to regulate himself sufficiently to settle for a choice that, whilst not perfect, was good enough.

I was able to spotlight Philip’s fantastic work in remaining regulated whilst under stress, as well as making a good decision.

Dema says ‘I believe (the Nurtured Heart approach) is compatible with RDI and can greatly help with the GPR. I’m using it with the folks I coach. Check out the info on the website: the goal is full designation re being evidence-based by the end of this year.  You can see the various types of programs that are using it...foster care, schools, group homes, etc. and the results they are getting.’

The book is on my list as soon as I’ve finished ‘The Mindful Child’ by Daniel Siegel.

Tuesday 15 May 2012

BPP School Exclusions Project

A quick post tonight with a message from Steve Broach, who you will remember from the excellent series on   using the law to challenge cuts to services.  Over to Steve:

 I am asking for your help to spread the word in relation to the BPP School Exclusions Project, which I chair.

The Project offers free advice and representation to parents whose children have been excluded from school, whether permanently or for a fixed term. Student reps from BPP receive detailed training and have access to guidance from myself and colleagues at Doughty Street. They support families from the earliest stages in any appeal to the school governors through hearings at Independent Appeal Panels. In the past three years the student reps have achieved some fantastic results, including winning cases for children with very complex needs.

At present our referrals seem to have slowed down - yet there is no suggestion the number of children being excluded from school is decreasing. As such it would be fantastic if you could help us spread the word that the Project exists and that we have capacity to help many more excluded children and their families.

Any family who may want representation simply needs to email the project address above - - and a referral form will be sent straight out.

Please pass this message on through your networks. If you have any ideas about ways we could promote the project, for example through a feature in your magazine our e-news, please get in touch with Jon, our communications officer.

Thanks in advance, and all best wishes,


BPP is a provider of professional development and professional qualifications, including flexible learning.  They provide other projects involving students advising clients under the supervision of a qualified practitioner.