Therapy Approaches

Ayres Sensory Integration® (ASI) was developed in the 1970s by Jean Ayres, an Occupational Therapist, Psychologist, and Neuroscientist. It is an evidence-based intervention that has very specific criteria that must be incorporated into sessions to be classed as ASI. It is provided in a specialised therapy space using sensory equipment that affords tactile, visual, proprioceptive and vestibular opportunities in a structured way and includes the parent-carers in the process. ASI differs greatly from common sensory-based activities.  

Who will benefit:

ASI is effective with children with learning challenges, behaviour difficulties and a range of diagnoses such as autism, hyperactivity and attention deficit and dyspraxia. It improves sensory perceptual abilities, self-regulation, motor skills, and praxis which has a flow-on effect to improve the child’s behaviour, learning, and social participation. 

How does it work:

The theory behind sensory integration focuses on the child’s ability to receive, sort, process, and then use the information from our 8 sensory systems (hearing, touch, movement, body position, sight, smell, hearing, taste, internal body cues). The child can then adaptively respond to the demands of the task or environment to achieve their goal. ASI, therefore, guides children beyond just learning a skill or behaviour. The intention of ASI is for the child to produce an ‘adaptive response’ to sensations produced from physical activities. This is achieved through the child’s number one occupation, play. 

DIR is a comprehensive framework for understanding human development (the philosophy). Floortime is the application of the DIR framework into practice (putting philosophy into action). The Developmental, Individual Difference, Relationship-based (DIR®/Floortime) Model aims to build healthy foundations for social, emotional, and cognitive capacities rather than focusing purely on skills and isolated behaviours. It helps us to understand human development and how each child individually perceives and interacts with the world differently.  

The model highlights the power of relationships and emotional connections to fuel development. It promotes such growth through the adults developing the skills to attune, respond, expand, pretend, challenge, and reflect. Whilst the child is supported to learn to regulate, connect, reciprocate, communicate, create, think, and self-reflect.  

How does it work: 

The D (Developmental) describes the development from the perspective of the child, where they are, and where they are headed. Understanding the unique developmental process means allowing space for a child person to be respected and guided in their own developmental journey. This may include developing capacities to attend and remain regulated, relate with others, engage in shared social problem-solving, and think and play creatively.  

The I (Individual differences) describes the unique biologically-based ways each child takes in, regulates and responds to, and comprehends sensations such as sound and touch, and plans and sequences actions and ideas.  

The R (Relationship-based) describes how relationships fuel our development. The relationships with caregivers, educators, therapists, peers, and others who tailor their affect-based interactions to the child’s individual differences and developmental capacities enable the child to master the essential foundations.  

The Interactive Metronome® (IM) was developed in the early 1990s and is an evidence-based training and assessment tool designed to improve cognition, attention, focus, memory, speech/language, executive functioning, comprehension, as well as motor & sensory skills. The IM has three goals:   

• 1. improve neural timing and decrease neural timing variability (jitter) that impacts speech, language, cognitive, motor, & academic performance. 
• 2. build more efficient & synchronised connections between neural networks in the brain.
• 3. increasing the brain’s efficiency, performance, and ability to benefit more from other interventions. 

Who will benefit: 

Children who may benefit from the IM include Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorders, Auditory Processing Disorder, Sensory Processing Disorder, Language-Learning Disorders, Dyslexia and Other Reading Disorders, Executive Function Disorder, Cerebral Palsy, Sports and Performance Enhancement. 

Academic Improvement: Rhythmicity plays a critical part in learning, development, and performance. A study of 585 children aged 4-11 showed that improved timing in the IM linked directly to improved academic performance in reading, mathematics, oral/written language, and motor coordination. 

Autism and the IM: White matter tracts are involved in language, speech processing and integration of auditory and motor function which are impacted in the autistic brain. Autistic children generally have trouble integrating simultaneous auditory & visual sensory information. This timing deficit hampers the development of social, communication & language skills. Autism has been hypothesised to arise from the development of abnormal neural networks that exhibit irregular synaptic connectivity and abnormal neural synchronization. The IM targets the integration of visual and auditory timing.  

ADHD and the IM: In a study of 56 boys with ADHD aged 6-11 years, the control group experienced a placebo video game experience and the second group received 15 one-hour IM sessions. The IM group showed statistically significant improvement on 53 out of 58 tests and subtests. Improvements were seen in:  attention to task, processing speed & response time, attaching meaning to language, decoding for reading comprehension, sensory processing (auditory, tactile, social, emotional), reduced impulsive & aggressive behaviour. 

How does it work: 

Interactive Metronome® (IM) measures & improves neuro-timing, or the synchronisation of neural impulses within key brain networks. As the child activates a trigger in time with a steady auditory beat, IM technology provides real-time auditory and visual feedback for millisecond timing. Knowing whether the child is hitting before, after, or exactly in sync with the beat to the millisecond allows the child to make immediate, online corrections to improve timing & rhythm over the course of training. The Interactive Metronome can be used within therapy sessions or as an intensive therapy program. Within therapy, it is incorporated into sensory-motor activities to increase the child’s motivation and performance. The IM can be purchased for home use and links directly to the Motivate Kids unit, this allows the therapist to set the child’s home program settings, so the parent-carer simply needs to turn on the device and the child begins. This also provides feedback to the therapist to adjust the home program as required.   

Rhythmic Movement Training International (RMTi) is a reflex integration program based on movements and other activities that replicate our earliest movement patterns to establish, strengthen or retain the foundations of posture, central nervous system maturity, vestibular function, sensory processing, memory, learning, and emotions. The movements used in the RMT by Moira Dempsey are based on those first devised by Kirstin Linde, a Swedish movement training specialist, who developed movements based on her observations of how infants are meant to move.   

Who will benefit: 

Studies show that retained primitive reflexes are involved in learning challenges, ADD/ADHD, dyslexia, dyspraxia, dysgraphia, focussing and comprehension challenges, coordination difficulties, and autism. It is also beneficial for individuals with anxiety, panic, emotional imbalances, behavioural problems, schizophrenia, Parkinson’s, psychosis, PTSD and general overwhelm. 

How does it work: 

RMTi works by integrating the retained, or underdeveloped, infant reflexes (also called primitive reflexes). Primitive reflexes help a baby to survive when they enter the very sensory-stimulating world from the very protective womb where all needs were met. Primitive Reflexes are automatic and do not involve the conscious brain. Primitive reflexes emerge in utero, are present at birth, and should be inhibited or integrated by 6-12 months of age.  

When the baby does not integrate reflexes in time, they may experience delayed motor skills, experience attention, and learning difficulties, and in general, it is more difficult to mature the brain. This is especially true for premature babies who may enter the world before some primitive reflexes develop and for C-section babies who have missed the normal delivery process and therefore do not get the stimulation necessary for maturing reflexes.  

The movements in Rhythmic Movement Training International are based on replicating the movements that infants naturally make such as gentle rocking that stimulates neural pathways. In RMTi the therapists use these movements to integrate the reflexes so that learning, communication, behaviour, emotional and general well-being can be given the opportunity to be accessed and developed. Parent-carers are then provided with the tools to complete a daily home program to integrate these within the home environment. This may be just 60 seconds a day as a part of the child’s morning or evening routine.  

Éadaoin Bhreathnach an Occupational Therapist & Attachment Counsellor who established The Ash Cottage Sensory Attachment Centre in Northern Ireland in 1995. Éadaoin developed the Sensory Attachment Intervention (SAI) integrative approach that is used to treat children and adults who have experienced trauma. It is centred around the principles of supporting co-regulation and self-regulation. It combines the body of knowledge from Ayres Sensory Integration and Patricia Crittenden’s Dynamic Maturational Model of Attachment and Adaptation.  

Who will benefit: 

Any child and parent-carer who experience challenges in regulation and connection. It is particularly powerful for children and adults who have experienced abuse, neglect or high levels of stress in pregnancy and early childhood. Negative experiences in the womb and in early childhood impact one’s capacity to cope with stress throughout life. 

How does it work: 

SAI recognises the need to target the areas of the brain that are the source of the dysfunction. The priority is to establish safety and regulation by shifting the nervous system from a state of fight, flight or freeze. It then focuses on facilitating modulation of the body’s senses through the just right combination of up-regulating and down-regulating experiences. This then enables higher-level sensory, emotional and cognitive functioning. 

As attachment is a co-regulation process, the sensory and attachment patterns of the child and parent-carers are explored and supported. This can be considered a radical change from the notion of the child attending therapy once a week and the therapist being the regulator of the child in those sessions. In SAI the parent-carer is the regulator, whilst still allowing the child to lead the play.  

Neuroscientists such as Perry highlight the need to carry out regulating activities little and often throughout the day. If the activity is done with the attachment figure (parent-carer) it has an even more powerful effect. Therefore, SAI in therapy looks at the way regulation should be embedded into activities of daily living in the home and school settings. For example, briskly washing and drying the skin is highly alerting and can inadvertently add to stress levels. 

The Wilbarger Therapressure Protocol, often called the brushing program, was developed by Occupational Therapist Patricia Wilbarger. It is an advanced treatment program used to specifically treat primary and secondary challenges related to ‘Sensory Defensiveness’ through the use of consistent and frequent application of very deep touch pressure and proprioception without noxious input such as scratching or tickling. Sensory defensiveness is simply the over-activation of our protective senses. It can be seen in a constellation of behaviours related to aversive or defensive reactions to non-harmful stimuli across one or more sensory systems. It is a misperception that makes our clothes feel like spiders on our skin, and stairs seem like cliffs for example. Although research on this technique is limited, clinical experience indicates it can be very beneficial in reducing or eliminating sensory defensiveness when applied correctly within the context of a comprehensive OT program. 

Who will benefit: 

Any child with sensory defensiveness may benefit greatly from the Therapressure Program. Children with primary sensory defensiveness may show negative, avoidant or adverse reactions to sensory experiences that most cope with. Children with secondary sensory defensiveness may show anxiety, stress, distractibility, sensory overload, sleep difficulties, postural tension and social-emotional challenges such as social avoidance, fighting, aggressive behaviours, emotional fragility or ‘meltdowns’. Children with sensory defensiveness may to try to manage to cope through behaviours such as avoidance of sensations or events, controlling or obsessive-compulsive behaviours such as rigid routines or producing loud sounds to block auditory irritations, cognitive strategies include self-talk, sensory seeking behaviours including repetitive actions, craving pressure touch, sucking and biting objects or jaw clenching and sometimes potentially self-harming behaviours. Sensory seeking may appear more functional such strong craving for physical activity. These children are working hard to try to cope with their sensory defensiveness. The Therapressure Program aims to work on the root cause rather than seeing these as purely behaviours.  

How Does it Work: 

The Wilbarger Therapressure Protocol includes BOTH deep pressure touch input with the Therapressure Brush to specific areas of the body including the hands, arms, back, legs and feet, and must be followed immediately by joint proprioception/compression input to joints in the trunk, shoulder, elbows, hands, hips, knees and ankles. Deep pressure touch and joint proprioception must be applied consistently every 90 to 120 minutes during walking hours or 8 to 10 times a day for at least 2 weeks. The protocol requires training and ongoing supervision by a therapist who has advanced training in treating sensory defensiveness. Every child should have an individualised program that includes parent-carer education and a sensory lifestyle program to be incorporated at home. There are numerous precautions that must be carefully considered before commencing the program. 

The Circle of Security® is an evidence-based program developed by Robert Marvin, Glen Cooper, Kent Hoffman, and Bert Powell. It supports the notion that every child comes into the world seeking a secure relationship with their parent-carer. This program recognises that secure attachment between child and parent-carer is fundamental to a child’s well-being and developmental trajectory. Research clearly shows that secure children have increased empathy, self-esteem, relationships, school readiness, and emotional regulation. Secure children are less likely to grow into adults who struggle with poverty, have legal problems, or experience chronic emotional difficulties. 

Who does it help: 

Any parent-carer who may feel lost or confused about what their child’s behaviour is trying to tell them. It supports parent-carers with the understanding and skills to strengthen and support a secure relationship with their child. The program helps parent-carers to read the child’s emotional cues to understand their emotional world, regulate emotions and improve their child’s self-esteem. It also values the notion that every parent-carer has the innate wisdom to connect with their child in a secure way. 

How does it work:  

The Circle of Security® was originally a ‘user-friendly’ description of attachment theory for parent-carers and educators to understand. Attachment theory put simply is the secure relationship between parent-carer and child that fosters optimal social and emotional development. The program has now advanced into a video-based intervention that strengthens parent-carers abilities to observe and improve their caregiving skills. It involves weekly group sessions with our Motivate Kids OT facilitator. It is a journey shared with other parent-carers.  

Therapeutic Listening Program (TLP) is a multi-faceted, sound-based intervention that was developed by Occupational Therapist, Sheila Frick. Sheila was strongly influenced by the works of Dr Jean Ayres and subsequently, the TLP aligns with sensory integration therapy. Like all sensory systems, the auditory system does not work in isolation. The auditory system is connected to all levels of brain function and therefore can influence a range of areas such as motor control, cognitive perceptual skills, emotional regulation, attention, and learning. The ability for a child to actively listen requires the desire to communicate and the ability to focus the ear on certain sounds selected for discrimination and interpretation. A child actively listens and directs attention to sounds in the environment with their whole body. How a child listens impacts their physiology as well as their behaviour.  

Who will benefit: 

TLP may benefit a wide variety of children of various ages who may experience poor attention, difficulties interacting with peers and limited play skills, challenges with transitions or changes in routine, difficulty communicating (both verbal and non-verbal), struggles with sleep, bowel and bladder control, and eating, difficulty following directions, challenges perceiving and navigating space, poor timing and sequencing of motor skills, difficulties with irritability, mood, difficulties with regulating their energy level (i.e. too low arousal or hyperactive), postural insecurity (fear of heights, playing on playground equipment), challenges responding to sensory stimuli (sounds, touch, taste, pain), poor praxis and motor planning: coming up with an idea, planning, and completing the task.  

How it works:

The music in the TLP gives the child unique and precisely controlled sensory information. It is electronically modified to highlight the parts of the sound spectrum that naturally capture attention and activate body movement, synchronising it with the environment. With organised, rhythmical sound patterns inherent in music, the TLP promotes self-organising capacities of the nervous system. When used with sensory integration, the intensity of the program can be increased and the duration of therapy required reduced. After careful observation and assessment, it involves the therapist prescribed a sequence of albums for the child to listen to daily. Each album is used for two weeks and listening takes place for 30 minutes each day alongside sensory-motor activities to enhance the effectiveness of the program. The TLP can be easily implemented at home or educational setting by parent-carer and educators under the guidance of an OT. 

Compassionate Inquiry® is a psychotherapeutic approach developed by Dr. Gabor Maté that reveals what lies beneath the appearance we present to the world. Using Compassionate Inquiry, both the individual and therapist unveil the level of consciousness, mental climate, hidden assumptions, implicit memories and body states that form the real message that words both express and conceal. Through Compassionate Inquiry, the client can recognise the unconscious dynamics that can impact their well-being and parenting journey run their lives and how to liberate themselves from these. 

“The purpose of Compassionate Inquiry is to drill down to the core stories people tell themselves – to get them to see what story they are telling themselves unconsciously; what those beliefs are, where they came from; and guide them to the possibility of letting go of those stories, or letting go of the hold those stories have on them… That’s what Compassionate Inquiry is.” ~ Dr. Gabor Maté 

Who will benefit:  

Any parent-carer who feels they are struggling to support their child in the way they want to be able to.  

A Harvard article in the Journal of Paediatrics published that “the essential condition for healthy development is the presence of nurturing, non-stressed, non-depressed, attuned parenting caregivers. The architecture of the brain is constructed through an ongoing process that begins before birth, continues into adulthood, and establishes either a sturdy or a fragile foundation for all the health, learning, and behaviour that follows.” Motivate Kids recognise that optimal child development is when parent-carers and the family are therefore supported by the village.  

How does it work: 

This is an approach to working with parent-carer that will enhance the modalities the therapist is currently using in therapy sessions with their child. At Motivate Kids we call this Connect with Compassion. It can be through individual or small group sessions. Individual sessions can include both care-giving parents. The aim of Motivate Kids is to support parent-carers on their journey to unpack the unconscious stories that are influencing their regulation, relationships, and parenting. This journey is toward being able to support their child from a new place of clarity and compassion. We recognise a child does not function in isolation, they are part of a unique family unit and that the child’s therapeutic growth often aligns with the growth of the family as a whole. Sessions also include how therapy strategies can be incorporated into daily life by exploring the barriers and enablers to creating more ease when applying this outside of therapy.