Review of Chapter 11:

1. Review of flexibility with stability in the Relevance System: Flexibility to have stress responses with negative emotional valences and to return to stability with the green zone with positive emotional valences.

2. Links between Regulation and Relevancea. Colors from arousal states are the background to emotion and affectb. Parallel process of both stress responses and emotional valences include uncoupled (all or

nothing), reciprocal (one moves up/down or stays the same), and coactive (both going up or down) patterns

c. Three functional capacities (emotions, memories, and meaning-making) and their links with the Regulation System

d. Using the Early Phase Assessment Form for documentation of these functional capacities3. Triggers and Toolkits for Treatment in the Relevance System

a. Working Bottom-Up, Triggers and Toolkitsi. Use of non-verbal communication

ii. The importance of understanding emotions as sensationsb. Working Top-Down, Triggers

i. Expectation Gaps between developmental age and chronological ageii. Global concerns re: these gaps regardless of where the developmental age delay is

emanating from – inherent disabilities, trauma, or bothc. Working Top-Down, Toolkits

i. Heart Tools1. Feelings as messengers, the Feeling Wheel2. Validation and listening skills

a. Using non-verbal communication b. Taking turns listening and talking

3. The Three Yes-es4. Understanding the reversals of safety and threat with arousal and affect

ii. Hand Tools1. Modulating intensity, Intensity Meter2. Safety vs. Danger3. Emotions Color Wheel 4. Making Personal Intensity Meters with Paint Chips

iii. Head Tools1. Organizing Structure

a. 1s, non-negotiablesb. 2s, negotiablesc. 3s, your choice

2. Balancing 1s, 2s, 3s3. Spheres of Control4. Imbalances and Flips5. Balancing the No’s with Yes’s and Vice Versa6. Making real-world decisions in real-time

a. Trying this on - vignettes7. Ruptures and Repair

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8. Contextual consequences with sensory support vs. Punishmentsiv. Summary of Toolkits (Micro level)v. Macro level – Referrals

1. Matches and Mismatches with EBTs

Chapter 12, Step 3, The Sensory System, Intermediate Learning Phase.

For Supplemental Material, Please Read Chapters 6 and 7 in the NRF Textbook on the Sensory System

Sensory linkage with all brain systems. What is most unique about the sensory system is that it provides raw data to the brain. So, all brain networks and regions are greatly influenced by sensations. This is one of the reasons why we often turn first to the sensory system to provide bottom-up strategies for getting to sleep, alerting to green, staying green, and recovering from a stress response. While there are “five senses” that most people are familiar with, we add three more.

1) “Interoception” we’ve placed in the Regulation System, and sometimes it also shows up here in the Sensory System as well! These are the inside sensations from the body to the brain. These emerge from our gut, our stomach, our heart and lungs. Chapter 11 has a picture of our internal organs (page 16), and these organs are also in their own sensory-motor feedback loop, either relaxing or tightening or just right. These sensations may be more “hidden” and the combo zone is a good example where someone may not appear as anxious on the outside as they are in the inside. There can be a light shade of green presentation, while the internal organs are churning. This is one of the reasons for the NRF’s research tracking internal physiology with wristband equipment that can accurately measure heart rate and electrodermal activity (EDA) responses that are sensitive measures of the sympathetic (gas pedal) side of the ANS. We are looking for matches and mismatches between what the inside physiology shows and the external behaviors that we see.

2) Proprioception is when we receive input into our muscles and our joints. This can occur through more passive means, such as when receiving massage. However, the more active means are more powerful ways that our nervous system receives this input. Active measures mean actual input into our joints and muscles through running, jumping, wrestling, squeezing, and joint compression.

3) Vestibular input is any movement that we make. Our inner ear registers a head turn or movement of our bodies and works to keep us in balance. Vertigo is when our body does not handle movements and one’s world is left spinning. Being swung up, down, or sideways as a baby is one form of input that can be soothing or disorienting. Roller coasters for some are exhilarating and perturbing for others.

Some refer to “energy” as another form of sensory input. As mentioned in Chapter 11, arousal “energy” is really distributed energy across all brain systems. So as the relevance system brought emotional reactivity to arousal, the sensory system brings the energy of sensory reactivity.

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Flexibility with Stability. As mentioned, each brain network has functional capacities that honor stability and others that honor flexibility. There are only two functional capacities in the sensory system, so each honor one aspect of this dialectic.

Functional Capacity #1 – the capacity to accurately process sensory information: To better understand the first functional capacity we begin with a picture of the primary cortical areas of the brain where sensory modalities reside in their most pristine form. Notice that the “interoceptive” sensations are coming up into the brain, labeled as “somatic senses.” Notice that the Thalamus is a large “relay station” that all sensory modalities pass through except for the olfactory sensation.

The first functional capacity has to do with how accurately one receives information as energy that is transformed from its receptor site into sensory information. In the Table below (see page 56 of the NRF Textbook), note how different forms of energy are received by various receptor sites on our bodies. These signals then are first transmitted to the primary area of our brains, which turns the signal into sensory information we experience as various sensory modalities.

Energy Receptor Site Primary Area Sensory InformationThermal Skin Somatosensory Temperature, painMechanical Ears, skin, muscle Heschel’s gyrus,

somatosensory, vestibular

Sound, balance, touch, proprioception, pain

Chemical Skin, tongue, nose Somatosensory, gustatory, olfactory

Pain, itch, taste, smell

Electromagnetic Eyes Calcarine fissure Sight, vision

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These signals continue along other stations in the journey, shifting from one brain location to the next. This whole process/journey is referred to as the “information hierarchy” where sensory neurons shift from their primary (pristine) areas of our brains into secondary (association), tertiary, and transmodal areas [see picture below of primary and association (secondary) areas]. Each of these additional areas accumulates more sensory neurons from different discrete modalities that share sensory signals. As the gathering of sensory neurons occurs from one location to the next, further transformation occurs. For example, in the primary visual cortex, the visual signal may convey a line or contrasting shade. As it moves along the information hierarchy (to the secondary area), it becomes more defined with color and movement; next, as the sensory signals congregate further, it is elaborated into a face (tertiary area), and as it integrates with other sensory signals, now in the transmodal areas, it adds meaning that this is one’s mother’s face with facial expressions that represent safety with joy. This information hierarchy also matures in a hierarchical fashion, with primary areas maturing before the association areas, etc.

Thus, the NRF (Manual) refers to this first capacity as sensory information processing. How accurately does the first leg of the journey occur? If there is a problem from the receptor site to the primary area, for example, one will not be able to see or hear. The breakdown occurs very early in the hierarchy. If there are other sensory information glitches along the information hierarchy, there will be a learning disorder/disability. While those with learning disorders (LD) can hear and see, all LD’s have a breakdown occurring somewhere in this information hierarchy, in the movement from the primary areas to the other community gatherings.

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In summary, sensory information processing capacities have to do with the infant, child, adult accurately:

1. Orienting and registering sensory information2. Identifying and discriminating the source of sensory information3. Following and tracking the sensory information

Of course, the phenomenon of accuracy links with both the relevance and executive systems. If one cannot read facial or auditory cues accurately, then one’s meaning making system may be overly positively or negatively biased based upon sensory information that may have been challenging to “read.” Equally challenging is executive functioning and language expressions. As the hierarchy moves into more complexity, language processing and organization of thoughts into words may be more challenged.

Functional Capacity #2 – the capacity to modulate sensory information: The second functional capacity is influenced by the first capacity. If the sensory signals are not clear and accurate, it will be harder to modulate the sounds, sights, movements, etc. For example, I am losing my capacity to accurately process sounds due to some hearing loss. This now makes it nearly impossible for me to dine at noisy restaurants and ever hope to have a conversation. However, one can have very accurate sensory signaling occurring and still have difficulty managing the intensity, duration, and frequency of sensory input, referred to as modulation. For this concept, another couple of brain pictures may be useful. Consider the picture below which shows the blue organ of the Thalamus. Recall this was noted above as the sensory relay station. The olfactory bulb bypasses the Thalamus and goes directly to the amygdala (emotional center) which gives credence to our scent being a very powerful emotional-memory signal.

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All the other sensations do get to the emotional-memory (amydala/hippocampal) centers quickly through the thalamus. Dr. Greenspan referred to this as the “dual coding” of sensations with emotions. I would call it a “triple coding” of arousal, sensations, and emotions. So, the capacity for modulation has more to do with our linking sensations with our regulation (arousal) and relevance (emotional) systems. When one is responding to “normal” levels of sensory input with under-or-over-responsiveness (blue, combo, or red zone), one is considered to have a modulation challenge.

The triple coding occurs immediately, from birth onward and this circuit has been named by LeDoux as the “low road.” This is akin to our terminology of procedural learning and procedural memories. Memories are in and of themselves, “sensory fragments” that house usually either a highly positive or highly negative emotion surrounding a sensory preference (positive) or sensory trigger (negative). Thus, the low road becomes an automatic pathway that immediately picks up on sensory stimulation as representing safety, challenge, or threat. Recall that Porges refers to the safety/danger network as “neuroception.” He emphasizes, as the NRF does, that our greatest source of sensory information comes from all of the non-verbal relational cues listed within our states of arousal – our eyes, our face, our voices, our body gestures/movement, and the rhythm and rate these non-verbal cues are expressed. So, the NRF makes distinctions between relational sensations and environmental sensations. Both are important, yet, far too often, the relational cues are not tracked as part of the sensory environment. What is motor output to one person is sensory input to the other!

One way to figure out if an infant/child/adult has a sensory modulation challenge, is to consider whether one tends to need either low intensity, slow rhythms in order to get to green or high intensity, fast rhythms in order to get to green. If one needs one extreme or the other, or both extremes, this is a telltale sign that sensory modulation may be difficult!

Integrated clinical concept: Rate, rhythm, force, and accuracy. The clinical concepts of rate, rhythm, force, and accuracy holds the tension between the NRF’s two functional capacities – the sensory

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information processing hierarchy and the sensory modulation pathways. How well does one’s sensory-motor feedback loops provide the ability to smoothly start, stop, continue, combine, shift, and switch motor action, speech, thought, memory and emotion (Anne Donnellan, xxxx)? What is increasingly clear, articulated by dual track neuroscientists who study the links between bottom-up and top-down processes, is that as the rate, rhythm, force and accuracy of movements are occurring smoothly or not (bottom-up processes), so is the speed, consistency, capacity and appropriateness of emotional and cognitive thoughts (top-down processes) (Jeremy Schmahmann, Harvard Neuroscience, 2013). The bottom-up processes are integral to influencing the top-down processes! The cerebellum is now described not just as participating in sensorimotor functions, but as influencing the autonomic (ANS/regulation), the emotional (relevance), and cognitive (executive) neural circuits (JS, 2013).

We now summarize the two functional capacities of the Sensory System and offer some prompts on the right side of this table for you to see how you might already have access to that information or where you can find it and follow it.

Two Functional Capacities of the Sensory System1. Capacity to accurately orient to, locate,

and register, discriminate and translate, as well as associate and elaborate within and across sensory modalities in a developmentally appropriate way (sensory information processing hierarchy)

During the “developmental story” there may be stories from parents that pertain to speech delays, language processing concerns, reading/writing/math challenges, and struggles with learning in pre-school or any educational setting. These are clues that there are challenges in the sensory information hierarchy. As one spends time with the child/parent, there may be observational data that one notices that may have gone unnoticed by others. Any delay in accurately locating, orienting to, and then tracking faces, voices, gestures, scents, taste, body awareness in space (proprioception), movement, and internal bodily cues is a red flag!

2. Capacity to balance the rate, rhythm, force, and flow of sensory signals in a way that is appropriate to the context (sensory modulation)

With a good mapping of the PIE early on, one will know if any of the toxic stress patterns are at play. Inherently, a toxic stress pattern is a cue that there is an arousal modulation challenge going on, and often one of the reasons for these state changes can be sensory triggers. This option needs to always be investigated as a working hypothesis until ruled out! Note that sensory triggers that participate in toxic stress patterns are common with several “diagnostic” categories ranging from Sensory Processing Disorders (SPD), to Autism (ASD), to Reactive Attachment Disorder (RAD), to Post-Traumatic Stress Disorder (PTSD), to Schizoaffective Disorder. Becoming a good sensory detective and noticing if certain sensations are

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under or over-responded to, is a way to begin. Unless parents are oriented to sensations as triggers, sensory screeners may not be as useful at the front-end of a relationship.

Introducing sensory information processing and modulation to parents: In introducing these items to parents, there are a couple of things to keep in mind. For inquiring about the sensory information hierarchy, asking parents to notice how well their infants find, locate, and track their parent’s facial expressions, voice as it moves around the room, and gestures, is a good place to start. Are these non-verbal relational cues being noted with the child’s eyes, ears, and movements? Does the child respond to his name being called? Isolating only the visual field (smiling with funny faces without sounds) or only the auditory field (talking behind one’s visual field) is simple ways to see of the child is able to orient to, locate, register and discriminate. Please refer to pages 252 to 254 of the NRF textbook (Worksheet 7.2) as a guide that takes you through each sensory modality and offers suggestions for this line of inquiry and observations.

For inquiring about sensory modulation, one can both ask and observe what the rate, rhythm, and force of sensory input supports or knocks out the green zone (into blue/combo/or red). For practitioners that use the Socio-Emotional Growth Chart or the Bayley III version of it (PsychCorp), the first 11 questions are sensory-based inquiries that emerge from within relationships. How well does s/he handle the intensity of sensory input, such as being picked up, danced with, or quickly lifted into air or does slow movement need to occur? Does one have to be slow paced or dramatic to get his or her attention? These relational questions are great sources of information. Please refer to pages 254 to 256 of the NRF textbook (Worksheet 7.3) as a simple guide that helps you isolate each sensory modality and think about how it might be a sensory preference due the modality calming and alerting or a sensory trigger due to it stimulating a stress response. Tracking the actual events are helpful in picking up the rate (slow/fast), rhythm (short or long duration), and force (high or low intensity) of the sensory experiences.

While the NRF emphasizes the relational components of sensory experiences, environmental experiences are also very important. Unexpected events such as a car accident or an earthquake often leave memory traces that are triggered by sensations. The backfiring of a car may send a Veteran into a flashback of being fired at. One infant who was inconsolable every Wed afternoon was very hard to understand until the home visitor slowed down to notice any unusual environmental triggers. All of a sudden it made sense! The garbage truck came every Wed afternoon and made a steady beeping sound when backing up. This sound was a sensory trigger from this child having been in the Neonatal Intensive Care Unit (NICU), hooked up to a heart monitor for several weeks. That procedural memory kicked right back in and now the parents understood why her infant could not be consoled immediately. Noisy playgrounds, fluorescent lights, and clanging bells may all be “normative” yet triggering to a sensitive, over-responsive child.

On a Macro, big picture level assess for any undiagnosed learning issues that may be contributing to a toxic stress response.

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On a Micro level assess for any accuracy, tracking, or modulation triggers.

Go to Early Phase Assessment Form, pages 15 to 17 or Early Phase Assessment Sensory Form, pages 1 to 3. Now you can fill in the functional capacities on the designated case that you have been following.

Treatment implications in the Sensory System: Working Bottom-up

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Knowing Yourself, Individual Preferences: Just as you have been encouraged to look at your colors and your full range of feelings (feeling wheel), it is time to look at your own personal patterns with sensory rhythms. The best way to learn this material is to apply it to oneself. We all have different sensory preferences and rhythms that regulate our arousal. A personal Sensory Profile is in your web chapter and it guides you through how you alert yourself through am routines, afternoon and evening rituals and how you pay attention and concentrate.

Individual sensory thresholds. Sensory preferences also include sensory thresholds. Some thresholds are naturally low, which lead to over-responsiveness; some are naturally high which support under-responsiveness.

Thresholds can also change throughout a day and more complex profiles have mixed sensory thresholds. The picture below describes the various types of thresholds that match different arousal zones. The

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sensory “events” at the bottom of the chart can be both relational and environmental in nature. The bottom of the chart starts with an under-responsive threshold that would match a blue zone arousal state. The second line from the bottom of the picture shows a threshold that is within the optimal green zone and can handle sensory events with modulation. Notice that the arousal level does cross over into a mild stress response yet comes back down into the green zone in a smooth way. The third line from the bottom shows that after the third sensory event, there is a crossing over into a mild stress zone that then escalates into a high stress zone and is appearing to stay there. The fourth line from the bottom starts off at a higher level, already in a stress state and then by the second sensory event is in a full blown stress response that continues on without stress recovery.

Many events can influence one’s sensory thresholds. Here, below we see that low thresholds to sensory events, and therefore to stress, can come from in utero vulnerabilities including exposure to toxins. Medical care, while lifesaving, can affect the outcomes of sensory thresholds. As mentioned, an infant who was tube fed may develop a strong gag reflex and aversion to having anything inserted into one’s oral cavity, which may alter one’s ability to swallow, eat, and drink. As a NICU graduate, a return visit to the NICU can be cause for intense alarm. Infants can immediately recognize the sights and sounds of the environment associating it with threat.

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In another example, a young child who was removed from his home due to gang violence was placed with a fost-adopt family. The following weekend he was taken to a birthday party. The fost-adopt parents thought this would be a lovely event for him to attend. In the middle of the party, the young boy ran into the street. The fost-adopt parents were angry, feeling disrespected that he would place himself in danger and that he would run away from the party. It wasn’t until they met with the social worker that they realized that the boy had run into the street out of panic and fright for his life. He had witnessed one of his family members shot to death by gang violence. When a balloon at the party inadvertently popped he immediately thought gun had been fired and with a full shot of adrenaline, he ran for his life.

As such, safety and threat lies in the senses of the beholder!

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Individual preferences include relational sensory preferences, which are different rates, rhythm, and force of emotional expressions. Chapter 11, on the Relevance System, notes these crucial non-verbal signals require special attention. Please go to pages 11 & 12 to see the relational aspects of sensory preferences.

Porges highlights that when one is using his or her facial expressions, with open eyes and vocal intonation, we are modulating the middle ear that picks out human sounds over other environmental sounds. Vocal tones and rhythms are often critical for promoting safety. The nerves from the middle ear are not only involved in the function of our hearing, but also are primed to hear higher frequency sounds, which signify safety, and to distinguish them from lower frequency sounds which connote danger. Porges believes this finely tuned middle ear can become permanently attuned to picking up predators and that listening programs with melodic and high frequency sounds can help facilitate an orientation to the human voice being associated with safety. https://therapeuticresource.com/blog/middle-ear-may-hold-answers-for-autism-treatment.

As a refresh, this slide reminds us of our noticing what we need and honoring what others need as well.

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Linking sensations with our Levels of Engagement. Our first three levels of engagement are often where we begin with infants, toddlers, and youth alike. When “words don’t work” with older children, we start at the beginning of the breakdown. The first three levels of engagement are very sensory based! First of all, getting to green is contingent upon our individual sensory preferences. Our second level of engagement is a continuation of that on a relational level. What sensory modalities can we share that are dyadic that keep our green zones going, allow us to feel safe with comfort, that lead us into joy (the third level)? I always say, “We most often begin with getting to green, comfort, and joy.” That joy is often contingent upon relational sensory experiences (facial, vocal rhythms) in conjunction with shared sensorimotor aspects of play (from rocking, to peek-a-boo, to passing a ball back and forth, to chasing, to playing dodgeball, etc.).

Once we have joy, then, can we keep it going? Level four is about keeping the positive engagement going into long chains of that serve and return process, also coined as circles of communication. Level five is about furthering our emotional and gestural cue sending and cue reading. These are all intensely sensorally driven nuances to engagement. Are we accurately processing these visual and auditory cues? Coinciding with these levels during the first year of life are the links with cooing, babbling, jargoning and early speech production. Can we hear our parent’s words? Can we watch their mouths? These sensory links support our proto-linguistics and speech production.

Once we cross over from bottom-up levels of engagement to into top-down levels of engagement, we continue to use all of our bottom-up levels while adding words. Our speech is gestures made audible. Think about being in a foreign country and how quickly those gestures return! These early levels are always with us because they are our most authentic form of communication. While words are also important if we see discrepancies between our words and our actions, we will believe the nonverbal cues over the words.

Go to the Triggers and Toolkits Menu for Providers Under Sensory. As we walk through these triggers and toolkits in this chapter, please review and check off your understanding of both the triggers and

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toolkits as they unfold. The Trigger and Toolkit Menu is organized by the each sensory modality. If you have questions understanding the Menu while you read this chapter, please let your NRF Trainer or Consultant know so you can get the help you need.

In now looking at both sensory preferences and sensory triggers, we remind ourselves that sensory preferences are organizing how we down-regulate to sleep, how we get to green and stay there with increasing levels of engagement, and how we promote stress recovery. Sensory preferences are there to help us prevent a stress response and to recover more quickly from one.

Sensory triggers are based upon our memories of sensory fragments that stimulate challenge or threat, tipping us into a stress response from our emotional/memory system. If we have challenges with accurately tracking sensory information we are more likely to have trouble modulating our sensory input and our stress responses.

The more toxic stress patterns one has, the more likely that sensory triggers prevail over sensory preferences. Finding sensory preferences are essential to modulating arousal. In the Relevance System chapter (11) we discussed that high intensity levels of arousal often required some type of an exit strategy. When the intensity is not as high, and mid-ranged, one may be able to “stay” in the current context he or she is in, as long as there are modulating and calming sensory preferences one has access to. The Table below, organized by sensory modalities, offers suggestions that one can experiment with. What’s most important is to note for each experience, what tends to support getting to and staying green, what supports getting to or staying blue, and what supports getting to or staying combo/red?

While there is a lot of emphasis in the NRF about getting to green, that is not the only goal! Recall that building a deep basin of green zone that participates in modulating stress responses is also a very high developmental goal within the NRF, referred to as building stress tolerance or an emotional muscle.

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Thus, the use of this table can be multi-layered. For those with extensive trauma histories with toxic stress patterns, the first goal may be to reduce the number of sensory modalities that trigger stress responses and to highlight and increase the ones that promote the green zone. As the green zone becomes tolerated and sustained, and for others without this profile, the goal is to build stress tolerance! Being able to get into mid-range intensities of stress responses, while maintaining some repository of green zone, is critical for building an emotional muscle that can tolerate blue zone disappointments, pink zone frustrations, and combo zone anxieties. So, sensory preferences can be for getting to green AND for modulating red/blue/combo zone stress responses.

Bottom-Up Sensory Modalities for Calming and Modulation

Legend: SP= Sensory Preference (implies green zone); ST= Sensory Trigger, if a Trigger, state which zone it triggers – R=red, B=blue, C=combo; N= Neutral

Please use this Table to Identify Sensory Preferences & Sensory TriggersPlease circle what impact each sensory modality has on your zones

Auditory: Listening to ___________ music SP ST - ( R ) ( B ) ( C ) ( N )Listening to ___________ SP ST - ( R ) ( B ) ( C ) ( N )

Proprioception:Deep pressure, massage SP ST - ( R ) ( B ) ( C ) ( N )Butterfly hugs, squeezes SP ST - ( R ) ( B ) ( C ) ( N )Yoga poses SP ST - ( R ) ( B ) ( C ) ( N )Exercising SP ST - ( R ) ( B ) ( C ) ( N )Playing sports SP ST - ( R ) ( B ) ( C ) ( N )Heavy blanket wrap, swaddle SP ST - ( R ) ( B ) ( C ) ( N )Grounding body through proprioceptive input SP ST - ( R ) ( B ) ( C ) ( N )Muscle tension, relaxation SP ST - ( R ) ( B ) ( C ) ( N )Curl and release SP ST - ( R ) ( B ) ( C ) ( N )Doorway stretch SP ST - ( R ) ( B ) ( C ) ( N )Crunching ice SP ST - ( R ) ( B ) ( C ) ( N )Chewing gum SP ST - ( R ) ( B ) ( C ) ( N )Walking (e.g., dog, to mall, park) SP ST - ( R ) ( B ) ( C ) ( N )

Smell:Smelling _________ SP ST - ( R ) ( B ) ( C ) ( N )Essential oils __________ SP ST - ( R ) ( B ) ( C ) ( N )Bubble bath SP ST - ( R ) ( B ) ( C ) ( N )

Tactile:Lotion (self or relational) SP ST - ( R ) ( B ) ( C ) ( N )Clay SP ST - ( R ) ( B ) ( C ) ( N )

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Play-dough SP ST - ( R ) ( B ) ( C ) ( N )Silly Putty SP ST - ( R ) ( B ) ( C ) ( N )Sand SP ST - ( R ) ( B ) ( C ) ( N )Rice SP ST - ( R ) ( B ) ( C ) ( N )Tapping (some prop) SP ST - ( R ) ( B ) ( C ) ( N )Warm bath SP ST - ( R ) ( B ) ( C ) ( N )Chicken fingers (taking thumb and tapping each finger lightly and sequentially)

SP ST - ( R ) ( B ) ( C ) ( N )

Touching ___________ SP ST - ( R ) ( B ) ( C ) ( N )Taste:

Sucking on candy SP ST - ( R ) ( B ) ( C ) ( N )Chewing gum (also prop) SP ST - ( R ) ( B ) ( C ) ( N )Eating _________ SP ST - ( R ) ( B ) ( C ) ( N )

Visual:Drawing SP ST - ( R ) ( B ) ( C ) ( N )Coloring SP ST - ( R ) ( B ) ( C ) ( N )Painting SP ST - ( R ) ( B ) ( C ) ( N )Visual imagery of a safe place (can include other senses)

SP ST - ( R ) ( B ) ( C ) ( N )

Reading a book or magazine SP ST - ( R ) ( B ) ( C ) ( N )Vestibular:

Bouncing on stress ball SP ST - ( R ) ( B ) ( C ) ( N )Riding bike SP ST - ( R ) ( B ) ( C ) ( N )Swinging SP ST - ( R ) ( B ) ( C ) ( N )

Top-down Strategies for Calming and Modulating

Legend: SP= Sensory Preference (implies green zone); ST= Sensory Trigger, if a Trigger, state which zone it triggers – R=red, B=blue, C=combo; N= Neutral

Body/Regulation:Breathing SP ST - ( R ) ( B ) ( C ) ( N )Yawning SP ST - ( R ) ( B ) ( C ) ( N )

Feelings/Relevance:Helping someone else SP ST - ( R ) ( B ) ( C ) ( N )Journaling feelings SP ST - ( R ) ( B ) ( C ) ( N )Meditating, praying SP ST - ( R ) ( B ) ( C ) ( N )Talking to a friend about feelings SP ST - ( R ) ( B ) ( C ) ( N )Watching something funny SP ST - ( R ) ( B ) ( C ) ( N )Spending time with loved ones SP ST - ( R ) ( B ) ( C ) ( N )Hanging out with friends SP ST - ( R ) ( B ) ( C ) ( N )Playing with a pet SP ST - ( R ) ( B ) ( C ) ( N )Doing craft or hobby SP ST - ( R ) ( B ) ( C ) ( N )

Executive/Planning:Cleaning or organizing room SP ST - ( R ) ( B ) ( C ) ( N )

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Listing things grateful for SP ST - ( R ) ( B ) ( C ) ( N )Repeating positive thought statements SP ST - ( R ) ( B ) ( C ) ( N )

Tables created with Jennifer Hixson

Duration, Intensity, & Rhythm. Finding sensory preferences is a huge step forward in building stress tolerance and stress recovery, but not the only thing that needs to be kept in mind. Sensory preferences can also be contingent upon the rate, rhythm, and force of how the sensory preference is delivered. Sounds in the form of music may be a preference, yet one person wants light classical music playing in the background to feel calm and grounded while another may want an Indy band playing loudly in the foreground.

The next question to ask is this. Does the sensory preference need to match the intensity, rhythm, and rate of the child/adult’s arousal state or does it need to counter it in order to get to sleep, get to green, to stay green and comfort, to fall in love, or help with stress recovery?

This is not always immediatley apparent! This requres the necessary trial and error of experimentation. Joining with parents in an collaborative spirit of discovery is what is often so helpful to parents. We can have hunches, so can they. We discover together what the individual needs and preferences are for each infant/child/youth/adult.

In the spirit of discovery, we also want to do no harm. A safety rule when experimenting includes always starting with short durations, low intensity, and slow rhythms. This way, keeping the input low and slow is not likely to effect the nervous system adversly. We are always observing the child/parent’s state of arousal. The response of the state of arousal is what becomes our guide. Are we making progress by getting to green or staying blue, getting activated, or staying activated? By keenly observing, we find our way. As we get to green we note the duration, intensity, and rhythm (DIR) that got us there. This is how we find individualized “sensory preferences” for arousal regulation. Please note: some practitioners

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associate DIR with the clinical model of Developmental, Individual, Relationship based treatment. I’m hopeful that if you already have this acronym in mind, that you will be able to easily adapt it to include these dimetional properties of intervention.

Sensations that match a blue zoned state are offered with low intensities and slow rhythms. Sensory modalities that match a more combo or red zoned state are higher to high intensities and faster to fast rhythms. Table 5.3, pages 172 to 174 in the NRF Textbook, is an elaborated table, taking you through each sensory modality and providing both environemntal and relational examples of matching or countering.

Some programs offer a suggestions in a more univeral manner. For example, Dr. Karp’s work is offered as relevant across all cultures and a guranteed way to soothe a crying baby. As a parent of a regulatory challenged child, I caution against such statements in favor of highlighting individual differences. While it is common that swaddling (proprioceptive) input can be upregulation as well as downregulating, not all nervous systems are alike!

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These are certainaly worth trying yet many a parent has been shushing, swaddling, rocking, etc. to no avial of calming an inconoslable infant. Each infant’s nervous system has to be unlocked, finding that sweet spot combination of what is soothing to that particular child. And, if there is a very limited reportiare of what is soothing, an Occupational Therapist is essential in order for that nervous system to expand into more realms of soothability.

Journaling and Documenting as Part of Discovery: With complicated cases, setting up a journal grid or a google document for parents and multiple team members to contribute to is often necessary to begin to understand the multiple triggers and toolkits and to organize them. A journal for 24 hours to a week often reveals new information that was not yet clear once one looks for trends and patterns. The following table works for infants and very young children where the variables may be less than the complexity of all four brain systems (see the Executive System for another version with more complexity).

CHARTING STRESS, TRIGGERS, AND PREFERNCES FOR STRESS RECOVERY

Time Activity Trigger(Sensory, Verbal or

Non-Verbal Cues)

Stress Response

Preferences Recovery(what

worked?)

Note quality of eating and sleeping

06:00 Baby wakes up

hungry Crying Bottle fed & rocked

Calmed down quickly w food

Took 4 oz in 30 mins

07:00 Playing w baby

Likes being swung up in air

08:00 Bathing baby

Washing hair

Crying Wash body parts separately;

Took 15 mins to recover; having hair

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wash hair at sink

dried worked

09:00

10:00 Toddler playing w/friend

Friend took toy

Screaming Sitting w/him, using soft voice, encouraging him to calm

Took 5 mins

This is an example of discovering that movement up into the air is engaging with joy and that this child is tactilely sensitive to water baths. This parent is slowly finding her way with the options that a full bath may not work for this child. Washing each body part while keeping the child warm may work for the body and washing the hair still is provocative. Other experiments can be tried. Does it make a difference if taking a bath or shower with mom or dad? Does washing the baby’s hair while being swaddled help? Does blow drying work better than towel drying?

This type of charting was very useful to me in the throes of my distressed two year old. By charting these types of sequences, and taking time to look at the big picture, I discovered the following patterns:

a. I was trying to change my tactically defensive child’s clothes and diaper before feeding him. These were way too many transitions for him and he was hungry!

b. We began to do two different things. He got a sturdy snack at bedtime, like a banana or peanut butter so that his blood sugar would not bottom out as quickly.

c. He was fed immediately upon awakening before making any other transitionsd. Other transitions such as changing his diaper and his clothes were paced with after he was

fully fed

Just enhancing the nighttime snack and rearranging the order of these items in the am brought about much more green zone. This was around the same time that he was able to gesture to his bottom and say the word “towel” which communicated that he wanted his bottom dried before his next diaper went on. Now, for a 2 year old with a speech delay to be watching us and to figure out that the word “towel” is what he needed, is surprising in and of itself. While I knew something was bothering him about the diaper changes, instigating a 2 hour red zone response, I had not known what it was that was driving this. I had thought perhaps the temperature of the wipe on his skin was an issue but whether it was a warm or cool wipe had not made a difference. By not thoroughly drying his skin with a towel, then applying the next diaper, which was purposefully designed to “hold” moisture, the wet moisture on his skin was being sustained. This sensation was very distressing to him. As these all came together, we had stress free mornings for the first time in two years. During this two year mark, we really gained a new reservoir of green zone, comfort and joy. It was a long time in coming and we were thrilled to have this respite.

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Summary: Macro level toolkits link up with the big picture of early intervention services due to speech delays, language delays, sensory modulation, and sensory information processing challenges. Our Part C providers through Early Intervention or Regional Centers are what often fund these services. Sometimes the delays are not considered significant enough and parents have to use private funds to gain services. In general, the NRF supports “the earlier the better” concept rather than the “let’s wait and see” due to brain plasticity being so robust during these early years. Older children with Learning Disabilities will most often benefit from an Educational Therapist as well.

On a Micro level, knowing one’s sensory preferences for arousal regulation is critical for bottom-up intervention.

Knowing what up-regulates and down-regulates each person including ourselves is critical for getting out of and staying out of toxic stress patterns. As we get to mapping out our Triggers and Toolkits on the

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Brain System sheet with parents, we always want to know what can the infant/child/youth/adult do on his or her own?

By knowing what up-regulates and down-regulates each person in the household, parents and children alike can begin to catch stress response at the front-end.

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By knowing what co-regulates each parent/child, stress responses can be caught at the front-end as well as at the back-end.

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