Katie and Jason came to me at their wits’ end over four-year-old Mabel’s frequent meltdowns. “She’s been like this from birth,” Katie explained at our first visit. She described needing to nurse Mabel as an infant in a dark, quiet room because she was so easily distracted by sights and sounds. When I asked them to tell me about a recent specific moment of disruption, they described a visit to a county fair. Mabel was clearly so hungry that she was falling apart, yet despite the abundance of appealing snacks she refused to eat.
Katie had lost her cool, yelling at Mabel in the face of what seemed like irrational behavior. Finally, recognizing the futility of this battle, they gave up and took her on a hayride. At the conclusion of the ride, to the astonishment of her beleaguered and exhausted parents, she asked for a hot dog, as if nothing had happened. “In a sense, she’s still that infant you nursed in that quiet, dark room,” I said. Both nodded in agreement and recognition.
When we took the time to look at the moment in detail, by slowing things down, it was clear that the intense stimulation of the fair overwhelmed Mabel, and only with the gentle movement of the hayride, when her body could again feel calm and organized, could she focus on eating.
Next, Katie went on to describe a difficult visit to a butterfly museum, where, as she demonstrated, Mabel winced and withdrew her entire body when a butterfly came near her. Mabel was trapped between fear and desire, as she longed to be like the other kids and have one land on her shirt. She became increasingly frustrated, and finally disrupted the whole outing. For Katie, the day had been a humiliating failure that she just wanted to forget. But now, in this safe environment when she could stand to take a closer look, she saw clearly the significance of Mabel’s sensory experience.
When I next saw the family, Katie described an apple-picking adventure. This time they let Mabel ride the tractor rather than insisting they first pick apples. They saw how the movement calmed her. The rest of the outing was a success. Katie and Jason helped Mabel notice that she had a hard time calming down when there was a lot going on, and that movement helped her feel settled. Over time, as her parents gave words to his experience and she grew to understand her vulnerabilities, she learned how to calm herself in the face of overstimulation.
Recently in my role as faculty with the University of Massachusetts Boston Infant-Parent Mental Health Program I had the privilege to learn from Erna Blanche, a leader in the field of occupational therapy who trained with Jean Ayres, the mother of sensory processing theory and sensory integration therapy. Ayers defined sensory processing as the organization of sensory information from the body and the external world that allows a person to interact effectively with their physical and social environments.
Blanche described the connection of movement with many different sensations including body position in space, internal workings of our bodies (interoception), and even the pull of gravity. A number of the fellows, who come from a wide variety of disciplines and from all over the world, expressed a wish to “be an OT in another life.” Since I first became aware in my journey from pediatrician to infant-parent mental health specialist of the depth and breadth of knowledge in the field, I too have had the same thought.
Looking back over my decades practicing pediatrics I recognize that, as with Mabel and her family, many children and caregivers discovered what I call “OT in real life.” The healing qualities of these discoveries suggest that in trial-and-error process. they found their way to an activity or activities best suited to their child’s unique sensory processing profile. Some solitary, some in partnership with one other, and some with a whole group, they include such things as swimming, dance, martial arts, playing an instrument, singing in a chorus, or even simply knitting, walking, or playing catch.
Perhaps years of working with parents together with their newborn infants has led to my respect for the inexorable linking of sensory and emotional experience. This recent consult offers an example. When Marsha called for a scheduled phone consultation, I could hear the panic in her voice as doubts about her ability to care for her infant daughter poured out. Her wife worked remotely in another room; her simultaneous presence and absence accentuated Marsha’s sense of aloneness “Wait,” I said, using my voice to halt the relentless flow of her distress, “Let’s do to FaceTime.”
The electronic tone signaling the switch revealed on my phone the image of Marsha’s anxious, drawn face as she tensely held in her arms 4-week-old Kelsey drinking from a bottle. Over the next 30 minutes, I narrated detailed observation of the moment-by moment interaction as Marsha scaffolded her daughter through feeding, burping, fussing, to deep sleep snuggled into her arms. We did not talk about her anxiety or what to do but rather allowed ourselves to be immersed in the sensory experience of moment-to-moment mismatch and repair. Mother and daughter transformed from of agitation and stress to calm, peaceful connection. Towards the end of the visit, as we discussed how to carry the experience into future moments when she didn’t know exactly “what to do,” Marsha gazed at her sleeping infant saying simply, “I love her so much.” By literally (virtually) bringing Kelsey into the visit, we three shared a powerfully transformative moment of meeting. Both Marsha and Kelsey knew in their bodies what to aim for and what they could achieve.
This perspective on sensory processing has relevance throughout our lives. We tend to place a kind of over-reliance on our cognitive capacities. When we feel calm, discovering meaning of our experience in the form of language may help us to heal and grow. But when we feel overwhelmed, attempts at explanation in words often proves futile. The authentic presence communicated by Marsha’s loving smile with Kelsey’s body molded into hers offer a vivid representation of the link between sensory and emotional experience, showing what to strive for as we navigate a complex social world,