There are two contrasting views on the effectiveness of exposure to sensorially dysregulating stimuli in children: those who follow the behaviorist approach and those who support neurodiversity.

Behavioralists believe that exposing children to overwhelming stimuli repeatedly can help increase their tolerance and regulation around the trigger. However, this approach can actually be counterproductive and may teach children to suppress their emotions rather than regulate them. This is because the behaviorist approach focuses on changing behavior through conditioning, rather than addressing the underlying emotional and neurological factors that contribute to dysregulation.

On the other hand, neurodiversity-affirming supporters understand that exposure to overwhelming stimuli can cause actual harm to a child's developing brain and nervous system. They believe that every child's sensory experience is unique and that it is important to provide individualized support and guidance in regulating their emotions. Effective strategies include identifying and avoiding triggers whenever possible, providing calming activities and sensory experiences, and teaching specific coping skills for managing emotions.

Therefore, it is important to take an individualized approach to supporting children with sensory dysregulation. Exposing individuals to potentially harmful stimuli in an attempt to increase tolerance and the overt signs of dysregulation is invalidating to neurodivergent individuals. Learning sensory triggers, dysregulating stimuli, and regulating stimuli is the foundational work that when combined with a support personnel (e.g., parents, teachers, etc) providing support, co-regulation, and self-regulation is affirming of the individual’s neurotype. This approach will promote healthy brain development and long-term well-being.

Supporting research:

1. Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1-11.
2. Green, S. A., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: Is there a causal relationship? Journal of Autism and Developmental Disorders, 40(12), 1495-1504.
3. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2007). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37(5), 894-910.
4. Dunn, W. (2001). The sensations of everyday life: empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy, 55(6), 608-620.
5. Case-Smith, J., & Arbesman, M. (2008). Evidence-based review of interventions for autism used in or of relevance to occupational therapy. American Journal of Occupational Therapy, 62(4), 416-429.
6. Baranek, G. T. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and Developmental Disorders, 32(5), 397-422.
7. Lane, S. J., Reynolds, S., & Thacker, L. (2010). Sensory over-responsivity and anxiety in typical children and children with autism and attention deficit hyperactivity disorder: Cause or coexistence? American Journal of Occupational Therapy, 64(3), 453-464.
8. Engel-Yeger, B., & Dunn, W. (2011). The relationship between sensory processing difficulties and anxiety level of healthy adults. British Journal of Occupational Therapy, 74(5), 210-216.
9. Jones, S. M., & Miller, G. E. (2013). The psychological costs of exposure to uncontrollable stressors in children and adolescents. Child Development Perspectives, 7(1), 29-34.
10. Glover, V. (2011). Annual research review: Prenatal stress and the origins of psychopathology: An evolutionary perspective. Journal of Child Psychology and Psychiatry, 52(4), 356-367.
11. Schore, A. N. (2001). Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1-2), 7-66.
12. Schore, A. N. (2003). Affect dysregulation and disorders of the self. New York: W. W. Norton & Company.
13. Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In C. R. Figley (Ed.), Trauma and its wake (pp. 103-128). New York: Brunner-Routledge.

1. Hahn, E. J. (2011). Risk of harm to children who experience developmental trauma: Potential impact on their life span. Journal of Evidence-Informed Social Work, 8(4), 420-429.
2. Siegel, D. J., & Bryson, T. P. (2012). The whole-brain child: 12 revolutionary strategies to nurture your child's developing mind. New York: Delacorte Press.
3. Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books.
4. Mullen, E. M., & Gorman-Smith, D. (1998). Parenting in community context: The role of social support, social capital, and parenting efficacy. Family Relations, 47(4), 323-332.
5. Sajed, S., & Lee, H. (2018). Exposure therapy for posttraumatic stress disorder: An overview of evidence-based treatment. Korean Journal of Family Medicine, 39(4), 191-199.
6. DeKlyen, M., & Greenberg, M. T. (2008). Attachment and psychopathology in childhood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 637-665). New York: Guilford Press.
7. Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books.
8. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: W. W. Norton & Company.
9. Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York: Guilford Press.
10. Fonagy, P., Steele, M., & Steele, H. (1991). Intergenerational patterns of attachment: Maternal representations during pregnancy and subsequent infant-mother attachments. Child Development, 62(4), 891-905.
11. Gunnar, M. R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology, 27(1-2), 199-220.

Written by: Emily Swogger, OTR, MS

At Therapy Center of Buda we feel strongly about outdoor free play and providing our kiddos with a safe outdoor play space. Why are we so passionate about play? Because a child’s main occupation is to play. Play is how they learn new information in the most efficient manner. Yet in a world where children can spend up to 1200 per year on average in front of a screen, play time is rapidly being replaced with screen time. Time spent outside for children, research has shown, can be as little as 7 minutes per day!  Time spent in play in general can be as low as 30 minutes per day. Play-based activities are being decreased for a variety of reasons. On the early education front, a societal emphasis on increasing test scores or meeting Common Core requirements has shifted the focus of early learning and preschool from social emotional skills to building math and reading skills. After-school the amount of play time is decreased due to lack of time to engage in play between longer work hours and the nightly routines of dinner, homework, and bath time. For some, lack of a safe place to play in neighborhood playgrounds and parks is also contributing factor to a decrease in outside play time.  

So, why is the loss of unstructured play so important?

Diversity.  We all know the obvious forms of diversity; race, nationality, gender, socioeconomic status, general background, etc. But, lately I find myself discussing a lesser known type of diversity; neurodiversity.  Neurodiversity is the concept that neurological differences (e.g., Dyspraxia, Dyslexia, Attention Deficit Hyperactivity Disorder, Dyscalculia, Autistic Spectrum Disorders, etc.) are respected as any other human variation.  Therapy Center of Buda has always embraced diversity and we celebrate the diversity of our families.  We don’t believe in “cures” and we don’t want neurodivergent people to look neutrotypical.  In fact, suppressing the communicative efforts, including stims and non-spoken forms of communication have long been proven to be counterproductive to overall communicative and daily living success.  Rather, listening to each individual and their wants, desires, requests, and rejections is a way to honor their communication styles.   

I played the video game Fortnite the other day with my teen grandson. As an educator, I’ve worked with thousands of kids with ADHD, social skills issues and similar challenges. And I wanted to know more about how Fortnite might affect them.

Fortnite is an online, multiplayer shooter video game. It’s free and can be played on a computer, on a gaming system like the Xbox, or on a mobile device. The most popular game mode is Battle Royale, where 100 players drop onto an island, try to find construction materials and weapons, and fight each other to be the last person (or team of people) standing. Players can talk to one another, and each game lasts 20 minutes. To get a sense of what it’s like, imagine an arcade version of the film The Hunger Games.

Fortnite has taken the world by storm. An estimated 50 million people play. There are news reports of kids playing at all hours of the day, late at night, and even under their desks at school. And many experts have weighed in on whether the game is good for kids.