Mike is a 7 year old boy who is in first grade. Mike first came to me for an initial occupational therapy evaluation in November 2018 for self-regulation issues that included big emotional outbursts towards his siblings and difficulty with transitions. Mike has a diagnosis of ASD and Reactive Attachment Disorder. He has an extensive history of child abuse and neglect from a very early age. Mike was removed from his parent’s custody when he was two years old and placed with his aunt and uncle who are now his legal guardians. Mike has been in and out of occupational therapy services since he was three years old. He is also currently being seen by a mental health counselor for his extensive trauma background.  

I began working with Mike one time a week for one hour sessions each time. After the initial evaluation I preceded with traditional occupational therapy interventions such as the Social Thinking program to address his difficulty with transitions and emotional regulation, visual schedules and timers to help with transitions, and behavior charts to help reinforce positive behavior regarding self-regulation. I also incorporated proprioceptive and vestibular input to promote a calm body while working towards self-regulation and transition goals with little to no results for our first 12 months of treatment. Parents stated that Mike was still struggling with self-regulation and aggression towards his siblings, especially if things did not go his way or if he felt like he did not have control over a situation. They state that transitions were also still very difficult as Mike did not tolerate changes to his schedule very well and again felt like he did not have control over the situation. After taking the Brain and Sensory Foundations class I decided that I needed to switch up my approach with Mike as we were not making much progress and I believed he had unitegrated primitive reflexes hindering his progress in OT sessions. 

The session prior to starting reflex integration I started the session with 15 minutes of the rhythmic movements [from the Brain and Sensory Foundations course] which Mike tolerated well. After the rhythmic movements I proceeded to check/ stimulate his primitive reflexes and decided to focus on Moro and Fear Paralysis for the time being, which I believe were impacting his ability to self-regulate, transition appropriately and tolerate change in his every day activities. 

The first session of incorporating reflex integration begins with 10 minutes of rhythmic movements. Mike again tolerates these movements well and I notice a decrease in his rigidity. 

After the rhythmic movements I set up a multi-step obstacle course in the motor gym to promote vestibular and proprioceptive input. I also like to utilize obstacle courses where I can change the set up to work on tolerating change  and work on verbal direction following and self-regulation skills if the child is unable to perform some tasks. After the obstacle course we moved onto Fear Paralysis and Moro integration [from the Brain and Sensory Foundations course] after stimulating the reflexes. During integration I made sure to utilize heart connection to promote joy and gratitude and reassure Mike that he was safe during the activity. Mike tolerated the integration activities fairly well this first initial session. After integration of Fear Paralysis and Moro Mike picks out a preferred activity to end the session.  

Since starting the reflex integration activities with Mike, his mother states that he has shown some improvements at home with self-regulation and his ability to transition. She states that she has also noticed Mike is tolerating changes to his schedule a little better and does not always feel the need to be in control. Mike’s mother shared a situation recently where she had noticed Mike’s improvements. She states the family was at a pool party for a sibling’s birthday party. Mike and his siblings were playing catch in the water when other children started joining in. Normally Mike would not tolerate this change well and would either have an emotional outburst or quit playing the game. Mother states that this was not the case this time. She noticed Mike allowing the other children to join in on the game; tolerating new interactions and changes to the game as more people joined in. Mother mentioned that this was a great accomplishment for Mike and for once she saw Mike really enjoying himself and letting go of some of the control he normally needs to have. 

Mike is still having emotional outbursts at home and does still need to feel like he has control of situations. However, he is having outbursts a couple times a week now as opposed to multiple outbursts a day. He is also less aggressive towards his siblings when things don’t go his way or the way he thought they should have gone. 

There is still a lot of work that needs to be done with Mike. I feel that with his extensive trauma background this may take a little longer, but we are definitely on the right track with our reflex integration activities [from the Brain and Sensory Foundations course].

Edited, emphasis added