Rhythmic movements and primitive reflex integration make a difference for toilet training, biting, and more
This little boy refused to participate in daily routines, refused toilet training, and would bite as a sensory-seeking measure. As a student in the Brain and Sensory Foundations First Level course, his OT used rhythmic movements and primitive reflex integration to address these behavioral and sensory processing issues.
Submitted by Victoria Sacttini, Occupational Therapist
| Before | After |
|---|---|
| Non-compliance with daily routines | More compliant when participating in tasks, even new, unfamiliar activities |
| Highly intolerant at attempts for passive integration | More motivation to engage with OT in sessions |
| Refused any toilet training | Still refusing toilet training for bowel movements, but beginning to use public restrooms to relieve himself |
| Biting as a sensory-seeking behavior | Rarely biting/hitting others |
My client is 5-year-old Danny and I have been working with him since the age of 3. He was drug exposed in utero and adopted by his parents who took him almost immediately from birth. He presents with similar behaviors to a child with Autism. He was nonverbal when I first met him with extreme sensory aversions to tactile and movement (hated being touched, bathed/groomed, and dressed by caregivers and had gravitational insecurity). He also had a history of atypical sensory seeking behaviors (putting things in his mouth, biting others, fixation on visual stimuli, draping body over people, and head banging). His most challenging behaviors were his extreme rigidity, non-compliance especially to any type of transitions, non-preferred daily activities, and changes in routine.
I’m an OT at a mental health clinic and I had been specifically addressing his sensory reactivity and he had made great strides in his tolerance and threshold of engaging in active and passive activities incorporating tactile and vestibular input and his verbal communication greatly improved as well. However, he continued to need services due to his impulsive and aggressive behaviors and non-compliance with daily routines including toilet training.
The tools I began using with this client included the Brain Tune-Up activities and primarily active integration activities as the client was highly intolerant at attempts for passive integration (as was expected). I encouraged mom to begin the rhythmic movements [from the Brain and Sensory Foundations course] while the client was asleep due to his high intolerance of movement. All reflexes were identified to be present, but I primarily worked on TLR [Tonic Labyrinthine Reflex], ATNR [Asymmetric Tonic Neck Reflex], Moro [Moro Reflex], and Fear Paralysis [Fear Paralysis Reflex] due to the client’s rigidity, need for control, and sensory sensitivities that I believed were likely due to an underlying unintegrated Moro [Moro Reflex] and FPR [Fear Paralysis Reflex] . After about 6 sessions, nearly 2 months, I began active integration of the STNR [Symmetric Tonic Neck Reflex], hand, and foot reflexes as well as passive integration of the TLR [Tonic Labyrinthine Reflex], ATNR [Asymmetric Tonic Neck Reflex], and Moro reflexes [from the Brain and Sensory Foundations course].
When provided by mom, the client began to tolerate and enjoy the feet rhythmic movements as well as joint compressions fairly quickly—caregiver reported the client began requesting this at home. The client initially began displaying greater emotional insecurity, would cling to parents, and engage in “baby talk.” After several weeks of continued integration at slower consistent pace, this behavior stopped, and the client greatly progressed as far as his compliance with new, unfamiliar activities and motivation to engage with me in sessions. After about 6 sessions/6 weeks, the client was tolerant of a short bout of passive integration when I prompted him; prior to this the client would state “no!” and I never forced it. The client continues to not want to toilet train with bowel movements but is beginning to use public restrooms to relieve himself and biting/hitting others is very rare.
This client taught me the activities are powerful and the importance of disclosing to caregivers about the behavioral regression that may occur with these reflexes as there were several weeks that the caregivers had a very difficult time with client when they attempted to part with him for school or other daily life factors. However, going slow with the interventions and pairing with attachment-based interventions worked wonders for this client and he continues to make great strides with our services.
[Edited for length and clarity; emphasis added]