Occupational therapists are routinely asked to help young children that have poor self-regulation or modulation skills. What do difficulties regulating alertness and arousal look like in a very little person? Big shifts in excitement/agitation over seemingly minor events, sleep that isn’t very deep or very long for their age, and difficulty switching between locations/activities. Often these kids are edgy/easily agitated, but they can also be lethargic and difficult to energize as well. Poor self-regulation includes both ends of the energy spectrum. Parents are usually more frustrated with the edgy kids than the lethargic kids, and some children will start the day lethargic but end up too agitated to sleep at night. Their parents struggle to get even one day a week without tantrums and arguments. They will say to me “He just falls apart over nothing!”
Big issues like autism and sensory processing disorder will often make self-regulation a daily challenge. Children with language delays can be so frustrated with communicating that they live “on the edge” every day. And children who have medical issues like sleep apnea, digestive or respiratory problems, or those who live in physically or emotionally unstable homes often have difficulty with self-calming. This post’s intent is not to explain the origins or the mechanisms of self-regulation issues (post a comment if you would like to hear more on those aspects!), but to share the value of daily routines and limits for these kids.
Daily routines can be general (breakfast is always followed by brushing teeth and getting dressed) or specific (after you get dressed, you will get a chance to watch your favorite YouTube video once, and then you get milk in the Paw Patrol cup.) The reason that routines are so helpful is that children for whom communication and calmness are hard-won experiences can have an expectation of what will be happening to them next. They may be too agitated or too distracted to listen to our words as we explain the day’s events. Anticipating routines supports improved attention and communication skills. It doesn’t take the place of better speech skills, it allows them to use the skills they cannot access when upset. Knowing their daily routines gives them the reassurance of “what” and “why” in a world that can be confusing. Calmer and more confident children are able to pay attention, process thought and language, and respond more effectively.
Healthy routines are not burdens, and routines do not stifle a child’s mind or soul unless they are completely rigid. Think of daily routines as a slightly flexible scaffold to support all the challenges of the day. A positive routine allows enough calmness for reflective thinking and listening when those little frustrations or changes come along.
Setting limits is equally beneficial for children with modulation issues. They don’t always look happy to know that cookies are after a meal, not before, but knowing that there is structure to their existence helps very young children feel safer and actually more in control-of themselves! The job of children throughout childhood is to test limits and gradually develop an internal set of behaviors and values. Children need to know what is expected of them and they develop pride in their ability to behave according to their family’s values and goals.
Rigidity and harshness are not the same as limit setting. Limits on aggression and destructiveness are especially helpful to develop control over impulses without shaming the child. Being able to express a feeling without acting on that feeling is a big skill, but it gives permission to have those feelings without punishment. Setting limits may result in consequences for actions but not for emotions. I won’t be shamed for wanting that truck and not wanting to share mine, but I am not allowed to grab your truck and run away with it without a consequence.
In my professional experience, using routines and setting limits effectively has been at least as effective as all the neuro-sensory techniques I know to address modulation issues. For the children that do not have developmental delays, they can be very effective on their own. For the kids with autism and Sensory Processing Disorder, it super-charges every OT treatment I use. Needing to know how to create healthy routines and set appropriate and effective limits led me to learn The Happiest Toddler on the Block techniques. Now I teach these techniques to any parent that struggles with these issues, then sit back and watch the peacefulness start to spread in their home!