In this episode, we dive into the principles of adaptive responses and just right challenges as laid out by Jean Ayres in sensory integration therapy. We share our experiences and discuss the application of these principles in clinical practice. You’ll hear us talk about the developmental nature of this approach, the role of neuroplasticity, and the importance of individualized treatment. Through our conversation we highlight the significant impact of understanding and using these principles can have on children's functional abilities and overall quality of life.
00:00 Introduction and Excitement About the Sensory Integration and Learning Disorders
00:43 A Funny Story About a Lost Book
05:32 Discussing Adaptive Response and Just Right Challenge
06:55 Reading and Analyzing Jean Ayres' Work
14:31 The Importance of Developmental Sequences in Therapy
23:48 Understanding Executive Functions and Developmental Insights
25:00 The Profound Concept of Developmental Approach
25:31 Adaptive Responses and Internal Motivation
27:15 The Just Right Challenge in Therapy
28:43 The Importance of the Spirit Tool
29:58 Tailoring Therapy to Individual Needs
31:44 Trusting the Developmental Process
32:44 Real-Life Success Stories
37:42 Applying Developmental Principles Across Domains
43:03 The Role of Neuroplasticity in Therapy
50:10 Quirky Stories and Insights
53:58 Concluding Thoughts and Reflections
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[00:00:00] Cory: I cannot tell you how excited I am that we all have this book. I, I, the amount of times I've Michelle, I think you and I, having this book in the same physical space, I don't think I've ever had anybody like, have this book with me, if that makes sense. Like, I'm like, come on, I want to like, read this book with somebody or talk about it.
[00:00:22] And Michelle, you're like, the only one I can. And we're so busy that we really want to do it and then we read it separately instead of. Tracy, I always admire you guys at DFX because you do a certain month where you all go through, re, reread this, don't you? I love that we all have like notes and things.
[00:00:41] Oh,
[00:00:43] Tracy: have to go. Okay, now just hold on, hold on.
[00:00:46] You guys probably have heard this story, but I'm going to say this story cause I think it's funny and maybe we'll put it on the podcast. I don't know if we will, but here's the, here's the reason why. Okay.
[00:00:55] So I, okay. So this is this copy of Jean Ayer's book, Sensory Integration Learning Disorders, and I've had this, since I was first an OT in the early 1980s. Of course, this book was published in 1972. So,
[00:01:12] Michelle: The year of my birth.
[00:01:15] Tracy: So, I mean, it's been around, you know, for a while and I, it's, I was 10 years old when it was published. Um, so, I had this book for a long time and then it, and then I lost it. And so I had to have a different copy of this book. because I lost this book. But then, a few years ago, our team at DFX, we were going to read this book because we choose Ayres readings that we're going to read every year.
[00:01:44] And often we've read the sensory integration in the child book. But then one year we were going to read this book. And so I only had this copy and I'm quite protective of it because I lost one of them. And so one of my therapists ordered. A copy on Amazon. Okay. And so then she comes to me and my husband.
[00:02:11] is a very, very funny person. And I could go pull off of my bookshelf right behind me, many, many, many, many books. And he does two different things with me and has done this our whole marriage. And we've been married a long time. So will either retitle books with like a sticky note and make funny comments.
[00:02:34] But in this book, he had written to me. And so this call, my colleague, Angela Graff, she's actually the co person on the Spirit. She came in one day completely dumbfounded and she said, I ordered this book on Amazon and I got it. And inside she said, you have a, you, it is, it is signed to you. It's your name and it has your name in it.
[00:03:04] And she had it, it's this book, I'm showing it to you and it's your name. And she said, and Jean Ayres. signed it to you. And I started, I was like, wait a second. First of all, it wasn't Jean Ayers, it was my husband.
[00:03:18] Oh
[00:03:18] my And he wrote a note in here to Tracy. May you always practice with happy hands, Jean Ayers. But of course it wasn't Jean Ayers, it was my husband and he does these goofy things.
[00:03:31] So here's the weird thing. Somebody in the world had borrowed my copy of this book and then ended up selling it on.
[00:03:42] And then our community is so small that Angela bought a, you know, a used copy online and it happened to be my copy. So then she, it is that fun. It's a hilarious story.
[00:03:56] Cory: That is so funny. I mean, amazing that it made its way back to you.
[00:04:01] Tracy: it made it back to me. So now I have two copies of this book because then I bought Angela a copy of the book. So she could have one that was not mine. Uh, I don't know whose hers was, but anyway, that's a pretty funny, weird story.
[00:04:16] Michelle: Wow, we're sharing. That is gracious. Mine's Debbie Bingham.
[00:04:21] Anybody know Debbie Bingham? I have your book
[00:04:24] Cory: Yeah,
[00:04:25] who
[00:04:25] Michelle: Orange, New South Wales.
[00:04:27] Cory: I have, oh, I don't know.
[00:04:31] Michelle: You don't have a name.
[00:04:32] Cory: No, I think it might have been a library book. I don't, I'm not sure. That's cool.
[00:04:37] Michelle: Oh, that's interesting. we're just, we're just, we're just, we're
[00:04:38] Cory: Oh, bummer. Anyway,
[00:04:40] Michelle: Well, we're talking about funny families. Our family has a tradition. Well, my dad and sister, actually, they find the most expensive, almost unusual book and they'll, um, sign it from each other. Like to dad bought himself this book about knots and whip making and like, it was quite a expensive book. Tanya got it from the bookshelf and wrote in it. Dear dad, I hope you love this book. You know, happy birthday from Tanya, your favorite daughter or something like that. Dad opened it up, was like, what? I bought it for myself! Anyway, I'm
[00:05:15] glad we all have quirky family book stories.
[00:05:19] Cory: I love hearing that as well about John and it doesn't surprise me in the least. That is so funny.
[00:05:26] Tracy: you know, John from Camp Jabiru. So he's not a, he's been lucky to go to Camp Jabiru. So the reason that this whole conversation about these books books is happening is because we decided that we wanted to have in the podcast a little bit of a focus on basic principles from Ayers and, and have a chat about that.
[00:05:50] And so, In thinking about it, we were going to talk about adaptive response and just right challenge today. And so I think all of us pulled our books out and we all have them and we're all happy to be holding them to go to the source, right?
[00:06:08] Cory: if you're following us on YouTube, you'll be able to see us holding our books like the nerds we are.
[00:06:14] Tracy: We're, we're trying to let this information seep into our brains. This is how we sleep at night. Put them under your pillow and let it seep in, uh, literally,
[00:06:27] Cory: I
[00:06:27] had visions of like recording myself reading this book so that I
[00:06:33] could like listen to it when I was driving. Cause I'm like, I can't read it all the time. Like, but it's, um. It takes a bit to get your head to sink into the language that is
[00:06:45] Jean Ayres, but it's good, it's good stuff. You just gotta, you gotta be really present with it.
[00:06:53] Michelle: yeah,
[00:06:53] Tracy: true. It is so true. And I actually thought, you know, not to like make anybody on the podcast fall asleep, but I thought we could like read what she said about adaptive response. Literally her words, right? So, I think Michelle, you and I were having a meld, a mind meld about that, weren't we?
[00:07:14] You were, you were thinking the same thing.
[00:07:16] Michelle: Yeah.
[00:07:17] I went to, yes, I just this morning thought I'll pull that out. What she you say? I opened it up on page 114, 125, got my I as well.
[00:07:29] Tracy: 125. I know. Important pages in this book. open it to 125 because there's actually a description that she has on the adaptive response. And I think there's a couple of really important things that she says here. Every word she says is important, but I mean, seriously, seriously, this phrase is an important phrase. So right now in our world of trauma informed care and being responsive and understanding that, there's no kind of black and white, yes or no answer in most intervention. And it's all in this both and space. And we say that all the time, but look at this, Dr. Ayers, 1972, she says, an adaptive response is not an either or reaction.
[00:08:18] Like most behavior, there's a continuum of degree of complexity, quality, and effectiveness. The ability to evaluate the nature of the adaptive response contributes immensely to the therapist's ability to concurrently judge the treatment effectiveness for the degree of complexity. adaptive response. And this is the major subjective indicator of the degree of sensory integration.
[00:08:49] So the reason that we're obsessed with this topic, and actually with this theory, is that you have to live in this zone of continual, continual, continual, drinking in and understanding and deepening your understanding of every moment. And I think that that's why it's so compelling in a way, right?
[00:09:13] Michelle: Yeah. Absolutely. Absolutely. I, um, I love that part of it where she says the either or, uh, actually where is the exact phrase?
[00:09:25] Cory: It's not an either or reaction.
[00:09:28] Michelle: Yeah. And, it's this continuum of degree of complexity, quality, and effectiveness. And that's what we are seeing when they are first, making a new move or, playing with something in a new way, it. Mightn't be really precise and have the great finesse and smoothness and quality, but it's just that, you know, the proximal zone of development? So it's just that burgeoning into this new skill. So sometimes it doesn't have the quality that it ends up having with continued practice.
[00:10:02] And, um, yeah, so that, that. quote in particular talks to that, it'll start to burgeon, out, I guess, and then the qualities improve as the complexity and the degree of integration improves.
[00:10:16] Tracy: Yeah, yeah. And I think this idea of, in any particular moment that whatever the target is that the child is on, it's really about what are they trying to come into. And, and then it's just this little by little, baby step by baby step, little bit more capacity in the next opportunity.
[00:10:40] And that unfolding of just one more little bit one more little bit whatever that happens to be. It could be in the postural response, it could be in a praxis response, it could be in a social moment sharing of a glimmer, it could be in just widening a little bit more range of adaptation and modulation.
[00:11:03] So we're really, we, we have to have enough clinical reasoning to know that in each moment we're crafting that just little tiny bit micro more and that little bit more for the child often feels quite spontaneous. feel coaxed, it doesn't feel, like we're forcing it or demanding it or expecting it, but we're kind of allowing it.
[00:11:28] And wow, I just think it's so beautiful. Uh, but it's so, much to hold, right, because all of these domains are happening in front of us, sometimes like in little shifts from one to the other. So you're, you're having to stay fluid with what does it mean in this moment.
[00:11:48] Michelle: And also with the child, because sometimes I've worked with children who see and feel it and know the enormity of what's just happened. You know, something's new when it's like, Whoa, did you see that? You know, whether they articulate that or not, but there's this knowing of Oh my goodness. I did a new thing. Did you see it?
[00:12:10] Versus others just kind of do it. And whilst I might want to go, whoa, that was really big. That was, you know, really working towards this. Uh, I want to celebrate big. It's just like, no, they need, they want to keep going. And, you know, I'm sure they felt it for themselves, but let Michelle just be present and hold space and let them repeat, repeat, repeat, a little bit more, a little bit more of whatever's going to unfold in that session.
[00:12:36] But, um, yeah, it can be super exciting. And that's part of, you know, my, discipline is to just stay with it and give a little, I, I saw that too, but, you know, stay in the moment. Let's keep going. Let's keep
[00:12:51] Cory: I'm honoring your signals around, okay, you're sunk into this and this moment is now like mastery. You're driving towards mastery,
[00:13:00] so I'm not going to, you don't want to be taken away with the social excitement of it.
[00:13:04] You want to get in and stick with it. Um, totally. Oh man, it's so interesting though. So I think as I have gotten better at observing the more discreet. adaptive changes and responses that happen in session. I think my enjoyment of treatment has improved continually grown because I'm able to actually, I guess, meaning to the things that I'm doing in a better way, if that makes sense. I, it's not like I kind of spray my approach and hope something lands, which I can remember feeling like I was doing that early on being like, okay, I'm just going to try all these things and hopefully something works.
[00:13:47] Right. And then you go to supervision and you're like, what am I doing here? Is this working? Is it not? And then as you start to. or as I started to improve my ability to really notice is, the child having more adaptive capacity in this moment or not? And I love that Dr.
[00:14:06] Ayers said that it's a continuum because there is so much gradation and variation in, in that. Um, but I, I kind of come back to Tracy, your, diagram, or I want to talk about the attain, maintain, challenge, um, that diagram that you have and the just right challenge, adaptive response element but I don't know if that's going to be useful in this context. So not sure where you guys want to go with things.
[00:14:35] Tracy: Yeah, I think we can, I think creating a visual image so that you, can figure out how to almost rate it is what we were trying to do when we created that diagram that it comes from really the step si. So, when we were working on the STEPPSI, there wasn't. a fidelity tool for air sensory integration yet.
[00:14:59] So Julie Wilbarger, Sharon Trinnell, and I worked on this tool. And we then, utilized it with our whole team at the Children's Hospital in Denver. And there were many team members who were involved in, in being really brave and, letting us watch each other in treatment, watch each other's videotapes and actually rate each other.
[00:15:20] Not in terms of our performance, but, trying to figure out these core elements that we read from Jean Ayers and thought, Hmm, these are critical elements. And we were trying to apply it to the space of sensory modulation, which wasn't super well defined at the time. And what we were trying to do is figure out.
[00:15:39] When you think about a just right challenge related to sensory modulation, which is really the underpinning of our regulatory capacity. So what you have to do and what we identified in, in the treatment process, we were all doing was that first we were helping that child to feel, regulated in sort of like, what is their foundation?
[00:16:02] So we called that attain. And then we were trying to figure out, what is it that we're doing there? Because really the adaptive response, pulling for an adaptive response, or actually Dr. Ayers uses this beautiful word that we don't ever hear in our day to day vocabulary, but the word is evince.
[00:16:24] She says that you, that the master therapist is evincing an adaptive response. So that word is so juicy. It's like a really rich word and really what it means. And I'm going to actually look at the definition, but it means that you're revealing the presence of so it's a cool word, right?
[00:16:52] And she would say that the therapist through the opportunity of the just right challenge is evincing the adaptive response. So it's this very shared space with the therapist really seeing and believing that this child has within them this presence of the next level of capacity. So in modulation, we created this, this linear, Visual analog.
[00:17:23] And we didn't create visual analogs, but we learned that other disciplines, when they were creating fidelity tools, you had to have a way to rate how are we aligned in our thinking. So if we have a child in front of us, we would probably agree that the child needs to either attain a regulated state, or they need to maintain that in the face of a challenge.
[00:17:51] So that dimension is really how, once I have you regulated, how is your capacity going to allow you to evince that, to reveal itself, given that these things are going on, these demands, these, stretch points to how you stay regulated are happening. And we're really good as clinicians at noticing the subtlety of how far over toward attainment, how far over challenge.
[00:18:26] If we put those on a imaginary 10 point scale, how much can we kind of urge towards this challenge dimension or how much do we have to hold to keep that maintenance and attain more salient and alive and vibrant and available to the child? So we're working across that dimension. And as we kind of named that dimension, it became like this tangible thing that we could put a mark on that, that sort of imaginary line of a scale, but then we could talk to each other about it.
[00:19:04] And then as
[00:19:05] Cory: mm-Hmm.
[00:19:06] Tracy: can kind of feel how you. You are a co regulator in helping to evince this opportunity. And that's really a therapy dynamic at play. That's what's happening. And Dr. Ayers wrote this as like, this is what you're doing in therapy. This is how you harness neuroplasticity. It's not a black and white either or phenomenon.
[00:19:31] It's this experience that the child's going through. It's so powerful. It's like mind blowing to me that she figured this out and could name it and articulate it as a therapeutic process. I still am blown away by it when I think, I admire it deeply.
[00:19:50] Cory: Yeah, it's impressive. And, you know, I like reading current, neuroscience doesn't ever make me go, oh, well, what she said isn't valid anymore, it. I've never had that like experience of, Oh, well, the sensory integration literature is just outdated now. It, it, it's. It, it's like
[00:20:12] amazing really around how well it, meshes or aligns with lots of the information that is available now.
[00:20:23] So that's amazing as well. Like I'm like, Whoa, Dr. Ayres, you, you got this, like you were amazing really way ahead as well. Do you feel like in current neuroscience Tracy, that there's still a lot of like, I don't know because I'm not in it, but, is there still a lot of people that just don't really know or understand any of this what's the science at around this process?
[00:20:45] Tracy: Yeah. Well, I think that the science is really around neuroplasticity is what we're talking about. It's the direct connection. So Dr. Ayers didn't use the terminology neuroplasticity, but when you look at the way that, the nervous system organizes itself for change, they do talk about adaptive response that you don't usually hear just right challenge, but you do hear that there's some quality of an opportunity to find the next, layer of capacity, there's lots of different ways it's talked about, but I think that if you put them all down on paper, they would all be some version of this same thing that we're talking about. Yeah.
[00:21:30] Michelle: I was just going to go into it. Another quote that I love,
[00:21:33] Cory: Yeah.
[00:21:34] Michelle: On page 114, uh, she says the central principle in sensory integrative therapy is providing planned and controlled sensory input with usually, but not invariably, the eliciting of the related adaptive response in order to enhance the The organization of brain mechanisms. The plan includes utilization of neurophysiological mechanisms in a manner that reflects some aspect of the developmental sequence. The objective is progressive organization of the brain in a method as similar to the normal developmental process as possible. Dun, dun, dun! dun! There's so much in that
[00:22:24] and I think
[00:22:24] for me, one of the things where I, needed to go back and do the work was around what is the developmental process in order to be really precise about if my goal is to facilitate postural stability, for example, actually need to know the developmental sequence so that I can set up or provide opportunities for the child in the right order because then I'll allow the just right challenge after I've assessed where they're at and when they need to go. That was a precision work. So I knew kind of philosophically, yeah, it has to be just right. I have to be, you know, there was, there was a knowing that that was the right thing to do, but I didn't have, um, I didn't have, the, precise knowledge of all the developmental sequences to allow me to be on purpose for the child.
[00:23:15] So I had to do quite a bit of work and look, I'm still doing it, to be honest, is going out so that I could set that up for the child.
[00:23:24] Tracy: Yeah. I also think that that's like the, the whole rationale for the spirit tool, because the spirit, organizes your thinking around the developmental unfolding of each of these capacities. And so if you're thinking about posture, you have to know a lot about the basic postural mechanisms, but you have to know that you're approaching it in this developmental manner.
[00:23:48] The same is true for, in the spirit, we call it the high route of a, the executive functions and effortful control functions. Those develop in an expected developmental sequence. And, um, a lot of the things that are in the spirit around the social emotional domain are drawing from interpersonal neurobiology and frameworks around understanding how our social and emotional selves emerge in the context of relationship and somatic sensory integrative processing. And then praxis and sensory modulation themselves are developmental phenomenon. So I think It is like, you have to have that developmental insight, but if you haven't really mastered everything that Jean Ayers ever wrote, and then all of the things that are in the related domains, I think we end up not staying developmental at all.
[00:24:41] Always, unless we have a tool, so more and more every time that I teach the spirit course or engage with people around it, I keep feeling heartened that it's kind of the tool that we need right now, because we have to have that developmental insight. And Dr. Ayers said it. You just read it to us.
[00:25:00] Like it's such a profound concept. So it's not just access to movement or, you know, a postural challenge. It's in a developmental frame that her theory sits. And I don't know that everybody always appreciates how true that is, that her thinking was, it's a developmental approach that we're taking.
[00:25:22] Michelle: And that it allows that unfolding to occur. There's another, um, quote on 125. There she talks about, The adaptive responses are purposeful, goal directed actions. Adaptiveness implies a certain mastery over the environment rather than the environment mastering over the child. This is another kind of part of the essential ingredient, I think. She says when a child is emotionally involved Um, I'm paraphrasing here, and believes they can cope. The child will gladly summons effort to make a response of a greater complexity of adaptivity. So I think that that gets to that internal drive and springs from what we spoke about last episode around that follow the child's need or follow the child's lead, is that's why we do that, because if they're internally motivated and driven. It will, allow them to kind of conjure up the energy and the attention. But also as it gets uncomfortable, you know, as we're
[00:26:32] trying a new thing that's outside of our comfort zone, there's a level of, um, discomfort in that or, um, some worries. Am I going to be successful or not?
[00:26:41] Or it just, feels that adrenaline, you know, is a state of agitation that we stick with it and stay goal directed so that we go to that next level of mastery. So, um, yeah, that, that kind of brought to me The concept that we explained last is that's why these things go together, follow the child's lead, because, you know, her words, the child will gladly summon effort to make a response of greater complexity. Oh, that is so true. True, they work harder.
[00:27:15] Cory: I feel like you're perfectly describing the just right challenge that she talks about. Like everything that you just said, if it's just right, if the challenge for me is just right, it's developmentally informed, then Even though creates some friction for me, I enjoy it and you and me together evince adaptive response in relation to this challenge. because it is just right.
[00:27:49] So that's what we're trying to do in treatment all the time across these domains in a way that is informed developmentally so that we can match the just right challenge to the need that's in front of us. And you're like, you said, Michelle, we follow their lead around that because that's where the child's going to find greater capacity with our support in relation to the skill that we're trying to master.
[00:28:16] And that could be socially, it could be in the sensory modulation system, it could be in their developmental, executive functions around attention and joint attention, and then, sustained effort, full control, or it could be in related to their praxis and their finer skill precision and mastery around any sort of motor skill or it could be in the postural system.
[00:28:43] So I think that's why, the spirit tool itself is important. is so useful and why though we need people around us to be able to help us think about this as therapists. Because like we, Michelle, we are coming at this all the time,
[00:29:05] There's no, and there's no moment where I'm like, yep, I've got it. I've got everything. I know it. I'm doing it. I'm like, okay, I think I've got this right now. And or I'm like, mm, I'm not a hundred percent sure what just happened. But I know that something just happened, and now I need to go and unpack that with somebody who can help me figure out what the heck just happened, so
[00:29:27] that I can understand potentially what occurred there, what was the reason that that was so successful, and how to then I understand to purposely recreate it or structure it so that I can be able to observe that next time and know a potential way of supporting that to unfold.
[00:29:48] Tracy: I think that in the current, sensory integration, theory and practice textbook, there's, there's a couple of references that say things like, this is on page 301 of that textbook. And the chapter was written by Anita Bundy and Stacy Skloot, but they're saying that the science of sensory integrative therapy, it kind of rests on this principle of what we're talking about, of tailoring the just right challenge and the expected adaptive response based on the particular needs of the child.
[00:30:19] So the thing that's tricky and, and why this is so complex. And like you said, you feel like you've got it, but then you don't because every single child's individual differences show up in their own particular, way. And we can understand and expect development in certain ways, but then every child is unique.
[00:30:39] So it always requires that we're showing up as little investigators, you know, kind of, um, uh, analyzing in this moment with this child in, in this situation, what is, salient and relevant related to their unfolding , of what's interesting to them in the moment because you're meeting them where they are.
[00:31:01] And, you know, you can work with a child where one week it is posture that they're really grooving on and they're really using movement and, The postural system is adapting and then sometimes that brings them to like this different level of social awareness. And the next week it's all about social cause effect play or something.
[00:31:21] And so it can feel sometimes to somebody who wants it to be more like educational in nature or discreet and specific that we're kind of floating about, but we're not because the nervous system makes available the most salient thing that needs to be addressed. To us. And then we follow that. And so over time, you might be working on posture and social and fine motor all in the course of several months.
[00:31:53] And you're sort of dancing across those adaptive things that are showing up, um, and creating the just right challenge to really allow that child to come into the fullness of that. so it is this kind of beautiful, process of trusting that Ayers had it right, which she did. Like you said, Cory, there's only mounting evidence that says this is the right way to go.
[00:32:17] And, then you have to know a lot and you have to trust yourself and, it's so, it's so big and cool and beautiful. It really is just a, admiration society that we're in here.
[00:32:30] Michelle: Absolutely. And I think sometimes like it really is that trust, in the process, because we've got it in the clinic, we're all sharing in the joy of this, little child's expansion, really. He, he has had some delays in movement. And so he has never crawled. He's bottom shuffled. He's just getting up on all fours.
[00:32:54] And just the other day, the therapist put, a slide on an angle and, you know, a thing of interest. And so he started that first movements of crawling up the slide to reach for it. Five days later, this isn't actually how it always unfolds, but it can. But you know, this morning in a, video was sent of a little kid climbing up a ladder onto the cubby house to get up with his big brother, uh, amazing, amazing.
[00:33:22] So that is how it can unfold. The mom's like, Oh, he's climbing now. But at the time where we were you know, going to back to four point, the little poppet was pulling to stand, but it didn't look awesome, like it wasn't graded. Um, anyway, so that was just like knowing everybody was really excited about that and wanted to move on to walking where, um, we're like, let's come back to the forepoint, let's work on that yeah, so it was just trusting, I know we're pulling to stand and I know it looks like we're moving to walking, but trust, let's come back.
[00:33:57] Anyway, it's just been amazing, that we're following that with this cherub and the carers have been trusting in us to do that, even though pull is for everybody to get him up walking, cause that feels like a bigger milestone for him to be hitting. So, um, yeah, anyway, it's paying off in the clinic this week.
[00:34:16] Tracy: Yeah.
[00:34:18] Good on you! That's great! Exciting,
[00:34:21] Cory: It is really exciting actually, cause it, especially when it relates directly to a functional change in that child's life as
[00:34:28] he can now climb up onto the cubby and join his brother in play. Like that is where we get, we're like, yep. We have a meaningful job.
[00:34:37] Michelle: I know.
[00:34:38] Cory: This is why I care and this is why I want to do this job, because it actually results in some sort of functional, greater capacity and better quality of life for this Child.
[00:34:48] Michelle: and do you know he did that at home? So the carer was videoing and then he looked a bit, the very last step was a bit difficult for him. And so you could see the carer's hand coming in to, you know, touch the little bottom to support him in case he was fell, but she actually didn't. So, you know, it's one of those things where, A) she let him have a go, because it was a couple of meters off the floor, and as he was doing it, she knew how exciting it was such that she pulled out the video to capture it. She knew he was getting there, he was getting there, he just needed time. At one point she cued in, oh, maybe this hand, you know, so he reached up a bit higher rather than on the base and grabbed the handle. So she gave him that little, hey, you could try this, but she didn't touch him. She wasn't in a
[00:35:33] hurry to, you know, push him up or too scared to say, Oh, you're up too high. The brother didn't pull him. He could have actually just yanked him up, which would have been fine too. But you know, that, I just loved that, that the biggest bang, the biggest thing kind of happened at home and that the family facilitated that.
[00:35:50] We kind of churned it out in the clinic cause we knew exactly what we were striving for, but then the unfolding happened spontaneously, you know, in family life. So fab, which we don't always see if we weren't all taking videos. That is what happens all the time, but yeah, this just happened to be captured on video.
[00:36:09] So it was gold.
[00:36:10] Tracy: ha ha.
[00:36:11] Cory: think we're all following the develop, like, so, you know, we, you could get caught up. It's sometimes as a therapist, you see a child and they're doing a certain thing and you think, Oh, we're missing this developmental skill. And then you, you know, okay, well we have to do all this crawling now, but actually just want to be able to help this child experience potentially what they need to support them in doing the upright more adaptively. So for him, pulling up to stand and he's looking like it's not super adaptive or the quality of that is tricky for him. You're wondering, well, okay, what pieces can I add that may help that be more adaptive? And developmentally for him at that point, it was useful to come back and help organize him around his midline
[00:37:03] and activation against gravity in a four point position. And if he was older, if he was a much older child and you tried to bring him back to that, if that was a thing he was trying to master. He wouldn't resist you. That's my gut instinct, is like when it's the right thing, the just right challenge, they like the feeling of pushing in that that zone.
[00:37:31] That is like, it's like, oh, yeah, there is something in this that my nervous system is trying to figure out and I want to do this even though it's tricky.
[00:37:41] Tracy: Yeah, for sure. And I also love, how you're taking the story of postural adaptation, is sort of one of the first things that Dr. Ayers really, really, really described in many clear descriptions around the levels of adaptive response around, what is your midline and how do you find it and how do you find stability and hold on and stay put?
[00:38:05] And then how do you start to navigate the complexity that might come because you can do that. And so the unfolding of the adaptive response and just right challenge naturally allow for building and building and building complexity. And we can see that and often name it and describe it the most concretely in that postural system.
[00:38:28] So it's a great example of that. but then Cory, you started to talk about how there's parallel thinking that we can use in these other capacities. And I think that's a space that Dr. Ayers didn't always write as explicitly about that. So for some people there, they always bring it back to, well, we must treat this through the postural system because that's what she described, but really it's more that she gave us the principle and we can apply it to any function.
[00:38:57] So if we were to think about the foundation of, the function is that attained space. It's sort of the, the referent point, the baseline. Sometimes I call that the landing pad. And then you're stretching into the zone of proximal development to broaden that. So in modulation, you're doing that by bumping the edges of the arousal system, or perhaps you're doing it, in the social system by just expanding what does a circle of communication feel like if it's just a little longer or a little bit more extended, or maybe we add two circles, or you can take that into, the other domains of development.
[00:39:41] So this developmental thinking applies across domains and the function is the same. The way that neuroplasticity allows us to become more adaptive, more us, more fully into our potential, is through that just right challenge and adaptive response in the domain that you're curious about or that the child is interested in growing.
[00:40:07] And I think that that's just a really important thing to make sure all of our listeners are appreciating that it wasn't a single domain and it wasn't just sensory integration itself, but it's the out products of sensory integration that are our adaptation. And those are, across all domains.
[00:40:29] Cory: mm
[00:40:30] Michelle: Tracy said something then about, and I've lost the verbatim what you said, but it was around where the child is wanting to go. And I know, as a therapist early on, that was tricky for me because I kind of got my head around the physical domain. Cause as you said, Ayres wrote about it and it was a bit more concrete and it would just in my learning about, you know, pediatric, you know, it was around more physical development. So I, if the child she knows, uh, was interested in, um, I don't know, I'm making it up, I don't have an example of it specifically, but if it was around social skills, I would keep thinking, but yeah, come on over here and we'll do this physical thing, you know, in my mind it was like, I want to take us here, let's go, hey, let's go over here and play with the rest of the game because I want to work on, you know, full point. Um, yeah, that was part of, um, my learning. around, well following the child's lead, but all that allowed more easily, um, this convincing of, you know, the adaptive response. Cause it was like, Michelle, I'm not into that jigsaw puzzle. I'm not into my pencil grip, you know, whatever I'm over here and I'm playing with, you know, the wheels of spinning of the wheels, which we spoke about in last one, but it was like, okay. Drop your agenda, Michelle, and come over and, and, and follow the child's lead and yes, catch up and learn more about the developmental sequence of what that is, you know, so that you can really be with this child and not have yourself pulled over to the thing that's, you know, I know more about, and I want to show you all the tricks that I know about, little fella, so come over to me.
[00:42:11] Cory: Oh, so funny. Um. All I was thinking about before as well. 'cause I, I love the way that what Tracy says ignites various trains of thought between Michelle and I. And so it's amazing. Um, and we both have to use such good working memory to hold onto the original thought that we might have had. But anyway, which is maybe not our strength.
[00:42:33] But anyway, we are getting, we, we love it. So I thought when you were talking. about the same piece than Tracy around just the way that the sensory integrative piece and the adaptive response, in that zone of proximal development, depending on which domain they're in, made me think about the way that sensory integration is organized in typical development, in and around usually a social interaction. And Especially reading Dr. Lisa Feldman and her whole thing about being able to predict an event I was like, well, sensory integration and the principles of treatment is like everything that we're doing is supporting a more predictive, organized brain, more adaptive, more function.
[00:43:24] And we're always doing that in. a relational way. And I was just like, like, we're on the money. Um, and it's not about like, it's not about just giving a kid deep pressure or it's not about just swinging them in space. It's like, how do we offer these principles of predictability or novelty or, um, intensity and duration and. um, landing that in an affective way so that the child is more adaptive. And now suddenly there's more capacity to do a wider range of skills and to just have the possibility of doing new things in their environment, anyway, I was blown away by how
[00:44:15] amazing some of the principles that we have in our current treatment match up to the current, uh, like latest sort of way that we're starting to think about the brain.
[00:44:25] Tracy: Yeah. Yeah. I'm catching the affect from both of you and how we're so leaning in and we're loving having this very kind of geek out conversation about this. And what I love is that this theory has given us the just right challenge forever. And we're evincing that we're revealing our own every time we say blown away, or we were amazed by that.
[00:44:47] It's like the affective tone is telling us that we're evincing, we're revealing our deepening understanding moment by moment. And so I just think it's kind of a lovely parallel process that we're in it and we're having our own adaptive responses to the work that we're doing to offer adaptive responses.
[00:45:06] It's, it's very parallel process universe kind of thing going on. And I, it's very meta, right? It's cool.
[00:45:17] Cory: Oh dear. Well, if people want to read more about the adaptive response, there are places they can go in our OT literature. The blue book is very hard to come by. So understandably people don't always have access to that, but Sensory integration theory and practice is there, but even if you didn't go to the OT literature, where else could you find, it sounds like any literature around neuroplasticity might
[00:45:46] Tracy: Sure. Yeah. So a couple of things. One is that when I was getting ready for our session today, I did pull out, you know, this new sensory integration theory and practice textbook, which I've been kind of dabbling in reading this and that. And so I pulled out all the quotes around adaptive response and, and what made me chuckle and I'm being very, this is honest humility.
[00:46:08] But, they kept referencing this article that I wrote in 2014, and I was like, that's hilarious. I didn't even realize that it was referenced pretty consistently throughout this book. So thank you, Shelly and Anita for doing that. But, um, you know, so I wrote this little article for AOTA on what is the adaptive response and just right challenge.
[00:46:29] And I wrote it because, um, I felt like people were focused so much in the world of sensory processing, that they had forgotten about some of Ayer's principles, and the primary one was this coupling. I was doing some, mentoring with a clinic in Ireland, and several of the clinicians had done some advanced training, and, and, And they had never heard the word adaptive response or just right challenge in their training.
[00:46:58] And they had spent thousands of dollars on this training. And I was sort of astounded in my mentor sessions with them, that, that I was having to teach this to them when they had just spent all of this money, you know, getting trained in, in this, treatment approach, but they actually hadn't learned the principles.
[00:47:17] So that's partly what motivated me to write that article back then. Um, but it was also, I think, why we wanted to have this little series of just touching base on the core principles because Ayers got it right. And all of us, as the, you know, the sensory processing disorder nosology has been retired and the field is kind of in this flux and shift, and we don't exactly know how all of that's going to, you know, end up ironing out, but Ayers had it right and the neuroplasticity information is so spot on.
[00:47:52] So, so that I'll mention. I'll also say that, when I was really first falling in total, like, nerd out land, love with neuroplasticity. Um, there is a neuroscientist named Bill Greenough. He's passed away now. But he coined these phrases about in neuroplasticity around experience expectant, and experience dependent development.
[00:48:15] And you often hear me talk about them because, when I was in graduate school, my cohort used to tease me because I used to tell them that I used to love to relax and take a bath and read Bill Greeno. And they were like, you are, you've
[00:48:32] Cory: in
[00:48:32] Tracy: the deep end.
[00:48:32] Cory: the right field.
[00:48:35] Michelle: ha ha ha ha
[00:48:36] Cory: You're in the right field.
[00:48:38] Tracy: and one of my really dearest friends who was a grad school colleague of mine, she still, like, we go out whenever, and she still teases me, like, what papers are you reading in the bathtub these days, Tracy? So Bill Greenough, is a person who really connected how the experience of a little animal
[00:49:02] you know, studying their brain, the neuroplasticity is dependent on these opportunities for just right challenge and adaptive response. And he wrote about that. And you know, his research was often with little rodents. And if you looked at the way that he would study it, they would be in these little cages, basically that boxes, but they look like a sensory integration treatment space because they had, these ramps and nets and things to climb and jump on. And, the opportunity for social adaptive response, for praxis and problem solving adaptive responses, for, finding relaxation after a stressful event. All of the things that we actually work on were things that he
[00:49:46] was Yeah, feed, yeah, all of
[00:49:49] it. Yeah. So, so powerful.
[00:49:52] So I do think like in just basic neuroplasticity, discussions, you'll hear about, uh, how the brain is an adaptive response machine basically. Yeah.
[00:50:07] Michelle: Amazing. Oh, great discussion. Do we have any other, uh, quirky stories or, um, insights you've gained?
[00:50:17] Tracy: Um, Here's this little boy who is about eight years old and he's had a real history of difficulty with impulsivity.
[00:50:26] And, whatever he's doing is so full on. And so whatever happens around him tends to sort of get pummeled by the full on ness. You know, he'll, he'll come into a room and he wants to go over there, but there's a chair and, uh, bag in front of him and it doesn't matter, he'll just go burn right through them or smash over them.
[00:50:46] He wants to reach for the pitcher of water on the table because he's thirsty and he just grabs it and it flings. Um, all of this very impulsive, ungraded, unaware kind of action. So those are kind of some of his goals in therapy, but here's the thing for that little boy. The just right challenge is that in a social context where his mate who's in the treatment room with him is a little less capable than he is.
[00:51:17] So it's really pulling for his empathy and it's really pulling for him to be more attuned to the other. And suddenly he's tuned in. So the background environment is less salient to him. But when you put him in a. context where connection and using the sociality of his nervous system using the fact that this other kid matters.
[00:51:42] So I'm watching this video and the other kiddo, who has a primary motor condition. So he's, gate is a little unsteady and wobbly and he's trying to move and he's trying to climb over this pillow and the game is that they're going in a little circuit where they're climbing and then they're getting up to the loft and they're going to jump.
[00:52:01] And the boy is a little, the one boy is a little slower to move and so the other kid gets up there and then he stops himself and he finds that internal stop signal because it matters that this other kid. have a positive experience too. And he generated that on his own. He wasn't like taught, like, let's take turns or let's do this thing.
[00:52:24] But the adaptive response was, I have more control. Now that other little boy goes away. And the therapist can put some items in the way, sort of like the bag or the furniture that might have been in his home. And now he's more tuned in. So that adaptive response transfers from the, condition of, social, pulling for it.
[00:52:49] Now his awareness is increased and he can use that to guide his graded control, his effortful control, his impulse control and inhibition. All of those things are the adaptive responses he needs, but giving him the exact just right challenge with the right quality is what pulled for the evincing.
[00:53:11] It revealed it to him and then he could make use of it. So I loved that. It was really powerful to see and witness and see the therapist trust the process. Yeah, it was really cool.
[00:53:27] Cory: I just think it really highlights the fact that like Dr. Ayres said, it's goal directed, it's purposeful. And when he had the goal in mind I want this child to have a good experience and enjoy this with me. And he probably was also able to pull together some sensory discriminative capacities that he wasn't pulling together before around grading his body and force. And so again, it's just amazing really. And I love that. That's a great story.
[00:53:58] Probably good one for us to end on, I
[00:54:00] Michelle: Yeah, gorgeous.
[00:54:02] Tracy: Thanks guys.
[00:54:03] Michelle: Perfect.
[00:54:04] Tracy: What a
[00:54:04] joy. Thank you.
[00:54:06] Cory: Bye.
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