Blog Posts

Being Mindful about Self-Injurious Behaviors

By Danielle Delorenzo, OTDS, OTR/L
Mornings with an OT Mom
Danielle Delorenzo Consulting Co
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www.danielledelorenzo.com

Headbanging and self-injurious behaviors are topics that hold a stigma.  My goal is to shift the mindset of the masses when thinking about self-injurious behaviors towards a more mindful and positive one.  Most often, children engage in self-injurious behaviors when they are frustrated and unable to express their wants, needs, and emotions.  Some children will head bang or engage in other self-injurious behaviors as a way to meet their optimal sensory needs.  It is imperative to determine what is driving the self-injurious behaviors to identify which strategies will be the most effective to increase a self-regulated response1.

When you observe a child engage in SIBs (self-injurious behaviors), what is happening before? How did you react? Is there a pattern? Are they in pain – teething? Are they trying to communicate? Did they want something, and it was not available?  A simple way to help determine what could be the cause of a behavior is to ABC it! 1

What happened before? (A-Antecedent)The Behavior (B- Behavior)What did you do after? (C-Consequence)Comments
  Ex. Child asked for an item that was not there i.e. asked for goldfish but we were out so I offered something else and that is what triggered him to run towards the wall.   Ex. When told no, child ran to wall and banged head against the wall.  Assessed intensity of headbanging; planned ignoring; once child was calm – I said, “I know you are mad” paired with modeling taking deep breaths; offered any other snack choice as well as a highly preferred option to support success; then offered two preferred activities to prepare for transition.  Notes: If child asks for something that you can anticipate and know you do not have, get within close proximity of child before answering to block/redirect attempt to run to wall and bang head; quickly provide a highly preferred choice and/or sensory activity to redirect attention and focus
    
    
    
Simple ABC chart and example

Once you have begun to discover patterns or reasons behind the behavior, you can start to implement strategies to reduce and replace self-injurious behavior. Simple manipulations in the environment and non-contingent sensory options available as needed can provide the child with opportunities to stay regulated throughout the day.  This will create a foundation for accepting non-preferred directives and engaging in non-motivating tasks more easily. 

Each child has their own unique sensory preferences.  With that being said, heavy work activities are my go-to and have been shown to help children calm, organize, and support achieving optimal self-regulation.  But first heavy work, right! Seriously! Lifting, crawling, picking up weighted objects, pushing weighted objects, can greatly help the body calm and organize to support optimal self-regulation.  Provide multiple opportunities daily to engage in heavy work and organized movement activities.  We must nurture and support the child’s sensory system while providing guidance with helping them express and understanding their emotions and the emotions of others2

Remember, headbanging and other self-injurious behaviors are a way of communication.  The more we are mindful of the child’s unique needs, the better strategies and supports can be implemented to help them regulate in a better way3.  One way to do this is giving children the words when they are unable to verbally communicate.  This is such a powerful strategy to help children understand that you do in fact know they are upset. 

My son uses signs, word approximations, gestures, and PECs to communicate.  When my son is upset and trying to express himself, we often say “I know you are mad” or “insert whatever I think he is upset about”.   This has been a strategy that consistently works to help him calm and organize.  Also, we pair this with a simple breathing exercise – just modeling taking a deep breath in and then exhaling.  We have been using these strategies since my son was about 13 months old.  He also loves deep pressure input and hugs.  When he is upset, we will also ask him if he needs a hug and this typically calms him down enough for me to then offer him alternative choices. 

The one consistent thing I have noticed is that when I am at my most regulated, I have better success with helping my son calm and organize as oppose to when I am frazzled, angry, or upset.  You are your child’s anchor to regulate.  The strategy you use is only as good as how you execute it.  Be mindful of your emotions.  When you as the parent or therapist are calm and organized you are using yourself as a therapeutic agent through co-regulation4.  This will naturally create a calming environment and set the stage to transition to a new task or activity.  Most importantly, be kind to yourself.  This journey is far from easy and will feel like an emotional rollercoaster, from both a parent and therapist perspective.  Stay mindful and know you are doing the best you can.  You are amazing!

Next time you are out in the community and you see a parent working through a “behavior”, look at them and smile.  Ask them if they need any help?  Give them a thumbs up.   Tell them they are doing an amazing job. You have no idea how much that could mean to them in the moment.  It may just be enough to get them regulated to be that anchor their child needs, to calm, organize, and work through the situation as gracefully as possible.  Sending everyone good vibes for a mindful day!

Disclaimer: This is me sharing my story as a pediatric occupational therapist and now mother to a neurodiverse toddler that engages in self-injurious behaviors daily.  This is just my thoughts paired with my years of experience, that guided me down the journey of determining the supports and strategies to use with my son.  This is not providing occupational therapy services or medical advice.  If you have any concerns about your child’s development, please speak with your pediatrician or occupational therapist for further evaluation and treatment options.

References

1Wacker, D., Northup, J., & Lambert, L.K. (1997). Self-injury. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company

2Dyer, K. & Larsson, E.V. (1997). Developing functional communication skills: alternatives to severe behavior problems. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company.

3Edelson, S.M. (1984). Implications of sensory stimulation in self-destructive behavior. American Journal of Mental Deficiency, 89, 140-145.

4Gulsrud, A.C., Jahromi, L.B. & Kasari, C. (2010). The co-regulation of emotions between mothers and their children with Autism. Journal of Developmental Disorders. 40227–237. https://doi.org/10.1007/s10803-009-0861-x

Blog Posts

It is OK to plug in and unplug

I express often that the world we live in now has smart phones and tablets as the norm and is what I feel, a main occupation- the preferred method for communication, social interaction, and gaming for many individuals

I grew up in the early 80s. I had a see through corded phone with an extra long cord so I could travel to all areas of my room. I played outside until the sun went down. I played kickball, paintball, and capture the flag with my neighborhood friends. I would write notes to my friends and fold them in cool, unique ways – totally awesome OT activity by the way

We engaged with each other more. We hung out in groups and figured out what to do for the day by talking to one another, face to face or talking on the phone/3 way calling. We looked at actual maps to get from point A to point B. We went on adventures. We did Werid NJ stuff (such a cool book). All without smartphones and tablets

We did so much thinking in creative and problem solving ways. And without us even knowing it, we were also building the foundations within our central nervous system and overall development through these connections and experiences, setting us up for success within the educational setting

Look, we watch TV and I give my 2 year old a tablet. And yes, he has his own kindle. For the most part, Luke uses the iPad/kindle for up to 10 minutes at a time. We use a timer and set it for 5 min and he is allowed to ask for more time when the timer goes off. This strategy actually makes transitions soo much better and he is much more willing to give it up after he has asked for more time

And then there are some days, we watch TV and play on our phones all day. Because we are tired. Why are we tired you ask? Life. Period. And when we watch movies and play games on the phone, we are all together as a family. We are asking questions about what we are doing, snuggling, sharing our moments together and just being a family

Luke has actually learned so many words and concepts via the TV that now I actually consider it a blessing in moderation 😂😂 and trust me, even though we are such an active family – always out in nature – I still feel guilty when I am on my phone. I am learning balance does not exist. It’s more like I never know what each day will bring so I just try to be as cool, calm, and mindful as possible when deciding how plugged in for the day we are going to be

The moral of my story is, unplug as often as you can and do not feel guilty for the times that you you plug in. Your brain does need a break and it is during these breaks that true creativity and problem solving thought bubbles can truly occur. Take some time for yourself but also get outside, go on adventures, play board games, laugh with friends. And when using technology, try to incorporate human interaction as much as possible

Happy Saturday Friends!

Blog Posts

Mindfulness in Motherhood

by Danielle Delorenzo, OTR/L

Part 4: Postpartum and Beyond

Part 4: Postpartum and Beyond
**At one point I said “8 months” and meant “8 weeks” when referring to how quickly women are expected to return to work after a c-section ✌
Audio Descriptions of the following pictures
Exclusive pumpers are warriors!
My husband’s mini me💙
My tiny bundle of awesomesauce 💙
Just a few days old💙
1 week old – Dr. Nate rocks! The first day Luke latched💙
Nice and relaxed after his first chiropractor visit💙
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My first time taking Luke out for Cheesewalla and iced coffee💙
We spent 5 weeks together after Luke was born. It was amazing💙
Baby wearing my way through the 4th trimester💙
The happiest baby ever💙
7 weeks postpartum
Best. Dad. Ever.
Best baby at Modern Times, San Diego
Blog Posts

Mindfulness in Motherhood

Part 3: Labor and Delivery

by Danielle Delorenzo, OTR/L

*These audio clips go into detail about my birth experience. I share it all, and I mean ALL. So if that is not something you are interested in hearing, no worries! I just wanted to give you a heads up before you embark on listening to my birth story and get blindsided by it 🙂 *hugs*

Jasmine’s Website💙 https://www.jasminerosedoula.com/

Part 3: Labor and Delivery – Intro
Part 3: Labor and Delivery – My story
Getting tatted up by Jasmine
oxytocin ❤
The beginning
When sh*t started to get real
Luke Kevin Delorenzo
All the feels
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Best. Dad. Ever.
Rocking it Day 1 as Dad feeding our son💙
Our superhero

Thank you so much for listening to my story. Please tune in next week for Part 4: Postpartum and beyond. Sending everyone good vibes to make it a mindful Monday💙

Blog Posts

Mindfulness in Motherhood

by Danielle Delorenzo, OTR/L

Part 2: Pregnancy

Part 2: Pregnancy

For those of you who had the pleasure of being around me in person, you all know how brutally honest I was during my pregnancy.

I mean, I have no reservations about expressing my emotions on the regular and pregnancy was the most emotionally unstable time of my life.

It was a recipe for disaster.

When people asked me how it felt to be pregnant, I said horrible.

This tiny fetus was sabotaging my body and sucking my soul.

But it was actually amazing.   It changed me.  Not better. Not worst.  Just different. 

Pregnancy taught me that I am a warrior. I am in awe of what my body can do and what a bad ass I am. Pregnancy, you have evolved me in a way I never thought I could. Thank you.

#makeitamindfulmonday #warriormamas #mindfulnessinmotherhood

Blog Posts

Mindfulness in Motherhood

by Danielle Delorenzo, OTR/L
Mornings with an OT Mom

Part 1: Pre-Pregnancy

Bushkill Falls, PA 2007
Part 1: Pre-Pregnancy (1)
Part 1: Pre-Pregnancy (2)
Coal Region, PA 2009

I have been working on this series for months.

Saint Peter’s Village, PA 2012

Each day I would sit down and write a tad more. I just kept writing.

Joshua Tree April 2015

I had been trying to figure out how to put it all down into written expression and then decided, I just could not do it

1 week before we moved to Cali July 2015

If you had the chance to listen to my podcast appearance on @ot.4.lyfe, episode 51, https://ot4lyfe.com/51 , you got an inside glimpse of my personal and professional life colliding.

Now, let me take you on a quick trip in my tardis a few years back.

Making it DMV official – Residents of Cali August 2015

I just wanted to say Hi. Thank you for following along. You are amazing. I hope you enjoy. Sending everyone good vibes to #makeitamindfulmonday

Our last mini vaca before trying to get pregnant July 2016

Blog Posts

Make it a Mindful Monday

by Danielle Delorenzo, OTR/L

Mindfulness is so simplistic in nature that I fear it is the reason it is most often misunderstood or overlooked as a hot, new trend
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The last year and a half, I have been buried in mindfulness research, talking to anyone and everyone about all things mindfulness, and gathering the best-evidence to support my final capstone project for my OT doctorate
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The majority of people I spoke with had such a positive and warming association with mindfulness.  On the other hand, some individuals that I spoke with brushed it off as a hot, new trend.  Something all the cool kids were doing.  Or, they would mock “being present in the moment”.  When I would express that there are several hundreds of research articles on this topic, I was met with redirection, avoidance, and almost mockery
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As a researcher and life-long learner, I found the concept of mindset interesting.  Doesn’t everyone want to learn more about the things they may not quite understand when presented with new information, especially if there is evidence backing it up
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Mindfulness has been around for centuries.  In the late 70s, John Kabat-Zinn brought mindfulness to modern day practices with Mindfulness-Based Stress Reduction programs.  The history of mindfulness is overflowing with research and unfortunately,  that history can sometimes get lost
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It promotes better self-efficacy to ensure you are giving your body and soul what it needs while being present in the moment
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I have tried to incorporate mindfulness into my daily routine my entire life.  It was not until I completed post graduate studies and I received a certificate in Infant Mental Health from Chatham University, did I truly embrace how important being a mindful individual was
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It has been just over a year that I have embedded mindfulness into my daily routines.  I will tell you that mindfulness is not a cure for all things.  What it will do, is get you better at knowing what your body needs to maintain optional self-regulation, mental clarity, and better adaptive responses in stressful situations
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When you increase your self-efficacy of what your brain and nervous system prefers, you can begin to engage in meaningful occupations that support the optimal regulation of your body and steer clear of the things that you know sabotage your soul
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I created #makeitamindfulmonday because we get a new Monday each week.  A new opportunity to start the week fresh, rejuvenated, and full of positive intentions.  Some Mondays, you will not feel like that.  This is when you have to be mindful the most as to what your body needs to nourish its soul
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Tag your posts and share how you #makeitamindfulmonday
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Sending everyone good vibes and positive intentions for a fabulous week!