A Total Approach offers children’s occupational therapy unlike any other therapy in the world. Using a holistic and individualized method, A Total Approach creates a family-centered, child-led therapy environment where children make significant progress fairly quickly.
If your child has attention, sensory, or learning disabilities, read on to learn how A Total Approach could help them learn how to process information more nimbly and reshape their own positive self-perception.
What Makes A Total Approach Unique?
We offer a child-led process that welcomes the family into the therapy environment. We’ve assembled a group of dedicated professionals, including occupational therapists and speech-language pathologists, to support each child’s individual needs and involve their parents in the process.
We call it “equipping the child and empowering the parent.” It’s not just a drop-off, pick-up model of therapy. We invite the parents into the sessions and use a consultative developmental therapy model, where we talk to the parents at scheduled appointments to keep everyone on the same page.
We even provide videos of your child’s sessions, including comments from the Director Maude LeRoux, OTR/L, SIPT, RCTC, DIR® Expert Trainer. This further enriches the process with additional insights to use at home.
How is Your Philosophy Different From Other Therapy Centers?
You may have heard of a different approach called the operant approach, which focuses on ending certain behaviors. However, the operant method is only about addressing a single performance problem. It’s a very limited solution.
With the holistic developmental approach of A Total Approach, we offer so much more. We go beyond one skill deficit, performance issue, or anxiety, and examine how the child is forming their total sense of self based on how they experience their world. We don’t just look at behavior; we also consider emotions.
It’s a dual approach – a balance between the performance and emotions of a child. We dig deeper to find the “why,” and then take it a step further by saying, “We can change the why.” It’s about reshaping the child’s self-perception to think, “I can do this.”
How Frequently Will Therapy Take Place?
The timing varies. At first, we might see your child daily for 2 to 5 hours a day and this may go on for a period of 2 weeks. This is known as an initial intensive meeting schedule. Research on neuroplasticity has indicated that high intensity and high frequency interventions are extremely effective in creating the pathways toward change.
Thereafter, we could move to a less frequent schedule of seeing your child once or twice a week for about 6 to 8 weeks. Then we might go back for another intensive schedule, then take another break to once a week therapy. It’s common to do a cycle of three intensives, followed by a longer-term, ongoing therapy schedule if needed.
Of course, this entire schedule depends on the unique needs of your child. Our plan will always be designed to support your child and help them find the best results possible.
Will My Child Benefit From Therapy Quickly?
Many children show significant responses just within the first intensive phase. In fact, they may gain such great results during the initial weeks that the positive effect lasts for months or years to come.
For other children, it may take longer and require careful planning over the long term. Timing matters. In order to benefit your child optimally, we may need to add certain therapies and solutions at precise points in the process.
A Total Approach is about looking at the full spectrum of each child. We will work diligently to address the areas of your main concern, and we will also address secondary issues that may be having an impact. The process could go quickly or more slowly, depending on your child’s needs.
Do You Provide Therapy Online?
If you live in Pennsylvania, the answer is yes. While we can offer certain online mentoring and consultation appointments to anyone in the world, state law requires that many therapy services must be provided in-person at our clinic in Glen Mills, Pennsylvania if you reside in the US, outside of Pennsylvania. If you live abroad, please contact us for a solution for you. Contact us for a consultation about which services we can provide online and which require in-person appointments.
What Kind of Impact Will it Have for My Child and My Family?
Rather than explaining it ourselves, we’d like to share some heartfelt words from happy parents who have seen their children blossom through A Total Approach.
“At ATA, I’m no longer alone. I no longer have to figure everything out for myself. I have open, willing collaborators who are always available to help me keep my son’s treatment program at an optimum place … Over and over I hear from teachers and other professionals that they are astounded at the amount of progress my son has made.”
-Jona
“The difference in Sam was remarkable. He was lighter, and happier, and had the tools and capacity to be kinder and more helpful with his siblings. He was also no longer nearly as reactive. If he fell or hurt himself, he would simply get up and keep going, whereas prior to his work at ATA he would have had meltdowns.”
-Ingrid
“My youngest son had major issues with his speech and hearing. He essentially was not talking, saying single words and labeling but having a very hard time communicating … I could cry talking about all the progress he has made. His speech blows me away. We now have conversations, he has a sense of humor, he tells me he wants to do it. I feel like I finally got to know my little boy.
-Nichole
If you’d like to read more about the real experiences other families are having with A Total Approach, click to see more testimonials. We also welcome you to contact us for more information about our unique approach to helping children succeed.
“This is the most wonderful time of the year”….. so the song
goes. Bright lights everywhere, white snow on the ground, shops open until late
and we rush around planning parties, attending gettogethers and shop until we
drop! Even as we may complain about the craziness, we love it! People are less
grumpy in the stores, less angry on the roads and overall it is “good cheer”! As
we enter Christmas, we also enter into the year 2020 and in moments of quiet,
we find time to reflect on 2019. I want
to challenge our readers during this time to consider the following 3 ideas.
We all love gifts and we all like feeling appreciated. What
does true appreciation mean? Is it the gift that was bought or the thought that
went into the gift? What does your gifts reflect on how you know the person you
are gifting to? What is the message you are bringing with your gift? Is there
relationship in your gift? So many times, we focus on the physical gift, but is
it the gift we value or the relationship? Do we give others the gift of
relationship? As I work with families who have special children, we frequently
have to dwell on topics such as their task performance, their strengths, their
challenges, their learning profiles. I frequently wonder if, amidst all the
craziness of schedules and “catching up on delays”, we stop to think on how
that child is perceiving life? Is life filled with the joy of living, or filled
with schedules of school and therapists? No blame or guilt trip here, we have
to do what we have to do as the future depends on it. But how much do we
reflect on the child’s experience? How does the child view us as a mother or
father, aunt or uncle? How much time is allowed for the natural relationships
that teach more about giving yourself
than the giving of gifts? How much of your enjoyment of Christmas is about
family time and how much is about the gifts? Give yourself and the family the
gift of being together this Christmas and reflect on how this joy of
togetherness could be perpetuated as a new years’ resolution for 2020!
Find a moment to sit still and reflect on all your friends
and family. Who has had a particularly “bad” year in 2019? Who do you feel
guilty about not spending enough time with? Call that person and gift yourself
and your time to a coffee date or lunch date and simply listen. Open the door
for that person to reflect and gather themselves for 2020. Give the gift of hope
through the giving of your time and listening ear. Focus on the person, not the
gift you may bring. Make that person feel worthy of being listened to.
Lastly, gift yourself this Christmas! So many consultations
I have contain tears of worrying parents and families. Sometimes we have tears
of joy, other times we are realizing perhaps for the first time how much your
child may be struggling. The families I work with will do anything to see their
child get better and would willingly sacrifice themselves in order to gain a
better future for their child. But somewhere, in the process of all this
giving, there always is a period of mourning a loss that cannot be named.
Sometimes it is as physical as giving up employment to take care of your
child’s needs. Other times it may be that along the way, amidst of taking care
of others, you lost time in taking care of yourself, your relationship with your
significant other. Give yourself the gift of time to make a wishlist of what
you would like for yourself for Christmas, for 2020, and make the plan to
achieve it. You only have one life to live and yes, you do have
responsibilities and the cost on your emotions, time and funding is high, but
somewhere, within that maelstrom, is you and your needs. It does not always lie
in having a vacation or a new car, sometimes it simply means allowing yourself
time to be you!
I sit here this morning and my heart is full. I want to write something eloquently and yet it feels difficult to express what I want to say in words. This time of the year is always a time of reflection and what I always want to write most about is the child’s right to simply “be”. This is at the core of everything that I do and that I stand for.
In today’s society we are moving at an ever-increasing faster pace and the value placed upon creating “product” and being “productive” grows in importance. Of course, it is important, but somehow the thought was created that by focusing on “product”, we will gain productivity. The value of “process” is undermined by what we can see and the mind that creates the thought is not valued as much. We forget that in order to produce, we need creativity, thought process and logical thinking skill. We also need intrinsic drive to please ourselves, which in turn would create and grow the self-discipline we need in order to produce according to the time lines set as well as maintain focus on quality. Let me give you a story that warmed my heart last week.
I returned from New York to the office late one evening and Noel, one of our Occupational Therapy team, was still at the office. With a great deal of emotion and some tearful joy she related an occurrence to me. We serve a family with an older autistic boy for a number of years now. The dedication of this family to their son, like so many others, continues to amaze me strongly. Our OT and Speech Language Pathologist, together with his mother, took him to J. Crew to purchase clothing for himself. Over the years he has developed some deeper sense of self with capability of understanding emotion, and this past year he developed an important milestone of riding a bicycle independently.
The staff at J. Crew was incredibly understanding and a mature gentleman was assigned to support this young man. He immediately grasped the situation and addressed him personally each time. It also is the first time that he was going to wear jeans in 10 years and they set off to find what he would like. Choices were provided, respect and warmth were relayed and he had his first shopping experience in his life. He chose, he fitted, he struck poses and displayed his sense of humor by choosing the funkiest socks available in the store. The gentleman even bought him a gift at the end of his visit, a gesture that had everyone tearful. His mother was elated and her joy was a sight for everyone to enjoy. This experience clearly left an imprint on our OT’s mind and now mine as well.
As my eyes teared up at the telling of this story, I reflected on how much good came of this situation. The gentleman at the store created a moment, not simply because of an action, but because he cared and he could care because he had a mind that grasped the situation, a mind that could stand in our young man’s shoes and be empathetic and warm to our cause. His mother understood the value of experience and creating opportunity for her son to enjoy the things in life we all take for granted. Our therapists understood that function was not related to “being social”, but being “present”. It is our presence of mind that creates the product we need in order to be functional.
There is so much talk about “mindfulness” and “mindful” meditation, yet in many instances it has just become another “buzz word” of the day. I remember when this trend started, I was wondering why this was suddenly so important. Are we not supposed to be mindful already in terms of each other and the place we hold in society? Where are we going if one of the most basic human concepts shared in empathy and relationship is now a “trend”? Are we so fixed on outcomes that the process of “being” is taken out of the equation? What happened in this store was an act of human kindness, an act of understanding that today’s experience counted and that this young man could feel his power in effecting choices of his own. It would help if he could do the math, it would also help if he could write his own check, but what mattered on this day was that an experience was created that would support his sense of self, support his identity and create everlasting meaning for all that were in that store on this day.
During this Christmas Season let us celebrate our ability to experience each other, to truly experience the gift of giving and feel the thrill of being able to simply just “be”!
There is something about the end of the year that is slightly nostalgic as I reflect on different Christmas events in the past, especially contemplating times when I was home with family in sunny South Africa. Sometimes I experience loneliness in the midst of people and the hustle and bustle around me. I was sad on Christmas Eve, but the church service at 4 in the afternoon perked me up and quiet enjoyment followed. On Christmas day I watched a 5-year old boy (we will call him Paul) waiting expectantly for Santa to arrive. This honor was bestowed on my husband and his “ho-ho-ho” really had me smiling as he entered the room in full gear, his green eyes sparkling as always! I know the feeling I feel is a strong bond of love for a man that I have been with since I was 16, and I thrive on the mutual trust and expectation we have of each other. I know this is what every child should be able to aspire to.
I watched the emotions on Paul’s face and picked up a range of at least 4 emotions, if not more, within 2 minutes. He was excited, joyful, though also a little scared, perhaps anxious. He was feeling these emotions and dealing with all of them simultaneously. As his breathing rate became faster, he made an active decision to overcome this tinge of anxiety and go with the anticipation of the moment. He took the risk of approaching Santa and started talking with him. One minute later, he was sitting on Santa’s lap, shyly talking about having been “naughty or nice”! I observed the resilience, the willingness to overcome, and the inner drive that came from high interest to see what Santa had brought for him.
There are 3 very important developmental facts that were brought to light in this very short incident, which are repeated moment after moment every day of our lives. These are necessary elements that assist us in making sense of our world, and enable us to cope with the different challenges we face every day.
Different emotions cause different sensations in our body, but they all center around the autonomic nervous system with a balance between over and under arousal. In the early developing years, we give in to the needs of our body most of the time. Our emotional responses center around the Amygdala, which is involved in deciding whether to flee, fight or stay. As we develop and grow, our ability to gather meaning from a situation can be used to cognitively override our emotions, enabling us to continue engaging in the moment. We “know” that if we overcome, there would a reward on the other side. This “knowing” is the result of multiple different experiences that allow us quick access into our hippocampus (memory), which supports retrieval of emotional associations from past experiences. Every typical youngster feels the stress and challenge of growing up and understanding different emotions. Children who struggle with developmental delay experience added difficulty and are more prone to being avoidant of feeling different emotions, robbing them of wonderful experiences that could have assisted them in feeling more safe and secure. They tend to want to avoid feeling the sympathetic over-arousal that different emotions can bring and forfeit the ability to simply go with a feeling of joy, which will ultimately lead to more successful experiences. Paul felt each of these emotions and due to his ability to reflect on past experiences; he was able to pull through. Many potentially wonderful experiences have been marred with negative associations of the past. Their memories are fraught with feeling “out of control” and this essentially becomes their retrieval. This is even more true in children who witnessed and experienced trauma in their lives.
Children who struggle with developmental delay have an even harder time and are more prone to being avoidant of feeling different emotions, robbing them of these wonderful experiences that can form the scaffold of the next experience.
The symbol of Santa is both strange, but good. He lives in the North Pole and spends all year making gifts with his elves. At 5, Paul knows deep down that Santa is not real, but he chooses to go with his fantasy as it suits his purpose for this time. The ability to make sense of fantasy vs. reality is a big milestone in children’s lives. For some, the reality they live in makes it better to stay in fantasy, never truly connecting in their relationships. Others cannot get into fantasy as they have difficulty imagining, operating with abstract thought, and visualizing in their minds what is not there in reality. They remain concrete, almost rigid, and experience great difficulty to understand past, present, and future, making it difficult to overcome developmental adversity.
Lastly, our first mother is the symbol of our first love connection, which made everything “right” and provided us with an anchor to overcome. This first relationship can be symbolized in many different ways (heart sign, teddy bear, blanky, binky, bottle of milk, to name a few). These different items remind the developing mind of the nurture and care of the mother’s heart and within this experience of nurture and consistent parenting, Paul builds his own caring heart within. This scaffolds the later development of empathy and the willingness to please others. Of course many experiences, including developmental delay, can upset this process, but it does not make it less true. My symbol of an anchor has become the Cross and knowing that whenever I “mess up” and make wrong choices, I am safe in the knowing that He is standing in for me. For me, He gave the symbol of a mother so we could understand His love for us.
There is so much more to say, but I am getting quite lengthy again. My wish for each parent and therapist is to reflect on these little nuggets and to consider how one would teach these very fundamental growth areas of the brain? Considering the previous blog I wrote on behavioral vs., relational abilities, what curriculum can we possibly create to build these capacities? Positive experiences, “overcoming” experiences need to replace the older, “feeling out of control” experiences. Can we check this on a tally sheet of 3 out of 5? Or do we use the tool created for all of us to enlarge our world and understand our experiences: Play?! If being able to reflect upon your life, your experiences, this past year, have meaning for you, can you consider what life would be without this? Let us be playful this Season, let us experience joy to replace past hurts, let us stand together in this world of abundant emotions!
We visited the Moremi wildlife park in Botswana last week. You can only enter with a 4×4 vehicle, as the roads are quite difficult to travel. We had to sleep in a ground tent with no encampment, so wildlife could enter your camping area at any time. I have done this before, but as this wildlife reserve was new for me, I was caught in a number of pangs of fear as I entered into this first night with my husband. He, of course, was undaunted, which helped me, but also strangely added to my fears. I really did not want to become any animal’s meal at any time. The first night we spent at the South Gate campground, Charl decided that as the weather was clear, we would sleep without the top cover and watch the open skies through the thin layer of see-through material. For me, this covering was all too little, and as I lay on the air mattress, with Charl snoring beside me in peaceful dreamland, I was listening to every sound north, south east and west from this very lonely campsite. It was a beautiful evening and I really did appreciate the myriad of stars I was gazing at. I just could not shake the fear and felt my heart beating in my throat and my chest constricting. I could not adequately discern the distance between the sounds and the location of our tent, as sound can travel very far in the African wilds. Finally, I shut my eyes tightly with a very earnest prayer for safety and decided to “shut down” my auditory system and rather visualize a nice calm vacation on one of our favorite Caribbean islands. I willed myself not to listen and finally fell asleep.
But as I did lie there pondering the night sounds, I did think about our kids at the practice, as they never seem to be too far away from my mind. I was in a temporary situation (of my own free will!!!), but our kids who struggle with sound sensitivity feel this way every day of their lives! It really struck home in a big way, how impossible it feels to listen to my husband’s reassurances with my heart beating the way I did, just wishing I could be away from that area at that point. Our kids cannot get away, they have to face this sensitivity every day and above and beyond these feelings of sympathetic over-arousal, they are expected to focus, learn, read and do their math. They do try to escape, but this is frequently judged as a “behavior” which has to be negatively rewarded. The only other alternative they have is too shut down their auditory system and use their other systems instead or start hyper focusing on something visually. This is when you have to call their name more than 3 times to gain their attention. Since their central nervous system is affected, they cannot access a cognitive strategy such as I did to support myself. Children with hypersensitivity to sound do not realize others do not feel this way, so they never really communicate that something is bothering them. This must be a very difficult life indeed, as the child cannot simply relax and feel safe. Charl felt perfectly safe in the exact same tent, though his safety could not penetrate my experience of the same situation. We cannot ask children to “feel safe”; it is an unconscious perceptual experience.
There are 3 major reasons why kids with auditory hypersensitivity can feel unsafe every day:
Hypersensitivity leads to sympathetic over-arousal, causing the nervous system to be in readiness of fight, flight and shut down.
The acoustic reflex in the middle ear is not doing a sufficient job of dampening the lower frequency sounds, bombarding the inner ear, not providing adequate protection.
The saccule of the inner ear (part of the vestibular system) receives the low frequency sounds first, causing the body to go into an alert state, increasing muscular rigidity, disallowing the ability to relax and calm down.
We cannot ask children to “feel safe”; it is an unconscious perceptual experience.
Recent research in 2016 also showed that we pick up emotional content from environmental sounds (no kidding – tent fear!!), increasing the possibility for children to go into fight, flight or freeze when bombarded with sounds that appear innocuous to us. All the more reason why we should “chase the why” of behavior before assuming it must be willful, manipulative or rigid. Sound sensitivity can be treated and be aware that even after sound sensitivity has decreased in the central nervous system, a child could still want to hold his/her hands over his/her ears in the face of simply feeling overwhelmed or anxious for a myriad of other reasons. Sound sensitivity decreases the child’s chances of developing very necessary skills, such as motor planning, as any new and novel experience first has to pass the muster of the overactive Amygdala going into fight, flight or shut down.
By the way, the next nights in the wild were much easier. My system normalized and as elephants were cracking down the limbs of trees around us on the second night, I fell sound asleep!
“Moira is so rigid! She wants everything her way and no other highway! Her siblings are fed up that her choices always seem to rule and her friends are tired of being bossed around. She is so self-centered and it is all about her. She keeps everyone hostage so that if some event does not go her way, there is great upheaval and no one gets to enjoy anything that we plan together as a family. It is like she has no empathy for anyone else. We know she has her sweet moments and we see glimpses of a softer nature underneath, but these moments are so spread apart that for the most part she leaves us exasperated.“
This is the lament of some of our parents on an almost weekly basis, though in varying degrees of occurrences. It is a tough behavior to deal with as most families simply want to enjoy their home and activities together and need the flexibility of changed schedules, venues and activities based on everyone’s needs. Many families reach out to behavioral therapists to “curb” the behavior or to drive this behavior to extinction. It frequently ends up getting worse rather than better. This is because it may manifest under the “behavior” category, but the reasons for this behavior is the key to planning the correct intervention.
The number one reason for this rigidity in behavior is that Moira may be struggling with anxiety. This anxiety may be rooted in aspects of her development with regards to emotional milestones. Children have to develop through several layers of emotional stepping-stones that would provide a rounded maturity that would prepare her for her social sense of self. Every typically developing child has to face different fears and anxieties as they grow into understanding their world and sometimes they can be stuck in facing these fears making the “fantasy” of their fear becoming larger than life. Because she is cognitively developing, we do not see this emotional developmental delay that is causing unreasonable anxiety and it is holding her back, disenabling her to match her cognitive IQ with her emotional IQ.
A second reason, very close to the first, is Moira’s sensory profile. Her sensory experiences may be causing her to respond to environmental stimuli in ways that are causing great physical insecurity. If she is not comfortable with the lighting in a room, the sounds in the background, the “feel” of her clothing, the taste or texture of food, she may respond with rigidity simply as a way to control her experiences. As she cannot rely on her body to interpret these experiences well, whether it is under registering it or over registering the information, she would need to contain the experiences she is exposed to in order to gain better control over a situation.
Because she is cognitively developing, we do not see this emotional developmental delay that is causing unreasonable anxiety and it is holding her back, disenabling her to match her cognitive IQ with her emotional IQ.
A third reason would pose the possibility of Moira having motor planning difficulties. Our brain tells our body how to move and how to arrange activity in a sequential manner while continuously adapting to new and novel changes in a fluid and flexible way. Moira may have difficulty adapting to a new motor plan and therefore tries to gain control by doing everything the same way or not tolerating changes very well as she has to renegotiate her troubled body each time to adapt to the change. What becomes automatic for other children, as their developing bodies grow into new and different experiences, never really becomes automatic for her. Think about learning to drive a car. It is almost like you have to face the learning to drive over and over as you never seem to get the hang of it. There are too many variables to consider and the adjustment each time asks too much of her.
All three reasons can be addressed by a thorough evaluation and it can be addressed. As Moira may be quite intelligent, families will mostly try the behavioral routes first because it does not make sense to them that they know she gets it, why does she not change or adapt to other’s expectations. But what they do not know is that she has no idea that her body and emotions are responding in a different way than theirs. She is unable to tell them what is really at the core. All she knows in her subconscious, is that it feels better if she could simply control or “boss” everyone so things could go her way and she could protect herself from having to adapt to too many unexpected changes. Most of her behavior is rooted in self-protection and it requires specific intervention to reach the core of her issue and to start change from within. There is no child that does not want to feel successful, no child that at the core does not want to please their parent, but if their developing systems are at war with expectations, the first human behavior they will turn to is self protection. And this is true for all of us, we all have this instinct in times of trouble and Moira is no different. There is always a root cause and the answer does not lie in addressing behavior alone.
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