Trauma, Brain and Relationship Helping Children Heal
From NEURONS TO NEIGHBORHOODS
Second Annual Conference
Interview with Jeanne Du Rivage, MA, OTR
MS. DU RIVAGE, COULD YOU GIVE ME AN ORAL SLATE, TELL ME YOUR NAME, WHAT YOU DO AND WHERE YOU PRACTICE?
My name is Jeanne Du Rivage. I'm an occupational therapist, and currently I am the program manager at an early intervention program in Maui, I also have a private practice in which I see children.
WHERE IS YOUR PRIVATE PRACTICE? In Maui. TELL ME HOW OCCUPATIONAL THERAPY RELATES TO CHILDHOOD TRAUMA, AND HOW YOU WORK WITH PATIENTS WHO HAVE EXPERIENCED CHILDHOOD TRAUMA.
Occupational therapy has a very positive relationship to working with children with childhood trauma, because as occupational therapists we look at the whole child. We try to understand all the different influences that are affecting their life. In particular we use a neurological frame of reference, and a particular frame of reference called sensory integration. Sensory integration looks at how the child's nervous system is taking in information from the different senses in the world, through their body, sight, sound, touch, and movement. We look at how are they using that information for organized behavioral responses.
Children who experience trauma often look like they have some type of sensory processing disorder or an attention deficit disorder, high arousal, high activity level, running around, throwing their body into different things. Occupational therapists use this frame of reference to begin to understand them and learn how to meet a child's sensory motor needs. To be able to help them get to a more calm, alert state, so that they can learn and process and be in the world, and do the jobs that people are asking them to do.
COULD YOU TELL ME ABOUT OCCUPATIONAL THERAPY AND SELF-REGULATION AND HOW THAT RELATES TO OCCUPATIONAL THERAPY?
As an occupational therapist, I use a program called The Alert Program of Regulation, and it likens the child's body to a car engine. We teach them that sometimes their engine runs too fast, sometimes it runs too slow, and sometimes it runs just right. Through this program we help children learn about how they're acting in a particular moment. "Is your engine running too fast?" "Is your engine running too slow?" "What do you need to do to get your engine into a just right place so that you can learn or answer questions or do what your mom is asking you to do right now?" That's the way we use the concept of self-regulation, teaching children sort of a process of self-awareness and self-monitoring.
Yes, I like to use a frame of references that I learned from occupational therapy. We would call it an integrated frame of reference. What people have been talking a lot about today at this conference is that we all have something to learn from the different disciplines, and to use a holistic approach. In particular, I like to look at children using this sensory integrative or neurophysiological frame of reference, trying to understand what is their behavior right now telling me about what's going on in their nervous system, and what are they needing? I also like to draw from psychological theories and look at emotional support and what is the emotional support that a child needs in this moment in order to be able to do their best.
WHAT CAN TEACHERS DO TO FOSTER SELF-REGULATION AND EMOTIONAL INTELLIGENCE IN THE CLASSROOM?
First of all, I think we have to give teachers a lot more support than we give them. Bruce Perry today was mentioning that a lot in the way we structure education. We have too many children, not enough adults in the classroom. That's probably not going to change anytime soon, so I think there are some very specific simple things that teachers can do in the classroom to help their students gain better awareness of their behavior and what their body needs for regulation.
First of all, teachers can look more at their children, be more emotionally present for children, touch them, and work on their own nervous system and their own regulation. If they're angry and they're out of control in terms of what's going on inside of themselves, then what they're going to convey to the child is, "I'm angry and I don't like you." Teachers can work on their own self, their own emotional control, and really try to work hard to convey that message of, "I care about you, you're important, and you're an important student in my classroom." You can do that through eye contact, through their emotional energy that they direct towards the child, through touching, through coming in close proximity to students.
Also, teaching children self-awareness skills and making comments like, "Gee, it seems like everybody's really rowdy right now. Let's all do something to get the wiggles out of our body." "Yes, " I think that there are some simple things that teachers can do every day. But they need support. They also need to collaborate. They need the support and collaboration of other professionals like occupational therapists, speech and language pathologist, social workers, and psychologists.
YOUR SPECIALTY AS AN OCCUPATIONAL THERAPIST HAS BEEN WORKING WITH TRAUMATIZED CHILDREN? IS THAT CORRECT?
I've actually worked with a lot of different children as an occupational therapist. I've worked with children with prenatal drug exposure, children who grew up in violent homes, children who have experienced birth trauma or are living in homes where there's domestic violence. So, I wouldn't say I necessary specialize in trauma per se, but I think that there's many ways in which children experience or perceive trauma in their life. I've worked with children who have experienced trauma from a variety of different perspectives.
DO YOU TREAT THE CHILDREN DIFFERENTLY BECAUSE OF THIS NEW TRAUMA INFORMATION?
I wouldn't say that I treat the children that differently from the perspective of this new trauma information, but I am excited that there is so much information to support professionals loving children, being kind to them, being emotionally present, meeting their needs. We have permission now to meet children's needs. We have permission now from neuroscience to give children what they need. And to me that is so exciting. So it hasn't changed so much what I do, except it gives me more information and more support to share with people, to use in doing presentations, to use in talking with people. But, it hasn't changed my exact perspective.
Teachers have a really hard job, and they don't really get the support, and they don't learn the kinds of things that they need to know. For example, they don't learn about the brain. So learning occurs where? In the brain. Teachers don't even get classes in neuroanatomy or anything about self-regulation. Teachers learn that you just open up the head and pour in the information and somehow it goes in there. Actually I went to a workshop recently where this teacher said, "You know, what we really want is just the head to come to school. If they could leave the body at home, that would be great." I think it was a funny joke, but I also think it accurately illustrates the situation, that teachers don't learn about movement, they don't learn about the brain, and how they need to incorporate movement into the classroom. All they really learn is behavior theory. They're not getting the adequate tools to be able to really do the job. Behavior theory is useful, but it is only one paradigm. There's so much more information now that teachers need to know, particularly I think from neuroscience literature.
AS AN OCCUPATIONAL THERAPIST, YOU UTILIZE THE BODY AND THE NEUROSCIENCE. TELL ME HOW YOUR DISCIPLINE CROSSES WITH ALL OF THESE BODY AND BRAIN SCIENCES.
Occupational therapists learn about neurophysiology, neuroanatomy, and psychological processes. It's a very broad field. They learn how to work with rehabilitation and to work with the developmental processes. Understanding the contributions of neuroscience is not new to occupational therapy. It's been something that's been part of the curriculum for a long time.
TELL ME HOW YOU UTILIZE IT IN YOUR PRACTICE.
The way that I utilize the concepts of neuroscience in my practice is by looking at children's behavior as a detective and saying, "Okay, what is this child's behavior telling me about what is going on in their nervous system?", "What is it that they're needing right now?", "What is this behavior telling me?" Then I try to then figure out what the sensory strategy is, what is the appropriate activity that this child needs to help them get to a more calm, alert state, so they can pay attention and learn?
Children who have experienced some type of trauma often have symptoms of A.D.D. It was a diagnosis dejour of the last decade. Now we have a different one-autism. Symptoms of Attention Deficit Disorder are difficulty paying attention, hyperactivity, moving, and not focusing. Children who have experience trauma exhibit exactly those same symptoms.
HOW DO YOU WORK WITH CHILDREN DIAGNOSED WITH ADD?
The way that I work with children who have symptoms of Attention Deficit Disorder is by, again, the same frame of reference of applying this idea of what is this child's behavior telling me about what is going on in their nervous system, and what is it that they need to be able to calm down, slow down, pay attention, and learn in this particular moment?
GREAT. THANK YOU MS. DU RIVAGE.
(END OF INTERVIEW)
Stan Tatkin, Psy.D. - Psychotherapist
Please read our disclaimer.