The Unique Role of Child-Led Occupational Therapy in Emotional Regulation
Rachel Cohen OTR/L
What is emotional regulation?
Emotional regulation involves the processing of recognizing, managing, and responding to emotions in an adaptive way. It is important for the development and participation in all areas of life. However, we are not born with emotional regulation skills right off the bat. The ability to stay calm and collected during challenging situations is a life-long journey that is developed, practiced, and refined over time. Children who are quickly overwhelmed and frequently exhibit meltdowns, aggressive behaviors, or withdrawal/avoidance, may have particular challenges with emotional regulation. Their “fight, flight, or freeze” response, which is our nervous system’s response to danger, can easily be triggered by seemingly “small” things. For these children, occupational therapy (OT), particularly when child-led, can play a unique role in fostering emotional regulation skills for improved participation in daily activities and improved quality of life.
What is unique about child-led occupational therapy?
Child-led OT allows for children to choose or lead their therapist toward activities of interest, forming the basis of most therapy sessions. Therapists facilitate, guide, support, and modify activities toward goals that are meaningful for the child and their family. Rather than following a set structure imposed on them (an inherent aspect in many areas of life), children are encouraged to pursue activities that intrigue and engage them. This approach taps into a child’s intrinsic motivation, sense of autonomy, and self-efficacy. It also builds a positive and trusting therapeutic relationship between a child and their OT, creating a sense of safety and understanding.
How does child-led OT help with emotional regulation?
Promotes feeling good and regulated
A main component of child-led therapy is engaging in activities that a child enjoys and finds motivating. This creates positive and regulating experiences, releasing feel-good neurotransmitters such as serotonin and dopamine. There are many aspects of a child’s life that they are not in control of and feeling out of control can impact emotional regulation. Child-led therapy provides children with the time and space to make decisions, lead activities, and assert themselves. Having a sense of control helps reduce feelings of helplessness or frustration, which are common triggers for emotional dysregulation. When children feel empowered, they are more likely to self-regulate in moments of stress.
Fosters emotional awareness and coping strategies
During child-led therapy sessions, children inevitably encounter challenging emotions, such as frustration from a block tower getting knocked down or anger when a desired toy is being used by someone else. These challenges offer opportunities to practice emotional regulation in real-time. Therapists can label, validate, and discuss emotions as they naturally arise. They can help the child identify the feeling, explore coping strategies, and problem solve different ways to approach the situation. Therapists can also incorporate emotional regulation concepts during periods of positive engagement in child-led activity, when a child may be more regulated and attentive to the ideas. Over time, this helps children develop greater emotional awareness, coping skills, and self-management.
Builds skills and confidence for challenging activities
Often there are OT goals set for children regarding tasks that typically lead to emotional dysregulation. A major perk of child-led OT is that it builds trust and is a safe place to participate in activities that are challenging, unfamiliar, or typically avoided. Therapists have a keen eye for upgrading, downgrading, and modifying activities to create the “Just Right Challenge”, facilitating feelings of success and positive engagement. Therapists investigate what specific areas may be impacting a child’s engagement (i.e. motor skills, executive functioning, confidence, etc.) and find creative ways to work on these skills during sessions.
Supports sensory processing
Sensory processing and emotional regulation go hand-in-hand. In child-led occupational therapy, therapists incorporate sensory strategies tailored to the child’s needs. This can include calming sensory input (such as deep pressure or soft textures), stimulating input (such as jumping or swinging), or modifying the sensory environment (such as reducing auditory and visual input). Therapists also provide sensory strategies for children and their families to use outside of OT. The more a child’s sensory needs are met, the better they can regulate their emotions.
Creates connection, trust, and support
A crucial aspect of child-led OT involves building a trusting and supportive therapeutic relationship between the child and their OT. Positive interactions with a non-parental adult can boost a child’s sense of self-worth, providing opportunities outside of the home to feel valued and capable. Often, other areas are improved without directly addressing them, due to the therapeutic relationship. Such as a child being excited to come to therapy to tell their OT that they used the toilet for the first time or to show their therapist good remarks on their school’s behavioral chart. OTs also collaborate with and provide support for parents/caregivers, which is equally as important!
In conclusion…
Child-led occupational therapy offers a unique approach in helping children develop emotional regulation skills. It provides emotionally regulating experiences, with benefits that can carry over into other areas of a child’s life. And, through playful exploration in a safe and trusted environment, a way for children to learn and practice skills to navigate their emotions, setting the stage for improved emotional regulation in their everyday activities and throughout their lives.