When Your Vestibular Sense is Out-Of-Sync

First of all, what is the vestibular sense? And where is it? Vestibular receptors are found in the inner ear, in the form of tiny hair cells. The vestibular system helps tell us when we’re up or down, moving or still, which direction we’re moving in, and how fast we’re going. When someone’s vestibular sense is out-of-sync, they may crave speed or be overly sensitive to it, they may be able to spin endlessly without getting dizzy or get motion sickness very easily, they may love dangling upside-down or be terrified of it, or they may not be able to tell if the train they are on is moving or if it’s the train next to theirs. An out-of-sync vestibular system, just like any other out-of-sync sense, likely leads to compensatory behaviors. Some of these may be harmful, disruptive, or not socially appropriate. Furthermore, they may interfere with the person’s ability to function smoothly in everyday life.

stock-photo-3791423-small-baby-boy-hanging-upside-down-on-white.jpg           What happens if one of your clients or your child has an out-of-sync vestibular system? They may be underesponsive or overesponsive to vestibular stimuli, or they may seek or crave vestibular stimulation. Any of these forms of sensory processing disorder can cause disturbance and frustration in their everyday functioning. Is the client terrified of moving/being moved? They may have an overesponsive vestibular system. Does the client not notice they are moving? They may have an underesponsive vestibular system. Does the child crave swaying, spinning, or being upside-down? They may be seeking more vestibular stimuli. The challenge arises in the fact that the child’s behaviors are not always so straightforward, and the category of sensory processing disorder under which their symptoms and behaviors fall may not be very clean cut. What I found most challenging is, how do you determine what sensory needs the child has and how to best address them?

The author of The Out-of-Sync Child, Carol Stock Kranowitz, recommends that parents or caregivers keep a diary of their child’s “troubling times,” noting the behavior, the date and time of day, and the circumstances. Parents and caregivers should also keep a diary of the child’s “terrific times,” again noting the behavior, date and time of day, and circumstances. This may help determine triggers for challenging behaviors and also the things or circumstances that lead to the child feeling in-sync. Matching the out-of-sync trigger with the in-sync antidote, can help parents, caregivers, and therapists determine which category of sensory processing disorder the child’s symptoms fall under, and how to provide the appropriate sensory diet and therapy for the child. I am challenging myself to keep track, in a similar way, of “troubling times” and “terrific times” in my some of my clients who have sensory processing needs, in order to better track cause-effect-solution patterns. In doing so, I hope to understand better what I can do to help their senses feel in-sync.

To better understand sensory processing disorders (SPD), or if you suspect your child, a client, or someone you know may have SPD, I highly recommend reading The Out-of-Sync Child by Carol Stock Kranowitz.

– Chiara

AEFCT – Learnings from Applied Behavior Therapists

Behavior serves a function.  From infants to the elderly, humans behave the way they do for a reason.  When it comes to our clients, addressing the reason can sometimes be the first step towards making progress in their goal areas.

Recently in symposium, Shannon Wallace and Maryann Le of AEFCT came to present to our staff on “Function of Behavior Training”.  (Find out more about AEFCT here: http://aefct.com/)  Their presentation opened my eyes to several important factors to consider while working with clients.

A key concept in knowing how to address the behavior of a client is understanding the function of the behavior.  I learned that this is a phrase commonly used amongst behavior therapists that basically answers the question: why is the client doing what they are doing?  Is their behavior seeking to gain the attention of somebody or to meet a physical need (are they hungry.. thirsty.. need to use the restroom)?  What is their specific purpose for what they are doing?  Sometimes this can be a very tricky question to answer.

Consider the fact that many of the behaviors we as therapists view as “challenging” are behaviors the client probably views as functional, because engaging in them gets their needs met in one way or another.  Maybe screaming at the top of their lungs in the store gets them the toy they wanted (mom gives in to alleviate the situation).  Maybe engaging in disruptive behavior in the classroom gets them out of doing difficult work (they are removed from classroom for disciplinary purposes).

The 3 functions of behavior are:

  1. Positive reinforcement (behavior produces an outcomes that is desired by the child)
  2. Negative reinforcement (maladaptive behavior like escape or avoidance)
  3. Sensory Regulation (maladaptive behavior occurs in order to regulate the level of input from environment)

First determining the function of behavior helps us understand how to appropriately address it.  According to Shannon and Maryann, “When we know the antecedents and consequences of behavior, we can intervene in ways that provide an appropriate behavior that achieves the same function.”  This was one of the biggest lessons I learned through this presentation: the importance of providing an appropriate alternative to undesired behavior.  Since this time, I have been applying this principal in many of my sessions.  This includes things like redirecting a client who hits the table vigorously with his palms to playing a drum in order to receive that sensory feedback as well as redirecting a client who constantly asks what’s next by helping them give positive compliments to other group members.  Always be thinking how you can provide clients with a functional, appropriate alternative.

One final important aspect to consider is being on board with the parents with your strategies and approach towards behavior.  It is important that you are handling the behavior in a way that is congruent with how the parents are handling it at home.  Although this is not always possible, when it is, it can be extremely effective for the client.  Discuss strategies and approaches with your client’s family in order to determine what is best for them.

I’ll leave you with a short story of how these ideas have manifested themselves over the past month of my internship.  I have been working for 5 months with a non-verbal 8 year old client who, ever since I started with him, will manage to have a handful of my hair at some point in almost every session.  I have worked so hard on developing my “mom” voice, being stern, changing my affect, letting him know that is not okay, singing songs about having “gentle hands” and practicing what that looks like, redirecting him to a drum or other instrument or ignoring the behavior.  Although some of these tactics have seemed to work in the moment, we had a session 2 weeks ago where we were in the middle of an intervention at the piano together and I felt like we were connecting more than we ever have – he was sustaining eye contact, following directions, smiling at me – we were communicating so much nonverbally to each other through our playing.  I look down at him and he’s smiling so huge and then suddenly he reaches out and grabs two handfuls of my hair.  In this moment I realized that my assessment of the function of his behavior may have been off all along – maybe the reason he is engaging in this behavior is because he wants to communicate something to me and doesn’t have a way to do so.  I didn’t struggle against him or whip out my stern voice and say “not okay”, I instead maneuvered my head so that I could make eye contact with him and just looked at him with a neutral affect, locking eyes – simply letting him know I was there and present with him.  After a moment, he let go, no words were said and we continued with the intervention.  Since this time, I have been motivated to give him absolutely every opportunity to make a choice, communicate with his device, and request activities in an attempt to provide him with a means to communicate whatever it was he was trying to say by grabbing my hair.  Through my clients I am learning countless lessons about the function of behavior, communication and human connection.




This weekend marked a celebration – many friends gathered together to share in the joy of Reid Moriarty and his family over the completion of Reid’s newest album, “Shine”.

Shine album

Reid has been a client of Angela’s at The Music Therapy Center for many years and several of the songs from this album were ones they wrote together (with the help of many other talented musicians!)  It is a worship album that tells a beautiful story of the hope, joy, and fulfillment that Reid has found in God.  Over 14 musicians came together to be a part of this project – from writing the songs, to recording in the studio, to mixing the finalized product – and had the privilege of celebrating the end result at yesterdays “Listening Party”  hosted by the Moriarty’s.

Reid at listening party

Listening Party fun Shine

I have had the pleasure of working with Reid during my internship and am constantly amazed at his creativity, genuine care for others, and love of life.  He will make your day with just a few words, guaranteed!

If you’re interested in buying Reid’s album as well as learning about any of his upcoming gig’s and other projects, please visit: http://www.reidmoriarty.com/

Reid, you are truly an inspiration and I’m so grateful that I came to know you during my time at MTCCA.

Keep on shining!

Reid Allie and Marissa.jpg