Therapy Secrets: How temperament affects therapy-Part 1

Therapy on new ground

My son's temperament

He is not a giggly, cuddly, extroverted "Gerber" baby.  He is a serious, intellectual, and very observant little man.  He is more interested in achievement and autonomy, than playing and relaxing.  He can spend an hour trying to figure out how something works and gets really disappointed when he can't figure it out.  Unlike some children, he is hard to distract from his current activity, unless you pull out the iPad. 

He is constantly seeking intellectual stimulation and will start sighing really loudly when he's bored.  Most of the time, his play time looks more like work time.  He can't wait to be old enough to do everything mommy can do.  When we go to the playground, he watches the older kids and gets overwhelmed by all the things he wishes he could do too.  He doesn't know that he's a baby and compares himself to the big kids.  It's obviously disappointing.  He uses his O-ball to test new surfaces before walking on it and also uses it to console himself when he's disappointed with himself. 

When he is finally able to achieve something, he squeals with delight and struts around like he won a gold medal.  He is internally motivated.  He is not as affected by praise, though he appreciates my encouragement.  He gets very upset when I miss his cues or if I'm distracted by some activity when he wants my attention.  On the other hand, he gets over being upset quickly and seems quite satisfied with my apologies.  He is very intuitive and frequently responds appropriately when I explain things.

Sometimes it's really hard to figure out how to set up an activity so that it is challenging, but not overwhelming.  He has a small threshold of things that excite him or bore him or overwhelm him.  He likes some regularity in his schedule, but needs some flexibility for possible intellectual pursuits or other exciting activities.  He hates the mundane and loves new experiences.

Learning how things work

How does temperament affect behavior?

Have you really thought about your child's temperament?  Temperament can play a huge part in your child's development.  Your child's temperament can affect when they reach their milestones, how they overcome obstacles, and how they interact with the world.  It can affect therapy by how you set up the environment, how you set up therapeutic activities, what activities you choose, how you present them, etc.

My little guy has sensory issues that can overwhelm him in crowds, but his intense desire to experience new things can help him overcome his inclination to run from crowds.  For example, he will often refuse to go to a small crowded familiar playground, but he is willing to go into crowds if it is a new place.  His curiosity helps him tolerate the discomfort of being in a crowd.  However, on a bad sensory day, this method may fail because he's not feeling well enough to override the discomfort.

If your child likes people, they may tolerate crowds better than a child who prefers intimate settings.  I know that my little guy may tolerate doing easy tasks in a crowded place, but he will most likely refuse to do anything that he has not yet learned how to do.  Unless the activity has sparked his curiosity or his intense desire to accomplish a task.  I know not to push him because it will only push him away.  However, if I expose him to the task and wait, his own curiosity will force him to try the activity.

I also know that he prefers new experiences more than socializing with people.  He's young and true cooperative play doesn't start until much later, but some baby's are interested in other people.  My baby is more interested in things.  He is quite wary of strangers, except other babies and some children.  He is very social with me and with his aunt (Most likely because she lives with us).  Eventually, he will socialize more, but right now I'm focusing on his strengths.  I know this will build his self confidence, while I expose him to social events slowly.  As he slowly gets used to other people, I know that he will find the courage and interest to tolerate social events more.

A place of his own

How does temperament affect therapy?

Why is the consideration of temperament important for success in reaching therapeutic goals?  It's important because intrinsic motivation works better than extrinsic motivation.  What does that mean?  When a person or child is motivated from within themselves, they are more likely to reach their goals than if they are only being motivated by an outside source: therapist, parent, or other...saying, "Good job!"

When a child is motivated from within themselves, feel good chemicals flood the body and these help to decrease sensory defensiveness, fear, or any other negative emotion.  You may recognize this when your child does something you never thought they would do.  Some parents feel confused by this because "He won't do that at home".  Why won't he do that at home?  If he's motivated by the behavior of other children, then he may "not do that" at home.  Or perhaps he's motivated by the mats on the floor, he's not afraid to fall on the mats.  Or he's motivated by the swing.  It usually takes a lot of observation with trial and error, before we can really see our children's personalities and figure out what motivates them.

Whenever I started to work with a new client, I spent the first sessions observing their behavior and building trust.  Depending on the child's personality, this process may take between 1 session to 16 sessions.  I accomplished most of the therapy by setting up appropriate activities, but I usually follow the child's motivation.  Each session was set up to build on the last session.  The goal was to find out what motivated my client and to build enough trust so that they would be willing to try things that feel uncomfortable. 

As a parent, this process is slightly more complicated, as my own son has taught me.  Your child is more comfortable with you and will be more likely to complain and generally be a more difficult client.  For the first time in my therapy career, I have to use an iPad to bribe my son into therapeutic exercise!  It's so much harder to be a therapy parent!

Placing the easy one closer

What is intrinsic motivation?

When I say intrinsic motivation, I mean that a child is motivated to succeed from within themselves.  In a therapy session, there is usually a combination of intrinsic and extrinsic motivations.  I believe a session is the most successful when there is more intrinsic motivation.

The ultimate goal is a child who is self motivated and also motivated by you.  This is where the parents have the upper hand.  Your child already wants to please you.  They may complain, but they feel very accomplished when they make you proud.  As therapists, we have have to build that kind of relationship.  So being the parent has some perks!

When your child is self motivated, she will practice tasks without prompting.  The feel good chemicals are helping her to keep trying despite the repeated misses and fatigue.  She's excited by the little progress she makes and feels good about the effort she's putting in.  Even if she doesn't completely succeed with the task, she is happy about what she's done.  She can't wait to try again!  This is where extrinsic motivation by the parent or therapist can cement the feeling that she is making progress and she will accomplish this task soon!

If your child is dependent on extrinsic motivation during therapy, the feel good chemicals aren't providing the extra boost.  The misses make him feel bored and exhausted.  Each effort seems a monumental task and he feels like he'll never accomplish this task.  He may want constant praise, food rewards, or other rewards to help him feel accomplished.  This isn't to say all kids who want these rewards are not motivated.  Kids want rewards all the the time.  The difference is realizing if these rewards are the only things making him feel good or if these rewards are a bonus for how good he already feels about his accomplishments.

This theory applies to all kids, including typically developing kids.  However, for children with special needs, motivation is even more important.  Special needs kids have to push through a variety of obstacles that are much harder than the average kid.  Either physical, mental, emotional, or medical problems make reaching milestones difficult and challenging.  It's easier to feel discouraged and defeated, especially when it seems easier for everyone else. 

Easy to learn when you're interested

What is the Occupational Therapist's role?

It's my belief that an occupational therapist (OT) is the facilitator, the professional who finds a way to help your child achieve their goals.  OT's have two basic ways of treating: improving deficits (i.e. strength, coordination, cognitive skills, etc.) and teaching compensatory skills (i.e. using equipment, alternative methods, etc.).  However, without instilling motivation, the child may only do well in therapy and have a hard time generalizing their skills into other areas of their lives. 

Most people don't realize that OT's are trained to work with psychiatric diagnoses, as well as physical ones.  Occupational Therapy is based on holistic health.  OT can only be successful when you are treating the whole person from a mental, emotional, physical, and social perspective.  Modern medicine has been splitting the person into parts for different specialties, but OT is about putting the person back into one whole being. 

This is why it's appropriate to take temperament into consideration when making a treatment plan.  A child's temperament affects every part of their recovery.  It affects what goals are made and how they are reached.  It affects which tasks are used to practice their skills.  When a treatment plan is tailored to the child's temperament, it can instill motivation and really bring out their potential.

Parents are the key in this process.  When a parent is able to define their child's temperament for the therapist, the therapist can tailor their treatment and progress can be observed sooner!  This can also improve the likelihood that treatment will be successful. 

So how do we increase motivation and use it to reach therapeutic goals?  Children are naturally motivated to reach their milestones.  However, this motivation can be affected by their temperament and their experiences.



How does temperament affect reaching milestones?  How do you take temperament into consideration?  What if my child doesn't use words to communicate?  Learn the answers in Part 2!