Monday, August 20, 2012

Therapy Secrets: How temperament affects therapy-Part 2

Eating things that stick to the spoon

 How does temperament affect reaching milestones? 

Most babies learn to roll when they are trying to reach for their favored toy.  However, there are different ways to accomplish this desire. 

Laid back baby
The laid back baby will see the toy, try to reach it, decide it's too hard, see a closer toy, pick that up instead, and is very happy to play with this toy instead.  Both toys are cool! 

In general, a super laid back, typical developing baby may reach their milestones a little later than their same age peers because their enjoying themselves and aren't really in a hurry to "grow up".  Many people tend to describe these babies as "good" babies because they are easily comforted, aren't very particular about what they want, and just seem to roll with the punches. 

Physical baby
The physical baby will see his desired toy, try to reach it, try to scoot, try to pull his body with his arm, try to reach it with his leg, try to reach it with both his leg and arm, starts to play by rocking back and forth, and suddenly finds himself on his stomach.  This is so much fun!  He rocks again and rolls to his back.  Surprised, but delighted, he keeps practicing this knew skill until he's tired!  What toy?  Rolling was so much fun!

A baby who is super physically oriented, may reach all their gross motor milestones sooner than their same age peers, but may be a little later reaching their fine motor milestones.  They love to move and they may focus most of their energy on becoming mobile.

The verbal baby
The verbal baby will see the toy, try to reach it, make a cooing sound, try to reach it, make a frustrated sound, try to reach it, keep making frustrated sounds or cry until mom figures out what she wants and brings the toy to her.  Then she cries in delight...making sounds worked!

A very verbal baby may be a little later in reaching their gross motor milestones, but may begin to "communicate" sooner than their same age peers. 

The thinking baby
The thinking baby sees the toy, tries to reach for it, tries to reach with the other hand, takes time to think, tries to reach with his legs, takes time to think, he lunges with his whole body and rocks towards the toy without enough strength, then he leers at the toy.  Finally, he scoots closer using his legs against the floor.  He still can't reach the toy!  In his frustration, he flails his limbs and somehow ends up on his stomach.  It takes a moment to orient to his knew position.  He's not sure what happened, but he sees the toy, reaches for it and grabs it with delight!

A thinking baby may develop their cognitive skills a little faster than their peers, but may have more difficulty developing their physical milestones at the same pace as their cognition.  This often leads to a very frustrated baby who may be more fussy in the beginning.

Every baby can display some aspect of all these behaviors, but most will show a tendency towards certain behaviors over others.  Just like the adults they become, children are all different and their corresponding areas of interests are also different. 

Using laughter to encourage

What temperament is my baby?

I have used the Myers Briggs method of assessing personality for over 10 years.  I was originally introduced to it when I read "Do What You Are" by Paul D. Tieger and Barbara Barron-Tieger, a book about finding your perfect career or job based on your personality.  It shows you how to assess your own temperament and match it to a career or job situation.  Then I found the book, "Please Understand Me II" by David Keirsey.  It's a much more detailed book about the same personality descriptions. 

The above baby descriptions are somewhat based on these personality descriptions, only simplified for clarity.  "Please Understand Me" has a great section describing what these temperaments look like in children, but I also bought "Nurture by Nature", written by Barbara Barron-Tieger. 

It would take too long to go into detail on this post.  If there is interest, I may write a separate post.  In summary, there are four basic types of personalities: Guardians, Artisans, Idealists, and Rationals.  Then there are four subtypes in each main group, which makes 16 different personalities.  It sounds too simple, but there many things to consider and in the end everyone is a unique individual.  However, these descriptions can help us understand some general tendencies, especially if they are very different from our own. 

I really use these descriptions more as a guide, not as a definite description of a person or child.  It's only there to help me understand, not to replace my observations of the real person.  For everyone is affected by their life experiences and choices, making us all very unique.  However, as the examples of the different baby temperament shows, this general guide can help you understand your child and help you find the key to their inner motivations.

My son is definitely a Rational (see thinking baby description).  It's not always easy to figure out a baby's personality, but he is an extremely opinionated little guy, making his preferences and personality quite clear.  I am also pretty sure that he is an INTJ: introverted, intuitive, thinker, and judger (the words have different meanings than popular definitions). 

In general, INTJ's are super independent, innovative little thinkers, who tend to be socially awkward.  They are super competitive with themselves and refuse to accept anything less than their own expectations of themselves.  They are the quintessential nerds, who tend to be lovers of technology all their lives.  They are super intuitive and are great people readers. 

So I try to take his temperament into consideration, when I set up his environment.  If you look at my previous post on setting up the environment, you can see that there are places for independent play, technology toys, blocks, and a private zone.  Rationals seek autonomy all their lives and they have a great need to experiment and achieve their visions.  So I give him plenty of freedom to try things at his own pace and I try to give him space even when I'm right next to him.  He's very sensitive to "failure", so I make sure to set things up for success whenever possible and try to show him through example that it's okay when things don't turn out the way we planned. 

Why is this important?  When we work with a child's temperament, they feel honored and accepted for who they are inside.  This increases their confidence and their willingness to be courageous and try new things.  This translates well into therapeutic goals because we frequently ask the child to try things differently.  If they feel confident to try things without falling apart, they are going to be more willing, not only to try it but keep practicing until they succeed.  As their experience of success increases, they're willingness to practice outside of therapy increases.  Then this leads to a child to practice skills in a variety of settings and situations, making reaching milestones a smoother process.

Learning to balance, while discovering the new

How does this fit into therapeutic goals?

Though we make very specific goals to measure progress, progress is really an organic process, especially in children whose condition affects their function overall.  In my experience, when I'm finally able to motivate my client intrinsically, they seem to suddenly make progress in many areas.  It seems like something finally clicks and they are excited to reach goals and try new things.  This process can be quick for some and longer in others, especially if they are not using words to communicate.

The light-bulb moment is amazing to see.  Some of these moments happened right in front of me and they stay with me forever. 

One moment that comes to mind happened with an 11 year old boy, diagnosed on the Autism Spectrum.  He was considered non-verbal and also suffered from severe sensory issues that prevented him from participating in social gatherings.  After 6 months of therapy twice a week, he seemed more relaxed and even began to smile and giggle in response to appropriate stimulus.  One day, I was playing around with paint in a silly way, just to make him laugh.  He kept giggling and watching my "amazing" painting skills.  When I finally stopped, he slowly looked up at me with a huge smile and a look of happiness and said, "funny!". I was floored!  Not only did he say something appropriate, he was describing my a qualitative action!  It was the day that changed everything.  He began trying to communicate more, he had fun at parties, he began to cuddle with his family, and he made amazing strides in his academic skills.

This young guy was a cautious, quite, thinker.  He preferred and needed to observe first, before he could trust.  He didn't like being rushed and he learned best on visual mode.  He really liked art and being silly tickled his sense of humor.  I used this knowledge to set up the treatment sessions progressively.  It started with the swing and providing plenty of vestibular (movement) therapy.  It was a slow progression, but it was worth every moment. 

Taking temperament into consideration when setting goals and setting up treatment can lead to success.  This process tailors treatment to an individual and creates the opportunity to motivate the person from within themselves.  This can really affect their ability to generalize their skills from one setting to another and can also lead to progress in many areas.

How do I take temperament into consideration?

Many parents automatically start learning the preferences of their children and may begin to take a child's preferences into consideration before making decisions on everyday activities.  For example, you might realize your baby loves being around a lot of people, so you sign up for a mommy/baby class.  Or your child may prefer quieter occasions, so you make a play date with a mom and another gentle baby.  Your child may prefer being outside, so you go walking everyday.  We are naturally affected by our baby's temperament and we adjust our lives to make things smoother. 

Well, this consideration can be taken to the next level.  You can begin to actively use the knowledge about their temperament to encourage progress towards their goals.  Notice I emphasize "their goals".   As you're observing your child, try to figure out what they are trying to do.  Are they trying to roll?  Are they trying to put the peg in the hole?  Are they trying to talk?  Then figure out how you can help them succeed by making the task just hard enough to be interesting and easy enough to accomplish.  If you need some ideas, this is a great question for your OT. 

Then set up the activity and wait.  Let your child take the lead.  This will make them feel more independent and it will give them time to figure out the task on their own, a very good cognitive exercise. Don't worry if they don't do the activity "the right way".  If your child asks for help, show them how to do it, but let them finish the last step.  This will make them feel accomplished, despite needing help.  Plus they will begin to learn the activity.  If they end up needing a lot of help, it may mean the task was still too hard, so next time set it up with fewer steps.

Remember to consider your child's strengths.  If they are good at sitting, but have difficulty standing, set up a sitting task that is challenging.  If they want to stand, make the task easy, so they're mainly working on standing.  Make sure to give positive reinforcement on the actual goal.  (You can do that standing!  Amazing!).

What if my child doesn't use words to communicate?

Observation is important with all children, but is especially useful, when your child is not using words to communicate.  When your child isn't using words to communicate, observing their behavior can tell you a lot about what's going on inside.  Try to take time to observe without speaking.  Communicate on their terms.  If they're using gestures, use gestures.  If they use eye contact, use eye contact.  If they aren't really communicating, use silence with action. 

It's important to balance their communication style, with our talking.  Yes.  It's important that they learn language, but it's also important that they feel understood.  When a child feels understood, it opens the door to try and communicate with us, using "our language". 

When I first immigrated to the US, I didn't speak English.  Not only did I not understand English, I didn't understand the accompanying gestures or cultural nuances of people's actions.  The more they talked, the more everything sounded like gibberish.  I usually felt confused and ended up with a headache.  But as soon, as people stopped talking to me, I was able to focus, observe, and understand.

So, it's important to give someone plenty of speaking breaks, so that they can observe and learn while you're spending time together.  Learn to speak less and do more.  Give them time to process what you're trying to communicate.

A place of his own

What does this look like everyday?

As a parent of a special needs child, I can honestly say that it's hard to be "on" all the time.  In fact, it's impossible.  I'm a therapist, but being a mom is my primary role with my child.  That means I have to fit therapy in little 15 minute spurts throughout the day.  I try to think of what I can fit into our day, then decide what goal I'm working on that day.  At most I have, one structured activity per day.  Then I try to fit in as much "physical" activity as I can.  Then I do one session of the Masgutova Method per day.  I also try to give Baba the opportunity to do things on his own when possible, as therapy.  Honestly, some days one therapeutic thing may be the only thing I can do that day.  I try not to go longer than three days of zero therapy, though that's not always possible.   But this is really okay.  I know that we're looking at the long term, not just the short term goals.  We are creating our own pathway.  One that works for us, and so far it's been successful. 

Every family must find their own rhythm.  It's best if the whole family can be involved, sharing the load is so much better.  Even if the person can only be a supportive helper, it can really help the main caregiver.  It's also okay to take short to two weeks.  Everyone needs to be refreshed and have time to just be a family doing "family" things.  Though if you're feeling loaded down, it's also a good opportunity to see if things can be re-arranged or re-organized.  Most of the therapy should be fun, not difficult work.  Be sure to enlist the help of your OT and request for ideas on how to make things easier and what to focus on.

Most importantly, remember that having loving family support is the most important thing for your child.  They are children first.  Their diagnosis does not define who they are.  It just something they deal with, just like everyone deals with some sort of difficulty. 

Easy next to hard activities


The act of trying to figure out your child's temperament will have another important effect.  It will help you to see your child first, his diagnosis will fade into the background.  It will also help you help support your child, they way they would like to be supported.  In this arena of special needs, it's often easy to forget our children are unique individuals that have preferences that may not fit into nice little "diagnosis" molds.  Their temperament has a huge effect on how they will navigate their lives.  Their temperament may hold the key to what will motivate them to push through whatever obstacles lie in their path.  Setting fire to this intrinsic motivation will also reduce the pressure on the main caregiver to provide extrinsic motivation, since the child will be motivated to try things on their own.  In the end, this motivation will help them create a path to their maximum potential...whatever that may look like. 


  1. WOW Bea! I just got caught up with Part 1 and Part 2 of this series. So informative. And I'm so glad you included all the different ways we can communicate rather than just using words. Are you on Pinterest? If so, you really should pin these posts. :)

    1. Hi Lana!

      Yes, I pin! No I'm not regular about it. I will pin it, when I replace the photos I lost when turned this into two parts.

      Thanks for the advice! I'm glad you liked it!


  2. How interesting! I have been interested in MBTI since before I was a parent. In retrospect I can see my son's temperament shining through practically since the day of his birth (I feel pretty certain that he is an NF). Still no idea about my daughter. I am not sure if she will fit as neatly into the MBTI boxes, but I guess we'll see!

    1. Yes! My son is easy to read, but some children are harder to read at a young age. I'm sure you'll enjoy watching her blossom to whoever she is inside!


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