The Nine Targets
Now that we have reviewed the foundational principles of the program, let us review the targets. These targets are based on the four principles. Addressing the targets supports the use of the science and evidence previously provided. This chapter gives an overview of the nine daily targets:
1. Touch and heavy work
2. Hydration and oral motor
3. Metronome and timing
4. Right and left brain integration
5. Patterns and repetition
6. Breath and Valsalva
7. Vision and sound
8. Movement
9. Inhibition
TARGET #1: TOUCH AND HEAVY WORK
Touch is the first sense (at the start of life) and last sense (retained at the end of life) we experience. Our skin is our largest organ, so targeting the touch system is powerful. Touch, or tactile input, is a natural part of life. Some children desire touch. They present with seeking behaviors to get their needs met.
Children may seek out input inappropriately, affecting their participation in functional activities. Such behaviors have a connection to the RAS, which is a conduit between the brainstem and the cortex that helps regulate attention. To address inappropriate touch-seeking in children, it is important that they experience touch activities in addition to other sensory stimuli. Presenting desired touch activities along with other sensory activities may enhance the child’s ability to process sensory information: A multisensory approach is necessary.
On the other end of the spectrum, some children experience challenges with tactile input. For example, they may become upset or hypervigilant and experience a fight-or-flight reaction when touched. This can occur even when the child is presented with nonthreatening stimuli. Challenges result from the child wearing certain clothing, eating a variety of foods, and interacting with others. As was reviewed in Chapter 1, the RAS plays a vital role in determining to which stimuli we pay attention and how much arousal results. Participating in nonthreatening, purposeful daily touch activities can decrease overreactions. Pairing such activities with a desired stimulus can assist in decreasing the challenges that arise when children are presented with an unwanted stimulus.
Additionally, pain is typically triggered at the areas closest to the surface of the skin. Targeting deep pressure decreases activation of the receptors causing the pain reaction. Prolonged, continuous, and generalized touch also decreases the activation of those receptors, as they respond more quickly to the starting and stopping of stimulation to the skin. The following illustration identifies the levels of touch receptors in the skin.
The free nerve endings and those for sensitive touch are located in the more superficial skin layers than are those for vibration and pressure. When attempting to decrease a child’s hyperreaction to light touch, it is crucial to provide deep input by applying pressure to the joints and muscles. Deep pressure input can also occur through physical activity because the receptors for pressure having a connection to the tendons, bones, and muscles. Heavy work is a great method for triggering those receptors.
Providing deep pressure input to the body can decrease hyperreactive responses to touch.
Touch can result in the release of calming neurochemicals. This is where heavy work comes into play. Weight bearing, stretching, and pressure can release stress hormones and relax the body. Whether a child has a high or low arousal, heavy work is an approach that may assist them with self-regulation. Stress hormones cause the heart and respiratory rate to increase; they can also enhance hypervigilance and focus and suppression of immunity and digestive systems. Overactivation of stress hormones can lead to decreased activation and use of the front parts of the brain. It is crucial to find ways to release such hormones to enhance executive functioning.
Target #1, Touch and Heavy Work, correlates directly with the principles of multisensory integration and executive functioning. Mindfulness is a component of all of the targets, but for target #1, it plays a special role during touch and heavy work activities requiring focus and repetition. Specific touch and heavy work activities are described in the chapters that follow.
TARGET #2: HYDRATION AND ORAL MOTOR
Hydration of the body is often undervalued. Muscle tension and pain can decrease secondary to proper hydration. If children are dehydrated, they can experience discomfort and hypersensitivity. A strong correlation also exists between hydration and brain function: Drinking proper levels of water can increase focus and attention. Furthermore, the act of swallowing triggers a regulatory response through stimulating nerves connected to the parasympathetic nervous system, which controls rest and digestion.
Oral motor activities involve input to the mouth. There is a strong connection to the brainstem and RAS: When we chew, cranial nerves connected to the parasympathetic nervous system can be calming and organizing. Sucking, eating chewy foods, and rhythmic chewing help to regulate the RAS and produce a calming response. Crunchy foods produce a stimulating reaction in the RAS, enhancing attention and alertness. Children, whether they have high or low arousal levels, may seek out oral motor input. Oral motor input connects to our emotional brain, due to activation of the RAS, and can provide stress relief.
While children may desire input to their mouths for different reasons, attempting to stop the behavior could be unsuccessful and reinforce the undesired behaviors. Target #2, Hydration and Oral Motor, directly correlates with the multisensory integration and emotional regulation principles. There is certainly an indirect correlation with executive function. As with all of the targets, mindfulness is an important aspect.
TARGET #3: METRONOME AND TIMING
Starting and stopping activities helps to activate the front part of the brain as well as the IC. Daily activities enhance attention and focus. Timing and sequencing can help develop organizational skills and improve motor planning. Target #3 introduces the child to fun activities to stimulate their brain. An important component to the activities is the use of a metronome. The brain loves rhythm and repetition. Several bodily functions rely on or produce rhythm. Heartbeat, circadian rhythms, breath rate, and the sucking reflex are just a few of the rhythms of the body.
Interventions based on brain rhythms are an important component of this program and are supported by research. As we participate in various activities and tasks, our brain produces rhythms called brain oscillation. A synchronous rhythm occurs when we participate in focused, repetitive behaviors. For this reason, some children perform self-stimulatory behaviors in a repetitive fashion. While many of these behaviors are discouraged, they actually can produce a good feeling secondary to endorphin release. There are specific methods to enhance such preferred responses in the brain that utilize rhythmic activity. The use of a metronome is one of them. Target #3, Metronome and Timing, relates to the principles of executive functioning and mindfulness.
TARGET #4: RIGHT AND LEFT BRAIN INTEGRATION
The two sides of our brain are not the same. Yes, we generally have the same structures in the left hemisphere as in the right. However, each side of the brain has a somewhat different function. Both sides must work together for successful participation and interaction. Some children have more activity on the left or the right side of the brain. Their behaviors reveal evidence of where the imbalance lies. A child with more left-brain activity may have higher levels of verbal communication and may be analytical, yet can lack social skills and miss the “big picture.” Having more activation of the right brain may result in creativity with challenges in more analytical problem-solving abilities.
Luckily, our body activities directly activate our brain. The right side of our body causes activity in the left brain hemisphere and vice versa. Performing activities with both sides of the body can enhance integration of the hemispheres. Target #4, Right and Left Brain Integration, provides activities for this purpose by applying the principle of multisensory integration.
TARGET #5: PATTERNS AND REPETITION
The world functions with rhythm and patterns: the birds flying in the sky, the rotation of the earth, the beautiful patterns made by fireflies. These rhythms keep the world moving. Several body systems produce and require rhythm; for example, our circadian rhythms, heartbeat, breathing, and the suck of a baby feeding. Similarly, our brain and nervous system respond to focus and repetition, which provide a sense of well-being and comfort. Using patterns and repetition is a key component of enhancing self-regulation. Ritualistic behaviors, such as routines, may produce calm feelings. Some rituals support self-regulation, such as practicing meditation. However, ritualistic behaviors often observed as symptoms of ASD (e.g., rocking, spinning) often isolate the child and impede them from interacting with others and the environment. While the child’s repetitive actions may not seem to pose much of a threat, there may still be some concerns around safety and development. The more thoughtful use of activities involving patterns and repetition can provide a sense of well-being while enhancing participation and engagement. Target #5, Patterns and Repetition, relates to all of the principles, specifically mindfulness.
TARGET #6: BREATH AND VALSALVA
How do we activate the system for rest and digestion, the parasympathetic nervous system? There are various methods. Deep rhythmic breathing is one of the most powerful methods to activate regulation. The connection between deep breathing and the vagus nerve allows for the heart and breath rates to decrease. There is a release of calming neurochemicals and decrease of stress hormones. However, when we tell children to take a deep breath, they often do the opposite and take shallow, short bursts of air, resulting in the triggering of an excitatory response. It is crucial to utilize methods to assist children in performing correct deep breathing (e.g., have the child lie down and place a stuffed animal on their abdomen and watch the animal rise and fall as they take deep breaths).
Similar to deep breathing, the Valsalva maneuver produces an immediate activation of the parasympathetic nervous system. Parasympathetic nervous system responses, along with other natural reflexes, can improve regulation, attention and focus. For example, both spinning activities and cold temperatures trigger the vagus nerve. Many children spin in attempt to activate the vagus nerve; however, their attempts are usually unsuccessful and result in increased arousal rather than calming. Some children perform self-injurious behavior to elicit calming reactions; a less harmful way for them to get a similar response is to engage in activities involving ice. This is partly due to the fact that the receptors for pain and temperature have the same neurological tracts to the brain. For those challenging children with high thresholds, ice therapy can be a marvelous change agent.
Target #6, Breath and Valsalva, involves techniques to trigger the regulatory responses in our nervous system. Frequent implementation of these activities fine-tunes the function of the IC in teaching our body the feeling of calmness. In addition, children can learn the techniques to implement later during periods of stress and anxiety. Target #6 addresses the principles of emotional regulation and mindfulness.
TARGET #7: VISION AND SOUND
The visual and auditory systems are vital to survival. When dysfunction occurs, severe distress may result. Children who have a sensitivity to light or sound can experience discomfort and physiological stress. Conversely, some children seek out activation in the visual and auditory systems. If these sensations are “highly wired” or organized, a child may utilize them to block out other unwanted stimuli. Appropriately addressing both systems can improve self-regulation.
Activities targeting the visual and auditory systems can decrease hypervigilance and enhance regulation. Such activities must be structured and organized. Inappropriate stimulation or overstimulation can lead to dysregulation. In our brain, there is an area near the RAS that involves both the visual and auditory systems. For example, when you hear an unexpected noise, you turn to look for where it came from. This brain area is hyperresponsive in some children and underresponsive in others. Performing activities that integrate vision and sound can further improve a child’s response. Target #7, Vision and Sound directly addresses the principles of multisensory integration and mindfulness. In addition, with the connection to the RAS the other principles are indirectly addressed.
TARGET #8: MOVEMENT
Movement-based activities are very important in the Self-Regulation and Mindfulness program. We previously reviewed how retained primitive reflexes (e.g., Asymmetrical Tonic Neck, Symmetrical Tonic Neck, Moro, Spinal Galant, Palmar, Rooting, Tonic Labyrinthine, Landau) can impair the functioning of some children. In Chapter 4, we identified methods for assessing children in revealing nonintegrated reflexes.
The vestibular system is located within the inner ear. When we move, specifically our head, the receptors are stimulated and send a message through the nervous system to the brain. Fluid in the semicircular canals moves as we rotate our head and move it up and down and from left to right.
There is a strong connection between movement and vision. As our head moves, our eyes must be able to shift to maintain our gaze. Challenges in disconnecting eye and head movements are correlated with difficulty with activities such as reading, writing, and gross motor skills.
The activities for Target #8 provide opportunities for functional movement and decreasing the activation of the primitive reflexes. Furthermore, children often desire movement and require it throughout their day. Children who are underresponsive and lack physical activity also require enhanced opportunities for movement. Target #8 provides physical movement activities while addressing all of the principles.
TARGET #9: INHIBITION
The ability to stop oneself from making poor decisions develops over time. Some children have significant deficits in this area. Judgment, choice making, and flexibility are possible once nonpreferred behavior is ceased. It is important for children to begin to learn how to stop what they are doing. Many childhood games incorporate starting and stopping, and unspoken playground rules address inhibition of poor behavior. When certain neurodevelopmental conditions arise, theses skills may be hampered. Target #9 provides games and activities to address inhibition. Such activities activate the front part of the brain and the IC. This target addresses all of the principles of this program.
SUMMARY
Having reviewed the nine targets, we now present activities supporting each target. Please be sure to review Chapter 4 to assist in identifying the child’s arousal and threshold levels. You should also reflect on the science behind the program to have an idea of where the child falls on the Self-Regulation and Mindfulness 7-Level Hierarchy. The following activities may act as a catalyst to inspire your developing your own plan for meeting the child’s needs.