Note from John Pagano FAB Strategies: I received this guest blog story from Constance Ray. She tells Shawn’s story of how he is courageously living each day to overcome childhood trauma and addiction, and prevent it’s legacy in his own family. May of the teens I work with show the same courage in facing family trauma and addiction. You can e-mail Constance and find out more about her work at firstname.lastname@example.org Photo By: Pixabay
Shawn’s Journey to the Top: How He Overcame an Abusive Childhood and Addiction
When we picture addiction, the image that often comes to mind is that of an adult. However, what many people don’t realize is that childhood experiences often set the stage for potential addictive behaviors later on in life. Once it has its iron hold, it can seem impossible to get out. We talked with one addiction survivor about how he not only broke free from his dark past, but found it in his heart to forgive.
Shawn’s story begins when he was just a young teenager. While other boys his age were learning life skills from their fathers, Shawn did his best to avoid his father and the accompanying pain.
“I grew up in an extremely abusive household. I was abused mentally, physically, and emotionally by my dad. I started using cocaine to numb the pain. I didn’t use it everyday, but I used it often and I used it on and off for about 20 years,” Shawn said.
Fast-forward several years later, and Shawn found himself moving to Rhode Island after a failed marriage, leaving behind a son. He remarried, but the drug use followed, sending him spiraling into depression.
“One day, my wife had enough of what I was doing and tossed me out on the street. My so-called ‘friends’ at the time all backed out and were nowhere to be found,” Shawn said. “I had nowhere to go and nowhere to stay, and so I was homeless.”
Shawn was left with nothing but a motorcycle to his name, but even that failed him.
“I’ve been riding a motorcycle for nearly 40 years and never had a wreck, but one day I left the kickstand out and wrecked my bike, breaking four ribs in the process,” Shawn explained. “I was without a job, without a home, without my wife, and I was in a lot of pain. And that’s when I felt like God said to me that it was time to get my life together.”
Looking up addiction rehabs on his phone, it just so happened that the first one he came across was the Treehouse in Texas. Not able to afford the trip, Shawn’s family chipped in, much to his disbelief.
“Most surprisingly, my son helped to pay for my plane ticket, which made me feel both good and bad about where my addiction had taken me,” Shawn said.
Shawn credits the kind and caring staff for helping him put an end to his drug use and move forward from his painful childhood.
“I learned to forgive; I forgave my dad and let go of that anger and pain. I forgave myself for all of the hurting that I caused myself and my family. I really had a spiritual awakening at the Treehouse. When I surrendered to God, I felt like I was 1,000 pounds lighter, because He took all of that from me,” Shawn said.
As for his family, Shawn said they are continuing to heal each and every day, crediting his wife for saving him from a life of drug abuse and sadness.
“I’m still working to try to patch things up with my wife. I know that the day she put me out of the house is what saved my life … I know everything happened this way for a reason, and I am going to do everything I can to make it work with us. I’m also working towards reconnecting with my son,” Shawn said.
Addiction was Shawn’s way of coping with the pain his father caused him, but he realizes now that ultimately, everything he did was self-inflicted as a way to dull the pain.
“I was so used to being put down and was never good enough for my father, but now I truly know that I have a purpose in life: to help others and to enjoy life as it comes — through good and bad,” Shawn said.
No matter how difficult your past has been, drugs are never the answer. Facing it is scary, but you aren’t in this alone. Like Shawn, you can break free from whatever has caused you such immense pain, beat your addiction, and find your life’s purpose.
Many children with behavioral, developmental and sensory challenges have difficulty maintaining a quiet alert state for learning. These children tend to be low registration (miss important sensory input) and/or sensory sensitive (overly responsive to functionally irrelevant sensory input) the majority of the time. The Sensory Profile is a reliable, valid assessment that can be used to determine if children have significantly different sensory modulation. It is important to help children with significantly different sensory modulation to learn to monitor and regulate their arousal levels and maintain a quiet alert state for learning. Colors can help children understand their sensory modulation level by using Blue to designate hypo-responsive, green an optimal quiet alert state for learning, yellow a hyper-responsive, and red an extreme hyper-responsive state.connotapres2017handout
A visual support integrating colors, energy levels, and sensory modulation can help children learn to identify and modulate their arousal levels. Children are encouraged to work with the teacher or therapist to identify their common feelings and actions when experiencing various energy levels.
A simpler alternative is to make a High, Low and Medium Energy visual, and have children identify their arousal level and whether their current energy level feels O.K. or not O.K and why. Some children learn better using the visual supports shown above, while others do better without it through only adult modeling. without it can be used to teach children to modulate their arousal levels. For example, the therapist might model by saying, “I am high energy and feel not OK, because I’m too hyper to be a good teacher. My heart is beating really fast, I’m breathing fast, my hands are shaking, my arms feel tight like raw spaghetti, and I’m talking fast and loud. I’m going to do 10 pushups to lower my energy level”.
For some children high energy is their only problem, while others experience low energy as well. For low energy children I model “I’m low energy and feel not OK because I don’t have enough energy to be an exciting teacher. My heart rate and breathing feel slow, my arms are soft like over-cooked spaghetti, and I’m talking slowly and soft. I feel sad and dead inside. I’m going to do do 10 fast jumping jacks to increase my energy level”.
As children develop, yellow can be added to designate a slightly hyper-alert state that precedes the red hyper-arousal state in which they misbehave. This is helpful because early recognition of high energy is easier to control. They can also be encouraged to use colors to relate their most frequent arousal level accompanying their feelings. The student who constructed the feeling wheel shown below depicted sad and lonely as low energy; embarrassed as high energy; and frustrated & mad as very high energy. In addition, happy & nervous were depicted as related to both average energy and high energy states.
A general FAB Strategy for helping all students modulate their energy levels is to first decrease, then if needed gradually increase sensory input. This is depicted below using a visual support that shows a student who frequently fluctuates between a low energy and high energy state, with only a small window of quiet alert functioning. In a classroom the teachers response would involve first lowering the noise level and visual distractions for a dysfunctional high energy or low energy student. This alone will often enable students to achieve a quiet alert state. If they are still not in a quiet alert state, give graded input from the lowered sensory level in a predictable, socially acceptable way until a quiet alert state is reached.
Once the therapist is able to vary environmental input to enable a student to reliably achieve a quiet alert state, they can help the teachers, parents and student to do this independently.
Therapists and teachers can expand their understanding of arousal levels by synthesizing theories of the Autonomic Nervous System, sensory modulation, influences of early childhood PTSD, and Bipolar Disorder to expand their understanding of arousal level challenges. The focus is on helping children notice when they first enter the blue or yellow zones, so they can find ways to increase or decrease their arousal levels as needed.
Students can use colors through visual supports, modeling, and/or using the smells of the scented color markers to learn if they are in the blue, green, yellow or red arousal zone. This understanding provides a foundation for developing individualized coping strategies to manage their arousal levels.
I developed FAB Strategies (Functionally Alert Behavior Strategies) to help children, adolescents and young adults who have complex behavioral challenges. The FAB Strategies Form guides the use of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies. The FAB Strategies forms enable teachers, families as well as occupational, physical, speech/language and mental health therapists to work towards the same functional behavioral goals using consistent strategies. The copyrighted FAB strategies forms are offered free of charge to therapists for use in developing home programs that improve functional behavior.
FAB Strategies combines positive behavioral support and sensory processing strategies to improve behavior. School occupational therapists can effectively team with parents and school staff to reduce school aggression, restraint and seclusion.
Many adolescents and young adults with behavioral disorders (e.g., Autism Spectrum, Post Traumatic Stress, Oppositional Defiant Disorder, Anorexia Nervosa) have body image challenges that negatively impact their behavior and social relationships. This is especially true for individuals who have developmental, mental health, and/or sensory processing challenges. Adolescents and young adults with body awareness challenges can be helped to improve their social skills with body awareness interventions.
Developmentally appropriate body awareness intervention involving massage, touch, movement, relaxation and mindfulness activities can take place within their work, school, home and community recreation activities. Body awareness provides the foundation for mindfulness, meditation and other calming activities that have been shown to decrease depression, anxiety, distress, aggression and addiction. Developmentally individualized body awareness tasks promote the emerging development of self-control using individual and group trauma-informed mindfulness, yoga, relaxation, visualization, massage, sensory processing, and movement activities.
Regardless of their chronological body awareness activities must match the adolescent or adult’s developmental level to be effective. The most developmentally basic and clinically effective experiences of embodiment, based on brain gym activities for special needs www.movementbasedlearning.com www.braingym.org , provide sensory awareness of the front, back, top and bottom of the body. Two activities for providing this experience is the X Marks the Spot movement game
A second basic body orientation activity is the Roll therapyball on client core progression Strategy, in which a therapist specifically rolls a therapyball sequentially over the center, front, back, top and bottom of the body https://www.youtube.com/watch?v=LCD9JeFviKY
Sensory body awareness experiences help develop adolescent and young adults awareness of their body and understanding of body based triggers for early identification of the need for coping strategies.
Frank, J. L., Bose, B., & Schrobenhauser-Clonan, A. (2014). Effectiveness of a school-based yoga program on adolescent mental health, stress coping strategies, and attitudes toward violence: Fingdings from a high-risk sample. Journal of Applied School Psychology, 30, 29-49.
Kovacs, M., & Lopez-Duran, N. L. (2012). Contextual emotion regulation therapy: A developmentally-based intervention for pediatric intervention. Child and adolescent psychiatric clinics of North America, 21(2), 327.
Silva, L. M., Schalock, M., & Gabrielsen, K. R. (2015). About face: Evaluating and managing tactile impairment at the time of Autism diagnosis. Autism research and treatment, 2015.
Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Ann. Rev. Clin. Psychol., 3, 377-401.
Sensory strategies have a significant impact on the behavior of children and adolescents with developmental, mental health, Post Traumatic Stress Disorder and sensory processing challenges. Deep pressure touch provided by pediatric occupational therapists through massage, brushing, weighted blankets, mat sandwiches and other sensory strategies are described as extremely positive experiences for children and adolescents with developmental, mental health, Post Traumatic Stress Disorder and sensory processing challenges. Finding preferred activities is helpful because motivation can be a significant problem when treating these youngsters.
A significant relationship was found between sensory and behavioral problems in children with developmental disorders. Research indicated that deep pressure sensory input functioned as positive reinforcement while matched sensory activities reduced repetitive non-purposeful behaviors in children with Autism Spectrum Disorder. Offering opportunities to use sensory strategies for self-regulation significantly reduced behavioral problems as well as the need for restraint and seclusion in adolescent and adult residential treatment centers for psychiatric and trauma challenges.
The usefulness of offering clients deep pressure sensory strategies as an alternative to aggression and restraint makes sense, as it can replace the use of restraint as reinforcement for aggression with sensory activities to reinforce avoiding physical aggression. School occupational and physical therapists have begun using sensory activities as reinforcement for avoiding aggression to reduce student restraint and seclusion. SchoolOTRedAgg The functioning of sensory strategies as positive reinforcement makes it important for therapists to avoid using sensory strategies immediately following aggressive or inappropriate behavior. Despite bitter conflicts between behaviorists, pediatricians and therapists clients would greatly benefit from their collaboration.
Canfield, J. M. (2008). Sensory dysfunction and problem behavior in children with autism spectrum and other developmental disorders.
McGinnis, A. A., Blakely, E. Q., Harvey, A. C., & Rickards, J. B. (2013). The behavioral effects of a procedure used by pediatric occupational therapists. Behavioral Interventions, 28(1), 48-57.
O’Hagen, M., Divis, M., & Long, J. (2008). Best practice in the reduction and and elimination of seclusion and restraint; Seclusion: time for change. Aukland: Te Pou Te Whakaaro Nui: The National Center of Mental Health Research, Information and Workforce Development.
Rapp, J. T. (2006). Toward an empirical method for identifying matched stimulation for automatically reinforced behavior: A preliminary investigation. Journal of Applied Behavioral Analysis, 39(1), 137-140.
Sutton, D., Wilson, M., Van Kessel, K., & Vanderpyl, J. (2013). Optimizing arousal to manage aggression: A pilot study of sensory modulation. International Journal of Mental Health Nursing, 22, 500-511.
Warner, E., Spinazzola, J., Westcott, A., Gunn, C. & Hodon, H. (2014). The body can change the score. Journal of Child & Adolescent Trauma, 7(4), 237-246.
School Occupational, Physical and Speech Therapists play a significant role in improving student behavior. While traditionally viewed exclusively as the role of school social workers, psychologists, and behaviorists the complex problems of students with interrelated behavioral and developmental challenges can be helped by the contribution of school therapists. The relationship between behavioral problems, the occupation of students, communication/language abilities, and gross motor skills supports the role of school occupational, speech/language and physical therapists as members of school teams helping students with behavioral and developmental challenges.
By teaming with occupational, speech/language and physical therapists, teachers and school mental health specialists can enhance their school positive behavioral support programs with expanded use of visual supports, mindfulness, music, exercise, and sensory-motor activities (Patten et al., 2013; Schaaf et al., 2014). There is emerging evidence that cardiovascular and resistance exercise enhances body awareness, attention, as well as functional strength and endurance for improved participation in school learning tasks http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208137/pdf/nihms297861.pdf
School therapists can utilize evidence based mindfulness strategies as movement breaks that improve attention, and integrate behavioral strategies into their school therapy to enhance student’s school behavior. Behavior for Therapists Slides The picture below describes the FAB Strategies adaptation of the PATHS PBS Turtle Technique to help students with special needs learn to calm down and avoid aggression.
The AOTA supports the role of school occupational therapy in helping to improve student’s behavior (Cahill & Pagano, 2015). The following Occupational Therapy article describes clinical school occupational therapy strategies that can be used to reduce student aggression (Click on highlighted, then double click on lower heading) SchoolOTRedAgg
Cahill, S. M. & Pagano, J. L. (2015). Reducing restraint and seclusion: The benefit and role of occupational therapy. AOTA School Mental Health Toolkit. http://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Reducing-Restraint-and-Seclusion.pdf
Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., Ishijima, E., Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26(1), 70-95. http://skolenforoverskud.dk/Artikler%20-%20mindfulness/Flook-Effects-of-Mindful-Awareness-Practices-on-Executive-Function-1.pdf
Kazdin, A. E. (2008). The Kazdin Method for parenting the Defiant Child. NY, NY: Mariner Books.
Laugeson, E. A. (2014). The PEERS curriculum for school-based professionals: Social skills training for adolescents with autism spectrum disorder. Routledge.
Mahammadzaheri, F., Koegel, L. K., Rezaee, M., Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavioral analysis (ABA) intervention for children with autism. Journal of autism and developmental disorders, 44(11), 2769-2777.
Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., … & Sendecki, J. (2014). An intervention for sensory difficulties in children with Autism: A randomized trial. Journal of autism and developmental disorders, 44(7), 1493-1506.
Warner, E., Spinazzola, J., Westcott, A., Gunn, C. & Hodon, H. (2014). The body can change the score. Journal of Child & Adolescent Trauma, 7(4), 237-246.
As an occupational therapist working with children and adolescents who have special needs, I am repeatedly impressed by the amazing love and perseverance of their parents. Supporting and encouraging parents is the most important job of doctors and therapists who are trying to help children and adolescents. I repeatedly recall my doctoral dissertation on parental perceptions of feeding their young children who had special challenges.
My study found that half of the parents who had young children with developmental and feeding problems had problematic levels of parental stress. I further discovered that feeding satisfaction was inversely related to parental stress, with parents who were most satisfied with their feeding experience reporting the least parental stress. When rating the influence of occupational and speech therapy intervention on their feeding experience 42% reported a positive effect, 23% both a positive and negative effect, and 11% a negative or no effect.
In my current work with adolescents who have psychiatric illness I continue to see the great healing effects of supportive parents. It is extremely important for therapists and physicians to support these parents through their trials, and help them understand the importance of taking care of themselves. Parents reported that the most effective component of therapy in reducing parental stress was the experience that the therapist cared about them and their child. If I do nothing else as a therapist, I hope to always convey to youngsters and their parents how truly valuable and important they are.