Being Mindful about Self-Injurious Behaviors
By: Danielle Delorenzo, OTDS, OTR/L

Headbanging and self-injurious behaviors are topics that hold a stigma.  My goal is to shift the mindset of the masses when thinking about self-injurious behaviors towards a more mindful and positive one.  Most often, children engage in self-injurious behaviors when they are frustrated and unable to express their wants, needs, and emotions.  Some children will head bang or engage in other self-injurious behaviors as a way to meet their optimal sensory needs.  It is imperative to determine what is driving the self-injurious behaviors to identify which strategies will be the most effective to increase a self-regulated response¹.

When you observe a child engage in SIBs (self-injurious behaviors), what is happening before? How did you react? Is there a pattern? Are they in pain – teething? Are they trying to communicate? Did they want something, and it was not available?  A simple way to help determine what could be the cause of a behavior is to ABC it! ¹

What happened before? (A-Antecedent)	The Behavior (B- Behavior)	What did you do after? (C-Consequence)	Comments
Ex. Child asked for an item that was not there i.e. asked for goldfish but we were out so I offered something else and that is what triggered him to run towards the wall.	Ex. When told no, child ran to wall and banged head against the wall.	Assessed intensity of headbanging; planned ignoring; once child was calm – I said, “I know you are mad” paired with modeling taking deep breaths; offered any other snack choice as well as a highly preferred option to support success; then offered two preferred activities to prepare for transition.	Notes: If child asks for something that you can anticipate and know you do not have, get within close proximity of child before answering to block/redirect attempt to run to wall and bang head; quickly provide a highly preferred choice and/or sensory activity to redirect attention and focus

Simple ABC chart and example

Once you have begun to discover patterns or reasons behind the behavior, you can start to implement strategies to reduce and replace self-injurious behavior. Simple manipulations in the environment and non-contingent sensory options available as needed can provide the child with opportunities to stay regulated throughout the day.  This will create a foundation for accepting non-preferred directives and engaging in non-motivating tasks more easily. 

Each child has their own unique sensory preferences.  With that being said, heavy work activities are my go-to and have been shown to help children calm, organize, and support achieving optimal self-regulation.  But first heavy work, right! Seriously! Lifting, crawling, picking up weighted objects, pushing weighted objects, can greatly help the body calm and organize to support optimal self-regulation.  Provide multiple opportunities daily to engage in heavy work and organized movement activities.  We must nurture and support the child’s sensory system while providing guidance with helping them express and understanding their emotions and the emotions of others². 

Remember, headbanging and other self-injurious behaviors are a way of communication.  The more we are mindful of the child’s unique needs, the better strategies and supports can be implemented to help them regulate in a better way³.  One way to do this is giving children the words when they are unable to verbally communicate.  This is such a powerful strategy to help children understand that you do in fact know they are upset. 

My son uses signs, word approximations, gestures, and PECs to communicate.  When my son is upset and trying to express himself, we often say “I know you are mad” or “insert whatever I think he is upset about”.   This has been a strategy that consistently works to help him calm and organize.  Also, we pair this with a simple breathing exercise – just modeling taking a deep breath in and then exhaling.  We have been using these strategies since my son was about 13 months old.  He also loves deep pressure input and hugs.  When he is upset, we will also ask him if he needs a hug and this typically calms him down enough for me to then offer him alternative choices. 

The one consistent thing I have noticed is that when I am at my most regulated, I have better success with helping my son calm and organize as oppose to when I am frazzled, angry, or upset.  You are your child’s anchor to regulate.  The strategy you use is only as good as how you execute it.  Be mindful of your emotions.  When you as the parent or therapist are calm and organized you are using yourself as a therapeutic agent through co-regulation⁴.  This will naturally create a calming environment and set the stage to transition to a new task or activity.  Most importantly, be kind to yourself.  This journey is far from easy and will feel like an emotional rollercoaster, from both a parent and therapist perspective.  Stay mindful and know you are doing the best you can.  You are amazing!

Next time you are out in the community and you see a parent working through a “behavior”, look at them and smile.  Ask them if they need any help?  Give them a thumbs up.   Tell them they are doing an amazing job. You have no idea how much that could mean to them in the moment.  It may just be enough to get them regulated to be that anchor their child needs, to calm, organize, and work through the situation as gracefully as possible.  Sending everyone good vibes for a mindful day!

Disclaimer: This is me sharing my story as a pediatric occupational therapist and now mother to a neurodiverse toddler that engages in self-injurious behaviors daily.  This is just my thoughts paired with my years of experience, that guided me down the journey of determining the supports and strategies to use with my son.  This is not providing occupational therapy services or medical advice.  If you have any concerns about your child’s development, please speak with your pediatrician or occupational therapist for further evaluation and treatment options.

References

¹Wacker, D., Northup, J., & Lambert, L.K. (1997). Self-injury. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company

²Dyer, K. & Larsson, E.V. (1997). Developing functional communication skills: alternatives to severe behavior problems. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company.

³Edelson, S.M. (1984). Implications of sensory stimulation in self-destructive behavior. American Journal of Mental Deficiency, 89, 140-145.

⁴Gulsrud, A.C., Jahromi, L.B. & Kasari, C. (2010). The co-regulation of emotions between mothers and their children with Autism. Journal of Developmental Disorders. 40, 227–237. https://doi.org/10.1007/s10803-009-0861-x

It is OK to plug in and unplug
By: Danielle Delorenzo, OTDS, OTR/L

I express often that the world we live in now has smart phones and tablets as the norm and is what I feel, a main occupation- the preferred method for communication, social interaction, and gaming for many individuals

I grew up in the early 80s. I had a see through corded phone with an extra long cord so I could travel to all areas of my room. I played outside until the sun went down. I played kickball, paintball, and capture the flag with my neighborhood friends. I would write notes to my friends and fold them in cool, unique ways – totally awesome OT activity by the way

We engaged with each other more. We hung out in groups and figured out what to do for the day by talking to one another, face to face or talking on the phone/3 way calling. We looked at actual maps to get from point A to point B. We went on adventures. We did Werid NJ stuff (such a cool book). All without smartphones and tablets

We did so much thinking in creative and problem solving ways. And without us even knowing it, we were also building the foundations within our central nervous system and overall development through these connections and experiences, setting us up for success within the educational setting

Look, we watch TV and I give my 2 year old a tablet. And yes, he has his own kindle. For the most part, Luke uses the iPad/kindle for up to 10 minutes at a time. We use a timer and set it for 5 min and he is allowed to ask for more time when the timer goes off. This strategy actually makes transitions soo much better and he is much more willing to give it up after he has asked for more time

And then there are some days, we watch TV and play on our phones all day. Because we are tired. Why are we tired you ask? Life. Period. And when we watch movies and play games on the phone, we are all together as a family. We are asking questions about what we are doing, snuggling, sharing our moments together and just being a family

Luke has actually learned so many words and concepts via the TV that now I actually consider it a blessing in moderation 😂😂 and trust me, even though we are such an active family – always out in nature – I still feel guilty when I am on my phone. I am learning balance does not exist. It’s more like I never know what each day will bring so I just try to be as cool, calm, and mindful as possible when deciding how plugged in for the day we are going to be

The moral of my story is, unplug as often as you can and do not feel guilty for the times that you you plug in. Your brain does need a break and it is during these breaks that true creativity and problem solving thought bubbles can truly occur. Take some time for yourself but also get outside, go on adventures, play board games, laugh with friends. And when using technology, try to incorporate human interaction as much as possible

Mindfulness in Motherhood – Four Part Series
By: Danielle Delorenzo, OTDS, OTR/L

Part 1: Pre-Pregnancy

I had been working on this series for months. Each day I would sit down and write a tad more. I just kept writing. I had been trying to figure out how to put it all down into written expression and then decided, I just could not do it. If you had the chance to listen to my podcast appearance on @ot.4.lyfe, episode 51, you got an inside glimpse of my personal and professional life colliding.

Early Intervention with an OT Mom with Danielle Delorenzo

Part 2: Pregnancy

Part 3: Labor and Delivery

*These audio clips go into detail about my birth experience. I share it all, and I mean ALL. So if that is not something you are interested in hearing, no worries! I just wanted to give you a heads up before you embark on listening to my birth story and get blindsided by it 🙂 *hugs*

Jasmine’s Website💙 https://www.jasminerosedoula.com/

Part 4: Postpartum and Beyond

Step out of Your Comfort Zone
By: Danielle Delorenzo, OTDS, OTR/L

I had a work trip planned for months to Seattle.  This would be the first time that I traveled without my family and the first time ever being away from my son.  While booking my tickets at work, I had tears running down my face because I had no idea how I was actually going to get myself there in one emotional piece.

Also, I legit pack for a trip weeks in advance. I have several checklists created to ensure that when traveling, I do not forget to pack the gazillion essential items my anxiety thinks it needs.  Not this time.

I flashed back to the Ted Talk I had been listening to about being mindful and breaking bad habits.  Only this time, I wanted to switch out bad habits for anxiety responses.

I decided to pack the night before and finished up the next morning.  Every time anxiety tried to creep in my brain, I honored its concerns, and moved on with the day.

We were late getting to the airport.  One woman made us feel horrible for being late and when anxiety/anger tried to creep in, I honored it, and kept on moving.

We got to the gate with minutes to spare. We were greeted by a lovely lady and man who saw I was a tad overwhelmed.  I expressed that we were late because I was giving extra snuggles to my son and that it was the first time I had ever been away from him.

He saw I was traveling with my friend and asked if we would like to sit next to each other.  I knew the plane was full and somehow, this amazing man got My (Mimi) and I two seats next to each other.  We were the last ones to  board the plane and off to Seattle we went.

The flight was perfect.  I read a book for a bit, engaged in meaningful conversations, and listened to my favorite tunes.

Once we were flying over Seattle, all I could see was different colored leaves for days.  It reminded me of the Pennsylvania rolling hills of oranges, reds, and yellows.  Even though I was feeling extremely nervous on the plane about leaving my boys, I stayed with the trees.

I stayed mindful in the moment and reminded myself that I had three days to explore Seattle.  I did not want to waste any of that time letting my anxiety dictate my trip.  And that is exactly what I did.

When we went to the rental place to pick up our car. I was secretly hoping to get an upgrade and sure enough, we were able to get a luxury-ish SUV.  We had not even set foot in Seattle for more than an hour and the stars were already aligning in our favor.

My and I got to visit with friends, explore the city, eat amazing food, and make the most out of our work trip within the short time we had in this beautiful city. 

I stepped out of my comfort zone and had three days of Seattle self-care.  I was able to facetime with my family and still put my son to bed while showing myself, “Wow, I really can do this!”.

I could feel the new neural connections being formed.  I could feel my brain resetting its foundation with each affirmation of honoring my anxiety and then moving on, all without skipping a beat. 

This experience changed me, for the better.  I began to break the anxious cycle of fear and Motherhood guilt for having much needed “me” time.  Self- care is a necessity.  It is not something one should feel guilty about, rather, it should be incorporated into everyday routines to ensure you are giving your brain and soul the nourishment it needs to maintain optimal mental health.

Here are some of my favorite Instagram accounts, in no particular order because they are all amazing, that help me stick to my daily affirmations, nourish my soul, and support my rollercoaster of emotions on my journey as a mother:

@the.holistic.psychologist
@drsabina_phd
@joy.energy.time
@nurture_neuroscience_parenting
@synergy.gentle.parenting
@transformingtoddlerhood
@betterpostpartum
@journey_to_wellness_
@heyamberrae
@thrivinglittles

Sending everyone good vibes for a fun-filled Sunday and Mindful Monday #nourishyoursoul #selfcare #stepoutofyourcomfortzone #sundayfunday #makeitamindfulmonday

Disclaimer: It took a village to make this trip happen. To my hubby, thank you for watching Lukey alone for three days. I love the new hot pink nail polish designs Luke added to the carpet😂 You are amazing. I love you.

My buoy, you are the reason I actually made it on the plane. Your friendship will be cherished by me for life. Cheers to the most organically flowing, much-needed trip, that was filled with a little bit of learning and a whole lot of fun. I love you!

Jen, thank you for always being amazing. Thank you for helping Chris with Luke’s first dentist appointment while I was away. We love you!

Make It A Mindful Monday
By: Danielle Delorenzo, OTDS, OTR/L

Mindfulness is so simplistic in nature that I fear it is the reason it is most often misunderstood or overlooked as a hot, new trend
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The last year and a half, I have been buried in mindfulness research, talking to anyone and everyone about all things mindfulness, and gathering the best-evidence to support my final capstone project for my OT doctorate
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The majority of people I spoke with had such a positive and warming association with mindfulness.  On the other hand, some individuals that I spoke with brushed it off as a hot, new trend.  Something all the cool kids were doing.  Or, they would mock “being present in the moment”.  When I would express that there are several hundreds of research articles on this topic, I was met with redirection, avoidance, and almost mockery
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As a researcher and life-long learner, I found the concept of mindset interesting.  Doesn’t everyone want to learn more about the things they may not quite understand when presented with new information, especially if there is evidence backing it up
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Mindfulness has been around for centuries.  In the late 70s, John Kabat-Zinn brought mindfulness to modern day practices with Mindfulness-Based Stress Reduction programs.  The history of mindfulness is overflowing with research and unfortunately,  that history can sometimes get lost
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It promotes better self-efficacy to ensure you are giving your body and soul what it needs while being present in the moment
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I have tried to incorporate mindfulness into my daily routine my entire life.  It was not until I completed post graduate studies and I received a certificate in Infant Mental Health from Chatham University, did I truly embrace how important being a mindful individual was
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It has been just over a year that I have embedded mindfulness into my daily routines.  I will tell you that mindfulness is not a cure for all things.  What it will do, is get you better at knowing what your body needs to maintain optional self-regulation, mental clarity, and better adaptive responses in stressful situations
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When you increase your self-efficacy of what your brain and nervous system prefers, you can begin to engage in meaningful occupations that support the optimal regulation of your body and steer clear of the things that you know sabotage your soul
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I created #makeitamindfulmonday because we get a new Monday each week.  A new opportunity to start the week fresh, rejuvenated, and full of positive intentions.  Some Mondays, you will not feel like that.  This is when you have to be mindful the most as to what your body needs to nourish its soul
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Tag your posts and share how you #makeitamindfulmonday
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Sending everyone good vibes and positive intentions for a fabulous week!

It is OK to be mad. It is OK to be sad.
By: Danielle Delorenzo, OTDS, OTR/L

I love my son. He is the most energetic, rambunctious ball of high energy with so much love to give. He truly is the most amazing human I have ever met.   I will advocate for him and his needs every single day of my life
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But I am angry and I am sad and I have been struggling for years with that gut feeling knowing something was not right and now other people see what I have been seeing since day one
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It’s OK to be angry. It’s OK to be sad.  But don’t let it overwhelm you. Don’t let it consume you. Think of it as a cloud that needs to pass by
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I spoke with so many beautiful, amazing friends these past few days and it’s funny, when you are in special education the 1st thing that you do when you think something is wrong with your kid is contact every single person you know in the field and pretty much they all said the same thing, “He has the best mama he possibly could have and whatever it is you are going to be able OK”
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Luke is who he is and that will never change and no diagnosis will change who he is as a person
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This post is more about it’s OK to be angry and it’s OK to not feel guilty for feeling angry because that does not make you a bad mom. In fact, it just shows how authentic and human a mother’s emotions can truly be
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Navigating the early intervention system and medical world via seeking out a diagnosis can feel like an unstoppable rollercoaster of emotions.  Honor yourself.  Honor the warrior parent that you are.  Trust your judgement and seek out individuals that will actively listen to your concerns and help guide you in the right direction. Remember, no one knows your child better than you
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#itsOKtobemad #itsOKtobesad #honoryourself #honoryouremotions #warriormama

Mindfulness is not trendy
By: Danielle Delorenzo, OTDS, OTR/L

The last year and a half, I have been buried in mindfulness research as well as talking to anyone and everyone about all things mindfulness, and gathering the best evidence to support my final capstone project for my OT doctorate.
🌴
The majority of people I spoke with had such a positive and warming association with mindfulness. On the other hand, some individuals that I spoke with brushed it off as a hot, new trend. Something all the cool kids were doing. Or, they would mock “being present in the moment”. When I would express that there are several hundreds of research articles on this topic, I was met with redirection, avoidance, and almost mockery.
🌴
As a researcher and life-long learner, I found this mindset interesting. Doesn’t everyone want to learn more about the things they may not quite understand when presented with new information, especially if there is evidence backing it up?
🌴
Mindfulness is not a hot, new trend. It has been around for centuries. In the late 70s, John Kabat-Zinn brought mindfulness to modern day practices with Mindfulness-Based Stress Reduction programs (Kabat-Zinn, 1994). The history of mindfulness is overflowing with research and unfortunately, that history can sometimes get lost.
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Remember, mindfulness is not a trend, it is a way of life. It promotes better self-efficacy to ensure you are giving your body and soul what it needs while being present in the moment.
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I received a certificate in Infant Mental Health from Chatham University over 10 years ago.  That was the beginning of my realization as to how important being a mindful individual was.  I spent the next decade of my life, leading to present day, trying to embed mindfulness techniques in my life, however, I never quite mastered the balance.
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Day 1 of my post professional occupational therapy doctoral program marked Day 1 of giving my all to my mindfulness journey.  It has been just over a year that I have put 100% effort into embedding mindfulness into my daily routines. I will tell you that mindfulness is not a cure for all things. What it will do, is get you better at knowing what your body needs to maintain optional self-regulation, mental clarity, and better adaptive responses in stressful situations (Quach, Jastrowski, & Alexander, 2016).
🌴
When you increase your self-efficacy of what your brain and nervous system prefers, you can begin to engage in meaningful occupations that support the optimal regulation of your body and steer clear of the things that you know sabotage your soul.
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Thank you for taking the time to read my blog and embracing mindfulness for your soul.  Sending you all the vibes to #makeitamindfulmonday

References

Kabat-Zinn, J. 1994. Wherever You Go, There You Are: Mindfulness Meditation in Everyday  Life. New York: Hyperion.

Quach, D., Jastrowski, K., & Alexander, K. (2016). A randomized controlled trial examining the effect of mindfulness meditation on working memory capacity in adolescents. Journal of Adolescent Health, 58(5), 489–496.

Check out my post with aboutredlands.com!
By: Danielle Delorenzo, OTDS, OTR/L

Happy Friday Fabulous Friends !!!!! I was asked to guest write another post for aboutredlands.com. I love everything they are about and I love working with Niko to support all things related to OT and how we can continue to benefit our community by sharing fun and easy ideas to support overall development and optimal mental health within the child caregiver dyad.

Also, I asked my work wife @elevatedstateofplay, Mimi, to join me in creating a Top 5 morning activity list. Be sure to click on the link within the article to check it out, let us know what you think, and what else you want us to share🤸‍♂️Sending everyone good vibes and positive intentions for a happy friday and mindful weekend!!

Photo credit: @bigoimagery

https://aboutredlands.com/articles/mornings-with-an-ot-mom-a-mindful-business

A hug goes a long way…
By: Danielle Delorenzo, OTDS, OTR/L

There has been so much going on behind the scenes, balancing and navigating through so much amazingness and stress at the same time, and all I want to do is scream all about it to the rooftops. Big announcements coming soon, hold tight, it’s going to be an amazing and mindful ride. For now, I must share with you a recent amazing experience.

It all happened so fast. It was last Monday. I was watching my Instagram stories, keeping up with all the awesome accounts I follow, my amazing colleagues, and soul OTs slaying it out there, and @thesensoryproject208 posted a story of a mother and her daughter and I remember reading something about weighted blankets.

One, if @thesensoryproject208 is posting about it, I am going to totally check it out. Two, I have been searching for the perfect weighted blanket for years. I have even made my own but have never been able to get the exact feel and weight my body needed. Three, I now have a two year old with very similar sensory needs as myself.

So down the Instagram rabbit hole I went, to @sheltered.co. I went to their website and got stuck there for about 30 minutes. I had finally found not only a product that I truly thought would help my son and I but a company that had values and a mission I could stand behind. As a pediatric occupational therapist and mother to a son with specific sensory needs, this company and their products gave me all the feels.

I immediately went to their stories. I discovered that they were releasing four new colors the next day at 9 am. The next morning I placed my order. I even paid for overnight shipping because I wanted to trial it out Thursday night into the weekend!

The blanket arrived Thursday morning. It was a very fast- paced day, as per usual, and my brain was racing, as it typically does on a daily basis. When I got home, I had discovered my son had got to the box first and ripped off the labels. Clearly he was just as excited as I was for this blanket. I went into a room by myself and opened up the box. It was so beautifully packaged, screaming hugs and love, that I did not want to touch it until I had uninterrupted time to explore what I had just purchased. Fast forward two hours later, toddler asleep, let the fun begin!

The Blanket. Orchid adult sized blanket. 100% cotton. Imagine, me staring and smiling at the blanket in awe of its beauty, honoring how much love, thought, and care was put into making such a stylish, sustainable product. Did you know Pam only uses dead stock fabrics?! You can read all about it on Sheltered Co.’s blog!

The presentation of materials was simplistic, eye-catching, and dazzled with personal touches. As an Educational Occupational Therapist, I truly appreciated the enclosed post card with a thoughtful written message. In this fast-paced world of innovative technology, one must always appreciate written expression. Moreover, the blanket came with its very own travel/storage bag. You better believe I will be taking this blanket everywhere with me!

Since I have been using this blanket as needed throughout my days and nights, I have felt less anxious and more calm consistently throughout the day. That constant edge of anxiety felt quieter and for the first time in a long time, I actually was able to rest my brain. I vary the amount of time I use it based on how my nervous system is feeling day to day. Also, my sleeping patterns started to regulate. I am a very light sleeper and startle awake from sound quite often. The first night I slept so deeply that I slept through my first alarm. I am pretty sure my body had no idea what to do with its rested self. This blanket has truly been the best additional item to my sensory suitcase.

As for my son, he has his own agenda. He prefers to drag the blanket around the house, pull it over him and throw it off of him while laughing, and run around on top of it. He does calm and organize for a few minutes and then he is off running again. We have just begun our journey with helping him figure out what he needs to calm and organize. We just keep adding to his sensory tool bag to increase the variety of choices he has to access when needed. This is just another beautiful example showing that every individual has a unique and ever-changing nervous system.

I have been on a life-long search for sensory supports to help me calm, organize, and maintain optimal self-regulation. The last ten years as an occupational therapist has provided me with extensive knowledge of sensory processing and various intervention strategies that I have tried and ruled out as ineffective or added to my sensory suitcase. The important thing to remember is that each person has a unique nervous system with their own specific needs. One must explore and determine which sensory supports they would need to promote their own optimal self-regulation.

Thank you Pam for creating a business that supports our hidden sense of proprioception and for making your business grounded in ethical and sustainable practices providing fashionable hugs to all!

#hugslikeamother

https://www.shelteredco.com/

*disclaimer * This is my personal review of a product and a business I chose and will continue to support. I am not affiliated with the company in any way and they did not ask me to write this review. I just truly think Pam is amazing and her company is sensational!

*disclaimer* This blog post is not providing medical advice and it does not claim to do so. Please consult with your pediatrician, doctor, and/or occupational therapist for recommendations, treatment, and specific intervention plans.

I did a thing!
By: Danielle Delorenzo, OTDS, OTR/L

I was asked to write a guest blog for aboutredlands.com. I love aboutredlands.com and what they are all about. If you are a local business in the Redlands area, I highly recommend you check out their site! Local people supporting local business!

Here is the link to my article!

Start your day off with “How Mindfulness can bring you home”.

https://aboutredlands.com/ar…/mindfulness-can-bring-you-home