Dysregulation & dyspraxia in toddler

Hi! I am a new grad EI OT. I am suspicious that a kiddo on my caseload has dyspraxia and am planning to submit a referral for the child development clinic in my area to seek confirmation/diagnosis/etc. The child is 21 months… but super dysregulated. I want to try challenging motor planning in a controlled way but I can’t get this child to do anything other than run (full of stumbles). No purposeful play. The only play really is “chase” which is meeting this child where their at for sure… any tips on regulating this child so I’m best able to access them during a motor plan challenge/obstacle course would be very helpful. This child appears to only have one speed (fast!!) and will run on all surfaces with no regard for safety (uphill on asphalt, down hill on rocks, etc). Needless to say, this child stumbles and falls quite frequently which is very stressful for Mom. This child is best described as pinball - back and forth constantly with little to no functional play. This child HAS the gross motor skills expected at this age, but does not use them functionally at all… and has no more refined play skills/ability to sustain attention.
Happy to answer any further questions to paint a better picture :slight_smile:

Hey there! He seems to be a bit of a sensory seeker, although the input never satisfies him. Why do you think he has dyspraxia? I would want to observe him on the playground. Does he know to go up the ladder and down the slide? Does he seem to have a plan for his play or will he only run around in circles? Does he do any sort of gross motor imitation like touching his head or tapping his knees? Will he tolerate vestibular input on the swing or does he prefer to keep his feet on the ground?

I have a lot of questions, sorry! :slight_smile:

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And I would definitely see if I could use linear swinging and deep pressure to see if that would help him regulate!

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Hi @Allison! It sounds like you’ve got a very energetic little man who has difficulty controlling his body and movements.

I have often seen kids who appear to move very fast because they actually lack core & postural strength and literally can’t hold still. I have even seen these children climb and move as you describe, but when they need to stop to perform activities when just sitting or standing, they really struggle and also trip and fall because they can’t activate those postural muscles to pull themselves back.

Obviously I’m speculating here and speaking generally because I haven’t seen this Tot, but I would probably start in sitting actually-maybe on a therapy or small peanut ball, maybe on a wobble cushion on the floor with toys all around.

Try playing on a scooter board in prone to strengthening extensors-even if you are just pulling him around.

Log rolling, crawling through tunnels, and quadruped play can really help develop those weaker muscles and improve body awareness.

Doing purposeful obstacle courses at this age can be tough for attention span, but starting by slowing him down could be a great way to focus your sessions.

@Starfishtherapies @Emily_Whigham_Heisey @BreeMilani @PT4kidz80 @magicmomentstherapy @Tinytotspt any other suggestions??

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I agree with all of these ideas and I had the same thoughts. If you have a crash pad I would do crawling over that, also pushing heavy objects (fill up an upside down stool). Basically you want to look at making his desire for movement into something you want him to do and make it so that he is getting the strengthening and his sensory needs met. For these kids we start with bouncing on a ball or swinging a lot of times to get that first and then try to do a task that is more functional. Also if you have a bosu or something like that where you can have him stand on an unstable surface that he has to pause before he can figure out how to get down. Often stepping stones or stools work as well.

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Hi @Allison,
All the above suggestions from Mary and Allison and @Starfishtherapies are great! I might add if you have a trampoline (large one) with enclosure where you and he can be on it GENTLY bouncing up and down in stance. I am assuming at 21 months he isn’t jumping yet . Fingers crossed :crossed_fingers:. If he is , then maybe scratch this :bulb: idea! Lol! But if he doesn’t have control and strength to jump off the ground yet, then by gently bouncing in stance while y’all look at a book or sing a song or talk or blow bubbles. Would be a great way to slow him down and do something cognitive while trying to maintain balance. This is similar to the bosu ball idea but the trampoline is a larger surface area and will be hard to run around on. And again, not something he can jump on yet. I love the uncertainty of that large surface before they can jump. It’s like a large balance pad. Also blowing pinwheels, water with a straw and breathing activity may help calm him to do an activity as well. Keep exploring
Jennifer PT PCS

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