What does it mean and what do we do about it in Occupational Therapy?
Regulation is how a person responds or adjusts to changes in the situations and environments around
them. Responses include:
● Arousal (are they awake and alert or do they look like they are about to fall asleep?)
● Emotions (are they happy, sad, anxious, annoyed, fearful, angry, frustrated…)
● Attention (are they engaged or having difficulties concentrating?)
● Organization (are they having difficulties putting their thoughts or actions in an order that
● Behaviours (are their actions expected or unexpected given the situation?)
When someone is described as “dysregulated”, it means their responses are not what is expected given
their age and the situation. For example, a child who is running around the classroom while his peers are
sitting quietly making their way to story time, or a child who hits in response to a light touch on the
shoulder may be considered dysregulated.
What do we do in occupational therapy?
The primary goal of occupational therapy is to help people to better participate in the activities they
need and want to do in their daily lives (i.e. their “occupations”). For children this includes playing,
making friends, doing school related activities, sleeping, helping around the house and doing self-care
activities such as getting dressed and using the toilet. A dysregulated nervous system can make it very
difficult for a child to participate in many of these occupations. Therefore, before or in addition to
working on specific activities, occupational therapists often engage children in certain types of play,
movements and sensory experiences aimed at regulating the nervous system so the child can access
their upstairs brain for better learning.
Why might a child be dysregulated?
The nervous system is basically the brain and its connection to the entire body. It can be helpful to think
of the brain as having two parts: the“upstairs” or “grown up” brain (the outer part of the brain, or the
cortex, that is especially large in humans and allows for complex thinking) and a “downstairs” or “baby
brain” (the midbrain and the brain stem which are in charge of automatic responses, including the stress
response and reflexes required for basic survival).
Our bodies receive information from our environment through our various senses. This information
travels up the nervous system to the downstairs and then the upstairs brain. The brain looks at this
information (processes it), comes up with a response and sends that information back down to the body
to be acted out. This is a complex system. Sometimes parts of this system are underdeveloped,
overactive or under-active causing miscommunication and confusion. This is what leads to dysregulation.
The following videos explain help explain these ideas further:
Why Do We Lose Control of Our Emotions?
Brain Highways Organized Brain?
A Child's View of Sensory Processing
What is “co-regulation” and “self-regulation”?
As social beings, our regulation can be significantly influenced by those around us. This is called “co-
regulation”. Before a child learns to “self-regulate”, they rely heavily on the adults around them to help
them co-regulate, by recognizing and responding to their needs, modeling appropriate responses,
supporting them through difficult situations or providing them with soothing sensory experiences (for
example, rocking a baby while singing softly). As the nervous system matures, children gradually learn
more self-regulation strategies. Occupational therapists work with children and their families to help
them develop co-regulation and self-regulation strategies that promote participation both the family’s
and the child’s occupations!
Nicole (Nikki) Lemire OT. Reg. (Ont.) / Erg. Aut. (Ont.)
Occupational Therapist / Ergothérapeute