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Podcast Episode Transcript

Episode 16

Navigating Sensory Processing Differences with Dr. Winnie Dunn

Interview between Speaker 1 (Meg) and Speaker 2 (Winnie Dunn)

[Introductory note]
Hey, podcast listeners! Just jumping in to tell you about a free live event that you will not want to miss. January 11th through 15th, 2021, Learn Play Thrive is hosting the second annual Neurodiversity in the New Year Summit. It's always a huge party, and the theme this year is Self-Actualization and Self-Advocacy. When you register for the summit, you'll get to hear five days full of live talks from autistic OT's, psychologists, self-advocates, and even an autistic comedian. This is a New Year celebration you will definitely want to be a part of. Get the details and RSVP 'Yes!' at learnplaythrive.com/summit.

[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in occupational therapy practice. I’m Meg Proctor from learnplaythrive.com.

Meg: Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say, ‘autistic person,’ rather than, ‘person with autism’. What we’re hearing from the majority of autistic adults is that autism is a part of their identity that they don’t need to be separated from. Autism is not a disease, it’s a different way of thinking and learning. Join me in embracing the word ‘autistic’ to help reduce the stigma.

Hello! Welcome to 2021, and welcome to Episode 16 with Dr. Winnie Dunn. I didn't plan that but I'm pretty excited that that rhymes. The reason this is the first episode of the season is because Dr. Winnie Dunn is a huge player in the field of occupational therapy and beyond. I'm going to tell you all about her and about the insight that she is going to share with us in this interview.

Dr. Winnie Dunn is a distinguished professor of occupational therapy at the University of Missouri and a certified positive psychology coach. She's an expert for her work on sensory processing in everyday life with hundreds of publications and presentations. She's also the author of the sensory profile which is a ubiquitous tool in occupational therapy practice. Dr. Dunn's most recent work demonstrates the effectiveness of parent coaching and telehealth. She's published about the effectiveness and fidelity of coaching as an evidence-based practice, and her accolades are abundant. She's received top honors in her field, including the Academy of Research; she's received awards for engaging teaching, including the Chancellor's Excellence in Teaching Award, and the Kemper teaching fellowship, and the Chancellor's Distinguished Professorship.

But if I can tell you something else about Dr. Winnie Dunn, it's that she's kind and funny to talk to. She cares deeply about people who experience the world differently, and she is a total trailblazer. In her lifetime, she has completely changed the way we think about sensory processing. So, whether your work is super focused on sensory processing, or if this really isn't a lens you use very often, it doesn't matter. There is so much that anyone working with autistic people can learn from Dr. Dunn that we can apply to our work right away. Here's the interview.

Hi, Winnie! I'm so happy to have you on the podcast.

Winnie: Thank you for having me!

Meg: All right, so, I'm going to start off with a confession to you, Winnie. I finished OT school as a real sensory intervention skeptic. There was just so much confusion about sensory processing, so much pseudoscience, so many things that lacked evidence or veered away from occupation-centered practice. I didn't know what to do with any of it, so I just mostly avoided it. And for a while that sort of worked but as I saw kids in my work and I talked to their families, and certainly as I've been listening to autistic adults describe their own sensory experiences, it's so clear that sensory processing is hugely impactful in autistic people's lives, and in their engagement and daily activities. So, to start off, talk to me about why you focus so much of your work on sensory processing, and what are some of the key elements of the model of sensory processing that you have come up with?

Winnie: Well, before I talk about the model, I think I want to say to you, I'm happy that you were a skeptic, you know. That's what all of us should be doing. We should all be asking those questions about ourselves and being willing to listen to the people we serve, and what they have to say about what their experience is. I mean, if occupational therapists can't do it, who's going to? You know, our whole profession is focused on how people live the most satisfying life possible. So, as with many things, when you look back on your life, you figure out how things happen but you didn't understand that that's how they were happening when you did it.

One of my field works when I was an OT school was then — because then children were still segregated into separate schools — you know, it's in my lifetime that the public law has affected children being in their neighborhood schools. But I was working — what I know now as working with men and women, therapists and teachers, administrators — that they just weren't going to take 'No' for an answer. They were tenacious, they were willing to try things, but they were also willing to look and see if what they tried had an impact, and abandon it if it didn't. They taught me how to be adventurous and willing to just find out what was true.

So, I'm so grateful to all of them about that. One of the things they did, for example, was it was very controversial to use sign language with young children back then because everybody thought that you would — the kids would never talk. What we know now from the evidence is they talk sooner because they're not frustrated, but back then it was very controversial. And these men and women would sneak signs to the children. [Laughs]

Meg: Wow.

Winnie: You know, like, they'd just hide them, and they just did the basic ones, you know, 'potty', and 'more', 'food', and 'drink'.

Meg: And I'll say you were signing more and mouthing it when you were describing what you were doing.

Winnie: Because they, you know, they wanted the children to be able to communicate and they were willing to try it. So, I have this model from my early, early career of people being willing to try what might be useful for a person's life. So, as things then proceeded, I worked in the public schools and I had the experience of this whole range. I worked in a school that had all kindergarteners. And, you know, there were this whole range of skills and behaviors, and I was trying to figure out what was going on, and that was right when Jean Ayres was also trying to figure out. Children were coming out of institutions, they had behaviors that weren't fitting into the patterns of other categories that we already had. And so, this idea about sensory processing, of course, Jean Ayres was the one that pointed it out to us and helped us understand that it's another place to look.

And so, you know, I learned some of my early stuff, was from learning from her and finding out what this other way of interpreting behavior meant. Because I always worked in public education, I've always looked through the lens of what does everyday life look like. It never occurred to me to separate out a factor or a feature of a person, and try to fix that thing. It was always like, "How's this gonna help him when he goes back to his class?", or "How's this going to help him at recess?", or "How's this gonna help when he plays with his friends?" And so, I feel like some of my early things that I understand now helped me to ground all of this.

So, when all the OT's got more and more interested in sensory processing, I was working in this public school with all the children, and nobody knew which children would be in special ed, or, you know, it was like the first year of the special ed laws, and everybody's like trying to figure it out. And so, I did a whole bunch of tests on every child in that kindergarten to figure out what made them distinct. That's like the roots of all of this, is like the everyday experience of children. It's cool. And so, through repeated questions I kept asking, I kept figuring out that there were patterns, and things got bigger and bigger, and I had other therapists offering to help me gather information.

So, what we know now is we have, you know, from looking at thousands of people from birth to death — I mean, the whole age range — four patterns keep showing up. No matter how old you are, no matter if you have a condition or not, these four patterns keep showing up. And they are based on how the nervous system operates. So, 'Seeking' is when you have a really high threshold in your nervous system to react, and you're really interested in getting those reactions. Seekers do a lot of engaging in a lot of behaviors to get more. They rub on the walls to feel the texture, and they might reach out and touch your clothes, or want you to try their food because the texture so cool. So, Seekers really love sensory input, and they want more because they need more to get their thresholds to fire.

The second category are called 'Avoiders', and these are people that have really low thresholds. Their brains are geared to detect everything. When they detect something that's unpredictable, their tendency is to perceive it as potentially harmful or dangerous. And so, the reactions are big. They're either withdrawing to get away from it, or maybe acting out to push it away, but it's the unfamiliarity and the frequency that causes them to have that reaction because their nervous system is firing a lot. So, we have to see those things as adaptive behaviors, because all of us have them, not just people who have conditions like autism.

The third category is called 'Sensitivity'. And these individuals also have low thresholds like Avoiders, but they try to participate! Like, they get in there and try, and then they get kind of overwhelmed. And so, Sensors — that's what we call them — they might be bossy because they're trying to get you to, like, stop rustling your paper, or not chewing the gum that has all the sucrose in it because they can smell it, or not wearing perfume, or being picky about their socks. So, they're trying to get in there and participate. They're not withdrawing as much as the Avoiders do.

And then the fourth category is called 'Bystanders' and they have really high thresholds just like the Seekers, but they are just easy going. Those thresholds can stay up there. They miss cues, they don't get riled up about stuff. I think we could all do a good service by having a Bystander in our lives, because they're kind of chill. They can also miss cues that they need to notice, but each one of these patterns has good features, and hard features. They're not diagnoses, they're just characteristics.

Like, I have Seeker tendencies, so I'm much more likely to try to get a whole bunch of errands done in a really short period of time. Or, say, I make a rule for myself like, "You can't cross your own paths or it has to be in a circle," like, those are the sort of things that Seekers do. It doesn't mean I have to fix it; it's just a quirky thing that Seekers do because they want to keep those thresholds firing. Those are the patterns, and we've tested kids and adults, we've tested people with mental illness, people with learning conditions, we've tested all the people. Your parents, your grandparents, and the same patterns keep showing up.

Meg: You know, these terms are so ubiquitous now that we have them in our pocket to describe and see.

Winnie: I know!

Meg: So, it's so interesting imagining your experience when they weren't. When these things were described as 'challenging behaviors' or 'unexpected behaviors', and it sounds like you said, "Wait a second, maybe these kids have different needs and they're trying to meet them."

Winnie: Oh, yeah. They're doing adaptive behaviors or not, but behaviors are okay, but they're still adaptive because it's telling us that they understand what's going on with them. You know, I think it's so ironic that we do a lot of research with people who have conditions like autism, or ADHD, or whatever categories, schizophrenia. And they, as a collective, experience the world in a more intense way than the rest of us, so it makes it easy for us to see what the pattern is. But that being said, I would go out and give talks about a group of children and families who had a kid with autism, or adults who have anxiety or other mental illnesses, and they would come up and say, "My neighbor does this, my pastor does this, you know, my husband does this—" And it just like dawned on me, these constructs are all of us. They're about all of us.

Just because one person experiences it in a more intense version, or they're in an environment that isn't very friendly to them, doesn't make it pathology. It's the same thing. It's the same thing that all the rest of us have. It's humanity. It's the way that our brain understands what's going on in our bodies and in our world. And that's how I figured it out. But, of course, we started with people who had disabilities because they were easy to see.

Meg: That's really interesting, and I love the inherently strengths-based approach to that. And it comes up again and again, this idea of moving out of the medical model, and moving out of pathologizing different ways of thinking, and learning, and experiencing the world. One of my favorite things is when autistic people turn it back to us and say, "You experience the world in such a shallow way compared to us. How sad that you can't experience the joy of sensory stimming."

Winnie: Right! Exactly. And I read a piece the other day — I have an article that we have our students read — and it's about people with bipolar disorder. And they talk about the richness of their lives. You know, that they can't imagine not having that richness. That's what the texture of it is what makes the life so interesting, and they can't imagine who they would be without it. When people say, "Don't you want a cure?" and they're just like, "It's me, you know, like, it's who I am." And I want people to think about — like, I have degrees in three different things. In neuroscience, and special ed and learning disabilities, and in OT. I could find something wrong with everyone.

And if you lined up all of my characteristics, there are some that I'm really low on the bell curve, and some I'm in the middle of. You know, I have brown eyes, lots of people have brown eyes. I'm 5'10, well, not so many women are 5'10, so I'm a little higher on the bell curve. So, you can look at that whole bell curve of 'Characters of Winnie', and you can find something to focus on and say, "Well, she's not very good at that." But that isn't who I am. Who I am is the collection of all of those things. And autobiographies of autistic adults make that so clear. Because they say, "If you want me — if you want to know how I can socialize, put me around people I know, because I understand what they're going to — how noisy they're going to be, or how visually distracting they're going to be. I already know. Don't put me on strangers where I have to start figuring it out from scratch." Like, that's pretty sensible!

Meg: It is, yes. Yeah. And I think that we're really learning that neurotypicality is just one paradigm. It's not the right paradigm, it's just one.

Winnie: Right.

Meg: And I want to talk about how your model of sensory processing is a little bit different from some of the others that are out there. So, some sensory processing interventions claim, or attempt to change the person on a neurological level, which to me seems to tie so clearly into the deficit-based model of intervention. The message is 'You're different', 'The regular world doesn't work for you', 'You need to change'. How is your model of sensory processing different from that?

Winnie: Well, the first thing that I want to say is that it is true that everything we do changes our nervous system. We could say that about our conversation today, we can say that about, having some tea, we can say that about anything. Everything we do as human beings, our brain is logging it, making meaning out of it, and that meaning then combines or integrates with all the other things we've already learned or done. So, everything we do changes how the nervous system operates. We got to set that aside and quit acting like that's a distinct thing. It's like what all the things that OT's do. That's what happens, our brains change.

I think the difference is, if you think about an OT model, that deficit approach really focuses on the person factors. And I would say a sensory processing approach with strengths-based foundation focuses on the question, "What is it going to take for Meg to have a satisfying life? What is it going to take for Meg's family life to be smooth and harmonious and full of joy?" Not, "What's wrong with Meg?", but "What do we need to tweak up now that I know what a person's sensory patterns are? How can I help their bedroom be better for them? How can I help their morning routine get better? How can I, knowing that a person is sensitive to sound, what things can we do to make adjustments in the context so that that sound sensitivity doesn't interfere anymore?"

And you and I do that automatically, don't we? We figure out ways to make those adjustments. And the people that we're serving that are vulnerable and their families, they can't always figure all those things out. That's what they need our help for. They don't need us to fix them or to say, "When you can do this, you're going to be okay." It's like, "You're okay right now, and this is annoying. So, let's figure out a way for it to be better." The thing I love about sensory processing as a set of ideas is they're easy for people to understand and they can experience them themselves. You know, the mom, or the dad, or the husband, or the wife can say, "I can be quiet for 10 minutes so he can adjust. I can take him outside for 10 minutes because the family's getting really noisy."

It makes everyone feel more competent. And it increases sort of that intimacy of interaction with people because they see what the precursor event is and they understand what to do about it. It makes the child feel cared for. It makes the adult feel smart. The best thing, for me, is when a parent will say, "I figured it out! I figured out what to do! You know, like, I saw that the noise is getting to him, you know, the blocks are just going to be hard. They're always noisy. So, we put a rug down," and they just feel like magic happened because the rug made it softer for their child to play. So, I just think that OT's have the capacity to think like this, and we have gotten so interested in person factors, we forget we have equal capacity to change the environment, or to adjust an activity in service to others as well. Those are therapeutic, too.

Meg: So, the sensory profile isn't intended to pathologize a person and say, "Here are the ways you're different," it's intended to help that person understand themselves and their needs, help the people around them understand them so that they can feel more comfortable and engaged in their life.

Winnie: Right. And then that we understand why something happened. Like, there's a relationship between the child having a meltdown and fact that the door was open in the bathroom, and the hall was noisy. Like, they get the relationship. It's not like, "All of a sudden he had a meltdown!" You know, it really gives them meat on the bones.

Meg: That ties in really nicely to the premise of the podcast, which is that non-autistic people are terrible at taking the perspective of autistic people. We're flipping the script, right, the double empathy problem. It's not that autistic people are bad at perspective-taking, it goes both ways. I didn't come up with that. A very smart autistic researcher who was on Episode 2 of the podcast came up with this idea.

Winnie: I love that!

Meg: Yeah, and I hear you saying the same thing with sensory, that when we can't imagine another person's sensory experience, we misattribute it.

Winnie: Right.

Meg: We say, "All of us sudden they were freaking out for no reason." And there was a reason, we just didn't have the right lens to understand it.

Winnie: Right. And it isn't always a sensory lens, you know, it might be a cognitive lens, or it might be a, you know, he had a bad experience with dog lens, you know. There's all kinds of lenses, this is just another one that sort of dials them in for families because it's easy to see, it's easy to notice that it's noisy, or that they have a scratchy sweater on, or whatever it is. I think that's why it's really helpful to families pretty quickly.

Meg: I appreciate you saying that, because one of the things that's happened to many OT's as they became very competent in looking at sensory processing, is that became the only lens. And we miss things, because there's a lot if we're thinking about an autistic person. There's so many differences. There's executive function, and social communication, and routines, and sensory, but it's not the only thing that we might be missing. So, I appreciate you saying this is one tool amongst many.

Winnie: Oh, so important. If you think about a place like church, you know, it's quieter, that might be an easier place for a person that's sensitive to sound, which is pretty common among autistic people. But it might be that the priest in the Catholic ritual has changed the pattern. An autistic person could get just as disrupted by, "He didn't say the prayer in the same order that he said it last week," you know, like, that's a cognitive reason for feeling a little bit more disrupted just like you and I might feel. Like, wait a minute, I don't know what's going on next. And we have all those skills. We really diminish ourselves as professionals when we act like there's only one way of looking at a behavior, or a problem, or a challenge in everyday life.

Meg: Absolutely. I want to ask you a little bit more about the sensory profile, too. So, most OT's and many others are familiar with this, but it's a standardized sensory tool. It's a questionnaire that helps describe a child's sensory processing patterns, like you mentioned before, in a variety of contexts. And when you complete it, you wind up with all this great information about how the child experiences their sensory world, how this might impact their behavior, and their need for support in daily life. But what do we do with that information? In a perfect world, when an OT has completed the sensory profile too, how would you like to see that informing the work that the therapist is doing with that child?

Winnie: I'm so glad you asked me because the first thing I want everyone to hear Winnie Dunn saying is, you do not have to report all the scores. There's like, what, 25 or 30 of them? Make a summary sheet, put it in the back, record it — I understand you have to have it documented — but it's just like listening to the psychologist say all the scores on the Wechsler scale. It's like, we're all like, "Okay, okay, okay." We don't know what it means. Like, we want to know what it means. And for me the most important main event is, what is the daily life interest? You know, is it the mom and dad need a morning routine to get off to school on time, is it that that there's an afterschool playgroup that they want to go to? But, you know, that's the main focus.

And so, in my best world the only reason, the only way you would use the sensory profile is to say, "He does really great with this kind of play and he has a really hard time with this kind. What might the sensory profile help me understand about what's the same or different about those two situations? What is it about this difficult circumstance of getting ready in the morning? What is it — what do I know about him from his sensory patterns that would help me make adjustments to that morning routine to make it better for him?" And in a place he's doing really good, what about, "What are the sensory features there? How can we use the information we know from the sensory profile to understand why this is good, and this is hard?" It's a triangulation back to the daily life, always. Always back.

And so, there might be scores on the sensory profile you don't even use because they're not relevant to the choices that that family has made, or that — if it's an adult — that individual has made. Maybe, you know, they live alone so noise isn't a big deal. So, you don't deal with it. You just say, "Well, when is it a big deal?" You know, when are the big deals, and you work from there. So, rather than working from the sensory profile out, I like to stay with the Life, and then reflect back, "Oh, you know, he's gonna have a hard time watching his brother's baseball game because it's really noisy there, or people are bumping into him. How can we reconstruct that?" It's like background information, not foreground information.

Meg: I love how you come back over and over again to, "We aren't sensory therapists, we are occupational therapists."

Winnie: Yes.

Meg: So, what is the real daily occupation or activity that that person needs or wants to do, and how might this amongst other tools help us decode what's going on. And one of the things that you talk about so much in your work is situating the work we do with our clients in everyday life and routines. Why is everyday life and why are routines so important?

Winnie: Because they are the fabric of the human experience. We talk about big, big things, but it really is that every day that grounds us, that tells us who we are. You know, whether you get up and read paper, or I read an article just today about 'What are you spending your time doing and how is it affecting your mood?', with all the politics and world news that are going on right now, you can feel anxious before you even eat breakfast if you start your day a different way. So, for me, these rituals and the organizational structure of your every day is actually the richness of your life experience.

And so, if we can make those as satisfying as possible, we're going to increase this person's quality of life. And we're visiting their life. It isn't our life. It's their life, and we're so honored to be visiting and joining with them in a portion of it. But it's who they are, and how we spend our time is who we are, and I don't want us to lose track of that because it's such a beautiful, intimate place that we have the opportunity to be in.

Meg: I imagine that therapists who are listening who work in early intervention, and child's homes, or in the schools, have an easier time imagining working within daily routines and real occupations. And I know that many OT's who use a sensory lens are working in clinics with highly specialized equipment, I imagine their clients love their therapy sessions, but because these spaces look so different than the child's environment in their daily life, I can also imagine — I've never worked in a clinic space like that — but I can imagine that it's hard to translate into daily life. So, for those therapists who are listening and want to make that shift, what advice do you have for those folks who work in more contrived settings?

Winnie: Well, they don't get off the hook, you know? And it isn't enough to say, "Well, I chatted with mum when they dropped him off or when they picked up." You know, you really have to ask yourself, like, "What is occupational therapy for me?" And I do things — you know, I recommend things, I talked to therapists that work in settings like that a lot. And you can have them bring videos in of an easy time and a hard time during the week so that you can sit and problem solve it together. You can ask the parents for information, or "Look for this next week and come back and tell me about it," you can text with them about it.

I had a therapist that worked here at the Children's Hospital, she goes, "I just can't think of anything," and she was dealing with a whole range of children with different diagnoses. And we were problem-solving in a class she was in, and they came up with a great idea. They said, "Walk out to the parking lot and help the parent get the child out of the car and into the building," because that is an enormous task for families when they're bringing a kid that's, you know, maybe is tired of being in the car, you know how kids can be. And that would send such a strong message about, "I care about your everyday life and your everyday routine of getting in and out of a car." It opens the door to intimacy, you know, "I see what your life is like. I see you." This isn't an antiseptic therapy process, this is me joining with you. So, even simple just like that, doing Zoom with families, is a great way to stay in touch with what their life is actually like.

Meg: It does seem like one of the silver linings of these times is that a lot of therapists have gotten into the homes, if only virtually, to see what's happening. To see the environment and to really work with parents.

Winnie: And I see the therapist getting all excited and activated because that's what they chose OT for in the first place, and they lost track of it sometimes. And all of a sudden they're like, "Well, we were working on fine motor but the mom says he can't get his toothbrush in mouth," and I'm like, "Get in the bathroom! Carry the computer into the bathroom and see what it looks like," you know, and they're like, "I can totally do that." You know, so exciting!

Meg: It is exciting, and I think there's probably some fear, too, if you're used to having the super fun bag of toys and early intervention, or clinic equipment. And there's a real shift there though, because it's not, "I'm the expert and nothing is ever going to go wrong while I'm working with your child," it's, "Let me enter your world, and see what's happening, and be present with you, and not have all the answers."

Winnie: You have to trust yourself that no matter what the family says, no matter what the teacher says, no matter what the partner says, that you will see the therapeutic opportunity that's out there.

Meg: I love that. Why is coaching so central to everything we're talking about? I know that's one of the things you really have focused on in your work as well.

Winnie: Yeah, lately we've done some studies about it because there's so much good evidence. You know, one of the things that we forget is that there's a lot of evidence developing in other disciplines that would be helpful to us, and coaching is a good example. It developed in executive business and in education, and the evidence is really strong that when you create an environment for a person to explore their own possibilities, that they are more committed to the work of solving whatever their challenge it. And as they gain insight, they get smarter about how to do it for themselves in the future.

So, this idea, it goes back to this strength-based idea. If I trust that you have all the skills and knowledge inside of you to solve the problem, and my job is to be really skilled at reflecting back to you what you said — and I pause and give you time to think — people come up with amazing things. The families in our studies say, "I thought of all these ideas myself. You just helped me, and you stood there and waited for me to come up with the answer. And when it didn't work, we found another one." You know, they feel so powerful because they can feel our trust in their process of solving their own challenges.

And so, to me, it pairs really well with sensory processing because when a parent can understand their family members' patterns, and their own patterns, and then sort of navigate, you know, mom has low sensory thresholds and she has a kid that's a Seeker, how do we navigate times when mom just needs to have a little bit less information, and the child has the opportunity to get some more? But that becomes the strength of the family tool, for them to solve it without me saying, "Well why don't you try X, or why don't you try Y," which is my idea. In our studies, what we find is people get more passive when we do that. They then wait for us to tell them the answer and that doesn't — it actually doesn't work.

Meg: So, we're diving in to daily life, we're looking at a child's strengths, a child's challenges and how that fits within their family system, and within the demands of their daily life, and their environment; not just, "What are the child's weaknesses, and how can we build from there?"

Winnie: Right. Well, it's like, I don't know what you do for recreation or exercise, but let's say — I know for me, my recreational activities are things like cooking, and reading, and dancing, and crocheting, and knitting, and painting. If you then tell me I have to go do an exercise program, even though I do exercise, I'm going to be like, "I'll do it but it isn't giving me joy. Let me paint."

Meg: Yeah, I think I would cry if I had to do your hobbies. I would cry. [Laughs]

Winnie: [Laughs] You know, we get to pick what we want joy from, and OT's need to recognize their own capacity to embrace no matter what that person says. I had a mentee one time call me, she was out in a rural part of Missouri, and this kid wanted to — it was one of the games that the kids were playing. It wasn't Pokémon, but it was like that, but it's kind of an earlier version. And she's like, "I don't even know what it is, Winnie!" I'm like, "Well, let's figure it out," because she said, "Oh, of course, that's what we can work on." And she had no idea, but she had so much fun figuring it out to join with this little adolescent boy about this game. And then he could tell her what his stats were and all that. The therapy process isn't just this thing we patch on to a person, it's this thing we infuse inside of them so they see their own beauty and joy. That's the kind of thing we just have to go, "Okay, I'll figure it out!"

You know, I had to learn how to tie flies, because I had an older gentleman when I was a young therapist. I didn't know how to tie flies, but I knew that I knew how to see what it required so that I could help him. And that's what we have to trust about ourselves.

Meg: Yeah, we're in the process, too. I know a lot of therapists are really new to trying to use a strengths-based lens and approach. So, I want to come back there just briefly and see if you could give me some concrete examples about how to look at sensory processing differences from a strength-based perspective.

Winnie: Sure. I think that people get more concerned about kids and adults that have sensitivities than the high thresholds. Like, the kids that need a lot of input, you know, you can say, "Well, we'll just send them outside and give them more time to run around or whatever." But when children have sensitivities, we have choices. And I ask adults who have sensitivities a lot. And I think this is — you know, we learn a lot from each other, we just listen. So, if an adult has a sensitivity to texture, we don't say, "Well, you're gonna have to wear these socks until you like it." We go to the store, and we try to find socks that are acceptable if an adult is sensitive to touch. And if they find one pair of pants that they can't feel the seams, and the elastic isn't bothering them, and it's just the right rise, then you buy all the pairs in your size. This is what all of us do in the sort of background of all of it. We buy the clothes that matches our needs.

And like, why can't we just do that with everyone? Why does it all of a sudden become a problem to solve? I think we should have an International Sock Exchange, actually, because I know so many families that have five socks left out of the six pack, because they tried the one, it wasn't good, and they don't know who could use those other socks. I think other examples are cooking food at home, and putting different condiments on the table so that people can make it acceptable to them, instead of cooking it all as one thing. One spice profile, or one texture profile.

We can talk about different ways to do family activities, like letting the people with low thresholds in the family drop everybody off so all the bustle of getting the tickets, and getting the popcorn, and the sodas, and sitting down and finding a place, that they don't have to participate in that part. And they can go park the car, take grandpa and one of the grandkids, and then they can walk into the quiet room and the quiet theater and sit down. Everybody's still going to the theater, but they've each their ways of going to the theater. The Seeker family member is getting all excited about getting the popcorn, and then soda and finding the right seat where grandpa can sit, and making sure they have napkins. Like, that's what the Seeker family member can do.

So, instead of making us feel shameful because we have a different way of experiencing that activity, we find a way for each person. Because if you have the Seeker child go do the parking, they're going to be jumping, and running, and doing all that to get into the theater because they need it. Acknowledging that we all need something different and it doesn't have to all be the same. I've said for many years that the extra table at Thanksgiving should be for the low threshold family members, not for the children. There's all these ways that we can just make an adjustment to just honor who that person is. I know that it's hard for you at the big table, so I'm gonna give you the gift of sitting at the other table.

Meg: Are there ways that you've seen that people's sensory differences can be a unique strength for them, or bring to them something that the rest of us are missing?

Winnie: Oh, my God.

Meg: We look at having people with sensory differences is good for us as a culture and a world.

Winnie: So good. One of the most emotional experiences I ever had was with a mom who had a little boy. He was a toddler; he was about 18 months. And he is very sensitive to sound and to touch. She had a three-year-old that was really happy and vivacious, and her friend had a three-year-old that was more like her son was becoming. And she was not bonding with this kid at all. She was very flat, very disengaged from him. And we had this conversation, and I could see that she was doing all these great things, you know, like putting a fan, like white noise in the bedroom so he wouldn't hear the sound in the hall. She was doing really good instinctive things, but when I would say that was a really good idea, she wouldn't have it.

She just couldn't take it in. And so finally I paused and I said, "You know, I know children like your son when they grow up. So, let me tell you some of the things I know about them." And I started talking, and I said, "You know, this is the child in your family who's going to notice your emotions before everyone else. And he's going to come up and say, 'What's wrong, mommy?'" And I said, "And he's more likely to have artistic tendencies because, you know, people with low sensory thresholds notice details the rest of us miss, and that's why we love their art because it reminds us of something that we didn't notice in the first place." As soon as I said that, she starts crying. And in this tiny little primal voice, she said, "I was an artist." I'm an artist, and I told her about putting tights on him when he went to bed. And she said, "I snuck tights on my bed at night when I was a little girl." And so, in this one moment, Meg, she went from, "I don't know what to do with this kid," to, "I am him."

Her ability to know about him escalated by this simple conversation about some sensory experiences and how they manifest in behavior. All of a sudden, she knew what to do. She went from feeling overwhelmed to feeling competent, and feeling like I know what to do. Now she can take in all those compliments about her great strategies. And she had the great strategies because she was him. Like, she knew what to do. And I think that's the beauty of the conversations that OT's can have with families by just listening and reflecting back. That was, "You were so smart to try that. That was such a good thing to try. I wonder what you'll do next time to make it better. How can we use them in another place during the day that's hard?"

You know, just trusting them to know the answer. And when they get those insights, it's so powerful. Like the mom that said, "You know, blocks will never be playing for him, because it's just so hard. I'm gonna have to look elsewhere for play. If play is pleasurable, that's not it for him." Like, that's pretty insightful, isn't it?

Meg: It is.

Winnie: But that's what an OT does. We create space where they can figure that out.

Meg: I love that this shift both empowers the parent to trust themselves, and it also moves us away from listing all the things that their child is bad at, or struggling with, towards. And I think this is something we really need to strengthen our muscles at doing, showing how those same things will also serve the child. And that's what you want to know as a parent; how is my child awesome? How are they already awesome?

Winnie: And they already are awesome things, aren't they? That sensitivity is the thing that's gonna make this kid distinct. Temple Grandin invented things about animal husbandry because of her autism, that were available to anybody to figure out but they couldn't figure it out because they didn't experience it the way she did, you know. Like the inventions, the innovations, the new art, all those things are because somebody saw the world a different way.

Meg: And I think also the insights that we can gain about ourselves. I have an autistic colleague who said, "You neurotypicals are obsessed with time. You say we're rigid? You're obsessed with time," and I was like, "Oh, man. We so are."

Winnie: [Laughs] It's so true. It cracks me up to hear that.

Meg: It's not that functional, it's very stressful.

Winnie: It is. It creates a lot of anxiety. I'm married to a man who — he's closed the store a couple years ago, but he owned a pet store. And he had no idea about time because you show up, and you hope people come. He didn't know how long it took to clean the fish tanks because they did it in between customers. But you and I, on the other hand, we have an appointment at 10:00, we have an appointment at 11:00, we have someone at 11:30, we have someone at 12:15 — we are obsessed with it. And his showing up and being ready for whatever comes at him is pretty — that's a pretty great way to be.

Meg: It is, it is. We can learn a lot from those differences. This is so lovely, Winnie. I want to end with one final question that I always ask my guests — of everything we've talked about today, if there was one thing you would like OT's to start doing, or to do differently with their autistic clients, what would that one thing be?

Winnie: See them, and appreciate who they are. And trust yourself to have the right questions to help them evolve the way they want to evolve. Don't miss it. Don't miss it. It's your life too, you know. The minutes you spend with the people we serve are the same number of minutes that they're spending with us. And I fear sometimes that people miss it because you're so busy with the list, or the procedure, or the technicality, when in fact, this life is sitting there. You're immersed in it. The gift from the person you're serving, and we miss it sometimes. And so, don't miss it. Sorry.

Meg: Don't be. That is really powerful. Thank you so much. And thank you for your time, and all of your wisdom, and everything you've done for OT as a field, and for people who experience the sensory world differently.

Winnie: I'm so happy to have talked to you, Meg. This is so great.

[Ending music]
Thanks for listening to the Two Sides of the Spectrum podcast. Visit learnplaythrive.com/podcast for show notes, a transcript of the episode, and more. And if you learned something today, please share the episode with a friend or post it on your social media pages. Join me next time, where we will keep diving deep into autism.