Sensory Integration Education

Dr Varleisha Gibbs PhD, OTD, OTR/L is the Vice President of Practice Engagement and Capacity Building at the American Occupational Therapy Association (AOTA). Dr Gibbs is an international lecturer, researcher and author. Her areas of expertise include neuroanatomy, self-regulation strategies across the lifespan, health disparities and paediatric therapist interventions. Dr Gibbs is an Occupational Therapist who has founded and operated a private therapy firm for over 10 years. Varleisha Gibbs has authored many books including Self-Regulation and Mindfulness: Over 82 Exercises & Worksheets for Sensory Processing Disorder, ADHD, & Autism Spectrum Disorder; Trauma Treatment in ACTION: Over 85 Activities to Move Clients Toward Healing, Growth and Improved Functioning; Raising Kids With Sensory Processing Disorders: A Week-by-Week Guide to Solving Everyday Sensory Issues; Raising Kids With Sensory Processing Disorders: A Week-by-Week Guide to Helping Your Out-of-Sync Child With Sensory and Self-Regulation Issues. There is a recording available for you to watch this interview and a podcast version for listing on the go! Below, we have provided a brief summary of the main points from our discussion. We hope you enjoy this multimedia feature! 

SensorNet: Welcome Dr. Gibbs to our SensorNet feature interview for this upcoming edition. We are truly honoured to have you contribute to our edition and to have you join us for a discussion about your work. We will jump right in to some questions that I know some of our readers will be very interested in! Tell us about your background and your current role. 

Varleisha Gibbs: It’s my pleasure to join you and it is always wonderful to talk about sensory integration. Being an occupational therapist is a real pride of mine. I have been a practitioner for twenty years and it has been a really exciting journey to date. I started off my journey with a degree in psychology and I quickly discovered how occupational therapy aligned with that. I have authored some books such as “Raising Kids with Sensory Processing Disorder” which I co-authored and “Self-regulation and Mindfulness”. My work on these books has allowed me to do different talks and conversations, not only with practitioners and educators but also with parents. My latest work is “Trauma Treatment and Action” which identifies how we use sensory based strategies to address the needs of those who have experienced trauma, which is very topical currently. Given what’s happened in the last two years, all of us have been exposed to some level of trauma, but how we deal with this is a very different thing. This is where my focus has been during the last few years. 

I have a history of being in academia, I used to be a professor and then chair and a tenured faculty member. I started the first occupational therapy programme in Delaware, USA and from there I went to work for a foundation as a scientific programmes officer. Currently, my full time job is with the American Occupational Therapy Association (AOTA) where I am a vice president of Practice Engagement and Capacity Building. My work in terms of sensory integration is separate from that, and I always give the disclaimer that my thoughts are my own. Certainly they feed and lend well to each other, as I can use my clinical expertise for helping our clinicians to navigate the evidence base and identify the resources that they need within practice. 

SN: I was interested to learn that you completed a degree in Psychology before continuing your studies in the field of Occupational Therapy. This is a very fitting combination and I would like to hear how you have combined both areas together. 

VG: This is a good place to start! Many people don’t ask me about this so I enjoy being able to answer this question. I believe as allied health professionals, we are in the business of working with people and dealing with human behaviour. For me, having that background in psychology really set the stage and tone for that. I feel like it helped me to understand human behaviour and helped me to learn how to deal with my clients, not just from an individual level but from a biopsychosocial view. This includes looking at their families and how society impacts them. Of course, looking at clinical conditions and mental health is one aspect of it but I feel like the degree in psychology gave me a mass view of the clients I had would be serving in the future. Certainly for the field of occupational therapy, the field of mental health is the foundation of our profession. In the USA, when we had our veterans return from war, we needed to meet their needs not only physically but also looking at how those individuals used their time when living with an acquired injury and/or learning how to navigate life with a traumatic brain injury. Occupational Therapy was really the avenue for being engaged in occupation and allowing that premise led us into the field of mental health which many people don’t realise was a foundation for our profession. The degree in psychology was a direct fit. I went to OT school in 2000 to complete my masters and there was a requirement to do an affiliation in mental health, so it certainly prepared me for that. 

SN: What subject did you focus on for your PhD and how did that experience influence your career/practice? 

VG: I used the biopsychosocial model to look at the health disparities in the diagnostic process of individuals with autism. It was a secondary data analysis. There was a bank of data gathered over time in the USA, which surveyed parents on their experiences and perspectives of their children who were diagnosed with intellectual disabilities and autism. My job was to tell the story of what the disparity looks like in terms of race and ethnicity. I was seeking to find out whether there is a disparity and what the lived experiences of the parents were. I discovered that within that cohort, there wasn’t a significant disparity. This had a lot to do with socioeconomic status. Many of the people who completed the survey identified as middle class and they had similar levels of education, which was an outcome that emerged. What emerged qualitatively, was that parent voices were not always heard. This was the case especially when English was a second language for individuals. The healthcare professionals were not always equipped to give an evaluation in another language. They did not always have the available resources to be able to provide this. Culturally, how we view sensory processing is also an important consideration. Cultural norms and behaviours really fed into how the diagnosis went. The outcome of all of this was what I call a two person factor – the caregiver and child together. There were also the biopsychosocial aspects, society, the communities they lived in, and the medical professionals' knowledge were all contributing factors to a timely diagnosis of autism. 

SN: Autism and ADHD are two areas you have developed an expertise in and the language around neurodevelopmental conditions is evolving and changing. Tell us more about this terminology (Neurodiverse, Neurodivergent and Neurodisability) and how we should be using these in practice? 

VG: I am a proponent for whatever we can do to reduce stigma and bias and promote inclusivity. Neurodiversity is a term that describes all of us. We all bring something different to society. I prefer the term neurodiversity to neurodisability because dis-ability is taking away a person’s ability and acknowledging that there is a difference, which may not be acceptable. There are many individuals with autism, ADHD and sensory processing differences who contribute a lot to our society. The term neurodivergent, acknowledges that there are some differences. These are not necessarily bad or negative, but they are present. 

SN: In your recent SIE webinar entitled: “Dissecting the brain-gut connection to address self-regulation and sensory processing” you speak about the nine senses and more. Tell us about these nine senses and what they are? 

VG: Many of us were taught we had five senses when we were children. This then expands when you are attending OT school or doing sensory based courses where you also learn about proprioceptive, vestibular and interoceptive sensory systems. But there are many others – such as nociception and thermoreception for example. Science is telling us there are more senses than we ever truly realised. For me, I feel it is important to acknowledge that there are many more senses. In any given moment, the individuals we support have to struggle with integrating all of these various components to be able to function and engage appropriately in their daily lives. 

When it comes to the brain gut, we are discovering that a lot of the behaviours we see are coming from the discomfort in the gut, as well as the chemical reactions that are produced in the gut, which the nervous system and brain depends on to optimally function. When that is disrupted, such as when we have too much or too little dopamine, then our behaviour, focus, attention and sense of satisfaction will be affected. The process works together – what we eat can affect us neurologically, mentally and psychologically. Likewise, the brain will send messages to the gut and it is a cycle that continues. 

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SN: The brain-gut connection is something that is getting greater attention across the health and well-being sphere in general but how does it affect self-regulation and sensory processing? 

VG: It's multifaceted. When you do whole body approaches, it activates the autonomic system which can impact what’s occurring in the gut. It is bidirectional. When in fight or flight mode your eating habits change and your GI system changes. If you are in a parasympathetic state, you are in rest and digestion and able to take in the nutrients that you need, therefore using that energy optimally. Being aware that whole body work has an impact on what is happening in the gut is important. 

Many of our colleagues are doing lots of interesting work in this field especially from institutes in California. It’s an area that is gaining a lot of popularity. There is new information from this field emerging all the time. It is best to review the literature within the last five years as it is an area that is constantly evolving. 

SN: Many of our readers will be working in a setting which focuses on trauma informed care. You speak about the “ACTION from trauma approach”. Can you explain what this approach is and how it can inform our practice? 

VG: Trauma informed care is the foundation of this work in looking at trauma from a different lens, beyond Post Traumatic Stress Disorder. Children can experience trauma and there are individuals who have experienced trauma across their lifespan (complex trauma). Trauma informed care puts the spotlight on the need to address trauma which a lot of people experience. It is for the vast majority of our population. The action from trauma approach is a trauma responsive approach. Once we acknowledge it, we start to have these trauma informed practices. My stance as a therapist is that I want to be able to do more action responsive care, which means more hands-on activities. There is always a place for talk therapy and behavioural approaches but taking some of that sensorial approach to the body is also important. We know that trauma lives in the body and the body is constantly like a watchdog based on what is happening in the brain, based on a threat that may appear at any time. In order to truly tackle the outcomes of a traumatic experience or a traumatic life then we need to tap into the body. It also includes intergenerational factors, epigenetics, family history, and looking at the genealogy of that family. This can identify whether the person is responding in a way that is based upon the family history.

SN: The most recent book you have co-authored is “From Trauma Informed Care to Action” – I think many of our members want to find out more about what they can expect from this book and how it can influence their practice. 

VG: It is a book that has informative literature and is evidence based. It is more of a workbook, with different activities and exercises which you can use with your clients. The premise of it is for any allied health professional that wants to use more of these techniques with their clients. This could be used by any clinician supporting someone who has experienced trauma and it is not exclusive to a mental health setting. It includes screening assessment tools which can help identify the need for additional services and direct you to complete onward referrals depending on the presenting issues. There are also different growth plans – which allows you to map out the areas of importance for the client. It includes worksheets, tools to develop plans and goals and language to use to prevent re-traumatising or triggering clients who may have been exposed to trauma. 

SN: We would be interested to hear about the Self-Regulation and Mindfulness Program you have developed. We hear so much about these areas in practice and we are often asked for our advice and support. What are the core principles of this programme? 

VG: That programme is within the book “Self-regulation and Mindfulness” and it includes how we can target all the senses while ensuring the individual is in the present moment, which is the mindfulness piece. There are a wide variety of activities to choose from. 

The book is split into two different parts, which I encourage people to do in order. Part one gives you an understanding of the neurological piece in a way that is digestible, which you can explain easily to a parent. Part one delves into the nervous system, the autonomic nervous system, the flight fight response, and the vagus nerve (how we tap into that and why). We discuss why the exercises in the book help support a more balanced parasympathetic/sympathetic activity within the body. There are nine different targets within the book which the activities are categorised into, thus ensuring we are doing whole body approaches. 

SN: Your book on “Raising Kids with Sensory Processing Disorders” is a topic that clinicians will be supporting caregivers and families with. Have you any advice on how we can best support and coach parents in regards to this? 

VG: When I had my own children, it was a turning point for me as I developed a greater insight into what parents are coping with and how they are navigating life with their own circumstances. I used to give out many sensory programmes with lots of detailed content. Reflecting back on this, has made me question: were they right for that specific family at that time in their lives? A family centred approach should always be key. The family’s support system is an important consideration. With the book,Raising Kids with Sensory Processing Disorders, we provide week by week activities, however the key for the therapist is to figure out how that can fit into this into a family’s/individuals daily life. I advise therapists to take the time to find out their schedule and map out what their everyday life looks like. Then you can find those opportunities to embed the activities into their routine. 

SN: Where to next for you? 

VG: I would like to continue my work in promoting self-regulation, mindfulness, trauma and highlighting that we have more than the nine senses. I feel like this is the time now to solidify that and continue to share it with more audiences. I am looking at incorporating inclusivity and access into this work also, which loops back to my PhD work. I want to show that there are true clinical intersections that go beyond clinical diagnosis, and really look at the individual in an everyday sense. We have to work using more systems, holistic and universal approaches, rather than just looking at diagnosis alone. 

Thank you Dr Varleisha Gibbs for a fascinating and engaging discussion. We look forward to following your work and hearing from you again soon.