Mental health articles

Sleeping problems are  related to regulatory disorders Sleeping problems related to getting to sleep or, when woken, getting back to
sleep, are often related to difficulties with self-regulation, self-calming and the
ability to manage transitions. These usually improve with maturation given a
relatively consistent, sensitive and responsive environment. For some babies
there can be both a distinct behavioural pattern, and a sensory, sensory–motor or organisational processing difficulty that affects daily adaptation and
relationships (Greenspan & Wieder, 1993). An organisational processing
difficulty implies that there are regulation difficulties in several systems, atypical patterns of sensory reactivity as well as difficulties with motor organisation and
state regulation. Babies with considerable maturational or constitutional
variations that contribute to specific behaviour may have a regulatory disorder
(Greenspan, 1989). For example, premature infants, in the early weeks after
discharge from hospital, which is around the time of the date when they were
due to be born, often have difficulty keeping their bodies still, especially when
tired. They also struggle with modulating auditory and visual stimulation and
moving smoothly between states. This is usually a temporary situation and,
tempered with sensitive, responsive care, continuing regulation difficulties can
be avoided or minimised.
Behavioural patterns
Difficulties with either processing sensation (inflow) or motor planning
(outflow)—that is, difficulties with being able to take in or respond back to the
world—compromise the infant’s ability to negotiate with and adjust to his
caregivers and environment (Greenspan & Weider, 1993). Initially, the parents
present with concerns about their baby’s feeding or sleeping, or express their
frustration with their baby’s irritability. Parents may talk of their baby being
very sensitive to sound, touch or light. As toddlers, the problems may present as behaviour control difficulties, or fearfulness and anxiety. In the third year,
parents may be concerned about speech or language problems, or they may
speak of their child not being able to play alone or with others, or report that
their child gets upset easily or has difficulty adjusting to change. Babies
exhibiting these behaviours make daily caregiving and development of
relationships difficult for their caregivers. These babies require very sensitive
handling and more containment and holding and, in our society, parents are
often accused of ‘spoiling’ them when they provide this level of support.
Very often a baby born prematurely, because of his organisational processing
difficulty, will require much more assistance from his caregivers to achieve a
rhythm of sleep and wake periods, as discussed. To achieve sleep,
he may require wrapping, holding firmly until the body stills, maybe gently
rocking, and then placing in a crib in a darkened room.

Research into regulatory disorders is in its early days, with few empirical
studies available to support the construct. The current understanding is
primarily based on the clinical observations of experts in the field. Some
empirical evidence is beginning to emerge from small studies, as well as from the work of occupational therapists investigating the related concept of sensory modulation, one aspect of the spectrum of regulatory disorders.

Tags: disorders