If you have been around No Limits Pediatric Therapies long, you have probably heard the terms AROUSAL level and ACTIVITY level; but what do these terms really mean? Let’s go to one of No Limit’s OT teams favorite sensory gurus named Dr. Julia Harper for some more information.
Dr. Julie Harper, PhD, MS, OTR/L is a wife, mother, occupational therapist, business owner, psychologist, life coach & mentor, speaker and writer. She holds a BS in Occupational Therapy from SUNY Health Science Center (Downstate), Brooklyn, NY, a MS in Occupational Therapy from Boston University, Boston, MA and a PhD in Psychology from Capella University, Minneapolis, MN. She brings all of these roles together to serve her mission of helping people-all people to live their lives beyond limitations.
For over 20 years, Julia has worked as a pediatric occupational therapist focusing on creating brain-based therapeutic programs that tap into neural-plasticity, the brain’s ability to adapt and change. Her world-renowned therapy center offers a W.A.Y. to H.O.P.E.™ which merges her two models: HOPE (Harper’s Optimal Protocols for Enrichment), which focuses on re-wiring the brain of those with physiological, learning and limitations in attention and W.A.Y.™ (What About You), which retrains the brain to move beyond emotional and thought limitations.
Creating change is at the center of her work, as she knows that to best serve the world, she needs to be an agent of change. This begins with the work she has done to change her own life, from becoming a Certified Master Life Coach, a Master Clinician, a Certified Daring Way Facilitator and Master Practitioner of MER. She hopes that through her change, she can change her clients and have the ripple effect of changing the world. She is a firm believer that all change begins with her. Daily, she lives this change to be the change. (http://therapeeds.com/en/about-us/julia-s-story)
Now you know a little background on one of our favorite resources when it comes to sensory processing, arousal level, and activity level, but what does it all mean?
Activity level can be broken down into two categories: high activity and low activity. When speaking about activity level, we are referring to physical activity. The World Health Organization defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical activity refers to all movement including during leisure time, for transport to get to and from places, or as part of a person’s work. Both moderate- and vigorous-intensity physical activity improve health (https://www.who.int/news-room/fact-sheets/detail/physical-activity). This is leading to the idea that a child or adult who demonstrates a high activity level demonstrates significant physical activity and seeking of movement. It then leads us to an idea of a child or adult who demonstrates a low activity level demonstrates minimal physical activity at any given time.
Activity level is visible, fluid and changing. You can move from high to low activity level or low to high activity level at any point in the day and it usually changes multiple times during a day. It can even change hour to hour or in shorter time spans. Remember, activity level is seen and is changing; although you may have a child who typically demonstrates either a high or low activity level.
Now, let’s move on to arousal level. This can easily be confused with activity level, but it is different and cannot be used interchangeably. Your arousal level tends to remain unchanging and can be considered more as your state of being. With that said, according to Julia Harper, a child or an adult can be considered high arousal or low arousal. She describes the different neuro-chemicals and brain wave patterns within the body that determine arousal level, but that will be left for another day. What we will discuss today is that depending on your child’s arousal level, the occupational therapy team can better serve your child’s sensory needs by meeting their specific sensory input needs. This is based on neuro-chemical needs and we can then help create a protocol to meet those needs based off of Julia Harper’s research.
Moving forward, let’s discuss how we determine if your child is high arousal or low arousal. We can typically describe a high arousal child as a child who thrives on routine, structure, and predictability. A high arousal child is unable to start off their day with intense sensory input such as spinning and participating in inverted activities, because intense vestibular input is only going to dysregulate your child even more. This would be working against the whole goal of working with your child to build a toolbox to help improve attention, participation and overall regulation based on their individual arousal level. They tend to benefit from deep pressure touch and passive proprioceptive input which is calming and regulating. Now on the other hand, you have a low arousal child. A low arousal child is a child who tends to be unpredictable, constantly changing, and unrhythmical. You can usually see this in everything they do. A low arousal child may always be on the go because they are seeking input to help regulate, but they do not need to start the day off with calming activities. Instead, they need to start off with intense vestibular input that is constantly changing, unrhythmical and unpredictable. Starting with intense input followed by deep pressure and tactile input will help set your low arousal child up for success.
Now, here is where it gets tricky! Is my child high or low arousal? Or are we just looking at if they have a high or low activity level? This is where your OT comes in. We at No Limits want to work with you as a family and complete a variety of clinical observations to help determine if your child is high or low arousal. We can then work with you to see how their activity level usually runs at different points in the day. After determining your child’s arousal level and gaining a better idea of how their activity level presents throughout the day, we will then work with you to create a home programming plan to help build your family’s sensory toolbox to better suit your child’s individual needs.
I do want to take the chance again to reiterate, activity level and arousal level ARE NOT THE SAME. Activity level is what we see every day, it is visible and changing. Arousal level is our state of being, and typically unchanging. If we are only treating activity level we may not truly be giving your child the necessary input in order to achieve their highest potential and meet the goals you have set in place.
Here are just a few examples of high and low arousal kiddos with both high and low activity levels.
Jase is an 8-year-old boy who is constantly on the go. He likes to bounce off the walls, climb onto everything, and jump off the bed. He has a lack of body awareness, decreased awareness of pain, is very unpredictable and constantly changing. If we were just looking at his activity level, we would say he is high arousal and he needs deep touch and pressure calming activities to help improve his attention and participation; BUT WAIT! I mentioned Jase is very unpredictable and constantly changing. This tells me Jase is really a low arousal child who exhibits a high activity level. Jase is constantly on the go because his body is seeking intense input, so his body can move up to a “just right” state so he can then better attend and participate in his daily activities. So as an OT we need to stick with unpredictable, constantly changing and non-rhythmical input, and we are going to start off with intense vestibular input and big gross motor movement activities.
Let’s look at another; Cole is a 9-year-old boy who would love to stay at home all day, lay around in his PJ’s and play on his tablet or watch TV. He will turn down going outside to play and playing a sport almost every time he is asked. Cole is very predictable and thrives on routine and structure. If we looked just at his activity level, you might say that Cole is low arousal; BUT WAIT! I mentioned Cole is predictable and thrives on routine and structure, so he is in all actuality a high arousal kiddo with a low activity level. Cole stays with his routine, predictable daily activities and his little physical activity, because Cole feels like his lid is always about to flip open and he will lose control. Cole thinks this is the only way he can maintain control, so as an OT we need to stick with predictable, rhythmical and unchanging input, but we are going to start off with calming activities such as deep touch and passive proprioceptive input like joint compressions. This will allow Cole to better regulate improving attention and participation in his daily life.
I hope this helps better explain the difference between activity level and arousal level. Be on the lookout for more information on arousal levels and the neuro-chemical make-up to better describe a child’s arousal level.
If you have any questions, please reach out to your OT. We will be happy to work with you to help determine if your child has a high or low arousal level, help you better understand when they are demonstrating a high or low activity level, and help create a home program to better meet your child’s individual needs in order to help them reach their maximum potential.
*Information based off of Dr. Julia Harper, PhD, MS, OTR/L Practical Sense in Sensory Integration
