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Season 1, Episode 6: Megan Bresnahan, ORT/L, an Occupational Therapist at the Adoption Medicine Clinic at the University of Minnesota discusses her role at the interdisciplinary clinic and the value of multi-disciplinary assessment and intervention among adoptees and children in foster care. She provides valuable information regarding sensory difficulties, explaining why these can occur among adoptees and gives suggestions and resources for parents. 

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Dr. Emily Helder: Welcome! I’m Dr. Emily Helder and I’m here with Megan Bresnahan, who is an occupational therapist, and she works at the Adoption Medicine Clinic at the University of Minnesota. So welcome. Thanks for being here.

Megan Bresnahan: Thank you for having me.

Dr. Emily Helder: So tell me a bit about your role at the Adoption Medicine Clinic. How did you end up there? What do you really find rewarding?

Megan Bresnahan: So my role with the Adoption Medicine Clinic is to provide support in many different ways as an occupational therapist.

So my main focus is just global development skills for the kids and their families. And so helping assess where they’re at with their skills and also then provide support to the families and the patients when they need some help developing some of those skills as well. That might entail us doing an evaluation or an assessment and kind of just providing education as to where the child is at. It may also then incorporate some ideas of things the family can work on at home, or maybe even recommending that the child come in for some therapy to help them with some of their skills and help provide support to the family too.

So really our role in, in clinic is to provide support for the patients and families in whatever way we can and is most appropriate for them.

Dr. Emily Helder: Yeah, and I we’ve been so impressed with your interdisciplinary clinic over the years as we’ve been adoption researchers following your work both clinically and research-wise.

So we were really thrilled when your team was available and interested in writing this chapter for us, because we think you do really excellent work there.

Megan Bresnahan: Thank you. Yes, we, I, I feel very lucky and very grateful to be a part of this team just because I feel like it is very unique and very special.

And we are able to provide such great support for families and patients and, and, and in whatever way that they need.

Dr. Emily Helder: Yeah. Yeah. So the beginning of the chapter focuses a lot on kind of giving a history of adoption trends with that special focus on adoptees with disabilities. And so I would love to hear, you know, you’ve been at the clinic, is it about 15 years or so?

So adoption has changed a lot even just in the last 15 years. So how do you see those trends that you described in the chapter really evidenced in your own work?

Megan Bresnahan: Yeah, I think that I see it in my everyday work and just the more we learn, the more we learn about everything helps us in directing what we’re doing.

It helps us really know how we can help and support them. So the more we learn, the more evidence that we get just really directs our care. It also helps us have a really good understanding of the child and where the child is coming from and why the child might be at a certain point in their development or what was the history that defines some of this. And so it just helps us with that overall understanding and the more education, the more we learn, the more we’re able to incorporate that into our therapy approaches and how we’re working with them. One of the other things that we have learned just over the course of many years, and the research that we have done is the importance of the early intervention and finding that sweet spot of when the intervention is appropriate, because when a child first comes home and they’re with their family, there’s a time of transition. And we want to understand and respect that time of transitioning and know that some things that are really important during that time is really building attachment and helping the child transition to their new home and their new family life.

And so recognizing that, but also then getting therapies and interventions involved when appropriate so that we can help support them.

Dr. Emily Helder: Yeah. That balance. I talked with Judy Eckerle about that a little bit as well. That balance between what’s gonna unfold through the developmental process of the child entering that new family versus what needs intervention.

I find families have a lot of questions about how to discern what’s what.

Megan Bresnahan: Absolutely. They do have a lot of questions about it and that’s one of the ways we can help them then is help them discern that and help provide some guidance as to, okay, when is the time to say we need to get a little bit more intervention involved.

Dr. Emily Helder: Yeah. Yeah. The other section later on in the chapter that I wanted to ask you about was the section on the multidisciplinary assessment of the child themselves. In particular there’s a great section in there on sensory challenges. And I’m assuming that’s kind of where you contribute quite a bit to the, the clinic and the team’s understanding.

So, yeah. Could you tell us a bit about what are some of the common sensory challenges that you see in these kids and how you help families sort out, like what sorts of behaviors are caused by sensory issues versus something else?

Megan Bresnahan: So what we, what we see is for our kids, they sometimes have not had the best sensory experiences or they may have had a lack of sensory experiences prior to their adoption. They may have just not gotten a lot of that sensory opportunity. So for example, a child may have not been held as much, or rocked as much, given as much visual. So their body doesn’t learn what to do with it. And so in some cases, some kids will then learn to just do without, and they will just kind of become aversive of the sensory input.

Some kids will seek it out. So then when kids come home, they could be in a couple of different buckets. They might be like, “Oh my gosh, this is great. I’ve got so much sensory experiences” and really just seeking it out and gravitating to it. Other kids might be more aversive and be like, “I don’t know what that is. And I don’t feel comfortable with it. So I’m really going to be aversive to it.” And we also have the kids where they just, they don’t process the input appropriately. And so they are just not having appropriate reactions. So one of the examples we use a lot is if a child had a small cut. And they don’t have good sensory processing skills.

One child might be like, their reaction might be that they felt like they have a really deep cut that needs stitches. Another kid child may actually have a really deep cut and needs stitches and they don’t have any response to it. So their body just has not learned how to make these good responses to sensory input.

So kids can fall into lots of different categories as to what they, you might see, but overall, it’s just that they’re not processing the sensory input and making the response to it that we would think would be an adaptive response or what the response we would expect to see.

Dr. Emily Helder: Sure, sure. And are there behaviors that you see?

Oh, I’m just thinking of common disruptive behaviors or those kinds of things that, that you, your sense sometimes as the OT is that these are related to sensory sorts of challenges.

Megan Bresnahan: Yeah, definitely. Because if you think about it, the child’s just totally dysregulated because they, it’s new sensory experiences.

They don’t know what to do with it, or they’re feeling like they need to seek it out all the time, or they’re always aversive. What’s happening is this overall dysregulation. And so that poor regulation, if you don’t feel good, if you feel dysregulated, that is going to contribute to behavior, it’s going to contribute to behaviors if it’s something you don’t feel comfortable with, and then you throw in a little bit of a language piece. So they’re not able, depending on the age of the child or where they’re at with the language, they might not be able to communicate how they feel about these things. So that plays a roll in it too.

And so when we’re helping families try to decipher, is it sensory, is it behaviors? Is it transition? It just takes a lot of us kind of talking through some of the different situations to see what happened. And, and, but yeah, allowing for some time to say, okay, we need some time to see. So I may not have the best answer for you if the childs been home for a month.

I may not have the best answer for you, but in three months, let’s revisit this and see what changes you’ve seen. And so for a lot of our kids, we are watching too, to see a parents are seeing small, incremental improvements. As they are settling into their routines and their structure. And, and if they’re seeing that, that’s a really good sign to us.

If they’re not seeing any of that, that might be more, the child might be on our radar a little bit more.

Dr. Emily Helder: Sure, sure. No, that makes a lot of sense.

Megan Bresnahan: Our biggest recommendation for families across the board, whether it’s we’re working on attachment or development or sensory, is to have lots of structure and routine in their day.

So that the child starts to learn that this is safe. This is secure. It’s going to be the same every day. And that helps with all of those skills. So that’s our biggest recommendation that we make to families as well.

Dr. Emily Helder: Yeah.

Megan Bresnahan: If I have a family who are really trying to figure out, Oh, what’s going on? Is it the sensory, is it behaviors?

I will sometimes ask the family to just jot some notes down in like a little bit of a journal when the child has a significant behavior outburst or when they seem really emotional or something like that. So that we can try and look into it a little bit closer to really identify what’s going on.

Dr. Emily Helder: Okay. That seems really valuable to have those in the moment notes. Cause maybe sometimes if it’s a month later, it’s hard to remember some of the context surrounding it.

Megan Bresnahan: And so it’s, it’s interesting because some families will be telling us about an incident that happened and I’ll be like, okay, break it down for me a little bit more.

Tell me what was going on. And for example, I had a mom who the child had just a complete meltdown was very upset and she’s like, well, we had gone to Dick’s right before, Dick’s is a sporting goods store in our area. And I was like, well, maybe that, that was just too overwhelming and it was too much going on.

And then the child was dysregulated and then you tried to do that. So it helps you kind of break it down so we can all be aware of what’s going on.

Dr. Emily Helder: Right, right. Yeah. And tell me a little bit about what you see as the benefits of working in the context of this interdisciplinary team model. Cause that’s pretty unique.

Megan Bresnahan: Yeah. I think it’s just makes it a really special, unique model because we can brainstorm together. We can work through some of these things together. For example, if you’re trying to decide if it’s a sensory thing going on or more of a emotional health/ attachment thing, I don’t have to go try and seek out all these different providers.

I’ve got the person right there with me, who we can bounce these ideas off each other. I think it allows us to provide this really great comprehensive care for, for everybody involved in this collaborative approach. And so I think that’s the benefit that we have with our clinic is that we’re able to provide this collaborative care for our patients and their families.

Dr. Emily Helder: Yeah, and I would think families so appreciate having kind of a one stop shop where they don’t have to navigate multiple systems to have access to all the different types of providers they might have to access

Megan Bresnahan: Well, and even things as simple as, okay, there’s three of us who want to hear about your sleep.

Okay, tell us about it. So that way you don’t have to repeat the whole thing to three different providers. We’re all right there on the call, right now, or in person. And then we can all hear about the sleep. So yeah, I think it’s really a very unique and very special clinic.

Dr. Emily Helder: Good, good. Well, and just to end, I’d love to ask you, are there resources that you share for families that you think are particularly helpful? Either about  sensory issues or, or other things as well?

Megan Bresnahan: Yeah. I have a lot of our own things, materials that we have put together over the years just to be able to provide for families. It’s hard because every child is so unique. So my biggest go to that I would say is when I’m just trying to explain sensory processing to a family.

And there’s a series of books and the first one’s called the Out of Sync Child by Carol Stock Kranowitz. And then she’s got a series of other books as well. And she is who I probably recommend the most, the things is that it doesn’t always speak to the adoption piece, but it’s good for just a good overall understanding of sensory processing.

Dr. Emily Helder: Great, great. Thanks. And we’ll provide those links for people listening or watching.

Megan Bresnahan:  Okay.

Dr. Emily Helder: Good. Good. Well, Hey, thanks so much for your time. I really appreciate you describing your work and how it fits in with the chapter that you wrote. Thanks also for contributing to the Handbook. We appreciate it.

Megan Bresnahan: Thank you very much.

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