「2.5-Year-Old Toddler: Anxious Attachment, Frequent Caregiver Changes」
Background
2.5-year-old girl. Both parents are high-intensity working professionals. From age 2 onwards, home caregivers had changed 4 times (two domestic helpers left HK due to contract issues, one grandmother paused due to health). Parents recently observed: daily crying refusing to let mother go to work, prolonged evening meltdowns, emerging repetitive self-stimulating head-banging behaviour, decreased appetite. MCHC developmental milestones remained within normal range, but the behaviours alarmed the parents deeply.
Evaluation Findings
Developmental milestones (gross/fine motor, language, cognitive) broadly at age level. Nervous system profile: chronically in sympathetic activation (fight-flight) — rapid heart rate, shallow breathing, difficulty falling asleep. Attachment profile: typical anxious-attachment features — hypervigilant toward primary caregiver. The self-stimulating behaviour (head-banging) was her attempt at self-regulation. Critically: this isn't purely an OT issue — the root is attachment trauma requiring multi-disciplinary intervention.
Intervention Approach
I spoke frankly with the parents: "I'll do everything OT can offer, and I recommend bringing in a registered child clinical psychologist for attachment-oriented parent-child therapy." Parents agreed; we coordinated with the clinical psychologist. OT role: Polyvagal-informed co-regulation training (teaching parents body-rhythm techniques like rocking, deep pressure, soft humming to help down-regulate); home sensory environment design (establishing predictable sensory rhythms: fixed bedtime routine, fixed singing, fixed transitional object); "same therapist" continuity (I committed to staying with her throughout her OT journey — for her nervous system, having another stable adult is itself part of treatment); strongly advised parents to stabilise home caregivers (no changes for at least 6–12 months). Equally important: psychological support for the parents themselves.
Outcome
After 4 months: parents secured a stable domestic helper arrangement (2-year contract with additional support). Bedtime routine shifted from 90-minute meltdowns to 20-minute calm sleep onset. Self-stimulating head-banging dropped dramatically (from 10+ daily to 1–2 weekly, mostly when extremely tired). Mother-leaving-for-work separations changed from "end-of-world crying" to "reluctant but able to wave goodbye". Clinical psychologist continued attachment work; OT frequency stepped down to monthly review.
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