Building Underdeveloped Sensorimotor Systems

BUSS: Building Underdeveloped Sensorimotor Systems in Traumatised Children


The BUSS Model has been developed by Sarah Lloyd, a nationally recognised thought leader who has developed a new paradigm for understanding and working with children with developmental trauma.

About Sarah Lloyd

Sarah has worked with children and young people in child and adolescent mental health services (CAMHS) for over 25 years.  She has worked in England in CAMHS teams and in Scotland in a specialist CAMHS/ Social Work team working with children that are looked after (2005-2013).  Sarah trained first as an Occupational Therapist and has done further study in psychoanalysis (MA, Psychoanalytic Studies) and completed a number of clinical trainings, including Play Therapy and EMDR (Accredited Practitioner).  Sarah currently works part time in CAMHS and part time providing BUSS services in partnership with the Oakdale Centre. Sarah published a book in 2016, Improving Sensory Processing in Traumatised Children, which outlines this model. Her second book, Building Sensorimotor Systems in Children with Developmental Trauma: A Model for Practice, is due out in April 2020.


A lot is understood about the psychological impact of abuse and neglect on children. We know that just moving children from an abusive situation and putting them into a loving family is rarely enough to undo the impact that early abuse has had. Children and their adoptive parents are often offered psychological therapies to try and address the original trauma, and for some children and families, this is helpful.

Much less is known about the effect an early abusive environment has on a child’s bodily regulation.  In Sarah’s clinical work with children who are adopted, fostered or looked after, she has become increasingly aware of a group of children who are really out of touch and out of sync with themselves on a bodily level.  These children are often quite hyped up or frenetic in their activities in a way that feels different to the exuberance or energy of typically developing children.  Their movements are often stiff and jerky or floppy and they may find themselves bumping into things / tripping up or unable to do things like hold a pencil properly or use cutlery.  Offering psychological therapies to these children feels like putting the cart before the horse – if they don’t know where their feet are then it’s really hard for them to think about things on an emotional level.

The Model

In her clinical practice, Sarah has developed a model for working with children and young people who are dysregulated on a bodily level and she is convinced of the importance of addressing this bodily dysregulation before trying to think about the psychological impact of their experiences. The Building Underdeveloped Sensorimotor Systems (BUSS) Model brings together a neurodevelopmental understanding of the impact of trauma on the developing brain, sensory integration theory and an understanding of attachment and child development.  Clinical experience is showing that it’s possible to go back and rebuild these foundation systems and that the best people to do this are parents/carers and schools – people who are in contact with the child every day.

This is different to work with children who have a sensory processing disorder. Although a child with an underdeveloped system may move in a similar way to a child with a sensory processing disorder, they’re actually completely different. For a child who has experienced abuse and neglect, it’s usually the case that the system isn’t broken, it just hasn’t been built yet.  Building these lead to huge changes not only in bodily regulation, but also significant changes in emotional regulation and learning.  Parents describe not only great leaps in the parent child relationship, but also greater impulse control and frustration tolerance, which might suggest this is an important adjunct to psychological therapies.

The starting point of this model is an understanding of each of the frames of reference and helping parents identify the foundation systems that are underdeveloped in their child.   Sensory integration theory helpfully maps out exactly how these kinds of early movements contribute to the development of the brain and central nervous system, building the foundation systems (vestibular, proprioceptive and tactile) that form the basis for social and emotional development.  If these systems are well enough primed, a child can progress through the normal stages of development and move towards smooth, well co-ordinated movements; a sense of connectedness with themselves; feeling their body is helpful and reliable and does what they want and need it to; as well as being able to challenge themselves and learn new, more complex skills. 

Combining this understanding of which foundation systems are underdeveloped with an understanding of child development and attachment, it’s possible to use games and activities to go back and address the gaps in those systems, and it’s fantastic to see the changes as children become more comfortable in their own bodies and to feel that their bodies are working with them rather than it being a battle.   

Once children have a sense of themselves and feel regulated on a bodily level it’s a good point to begin to think about their emotional and psychological wellbeing.

Will this help my child?

It’s helpful to spend a bit of time thinking about how your child holds themselves and how they move.  Look at how they stand and walk – is it a smooth, well co-ordinated movement? Do they seem to have good core strength? Are their movements floppy or jerky? Does their body look as if it’s working as one fluid unit? Is it well synchronised? Do arms and legs work helpfully together? What’s their head position like? Then Sarah would suggest applying these questions to other kinds of movements that we expect children to be able to manage well by the time they get to school.  For example, walking downstairs in a controlled way without having to put both feet on each step or having to hold on to the banister, or being able walk around without bumping into things or falling over. Slightly older children can usually expect to see improvements in handling cutlery, hand writing and in their progress at school.

All of these, combined with information about a child’s level of arousal, can give useful information about those foundation systems.  If a child is struggling with these sorts of movements it’s generally useful to spend some time building the foundation systems so that your child has a good solid platform on which to build social, emotional, relationship and learning skills.

Age limit

Sarah and her team work with children and young people from babies through to 18 years.

Clinical Intervention

Oakdale provides the BUSS intervention as a Four Stage Model that is a combination of psychoeducation, individual assessments, personalised exercise and activity plans, follow ups, reviews and reports. This works well for school age children because, while the most active participants are parents and carers, it can be helpful for schools to be involved.  Professionals already working with the family (if children are adopted this is usually the  adoption support workers or if children are looked after, then it’s usually the child’s social worker) are asked to support parents and carers in completing a BUSS screening tool to help them understand more about the intervention and to help them begin to notice bodily regulation and movement.


A Description of the Four Stage Model

  • Part One

Psycho education for parents of the children who have been referred for BUSS, and the team around that child. (This may include the child’s school and adoption support worker for children who have been adopted.)

The morning part of the session introduces the model, increasing understanding of the development of the foundation sensorimotor systems in typical development, and exploring the impact of early neglect and adversity on a child’s development.  Participants are encouraged to think about their children on a bodily level, tuning in to how they move and the information this gives about their foundation sensorimotor systems.

During the lunch break parents have an opportunity to meet the BUSS practitioners they will be working with and other parents who they might see as part of doing this work with their child.

The afternoon session gives parents and educators the chance to practise some of the games and activities that they’ll be using with their child, think more about child development as a sequential process, as well as an opportunity to think about what support they might need to be able to do this work.

  • Part Two – Assessment

The assessment happens within a week or two of the training day and a BUSS accredited practitioner meets with the child / young person and their parent(s) or carer(s) to look more closely at the child’s foundation systems.  This is very much a collaborative approach, encouraging parents to use what they learned at the training day and to think together about their child’s vestibular, proprioceptive and tactile systems.  Generally, parents come to this assessment with a sense of how things are for their child and there is discussion about what the BUSS practitioner is noticing and how this fits with the parents’ ideas.

The BUSS practitioner then writes a summary of their observations and a comprehensive programme of activities for the parents (and the identified person at school, if they’ve attended the training day) and child to work on over the next month.  Families are asked to keep a video diary, taking pictures or film at least twice during the four week period.

  • Part Three – Follow up

This follow-up session takes place one month after the assessment.  It takes the form of a two-hour group session facilitated by the BUSS practitioner for up to four sets of parents.  Parents and carers are encouraged to talk about their child’s progress and challenges in relation to the BUSS programme and share videos of their children.  The practitioner then writes an individual programme of the next steps for each child.

  • Part Four – Reassessment

The reassessment session takes place two months after the original assessment.  It follows a similar format to the original assessment session.  For most families, this will be as much support as they need – they will have made significant progress in rebuilding their child’s underdeveloped sensorimotor systems and feel confident to continue with some guidance (in the form of a written report) from the BUSS practitioner.  A small number of families, usually families where the child has been significantly impacted by FASD or drug use in utero, may need ongoing support.  In Yorkshire, this may be provided through a weekly gymnastic club that Sarah Lloyd runs in conjunction with Leeds Gymnastics Club.  Children and families can continue to attend sessions here for as long as is helpful (the longest so far has been three years, the shortest two terms).  Schools are encouraged to attend once a term to make sure that they’re familiar with the activities the child is doing and have enough support to continue with them in school.

Feedback from parents who have been through the BUSS Model:

The impact so far on our daughter is remarkable. Our main concerns were around the way she manages her emotions, mainly at school and when playing with other children. She can feel very angry very quickly at seemingly small things. She also struggles to sit still and can’t cope with unpredictability.  These were impacting on her friendships and her learning.”

“We were struggling to understand how this physical work could help her emotionally, but the improvement so far has been remarkable. We have noticed that her reactions to unexpected situations are much more measured, school has fed back that she is calmer when she is there and that they can reason with her much more easily, she seems to be able to stay in the moment a little longer and generally seems less angry and frustrated all round. We will be continuing with great gusto and hoping that the improvements will continue!”

“My own personal understanding of what’s going on with my child and what they need is incredible. I have learned so much in the last few months and become really creative in how to use the sensory integration techniques in everyday life. Taste tests, exercise balls, balancing and combat crawling fun games that have been adapted to suit my child.”

“For her to feel comfortable walking down the stairs without being afraid was the biggest accomplishment I can think of, and in a very short space of time. I would definitely highly recommend this work; an essential understanding of what has been missed or gotten stuck and how it affects the body.”

“It’s amazing that something that’s so completely life changing can be so much fun!”


The Oakdale Centre also organises training for fostering and adoption organisations or educational establishments who are keen to embed this way of working into their practice.  There are different levels of training, from one and two day trainings to a combination of training, ongoing work and consultation.

Please click here to find out more about the BUSS training.


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