Threaded Dialogue Play: A Story from the OT Room with Leo

Leo is a bright, energetic child with a PDA profile who often meets the world with resistance, especially when it feels like it's closing in on him. Words like school, subjects, or teachers are instant triggers. He’s quick to challenge, quicker to flee or fight, and swearing is often his shield when things feel too much. But in one of our recent OT sessions, something shifted.

I introduced Threaded Dialogue Play (TDP)—a conversational technique I’ve developed that keeps dialogue open-ended, flowing from one topic to the next without pressure or conclusion. It’s not evidence-based, but it’s been a lifeline in my sessions.

Leo was bouncing between swings, monkey bars, and the trampoline—his body seeking proprioceptive input to meet his high neurological thresholds. I started with a casual thread:
"One of my kids used to bite his nails, but since he started playing with Lego, his stress dropped and his nails grew back. You know guitar players grow their nails? Do you play any instruments?"

Leo paused mid-swing. "I play the guitar."
"Ah, cool! I play too. Guns N’ Roses—all long hair. If you want to be a rock star, maybe grow yours out?"
"I just cut it at the barber’s."
"Oh great! I didn’t know that. How come you weren’t cutting it before?"
"I don’t like people touching my head."

That was my opening. I gently linked it to the rainbow lycra swing, his favourite. "You know, when we spin in the rainbow swing, I usually follow it with a deep pressure massage on the head. Want to try it?"

He nodded.

Throughout the session, whenever Leo started to get agitated or called me names, I didn’t correct or confront. I found a gap, a thread, and pulled gently. The topics were never directly about him. No commands. Just curiosity, connection, and movement. He swung, climbed, jumped, pushed, and pulled—his body regulating while his mind stayed engaged.

And then, something rare happened. As he transitioned out of the room, he turned and said, "Bye."

That simple word was a milestone. For Leo, it meant safety, trust, and regulation. For me, it was a quiet affirmation that TDP had done its job.