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WHAT IS IMPORTANT TO KNOW ABOUT PEDIATRIC OCCUPATIONAL THERAPY?

Occupational therapy is a healthcare profession concerned with helping people of all ages to better perform those tasks that occupy their time. For children this typically means playing and learning as well as eating, getting dressed, grooming and so on. Occupational Therapists use a knowledge base of neurology, anatomy, physiology, child development, psychology, activity task analysis and therapeutic techniques.

“Play is the work of children. Through play children learn about themselves and the world around them”

An OT provides carefully designed challenges that build on your child’s unique strengths and interests to build developmental skills such as…

☺ Attention span and arousal level

If a child isn’t interested, fidgets constantly, or simply doesn’t look at what she is doing, she can’t learn effectively. An OT will help you discover what motivates your child, makes his body ready to learn (that is, what helps him keep still, calm, and alert), and to pay attention and stay focused.

☺ Sensory processing skills

A child needs to effectively use information derived from all the senses that pick up input from the environment (vision, hearing, touch, smell, and taste) as well as from inside the body (movement and internal body awareness). All this input must be registered by sensory receptors, processed in the brain, and acted upon in an adaptive way for a child to function at her best.

☺ Fine motor and gross motor skills

Many children have difficulty with fine motor skills such as drawing, using scissors, buttoning, and stringing beads. Their small hand muscles are still maturing, and they may not have developed the strength, coordination, and dexterity needed. OTs also work on gross motor skills that use “larger” muscles, such as throwing and catching a ball, climbing stairs and playground equipment, jumping and hopping, and so on.

☺ Activities of daily living (ADLs)

Children have lots of ADL tasks to master, and most children love becoming independent with these tasks. OTs help children learn to eat with utensils, drink from a cup, get dressed and undressed, take a shower or bath, use the toilet, and handle grooming and hygiene tasks age-appropriately.

☺ Visual-perceptual skills

From stacking blocks to doing puzzles to understanding geometry, a child must be able to perceive differences and relationships between objects in the environment. An OT can help a child to form a mental map of how the world works and where he fits in it, all of which are essential to feeling physically and emotionally secure.

☺ Handwriting

Handwriting skills, from the basics of letter formation to taking class notes legibly, can be extremely difficult for some children to learn quickly. OTs use a fun multi sensory approach to handwriting, including use of touch (e.g.., using a wet finger to write on a chalkboard) and sound (teaching a special story about how a specific letter is formed).

☺ Assistive technology

Low-tech devices (like pencil grips) and high-tech equipment (like computers) are increasingly used in schools. An OT can help you to find the right technological solutions for your child, teach him how to use it, and help integrate it into the classroom. Many OTs work with kids with mild to profound physical disabilities, helping them function at their best using wheelchairs and other ambulatory devices as well as adaptive equipment like reachers and dressing aides, and helping non-verbal clients access communication devices that help them communicate with the world.

Creating a Strong OT-Parent-Child Team

Children with sensory processing disorder benefit from a sensory diet of daily activities set up by a pediatric occupational therapist who is trained to work with children who have SPD. However, the best OT in the world can't "fix" a child in a few sessions a week. What she can do is serve as a crucial part of the OT-parent-child team and help your child tremendously even as she's helping you to teach your child to develop sensory smarts.

☺ The OT's Perspective

The OT must get to know your child and establish a rapport and trust. Then she'll be able to use her skills to coax him into engaging in sensory challenging activities he might otherwise avoid, such as sitting on a swing or touching a slimy substance like shaving cream or soap. She can also then guide him to stop an activity and notice that his arousal level is getting too high, then use calming, focusing activities to return to a "just right" state of energy. An OT can teach your child the basics of sensory smarts: Observing what you are experiencing in your body and discerning whether you need to adjust what's happening in your body or the environment. A great OT observes and listens, and draws upon her own knowledge and experience to teach your child how to function better in his body and his world.

Because she spends a limited amount of time with your child, she may not be aware of how difficult it is for the child and you to carry through with a sensory diet, the "homework" that builds upon the OT sessions she gives and keeps the child on an even keel throughout the day. She may have no idea how much your child resists grooming or other important activities, whether it's wearing his headphones to do his listening therapy for auditory issues or brushing his teeth. Let the OT know your biggest challenges and she can provide you with strategies and practical tips that may work for your child, based on her observations of him and her knowledge of sensory issues. Don't be afraid to ask questions!

☺ The Parent's Perspective

As the parent of a child with sensory processing issues, you have a picture of your child's challenges based on all the time you've spent with him as well as feedback you've received from others and research you've done on your own. Your information and perspective is incredibly valuable to your child's OT, and it is up to you to lead the team, coordinating the communication so that everyone is on the same page. Let's say your child gets lethargic after lunch and is at his most uncooperative. Work with the OT to switch the session from after lunch to a better time, and together, exchange ideas about how to help him switch into a higher state of arousal and cooperation. Tell her about what has worked before. If your child doesn't like sticky candy (or you don't want him to eat it), make sure the OT knows she can use a different reinforcer for behaviour or a different food for practicing a particular skill. If your child has been sad for days because her pet hamster died, let the OT know so that she will understand why your child is less cooperative than usual. You are looking at the big picture of your child in sessions, at home, and at school or day care; be sure you communicate to everyone what they need to know.

☺ The Child's Perspective

Ultimately, we want our wonderful sensory kids to develop their own sensory smarts so they don't have to rely on a sensory smart adult to advocate for them. Whatever your child's level of communication, try to get his take on how he feels in his body when he engages in certain activities or when he's in particular environments where you can see he's uncomfortable. Provide him with language to express what is going on, so that eventually he can communicate, "I'm uncomfortable with all the sounds going on in this room. I need a break. Can I go outside for a few minutes?" Praise your child when he begins to show signs of being aware of his body's needs and advocating for himself in a socially acceptable way. In this way, he'll learn its his responsibility to meet his needs (with the help and cooperation of others) and advocate for himself.

Everyone on the OT-parent-child team can learn from each other and work together toward the goal of helping your child to become sensory smart and to function better. When you don't understand the actions or attitude of a team member, become curious. Ask what's going on rather and listen with an open-mind to the answer. Reassure your child that you are listening and support your OT in delivering information that may make you feel a little sad, frustrated, or unhappy. Tell her, "I'm sorry if I'm a little defensive, it's just that getting him to cooperate at home is much more difficult than you might guess." (In fact, remember that children will often "hold it together" and behave better around those they don't have as strong a relationship to, such as a therapist or teacher, than around those they can trust fully, like Mom!).

Communicate with respect, curiosity, and compassion not just for the OT whose job is difficult, and your child who has challenges, but for yourself. You will make mistakes and have bad days. Be gentle with yourself and just keep recommitting to doing the best you can. You may be amazed by what you and your team can accomplish together.

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