Most people are unaware of what occupational therapists do and are surprised to learn that many of them work with children. It helps to think about the “occupations” of a child’s life: play, school, and self-help skills. If a child is struggling in any of those areas, an occupational therapist may be able to help, particularly if the problems arise from a difficulty in sensory processing or motor coordination.
MOTOR SKILLS: Occupational therapists help children develop gross, fine, and visual motor skills. They typically use play rather than exercises to involve children in activities that are motivating and developmentally appropriate. Children may experience motor delays for a variety of reasons, although common findings are difficulty with motor planning (dyspraxia), low muscle tone (hypotonia), poor bilateral integration, or difficulty with postural control and balance. Children with motor delays often struggle to keep up with their peers in play and may have significant difficulty with handwriting. Without intervention the gap between the child with motor delays and his or her peers tends to increase over time.
SENSORY PROCESSING AND INTEGRATION: Efficient sensory processing involves the ability to appropriately register, interpret, organize, and execute a response to sensory input from the environment and from within the body. We all do this all the time, without even thinking about it. When a child is unable to process information from the senses efficiently, they are said to have a sensory processing impairment. Sensory processing impairments may manifest in a variety of ways and can affect a child’s motor skills, learning, activity level, behavior, social skills, and emotional regulation. Children may be under responsive (sensory seeker) or over responsive (sensory avoider) or may demonstrate elements of both depending on the situation and their sensory system. Occupational therapy with such children involves meeting their sensory needs through active engagement with specific equipment and activities. Therapy in a sensory gym is invaluable in providing the environment needed to make lasting change. One overriding goal in therapy is to continually present the child with the just right challenge that requires an adaptive response. Too easy and the child does not make gains; too hard and the child is discouraged and gives up.
- On the Go/Energetic Child (Sensory Seeker): Sensory seekers often under register sensory input. These children are typically very active. They love to crash, jump, climb, etc., continuously engaging with their environment in a vigorous way. They seek out extra input in attempt to provide their bodies more feedback, help regulate themselves, or improve their ability to focus. They may demonstrate poor awareness of their bodies in space and accidently run into others; knock over classroom materials, etc. When trying to do quiet, focused work, they often make noise, fidget, or chew on things. These children benefit from lots of heavy work input, using lots of whole body movements, such as carrying, pushing or pulling heavy items, jumping, and climbing. Good recreational choices include: swimming, horseback riding, gymnastics, gardening, and skating.
- Easily Overwhelmed Child (Sensory Defensive): Sensory defensiveness refers to a tendency to overreact to routine sensory (tactile, auditory, visual, movement) stimuli. We have two ways of responding to sensory input. The higher, more mature response is discrimination, which allows us to immediately interpret what the stimuli is and whether or not we need to respond to it. The more basic, survival-oriented response is a protective fight, flight, fright, or freeze reaction. Children with sensory defensiveness tend to be operating more in a survival mode, with stimuli being interpreted as threatening or annoying. As a result, such children may be easily overwhelmed, struggle with finding clothes that are comfortable to wear, have melt-downs that seem to appear out of the blue, be distressed by loud noises, eat a very limited diet, etc. It is important to recognize that the child with sensory defensiveness is operating in a stress mode much of the time. They benefit from a quiet, orderly, predictable environment. Occupational therapy intervention with a strong home program can be very effective in reducing or eliminating sensory defensiveness.
CLINIC BASED VS. SCHOOL BASED SERVICES: Occupational therapy is a mandated service in the public schools, however it is considered a secondary service. That is, children typically must have a diagnosis or disability (sensory processing disorder or dyspraxia are not considered qualifying disorders), an IEP, and receive a supportive service, such as special education. Once those qualifications are met, OT may be considered if needed for the child to meet their educational goals. How this is interpreted varies widely from state to state and school system to school system. In many schools, OT is limited to handwriting intervention, unless the child is presenting with more significant delays.
Occupational therapy intervention can make a profound difference in the life of a child and their family. If you want to learn more about occupational therapy, check out our website: www.Emergeachildsplace.com and http://sinetwork.org/.