Occupational therapy isn’t as easy to explain as Speech and language. Traditionally OT’s used everyday activities therapeutically. So for a geriatric OT, working with elderly, activities such as arts, crafts, bingo, dancing etc might be used to maintain dexterity, build fine motor control, build memory and alertness, and fight depression. OT’s also look at aids and supports to help people be independent, such as mobility aids, aids with dressing etc. Everyday tasks are use to help with specific goals, and then aids are used to help people compete everyday tasks. How does that work for children?

In Pediatric OT everyday child-appropriate tasks are used to help them develop certain skills. The skills OT’s focus on are ones that will help a person live independently. So for example an OT might give a child work to do at home squeezing theraputty and picking beads out of it. This activity focus’s on building up the child’s strength and control of their fingers, their fine motor control .This will help with a child’s writing skills, but also their ability to open and close buttons, zips, laces, cut food and feed themselves as well as loads of other everyday tasks. An OT may advise a child gets a special weighted pencil to use, which again helps to build up the muscles in their hands but also builds up the neurons in their brain controlling writing as the extra weight gives more feedback.

Essentially an OT works with you and your child to help them to become as independent as possible, using everyday activities to achieve this goal . They also recommend aids and supports. Ot helps your child’s handwriting, dressing skills, feeding, sitting , coordination and planning.

In the 1970’s an Occupational therapist called Jan Eyres was trying to find ways to support certain children. She found that when she engaged in sensory rich activities with them they become calmer, more alert and responsive. She was the first to start exploring the area of sensory processing and integration. Interestingly she based most of her therapy in the outdoors, but unfortunately most OT is in inside now.

An OT can get an extra qualification on their primary degree to specialise in sensory integration therapy. It is always worth checking your OT has this qualification if that is the support your child needs. They don’t all have it. This therapy uses specific sensory rich activities such as swinging, deep squeezes, climbing, playing in sand – to stimulate a child’s sensory processing system and help ‘integrate’ and work more effectively. Check out the page on sensory processing to get a better idea of that.

Jargon –

OT’s use a lot of Jargon.

Visual Perceptual skills: the combination of vision and thought to process patterns, space, seeing the difference between foreground and background. SO to put on a sock, you need to see the sock, perhaps in a pile of other socks, recognise the colour, match it to the other one, find the opening of the sock before you can put it on. These are visual perceptual skill.

Visual-Motor Integration Skills: coordinated use of eye and hands together. So you have the sock, have figured out the opening, now you have to use both your hands and eyes together to bring it towards your toes and put it on.

Gross and Fine Motor Difficulties: gross motor (balance, ball skills), fine motor (finger strength, dexterity, control). Your fingers need to work to get the sock up onto your foot, pinching and pulling it upwards, using fine motor skills. This is hard, even harder if you are wearing tights. While you are ding that you need to balance with your leg up, even if you are sitting, or balance leaning over to reach you foot. BOth these take gross motor control and can end up with you falling over and hurting your

Sensory Processing Difficulties: There is a full post on this. Basically this is how your brain sorts out the sensory information coming in. It might decide certain sounds are too loud or not hear them at all, or certain textures or tortuous, or not feel them at all. SO that dreaded sock might feel like agony as you drag it onto your foot because the wool is too scratchy and it has a horrible seam at the end that feels like a line of glass and the seam around your leg digs in and makes a line on your skin which is just not on.

Social Skills: OT’s have decided they own this area as well, only they know why. I’m not sure how different their social skills groups are to speech and language skills. I’m sure turn taking is probably focused on. I think they try to explain social skill in a way that children with processing issues might understand, but Speechtherpaists do this too.

Vestibular: we normally think of only 5 senses but there are more than that. Vestibular input is the information from our inner ear about whether we are moving or not, our sense of balance. SO whether yo fall over putting that sock on.

Introception; This is the information form our bodies, whether we are hungry, cold, hot, tired, sad, happy, angry, and so on. I can’t think of a sock analogy.

Proprioception: the information form our joints and muscles about where we are in space, are we sitting, standing how to we move from one to another, that’s all proprioception. So when you are putting that sock on and you sit on the bed and pull your leg up on to your knee, you are getting lots of proprioceptive feedback form your joints and muscles.

I could keep going with Jargon, they use a lot!

When should your child see an OT?

Occupational therapy has become a bit of a go-to intervention. I guess maybe because it’s hard to say exactly what it does, kids can get sent there for lots of reasons. Some OT’s can diagnose issues such as Dyspraxia (coordination disorder) and Dysgraphia ( writing disorder) and Sensory processing disorder. They can also be part of a multi disciplinary team to diagnose Autism.

As a parent, obviously if you are referred to an OT for a specific reason, then you go. If your child is struggling with their handwriting still at age 8 or 9, an OT is the place to go, similar if they have difficulty with dressing, toileting, everyday jobs like getting their stuff ready for school or following more then one or two directions.

If your child has sensory stuff going on an OT is the person to talk to. What does sensory stuff mean? All kids show likes and dislikes about things at different ages. They only drink from a blue cup, or won’t eat carrots because they are orange, or only wear pink clothes. Sensory processing issues are more than preferences. They are not being able to stand getting your nails cut so much it takes two parents to hold you down to do it. Or finding the transition into a shower so horrendous your scream so loud the next door neighbours are knocking at the door to see if everything is alright, but then you won’t come out of the water. Or not being able to stand the feel of jeans, or getting your hair brushed even when there are no tangles. Its not eating for days because you can’t stand the feel of food. Or nearly throwing up because your sisters porridge smells so strongly. Or needing to be wrestled into bed because you are so hyper and only really big squeezes can help you settle. It’s these things not getting any better whether your child is two or ten.

It’s fairly obvious how practising squeezing play dough can build up your hand muscles and improve your writing, there’s a link there so it makes sense. But how can an OT help with sensory integration. The theory is by linking the input from regulating (calming) activities with the deregulating ones, the child’s brain figures out how to manage better. So a child might bounce on a gym ball while playing in mucky sand. The calming action of the bouncing helps her not get overwhelmed by the muckiness of the sand. Or they use alerting activities to help a child who can’t process informing to focus better. So they might jump on a trampoline or swing on a swing which then helps to wake up their sensory system so it can process things better. Confused yet? It is even more complicated than that, but I go through it more in the post on sensory processing.

Something to consider is that most of the work an OT does is most effective if it can be done everyday. So once a week for half an hour might not have a huge impact. After all essentially OT’s are trying to reprogram childrens nervous, muscular and sensory systems. So if you want to get the most from OT intervention then ask for stuff you can do at home or that the teacher can do in class. This can be hard work for you but it can make the world of a difference. If your going to an OT for sensory processing stuff a home program is essential and should be the first thing on the list. This might be as simple as just adding more movement, going to the playground everyday instead of homework, or they might have specific activities for you to do. Give them a session or two to assess what’s going on then ask for a home program, in writing so you won’t forget.

OT’s are now starting to work with children around anxiety. Unless your child’s anxiety is directly related to a sensory processing disorder I woudl recommend going to a play therapist, psychologist or counsellor rather then an OT.

OT’s are not magic. Every child is different, with unique processing systems. They need to learn each child’s individual needs, which can take time. They can also get it wrong. It’s okay to question them. Its okay to ask them to explain if they use too much jargon.If they can’t explain in simple terms then they might not quite understand it themselves. Not every issue is within the scope of an OT. A physio might be better if your child experiences fatigue, because they might recognise low muscle tone, hypermobility or other syndromes. Behavioural or emotional issues are not part of an OT’s specialisation, unless they are directly related to sensory issues. So if your child has a diagnosis of Dyspraxia and is struggling with self esteem and can’t make friends, an OT social skills group may not be the right place, as it may just make them focus on their deficits, rather than building them up.

OT is really necessary for lots of kids. I think the best support an OT can give is to help the parents understand, so that you can hep your child out at home. Thats why I”m doing this blog, to hopefully empower parents so you feel able to walk into the OT’s office and say I want you to explain this, tell me how I can help my child do this, what to I need to do everyday with him to support his needs? Then the OT becomes a source of information that you tap in to as you need it rather then a weekly drain on your finances.