Day 9: Occupational Therapist

Occupational Therapy

This is Day 9 in the series: 31 days on Living with ADHD, Autism and Sensory Processing Disorder: What We Have Tried, What Has Worked, What Hasn’t Worked, and Never Giving Up.

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Shortly after turning 3 Mr Rockstar started occupational therapy (OT).  If you are like me I didn’t know much about OT until Mr Rockstar started going.  Starting OT kinda freaked me out but it turned out to be one of the best things we have done.  Some examples of tricks we have learned:

  • If Mr Rockstar is gagging on a particular food, the OT recommends he play with a similar texture to first get used to the texture.
  • If he hates having his teeth brushed, the OT recommends I massage around his lips, nose and chin and then hold him in a tight hug with one arm while brushing their teeth.  This all helps desensitize the area.
  • If he is playing to rough or is lacking in focus, the OT recommends some heavy work/exercise.

Evaluation for OT

Just like with speech therapy, you have the right to get your child evaluated but the state and if they are found to be behind then the state will provide services either through the public school or through an early intervention program.  The OT evaluation is pretty straightforward.  Kennedykrieger.org explains an OT evaluation as: “An occupational therapy evaluation will assess a child’s gross motor, fine motor, visual motor, visual perceptual, handwriting, daily living and sensory processing skills. The use of standardized assessment tools, non-standardized assessment tools, parent interview and clinical observations will be used to assess the child’s performance.”  

When Mr Rockstar was little the evaluation was based almost entirely on a parental questionnaire.  The big clues he needed therapy were:

  • He had strong food texture reactions
  • He over stuffed his mouth
  • He hated having his teeth brushed
  • Most clothes bothered him
  • He always wanted a toy in both hands
  • He frequently crashed into things and played too rough
  • He hated getting his hands dirty or his clothes wet
  • He would cry just watching other kids finger paint
  • He had a delay in fine motor skills for his age
  • He hated to color
  • He had difficulty with buttons and cutting
  • He refused to feed himself partly because he disliked getting messy and partly because he didn’t like the feel of holding the spoon, etc.

How Does OT Work?

So how does an OT develop a course of treatment?  How does OT help?

According to the SPD Foundation: “During the course of treatment, the therapist continually evaluates each child’s abilities in several areas summarized as “A SECRET” in Sensational Kids, Dr. Lucy Jane Miller’s definitive book on Sensory Processing Disorder in children. 

  • Attention: Is there a way to enhance sustained or divided attention to people and activities around the child?
  • Sensation: Is there a way to modify the child’s responses to sensory input?
  • Emotion: What emotion is the child experiencing, and can these emotions be regulated?
  • Culture: What part of the family’s culture (habits and routines) can be changed to avoid challenging situations?
  • Relationship: Is there something in the relationships experienced by the child that is causing his or her responses? For example, does the child need closer support or need more space?
  • Environment: What in the environment is not optimal for the child? How can those environmental factors be modified?
  • Task: What is troubling the child or difficult about the task at hand? How can the task be modified so that it is not so problematic?

In other words, the focus in therapy and in natural settings when sensory challenges occur is to first examine the factors contributing to the observed challenge and second, to modify or use the other “SECRET” factors to affect the problem area. 

The goal of OT for children is always on developing automatic and appropriate responses to sensation so that daily occupations can be competently performed and social participation fostered. As these competencies increase with effective treatment, social participation, self-esteem, self-regulation, and sensorimotor abilities also increase, and other family goals and priorities are achieved”

Mr Rockstar’s occupational therapists are constantly asking how things are going at home? what are we struggling with? how is school? how is Mr Rockstar doing in self care? how is he doing socially? what are his big triggers for melt downs? and then based on their experience with other kids they develop a treatment plan.  As Mr Rockstar progresses or a new issue comes up they change the plan.

But What Does the OT Actually Do?

“Occupational therapy uses purposeful activities to enhance and encourage skill development. Guided by the child’s interests, the therapist provides fun and motivating activities that aim to provide a “just-right challenge” so that the child will develop the underlying skills needed to effectively complete functional tasks. The goal of occupational therapy treatment is to use meaningful activities to assist the child in achieving functional skills needed for daily living.”  according to Kennedykrieger.org

Usually the first few weeks with a new OT are spent with them exploring what is stimulating vs what is calming for your child.  For instance Mr Rockstar finds hard exercise (like running the treadmill or rock climbing) to be calming as well as the lycra swing.  Once the OT knows this they usually start with an activity that is calming followed by a difficult activity such as finger painting with shaving cream, cutting out designs, writing, etc.

Not All Therapists Are Equal

Our first couple occupational therapists for Mr Rockstar weren’t that great.  They were more worried about getting Mr Rockstar to “pass” the test so he wouldn’t qualify for services anymore rather than working on the bigger picture.  Instead of doing sensory activities to make him more comfortable holding scissors they would skip directly to trying to get him to sit and cut.  These therapy sessions were so painful.  Once we got a better therapist, most of the time Mr Rockstar enjoys therapy.  There are a lot of “fun” activities and the hard activities are closer within his ability.  We still sometimes have battles at therapy drop off with Mr Rockstar not wanting to go…but usually once they start therapy he does a good job and enjoys it.  So don’t feel afraid to switch therapists if you need to!

Home Activities

Some of the activities the therapists suggested we try at home:

Fine Motor:

  • Sensory bins
  • Cutting
    • To practice using scissors the Ot had us first start on small strips of paper.  As he mastered that he would get wider and wider strips.  Draw a line across the paper to help them concentrate.  Eventually he was cutting zig zag lines and then circles and other shapes
  • Pennies in bank
    • Putting pennies into a piggy bank is a great fine motor activity
  • Finger painting with pudding
    • Get some chocolate pudding and finger paint or even drive matchbox cars through it!
  • Chopsticks
  • Small crayons
    • Our first OT recommended giving Mr Rockstar the smallest bits of crayon I could find.  Since the pieces were so small he was forced to use more of a tripod grasp instead of using his whole fist.  I thought this was a great insight!
  • Applying stickers to a sheet of paper
    • Another great activity for fine motor development

Soothing:

  • Any Heavy Work!
  • Body Pod Sensory Sock
  • Lycra Swing: Therapy Swing Cuddle Hammock Autism Adhd Aspergers Sensory Kids Outdoor Indoor
  • Treadmill
  • Trampoline
  • Bike riding
  • Hiking
  • Hard squeezes.
    • I am sure sometimes people think I am crazy sitting in church squeezing Mr Rockstar’s head or pulling his arms out and pushing them in around his joints.
    • We have been advised to give him tight squeezes whenever there is an unpleasant “tickly” sensation coming.  So for instance while we help him brush his teeth we usually have him in a tight hug with one arm.
  • Sensory Brush – the therapists have given us a few of these.  They recommend HARD brushing on his arms, back, etc.  Usually starting on top of his clothes until he is used to it.  This is supposed to help desensitize him to ticklish touches like clothing irritation.

More ideas are posted on the Sensory Integration Disorder and the category Work Hard, Play Hard Kids.

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