Occupational therapy and Children.

 

A lot of parents who come to meet me for the first time- ask me if I am an Occupational therapist? And when I answer yes – the question is “what do we do?” and what exactly is Occupational therapy?”

The main job responsibility of an Occupational therapist is to put the person back to his Occupation. Occupational therapists works with various strata of people right from schools to hospitals to geriatric care.

Since I have explored my role of an Occupational therapist with kids, I would like to describe more about how we help the kids. Also, my explanation or description is only about my experience and it does not in any way limit what Occupational therapists do in various other setups in which they specialize.

 

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Do kids really have an Occupation ?

Does Occupation mean only working to earn money or it means constructively and independently engaging in activities which we love?

Some of the roles in a child’s occupation are

To play and make friends

To take care of his own self care needs

To be able to learn in school

To be able to participate in all events or activities that happen in his or her community.

Does the child need any skill to be able to do the Occupation of a child?

What does he need to play?

Early social play- this is the play which is mostly initiated by adults in the form of silly sounds, peek a boo etc. Infants as young as 6 weeks start learning and setting the base for later language development. Infants learn to pay attention, understand the use of language by adults and learn to read the intentions of the care givers. There is a lot of base being set in play for future development.

Exploratory play- Child is learning to explore the environment through the sensori-motor play by banging toys, mouthing them, throwing them, smelling them and feeling them. They are little scientists in making who need the inquisitiveness and the intrinsic motivation to sustain the exploration and to make that exploration fun. Main focus is on their own bodies. They are developing a large repertoire of sensory experiences and also laying foundations for body scheme which will be needed for motor planning or praxis. Lot of learning is happening till this time roughly from 6 months to around 15 months of age.

Constructive play – They learn about cause and effect, simple fixing, pulling and stacking from around 12 months of age. In doing so, they are training their postural muscles, attention skills and also gross and fine motor skills. They are learning to effectively use their body while they are playing. The play becomes more goal oriented and they learn to expect results of making a tower of cups or blocks or stacking rings and completing them. Their little brains are also developing social connections of getting praised for their attempts and also a lot of language development is happening.

Pretend play- this starts as early as one year of age where the infant is holding a remote to his ear and pretending to talk on the phone. They are trying to eat from a empty bowl with a spoon or drink from an empty cup. First words emerge with pretend where they learn the names of objects that they play with. When a sequence of play is done, they learn to understand two word sentences and even understand “first- then” relationships.

Parallel play- Children play next to each other and not with each other. They learn by observing their peers. Lot of imitation skills develop at this stage. Their own basic level of pretend play is expanded and extended by observing other kids. Their language skills also expand and they also learn to coordinate their actions with other kids. They are also learning to manage their own materials and toys.

Socio- dramatic play- This play emerges at around 30 months of age. They play simple doctor doctor, fireman, lift man or whatever that they are exposed to. So the play develops language which they use to convey their imagination to other kids. They also learn to mind-read whether the other child is interested in them or not. They start developing preferences for those who listens to them or understands them well. Inter-personal relationships start developing by now and whole big world of social development is now open for learning. They are learning to incorporate their friends ideas in their own play and thus learning what to and what not to imitate. They learn to act out their fears and adults help them to understand how to express and how to manage fears and anxieties. They are learning a very critical skill called self regulation. They are learning to manage their own toys and maneuver within space- not to wander away too much. They are also learning to organize their behavior through self regulation.

Games- Kids start this from 48 months of age and stay through life. Here is where the abstract language starts developing. Games such as hide and seek, stone, paper scissors start coming in.

So what exactly does a child need to perform the occupation of play?

I am sure by now you must be convinced that a lot of skills are needed in just playing and these skills lay the foundations for further learning and development. An Occupational therapist’s role is to help the child to play by checking where is he stuck in development because of what reasons and to take him from where he is stuck to restart the process of development that has stopped. All that is done is to provide the child with the right opportunities which he did not get and got stuck. Using activities to assist play is what an Occupational therapist will do to assist play.

Self care needs include

Eating – requires fine motor skills and good eye hand coordination, requires good integration of the tactile input so that the child is fine with messy food textures. The development of the oral motor system is also important as kids may stuff their mouth with food because of not being aware of food or become picky eaters. Kids also need to have developed interoceptive sense so that they know when they are hungry or thirsty and also to know when they need to stop eating or when they are full.

Dressing- This requires a good body scheme and also good coordination to be able to dress and undress independently. Tactile system also needs to be developed so that all fabrics are tolerated well.

Grooming and Bathing-Again tactile system and a very good body scheme is very crucial because kids have to be comfortable with brushing teeth, washing hands, wiping hands and so on. And when the body scheme is developed well, kids will be able to plan the actions well.

Toilet- Child needs to have good interoception so that they know when they need to use the toilet. Good coordination and body scheme is needed to clean themselves after bowels

Manage space and community mobility – how far they can go how safe is “safe”. They understand that it is safe to go to a neighbors house on the same floor but not safe to go to neighbour’s house on a different floor. They gradually expand their limits and start understanding that it is safe to go to a neighbour’s house in a different wing of the same building or a different building.

What do kids need to learn in school?

Visual perceptual skills

Attention

Fine and gross motor skills

Integrated primitive reflexes

Most of the above skills develop when the child gets enough opportunities to play while young. However, sometimes there is a scatter in development because of prolonged illnesses or a medical diagnosis.

What do kids need to be able to participate in the community activities or events?

Self concept

Self confidence

Self esteem

Inquisitiveness

The base of the skills is built on opportunities that the child receives when he is very young and playing.

So, the role of an Occupational therapist is to check what is coming in the way of the development and what is stopping the child from performing his Occupation. Some of them are

Poor body scheme

Poor fine and gross motor skills

Poor visual perceptual skills

Poor pretend and imagination skills

Poor mind reading skills

Poor attention and concentration

Active Primitive reflexes

Inadequate development of postural or righting reflexes

Difficulty coping with academics because of poor handwriting, reading or spelling skills

Poor self help skills

Poor confidence

Low self esteem

No inquisitiveness

Poor self regulation

Poor management of space

Poor eating habits /picky eating

Delay in toilet training

Not understanding when to stop eating

Difficulty understanding Social skills or abstract concepts

Difficulty making friends

 

All of the above is developed by engaging the child in meaningful activities suited to their level of development and developing a Occupational therapy plan where the goals are decided monthly. Goals need to be revised monthly or quarterly and assessment needs to be done to check how much progress is achieved. Goals need to be modified if the child is not improving and all of this needs to be done according to how normal development happens for any other neurotypical child.So when an outsider sees an Occupational therapist work with kids, it just looks like play and fun…..But there is a lot of deeper work happening within the therapist to make that work look like fun and play!!!!

 

Hope I have done justice in explaining about what Occupational therapists do, fellow OT’s reading this, feel free to add more whatever that I have missed.

Reena Singh

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