Occupational therapy, known as OT, is designed to help children and adults acquire (or regain) the skills needed to perform the activities—or “occupations”—of daily life.
“It’s a huge field,” says Lindsey Biel, an OT specializing in pediatrics and coauthor with Nancy Peske of Raising a Sensory Smart Child. When a child shows delays in mastering typical activities, or displays unusual or disruptive behavior, the OT is often the first professional to work with her.
Biel breaks down a litany of issues OTs address on her site Sensory Smarts: attention span and arousal level; sensory and processing skills; fine and gross motor skills; activities of daily living (ADLs), also known as self-help skills, such as brushing teeth, dressing and toilet training; visual-perceptual skills; handwriting; and assistive technology.
What are sensory processing issues?
When it comes to attention, arousal level, and sensory and processing skills, the work OTs do is based on theories presented by occupational therapist Dr. A. Jean Ayres back in the 1970s.
She posited that children and adults with sensory processing issues can’t synthesize all the information streaming in from the traditional five senses—touch, hearing, taste, smell and sight—as well as two “internal” senses, body awareness (proprioception) and movement (vestibular).
Proprioception allows for motor control and posture, while vestibular receptors tell the brain where the body is in space, which links directly to balance and coordination. (Peske has made a short, fun video that introduces these seven senses.)
What are sensory processing issues?
When it comes to attention, arousal level, and sensory and processing skills, the work OTs do is based on theories presented by occupational therapist Dr. A. Jean Ayres back in the 1970s. She posited that children and adults with sensory processing issues can’t synthesize all the information streaming in from the traditional five senses—touch, hearing, taste, smell and sight—as well as two “internal” senses, body awareness (proprioception) and movement (vestibular). Proprioception allows for motor control and posture, while vestibular receptors tell the brain where the body is in space, which links directly to balance and coordination. (Peske has made a short, fun video that introduces these seven senses.)
Children who have trouble modulating sensory input may experience over-sensitivity (hypersensitivity), under-sensitivity (hyposensitivity) or both to an impairing or overwhelming degree, at school, at home and in the world at large.
An extremely hypersensitive child tends to be withdrawn; because she’s easily overwhelmed by auditory and visual stimuli, she may want to avoid gym, recess and lunch. The buzz of fluorescent lights and anxietyabout the loud fire alarm going off may distract her, making it difficult to pay attention and participate in class.
Meanwhile, those who are under-sensitive crave input. In the classroom, that translates into “disruptive” sensory seekers, since they want to keep moving, touching everything, and even tripping or crashing into other kids. It’s easy to see why this type of behavior leads to a diagnosis of ADHD, which the child may or may not have.
How do OTs help kids with sensory issues?
For hyper-sensitive children, OTs may suggest things like special seating and testing in a separate room, which will help avoid sensory overload. To help sensory seekers achieve an optimal level of arousal and regulation, OTs working in sensory gyms provide movement activities like swinging, crashing onto huge bean bags, and jumping on trampolines. They may also build sensory breaks into the day, allowing the child to walk around, stretch and even do jumping jacks at regular intervals. A wide variety of products including fidgets and chewable pencil tops and jewelry may provide calming input that helps children sit and focus.
Controversy continues as to whether two widely used practices, joint compressions and a brushing of the skin, actually “rewire” the brain so that kids can appropriately integrate and respond to sensory input, allowing them to feel more comfortable and secure as they negotiate their environment. Even Biel admits that she isn’t always sure these practices have merit but “just when I have my doubts, there’s this great intervention. I had a child making almost no eye contact who was constantly in motion. I put him on cushions and gave him a good brushing. I got eye contact through the whole session; his parents were gasping. Is he cured? No. Was it organizing? Yes.”
Because there are so many different signs that may indicate sensory issues, Biel and Peske have devised a sensory checklist for parents to help them determine if processing difficulties may explain their children’s atypical behavior. Another tip for parents, educators and clinicians: If the child does much better in one setting over another, i.e. more hyperactivity is noted in a classroom versus home, sensory issues may be at play.
Helping with gross motor skills
When gross motor skills involving the major muscle groups are at issue, the child will struggle with things like balance, coordination, strength and endurance, all of which will have a direct impact on everything from walking and climbing stairs to hopping, jumping and catching and throwing a ball. Such deficits can keep kids from participating in recess and sports, which can in turn affect socializing and self-esteem.
Throwing and catching balls of various sizes and weights and obstacle courses help with things like balance and coordination, while riding a trike builds strength and endurance. OTs will often work on gross motor skills in tandem with physical therapists, since some of their goals are so much aligned.
Additionally, low muscle tone and core body strength impedes kids’ ability to sit erect and alert, important for class participation and fine motor skills like handwriting. Crab walking, curls and rolling and bouncing on atherapy ball help address this deficit.
Helping with fine motor skills
Fine motor skills involve the small hand muscles. When there’s a lack of strength, motor control and dexterity, kids will have difficulty drawing, using scissors and stringing beads. Such delays, if not addressed, will make academics—turning pages, writing, using a computer—that much harder. They also come into play with regard to self-help skills including buttoning, zipping and using utensils
OTs employ many fun techniques to help develop fine motor skills. For instance, a dot dot paint activity helps develop control, dexterity and the thumb-and-finger hold, aka the pincer grasp, key to using a pencil or fork. Popping bubble-wrap also develops the pincer grasp, along with dexterity and eye-hand coordination. Simple activities like picking up coins with one hand require manipulating small objects. Lacing helps develop fine motor coordination and also provides a visual focus. Preschoolers who play pickup games with larger tweezers graduate to Operation. Varying resistant consistencies of Theraputty increase both hand and finger strength and dexterity.
Teaching self-help skills
To become proficient in self-help skills, children may need to work on fine motor skills for things like dressing and undressing (buttoning, zipping, tying shoes), grooming (brushing hair and teeth, using the toilet) and eating (holding and using utensils.) OTs will model and practice these skills with clients, using many of the techniques noted above.
Sensory issues present a different challenge: For instance, a child who can’t stand getting her face wet, wearing anything that feels scratchy or tight, or putting anything in her mouth is also going to have trouble with ADLs.
Biel and Peske offer many tips to help children through challenging experiences including teeth brushing (desensitize gums; switch toothpastes), bathing (cover the face to avoid splashing) and shopping (avoid peak hours; let your child push the cart to get deep input).