Parents often have many good questions for us, such as “How do I know if my child needs your services?” or “Why does it look like they are just playing?” and “What exactly is occupational therapy, anyways?” You can find detailed answers to these questions and more by reading more.
I have been told that my child might benefit from occupational therapy. What is it?
Occupational Therapists who specialize in pediatrics are trained to create opportunities for children to master developmental tasks and achieve independence in their home, school, and community. Children may be seen for an evaluation and treatment due to concerns about their ability to process sensory information (ex: don’t like to move, to touch messy things, to wear certain clothes etc.), clumsiness, difficulty with grasp or motor skills, feeding problems, and difficulty playing with toys or people. The therapist may recommend individual or small group intervention if your difficulties directly interfere with daily life tasks (ex: eating, sleeping, dressing, playing,etc.). Private occupational therapy which is often covered by insurance companies, use a variety of treatment interventions that include techniques to enhance muscle tone and motor control, oral motor treatment, sensory integration/sensory processing strategies, handwriting, splinting, Floortime/DIR, and Interactive Metronome.
What is sensory integration or a Sensory Processing Disorder? What do these terms mean?
Sensory Integration is a theory of intervention developed by Dr. Jean Ayres which helped us understand how the brain made sense of the information we get from our environment and to act on it. Recent research by Dr. Lucy Miller has helped identify several types of these disorders (i.e. sensory modulation disorder, sensory over and under responsivity, sensory seeking, dyspraxia etc.) and helped others understand the neurophysiological mechanisms that contribute to the challenges observed in many of the children. Her book called The Sensational Child and website www.spdfoundation.net have many valuable resources to help parents and family members better understand this complex disorder. She has also been at the forefront of helping this become a recognized diagnosis which can co-exist with others (e.g. autism spectrum disorders, learning disorders, attention deficit disorders, cerebral palsy, and Down syndrome) or exist alone. In a well functioning central nervous system, this process happens automatically and provides a foundation for more complex learning and behavior. For some individuals, however, these normal sensations can be interpreted incorrectly and result in motor, developmental, and learning difficulties, or behavioral concerns. Other resources for information include the books Tools for Tots by Henry, Kane-Wineland, and Swindeman and The Out of Sync Child by Carol Kranowitz, or www.ateachaout.com.
We began therapy, but aren’t they just “playing” with my child?
A sensory integration/sensory processing treatment approach uses a variety of activities that are interesting and motivating to children to address underlying problems. Although it is very play oriented, the therapist will set up the play to include different types of activities your child needs to process sensory input more effectively. Within those activities she will constantly seek to increase the challenge and to encourage the child to master new skills, learn new ways of responding and to work through areas that are uncomfortable for him. By picking activities that are interesting and motivating for the child, he can be more comfortable when challenged to move on in his skill development.
How do I know if my child has a sensory processing disorder?
Quite often observations by the family members and the therapists lead to a discussion about a child being suspected of having a sensory processing disorder. These may include developmental, behavioral, and emotional responses to a variety of situations. For example, a child may have an unusual need to seek certain types of input (ex: touching everything, or to run and crash into things or people) or he may avoid touching many things (ex: paint, glue, finger foods). He may also have a very strong need to move and have a great deal of trouble sitting still, or seem to be under aroused and have trouble generating enough energy to actively participate in different activities. Another example would be if he seems to be interested in a task, but has trouble organizing himself to actually perform the task, gets frustrated quickly, or has to do it his way or not at all.
Sensory Integration International has the following list of concern that may suggest sensory integration problems:
- Shies away from touch or wants affection only on his or her terms.
- Dislikes getting hands dirty and avoids messy materials, or seeks out messy experiences.
- Hits and pokes others, bumps into objects and people.
- Is easily distracted by visual or auditory stimuli – covers ears and complains about loud noises or makes excessive noises.
- Avoids eye-contact, especially when being reprimanded.
- Has language processing problems (gives answers unrelated to questions, has difficulty following directions).
- Has poor balance (sits in “W” position, leans against others); avoids gross-motor activities requiring balance.
- Runs, swings, spins, paces excessively, or flaps hands when excited.
- Has difficulties interacting and playing with peers (play is often immature) so may prefer to play alone.
- Is restless, inattentive, and disruptive, may not participate at group times.
- Has immature grasp; switches hands during a task, avoids visual motor tasks.
- Is hyperactive or under-active; exhibits anger; falls apart or loses control easily.
- Has difficulty with transitions.
- Objects to changes in routine; falls apart during transitions.
- Other checklists can be found at www.sensory-processing-disorder.com.
What should I do if I suspect that my child has this difficulty?
If you suspect that your child has a sensory processing disorder, first obtain a referral from your physician for an occupational therapy evaluation. Then schedule a time to have an evaluation done. Having a list or description of your concerns or those mentioned by others is helpful to get started. You will be asked to complete a Sensory Profile or Sensory Processing Measure. These are questionnaires that have been standardized to help determine if your child’s responses to certain types of sensory input (ex: touch, movement, sound) are typical or different from the normal response. It will also help identify if the problems are with the processing (interpreting the information), in the modulation of responses (having the appropriate response to the sensation- and not one that is too high, or too low, or not at all), or even in the planning, or praxis component. In addition, a series of assessments, both standardized and non-standardized, will be done to examine age level developmental skills, as well as these specific processing components.. In some cases a Sensory Integration and Praxis Test (SIPT) may also be scheduled. This is an extensive test battery that looks in much more detail at these issues. It may or may not, be needed to accurately identify the underlying concerns for your child but many of our therapists are certified in giving this test if necessary.
Will these problems go away on their own?
Many families recognize some of the sensory behaviors identified during evaluations as something another family member has had all their life. While all of us have a different sensory make-up, in general sensory preferences do not interfere with developmental skills, social and emotional development, or result in behavioral problems. When the problems do get to the point that they interfere with daily life it is unlikely that they will resolve spontaneously and have an increasing change of interfering even more with age.
Can’t they just practice?
Most families and teachers try very hard to help the children work through these issues that are challenging but at some point additional help by a therapist is needed. Sometimes it is the underlying foundation for certain skills that is problematic and until that is addressed the children will not be able to move forward to master certain skills no matter how many times they are shown how to do it. It is important to remember that not all types of learning, particularly motor learning, can be mastered by practicing. No matter how many times children practice a wrong pattern, it won’t make it right. Until they have the internal ability to do it correctly, they will be unable to correct the problem.
What happens after the evaluation?
The therapist who completes the evaluation will give you her initial impressions and recommendations on the day of the evaluation. Recommendations regarding the type, amount, and frequency of therapy will be made and discussed with you. Depending on the availability of treatment times to meet your needs you may be given an appointment immediately, or placed on a waiting list. If you are placed on the waiting list, the therapist will give you some suggestions for interventions to begin at home and is available for phone consultation. She may also suggest some of our group programs as an alternative or supplement to the individual therapy program. Following this, it will take her 2-4 weeks to complete all of the scoring and interpretation of test results and to have this all typed in a formal report for you. This will be mailed to you and the referring physician and outlines the issues identified and recommended interventions. You being willing and able to carry out therapeutic suggestions at home are keys to have a successful outcome.
What would happen during therapy?
An important component of sensory integrative therapy is trying to harness the inner drive or motivation of the child to try things that are challenging for him or her and to work through these. Using the information gained during the assessment the therapist will customize the activities during the session based on your child’s needs. Simply put, the therapist will set up the treatment room with the types of activities that the child needs to practice in order to have more efficient processing of sensory input while allowing the child to help guide what is done. Often the children don’t realize they are working on specific skills because they are engaged in the playful nature of the activities and hence more motivated to try things that are challenging or frustrating. This active involvement and exploration enables the individual’s nervous system to become a more efficient organizer of sensory information. Families will then be given suggestions of ways to incorporate similar strategies at home after the therapist has been able to identify successful ways to address the child’s challenges.