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Sunday, July 19, 2015

smart & savvy kids - Occupational Therapy by Kelli Higgins

I am grateful to Kelli Higgins for sharing her awesome ideas about what Occupational Therapy (OT) involves for children. Such great activities she suggests any parent can do with their children, as well as some helpful tips for navigating an OT evaluation and sessions. 

Thank you, Kelli! This was so helpful to read! 

Images shared from Kelli Higgins
1. How long have you been an Occupational Therapist (OT)? What made you want to do this job?
I have been an OT for 15 years.   I always knew that I wanted to work with children and be in a career where I could be creative and have fun.  I have always loved kids, toys, and playing.  For awhile, I thought I would be a preschool teacher.  In high school, I decided that I didn’t really want to go into the educational field, but still wanted a profession where I could use my skills and have a lot of flexibility and variability with what I did each day.  The health care market was a hot industry at the time with lots of opportunities; I discovered Occupational Therapy, and it was the perfect fit for me!

2. What is OT? Can you explain it for the average mom who may not be familiar with it?
Occupational Therapy (OT) is a profession that is certainly not widely understood, for as when you hear the name OT, you think that Occupational Therapists find people jobs! 

Occupational Therapists work with clients of all ages from birth-elderly to address the “skills for the job of living”.  

The skills that are addressed are the skills for taking care of yourself, taking care of other’s, and for engaging in play/leisure/work activities.  Occupational Therapy looks at the client’s individual needs and lifestyle and identifies their strengths as well as areas of need.  Following an evaluation, based upon the client’s age, appropriate treatment goals are identified.  Pediatric OT’s might help a child develop their hand strength to be able to grasp items for writing or with holding a fork for self-feeding, working on self-dressing skills and with coordination for buttons, snaps, and zippers, developing balance and coordination to be able to walk on a balance beam or pump a swing, or working on self-regulation skills to be able to find appropriate sensory activities to help keep your body “just right” either with alerting or calming activities. 

3. What symptoms or signs in a child's development, behavior, etc. might a mom notice that would signify a child needing some OT support? When is it time to seek out professional help? 
*The information offered in the following questions is general information, and each child is different; use this information as a guide.

I always remind parents that children all develop differently and at their own pace, and each child is unique!  For some children, it takes them a longer time to feel confident and master a new skill. 

OT treatment is warranted when there is a dysfunction in the client’s ability to purposefully and functionally engage in needed and wanted life activities.  If your child is struggling with a task and it clearly becomes a battle and power struggle or seems to just not be able to grasp a new motor skill because they are lacking some of the foundational skills needed, it might be time to seek professional support.  

If your child is not meeting basic gross motor milestones (rolling, sitting, crawling, walking) within an appropriate time span, struggling to hold a pencil and engage writing activities, sensitivity to noise, clothing, foods, crowds, difficulty attending to tasks, decreased play skills, decreased social interaction, and sensitivity to movement may be signs that your child could benefit from an OT evaluation. 

4. What types of things does an OT work with children on?
Pediatric OT is fun!  It is child-centered and uses the interests and likes of the child to help develop activities to address the areas of need; we build on the child’s strengths.  Play is the “work” of children! For children, some areas that are focused on can include working on self-dressing skills, feeding skills, grooming/personal hygiene, fine motor skills, gross motor skills, play skills, and sensory processing skills (ability to organize all of the sensory information from the environment and process it in an effective and purposeful way.) 

5. What are some examples sensory concerns kids might have, and what are some suggestions for parents to support their child with those concerns?
We all have sensory preferences in our environment.  For example, I hate going to a crowded shopping mall, as it is so overwhelming to me.  I shop the stores at the end cap of the mall to avoid having to go into the mall, shop online, or go during times when it will be less crowded.  I have accommodated my life to meet my sensory needs; this does not interfere with my ability to engage in my life and any daily activities. 

When sensory concerns start to interfere with a child and family’s ability to participate in daily and functional life activities (such as dressing, feeding, playing with peers, motor skills, etc.), then is time to seek professional support.  OTs can help by assessing your child’s sensory systems and looking at each system (hearing, vision, taste, touch, movement, balance, body/space awareness) to see which areas may have heightened sensitivity (. i.e., avoidance of clothing tags because it feels itchy, wont’ climb on playground equipment as their feet are off the ground, picky eater and limited diet) or those that have under responsive and less awareness (i.e., constant spinning or jumping, can swing forever, appearing as “messy or disheveled” with food on their face, clothing all askew and not noticing their appearance). 

Children with sensory concerns often want to try to control their environment, because the world can be a scary and unpredictable place when you do not know what is going to happen.  By trying to be in charge, you can then have a sense of security and your body will know what to do and how to feel.  Offering your child choices and helping to understand their preferences can help reduce situations where they will feel overwhelmed.  

Parents can “pick” their battles and prioritize the areas of concern.  For example, if your child is particular with clothing, choosing clothing types that they will tolerate can help alleviate the battle of getting dressed. 

6. What are fine motor skills? What are gross motor skills? How can moms help their children develop these skills from an early age?
Fine motor skills involve using the smaller muscles in your hands and fingers for coordinated and refined movements, for tasks such as holding a crayon, holding a spoon, and picking up toys.  Gross motor skills involve using the larger muscles of the body for bigger movements such as crawling, jumping, and riding a bike.  From an early age, parents can encourage tummy time.  Tummy time during supervised play time daily helps to build strength in the back, neck, and abdominal muscles; this weigh bearing and reaching activity is a foundational component needed for later development of motor skills.  This link provides a nice handout to explain tummy time.

7. What are some common questions you get from parents, and can you answer those for us?
Questions parents ask do really depend upon their child.  If you have concerns regarding your child’s development, ask someone who works with your child such as a teacher, their pediatrician, or their therapist. Be persistent if you do not feel like you are getting an answer to your question.  Be aware of your health insurance coverage for what they will and will not cover, as unfortunately, insurance companies may cover an evaluation but not treatment or only a specific number of treatment sessions. 

8. What are some great resources you know are available to parents - books, Web sites, Facebook pages to follow, local organizations, etc. ?
The American Occupational Therapy Association ( is a good resource for learning about OT and has some good consumer resource tip sheets to download.

The Out- of- Sync Child, by Carol Stock Kranowitz is a good book that is easy to read that explains sensory processing disorder and gives some home activities.  

Handwriting Without Tears ( by Jan Olsen, OTR/L,  is a multi-sensory hands-on handwriting program that works on pre-writing skills such as grasping, coloring, and forming lines and shapes; teaches early elementary printing skills; and teaches mid-elementary cursive writing.  It provides an easy to use format and can be very successful for students struggling with handwriting. 

Using your local communities resources such as public library story times, playgrounds, the beach, and outdoors in your backyard can be great places to learn, explore, and develop motor and sensory skills.

9. What is your favorite part about being an OT?
I love being an OT because I work with children, and many people say I get to “play” all day!  OT is a lot of fun and you get to be creative and use toys every day!  I like that each child is unique and brings their own ideas and personality to the session.  It can be a challenge to think outside the box sometimes to come up with activities that will be motivating and interesting and fun for a child. 

As an OT, you get to celebrate the success of each child, no matter how small the accomplishment.  You are along for the ride to see the child be able to engage in activities that were once difficult and see the confidence and pride of the child and their family.  

OT’s who work in pediatrics get to work with the whole family and intervention is family centered to get all family members involved in the child’s treatment.  I always thank parents for caring enough to share their child with me, so that we can learn and grow together!

10. What is something that is challenging for parents of children with OT needs? How do you encourage them to get through those challenges?
As a professional it is easy to give “tips and suggestions” to parents about what to do.  When I put my parent hat on, it can be more difficult to take those friendly tips and suggestions home at the end of the therapy session and integrate them into the daily family routine. 

When your child starts OT services, I encourage you to have 3 C’s: communication, collaboration, and commitment.  

You need to have open communication with your OT about what the concerns are and how it is going at home, in the community, and in school.  Your child’s therapist relies upon your report of information to understand what the needs are and what might be working and what is not working.  You need to collaborate with your child’s therapist; you know your child best! Sharing what has worked in the past, sharing what has not worked in the past and why, sharing what type of toys and space you have at home as well as some family rules (for example, some families do NOT allow jumping on couch cushions, so this would not be a good activity for your therapist to suggest!) all allow treatment to be individualized to meet your child and family’s needs. 

And, last is commitment.  It takes time to work on skill building.  Some skills may come more quickly and others may be an ongoing work in progress.  Commitment to therapy means being aware that you have therapy appointments to attend and show up for and actively participate in.  Also, an understanding that although OT sessions are generally fun and child-centered, that your child will have to work (in a playful way!) and sometimes complaining can happen when we (even as adults!) have to do something that is hard for us.  Encourage your child to keep at it!

11. What are your top 3 tips for helping kids with sensory concerns or other OT needs?
1.     Encouraging safe and appropriate physical activity throughout the day is essential.  Become a detective and look at what types of activities your child either seeks out or avoids.  If they seem to seek a certain type of input, then provide frequent opportunities for that type of activity (swinging, spinning, jumping, etc.).  If they avoid a certain type of movement, then slowly encouraging them in a safe way to build upon their skill (for example, if afraid of swinging, start first on a swing where their feet can touch the ground and practice just sitting on the swing without swinging on it).

2.      Respect your child’s sensory system and understand that they may show strong likes and dislikes, and that is okay.  

By having an understanding that sensory issues are “real” and that if your child has sensory issues, that they are not just being “difficult”, and that the behavior you see may have a sensory component to it 

(for example, the tantrum following leaving a busy, crowded place may be due to being mad about leaving but it also may be the sign of a child whose sensory system is overloaded by the noisy crowds, smells, unexpected touch from bumping to strangers, overhead fluorescent lighting, visual clutter of lots of signs and displays.)  However, that being said, children are children and behaviors do happen.  At times, it can be hard to tease out what is behavioral and what is sensory based.

3.     Be patient.  Your child can sense and feel your frustration.  Having a calm and collected demeanor will help you be able to work with your child in what might be a challenging situation. 

12. What can parents do every day to help their kids develop a strong, healthy sensory
A sensory diet, is like a diet for when you are trying to lose weight; you carefully create a plan for types of foods to eat, how many calories to eat, and how often to eat throughout the day.  A sensory diet is a “diet” for your child’s muscles and body designed with specific activities to help them be able to stay focused and alert throughout the day.  It is dependent upon your child’s individual sensory needs, as a sensory diet is custom to each child.  Sensory needs and types of sensory input needed can vary each day and within each day.  Working with an OT, together you can design an effective sensory diet for your child.  Being active and encouraging safe physical activity can help your child’s body get movement and input it needs.  

13. Anything else you think would be helpful or that you want to share?
Use what you have around your house already to play and have fun and work on your child’s motor and sensory skills.  You do not need a lot of expensive equipment or stuff. 

Be creative and look around…it can be amazing to see what fun activities you can come up with using every day objects.  The ideas can be endless…string pipe cleaners through the holes in a colander turned upside down, use clothespins to pick up cotton balls or pom poms, squeeze water out of a sponge to fill a bowl, use an egg beater to beat soapy water to make bubbles, spread shaving cream on the bathtub wall for finger painting, crawl across a pile of pillows spread on the floor, create a fort by placing blankets over kitchen chairs as a quiet space to take a break, push a laundry basket upside across the floor to make a walking toy for new walkers, jump off the bottom step to see how far you can jump, write the grocery list, cut out coupons, stack can goods into a tower, roll across the floor, climb under a pile of pillows, jump on a pile of pillows, pull a sibling on a blanket across the floor, push a wheelbarrow, water the plants with a watering can…

~Kelli Higgins, MS, OTR/L

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