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Friday, July 24, 2015

smart & savvy kids - Occupational Therapy - Elizabeth Johnson

We have featured several fantastic Occupational Therapists in our "smart & savvy kids" series this month, and Elizabeth Johnson is one more outstanding resource! I am so happy to feature here today, as she brings a wide variety of experience as well as she is a mom to three little ones. She knows her stuff! 

She gives great descriptions of what kids might be experiencing when they go through some sensory difficulties. I love all of her ideas about getting into play doh and mud versus playing with the latest new toy all the time. Great suggestions!

Thank you, Elizabeth! 

Images shared from Elizabeth Johnson

1. How long have you been an Occupational Therapist (OT)? What made you want to do this job? I have been an occupational therapist for 8 years this October. I spent my first 2 years in a skilled nursing (rehab) setting before transitioning to the school system shortly after I had my oldest child. I spent 5 years in the school system working first with k-8 students and then with children grade 6 through age 21.
As a child I had many undiagnosed sensory processing differences that made learning and attention very difficult and my world very uncomfortable and frustrating. When I was in high school, I job shadowed a pediatric occupational therapist and as she explained sensory processing to me I realized, for the first time in my life, that I was not alone in this and that all of the discomfort I had been experiencing for years was real. I decided then and there that I wanted to be an occupational therapist!

2. What is OT? Can you explain it for the average mom who may not be familiar with it? Occupational therapy is, quite simply, using your occupations, or everyday activities as both the method and desired outcome of therapy. This means that an occupational therapist takes the activities that you do every day modifies and uses them to help strengthen the underlying skills that you need to eventually complete the activity independently.  
In the case of children, whose main occupation is play, this means breaking play activities down and choosing play activities that target specific skills such as speech, fine motor, gross motor, social skills or sensory processing. There is a misconception that occupation means “job” when in reality, within the context of OT occupation means any activity that you choose to fill your day with including self-care, house work, cooking, socialization, play, driving, leisure activities, etc.
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? This question could vary greatly depending on the age of your child but in general, 

If you have concerns about your child’s ability to complete self -care activities, participate in social or community activities, play appropriately, complete fine motor tasks such as coloring or cutting, self-feed or if they have significant sensory preferences that significantly impair their ability to participate in any of these activities, you should certainly seek out a professional opinion.  
In general, if you have concerns about your child's development, you should always refer them for evaluation sooner rather than later. Many parents do not realize that, for children under 3 a full developmental evaluation is provided at no charge to you through your local early intervention agency. Depending upon your state children ages 3 until kindergarten are evaluated either directly by the school or by a different part of the early intervention agency, also free of charge. Children from kindergarten to 12th grade (or age 21) are evaluated and provided services that are educationally based, also free of charge. If you have any concerns at all about your child’s development, make the referral. The worst thing that will happen is that the agency/school will do the evaluation and tell you that there is nothing to worry about and give you an idea of how to help your child reach the next steps developmentally.  
4. What types of things does an OT work with children on? One of the reasons that I love occupational therapy so much is that is really looks at the whole person, or in this case, child. Occupational therapists are very skilled at analyzing activities and breaking them down to the foundational skills that are needed to complete them. We then work on these underlying skills including but not limited to fine motor strength and coordination, gross motor strength and coordination, trunk control, sequencing, memory, visual perception, balance, endurance and attention within the context of everyday activities that are important to and fun for the child to help them eventually complete them independently. 
Exactly what the focus of therapy is depends greatly upon the setting and the age of the child. Within the middle/high school setting I was able to work with children on a wide range of skills including handwriting and visual perception for copying from the board or completing projects in art class, memory, sequencing and fine motor coordination for completing projects in shop class and safety awareness, sequencing and hygiene for making their own lunch in life skills class just to name a few. I now work in early intervention where the focus is on the whole child, not just the skills that impact their education. I use play and a coaching model to teach the parents how to be the childs therapist when I cannot be there. Many of the children that I see are working on speech skills, learning to crawl or walk, potty training, self-soothing for bed time, making daily transitions and managing sensory input from their environment.  
5. What are some examples sensory concerns kids might have, and what are some suggestions for parents to support their child with those concerns? Children by nature have underdeveloped sensory systems, just like we would expect them to have underdeveloped bodies and brains. Many children learn naturally how to get their body the input that it needs to function in an appropriate way.  

Some children have more significant sensory processing differences and need a more help getting enough sensory input and doing so in a way that is safe and socially appropriate.  

We all have sensory preferences and things that we do to help ourselves stay alert through that long meeting or settle down for bed a the end of the day, over the years we have learned that although it would feel really good to stand up and do jumping jacks in the middle of the bosses presentation, it would not be well received, so instead we tap our foot or chew gum or doodle on the corner of the handout.  
The most common issue that I see in young children is a tendency to become overstimulated and act inappropriately or aggressively. These children are your crash bangers and your biters. They are the kiddos who hurt other kids, not because they are mean but because they get overwhelmed and don’t know how to calm their body down. These kiddos need more consistent “heavy work” types of activities built into their day to help them get more of the grounding input that will help them to know where their body is in space and better process the information coming in from their environment. They may also need a quiet place built into their space that they can access for a break when they can be squished in pillows or a beanbag chair and in a small enclosed space with some familiar toys or books.  
Another common difficulty that I seen frequently is the kiddo who seems to be in their own world. They are doing their own thing and are not generally aware of subtle changes in the environment, social cues or routine changes. These kiddos may come off as sleepy, lethargic or look as though they are not listening. These kiddos need a lot of fast paced activities including bouncing, vibrations, jumping, upbeat music etc. They may benefit from sensory play, like a sand or rice table before they sit down to eat or do an art project.
Last but not least are the sensitive kiddos. These are the kids close to my heart as I had (and still have) many sensitivities that directly impacted my participation as a child. These are the kids who startle and or cry at loud noises, will only wear certain clothes or eat certain foods. They may be the kids who freak out when the bath water splashes their face or when someone bumps them in the day care line. For these kiddos, desensitization and preparation are key. They need to be warned, prepared and allowed, with encouragement, to engage in noxious activities at their own pace. Deep pressure such as massage, layered clothing, squeezes, bear hugs etc. generally are very helpful to this crowd.

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 refers to the smaller more precise muscles in your hands, fingers and even your mouth. For the purposes of this write-up I will focus on hands and fingers but in some settings OT do do a lot more feeding and even swallowing evaluations. Gross motor refers to the larger, stronger muscles in your arms, legs and trunk.  
The very best thing that parents can do to help their child develop these skills is to expose them and give them plenty of opportunities to try them out. Kids are naturally curious.  

If you make a pillow obstacle course for a crawling 12 month old, they are going to learn a lot more about their body then if they are scooting around a walker. There is of course a time and a place for the fancy toys that we have all come to love, but too much of a good thing is not good for anyone. Put your kiddos on the floor, play with them, give them paper and crayons, give them play dough, let them explore and they will take care of the rest.  
7. What are some common questions you get from parents, and can you answer those for us? There is one question that (wasn't addressed above) and it is the one that always breaks my heart. So many parents ask me “what could I have done differently?” or “did I cause this?” My answer here is almost always no. I do work with a pretty wide range of parents and there are some occasions of course where there were things I would definitely have done differently if it were my child, but then I have 6 years of school, a masters degree and 8 years of experience to back that up. ( I should add that even with that my 3 year old had early intervention for a motor delay!) 

As parents it is our job to take care of our kiddos and encourage their development in the best way we know how. When that doesn’t work, our job is to call for help so that someone can show us how to be even better at that job.  
8. What are some great resources you know are available to parents - books, Web sites, Facebook pages to follow, local organizations, etc. ? I am sorry to say that I do not have a great list here. Aside from “The Mommy Stories” of course, I do not have a ton of parent friendly resources that I could send you looking for on your own. That said, if anyone is looking for anything specific I have dug up or created handouts on pretty much all things toddler so just shoot me a message and I would be happy to share. 
9. What is your favorite part about being an OT? I think this may be the hardest question so far! I love pretty much everything about being an OT. I love that it is very person/child centered and looks at the whole person, rather than just their deficits. I love that I have the freedom to take my skills, degree and license and, with some continuing education, change settings and locations to find a job that is the best fit for me and my family. Most of all, I love watching the children that I work with grow and develop and meet their goals.  
10. What is something that is challenging for parents of children with OT needs? How do you encourage them to get through those challenges? I think that one of the things that I hear a lot of parents struggle with, particularly parents of kids with sensory processing differences is that no one understands their child. They are not able to take their child out to very many places because they are overwhelmed or they are not able to have play dates with other kids or they keep getting kicked out of preschools. My best advice here is to educate yourself. Really invest yourself in this and learn how to explain your child to others while teaching them to advocate for themselves.  
11. What are your top 3 tips for helping kids with sensory concerns or other OT needs? Be observant- Know what makes your kiddo tick, what winds them up, what calms them down. Keep a list. Know what will set them off before it gets to them and help them to prepare for it.  
Be patient and understanding- What you perceive as a brush on the skin felt like knives to them. This can be incredibly difficult for a parent without a sensory sensitivity to fully understand. The jeans you want her to wear feel like sandpaper and the radio that you think is just right is giving her a headache and she can’t tell you so she is having a meltdown. Be patient and help her figure out how to tell you what the problem is so that you can fix it together.
Educate yourself- Both so that you know how to help and advocate for your child and so that you know how to eventually teach him to help and advocate for himself.  

12. What can parents do every day to help their kids develop a strong, healthy sensory diet? Again, the best thing that you can do is expose them to it and help them access and explore their world. Let them play in the grass barefoot and get mud on their hands. Encourage them to try that new food that you cooked for dinner or put just one finger in the goo that you made as a science experiment.  

Let them run jump and play like crazy and then teach them activities to help calm themselves down.

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