Category Archives: Sensory Integration

What Pediatric Occupational Therapy Is (and isn’t)! By, Michaela Gordon, OTR/L

What Pediatric Occupational Therapy Is (and Isn’t)!

By Michaela E. Gordon, OTR/L

 
Throughout my time as an OT, I have worked hard to find ways to capture, explain, and demonstrate the full scope of occupational therapy. I think back to all the settings I have worked in and how I worked as an occupational therapist in those settings/systems. Each setting taught me something new that I carried into the next—broadening my understanding and deepening my practice as an OT.  Here are some examples from my experience as an OT over the years:

 

 

  • Mental Health Center: Collaborated with a multidisciplinary team of medical professionals to discuss cases and coordinate care, facilitated self-care and life-skills groups, and developed sensory-based programs to support regulation and coping.
  • Pediatric Burn Hospital: Fabricated splints in the operating room to support long-term range of motion in the upper extremities, fitted facial orthoses and pressure garments to minimize scarring, developed adaptive devices for self-care tasks, and provided emotional support to patients and families navigating recovery.
  • Hospital Setting: Supported infants in the NICU to promote feeding and sensory regulation, conducted neuro-motor and self-care assessments for adults in acute and subacute units, and designed discharge plans to promote safe transitions home or to other care facilities.
  • Nursing Homes: Addressed memory and cognitive strategies for daily routines, and implemented strength, coordination, and range-of-motion programs to improve independence in self-care and mobility.
  • School for Children with Autism: Collaborated closely with a team of medical and educational professionals to provide sensory–motor, social–emotional, and self-care interventions; trained parents and teachers on carryover strategies; and supported community participation through vocational and independent-living experiences such as starting jobs at local businesses, shopping, money management, and dining out.
  • Public Schools: Conducted school-based assessments, provided direct services for students with identified needs, consulted with teachers to support students who did not qualify for services, and participated in IEP meetings to collaborate with families and interdisciplinary team members.
  • Aquatic Therapy: Used neurodevelopmental and sensory-based techniques in the water to promote regulation, strength, coordination, and safety.
  • Early Intervention: Provided home- and community-based services to infants and toddlers, focusing on early sensory–motor, fine motor, and self-care development. Supported parents and caregivers through education, hands-on training, and individualized home programs.
  • Clinic-Based Practice: Served children of all ages, with an emphasis on sensory–motor development, fine motor skills, and self-regulation. Ran early intervention and social skills groups, collaborated with other professionals (e.g., PTs, SLPs), and provided home programming and parent training to promote skill carryover.
  • Private Practice (In-Home): Worked with families in their natural environments to support sensory–motor, self-care, social–emotional, and executive functioning skills. Designed individualized home programs, provided parent education, and integrated holistic interventions such as aquatic therapy and craniosacral therapy.
  • Private Practice (Office Setting): Offer similar services to in-home care with expanded access to specialized equipment and materials, incorporating sensory–motor play, regulation-based supports, and holistic interventions.
  • Community Outreach: Partner with schools and community centers to educate families and professionals about occupational therapy, facilitate support groups, help with developing community programs, and promote public awareness through blogs, social media, and outreach materials.

 

Each of these settings offered unique insights into how occupational therapy helps individuals adapt, recover, and grow. Whether in hospitals, schools, clinics, or the community, the common thread is helping people participate more fully and meaningfully in their everyday lives.

 

As you can see, the role of the OT can widely vary based on the setting/system, the role of the other professionals involved, and the experience of the therapist. I’m sure you could meet another OT that will tell you other ways they have worked in the field.

 

In terms of pediatrics, I would say pediatric occupational therapists are most well-known for helping kids with developing sensory and handwriting skills. However, we do so much more than that! I find that once an OT starts working with other professionals and families, they are often surprised to find out all the ways we can help kids and families.

 

Occupational therapy is one of the most versatile fields in healthcare. While it overlaps with psychology, physical therapy, and speech therapy, OT is distinct in its focus on helping children participate in the many occupations of daily life—everything from getting dressed and playing, to learning, socializing, and building independence. Our goal is to strengthen the skills that make everyday living meaningful and successful.

 

The Domain of Occupational Therapy (AOTA, OTPF-4)

 

According to the American Occupational Therapy Association (AOTA), the domain of occupational therapy outlines the full range of areas OTs address to support meaningful participation in daily life. This framework is described in the Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF-4, 2020).

 

The domain is composed of five interrelated areas:

 

1. Occupations – The everyday activities people want, need, or are expected to do. For children: play, education, self-care, rest/sleep, and social participation.
2. Client Factors – The underlying capacities that influence performance. Includes values, beliefs, body functions (sensory, cognitive, emotional, motor), and body structures.
3. Performance Skills – The observable, goal-directed actions used in daily life. Includes motor skills (e.g., posture, coordination), process skills (e.g., organization, attention), and social interaction skills.
4. Performance Patterns – The habits, routines, and roles that structure daily life. For children, these may include school routines, bedtime rituals, and family roles.
5. Contexts – The environmental and personal factors that influence participation. Includes physical, social, cultural, temporal, and virtual environments.

 

Together, these areas describe the scope of what OTs assess and address—providing a holistic, person-centered framework that supports participation across all areas of life.

 

In the following sections, I describe what this looks like in practical terms—how occupational therapists may help children and families build the skills and supports they need for everyday life.

 

What OT Is

 

Occupational therapists support the whole child—addressing interconnected systems of sensory, motor, cognitive, and emotional development. These domains are interdependent and together build a child’s capacity to learn, connect, and thrive in daily life. Below are the primary areas pediatric OTs focus on when helping children reach their fullest potential.

 

Sensory Integration and Other Sensory-Based Approaches

 

Occupational therapists (OTs) assess and treat sensory integration challenges using evidence-based approaches that help children process sensory input more effectively and participate more fully in everyday activities such as play, learning, and self-care. One of the most established models is Ayres Sensory Integration® (ASI), developed by Dr. A. Jean Ayres, which focuses on enhancing the brain’s ability to organize and interpret sensory information through play-based, child-led activities.

 

In addition to ASI, OTs may draw from a range of sensory-based and sensory-informed frameworks to address individual differences in regulation and participation. These may include the Sensory Processing Model (Winnie Dunn), which helps identify sensory seeking or avoiding patterns to guide environmental adaptations; The Alert Program® (“How Does Your Engine Run?”) and The Zones of Regulation®, which teach children to recognize and manage their arousal states; and the Sensory Diet Framework (Patricia Wilbarger), which provides structured daily sensory activities to promote attention and self-regulation.

 

OTs may also incorporate specific sensory-based modalities—such as the Wilbarger Deep Pressure and Proprioceptive Technique (Brushing Protocol), Therapeutic Listening® (Sheila Frick), and Astronaut Training, which integrates vestibular, visual, and auditory processing—when clinically appropriate and with specialized training.

 

All of these approaches are used within an individualized, occupation-centered treatment plan that supports the child’s ability to regulate, attend, and engage meaningfully in daily routines across home, school, and community settings.

 

Gross Motor & Physical Development

 

Occupational therapists address foundational movement skills that support a child’s ability to play, learn, and participate in daily life. This includes developing balance, coordination, postural control, strength, endurance, and body awareness.

 

A core focus of gross motor development is bilateral coordination—helping the left and right sides of the body work together in an organized way. OTs also support motor planning, or the ability to generate motor ideas, plan and sequence actions, and carry them out with timing and fluidity.

 

Through engaging, play-based movement activities, children build the gross motor foundations they need to participate in functional tasks at home, school, and in the community—from climbing and playground play to navigating hallways, carrying materials, and maintaining posture during classroom activities.

 

Fine Motor & Visual–Motor Skills

 

Occupational therapists help children develop precise hand movements, coordination, and control that support participation in everyday activities such as dressing, feeding, writing, and play. This includes building hand strength, grasp patterns, in-hand manipulation, and bilateral coordination for tasks that require both hands to work together.

 

At the fine motor level, OTs also address motor planning—helping children generate ideas, plan and sequence actions, and carry them out smoothly with appropriate timing and fluency. This process allows children to approach fine motor tasks such as cutting, coloring, writing, manipulating small toys, and using everyday objects like containers and bags with greater confidence and efficiency.

 

OTs also support visual–motor integration, helping children coordinate what they see with how they move. These skills are essential for tasks like handwriting, lining up numbers for math, completing mazes or tracing paths, and connecting dots—all of which build the foundation for academic success and everyday functional performance.

 

Through engaging, play-based activities, OTs help children strengthen fine motor control and visual–motor coordination so they can participate more fully in classroom, play, and self-care tasks with precision, confidence, and independence.

 

Visual–Perceptual & Oculomotor Skills
 
Occupational therapists help children develop the visual foundations needed for learning, play, and everyday functioning. This includes both oculomotor control—how the eyes move—and visual–perceptual processing—how the brain interprets what the eyes see.

 

Oculomotor skills involve the ability to track moving objects, visually shift from point to point, adjust focus between near and far distances, and move the eyes independently from head movements. These skills are essential for reading, writing, copying from the board, ball skills, and navigating environments safely and efficiently.

 

In addition to oculomotor control, OTs address visual–motor integration (coordinating visual input with motor output) and broader visual–perceptual skill development. These include the ability to recognize and remember visual details, distinguish forms and symbols, perceive spatial relationships, and identify objects within complex backgrounds. Together, these ‘motor-reduced’ visual-perceptual skills—such as visual discrimination, memory, spatial awareness, form constancy, sequential memory, figure-ground, and visual closure—help children process visual information accurately and efficiently.

 

Through individualized, activity-based intervention, OTs strengthen the connection between vision, movement, and perception—helping children participate more successfully in classroom, play, and daily life tasks.

 

Cognition & Executive Functioning

 

Occupational therapists help children strengthen the mental skills that allow them to plan, organize, remember, and carry out daily tasks effectively. These executive functions support participation in learning, play, and self-care routines.

 

 

OTs work with children on skills such as attention, memory, organization, sequencing, and problem-solving—all of which help them stay focused and complete tasks from start to finish. Intervention often involves teaching children how to visualize their day and break larger tasks into smaller, more manageable steps.

 

Examples of OT support in this area include:

 

– Using timers, visual schedules, and checklists to help children understand routines and transitions.
– Supporting the organization of living spaces, school areas, and materials such as desks, lockers, and backpacks.
– Teaching children to sequence tasks—like getting dressed, packing for school, or following multi-step classroom directions—in a logical and efficient order.
– Using memory strategies to help recall important information such as days of the week, home addresses, or phone numbers.
– Encouraging self-monitoring and task persistence—helping children notice when they are distracted, return to the task, and complete it successfully.
By fostering these cognitive and executive function skills, occupational therapists help children become more independent, confident, and capable of managing their responsibilities at home, school, and in the community.

 

Play, Social Participation, and Social–Emotional Development

 

Play is a child’s most natural occupation and the foundation for learning, connection, and emotional growth. Occupational therapists use play-based interventions to build the skills children need to engage meaningfully with their world—socially, emotionally, and behaviorally.

 

Through play, OTs support children in developing emotional regulation, social communication, relationship-building, problem-solving, and flexibility. Play provides a safe, motivating space to practice managing frustration, coping with challenges, and taking turns or sharing with peers.

 

OTs also help children recognize and express emotions appropriately, read nonverbal cues, and develop empathy and self-awareness. Using frameworks such as The Zones of Regulation®, The Alert Program®, and other self-regulation models, therapists teach children to identify body cues, regulate energy levels, and apply calming or alerting strategies to meet the demands of different environments.

 

In this way, play becomes a powerful medium for developing social participation, emotional understanding, and self-regulation—allowing children to practice these essential life skills naturally within joyful, meaningful experiences.

 

OTs also collaborate with caregivers and educators to ensure that play and social–emotional strategies generalize across home, school, and community settings.

 

By fostering joyful, connected participation, occupational therapy helps children build the emotional resilience and social confidence needed to thrive in relationships and in life.

 

Behavioral Management

 

Occupational therapists actively address behavior as part of a child’s ability to participate in daily life. Rather than viewing behavior as something to “fix,” OTs understand it as a form of communication about a child’s sensory, emotional, cognitive, or environmental state. Often, maladaptive behaviors emerge in response to underlying developmental challenges and/or relational or social-environmental factors. As those foundational skills strengthen, OTs help children learn and practice new, more adaptive behaviors that support participation and success across settings.

 

Intervention is not designed to suppress behaviors but rather to build regulation, self-awareness, and adaptive responses through supportive, relationship-based, and developmentally appropriate strategies.
In practice, occupational therapists draw on a range of evidence-based and developmental strategies to support behavioral growth, including:

 

  • Focus on self-regulation: OTs use frameworks such as The Zones of Regulation®, The Alert Program®, and other sensory-based strategies to help children identify their arousal states, interpret body cues, and choose tools that promote calm and focus.
  • Behavioral management methods: When appropriate, OTs may integrate structured, evidence-based behavioral management programs—such as 1-2-3 Magic (Dr. Phelan), The Nurtured Heart Approach (Howard Glasser), or Positive Discipline (Dr. Nelsen)—to support consistency, clear boundaries, and positive behavior reinforcement. These approaches emphasize balanced, developmentally appropriate use of structure and consequences, helping children and families establish predictability and mutual respect. When used within an occupational therapy framework, these methods complement self-regulation, emotional awareness, and relational skill-building—without replacing psychotherapy or ABA.
  • Environmental design: Behavior is influenced by the environment. OTs modify sensory input, physical setup, schedules, and routines to prevent dysregulation and reduce triggers.
  • Collaborative coaching: OTs use coaching and education-based approaches to help parents, caregivers, and teachers understand their child’s sensory and emotional needs. Through modeling, reflection, and consistent practice, OTs support families in applying regulation and behavioral strategies across home, school, and community settings.
  • Goal orientation: Behavioral change is achieved through improved sensory modulation, emotional regulation, and task fit, leading to genuine participation rather than surface-level compliance.

 

In short, OTs manage behavior from the inside out—building the foundations of self-awareness, regulation, and environmental support so children can thrive across home, school, and community settings.

 

Family Dynamics, Parenting Support, and Interpersonal Relationships

 

Occupational therapy is inherently family-centered. Children grow, learn, and self-regulate within the context of their relationships—so OTs work closely with parents and caregivers to strengthen the systems that support each child’s development.

 

Therapists help families understand how sensory, motor, emotional, and cognitive factors influence behavior and daily function. We collaborate to create predictable routines, reduce stress around daily tasks, and establish strategies that help everyone feel more connected and capable.

 

Parenting support may include developing structured routines, visual supports, and sensory-regulation tools that fit seamlessly into daily life. OTs also provide education and coaching to help caregivers interpret their child’s cues, respond effectively during moments of dysregulation, and promote independence while maintaining emotional connection.

 

In addition, OTs help families navigate interpersonal dynamics—supporting communication, role balance, and shared problem-solving among family members. By fostering understanding and compassion within the household, occupational therapy strengthens not only the child’s development but the well-being of the entire family system.

 

Self-Care and Activities of Daily Living (ADLs)

 

Self-care is a cornerstone of pediatric occupational therapy. OTs help children build the skills, routines, and confidence needed to participate in everyday activities such as dressing, feeding, hygiene, toileting, and grooming—promoting greater independence at home and school.

 

Intervention may include improving fine motor coordination, bilateral hand use, sequencing, sensory processing, and body awareness—skills that allow children to complete daily routines smoothly and confidently.

 

As children grow, these foundational self-care abilities expand into more complex daily living tasks—often referred to as instrumental activities of daily living (IADLs).

 

Instrumental Activities of Daily Living (IADLs)

 

As children mature, occupational therapists support their participation in more complex daily tasks that promote independence and prepare them for adolescence and adulthood. These “instrumental” activities build upon the foundation of self-care and include organizing school materials, managing homework routines, packing backpacks, preparing simple meals or snacks, participating in chores, and learning to plan and manage time. For teens, IADLs may expand to include money management, shopping, community navigation, and caring for others or pets.

 

By developing these higher-level life skills, OTs help children and adolescents build confidence, self-reliance, and readiness for the increasing demands of home, school, and community life.

 

Rest and Sleep

 

Healthy sleep routines are essential for emotional regulation, learning, and overall well-being. OTs evaluate how sensory preferences, daily habits, and environmental factors affect a child’s ability to fall asleep, stay asleep, and wake feeling rested. Therapists work closely with families to develop calming bedtime and wake-up routines, adapt the sleep environment for comfort and consistency, and integrate sensory or self-regulation strategies such as deep pressure input, rhythmic movement, or breathing exercises.

 

By addressing the sensory, environmental, and behavioral aspects of sleep, OTs help children and caregivers establish rhythms that promote rest, balance, and readiness for each day’s activities.

 

Health Management

 

Health management involves building awareness, habits, and routines that support physical and emotional well-being. For children, this may include learning to recognize body cues such as hunger, fatigue, or overstimulation; understanding and participating in health-related tasks like using inhalers, taking medication safely, or caring for braces or glasses; and developing organizational and time-management strategies that promote consistency in daily self-care.

 

Occupational therapists also work with families to build structure around nutrition, hydration, physical activity, and mindfulness practices, tailoring these routines to each child’s developmental and sensory profile. By addressing health management holistically, OTs empower children to take an active role in maintaining their well-being—laying the groundwork for lifelong self-care, confidence, and resilience.

 

Leisure

 

Leisure refers to the free-choice activities that bring enjoyment, relaxation, and fulfillment. For children, leisure often grows out of play but becomes more purposeful as they develop personal interests, hobbies, and ways to recharge. Occupational therapists help children and teens explore what they enjoy, identify barriers that limit participation, and build the skills needed to engage in meaningful recreational activities.

 

This may involve fostering confidence to join a sports team, encouraging creative outlets like art or music, or helping children find calming, screen-free ways to unwind. Supporting leisure allows children to experience balance—between learning, responsibility, and rest—while nurturing creativity, self-expression, and a positive sense of identity.

 

When self-care, instrumental activities, rest, health management, and leisure are addressed together, children develop balanced rhythms that support both physical independence and emotional regulation. By helping families create predictable, nurturing routines across morning, school, and bedtime transitions, occupational therapy fosters confidence, participation, and a sense of mastery in the tasks that shape everyday life.
 

 

Transition & Vocational Skills

 

For older children and teens, OTs help prepare for transitions to higher grades, community participation, and future employment. This includes teaching organization, time management, community navigation, and self-advocacy skills.
 
Assistive Technology & Environmental Adaptation

 

OTs recommend and train children in the use of adaptive tools such as pencil grips, slant boards, communication switches, and computer access devices. They also modify physical and sensory environments to promote accessibility and comfort.

 

Specialty Approaches: Aquatic & Equine OT

 

Beyond traditional settings, OTs may use water or horse movement as therapeutic tools. Aquatic OT enhances sensory-motor coordination; equine-assisted OT promotes balance, confidence, and emotional connection.

 

Liaison, Consultation, and Care Coordination

 

Occupational therapists often act as bridges between professionals, families, and systems of care. We collaborate with teachers, speech-language pathologists, psychologists, medical specialists, and other providers to ensure each child’s support plan is cohesive and effective.
Through regular communication and team meetings, OTs help align therapeutic goals across settings—making sure that strategies used at home, school, and in the community reinforce one another.

 

OTs also assist parents in assembling and coordinating an interdisciplinary care team, ensuring that every provider understands the child’s sensory, emotional, and functional profile. This collaborative model allows interventions to work synergistically, maximizing the child’s growth, participation, and success across environments.

 

Although occupational therapists are able to help in many ways, there are many other types of therapies that are highly beneficial in supporting children and families. Because occupational therapy encompasses such a broad scope of practice, it’s equally important to understand what falls outside of that scope. Recognizing these boundaries helps parents appreciate why they may work with an OT and another professional on similar goals—but in slightly different ways. It also highlights that the OT’s role may shift when other specialists are already fulfilling complementary aspects, such as serving as the primary care-team coordinator.

 

What OT Isn’t

 

While pediatric occupational therapy addresses the whole child—integrating sensory, motor, cognitive, emotional, and behavioral systems—OT is just one of many valuable supports a child may benefit from. What matters most is that children receive the right combination of services from providers who are a good fit, and that all professionals and caregivers work collaboratively for the child’s success.

 

Because occupational therapy has such a broad and integrative scope, it’s equally important to understand what OTs do not do. The following distinctions highlight how OT overlaps with—but remains distinct from—other disciplines such as speech therapy, physical therapy, psychology, and applied behavior analysis.

 

Not Physical Therapy

 

OTs and physical therapists (PTs) often share similar tools and techniques, and both address the musculoskeletal and neuromuscular systems to help children build strength, coordination, and body awareness. However, their focus and goals differ.

 

Physical therapists (PTs) specialize in the quality and mechanics of movement. They focus on alignment, strength, endurance, range of motion, and gait (walking) patterns, often addressing orthopedic, neurological, or developmental movement conditions. PTs are typically the professionals who evaluate and treat gait abnormalities, balance issues, and postural control, and in some cases, may diagnose or manage physical conditions related to motor function.

 

Occupational therapists (OTs) work on similar motor foundations—but always through the lens of function and participation. OTs address how strength, coordination, and balance translate into meaningful daily skills such as dressing, writing, feeding, or sitting upright in class. They integrate sensory, cognitive, emotional, and physical systems to help children use their bodies purposefully and confidently across home, school, and play settings.

 

In many pediatric programs, OTs and PTs work side by side—PTs supporting how the body moves, and OTs focusing on what that movement allows a child to do. Together, they provide a holistic approach that nurtures growth, independence, and everyday success.

 

Not Speech Therapy

 

OTs may address feeding and oral-motor mechanics (chewing, swallowing, posture for feeding), but they do not provide therapy for articulation, expressive/receptive language, or fluency. These are within the expertise of speech-language pathologists (SLPs).

 

Not ABA Therapy

 

While OTs address behavioral management, they do so from a developmental, sensory, and emotional regulation perspective—not through the strict operant-conditioning framework of Applied Behavior Analysis (ABA).

 

  • OT focuses on understanding why behaviors occur — by exploring sensory needs, emotional regulation, cognitive processes, and how the environment fits the child.
  • ABA focuses on modifying which behaviors occur — using reinforcement, structured teaching, and behavior analytic techniques to increase desirable behaviors and reduce undesired ones.

 

Together, they can complement each other—ABA supports measurable skill learning, and OT builds the internal and environmental foundations that sustain it.

 

Not Psychotherapy

 

Occupational therapists absolutely address aspects of mental health—such as emotional regulation, stress management, social participation, and coping within daily routines—but they do not provide psychotherapy or clinical mental-health treatment. Processing trauma, family conflict, or deeper emotional patterns falls within the expertise of psychologists, marriage and family therapists (MFTs), or licensed clinical social workers (LCSWs).

 

  • OT focus: Supporting mental health through participation—helping children recognize emotions, use sensory or movement-based regulation tools, develop coping routines, and build confidence in daily roles (home, school, play).
  • Psychotherapy focus: Exploring the roots of emotional distress—such as trauma, relationships, or thought patterns—through talk therapy, play therapy, or other relational methods to promote emotional healing and insight.

 

Together, these disciplines complement each other: OT helps children manage daily life and strengthen regulation skills, while psychotherapy provides deeper emotional processing and long-term psychological healing.

 

Not Educational Therapy

 

While OTs address skills that support learning—such as attention, executive functioning, visual–motor integration, and self-regulation—they are not educational therapists. Educational therapists primarily provide academic intervention, remediation, and tutoring for specific learning differences (e.g., dyslexia, dyscalculia, ADHD-related study skills). In contrast, occupational therapists focus on the underlying developmental and functional foundations that make learning possible: sensory processing, posture, motor coordination, attention, and participation in classroom routines. OTs often collaborate with educational therapists and teachers to ensure a child’s functional skills and learning strategies work hand in hand.
 
Not Vision Therapy

 

Occupational therapists address visual–perceptual, visual–motor, and oculomotor skills as they relate to participation in daily activities like reading, writing, and play. However, OTs are not vision therapists and do not prescribe or provide interventions involving prisms, colored lenses, or optical corrections. Vision therapy is within the scope of a developmental optometrist or ophthalmologist. OTs and optometrists often collaborate—OT focuses on functional participation and environmental adaptation, while the optometrist addresses visual efficiency and eye health.

 

Conclusion

 

 

Pediatric occupational therapists support the whole child—addressing sensory, motor, cognitive, emotional, and behavioral systems together. Through evidence-based practice, collaboration, and thoughtful environmental design, OTs help children participate meaningfully in the daily occupations that shape their growth and well-being.
With that being said, occupational therapy is just one of many valuable supports a child may benefit from. What matters most is that each child receives the right combination of services—from providers who are a good fit—and that all professionals and caregivers work collaboratively for the child’s success.

 

OTs also recognize that a child’s well-being is shaped not only by direct therapy, but by the environments and relationships that surround them. By partnering with families, teachers, and other care providers, OTs help design spaces, routines, and interactions that nurture participation, confidence, and connection across all areas of daily life.

 

Resources for Further Exploration

 

Core AOTA Frameworks and Standards


– American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.). American Journal of Occupational Therapy, 74. (Suppl. 2). https://research.aota.org/ajot/article/74/Supplement_2/7412410010p1/6486
– American Occupational Therapy Association. (2021). Standards of Practice for Occupational Therapy. American Journal of Occupational Therapy, 75 (Suppl. 3). https://research.aota.org/ajot/article/75/Supplement_3/7513410030/23113
– American Occupational Therapy Association. (2021). Guidelines for Occupational Therapy Services in School-Based Practice. American Journal of Occupational Therapy, 75 (Suppl. 3). https://research.aota.org/ajot/article/75/Supplement_3/7513410060/23118
– American Occupational Therapy Association. (2021).  Scope of Practice Chart. https://www.aota.org/-/media/corporate/files/advocacy/scope-of-practice-chart-10-21.pdf
– American Occupational Therapy Association. (2022). Model Occupational Therapy Practice Act.  https://www.aota.org/-/media/corporate/files/advocacy/state/resources/practiceact/final-model-practice-act-2022.pdf

– American Occupational Therapy Association. (2017). Occupational Therapy’s Role in Physical Rehabilitation. OT Practice.

–American Occupational Therapy Association. (2015). The Role of Occupational Therapy in Rehabilitation for Individuals with Neuromuscular Conditions. AOTA Fact Sheet.

-Case-Smith, J., & O’Brien, J. C. (2015). Occupational Therapy for Children and Adolescents (7th ed.). Elsevier.

 

Sensory Integration, Social-Emotional Learning, and Collaboration


– Schaaf, R. C., et al. (2021).  Effectiveness of Occupational Therapy Using a Sensory Integration Intervention for Children with Developmental Disorders. American Journal of Occupational Therapy, 75 (6).
– Bazyk, S., & Bazyk, J. (2021). Fostering Social Participation and Emotional Well-Being in Children Through Occupational Therapy. American Journal of Occupational Therapy, 75 (3).
– Ward, S. C., et al. (2020). Collaboration Between Behavior Analysts and Occupational Therapy Practitioners. Behavior Analysis in Practice, 13 (4).
– Dunn, W. (2014). Sensory Processing Frameworks and Everyday Participation. AOTA Press.
– Williams, M. S., & Shellenberger, S. (1996). How Does Your Engine Run? The Alert Program® for Self-Regulation. TherapyWorks, Inc.
– Kuypers, L. (2011). The Zones of Regulation®.  Think Social Publishing.
– Frick, S., & Young, S. (2009). Listening With the Whole Body: Therapeutic Listening® and Sensory Integration.  Vital Links.

 

Specialty Practice Areas

 

– American Occupational Therapy Association. (2023). Spotlight on Pediatric Aquatic Occupational Therapy. https://www.aota.org/about/for-the-media/aquatic-occupational-therapy
– American Occupational Therapy Association. (2023). Incorporating Hippotherapy in the Treatment of Pediatric Populations. OT Practice.
– American Occupational Therapy Association. (2018). Role of OT in Comprehensive Integrative Pain Management. https://www.aota.org/-/media/corporate/files/practice/role-of-ot-in-comprehensive-integrative-pain-management.pdf
– American Occupational Therapy Association. (2023). Social and Emotional Learning Info Sheet.  https://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Social-and-Emotional-Learning-Info-Sheet.pdf

 

Enjoying the Holidays With Your Neurodivergent Child

Enjoying the Holidays With Your

Neurodivergent Child

By Michaela Gordon, OTR/L

It is that time of the year again. Summer is behind us and we have entered the fall and winter seasons. The clocks have turned back and the weather has cooled. If that isn’t enough change, most of us celebrate 4 holidays up to the New Year! That is a lot of change! As much as we enjoy communing and celebrating, the holidays do come with some level of stress. This can be especially challenging for our neurodivergent children. Whether your child has ADHD, Autism, Anxiety or Sensory Processing Disorder, it is important to consider everyone’s needs as you make plans during this holiday season so everyone can enjoy themselves.

 

Here are some holiday suggestions so you can plan ahead:

  1. Try to stick with your self-care schedule as much as possible. Kids generally do best, when they stick to their daily self-care routines. It can be an anchor at the start and end of their day to re-center them. This means going to bed and waking up at the same time, eating balanced meals at regular times, and brushing teeth and bathing at regular times.
  2. Bring familiar items with you if you won’t be at your house. Again, the holidays come with a lot of novelty and this sometimes can overwhelm kids. You can consider bringing toys, blankets, books, food, or anything else that will make the child feel more comfortable while visiting friends and family.
  3. Share with your kids the events that will happen and also discuss what you don’t know to allow for some flexibility in their thinking about the novel events. It can be helpful to let kids know what activities they will be doing and who they will be doing them with. Showing them pictures of places and people can also be helpful. It’s really important to also let them know about the unpredictable by using “maybe” or “might” statements. Example: “We are going to your Aunt Margaret’s house for Thanksgiving. We are going to leave after breakfast and it will take 3 hours to get there. When we get there, you can go out and play in the yard and then we are all going to have dinner together. Some things might happen that we don’t know about. We might get stuck in traffic or it might rain. We will come up with a new plan if that happens.”
  4. Have an exit plan if needed. Sometimes things just become too much, even when we have tried our best to make sure the holidays as successful as possible. This means you may have to arrive a little later than expected or leave a little earlier to reduce the stimulation and demands that are becoming too much for your child. You can also go into a quieter room to do a preferred activity or go outside for some movement and fresh air.
  5. Know your child’s tipping point. Some kids can handle lots of treats, candy, screens, and high intensity play, and then return relatively quickly to a calmer state, while for other kids, that can send them right into a spiral, turning a fun event into a sad ending. You know your child best so even though it’s supposed to be a fun, care-free experience, you may have to put a limit on items and activities that historically cause overstimulation.
  6. Ask for support and help. You don’t have to do the holidays alone and bear through them. Ask the people you trust for help. It might be helpful to have a conversation before you arrive about what your child’s needs are so that family and friends can be prepared ahead of time. Whether it is making them special food, playing with your child while you socialize, turning down the music, or not insisting on a hug, asking for support can make the day a lot more enjoyable.

 

May you all be safe, healthy, and joyful this holiday season!

What is Dyspraxia?

What is Dyspraxia?

By Michaela Gordon, OTR/L

You most likely understand a therapist when they use the terms coordination, balance, and strength. However, do you understand the term praxis or dyspraxia?

 

Praxis can be broken down into three steps. Before a child can perform a motor action, two cognitive steps occur. The first cognitive step is ideation. Ideation is the ability to come up with new ideas for using your body and objects. In other words, is the child able to figure out what to do when they are presented with something new?

 

The second step is motor planning which involves planning out the sequence of motor steps to accomplish a task. Part of motor planning includes the timing of each step and getting the body into the various static and dynamic positions for each step moment by moment. In other words, now that the child has an idea of what they want to do, do they know how to put that idea into action in a timely and fluid way?

 

After these two cognitive steps have occurred there is then motor execution. Motor execution is the observable result of all these steps. In other words, was the child able to accomplish the task, and if so, was their performance within a range appropriate for their age?

 

The concept of praxis may be confusing for parents to understand if their child presents with high verbal skills or a vivid imagination but also presents with poor ideation in praxis. Ideation in praxis is specifically coming up with new ways to move or use the physical body in the physical world.

 

The other variable that may be difficult for parents to understand is the difference between praxis and motor patterns. The reason this can be hard to understand is because your child may be able to perform and even sometimes excel at one or more motor tasks i.e. riding a bike, or playing tennis, but then may not be able to perform a new motor task, even if that task is easier than the other tasks they excel at. Praxis requires focused attention in order to conceptualize and plan the novel task. The child’s level of praxis will not be revealed until the child engages in a novel task.

 

A motor skill (or a motor pattern) is a task that is familiar and has been repeated many times to the point that the motor pattern has become programmed into their muscle memory. When this happens, the child can perform those motor patterns automatically. For some children, if an element of a familiar task has been changed i.e. a longer rope, a smaller ball, someone else joins in, the task is done in a new environment etc., this may be enough novelty where praxis is needed and the child may have difficulty performing the task or may simply refuse to engage in the task. 

 

One important contributor to the development of praxis is body scheme, which is a sensory-cognitive map of the physical self. Body scheme is developed through multisensory information with tactile and proprioceptive processing (sometimes referred to as somatosensory) being the biggest contributor to body scheme. Body scheme provides the child with physical safety to explore their environment, the ability to connect with the social world, to learn and develop motor skills, to refine movement, and influence regulation.

 

Issues with praxis may be referred to as motor planning issues or dyspraxia. Dyspraxia means difficulty with praxis even in the presence of normal intelligence and environmental opportunities. Somatodyspraxia means praxis issues that originate from issues with body scheme due to inefficient tactile and proprioceptive processing.

 

If praxis issues are present, it may take regular practice over a period of time to learn simple tasks and the child may need to re-learn the task on some level each time. Dyspraxia is easier to determine as occupational therapy services and programs are implemented since you often see this issue when the child is engaging in a novel task or engaging in tasks within a novel environment.

 

Dyspraxia can be addressed through sensory integration treatment and other sensory-based modalities.

Environmental and task modifications may need to be made at home and school to support the child while they build up their praxis skills. The child may also benefit from using cognitive strategies so they can better manage challenging tasks on their own. Lastly, engaging in a daily home program that supports the development of their sensory-motor skills is both important and helpful for long-term results.

What is Sensory Regulation?

What is Sensory Regulation?

By Michaela Gordon, OTR/L

Sensory regulation is the brain’s ability to turn sensory signals up or down to adapt and respond appropriately to everyday events.  

 

Similar to a thermostat, people tend to have a baseline that reflects their general energy levels. A person can tend towards a low, moderate, or high energy level depending on how their brain is regulating sensory information. This general baseline gives us an idea of the person’s ability to regulate sensory information.

 

Even though we all have different energy level baselines, that doesn’t mean we never shift into the different types of energy states. To be adaptable, you want to shift from one state to the other based on the situation you are in. For instance, if you are excited and social while at a party, then that would be an appropriate energy level for that situation. However, if you are trying to go to bed, then that higher energy wouldn’t be helpful to you.

 

For the person with a moderate energy level as their baseline, it’s easier for them to regulate sensory information and respond to daily stressors. However, if a person tends to have a lower energy level that doesn’t rise much or if a person tends to have a higher energy level that doesn’t lower much, that might affect their performance, their feelings about themselves, and their relationships with other people. If this is happening, then typically it would be good to see an occupational therapist to help them build their sensory regulation skills because their difficulty with sensory regulation is impacting their quality of life.

 

The goal of improving sensory-regulation skills is not to stay in an even energy state at all times. It is also not to change the person’s personality. The goal is to teach someone to monitor their energy levels as they go about their day and then use specific tools to return to an optimal state for the situation they are in while still being their wonderful selves. 

 

Another important note is that sensory regulation is just one piece of self-regulation. Self-regulation is the ability to regulate both sensory information and our emotions. Other parts of the brain help us regulate our emotions and help us make decisions. 

Sensory Processing: Your Online Brain Store

Sensory Processing: Your Online Brain Store

By Michaela Gordon, OTR/L

The brain is a complicated organ that we continue to study and understand. Sensory processing is a complex process that occurs in the brain. I wanted to come up with a simple way to explain the process.

 

To do this, let’s think of our brain as an online store, the sensory information as the products available to order, and the packages as what is sent out for delivery after an order has been made.

 

Normally on the store’s website, there are pages of different types of products made for different uses.  Some of those “sensory products” will come from our environment such as sight, sound, touch, taste, and smell. Some of the sensory products will be “store brand products” coming from inside the body such as movement from the inner ear, proprioception from the joints and muscles, and interoceptive input, which is the felt sense that tells you what’s happening in the body like temperature changes, hunger, thirst, needing the restroom, etc.

 

The sensory products are scanned and selected by the person as they go about their day. Some of these sensory products are hand-picked such as “you may like” while others are just there and you must shift through what is relevant for you and what is not.

 

The sensory order gets sent through the brainstem, which is the main delivery route for sensory products (except for smell which has its own special delivery), and then gets dispersed to the various departments of the brain store.

 

Once that sensory order has been placed, the brain then has to look at that order to see what’s on the list, determine what those items are, and what they mean. Special instructions are then created that will go into the delivery package with the sensory products so the person knows what to do with the products once they are ready to use them.

 

Now the brain is a very savvy business owner and committed to being environmentally conscious, so it’s not going to send you out one package at a time with one product. The brain is going to put all the products together with the best instructions on how to use these products in combination. 

 

Once you receive your package, you open it and use the products to take action. The items in the package along with their special instructions will help you to take action with your body, engage in daily activities, and socialize with those around you. In other words, these are the things you need to interact with your environment.

 

As you interact with the environment, you go back to the online store where you continue to browse, purchase, and use the sensory products. This is a continual cycle that keeps you hopefully living your best life!

 

Everyone has their own unique “online brain store” that will dictate what products are available and how efficient the brain store is with managing incoming orders, communicating between departments, and providing you with the best-delivered products with instructions possible.

 

Pediatric occupational therapists are trained to analyze an individual’s online brain store and how it is functioning so we can make sure their sensory shopping is a pleasant and effective experience!

 

 

 

 

Lessons From Zoey

Lessons From Zoey

By Michaela Gordon, OTR/L

If you asked me 3 years ago if I would be an author, I would have most definitely have said, “No way!” It started very innocently. A child I was working with was struggling with her friend. The more she tried to connect with her, the more her friend pulled away. We discussed that our energy takes up space, other people can feel our energy, and sometimes it can feel too much, even when we have the best of intentions. I explained that if she just made her energy a bit smaller, her friend might feel more comfortable, and they could spend more time together. 

 

I thought these points were important to understand. I often use books and activities to further explain concepts to the kids. The trouble was I couldn’t find anything explaining how our energy takes up space and how people feel that energy, so I wrote her a story. The child liked the story and it helped her. I had some other kids that I thought would also benefit from this concept so I read the story to them. They also liked it. A handful of parents mentioned I should publish the story and with enough encouragement, I decided to start the publishing process. 

 

From there, it was a long windy road to self-publishing. I had no idea what I was getting myself into! My years of being a novice occupational therapist were several decades behind me, but when it came to writing and publishing a book, I was right back at the starting line and the race to the finish line has not linear, but a course with winding roads, hills, and let’s be honest, sometimes I felt like I was climbing a mountain! Don’t believe me? Just take a look at the picture above and the final cover of my book and you can get a sense of where I started!

 

I bring up this point because it is important to know that something being hard and not being good at it right away, does not mean you shouldn’t do it or that you aren’t capable. Even if you never master that one thing you put so much effort into, there is something about challenging yourself and continually learning that can be highly valuable in discovering more about yourself. 

 

Here are things I learned from writing Zoey and Her Amazing Energy Bubble! and what I’d like to pass on to you:

  1. Let life surprise you! Every time I think I have life figured out, it decides to shake things up for me! Having no idea what I was doing during this process, I had to just trust the steps I could see in front of me, hoping the next steps would reveal themselves as I went along. I am still in the process as I approach the launch of my book at the end of the week and I navigate what happens next. I am not too sure you ever get to the end of anything, but maybe that is ok. What matters is that you are taking those steps forward!
  2. Expand your I am (fill in the blank). You are constantly discovering who you are through your experiences. Challenging yourself with new experiences keeps you open to who you could be. I am a writer. Even though I write all the time as a therapist, I didn’t consider myself a writer, but now I do! I never thought I’d be a publisher, but I am now! I didn’t think I could make and edit videos for social media. Now I can! I had no idea I had that in me. What do you have hidden inside of yourself?
  3. Look for your helpers. I had a mix of experiences along the way. Some people were so incredibly helpful and others were not. Although I don’t like to admit it, even the people who were not helpful to me, were an important part of the process because I learned important things about myself and it strengthened my discernment to make better future decisions. Of course, we love it when we find our village. Those people who understand us and support us in reaching our goals. I was so fortunate to have connected with some amazing people with whom without their help, my book wouldn’t have existed. Don’t let bad interactions stop you and keep looking for those helpers!
  4. Step towards your fears when you are called to action. At first, I wrote this story for one child. Then that turned into multiple children. Then I thought I would publish this book and then whoever happened to randomly find it, could enjoy it at their leisure. What I didn’t know was that it was time for me to come out of my comfort zone and speak up. I know for the energy bubble concept to be powerful, it needs to be learned by all kids. It’s time we start to teach the concepts and tools we teach to our neurodiverse children to their peers as well. It is time a time when accommodation is just not enough for many of our children. Inclusion can’t happen unless peers are helping peers. It is time we have books that explicitly teach social-emotional skills so that we don’t leave behind the kids who won’t get the hidden message in many children’s books. We can all help in our own ways to make the changes we wish to see in the world around us. Zoey is a vessel for me to be a voice for kids of all abilities on a level I couldn’t have imagined 3 years ago. When the opportunity comes, take action! If not you, then who?
  5. Be a good model. I ask kids all the time to do hard things and they tell me they can’t, all the time. It is so rewarding to watch them overcome obstacles and gain skills to become their best selves. I think it’s really important for us to show them through our actions that we too are doing hard things. Let’s talk about it, let’s work through it, and let’s celebrate each other as we navigate through the challenges we face in life!
  6. Use your gifts to help others. No matter your gifts and talents, they are needed. There is something about you that no one else possesses. Sometimes we take our gifts and talents for granted, assuming that everyone has them, but that is not true. It might not always be clear what we should be doing, but if it’s helpful and feels right, then pursue it. 
 

I hope Zoey and Her Amazing Energy Bubble! has a positive impact on those who read it. I hope the concept helps them understand themselves better and helps them feel empowered to manage what shows up in their day. I hope this concept promotes healthy relationships with others and builds a sense of compassion for each other’s needs. Learning to co-regulate is one of the most important things to learn in life. When we can co-regulate, we can create healthy living with one another. 

 

 -Michaela E. Gordon, OTR/L

How We See Changes Everything!


How We See Changes Everything!

By Michaela Gordon, OTR/L

Contributing Author, Dr. Felicia Lew

   Since the arrival of technology, we are spending much more time sitting and looking up close at 2D environments such as phones, tablets, and televisions. A study was published in Preventative Medicine, (Varma et al., 2017) involving 12,500 people 6-84 years of age. The participants wore activity trackers to measure how long they were active and sedentary throughout their day. The outcomes indicated that 19 year olds spent as much time in a sedentary state as 60 years old individuals! The study also indicated that 25% of boys and 50% of girls ages 6-11 did not engage in the recommended amount of 1 hour of moderate to intense level of exercise per day.

If this is the case, what activities are our children and teens doing on a daily basis? How are they using their time? According to the Common Sense Media website (www.commonsensemedia.org, 2019) , a survey of 1600 children and teens revealed the average 8-12 year old spent almost 5 hours on screens per day and the average teenager spent 7.5 hours on screens per day. This number did not include additional screen use for school or to complete homework. I think this answers what children and teens are doing with their time!

As caretakers of children and teens, we must then assess what ill effects technology and media have on their health and well-being. According the Common Sense Media website, ill effects of prolonged screen time include addiction to screens, loss of focus, lower empathy and social connection, and health problems such as eye strain. The researchers indicated that parents must educate their children and teenagers about the ill effects of technology and teach them how to moderate its use.

Occupational therapy can address these present concerns. One focus area of occupational therapy is sensory integration, which is our brain’s ability to recognize, interpret and organize information obtained through our senses. Our sensory systems have an intimate relationship with each another. The systems work together to give us a sense of where we are in space and influence how we relate to our surroundings. Sensory-motor experiences are critical to brain development. Unfortunately, a child minimizes their movements, exploration, and interaction with the world when sitting for many hours in front of a screen. They deprives their brain of the rich sensory experience of the real three-dimensional world. Their view is fixed on a two-dimensional object and they are missing out on what’s around them!

What about vision and technology? The visual system is the primary sensory system being used during screen time. The increased time looking at screens has taken a toll on our eyes, both short-term and long-term. There is evidence that outdoor play reduces the incidence of near-sightedness (myopia) in children. The American Optometric Association (www.aoa.org, 2020) states that the rate of myopic school-aged children continues to rise. The AOA states that 1 in 4 parents have a child that is near-sighted and 75% of near-sighted individuals were diagnosed between the ages of 3-11. The AOA recommends that family members receive annual comprehensive eye exams. Myopia can increase the risk of retinal detachment, early cataract development, and glaucoma. Therefore, early detection is important.

Furthermore, the importance of vision in child development is multi-layered. A child may have 20/20 vision, which is considered “perfect vision”. We call this visual acuity or how clearly the child can see. What is often missed is assessing a child’s functional vision. One important area of functional vision is visual perception. Some examples of visual perception are: finding objects within a background, identifying objects based on their parts, and determining the spatial orientation of objects. Another area of visual function is eye motor skills and coordination of movement between the two eyes. A child who is unable to visually fixate in one spot or track words across a line to read is a very frustrated child. I see a variety of negative behaviors in children when visual challenges are undetected and untreated.

As an occupational therapist, I want to do my part to guide children towards healthy development. Many occupational therapists can provide assessment and treatment to address visual perceptual challenges. A therapist who is trained in sensory integrative treatments typically uses a ground-up framework by assessing how the child processes different types of sensory input. We often see that children with poor vestibular processing also have poor visual perceptual skills. Assessment of balance, postural imitation, and bilateral coordination skills gives us a sense of the child’s visual perception. We also look at reflexes like anti-gravity postures, which can also tell us how the other sensory systems are interacting with the child’s functional vision. We also look at fine motor skills and handwriting skills to gain more specific insight into the organization and precision of the visual system.

Once we have gathered the appropriate information, we treat targeted areas to improve sensory-motor functioning. Part of the therapy process involves providing a home program to promote healthy sensory function at home. The program may be a schedule of sensory-motor activities, modifying or eliminating unhealthy habits, and educating the family and child on how to develop their sensory systems for long-term success.

Occupational therapists can work with children on ocular-motor exercises (e.g. shifting eyes from one spot to another) and visual-perceptual activities (e.g object finding board games, block design games, mazes, and handwriting). We can address upper-body coordination skills to assist with improving ball skills. Occupational therapists can perform visual screenings to determine if further examination is needed by an optometrist. Occupational therapists are not licensed to work with lens prisms or color lenses unless under direct supervision of an optometrist. Visual therapies can be quite powerful on the central nervous system. When we work with the eyes, we are really working with the mind.

Occupational therapists may not be able to treat all of your child’s vision struggles so it is important to receive further assessment by a developmental optometrist if your child presents with more complicated visual challenges. Engaging in both occupational therapy and vision therapy either simultaneously or sequentially can be beneficial. Despite some overlap of therapies provided by both disciplines, an optometrist and an occupational therapist will bring their unique perspective and expertise when working with your child.

Developmental optometrist Dr. Felicia Lew has kindly offered more insight into her work as a vision therapist. She gives us further insight into what a parent would expect from vision therapy.


Dr. Lew, what is the difference between a developmental optometrist and an ophthalmologist?


Good question, as there seems to be some confusion about this. First, the similarities. Both optometrists and ophthalmologist evaluate and treat eye conditions that do not require surgery. These include infections, glaucoma, and removal of foreign bodies. Both optometrists and ophthalmologists also administer comprehensive eye exams.

Second, the difference – surgery. Ophthalmologists operate. Optometrists do not. Ophthalmologists undergo extensive surgical training, and usually specialize in particular types of eye surgery. The most common form of pediatric eye surgery is to correct misalignment of the eyes. This is done by cutting the muscles surrounding the eyes and then repositioning them. Optometrists spend all their time in graduate school learning about the eyes and vision system, as well as related subjects such as optics, pharmacology, and neurology. Optometrists’ training also emphasizes optical correction, which allows them to help patients correct their vision without surgery with devices such as glasses and contacts.

Developmental optometrists are a sub-group of optometrists who take a more holistic approach to vision care known as “vision therapy.” They obtain a doctorate degree in optometry and then pursue further training through organizations such as the College of Vision Development and the Optometric Extension Program. Most developmental optometrists begin their careers as traditional optometrists. But then they realize that vision care is much more than helping patients see 20/20 and making sure patients do not have eye disease.

A traditional optometrist usually spends 30 minutes or less with a patient for a comprehensive eye exam. A developmental optometrist, however, may spend several hours with a patient, spread over several appointments, to complete a comprehensive eye exam, a developmental eye exam, and a functional vision evaluation. In my practice, I watch a child’s eyes and look to evaluate issues such as (1) whether the eyes work together as a team, (2) blinking, (3) reading difficulty, and (4) sensitivity to sensory stimuli. I also evaluate head and body posture, balance, and interactions with surroundings. I thoroughly assess eye movement and alignment with the aid of computerized tracking equipment which utilizes sensors to detect and record eye position. I also evaluate visual perception and processing areas such as visual memory, visual closure, directionality, visual figure-ground discrimination, and writing skills.

Following such a comprehensive evaluation, a developmental optometrist will create a treatment plan that does not include surgery or drugs. The goal of vision therapy is to rewire the connections between the eyes and the brain more efficiently. This leads to improvements in the patient’s life which can include a safer and more stable visual world, interest and engagement in surroundings, enjoyment of reading, faster completion of schoolwork, and cosmetic and functional alignment of the eyes.

Developmental optometry’s less traditional approach has gained much attention in recent years. World renowned institutions such as the Mayo Clinic and Harvard’s Boston Children’s Hospital have been implementing programs in developmental optometry and vision therapy.

And this just makes sense. In his book Brain Rules, developmental molecular biologist John Medina explains that vision “trumps all the other senses,” occupying more space in the brain than the other senses combined. Given its importance to overall health and wellness, we need to address all the complexities of the visual system when fostering learning and development in children.


What type of specialized therapies do you perform to improve visual perception?

     

My toolbox is overflowing. In addition to prescribing glasses and contact lenses in the traditional sense, I can use lenses, prisms and filters to modify sensory perception. For example, I can place lenses in front of the eyes to enable a patient to more accurately identify sounds and locate where the sound came from. I also use a lot unique gadgets and gizmos for vision training which keep a child visually challenged – and having fun at the same time.

Both in-office and home therapy incorporate games and activities which give feedback to a child to make them more aware of how their eyes and brain work together. Many activities integrate the other sensory systems so a child can make connections between the senses to better understand their surroundings. When appropriate, I use computer programs like virtual reality games to provide controlled increases in complexity and difficulty to improve visual skills.


When do you think it is appropriate for a child to work with both you and an occupational therapist?

    

Good question – and difficult to answer because each child is unique. I will recommend seeing an occupational therapist or other professional if the concerns that need to be addressed are beyond my scope of practice. I find collaboration with occupational therapists and practitioners of other disciplines invaluable to a holistic approach.


Do you recommend vision therapy before occupational therapy or vice versa?

     The general rule is that a child with developmental concerns should have a developmental eye and vision evaluation in addition to evaluations with other professionals to identify whether the areas which need improvement are primarily related to vision. If so, I would probably recommend vision therapy first.

However, I see many children after they have seen an occupational therapist. I appreciate this, because it means that they already have done work in areas related to vision development such as primitive reflexes. This primes them for what I do. Often, occupational therapists will refer a child to me if they think there should be more emphasis on the visual system.


If you could pick one habit to change in order to improve a child’s visual health, what would it be?

     

Ah, an easy one — less screen time and more real-life play, especially outdoors. Playing in free space is so important for healthy development.

That being said, some newer studies indicate that computer games can aid the development of vision skills. Also, exposure to blue light – which digital screens emit – boosts memory, alertness and cognitive function, but too much can cause eyestrain, poor sleep and possibly macular degeneration.

So, a moderate amount of screen time is OK. But focus on playing outside.

References:

aoa.org

commonsensemedia.org

sciencedirect.com

Progress Through Partnership


Progress Through Partnership

 

By Michaela Gordon, OTR/L

 

 

  Deciding to start occupational therapy services with your child can feel
overwhelming. It takes a great amount of trust in the therapist and the process.
We are talking about your child’s life and well-being so we must approach their
needs with the upmost of care.

 

 

We are living in a time where clients have more access to information and
therefore want more choices and more explanation. Clients will ask me about differing
opinions about certain approaches or perhaps a new gadget or therapy they saw
online. To be honest, I am also being inundated with online information and I’m
often researching what approaches and tools are effective and which are
ineffective. It is very easy to become skeptical, defensive, indecisive, and

sometimes paralyzed in a state of overwhelm with everything coming at us. It is
also very tempting to click on a quick fix or become fixated in our view points
because the algorithms in our social media feeds keep bringing up the same or
similar content. With all this information, it sometimes can distract us from
the most important part of therapy, which is the therapeutic relationship.
Humans really are interdependent. Information is great, but it really isn’t
helpful unless we know how to use it or know how to apply in a way that is
meaningful to your child.

 

I believe that the relationship I have with my clients is the foundation for
all the good work that is to follow. When entering into any relationship, we
must hold ourselves accountable, have empathy for each other, and work on
developing strong communication with one another. With these aspects in place,
we can effectively work together to help your child learn and grow.

 

Let’s explore these three aspects a little more. First is taking
responsibility for our actions. As a therapist, I’m upfront with my clients
about my responsibilities and the client’s responsibilities. Some are written
in policies and some are discussed in person. This ensures that we are all in
agreement about how we are going to contribute to the therapy process. If we
get off track, this allows us to have a discussion about the challenges occurring,
assess our plan, and then refocus back to our individual responsibilities.

 

Empathy is another important aspect in a partnership. As human beings, we
know that life can bring us both joy and challenges. Our goal is to try to be
fully present and on top of our responsibilities so we can make good gains in
therapy. However, there are going to be times where that doesn’t happen and we
must show empathy towards one another. As the therapist, I might make a mistake
in a report or forgot to send out an email out. Perhaps I misunderstood something
you said and took a situation in the wrong direction. These things will happen

from time to time. As the client, maybe you really want to get your home
program going, but you realize you don’t have a strong support system to do
that. Maybe you really want to work on setting a different boundary with your
child, but you are tired from a long day at work and you don’t feel you have
the energy to deal with a meltdown. None of us want to be dealing with
tribulations, but they are indeed part of life. So, whether big or small, we
need to have patience and be understanding with one another. It’s important to
take accountability when we miss the mark, but it’s equally important to know
our strengths and limitations so we can come up with a reasonable plan that we
can all follow.

 

Lastly, partnership requires good communication. Effective communication
includes accountability. We need to check in with how things are going and make
sure we are working toward our goals. Empathy is also part of good communication.
The words we choose and the tone we use to deliver those words, sets the stage for
how strong our therapeutic relationship will be. Bringing accountability and
empathy into our communication allows us to speak with honesty about our needs
so we can be the best support team for your child.

 

A partnership is an investment. It is an exchange of effort and belief in
one another. It is a chance to reconfigure life’s challenges into something
fruitful. It is about both you the parent and your child leaving therapy
empowered with skills and confidence. It keeps me motivated to study and learn
new things to bring to the therapeutic experience. A strong partnership leaves
me more experienced, wise, and skilled so I can help the next family with the same
level of passion.

 

So, let’s be good models for our children. Let us get away from divide and disconnect
and choose connection and collaboration. Let us show them good boundaries and how
to be accountable. Let us show them how we can be empathetic towards each
other. Let us show them how we listen to each other and that we are responsive to each others’ needs through

our actions. These skills can not only be learned in their therapy sessions,
but through our simple interactions.

Michaela E. Gordon, OTR/L

Cleaning up the facts about The Wilbarger Deep Pressure Protocol (Therapressure Protocol)

 

 

  At my first job, I remember seeing these white brushes. I knew they were for some sort of tactile stimulation, but I did not use them with students. I moved to CA and here, I would also find the white brushes! I was shown the protocol at an in-service. I didn’t fully understand the neurological underpinnings of the protocol, but I thought this was a great tool, so I started using it with clients.

 

I later realized after taking the class, it is really important to go to the training because you need to learn about the mechanism of pressure, which is difficult to conceptualize from verbal or written directions. Also, when I trained families in delivering the protocol, I typically had to review the technique with them 2-3 times before they could execute the procedure in an effective way on their own at home.

 

I was excited when Pat Wilbarger and her daughter Julia were coming to the area to teach the neurological foundations and the application of their protocol. Pat was one of the first pioneers in the field of sensory integration and she created this protocol to help children with sensory defensiveness. Sensory defensiveness is when the brain perceives non-threatening sensory signals as a threat, causing chronic, undue stress to the individual. During the class, Pat said something that helped me to truly to understand the importance and intent of the protocol. She said, “This sensory defensiveness is serious stuff! This is a matter of quality of life for these people so you really need to understand what you are doing.” It’s a matter of quality of life. I will never forget that. It’s a matter of being able to function in the world and being able to let others close to you. It matters.

 

There are lots of misconceptions about the Wilbarger Deep Pressure Protocol from its purpose to its details. I am hoping to clear some of these misconceptions up. First, the protocol is often called the “brushing protocol”, which sometime leads both non-trained professionals and non-professionals to miss the objective of the protocol, which is to provide pressure. Some individuals also confuse “brushing” with lymphatic dry brushing, which is surface, light-touch brushing with a different type of brush, which is counter-productive to addressing sensory defensiveness. Pat developed a specific brush where the bristles are a particular shape and texture as well as a rounded handle to ensure good delivery of deep pressure. This pressure is without scratch, tickle or itch.

 

Second, the purpose of the brush is to apply specific PRESSURE to the skin. It is not light touch or a massage. It is all about specific pressure. The brushing procedure is followed by joint compressions, which is also specific PRESSURE delivered to the proprioceptive (joint/muscles) system. Doing both is important so the brain can properly interpret and integrate the messages from the sensory signals. The tactile stimulation is given with pressure, but even so, can over-arouse the system. The joint compressions that follow are given to provide grounding input without overstimulation so the individual can benefit from both types of stimulation.

 

I often get complaints about the frequency the Wilbarger Deep Pressure Protocol has to be delivered, which is to be performed every 1.5- 2-hours throughout each day for at least 4-6 weeks or until symptoms resolve. I can assure you that this is not to torture you or your child. If you want to change physiology, the body needs consistent input that is delivered at a specific frequency and duration over time. So the more you can follow the protocol, the more likely your child’s physiology can shift.

 

Another missing piece is the sensory diet. This is Pat Wilbarger’s coined termed for providing other types of sensory inputs throughout the day along with the therapressure protocol. Again, we are looking to shift sensory input into informative data versus false alarms that puts the individual into distress. The person needs an opportunity to get organized input on their own in conjunction with the therapressure protocol that is delivered by an adult or themselves. Individuals with sensory defensiveness are often avoidant or distressed by daily activities so they do best with predictable, planned sensory activities. Over time, the person will be more likely to seek out and engage in a variety of activities that fulfill their sensory needs. However, until their physiology changes, they will need support and encouragement.

 

It must be noted that Pat Wilbarger figured out something remarkable. While working with her friend and colleague Jean Ayres, she realized that some of these children were avoidant of treatment versus naturally gravitating towards sensory stimulation that met their needs. Pat was also able to determine that the timing of sensory input was important. Her clinical findings indicated that children generally needed to be engaged in sensory input every few hours in order to keep the integration process going. Due to this discovery, she realized that it wasn’t enough to treat a child just in a clinic, but sensory stimulation needed to be continued in homes and schools. That is why it is important for parents, therapists, schools and other adults in the community working with the child to communicate in order execute the sensory diet and therapressure protocol. As they say, “It takes a village!”

 

So do the sensory diets and the therapressure protocols require some planning and effort? Yes. Can it feel stressful and at times tedious? Yes. However, I think the missing link is that parents, teachers, therapists etc. may not have gotten the message I received and that is, “This sensory defensiveness is serious stuff! This is a matter of quality of life for these people so you really need to understand what you are doing.” I think when we keep the intent of what we are trying to achieve out in the front, it keeps us on track. We do the best we can to deliver consistency to the defensive/avoidant individual. We do our best to come up with a plan that can be realistically implemented. It doesn’t need to be perfect. The goals just needs to be clear and we have to keep working at it.

Pat Wilbarger has absolutely left her mark on this earth. Both she and her daughter Julia have gone all over the world delivering their knowledge and expertise on sensory defensiveness. I have seen with my own eyes the difference this method can make for individuals with sensory defensiveness. They regain confidence and joy. They begin to understand themselves and connect with others.

 

A thank you to Pat and Julia Wilbarger for all they have taught me and the rest of the OT community.

“Never doubt, that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.” -Margaret Mead

Michaela E. Gordon, OTR/L

You Don’t Know How It Feels To Be Me!

 

 

    Do you ever hear a kid say, “You don’t get it. You don’t know how it feels to be me!” That is the truth. We don’t know what it feels like to be them. We can only empathize and try to relate based on what we are experiencing. When it comes to sensory defensiveness, children are over responding to sensory input, which causes a fight, flight, or freeze response. It is not necessarily the actual stimuli that is the issue, but rather the way the sensory signal is being processed when it reaches the higher level pathways of the brain.

 

 

We all have some degree of sensory preference and sensitivity. And some sensitivity is good. If you were walking across a street and noticed that a car was both close and coming at you, it is a smart move to run as quickly as you can! However, if you are walking across the street and you hear a car way off in the distance, but your brain says, “Run, you are about the get hit!” when that is not the case, then the brain has just sent you a false alarm, which can be confusing and distressing. If the brain is constantly misinterpreting  non-threatening sensory input as a danger, this can impact the child’s confidence while interacting with the world and can give them a sense that the world around them isn’t safe and at the very least, uncomfortable.

 

 

Here are the types of sensory defensiveness one might be feeling:

 

      1. Tactile defensiveness. This is the most recognized type of defensiveness. These children have strong reactions to touch information. They may complain about hygiene routines. These complaints can include brushing their teeth or hair hurts, bathing is uncomfortable, clipping their nails or getting a haircut is painful. These children complain about their clothing, refusing to put on their socks and shoes or only wanting to wear a specific piece of clothing. These children may also have difficulty with accepting touch from others so they avoid hugs or they will report that others have hurt them because normal touch felt like a push or some other assault.
      2. Auditory defensiveness. This is also a widely recognized sensitivity. These children put their hands over their ears to block loud noises. They may refuse to go into public places or use the restrooms because of loud sounds like music or the toilet flushing. These children may be bothered by everyday sounds at home and school so they avoid situations, have meltdowns, or become aggressive due to the noise.
      3. Movement defensiveness. In the OT world, we call this gravitational insecurity where the child develops great anxiety when experiencing movement. These children do not feel comfortable moving through space, especially if their feet leave the ground. In babies, they may be fearful to stand or walk. In toddlers and children, you might see them avoiding riding their bikes, climbing playground equipment or using swings. These children usually crawl upstairs versus standing. You will often seem them keeping both their hands and feet on the ground when scared or unsure. They often cling onto parents and teachers for dear life and can’t bring themselves to go enjoy play with the other children.
      4. Visual defensiveness. These children are often sensitive to light. They may ask to turn the lights off or you’ll see them squinting or rubbing their eyes.  Their parents may need to put a screen up in the car to block the sunlight. These children may become overwhelmed with fast moving environments or fast moving television shows. These children can be easily startled by visual stimulation, especially peripheral stimulation they weren’t expecting.

    If you are someone without defensiveness, these scenarios may not make sense to you. Perhaps you are a good integrator of sensory stimulation, but your child or student is not. Instead of the sensory signals informing the various parts of the brain in a rational way so the child can learn, play, and relate, these signals are heading right to the watchdog of the brain, the amygdala. The brain tells the child, “Danger, danger! You must protect yourself!” These constant false alarms can be overwhelming over time and can impact the child’s emotional well-being and their ability to participate in everyday life tasks. It can take a toll on relationships and make the child feel like there is something “wrong with them”. So when a child says, “You don’t know how it feels to be me,” you may want to answer, “You’re right, I have no idea how it feels to be you AND we are going to figure out how make this better.” In other words, we are going to figure out how to get your brain and body working in a more integrated manner.

     

     

    Here’s the good news! We know that using sensory integration treatments and tools, we can retrain the brain to better understand the sensory signals so they are correctly informing the child as they interact with the world. Several things need to happen in order for this to be accomplished. The right tools need to be identified, the tools need to be implemented with frequent consistency, and the child needs to want to participate on some level. If that can happen, it is amazing how the nervous system can shift and the defensiveness can either be reduced and in some instances completely resolved.

     

     

    It is an honor to help children overcome these challenges. It can really have such a positive impact on their quality of life, yielding to a more comfortable and confident child. If your child or a child you know presents with sensory defensiveness, I encourage you to get them to an occupational therapist.

     

     

    “Dwell in possibility.” Emily Dickinson

    Michaela E. Gordon, OTR/L