Understand Your Child

What is OT?

Occupational Therapy for children focuses on the child’s ability to master the skills and perform activities necessary for everyday life. In essence, how children “occupy” their time. These include; academic learning, physical play, social interaction and self care skills (organization and ‘getting ready for school’-dressing, brushing teeth etc).

Skills expected of children change rapidly with age. A toddler is not expected to tie their shoelaces, but is expected to build with blocks, climb on play-gyms and play alongside their peers. In doing so, they are developing the foundations for future skills. At kindergarten/preschool, we teach children to develop self responsibility in collecting material for an activity, writing their name and playing ball sports. At school age, we expect that children can handwrite to show their knowledge, play team sports, and pack their school bag. In order to perform all these activity, a range of hidden skills are required. It is here that Occupational Therapy focuses to ensure children demonstrate age appropriate abilities across the range of tasks required in their day; from academic performance to playing with friends to self management (toileting).

Children’s skill development is much like building a house. Much like building a house, where you must lay solid foundations before erecting the walls and only then add the roof, a child must have the mastered underlying (hidden) abilities before being able to successfully perform a task. For children, the necessary foundations are effective processing of sensory information (eg touch, sight and sound) that allows children to register the world around them, as well as to know how to use their bodies. With effective sensory processing ‘foundations’, the physical components such as finger strength, hand dexterity, and postural control (keeping an upright posture) can be developed (these are the walls of the house). Only then with the sensory processing (foundations) and physical skills (walls) in place can tasks such as handwriting or bike riding be performed skilfully (like adding the roof).

Occupational Therapy helps when a child is having difficulty learning to perform a new skill (especially over a longer time than considered typical for their age). It also helps children developing age appropriate attention and behaviour. In particular, where difficulties occur, Occupational Therapists ask ‘why is the skill difficult’ (that is, ‘why is the roof so shaky’?) and then review the underlying foundations and physical abilities (the walls) to determine where the origin of the challenge is, to then deduce appropriate strategies to resolve the problem.

The areas of development that Occupational Therapy focuses on include:
Fine Motor (table top skills, eg using pencils and scissors)
Gross Motor(physical skills like running and jumping)
Self Care (eg sensory reactions that influence behaviour, attention and skills like dressing) and
Self-management(organization).

FINE MOTOR (Table Top) skills involve the smaller muscles of the hands in precision movements (such as doing up buttons, using pencils/scissors or building with blocks). Fine motor skills are essential for school related performance (eg writing), everyday life (eg using eating utensils and toileting) and play with peers (building constructions).

Although there are a number of underlying physical skills necessary to be able to perform table top activities, the following are easily observed by parents and teachers:

Pencil skills: scribbling, colouring, drawing and writing are monitored by how the skills are performed (how the pencil is held and moved) as well as what the outcome product looks like.

Scissor skills: are monitored by how the skill is performed (how the scissors are held and moved) as well as what the outcome looks like (is it choppy, on the line?).

Manipulation skills: involve precise finger control of objects. This is crucial for academic performance (eg pencils and scissors), self care (buttons, lunch boxes, cutlery), as well as play (dressing dolls, Lego construction, holding cards).

You can tell there are problems with fine motor skills if the child displays difficulties with:

• Hand dexterity: The use of the smaller muscles of the hands, to perform activities such as doing up buttons, opening lunch boxes, or using pencils or scissors.
• Handwriting: The art of writing which involves what is the outcome looks like on the page as well as how it is physically performed.
• Pencil/Drawing skills: All skills involving pencils including scribbling, colouring, drawing and writing.
• Scissor skills: The use of scissors which involves what is the outcome looks like (is it choppy, on the line) as well as how it is physically performed.
• Manipulation: Precise finger control of objects, be they pencils and scissors, buttons, shoelaces, puzzle pieces, building blocks, keys or others.
• Daily skills: Everyday tasks undertaken to be ready to participate in life activities (including dressing, eating, and cleaning teeth).

Implications of these difficulties on fine motor skills
• The inability to hold and move the pencil or scissors using a correct grip to allow a controlled outcome
• Written documentation (writing/drawing) that does not reflect the child’s true abilities
• Poor performance of art and craft activities
• Avoidance of (or rapid tiring when performing) ‘fiddly’ tasks (eg pencil and scissor skills)
• Rushing of table top skills (to get them over and done with)
• Immature play and construction skills
• Trouble acquiring basic self-help skills (brushing teeth/hair, wiping bottom etc).
• Poor table manners (awkward utensil use)

GROSS MOTOR (physical) skills involve use of the large muscles of the body such as the arms and legs for running, skipping, jumping and ball skills. Occupational therapy is not able to accurately assess the quality of the outcome skills (such as skipping, jumping, and running) but instead addresses some of the underlying foundation skills required for the performance of physical skills.

Although there are a number of underlying physical skills necessary to be able to perform gross motor activities, the following are easily observed by parents and teachers:

Balance and coordination: involve maintaining largely motionless and controlled upright positions (sitting at a table or on the mat) as well as controlled upright position when in motion (eg when playing chasey). These balance skills influence the fluid ability to perform multiple complex movements simultaneously with control (co-ordination)(such as those required when playing handball).

Endurance and strength: Adequate strength allows the body to perform movement with an appropriate force for generating momentum of the body/ object (eg bat/racquet). Endurance is the ability to repeatedly perform controlled movements with a consistent outcome/skill over time, and it determines a child’s ability to attend for appropriate durations (eg a full school day or full soccer match).

Skill Performance and participation: Skill performance is the quality and consistency of the skill being performed, which often influences a child's ability and willingness to participate in activities. Active participation in well chosen movement opportunities can develop the underlying abilities necessary to be successful in gross motor tasks, as well as hold significant social importance.

You tell there are problems with gross motor skills if the child displays difficulties with the following:

• Balance: The ability to maintain controlled body position during task performance; be it sitting at a table, walking the balance beam or stepping up a kerb.
• Strength: Strength allows the body to perform movement with appropriate force for generating momentum of the body/ object (eg bat/racquet).
• Endurance: The ability to repeatedly perform an activity for the required length of time to participate appropriately without the quality deteriorating significantly.
• Coordination: The ability to perform physical tasks by synchronizing or controlling the movement of multiple parts of the body at the same time.
• Performance – The outcome quality attempted skill.

Implications of these difficulties on poor gross motor skills
• Poor strength resulting in inability to perform tasks (eg hold racquet for handball game) efficiently and effectively.
• Unable to participate in physical play for extended periods of time and reduced persistence with a physical task.
• Poor body awareness, contributing to a child possibly looking clumsy and awkward, or using more force than intended in movements.
• Poor planning and sequencing of bodily movement resulting in reduced coordination.
• Very flexible joints which increase injury risk and compromise movement control.
• Below age appropriate physical skills overall, leading to poor self-confidence and/or avoiding physical play.

SENSORY PROCESSING (the processing of sensory information): is the processing of sensory information in the world around the child (be it the bird outside, the pain from their ear ache or heat from the sun on their body).

It is the way the child’s brain receives, organises and responds to sensory input in order for the child to behave in a meaningful & consistent manner with the world around them. Difficulties in doing this effectively (otherwise known as Dysfunction of Sensory Integration) can result in deficits in; co-ordination, distractibility and inattention, language, behaviour, play and social skills and learning difficulties. The particular, the three functional areas that are affected by poor sensory integration include:

Attention: The ability to selectively ‘tune in’ or attend to a stimulus, to sustain that focus and to ‘shift’ that focus at will from one stimulus to another. Children can either be overly ‘tuned in’ to the world around them (easily distracted) or fail to ‘tune in’ and subsequently notice the world around them (appearing lethargic and oblivious to their surroundings).

Behaviour: The way the child acts or responds to the environment or a situation around them. In the case of sensory integration difficulties, the child may behave in a particular manner influenced by their physical environment, the emotional or social constructs, their own alertness levels, sensory processing and/or their experience in the situation.

Learning: involves attempting skills, making mistakes, retaining the memory of mistakes, repeated practice and ultimately mastering new skills. In the process, the child develops their own preferred style of learning.

You tell there might be problems with sensory processing skills if the child displays difficulties with the following:

• Attention: The ability to focus (at will) on a task/object/picture or sound without being distracted.
• Organisation: The ability to arrange and manage sequential steps to complete tasks required in daily life (be it getting ready for school or mapping out a school project).
• Coordination: The ability to perform physical tasks by synchronizing or controlling the movement of multiple parts of the body at the same time.
• Learning: The process of acquiring knowledge or skill performance.
• Self Help: The performance of everyday tasks (including dressing, eating, cleaning teeth etc)
• Play/Social Skills: The ability to interact with peers and adults in appropriate manner with an understanding of social norms.

Implications of these difficulties on sensory processing skills can vary significantly from one end of the continuum, and may include:
• Needs activities of short duration or may need much longer time than typical
• Can remain focused and attentive on high interest tasks only, or can be overly focused on a project to the exclusion of others.
• Inconsistency in skill or task performance.
• Shows poor attention to details, or is overly attentive to details.
• Is boisterous and ‘in your face”, or withdrawn and lacking social interaction skills.
• Focuses heavily but only on a few details at one time or fails to notice details due to distraction by the environment around them
• Likes to know what is happening now/next.
• May have difficulty coping with change.
• Enjoys sequences and predictable outcomes, or might prefer very spontaneous occurrences.
• May need to complete all steps to be ready to do something else, or may never finish anything.
• May attempt to control behaviours of others.
• Dislikes hands on approach, or loves to touch excessively.
• Notices change quickly.
• Dislikes group learning (prefers solitary learning) or loves group interaction for learning.
• Is very busy physically (jumps form one activity to another) or tires quickly and is hard to motivate to engage in tasks
• Responds very quickly to others/events or takes a longer time than usual to respond

SELF-MANAGEMENT is the ability to ‘look after’ yourself as you get older. The ability to engage in an academic setting (pre/school), a social setting (play with peers) or even the home setting (getting ready for school, playing independently) is largely influenced by our ability to ‘take care’ of ourselves. This includes the everyday tasks (eg getting ready for bed and for pre/school) as well as the ability to organize ourselves to do these tasks (ie memory, being ‘organized’, stopping and thinking before doing). These skills are precursors to many school related tasks. As these skills are predominately involved in home based tasks, assessment is often limited to parental discussion though therapists will often be able to see some indicators in the way the child attempts tasks. The two main functional areas of self management skills include:

Organisation: The ability to; establish what you want to do, to know where to begin the task, the sequence in which to carry it out (including collecting the necessary materials), to problem solve in the event of a challenge, and to persist with the task to completion (within an appropriate time frame).

Daily skills: The everyday tasks undertaken to be ready to participate in life activities (including dressing, eating, cleaning teeth). It is expected that children develop independence in these as they mature.

You tell there are problems with self management skills if the child displays difficulties with the following:

• Attention: The ability to focus on a task/object/picture or sound without being distracted.
• Organisation: The ability to arrange and manage sequential steps to complete a range of tasks required in daily life
• Self Help: The performance of everyday tasks (including dressing, eating, cleaning teeth etc)

Implications of these difficulties on self management skills
• Reliance on adult support and poor independent problem solving abilities.
• Frequently loosing items.
• Ineffective time management skills.
• Reliance on structure to be provided by others in thinking and task performance
• Academic tasks not completed in a timely manner.
• Inability to self monitor time and behaviour.
• Lack of awareness regarding timelines.
• Unable to meet deadlines.