Occupational Therapy is therapeutic intervention to support a child in his or her everyday life occupations. For children, occupations include:
- everything a child wants to do (play and have friends)
- everything they are expected to do (eat with cutlery, talk kindly and respectfully to friends and family, get dressed, hold a pencil correctly, remember directions, use the toilet) and
- everything they have to do for survival (eat, sleep, pass bowel and bladder motions)
Occupational Therapists check why a child is not performing in the relevant everyday life occupations and then works with the child, parents and teachers to help overcome. With the child, we work on both facilitating development and teaching skills and strategies. When we facilitate development we provide sensory and relationship rich opportunities in tasks of the just right challenge. In this way we improve regulation, tolerance and processing of sensations, engagement with people and to tasks, problem-solving, sequencing and executive functions. We then see improvements in movement, school engagement skills, daily living skills and learning. With the child we also do direct skill development to strengthen areas such as fine motor skills, gross motor skills, learning, handwriting, eating, toileting and problem-solving skills. We also do direct problem solving and work together with teachers and parents on strategies for challenging tasks such as assembly, sitting still and listening, meeting behavioural expectations, keeping up with writing demands for exams and tolerating new foods.
With parents, we give a lot of education about why a child is struggling and home ideas to reinforce the learning from therapy. Some parents choose to have a home program where they get a list of exercises from their therapist. Other parents prefer ideas and strategies in everyday life. Some parents get both. Where needed, we will have parent only sessions for education and collaborative problem-solving.
With teachers, we connect initially in the assessment process usually by forms, email and the occasional phone call. Where the child has significant needs at school, we will often suggest a school visit, where we educate and support.
All therapy is guided by a treatment plan that is based on the goals you have for your child and where we customise treatment approaches and activities to the needs of your child.
Occupational Therapy intervention can achieve the desired outcomes in one session or be a journey of several years. For simple issues where parents want a professional opinion and advice, therapy is shorter – usually 1-3 sessions. This is often the case with simple toileting issues.
Where there is only 1-2 simple issues such as simple feeding, handwriting or fine motor concerns, therapy usually takes an initial assessment and 5-6 treatment sessions.
Complex motor challenges can often take 6 months to a year to address. Where there are syndromes, diagnoses and disorders and associated behavioural concerns (Downs syndrome, Autism, genetic disorders), therapy is more long-term and can take years to move through the various levels of functioning. In these cases, sometime children come for 6 months to a year, have a break and then may come back at a later time.
Saying that, the depth and length of therapy is always discussed with parents who keep coming as long as therapy continues to make gains and it fits with time and budget constraints.
The frequency of sessions may change based on the concerns that you have for your child, the severity and complexity of their difficulties, what times are available and whether or not they suit your family.
With therapy, most children start weekly for about 6 weeks if possible so we can get a really good handle on their challenges and see what kinds of treatment and strategies work. This is the visual phase of treatment where you are starting to see results.
After this, children who need it will either stay weekly or go fortnightly if they are in the results phase of treatment where results are starting to stick or monthly for maintenance or home program support. Frequency depends on their progress, family time, other commitments and budget. This is individually negotiated with each family.
Yes – especially for the young ones, and early on. You are the expert on your child and we need your insights and assistance. As the relationship between your child and your therapist grows, you and your therapist may decide the time is right for you to step out of sessions.
The exceptions to this are:
- Where a child plays up when their parent is with them and refuses to cooperate.
- Where an older child is taking more responsibility for their challenges – e.g. upper primary, teenagers
- Where there are challenging behaviours and the therapist is seeking an understanding of the situation from the child’s perspective.
Siblings are welcome but we ask you to keep them occupied and safe so we can focus on the child needing therapy.
In some cases, normal everyday activities are enough for a child to develop the skills needed and overcome any developmental challenges. For example, many gross motor challenges may be addressed through lots of park play and gymnastics. Sensory challenges may be overcome through repeated exposure in a graded, calm way.
In some cases, the child actively avoids any tasks that are challenging and so does not develop the necessary skills he or she needs. In other cases, the challenges are so severe that many behavioural issues arise that take the focus off developmental challenges. In both of these cases, occupation or function is impaired and the gap tends to widen between the child and his or her peers and often the strategies used by parents or teachers do not seem to work.
In any of these cases, early intervention by an Occupational Therapist or other relevant professional (Speech therapist, psychologist) is recommended to prevent further spiralling down and help the child and family get back onto the positive path of development.
Again this depends on the severity of the child’s challenges, the family and school situation and how able parents are to follow home program ideas at home. For most children, the first session is about building rapport and relationship, and the hope that things can improve. Within 2-6 sessions, there are earIy changes and the child is beginning to reach some early goals. We call this the visual phase. In 7-12 sessions, these changes are becoming habit. We call this the results phase.
Please refer to the Phases of Therapy journey map for further information about this.
Therapy finishes when you as a parent feel like you are happy with the progress made. This may mean that all of the goals have been met or that you have enough tools to keep on working at home. Sometimes, you will come back monthly to 6 weekly for support or sometimes you feel ready to finish. Of course your child is always welcome back should another challenge come up.
Some families of children with lifelong disabilities prefer to keep working on increasingly complex goals over time. We see these children once to twice a week over the long-term for a year or more and work on areas such as social skills, shifting thinking or flexibility, waiting, play skills and anything else that comes up. It is not uncommon for us to see children on and off for several years.
Other children stay for as long and the initial goal are needed. An average length of time is 3-6 months of therapy on a weekly or fortnightly basis. It is common to start with a weekly block of 6 treatment sessions followed by some fortnightly sessions.
Parents are partners in this process and we discuss with you your needs, funding and time throughout this process.
Some parents love getting a home program at home. For others this causes extra stress and guilt. As therapists, we will find out for you if you are able to do a home program and to what level, and will tailor the home activities according to this. All parents are educated about what we are doing in therapy and why, and ideas for everyday home life discussed with you. This makes it easier to apply your learnings in everyday life.
Young children learn best through play, it is at the centre of our therapy. So you will see us observing their natural play, and proposing games that will reveal their sensory, motor and cognitive abilities to us in assessment sessions and in treatment.
Also, learning and skills development works best when a child is having fun. The child is engaged, his or her mind is open, receptive and the skills come more easily. His or her executive function is at it’s best. This is in contrast to when a child is angry, anxious or frustrated, where the executive functions largely shut down and learning is blocked.
Occupational therapy is very fun for most children. They love coming and learn so much. On average, within 3-6 treatment sessions early improvements are seen.
A school visit can serve many purposes. Firstly, it means that the OT can see the child in his/ her natural school environment. Secondly the OT can meet the teacher and/ or support teachers and understand the teacher’s perspective, educate on the child’s challenges and collaborate to problem-solve together. Thirdly it can inform the therapist’s treatment planning and priorities.
School visits are an integral part of what we do at Kids Matters.
Our OTs need to know why your child is having his or her problems. There a many reasons why a child may present with a certain symptom. For example, handwriting challenges can be caused by weak fine motor skills, weak visual perception, weak core, weak visual motor integration and more. We need to know enough about your child so as to design an effective treatment program.
Children can be funded through NDIS – plan or self-managed. Private health funds for eligible members will give a partial rebate. Medicare plans are available through your doctor for eligible kids – complex care needs or mental health care plans