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Occupational therapy (OT) provides essential support for children in optimizing their motor, cognitive, and sensory development. By targeting daily tasks, OT aims to enhance school readiness, improve play, and boost self-regulation abilities. OT is beneficial if your child is facing challenges with basic self-care, sensory processing, fine motor, or motor planning skills. Sessions are individualized depending on your child’s needs and may focus on refining upper body strength, postural control, coordination, body awareness, and visual skills to navigate space more effectively.
The senses provide us with essential information about our own body and the environment in which we function. They provide us with information about where our body is in space, how our body is moving, what impact the environment is having on our body, and helps us in knowing how to effectively respond to tasks and environmental demands.
Let’s think about just the simple action of walking down a step, something which we are able to do without looking or even thinking about. How do we know where our body is, how do we know to shift our balance between our feet, shift the balance of our body, and know when our foot has touched the step without even looking? We know this because each of our sensory systems is telling us what is happening, and it is helping us generate appropriate responses.
Sensory Processing is the process in which the nervous system receives information or “messages” between the brain and the body and generates that into a response. We are all born with the capacity to receive sensory information and unconsciously respond to it with both behavioral and physiological responses such as pulling a hand away from a burning stovetop, recruiting the “just right” amount of force to drink from a cup, or for handwriting.
Simultaneously our bodies respond to produce a physiological response such as increased heart rate, sweating response, rise in blood pressure or respiratory rate (Adapted from Miller, 2006). Our sensory system is the foundation of our development and begins in-utero with the sense of smell, registering sounds, and tolerating various forms of movement.
It lays the structural foundation for all sensory processing and development of our skills from walking, negotiating your environment, body awareness in space in relation to objects and people, how we experience movement against gravity and changes of head position, to how we receive and respond to tactile (touch) or auditory information. All of these factors assist in guiding our social interactions and ability to participate in daily activities and routines.
If we are unable to process information on this foundational level, we are required to use compensatory strategies that can often take away the cognitive and mental energy necessary for completing more complex or multi-step tasks and making sense of the world. This can include activities such as reading, handwriting, dressing, riding a bike, preparing items for a meal, or just sitting down at the table for a long enough period of time to complete a task.
3 Types of Sensory Processing Disorder:
1. Sensory Modulation Disorder (SMD)
Sensory Modulation Disorder (SMD) is characterized by difficulties in regulating and modulating sensory responses to stimuli from the environment and responding or behaving in such a way that matches the intensity of the sensory input. There are 3 types of SMD that can cause individuals to overreact, underreact, or have inconsistent responses to sensory input such as touch, sound, light, or movement. These atypical responses can impact their ability to engage effectively in daily activities and may lead to emotional and behavioral challenges.
2. Sensory Discrimination Disorder (SDD)
Sensory Discrimination Disorder (SDD) is characterized by challenges in accurately perceiving and differentiating between similar sensations. Individuals may need additional time to process and recognize subtle differences in sensory input, such as distinguishing between textures, identifying varying degrees of temperature, or discerning different pitches of sound. For example they may struggle to find their pencil in their bag without looking. This can lead to difficulties in understanding and responding appropriately to sensory information, impacting their ability to interact with their environment and engage in activities effectively.
3. Sensory-Based Motor Disorder (SBMD)
Sensory-Based Motor Disorder (SBMD)occurs when there are difficulties processing sensory information, which disrupts the coordination and smooth execution of motor movements. This affects motor planning, coordination, balance, and overall motor abilities. There are 2 types of SBMD:
Pediatric occupational therapy (OT) is a specialized field/branch within OT that focuses on helping both neurodiverse and neurotypical children who are facing a variety of challenges or delays in their physical, cognitive, and developmental capacities. Pediatric OTs have the capability to treat a range of conditions including autism spectrum disorder, ADHD, sensory processing disorders, developmental delays, and more. Pediatric OTs not only provide support to the child, but also extend their assistance to the child’s family, caregivers, and any professional that is involved in the child’s support team.
The term “occupations” refers to the meaningful activities in which an individual regularly engages in, effectively occupying their time. OTs work towards enhancing a child’s engagement and their performance in daily occupations or activities. These occupations encompass a child’s role as a family member, friend, student, as well as their ability to independently carry out self-care responsibilities like dressing, feeding, toileting, sleeping, bathing as well as playing.
To achieve this, OTs begin by identifying the child’s areas of strengths and where they are experiencing delays or limitations. These could encompass fine motor skills, sensory-motor skills, visual motor skills (eye-hand coordination, visually tracking a moving object, scanning the environment) cognitive skills (problem solving & attention), play skills, social competencies, self regulation, and self-care routines. After determining these specific areas, an individualized set of goals and treatment plan are developed for each child and their family. These plans are rooted in evidence-based approaches, drawing from both practical experience and research, as well as child-centered, placing a strong emphasis on the child’s unique interests and needs.
Pediatric OTs utilize a range of tools and strategies tailored to address each child’s strengths and challenges. OT can often look and feel like playing, employing play based therapy sessions centered around motivating activities such as building obstacle courses, playing board games, and crafting artworks. These play-based approaches serve the dual purpose of facilitating learning and development while simultaneously having fun or while building their frustration tolerance for challenging or non-preferred tasks. By nurturing their physical, cognitive, and sensory abilities, children are empowered to partake in their daily activities with greater ease and independence, thereby improving their quality of life and their mindset (Growth versus Fixed).
Below is a list of some of the many skills needed in order for a child to engage in and perform their occupations of daily living:
Although OT is not a diagnosing profession, OT can help identify issues that may have been overlooked or misunderstood through understanding the sensory difficulties and work on the underlying challenges to improve daily functioning. Outside the scope of occupational therapy, OT professionals can also support and guide you. Sometimes this means it is best to see a neuropsychologist, individual psychologist or family therapist either for more information about how your child’s brain works or about how to handle challenging behaviors.
OT is fun and most children will enjoy participating in sessions as it is play-based, despite the hard work they are putting in! The overall goal is to impact the development of the brain-body connection and retrain the brain to respond to sensory messages and produce meaningful responses. Therapy also involves parent/caregiver education to generalize the outcomes of therapy across environments, home, school, and community.
The child is an active versus passive participant in therapeutic play. The therapist will help to activate the neural pathways and provide organization within the central nervous system to produce more regulated responses by freeing up the higher cortical levels which are currently being used to process sensory information.
Sensory based OT is also based on the successful ability to tap into a child’s (Neural) Plasticity, or the capacity of the brain to exhibit persistent structural and functional change which can take different forms, including the formation and elimination of synaptic connections resulting in the reorganization of brain networks and connections (Adapted from Zatorre et al., 2012).
The therapist will provide a variety of therapy techniques and these will be
individualized to your child’s specific sensory or developmental needs, the context in which they need to function, and the dynamics of their social environment working in a sensory gym setting for intensive treatment. Some of the intense and direct intervention techniques implemented in a sensory gym often include:
Self Regulation for building the child’s awareness of their arousal levels and improving their adaptive responses, changing maladaptive responses and appropriately respond to the sensory demands on the Central Nervous System (CNS), to adjust to unexpected sensory input and improve internal modulation, implementation of the Zones of Regulation (ZOR) program (Leah Kuypers, OT) to promote self-regulation using color coding to match emotions or “zones”
Social Participation using core concepts from Social Thinking (Michelle Garcia Winner, SLP) and teaching Growth Mindset (Carol Dweck, Psychologist) tools for improving social interactions and persistence with challenging tasks or that require cognitive flexibility and problem-solving skills.
Vestibular-Proprioceptive input such as deep pressure to muscles and joints combined with movement that involves changes of head position against gravity, such as hanging on a trapeze bar, jumping on a trampoline, rolling or sliding down an incline, climbing inclines, balancing activities, using drop ropes, suspended ladder, or rockwall structures, swinging in a hammock, and inversion positions such as down-dog or hanging upside down.
Deep Pressure/Heavy Work such as pulling a resistive rope, carrying heavy objects, weighted ball play (rolling, throwing, carrying, or therapeutic exercises), or using a weighted blanket.
Therapressure for tactile integration such as utilizing massage tools, brushes, textured rollers, or digging in sand or theraputty for hidden items/“treasures”.
Interoception or our interoceptive sense is the awareness of internal bodily sensations, encompassing organs like the heart, lungs, stomach, muscles, as well as skin and even the eyes. It enables us to recognize how our body feels such as if we are hungry, sweating or breathing rapidly, which the brain then uses as clues to interpret emotions such as feeling tired, excited, or nervous.
Oral Sensory Motor to improve registration of food around the mouth and reduce overstuffing or for desensitization.
Ocular Motor/Visual Skills refers to the ability to track moving objects or people in space with smooth eye pursuit movements such as localizing a bouncing ball, scanning a person’s environment visually to successfully navigate obstacles in the environment, shift eyes from near to far distances for tasks such as copying from a board or between two objects (saccades), and process visual sensory information such as tolerating objects approaching one’s face.
Fine Motor Skills refers to the precise coordination and control of small muscle groups, typically involving the hands and fingers. These skills are essential for performing intricate tasks that require dexterity, accuracy, precision, and encompasses a range of activities such as grasping objects, manipulating tools, writing, cutting with scissors, buttoning clothes, tying shoelaces, and completing puzzles.
Postural Core Activation such as using acceleration, rapid changes of speed and direction on a swing, flexion discs (ex. child hangs onto a tear drop shaped swing or a tire swing) or is provided intense proprioceptive-vestibular stimulation prior to performing seated tasks to facilitate optimal levels of arousal and attention to task.
Bilateral Motor Coordination refers to the ability to use both sides of the body together in a coordinated and synchronized manner to perform tasks that require complex movements, which involves the smooth integration of symmetrical or asymmetrical movements between the right and left sides of the body, allowing for efficient and controlled actions such as crawling, walking, writing, using scissors, tying shoes, and playing musical instruments.
Motor Planning involves understanding when and how to move one’s body and/or objects, carry out the intended non-habitual motor action (execution), evaluate the task’s outcome (feedback), and identify areas for improvement and making necessary adjustments (adaptation). Children may appear clumsy or awkward when navigating their environment or attempting to enter and exit large equipment such as climbing into a swing.
Praxis involves not just the sensory system itself, but rather higher-level functions that rely on the integration of multiple sensory systems. When someone experiences praxis difficulties, it may indicate problems generating an idea (ideation), initiating tasks, completing multi-step tasks, avoiding novel tasks and tending toward choosing the same activities over and over, or displaying a limited variety of play schemas.
Executive Functioning refers to a set of cognitive skills involved in self-regulation, decision-making, attention, working memory, flexibility, emotional control, perspective taking, planning, and organization. It acts as the CEO of the brain, controlling various abilities needed to plan, execute, and complete tasks. Children with executive function difficulties may struggle with problem-solving tasks, easily give up, become frustrated, take a very long time to get dressed, have trouble performing multi-step tasks such as simple chores, struggle with transitions, or engage in off-task behavior. Organizing materials and following routines for homework or long-term rewards can be challenging for them
Environmental Supports & Modifications such as seat cushions, wobble stools, slant boards, and seating recommendations that promote optimal angles of 90 degrees at the hips, knees, and ankles.
Listening Supports or Programs such as sound reducing headphones or therapeutic listening home programs.
Home Exercise Programs (HEP) or Therex includes suggestions for home and school carry-over and may include hand, upper body, and or core therapeutic HEP, recommendations for sensory strategies and tools such as noise reduction headphones, hand fidgets, mouth tools, weighted tools, calming strategies, tools for improving handwriting skills, and strategies for self-care independence.
A sensory gym is a purposefully designed space outfitted with a variety of sensory-based equipment and activities that offer both sensory play and therapeutic benefits. A sensory gym resembles an imaginative indoor playground for children fostering their independence, sensory-motor abilities, and develops their social competencies as they interact and communicate with others in the space. Play holds paramount importance for the holistic development of every child, and within the sensory gym, it nurtures their creativity, and enables them to forge their own adventures as they explore their environment. In turn, this can also be a powerful tool in building their perseverance and confidence.
The equipment in a sensory gym can include diverse suspended swings,
climbing structures like rock walls or rope ladders, incline hills, tunnels, trapeze pits, monkey bars, obstacle courses, jumping crash pads, and interactive elements that stimulate sensory systems such as touch, vestibular or movement and balance, as well as proprioception or one’s body awareness in space. In addition it provides options for down-regulation such as cozy corners, forts, weighted blankets, and bean bag chairs. The goal of a sensory gym is to assist children in regulating their sensory responses, enhance sensory integration, and foster overall sensory well-being.