Occupational therapy (OT) is the therapeutic use of activities to help school-aged children with disabilities perform simple everyday tasks, or "occupations," such as dressing, eating, playing Simon Says, and writing school essays. It is provided in a variety of settings, including Early Intervention (EI) services before children even enter school. EI consists of a team of health-care professionals working to promote development in children aged 0 to 3 years. Occupational therapists use a combination of evidenced-based strategies (proven by research) and creativity to help children learn and to be as independent as possible. They also provide evaluations to determine the need for continuing services in preschool or kindergarten and are involved in the transition process. Even if your child has never had EI services, a kindergarten teacher may recommend an OT evaluation if the child has difficulty with:
OT services have differing aims, depending on the setting. School-based occupational therapy helps students develop the skills they need to perform schoolwork; occupational therapists who treat children in a clinic may address the child's global rather than strictly academic needs.
"In schools, occupational therapy is focused on function and participation," says Beverly H. Moskowitz, DOT, and president of Real OT Solutions, Inc. "Its mission includes helping children reach their educational potential, access the curriculum, and participate fully in the school environment," Dr. Moskowitz says. As a result, "occupational therapists may work with the child on handwriting, problem solving, and identifying accommodations, and collaborating with teachers or specialists to learn the needs for various settings." Examples of occupational therapy interventions in school settings can include:
School-based OT also addresses underlying sensory processing disorders that contribute to difficulties with attention, hand-eye coordination, and emotional regulation. "A student with sensory processing issues is at increased risk for academic difficulties and social isolation. The student who, for example, is distracted by the sensation of clothing tags or sock seams, who gets dizzy very easily, or who is upset by noise in the cafeteria or on the playground is not fully available for learning or playing," says Lindsey Biel, M.A., an occupational therapist and co-author of Raising a Sensory Smart Child. If parents or teachers suspect that a child has impairments in the areas of visual perception, sensory processing, and/or fine-motor skills that interfere with his abilities to perform school-related tasks, they may request an OT evaluation. Evaluations are always performed by registered occupational therapists (OTRs), but treatment may be provided by an OTR or a certified occupational therapy assistant (COTA) who is supervised by the OTR. Both OTRs and COTAs are licensed in most states and all school districts are required by law to pay for these OT services for eligible students.
Treatment in clinics addresses a child's abilities to perform her "occupations"; the focus, though, isn't necessarily on school performance but on developing the motor-visual, sensory processing, and cognitive abilities needed to perform daily living skills, such as playing a board game with a peer, riding a bicycle, and eating a variety of food textures. Typically, clinics are packed with equipment that enables children to jump, swing, spin, and leap into piles of cushions. This promotes sensory stimuli in a therapeutically controlled way to meet a child's sensory needs and to help her engage in hand-eye coordinated activities such as throwing and catching a ball. Occupational therapy costs in clinics may be covered by health insurance companies.
Children with complex medical or behavioral challenges (such as autism) may receive OT services at home. "The current trend is for occupational therapy services to be provided in the home," says Anne Zachry, Ph.D., assistant professor of occupational therapy at The University of Tennessee Health Science Center in Memphis and author of Retro Baby. "When an occupational therapist sees a child in his natural environment, there's an opportunity to observe firsthand any functional challenges that the child might face on a daily basis. Working in the home also allows parents the chance to be 'hands-on' in the therapy processes, which is empowering," Zachry says. Interventions may include educating parents on the strategies to help their kids develop skills for feeding (using a spoon, tolerating new foods), balancing play, sleeping, doing schoolwork, and creating what is called a "sensory diet." (For a list of sensory-based activities, visit sensorysmartparent.com/sensorydiet.html.) Although occupational therapy home services may be covered by private or public health insurance plans, some parents choose to pay privately for OT services.
Some occupational therapy services that take place in specialized settings include after-school "handwriting clubs," summer camps for children with visual and hearing impairments, yoga classes for children with autism, and farms that incorporates animals into therapy. Therapies in specialized settings do not typically substitute for school or clinical therapies but provide an adjunct that parents (and possibly insurance companies) choose to pay for. They enable children to develop specific skills (such as handwriting) or enjoy a special interest (such as horse riding) that makes learning fun.
Teachers and guidance counselors typically suggest that students struggling in school get an OT evaluation. But parents with concerns about their child's development and learning may also request an OT evaluation to be performed by either a school OT or a private clinician. A community hospital or family physician would also be able to refer parents to an occupational therapist. Find more information on the American Occupational Therapy Association's website (aota.org).
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