What is occupational therapy? How does a therapist help different age groups?

A person’s occupations are the meaningful things that he or she does each and every day. This includes the things we have to do, the things we want to do, and the things we love to do. For adults, occupation can be easily summarized as work, leisure (sports, hobbies, dining out), and other responsibilities to self and others (self-care skills, child rearing, housework, shopping, etc.). A child’s occupation is centered on play.  As a child gets older, he or she is expected to go to school and begin to bring all the fine motor, gross motor, social, self-regulation, and problem solving skills together to become a student. A person’s occupation changes constantly throughout their lifespan.

A pediatric occupational therapist will assess a child’s development and functional skills in order to identify any underlying deficits, delays, or challenges that may be causing difficulties in his or her life. At the same time, a therapist will take into account what is meaningful, relevant and purposeful for each child. The therapist then works with the child to rehabilitate old skills or to teach and facilitate new skills. The therapist may need to adapt the task, the environment, or provide adaptive techniques for the child. Therapy is play-based, with an emphasis on fun, challenging activities to build confidence and independence, and to support age-level skills across all areas of a child’s occupation.

Infant/baby: birth-1 year

An infant’s occupation centers on learning how to feed, ensuring proper nutrition to grow a strong mind and body.  An infant/baby is also learning how to regulate or calm herself.  She learns that her caregiver will come and soothe her when she cries.  She begins to recognize her own basic needs: hungry, wet, tired, or overwhelmed; at the same time beginning to build the social bonds necessary to share those basic needs with her caregivers.  She responds to the coos of her mother, or the playful bounces from her father, and the barely-containable excitement from siblings, friends, and family members. An infant must process all of the sights, sounds, smells, movements, and tastes that are so different from life in the womb.  Physically, a baby works to gain strength and control over gravity, reaching, pushing up, sitting, creeping, crawling, cruising, and finally walking.

A child born prematurely, who experienced a difficult birth, or with an identified disability may have an extra hard time learning his important new job outside the womb.

Is she too weak to suckle? Why won’t he sleep?  He looks scared all the time. He startles to every noise. He’s not reaching, sitting, or crawling.  I know something is wrong. What do I do?

When a piece of this newly-born puzzle does not fit perfectly, an occupational therapist can help parents to understand their child’s needs.

Toddler: 1-3 years

A child’s occupation is play. A toddler is learning independence. His occupations include figuring out how things work, experimenting with cause and effect, learning boundaries and social rules, developing a sense of self, learning safety awareness, playing with toys and people, and problem solving challenges by himself.  A toddler is beginning to assist his caregivers with self-help skills such as dressing, feeding himself, toileting, and doing simple chores around the house.  He learns about his position in space, the boundaries of his body, and the effect he has on everything around him.  His mobility increases from crawling to walking to running, jumping, and climbing. A toddler is also learning how to get what he wants but doesn’t quite have the reasoning, language skills, or wisdom to understand why it can’t be his way all the time.

For some young children the world becomes a confusing, scary place. They can’t figure out how to play with toys or connect with other children.  For children with language or processing delays, communication becomes frustrating and their resulting behavior can be challenging.  Family dynamics are often affected as caregivers struggle to deal with their child.  Whether a child is experiencing motor delays, difficulties with regulation or behavior, feeding challenges, and/or difficulties with self-help tasks, a skilled occupational therapist can work with the child and his family to interpret his challenges and work on a plan to support his developing needs.

Preschool-aged child: 3-5 years

The preschooler continues to develop all of the skills like a toddler, but has become much more skilled in his movements and communication abilities.  He can wait for longer periods of time, can understand rules and expectations, and can assume bigger responsibilities with less supervision.  The preschooler’s fine motor skills and visual motor coordination have improved and he or she begins to have an interest in painting, coloring, drawing, and completing simple art projects.  Play is much more constructive and cooperative in nature.  A preschooler can dress and eat with little assistance from caregivers. He or she should be finishing up with potty training at this point.  Oftentimes a child this age spends time in daycare or in a preschool setting where he or she can practice and hone social interactions, fine motor skills, attentional skills, self-regulation abilities, and self-help skills in preparation for entering kindergarten.  Delays in fine motor skills (coloring, holding a utensil, feeding self, managing clothing fasteners) or difficulties with strength, endurance, or coordination can impact a child’s ability to perform age-level skills. This may result in low self-confidence, oppositional behaviors, or fear relating to entering school.  An occupational therapist can tease out the specific underlying reasons why a preschooler is struggling and can create play-based therapeutic activities to bolster their skills and confidence to enter school on par with their peers.

Grade Schooler: 5-12 years

As a child gets older, his occupations become more complex.  In addition to academic demands, he may participate in extracurricular activities such as sports, music lessons, or other hobbies, as well as taking on more responsibilities around the house.  Writing demands skyrocket and school becomes less about play and more about work.  A child this age begins to be more critical of himself and aware of his peers and how their performance compares to his.  Oftentimes parents hope that their child will “mature” or “grow out of” an undesired behavior by the time they are school-aged.  Sometimes a child does finally grow into her body and develop the ability to focus that was so tricky as a younger child. A slower child may finally catch up or surpass his peers.
When a child continues to struggle with self-care skills, fine or gross motor skills, self-regulation, attention, or social skills his or her performance in school and home occupations will be extra difficult.  This child not only recognizes that he is different or “not as good” as his friends, but he likely also feels pressure from parents and teachers to perform up to expectations that he increasingly cannot meet.  This is a recipe for poor self-image, behavior problems, difficult family dynamics, and poor academic performance. An OT can help.

Teenager: 13-19 + years

The teenager is preparing for a life independent from his parents or caregivers. A teenager faces many pressures and has numerous responsibilities to deal with, armed with a mixed-up set of hormones and a still-developing brain as tools.  Of course, many teenagers sail through this period of life fairly easily and transition into adulthood without too many battle wounds.  Teenagers with cognitive, social, or physical delays, or those with affective disabilities often end up in a no-man’s land. All of a sudden they are expected to take care of their own self-care needs, even though these tasks may have been done for them up until this point.  These children may be confused by their changing bodies or unable to self-regulate as hormonal fluctuations affect their moods and energy levels.  The development of sexual feelings may be very difficult to understand and some teenagers may need assistance to deal with these questions or urges in a socially appropriate way.  A teenager struggling with appropriate social skills may become isolated from peers and family member and may develop anxiety or depression.
Teenagers are honing skills that will help them in college or in the work force. They are likely deepening close friendships, developing crushes on others, and becoming interested in having a boyfriend or girlfriend.   During this phase of life, an occupational therapist can help the teenager to develop study routines or personal routines, to become more independent with self-care skills, to improve social skills, and to manage sensory processing needs to improve regulation.  Teenagers with disabilities may regress a bit during this time as they are dealing with increased pressure and life changes.  An OT can help to steer them back on course.

The Parent

A parent’s occupation is unbelievable.  It starts as soon as a mother realizes she is pregnant and it never, ever ends.  A parent’s occupation is so complex that it is almost too daunting a task to undertake. A parent can be biological, adopted, foster, or otherwise attached to a child. This being said, humans have been reproducing and raising children forever, and, most of the time, do a pretty good job.  I will list out the occupations that I feel are most critical to both child and parent, and the responsibility that a parent has to their child.

  • Creating and maintaining a safe and nurturing environment for your child. This means both before and after your child is born, and for as long as he or she is living with you.
  • Understanding that your child is doing his best. Praise and teach your child the right way to behave. Harder initially, but the payoff is sweet. Respect your child and expect respect in return.
  • Providing boundaries and appropriate limits for your child.  A child may become controlling or inflexible if decisions are left to him before he is developmentally ready.
  • Understanding personality and temperament differences between you and your child.  Some children are very difficult to parent. An easy-going parent may have trouble with a high-strung child. An outgoing parent may have trouble with a shy, introverted child.  Both parties can learn to meet somewhere in the middle.
  • Communicating effectively. Use appropriate language, explanations, and communication strategies, especially if your child experiences difficulty in this area.
  • Being strong. For your child. For yourself. For the rest of your family.