Occupational Therapy uses a family centered approach to enable children to engage in the activities they want and need to do. This is done using play as a means to assist in the treatment of motor, sensory, cognitive, social and emotional needs of the child.
The visual system is much more important than having the ability to see, having perfect 20/20 or sharp vision. It is also understanding what you see and making appropriate decisions or actions accordingly.
Visual processing refers to that ability to make sense of information taken in through vision. It involves cognitive processing or interpreting visual information in order to make sense of the world around us.
What does it mean to have a visual processing disorder?
A person with visual processing problems may have difficulties with:-
- Difficulty discriminating the foreground from background (visual figure-ground discrimination).
- Difficulty with recognising objects or symbols (visual discrimination).
- Difficulty telling the order of symbols, words or images (visual sequencing).
- Difficulty with body coordination stemming from vision (visual motor processing issues).
- Difficulty with recalling what they have seen (visual memory).
- Difficulty with telling where objects are in relation to each other (visual spatial issues).
- Difficulty identifying an object when only parts of the object is visible (visual closure issues).
As you can see, the visual system is responsible for letter, number and shape recognition, spatial relationships, coordination, reading skills, focus and attention to detail – all activities and skills which are required for a child to improve developmentally. Accordingly, it is important for any visual processing difficulties to be identified and addressed.
Visual tests may not necessarily identify a person has visual processing difficulties as the object of a visual test is to test vision, rather thanperson’s ability to process or interpret information taken in through vision.
Signs of visual processing difficulties can include:-
- Avoids eye contact
- Rubs their eyes
- Bumps into objects
- Sensitive to light
- Easily distracted by stimuli in the room
- Difficulty focusing on a singular task
- Difficulty writing at the same size and spacing
- Difficulty with tasks involving copying
- Difficulty with puzzles
- Difficulty differentiating similar letters or figures (e.g b and d or p and q)
- Difficulty locating items amongst other things (eg locating a sock within a laundry basket).
- Reverses or substitutes letters when reading and writing
- Skips words when reading or reads a sentence more than once
- Difficulty controlling eye movement to track and follow moving objects
It is important to note that if you or your child displays these symptoms that it does not necessarily mean you have a visual processing difficulty, however you may have signs of such a difficulty and should consult a healthcare professional.
Activities to develop visual skills
Visual processing disorder is not a recognised learning disability but can affect a child’s ability to engage in the learning environment.
A child that is highly distracted by visual stimuli would be assisted by removing distractions from the room to help them to retain focus. To ensure they are listening and focused, you should maintain eye contact when communicating with them (for children not diagnosed with Autism).
A child that is visually under responsive may barely notice details and objects around him unless brought to his attention. This child would benefit from visual stimulation like bright colours and posters in order to hold his attention or visual sequences and directions to keep on task.
Some activities you can do to develop visual skills include:-
- Practice reading
- Practice writing
- Memory games using cards or objects
- “I Spy”
- Colour by number
- Connect the dots
- Word searches
- Visual scavenger hunts like “Where’s Wally?”
If you feel your child may have visual processing problems, we recommend that you visit your GP to determine whether any problems stem from visual acuity, or from visual processing, in the first instance. What may be perceived as a visual processing problem may be an issue with vision which can be remedied with glasses.
If your child has decreased visual perception, an Occupational Therapist can undertake an evaluation to investigate the extent to which your child’s visual processing problems are impacting on their day-to-day life. Following an evaluation, the Occupational therapist can create goals and set up a treatment plan which will involve various activities aimed to enhance visual perception.
To TOUCH or not to TOUCH…
Does your child over-react to being touched or cuddled? Do they avoid certain clothing textures or tags? Do they avoid handling certain objects like slime (ewwww)? Perhaps your child constantly seeks to touch certain textures or is drawn to messy activities.
Touch processing skills are also referred to as tactile processing skills. Everyone has touch receptors (tactile receptors) located under the surface of the skin. These touch receptors send messages to the brain, giving the brain information about the nature of the environment that a person is engaging with. Is the environment or object inviting, or is it threatening? The brain’s perception of this information differs from child to child, and this is the reason for varied responses and behavioural presentations.
Some children experience too much or too little stimulation through their touch receptors. In order to balance their sensory system and bring themselves back to a comfortable state, children often adopt certain behaviours. These behaviours can be referred to as ‘sensory seeking’ or ‘sensory avoiding’.
Picture a kindergarten room with a group of children doing a painting exercise. Some children will be totally immersed in the activity, painting not only the paper, but their hands and perhaps face as well (or the face of the child next to them!). Whilst other children are very careful not to get any paint on them at all, perhaps avoiding the activity altogether.
Children who actively seek more stimulation through their touch receptors engage in behaviours that are ‘sensory seeking’. There appears to be a constant need to touch or stroke preferred textures. Should the child not have opportunity to bombard their touch receptors, they may become irritable or have difficulty sitting still. Without such knowledge of the sensory system, many people label these children as being naughty or lacking self-control. Parents of such children may say, “My child is always messy?” or “My child always has food all over their face”.
On the other hand, some children actively limit stimulation through their touch receptors, as this sensation is perceived as painful or uncomfortable. In this case, the sensory system is hypersensitive. There are intervention strategies that can help to desensitise the touch receptors and it may be beneficial to also explore the options of ‘pressure touch’ which has been noted to calm the nervous system. For these children, the thought of engaging in certain activities can be very anxiety provoking, which leads to ‘sensory avoiding’ behaviours such as avoiding being touched by others, having their hair washed or brushed and only wearing certain clothing textures.
Whether your child exhibits ‘sensory seeking’ or ‘sensory avoiding’ behaviours, there is often a flow-on effect to other areas of development. From a social perspective, children who constantly seek out sensory stimulation may become distracted by their need to engage with certain textures, which can affect relationships with their peers. Alternatively, children who avoid certain environments are often limiting their learning opportunities as they become overwhelmed by the incidental touching of others in the school environment, for example having to hold hands to walk into class or little Johnny leaning on he/she during mat time.
It is important to note that touch sensation releases serotonin…yep…that’s the feel good chemical. So if you have a child that is anxious or stressed, you can use touch to calm them. A long bear hug works just as well as a nice back rub before bed.
Should you have any concerns about how your child in interacting with their environment, it is important to seek professional advice. An OT can undertake an assessment of your child’s touch processing skills, and provide intervention strategies to help maximise your child’s learning and life experiences.
What is Auditory Processing?
Does your child find it hard to follow conversations, have difficulty understanding instructions in the classroom, or become easily overwhelmed in busy environments? If so, they may need an assessment of their auditory processing skills.
Auditory processing is the ability to interpret information that is heard. Sound travels through the air, the ear receives the sound, then sends this information to the brain to be interpreted and acted upon.
In some instances, sound can be interpreted as being louder than it actually is and so certain environments can be very distressing. In some instances, background noise can be so distracting, that no clear information can be understood at all.
An updated hearing test is recommended to rule out problems with receiving sound. In most instances, hearing is within the ‘normal range’. Some professionals then recommend a formal test for Auditory Processing Disorder.
What is an Auditory Processing Disorder (APD)?
Auditory processing disorder (APD), also called central auditory processing disorder (CAPD) is a disorder affecting the ability to understand spoken language. With APD, the way the brain interprets and recognises sounds is distorted. Spoken language can be so confusing that certain environments are often avoided or the child may seem to ‘switch off’.
There may be a problems with the speed in which your child processes sound, or problems with how they process sounds from multiple directions which often manifest as difficulties in relation to attention.
Imagine sitting with a group of friends, trying to follow the conversation when all you hear is “bla-bla-bla”. For some children with moderate to severe difficulties,
this may be their reality. Other children may struggle to a lesser degree. Whilst there is not a magic cure, these difficulties can be managed and auditory processing skills can be improved with the help from professionals.
An OT can help you to better understand your child’s auditory processing abilities and how this may be impacting on his/her performance in daily routines.
The auditory system influences so many other areas of functioning. Often the behavioural symptoms are the main focus and the auditory system gets overlooked. Some children are labelled as ‘lazy’ or ‘defiant’ when in fact the underlying issue is an Auditory Processing Disorder.
There are a number of signs to look out for in your child:
- Poor focus in the classroom.
- High levels of distractibility.
- Difficulties following instructions.
- Poor reading comprehension and/or spelling.
- Poor organisation.
- Difficulty following conversations.
- Poor short-term auditory memory.
- Frequent requests for repetition.
- Poor group participation.
It can be hard to determine what is going on for your child at any given moment. So many factors can contribute to apparent ‘poor listening’. If you have concerns over your child’s development in any of the above areas, please seek professional advice to identify where your child’s auditory processing abilities lie and what can be done to improve overall daily performance.
What is Proprioceptive Sensory Disorder?
Ever wondered how your body just knows where your limbs are? How your body can coordinate itself without you seemingly having to think about it?
That is called proprioception. It’s the body’s ability to be able to subconsciously sense where your limbs are at any given time so it can react and move them accordingly when required. Proprioception means “sense of self” and the proprioceptors are the sensors that provide the brain information about joint angle, muscle tension and muscle length so it knows the exact position of the limbs “in space” at any given time.
Proprioception and kinesthesia are the sensory feedback mechanisms in the body responsible for motor control and posture. Along with the vestibular system, which controls balance and stability, your brain receives a multitude of information to help it function, controlling all motor reactions in the body. It is this continual flow of information that allows the body to make unconscious adjustments to the muscles and joints and make immediate corrections to achieve movement, posture and balance.
A simple explanation of proprioception is this: Take your finger and move it up and down. Your brain starts off by telling your finger to move. But in order to move in the right direction, your proprioceptors first inform your brain on where your finger is. Your brain then sends instructions to move your muscles accordingly. Hence, because of proprioceptors, you can move your finger and down without even looking at it because your brain knows where your finger is and what it’s doing. The senses have sent the message to your brain telling it at what angle your finger is and what length the muscles are. A person with a proprioceptive sensory disorder may not be able do this simple task without the intervention of another sensory process. For example, they would need to look at their finger for their brain to see which angle their finger would be at and where it would be in relation to the body as their proprioceptors would be unable to send this information to the brain.
HERE ARE SOME POTENTIAL SIGNS OF PROPRIOCEPTIVE DYSFUNCTION:
- SENSORY SEEKING BEHAVIORS:
- seeks out jumping, bumping, and crashing acti
- stomps feet when walking
- kicks his/her feet on floor or chair while sitting at desk/table
- bites or sucks on fingers and/or frequently cracks his/her knuckles
- loves to be tightly wrapped in many or weighted blankets, especially at bedtime
- prefers clothes (and belts, hoods, shoelaces) to be as tight as possible
- loves/seeks out “squishing” activities
- enjoys bear hugs
- excessive banging on/with toys and objects
- appears to be
uncoordinated or seem clumsy (i.e., bumping into objects/people)
- laying on the floor during ‘mat time’ at school
- DIFFICULTY WITH “GRADING OF MOVEMENT”
- misjudges how much to flex and extend muscles during tasks/activities (i.e., putting arms into sleeves or climbing)
- difficulty regulating pressure when writing/drawing; may be too light to see or so hard the tip of writing utensil breaks
- written work could be messy – they may even accidentally rip paper when erasing
- frequently appears to be breaking objects and toys
- misjudges the weight of an object, such as a glass of juice, picking it up with too much force sending it flying or spilling, or with too little force and complaining about objects being too heavy
- may not understand the idea of “heavy” or “light”; would not be able to hold two objects and tell you which weighs more
- seems to do everything with too much force; i.e., walking, slamming doors, pressing things too hard, slamming objects down
- plays with animals with too much force, often hurting them
It can be hard to distinguish between your child being an active child or suffering from a sensory processing disorder. Only a trained medical professional will be able to make this diagnoses for you. If you have concerns over your child’s development or your child displays several of the points listed above, it would be best to seek professional advice.
Have you ever sat back and wondered what anger really looks like? Is it yelling, cursing, screaming or crying? Or is it more than that and we just can’t see the whole picture of what lies beneath the surface.
Have you seen the movie Titanic? If so, you will remember watching as the ship crashed into an iceberg hidden in the cold ocean. The fact is, the Titanic ran it’s bow over the submerged ice causing the ill fated damage. It’s considered only around 10% of an iceberg is actually visible, with 90% submerged under water. With the majority of the iceberg hidden, no one realised how much damage it could do until it was too late.
Anger is like an iceberg. We only ever see the tip and underestimate what is lying below. Underneath the surface is a myriad of emotions that rise up, resulting in the outburst of anger that we see. Think of the anger iceberg like this. The tip of the iceberg is the physical signs that we can see – the crying, the angry outburst, the yelling etc. The underneath of the iceberg is where the emotions that draw out the anger lie such as frustration, fear, embarrassment, helplessness and grief. By choosing to focus on the underlying emotions, we can better understand the cause of the anger in order to help rather than hinder. Anger always has an emotional trigger and treating the trigger will help in curing the anger.
Tips for treating anger in the moment are counting to ten (redirecting) or taking deep BELLY breaths (to stimulate the parasympathetic nervous system). These can help treat the anger in the short term, but it will not cure it as it does not address the emotional underlying cause. Helping the person find the reason for the anger will help them to identify with the problem and fix it, therefore removing the anger from their life. In the case of anger caused by sensory overload, it’s helpful to name this for the child and work through sensory strategies that can help calm them such as taking sips of water or squishing in cushions (deep calming pressure).
Phrases such as “calm down” or don’t overreact”, although they may have the best intentions, only make the person more angry as they are thinking with their primitive ‘fight or flight’ brain not the cortex which can be reasoned with. The underlying emotion that has triggered the anger is not being addressed, or worse, pushed aside. Using ‘I wonder’ questions will help your child in developing emotional intelligence. Label what you see ‘I see your face is all red and scrunched up and it looks like your angry’ or ‘You look really upset, I see your fists all tight and you’re breathing quickly, I wonder if you’re hurt because Sally wouldn’t give you her toy’.
But what if my child is angry?
Just like us adults, children feel emotions too, but their maturity level and juvenile brain development means they can not address the cause and have very limited self regulation. Children don’t know why they are angry and communicating their feelings may not be something they have developed as yet.
Communication and frustration from not being able to communicate effectively is one of the lead causes for anger in children. They can not process their feelings or communicate them well enough to be heard, leading to the anger outburst in the form of a tantrum or crying. By only focussing on the action, we are missing the 90% that is lying beneath the surface causing the real damage.
Try and look at the situation from their point of view. What is it that has made them express their anger in this way. Was a toy taken from them and they can’t find the words to ask for it back? Is their vocabulary underdeveloped so they can’t express what they need to say so anger in the form of screaming takes over? It may be that they have a fear and that fear is being expressed in the form of anger.
In the same breath, anger in adults can also manifest itself from fear or fright. Seeing your child run out onto the road will be seen as anger in the heat of the moment, when in fact the emotion is fear. The fear that your child could be hit by a car. Explain this to your children so that they understand your emotion aren’t always what they seem e.g. ‘It looked like mummy was angry but I was really scared then because you ran onto the road and you could have been hit by a car’.
So whilst we will always have angry moments in our lives, look at the emotional trigger first and by addressing that, the anger will in turn disappear, increase your child’s emotional intelligence and create a more harmonious family life.
So who is an Occupational Therapist?
You’ve probably heard the term used in hospitals, by specialists and even your friends when referring to treatment they or a family member may be receiving. But do you actually know what an Occupational Therapist (OT) does? There are a variety of fields you may see an OT in – Aged Care, WorkCover, Hospitals, Community Settings but here we’ll talk about what a Paediatric OT does.
An Occupational Therapist is a highly trained professional who, after attending university for many years, is skilled in helping clients improve their quality of life and skills in order to effectively function in both everyday and working life. They work with individuals who have conditions that are mentally, physically, developmentally, socially or emotionally disabling. Basically, an OT will put into place exercises or processes that will enable the client to develop what is currently missing in order to live life to the fullest.
Paediatric OT settings:
An OT may see a client in a clinic specifically set up to provide an experience for a child, for example a sensory gym. Additionally, an OT may see a client at home to view how the child performs their activities of daily living, how the child interacts with their family and any equipment that may allow the child to develop. If your child is in hospital they may see an OT there who could provide casting and splinting or skill building. OT’s in the school setting could be provided to give group therapy to children or be employed by the parent to see the child within the School environment. Additionally, you could find an OT with a child or adolescent accessing the community such as a shopping centre or on public transport.
Who sees an OT?
The sorts of diagnoses a child may have differ greatly. An OT will typically see children that have been diagnosed with conditions such as Autism Spectrum, Attention Deficit Disorders, Intellectual Disability, Dyslexia, Cerebral Palsy, Developmental Disorders, Down syndrome. Additionally, some children may not have been diagnosed with a condition but have difficulties with sensory processing, friendships and/or behavioural difficulties.
What does an OT work on with a child?
An OT assessed a child to see what areas of development they are not functioning at compared to their peers. Those areas could be:
- Gross Motor Development – for example motor planning, strength, endurance, core stability, posture.
- Fine Motor Development – such as handwriting, scissoring, shoe laces, feeding independently with utensils.
- Executive Functioning – Memory, planning and initiating tasks, organisation, shifting thinking.
- Social/Emotional – impulse control/self regulation, making and keeping friendships, turn taking, flexible thinking, theory of mind (knowing that other people have different ideas than you)
- Sensory Processing – feeding issues, clothing sensitivities, attention disorders, noise sensitivities.
- Activities of Daily Living – an OT will assist with adaption or skill building in areas such as dressing, feeding, transport, hygiene and grooming, toileting, mobility, managing money, safety and travelling.
- Equipment prescription – such as wheelchairs
- Home modifications – an OT may modify your bathroom or kitchen to be easily accessible
Why does it look like they’re just ‘playing‘?
Your OT is the unique position to use fun and meaningful activities (often games) that match the skills we are working on to build the motor and sensory foundations needed for children to function independently. For example, a game of Trouble is perfect for fine motor precision and turn taking; Monkey Bars work on a upper limb strength and coordination, intrinsic hand muscles and the proprioceptive and vestibular sensory systems.
Where do I start and who pays for the sessions?
Your GP or Paediatrician can refer your child to an OT. Your GP will let you know if your child may be eligible for a health care plan to be rebated under Medicare. Children can now be funded under the National Disability Insurance Scheme to see an OT that is registered, such as Sensory Spectrum OT.
Kris Kross must have know that Vestibular input is one of the most important foundations of our sensory system!!
Whilst not always mentioned with the ‘common’ sensory processing centres such as sight, touch, hearing, taste, smell, the vestibular sensory system is a vital component in a human’s development. It is responsible for helping us maintain balance and coordination, centering around the auditory system being the cochlea and labyrinth of the inner ear. It also assist us in developing and determining our processing of visual information and the other unknown sense of proprioception (where you are in space).
To put it simply, when you feel vertigo, lose your balance when you spin around and around, that is your vestibular system being affected. The fluids in the inner ear shiftwhen your head changes direction or tilts, sending messages to the other sensory organs that alignment is off. This allows the other senses to make the necessary adjustments to maintain balance.
A person who suffers vestibular sensory disorder does not send the right messages, therefore unbalancing their overall equilibrium. A sufferer can either be hypersensitive or hyposensitive. Meaning, they can be more over-responsive and more sensitive to movement or less sensitive and crave more movement due to an under-responsive system.
Key signs of hypersensitivity (over responsive):
- Clumsiness or loss of balance
- Avoid rapid or rotating movements e.g.- playground roundabouts
- Avoid going upside down or being tilted
- Fear of heights or falling as a result of uncertainty or even motion sickness
- Fearful of, or difficulty, riding a bike or jumping
- Dislikes lying on their stomach, especially as an infant
- Motion sickness travelling in elevators or stairs.
- Avoids playgrounds
- Fearful of leaving the ground
Key signs of hyposensitivity (under responsive):
- In constant motion i.e. can’t sit still
- Likes sudden movements and even craves them
- Likes to go upside down
- Runs, jumps, hops instead of walking
- Thrillseeker – loves fast rides at amusement parks
- Jumps on furniture, trampolines and anything else bouncy for longer period of time and more intensely than usual.
- Loves to swing as high as possible on swings.
- Never seems to get dizzy or lose balance or control.
Vestibular sensory disorder can be managed with the correct treatment. There are also steps you can take at home to help with your child’s development in between your OT sessions.
- If hypersensitive: Encourage your child to play on playground equipment with your support. Swing them gently on the swing to get them use to the movement without being too vigorous.
- Jumping rope.
- Riding a bike or trike
- Tyre swing or hammock
- Climbing frames
- All playground equipment
- Rolling down a grass hill