Occupational Therapy aims to helps people, both children and adults, learn how to effectively and appropriately live, act, and respond to their life, responsibilities, and others around them. Now, while most people don’t need help with these things, it is more common than you would think for someone to need Occupational Therapy.
The best way to figure out if your child needs to go see an Occupational Therapist or not is to look at a few identifying factors and compare them with your child’s daily behaviour.
1. Developmental Delay
Once you have a child, you will be asked to bring your child to the doctor, especially in the first few years. These checkups are crucial, especially to those first-time parents or parents who are not sure what typical development is supposed to look like.
Upon arrival to the doctor, you will be able to fill out forms or answer a list of questions about your child’s development that will help your doctor to assess whether your child is developing at the correct speed or not. A few things the doctor looks for in the first few years are:
- Your child’s responses to facial expressions and voices
- Your child’s ability to control body movement
- The desire to move and do new things such as holding their head up or rolling over
- Ability to grasp objects or reach out for things
- Vocal sounds or babbling
- Typical responses to eating, bathing, clothes changes, normal stimuli, etc.
- Your child’s ability to track faces when they move.
While every child will likely meet these milestones at different exact points in their development, there are certain ages where certain things should be happening or have already happened. For example, if your child doesn’t respond to facial expressions or emotions, at the age of 1 year, this can be a cause for concern.
Once you and your doctor notice a few developmental issues, you will usually be referred to a specialist or an Occupational Therapist to further investigate whether it is a problem or not.
2. Gross Motor Skill
Developmental delays in gross motor skills can be one of the easier things for parents to recognise due to the focus on developmental milestones. Gross motor skills are some of the first skills for parents to notice like lifting up their head, rolling onto their tummies and crawling. Some additional examples of gross motor skills issues that older children might have include:
- Balance issues
- Using the stairs appropriately
- Not understanding the concept of left and right
- Fear of their feet leaving the ground
- Avoiding tasks or games that require gross motor skills
Of course, every child is going to develop at their own pace, so a developmental delay of a couple of months is not usually a huge issue, but once your child is considerably behind, it would be a good idea to ask your child’s doctor for their recommendation of how to go about getting them help.
3. Fine Motor Skills
It is a good idea to regularly screen your child for normal fine motor skills abilities. Most of the time, this just looks like watching them do their daily activities and not noticing anything out of the ordinary. However, sometimes you can see your child struggling to learn to grasp or skills that require an intense focus using their smaller hand and finger muscles.
Some examples of things to watch when looking for fine motor skills development, with respect to age-appropriate milestones, are:
- Grasping toys, eating utensils, or writing utensils
- Effectively using straws or sippy cups
- Effectively using zippers, shoelaces, or buttons
- Developing hand dominance
- Avoiding tasks that require fine motor skills
It is not caused for concern if your child is sparingly doing these things or avoiding them because they don’t want to do them, but only if your child is seriously struggling to grasp the idea of how to accomplish these tasks or constantly avoiding any activities that require fine motor skills.
Most of these skills are tasks that your child will do throughout their daily routines, so it should be pretty evident if they have an issue that they need help with.
You especially need to watch out for moments where your child becomes overly frustrated with things to the point of needing time and support to calm down after every task. If you noticed your child doing this during fine motor tasks, this may be a good indicator that they are having fine motor difficulties.
4. Education Challenges
Education and schooling can be a huge obstacle for someone who needs therapy for day-to-day skills. It can become apparent very quickly if your child needs more help than the teacher or you can give them. Unfortunately, trouble in class can often be miscategorised as things like:
- Laziness
- Intentional class disruption or behaviour issues
- Learning disabilities
- Mental health concerns
If you are having trouble distinguishing between whether your child is genuinely having trouble, or if they are simply acting out or being lazy, two subjects that can easily help you identify problems are math and writing.
Math or Writing Problems
Children who have issues that require the help of Occupational Therapists or other professionals will usually have trouble in either, or both, of these subjects.
In math, you will see:
- An issue with lining up numbers correctly
- Issues with writing legibly enough to read problems
- Number reversals
In writing, you will see:
- Handwriting issues, like writing words on the line or how they hold their pencil
- Reversal of letters
- Tires easily after attempting schoolwork
- Noticeable literacy issues
These are key signs to look for when trying to decipher if your child needs to see an Occupational Therapist and will often be grouped together with other signs instead of single issues. It is likely that you will see issues in other subjects as well, stemming from this.
5. Social Issues
Social norms are things we learn as we grow. While we learn a majority of things from our parents, we often create our own habits and reactions based upon the environment we are exposed to in certain developmental periods. The visible issue is when children don’t respond to social cues in a way that is considered developmentally appropriate. Some things to look for are:
- Issues interacting with family or with someone who has close emotional ties
- Exaggerated response or difficulty responding to new environments or routines
- Delayed language skills
- Avoiding eye contact when interacting
- Avoiding large or intimate gatherings where a conversation is expected
- Overly focused on one topic and will only have conversations about that
While every child will show signs of these, it should not be an issue unless it becomes a normal thing for them over a longer period of time, or is coupled with other issues or signs as well. You should also consider the expectation of social cues for your child’s age.
6. Play Issues
While some would say that play interaction is the same as social, other specialists choose to separate the two topics due to the closeness and different skills that play causes someone to use. When watching for play issues, you are looking for:
- Inability to understand sharing at an age-appropriate time
- Lack of desire to engage with other kids or groups
- Struggles with independent play without parent interference
- Struggles with imaginative play
- Repetitive play habits (lining up cars, only playing with two or three toys every day, etc.)
- Seemingly aimless play with a lack of purpose
Play is important for a child’s development. Play allows a child develop gross motor, fine motor, imagination, social skills etc. Catching issues with play early on can help your child meet their developmental milestones.
7. Noticeable Issues with Behaviour
As Occupational Therapists, we find that parents sometimes struggle to understand the underlying reason for their child’s behaviour. Sometimes, behaviour issues can stem from a sense of control that the child is trying to achieve. Other times, it can because the expectation of the task is too hard or even too easy for them.
If your child is having difficulty with behaviour, try some of the following strategies to see if this helps reduce the level of your child’s behaviour:
- Give them choice between two items (e.g. do you want to play with the car or truck?)
- Ask them why they don’t want to do the task
- Make the task a little bit easier for them (e.g. if they are avoiding all spelling tasks, get them to spell it aloud rather than writing it. This might indicate that they are able to spell but have trouble with handwriting).
- Notice if the behaviours occur only when there are changes to routines
8. Sensory Issues
Sensory Issues can be a large key to recognising if and when your child would need Occupational Therapy. Children with sensory difficulties can often be seen as ‘behavioural’ or ‘withdrawn’. Children with sensory issues may exhibit some of the following behaviours.
- Not liking loud and unexpected noises
- Constantly moving around and fidgeting
- Need to constantly touch everything
- Does not like wearing clothing (especially with tags), shoes or socks
- Issues with a variety of food textures, or a few large problems with two or three textures
- Prefers to be in a dark room
- Zoning out and not responding to instructions
In most cases, sensory issues can be seen as behavioural because your child’s way to respond to the sensory stimulus may not be appropriate. For example, if a child has difficulty with loud noises, they might be super sensitive to the noise in the classroom. When it becomes a loud classroom, the child might run outside to avoid the loud noise. This can be seen as a behaviour of running out of the classroom. However, the underlying reason is due to a sensory issue rather than the child avoiding the task at hand.
One of the best way to help your child figure out whether they have sensory concerns is to notice and list out the sensory aspects of the environment when they exhibit these behaviours. For example, if a child constantly runs out of the room, notice what is happening in the room at that particular time point. If they happen to do it during group time but remain in the classroom during quiet learning time, they may have sensory concerns in relation to noise.
9. Emotional Regulation
A child who has difficulty with emotional regulation may not understand their emotions and why they are feeling that way. They often need support from surrounding adults to help with calming down. This is called co-regulation.
We all have our “good days” and our “bad days”. However, your child may have difficulty with emotion regulation if:
- It takes them a long time to calm down when they are feeling upset
- They don’t talk or like talking about their emotions
- They have trouble recognising other people’s body cues
- They do not use emotive terms like happy, sad, or angry in their daily lives
10. Daily Living Skills
Every day, we have a range of tasks we do such as eating, sleeping, toileting and dressing. These are our daily living skills. For children, they initially require support from adults to do all these tasks for us. Gradually as the child grows up, they learn to become more independent in these skills.
Individuals with gross motor and fine motor challenges may find some daily living skills more challenging. For example, putting pants on require body awareness of where your legs are, ability to hold the pants and balance to put your leg through.
As we engage in these living skills everyday, it is important for a child to become more independent in these skills. Although it may be easier to do it for them in the beginning, if your child is able to do it themselves, this will save your more time and effort in the long run.
(Source: aota, Healthcare, ardorhealth, 1 Special Place, Css, Little Steps, OT edu, New Horizons)
How Can You Identify A Child In Need Of Occupational Therapy?
When children are having issues with learning or behaviour, it is important to find out the underlying reasons for these issues. Usually, there are common signs that a child needs help in the form of Occupational Therapy and those are:
- Fine and gross motor skill issues
- Visual perception issues
- Mental health concerns
- Inappropriate responses to a sensory stimulus
- Extreme difficulties focusing on tasks
- Difficulty with self-care tasks such as toileting, dressing and eating.
- Delays in meeting developmental milestones.
Just because a child has an issue with one of these does not always mean that an Occupational Therapist is needed. In most cases, the child may just need additional time or there may be some stresses in their current life. For example, if a child is dealing with sickness or there are changes in their home life. When these symptoms are recognised consistently over a long time, this can be an indicator that therapy may be needed.
It is always better to be safe than sorry, so if you have concerns or fears about a child’s development, ask questions. Catching something early can reduce the risk of a child behind on developing other things and, therefore, more capable of living a more independent and successful life. If you aren’t sure if your child is meeting their developmental milestones, ask your doctor or friends with children of the same age.
It is also important to observe your child in different environments as your child may respond different to different places and people. Consider taking your child to the park, shopping center, playgrounds etc. If your child goes to childcare or school, ask their educator if they see the behaviours you are seeing at home.
(Source: Enable My Child, CDC)
Final Thoughts
Not all children require help from an Occupational Therapist. However, it is always best to know what they do so if your child ever needs help, you know who you can go to if these concerns arises. Thankfully, regular doctor visits and feedback from educators can allow early detection of most developmental delays.
However, parents can often see things others may not. Therefore, if you do have any concerns, consult an Occupational Therapist and they can do an assessment with your child to see if there are any underlying issues.
