Happy Occupational Therapy Month!

April 25, 2017

Throughout this month, we will be posting about how Occupational Therapy is able to impact different areas of functioning. We celebrate OT in April, but the value and benefits of occupational therapy are life-long!

Occupational Therapy is not widely understood in pediatric populations, but it is a valuable therapy that can be life-changing for families. OT begins with an evaluation in which the therapist collects information on your history, health status, and what activities you are currently limited in. They use this information to layout a plan of care that involves specific goals and the treatment techniques they will use to achieve them.

If  you would like to see more about what BRAINS has to offer, please visit our Occupational Therapy page. If you are a professional, student, or just want to learn more about OT basics, join us on May, 17, 2017 for a breakfast and lecture on “Occupational Therapy, What is it and how it works”.

To learn more about our amazing OT Team, click the picture below.

Danielle Boog, MS, OTR/L & Jennifer Rodriquez, MS, OTR/L

Misinterpreted ADHD

ADHD and sensory processing difficulties have very many similar characteristics. It is difficult to tell the difference between the two, but it makes a difference as to what approaches are going to be effective. When trying to determine the difference, it is important to determine what (if any) sensory difficulties are present. If there are significant sensory difficulties that can be pinpointed, it will make treatment much more effective. A child with sensory difficulties will become overwhelmed and inattentive if their environment is too “distracting” with stimuli. If these stimuli are taken away, a child with sensory processing difficulties will be able to attend with increased ability. However, if the child is struggling with ADHD, it won’t matter what changes are made to the environment, they still will have difficulties.

There was a study done at the STAR Center that took a look at these two similar but different diagnoses: http://www.spdfoundation.net/files/9914/2430/1294/Miller-Nielsen-Schoen2012ADHD-SMD.pdf


Many of the children that we see have difficulty with focusing on a specific task. In order to increase their ability to focus, we use various techniques. It may involve getting up every 5-10 minutes in order to swing on the swing and then come back to the table, or perform heavy work (i.e. push-ups or sit ups) and then come back. All of us have difficulty focusing if we have to sit still for long periods of time.

Another technique would be to have the child in a different position while performing the difficult task (or the one that involves increased focus/attention). This may be through a t-stool, a wiggle seat, putting theraband around the legs of their chair, or having them stand.

Red flags/Reasons to refer:

  • Other strategies have been trialed, without success
  • Medications have been tried, but have not been effective
  • They can attend well for a short amount of time, but struggle if the time is increased

When looking at focus, an occupational therapist is going to also look at core strength skills as well as whole body awareness. The visual system is also assessed, as if visual information is too stimulating or not stimulating enough, this will also affect focus. An evaluation focuses on trying to get to the root of the difficulties and treat that difficulty.

Zones of Regulation

The widely used curriculum, the Zones of Regulation, was developed by an Occupational Therapist to combine social thinking concepts with the challenges of self-management of emotional and sensory regulation. Our OT team at BRAINS use the Zones with many of our clients, as these are critical factors influencing the successful navigation of their daily interactions with their environments and others.

Although many of our behavioral health team are familiar with and use the Zones, Occupational Therapy sessions can be especially geared toward the development of physical strategies and activities to be used as “tools”. Occupational Therapists are skilled in assessment and analysis of sensory processing patterns and preferences, and are experts at developing individualized sensory diets. To complement the social/behavioral components of the program, physical exploration of how the brain and body are connected, training in calming strategies, education on various equipment, and implementation of calming vs. alerting activities can be built in to goals and objectives for any client receiving Occupational Therapy services.

Red flags for self-regulation difficulties:

  • Meltdowns in overstimulating environments
  • Relies on others to calm down
  • Reactions to situations do not reflect the size of the problem
  • Takes longer than 10-15 minutes to calm
  • Does not recognize their own body control and how it impacts others

Occupation Therapy and Play

When observing an occupational therapy session, it may seem like we are just “playing” with a child for the hour. In essence, we are playing. As a child, their primary “occupation” is to play, so we need to make sure that they are able to engage in this task effectively. But we aren’t just playing. As we engage in a task with a child, we “twist” the activity to target the specific muscle groups or skills that are in their goals. These may include following one step directions, engaging with the therapist or a peer, or increased muscle strength/coordination. When using the various pieces of gym equipment, we are aware of how these activities will affect a child’s body and either help to calm or stimulate them, depending on what the child needs.

Red flags for play:

  • Avoids engaging with peers, prefers to engage with older or younger children
  • Wants to always be “in control” of play environments
  • Is still engaged in parallel play when their peers have moved on to engaging with each other
  • Does not want to follow the “rules” of a game or is always changing the rules

Obstacle Courses

Completing an obstacle course is not as easy as you might think! This type of task not only involves core strength and coordination, but also being able to time movements and patience to wait for the most opportune time to complete a desired action. This type of task is also beneficial to sequence a series of steps together to complete a whole activity, such as the steps needed to complete a morning dressing routine. When using moving objects, the child’s vestibular system also needs to be working properly.

Ways an obstacle course can be therapeutic:

  • Build strength/coordination
  • Sequencing specific steps over and over to gain mastery and transfer to daily life tasks
  • Turn taking/waiting when performing with a peer
  • Working as part of a team to build the course and stringing the different pieces together
  • Finding the “just right” challenge and helping the child find their medium level of difficulty
  • Increase their ability to process incoming sensory information correctly

Activities of Daily Living

Often labeled ADLs, activities of daily living include many of the everyday tasks an individual needs to complete to successfully get through the day. For children, basic self-care is a major area of ADLs that can be addressed in Occupational Therapy. Difficulties with self-care/ADLs can impact a child’s self-esteem, their health, and their independence at home, school, and in the community.

Examples of childhood ADLs:

  • Bathing or showering
  • Washing hands
  • Brushing teeth
  • Toileting
  • Dressing- managing fasteners, tying shoes
  • Feeding and eating
  • Brushing hair

As children become older, advanced ADLs become increasingly important. These activities may include more complex hygiene routines, home management skills (chores, meal preparation), community participation (errands, shopping, banking, and transportation), and care of others (babysitting, taking care of a pet). Successful participation and growing mastery of these skills leads to greater independence transitioning to adulthood.

If a child or adolescent is struggling with participation in any of these areas or relying on parents/caregivers for all of their ADLs, they would be an excellent candidate for Occupational Therapy services. Occupational Therapists will assist the client and family in developing attainable goals for increased independence using task analysis, environment modifications, adaptive equipment, and creative recommendations.

Fine Motor Skills

Fine motor skills are utilized in many activities throughout a child’s day. When a child is picking up a small cracker, grasping a crayon, holding a toy, using a toothbrush, zipping a jacket, stringing a bead, squeezing glue, turning the page of a book, or using scissors he or she is using a set of complex skills.

Fine motor skills require the use of small muscles in the hand, but successful use and precision also relies on strength and stability through the entire arm and shoulder, as well as stable positioning through the core. For a child struggling with strength and coordination, fine motor tasks may be “boring” or avoided. What this may translate to, is fine motor activities are HARD. For any child, fine motor tasks are meaningful work that require practice for increased strength and endurance. A child may not love to color or sit at a table and string beads, but this may be a red flag for underlying strength and motor deficits that make participation difficult.



With growing emphasis on technology and computer skills, many children are spending less time physically manipulating their world and using fine motor manipulatives. This can directly lead to an underdevelopment of small hand muscles, which may later look like poor handwriting, difficulty using utensils, struggles with managing clothing fasteners, and opening/closing containers.

Red flags for fine motor struggles:

  • Avoids tasks like coloring, opening containers, managing fasteners
  • Has difficulty sustaining seated position at a table
  • Persists in grasping a writing utensil with whole fist
  • Difficulty using toys or manipulating small objects
  • Poor handwriting

Occupational Therapists are skilled in evaluating fine motor skill development, as well as assessing additional factors that may impact performance (strength, coordination, visual perceptual skills, sensorimotor development, etc). If a child is struggling with fine motor skills early, it is important that these skills be facilitated to increase the child’s confidence and independence in meaningful activities.

*Potential, LLC. (2016). What is Occupational Therapy? Retrieved April 03, 2017, from https://otpotential.com/what-is-ot