Last week, in Part 1 of “What is Occupational Therapy?”, I spoke about what OTs look at for in the age range of birth to 4 years. I will now discuss ages 5-18 years. Remember, I am looking at the overall development levels of the child. I need to know this information in order to help families and children reach the ultimate goal of OT treatment. The ultimate goal is to support a child’s ability to participate in their daily living activities.

What is Occupational Therapy Assessing?

I begin by assessing cognitive, sensory, motor, and social-emotional skills. I am going to give a brief explanation of each followed by specifics for specific age ranges.

Cognitive

How is the child developing cognitively? This includes looking at basic arousal and attention skills as well as what is labeled as executive function skills.

Sensory

How does the child respond to the sensations they receive on a daily basis? This includes how they take in sounds, sights, smells, tastes, touch, and movement to interpret and respond.

Motor

How is the child moving? What skills do they have? This includes the basics of strength, mobility, balance, and coordination. I am also looking at how they plan and execute movement as a whole.

Social-Emotional

How is the child developing their abilities to understand themselves, their emotions, and how they interact with others?

Occupational Therapy for School Age (5 to 12 Years)

Firstly, I am looking to see how developmental skills from early childhood are carrying over and how the child participates in school demands. I am now looking at motor and cognitive skills needed to participate in structured learning. Is motor planning supporting more organized play, sports involvement, and daily living? Are a child’s social-emotional skills growing so they can now manage themselves in the family and in learning environments? This is where OTs are also called in to look more closely at fine motor skills and visual skills. It is also a time where we hear more about executive function skills. This age range is where these skills become more noticeable by parents and teachers. Now I am looking to see if problem-solving, time management, organization skills, etc., are growing?

I also continue to look at participation in routines and how independent a child is becoming. Can a child manage their self-care, feeding, and toileting? Some OTs will specialize in feeding (mealtime routines, behavior, self-feeding), toileting (potty training routines, bladder/bowel control), primitive reflexes, visual development (more specific when visual problems are present), sleep, sensory processing, mental health, social skill training, and learning challenges or disabilities.

Occupational Therapy for School Age/Adolescents (13-18 Years)

OTs continue to support all areas of development. In addition, in this age range, I am looking at how to continue supporting growth. Involvement in school; academics and social participation. Are executive functioning skills supporting higher levels of independence? Have motor skills continued to grow? Some OTs will specialize in mental health, social skill training, learning challenges or disabilities, driving, and vocational/job training.

Finally, the key to what makes OTs experts in their area is their ability to take all of this information and develop a treatment plan that will improve a child’s overall participation in daily activities. Of course, these activities vary with every child and family. Hopefully the information provided here can help better explain what an OT is thinking about when working with your child. For more information, check out the American Occupational Therapy Association’s What is OT? brochure.

“What is occupational therapy?” is the most frequently asked question I hear, but I think it is the wrong question. I think the question should be, “What does a pediatric occupational therapist look at?”

To begin with, for children and youth, I am looking at the overall development levels of the child. I need to know this information in order to help families and children reach the ultimate goal of OT treatment, which is to support a child’s ability to participate in their daily living activities.

What is Occupational Therapy Assessing?

I begin by assessing cognitive, sensory, motor, and social-emotional skills. Below is a brief explanation of each, followed by specifics for specific age ranges.

Cognitive

How is the child developing cognitively? This includes looking at basic arousal and attention skills as well as what is labeled as executive function skills.

Sensory

How does the child respond to the sensations they receive on a daily basis? This includes how they take in sounds, sights, smells, tastes, touch, and movement to interpret and respond.

Motor

How is the child moving? What skills do they have? This includes the basics of strength, mobility, balance, and coordination. I am also looking at how they plan and execute movement as a whole.

Social-Emotional

How is the child developing their abilities to understand themselves, their emotions, and how do they interact with others?

Occupational Therapy for Infants/Toddlers (Birth to 2 Years)

O.K. so now we know the basics. Here is how it applies to age ranges!! Get ready! General therapist skills are in regular font and specializations are included in bold.

Firstly, I am going to look to see how an infant is growing in their most basic foundational skills. I support an infant in learning movement to support their ability to play and interact with their environment. Is the infant able to see and move towards a toy of interest? How does the infant take in their surroundings? I will support a child’s interest and involvement in sights, sounds, and touch. I use a variety of methods to engage and support an infant’s development. Yes, this includes upper body movement but really involves their entire movement ability.

The goal for therapy at this stage is to ensure that the infant is learning their skills typically measured to developmental milestones. Occupational therapy (OT) overlaps with physical therapy (PT) and speech therapy (ST) in areas of movement, play, and in feeding. OT will differ from PT and ST in that we also assess daily regulation, which includes sleep and play routines. Some OTs specialize in NICU level of care, infant feeding, and positioning and primitive reflexes. 

Occupational Therapy for Toddlers/Preschool (2-4 Years)

I am again looking at all the skills listed above for infants. The difference in this age group is that the focus increases to promote the skills needed for more involvement in daily routines including attending pre-school and play in general. Can the child play alone? Can they begin to play with others? Is the child showing more interest in their emotions? Are they now showing more interaction skills? Is the child able to perform more specific motor skills such as setting up their own play, using a cup/utensils, helping with dressing, and toileting? As they grow, is the child showing the motor skills for more complex activities such as coloring, legos, painting, puzzles, etc?

My job is to look at all these skills in the context of a daily routine. So this stage also includes treatments to support attention and ability to follow more structure and directions. Overall, I want to help a child be ready for increased learning. Some OTs will specialize in feeding (mealtime routines, behavior, self-feeding), toileting (potty training routines, bladder/bowel control), primitive reflexes, visual development (more specific when visual problems are present), sleep, and sensory processing.

The key to what makes OTs experts in their area is their ability to take all of this information and develop a treatment plan that will improve a child’s overall participation in daily activities. Of course, these activities vary with every child and family. Hopefully the information provided here can help better explain what an OT is thinking about when working with your child. Next week, look for Part 2 for information for age ranges 5-18. And, for more information, check out the American Occupational Therapy Association’s What is OT? brochure.

Parents often wonder about using baby sign and how sign impacts speech and language development. Sign language and baby sign are not the same. American Sign Language (ASL) is an official language. It follows its own vocabulary, grammar, and social rules. ASL uses hands, fingers, facial expressions, and body gestures to express wants and needs, and for socialization. Similar to Standard American English, ASL has its own culture and community.

Contrary to ASL, Baby Sign is not its own language. Instead, it consists of manual signs and gestures that originate from ASL, or modified from ASL. It is used to improve communication between infants or toddlers, and their caregivers. In Baby Sign, signs and gestures are taught in conjunction with speech and language.

Whether using ASL or Baby Sign, research strongly supports that a child’s speech and language development can benefit. In this article, I will discuss the research that supports this statement. Additionally, how caregivers might implement sign language or baby sign with their developing infant or toddler.

Will Sign Negatively Impact My Child’s Ability to Develop Spoken Language?

In short, the answer is “no.” Parents often express their concern that use of sign early on will delay the onset of spoken language. Researchers Goodwyn, Acredolo, and Brown (2000) suggest that using sign, and other augmentative and alternative communication (AAC) approaches may facilitate spoken language versus inhibiting it.

Furthermore, a research review completed by Millar and Light (2006) supports that use of sign does not prevent children from talking. Research also supports that any AAC option (e.g., speech generating device or picture exchange) can help facilitate spoken language. Per Millar and Light, the use of AAC supports both young and older children to communicate. It also serves as a functional language system.

Will Sign Benefit Children with Speech Difficulties?

Research supports that sign can be an alternative to verbal expression for children who have difficulties with oral motor control (e.g., Childhood Apraxia of Speech). For these children, sign may be easier to teach than oral language. The benefit is, sign can be physically prompted by a caregiver (e.g., hand over hand to teach signs). Just as sign can help to facilitate language, it can also help facilitate speech.

Other Benefits of Sign:

According to babysignlanguage.com, use of sign can reduce frustration, and eliminate tantrums and meltdowns. It allows the child to consistently communicate what they want or need. When communication improves, a closer bond between the child and their caregiver can develop. Relationships are built on communication, understanding, and feelings of closeness. Therefore, there is a significant social-emotional benefit of using sign. Research also shows that early exposure to sign aids children’s language acquisition. Additionally, research shows long-term cognitive benefits including:

• A 12+ IQ point advantage
• Increased expressive vocabulary
• Increased ability to form phrases and sentences
• Early literacy skills
• Positive academic outcomes (e.g., good grades in school)

We Understand the Benefit – So Now What?

To begin using sign with your infant, toddler, or child, start by introducing yourself to sign. Use resources including: books, websites, or other sources. Reach out to your child’s speech therapist, or other specialists, to obtain resources. Here are some things to keep in mind when getting started:

• Start simple. Use signs that can be incorporated into your child’s daily routine. This includes requests, activities, and objects from their environment (e.g., eat, drink mom, dad, please). Ask your speech therapist for a list of common first words if you need a place to get started.
• Don’t forget about eye contact, facial expressions, gestures, and pointing. These prelinguistic acts to communication help support the development of speech and language for your child.
• Keep things interactive. Model using signs when communicating with your child. Signs help provide context and understanding. For example, introduce signs during activities such as feeling, bathing, or reading to your child. Before you can expect your child to start using signs, you need to be consistent in your own use of signs.
• Lend a helping hand. Once you have exposed your child to sign in their environment, start helping them sign back to you. As appropriate, give them hand-over-hand supports to use signs that might be difficult for them at first.
• Be patient. If your child is not using signs correctly at first, that’s ok! If your child does not start using sign right away, that’s ok too! Remember, the goal is to improve communication, not to add more frustration.
• Set realistic expectations. You may start signing with your child at any age. But remember: many children cannot use sign until 8 months or older.

Sign positively impacts the speech and language development of your baby. So start today! Here are some more tips for starting sign with your baby.

References:

1. Baby Sign Language (2020). Benefits of baby sign language.  https://www.babysignlanguage.com/basics/benefits/.

2. Goodwyn, S., Acredolo, L., & Brown, C. (2000).  Impact of symbolic gesturing on early language development.  Journal of Nonverbal Behavior, 24, 81-103.

3. Hoeckler, J. L. (2019). Infant and toddler health – Is baby sign language worthwhile?  Mayo Clinic.org.

4. Millar, D., Schlosser, R. W., & Light, J. C. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49, 248-264.

5. Speech and Language Kids by The SLP Solution. Can sign language help children with speech delays? https://www.speechandlanguagekids.com/using-sign-language/.

Why is reading speed important? People often assume that students who are slow readers have difficulty remembering the sounds that alphabet symbols make or that they have difficulty sounding out words. While this may appear logical, it is not always true.  There are students who have these skills but continue to be slow readers. They can sound out most words but are painfully slow when reading. They do not read with expression and frequently do not remember sight words. By the time they get to the end of the passage, they cannot remember any of the content.

Students are proficient at reading when they can read text quickly and accurately. They pay attention to punctuation and read with expression, enhancing the understandability of the text. They are able to read and understand text at the same time.

There is a close relationship between proficient reading, amount read, and the ability to understand the text. Reading progress is largely dependent on how much a student reads. Students who read more will read faster and understand more.

Reading Speed Affects Slow Readers

Slow inefficient readers read fewer words per minute. Thus, they must read many more hours just to keep up with their peers in school. Unlike proficient readers, they cannot read and comprehend text at the same time, so they must often reread the same text one or more times, further adding to the time needed to read the same amount of text as peers. Inefficient readers are often referred for reading intervention by middle or later elementary grades. This is because the amount of text information they must read for a test or to complete a project increases significantly in these grades.

As a result, proficient readers read more and thus continue to improve, both in reading speed and academic performance. Struggling readers become frustrated and avoid reading, leading to slower reading speed, difficulty with comprehension of text, and subsequently, poorer grades.

It is crucial that we identify students who struggle with reading in the earlier grades. By third or fourth grade, the focus is no longer on teaching students to read. Kids must read to learn. To do so, they must read textual material quickly and smoothly, i.e., they must read at an automatic level. Early identification of this decreased automaticity will allow for early and effective reading intervention.

Check out Early Literacy: Reading, Writing, Learning for tips on how to build a good foundation for your child’s future reading!

This past summer, I took a few days off from the everyday chaos of life. Why, some may ask? It was summer, beautiful outside, and I live in Montana! This year has been anything but ordinary, mainly due to the effects of COVID. Spring break was cancelled and the kids were home schooled starting in March. I am still hoping to go on a big trip for my birthday, celebrate with my kids on the beach, and make memories. But I am not holding my breath for this year. So, instead of pining about the things that I was not able to do, I decided to take a trip in the mountains. I turned off the technology and just slept, ate, hiked, and took time to breathe. And enjoyed the golden silence.

One aspect of my profession is teaching people, young and old, how to effectively communicate with others. I absolutely love what I do! Being able to speak to one another is often the primary form of communication, though some people use gestures, facial expressions, sign language, and a variety of devices to assist them to communicate. Communication continues to evolve with technology, for better or worse. Sometimes I wish for the old tape recorder answering machines, land lines, and leaving messages on pieces of paper instead of hitting “send.”

Take Time to Unplug

Being able to access anyone instantly through emails, texts, chat rooms, and video calls has made people accessible 24 hours a day 7 days a week. There are those that are great about turning off their technology.  However, a lot of people are glued to it all the time. You often see multiple people checking their phones when a beep or ting is heard. I admit, I have been guilty of this. I’m just tired of it. I will keep my phone available when my kiddos are with their dad, or I know I’m expecting a call. Otherwise, I am trying to be less connected. Hence, my exploratory adventure to the mountains.

Silence is Golden…and Amazing

You may not be the type of person that enjoys the silence, but I am. I guess you could call me the typical introvert that enjoys being around people but finds time to recharge when I am alone. My little adventure lead me to staying up in the Spanish Peaks for three nights. Granted, I am probably in the worst shape of my life. Still, the solitude of being by a lake, in a tent, wandering around and exploring, and not having to answer the phone, talk to people, or check emails was too much too pass up. Honestly, besides the hordes of mosquitoes (that thankfully could not get through my rain jacket) and those nasty horse flies, it was perfect. The silence WAS golden.

Being able to “turn off” that part of my life made me realize that I had too many things going on. I needed that time to recharge and find my focus again.

Lesson Learned

I am very fortunate to be able to take a trip to the mountains. I know that there are a lot of people that are unable to do so, but you can still find time to “turn off.” If that means turning your phone on silence for even five minutes, sitting on the steps while the children nap, walking around the block, or even sitting in your car for a few minutes before going in to do the weekly grocery shopping…try to take the time to leave the ability of the world to communicate with you and you with it. I think it will be worth it. For another perspective of how and why to unplug, click out Becoming Minimalist. And for activities that do not include technology, check out Growing Up Montana Style and Summer Scavenger Hunts.