Here’s a scenario that happens to me a lot: A family comes to see me. They say, “Well we have another OT, but they’ve been working on stacking blocks and coloring for months. He doesn’t know how to play with other kids, screams every time I try to feed him, and going to the grocery store together is so difficult.” Now whether or not you’re trained as an OT, think with me, what are the most important occupations (daily activities) that a therapist could help this child with? Social play. Feeding. Community outings. Right?
Here’s another one: A family comes to see me. They say “My child LOVES OT. He does awesome on the swings and slides at the clinic; he’s really come a long way. I’m not sure that we need more OT. We really need someone to help us with our morning routine, and with focusing during homework time.” I cringe. Helping with routines and with focus are some of my strengths as a therapist. This family totally needs more OT.
As an occupational therapist, I was trained to help with a child’s occupations, meaning any of the things they need and want to do in their daily life. I learned to consider a parent’s priorities, the family’s culture, the child’s age and developmental level.
At no point in my training did someone look at me and say, “Your #1 job is to address a child’s sensory processing and fine motor skills.” If they had, I’d have been so confused. Because in my work with kids on the autism spectrum, these are rarely the main things families really need help with.
Fine motor skills matter, but only as a part of real daily activities. Sensory processing skills matter; they affect absolutely everything we do. But when we only have one lens, we necessarily see everything through it. I could look at each of my clients and see a child who needs fine motor work or sensory intervention, but I’d be missing what they really need. They need help with their daily activities. Fine motor skills and sensory processing skills might be part of that. But they are just one piece.
Here are the things I hear most from parents:
"I need help with my child’s self-care skills." When I hear this, I leap to my feet to get started. A few years ago at UNC Chapel Hill’s TEACCH Autism program, someone found a closet full of old files with lots of data about kids on the autism spectrum who had come to TEACCH decades ago. These kids had now grown up. The researchers found these folks again and asked them a bunch of questions. They studied what skills in childhood led to happiness and success in adulthood. These psychologists thought for sure it would be something like IQ (nope!), verbal skills (nope!), or amount of intervention (nope!). What was it that best predicted adult success? Daily living skills. Kids on the spectrum learn differently, and families need help teaching them to do things like eat, use the toilet, get dressed, and do chores. Parents know they aren’t just raising kids, they are raising future adults. OTs must get on board with them and help them raise their future happy, thriving adults.
"I don’t know how to play with my child." I’ll venture to guess that we all agree that play is important. It’s how young kids learn about the world, develop skills (like fine motor skills and sensory processing skills!), try out new behaviors, and connect with each other. Many autistic kids don’t naturally imitate others, and have trouble learning to play with toys without being taught. The good news is, when I’ve seen my young clients learn how to play, they are unstoppable. They play at the table, on the floor, in school, and on play dates. Many kids on the autism spectrum want to play, they just need us to help them figure out how.
"Daily routines are such a battle." Parents are fighting constantly to get their kids to follow directions, to get ready for bed, to do their homework, to do their chores, to get in the car to leave, etc. They are stressed and drained and may even have started limiting their activities. The thing is, most kids can learn to be successful at some independent routines, but the routines need to be tailored to the child’s unique learning style. Parents, you aren’t supposed to know how to do this! When your child thinks differently than you, you often can’t just come up with a way to teach them new routines. None of us therapists figured it out on our own. We went to graduate school. We were mentored. We took continuing education classes. We tried a thousand things and failed and kept trying. We did all of this so that we can more effectively help you support your child in daily routines.
When OTs limit ourselves to working on fine motor and sensory, we miss a great opportunity. That opportunity is helping parents and kids feel successful in those every-day activities that matter so much to their development and happiness.