From your OT bestie: Answering Your OT Questions

OTs that really are good at what they do. We’ll make it look like play, but I promise there are some things going on in their brains and clinical analysis that’s happening that’s actually working on something specific. Welcome to the sensory wise solutions podcast for parents, where parents can get real actionable strategies to support kids with sensory processing disorder. I’m Laura, OT and mom to Lilyana, a sensory sensitive kid who inherited my anxiety and my love for all things Disney. Consider me your new Oh, T mom, bestie. I know my stuff. But I also know what it’s really like in the trenches of parenting a child with sensory processing disorder.Okay, mom, enough about me. Let’s try the podcast.Hey, everyone, welcome back to the podcast. Today we are celebrating occupational therapy. Because in the US, it is oh T month. And all this month on my social media. I’ve been singing the praises of OT. Of course, I hope you know that I am ot given my name, the OT butterfly. But today, I want to give you a little bit more insight into how ot can help various kinds of neuro types, different challenges that come up for your kids. And I am just answering questions that I received from people on Instagram about OT, specifically how ot can help with XYZ. And so I’m just going to go down the list and answer those questions for you. But first, I want to give you some information on occupational therapy. And really what it is. So if you’ve never heard of occupational therapy are not super clear on it. Occupational Therapy got its start in 1917. And its roots are actually founded in the mental health space, as well as rehabbing soldiers coming back from the war. So not many people know that that’s how it got its start. And then they just realized the amazing benefits when you can see a client or a patient for the skills that they have. And the skills that they don’t have and tried fill that gap by building skills, whether it’s physical skills, cognitive skills, mental health skills, sensory processing skills, and also filling that gap with accommodations so that the person the client, the patient, can be as independent and have a high quality of life as possible. And so OTS can work, honestly, across the lifespan. You’ll see OTS in the hospital with newborn infants, all the way up to the end of life. There are OTs and the end of life care. So every stage of life and in between, and in various settings. There are OTs, in prisons. There are OTs, in the mental health community. There are OTs, of course, in a school setting in a private clinic for children in a private clinic for adults and adolescents. In hand therapy clinics and sensory processing clinics. There’s, there’s so many different fields for OTs, which is great, we are so versatile, and yet it still makes it really hard for people to understand exactly what it is that we do. So obviously, I am a pediatric occupational therapist. And the setting that I worked in was a private clinic. And I worked with kids ages two to 10, who had various neuro types. Because we were a private clinic, I didn’t only work with kids with specific diagnoses, there were a lot of kids who didn’t have a particular diagnosis. But were experiencing some challenges in the home or in the school that was prohibiting them from being successful in participating in those environments. And I specialized in sensory, so understanding what parts of their sensory systems need to be enhanced how to provide those enhancements through activities through environments, and also teach the kids about their body, and how to utilize the tools and then of course, teach the grownups around them, the teachers, their parents, so that they could provide the most optimal environment for learning and participation for those kids. Now, I am no longer working in the clinic. I spend all of my time online creating content like this on my podcast and in my website on My Courses, social media to spread awareness of neurodiversity, but I use my occupational therapy lens to do that. And before I jump into this episode, I wanted to let you know I have a few Other episodes that might be helpful in helping you understand OT and also how to access OT. So write down these episode numbers. And if you ever want to find these episodes, all you have to do is go to the OT butterfly.com And then slash, then the number. So if I say it’s Episode 30, then just do slash 30. And it’ll take you to that episode. So one of the episodes that might be helpful for you is called How to Get Started with OT and how it can change your life. This episode highlights testimonials from people all over the world who have had ot services for their child and you hear voice memos from them about what that did for them and their family. And then I also give some tips on how to get started with OT and how to find it. So that is episode 30. Another episode that you might find helpful is episode 93. And this one is me telling you how to identify neurodiverse affirming therapists and some green flags for you to look for. Next, I have an episode with Dr. Krupa play fourth, she is known as at the pediatrician mom on Instagram, she and I did an interview on episode 70. How to advocate for ot with your pediatrician because oftentimes we hear parents keep getting brushed off by their pediatrician. So we get a pediatricians point of view in this episode and some tips on how to get that referral to OT if that’s what you need. Then there’s an episode for those of you who maybe are already in the OT setting, your child is getting ot services. And maybe it feels like you’re disconnected from the process or you’re not sure if it’s working. This episode is called making the most out of OT services. And I’m giving you some insights on some things that you might be able to ask your ot to better understand your child’s progress, some questions or things that you could ask them to do as part of their ot service with you. And also how to know when it’s time to take a break or a pause from OT and if that’s the right choice for you. That again, is episode 24.Lastly, this is specific Glee information for parents who were wondering about the role of OT in a school based setting. And this episode is going to help you understand IEPs and 504 plans, those words, and names of these services might sound different if you’re in a different country. But that’s what it’s called here in the US. And if you want to understand more about that, then that is episode 69. All right, let’s jump into the questions that you all have for me. So again, I asked Instagram, I said what are some things that you want help to understand how occupational therapy can support those specific needs or diagnoses? So one of the questions was motor planning slash clumsiness. So when you have a child who is having a lot of clumsiness bumping into people bumping into objects, and or they have a hard time with what we call motor planning, which is the ability to know how to move your body in a certain way to move through an environment to copy an exercise to copy a dance routine to do something like learning how to button a shirt for the first time. And it just feels very, very effortful for them. And it just feels like they cannot figure out the motor movements and the patterns to do it. So those skills really depend on a solid sense of proprioceptive input. So this is one of the senses that is provided to your muscles, tendons and joints and helps inform your brain about your body awareness. So if you lack body awareness, then of course, it makes sense that you would bump into things and have a hard time coordinating your movements if you can’t really have a good sense of where your body is in space. So an occupational therapist would help the child learn motor planning skills and become better aware of their body by providing a lot of heavy work activities, providing a lot of proprioceptive activities. They may also be scaffolding and grading down a task to make it easier for the child to learn. So maybe they teach an exercise, step by step, like really, really slowly, or they do an activity with them in front of the mirror to provide them visual feedback. Or maybe they are using tactile or touch cues to help draw more awareness towards that part of the body. There’s so many different ways that it could happen, but it’s going to be a mix of providing activities that enhance body awareness, and also providing some accommodations and other supportive tools to make the task a little bit easier. Someone else wanted to know how occupational therapy can help with executive functioning. So executive functioning skills are the higher level skills that include things like planning, problem solving, safety awareness, impulse control, emotional regulation, working memory, attention, all of those things that we really, really need in our day to day life, and all of those things that are hard for really, really young kids. And for people who have things like ADHD, and anxiety that tends to pull away from the executive functioning skills. So a lot of these kids and people tend to have a hard time in school settings, or in like morning or bedtime routine, they’re forgetting steps, they’re having a hard time figuring things out in a sequence or remembering things. So OTS would help with executive functioning by providing primarily a lot of environmental accommodations. OTs are really good and creative at coming up with systems and hacks, and solutions that work for different people based on the environment around them. There are certainly a laundry list of our go to strategies to support different kinds of executive functioning skills and different kinds of environments. But we are also good at coming up with new systems and solutions on the fly. So accommodations and hacks are going to be the lowest hanging fruit to work with for executive functioning skills. And they need to be put in place at school and in your home. Not only that, but I always like to remind parents that when we’re thinking about executive functioning, skills and challenges, specifically, especially if your child has already been identified as having ADHD, we know that an ADHD neuro type, when we think of the executive functioning skills and abilities that they have, they are typically functioning at about three years younger, in terms of executive functioning skills than what their chronological age says. So if we expect a seven, if we have a seven year old child with ADHD, we should not be expecting them to independently complete tasks on their own. From an executive functioning perspective, as other seven year olds, we would think of them as being able to do it at the level of a four year old. That does not mean academically, or intellectually, it just means, you know, let’s say for our four year old, they have afour to eight minute attention span. And a seven year old would have maybe like a 14 to 15 minute attention span, I’m those are not real numbers, I don’t have that actual information in my brain right now. But that’s just for an example. We can’t expect our seven year old to have the same amount of attention. As other seven year olds, we would think of it as lower. And so we would accommodate for that. And maybe we would provide movement breaks or break tasks down that are shorter in duration, rather than expecting them to sit through a longer period of time. So OTS will again, bring down accommodations, help you understand what is realistically something that we can expect out of these kids. And if it’s not specifically ADHD, or there’s other things in the picture, we can use sensory support and nervous system regulation to enhance executive functioning. But we really, really want to focus on providing as many accommodations and supportive tools like visual cues, countdowns timers and systems as possible. Another question, someone asked, How does exploring sensory with OTS prevent unwanted or unsafe behavior at home? I really liked this question. So the first thing that an occupational therapist is going to do with this is really do a lot of detective work and a lot of digging to understand where that unsafe behavior is coming from and why it’s happening. Remember, when we have really, really big, aggressive, unsafe behaviors, whether that’s hitting someone hitting themselves, breaking things, eloping running away, breaking locks, all of those things that are unsafe behaviors, those are coming from a nervous system that that is activated in the stress state it is in the sympathetic nervous system state, which is something that can be triggered automatically by things in the environment, whether it’s a direct threat to them, or a perceived threat, or something that has to do with a traumatic history where their brain is just coding something as a threat. So the OT should be doing some good detective work, whether it’s questioning the parents, like not questioning the parents not not like interrogating them. But using parent report to understand more about, you know, what time is this behavior happening? What is going on at this time? What has happened in the past around that time? What’s going on in the environment, what day of the week, is it happening? Has this happened before? What is their sensory profile? They’re going to be looking into and asking a lot of questions to help get a clearer picture of what is the main trigger for the unsafe behavior, and then whatever they determined is that trigger They should be providing accommodations or ways to avoid that trigger if possible. Sometimes it’s as simple as changing a certain schedule. Sometimes it’s something like creating a separate space from a sibling at that time, you know, whatever the trigger is, they will start there and, and be providing accommodations and supportive tools around that. They will likely also be introducing some safe, regulating strategies and exercises and things for the child to do with their family to proactively regulate their nervous system so that their nervous system has more of a common regulated baseline. And hopefully, if the child is able and willing to learn some strategies themselves, we always want to teach the children how to better advocate for what they need, in certain moments of stress. Because even if they figure out in a nice way, like oh, this seems to be triggering my child, and they’re able to fix that time of the day, it’s never going to be so easy cut and dry like that there are going to be things that come up. And if a child has a nervous system that’s prone to sympathetic nervous system activation, you definitely want some easy immediate tools, and access to parasympathetic activation strategies as possible. And that does take a period of learning and exploring, and again, empowering the kids and their families to understand how they can use that most effectively. And an OT should get that kick started for you and your family. All right, the next question, someone wants to know how ot can help with anxiety and like really big meltdowns and emotional regulation stuff. So OTS would tackle this from both a top down and a bottom up approach, meaning, they will probably do some version of talking and figuring out things that your child is anxious or worried or upset about. And they will probably do some talking about that situation and problem solving and what they can do instead. And of course, for some of you who have tried that, you know, that only goes so far. And yet it’s still part of the picture. So they will go through some talking about the problems, problem solving with them again, and trying to figure out some solutions and ways that your child can get around this certain anxiety piece. OTs are part of the mental health space, but we are not mental health therapists. So they should also probably if the anxiety is intense enough, hopefully they are referring you to a mental health counselor, or someone else to work with your child in that regard. But those will still be part of the lesson. A lot of OTS will use something like the zones of regulation, or the alert protocol to talk about how our nervous system and emotions kind of go hand in hand, which is really important, and is more of a top down approach that starts to introduce the bottom up approach. So the bottom up approach is knowing how we can regulate our nervous system through body sensations and motions to then influence our emotions. So what actions what movements, what kinds of breathing exercises, what things can we do with our body, to give our nervous system signals of safety, which will then help our brain feel clearer and able to activate more of the higher level parts of the brain rather than the safety fight or flight parts of our brain. So an OT should be taking both of those. Both of those perspectives, not just relying on top down, talking about feelings talking about problem solving, not just that top down approach, but they should also be talking about and using bottom up approaches. And so when they can help your child access more feelings of safety, from a body perspective, through swinging through obstacle courses, through body movements through heavy work through whatever body based strategy they find, then the idea is that they that your child can have a larger window of feeling regulated, and then that when they do experience things that would trigger anxious thoughts worrying, frustration, anger, that they would be better able to handle those emotions in a more logical adaptive kind of way. Some OTs, if they’re really good at what they do, would also be providing you with some specific like scripts, or examples on how to hold specific boundaries and be coaching you through the fact that we should be holding boundaries and accepting our child’s feeling at the same time. So this comes with the idea that parenting kids who are highly sensitive or have meltdowns easily we tend tend to want to give in or avoid those meltdowns. So an OT could help coach you through knowing what parts of your day routines, you should be holding firm on certain boundaries, and also how to accept your child’s meltdowns and feelings around them, so that they can practice some of the tools that they are learning in therapy so that I can actually generalize at home. I had a lot of questions on specifically how OTS help with kids who are sensory seekers, sensory avoiders whatever sensory profile they are for various neuro types. Sensory Processing differences overlap a lot with anxiety with OCD with ADHD with autism. So whatever neuro type your child is, the way that ot helps support their sensory profile is first obviously finding out what that sensory profile consists of. And this can look so different for every child, they could seek vestibular, but be sensitive to sound, another child could be seeking tactile input, but be really sensitive to vestibular, and be unresponsive to sound, there’s so many different ways so an OT would likely provide you and or your child’s teacher with a sensory profile, which is a questionnaire that is standardized, that is a list of common behaviors that you and the teacher circle, how often you notice the child engage in those certain behaviors. And then that comes back with a specific result that shows if your child is displaying behaviors that are more congruent with average peers their age, or if they are showing more likemore problematic challenges that would indicate sensory processing challenges in those environments, then an OT would probably also do some observation of your child in the clinic and doing a certain set of activities and things for your child to do. And then they would combine what they noticed in the report, in the clinic, with what you reported on the questionnaire, and then come to a conclusion in terms of what kinds of sensory interventions would benefit your child best. And this would include probably weekly therapy, and a private clinic, where they would curate certain like obstacle courses, movements, things to do in the clinic to really try to get your child to an optimal level of regulation. And they’re going to constantly be monitoring your child and seeing their level of alertness or their level of calmness and seeing how that translates and behavior. And as they take notes and get to learn your child more than they will teach you and say, hey, you know what, I noticed that your child really, really likes this kind of swinging, or your child really benefits from lights off, slow hammock swinging, or, you know all of these different things. And then they teach you to try to do that at home and try to be more proactive in providing that in a sensory lifestyle. So over time, you and your child’s ot should have a toolbox, kind of a symbolic toolbox of sensory strategies and things that tend to work for your child and you hopefully feel more comfortable in providing them daily and proactively, which is really going to nourish your child’s nervous system with the exact kind of sensory input that they need in order to have access to their higher level learning skills, their emotional regulation, skills, all of those things that you want your child to, to have in the school setting, and at home. Okay, I have two more just general questions about ot that are really, really great to end this episode with and then I’ll say bye for today. So someone asked what makes ot different than other resources for my child? And I love this question. Because when you have a child who has behavioral challenges at school and at home, whether it’s because of ADHD or autism, something that you’re not aware of yet, you’re gonna get a list of commonly referred to services, it might be any combination of behavioral services with ABA, maybe speech services, maybe mental health guidance, counseling, maybe work with a social worker, maybe work with an OT, maybe even physical therapy if your child has some physical challenges. So OTS are really your go to when you want to learn how to accommodate certain environments, whether it’s the classroom or the home setting, or some other setting that your child spends a lot of time in. So accommodations meaning how to transform an environment to be more conducive to more regulated behavior from your child. And that could be anything from sensory changes to the environment, to physical manipulation or moving certain things around the environment. That’s an OTS wheelhouse, OTs are really a good place to get started to just really understand what kinds of skills your child currently has, and where they need improvement in. And sometimes the skills that they need improvement in the OT will refer out. So for example, if your child is having social communication challenges, and they’re noticing that it’s hard for them to make and keep friends, they’re having unwanted behaviors around other people at school and the OT observes us, they’re going to try to make accommodations as best as they can, then they’re going to really do some observations around the child and see what skills they have, what skills are lacking for them, and how they can support that. If the skills that they notice are lacking in, in the communication and language and how they really interact with those peers, they might say, this is a skill that your child can build on. I am not the person to do that. But a speech therapist can do that. But the OTS are really, really good at honing in on what kind of skill your child needs to focus on. And a lot of them OTS can help with, but the other times they may refer out, like I said, OTs should not focus specifically on behaviors and saying, let’s stop that behavior. Let’s change that behavior. Let’s do this for that behavior. Instead, an OT will help look at a behaviors zoom out and see what’s going on what is causing that behavior from a nervous system or skills based perspective. And then work on those underlying skills, not just say, Can we change those things so that the behavior changes. So OT is really good for a lot of long lasting, maintained nervous system regulation, which again, is the bottom foundation for a lot of these behaviors that we’re noticing to begin with. Now, to just an observer, an outsider looking in, if you were to peek into a clinic, and you like put your head up to Window, you probably wouldn’t be able to tell much difference between what a speech therapist ot PT, ABA therapists looks like playing with a kid in a clinic gym, for example. They all look like they’re playing, but everybody’s goal and what they’re looking for and how they’re supporting and responding to the child is going to be different. And I often hear from parents that it looks like the OT is just playing with their kids. Which is great, to be honest, because OTS that really are good at what they do will make it look like play. But I promise there are some things going on in their brains and clinical analysis that’s happening that’s actually working on something specific, it might feel a little less concrete than say a physical therapist who can measure their progress in, you know, steps taken their range of motion, how long they balanced on one leg for all of those things. Sometimes those things overlap with ot sometimes we work on balance as it contributes to functional tasks. And also less concrete than a speech therapist who can measure in you know, certain words said and how they pronounce certain things. So a lot of OTs and families that we work with, you really need to trust the process. But I highly recommend asking your ot to clue into it. I’m not going to go further into that because again, some of those other episodes I linked at the beginning of this episode are going to dive into that aspect more but definitely check out the information on how to make sure you’re making the most out of OT services and also how to know when to take a break from ot services. Okay, the last question I want to end with is someone asked, is there an age that’s too old to start ot for sensory and emotional regulation? I will say no, there’s no age that’s too old. But it’s going to look different. And your access to sensory based OTS who really understand this is less and less as the child gets older, like most pediatric ot clinics serve the toddler age to like middle Elementary, I would say like 10 to 11, sometimes even 12 year olds, but even then they start to grow out physically and cognitively of a pediatric clinic setting. And there is really really a huge gap in clinics that serve that like early adolescent age of kids in terms of the sensory processing stuff. So I won’t say that it’s too old to work with them to work with an OT, but you’re going to have a harder time finding them, the older your child is, but if your child is anywhere from like preschool age to like, eight, nine or 10, that is not too late to work on sensory with an OT. And there are probably just going to be different kinds of methods that they use with your kids. Like obviously, the older the kids are, they’re going to do a lot more talking about the strategy. They’re going to try to do a lot more teaching of what strategies work for them directly to the child. It’s going to look different, but it’s definitely not too late. All right, thanks so much for following along this week and learning more a little bit about occupational therapy. I will be back next week. If you enjoyed this podcast, please consider rating it and leaving a review which helps other parents find me as well. Want to learn more from me? I share tons more over at Instagram at the OT butterfly. See you next time.