Occupational Therapy Services for Children
Areas of Practice
Fine Motor Skills
'Fine motor skills' refers to the production and coordination of movements using the small muscles in the hands, fingers, and wrists. We need fine motor skills for picking up things, grasping objects, using tools like pencils, forks, toothbrushes, computers, phones, and screwdrivers. It requires coordination with our eyes (e.g., drawing), ears (e.g., playing a musical instrument), and gross motor movements (e.g., hammering a nail).
Children with fine motor difficulties may have trouble with writing, drawing, using scissors, using eating utensils, typing, using a smartphone, doing up buttons, etc. You may wish to consult with an OT if you observe your child having difficulties with the following that are unexpected based on their age and life experiences:
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difficulty participating in self-care activities (brushing teeth and hair, putting socks and shoes on, tying shoelaces and doing up buttons)
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frustration doing arts and crafts
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unexpected difficulties with scissors, stringing beads, colouring inside the lines
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difficulty manipulating toys and games with small pieces (e.g., Lite-Brite, Lego, Barbie clothing)
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difficulty catching or throwing a ball that’s unexpected
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turning pages in a book
Typical development:
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https://www.ctctc.org/wp-content/uploads/2021/11/FM-Fine-Motor-Milestones.pdf
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https://www.kamloopschildrenstherapy.org/fine-motor-skills-toddler-milestones.htm
Handwriting
Children who are having difficulty learning to write may have problems with the mechanics or fine motor skills needed to write (physically producing the letter), learning the symbols or letters (e.g., ‘b’ vs ‘d’), how to spell, and/or composition - how to express their thoughts in writing (e.g., retrieving the right word and its spelling and combining the words into sentences into paragraphs). When children have trouble learning to write, they may just require additional instruction (e.g., with a tutor) or they may have dysgraphia.
Both OTs and SLPs may be involved in supporting children with dysgraphia. OTs work with children on the fine motor and hand-eye coordination skills needed for writing (e.g., letter reversals, letter formation) and organizing thoughts for composition. SLPs work with children on the linguistic aspects of dysgraphia (symbols, spelling, composition). There is certainly some overlap in this area. For example, if an OT is working with a child on their fine motor skills for writing, they will also be working on letter learning (symbol knowledge). Your OT/SLP will let you know which is the most appropriate professional to work with based on your child’s specific needs.
You may want to consider consulting with an OT if any of the following apply:
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Persistent difficulties at age 7 years of age despite adequate instruction.
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The student's teacher notices that the child is having difficulties compared to other children in the same grade.
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Slow, painful, and/or illegible writing.
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A strong dislike of writing.
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An immature pencil grasp. By age 7, we expect a child will hold a pencil with their thumb and first 2 or 3 fingers with fluid hand movement - a dynamic tripod or quadrupod grasp.
Before the age of 3 years, it's normal for children to use immature grasps when using pencils and crayons. They may hold writing tools with their hand closed around the tool like a fist (palmar grasp), or hold the tool with their thumb and finger tips (digital grasps).
At around age 3, they start to use a tripod or quadrupod grasp some of the time, but move the tool using their whole forearm. Between age 3 and 7, they use their tripod or quadrupod grip more frequently and in more situations and with a variety of writing and drawing tools. They also start to control the movement of the tolls using wrist and finger movements rather than moving their whole arm. By age 7 years, children are typically using their mature grip comfortably and efficiently.
If a child is using a grasp other than a dynamic tripod or quadrupod grip, it doesn't automatically mean it's problematic. It's important to determine whether or not it's functional. If the grip causes pain or discomfort, reduces their speed and thus efficiency, causes fatigue, or contributes to illegible writing, then it's likely not functional for the child.
With handwriting, early intervention is very important. As a child with dysgraphia gets older, expectations regarding possible outcomes change.
Typical acquisition:
Gross Motor Skills
If an OT observes signs that may be consistent with gross motor difficulties, they will refer the client to a physiotherapist.
OTs may be involved in supporting clients with functional adaptations related to gross motor difficulties.
Sensory Processing
Sensory processing refers to the brain’s ability to process and interpret the information it receives through the body’s sensory systems – the visual (sight), auditory (hearing), tactile (touch), olfactory (smell), gustatory (taste), vestibular (position of the head – involved in posture, movement, and balance), proprioceptive (position of the body – involved in movement using force such as pulling), and interoceptive (information from internal organs such as hunger, feelings, and pain) systems of the body.
Sensory processing disorder may be identified when a person has significant difficulty processing this information from one or more systems. Persons may be overly sensitive or insensitive to input or have trouble integrating information from more than one system. SPD may be secondary to a disorder such as autism spectrum disorder, anxiety, or attention deficit hyperactivity disorder. People may also have difficulties with sensory processing without any other diagnosis. Children with sensory processing or regulation difficulties may get overwhelmed by sensory information or appear inattentive to it.
If an OT observes signs that may be consistent with SPD, they will recommend that the client be seen by a psychologist, neurologist, or developmental paediatrician for further assessment and/or confirmation that the client meets the criteria for SPD.
OTs are involved in the treatment of children with sensory processing disorder. Even while awaiting additional assessment by other professionals, an OT can address the child’s occupational performance difficulties.
Children with sensory processing difficulties maybe sensitive to itchy fabrics, loud noises, crowded places, bright light, appear clumsy, seek out movement like jumping from high places, etc. It’s important to note that if a child demonstrates some of these behaviours or sensitivities it doesn’t necessarily mean that they have sensory processing difficulties (e.g., many kids like to jump or find clothing tags itchy). When these issues affect functioning in daily life, however, such as success at school or social situations or engaging in unsafe behaviours guardians may develop concerns.
Resources:
"Sensory Processing Fact Sheet"
Canadian Association of Occupational Therapists
https://www.caot.ca/document/7521/OTSPD_FS.pdf
“Sensory Processing Disorder”
Health Link BC
Emotional Regulation
Emotional regulation refers to a person’s ability to control their emotional state. We use emotional regulation skills to deal with difficult situations that elicit emotions such as anxiety, anger, fear, sadness, or frustration. We also use emotional regulation to control the expression of happiness and excitement. It enables us to control our impulses. Focusing on tasks also requires emotional regulation.
If an OT observes signs that may be consistent with emotional regulation difficulties, they will recommend that the client be seen by a psychologist.
OTs are involved in the treatment of children with emotional processing difficulties. Even while awaiting additional assessment by other professionals, an OT can address the child’s occupational performance difficulties.
Resources:
"Self-Regulation in Children and Teenagers"
Raising Children Network Australia
https://raisingchildren.net.au/toddlers/behaviour/understanding-behaviour/self-regulation
Executive Functioning
Executive functioning refers to a large set of mental skills including attention, inhibition, initiation, self-monitoring, reasoning, and planning. They are critically important for everyday functioning in school, work, and social situations.
Many professionals may be involved in the identification and treatment of executive functioning difficulties. For example, psychologists assess and diagnose impairments in executive functioning and are involved in the management of these difficulties. Speech-language pathologists work with people with impairments in executive functioning because such difficulties frequently impact communication (e.g., verbal reasoning, initiation in conversation, verbal retention). OTs are involved in the treatment of children and teenagers with executive functioning difficulties as they can have a substantial impact on functioning in daily occupations. This may include focusing on the teacher during class, inhibiting inappropriate behaviours when interacting with classmates (e.g., not saying something that could be interpreted as rude), and planning and executing complex tasks (e.g., cleaning their room).
Resources:
"Executive Function & Self-Regulation"
Centre on the Developing Child, Harvard University
Activities of Daily Living (ADLs)
Basic 'activities of daily living' (ADLs) are the essential tasks we must do to meet our daily physical needs. Basic ADLs include walking, feeding, dressing, grooming, toileting, bathing, and transferring (moving from one body position to another such as sitting down).
ADHD Management
Children with ADHD may benefit from working with an occupational therapist to improve their executive functioning skills and success in school and other occupations.
Anxiety Management
Children with anxiety may benefit from support from an occupational therapist to learn how to manage feelings of anxiety and to be successful in daily activities such as social situations and classroom participation.
Support for Autistic Youth
Occupational therapists frequently work with autistic children and their families. Depending on the individual child's strengths and areas of need, this may include help with sensory processing, emotional regulation, play and social skills, and executive functioning to build their success at school, in social situations, and working toward future employment. Just as any other child, they may have other needs as well such as with fine motor skills and/or handwriting.
Resources:
"Occupational Therapy and Autism Spectrum Disorder"
Canadian Association of Occupational Therapists
https://caot.ca/document/4043/Autism%20Fact%20Sheet.pdf
Infant Development
Services are available for infants and their families seeking support with meeting developmental milestones. Services include support with head shape management, sensory processing, fine and gross motor development, and social interaction. Developmental check-ups are also offered for guardians seeking education on developmental milestones at this stage in their child's life.
Learn more here.