August, 2012 Archive

Anxiety in Young Children

Posted August 27, 2012 by pehl

In perusing my most recent copy of Advance for Occupational Therapy Practitioners, I discovered an article regarding the role of OT in treating Anxiety Disorders in children.  Titled, “Treating Pre-Adolescents with Anxiety Disorders”, written by Jill S. Feldman, OTR/L, C/SIPT I decided it was exceedingly pertinent to my personal OT practice and have decided to share it here.

Ms. Feldman states that children who had a primary diagnosis of anxiety disorders and had given up on “traditional types of therapy” began to filter into outpatient clinics.  In my practice I have never had a child enter therapy with a diagnosis of anxiety disorder.  Rather, many of the children who enter my practice display symptomology of anxiety disorder, but have not been diagnosed.  I have often wondered over the years, and to this day, why that is.  I can only assume that it is a regional issue, as Ms. Feldman writes from the southern US in Georgia.  Also it seems that there is a distinction made in this article regarding whether the anxiety disorder is a result of inadequate sensory processing or a primary diagnosis, i.e. considered a mood disorder.  Nonetheless, diagnosed or not the issue is the same – children with anxiety disorder benefit from receiving Occupational Therapy.

From the article:

Treating Pre-Adolescents with Anxiety Disorders

The Anxious Child

Anxiety is a rather tricky phenomenon.  However, the beauty of occupational         therapy is that, initially, the therapist does not have to focus on whether a child is anxious.  Instead, the therapist concentrates on the symptoms of the anxiety.

Many times the child’s heightened state of awareness causes difficulties with planning and organizing.  This often results in a heightened emotional-sensory response.  In other instances, if the child primarily has praxis and sensory-processing concerns that cause the anxiety, the occupational therapist can address these core issues and not talk or try to discuss feelings – an approach which is often challenging for children in this age range…

In many cases, occupational therapy’s role is to be a safe place where the child can literally just relax.  There are no consequences to imperfect performance as long as there is effort, nor are there time constraints.

In addition, the activities presented are often designed to reduce the children’s arousal states.  Linear movement, deep pressure, proprioception and oral input, in a fun and low-pressure setting, help to set up an internally organized child.  In turn, discussion is often more beneficial because the child is more apt to share, process and assimilate what has transpired in therapy.

Scales and Self-awareness

In my experience, these pre-adolescents know that they feel anxious when they are anxious.  They understand the difference when they are not anxious, but do not have the ability to feel the “in-between” stages.  Some children know their triggers, but most do not…  [As an aside, because the author does not identify any ages in the article, I would have to say that in my experience children don’t have the personal insight into their feelings and the language capacity required to discuss them escalating or not, until they are about 7 to 8 years of age, possibly a bit younger, but not much.]

[The author goes on to discuss the Alert Program/How Does Your Engine Run? by Mary Sue Williams and Sherry Shellenberger, which makes use of “engine-run” language to provide the child a way of talking about how he feels and train him to recognize triggers and learn strategies he can employ to decrease his arousal state.  She also discusses The Incredible 5-Point Scale by Kari Dunn Buron and Mitzi Curtis, which can be helpful in identifying triggers and what decreases arousal states.  Both of these treatment strategies require a certain level of self-awareness that I don’t see developing until around 7 or 8 years.  In children with developmental delays this may take even longer.]

Fun Breeds Success

Once the child understands how his body works from a cognitive perspective, introducing sensory-motor activities may be highly beneficial.  Although many of the linear swinging, bouncing, “crashing,” scooter boarding, gum chewing, straw blowing, and other tasks are designed to make the nervous system feel good, they are also fun.  Many children with anxiety disorders have trouble just having fun.  [I read this as indicating that Ms. Feldman, as a therapist, teaches the cognitive components first, and follows this with sensory-motor play.  I work with a lot of children under 7 and I introduce sensory-motor play first and allow the child to feel the change, but rarely talk about it at those young ages.]

…Once they start seeing successes in therapy, these [anxious] children are able to generalize the skills they have learned to other environments.  This progress is further extended when family members see growth and provide even more encouragement.  In addition, movement inspires language, facilitating discussions that might not happen because of a lack of organization of thought processes.


 As I continue to see young children, often under the age of 5 years, who clearly display behaviors associated with anxiety I am confident that sooner is better.  That is, the child’s brain has the most plasticity under the age of 6 years, meaning that change in structure, as well as on a neurobiological level, occurs faster and more easily at these young ages.  That is not to say that if a child is over 6 years old change won’t happen, but it will be a more lengthy process.

Questions?  Insights?  Comments?  Start a conversation in our parent forum or email Elizabeth at

5 Skills Your Child Needs for Kindergarten Success

Posted August 9, 2012 by pehl

Whether your child is beginning kindergarten in a few weeks or is further along in his academic career there are 5 skills he will require for classroom success this year.

Attention to Task:  Your child needs to have developed the ability to remain focused on an activity for up to thirty minutes in some situations and in some classrooms.  More realistically, at least to begin the school year, ten to twenty minutes is not unusual.  How long is your child able to attend to a learning activity (not including electronic games or computer-based learning programs) without requiring your attention, assistance or re-direction?

Sitting on a Chair:  This may sound silly, I mean most kids can sit on a chair, right?  Probably, but how long can your child sit still in a chair?  How long can he sit while attending to a task or story without standing up or fidgeting?  And as long as we’re talking about sitting let’s discuss sitting on the floor.  Your child will likely be expected to sit criss-cross on the floor with the rest of his class for periods of time, often in a circle or group.  First of all can he sit criss-cross?  This means, of course, with his feet crossed IN FRONT of him, not under his knees or behind/to the side of his hips, (i.e. W-sit. W-sitting is just plain awful for the development of his feet, knees and hips.  Don’t let him do that.)  If he can sit criss-cross, can he do this without touching the kids on either side of him?  How long can he sit in this position without touching anyone else?

Following Directions:  There is a huge emphasis on auditory learning in our classrooms today.  Children need the ability to understand spoken language in order to learn concepts, of course.  But even before that they need to be able to complete multi-step commands.  For example, “Go get your coat and backpack and line up at the door.”  Is your child able to follow 2 and 3 step directions?  Now see if he can do it without your use of hand gestures.

Sharing:  The classroom environment is one of cooperation.  There is a great deal of sharing these days. In fact little, as I understand it, belongs to a child individually other than his coat and backpack.  I’ve been told that boxes of Kleenex, pencils, erasers, glue, all of those items on the back-to-school list are pooled and shared by everyone.  And that’s the easy part.  What about sharing the basket of crayons and markers, knowing how to wait or ask for the red one, waiting for a turn at the drinking fountain, or giving someone else a turn?  Does your child know how to make a polite request or how to respond to one?  Does he know what to do if he isn’t ready to give up something he’s using?  Does he know what to do if something is taken from him by someone else who doesn’t yet know how to be polite?

Pencil Grasp:  Granted I’m an Occupational Therapist so I have a bias about this particular issue.  But although you might think kindergarten is the time to start practicing this, the truth is kids have already been practicing for 2 or 3 years.  And many of them have established bad habits.  It’s really difficult to train away an inefficient pencil grasp, so let’s look at what’s good and what’s not so good.  An efficient pencil grasp allows mobility of the fingers and pencil, marker or crayon.  It is exemplified by the tripod grasp.  The tripod grasp uses the pad of the index and thumb to guide the pencil with the middle finger providing “mobilized stability”; the ring and little finger are held close to or into the palm.  Also, the pencil lays against the web of the thumb rather than standing straight up.  Many children wrap their thumbs around their index and middle fingers in order to stabilize them on the pencil.  This grasp lends strength, but disallows mobility.  There are many variations on this type “power grasp”, but all have the same outcome.  How does your child hold a marker or pencil?  When he colors does he move his fingers and hand or does he move his whole entire arm?  Does he change the angle of his hand to accommodate the needs of the page, or does he turn the page this way and that?

Here’s to a fun and safe Labor Day weekend and a bright and happy first day of school!  – Elizabeth