Posts Tagged ‘pediatric therapy’

Time Flies When You’re Having Fun

Posted October 24, 2012 by pehl

I received a wonderful surprise just the other day – evening, actually.  I had completed my preparations for the new week on Sunday evening and was lazing about when my phone chimed indicating a new email in my ECPT account.  I do my best not to attend to work related issues on the weekends, but I don’t often succeed.  This time my lack of discipline was rewarded with the previously mentioned surprise – an email from a former client who left our practice about 8 years ago when they moved out of town.  I truly do love it when “our kids” come back to us.  Robin and I often wonder, “…what has become of so-and-so.  Let’s see, he/she would be…what? 12 – no 15 years old by now!  Wow, time flies when you’re having fun!”

I asked the sender, J. permission to post her email as I felt it would provide hope and encouragement to those of you who are just beginning “the journey.”  It’s a long road ahead for many of you, with much hard work and often some heartache and tears.  But it also includes the joy of growth and independence gained.  In response to my request J. wrote back, “I’d be honored to help others.”  So here it is:

Do you remember helping a little three-year-old boy, S. and his family 9 years ago?

We moved from Vancouver to Southern California after we’d worked with you both for about 18 months.  Robin started with casting S. for toe walking after he’d had Botox injections in his legs.  She provided PT to address S’s toe walking.  Then Elizabeth added OT and introduced us to Sensory Integration Therapy.  Dr. Willis helped with the AD/HD and sleep issues….

You started us on a very long journey.  We knew so little at the time and all the information was overwhelming.  Not only did you provide therapy for S., you cared about the mental health of Mom and Dad too.  You both were saviors for us at this time.

Fast forward many years…..S. is in sixth grade now.  At age 5 he went thru several intense neurological evaluations and we learned that the ‘something more’ was Autistic Spectrum Disorder, specifically Asperger’s.  We went thru school district evaluations and S. has had an IEP since Kindergarten.  He has always been mainstreamed but with a one-on-one aide.  After all the hard work and thanks to a wonderful support team, S. is now in the Gifted and Advanced class, completely independent.  There are still challenges, but he has made amazing progress.

There was more, but in an attempt to not be self-aggrandizing I edited out the parts that were the most touching to Robin and myself.  My point for posting it in the first place is to provide a sense of the possibilities that lie ahead.  I am honored to have been trusted with this young man’s care, and to have had the opportunity to work as a team member with his parents and I know this is true for Robin also.  We learn from each child we touch and each family we teach, which is what keeps our work exciting and new.  It’s true that time does fly when you’re having fun.

Blessings to all of you as you walk your path, Elizabeth

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