Posts Tagged ‘sensory processing’

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


Posted July 8, 2012 by pehl

All of the children with whom I work have sensory processing difficulties of one sort or another, to one degree or another.  Because all of the sensory channels work together synergistically it is highly unlikely for any one system to be unaffected.  But the one sensory channel that is the most over-looked and taken for granted is the visual system.  It is also, in many ways, the most important, as well as the most controversial.

A child with perfect eyesight may suffer from significant visual difficulties, which can negatively impact academic learning, sports and daily function.  Visual development and behavior begins at birth and progresses along a continuum with clear milestones.  By the age of 12 months visual tracking skills are typically mature and this is one area I screen in all of the children I see.  A typical 5-year-old should be able to visually track a moving target horizontally, 180 degrees in both directions without moving his/her head, (upon request) and without any jerks or loss of pursuit at midline.  This same child should be able to do this in the vertical plane as well, follow a moving target in a large circle both directions and in random patterns that cross his midline and should also be able to maintain convergence on an object moving towards his nose to approximately 2- 4 inches from his nose.  If I see any difficulties including fatigue with this exercise, I have concerns.

Another visual screening tool I use is a game of catch with a playground ball of approximately 9-inches in diameter.  A five-year-old should be able to catch this without allowing it to touch his/her body, consistently.  If the child traps the ball against his body, closes his eyes, looks away and guesses or grabs at it, or consistently misses the ball, his visual skills are not supporting a functional outcome, and again I have concerns.

Likewise the manner in which a 5, 6, 7-year-old sits while writing or coloring at a table is full of clues to his visual function.  Can he hold his paper or project still with his non-dominant hand, while his dominant hand is busy?  Does he hold his chin in his non-dominant hand?  Does he cover the eye on the non-dominant side after working for a few minutes?  Kids can be cagey about this – it can appear that he is holding his head up, when in fact he may be doing both, covering his eye and holding his head.  Does he always tilt his head to one side, or turn his head so one eye is closer to the page than the other?  I’ve seen children who do all of these things, (not one child who does all of them, but often a couple) and they all had difficulty with writing and/or reading.

Yet another big red flag with respect to visual function is the child who “just doesn’t like to _______” color, draw, write – you fill in the blank.  Kids start wanting to use a writing tool as soon as they’re able to take yours away from you, so not wanting to, or not liking to color just isn’t a typical response.  I worry about these kids and I feel that it is my job to try to figure out the, “why not?”

One strategy in figuring out the “why not”, and/or the “why” is an assessment by a Developmental/Behavioral Optometrist.  This is usually where the issue becomes controversial.  Unfortunately not all insurance companies will pay for these evaluations, or reimburse for vision therapy.  Their reason is often because they consider it to be “experimental” and this is unfortunate because it’s been around almost as long as Occupational Therapy, which officially began in the early 1900’s.

The field of Behavioral Optometry was founded in the 1920’s, based on the work of Dr. A. M. Skeffington.  I found the following quote from Dr. Skeffington in Seeing Clearly, by Lois Hickman MS, OTR, FAOTA & Rebecca Hutchins MS, OTR, FAOTA:

“Vision cannot be separated from the total individual or from any other sensory systems, as it is integrated in all of human performance.  Vision is learned, and therefore, trainable…Behavioral optometrists put a major emphasis on the prevention of vision problems as well as enhancing visual related performance which is at a level less than the individual’s potential.”

Did you know that once a child enters school, approximately 75% of all classroom learning is through the visual pathways; that 90% of the people who have problems with their visual skills are never diagnosed.   I agree, it’s a little overwhelming but as Dr. Richard Kavner, OD, FAAO says, “…seeing, more than any other sense, guides and shapes a person’s behavior and experience of life…it is one gift all people deserve.”