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Children Are Different

Many aspects of pediatric occupational therapy are similar to adult therapy, except that adult goals relate mostly to work and home skills and children's goals relate mostly to play and school. But certain aspects of OT with children are very different from adult OT. That's because, says psychologist Jane Healey, children's brains are just not the same as adult brains.

Healey is a child neuropsychologist, which means she's had extensive training in how the developing brain and its various structures and functions affect learning and behavior. Her particular interest is children with dyslexia, a disorder in learning to read, and her practice has included many children with seizures and one child with myotonic muscular dystrophy (MMD).

Occupational therapists may prescribe mobile arm supports, splints and head supports like those being used by this child with muscular dystrophy. Photo courtesy of Rancho Los Amigos National Rehabilitation Center, Downey, Calif.

Healey says children's brains are in a state of flux, with various functions and their connections in the brain not yet assigned to a particular locale, as they generally are in adult brains. The child's experiences with his environment can influence brain development, just as brain development influences experience, she says. Healey, who has been an assistant professor of psychiatry at Mount Sinai School of Medicine in New York, now has a private practice in Ridgewood, N.J.

"What you normally find in neuromuscular diseases or diseases that affect the motor system are more perceptual and motor difficulties," Healey says. "They can't explore and touch things like other children, so naturally, they may not understand the complexities of three-dimensionality and other things quite as well as if they were moving in the same way that other kids are." Healey says that kind of problem may or may not lead to learning disorders.

"I think when there's motor impairment, their experiences in life are so altered," says Jamie Hillesland, an occupational therapist in Northwood, N.D. "Their ability to play and to get their hands dirty and to move a lot and to get those normal sensory experiences that kids get in growing up and playing — they miss that, for one thing.

"Kids with neuromuscular disorders become more sensitive," she adds. "Their threshold [for sensory stimulation] changes, because they don't stimulate those [sensory] systems as much." Hillesland, who manages rehabilitation services at Northwood Deaconess Health Center, is a certified specialist in sensory integration therapy (see "Sensory Integration Therapy").

While few experts today dispute that therapies offered to children, including occupational and physical therapy, have to take into account the changing nature of a child's developing brain and how it's related to both motor and cognitive skills, they may disagree on exactly how that's to be accomplished. The method may depend on the thinking that prevails at a particular center or school district, as well as on each child's individual needs.

Both Jennifer Schwartz and Carol Olimb say they incorporate some sensory integration theory and techniques into their practices, but they don't rely on these exclusively.

Televisionitis

Noah has received many kinds of therapy in his short life and has "come a long way" since his OT and other sessions began about two years ago, Faith Varcadipane says.

She's become an expert in Noah's various treatments and in the implications of his medical disorder. She now tries to incorporate OT activities into everyday life and advises other parents to do so without being too hard on themselves or feeling like failures if they aren't "doing therapy" the way they think they should be.

She remembers what a therapist told her a while back, after she'd broken into tears at having forgotten to practice something with Noah. "Calm down," the therapist told her. "It's not that you have to say, 'OK, it's therapy time.' It can be worked into your day."

The Varcadipanes live a few blocks from the beach, which, Faith says, "is fantastic for OT activities, like digging, putting the big shell in, taking the big shell out."

Noah now has glasses and seems to recognize (after breaking several pairs) that they help him to see. His hearing appears to be normal, and his walking has improved so much that he only uses a walker for long distances.

With help, he's starting to eat with a spoon, and he knows what to do with a crayon. Not long ago, says Faith, "he just wanted to bang everything. Now he knows, 'This is a crayon. This goes on paper.' I can see he's made that correlation."

For a child who two years ago couldn't pay attention long enough to pick up a Cheerio, it's a mark of progress that he now watches "Sesame Street," "Barney" and "Tele-tubbies" with evident pleasure.

Some parents might not be grateful for what Faith calls Noah's "televisionitis," but for her, she says, "it's an awesome thing."

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