OT Australia describes Occupational Therapists as, “using a whole person perspective to work with individuals, groups and communities to achieve optimal health and wellbeing through participation in the occupations of life.”
In this definition the word occupation is used to describe all the everyday tasks that occupy us. They are the meaningful activities that we either want to, or need to, engage in.
For kids, their occupations might include…
- Developing relationships with other people. (parents, family, and friends)
- Learning to look after themselves. (eating, toileting, sleeping, hygiene, dressing etc.)
- Gaining education about the world around them, either at home or at school.
- Developing self-regulation skills.
- And underlying these areas, kids are developing their functional fine motor skills, gross motor skills, visual perception skills, executive functioning skills, and developing an awareness of their emotions and unique sensory preferences.
What might OT look like for a PDA child?
When making suggestions OTs take a holistic view and consider the environment, the task, and the child’s unique abilities. Any recommendations have to work for the whole family unit.
The Environment- eliminate or reduce triggers and increase the child’s sense of safety.
- This might be achieved via educating people that interact with the child about PDA, polyvagal theory, sensory processing, and declarative language.
- Having access to people that can foster co-regulation. People that the child has a strong relationship with, based on trust and connection.
- Lowering the sensory demands of the environment or selecting environments that align with the child’s preferences.
- Making changes to the physical environment to foster success.
The Task/Expectation- match expectations to the child’s ability.
- Reducing unnecessary demands across the board.
- Providing the child with assistance to make tasks achievable and allow for a ‘just right’ challenge.
- Altering the way tasks are presented to minimise eliciting a stress response.
- Ensuring intrinsic motivation is maintained. Explaining the ‘why’ and aligning with the child’s interest areas.
- Considering how can choice, control and flexibility can be incorporated.
- Allowing lots of time.
The Child- consider their unique nervous system.
- What are their sensory preferences?
- What are the signs that their nervous system is starting to escalate?
- How can you tell that their window of tolerance is opening up?
- How can they be collaborated with to solve problems that might be preventing them from engaging in meaningful tasks.
- How can we facilitate them to develop awareness of their internal experience of sensations, so that they can understand, process, and start to advocate for what their nervous system needs.
What if your child can’t attend therapy sessions?
For many families of PDAers, ours included, that emotional energy cost of face-to-face sessions on the child and the whole family unit can be too high. A parent education model that utilises telehealth can be a highly effective alternative, in fact I think this should be the first line approach when working with PDAers and their families.
What to look for if engaging in face-to-face therapy?
Depending on the type of therapy, home visits may be more suitable than clinic-based sessions. The highest focus should be on developing a relationship of trust and safety. It is essential that sessions are child-led, play-based and link in with your child’s interests. They must always have the choice to opt in or out of any suggested activities and their therapist must back off at any sign of escalation.
What approach to therapy has worked for your family?
