Occupational therapy (OT) encompasses a wide range of treatments and interventions to help people adapt to physical and neurological disabilities that affect their ability to go about their daily life. Wondering how OT can benefit your child? How does OT interrelate with other skills our children work on in physical therapy, speech therapy, and other types of therapies such as AAC and assistive technology?
To answer these questions and more, we spoke with licensed and certified occupational therapists Anna Baker (M.A., OTR/L BCP SIPT) from LKS and Associates and Katherine Ambrose (OTR/L) and Katie Krcal (MSOT, OTR/L) from Kidspace.
Occupational therapy has one primary function: to enable people to participate in the activities of daily life. As the American Occupational Therapy Association (AOTA) states, occupational therapy “help[s] people participate in their desired occupations with the therapeutic use of everyday activities.” Think of “occupations” as the things people need to do, want to do, and are expected to do. This can include getting dressed, brushing teeth, going to school, socializing or playing, and using tools or assistive devices.
As Krcal explains, “OT helps people all across a lifespan live a more engaged and independent life. We help babies in the NICU, people with traumatic brain injuries, kids and adults with developmental disabilities, and the elderly in hospice.”
Occupational therapy is person-centered, meaning it is based on a child’s unique needs, interests, and short- and long-term goals.
OT may help with the following skills:
While the two modes of therapy can overlap, the main difference between physical and occupational therapy is the focus. Physical therapy (PT) focuses on addressing problems related to pain, strength, and gross motor skills while occupational therapy uses a wide range of tools and techniques to increase fine motor skills, life skills and activities of daily living, social skills, sensory processing, and the use of adaptive equipment such as mobility or communication devices that enable a child to access their school and home environment.
OTs often collaborate with PTs on gross motor skills by working on proprioception or body sense — see more on this below.
A child may benefit from occupational therapy if they have difficulties with:
Baker explains the importance of addressing self-care activities and building age-appropriate independence:
In traditional OT, a child is identified as needing services and stays in therapy until they age out or are discharged after growth. Think of it as lower frequency over a longer duration.
Episodic care, a newer form of OT, is a twelve-to-sixteen-week burst of therapy sessions in which the therapist, parent, and child (if applicable) identify a set of goals and then work to meet them. Think of it as higher frequency over a shorter duration. When someone leaves episodic care, they're not discharged forever.
Krcal tells us that because of the “bursts of therapy” that characterize episodic care, the therapist, parent, and child have the opportunity to meet their goals quicker than with traditional OT, allowing for a childhood that isn’t defined by a million afterschool therapy appointments.
Krcal explains, “Development is always happening. Expectations are always changing. Circumstances are always changing. So after a quick break of services which can last anywhere from three months to a couple of years, they can say, ‘We're having trouble with X, Y and Z. Can we come back in and see you?’ And you do a short catch-up with your therapist, establish those new goals, those new areas, and then you get started again on that twelve-to-sixteen-week burst.”
Episodic care can be useful not only in clinics, but in school settings as well, benefiting students transitioning to a more independent lifestyle. Listen to Ambrose’s explanation:
One of the most important needs for kids in the zero-to-three range is identification and hitting fine and gross motor milestones. Krcal clarifies some of these milestones as “rolling over around three months, sitting up between six and nine months, crawling around nine, and then walking anywhere from twelve to fifteen months.” She reminds us that “kids all develop on their own timeline,” and that “it’s important for parents in this day and age of so much information overload to understand that if their child isn’t crawling right on time, if their child isn’t walking or talking right on time, sometimes that’s okay, because we all develop things differently.”
If you’re wondering about your infant’s or toddler’s developmental milestones and whether they might need OT, consult with someone who’s an expert in the field, such as an occupational therapist, physical therapist, speech therapist, or your child’s pediatrician.
In the five-to-ten age range of elementary school, academic and life demands arise. These demands include writing skills, social skills, and activities of daily living. If a child is not picking up these types of skills after months of teaching, pre-teaching, and practice, Ambrose says it’s a good time to seek out professional intervention.
Ambrose and Krcal answer some common questions about the skills that start developing around elementary school age:
What age/development stage should a parent start working on handwriting? Does pencil grip matter?
Handwriting is very child-led. Making sure the child is approaching this in a playful and developmentally appropriate way is important. Always have the pencil ready as an option, but if your child would rather use their finger, do air writing, or write on a sensory tray — great. There is developmental merit to what OTs recommend and the developmental progression of pencil grip. However, should we be pushing the same goal over and over again, if at a certain point those muscles just aren't quite developing for a specific pencil grip? Is it functional? Is it serving the purpose? Maybe it's fatiguing. If so, we then transfer to more meaningful and purposeful ways of getting that writing out, which can be through typing, dictation, or other adaptive ways of producing written work.
There’s also a list of ways that parents can promote handwriting skills through play. These include taping paper on a wall or using easels to help with movement, sensory trays, putting shaving cream or rice and beans on a tray to practice finger drawing, sponge painting with a cut-up kitchen sponge, and using small materials like golf pencils or breaking crayons or chalk in half. Something to remember: kids have smaller hands, so giving them adult-size tools doesn’t always work!
What stage is a good time to work on typing? Should an OT know about assistive technology to teach typing?
Again, this is going to be child-appropriate. They’ll need to have bilateral coordination skills to use both hands, as well as visual skills to see the keyboard and look for the keys. For some, this can start as early as second or third grade. For others, we may start with dictation before moving to typing if speech skills come first. Most OTs have a general awareness of assistive technology. One of the best things about an OT is our creativity. We’re able to use a collaborative approach and be open to doing the research and help families seek out AT. There are OTs who specialize in AT, so if you’re seeing a current OT who may not have a very specialized skill, it’s okay to ask for a recommendation for someone with that specialization who can fulfill that need better.
Why is playdough and finger painting so important? Any other suggestions for strengthening fingers?
The main goal of strengthening hands is to foster grasp and coordination. Most of these intrinsic hand muscles start and stop within the palm and connect our fingers to our wrist and forearm. Doing things like fingerpainting, using playdough, and sponge painting will strengthen those muscles that will then translate to pencil grasp and so much more. Gross motor play can also surprisingly help strengthen hands, such as crawling around at the playground, reaching for the monkey bars, or climbing a ladder or rock wall. These activities will, in turn, strengthen that whole upper arm, shoulder, core stability, and more, which is so important for school and everyday life. In the future, these manipulation skills will translate to all sorts of activities such as putting coins in the parking meter, unlocking your apartment door, typing, texting, and so much more. Having a strong foundation with your hands is key.
Why does it matter if my child can color in the lines?
An underlying skill that comes with coloring in the lines is visual motor standpoint. Is your child seeing where the lines are? Can they match their motor movements to stay within those lines? Visual motor skills are used in childhood for writing, typing, playing games, etc. We’re also looking at coordination — how is the child controlling the pencil? Is it with the shoulder, the whole arm, the forearm, the wrist, or the fingers? Coloring in the lines is a huge dictator of how those coordination and visual motor skills are developing.
Why do OTs use adaptive scissors?
An OT’s bread and butter is figuring out when we need to adapt the environment to the child’s needs. Adaptive scissors are great for kids lacking some of those inner hand muscles. It takes away some of the finger strength needed and just focuses on palm strength. With adaptive scissors, there is still that visual motor and coordination element, but it’s simplified to focus on those foundational skills. And maybe eventually the child can use regular scissors, but maybe not. Maybe you’ve just found a tool that allows the child to be successful at this task for their life. And that really is the goal — figuring out what is going to be successful for them.
From ages eleven to seventeen, executive functioning is the main skill needed in school and everyday life environments. Executive functioning skills include organization, time management, and short-term memory. Middle and high school students start to manage schedules, bring books to class, do more homework, and have more responsibilities at home, such as chores and learning to drive a car.
Listen to Krcal explain how utilizing these skills in a way that works for the individual child is key to empowering all children, but especially children with developmental disabilities and those on the neurodivergent spectrum:
Another element that can occur around middle and high-school-aged children are behaviors such as acting out or refusing to go to therapy. A good way to combat this? Understanding OT from the child’s perspective. An OT clinic can be a very childlike, playful environment, and your tween or teen may not feel comfortable or want to be there anymore. If the child has the cognitive ability to do so, invite them into the conversation and ask why they have these new feelings about OT. Switching up the environment can help, and if that means switching to another OT who can provide that, that’s okay. Parents can facilitate OT progression at home as well by working on grocery shopping, meal prepping or baking together, doing laundry — anything that can provide a child with more independence and privacy.
Similar to those tween and teen years, executive functioning is a big focus of OT in adulthood, with more environmental adaptations. OT in adulthood also looks at providing the person with tools needed to advocate for themselves, as well as providing coaching and education to the people in that person’s personal life and work environments.
Ambrose says there is an unfortunate drop-off that tends to happen when children age out of their services, resulting in a loss of goals and progress within the OT spectrum of services. However, she says, it is still vitally important to provide support:
“There are still all these executive function needs, and they're even greater. Can you hold a job independently? What kind of job do you even want? What are you interested in? What kind of environment are you going to thrive in? As the OT, can I then go into that workplace and help support the team there to help them understand how this adult best functions? You're also going to see navigating relationships and all those kinds of skills that come in. I mean, as a neurotypical adult, I have difficulty navigating relationships. I know that for these adults, it's going to be even more of a challenge.”
Occupational therapy can be both school-based and clinic-based. Let’s break down what the differences are and how each one can support a child’s academic, sensory, and social goals.
OT at school is typically focused on the development of fine motor skills needed for handwriting, scissoring, and other school-related tasks, but it can also work on life skills — like opening lunch boxes, milk cartons, zipped plastic bags, three-ring binders, locker padlocks — and any fine motor skills a student needs to access their school environment.
Collaboration
Ambrose — who has eight years of school-based OT experience — explains that school-based OTs can collaborate with other therapists, including other specialists and teachers, in choosing the right assistive technology and adaptive tools and equipment for a student, from desks and seating to writing implements. Push-in services — which are therapy services provided when a student is in their natural environment such as a classroom, cafeteria, or playground — allow for an even greater sense of collaboration with the teacher, as the OT can see the function of the classroom and how the child reacts to their environment.
Sensory integration
School-based OTs also focus on sensory integration, or the strategies used to process sensory input. As Baker explains, sensory processing is “the ability of the brain to process information through the typical five senses — which we know as vision, hearing, taste, touch, smell — but also three other senses, senses that we don't usually think about.” These three senses are the body sense, or proprioception, known as the conscious awareness of body and limbs; the movement sense, or vestibular system, relating to how the body is located in space; and the internal body sense, or interoception, which is the messages coming from inside the body, such as headaches, stomachaches, and varying emotions.
Sensory processing disorder is when difficulties with sensory processing occur from one or more of the sensory systems (touch, taste, vision, hearing, smell, movement, pressure, and internal body sense). Sensory integration can help students with sensory processing difficulties that may arise while at school, such as loud noises, crowds, and touch. OT can address this by completing observations, parent interviews, and testing to determine and then work with specific areas of difficulty.
IEPs and 504 Plans
In an IEP, OT falls under related services and must be supported by data, assessments, and service providers that show it is meeting an educational need. While most students receive OT services through an IEP, if a child doesn’t qualify under the Individuals with Disabilities Education Act (IDEA), OT can also be provided as an accommodation under a 504 plan to any child who needs it.
If you believe that your child needs occupational therapy, you can request an assessment by an occupational therapist or occupational therapist assistant (OTA) from the school.
Check out our list of accommodations that can be used to support students in school. Some accommodations specific to occupational therapy include:
You can also check out these frequently asked questions from the California Board of Occupational Therapy.
If your child would benefit from OT for activities that are not related to education, the service can be provided through Regional Center, SELPA Early Intervention, private health insurance, or Medi-Cal. (Funding therapeutic needs can be tricky. Read more about funding resources in this article!)
Clinic-based OT focuses more on sensory issues and activities in relation to social and family life, and is conducted in clinics, hospitals, and homes. Clinic-based OTs can help your child gain independence through functional life skills, such as getting ready for the day. OTs can also help with expanding and adding nutritional value to your child’s diet; teaching life skills such as dressing, toileting, washing hands, and brushing teeth and hair; and using adaptive equipment. A common service under clinic-based OT is feeding therapy to teach a child with sensory or motor challenges how to eat or to eat more effectively.
For more information, head to our article on the differences between school-based and clinic-based services.
Having a close relationship with your child’s therapist can be one of the most important and helpful ways to promote success in the process. As Kidspace OTs, Ambrose and Krcal both say that it’s okay if you’re not vibing with your therapist! Asking questions, being present at therapy sessions, and having those tough conversations can help find the right OT and see successful progression toward your child’s goals.
Ambrose has some tips and suggestions for how parents can be involved with the process: “Sometimes parents are available and they can come into the sessions, or they're doing pickup and drop-off, so I can at least have that face-to-face time with them. But if that's not the case, can we do weekly check-ins? Or do we need monthly check-ins or email communication by shared Google Docs? There are so many ways to make that communication more fluid and to encourage a home program. I think really empowering the family by providing things that can be done at home will maximize the benefit of OT because if it's just done in isolation, we're not going to see as much or as quick progress as we would like.”
Here are some questions to ask your child's OT:
And finding a good match with your therapist is key. It’s important to find someone with whom you can communicate and who you feel wholeheartedly listens. If you feel unheard or pushed in a direction against your instinct, the therapist may not be the right fit. As Krcal explains, “Occupational therapy pushes children, but we never want to push your child beyond their needs. We never want to push your child to harm them psychologically, physically, or emotionally. There will be hard sessions, and it’s important to know there will be days where we feel frustrated. But there’s always a line. And whenever your gut instinct is telling you, ‘I don't know about that,’ then I think it would be time to call it.”
Remember: You know your child better than anyone! If you don’t feel you or your child is getting the support or empowerment they need, it may be time to have an honest conversation with your therapist.
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