This blog post was written by guest blogger, Jennifer Bullock

While we all know April is Autism Acceptance month, it is also Occupational Therapy month - something that many of us are also just as familiar with. My daughter has been receiving OT for many years, either through private pay, the school district, or now via a Charter school we are a part of for homeschooling. 

Locally we do not have many in-person OT choices and therefore my daughter was assigned virtual OT sessions. At first, this was going to be very tricky as my daughter did not do well with video sessions of any kind. After a while, my daughter warmed up to it and the routine that we developed. Thankfully, her sessions go very smoothly now – much of which is attributed to the knowledge and advice I’ve received from her OT these past two years. 

For this month, I thought it would benefit others if we did a short Q&A session with my daughter’s therapist, Christine Coe.

Christine, can you let our readers know a little bit about you and your background?

I’ve been working as an Occupational Therapist (OT) since graduating from San Jose State with my Bachelor’s in Occupational Therapy 1981. I have worked primarily in the area of pediatrics, but have also worked in acute care in a hospital as well as in a Skilled Nursing Facility. In pediatrics I worked for California Children’s Services in California for about 15 years, and as a contract OT for a few school districts in California.  I have also worked in clinics and a few school districts up here in Washington where I currently live. Currently, I work for McColgan and Associates (very part time as I prepare to retire) and provide OT virtually to a few students in California.

Just some basics so we’re all on the same page, what does an Occupational Therapist do? 

OT’s do quite a bit in a variety of settings, since I am assuming that most of your audience is interested in the pediatric setting, I will address that area. Occupational refers to “how you occupy your time”; therefore, OT’s are involved in helping children increase their independence across a variety of settings, this differs whether it is in the medical or educational setting. In general, OT’s address: activities of daily living (ADLs; i.e. dressing), fine motor, postural strength, visual motor, visual perceptual, and sensory processing. We also deal with adaptive equipment, including wheelchair, power wheelchair, and all equipment needed to address self care (i.e., adaptive toilets and bathing equipment).

How does occupational therapy play a role in the communication process?

This can be a tricky question. OT’s can deal with communication if the children are using an assistive technology to help with communication helping the child address motor issues or how to access the communication device. However, OT’s also deal with sensory processing, which impacts every part of a person’s life and their ability to function in this world, including communication.

You’ve told me specifically that motor planning and movement has helped improve my daughter’s communication skills. Can you elaborate on the connection between those?

Motor planning is connected to sensory processing. In a nutshell, sensory processing (originally called sensory integration by Jean Ayres, who developed the theory) is the process by which our bodies take information from the environment, send it to the brain, where it is processed and integrated. It then goes back through the body and spits out what is called an adaptive response. This ability to process and make sense of the information we obtain from our environments and then function in our environment impacts everything we do: our language, ability to learn, play, and socialize. Motor planning is the ability to come up with an idea and then execute that idea using your body. If you can’t do something with your body, you have a lot of trouble talking about it.

Do you have any books or websites you’d like to suggest for parents and caregivers that have valuable information?

Another tricky question for me, remember I was born “BCE” before the computer era, most of you will be able to find things online much better and easier than I can. In short, google “sensory processing and behavior”, “motor planning”, etc., to find out information. The one caution I have is to be careful about spending money on a website. I am sure that much of this is valid, but I rarely pay money for information about OT and sensory issues as there are many knowledgeable people who publish information for free.

If one of our readers were interested in pursuing OT for their child, what do you suggest that they do?

There are 3 ways to obtain OT for your child:

1. Pay for it yourself. Unfortunately, this is quite expensive and therefore not a reasonable option for most people.
2. Medical insurance. If you go through the medical route, you will need a prescription from your doctor and an authorization from your insurance company. Most clinics do the work of obtaining the authorization and will let you know how much your copay is. The tricky part with medical insurance is dealing with the insurance company. When I worked at one clinic, I once had an insurance company deny OT retroactively because one of my goals was that the child would be able to sit at a desk and complete a table top/visual motor activity for 5 minutes. The insurance company stated that this was a behavioral goal and therefore did not qualify for OT. Clearly, they had no idea what I did for a living, since I have dealt with behavior in children for the last 40+ years. I also once had an insurance company deny a bath chair for a severely disabled child because a bath was deemed “not medically necessary”. That being said, most medical insurance companies (including state insurance) pay for OT, they just vary in how much and the co-pay.
3. Educationally based OT through your school district. At least in the state of Washington, you must have a diagnosis which has a negative impact on your ability to obtain a Free and Appropriate Education. There must be a negative impact and it must relate to your child’s education. From what I have heard, there is a lot of variety in how this is put into practice in various states and various districts.  

I would also say that much of what I do as a pediatric OT is to try to replicate what children naturally learn through normal play. Therefore, do not discount playing and community based activities. The Special Olympics is a great organization and provides many opportunities to obtain the same experiences that I provide. Outdoor parks and playgrounds can provide a lot of opportunities for sensory motor development. Many places that provide indoor play structures and activities now have special times set aside for children with sensory issues and these can provide wonderful opportunities. Music lessons and sports are excellent for motor development.  Any activity that develops rhythm, timing and core strength is working on the same foundational skills that I work on.

I know that we’ve only scratched the surface about Occupational Therapy and the benefits it could have with our kids and students but are there any extra tidbits you’d like to share before we end our interview?

When a child has a “fight, flight or freeze” response, it’s indicative that we need to change something. Jean Ayres referred to the “just right challenge”, if an activity is too easy, the child gets bored and walks away, if it is too difficult the child becomes frustrated and gives up. We are always looking for that sweet spot, where we are challenging the child, but not too much. Also, the best activity is the one the child enjoys. Of course, we can’t always give them what they want, but if they like music, use music to help them gain skills, find some sports at their skill level, etc.

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Thank you, Christine, for providing some information about Occupational Therapy and the beginning steps for those that are interested in pursuing it for their child and/or student.