Is Occupational Therapy Overused?

I recently read an article from the New York Times that appeared several years ago about parents in New York City, particularly in Brooklyn, hiring occupational therapists for preschool children.  The article states, “In affluent neighborhoods in and around New York, occupational therapists have taken their place next to academic tutors, psychologists, private coaches and personal trainers — the army that often stands behind academically successful students.” (TYRE, 2010)  There were 115 comments attached to this article, many commenting on overly anxious parents or parents pushing their children to get an edge.  Others commented on how observant some parents are, noticing small problems, and addressing problems early on.  Any of these comments may or may not be true.  What I do know is this, if small issues are not addressed early on, they can and often will become major issues later on and more difficult to address. 

Children develop at different rates.  There is never a distinct day or time that your child will do something.  Take for example, walking.  According to the CDC, your child should be walking independently by 18 months.  Yet we have seen children walk at 10 months and 12 months.  Does that mean that your child is motorically gifted?  Probably not.  So from this we can assume that there is at least a range of time in a child’s life when we should expect a child to begin walking.  Once outside this range, we should be asking questions of the doctor. 

This range of development occurs within fine motor skills, as well.  The CDC lists many of these items under the heading of Cognitive (learning, thinking, problem-solving).  Under this heading are motor skills that an occupational therapist would address, such as using one hand more than the other (handedness), sorting, pointing (finger isolation), stacking (eye-hand coordination), throwing a ball, copying lines, etc.  All of these items are listed in the 2 year old section of their developmental checklist.  What is also listed in this checklist is when to be concerned and talk with your doctor.  http://www.cdc.gov/NCBDDD/actearly/pdf/checklists/All_Checklists.pdf

Now look at the flip side of this issue, gaining an edge.  I was speaking with a colleague, a psychologist, at lunch the other day.  I had been considering writing on just this topic for my next blog post.  We both agree that there is a range in which a child should accomplish developmental milestones.  We also agree that pushing a child may backfire and frustrate the child because the brain may not be ready.  The brain will help a child accomplish a task when the brain is developed enough to handle the task.  While the basic structures are present at birth, the experiences [motor, cognitive, sensory] that a child has along with the actual physiological maturation of the brain further develop to increase the speed, efficiency, and complexity of signals in the brain which then allows the child to accomplish more difficult tasks.  In a fairly typically developing child, when the brain is ready, the task will occur and not before. 

So as an occupational therapist, I might work on hand strengthening and finger isolation to help a young child to eventually develop a tripod grasp for a crayon.  Let’s just say that this did not occur adequately before kindergarten.  It may not be such an issue this year but when a student is challenged to keep pace with his or her peers in handwriting in subsequent years, it most definitely will.  Reaching middle school with handwriting problems just compounds the already difficult tasks, of taking notes at the same pace with peers, and writing legibly to express what they have learned.   Can you imagine, knowing that your child studied and knew this information but failed the test because his teacher was unable to read what was written?

Can you imagine thinking that your child is brilliant at an early age because he or she is ambidextrous? But in fact, has not developed a preferred hand which may be an early indicator of dyslexia.  Is it a sure sign of dyslexia?  No.  Only someone skilled in child development can determine if this is a problem or not. 

So, I recommend that parents use the CDC Act Early Checklist to monitor a child’s development.  Keep in touch with your doctor and if concerned, ask the pediatrician to evaluate your child.  An occupational therapy evaluation does not require a prescription but services do.  Progress reports should be expected and shared with the pediatrician. 

Acting early, helps your child be as successful as he or she can possibly be.  Once in school, having a child pulled from class for therapy can be embarrassing and frustrating.  He or she may be very receptive to services when young but very resistive when in a school setting, particularly middle and high school.  I have developed programming to address these needs [http://www.mseleanorsapples.com/Fine-Motor-Skills.html] and offer a free 30 telephone consult for any questions or concerns.  

Bibliography

TYRE, P. (2010, February 24). Watch How You Hold That Crayon. Retrieved from N.Y. Times: http://www.nytimes.com/2010/02/25/fashion/25Therapy.html?pagewanted=all&...