Is Occupational Therapy Overused?

When is it the right time to become concerned about your child's development.

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.  


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&_r=2&


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Eleanor Cawley February 22, 2013 at 02:59 PM
There is one thing that I did forget to add. A checklist, such as the Act Early Checklist, helps open a dialogue between the parent and the pediatrician. Even though a pediatrician has extensive training in child development, the 15-20 minutes that a doctor may have for the visit, is only a small snapshot of your child and cannot possibly assess all issues. This is a tool to promote better and more effective communication with the pediatrician. While nothing is or can be perfect, this checklist does a decent job. Enjoy your day!
Artie Fischl February 22, 2013 at 08:19 PM
I wish there were more therapists who were willing to (stick their necks out to) comment on the root causes of disorders the mere symptoms of which they are addressing. The kids who are neurologically and otherwise damaged desperately need advocacy, most especially from those who work so closely with them and have direct contact and influence with their parents
Eleanor Cawley February 22, 2013 at 08:45 PM
Dear Artie, It is not that I do not have an opinion, of course I do. However, it does not fall within my license to publicly comment on it as a health care professional. It is not a matter of sticking my neck out, I often do in areas where I have specific and relevant education and experience. I would be beyond my scope of practice to offer expert opinion on something such as whether or not vaccines play a role in any neurological condition a young child might have and it is beyond the focus of the blog post. By simply writing a blog and loading to a public forum is sticking my neck out there. Your tangential comments serve to focus attention to this blog post and I appreciate your input. Have a wonderful day and stay dry over the weekend. Eleanor
Eleanor Cawley February 22, 2013 at 08:55 PM
I do agree with your comments on children with disabilities needing advocacy. There are many therapists who work both in front of and behind the scenes to support those children and their families. We often donate our time and money to a point that we are suffering ourselves. I don't know one therapist, in any domain, whose career choice was not triggered by exposure to someone they know with a disability. I will refer you to my own blog post [http://eleanorot.blogspot.com/2012/12/occupational-therapy-me.html]. So do I have an opinion? You bet! And just so that you know, I am one of those parents.
Artie Fischl February 23, 2013 at 01:55 PM
Fair enough, Eleanor, I totally understand. Thanks for your forbearance, probably I should not have used your blogpost to bring greater awareness to a very touchy issue, but it is very difficult to bring to wider attention this hidden-in-plain-sight crisis. Every day of the week except Sunday, parents are hauling their kids to pediatricians, who will casually and arrogantly and ignorantly and smugly inflict on these precious little ones another dose -- or three, or five! -- of permanent damage, for big-hearted people like you to try to alleviate. The neurological is merely one area of damage, and not always is it immediately obvious. Often infants are having seizures (for example) that are unobserved, undetected. For those that can be bothered to educate themselves on the case against vaccines I am grateful for the opportunity to recommend Neil Z Miller "Vaccine Safety Manual." Spend a few hours reading and re-reading the introduction and foreword. You can order it though amazon for about $12. But thank you so much for being a braveheart in your vocation and being a good sport with my comments here.


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