A common misconception of occupational therapy is viewing the therapist’s primary role as aiding children with their fine motor skills. While occupational therapists provide various services, the role of occupational therapy for children with autism is essential in first treating their underlying issues with anxiety. We’ll examine these underlying issues in children and why utilizing the treatments and occupational therapy strategies can provide the most benefit. We’ll discuss the therapists’ roles and how ABA therapy and parental involvement are critical to treating anxiety by targeting sensory processing disorders.
What is Occupational Therapy?
Occupational therapy addresses the struggles people have with daily tasks, preventing them from thriving in their natural environments. It is a holistic therapy approach to help children, adolescents, and adults find comfort and safety in their environments and function at their optimal levels. Occupational therapy helps people learn skills that enable them to participate to the best of their ability in everyday life. This method may require teaching new skills, rehabilitating a skill, or modifying their environment to support their needs in achieving mastery of these skills.
Occupational therapy helps strengthen various areas of one’s life, including:
- Self-esteem
- Self-confidence
- Learning
- Gaining independence
- Social interactions
- Overall health and wellness
The central role of the occupational therapist is to treat the whole child. They consider all physical, emotional, social, sensory, and cognitive abilities and areas of need. The goal is to help children develop the necessary skills to engage and thrive across all environments.
Anxiety in Children
Unfortunately, anxiety disorder is the most diagnosed mental disability in children under the age of six. While many of these children have an autism diagnosis, it is becoming more apparent over the last five to seven years that many children suffer from anxiety disorders alone.
Many sensory integration issues may cause anxiety in children. Examples include meltdowns from their socks bunching up or a tantrum over the feel of their clothing labels. Some children may overreact to the temperature or the texture of particular food. All of these sensory inputs may lead to significant distress and cause anxiety. Once anxiety sets in, the smallest day-to-day task may become inconceivable to attempt.
Why is Occupational Therapy Helpful in Treating Anxiety in Children?
It’s essential to understand the crippling effects of anxiety many children suffer from. Children who suffer from anxiety may experience difficulty interacting within their environment, affecting every aspect of their daily routine and ability to function. Children with anxiety typically express their anxiety much differently than adults, often causing misconceptions and misdiagnosis. They may present as angry, disruptive, overly worried, throw tantrums, or avoid people and situations. Occupational therapy (OT) significantly improves communication, interaction, and motor skills in even the most challenging cases.
The role of occupational therapists requires them to dig deeper to unveil possible underlying issues of anxiety before taking on more obvious ones. By discovering and identifying issues with anxiety, occupational therapists can then address the larger issue first, then work with the child to develop the skills necessary to perform their daily tasks.
There are various obstacles your child may encounter, leading to or increasing their anxiety. These may include impairments such as:
- Cognitive
- Physical
- Developmental
- Behavioral
Occupational therapists work with your child’s ABA therapy team to properly assess root issues and create an action plan. Through continuous therapy, treatment, and weekly meetings with their ABA therapy team, ongoing monitoring, and necessary changes are easier to implement. Much like your child’s ABA therapy sessions, OT goals, and recommendations will focus on (teaching self-regulating strategies when anxiety begins to rise in order) to help your child thrive in everyday life across all environments.
Examining Overload Responses
Children with autism spectrum disorder (ASD) typically exhibit significantly different patterns of sensory processing while around others. Children with autism tend to deal with various sensory issues, leading to extreme overload and anxiety. One such issue is attention deficit hyperactivity disorder or ADHD. In another 60 to 70 percent of children with autism, sensory modulation, and processing disorder exist. While these issues add to the degree of stress and anxiety these children feel, studies show children with autism are generally slower to recognize and integrate various inputs from their senses. This delay makes their processing speed much slower, often leading to tantrums and meltdowns due to their inability to cope and respond.
Children with autism lack the appropriate filters necessary to screen out possible irrelevant information. Unfortunately, as the input builds and is unfilterable, the anxiety sets in, and meltdowns erupt. And this may very well overlap prior sensory input they are still attempting to process. Many classroom disruptions can trace back to a child working towards processing a noisy hallway or unpleasant texture from earlier while now attempting to process input from teachers and peers inside the classroom. Sensory overload knows no time limits and can present itself at any moment. As the tension and anxiety build, an outburst, meltdown, or overload may erupt.
The Role of Sensory Dysfunction
Let’s consider anxiety in school-age children. Often, children who struggle in school are mislabeled as lazy, disruptive, or perhaps having issues at home. They may seem disruptive or ADHD. Yet, it may become clear that the child is experiencing a sensory dysfunction when we take a closer look.
If a young student struggles with fine motor skills necessary for developing a pencil grip and mastering handwriting, the school’s occupational therapist may be of service. The therapist may find the student battles an underlying sensory dysfunction, causing severe anxiety and resulting in undesirable behaviors. This discovery allows the therapist to address one issue at a time, developing a stepping stone of occupational therapy strategies to work through sensory dysfunction, anxiety, and fine motor issues.
Sensory Dysfunction Therapy Integration and Autism
Children with autism have difficulty with the average day-to-day tasks and display behaviors that can hinder their participation throughout their daily lives. The focus of occupational therapy ensures that children with autism develop the skills necessary to participate in communal life by minimizing their difficulties in daily activities. Children may experience anxiety that hinders their optimal abilities and independence. Through integrating sensory dysfunction therapy with occupational therapy, children with autism can learn to participate in meaningful relationships and function within their community with a healthy support system.
Sensory processing difficulties affect more than 80% of children with autism. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, Sensory integration therapy, hyper or hyporeactivity to sensory inputs is now an official diagnostic criterion for Autism Spectrum Disorders commonly and successfully in use with pediatric occupational therapy. Sensory integration is the process of organizing sensory information in the brain to create an adaptive response. Utilizing sensory integration therapy provides a controlled and meaningful sensory experience, allowing the child to form responses spontaneously and appropriately, requiring the integration of particular sensations.
This integration process is successful because we know:
- Sensorimotor development is vital for learning.
- Each child’s interaction with their environments shapes brain development.
- Their neuro system has plasticity capability.
- Meaningful sensory-motor activities are a strong mediator of plasticity.
The Importance of Sensation
Sensory integration consists of the proper function across the following systems:
- Tactile
- Vestibular
- Proprioceptive
- Auditory
- Visual
- Gestation (taste)
- Olfaction (smell)
Sensory processing issues we see in children with autism are associated with most behavioral and functional performance problems. Most common are the repetitive or stereotypical self-calming or sensory-seeking actions. Many studies show that repetitive behaviors, including spinning, rocking, climbing, and turning, may indicate the existence of various sensory processing dysfunctions and behaviors.
Children with autism who struggle with sensory registration problems struggle to create appropriate adaptive responses to touch, pain, movement, light, sound, taste, and smell. They cannot process the degree, intensity and formulate a proper response to the sensory input, triggering stress and anxiety. Their inability to discriminate and process these inputs is vital for developing motor functions, postural tonus, and postural adjustment.
Along with anxiety, they may develop various sensory problems, including:
- Hyperresponsivity
- Hypo responsivity
- Sensory avoiding
- Sensory seeking
Occupational Therapy, Sensory Therapy, and ABA Therapy
Integrating ABA therapy, sensory, and occupational therapy helps remove the child’s barriers that may hinder socialization and learning. Combing ABA therapy with sensory and OT can help create an atmosphere of calm and focus for the child. Through close work with your child’s ABA therapy team, a systematic plan can help set goals to address your child’s anxiety by eliminating over-stimulation or under-stimulation within each environment. Working closely with each ABA therapy team member helps all therapists improve your child’s brain’s ability to process sensory information, form reasonable and acceptable responses, and develop skills to assist in their daily activities.
All therapists will work together to meet the ABA therapy team’s goals according to assessments of your child’s abilities and needs. The ABA therapy team will continue to encourage active parent involvement to help you learn new tools and strategies to implement at home and school. Through constant communication, your ABA therapy team will provide hands-on experience and resources and act as a direct link to all other ABA therapy team members if you should have questions, concerns, or insight to provide.
Your child’s ABA therapy team is a valuable resource for your entire family, as well. While children with autism struggle with anxiety, your ABA therapy team recognizes the entire family does too. Reaching out for additional support is part of the ABA therapy team’s commitment to your family. Through support groups and family counseling, your ABA therapy team is there to help reduce the stress and anxiety your family faces.
Tips, Tools, and Strategies
Your child’s entire ABA therapy team will have a wealth of tips, tools, and strategies for you to practice and implement at home. While you attend various therapy sessions, you can also note the many techniques and props they utilize for various skills, behaviors, and situations.
Tangible and Intangible Techniques During Occupational Therapy
The various tools and strategies in use during occupational therapy will help your child learn to handle anxiety by teaching coping mechanisms. This process may use both intangible and tangible techniques. An intangible technique may include lessons in belly breathing, guided imagery, or progressive muscle relaxation. Tangible techniques your OT therapist may utilize might include fidgeting toys and seats or weighted equipment and blankets.
Sensory Activities
As with ABA therapy, occupational therapy is full of helpful sensory-motor activities you can implement at home and across all environments. Sensory circuits are sensory-motor activity programs that help your child achieve a ready-to-learn state. Sensory circuits are a series of activities specifically designed to awaken all their senses. They work to energize or settle your children and get ready for the day. Sensory circuit activities include:
- Alerting activities stimulate the body’s central nervous system and prepare it for learning. These activities may include spinning, jumping, or bouncing a favorite ball.
- Organizing activities require the brain and body to work together, such as balancing on a board or juggling objects.
- Calming activities give the body an awareness of space and increase their ability to self-regulate sensory input. These activities may include deep pressure, weighted toys, and heavy muscle work.
Additional Occupational Therapy Strategies to Help Reduce Your Child’s Anxiety
- If your child gets overwhelmed by excessive noise, try using noise-canceling headphones or headphones playing music.
- If touch is your child’s anxiety trigger, allow them to sit or stand in an area where they can avoid being accidentally brushed or bumped. Also, consider allowing additional transition time if in school or church to avoid crowds.
- If your child struggles to sit still, include plenty of movement breaks, or use a wobble cushion.
- If your child has anxiety over smells, use a sweatband with a small drop of essential oil, lotion, or shampoo they like.
- Encourage food play whenever possible to help alleviate anxiety over food texture.
While your child’s occupational therapist is key to suggesting the best strategies and filters for your child, each member of the ABA therapy team is available to help. Together, you can implement proper techniques to target your child’s sensory systems, helping them learn to cope with anxiety and establish new skills to thrive.
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