By Rachel Revehl, FOCUS Therapy Parent
Earlier this year, prior to the pandemic, one of our son’s speech therapists from FOCUS approached me with what seemed at the time an absurd idea: Would we consider allowing him to do some of his speech therapy sessions via teletherapy? He’d be a great candidate, she said. She also thought it might help us with our busy schedule.
That last part was tempting, but…
“Um, thanks,” I replied. “But, I just don’t think that would work for him.”
Seriously, how could it? He would NEVER sit for a full session without a therapist physically in front of him, I thought.
Our Therapy Journey
Our son was diagnosed with autism spectrum disorder and ADHD at 18-months-old, beginning our journey of intensive therapy schedules, specialist appointments, IEPs and support groups. It was an overwhelming time simply because of what we didn’t know: Whether he would ever speak, have meaningful relationships or achieve the same things as other kids.
I’m a bit sheepish to admit now, but when we first started therapy, I didn’t realize parents weren’t encouraged to sit in on every therapy session. At the time, though, no one said anything. So I sat in the corner of the room, quietly watching, observing like a fly on the wall, careful not to interject. And I learned SO much about the techniques and strategies the therapists were employing to help my son talk and tackle the functions of daily life. As I absorbed all this information, I began to grow more confident in his abilities. My own too. For all the difficulties and hurdles we faced, we were also discovering all the AMAZING ways his mind works. He could do this. WE could do this.
Later, I stopped going into his sessions, but still watched as day after day, week after week, month after month and year after year – slowly (and sometimes in fits and starts), he began catching up to his peers. Therapy really does work!
Faithfully after each session, FOCUS therapists would fill me in on all the details of what they worked on, challenges they faced and ways we could practice greater consistency and carryover at home and in school. Still, I did find that I sometimes missed seeing some of the progress in action.
Then came the pandemic. School closures. Day care closures. Therapy center closures. Suddenly, the only way he was going to continue to get therapy services for a time was through teletherapy.
“Well, here goes nothing,” I thought.
Luckily, FOCUS already had a teletherapy department up and running. In fact, it had been featured in Florida Weekly just weeks before the clinic was forced to temporarily close. I considered us fortunate that we had this stop-gap, an imperfect, temporary solution to an all-around bad situation. And for some parents, it turned out to be exactly that. But for us, it turned out to be a wonderful, eye-opening learning experience.
Why Occupational, Speech Teletherapy Works for Us
Initially, I was not convinced it would go well. But to my surprise, for the most part: He loved it. Not every time, of course. I certainly can’t pretend it’s been without its challenges. But truth be told: In-person therapy has its challenges too. Some days are good, and others… well, you know.
But teletherapy gave me an opportunity to gain deeper insight into WHY some days were better than others – and how we could be active participants in improving it.
I first began studying the practice of teletherapy in general. I found ample and growing research that for many kids, teletherapy can be just as effective as in-person therapy. It depends on the child, the diagnosis, how far along they are in their treatment, etc. It’s not for everyone. But for some kids, it’s every bit as good as seeing a therapist face-to-face. It does sometimes require a little more parent involvement during sessions, but if we’re being honest: It’s not like in-person therapy works well either if parents expect the therapists and kids to do all the work.
Worth noting: Teletherapy is very different than sticking him in front of a video game or a movie (something about which I was worried). The whole session is interactive. The point is to get him engaged and talking. There are clear expectations. The therapists set up visual schedules and rewards systems. He enjoys choosing his “stickers,” picking out fun backgrounds for the therapists or checking off his achievement boxes one-by-one. In sitting nearby, clacking away on my own computer, I realized I once again had the chance to passively observe, to soak in the techniques his therapists were using – why they were using them, what worked and what didn’t.
Sometimes, I’m simply within earshot while his therapist handles the whole session, start-to-finish. Even just hearing in the background the terminology they use, seeing the way he responds, observing the importance of his visual schedules and rewards – all of that naturally finds its way more into our day-to-day vocabulary and interactions with him, resulting in better carryover of the skills they’re trying to teach him.
Other times, I need to jump in to give some physical redirection or hand-over-hand assistance. But I’ve found that these moments have meant valuable, hands-on learning for me as much as my son. The therapist guides us through the challenges in real time, and those lessons are more prone to stick.
I also began to better understand the importance of something his occupational therapists had been gently pressing me on for months prior to our switch to teletherapy: A more consistent sensory diet. They had asked a few times (ok, more than a few) if I might consider stopping at the playground with him before in-person sessions to allow him to burn off some energy so he could better focus during therapy. Time-wise, it didn’t seem realistic. But as I watched during teletherapy – I witnessed the HUGE difference it made when he spent just 10 to 15 minutes prior to a session playing guided “heavy-work” games like bear crawl races or jumping jacks contests. It wasn’t that I didn’t believe what his therapists were telling me before. I just always felt so pressed for time, and I didn’t appreciate the significance of the cost-benefit. Actually seeing it – doing those exercises with him during a session, realizing how simple it could be and what a difference it made – compelled me to make it much more of a priority.
Now, it’s something we make a point to do not just before therapy, but any brain-intensive activity. What’s more, we actually have a bit more time to devote to this because teletherapy allowed us to eliminate the back-and-forth trips to the clinic every other day. As my husband and I are both small business owners, that aspect alone has granted us a lot of relief, especially during such a stressful economic time.
To be fair: I fully recognize our positive experience isn’t shared by everyone. For some kids and families, in-person therapy services are critical. Many were desperate for them to return, and for their sake, I’m grateful that they have. I do look forward someday to our son returning to the clinic, at least part-time (if nothing else for all the great hugs I know he’s missing out on!). But for now, as our family continues to social distance and we embark on at least another year of virtual learning, FOCUS teletherapy has proven a vital lifeline for our son and our family. I expect to continue at least some of his services via teletherapy, even after the threat of the pandemic has fully passed. I can confidently say: I’m no longer a teletherapy skeptic.
FOCUS Therapy is an excellent teletherapy source if you live in Florida and are interested in giving it a try.
FOCUS Therapy offers speech, ABA, physical and occupational therapy for children in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online for more information.
More Blog Entries:
FOCUS Now Offers Online Speech Therapy for Kids in Fort Myers, Feb. 18, 2020, FOCUS Teletherapy Blog
Many of the children we treat at FOCUS have some sensory processing issues. These are difficulties organizing and responding to information that is “read” through the senses. Some kids are undersensitive (sensory seeking), some are oversensitive (sensory avoiding) – and some are both, depending on the sense and stimuli. When a child has trouble managing sensory input, it can have a significant impact on learning and everyday life. One of the things our Fort Myers occupational therapists frequently recommend to help children with sensory processing issues is called “heavy work.”
Heavy work is a strategy we use in therapy and recommend to parents to target a sense called proprioception, with the ultimate aim of:
- Improving attention and focus.
- Decreasing defensiveness.
- Helping to calm/regulate.
Heavy work can actually benefit all children, not just those with sensory processing difficulty. Our occupational therapists have found it especially helpful to have kids do heavy work just before or at the very beginning of our sessions.
There are many established benefits to giving children regular household chores. From an occupational therapy perspective, this holds especially true for children with special needs.
Some of the known upsides include:
- Establishing routine. Having chores on a set schedule can help reduce anxiety, improve focus and even avoid meltdowns. Many kids on the autism spectrum, for example, feel more secure when they know what to expect next. Chores assigned at the same time each day or day of the week or after certain activities can make for smoother transitions. Visual schedules can help with this too.
- Teaching valuable life skills. This includes learning the task itself but also responsibility. Children with developmental delays and other conditions may need more practice with certain things and sometimes modifications are necessary, but never assume they can’t just because of their diagnosis. Talk to your occupational therapist if you have questions.
- Contributing to the family. No matter what a child’s abilities, there are always ways to help out. It also gives children confidence and a sense of accomplishment.
- Development of fine and gross motor skills and sensory integration. Chores require use of either big muscle groups (gross motor skills) or careful hand-eye coordination and finger manipulation (fine motor skills). These are things our Fort Myers occupational therapy team is probably working on with your child. Chores are a good way to practice and reinforce those skills.
Worrying about your child’s safety is something with which all parents are familiar. If your child is typically-developing, these concerns usually lessen as he or she gets older, becomes more mature and gains better judgment and safety intuition. However, children with autism and other special needs may be delayed in acquiring the skills necessary to navigate unsafe situations – if they are able to acquire them at all. That doesn’t mean there is nothing we can do. There are many ways that parents, caretakers, teachers and public safety officials can work together to create safer environments for children and adults with autism – both for individuals and on a broader scale. It is also something we can work on with our young patients in occupational therapy and ABA therapy at FOCUS.
Safety skills are life skills – and they are important. However, there is no single approach to safety that is going to work for every single child on the autism spectrum – because every person on the spectrum is different. Plus, some safety issues might be present throughout a person’s life, some might build over time, some may fade and others could become more complex. Like any other life skill, safety skills will take time, effort and different approaches to master. That’s why we advise early intervention with therapy and frequent practice.
Learning to read is not simply about gaining knowledge. Literacy (which is not just reading but writing, speaking and listening too) touches everything we do, from finding our way around to learning new things to staying informed. It’s one of the core ways in which all of us engage, communicate and connect. When a child has reading difficulties, it can result in anxiety, frustration, social isolation and even depression. One longitudinal study of 4,000 students found that kids who don’t read proficiently by third grade are four times more likely than proficient readers to drop out of high school. Pediatric occupational therapists work to support child literacy and help kids who are struggling to learn how to read.
Literacy often begins at or even before birth. Many kids are exposed to books and stories before they even know what to do with them. Sometimes for children with disabilities, it’s tougher because their early years are filled with doctor appointments, day care issues, therapies and other challenges. This is beyond the family’s control, but it unfortunately leaves less opportunity for literacy development.
Our Fort Myers occupational therapists at FOCUS work with many children who have a broad range of challenges that can interfere with learning to read and other aspects of literacy. It could be fine motor skill problems that impact one’s ability to manipulate a book. It could be a visual processing difficulty where the child has trouble tracking pictures or letters in a story. It might be auditory processing difficulty, where a child struggles to process and understand what he hears. They may have attention problems that make it hard to sit long enough in a lap to read a book. It could also be sensory issues like tactile defensiveness that make it arduous to interact with printed materials or writing utensils.
The way we address it in our OT sessions is first to break down these challenges into bite-sized pieces that can be addressed in smaller steps. From there, we turn our attention to finding what interests the child. Then we incorporate activities and tools that will help strengthen their abilities.
Recently in Fort Myers, Heights Elementary School unveiled a new “sensory room” to provide “brain breaks” for exceptional student education (ESE) pupils. Smaller-scale versions of this are open at two other Lee County schools, according to FOX4. Our FOCUS occupational therapists hope this is just the beginning of a new trend at Lee County Schools – and elementary schools throughout Florida and across the country.
Schools are noisy, busy places overflowing with all kinds of stimuli: Florescent lights, echoing sounds, lots of people in close quarters, lingering cafeteria smells, brightly-colored walls and more. All of this can be quickly overwhelming to children with conditions like autism spectrum disorder or ADHD.
The human brain is designed to produce and regulate responses to our sensory experiences – those we see, touch, taste, hear and smell. “Sensory integration” is how we refer to this link between our brain activity and behavior. For children with certain developmental disorders, the way the brain processes these senses can cause significant discomfort or distress; the brain either overreacts or doesn’t respond adequately. When a child has difficulty regulating their sensory stimuli, it’s called “sensory processing disorder,” which can lead to all sorts of negative behaviors that can be a discomfort to the child and a disruption in the classroom.
Sensory rooms in schools can be a practical solution, providing calming, safe spaces for children with an array of sensory needs. As our FOCUS occupational therapists can explain, a child whose sensory diet is adequately fed will be MUCH better equipped to relax, focus and get down to the actual business of learning.
“No-Brush” Tooth-Brushing, Sensory Toys & Other Quick Fixes: Consult a Fort Myers Occupational Therapist First
Recently, a FOCUS Fort Myers occupational therapist was asked about a Facebook advertisement for a “no-brush toothbrush.”
“You know how much (my child) struggles with brushing their teeth. Would this help?”
Another recent inquiry involved an ad for a sensory toy that claimed to be, “perfect for children with sensory processing disorder.”
It’s not that there is anything innately wrong with these products. It’s true that for some kids, they might be really beneficial.
The key word is, “Some.” There is no one-size-fits-all answer, and these parents did the right thing by asking their child’s OT first.
Most children have at least a little anxiety about the dentist. The bright, fluorescent lights, sharp tools, the smell/taste of oral products, touch on the face and mouth and masked strangers – the combination would have anyone on edge. For those with special needs – especially those with sensory disorders – going to the dentist can seem an overwhelming impossibility. The good news is a combination of occupational therapy to prepare a child AND the increasing availability of pediatric dentists giving special consideration to patients with disabilities makes these necessary visits not only possible, but successful.
How Dentists Are Trying to Improve Services for Patients With Special Needs
The American Dental Association reports there are a significant number of people with developmental and cognitive conditions that can make dental procedures or even routine visits very difficult. Among young children, these primarily include those with autism spectrum disorder (95 percent of whom have a sensory processing disorder), Down syndrome and spinal cord injuries. Complexity in treating this population has led to an evolution of a whole new specialty in dental care.
When does picky eating become a disability? Fort Myers OT (occupational therapy) services for children may be necessary for picky eaters when severe aversions to certain foods morph into “problem feeding,” a significant hindrance to healthy growth and development.
Parents of picky eaters can easily feel consumed by mealtime battles. They aren’t alone.
An 11-year longitudinal study of 120 kids published in the journal Eating Behaviors revealed that at any given time, between 13 and 22 percent of kids were reported by parents to be “picky eaters.” (Other researchers have put the figure as high as 50 percent.) About 40 percent of picky eaters kept it up for 2 years or more. This was different from those who simply went through short-burst phases of strong dislike for one food or another.
Instead, as our Fort Myers OT providers have seen, truly picky “problem” eaters consume an extremely limited variety of foods, even requiring it to be prepared in certain ways. They tend to show much stronger dislike for most foods and throw major tantrums. Some simply refuse to eat.
“What we see is their pickiness is extremely restrictive,” said Fort Myers OT Krystle Hofstetter. “They’ll eat just two or three items – and that’s it.”
The good news is: We can help!
Many of our Fort Myers occupational therapists at FOCUS Fort Myers believe in a holistic approach to treating children with a wide range of delays and disorders. What that means is we focus on “the whole child,” and not just a series of symptoms or conditions – and treat with evidence-based therapeutic strategy and (hopefully, where it’s possible) avoid the need for pharmaceutical intervention. Part of this can involve essential oils, powerful plant extracts that have proven effective in a wide range of applications from boosting focus and attention to promoting relaxation and calming.
Often referred to as “aromatherapy,” (and many do smell very good), our occupational therapists wouldn’t bother to mention it if it were simply expensive potpourri. Far from a gimmick, the truth is there is real science to support the effectiveness of essential oils in numerous applications – from promoting healing in prematurely-born infants to helping a child who struggles with transitions calm and self-regulate.
Exploratory Study Promotes Essential Oils as a Benefit for Children With Autism
On analysis conducted by researchers at AirAse found that certain combinations of therapeutic grade essential oils applied topically every night for several weeks were associated with positive improvements in children’s behavioral, cognitive and emotional well-being.