With an eye toward issues of prevention and resiliency, but also with a view toward the challenges with recovery and inclusion, today’s E-Weekly explores the roles that occupational therapy and related activities may play in enhancing rehabilitation and adaptation for individuals with developmental and behavioral health disorders. The old adage that “if the only tool you have is a hammer, everything looks like a nail” can be a useful reminder that interventions such as psychotherapy and psychopharmacology are not the only interventions that can be of value for individuals with mental health difficulties.
While there are resource challenges of both time and funding for families, and continued attention to the primary treatment needs of youth with mental health disorders should never be ignored, efforts to develop treatment plans that integrate diagnostic and treatment strategies across disciplinary boundaries is a sensible approach. Though often not pursued with appropriate vigor, occupational therapy approaches can aid in identifying neurosensory, emotional regulatory, and cognitive ‘style’ considerations as part of the diagnostic process and can assist in identifying and promoting relevant social and emotional competency building experiences that can be incorporated in therapeutic intervention strategies to enhance self-esteem, social skills, and overall well-being in conjunction with psychological and psychopharmacologic interventions .
Two clinical examples:
- ADHD: Providing parents, teachers and the affected youth with a better understanding of their unique strengths and challenges in attending and in executing cognitive functions can often lead to the development of viable strategies in learning and can reduce feelings of helplessness.
- Anxiety: Recognition of an individual’s heightened sensitivities and reactivity to various environmental triggers can assist parents, teachers and the affected youth make choices about how to modulate exposure to stressors and to define social and recreational regimens that accommodate a youth’s individual needs.
Following are abstracts culled from the American Occupational Therapy Association’s Fact Sheet on this theme.1
“Participation in meaningful roles (e.g., student, friend, family member) and activities (e.g., sports or hobbies) leads to enhancement of emotional well-being, mental health, and social competence. Social competence for children and adolescents includes doing what is necessary to get along with others, making and keeping friends, coping with frustration and anger, solving problems, understanding social etiquette, and following school rules. Recent studies indicate that behavior and social interaction skills (i.e., social competence), are stronger indicators of academic and lifelong success than academic skills.” 2
An occupational therapy evaluation can “assess all the components of social competence and determine whether a child’s motor, social-emotional, and cognitive skills; ability to interpret sensory information; and the influence from home, school, and community environments … impact” their “ability to meet the demands of everyday life.3 ”
“Occupational therapists use a client-centered evaluation process to develop an understanding of the child’s primary roles and occupations (activities), such as play, schoolwork, and age-appropriate self-care. A client-centered assessment for children also requires interaction with school staff, parents, care providers, and community members. Therapists then seek to determine what factors affect the child’s ability to meet the demands of these roles and activities and fully participate in them.”
“Interventions are used to promote social–emotional learning; regulate overactive or underactive sensory systems; collaborate with families and medical or educational personnel; and more. For example, occupational therapy practitioners can help the child incorporate sensory and movement breaks into the day to enhance attention and learning; and provide support to teachers and other school staff by breaking down study tasks, organizing supplies, and altering the environment to improve attention and decrease the effect of sensory overload in the classroom. Occupational therapy practitioners can also provide programming to establish social competence through planning and development of playground skill groups, bullying prevention, social stories, and after-school activities.”
“Occupational therapists … also collaborate with adults in the child’s life:
- Parents or care providers—to provide education about the social-emotional, sensory, and cognitive difficulties that interfere with a child’s participation in play, activities of daily living, and social activities; and to help develop emotional supports, structure, and effective disciplinary systems
- Educators and other school staff—to develop strategies for a child to successfully complete classroom, recess, and lunchroom activities, and to interact effectively with peers and adults
- Counselors, social workers, and psychologists—to provide insights into the interpersonal, communication, sensory processing, and cognitive remediation methods that aid emotional and social development
- Pediatricians, family physicians, and psychiatrists—to support medical intervention for persistent mental illness and to provide a psychosocial and sensory component to supplement medical intervention
- Communities—to support participation in community leisure and sports programs; encourage education, understanding, and early intervention for children with mental health problems; and develop advocacy and community programs for promoting understanding of the mental health diagnosis and decreasing stigma”
“Ultimately, the goal of” occupational therapy “intervention is to promote successful participation in” activities “that characterize a healthy childhood and set up the child for success throughout his or her life. Occupational therapy practitioners” can “help to promote safe and healthy environments for learning, growth, and development by addressing both physical and mental health.”
Bottom Line: Judicious consideration of the potential benefits of referring an child and family for an occupational therapy evaluation and maintaining a focus on enhancing all elements in a child’s home, school and community environment can be important considerations in treatment planning and implementation in the face of underlying mental health and developmental difficulties.
1 Fact Sheet: Occupational Therapy’s Role with Mental Health in Children and Youth
Lisa M. Mahaffey, MS, OTR/L, for the American Occupational Therapy Association. copyright © 2016
2 Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early social-emotional functioning and public health: The relationship between kindergarten social competence and future wellness. American Journal of Public Health, 105, 2283–2290. http://dx.doi.org/10.2105/ AJPH.2015.302630
3 Arbesman,M., Bazyk, S., & Nochajski, S. (2013). Systematic review of occupational therapy and mental health promotion, prevention, and intervention for children and youth. American Journal of Occupational Therapy, 67, e120–e130. http://dx.doi.org/10.5014/ajot.2013.008359