Does my child need OT?
Your child may benefit from OT if your child is demonstrating some of the following:
Not mastered self-help development such as:
- Bladder control (by 3 years)
- Bowel control (by 3 years)
- Toileting independently (by 3-4 years)
- Snaps independently (by 4 years)
- Buttons independently (by 4-5 years)
- Zippers independently (by 4-5 years)
- Dressing independently (by 4-5 years)
- Brushing teeth (by 4-5 years)
- Tying shoes (by 5-6 years)
- Brushing/combing hair (6-7 years)
- Bathing independently (6-7 years)
Displays difficulty with behavior development such as:
- Become easily frustrated?
- Have outbursts of uncontrolled behavior?
- Have difficulty following directions or following the rules?
- Has difficulty forming relationships with peers, making friends, or being accepted by peers?
- Display a heightened sensitivity to sensory input (e.g. touch, smell, sounds)?
- Display hyperactive behaviors (e.g. can’t sit still, hard time focusing)
- Display any of following behaviors: hit, push, bite, chew on objects, throw toys/objects, bump into things, clumsy, fall easily?
Displays difficulty with fine motor development such as:
- Do they have a hand dominance?
- Have difficulty with using eating utensils?
- Have difficulty manipulating fasteners on clothing?
- Have handwriting difficulty?
- Complain that their hand hurts during writing or coloring?
- Color within the boundaries?
- Cut out basic shapes without deviating from the line?
What is primitive reflexes?
Primitive Reflexes are automatic, involuntary movements controlled from the brain stem and executed without cortical involvement. These reflexes work on enhancing the chances of survival, growth or development, and protect a child’s body from its external environment in the early months of life. These reflexes and their functions are as followed:
- Moro Reflex - Acts as baby’s fight/flight reaction.
- Asymmetrical Tonic Neck Reflex - Reflex emerges at 18 weeks in utero and is elicited when the baby moves its head to one side. This causes reflexive extension (straightening) of the arm and leg on the side in which the head is turned, and flexion (bending) of the opposite limbs. During the birthing process, it is one of the reflexes responsible for helping babies to ‘unscrew’ themselves down the birth canal. This reflex should be integrated by the 6 months.
- Spinal Galant Reflex - This reflex happens when the skin along the side of an infant’s back is stroked. The reflex response occurs when the infant moves towards the stroked side. This is an important reflex in the birthing process and should be integrated by 9 months.
- Tonic Labyrinthine Reflex (TLR) - This reflex is essential for head management and movement helping prepare a child for rolling, crawling, standing, and eventually walking. This reflex initiates in two ways: Supine-when you tilt an infant’s head backwards when they are on their back, making the legs stiffen, straighten and toes point OR Prone-when the head is tilted forward and the hands turn more fisted with elbow flexion. This reflex should gradually integrate with other systems maturing and disappearing by about the age of 3-3.5 years.
- Symmetrical Tonic Neck Reflex (STNR) - This reflex is generally present between 6-11 months of age. It is designed to help the infant defy gravity in order to help them get up from lying on their tummy and into a crawling position. Crawling is an essential skill which helps train the child’s eyes to cross midline and learn eye-hand coordination.
What are signs of non-integrated primitive reflexes?
If primitive reflexes are retained beyond 12 months of life, this may suggest some type of weakness of immaturity of the Central Nervous System (CNS). Identifiers of potential signs of retention for each reflex are as followed:
Moro Reflex - A child with a retained Moro reflex past 4 months, may become over sensitive and over reactive to sensory stimulus. Functionally, this can appear as poor impulse control, emotional lability, sensory overload, anxiety and immaturity, motion sickness, and difficulties with balance and coordination.
Some possible long-term effects of an unintegrated Moro are:
- Easily triggered, reacts in anger or emotional outburst
- Poor balance and coordination
- Poor stamina
- Poor digestion, tendency towards hypoglycemia
- Weak immune system, asthma, allergies and infections
- Hypersensitivity to light, movement, sound, touch & smell
- Vision/reading/writing difficulties
- Difficulty adapting to change
- Cycles of hyperactivity and extreme fatigue
Asymmetrical Tonic Neck Reflex - A retained ATNR can include difficulty crossing midline from one side of the body to the other (including eye movements, such as tracking words across a page), poor bilateral coordination, affected balance when the head is turned, and lack of dominant sides (e.g. dominant hand for writing). In a classroom, a child with a retained ATNR will usually struggle with handwriting.
Some possible long-term effects of an unintegrated ATNR are:
- Reading, listening, hand writing and spelling difficulties
- Difficulty with math
- Confused handedness
- Symmetrical Tonic Neck Reflex (STNR).
Spinal Galant Reflex - Retention can impact postural control (particularly seated posture), coordination, and sustained attention.
Some possible long-term effects of an unintegrated Spinal Galant:
- Poor endurance
- Attention difficulties
- Hip rotation to one side/scoliosis
- Poor concentration
- Poor coordination
- Poor posture
- Poor short-term memory
Tonic Labryinthine Reflex (TLR) - Retention can lead to reduced muscle tone, balance difficulties, and motion sickness.
Some possible long-term effects of an unintegrated TLR are:
- Balance and coordination difficulties
- Hunched posture
- Easily fatigued
- Poor muscle tone
- Difficulty judging distance, depth, space and speed
- Visual, speech, auditory difficulties
- Stiff jerky movement
- Toe walking
- Difficulty walking up and down stairs
Symmetrical Tonic Neck Reflex (STNR) - Children who retain the STNR may not have crawled or instead walked on hands and feet, bum shuffled or pulled themselves to stand then walk. A retained STNR can present as poor muscle tone, particularly a tendency to slump while sitting, impact concentration, reading and basic ball skills.
Some possible long-term effects of an unintegrated STNR are:
- Poor, hunched posture
- Headaches from muscle tension in the neck
- Difficulty writing and reading
- Difficulty sitting still
- “W" sitting
- Difficulty copying from blackboard
- Ape-like walking
- Vision disorders
- Find it difficult to stay on task
What is sensory integration/Sensory Processing Disorder?
Sensory Integration is the brain’s process of integrating all of the sensory information our bodies are exposed to on a daily basis. The brain must organize and integrate all of these sensations if a person is to move and learn normally. It is commonly held that we have five senses: touch, taste, smell, hearing, and vision. These basic senses respond to external stimuli from the environment. The slightest change in our brain processes can influence how we manage daily living skills, academic progress and social interaction. Sensory Processing Disorder is one example of what can go wrong in the processes of the brain.
Signs of SI Problems:
The following is a description of some of the commonly seen behaviors in children who exhibit sensory integrative difficulties.
- An acute awareness of background noises
- Fascination with lights, fans, water
- Hand flapping/repetitive movements
- Spinning items, taking things apart
- Walking on tip-toe
- Little awareness of pain or temperature
- Coordination problems
- Unusually high or low activity level
- Difficulty with transitions (doesn't "go with the flow")
- Self-Injury or aggression
- Extremes of activity level (either hyperactive or under active).
- Fearful in space (on the swings, seesaw or heights).
- Striking out at someone who accidentally brushes by them.
- Avoidance of physical contact with people and with certain textures, such as sand, paste and finger paints.
- The child may react strongly to stimuli on face, hands and feet.
- A child may have a very short attention span and become easily distracted.
- strong dislike of certain grooming activities, such as brushing the teeth, washing the face, having the hair brushed or cut. An unusual sensitivity to sounds and smells.
- A child may refuse to wear certain clothes or insist on wearing long sleeves/pants so that the skin is not exposed.
- Frequently adjusts clothing, pushing up sleeves and/or pant legs.
Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may seek out intense sensory experiences, or they may have other symptoms.
"Sensory processing" refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For most people, this process is automatic. When we hear someone talking to us or a bird chirping, our brains interpret that as speech or an animal sound, and we respond to that information appropriately
Children who have a Sensory Processing Disorder (SPD), however, don’t experience this process in the same way. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses.
What does SPD look like?
There are several types of Sensory Processing Disorder; each one may result in a number of different behavioral and sensory patterns. Some of the most common behavior patterns are described below.
Some children with SPD are over-responsive to sensation. Their nervous systems feel sensation too easily or too intensely and they feel as if they are being constantly bombarded with information.
Consequently, these children often have a "fight or flight" response to sensation, a condition called "sensory defensiveness." They may try to avoid or minimize sensations, such as by avoiding being touched or being very particular about clothing.
These children may:
- Respond to being touched with aggression or withdrawal
- Fear movement and heights, or get sick from exposure to movement or heights
- Be very cautious and unwilling to take risks or try new things
- Feel uncomfortable in loud or busy environments, such as sports events, malls
- Be very picky eaters and/or overly sensitive to food smells
Some children are under-responsive to sensation. Their nervous systems do not always recognize the sensory information that is coming in to the brain.
As a result, they seem to have an almost insatiable desire for sensory stimulation. They may seek out constant stimulation or more awareness of touch or pain, or touching others too often or too hard (which may seem like aggressive behavior)
- Taking part in unsafe activities, such as climbing too high
- Enjoying sounds that are too loud, such as a very loud television or radio
Motor Skills Problems:
Other children with SPD have trouble processing sensory information properly, resulting in problems with planning and carrying out new actions. They have particular difficulty with forming a goal or idea or developing new motor skills. These children often are clumsy, awkward, and accident prone.
These children may have:
- Very poor fine motor skills, such as handwriting
- Very poor gross motor skills, such as kicking, catching, or throwing a ball
- Difficulty imitating movements, such as when playing "Simon Says"
- Trouble with balance, sequences of movements, and bilateral coordination
- A preference for familiar activities or play, such A preference for sedentary activities, such as watching TV, reading a book, or playing video games
These children may get frustrated easily and may seem manipulative and controlling. Some may try to compensate with an over-reliance on language and may prefer fantasy games to real life. They also may try to mask their motor planning problems by acting like a "class clown" or avoiding new group activities.