How Occupational Therapy Changed My Son’s Life…
…And taught me how to better parent a child with special needs. Here are four carefully and thoughtfully designed occupational therapy home supports that helped our ADHD family tremendously.
“Brayden, the doctor will see you now.” After 15 long months, the day was finally here: My 5-year-old son was seeing the developmental pediatrician. My heart fluttered with nervousness as butterflies swarmed my body.
I grasped my son’s hand gently and walked down the long hallway to the office. We were seated in a large room that contained three chairs, an adjustable computer desk, and toys that were too young for my son. Once the doctor arrived, we went over his growth and development with a fine-tooth comb. We indicated areas of concern and areas of achievement and carefully examined and analyzed even the smallest details in order to have a clear picture of what makes Brayden… Brayden.
After about three hours of intense discussion, we left with a diagnosis including Sensory Processing Disorder, Developmental Language Disorder, Visual Impairment, and Obsessive-Compulsive Disorder. We were referred to multiple specialists and booked several ADHD therapy appointments — including one with an occupational therapist who suggested home supports to improve my son’s functionality and behavior.
Occupational Therapy for Kids with ADHD
It was a cold and windy afternoon when I took my son to meet our occupational therapist. We arrived early and sat impatiently in the waiting room until “Dr. Cici” arrived. She was a petite woman with long brown hair and thin black glasses. She introduced herself, shook my hand, and led us back to our room to go over the expectations for therapy. Right away she started observing Brayden, noting each nuance and inflection in his voice, in order to gauge his comfort level and formulate a plan. She suggested a sensory-integrative approach since the environment is designed to tap into the child’s inner drive to play and will give him the opportunity to actively pursue achievable goals.1
Each week, she introduced a new goal and technique to help him improve a different aspect of his life. I watched her mannerisms, tone of voice, and body language before I attempted to apply her techniques at home.
Occupational Therapy to Improve Attention
One of the first goals that Cici established was, “improve his attention span.” I watched as she guided Brayden from the blue squishy mat to the table, ignoring his resistance and redirecting his attention to the fun and colorful game she set up. The three of us sat at the table and played Super Slam: A tabletop basketball game where you use your finger to launch a ball at a hoop. We took turns, used encouraging words, and had fun as we laughed and played at the tiny table. Once our session was over, Cici instructed me to play more games at home in order to improve his focus and attention. I left feeling confident and hopeful.
The next night I orchestrated a family game night. I ordered takeout, turned on a movie, and grabbed three different board games from my basement shelf. I arranged all three games on the table and called my family over so the festivities could begin. We began with the game Break the Ice because the objective was simple and the turns were short. I gave my son the little mallet, and with one hard flick of his wrist, he knocked down his first piece of ice. The whole family shrieked with excitement, “Great job, Brayden!”
I smiled and instructed him to pass the mallet to his sister so she could have a turn. He looked at me, then looked down at the mallet, and with a sharp resonance in his voice he said, “No!” and started whacking at the ice again. I firmly advised him to stop and pass the mallet along, but he refused and continued to smash and bat at the game. He continued this behavior until all the ice pieces were gone and the game was over. My daughter started crying, my son started yelling, and my heart began to break. This wasn’t the family fun I had envisioned.
At first I didn’t understand why our night ended so miserably. I followed Cici’s instructions and mimicked her tone and behavior perfectly. Why didn’t he listen like he did at therapy? I began to question my parenting style and ability to take advice and direction successfully since everything ended so horribly.
Reflecting back on this experience now, I realize that the night ended so miserably because I made a mistake: I set up an environment that was way too challenging for a child with Sensory Processing Disorder. I overstimulated him by saturating the air with delicious Chinese food, turning on the TV, which illuminated the room with sound and light, and arranging way too many colorful and engaging games. I set my son up for failure because I forgot one of the most important lessons of the day: environment.
When Cici transitioned from that blue squishy mat to the tiny table, she put all distractions away and only concentrated on the miniature basketball game perched on the table. I did the opposite of what she taught me without even realizing it. If home supports were going to work, I would have to remember these small details in the future.
A few days later, I decided to try again. I waited until it was just the two of us at home so the environment would be calm and gentle. I set the game KerPlunk up in the living room, turned all the screens off, and put all the toys in their labeled bins. I escorted him to the table and explained the rules and expectations in hopes that this approach would have a better impact than the family game night. I took the first turn, so I could model the appropriate conduct, then set my shoulders and said, “Your turn.” I feared the worst possible outcome, but then something miraculous happened: he followed the rules and happily played the game.
He patiently waited his turn and giggled as he pulled a stick and watched the balls fall from the cylinder and onto the floor. Before I knew it, I had sustained his attention for a full 10 minutes without him even noticing. That moment was a huge revelation for me because not only did I alter my parenting strategy to fit his individual needs, I didn’t give up. I didn’t let the fear and rejection I felt earlier in the week stop me from trying again. I came to the realization that if I wanted to change his behavior, I would have to try and fail numerous times in order to succeed even once.
Occupational Therapy to Improve Anxiety
In addition to improving Brayden’s attention, we also wanted to “improve his anxiety.” When we arrive at therapy, we follow the same routine, sit in the same chair, and answer the same question. I always support this cycle because when his ritual is disturbed, he becomes restless and acts out. These disruptions then affect our session and hinder any progress or improvement that can be made.
Cici picked up on this right away and promptly developed ways to alleviate his anxiety in our sessions. When he would get “stuck” on certain habits or obsessive thoughts, she would simply talk through it with him. Instead of answering his question, “What’s the sound?” she would ask him, “What is that sound?” When he would answer her question, she would move on to the next task. She made it look so easy and offered me some communication ideas, coping strategies, and a book to read in hopes that this would help reduce his anxiety at home. I left feeling very uneasy and unsure how I could combat this on my own with only a few strategies and an unread book.
This uncertainty came to the forefront when I arrived home from therapy that day. We walked into the house and Brayden dashed to his room and closed the door. When he emerged, he was wearing his Spider-Man pajamas. He ran down the stairs, looked in the mirror for a few moments, then ran right back to his room and shut the door. A few moments later he reappeared with his Iron-Man pajamas on. He came down the stairs and made a quick lap around the living room, then headed back to his room to put on his Black Panther pajamas.
At that point, I became a little concerned because he was changing his clothes every thirty seconds and looked very distressed during the activity. I had never seen him do this routine before, and I realized that he was participating in a ritual. Rituals are the ways that children undo the bad feelings or ward off danger.2 To be honest, I didn’t know how to handle it. I asked him to pick one pair of pajamas and come downstairs or he would get in big trouble, but he couldn’t stop changing. He put the same four pairs of pajamas on continuously for the remainder of the afternoon and I had no idea how to help him.
I then referred to some of the relaxation techniques that Cici mentioned, like turning down the lights, closing the blinds, and lowering my voice. It didn’t work. I then asked him why he was changing so much. He ignored me. My last hope was to reference the book she suggested, but flipping through the fine-print pages I couldn’t find the answers I was looking for. All of a sudden, I felt very irritated and resentful towards our therapist because she didn’t properly prepare me for this episode. She was able to calm his anxiety, so why couldn’t I? I was becoming increasingly frustrated as the day went on and the outfit changes persisted.
Reliving this moment is very difficult for me because I placed blame when it wasn’t anyone’s fault. It wasn’t my son’s fault for changing so much; he couldn’t help it. It wasn’t Cici’s fault; she provided me with some useful tips to pacify his anxiety. And it wasn’t my fault; I’m not an expert. The problem is that I didn’t have the patience, explanation, or experience that I needed to understand his compulsion and help him through it. I was comparing myself to a trained professional and then getting angry when I didn’t achieve the same results. Going forward, I need to remember that I’m not going to master every single technique the second I learn it. I need to give myself time.
It’s been a few months since this incident, and I have learned so much about how to soothe my son’s anxiety. First off, fighting OCD is hard work and the techniques that I have tried have not always been successful. One thing that has helped has been shifting my perspective and understanding that Brayden is not trying to be oppositional when he has his episodes. When he continuously changed his pajamas, I kept asking him why he was changing, which intensified his anxious behavior and made us both angry. I should have just left it alone! Staying calm and collected and understanding what OCD is has turned out to be one of the most important steps I can take in helping him learn to live with his anxiety.
Occupational Therapy to Improve Gross Motor Skills
Another goal that Cici set for Brayden was, “improve his gross motor skills.” She noticed that he had low muscle tone and poor motor control, which affected his ability to move around and take care of himself. He struggled with balance, coordination, and lifting his body off the ground for more than a few seconds without getting winded or crying in frustration.
So we spent our session stretching, sliding, and climbing on the child-size rock wall. We hoped that we could build his stamina and strength with a new environment and interesting equipment. We made sure to offer positive praise and celebration at every feat so he would be encouraged to continue. The day was effortless and productive, so my homework was to build on those skills and come up with creative solutions that would improve his muscle strength and coordination at home.
I immediately enlisted the help of my husband and daughter. I figured any rough-and-tumble play that involved brute strength and audacious behavior was perfect for them. I instructed them to grab a laundry bin, a few balls, the gymnastic mat, and head to the basement. To kick things off, we configured a handcrafted game of basket toss. My husband picked up a ball, flung it across the room, and landed it perfectly in the white plastic laundry bin. “Score!” Both my husband and daughter screeched with excitement and picked up more balls to fling towards the bin.
I anxiously watched as Brayden got very confused by this new “game” that used his laundry basket as a toy. I could see his tension building and he looked like a teapot about to boil and whistle on the stove. He stalked over to my husband and said fiercely, “Dad, stop doing that!”
I immediately grabbed his hand and proceeded to walk toward the stairs when I heard my husband’s voice echo from behind me, “Honey, go upstairs. I’ve got this.” I remember standing there for what felt like an eternity while my body and mind wrestled with the question; Do I go upstairs and let him handle this or do I pull my son out of this environment? My instinct was to remove him from the situation. After all, I’m the one who’s home with the kids all day, don’t I know them best? I felt like there was no legitimate way to answer this question since I was uncomfortable with both scenarios.
The only thing I could do was remind myself that therapy was going to push us all out of our comfort zone, so I needed to try something new. I apprehensively walked upstairs leaving my son, daughter, and husband behind. A few moments later, I peered downstairs and saw my family laughing, playing, and giggling as they launched balls across the room and rolled around on the mat. Brayden wasn’t screaming or crying. He was happy.
This unexpected and welcome surprise made me self-reflect on my natural instincts as a parent. If I had listened to my intuition and brought my son upstairs, then he would’ve missed out on an opportunity to improve his motor skills, increase his comfort zone, and have fun with his family. Looking back, the hardest aspect of that moment was going against my instinct as a parent. My gut was telling me to remove him from the environment, but my head was telling me to trust my husband. A huge reason we enrolled in therapy was to improve his life by learning new strategies and techniques. I realized that if I wanted things to change then I would have to, on occasion, ignore his social cues and go against my innate desire to shield him from intimidating situations. I would have to start challenging our comfort zone.
A few weeks later, I put this theory to the test when my son was invited to a friend’s birthday party. It was one of those ninja warrior parties where children are challenged with obstacle courses, rope ladders, and warped walls. We opened the front door and were immediately bombarded with screaming children, loud music, and colorful decorations.
My son flashed me a hesitant look and said, “I wanna go.” I paused for a moment to evaluate the best course of action. Before therapy I would’ve said okay and left. This time I needed to try something different. I knelt down, looked my son in the eye, and said, “Bray, you are going to have so much fun. Let’s go over and see what they are doing.” Once I gave him that reassurance, everything changed. He dashed over to his friends and jumped over the wedges as if they were mountains and he was a conqueror. I had never seen that much strength or courage in him before. In fact, the smile on his face said it all.
Over the past few months I’ve gotten better at analyzing uncomfortable situations by asking, “Can he handle this?” instead of “Is he uncomfortable?” I now understand that removing him from an environment is more damaging than helpful because it doesn’t teach him how to deal with difficult feelings or overcome adversity. I also recognize that my parental instincts are not always going to be right. From time to time, I’m going to face tough choices and will need to rely on my knowledge and skills from therapy to either guide me in the right direction or lead me to mistakes that I can grow and learn from.
Occupational Therapy to Improve Behavior
Another essential goal that Cici established was, “improve his behavior.” She observed on numerous occasions Brayden’s frustration and resistance to new tasks, as well as his need to ask the same question over and over again, so she introduced me to some tools to aid in behavior management.
She began therapy by walking over to a steel metal cabinet that had pictures of toys laminated and taped to the front of the door. She reached inside and pulled out a box of chalk, a visual timer, and a stapled packet of papers. I watched carefully and took note of her skill and proficiency as she utilized a large chalkboard and a timer that “showed” when our session was over.
She drew pictures of smiley faces when he would listen and ears when he ignored a directive. She set timers to indicate when it was time to move on and referred to her stapled packet for self-regulation ideas when he would get angry or dismissive. I was stunned at the serenity and responsiveness that suffused the room that day and couldn’t wait to set up something similar at home; especially since a very popular night was just around the corner: pizza night.
Pizza night is the best night because there are no plates, no silverware, and no rules. My family and I sit on the couch, watch a movie, and squeeze in as much hot and cheesy pizza as our mouths can handle. Over the years, we have learned that there is one law that must never be broken, and that’s uttering the word “pizza” before it’s officially pizza night. If I even say the P-word, it consumes my son’s mind and he will continuously ask, talk, and think about pizza. He will say things like, “Is it time for pizza?” at 7:00 a.m. or “I want the pizza now!” at 7:05 a.m. It’s a vicious cycle that gives everyone, especially my son, unwanted stress and anxiety.
With pizza night fast approaching, I went online and purchased a few of the items Cici used in therapy. I bought a small dry erase board for my fridge and a visual timer for my living room. I waited until my son went to bed and then drew a visual schedule for the following day. I etched a couple of eggs, a school building, and a pizza on the glossy dry erase board. I put numbers in front of each item and a little checkbox next to the pictures to help him understand the sequence.
When my son woke up, I broke our law and told him it was pizza night. His little face turned red and his whole body started shaking. “Pizza… I love pizza… Can I have pizza now?” I was a bit nervous that this would turn into one of those continuous question moments, but I calmly directed his attention to the board. I pointed to each number and picture and told him that, once we were done with one activity, we could check the box. He quietly listened, stared at the board, and nodded his head in agreement. When I finished speaking, he repeated the sequence back to me, finished his eggs, and headed to school with no mention of pizza.
When he arrived home from school, I used the visual timer and turned the little clock hand to one hour. This timer is similar to an hourglass but instead of a slow trickle of sand, a red disc fills the entire clock face and slowly disappears as the hour passes. He watched the timer gradually turn from red to white and then asked politely if pizza was on the way. I couldn’t believe it. The supports worked.
This was a pivotal moment for me because it gave me hope that therapy was working. I have spent weeks trying to implement foreign techniques into my daily routine with little to no success, which left me feeling powerless and inadequate. To finally see all that hard work produce something positive was exciting and the boost I needed to carry on. For the first time, I saw my son’s mind and body work together in perfect harmony because I employed two very simple tools. That day I learned how capable I was as a parent, which isn’t something that therapy, a book, or a class could’ve taught me. I had to learn and experience it on my own.
Occupational Therapy Tips for Parents
This entire experience has been a whirlwind of emotions. There were times when I felt incompetent and helpless and other times when I felt empowered. I’ve learned that altering even the smallest detail can make a world of difference, that trusting your natural instinct isn’t always the right answer, and testing new strategies or techniques may surprise you. There is never going to be a right or wrong way to introduce something new into your household, you just have to try.
For other parents going through something similar, the best advice I can offer is to never give up hope and be patient with yourself. In the beginning of this process, I was comparing my capabilities to a trained and skilled occupational therapist, which only put pressure on myself and my child. Leaning on family members for help and guidance is so critical, especially when skepticism and doubt creep in, and you need reassurance that you are doing things right. But most of all, it’s important to understand that what works in one environment doesn’t always work in another. Techniques should be altered to fit your unique parenting style so you can find the balance, support, and patience that works for you and your family. If you do, you may discover something new about your child and yourself in the process.
1 Schaaf, R., & Miller, L. Occupational Therapy Using a Sensory Integrative Approach Children With Developmental Disabilities. Ment Retard Dev Disabil Res Rev. (2005) https://www.ncbi.nlm.nih.gov/pubmed/15977314
Updated on August 28, 2019