What is Attention?

Attention is the ability to obtain and sustain appropriate attention to a task. This can be influenced by motivation, self-esteem, sensory integration and language difficulties. Effective attention is what allows us to screen out irrelevant stimulation to focus on the information that is important at the moment.

What are the necessary elements to build Attention and how does Occupational Therapy help?

The main building blocks for attention include:

• Sensory Processing
• Self-Regulation
• Auditory Processing
• Motivation
• Environment influence

Occupational Therapists will consider and combine all elements, such as environmental factors, sensory-related needs and play skills to target attention from the child, tailoring these factors to the needs of each child.

The teacher says that my child is not holding the pencil the correct way. What can I do to correct it?

Development in pre-writing skills begins around 1 year old when children are exploring with different writing tools, such as crayons, markers, etc. while scribbling and doodling. As children grow up, their grasp on the writing tools become more refined and controlled. An Occupational Therapist is able to observe how the child holds a pencil and assess their control and how it impacts writing. Besides determining the type of grasp the child utilises, considerations will be given to the child’s endurance, pressure on paper and postural control and sensory issues. Intervention through Occupational Therapy may include postural control, sensory issues, fine motor strength and motor coordinationA, development of age-appropriate grasp and endurance training to facilitate the ease and legibility of writing.

My child does not like to colour/colours all over the paper/applies different pressure when colouring. What can I do?

Colouring is a simple and fun activity that most children enjoy. However, when it is broken down, there are several components involved. Visual attention is required to locate the lines and boundaries between the different areas. Fine motor control is needed to colour in different areas and still stay within the line. The ability to integrate sensory feedback from the paper is required to know how much pressure to apply when colouring. If it is a big picture, endurance is required to finish colouring the entire area. 

Darkening or bolding the outline of the picture with a marker increases the contrast and allows your child to become more visually aware of the spaces within. Colouring by numbers is a good way to way to limit the number of colours used (too many colour pencils/crayon options may be distracting). The numbers also provide a visual cue to the boundaries and which colour to use for different areas. An Occupational Therapist can identify the specific area your child is struggling with and provide personalised strategies to implement at home.

I cannot tell if my child is left-handed or right-handed. Should I force my child to use one hand over the other?

It depends on your child’s age. During the early years, children use both hands to explore the environment and to manipulate things around them. Hand dominance begins to develop around 2–3 years old and should be established around 5–6 years old. It is recommended to allow children to use both hands (and to switch between both) in the early years to promote fine motor dexterity, bilateral coordination and integration. 

Switching hands during activities may also be a sign of fatigue. A good indication of hand dominance is the quality of manipulation and dexterousness of each hand. An Occupational Therapist can assess your child’s fine motor skills and development and suggest different activities to implement at home.

What are gross motor skills?

Gross motor skills are larger movements your child makes with their arms, legs, feet, trunk or entire body. Some examples of gross motor skills are crawling, walking, running and jumping.

Why are gross motor skills important in a child’s development?

Gross motor skills are important to enable children to perform everyday functions, such as sitting on the chair for tabletop   tasks, walking, running, skipping as well as playground skills (e.g. climbing, swinging) and sporting skills (e.g. catching, throwing and hitting a ball with a bat, kicking a ball). Gross motor abilities also influence other everyday functions. For example, a child’s ability to maintain upright posture during tabletop task  (upper body support) will affect their ability to participate in fine motor skills (e.g. writing, drawing and cutting) and  to attend to class instruction. Gross motor skills can have an impact on a child’s endurance to cope with a full day of school.

My 7-year-old child’s teacher has given feedback about my child’s poor handwriting quality. How can I help my child improve it?

There may be many reasons for your child’s poor handwriting. Firstly, children with sensory processing issues may have difficulties paying attention while participating in any tabletop task. They find handwriting tasks to be very challenging as they cannot stay focused on their task. Children with sensory processing issues may present with tactile (touch) and proprioceptive (joint) sense challenges which may affect their pencil grip. Another issue could be related to your child’s visual-motor integration (VMI), which includes both visual perception and motor coordination. Your child’s handwriting will be affected if they have difficulties in any of these areas. Other reasons for difficulties with writing may include your child’s low muscle tone, poor posture, inappropriate pencil grip while writing or sometimes the lack of motivation to write properly.

My 9-year-old child complains of frequent hand pain when writing a large volume of work. How can I help my child with this problem?

Children with improper pencil grips, especially when applying too much pressure on the pencil to grip it while writing may result in muscle fatigue in the hand muscles, thus causing hand pain. Another reason may be that your child’s proprioceptive senses (joint sense) are poor and may have difficulty gauging how much pencil grip pressure is needed when writing. As a result, too much pencil pressure may be applied, resulting in pain. Hand pain when writing could also be caused by weak hand muscle, which would require your child to apply increased amounts of pressure on the hand muscle to hold the pencil properly.

What basic skills does a child need for preschool?

The child should be able to:

• Respond to their name when called and follow basic verbal instructions, such as sit down, give a high-5, etc. 
• Indicate simple needs, either by words or by taking an adult’s hand. 
• Have joint attention with adults and other children in order to learn.
• Sit for an age-appropriate amount of time, such as the time needed to finish a short storybook.
• Have foundational social skills, such as taking turns, waiting, sharing, etc.

How can I prepare my child for the transition to primary school?

• Help your child follow instructions in a bigger group by enrolling them in group activities, such as camps or drama classes. 
• Encourage your child to be more organised by getting them to create simple visual schedules and follow through independently. 
• Get your child to practise packing and unpacking a school bag and checking that all items are packed in the bag. 
• Ensure your child is independent in feeding, toilet trained and able to don and doff clothes. 
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• Your child should possess simple money skills so that they can buy food during recess. You can get your child to practise buying food and carrying a food tray at the food court. 

As your child reaches primary school, demand for handwriting will increase, so do ensure that your child is able to write legibly such as copy words or short sentences and maintain proper sitting posture with a good pencil grip.

What is Sensory Integration (SI)?

Sensory Integration Theory was formed by A. J. Ayers, an Occupational Therapist with advanced training in Neuroscience and Educational Psychology. She defined Sensory Integration as the neurological process that organises sensation from one's own body and the environment and makes it possible to use the body effectively within the environment.

All the information children receive from their environment arrives through the sensory systems. Most of us are familiar with the sense of smell, taste, sight and sound. There are 3 more senses that are lesser-known, namely: the sense of Touch (the Tactile Sense), the sense of Movement (the Proprioceptive Sense) and the sense of Balance (the Vestibular Sense).

The SI theory emphasises these 3 important senses:

• Tactile system detects the qualities and locations of external stimuli applied to the skin. Information from the skin, about the location of touch, pain and temperature is transferred through this system to the brain.
• Proprioceptive system refers to the sensation of movement (i.e. speed, rate, sequencing, timing and force). It is important for the development of body schemes, praxis (motor planning) and adaptive action. The information on proprioception arrives from the muscle receptors and partially from skin receptors which provide the brain with information about muscle change during movement. This allows the generation of a proper amount of force needed to act on objects.
• Vestibular system. The vestibular input contributes to posture and the maintenance of a stable visual field. The receptors for vestibular input are located in the inner ear. There is a combined impact of vestibular and proprioception input on muscle tone, posture, equilibrium and motor behaviour.

Dysfunction in Sensory Integration (DSI)

If one or more of the sensory systems are not fine-tuned to work in harmony with the rest or information from the senses is not well-processed, the child’s level of functioning might be compromised. The child may experience the following:

• Overly sensitive to touch, movement sights or sounds
• Under reactive to sensory stimuli
• High or Low activity levels
• Coordination problems
• Delays in speech or language skills
• Poor organisation of behaviour
• A poor self-concept

What is Sensory Processing?

Sensory processing is the normal neurological process of organising sensations for our use in everyday activities. We use sensations to survive, satisfy our desires, learn and function smoothly. Our brains receive sensory information from our bodies and surroundings, interpret these messages and purposefully organise our responses.

What are the red flags of a sensory processing problem?

Infants and toddlers:

• Problems eating or sleeping
• Refuse to go to anyone but their mothers for comfort
• Irritable when being dressed or are uncomfortable in clothes
• Rarely play with toys
• Resist cuddling or arch away when held
• Unable to calm self
• Floppy or stiff body
• Motor delays

Pre-schoolers:

• Over-sensitive to touch, noises, smells, other people, etc.
• Difficulty making friends
• Difficulty dressing, eating, sleeping and/or toilet training
• Poor motor skills – being clumsy, weak, etc.
• In constant motion – in everyone else’s “face and space”
• Frequent or long temper tantrums

Grade-schoolers:

• Over-sensitive to touch, noise, smells, other people, etc.
• Easily distracted, fidgety, craves movement, etc.
• Aggressive
• Easily overwhelmed
• Difficulty with handwriting or motor activities
• Difficulty making friends
• Unaware of pain and/or other people

Adolescents and adults:

• Over-sensitive to touch, noise, smells, other people, etc.
• Poor self-esteem – afraid of failing at new tasks
• Lethargic and slow
• Always on the go – impulsive, distractible, etc.
• Leaves tasks uncompleted
• Clumsy, slow, poor motor skills or handwriting
• Difficulty staying focused, e.g. during lessons, at work, in meetings, etc.
• Unmotivated – never seem to enjoy life

How will Sensory Integration (SI) Therapy help children with sensory processing problems?

It is important to conduct an assessment of the child and interview the child’s parents to identify the child’s areas of strengths and weaknesses to develop an individualised intervention plan and create a baseline for future intervention. The SI therapy is conducted mainly in a sensory gym, which includes a plethora of fun and play based equipment (swings, ladders, tunnels, therapy balls and more). The equipment provides the child with a variety of stimulation for all their sensory systems.

What will my child learn in social skills training?

Depending on the recommendation from the initial assessment, your child might benefit from individual or group social skills training. Your child will learn social skills that are required to interact with others through verbal or non-verbal (e.g. gestural, body language) communications.

To have effective social interactions with others, some of the essential social skills required include, but are not limited to:

• Joint Attention
• Eye Contact
• Following Instructions
• Turn-Taking
• Sharing
• Understanding of Emotions (self and others)
• Emotional Regulation
• Conflict Resolution
• Negotiation
• Problem-Solving

How will social skills be taught?

The social skills training sessions at Dynamics are fun, engaging and educational. In these sessions, games are used to facilitate children’s learning of various social skills. Some of the strategies used by our Therapists include: 1) Modelling, 2) Roleplay and 3) Feedback. Each session will focus on a different topic and every child has the opportunity to utilise skills learned from previous sessions. Parent(s) will be briefed after each session on their child’s progress and any follow-up home programmes.

What is Paediatric Occupational Therapy?

Occupational Therapy is concerned with a person’s ability to participate in daily activities or occupations, which include self-care, work and play. 

Paediatric Occupational Therapy

As a child enters adulthood, there is a continual adaptation to the demands of the environment and assimilation of its opportunities. The dynamic nature of this interaction is determined by the child’s internal clock of maturation as the child adapts to a changing environment. Occupational Therapy practice is based on an understanding of the interactions among children, their activities (or occupations) and their environment.

The Role of Occupational Therapy

A child’s occupational performance might be affected by developmental, physical, sensory, attentional and learning challenges. The goal of Occupational Therapy is to improve the child’s performance of tasks and activities that are important for successful school and life functioning. The Occupational Therapist is concerned with ensuring an understanding of and match between the child’s skills and abilities and the expectations placed on the child.

Who are the children who can benefit from Occupational Therapy? 

Children having difficulties in:

• Fine Motor Skills
• Gross Motor Skills
• Motor Coordination
• Sensory Integration Issues (Modulation and Discrimination of sensory input)
• Motor Planning (praxis)
• Visual-Motor Integration
• Visual Perception Skills
• Oral Motor (Oral Defensiveness and Motor Planning)

These difficulties could lead to the following concerns:

• Illegible handwriting
• Poor balancing responses
• Clumsiness
• Poor manipulation of objects and tools
• Lack of independence in self-care tasks
• Poor performance in physical education
• Unable to sit still in class
• Hyperactivity due to sensory-seeking behaviours
• Short attention span
• Feeding issues

Occupational Therapy services include:

• Assessments (screening and in-depth), such as administration of standardised tools and informal assessments that include clinical observations and short parents’ interview. An assessment is important to find out the core cause of the challenges and for the Occupational Therapist to establish the baseline of the starting point of abilities before the intervention starts and set intervention goals.
• Intervention (individual sessions)
  • The use of a child’s strength to compensate their weaknesses
  • Direct targeting of root causes of the observed behaviours
  • Modification of the environment to match the child’s abilities
  • Teaching strategies
  • Direct training in targeted tasks
  • Remedial approaches for sensory integration that may include a ‘Sensory Diet’
  • Oral Motor intervention to improve feeding and oral defensiveness
  • Advice to parents and teachers on how to better manage the child at home and in school
  • Occupational Therapy is child-directed and incorporates play for motivation and experience. It is important to design suitable challenges to provide the child with opportunities to learn and improve while not discouraging the child with failures.

Occupational Therapy sessions should be fun and motivating to allow the child to reap its benefits to learn and improve essential skills.