OT Graduate

My daughter just went through one of those little milestones that mean a lot to parents with a quirky kid: She has officially “graduated” from Occupational Therapy.

Before I had kids, I went for adult occupational therapy for a wrist injury. But I remember the first time I heard someone refer to the sort of OT my daughter received. It was a teacher in her preschool, who told me, “Some people recommend occupational therapy for kids like her, but I can’t really tell you what they do.”

That seems to be the point of view of lots of people: I’ve heard of OT, but I’m not sure what the point is.

At its core, pediatric OT is just like adult OT. Because of an injury or birth defect, children need to learn to do things they need to do in their lives. For adults, OT sometimes results from an on-the-job injury, so the “occupation” part of it makes sense. For kids, just consider eating, playing, and socializing their “occupation” and OT plays a similar role. So a classic case for OT would be a child who needs to be taught (or re-taught after an injury) how to feed herself.

The sort of OT my daughter had, however, goes a bit further afield. It starts with an evaluation. The therapist asks the child to do all sorts of things that kids normally do: Playing activities such as balancing on a beam or catching a ball, learning activities like tracing a picture and writing words, and social interaction activities like asking an excited child to suddenly be quiet as a mouse.

Neurotypical children have no problem with these tasks, and though of course all children vary in their skills, the typical mastery of these skills has been charted so that the therapist can see how far off the curve a particular child is. Some kids are just going to be generally behind the curve, and this may not be cause for worry if their development is otherwise normal. Some kids, such as a classic child with autism, will be further behind. Other kids are on the curve or accelerated in some ways, while at the same time wildly behind in others. That’s more like my daughter.

I’ve written before about how frustrating it can be to have a child who is clearly different, but not diagnosable. Depending on who we’d ask, we could come up with an alphabet soup of diagnoses, none of them fitting her any better than the next. The great thing about OT is that although they have to give a diagnosis for insurance purposes, the OTs we worked with over the years never focused on a diagnosis and thus an expected cluster of problems. They always looked directly at the child in front of them.

I loved the guidance I got from our OTs. My daughter had some autistic-like characteristics — toe-walking, lack of understanding of social cues, out-of-proportion emotional responses — but they never just gave her some “autism package” of treatments. When she was a preschooler, I got the great advice that helped us work on some of her more difficult physical behaviors. Our first OT gave me this memorable advice: “If this kid had been born 200 years ago, she’d have been up at the crack of dawn hauling water from the well as soon as she could carry the bucket. Kids need hard, meaningful work.”

Another OT helped me understand her need for tactile stimulation, and we brainstormed ways that she could get what she needed without a) destroying our house, and b) further damaging my fragile back.

As she aged, we got a new OT who started to help her with her fine motor skills such as handwriting and typing, which were keeping her from being able to do the things that she was intellectually ready to do.

My daughter still has stuff to work on. Her most recent OT would love to get her in a group situation where she has to control her responses and practice social cues, but luckily, life provides a fair amount of those. Her handwriting still doesn’t match her academic skills, but that’s what keyboards are for! (And hopefully it will continue to improve as she grows.) But in general, she’s showing positive change in all the areas we were so concerned about.

This sort of graduation is a strange thing. There’s no one event that announces its arrival. Just one day her OT and I realize, pretty much simultaneously, that she’s ready to move on.

Today she asked, “When do I go to OT next?” and I reminded her that she’d graduated.

“Oh,” she said, disappointed. “I wish I could go back and do the zip line.”

And see her wonderful OT, Melissa, who sent her off with a hug and the promise that she’ll be there if we need her again.