Thursday, June 29, 2017

HD: The Start of Our OT Journey

If you look at HD and watch him for a while he looks like a normal kid. That's because he is a normal kid - his brain just processes things differently than a typical kid's brain. He is so so so smart too but he often can't show it on paper. Ultimately I want him to have friends and I don't want him to struggle with school. But reality is often not what we want it to be. When it was first suggested that HD could benefit from a little bit of occupational therapy, I didn't even know what occupational therapy meant. What do they even do at occupational therapy and how could he benefit from it? I'm not even close to the right person to answer those questions, so I'll just give you my view of it.

What is occupational therapy?

The best way it's been described to me, it was posed as a question. "What matters to you?" is the question being asked by therapists, not "What's the matter with you?" In our case, engaging in good social behavior (you know, stop pushing and shoving when you're excited and such) was one thing that mattered to us. Occupational therapist are there to help with those problem areas by giving them tools to use to build skills to help them with everyday life. While I've only had experience with pediatric OT's, they aren't limited to just helping children succeed - they are able to help people of any age.

I don't openly tell people that my son goes to therapy, but occasionally it comes up in conversation. I'm not ashamed of the fact that he goes, but I personally have had a negative connotations when I heard the word "therapy" and I can't help but to believe I'm not the only one with those same feelings. More so, I always feel the need to explain why he's going after people give me the "he looks normal" look. Again, he is normal, and I don't want him treated like he's not normal. We're just trying to develop some of his skills that are a little bit behind what is typical for his age.

What did OT look like for HD when we first started?

I was really nervous going to our evaluation appointment. I had brought all the forms and questionnaires I was asked to fill out. As our OT looked through them, HD busied himself with Legos and Ms. Gail played quietly with the kitchen set in the corner of the room. HD was calm and collected as the evaluation began. Honestly, this was the ONE TIME I didn't want him to be. I wanted his OT to see what I was dealing with. It was a bit frustrating for me.

What the therapist did see, that I overlooked though, occurred while HD was building Legos. There was a small bin of pieces and a stack of cards for him to look at and then build what he saw. He built the designs for quite a while until it got too hard and he quickly gave up. Now that it was pointed out to me, it was very obvious that when posed with a challenge, he quickly gives up and wants nothing more to do with it. This is very common with his school work too, which in turn causes a strain on his academics.

After pushing the Legos aside, he went over to check out the kitchen with his sister and immediately grabbed something from her without asking for it - and he was mean about it. That behavior is very common with him. He struggles a lot with aggression. It often starts by grabbing things without asking, and then leads to pushing, hitting, or kicking when he doesn't get his way with his siblings. JP had quickly learned to defend himself, and as they get older, their fighting tends to get so much worse. One of my concerns for the therapist was HD's aggression. I didn't want to bring Ms. Gail with me to the evaluation appointment because I knew that it would inevitably lead to problems, but in this instance, I'm slightly happy it did. Just earlier in the year at the end of 1st grade, HD was suspended from school for choking two students on the playground and later kneeing one in the crotch. I needed help with his aggression.

Because we didn't have a lot of time left before we moved, we weren't able to work on a lot. In the short amount of time that we did have though, HD made significant progress. I sat in on several sessions with him and his OT so I could have a better understanding as to what they were doing, and what he was learning. Because aggression was a significant concern for us, our therapist opted to work on developing his awareness for his emotions first. To do that we watched and discussed "The Emotional ABC's." We watched about 10 minutes of the movie each week and then talked more about what each feeling looked like in his life. I was surprised as to how hard he often struggled to name feelings and emotions. No wonder he's had problems expressing himself!

To help with his emotional impulses, we started using the "Pause, Rewind, Play" toolbar to have him start thinking about his actions. For example, say JP throws something across the room and hits him with it. Before he reacts, he needs to pause and breathe.  Then he needs to think and name the feeling he's feeling as he rewinds, and think about the correct way to respond. Did it hurt? Is he mad? Was JP mad when he threw it? Then he needs to "play" and react appropriately to the problem. What ways could he respond? Throw it back at him? Hit him? Use his words? It's a big process for him to go through in a matter of seconds. At home while he was still learning the steps, I explained to him that if he was ever in a situation where he didn't know what to do, to yell " PAUSE!!" and I would come running to help him go through the steps together. If he was able to successfully call for help and react appropriately, he'd get a little prize from me. It could be as a little as an M&M but it worked. Don't get me wrong, there were still times when it didn't work. It wasn't fool proof, but it was part of the learning process.

As each session would begin, HD and his therapist would come up with a visual plan for their meeting. Using a dry erase board, together they would draw out pictures to describe what they were going to do, and for how long, while using a timer to keep them on task. (He didn't even know he was working on time management & awareness.) Even though HD didn't necessarily want to watch the Emotional ABC's video, knowing that time in the gym would happen later made watching the video more tolerable for him.

To give him credit, the gym was pretty sweet though. There was a small ball pit, a rope swing, a zip line, and a matted area at the bottom of a rock wall, to name a few things. I don't know if HD had a favorite because he loved them all. He especially loved the zip line though. At the end of it, he would let go and crash into the ball pit.
He also enjoyed taking a scooter down a ramp. Crashing through a tower of blocks and then hitting the padded wall at the end was often a highlight for him. He loves crashing into things and throwing himself on the ground. I didn't understand it, but he loved it.

Perry has been leary about occupational therapy for HD. By the time HD started his sessions, Perry was already living in Portland so he wasn't able to see first hand what HD was doing. Ask HD what he did at therapy and he'll tell you he played the whole time. But that's what OT's do - they do work through play. Playing IS work for kids after all! I can see his hesitations though.

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