Occupational therapy is one of those professions where the job description is hard to define. If you ask some people what it is, a typical answer would be that an occupational therapist is someone who helps you get a job. Another common response is that O.T’s help treat fine motor issues. Very few people really understand the nature of occupational therapy.
The profession really began when Eleanor Clark Slagel, a social worker, began treating patients who were veterans of World War I. We would say today that they had post traumatic stress disorder. Ms. Slagel found that if you kept the patient engaged in meaningful activity, their mental health improved. Their minds were kept occupied in this manner. Activities such as basket weaving, leather lacing and lamp making were introduced. Thus we have the confusion over fine motor skills. It was not the skill per se she was working on, but a way of eliciting better mental health. Today the goal of occupational therapy is to optimize the patient’s activities of daily living (ADL’s). This necessitates working with patients with mental health problems, patients with physical disabilities, and patients with sensory processing problems. A baby or child’s job is to play, and go to school, as well as to socialize. Whatever problem might affect those issues is the domain of the occupational therapist. An adult needs to manage their personal life as well as perform on the job. If anything impairs these abilities, it is also the domain of an occupational therapist.
O.T. education programs are divided into mental health and physical disabilities. The mental health curriculum includes information about all diagnoses covered by the DSM IV (Diagnostic and Statistical Manual). Classes include information about medications and their side effects, and about which medications benefit which condition. The physical disabilities education curriculum includes anatomy (dissecting a cadaver), physiology, neurology, kinesiology, spinal cord injury and cognitive dysfunction. Many courses are taught by physicians. Once class studies have ended, the therapist needs to do an internship in both mental health and physical disabilities settings. Employment depends on passing a certification exam.
What all this means is that the occupational therapist is highly trained in many areas. Because O.T. is so broad based, it might seem a little confusing to people not in the medical field. The best way to understand the scope of occupational therapy is to understand how problems can impact activities of daily living. For example, if you injure your arm, how does that affect your ADL’s? Well, if you can’t put on or take off your clothes, or can’t brush your hair, or can’t prepare food, it is a problem that needs to be treated by an O.T. The therapist’s job would be to rehabilitate the arm via exercise, and to retrain the muscles so that ADL skills can be restored to the pre-injured level.
So this is a long introduction to the real topic, which is about parenting a child who needs O.T. services. Over the years I have had the opportunity to treat very rare conditions and severely involved babies and children. I have probably treated hundreds of patients. What I found is that often times one of the biggest issues in the success of the therapy was in the behavior of the parent. For many years, I worked with a PT who was very good. We shared a case with a very involved baby who had ACC (agenesis of the corpus collosum). The disorder essentially meant that brain function was impaired. She also had myelination problems, which meant that her muscles were very weak. From day one the PT and I had a pretty good idea of what was wrong with this child. And for over a year, the mom insisted that the doctors said she was going to be okay. One day, while I was in the bathroom, I saw a medical report that had been forgotten on the sink. Of course it described in detail the official diagnosis – which is exactly what we had thought all along. Either the mom didn’t think we could figure out ourselves what was wrong, or she was in denial, but her refusal to discuss openly what was wrong affected the therapy sessions. We couldn’t treat her daughter as aggressively as we thought she needed, because the mom refused to admit anything was seriously wrong. Every time we broached the subject, the mom dismissed the conversation.
Conversely, I have had cases where the child had no marked issues and the parent was “over-treating”. The mom would insist that there was something seriously wrong with her child, and she would spend time and money visiting doctors and specialists in an attempt to validate her beliefs. All the attention and medical intervention made the child nervous and high strung, which added to the mom’s convictions.
Having a child with a problem, albeit large or small, can bring out a lot of personal issues with a parent. Family dynamics and unresolved emotional issues are entwined with the child’s condition. If a parent is in denial, the child doesn’t get appropriate treatment. If the parent “needs” to make the problem bigger than it is, such as the case in Munchausen by proxy, then the child is at risk as well. This is a condition whereby a parent literally makes their child sick in order to gain attention from the medical community and others. Parents whose attitudes are “what did I do to deserve this” can manifest in oppositional behaviors from a child who otherwise might be “normal”. Moms or Dads who get frustrated or angry with their child because of their child’s physical or emotional problems only serve to exacerbate the problems. Labeling a child who is not ADHD, but has hyperactive and inattention symptoms, into the ADHD category can stigmatize the child and cause self-esteem issues.
The overarching point I am trying to make is that an occupational therapist’s training is sufficient for them to sift through all the extraneous issues and recognize the true nature of any child development problem. I have never treated based on verbal report by family. I will listen to what they say, and observe the family interactions with the patient, but my treatment is solely based on symptoms and clinical observation. If there has been a conclusive diagnosis by a specialist based on quantitative information, rather than qualitative, I will use that as well to guide treatment. But I have learned that parents can be too emotionally tied in to be able to give accurate advice. I listen to their concerns, and I empathize with their situation, but my responsibility is to my patient, and to administer appropriate care. My education gave me the tools that I need to be confident in my treatment.
