When should a child be referred to an occupational therapist? (Part 2)

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7. Praxis

Praxis (also called motor planning) is the ability of the brain to conceive, organize, and carry out a sequence of tasks/actions. Praxis is the ability to self-organize. Praxis includes ideation – motor planning – task execution. Impairment here will influence gross motor skills, planning tasks, work speedand task execution negatively.

How will I know if a child has a problem?

  • Appear clumsy
  • Difficulty in learning new motor skills e.g. riding a bike, skipping, jumping-jacks, etc.
  • Struggles to follow instructions
  • Struggles to copy from the black-board
  • Difficulty in completing tasks with multiple steps
  • Difficulty in doing tasks in the proper sequence
  • Difficulty in adjusting to new situations or new routines 
  • Forgetful and disorganized
  • Need to go right back and begin again at the very beginning of the task when experiencing difficulty, instead of just ‘getting on with it’
  • Have difficulty using tools – cutlery, scissors, pencils
  • Hesitates before commencing a task

8. Sensory integration

This is the ability to modulate the 7 senses of the body to effectively function in your environment. There are 7 senses: vision, hearing, touch, smell, taste, proprioception and vestibular.

If a child over- or under-react to input in one of the above mentioned senses he will find it difficult to copy in certain situations/environments.

How will I know if a child has a problem?

Here are just a few examples:

  • Doesn’t like it when his hands are dirty (over-reaction to touch input)
  • Scared to climb jungle-gyms or jump on trampolines (over-reaction to vestibular input?)
  • Easily distracted in visually busy environments (over-reaction to visual input)
  • Easily distracted by noise (over-reaction to sound input)
  • Gets easily nauseous when smelling certain odours (over-reaction to olfactory input)
  • Loves rough-and-tumble play (proprioceptive seeking behaviour)
  • Doesn’t feel it when he has a runny nose (under-reaction to touch input)
  • Can’t spin on a swing for hours (under-reaction to vestibular input)
  • Not aware of changes in his environment (under-reaction to visual input)
  • His name has to be called more than once before he listens (under-reaction to sound input)
  • Shows under-reaction to smells that bothers other kids
  • Drops items or walks into people/furniture (under-reaction to proprioceptive input)

9. Proprioception

This is the internal GPS of the body. It helps us to know what our body parts are doing when vision is occluded e.g. to walk in the dark from your room to the bathroom or to walk from the back of the classroom to the front without bumping into other kids/furniture. It further assists us in knowing how hard/soft we are doing movements and with timing of our movement.


How will I know if a child has a problem?

  • Plays to rough/’hard’ with other kids and is then seen as a bully
  • Strokes the cat/dog to ‘hard’
  • Drops objects
  • Breaks toys without meaning to
  • Sits ‘hard’ on a chair scraping it backwards on the floor
  • Pushes hard with the pencil on the paper while drawing/writing
  • Appears clumsy
  • Bumps her toes a lot

10. Vestibular system

This is the system responsible for balance and postural control and gives us the guts to climb and to explore our environment. Kids with limitations here will struggle to perform gross motor tasks, is scared of climbing/exploring and doesn’t trust their own bodies



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How will I know if a child has a problem?

  • Avoids climbing/jungle-gyms/jumping trampoline
  • Falls easily
  • The child will rather perform table-top tasks than part-taking in gross-motor tasks
  • The child doesn’t realize when he places himself in danger e.g. will climb onto the roof of the jungle-gym/onto the roof of the house
  • Is scared to place his head in the backwards position
  • Appears clumsy
  • Doesn’t like it when her feet leaves the ground – wants to be on a stable surface

11. Insufficient concentration

There is many reasons why a child’s concentration may not be sufficient. Some of the skills that show impairment, mentioned above, can be the cause.

Other reasons include:

  • Emotional trauma
  • Tiredness
  • Hunger
  • Physical illness/pain
  • ADHD/ADD

One of the biggest reasons for insufficient concentration these days are children with insufficient postural control. Kids don’t play outside enough anymore and thus the proprioceptive- and vestibular systems doesn’t develop adequately. Before a child is taken to a doctor to be diagnosed with possible ADHD, please let an occupational therapist evaluate the child’s postural control before a miss-diagnosis is made.

10. Other reasons to refer a child for an occupational therapy assessment

  • The child reacted immature – cries easily, struggles to separate from mom/dad, can’t handle conflict, can’t handle criticism, cannot adapt to the class routine, etc.
  • If a child struggles to cope with the demands of his current grade i.t.o. reading/spelling/maths
  • If the child’s progress in his current grade is worrisome
  • If the child exhibits problematic behaviour e.g. hurts himself/other children, frequently in physical/verbal confrontations, struggles to handle their emotions, gets angry easily, has mood-swings, kids with a poor self-image, kids that struggle with impulse-control, etc.
  • Kids that struggle to sit still – out ‘busy bees’

More info on an occupational therapy assessment

A full assessment takes approximately 2:30 hours (for kids between age 5 – 12). A full report of approximately 7 pages is types and an hour feedback session given to the parents. Forms are given to the teacher and parents to complete to determine the child’s functioning in class and at home. In this way a holistic view of the child is seen.  Sometimes only a home-program is recommended but if the impairment in the child’s life-rolls/class functioning is influenced then therapy would be recommended. 24 sessions of therapy (1 hour per week) is done after which a full assessment is done again to determine progress.

The average child is seen in therapy for 48 sessions as we have to go back in development and facilitated the building-blocks that were missed. Some children finish after 24 sessions and some needs to continue for more than 48 sessions. It all depends of the severity of the impairment as well as each child’s progress.

Remember each child has the ability to improve!!

The younger a child is seen in therapy the easier it is to overcome the impairments. All kids are referred for vision-acuity and eye-muscle funtioning as well as a hearing test as this will have an immense impact on a child’s functioning if impaired.

We also refer to speech therapy, play therapy, paediatric neurologist and/or developmental paeditricians if necessary.

Services I offer

  • Assessment and treatment of dyslexia (Gr. 3 – 12)

For children 3 years and older

  • Sensory integration
  • Evaluation and treatment of kids struggling in school
  • Evaluation of kids for possible placement in a remedial/special needs school
  • School readiness assessments
  • Stimulation of expected developmental milestones
  • Evaluation and therapy for kids with learning difficulties
  • Scholastic assessments

I claim directly from the medical aid

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