At what point does a child with special needs need to see an occupational therapist?
As early as possible. Early intervention brings quick results because when children grow older without therapy, they end up with deformities and severe pathological patterns which could have been reversed. It is always safe to get a referral from the primary doctor who diagnosed the condition. Sometimes I have patients who walk in for consultations. We will then do an assessment to determine if the condition requires a multi-disciplinary approach.
How does a child who is floppy from cerebral palsy get help?
We use a splint to hold the leg or neck in the desired position to prevent it from bending. If the child is not able to hold anything in their hands or stand unsupported, we bring in supportive devices. This can be with something as simple as a body corset or a jacket to hold the back and abdomen in an upright position. Other children will have to make use of sitting, standing or walking aids. Stretching and massaging helps too.
Some children with special needs like autism might have tendencies that make it difficult for them to cope, like not maintaining eye contact or having repetitive behaviour. Can these be addressed by therapy?
Usually, they don’t make eye contact because they are too busy. In the case of maintaining eye contact, a therapist can help with behaviour modification. We do this through activities that they enjoy. We use toys to teach them to concentrate, in addition to taking turns in a game and completing an activity. Structure the child’s day from the moment they wake up and go to bed. The structure will help ease their frustrations too which causes some of the anti-social behaviour. A change of diet, like avoiding food with gluten, milk and sugar also makes the child less active.
How does occupational therapy help kids learn new skills?
First, we check if their cognitive aspects have been affected or if they have low intelligence. We then expose them to a routine they can copy, by doing it repetitively so that they know that it has to be done. For example, you can teach them to clap by taking their hands and clapping. Ululating and making the clap is an activity you do often to show appreciation or congratulating them. They will then learn that this is good and they will keep doing it. You also have to be on your best behaviour for them to copy.
What is your one unforgettable case?
A certain child who was three-weeks-old was moderately stiff. Parents had lost hope after a consultation elsewhere and were told the child will be dependent on them forever. At eight months, the child achieved milestones appropriate for the age and now walks and runs. This was a 100 percent achievement because the interventions were made early enough.
How do you help a baby who is always facing one side or cannot hold up their neck, to get balance?
We stretch the neck muscles by massaging them and doing side-to-side movements, then position it with a neck collar. Sometimes, the baby might prefer facing one side due to how they sleep, or watch TV and never getting turned. We then stimulate the child by playing with them in a way that encourages them to turn their neck to the other side. Sometimes though, this can be caused by a reflex, which comes when a child has brain damage, which makes the child turn its head to one side. That dominating side becomes stronger than the other side. We then work to inhibit those reflexes and normalise the tone.
How does a child who has a short concentration span and gets tired easily, learn to concentrate for a longer period of time?
Such a child has no concentration because in their brain, things are running very fast. So, they keep touching things and can’t stay on one thing for long. Since their energy levels are so high and they are hyperactive, we engage them in high energy activities like jumping on the trampoline, swinging and you let them do what they love as you get to introduce other things. Over time, we help them learn to maintain focus on a thing for longer periods. We use age appropriate toys that help to stimulate all the five senses. A good diet can also help lower their hyperactivity therefore giving room for concentration.
How long will it take a special needs child who can’t walk to master mobility?
Every situation is different and has its own timelines. Conditions like cerebral palsy are lifelong because it has a component of brain damage. It’s impossible to estimate how long a child can manage to do something or get better especially if they come to us when the condition is already severe.
Is there specific therapy for a child who can’t keep calm, one who is hyperactive?
A good diet is important to ensure they become less active. We use play therapy to channel their focus. In the therapy, they will also learn how to clear up their playing area and stay organised. Games like catch ball improve coordination, focus and their cognitive function. Doing things repetitively helps to organise their sensory system.
What happens to, say, an autistic child who doesn’t get occupational therapy early enough?
When a child with autism doesn’t get treated and is left alone, they became ‘social misfits’ who end up becoming ‘unwanted people’ in the society. They will get frustrated as they cannot understand you and you can’t understand them. They won’t concentrate in class therefore they will not excel academically and lead a meaningful life. Those with cerebral palsy however may get deformities and end up depending on people.
Can a child be unresponsive to pain?
In autism, we have children who when you pinch them, they will tell you to do it again. They have sensory processing issues and their system doesn’t recognise pain. They don’t show emotion and might end up laughing instead of crying when pinched. You should not punish them by beating them, tell them what they have done is wrong so as not to develop defiant behaviour. You need to be patient and empathetic when dealing with them. Because they may not feel pain, they tend to bite into their skin a lot; especially the fore arms and between fingers. We advise parents to protect the areas and we can cover them with a splint so that they don’t bite their skin directly. Also avoid and manage situations that make them aggressive to an extent of hurting themselves.
What do I need to know as my autistic daughter reaches puberty?
This is problem-specific. A child with autism might not know if she is having periods and the parent has to take care of that. When we toilet train them, we make them aware of what to do if they spot blood. You need to show them what a pad looks like to familiarise them with it so that when you put it on them, they don’t resist and throw it away.
Kids with cerebral palsy have very high intelligence, so they can easily understand instructions. However, they are prone to depression because of the deformities they develop and this could ruin their self-esteem. We often do some activities to build self-esteem where they write good things about themselves so that they know they are beautiful and wanted in society.
Autistic kids can also be obsessive, especially about the one thing they are particularly good at. We maximise on using that to build their self-esteem. In some of our sessions, we also talk about relationships too because dating might be a difficult process for them.
Any special considerations for special-needs boys as they approach puberty?
For boys, we talk to them about drugs because they are vulnerable. We talk to teachers and parents to be on the lookout for any signs of drug use. For those with mental challenges, we talk to them about careers or something physical they can do if they can’t handle the pressure of being in class. We teach them to be responsible and guide them when it comes to dating as some may be hypersexual. Therapy is a holistic treatment.
By Edith Kagendo as told to Beldeen Waliaula. Kagendo is an occupational therapist at Aga Khan University Hospital