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Occupational Therapy’s Role in Improving Self-Care Performance in Children

The role of the occupational therapist, when working with clients of any age, is to support participation and daily functioning. For a child, one of the primary occupations is self-care. Self-care Blog-Self-Care-Skills-Main-Landscapeskills, which include feeding, toileting, dressing, bathing and grooming, are classified as Activities of Daily Living (ADL’s), because they are a critical part of a child’s overall health and participation each and every day. In order to participate in self-care, a child must have component skills within a variety of performance areas, and delays in any of these areas can make seemingly simple tasks feel nearly impossible.

During an initial evaluation, an occupational therapist will help you determine which performance deficits or barriers within the child’s environment are causing your child to struggle with self-care. The OT will first obtain information by asking you questions about your home setup, your family’s routines, what kind of assistance your child currently needs to perform age-appropriate self-care skills, and what your goals are in terms of self-care independence.

These questions will help the therapist obtain a snapshot of your child’s current self-care performance and provide more information about the home environment in which your child is performing. The therapist will also complete a comprehensive evaluation of your child’s underlying skills through clinical observation and standardized testing to determine potential causes of delayed self-care skills.

Below are a variety of performance areas an occupational therapist will assess that could contribute to self-care performance:

  • Motor performance: A child’s physical ability to perform the motor tasks required for a self-care skill is dependent on his or her strength and endurance, range of motion, body awareness, grasp, manual dexterity, and bilateral coordination. In addition, a child may have decreased motor planning, or difficulty generating an idea for and executing a specific movement pattern.
    • Example: A child may be unable to tie his shoes because he cannot maintain a pincer grasp on the shoelaces.
  • Executive Functioning and Attention: A child may have difficulty sustaining attention to a self-care task, sequencing the steps of a task in an efficient order, or remembering when and how to do the task at all.
    • Example: A child may not be able to remember or mix up the order of steps to tying shoes.
  • Sensory Modulation: A child may have decreased sensory modulation, or ability to filter out irrelevant sensory stimuli. Children with poor sensory modulation may be hypersensitive to input, which can often make children very uncomfortable in their own skin, easily distractible, or easily upset and overwhelmed. Other children may be hyposensitive and not notice certain important sensory input. You can read more about how sensory processing impacts self-care and hygiene in one of our other blogs, “Horrible Haircuts and Terrible Toothpaste” http://nspt4kids.com/occupational-therapy/horrible-haircuts-and-terrible-toothpaste-helping-your-child-with-sensory-processing-disorder-tolerate-hygiene/
    • Example: A hypersensitive child may be bothered by the feeling of their socks and refuse to wear tie shoes; a hyposensitive child may not notice that his shoes feel or look funny when on the wrong feet.

Once the evaluation is complete, the occupational therapist will be able to determine if the child would benefit from ongoing occupational therapy. Future treatment would focus not only practicing specific self-care skills, but also engaging in activities that facilitate the overall development of underlying motor, sensory integration, and executive functioning abilities. In addition, the therapist will work with you to adapt your child’s environment through the use of home modifications, visual supports, and adaptive equipment to support performance. Through all of these modalities, the occupational therapist will be able to increase your child’s participation in self-care activities, thereby increasing his or her independence and overall development.

Check out one of our previous blogs on self-care written by a Board Certified Behavior Analyst: Self-Care Skills for Children with Autism

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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Self-Care Skills for Children with Autism

Self-care skills such as brushing teeth, washing hands, and dressing are important for children to learn Blog-Self-Care-Skills-Main-Landscapeas they affect their everyday lives. For children diagnosed with Autism, they often experience delays in learning these skills and may need a different way of teaching to acquire them. Using some behavior analytic techniques, these skills can be taught in an appropriate way suitable for your child to be successful.

Is your child ready to perform self-care skills?

  • Component skills: In order to ensure success with the desired self-care skill, make sure that your child can perform the basic skills necessary for the task. For example, for the skill of brushing teeth, this may include: pincer grasps, holding a toothbrush, moving a toothbrush in a back and forth motion, spitting out toothpaste, squeezing toothpaste tube, gargling water.
  • Attending: Can your child pay attention and tolerate the duration of the skill?
  • Complexity of composite skill: Can your child put together the component skills to perform parts of the desired task?

If your child is unable to perform the component skills, attend to the desired self-care task, or combine component skills, work on building up this repertoire before moving forward. Providing help and lots of positive reinforcement with these tasks will make learning the desired skill easier!

Now that your child is ready, how can you teach your child to perform self-care skills?

  • Chaining: This strategy involves breaking down the steps of the skill into multiple pieces. Once the steps are broken up, teaching can occur by linking steps together.
    • The steps can be linked together from the beginning of the skill. For example, brushing teeth can begin with allowing the child to put toothpaste on the tooth brush and run the tooth brush under the water. The rest of the steps of the skill can be prompted by an adult. As the child becomes more independent with the first few steps, more steps can be added for him or her to perform independently as a chain.
    • Steps can also be linked from the end of the skill. For example, for hand washing, you can have the child wipe his or her hands independently on the towel. As the child becomes more independent with that skills, you can also introduce turning off the water to the chain of steps. All the steps prior to those mentioned steps can be prompted by an adult.
  • Social Stories: These stories outline the appropriate way to engage in the desired task. Each page can describe the steps and how to complete the skill. They can be in the form of videos, audio, or written (with pictures). Each child may respond better to one form over another.

What supports can you use with these strategies?

  • Visuals: You can provide visuals of each step of the task posted in the location that the skill will occur in. For example, with hand washing, some pictures can include turning on the sink, hands under the soap dispenser, or rubbing hands with soap. Modeling the skill before the child engages in the skill may also help the child learn by imitating your actions.
  • Physical prompts: You can physically guide your child with your hands on top of theirs to allow them to get used to the motion of the task. Then, you can reduce your physical prompts (e.g., move your hands to their elbows or moving farther away and pointing to the correct step) until they can complete the skill independently.
  • Vocal prompts: You can vocally instruct the child to perform each step as they are performing the skill. Then, you can fade your prompts until they can do the skill independently.

Working on the component skills independently until the child can easily and reliably perform them can greatly increase their success with putting those steps together. A combination of different supports listed above can provide a way for you to teach your child how to engage in complex self-care skills. Providing and fading your physical and vocal prompts can take some practice. It may be beneficial to work with a BCBA to ensure the success of your approach and the acquisition of these skills.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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