As Occupational Therapists working with children, our focus is on developing a solid foundation for skill development. The pyramid above is often used to explain this approach.
Children are frequently referred to us because they are experiencing challenges with the areas at the top of the pyramid, e.g. difficulty learning, difficulty executing daily activities such as dressing, bathing etc. or behavioural difficulties.
We are trained in understanding the various aspects that contribute to skill development. When working with children, this enable us to evaluate a child’s ability to participate effectively in their environment and achieve the desired outcomes indicated at the top of the pyramid. Our aim/ approach is to determine the underlying components that are contributing to a child’s difficulty in achieving certain skills, rather than teaching them how to do something.
To use a simplified example, two learners may be referred to occupational therapy because they are having difficulty with writing. When evaluating each of the learners, the occupational therapist finds the following:
- The first learner’s difficulty stems from delays in their sensory motor development (the green layer of the pyramid). This is seen as the child has not yet developed an appropriate awareness of both sides of their body and therefore has not yet developed a dominant hand, resulting in frequent swapping of their hands when attempting to write as well as poor awareness of their body position in space etc. These aspects need to be addressed before a child can even begin to develop the perceptual-motor skills required for writing.
- The second learner’s difficulty with writing stems from delays in their perceptual motor development (the yellow layer of the pyramid). This is seen as the child has difficulty coordinating their eye movements in order to visually focus on details, either on paper or in their physical environment. This child has difficulty visually monitoring what they are working on and would have difficulty accurately perceiving as well as making sense of visual information. It would make sense that this child has difficulty executing tasks such as writing.
Writing, along with other skills, is a complex task that relies on sound development of a number of underlying components. These components need to be appropriately integrated before a learner can achieve success in this area.
Once the occupational therapist has evaluated the child’s performance, they are able to determine the underlying components that are impacting on the child’s difficulty executing the task. This enables to occupational therapist to tailor their treatment approach accordingly as well as ascertain whether adaptations or assistive devices may be beneficial.
This approach ensures that the underlying foundational skills are addressed/ appropriate accommodations are made in instances where improvement is not expected. This is important as these components frequently overlap and combine to facilitate appropriate output (the red layer of the pyramid). Our approach as a result, is not a “quick-fix” as it takes time to develop the pathways required for successful skill development. The benefit, however, is that, laying a good foundation ensures that the child is able to transfer the underlying components to new activities, e.g. if they have developed appropriate bilateral coordination skills, this can be used in all activities requiring this skill.
– By Nicole van den Berg