Does my kid need occupational therapy?

January 26, 2020 6:20 PM

My five-year-old is a little inflexible and a lot shy with her peers. Her other parent thinks this means she needs occupational therapy services. I do not. I’d like some informed feedback about who’s right.

YANMKOT, but maybe YAAOT? My daughter is a young five and in pre-K, a bright and verbal kid, a bit of a worrier, and pretty shy with peers and clingy with adults. Her teachers say she’s on track with learning and development.

Her other parent and I got a long, ugly divorce over the years she was three and four. During the time her family exploded, she changed from a preschool she’d been attending since she was a baby to a new school with some yucky social dynamics, she moved into two new homes in new neighborhoods, and she must have been aware that I and her other parent were both pretty angry and stressed out. She went to play therapy for support for part of this time, but the methodology was not what she needed, and it was a real waste of time and money. She has loving, nurturing relationships with both me and my ex, but we really, really dislike each other, and she’s not far out from some really destabilizing experiences.

Now, Kid is great in one-on-one play dates with peers, but often freezes up and isolates herself in bigger or unfamiliar groups. When lots of other kids are around, she often chooses to play by herself, but not always. If one of her parents is there she gets clingy - I give hugs and encourage her to go back to the group, and I understand my ex deals with this in a less...boundaried way. She sometimes will and sometimes won’t go back and join in.

Kid also has some challenges verbalizing feelings and dealing with frustration. When a friend she’s playing with does something she doesn’t like, she gets agitated and upset, and last week she bit a kid who took a toy from her - something she hasn’t done in at least a year. I’m working with her on self-soothing and frustration management, but it’s slow going.

My ex feels Kid has trouble with normal transitions between activities. I’ve seen her hesitate to jump into a class if most of the other kids are there, for example, but the transition problems my ex talks about don’t happen when she’s with me. I think they come down to different approaches to boundaries and expectations.

So my ex believes Kid needs occupational therapy because her current set of behaviors won’t be acceptable when she starts kindergarten next fall. I think she’s little, introverted, and coming out of a recent hard time, and I don’t agree that she needs extra services.

Who’s right here? I’d prefer feedback primarily from people whose kids have received OT, whose kids have been like this and have not received OT, and people who have relevant knowledge and insight. Thank you!!

posted by centrifugal to Human Relations (16 answers total)

As a parent who watched her much older kids shaken by a much less contentious divorce than what you describe, and afterwards benefit a lot from therapy: I think your little person would benefit from supporting guidance from a wise and insightful adult, with lots of experience with child development, who is not one parent warring with another parent.
posted by Sublimity at 6:26 PM on January 26, 2020 [25 favorites]

I am an OT student, so not an expert, but I know enough to try and answer this. I mean, it sounds like she could use some form of extra support and help. She's been through a Big Stress (as I'm sure you well know) and she is absolutely picking up on the continued animosity between you and Ex. The sooner you get her help, the sooner she can start reaching her full potential and blossoming.

Is it OT? Maybe. I don't know. There simply is not enough information here to answer that definitively. The only thing that raises some red flags for me is the fact that she bit another child. It sounds like she is around 4/5; most kids who bite have stopped by that age. It's possible that she has some tactile defensiveness, which can cause kids to react violently to other kids who come too close to them. If that is the case, she undoubtedly needs OT before the problem gets worse. But is that why she bit him, or is she just young and slightly traumatized (I know that's a strong word but it sounds like the separation was contentious and affected her) and reacting accordingly? I don't know.

It can't hurt to get her screened, not at all. OT is FUN! They get to use swings and do crafts and cuddle in heavy blankets and all kinds of other fun stuff. Plus, the school will only pay for it if she absolutely, utterly needs it, so you don't need to worry about enrolling her in a therapy that would otherwise been unnecessary.

Regardless, she's struggling, and there is nothing wrong with getting help, even for a kid this young. I was a kindergarten TA and I saw so many kids who had different struggles with emotional regulation, social skills, etc. Kindergarten (or earlier) is a fantastic time to address those issues because they are still so young and still developing regularly. Kindergarten sets the tone for their entire schooling career. You don't want to start it off on a bad note. I saw so many parents of kids who were really struggling in a school setting just assume that their kid will grow out of it. They won't, not always, and sometimes the problems just get worse. It cannot hurt to try some counseling, too, to see if it makes her life easier.

Good luck.
posted by Amy93 at 6:33 PM on January 26, 2020 [8 favorites]

Response by poster: Before I step away and let people answer, I want to be really clear that my ex and I both did a good job of not getting the kid involved in our divorce - there was absolutely no triangulating, no making her a messenger, she’s completely unaware that we fought over her in court for over a year, etc. Divorce stinks, but no one made it her problem. Ok, carry on.
posted by centrifugal at 6:42 PM on January 26, 2020

A good OT screen can’t hurt and may pickup if something else is going on (won’t go into details I’ve shared here before, but our OT picked up on something behaviorally significant long before anyone else in the medical community did).

Plus worse case your kid has a fun time and maybe your school district provides some additional support (handwaving the details but both my kids have IEP’s and have had various OT supports that have been very useful).

Also every OT we’ve worked with (maybe 5 or 6 by now) has been awesome and caring and we have learnt so much from just watching how they interact with our kids (or even seeing how our kids like something heavy on them - watching how they react to all the different OT devices has resulted in us buying some things for home our kids love to play on and burn energy on).

Finally there is no shame in going to OT - a lot of kids do it for everything from “little Timmy is finding it hard to use a pencil” to serious physical issues and everything in between.
posted by inflatablekiwi at 6:43 PM on January 26, 2020 [2 favorites]

I was a kid like this. I would have absolutely benefitted from OT and did not get it. You say your daughter has no idea about any of the strife, but even so, in the best of scenarios, parental divorce is characterized as a childhood adverse event for a reason. Yes, it's better in the long run for her parents to not be married to each other, but it's still really a trauma.

Please send your daughter for the evaluation. If the qualified professional agrees with you that your daughter does not need services, you will get to be internally righteous. If the qualified professional recommends services, you will know that you put your kid's best interest ahead of your own preferences.
posted by bilabial at 6:55 PM on January 26, 2020 [32 favorites]

Also - you mentioned play therapy. If you mean something like PCIT - my experience is OT is completely different - and where as my kids hated PCIT with a passion - OT is something they love and get a lot out of. They are excited to go because they get to jump and do weird crazy things with their body - but the OTs I’ve worked with are great at just responding to what the kids want to do, mixing in activities to help with both fine and gross motor skills, and just knowing when our kids need a break or to go faster, or just need a squeeze or a weighted blanket on them. They introduced us to the concept of “heavy work” that really calms and regulates both my 5 and 7 year olds (hello kids snow shovels!). They have really helped with social interactions - our kids are more aware of their bodies and what they need to do to be more regulated when in a group activity.

I’ll stop here (other than thanking any OTs reading or posting - you are awesome!). I could go on for hours.
posted by inflatablekiwi at 6:56 PM on January 26, 2020 [1 favorite]

I've done OT with two kids. In my opinion it is one of the closest things to true magic that exists in this world while being evidence-based.

Given what you describe, I would for sure get an OT evaluation for your daughter. The evaluation will tell you a lot, including how much your daughter might benefit from OT.

It will also likely give you and your ex structured things to do to help her during transitions, and this will likely improve your co-parenting because you will be more on the same page.
posted by medusa at 7:04 PM on January 26, 2020 [12 favorites]

Response by poster: Sorry, one more clarification - pre-K is at a private preschool. So we can’t make the school district do or pay for anything, unless there’s something I don’t know.
posted by centrifugal at 8:03 PM on January 26, 2020

Early intervention often nominally operates through school districts but all children that live in the district can be screened for services. My kid went to a Catholic preK but early intervention came out and screened all the children and provided services to all who qualified.
posted by soren_lorensen at 8:08 PM on January 26, 2020 [3 favorites]

You can still get services while enrolled in private preschool (at least in California), but after she enrolls in private kindergarten/elementary schools you cannot receive services (therapies, an IEP etc). You still have the right to be screened/evaluated through the district’s Child Find program and will be offered services if she were to enroll in public school. We did this for my son’s speech therapy, he received speech at the school while he attended private pre-k for two years. There is no harm getting evaluated and districts are notoriously hard to get services from so if you do find out she qualifies then you’ll know she really could benefit.

I also work for a program screening kids for developmental and social emotional delays. There are screening tools like the ASQ that can tell you if her development/social emotional functioning is on track or if she could benefit from an expert evaluation. Your pediatrician may offer this screening and some preschools do as well. It’s a short questionnaire for the parent to answer and can at least give you an idea if a full evaluation is worth looking into.
posted by wilky at 8:24 PM on January 26, 2020

Big life changes, like moves and and school changes can really impact a kid without a divorce . They can really impact adults as well! It's not anyones fault that change is hard!

I'm a social worker, in general I err on more services when younger. I enrolled my kid in early intervention when her speech was a bit behind, and within 6 months she was caught up which just means she saw some very nice people for a bit for no good reason. Probobly if we'd just waited her speech would have caught up on her own. But that doesn't mean the experience was useless. I enjoyed it, the team provided lots of useful feedback and new ways to play with my kid, and she seemed to enjoy it as well.

An assessment is a couple hours of your time for some clear feedback. I think it's worth doing. I think the feedback will be way more valuable than internet feedback, I also think that support for parents and kids isn't in general a bad thing. It's not a judgement on parenting styles, or life events. It's about dedicated time to trying new ways to teach kids skills so they navigate this complicated world successfully.
posted by AlexiaSky at 10:15 PM on January 26, 2020 [4 favorites]

Mine had art therapy for 6+ months due to signs of emotional stress during a contentious divorce. She was shielded from the worst but picked up how stressed her parents were. A child who is moving between two very different households where both parents disapprove of each other's parenting styles (little kids pick up on unspoken disapproval easily) is hard for them if they aren't good with transitions. Mine would act one way at one household than another because of differing reactions to her outbursts. It took third-parties vouching for her stress to get agreement on what she needed because she was so different with each parent. She still is but - she chooses now and is much happier and more resilient now thanks to that therapy and other OT support and diagnosis.

The assessment process mostly ends up being feedback on what specific strengths and difficulties your kid has, and parenting strategies and ideas they can teach you to use regularly with your kid and advice for school.

My ex and I differed on extra intervention. He was/is a wait-and-see person, I push and worry. Looking back, I absolutely think pushing is the right approach to take if you have children. They change so fast that you need to intervene early, and the good therapists have waiting lists (Crackpot places are pricey with no waiting list as a rule of thumb). Looking back with my young adults, I wish I had gotten more therapy intervention, not less.
posted by dorothyisunderwood at 11:57 PM on January 26, 2020 [1 favorite]

My kid had occupational therapy because of a known SPD. But I would recommend it for anyone whose children are having trouble adjusting to specific situations. Because it gives the kids and you concrete tools to deal with their difficult situations. It empowers them to find ways to be more confident in those situations.

Looking back at my parents' divorce, I think my mother was resistent to me getting therapy because she felt that a kid needs therapy only when things are going Very Wrong with their lives, so wrong their parents can't handle it. So it was an indictment of her Doing Things Wrong to ask for therapy.

But, you know. OT makes it easier for kids to learn how to handle their life stressors. Sure, you don't HAVE to make it easier for them, they'll probably get there eventually, but why wouldn't you, if you can afford it.
posted by Omnomnom at 12:56 AM on January 27, 2020 [7 favorites]

I went to OT for 3 years as a kid due to issues with getting my eyes to focus on text and a general clumsiness/lack of coordination. I felt weird and singled out for going at first but then really began enjoying the sessions because it helped me get better at the things that frustrated me. Fast forward to high school where I was in AP classes and known for my dance moves. Some kids just need some extra attention from a supportive adult specifically trained to deal with these issues.
posted by caveatz at 8:15 AM on January 27, 2020 [2 favorites]

So my ex believes Kid needs occupational therapy because her current set of behaviors won’t be acceptable when she starts kindergarten next fall. I think she’s little, introverted, and coming out of a recent hard time, and I don’t agree that she needs extra services.

Who’s right here?

I'm going to get a little meta for a moment here and say wait wait, "who's right about what?"

Are you right that kiddo has a more difficult time with transitions under your ex's parenting style?
Is your ex right that the kiddo's behaviors won't be acceptable for kindergarten?
Is your ex right that that the kiddo needs OT?

I am personally much more sympathetic to your assessment of your child sounding well within the range of normal for her age and personality. But it also sounds like a lot of parents upthread say that OT could really help her navigate her feelings and expectations about interacting with the world, especially since she's been through some stress.

So, it's not necessarily true that there's something "wrong with her" or that her behavior is unacceptable for kindergarten and needs intervention the way a broken leg needs a cast -- but maybe your ex does happen to be correct that OT is a thing that kiddo will find particularly useful and beneficial. (Even if his rationale feels grating to you.)
posted by desuetude at 11:58 AM on January 27, 2020 [5 favorites]

Your state/ school district has a child find mandate.
posted by oceano at 12:51 PM on January 27, 2020