How an Occupational Therapist Can Help Your Anxious Child

January 31, 2017

What is Occupational Therapy?

Occupational therapists often visited my special education classroom throughout the school day.

It wasn’t until I interviewed an occupational therapist, for an article on weighted blankets, that I learned the benefits occupational therapy offers an anxious child.

I shared my lack of knowledge with Brenda Richards, OTR/L, an occupational therapist and co-owner of The Center for Lifeskills in Solon, Ohio.  I told her my conception was that occupational therapists assisted with zippers and buttons and shoe-tying and using utensils.

Brenda laughed and said that most people think occupational therapists find people a job…at least I knew they worked with developing fine motor and life skills.

Apparently, there are many common misconceptions about occupational therapy.

“Occupational therapy, in its most basic definition,” explains Brenda, “is helping people participate in everyday life skills, whether that is teaching a skill, working to rehabilitate a skill or modifying the environment to better support the client’s needs.”

Brenda continues, “Occupational therapists look at children (and adults) in a holistic manner.  We can tackle things at all angles to make the child comfortable and functioning in his environment.”

How Can Occupational Therapy Help an Anxious Child?

Myshl Beyer, MOT, OTR/L, says, “Many kids suffer from anxiety which makes it difficult for them to interact with their environment, thus affecting their everyday functioning.  Kids with anxiety present differently than adults. They may be disruptive, angry, worried, or avoid situations.”

She continues, “Occupational therapists step in to bridge the gap so children can learn to function throughout the varied situations that fill their day.”

Anxiety disorder is the most diagnosed mental disability identified in children under age six.

Brenda says that correlates with the children she treats in her practice.

“We are seeing more and more children, in the last 3-5 years who have anxiety as their only diagnosis.  Not anxiety with an autism spectrum disorder or anxiety with attention deficit disorder.  We are seeing more children whose only diagnosis is anxiety disorder.”

Many sensory integration issues cause anxiety in children.  Maybe their socks are bunched up.  They don’t like the feeling of clothing labels.  They feel too hot or too cold.  Or too scratchy.   All these sensory inputs, when they seem off to a child, cause anxiety.

“When children are struggling in school, or at home, most parents and educators think attention deficit disorder is the culprit,” explains Brenda.  “But quite often the reason for the late homework, the acting out, at home or at school, is some sort of sensory dysfunction.”

The mother of a 4-year-old says, “Over the past 3 years we have sought treatment for speech impairments, behavioral issues and anxiety, but there was always something missing…the first time we came to occupational therapy, it was like completing the puzzle.”

“I had no idea an occupational therapist could help my very anxious daughter so much, so fast,” said the mother of an eight year old with anxiety disorder as her primary diagnosis.  “I wish I knew about the life changing work of occupational therapists a long time ago”

According to Brenda, parents of children with anxiety disorders find their practice through referrals from a child’s doctor, psychologist or therapist, or by word of mouth.  Families whose children who have had success with occupational therapy are great at spreading the word, but it is still a relatively unknown treatment for anxiety.

I would agree with this statement.  I saw occupational therapists in my school every day.  I never thought to consult with them about an anxious child.

“In the schools occupational therapists are pretty much bound to work on IEP goals and items specified in a 504 Plan.  But working on the fine motor skills to help a child write doesn’t work out so well if the underlying issue is that the child is too anxious to write,” explains Brenda.

She continues, “If generating an idea to write is as hard as the fine motor/visual skills necessary to complete the task, we need to address the anxiety first.  That helps the other things fall into place.”

Occupational Therapy Office

Consulting with an Occupational Therapist:

What to Expect

Stepping into the occupational therapy offices of a practice that specializes in treating children is a lot like entering a primary grade classroom.  It’s cheerful and bright with toys of all sizes filling the space.

You might find a rock climbing wall, a variety of swings suspended from the ceiling, colorful therapy balls, scooter boards, multi-colored mats on the floor, trampolines, tunnels to climb through, weighted blankets and vests, body socks, stuffed animals and therapy dough: it’s like an oversized playroom.

The assessment typically involves a 60-minute meeting with the parent and the child.  Parents complete a sensory profile which asks questions about the child’s hearing, vision, tactile input, whether the child is over or under sensitive to smells and tastes, vestibular input(relating to inner ear and brain ) and a child’s proprioceptive input (relating to body awareness from a child’s joints, muscles and connective tissues.)

Brenda explains that proprioceptive input (for example a child who is always falling out of his chair or crashing into things) can cause for great anxiety in a child.  “If a child cannot close his eyes and know where his feet are,” says Brenda, “that’s a very dysfunctional feeling to have.  That causes of a lot of anxiety in a child.”

“Many children are anxious because their body feels out of control to them.  They don’t understand the sensory input they are receiving and the disconnect causes anxiety,” Brenda explains.

After the consultation, the occupational therapist meets the child.  Her initial goal is to build rapport with the child.  The occupational therapist develops a treatment plan for the office and suggests skills the parent and child can work on together at home.  While duration of therapy depends on the child, some children complete their treatment program within 6-8 months.

What Skills Will Your Child Learn?

“Treatment by occupational therapists often takes the form of teaching coping mechanisms using both intangible and tangible techniques. Examples of intangible techniques include belly breathing, guided imagery, and progressive muscle relaxation.”Examples of tangible techniques include heavy “work” activities, fidget toys/seats, weighted equipment, etc.,” explains Myshl Beyer.

She continues, “An occupational therapist is responsible for helping children function with everyday activities, regardless of the reason or the diagnosis. Physical, cognitive, developmental, or behavioral impairments create obstacles for a child.  An occupational therapist can properly assess the root of the problem and help each child be successful through continued therapy and treatment.”

Whether an anxious child needs a chewy necklace to calm her so she can focus on classwork or homework, or a weighed backpack to administer Deep Pressure Touch Simulation, an occupational therapist will identify and remediate the sensory dysfunction, teach coping mechanisms and recommend ways to modify school and home environments.

Using Occupational Therapy Practices at Home

Here’s some good news:  Brenda says that most insurance plans cover occupational therapy.   In addition, parents can supplement and encourage positive sensory practices at home.  It’s easy and has instant benefits.

Here are a few suggestions:

  1. Use visual schedules so children see the day’s schedule in advance. (Free templates are available online.)
  2. Let children know changes in routine as soon as possible.
  3. Consider installing a swing in your yard, on your front porch, or mount a heavy-duty swing inside on a door frame.  The rhythmic motion of a swing is very calming for anxious children.
  4. Purchase a rocking chair.  It has the same rhythmic motion as a swing.
  5. Designate a “Quiet Corner” in your home. Furnish the space with a beanbag chair or a small tent or a large box (for climbing into).  Invest in some noise cancelling headphones, some stress balls, therapy clay, a stuffed animal, downloads of relaxation music, coloring books and crayons, books with soothing pictures or favorite stories.  Your child will love helping you create this special space.
  6. Try a weighted vest, backpack or weighted blanket after consulting with your child’s occupational therapist or doctor. If your child does well with them, consider making the purchase.
  7. Buy a mini-trampoline, a staple in many special education classrooms, which offers children another rhythmic activity that eases anxiety.
  8. Install dimmers on some of your light switches, or use table lamps. Soft lighting helps children relax.  Many children find bright overhead lighting stressful and anxiety producing.
  9. Use aromatherapy. Some kids may be scent-sensitive, but many children positively respond to diffusers with lavender and other essential oils.
  10. Try a scented lip balm. For children bothered by smells in the home or in the community, try putting the child’s favorite scented lip balm under his nose.  This often blocks the “bad” smell that causes the child anxiety.
  11. Use a Lycra sheet for your child’s bed or for relaxation.  These stretchy sheets, available at many online suppliers, offer light compression and, like a weighted blanket, help calm and relax anxious children.

The mother of a seven-year old with severe anxiety and high functioning autism sums it up best, “Using occupational therapy techniques with my daughter was one of the best strategies I ever tried for her, and believe me, I had tried many things over the years..”

“Here are the two things that helped Allison the most:  We bought a mini-trampoline to use at home.  She loves it!  Then we turned our spare room into her  “calm down” quiet place.  Allison goes there automatically when she is anxious or feeling overwhelmed.  She’s learned how to calm herself.  That’s empowering for her.”

“My daughter’s doctor reduced some of her medications due to the progress she made with her occupational therapist, and the occupational therapy activities we do at home. I think all parents of anxious children should try occupational therapy.  They will be amazed how much it helps their child.”




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  • Reply Amy February 4, 2017 at 2:59 pm

    I also had not known that occupational therapy could be so beneficial for anxious children. It seems like a lot of adults cold benefit from some of these strategies as well. Thank you for sharing this information!

    • Reply Jan Gioia February 5, 2017 at 2:27 am

      Thank you so much! I think occupational therapy is often overlooked. I am happy to help spread the word about its benefits for anxious children.

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