Written by: Sarah Appleman MS, OTR/L
After working a few weeks with that fussy 2 year old, you start feeling frustrated. What am I missing? Why can’t he sit still so we can work on the skills he needs to improve on??? You researched Pinterest, Instagram and so many other sites, you made your lesson plan, then one minute into the session, your child runs screaming from the room!!! Uggggghhhh!!!
Back at Grad School it was so easy to sit in a classroom analyzing case studies. After all, these cases were just “hypotheticals”. You all prepare your carefully researched answers and present them with your peers. The skills you learn in the classroom are important for critical thinking and to become an amazing therapist. However, what happens when your theories, research and classroom discussions don’t seem to be helping you in your current dilemma?
Now, you are an independent therapist in charge of making all those lessons make sense!
These tips will help guide you on how to help the distracted child focus.
TIP #1 Decrease Stimuli
I have worked in so many different settings (homes, classrooms, etc). In these settings, the number one item I look for in children is distractibility. What room are you working in? Are there visual or auditory distractors?
A challenging setting I worked in was in a New York City school system. My highly distractable workspace was a floor of a hallway with lots of foot traffic and lots of noise. This environment was non-controllable. How did I make it work? To decrease distractions, I made simple barriers out of wooden frames and mesh to go on the sides of my desk. Not 100% foolproof but a great quick fix in a pinch.
Are you working out of a large home with a million toys all over the place? or a tiny one-bedroom apartment with clutter? In either situation, you must find a way to decrease distractions so that you are setting that child up for success. You can nicely suggest to the parent, that they can hide or store the toys etc. This is not only great advice for your session but great for the parent as well. Too many choices can overwhelm a child. Instead, cycle out the toys to encourage independent play and improve the child’s attention.
Tip#2 Provide Appropriate Sensory Input
When providing a child with Sensory Input, don’t just do something because you saw a therapist do it. Ask yourself, “Why am I choosing this specific movement?”
If you have a child who is hyporesponsive (seeks input), first provide a “workout” movement (obstacle course, wheelbarrow walk, etc.). Then follow this exercise with a calming one. This will help the child transition into a “ready” state for learning. I often have the children I work with complete jumps, wheelbarrow walks, climbing, and crashing activities. While they are doing this activity, I introduce a piece of a puzzle or Lego for them to jump over or retrieve (parts to a Potato Head or coin to a Piggy Bank work well too). Have them repeat this 3 times. It will help them gather proper sequential patterns and proper motor planning.
It is incredible to watch the first round vs the last round. Sometimes, children even request a 4th round because they are feeling the benefit. After this movement activity, I immediately follow with a hand strengthening exercise using Play-Doh or TheraPutty. This helps connect the brain to the body, therefore, improving focus. Followed by a fine motor/feeding task, you will see how much better it is for the child to focus when given the correct input.
Tip #3 Use a Secondary System
The Visual System runs along the same pathway as the Vestibular System. The Vestibular System (inner ear mechanism that controls balance) and the Visual System (muscles, brain, and eyes work together allowing us to “see”). In order for you to maintain your eyes’ ability to focus, you require the skill known as “visual fixation”. The ear is connected to the eye through a vestibule-ocular reflex (VOR). Simply put, your eyes need to be able to fixate on an object so you don’t get dizzy. Knowing this, we can incorporate it into our OT sessions. Have your child sit on a therapy ball (or couch cushions), track an item across their midline of sight. Move it slowly in a large circle, and freeze at any point. When you freeze, the child has to touch the object to make it go again. Repeat this slowly increasing the length of duration the child has to maintain their gaze.
Tip #4 Be Aware of the Time
Currently, I work with the EI population (Early Intervention birth to 3 years of age). Their attention span is 6 minutes tops for any given task. It is important to remind ourselves of realistic outcomes. If you have a specific project you would like to have them complete, break it up into smaller tasks and create an appropriate timeframe. If you want to make “Valentines Day” Cards, the task may need to split into two sessions.
Tip#5 Sensory Time
A very good friend of mine was telling me how hard it has been with her 2 daughters at home on ZOOM. We can ALL relate. Children are not meant to be on computers all day. They need socialization, exercise, etc. She told me that fine motor skills were particularly difficult. I had her come to the house and we took rice, a cup and large tube socks. We made sock buddies. These are great fidget and proprioceptive (deep pressure) stimuli to improve attention, handle frustration, and provide calming input. Her daughters love them and use them for their shoulders, laps, or both. Various games can be played with them, such as tossing them at targets, playing a scavenger hunt (look for them pushing a laundry bin to collect them as you go) or pretend to play using them as props. Having many sensory toys available is a great resource to help focus your distractible child.
Sarah Appleman is the Author of “Play with Your Food” available on AMAZON.