Occupational Therapy and Early Intervention

Birth to age three is a critical period of a child's development. Early intervention services are mandated by Part C of the Individuals with Disabilities Act (IDEA). Congress established the program in 1986 in recognition of an urgent and substantial need to enhance the development of infants and toddlers with disabilities, reduce educational costs by minimizing the need for special education, and increase the capacity of families to meet their child’s needs. The purpose of Part C of IDEA is to give each state support in the maintenance and implementation of comprehensive and multidisciplinary services for infants, toddlers, and their families up to age three.

The capstone of early intervention is family-centered treatment principles provided in the natural environment. Infants and children are dependent upon their families for nurturing and survival. This dependence necessitates a family-centered approach to treatment. Each family has very unique structure, roles, values, beliefs, and coping styles. Respect for and acceptance of this diversity is crucial. In addition, early intervention teams must honor the ethnic, cultural and socioeconomic diversity of each family. Perhaps the most important principle of early intervention is that family and professional collaboration is necessary for successful implementation of all services.

Occupational therapists develop interventions based on analysis of the child’s performance of the occupations in which he or she engages and the context for those occupations. Occupations can be best described as what a child does to occupy himself throughout the day and where he does it. An occupational therapist will determine how performance is influenced by impairment and how the environment supports or constrains performance. An occupational therapy evaluation will assess a child’s ability to perform some or all of the following skills at a level appropriate to the child’s age:

  • motor control
  • hand skills
  • sensory processing/integration
  • visual perception
  • psychosocial issues affecting social participation
  • behavior
  • feeding skills
  • self-care
  • community participation
  • play
  • prewriting and handwriting skills
  • mobility
  • need for assistive technology/devices

Upon completion of the evaluation, the occupational therapist, the family, and the team members will determine the skills, supports and adaptations needed to work on identified weaknesses. Goals and treatment will be developed so that family, the therapist and other team members can address the deficits together. Natural environments offer therapists opportunities to coach caregivers to carry out occupational therapy outcomes. Natural environments are settings that are natural or normal for similarly aged peers. When services take place children can be at home with their families or at places within the community like the park, playground or daycare. The therapist has specialized knowledge and skills to share about growth and development, specific intervention strategies, and enhancing the performance of young children with developmental delays and disabilities. The caregiver has an intimate knowledge of a child’s personality, temperament, abilities, challenges, and typical performance in a given situation. The therapist supports the parent/caregiver and child through a process of self-discovery and personal development.

Play is one of the most important areas of a child’s development. Play therapy is open ended, self-directed, and unlimited in its variety. Objects and materials found in the natural environment should be the focus of play. Because play is naturally motivating to young children, therapy should focus on involvement in activities the child enjoys. Occupational therapists will use sensory-rich play to address any sensory processing deficits that may have an impact on skill acquisition. Treatment will be provided in the natural environment. Families will be able to carry over these strategies with more success and less disruption to normal routines, because the materials are readily available, the activities are enjoyable to the child, and the therapist has provided coaching/feedback to empower the family to provide the strategies on a more frequent basis.

Occupational therapists are trained to use a holistic approach with children and their families that emphasizes functional and developmentally appropriate strategies. Early intervention services epitomize the principles of occupational therapy. Children who require services beyond the age of three will have the support of the occupational therapist to develop a plan of care appropriate to meet the goals for the next stage of life.

References: Case-Smith, J, & O’Brien, J. C. (2010) Occupational therapy for children, 6th ed. Maryland Heights, Missouri: Mosby

Occupational Therapy and Early Intervention
Nicole Newell, MS, OTR/L

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