Development during early childhood is driven towards exploring and engaging in everyday activities in order to learn about the world. Children explore the world through their sensory systems (touch, movement, body awareness, hearing, seeing, smelling, etc). Once a child gains interest in an activity or toy, children then are asked to manipulate and further explore the object in order to learn more about how to utilize the item, toy, or object. Once these steps have been mastered, children are able to engage purposefully with an object or toy. An example of this can be when a 1-year-old child picks up two rings. First the child will explore it and manipulate it by touching it, moving it, visually inspecting it, and figure out what they may be able to do with the rings. Then the child may manipulate it further by banging it on a tabletop or banging the rings together at midline. Lastly, a child can engage in play with the rings in a purposeful manner, like bringing the rings together to make noise when listening to music. The skills needed for this process are highly driven by motor planning skills.
Motor planning is a large skill that includes our body’s ability to figure out what to do and how to do everyday activities. Difficulties with motor planning can lead to difficulties with learning and difficulties with mastering everyday activities.
Here are a few examples of motor planning tasks:
-Figuring out how to ride a bike
-Learning how to drive a car
-Learning how to walk, crawl, walk up/down stairs
-Learning how to use tools (i.e. scissors, crayons, etc) in a purposeful manner
-Learning how to kick a ball
-Figuring out how to use a spoon to feed oneself
-Learning how to write
-Learning how to organize day to day life
When a child has difficulty with motor planning, it can impact the child’s ability to learn how to interact with objects and activities in their world. In addition, difficulties with learning how to explore and engage with toys in novel ways can impact the child’s ability to learn in the school setting, play with peers, and function when changes or disruptions occur in their everyday activities. Here is an example of difficulties coming up with new ways to play with toys: If a child is having difficulty figuring out how to come up with new ways to play with their toys, they will prefer to play with their toys in the same way and have difficulty expanding on that. An example of this could be a child always pushing their cars or trains along a path on a table, and having difficulty taking that same toy and pushing it along a collection of pillows that create “hills”.
Here are just a few examples of what you may see if your child is having difficulties with motor planning skills:
-Difficulty figuring out a new way to play with a toy.
-Difficulties figuring out what to do with tools like scissors, spoons, forks, pencils, etc.
-Difficulty expanding on a play routine
-Difficulty coordinating the two sides of the body together to complete tasks like holding paper while coloring, stringing beads, riding a bike, playing catch and throw, etc.
-Difficulty with multi-step activities – obstacle courses, dressing, self feeding, etc.
-Difficulty learning how to complete prewriting shapes (vertical line, horizontal line, circle, square, triangle, oblique lines, etc) or difficulty learning how to form letters.
Here are a few questions to consider when looking at motor planning skills and determining whether difficulties with these skills are contributing to your child’s learning potential and development:
-Does your child have difficulty with expanding on their play routines?
-Does your child choose to play with the same toy in the same way?
-Does your child have difficulty dressing oneself?
-Does your child have difficulty feeding oneself without spilling a lot of the food?
-Can your child figure out how to assume simple yoga positions when you model it for them? (i.e. downward dog, child’s pose)
-Does your child have difficulty coordinating the two sides of their body to manipulate fasteners on their clothing, string beads, hold paper while cutting or coloring, etc.?
-Does your child have difficulty following multi step directions or multi step activities?
-Does your child seem to get lost while completing a task, and require modeling and verbal cues to help them figure out how to complete the task?
-Does your child get upset when they are asked to come up with new ways of playing with a toy?
-Does your child have difficulty with prewriting or handwriting skills?
These are only a few questions related to possible motor planning difficulties. If difficulties with motor planning are impacting daily life and your child’s ability to participate in age related activities to their fullest potential, an occupational therapy consultation or evaluation might be beneficial. Occupational therapy can assess a child’s individual motor skills, motor planning skills, and overall sensory processing capacity to assist with increase in functional independence.
Here are a few examples that an occupational therapist could utilize to assist you and your child with their motor planning:
-Completing an evaluation using the Sensory Integration and Praxis Test (SIPT), the gold standard for evaluating praxis (motor planning) related difficulties. This battery of 17 tests provides specific information in regards to sensory processing that directly impacts praxis skills. The test can be completed on children ages 4 through 8 years, 11 months.
-Determining what areas of sensory processing are delayed and impacting motor planning skills and focus intervention and home programming to increase those skills.
Determining adaptive techniques to assist with increased independence at home during motor tasks that are typically challenging for the child. An example could be to create a visual schedule or visual chart breaking a task down into simple steps with visual cues.
Dr. Neeha Patel is a licensed occupational therapist who offers a holistic approach to therapy, drawing from evidenced-based practice techniques, sensory integration theory, neurodevelopmental treatment, family-centered care, and a play-based approach. She is Sensory Integration and Praxis Tests (SIPT) certified, and has extensive experience helping children from birth to 16 years old with sensory processing delays, fine and visual motor delays, social skills, pre-writing and handwriting skills, as well as in their primary activities of daily life. She has worked with varying diagnoses including autism spectrum disorders, learning disabilities, developmental delays, developmental coordination disorder, cerebral palsy, disruptive behavior disorder, and down syndrome. Neeha has special interest and completed her doctoral work in the area of cultural sensitivity when working with children and their families. Neeha offers home, school, or community visits in Manhattan (Upper West Side, Midtown, Chelsea, Clinton, West Village, Soho, Tribeca, Union Square, Murray Hill, Gramercy Park, Upper East Side).
Tags: body awareness, Difficulty Completing Pre-Writing Shapes, Difficulty coordinating the two sides of the body together, Difficulty expanding on a play routine, Difficulty figuring out a new way to play with a toy, Difficulty Holding Paper While Coloring, Difficulty Playing Catch and Throw, Difficulty Riding a Bike, Difficulty Stringing Beads, Difficulty with Multi-step Activities, early childhood development, Hearing, Individual Motor Skills, Motor Planning, Motor Planning Difficulties, Motor Planning Difficulties and Mastering Every Day Activities, Motor Planning Skill Development, Motor Planning Skills, Motor Planning Skills and Toys, Motor Planning Skills in Children, Motor Skills, Movement, Occupational Therapists Chelsea, Occupational Therapists Clinton, Occupational Therapists Gramercy Park, Occupational Therapists Manhattan, Occupational Therapists Midtown, Occupational Therapists Murray Hill, Occupational Therapists SOho, Occupational Therapists Union Square, Occupational Therapists Upper East Side, Occupational Therapists Upper West Side, Occupational Therapists West Village, occupational therapy, Praxis related difficulties, Seeing, Sensory Integration and Praxis Test, sensory processing, sensory skills, Sensory Systems, Sight, SIPT, Smelling, Touch
Part 1: The Visual, Auditory and Tactile Senses
As a new parent to an 9-month old boy, I busy myself reading child development books and checking online resources, to assure myself that he is meeting his developmental milestones each month. While we are playing and having fun, I am assessing his emerging gross and fine motor skills, listening to his burgeoning language, and marveling at his cognitive gains. As an Occupational Therapist (OT), I have been encouraged to see that the books and online articles often reference the sensory skills that are developing in our babies; skills which continue to develop in children until their early teenage years. In this entry, I will discuss ways to support your child’s visual, auditory and tactile skills from an OT perspective. These are ideas that are easy to implement at home, and which can be enjoyed by children who are typically developing as well as assist those who are experiencing delays.
Definition: Our visual system allows us both to see and to interpret what we see. Developmentally, it is important for recognizing people, shapes, colors, and eventually letters and numbers. Socially, it helps us to read body language and facial expressions. For example, we must use our vision to guide our movement through the world safely and effectively.
Infants: Provide the baby with high contrast black and white images, bright colors (especially red and yellow), simple geometric designs, mirrors, and slow-moving mobiles. One of baby’s favorite things to look at is the human face (especially mom and dad). Books with pictures of faces are often interesting to babies and will stimulate their vision. As your baby grows, you can help their vision mature by presenting slowly moving items so that they have to track the item as it moves throughout their field of vision (first try horizontal movements, then vertical, then circular).
Preschool: Help your child learn shapes, colors, and begin letter and number recognition through activities like puzzles, blocks, and books. Children gain valuable “practice” with their visual system through activities such as rolling a ball, stacking blocks, pointing to pictures in a book, coloring and cutting with scissors.
School age: Higher-level visual skills are developing at this age, including figure-ground, visual discrimination, and visual memory. Hidden picture books (figure-ground), matching worksheets (discrimination), and games like Memory are all great for this age group. In addition to the school tasks of reading and writing, children can work on their eye-hand coordination at this age through mazes, connect-the-dots, and word searches.
For more information about the development of vision, visit the website of the American Optometric Association. It provides great information about what changes occur at each age and stage and development: http://www.aoa.org/x9419.xml
Definition: We use our auditory system (or sense of hearing) to identify both the quality and location of sounds in our environment. For example, our auditory sense alerts us so that we turn our heads when a car is approaching.
Infants: A baby is born with a very well-developed sense of hearing. Your baby can recognize (and prefers) the sound of parent’s voices. Talking to your baby is one of the best ways to help your baby’s auditory system develop. This can include your own singing, too! As young as one month, babies can remember sounds, such as a repeated lullaby. Parents should also talk to their babies as they go through their day, narrating what you are doing is a great way to introduce language. Babies respond to repetition, and to high frequency sounds (which is why many prefer female voices). As your baby begins to make her own sounds, repeat them back to her as this lays the foundation for the turn-taking of spoken language. Music, of course, is another strong auditory input that babies enjoy. This can be anything from classical music, to nursery rhymes and songs, to any music that mom and dad like! You can help your baby refine her sense of hearing by having her find (localize) a moving sound (slowly move a rattle or noisy toy). As your baby grows, introduce the following auditory/language concepts during play: animal sounds, names of colors, and counting (fingers, toes, blocks, etc.)
Preschool: Continue to explore music through playing simple instruments, learning finger songs, and singing. Playing with puppets and using different voices (high, low, silly, etc.) is a fun activity, and it also engages the child in pretend play. Have your child point to pictures in a book as you read it. Listen for and identify sounds in the environment (“that’s a car horn”, “hear the birds chirping”, etc.). Work on giving one-step, then two-step directions. As always, continue to talk to your child during your daily routines and continue to read books.
School age: At this age, you can help your child continually improve their auditory skills by giving him three- and four-step directions. Addressing the concept of voice volume may be an issue as children enter school, where they are asked to be quiet for long stretches of the day. Instead of expecting children to understand the term “inside voice”, a visual aid may be helpful. You can make a simple chart with the following information: 0 = silent, 1 = whisper, 2 = talking, 3 = yelling. Act out each volume with your child. Then, explain the rules of your home regarding when it’s OK to use each (i.e., yelling may be OK during play, or during an emergency; a whisper should be used at nighttime, etc.) One final piece of OT advice regarding school-age children and auditory input relates to that dreaded word…homework. My advice is to know how your child responds to noises and be aware how this impacts his/her focus during homework. Some children will require a quiet work space, away from distractions such as radio, TV, siblings, phone calls, or even a parent cooking dinner. However, other children thrive on “background noise” to help them. These kids may do well working at the kitchen table, or wearing headphones with music playing as they work.
To learn more about how your child’s hearing develops from in utero throughout childhood; visit the home of the American Speech-Language and Hearing Association: http://www.asha.org/public/
Definition: This is our sense of touch, which plays an important role in a child’s motor and social development. The tactile system provides information about the shape, size, and texture of objects. This information helps us to understand our surroundings, manipulate objects, and use tools proficiently. For example, you are using your tactile system when you reach into your pocket and find a quarter among several coins.
Infants: Touch helps promote parent-child attachment by giving your baby a sense of safety, security and love. Developing awareness of the nature and quality of a variety of tactile input also gives infant valuable information about the world around them, thus aiding their cognitive and fine/gross motor skills. Offer infants a variety of safe textures to explore (plastic or wooden toys, stuffed animals, soft blankets, “crinkly” toys, feely books, tactile mats, and tactile balls). Give her an infant massage (with or without lotion). Lightly rub her feet and clap her hands together. Expose her to different textures and sensations, such as a vibrating toy, a soft cloth, a feather, a scratchy piece of sandpaper or bumpy ball. Be sure to tell her what the textures are as you show them to her. Allow for some “naked time” every day, so that your child can feel textures on her arms, legs, back and belly. (If you are daring, you can go without a diaper for a while!) Also, be sure to have some supervised “tummy time” every day, so that your baby does not become too sensitive on her stomach (This position is necessary in order to prepare for crawling and develop upper body stability and strength).
Preschool: One activity preschoolers often enjoy is a sensory table (or at home, you can make a “sensory bin”). Fill a large plastic bin with a mixture of dried rice and beans, then you can hide small toys or “treasures”, puzzle pieces, or simply cups and spoons for empty-fill. Other fun suggestions include: modeling clay, Play-Doh, and finger paints. Don’t be afraid to let them get messy! They are working on developing their tactile awareness, as well as the small hand muscles needed for later activities such as handwriting. Finally, taking a nature walk to pick up and explore various outdoor items (leaves, rocks, petals, dirt, etc.) is a great way to enjoy a nice day, while promoting this important sense.
School age: The sense of touch is highly developed in this age. A few ways to challenge your older child to use and perfect this sense are: draw letters on his back with your finger and have him guess, fill a cloth bag with common objects and have him identify things (one at a time) without looking in the bag. Activities such as arts and crafts, stringing beads, and lacing cards can help children continually improved their tactile skills.
The neurological process that interprets sensations from the body and its environment is called Sensory Integration. The brain’s ability to process sensory information makes it possible to use the body effectively within any given environment.
The quick screening checklist below will help you assess your child’s sensory development. If you answer “yes” to one or more of these questions, your child may be experiencing difficulties with sensory integration:
• Was your child unusually fussy, difficult to console, or easily startled as an infant?
• Is your child over-sensitive to stimulation? Does he/she over-react to touch, taste, sounds, or odors?
• Does your child strongly dislike baths, haircuts, or nail cutting (screaming, crying, “melting down”)?
• Does your child use too much force when handling objects, coloring, writing, or interacting with siblings or pets?
• Does your child seem to have weak muscles? Does she tire easily? Does she prefer to lean on people or slump in a chair?
• Was your baby slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones?
• Is your child clumsy? (Does she fall frequently, bump into furniture or people, and have trouble judging position of body in relation to surrounding space).
• Does your child have difficulty following instructions or sequencing the steps for an activity?
• Does your child avoid playground activities, physical education class, and/or sports?
• Does he/she not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing?
For further information on Sensory Integration and for children diagnosed (or suspected) of a Sensory Processing Disorder:
Check out Kids Health website for further information on the development of senses, as well as other great information: http://kidshealth.org/parent/growth/index.html#cat166
If your child is experiencing difficulty with any of these areas of development, please contact your pediatrician and/or an Occupational Therapist to assess if there is an underlying problem. Children develop at their own pace, with a wide range of normal regarding skill acquisition. If he/she has difficulty in several areas of sensory development, it may indicate a Sensory Integration Dysfunction.
Stay tuned for Part Two of this discussion, which will address the ‘hidden’ senses that are developing in your child.
Lynn-Marie Herlihy is an Occupational Therapist in private practice in Park Slope, Brooklyn. She has over 12 years experience treating children from birth to school-age, with a variety of sensory and motor deficits, developmental delays, and learning issues. You can also visit her website at www.BrooklynOT.com.
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