Common Occupations

• based on family's habits, roles, routines, culture, environment (physical & social)

• influenced by:

  • child factors (body structures & functions), performance skills, & patterns

  • interest level, self-confidence, & motivation

  • health & disability status

Intervention Approaches

• promote & create supports

  • make ways for the child/adult to learn, practice, and be included

• establish, restore, and maintain performance 

  • teach skills using a developmental, cognitive, biomechanical, motor control, sensory, neurodevelopmental, or behavioral approach

  • focusing on underlying structures & function

  • e.g. teach a 7 yr old to tie shoes

  • **remember forward/backward chaining, prompting (visual, verbal, physical), repetition, use of picture schedules, etc.

• adapting (task/environment)

  • modify & grade the tasks to make individuals independent

  • assistive tech

  • work surfaces

  • materials

  • positioning

• prevention & education

  • cognitive approaches

  • coaching & education

Toileting

• typical development

  • potty training begins at 2 yrs old (typically), girls tend to be faster than boys

  • independent washing hands at 30 mons

  • goes to bathroom on toilet at 3 yrs old

  • independent wiping, toileting, managing fasteners at 4-5 yrs

• work on underlying skills required for toileting routine

  • positioning

  • motor skills

  • ROM & tone

  • strength

• develop routines

  • frequent bathroom breaks

  • learn about the steps, not just for toileting, but for handwashing too

• physical environment

  • toilet adaptations

  • consider sensory environment - are there any sensory-based adaptations to be made?

• teach social expectations

  • what is expected in the bathroom?

• menstrual hygiene

  • can use cognitive approach of repetition & practice, breaking down the activity, sequencing, schedules, proper disposal & social expectations

  • thing about the sensory considerations - practice to desensitize/normalize

  • adaptive devices - grab bars, long-handled mirrors, etc.

Grooming

• tooth brushing

• face washing

• hand washing

• hair care

Personal Tasks

• health management - health & wellness routines & promotion

• health maintenance 

• use of communication devices - sending, receiving, & interpreting info using a variety of devices/equipment

Community Participation

• shopping & money management

• driving & community mobility

• access to integrated activities 

  • what's out in the community that individuals can integrate in diverse groups, networks, have fun, seek resources?

• Sleep debt & deprivation

  • having less sleep than what's necessary for daily function NOT due to a medical condition, but instead due to lifestyle choices & environmental disturbances

  • always ask how have you slept? - will greatly impact session outcomes

• Sleep disorders (e.g. can be a side-effect of some of the necessary medications kids are taking - cannot be changed but ensure that the sleep that kids do get is high-quality)

  • insomnia disorders - difficulty initiating sleep, maintaining sleep, getting enough sleep, or having impaired sleep quality

  • sleep-related breathing disorders - respiration impaired while sleeping - down syndrome or low tone conditions (muscles relax, including throat & sinus - impacting breathing)

  • hypersomnolence disorders - excessive daytime sleepiness & difficulty staying awake during the day

  • circadian rhythm sleep-wake disorders - patterns are out of sync with society norms - not due to substance use, physiological, or jet lag

  • parasomnias - actions that accompany sleep - tooth grinding, sleep terrors, sleepwalking, etc.

  • sleep-related movement disorders - involuntary body movements during sleep - e.g. restless leg syndrome, leg cramps, sleep stars, foot tremors, etc.

Sleep Interventions

• medications - melatonin, etc. - use in moderation - will impact natural production of chemicals and develop a dependence

• improve sleep hygiene - sleep routines & habits

  • **need to ask about the child & parents!

• tech - apple watch, etc., - not a substitute for a proper sleep study

• adapt the sleep environment

• sensory aspects

  • slow down before bed, nothing too disruptive or alerting (tech, light, sound, etc.)

  • is bathing routine calming or alerting? should it be in the morning or at night depending on how it impacts their sleep?

  • temperature in the room

  • weight, texture of clothing, & bedding

Sex as an ADL

• engaging in the broad possibilities for sexual expression & experiences with self or others (e.g. hugging, kissing, foreplay, masturbation, oral sex, intercourse)

 Sexuality, Intimacy, & Identity

• sexuality - not only physical acts, but also seeing one's self as attractive & worthy of being liked, feeling confident, & secure around others, and feeling that there is something special & unique about oneself

  • represents feelings about ourselves, our gender, how we establish relationships, and how we express ourselves

• intimacy - bonding with another person, receiving affection, sharing feelings, thoughts and dreams for the present and the future

positive self-concept = healthy sexual identity 

Rights for Individuals with Disabilities

• individuals with disabilities develop gender and sexual identities at the same age as their non-disabled peers

• young people with disabilities are at higher risk of being sexually abused than their peers without disabilities - safety is very important of development to focus on within this occupation

• to support development, all children (including those with disabilities), needs access to support and education in all areas of sexuality, including puberty, pregnancy, pregnancy prevention, and social interaction

• denying sexual rights and sex education to people with ID/DD --> poor self-esteem, body image, gender identity, personal development, & social interaction

• exploitation due to dependency on others, often have a lack of privacy, learned helplessness, and nondiscriminatory compliance, lack of reasoning & judgment

• puberty occurs typically for all individuals regardless of disability - however, cognitive, physical, & social development/engagement may be hindered, which impacts one's ability to understand their changes & be independent in their care

• Adolescents with diverse gender identities and sexual orientations are more at risk for being victims of violence, mental health issues (including suicide), unwanted pregnancy, STDs, substance abuse, have poorer eating habits, and engage in less physical activity

Evaluation

• self-care - grooming, hygiene, toileting, menstrual care

• relational skills & friendship development

• self-concept & self-esteem (Piers-harris)

• quality of life (inventories)

• occupational performance inventory of sexuality & intimacy (OPISI)

  • within the OTSAF - framework for addressing sex in OT

  • includes: sexual knowledge, sexual activity, sexual interest, sexual response, sexual self-view, sexual expression, intimacy, sexual health, & family planning

• important to consider the individual's physical, psychological, and social maturation

• *Depending on the disability, there may be a range of issues related to social skill deficits: 

  • Less awareness of privacy rules and more inappropriate sexual behaviors

  • Not being able to read social cues, decipher between friend versus intimate partner relationship status, understanding courtship

Interventions

• social skill, social-emotional skill, & self-regulation development

• dating/relationship (courting) behaviors

  • what is a date, how to ask someone on a date?

  • what's expected, boundaries, how to say "no" if uncomfortable

  • stalking, coercion, etc.

• laws

• cognitive interventions for sex education

  • how to manage sexual urgers

  • how to care for developing bodies

    • grooming,

    • using deodorant

    • managing menstruation

    • determining appropriate places for masturbation

    • what's appropriate in public versus private

  • socializing & intimacy

    • what's the difference between girlfriends/boyfriends/partner status & regular friendships

    • personal boundaries

    • safe sexual behaviors

    • reporting abuse, it's okay to say "no" to people in charge or adults

  • anatomy

  • STDs

  • pregnancy prevention

• social groups/support groups

• understanding bullying/cyberbullying & exploitation - teach kids not to take inappropriate dares from "friends", impact of social media, etc.

• starting young will make the transition easier

• use of visuals