Occupational therapists have been treating children with complex medical conditions for a very long time. In acute care, in outpatient clinics, and at home. It is only recently that their unique constellation of cognitive, sensory, and social/emotional reactions have been formally recognized as PTSD.
Occupational therapists can help these kids and their families in ways that psychologists and psychiatrists cannot. Our wide focus is on therapeutic handling and activities, sensory processing treatments, and functional skill development. This allows us to directly address the neuropsychology of trauma, and help a child more effectively engage in life skills.
The Neuropsychology of Trauma
Complex medical courses almost always include the experience of pain and distress, which is variable in frequency, duration, and intensity. This means that a child cannot know when to expect it, how long it will last, and how bad the pain will be. Medical procedures are often painful. Even when they are being done with care, and when they will improve or even cure a condition. The younger the child, the less any of that matters.
We are learning more and more about how chronic trauma can create brain changes. None of the news is particularly good. What we see in therapy are changes in sensory processing, memory and attention, and stress-induced fascial restrictions. They are ALL the result of stress reactions rather than brain masses, surgeries, or physical treatments like casting. These brain changes that cannot reasonably be explained any other way. Kids who have been chronically ill, hospitalized OR NOT, have more in common with Vietnam vets than kids with a similar but acute medical condition.
That makes sense. They have been to war. They may still be at war. Their hospitalizations or daily treatments were/are essential to address their medical problems. It is a war. A war against illness or injury. Or both.
What OT Can Do
A skilled occupational therapist has the ability to address the physical effects of trauma with manual treatments that release fascial restrictions related to trauma. Sensory treatments can lower the sympathetic and parasympathetic nervous system’s chronic reactions to triggers, and improve the brain’s ability to modulate activation after being triggered. We can teach the child’s parents how to use a sensory diet at home, and teach older kids how to use a sensory diet on their own.
We can also build skills. Children with complex medical histories often engage with a life skills therapist in the hospital. These staff offer play activities. But life is more than play. Children are building daily living skills, skills that empower them. As they become more independent, they feel less like passive victims and have more agency in life. Anyone that has had to be fed or bathed while ill knows that they most want to be able to perform these tasks independently. They may have enjoyed crafting or listening to music, but they really want to be able to use the toilet alone.
Children are no different.
The biggest difference is that they may have never been given the chance or the tools. Adults are returning to a life of independence. A child who has spent years being cared for may not know that this life of agency and ability is out there for them. Their caregivers may have inadvertently messaged that it is too dangerous for them to do so, or to fatiguing, or too much work for them as caregivers. Occupational therapists can give them the adaptations and skills to make it happen!
We can give all of that back to the child.
I will be writing more on this topic this month. I may even decide to turn it into a short book. There is so little out there for parents and new therapists. No guidebook to navigate helping kids with medical PTSD heal has been written. And certainly nothing about how essential OT can be for their full recovery.
Looking for more? Read How Parents of Medically Fragile or Complex Kids Can Cope .
