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Presentation 4: What is occupational therapy (OT)? M. Windsor, ScD, OTR/L

General OT needs of the internationally adopted child

Children who have experienced physical and social deprivation or trauma often exhibit delays and disruptions in their performance of normal life tasks and activities (occupations). In addition, the circumstances of institutionalization often force the child to develop atypical adaptive responses and behaviors (i.e., gaze aversion, fear, and lack of attachment with adults; attention getting through aggression; antagonism or withdrawal when relating to peers). I do not refer to these behaviors as maladaptive because in many of these horrible contexts, the children must react in these ways in order to survive. This is frequently the circumstance of the IA child. It may be helpful to consult with an experienced OT before the child enters the family in order to anticipate and to understand behaviors that may be problematic. If the delays or disruptions are extreme and/or do not begin to improve within the first month or two after adoption, professional support might be indicated. Occupational therapy can be helpful in assisting the family in understanding the child's behaviors, measuring the child's functional performance, determining the needs and supports for improving the child's behavior, and planning meaningful intervention strategies with the family and the child. It can also contribute to developing meaningful social and educational programs in schools and day cares. The following is a non inclusive checklist of behaviors that might indicate need for a referral to an occupational therapist. They have been organized within three performance areas of occupation (1) Developmental Activities; (2) Play Activities; (3) Activities of Daily Living.

Task and Activities Checklists for OT referral developed by Mary-Margaret Windsor, ScD, OTR/L

Checklist 1: Developmental Activities

Checklist 2: Play Activities

Checklist 3: Activities of Daily Living

The purpose of these checklists is to alert families to behaviors that may indicate need for consultation with an occupational therapist or other professional. This is not a standardized assessment but an informal, noninclusive tool. Families should first consider if they suspect general problems or delays in any of the three major areas (Developmental Activities, Play Activities, and Activities of Daily Living). If there are concerns, then proceed to the specific activities, abilities, and behaviors; place a check beside those frequently observed; presence is determined by comparing the child's performance to that of OTHER CHILDREN his or her AGE. Presence of specific behaviors should support initial concerns. Use this information to organize observations for discussion when requesting further evaluation and services.



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