When it comes to occupational, physical and speech therapy, the needs of children sometimes overlap and sometimes are completely different. For many children in Grayson County, therapy is a way for parents to learn what their child’s learning patterns are and help them get a jump on activities of daily living to help their kids reach age-level milestones with their peers.


Certified Occupational Therapy Assistant Michelle Stinson and Speech Language Pathologist Marissa Patrick agree that if a stranger cannot understand about 75 percent of the things being said by a 3-year-old, that child may need speech therapy, and if a child is afraid of loud sounds or has hard to read handwriting, the child may be in need of occupational therapy.


“The biggest thing that I deal with here is with children that are not developing typically,” Stinson says about the work she does at The Rehabilitation Center in Sherman. “They are children that are not developing with their peers with their fine motor skills, their visual motor skills. Those are things like being able to cut with scissors, coloring and being able to draw a circle.”


These are activities that Stinson refers to as activities of daily living.


“Their biggest occupation is to be able to play,” she talks about the nature of toddlers and young children. “Playing is how they learn, but they also need to learn how to dress themselves, how to use the bathroom and how to brush their teeth. My older kids need to learn how to tie their shoes, how to button and how to do chores around the house to help their parents. They need to learn about how to make a peanut butter and jelly sandwich.”


About two years ago, Stinson made the shift from working with adults in geriatrics to working with children. She says that she has seen all sides of occupational therapy needs.


“So I typically see kids that are not acquiring those skills as they should be,” she explains. “It can be that they are just delayed. It could be that they have autism or cerebal palsy, or it could be a sensory or attention issue where they are just not able to learn. I try to bridge that gap, and since it is not occuring typically, I have to use different kinds of interventions to get there. It’s about different strategies and learning how to adapt things so they can learn. Since they are kiddos — they are not like adults where you can just say, ‘I need you to do this for me,’ — you have to meet them where they are.”


One of the most important aspects of therapy with children is to make it fun so it fits right in with the ADLs of children and does not feel like it is disrupting what they would normally be doing in a given day.


“We have to be kind of creative,” Stinson gives insight into the process she uses with the children that she works with. “It is like playing with a purpose. Sometimes it has to be very sneaky. It is very common with kiddos that if something is hard, they do not want to do it. Or, they reach that phase, where every little kid does, and they want to do it by themselves. They do not want any help. We have to get around that, and the best way to do that is to have fun. When something is fun, we really want to be a part of it.”


While there are certain routines that do help children’s occupational therapists, Stinson says that she creates a specific lesson plan for each child she sees.


“Each kid is different and each kid has their own limitations and barriers,” she talks about how the limitations of an 18-month-old may be different from the needs of a 5-year-old. “You sometimes have to look at their goals and make an individualized plan for how you are going to accomplish that. In that, we do a lot of parent training.”


Often times, Stinson has parents join in on sessions to ensure that she can help educate them about the learning process of their child. Most children meet with their their therapist for 30 minutes twice a week, so it is important that parents continue the lessons that are taught in sessions.


“They need to be doing these things at home so they can acquire these skills as quickly as possible so they can meet up with their peers,” Stinson explains the role parents play in the therapy. “And then we also want to educate them on the development of thier kids. Kids are meant to be develop for the rest of their lives. So even when we reach those goals and they are at the level with their peers, we need them to continue to grow and work to reach the next milestone and reach that milestone on time.”


Since the child did not reach the milestone on his or her own, parents and therapists have to put in work to get the child there.


“We also reach out to schools and we put recommendations in place for the schools,” Stinson says. “We sometimes find that they learn differently or they need something different, so we want the parents to learn how they learn so they can help and tell the teachers. We want to help implement that in school. Our main goal is to get them to the point so they can get where they need to be and then they can pass it off. We want to be a good steward of their resources.”


Though TRC most often works with children, the therapists at the facility can work with individuals all the way up to 100. The youngest person Stinson has worked with was six months and the oldest was in there 70s. Currently, she is working with several 2-year-olds.


When it comes to speech, Patrick sees a lot of children around the ages of three to four. She believes that is because parents want to help their children with speaking clearly before they make it into school.


“It is very often that the pediatricians are referring children after a well-child visit,” Patrick begins. “Many parents are seeing signs, and they start to see they are not developing. They may have other children and they are seeing that their child is not doing as much talking as their older brother or sister. Sometimes that is typical because an older sibing will bridge that gap and talk for the older sibling. And sometimes there are concerns.”


While Patrick has worked with children as young as 18 months, she has also worked with individuals in their 80s. She says that when it comes to speech therapy, it is very critical to start as early as possible to get children up to their age-level milestones.


“Eighteen months is going to be a lot of play,” she explains how she reaches the youngest of her clients. “We are playing with purpose. We are going to be putting strategies in their heads. We need to figure out what they really like to do. We want to find out what they are really interested in. If it is blocks, we are going to get out the blocks. I am going to ask him or her if she wants to play with the blocks.”


Then, instead of Patrick talking for him or her, she is going to pause and give them the opportunity to say more.


“We want them to be saying about 50 words by that age,” she explains age-level milestones. “We want them to say block and milk. They should be able to name objects and be able to say things like eat and drink. When they do not have the words, they get frustrated — then it can be tough. The parents are guessing and they do not know how to sign or acknowledge what they want or need. We do a lot of signs with them.”


A key sign that a child may need speech therapy is if a parent notices that his or her child is not saying as much as the kids at the park, the library or daycare.


“Kids are so smart, and they know that when they talk to people, others do not understand them,” Patrick says of why a child might appear to be shy. “You can see the confidence go away. They start to think that people really cannot understand them, so it is not worth the effort.”


Developmentally, it is common to not understand what your child is saying all of the time, and that is okay.


“At two years of age, I only expect them to be understood about 50 percent of the time by an unfamiliar adult,” Patrick talks about age-level milestones. “If they come in and I can understand them that much, I am okay with that. The speech sounds are still developing. By 3-4, I should be able to understand them about 75 percent of the time.”


By age two, they should be saying two to three word sentences.


“They should be learning action words and verbs,” Patrick continues to explain how speech develops. “They should be exploring describing words and being able to understand those concepts. Yes-and-no questions are important, and when they answer, that answer is what they mean.”


Receptive language actually comes before spoken language. That means a child should understand language to be able to use it. Parents can test this by giving a child a command and then seeing whether the child can complete it. If there are gaps in the receptive language, a speech pathologist needs to make sure a child can use those skills so that we can get to the spoken language.


“At ages two to four, gross motor skills, fine motor skills, speech and language pathology developing at a fast rate.


“It is one of the most important times for that,” Patrick talks about why the services at TRC are housed under one roof. “We also overlap a lot. They do affect each other. Sometimes we see children that have one first therapist and then we notice that they have another issue affecting the first. Michelle and I refer children to each other a lot.”


The biggest misconception that both Stinson and Patrick hear is that parents want to wait and see if an issue resolves itself.


“A lot of the times, people hear, ‘Maybe they are behind, but let’s check next time or let’s wait and see,’” she expounds. “Advocate for your children because parents know their children better than anyone else. You get that feeling as a mom and just know something is not right. If you want to wait, just get a second opinion. The pediatricians here in this area are wonderful.”


Also, parents should be careful of comparisons. While children should reach milestones around the same time, age-level milestones are always given in a range.


“If you as a parent have a gut feeling that something is wrong , then look into it,” Patrick asserts. “But, if a child at school is doing something before your child, that does not automatically mean that you child is behind. If they are still in the range and working towards getting to that milestone then they are right on time.”