Is that an Occupational Therapist's job?

 

Ask any newly qualified OT, what Occupational Therapy is, and 99.99% of the time you get the same answer, "Occupational Therapy is all about improving ADL skills and helping the client achieve ADL independence." Of course, if you probe deeper, you may get a more elaborate answer that may branch into other things (apart form ADL) that an OT can help a client with.

Let me just a do a bit of introduction first, before I get to the point! 

ADL, which stands for Activities of Daily Living, is the most common term you would hear many OTs use. It is a term used to collectively describe fundamental skills that are required to independently care for oneself such as eating, bathing, dressing, toileting, grooming and mobility. 

ADLs are essential and routine tasks that most young healthy individuals can perform without assistance. The inability to accomplish essential activities of daily living, due to an injury, illness or any other physical or emotional challenges, may lead to unsafe conditions and poor quality of life. 

The whole point of Occupational Therapy (OT) is to help people increase their functional independence in daily life while preventing or minimizing disability. OT is often combined with other treatments, including Physical Therapy through  structured, goal-oriented, and customized programs to meet the patient's needs. OT strives to promote emotional well-being, independence, and an enhanced quality of life. 

The activities of daily living are mainly of two types, namely Basic ADLs and Instrumental Activities of Daily Living (IADLs). 

The basic ADLs (BADL) or physical ADL are those skills required to manage one’s basic physical needs including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating. 

The Instrumental Activities of Daily Living (IADLs), which include more complex activities that are related to the ability to live independently in the community. This would include activities such as managing finances and medications, food preparation, housekeeping, laundry, etc.

If a client cannot feed, bathe or dress themselves, it may be a lot harder for them to do their IADLs. For example, if we have a lady recovering from a stroke, an OT would start with training her how to feed herself (with or without cutlery, based on her cultural and personal preferences), focus on swallowing and tidying up afterwards. Once this goal is achieved, the focus of the training would shift to meal preparation, like making a simple sandwich, or warming up some food or setting the table.

It is important for an OT to know how each ADL affects an individual to care for themselves, so that the need for assistance and level of assistance required can be determined.

Now let me get to my point!

I am a Pediatric Occupational Therapist and I deal with developmental disabilities and Sensory Integrative dysfunction. I, very often, do ADL training, specifically in the areas of feeding, oral care and toileting for my clients. There have been rare occasions where parents have come forward with concerns about their older/younger children (siblings of my client) not wanting to brush their teeth or having a messy toilet time. "Can you teach him to brush his teeth? I have no patience".

I don't intend to sound rude, but I'm sorry, that is not an OT's job! If a child is just cranky and doesn't want to brush his teeth, you certainly do not hire an OT to get him out of that stage, but you could get valuable tips and tricks to get him actively involve in the task. 

If a child is not yet weaned off his diaper or feeding bottle  as it was convenient  for the working mom when she were busy, and now the child is still dependent on it (which has now led to a habitual dependence), you do not hire an OT to help him learn to use the toilet or drink from a cup. Instead, the OT can give you suggestions on how to implement an effective toilet training program or a fun feeding routine.

If the child has a physical, intellectual or sensory integration difficulty that prevents him from doing his ADL successfully, the Occupational therapist will intervene, give you suggestions, remedies and therapy if required to get him out of that stage. Even so, it is more the parent's job to train the child in his ADL, than his therapist's. The OT acts as a support system or a catalyst to help your child get there, definitely not as a substitute for the parent. 

My take....Three is definitely a crowd! Self-care training is a personal thing, something between you and your child, something that begins at home. It is an important tool to build up your child's self esteem and confidence, and parent-child bonding. As much as possible, try not to ask for help unless you absolutely need it.