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Case Study: Online Occupational Therapy for a Child with Sensory Integration Needs

Headshot of Elizabeth Haas, OTR/L

This is the second post in a three-part series on school-based occupational therapy for sensory integration issues. You can read the first post here, where I provide an overview of sensory integration issues.

L. is a student who not only inspired me, but taught me that working online with children who have sensory integration needs is possible. When I met L., she was eight years old and in the third grade. When she started school in kindergarten, she attended a brick and mortar school, but she suffered so many traumatic experiences there that her parents switched her to a virtual school. L.’s needs were so severe and led to so many scary experiences for her and her family that she actually stopped going out in public altogether.

L. requires constant movement to stay focused, has something in her mouth almost all the time, gravitates toward objects that give her visual input such as toys that light up and/or spin, and is extremely sensitive to and frightened by background noises.

It took some time to get to know L. and establish a rapport with her. When we first started meeting online, she screamed, cried, and ran around the house. I felt puzzled and defeated, but did not give up. L.’s mother, M., worked with me every step of the way and was determined to make online therapy work, as in-person OT was not an option for her daughter. She told me how much L. would look forward to our sessions, but would then nearly sabotage them with her behaviors. She also told me how much L. loved working with me because I could not touch her, and therefore she wasn’t intimidated by me or by the experience.

M. dearly wanted her daughter to be able to love school, play, and interact with the outside world again. So we carried on together, and I slowly was able to make suggestions to M. about things we could do at the start of our sessions to help L. stay calm and focused. Rolling a ball over L. at the start of a session would have an unbelievably calming effect on her, and enabled her to work on much needed handwriting skills for up to 15 minutes at a time at the computer.

The more I observed L., the more I realized how in touch she was with her own sensory needs. For example, we might have been in the middle of working on an activity, and she would run to her room to get her toy butterfly that lights up and spins. She would be fine to continue working as long as the butterfly could join our session. Another time she grabbed her brother’s baby bottle full of water and brought it over to the computer. When she sucked on the bottle, she focused and completed a difficult puzzle independently and with 100% accuracy.

During our year together, L. taught me an incredible amount. Not every session was easy, and some days were harder than others, but I am okay with this. Much of my work with L. was just watching her, asking M. questions, and making suggestions. Some worked, and some didn’t, and it was a true process of trial and error.

Eventually L. started to show real progress. When M. and I would work together to give her the right amount of sensory stimulation, amazing things would happen in our sessions. She completed art projects and worked on her handwriting in writing books for longer and longer periods of time, with sensory breaks taken as necessary.

Around Christmastime, M. decided to take L. to see her brother perform in his school play. M. was terrified: What would L. do? How would she behave in a sensory-rich environment? Would she be able to handle it? Would she have fun?

We spent a lot of time discussing strategies to try before, during, and after the outing that would help L. to stay calm and behave appropriately. Over 500 miles away, I was also a nervous wreck. I waited anxiously all day to see if L. was able to pull off a successful outing. When she got home, L. sent me a message and I could sense her excitement about everything she saw and did. I breathed a huge sigh of relief — she did it! I was so proud of her, it brought tears to my eyes.

L. has continued to progress. She has now had several play dates, something she hadn’t been able to do before, and even met Santa. Every now and again, I sit back and remind myself how far L. has come. Though she and her mother deserve most of the credit, I’m thankful for the knowledge I have and the suggestions that I was able to make and observe being used online. I sometimes wonder how L. would react if she met me in person. Does our relationship only work because I cannot touch her? I likely will never know, but I’m grateful I met her and didn’t give up. Teletherapy opened up a new and special world for her, and I’m thankful for having been a part of it.

Elizabeth Haas, MS, OTR/L is a Clinical Practice Director, Occupational Therapy for PresenceLearning

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