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Developmental Delays in Children during Lockdown

by Tina MacArthur

Tina is an expert Paediatric Occupational Therapist, she specialises in Sensory Integration and over the last year has helped many children with developmental delays. In this article, Tina shares her experiences of delivering remote therapy and shifting her focus onto coaching parents and carers.

Tina MacArthur During the last year, I became aware that the parents I was working with were all expressing similar concerns about the impact of COVID-19 restrictions on their child’s ability to lead full lives and participate in activities they need and want to do at home, nursery and during play. They highlighted a lack of opportunity to support their child’s development through daily routines and activities due to factors including closures of schools, nurseries, and toddler groups along with restrictions on social and leisure activities.

The aim of this article is to highlight the role Occupational Therapy has played in the COVID-19 pandemic, specifically in supporting children and their families with developmental delays impacted by several lockdowns, social distancing and a year of uncertainty. With a background in the NHS and the independent sector, I have always been highly focused on positive outcomes of my intervention and like many of my colleagues I was apprehensive about how effective I could be without being as hands on as normal.

Through delivering Occupational Therapy during the pandemic, I believe I have been able to support children and their families to adapt to different daily routines and use appropriate activities to promote development and reduce loss of skills.

Lockdown and Developmental Delays

In the period December 2020 to March 2021, I worked with 32 children aged between 2 and 5 years old. They were referred to Occupational Therapy due to delayed development and the impact of this on their gross and fine motor skills, play, prewriting skills and self-care skills such as dressing and feeding.

Young children usually experience a variety of environments such as contact with family and friends, toddler groups, nursery, play parks, soft play, swimming pools and libraries which promote cognitive, physical and social development. The children I worked with had experienced almost a year of restrictions. For many, play was limited to their home and the people they lived with and not all had access to an outdoor space to play in. As a result, there had been reduced opportunity to develop fundamental skills required for playing and learning. This included movement skills such as hand strength to grip and control a spoon or crayon, and body awareness and balance for negotiating stairs, climbing and jumping.

A report by Public Health England, ‘Improving School Readiness Creating a Better Start for London’ stated that almost one in three children start school without the foundation knowledge and skills they need for learning. The Royal College for Occupational Therapy report ‘Unlocking the Potential of Children and Young People’ highlights that if gaps in skills are not addressed, inequalities can persist and grow throughout a child’s life. It is widely recognised that early intervention is key.

Occupational Therapy Support – Pasta Tubes and Shoelaces!

I found that rather than providing direct intervention with children, my role became focused on educating parents about the importance of developing foundation skills and how they link to their child’s ability to complete tasks they will be expected to do at home or nursery.

I taught parents how to use their child’s toys and everyday household items in different ways to promote development. For example, to encourage one 3 year old to develop fine motor skills, specifically using both hands in a co-ordinated way and improving pincer grasp, I advised his parents to encourage him to thread pasta tubes onto a shoelace. This started with teaching parents to provide hand over hand assistance then gradually step back as he progressed. I taught them to grade the activity by using a finer lace and smaller pasta to increase the challenge and promote further development. In an email check in, the parents informed me they had developed this activity, still working on co-ordinating both hands together, their child was using a spoon to transfer pasta from one cup to another, steadying the cup with one hand and holding the spoon in the other.

Another child in his preschool year was supported to develop core strength to enable him to maintain good posture while sitting on his chair when drawing. He did not have access to a safe outdoor space to develop his gross motor skills, so I advised his parents how to build obstacle courses at home with cushions to climb over, cardboard boxes to crawl through and rope on the floor to balance along.

27 of the 32 children (84%) were referred for Autism Spectrum Disorder assessment. Parents who were spending more time at home with their children reported they were noticing differences in their child’s development such as poor communication, repetitive play or sensory needs which contributed to challenging behaviours. These issues were not well understood by parents who did not have the usual support of friends, relatives and education staff to seek advice and reassurance from.

One 2 ½ year old boy was referred to Occupational Therapy so his parents could be provided with advice to manage his significant sensory seeking behaviours. During assessment he could not focus on purposeful play for more than a few seconds due to being intent on fulfilling his sensory needs. He constantly climbed, stripped off clothes, rubbed his body on surfaces and mouthed non-food items. His parents were concerned about his safety and his development. From the assessment of the child and his specific home environment, I developed an individualised sensory diet. I taught his parents how and when to incorporate sensory experiences throughout their son’s day to replace his inappropriate sensory seeking behaviours with the aim of improving his regulation. His parents worked for an initial period of 4 weeks, incorporating sensory activities every hour and reported that immediately after this input their son was able to focus for approximately 2 minutes on purposeful play including building with blocks and putting shapes in correct places on a form board. This was significant progress!

On Reflection

Looking back, after coming to terms with new ways of working, I found that changing the focus of my intervention to empowering parents using a coaching approach, rather than being ‘hands on’ allowed me to successfully support children with developmental delays who were impacted by the COVID-19 restrictions.

Intervention that was individualised for the child and their specific circumstances had the best outcomes as these children achieved their Occupational Therapy goals.

I noted that by using basic everyday items at home rather than therapy equipment, parents were more willing to actively participate in their child’s intervention rather than rely on me as the therapist to work with their child. Young children also responded well to being in their familiar home environments and could engage little and often in activities to promote development, allowing therapeutic activities to become embedded into everyday life. I maintained regular contact with these families to provide ongoing support and reassurance.

I believe, for the children I have been able to work with, this early intervention, delivered by parents with my guidance, has optimised children’s development with longer term benefits for their development, learning and achievement. I am acutely aware however that across the country there will be many children on waiting lists and children who have still to be referred. Therefore, early intervention with an increased focus on educating and empowering parents and carers will be even more essential as we rebuild following the pandemic.

Further Reading

Public Health England: Improving school readiness, creating a better start for London

RCOT Occupational Therapy Unlocking the Potential of Children and Young People

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