Thursday, April 19, 2012

Therapy Secrets: Setting up for success

This will be a series that will feature things that might be helpful for a parent who has a special needs child.  It will showcase some things I'm doing, but it will also include things I've learned from my experience as a therapist.  This is not intended to be therapeutic advice, but rather a place to get ideas.  Please discuss with your occupational therapist on how to incorporate these ideas with your child's goals.  If you have questions or ideas please feel free to leave them in the comments or email me at

Setting up up the Environment:

Setting up the environment is one way to encourage your child to pick therapeutic activities on their own.  It takes some thinking through, but it's very rewarding. 

To be successful, there are some things to consider.

1.  Your child's physical abilities.
2.  Your child's cognitive abilities.
3.  Your child's sensory issues, if any.
4.  Your child's current goals.
5.  Your family's availability to supervise.
6.  Your family budget.
7.  Available space.

Yes.  I know it's a lot, which is why it's ideal to have your OT visit the house and do a home evaluation.  They can give you specific ideas based on your house and the current goals of your family and your child. 

However, there are some simple ideas that can help you get started. 

1.  Get down to their level and take a look around. 

Are their toys easily accessible?  Are there places where they can practice their physical goals?  Are there places where they can play without supervision, if appropriate?  Is there furniture that fits there size?  Is the house accessible to their physical needs (If your child uses a wheelchair, have you tried getting around in your house on a wheelchair)? 


 When my son started to learn how to pull to stand, I made sure there were plenty of places to practice safely.  I put a few favorite toys on top of the sofa to entice him to practice standing and to encourage him to start cruising.  He was so excited the first time he was able to play standing by the sofa.  After a few practice sessions, he was able to play mostly on his own with supervision.

2.  Who's in control?

The great thing about setting up the environment is that your child will feel like they are in control.  They can choose to do the activity and they can feel independent.  Fostering this independence can increase their self confidence, their curiosity, and their ability to generalize one skill into many different tasks. 

This technique is based on the "client centered" approach.  The idea is basically that your child often knows what they need and want.  If they are given the opportunity to follow these desires, they will develop their skills according to their timetable, rather than our own.  This development feels more natural to your child and it will foster their desire to practice the skill frequently because they are motivated intrinsically (on their own). 

I used this method in my practice for ten years.  It's a great way to motivate your child to find their own therapy path, which leads to independently choosing therapeutic tasks.  The truth is you are choosing their activities by setting up their environment, but they get to choose which activity goes first and for how long.  This also encourages play, especially when they're young.  There's no need to finish a task.  They can go from one task to another as a natural progression of play.  As their skills increase, they will naturally be motivated to "complete a task". 

3.  Choosing the right activities

Ideally, the activities should be a variety of gross motor and fine motor tasks.  At least one activity should be something they already know how to do.  This will be the "go to activity" when the hard ones get frustrating. 

The other activities should be the "just right challenge".  This idea was promoted by the Sensory Integration Model.  It means the activity is just challenging enough to make it interesting, but easy enough for your child to accomplish with minimal or no help. 

This is the hardest part of this method.  In fact, this is where a skilled therapist can really help you.  Every activity can be broken into multiple steps.  Each step requires different skills.  Being able to set up the activity so your child can be successful is priceless. 


I put his electronic piano and his easy to grab balls on the sofa first.  Why?  Because he liked playing with balls and he enjoyed playing the piano.  He already knew how to do those activities.  I chose easy tasks because his goal was was pulling up to stand and standing during play.  So the activities were there as a prize, not as a task.  Why?  So that he would feel good about being able to stand and enjoy his accomplishment without being frustrated by another work task.  This made practicing standing enjoyable, not work.

4.  Change activities

When your child seems to finish everything quickly without too much effort, it may be time to change the type of activities you set up.  I usually leave the favored activity and change the ones he seems bored with at the time.

If your child is not happy about change, only change one activity at a time.  Also leave her favorite activity as home base, so she can use it as a comfort activity.

5.  How to play

Try not to overly show your child how to play with the toy "the right way".  Children who are allowed to play with toys "their way" tend to develop more imagination and confidence.  Only show your child how to play with a toy when they seem at loss or are bored doing it their way or they seem stuck doing only one thing with the toy.

I usually start playing with the toy, as if I'm playing with the toy, not showing him what to do.  I model play so he can watch without pressure to do it my way.  Besides play is fun, not stressful.  And play is how children learn.  This is the key ingredient.  If everything you teach is done in a playful way, they will learn faster, better, and smarter.

6.  Benefits

This method will also teach your child how to play independently.  At first, they might need a little more help, but eventually they learn to explore and play on their own.  The basic goal is to set them up to succeed.  The success encourages them to practice their skills even more.  The continued success, increases their motivation and their confidence.

7.  What I've done for my son.

Below are pictures and explanations of what I've set up for my son.

adult's view

From an adult's viewpoint, things just look messy.  Now enter from the viewpoint of a child who is just learning to walk.

child's view 1
As you can see, your height drastically changes your perspective.  This is true at any age.  This activity table is great for a baby who is cruising pretty well and needs a little more practice cruising and standing.  It encourages them to learn how to turn and increases their standing tolerance.

For an older child, a table might be set up at their height with appropriate activities.  For children practicing their fine motor skills, a table and chair perfect for their height is essential.  This means that when they're sitting their elbow, hips, and knees are all at a 90 degree angle.  Why?  Fine motor skills begin with good trunk control.  More about that coming up soon!

child view 2
child view 3

child view 4

We have fantastic bay windows, where the window ledge is just the right height, for a baby who's balance is getting better.  When his balance was still poor, we blocked off this area, so he wouldn't bang his head on the ledge.  Now he can spend all day playing for a few minutes at a time with a variety of activities.  Mostly, he takes everything off the ledge and I put everything back on.  He loves spinning toys, so I put them high enough so he needs to slightly tip toe to reach it.  This improves his dynamic standing balance, which is necessary to walk better.

child view 5
 The sofa is one of the best places for standing activities when you're still a baby.  It's a great place to practice pulling up to stand, as you can see here.  I also have a mat on the floor, so he can "read his books", breastfeed, and practice walking on a different surface...harder to walk on, but softer landing.  I use the stuffed elephant to hold his scooter in place, so it won't slide on him, since he's not ready to get on the scooter independently.  I still leave it out because he can play with the buttons and he's the kind of kid that needs a warm up period with his toys (more on how temperament and sensory issues affect therapy coming soon!)

child view 6
Many children with sensory issues like to have a space all their own.  Somewhere small enough to feel cozy and yet big enough to have their toys, their way.  This tent is from Ikea and works for Baba because he doesn't seem to have visual sensitivities.  This tent needs to be on top of a soft non-slip surface.  This is a great idea if your child shares a room and needs to have her own space.  I know a mom who used the space under the stairs to create a special place.  Inside this space, your child is the interior decorator.  You can add things if they're still young, but let them take the lead so that the space will really be their space.  A place where they can decompress in peace.  If your child goes into the tent or space to decompress, try to give them the space they need.

These are just some ideas.  I know there are moms with fantastic ideas, who create amazing little places for their children.  Making the space therapeutic for your child may give them a chance to practice their developmental milestones, independently.  This gives you a break and at the same time increases their self confidence!  I say that's a win-win.

What do you do?  Feel free to leave some of your great ideas in the comment section.  I would love to get more ideas!

Have a lovely day!


  1. Love how you have set up the room for your son! We did a lot of this stuff back in the day when my son was really young. Nowadays, he IS in control of the house... ;)

    1. That's so cute! I have a feeling that Baba is going to be in charge soon too!

      Thanks for visiting!

  2. wow... This is very helpful. My son is almost 44 inches tall at 4 yrs old. I need to get him a good table and chair set. Your ideas are great. I have to print this out. Love the tent also. Thanks again.
    (Follow me on twitter: @AutisticSeas)

    1. Yes! The right size table and chair can have a huge impact on fine motor. Some immediate and some over time. I will post more on fine motor soon.

      Thank for stopping by! I'm glad you found it helpful!

  3. Replies
    1. Thank you for your positive comment! I really appreciate it!


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