Episode 65: Judy Au (Occupational Therapist) - Unlocking Sensory Secrets: An OT's Guide to Child Development

Occupational Therapist Judy Au explores the holistic approach of pediatric OT, explaining how foundational skills underpin a child's ability to participate in daily activities and engage with the world.

• Occupational therapy supports children in all daily activities including play, social interactions, and self-care
• The DIR Floortime approach is relationship-based, considering each child's individual differences and developmental level
• Foundation skills like sensory processing and regulation must be established before working on specific tasks like handwriting
• Children need the right amount of sensory input to feel calm and ready to engage, communicate and learn
• Each child has a unique sensory profile that affects how they experience and respond to their environment
• Movement before fine motor tasks helps prepare a child's brain for learning and focusing
• Sensory-friendly strategies can be adapted based on a child's changing needs rather than following a fixed "sensory diet"
• Co-therapy with multiple professionals allows for more comprehensive support for both child and parents

danabaltutis.com,  mytherapyhouse.com.au, https://mytherapyhouse.com.au/your-childs-therapy-journey/ https://www.danabaltutis.com/services

Transcript

Meeting Judy Au, Pediatric OT

Speaker 1 1:17

Hi Judy Au, our wonderful occupational therapist at my Therapy House. Welcome to the Empowered Parent Podcast. As you know, I love occupational therapists. I think you guys have got a whole trove of information and you always know how to support clients with their social, emotional regulation, with their sensory motor skills, with all of these different areas. So welcome to the podcast.

Speaker 2 1:51

Hello Dana. Thank you for having me. I'm Judy. I'm a pediatric OT from my Therapy House.

Speaker 1 1:59

Yeah, and can you tell us a little bit more about yourself? Why, how did you become an OT? Like, why OT?

Speaker 2 2:08

Yeah Well, I've always been passionate about working with children and supporting them and their families in their therapeutic journey, and I, I guess, thinking about OT. I haven't really heard much about it previously. Yeah, so when I was looking at things that I want to do after high school, I was looking at the different occupations or different discipline that works with children, but I also really wanted to work in the health area and so I was doing my research and at that time my mom's friend's sister was an OT. She might still be an OT, I'm not sure, but that was the first time I heard about it and I did a little bit of research and was like, oh, it's a really broad area, but it looks like something that I want to do, yeah right.

Speaker 2 2:59

Yeah, and so I started my degree and I love it.

Speaker 1 3:02

Yeah, judy, were you born in Australia.

Speaker 2 3:07

No, I was born in Hong Kong.

Speaker 1 3:08

Wow, and what age were you when you came to Australia?

Speaker 2 3:12

I just turned nine at the time.

Speaker 1 3:14

Right. So you've had all your formative years in Hong Kong and then you came out to Australia and you did most of your schooling in Australia.

Speaker 2 3:24

Yeah, that's right.

Speaker 1 3:25

And then after that you went and studied OT, amazing, amazing. So, judy, when we talk about you and I sort of know what OT is and we sort of have that roll off our tongues, yes, what is occupational therapy, and can you explain how it supports a child's development, particular children's play, communication, social, schools and school readiness? What does an OT do?

Speaker 2 3:54

Yes, of course. So occupational therapy, like we were just talking about, is very broad. When we talk about occupation, it is everything we do in our day-to-day life.

Speaker 2 4:04

So, for children. This could include things like playing, engaging and interacting with siblings, with peers, with adults. It could be activities of daily living, so things like going to the toilet, getting dressed, mealtimes, things like that, and also participating in classroom activities, engaging in kindy, in childcare, and that's just some of them. So OT we work on supporting the participation and engagement in all of these occupations that are meaningful to the person. So in my role with children, we often have to take a big step back and look at the foundational skills that are needed to work on all these roles and occupations that children do.

Speaker 1 4:50

And.

Speaker 2 4:50

I'm sure we'll touch on more of the foundational skills later on in this podcast as well.

Understanding Occupational Therapy

Speaker 1 4:54

As you know me, I love foundation skills. Yes, right, oh yeah, they're very, very important yeah, so, judy, um, what it sounds like it's a huge area. How did you choose your area and what is your area of interest?

Speaker 2 5:10

yeah, so because I always wanted to work with children. So the bigger focus is pediatric. That's definitely my area of focus and then, within that, um is about exploring and learning more, and now I find that I am very interested in sensory processing and also play developments. I just love learning about and exploring how we all experience the world differently as an individual, but I also love play.

Speaker 2 5:36

Um, play is so valuable and it allows me to get into the child's world and know more about them, and it also works on everything without the child knowing that they're even working oh, so it's like sneaking in almost yeah, right, and what about?

Speaker 1 5:52

um? So you've done extra study and I know that you now use DIR, which stands for the developmental and looking at children's individual differences, and it's also relationship based. So you use the DIR approach in your work and you're a certified DIR occupational therapist. Can you explain to our audience, or to our listeners, what this is and why did you choose this framework?

Speaker 2 6:21

Yep, so the DIR floor time approach is a relationship-based developmental framework and it looks at where the child is developmentally, it recognizes each individual's differences and it uses a relationship-based approach, and that means using relationship as a mean to develop skills. Um, it looks at the child holistically, so we look at the child as a as a whole person, not just part of part of the child. Um, and we know that it's not possible to just focus on a specific area of challenge and just work on that, because everything is interrelated. Um, and the dir floor time approach really highlights this.

Speaker 1 7:01

So it's very neuro affirming. So are you really looking at what the child's strengths are and working to those strengths?

Speaker 2 7:10

Absolutely. We are very strength based. We look at what the child is good at and use that as a way to then support other areas because, Because if the child is not feeling motivated, they don't have the self-confidence to do the things that we're supporting them to do. They won't engage and there's really no meaning for that to happen.

Speaker 1 7:31

Then I understand that. So what's the difference between a DIR, floor time informed occupational therapist and, like traditional, ot, occupational therapy approaches?

Speaker 2 7:47

Yeah, that's a really good question. So OTs, we always look at a person holistically, but I have found that being DIR informed means that I am also always looking through a relational lens.

Speaker 1 8:02

Okay.

Speaker 2 8:03

And so I consider how the interaction between the child and their play partner or their communication partner may support the engagement and participation, or how it may make it more challenging, and this lens. Let me then use relationship therapeutically to work on areas of challenges in a very playful and motivating way so are you when you assess a child and say you set up the assessment the room?

Speaker 1 8:34

have you got the parent in the room or not? And what are you looking at?

Speaker 2 8:38

yeah, we definitely have the parents in the room and we always encourage parents to be part of the session, to be on the floor playing with the child, with us, because the child has a really strong relationship with their parents or caregivers and so this allow us to see the child's, I guess, best potential, especially with assessment. I am a new person. I'm someone unfamiliar for the child, so I won't be able to see as much if I am the only one interacting with the child and you know you talk about the child's individual differences.

Speaker 1 9:11

Do parents have individual differences and do they impact the child's interaction?

Speaker 2 9:18

Oh, definitely, we all have our own individual differences, our own profile, and I think it's really important to understand our own profile, be that parents or therapists, to see if there's a match or mismatch in the profile and how we can recognize it and then support the engagement and interaction in different ways that matches the child's profile so is it bad?

DIR Floor Time Approach Explained

Speaker 1 9:42

like, let's say, a child loves shaving cream play and he's like I love it, I love it, and just you know, I've seen you working as well and you all. The shaving cream is all over the room and the parent is sitting there and almost gagging. Because they have sensitivity to something like that, to the visual, the mess, the tactile. How do you start matching that?

Speaker 2 10:07

I think it's great that then, if the parents look at looking at the shaving cream, the messy play for them to recognize oh, I don't like this. Yes, that's huge yeah the parents able to say my profile might be different to my child and that's okay. Yeah, so then we might be finding different ways to be able to support the child, to still explore it.

Speaker 1 10:29

Could it be maybe outside, but the parents be able to accept this or more contained yeah, so it's not all over the room, but maybe on a tray or, yeah, in a container.

Speaker 2 10:40

yeah, right, um, and just exploring what the parents may be okay, may be okay to play with, um, but also still um work on what the child needs and have their sensory preferences, I guess, respected yeah right and met.

Speaker 1 10:59

Oh wow, that sounds amazing, judy. And I guess another question is like do you so you work more on the regulation, the sensory motor, more about those foundational skills, and we'll talk about regulation soon. But do you ever have parents who come in and ask for Judy, help us with fine motor tasks like handwriting, dressing, feeding, but that child can't even sit? Still, that child doesn't have any body awareness. Can you share how your approach is different? What would you do with a child like that?

Speaker 2 11:40

so, yes, we definitely work on the motor skills development, but it's also important to consider the foundational skills, so all the skills that are needed to participate in everyday life. So, for example, um, things like sensory integration, so being able to take in, process, make sense of the sensory environment and then adapt to it and respond to it. Um, so what's the sensory? Environment so it could be things like um, visually, what is the child taking in?

Speaker 1 12:11

what are they seeing? Yeah, what are they seeing?

Speaker 2 12:13

is it busy? Um, the colors, is it too bright, the lighting, things like that? Um, it could be the physical environment of the touch input. So, um, are they comfortable in what they're wearing? Um, is the carpet too rough for them? Um, the noise level? Is it too noisy, too quiet? And then also internally, what are they experiencing within their body? Can they understand what's happening? Are they comfortable, do they feel safe in their body? Um, these are. So this is one example of foundational skills that will be needed for the child to then work on if the parents come in to say want us to work on fine motor skills, if that's not supported the child is not ready us to work on fine motor skills.

Speaker 2 12:55

If that's not supported, the child is not ready to work on specifically fine motor skills.

Speaker 1 13:01

And what about toileting duty? Like what are some of the? I guess you know a lot of people want to work on help their child to be toilet trained, but again, the child doesn't even know their nappy is wet. What would be some of the foundational skills that you would be looking at there?

Speaker 2 13:22

so, firstly, I think it's definitely important for the child to um show signs of awareness, um be that the introception of oh, I need to go to the toilet, and the sensation of that, or knowing, like you were saying, that their nappy is wet, because if that sensation is not there, it's tricky for them to even understand that they need to go to the toilet.

Speaker 1 13:44

Yeah right.

Speaker 2 13:45

So that's the very, very first step.

Speaker 1 13:46

Yeah right.

Speaker 2 13:47

But if they do start showing signs that, oh yeah, they are starting to recognize it, then we need to consider do they have the motor planning to know what?

Speaker 1 13:59

they need to do in the toilet.

Speaker 2 13:59

Okay, are they aware of that? What about the environment? Um, because some kids can find it challenging to um hear the sound of the toilet flushing. That can be too much for them to overwhelming. Or even sitting on the toilet seat, that can be too much.

Foundation Skills Before Fine Motor

Speaker 1 14:13

So there's definitely a lot to consider when we think about um toileting so, basically, if a person you know, a parent, came to you and said I want to work on some of the what you, what you guys call like ot's call activities of daily living so let's say, feeding, dressing, toilet toileting, bathing you would be looking more at what are their foundation skills first, and then how they overlap on their activities of daily living and, if they're, if the child is ready yes, definitely so.

Speaker 2 14:47

Foundation skills is definitely the first thing that we need to look at okay, great.

Speaker 1 14:52

so let's talk about the big R word, regulation, and I know at my therapy house we focus a lot on regulation. What does it mean and why is it so important? Why is it an important foundation for children's learning and interactions?

Speaker 2 15:11

Yeah, so regulation is another foundational skills for children's development. Children need the right amount of sensory input and stimulation to feel calm and ready to engage, to communicate and learn. And children initially learn to co-regulate with their trusted adults and then, as they grow up, they learn to self-regulate. And then, as they grow up, they learn to self-regulate. And it is very important because when a child is regulated, they are then in what we call the just right space and they can then focus on tasks and process information. They will feel calm, happy and ready to engage, ready to learn, and they also have the ability to control their impulses and manage their emotions. So if regulation is not there, it's tricky for the kids to really participate or engage in anything else.

Speaker 1 16:03

So if a child comes into your session, and how do you support a child's regulation?

Speaker 2 16:11

So it's important to understand their profile first. So if they come in and they are feeling maybe anxious, unsure about what's happening, it might be a new environment, a new person they're meeting.

Speaker 2 16:24

So then, to allow space and allow time for them to feel safe in their body, to support them, to co-regulate with their parents or caregivers um, not rushing to have the kids participate, or anything like that so really reading their cues to know where they are at in that moment before before doing more really, um, another example of this regulation could look like um, the child is seeking a lot of movement because they need that movement to regulate their body, to feel organized, and then I will make sure the equipment are set up in ways that allow that to happen in a safe way. And it's really good that the child is doing that, because that means that they are already starting to know what their body needs.

Speaker 1 17:09

Ah, okay, and is equipment like like essential to help children regulate?

Speaker 2 17:17

it depends on what type of sensory input they might be seeking. So, for example, if it's more, say, the vestibular input, so the inputs, um, where you, you're changing position. I guess your head is changing position like a swing.

Speaker 1 17:33

True space.

Speaker 2 17:34

Yes, trampoline would be really helpful, but other kids also enjoy running around, and if that provides them with the input that they are seeking, then that's fine as well. But sometimes children might be seeking the movement in ways that are disorganized and it doesn't necessarily help them to organize their body. They might be seeking movement, they might be jumping on the trampoline, but the more they jump, the more dysregulated they become.

Regulation: The Essential Foundation

Speaker 2 18:02

So, then that's when it is very important for the adult supporting them to recognize it and maybe support them to create movement activities that are more structured. So it could be activities with a very clear start, middle and end Okay, and then start it over again, just to really help them organize their body, and then they can come back to the activity to feel calm and ready.

Speaker 1 18:29

So I'm listening to this and I'm going wow, there's a lot in it. I think if I was a parent of a child that needed a lot of regulation, I would be going to an OT.

Speaker 2 18:42

Yeah, so OT definitely work.

Speaker 1 18:43

But do all OTs work with regulation?

Speaker 2 18:46

Yep.

Speaker 1 18:47

Okay, so that's really good. Okay, so what about? Another term that I hear thrown around in the OT world is sensory processing. What does it mean and how does that impact child development?

Speaker 2 19:02

Yeah, so sensory processing is how a child, or really each person, takes in, processes and makes sense of their sensory experiences. Each person has their own profile and preferences and there is absolutely no right or wrong way of processing. But it is about understanding the profile and if it is impacting engagement and participation in everyday life, then we have to think about what strategies or adaptation modification can we explore to support that engagement? And when there are challenges in sensory integration, it may look like regulation challenges. It could be sensory seeking, avoiding being sensitive or some information might be missed, and it can also look like challenges with attention concentration or even just trying new things.

Speaker 1 20:33

In general, can be tricky as well, and so is sensory processing. Like, okay, I've heard some parents. They really want their child to go shopping with them at the supermarket, so does sensory processing really come into play there?

Speaker 2 20:52

it can. If we're thinking about going shopping, often it might be in a very crowded environment visually. So there's a lot to look at, there's a lot of colors, the lighting often is very bright, the lighting often is very bright, a lot of noises, there's a lot of people moving around very quickly and for some children this can create creates a very unpredictable sensory environment which is highly stressful and can cause anxiety as well.

Speaker 1 21:26

So if I know that some supermarkets have the sensory, what is it? The sensory friendly?

Speaker 2 21:34

hour like quiet quiet time?

Speaker 1 21:36

yeah, so is that something that parents could start with going to the quiet hours?

Speaker 2 21:41

yeah, that could definitely be a good place to start, but definitely have to think about where the child is at, because even that could also still be very overwhelming as well and what about?

Speaker 1 21:53

I've heard people say like nail cutting and hair trims or haircuts are very sensory overwhelming for children. What could parents do in those situations?

Sensory Processing and Development

Speaker 2 22:09

So it's definitely important to explore what it is that is challenging for the child. So, is it the tactile input, is it the touch of it, is it the sound of it? Or it could be that, moving away slightly from the sensory side of things, is it the activity itself that is scary for the child for some reason? Right, so, understanding what is the underlying challenges first, and then working on it. Um, so previously I have worked with a child who, um, who is very, who was very unsure about the sound the scissors make near his ears. Um, and what we did through play, we explored and model cutting Bluey and Bingo's hair, brushing their hair, cutting, blow-drying, things like that, and after a couple of sessions the child was able to tolerate mum cutting his hair, and that was really great.

Speaker 1 23:05

Wow, that's huge. So you use a lot of play when you're working on the sensory input and going, you know, like extending on this sensory subject. Some parents might have heard the term sensory diet. You know what exactly is a sensory diet? Is that things that we eat, or what is it and how does it help children?

Speaker 2 23:32

eat, or what is it and how does it help children? So not what we eat. A sensory diet is often thought of as a static set of strategies to support a child's regulation, but the reality is that a child's individual profile. It changes daily, so what works for them one day might not work the next. Instead of following a fixed plan, we need to constantly reassess through observations, so noticing what supports the child engagement and adjusting it accordingly. Oh, that makes so much sense.

Speaker 1 24:01

So do you create? Having said that, Judy, do you create sensory diets for children or do you have a different approach?

Speaker 2 24:10

Personally, I haven't created many sensory diets. I find that providing parents with different strategies they can implement, maybe before school or before mealtimes at home, things like that allow for that flexibility and it keeps it fun for the children because they're doing different things every time. But a structured sensory diet can definitely be beneficial for some children who prefers very strong predictability and know what's happening, and also it's important for them to be able to participate and engage in specific activities in specific times.

Speaker 1 24:42

But you have written sensory profiles, yes. So what's the difference between a sensory profile the way you write it and a sensory diet?

Speaker 2 24:52

so a sensory profile. I look at all the different areas um so, for example, like auditory, visual, um oral inputs.

Speaker 2 25:03

Uh, proprioceptive yeah things like that yeah, all the different ones and then so, in collaboration with the parents, then we write down a list of things using the sensory profile um, uh, sensory profile assessment, to create a like a chart to tell people supporting the child, um, what the child's profile is like.

Speaker 2 25:29

So, are they sensitive to specific things, do they avoid specific inputs, do they seek certain things or do they miss specific information and what that may look like.

Speaker 2 25:43

And then I provide strategies for each of these things.

Speaker 2 25:46

So it may be like oh, at school it will be important for this child to have a visual schedule so they know what to expect, they know when the bell's going to ring, or it could be things like it's important for the child to be seated in a location with less visual distraction to support them, to participate. So that that's a sensory profile, whereas a sensory diet is more about creating activities that the child can do to get them to the just right space of regulation so that they can then participate in specific activities. So often it might be, if we want the child to be able to concentrate and have the attention at school, then before school in the morning we might say all right, the sensory diet can look like you are going to do 10 jumps on the trampoline and then we are going to do, for example, five cartwheels, and then we will help mum carry the laundry because that's heavy work carry the laundry back into wherever, and that's a sensory diet that the child may then do every day before school.

Speaker 1 27:00

So basically what I'm hearing is the sensory diet the onus of change is on the child, whereas the sensory profile, the onus of change is on the child, whereas a sensory profile, the onus of change is on the environment. So basically, with a sensory profile, you're informing people what they could do to support the child, whereas with a sensory diet, the child has to do stuff.

Speaker 2 27:24

Yeah, that's right, yeah, right, that's a really good way to put it, yeah yeah, as a speech, pathologist I always like to make meaning around things.

Speaker 1 27:32

And what about co-therapy? Do you work in co-therapy and how do you do that?

Fine Motor Skills and Attention

Speaker 2 27:41

Yeah, I often work in co-therapy, be that with a speech pathologist or our development through play. Yeah, and so it's really great to have co-therapy because it firstly it allows one therapist to maybe talk to the parents about the parents' concerns or questions that they have, but it also allows us to model in-session strategies for the parents to then do in a different environment be that at home or in a different setting to then really transfer the skills setting, to then really transfer the skills.

Speaker 2 28:20

I also find that it's great for parents to be able to see what we're doing and then have another person explain to them why we're doing what we're doing.

Speaker 1 28:25

Yeah, right, without breaking the flow with the child.

Speaker 2 28:28

No, that's right, yeah, and that can be tricky to do if we're doing individual therapy, because then I'll be trying to support the child, but then I would also love to talk to the parents, but then the opportunity is not always there.

Speaker 1 28:42

So, judy, many parents. I want to move to fine motor skills and attention challenges. So many parents worry about their child's fine motor skills, but they also notice that their child struggles to sit still or attend to a task for a period of time. In these cases, what are three things you'd suggest parents focus on?

Speaker 2 29:05

Three things that parents can focus on could be maybe having movement before the fine motor task. So many children need the big body movement first before they can focus and concentrate on the smaller fine motor work. So movement can really help their brain get ready to learn. So parents can encourage things like jumping, climbing, pushing, pulling, swinging, balancing things like that before sitting on a sitting in front of a table for a task. And even small things like a quick brain break dance session can really make a big difference.

Speaker 1 29:42

That sounds great.

Speaker 2 29:44

Another thing parents can focus on is to engage the child's interest. So if a child is not engaging, it's hard for them to focus on the fine motor activity because it's not motivating. So using their favorite themes or toys, for example, if they love cars, then possibly let them push small toy cars through a garage using their fingers to build hand strength, or sensory play like play-doh or water, things like that can be really great to develop hand muscles without feeling like it is fine motor work.

Speaker 1 30:17

Yeah right.

Speaker 2 30:20

Another thing that will be really important for parents to focus on is supporting the regulation first. So a dysregulated child will really struggle to focus and co-regulation and sensory strategies can help with that. Some children focus better after receiving deep pressure input, so things like being squished between pillows or really tight hug or using wobble cushion instead of sitting still may also help with their regulation, and I think it's important to highlight that observing and adapting in the moment is key, because some kids they need quiet time before focusing, while others need movement first.

Speaker 1 30:59

So it's really about knowing what your child needs in that moment I love it, judy, if, um, you're a parent and you attending or is not sharing or is, you know, just having difficulty with taking all the information in at school. Should parents reach out to an OT at that point?

Speaker 2 31:35

I think yes. So if you have concerns or you are unsure and if it is in a school setting, the teacher may also have like recommendation for you to explore support and OT can then help and be that complete assessment or observation to see if your child will need extra OT support.

Speaker 1 32:00

And what about with young children? Do you guys support young children around their social-emotional regulation, holding those big emotions meltdowns? Is that what OTs can?

Speaker 2 32:11

do as well. Yes, we can definitely support with that as well. Regulation starts at a very young age, so if there are challenges in this area and you're unsure what to do, you're welcome to come and talk to an OT.

Speaker 1 32:26

Yeah, I just. I love OTs. You seem to be extremely versatile and well-versed in many different areas and I know you ground a speech pathologist very much and I love working with OTs. This has been such an insightful conversation, Judy, and I'm so glad that we had this time to chat. Thank you so much, and if parents want to ask you any more questions, I'm sure they will be able to ask you more questions. You're at my therapy house and thank you so much for joining me today.

Speaker 2 33:04

Thank you so much for having me on this podcast, Anna. Thank you.

Speaker 1 33:07

Great, thank you.