Therapy: A Guide
Schools often recommend therapy for children who are struggling to meet developmental milestones, or displaying challenging behaviour.
1. Play therapy
Play therapy helps children work through a variety of emotional, psychosocial and behavioural difficulties (including family issues) in a non-threatening manner. The therapist uses play and creative techniques to help children express, communicate and work through their feelings.
“This form of therapy is particularly effective with children who cannot, or do not want to, talk about their problems,” says Simone Lazarus, an art and play therapist.
How does it work?
Play diagnosis and therapy is practised by specially trained registered psychotherapists, who form short- to medium-term therapeutic relationships with the child.
“We often work systemically, taking into account and perhaps dealing with the social environment of the client, such as peers, siblings, family, and school,” says Lazarus. “Play therapy may be non-directive, where the child decides what to do in a session, within safe boundaries or directive, where the therapist leads the way, or a mixture.”
Among the many benefits of play therapy are that children:
Have an opportunity to reflect on how to relate to others, and the impact of past relationships or experiences;
Increase insight and self-awareness;
Learn to understand difficult feelings and experiences; and
Improve interpersonal skills.
A session lasts 45 minutes, and medical aid rates vary from R650 to R850 a session.
Children have different ways to mask difficulties – some clown around rather than standing out as the slowest or least capable, while others refuse to try, to avoid disappointment. Poor self-esteem and lack of confidence are often the result of delayed developmental co-ordination, which can be addressed with a physiotherapist.
What problems do physiotherapists treat?
Inefficient postural control/core stability: “These children struggle to sit comfortably at their desk or on the floor, and often seek outside support or sit between their feet (W-sitting),” says Dorothy Du Plooy, a physiotherapist skilled in paediatric neuro-developmental therapy.
“They are constantly moving, fidgeting, standing up or sitting in ways that don’t require the postural stabilisers to be activated. This all takes up a lot of energy and can lead to reduced concentration and an inability to complete tasks.”
Delayed gross motor skills: Hopping, skipping, galloping and climbing are all gross motor skills. Children who play only in the sandpit or indoors may not have developed these skills. “This affects their confidence and ability to socialise and problem solve around taking turns and sharing on the playground,” says Du Plooy.
Poor balance: These children may avoid scooters and cycles or walking across beams and might also be accident prone.
Poor quality of movement: Activities like running will look less co-ordinated, with feet wide apart and exaggerated movement.
Delayed bilateral integration: “Children with difficulty co-ordinating both sides of their body will struggle to perform star or scissor jump, march or string beads,” says Du Plooy.
Hand-eye co-ordination: Poor hand-eye co-ordination affects the ability to throw and catch a ball, copy from the board or follow text when reading.
Fine motor co-ordination: “Doing up buttons and tying shoe laces will be a challenge for children with poor fine motor co-ordination, which also determines their ability to hold and control a pencil and a pair of scissors,” says Du Plooy.
Proprioceptive feedback: Children with inefficient proprioceptive feedback might enjoy falling, bashing into objects or jumping continuously to stimulate a better sense of where they are in space.
Planning: “We develop planning, an integral part of learning, through movement,” says Du Plooy. “Through learning and perfecting basic movement skills, children progress to more complex planning activities. Learning to organise your desk, or the books in your schoolbag, all starts with basic planning skills.”
How does it work?
Physiotherapists assess the child and develop a programme specific to their requirements. “Exercises should be fun and graded with just enough of a challenge to improve confidence, pride and self-worth, while building strength and endurance,” says Du Plooy. “One of the most important effects of physiotherapy is the improvement in confidence and self-esteem.”
Session rates vary from city to city, and range from R500 to R700 for an hour.
3. Speech and language therapy
Speech and language therapy helps rehabilitate children with various conditions, including stuttering, cleft palate, hearing loss, sound articulation problems, auditory processing difficulties, autism, delayed speech and language development, head trauma and voice problems.
How does it work?
Each client is treated as an individual and has a specific programme designed for them to facilitate the rehabilitation of their unique condition.
“Speech and language therapists work in a team approach together with parents, teachers and other carers in the child’s life,” says Pauline le Sueur, speech and language therapist.
“Speech and language therapy can be a great deal of fun. As children respond so well to games, much of the work is done by using fun activities, choosing very specific games to motivate and encourage the child, while addressing the particular problems. This process, combined with encouragement, motivates and enables clients to change bad speech habits and learn new ways of doing things, all in all creating new possibilities and more confident individuals.”
After the initial assessment, sessions range from R230 to R540, depending on length.
4. Occupational therapy
Often known as OT, the primary aim of occupational therapy is to enable people to participate as fully as possible in their activities of everyday life and work. For children, these activities would include playing, climbing, learning, reading, writing, planning, socialising and generally experiencing the world.
“OTs assess why someone has difficulties managing their daily activities and what they can do to help them overcome these challenges, to make it possible for the person to reach their maximum potential,” says OT Marcelle Shaman.
“The paediatric OT evaluates the child’s play, school performance, physical ability, motor and sensory skills, social and emotional behaviour, and daily activities. They will then address any physical, psychological, social, emotional, environmental and sensory factors affecting the child’s functioning at home, at school or in the world at large.”
Who would benefit?
Paediatric OTs work with children with a diverse range of challenges:
Learning challenges and developmental delay;
Sensory processing disorders;
Attention deficit disorders;
Autism and pervasive developmental disorders;
Birth injuries or defects, traumatic injuries, juvenile arthritis;
Emotional and behavioural issues; and
Orthopaedic issues, post-surgical conditions.
How does it work?
Most OT rooms look like large, fun, play areas and are very inviting to children. “Treatment can range from games, swings and shaving foam (for sensory integration issues) to reflex work on a massage bed (for primitive reflex integration issues) and a myriad of other tools in-between,” says Shaman.
“The OT meets the child at their developmental level and slowly builds them up to reaching their optimal potential.”
Rates range from R200 to R400 a session, depending on length.