Transcript: Rethinking “Normal” in Child Development (Teacher Tom’s Podcast)

This post is a transcript for the podcast, which can be found here.

This podcast was graciously transcribed by Elizabeth Baker — thank you so much!

Teacher Tom’s Podcast: Taking Play Seriously

Tom: Hi it’s Teacher Tom and welcome to my podcast, where we take play seriously. Today, I’m talking with Kelsie Olds. Kelsie is an occupational therapist working with the children of family stationed at an air force base in the UK, but she’s more widely known, especially on Facebook, as the Occuplaytional Therapist. That’s right, Occuplaytional Therapist. I know that when I started teaching, I had no idea what an occupational therapist is, and I think there’s a lot of us out there who are confused by what they do. In this episode, I thought it would be interesting to talk with Kelsie about the work of an occupational therapist, especially one who grounds her work in play. She’s a thoughtful, innovative, and energetic advocate for a trauma-informed, neurodiversity-affirming, child-led play approach to therapy. Hi Kelsie, welcome to the show.

Kelsie: Hi, I’m super excited about getting to talk to you.

Tom: We had a little trouble getting scheduled just because we’re all on opposite sides of the world here. You work in the UK right?

Kelsie: Yes, I’m an American but I’m living in England and I work on a US Air Force base here.

Tom: Oh nice. All right, well, I’ve gotta tell you that I’ve been introduced to you through your incredible and very verbose presence on social media and I’m just so excited about what I read from you and what you’re up to and the things you’re doing and over the course of my career I have worked with a number of occupational therapists both through my school but also because parents will have engaged in occupational therapists to work with their kids, but I guess what I wanna ask, and I think maybe the burning question is, what exactly does an OT do?

Kelsie: That’s a fair question, it’s probably the number one that OTs get and the first time I had in grad school was to develop an elevator pitch that I could use to explain my profession. Most people hear the word occupation and they think of your job and so they’re confused about why an occupational therapist would be working with a child who doesn’t have a job or they think it’s coming from the angle of like, we’re supposed to make them ready for the workforce, or something like that, but it’s nothing like that. The root of the word occupation goes back to like occupy, anything that occupies your time, is what I say. So if it’s play, that’s a big one for me, if it’s work, if it’s school, if it’s the stuff that you do to take care of yourself every day and at whatever level along the life span that the occupational therapist is working with that person then an occupational therapist will take whatever occupies a person’s time, it could be rehabilitation, it could be maintenance, it could be whatever it is, to work on that, whatever it is that they need to do with their life, which is a very broad-sounding definition, and that’s kind of the definition from theory. And then in practice, when you talk about an OT working with children, they’re usually addressing either something difficult about fine motor skills or something difficult about sensory processing, those are kind of our biggest two realms we work with, but they’re not the only ones, and so it’s a very broad field with a very big scope, and that means that I get the chance to be pretty holistic which is good.

Tom: Well that’s awesome, I haven’t heard it described that way, I’ve always worked with OTs in the context of preschool, like young children and sensory processing is obviously one of the big areas that we work with kids and neurodiversity and all of that type of stuff and so I know that’s an area in which you are profoundly interested and professional about. But you call yourself an occuplaytional therapist, or The Occuplaytional Therapist.

Kelsie: Very prideful of me, in retrospect, as if I’m the only one, that wasn’t my intention by any means. I named myself the Occuplaytional Therapist because I practice occupational therapy with a child-led play-based lens, or framework, through which I do therapy. So it’s not the way that I was trained and it’s not necessarily the way every OT in the world approaches therapy this way or has the same views on play that I do, but for me, play is almost the vehicle by which the therapy is happening because I think that play is the primary occupation of childhood. So when the kids come into my therapy room, they are driving the session, they have free reign to gravitate towards what in my environment is interesting to them and play the way that they play and I will follow along and sometimes make suggestions, sometimes model things I would like them to pick up on, and I’ve always got stuff going in my brain about how to tie it back to what it is that I hope to work on or wat goals we hope to accomplish, but in the end, I developed their written goals with a team of adults and I figure out what they want out of their own life and their own body that they have to live in by playing with them and by watching them play, so it’s extremely important.

Tom: Okay, so I got a ton of questions right now. How do people even know to contact you, what is it that maybe you’re looking for in a child, or you’re concerned about in a child, that makes you say, “you know what, I need to contact an OT.”

Kelsie: Absolutely, so for me personally, I work for the schools on the Air Force base, so the schools are the ones who decide if an evaluation for occupational therapy would be something that they would ask my clinic for and then I would go and do the evaluation. And the things that they would see that would make them be concerned in a school setting would be kind of in the fine motor and sensory categories, fine motor is a little more concrete and maybe easier to explain. If the child is really struggling with handwriting or really struggling with typing at later ages or it could sometimes be struggling with things like being able to manipulate fasteners, that means buttons or zippers or snaps on clothing, or manage the zipper on your backpack or be able to take yourself to the toilet. If fine motor problems are impacting their ability to do things in the school setting, then that would be an appropriate time for the school to ask me to evaluate whether they need fine motor-related OT, and it’s usually handwriting, it’s usually the schools saying they’re not writing to the standard that the schools would like them to be writing at. The other branch of it in schools is the sensory processing component of it and realistically, it’s usually adults being like, “this child is behaving some kind of way we don’t like and we don’t know why and maybe it’s because of sensory, we don’t really know what that means or what that is or anything about it, can you come look at them at see?” And I can either recommend services if there are things that I think I can do ongoingly or I can just recommend some accommodations or make some suggestions to the school. Everywhere in the United States, this is the legal requirement of your local public school district, if a school has a fine motor or a sensory concern, they have an OT, and even if they’re far away, because I worked in the states before moving here in some very rural districts, and this is a legal requirement of the federal government that your kid can access these types of resources.

Tom: Okay, so as an educator, or as a parent, for that matter, how do we know the difference between this kind of normal development and something that really needs attention?

Kelsie: If a child is less than three years old, then they would fall under the government-mandated early intervention services and I’ve also worked in EI before in the past (which is early intervention) and so the simplest answer that I can give is that if you’re in the states and you are wondering at all, just call your EI clinic, that is what they are for. I’ve seen parents tear themselves apart trying to decide, should I contact them, maybe I’m taking a resource from somebody else, that’s not at all how it works, they want you to call them, and a big big part of early intervention services is literally just having a professional come into your house and be like, “hey, your kid is okay, you’re doing a great job, you’re doing okay” or “hey, your kid is actually really struggling with this, I can see this, you’re still doing a great job with this and maybe if you tried this other thing, that might help too.” Because sometimes sensory related OT for the little-littles is like, “I cannot tell if screaming bloody murder every time that you take a bath, is that just him being temperamental because he’s two or is that a bad thing?” And the kind of reassuring thing about OT at least to me is that most of our interventions, but I could say suggestions or things we try, most of them are completely non-invasive and they don’t hurt in any way if it turns out that when your kid turns three, they stop screaming bloody murder every time they take a bath. Okay it didn’t hurt anything for you to try, you know, taking a shower or taking a bath while holding them or washing their hair in the sink, nobody lost anything from that. So I would say that anybody, if you’re a parent and you’re like, I just don’t know, I don’t know if this is within the realm of normal or if this is outside the realm of normal, that’s okay, it’s not your job to have to know, and it’s absolutely okay to access the resources that are available and that the government wants you to and the therapists there want to help you. So just Google your city name or state name + early intervention services and you’ll see what you have close to you if you’re in the states and also in a lot of other countries as well.

Tom: Well it’s interesting, I think that – and tell me if I’m wrong about this – it seems like maybe one of the barriers to people taking advantage of the resource of OT is this idea that maybe there’s a stigma to it, because as advanced as we are, there’s still a stigma to seeing a therapist and they worry that, “oh my God, I’ve already ruined my kid and they’re only two years old.”

Kelsie: Right, yes, so people not knowing what OT is, people not knowing that it exists, or to ask for it, or people thinking that your kid is just kind of supposed to come out a certain way and so if they’re seeking help, then that’s a bad thing. There’s a number of barriers where you can go to that one but you can’t go to that other one or maybe that one has this kind of philosophy and this other one has a philosophy you don’t agree with and it just becomes a big mess.

Tom: You obviously help a lot of people just online, you know, the one thing that I really liked about what you just said is that you’re going in and basically just giving suggestions, giving advice, giving people some perspective maybe. Maybe 150-200 years ago, when extended families tended to stay together, you had the aunts and the uncles and the grandmas and the grandpas and all of those people around to say, “You know, you were just like that!” that kind of thing, so I like the idea that you’re there mainly, in some ways, to comfort the parent or the educator.

Kelsie: It really can be, and it’s super important out here because people don’t have any family members, they’re here because the military moved them here, so they’ve got absolutely no one and so we’re really, really just coming into parents’ houses and being like, reassurance and that resource of just like, human connection.

Tom: You mentioned, one of the things you’re talking about as you go into the homes and you go into the classrooms too and then educators ask you, one of the questions I have is, you’re a play-based person, and I’m a play-based person. To what degree does the environment of school impact behavior in ways that like, if you change the environment, the behavior goes away? IS that a factor?

Kelsie: Oh so much. Because people say, just homeschool your kids, and I am all for homeschooling your kids and I’m all for non-traditional schooling and I’m all for a variety of environments that work, but I also don’t want to just give up on the education system, and say well I guess all of the children who are in public school are just screwed and will just be in a bad environment forever and no one will ever try to work to change that. So yes, the environment can make a massive difference, even teachers within the same school, even if they have a really strict administration, one can be doing everything they can to be developmentally informed and have appropriate expectations of the kids and doing everything they can and then another one can be having absolutely no give and making all of these demands and it can just really affect how kids are responding to it, just like it would for any other human being alive of any age.

Tom: Got it. I see. The area that people talk about a lot now, sort of the whole neurodiversity era, right, we talk about the people who are on the autism spectrum and I’m probably gonna misuse some terms because I know we used to call it Sensory Integration Disorder but I don’t know if we use the term disorder anymore. It’s strange that we have all of these conditions now that we didn’t used to have. How do you respond to people who think we’re making it up?

Kelsie: Yeah. I think that there’s a lot of things that go into that. So autism is a neurotype, it’s just a type of brain, and it’s very genetic, it’s very heritable, a lot of parents find out that they’re autistic when their child is diagnosed with autism because a lot of those parents will say either like “Well, I used to do that and it toughed me up and made me ready for the real world” or “Yes, I used to do that, and it was very hard for me, that nobody would accept me and I would like to make it different for my kid this time around” you know, and so there’s this comparison that I read about how we know that being left-handed used to be stigmatized and when students showed tendencies of naturally being left-handed, they might be punished for it, or hurt for it, or be taught or trained to use their right hand.

Tom: I specifically remember teachers correcting kids for left-handed writing and making them sit at the right-handed desks.

Kelsie: Oh gosh. And so then when we look at data from statistics for how many people who used to be left-handed, it looks like it was one or two percent for a long time and then all of a sudden it was ten percent and it stayed at ten percent and it still is about ten percent today. For autism and for other neurodivergent conditions, we’ve thought that one in every sixty people was autistic and then it’s like, oh wait no, we think it’s this or this or this, and [the percentage] keeps going up and up. And I think we’ll hit a point where it’s less stigmatized or not stigmatized, that would be the ideal, and we’ll know [more] things about it because the other factor is that it’s not quite as simple as being right-handed or left-handed, it’s based on diagnostic criteria that are kind of in question or being adjusted and a lot of things that people consider to be autistic traits are more accurately distressed autistic traits and so a happy autistic person may not look like a distressed autistic person and so then they’re not being recognized as having the type of brain that they have because they’re not displaying traits of distress and the traits of distress are the ones that have been used to create the diagnosis, so there’s many, many factors that come into play here. But I believe that it’s much like handedness, where there is a percent of this naturally occurring difference in the human being population, and that percent is more or less stable over time and we will figure out that percent when we have had diagnostic criteria and reduced stigma for a long enough time for enough people to figure it out and know it about themselves and accurately be able to report it about themselves. And until then, it will look like we’re having a spike of new things because we can notice it more accurately, there’s less stigma around getting help, and we know different ways that it presents now than we did in the past.

Tom: I love that metaphor connecting it to left-handedness and I imagine that there are many other neurotypes out there that we aren’t talking about very much or that we maybe haven’t even identified yet because the human brain is an amazing thing. In fact, I was reading a physicist by the name of Patrick House and in his research, he believes that every single one of us is a unique neurotype and there is no such thing as normal. I find myself increasingly worried about the word “normal.” What about you? I mean, the word “normal” just is not a word that I try to use, I try to get it out of my vocabulary. Because people always ask me “what is normal development in a child?” or “What does a normal two-year-old do right now?”

Kelsie: Yeah, I think that I tend to say that “things are typical,” or “things are close to average,” or “things are happening as expected.” there’s a lot of different ways that I say it but it’s a better way of describing what it is that I actually mean. “It is typical for kids to go through a period where they experiment with lying.” That’s not me saying that it’s fine and everyone should lie to everyone and no one should ever do anything about it, it’s just me saying that you don’t have to freak out and pathologize your kid because they’re experimenting with lying because that’s a typical way where they go through a phase of development and figure out they can do that. That’s what they do.

Tom: Have you ever worked with communities where you can get the whole community behind talking to their children about these behaviors and inviting the kid over for play dates to get more comfortable?

Kelsie: I think it would be a dream to be able to. In the schools that I work in, I have suggested to the schools that I Could just come in and talk about the different ways that brains are, so not like “this is about Johnny,” but that hasn’t been something that we’ve been able to make work yet. The closest that I came was that I worked in a group foster home for children, it was all older children, I think the youngest was eight or nine, the oldest was seventeen, and they all had such significant disabilities of some kind, including neurodivergence, including physical disabilities, including behaviors, that they couldn’t be in a traditional home and so they were in this facility all of the time. Some of them went to school outside, some of them went to school inside, and so the scope of what I was doing there changed a lot over the course of my working there because the funding changed and I went from being able to provide individual OT to all of the kids to them asking me to pick three kids and only keep three kids and discharge all of the other ones, which is not even slightly how need works, and it was really devastating to me at the time. So I asked if, instead, I could shift the scope of what I did to doing group activities and any of them could come to the group if they wanted, but I would focus on those three kids or I would do activities that I thought would focus on the three kids, and they said yes, I could do that. Some of the staff would come and learn and join in and stuff and some would not be able to do that and there would be different people but the kids could all join in and we could talk about the ways that brains worked. That job was a stepping stone on becoming the Occuplaytional Therapist because I went into it with what had been modeled for me of “let’s all sit down at a table and do a worksheet” and they were all like “yeah…I’m gonna throw your pencil and leave the room.” And so I very quickly adapted because before that, I had worked with kids who might be sitting there silently thinking “I hate this, I hate you,” but they were polite enough to not say it, and these kids were like, “hey life has taken everything else from me but I don’t have to be here and I will leave the room, like I’ve got that autonomy if nothing else, you can’t stop me.” So I very quickly learned to at least be interesting enough that they would be interested and engaging and then we could go from there so we just talked a lot about sensory, what things felt like, what we were experiencing with our senses, and I was trying to do my best and there were situations where really horrible, violent things would happen with one kid toward a staff member or one kid to another kid and they would follow up on that but they still had to continue living in the same place. There’s an epidemic of little, little kids being expelled from preschools, being barred from community settings when they’re literally three years old, that’s a black mark you carry forever, you’re already the “bad kid,” you go anywhere and you’re already the “bad kid.”

Tom: Right, the reason I asked you this and the reason I wanted to get on this topic is that I think it’s pretty clear that we become who we’re going to become through others in many ways. And so, you know, I was thinking about your therapy room, you know, you have a kid in there, one kid, you have toys in there, and you’re observing them, but this has happened to me quite often working with OTs is that they’ll work with a kid in their office and then they’ll report different behaviors in the classroom.

Kelsie: Oh yeah, absolutely.

Tom: And they’ll say, “but it doesn’t show up in the office.” How do you find the balance between that, I guess you obviously have to see the kid in all their different environments?

Kelsie: I want inclusion. It is an important goal to strive for and it is what I want in schools and the push for it in schools is a magnificently societally important counter-balance to prior strategies of “take all the kids with any problems and ship them off to a facility and never see them again.” We obviously needed strong, strong steps away from that. Where I struggle is in token inclusion or inclusion by name but not by action, where a student is just sitting there drowning and they might be showing it with their behavior or they might have learned to at least be quiet and not be annoying, I could legally, theoretically, I could go and do push-in therapy in their classrooms but push-in therapy for fine motor would be me sitting next to their desk and try to make them write better, I cue them to do handwriting things better, or I bring my own worksheet and we work on it at their table. And push-in for sensory stuff, I do that sometimes and it’s when we have pulled out to my room, figured out a strategy that works for them, and then we go try it together with their teacher involved and all of that. And so I do a lot of pull-out therapy because I know that I can be this person in their life with unconditional positive regard for them. I can be someone who plays reciprocally with them however it is they play, so if they’re struggling at recess because they’re not playing well with other kids because the other kids aren’t playing the way they think they should, I can be a million times more flexible than another eight-year-old can be. You can win every game, I won’t be a sore loser, you can change the rules and I’ll be like “wow!” If I had all of the time in the world, then yes, I would love to be sculpting communities but I don’t have all the time in the world. I have, at most, thirty minutes a week, so I’m like, “this is gonna be the best thirty minutes of your week.” You have to have joy and delight somewhere in school before you can start to grow it out anywhere else in school. A lot of times, I think that one-on-one attention, joy and delight is more powerful than me sitting next to them and trying to make them do a worksheet, because you’ve gotta have sensory before you can have core strength, you’ve gotta have core strength before you can have upper body strength and you’ve gotta have upper body strength before you can have fine motor skills. And most of the kids are missing huge chunks out of that foundation. If I come up with an idea with a kid and we make something up and we’re making up imaginative play and I know that the thing that we’re making up is building their strength in those areas, then I know that they might go to the playground, or go home, or go to their friend’s house and teach them that game that they made up and then they’re practicing it all over the place, all over their life, as long as it’s interesting to them in a way that they wouldn’t do if I was like, “go home and do more homework.” They’d be like “maybe, but I hate it and I’m not getting anything out of it.” But if it’s play, then it’s the primary occupation of their childhood.

Tom: Indeed. Okay, I used to work with parent educators, and we would always tell the parents, “expect your child to be hit at some point, maybe many times” and we would also say “and expect your child to be a hitter sometimes.” As a parent, you’re gonna feel horrible both ways, you’re gonna feel horrible that it’s happening and that your child is involved whether they’re the perpetrator or the victim. What amount of hitting is normal, when do we start getting concerned, because every two-year-old is gonna hit at some point, but when does it become something that you would manifest as “you know what, we need to talk to Kelsie.”

Kelsie: Well, block them. Block them so that whenever brains learn to do an action, one brain neuron connects to another brain neuron connects to another one and it creates a pathway. And to some extent, the new pathways come with creative cognitive flexibility, and the brain being able to think of different ways of doing things, that happens with maturity, that happens naturally with maturity for most children. So the reason that I say this is because I do sometimes have daycares where they’re like, “every time we step away from him, he whacks another kid.” Okay, so when you need to step away, how about you say “hey Connor, come with me.” And then also, sometimes a verbal cue will not stop a two-year-old. You can’t stand thirty feet across the room and shout at a two-year-old “hey wait don’t hit them,” and expect that to work.

Tom: They’re very predictable, the arm goes up, you can see it in slow motion, so just grab their little wrist and say “I can’t let you hurt people.”

Kelsie: Yes, it is a little bit baffling to me when they say, they hit him out of nowhere, and I’m like, you can probably see it coming. What they mean is, I have 30 kids in the room and I can’t look at him every second of the day. And I also sometimes grab their hand and say, what do you need right now? Instead of I can’t let you hurt people. So how much hitting is too much hitting? I mean, if other kids are getting to a point where nobody ever plays with him because he’s mean and bad and hits people, then okay, you’ve probably gone past the threshold where this was already causing significant community distress in some way. Two-year-olds kind of instinctually have an understanding that everybody might get bonked or taking things and they’re like, ehhhhh, that was fair, and then they walk away – that’s probably not causing distress in some way. It feels like a lot of my job is saying “this kid is doing this for a reason and it’s a human being reason and you’re a human being so let me reframe it for you so that you can understand it and have empathy for it.” And that does a lot. I really do feel like that does a lot for their mood to just be a person in this kid’s corner and saying “this is a human being, this is not some alien force that you can’t possibly comprehend what’s going on in their head that’s making them act this way or whatever.” And I think that brings a lot to humanizing kids, in a way.

Tom: Well, Kelsie, this has been fun talking to you. Where can people find out more bout you about what you’re up to?

Kelsie: My main thing is my Facebook page, it’s The Occuplaytional Therapist, with “play” in the middle there. I’ve also got a website which is just I sometimes post stuff on Instagram, which is also Occuplaytional.

Tom: Well I asked you the questions that I had in mind, is there something I should have asked you, is there something you’d like to leave people with as we wrap here?

Kelsie: Please just let them play. Play is how they develop all of the things. I love screens and I use them in lots of ways. But when it comes to fine motor development, screens are not causing fine motor development. Playing by digging, gripping, hanging, squeezing, climbing, pinching, pulling, cutting, ripping, all of that is what twos and threes and fours and even fives and sixes, even though the American school system doesn’t agree with me, need to be doing with their hands in order to support the ability to write later on. They don’t need to be tracing, they don’t need to be writing, they don’t need to be copying, they don’t need adults holding the kid’s hand and making it move around and then being like, “look, they wrote this!” Never hand-over-hand, ever, ever, ever.