Randomized, controlled, peer-reviewed studies of OT efficacy?

[Anonymous]

Can anyone point me to any randomized, controlled, peer-reviewed studies showing that occupational therapy is effective in treating sensory processing problems or fine motor delays in preschoolers? I work in research but can't seem to find these. Most of the studies I've located do not have research designs that enable observers to distinguish the effects of treatment from changes that would have occurred in children regardless as they matured. Are methodologically rigorous studies out there?

If there aren't, and you decided to go ahead and spend the money on OT, how did you make that decision? It seems like a ton of money to spend without being more sure about efficacy, but maybe worth doing because OT at least isn't harmful, and might help even if it hasn't been studied properly? TIA.

[Anonymous]

Anonymous wrote:Can anyone point me to any randomized, controlled, peer-reviewed studies showing that occupational therapy is effective in treating sensory processing problems or fine motor delays in preschoolers? I work in research but can't seem to find these. Most of the studies I've located do not have research designs that enable observers to distinguish the effects of treatment from changes that would have occurred in children regardless as they matured. Are methodologically rigorous studies out there?

If there aren't, and you decided to go ahead and spend the money on OT, how did you make that decision? It seems like a ton of money to spend without being more sure about efficacy, but maybe worth doing because OT at least isn't harmful, and might help even if it hasn't been studied properly? TIA.

Well, most intervention research is crappy. So often the choice comes down to doing nothing or relying on the crappy research that is available.

We did OT for sensory sensitivities, motor planning, fine motor development, and picky eating. Our insurance paid for part of it. I liked our OT because she was very focused on teaching me what she was doing and giving us ideas for home and school. I don't think one hour of OT a week would have accomplished anything, but she helped me understand my child's sensitivities and needs better, and helped us develop better routines for our home. My kid enjoyed it at an age where few activities appealed to him. The OT was also just a decent, caring person who listened to me and gave me advice, and also advocated for changes for my child in school.

How much of my kid's progress is due to OT or due to development that would have occurred anyway? I have no idea. But it was worth it to me.

Also, I went through two other OTs before I found this one. The first was two serious and bossy, and the second was very passive. The right fit is important.

[Anonymous]

OT was the first step on our SNs journey. I can't tell you if there were measureable, quantifiable benefits. I do know that the OT we worked with had a lot of experience with kids like DD and I learned as much about working with her as she may have learned about regulating her senses. It was a tremendously helpful introduction to parenting differently abled kids.

Our OT also had lots of good advice about next steps on the journey and was able to guide us to a good therapist to address anxiety and interacted with DDs physicians about her observations. (There is a medical diagnosis related to the delays and processing issues.)

For various reasons, my DD found OT very regulating. Perhaps it was the one on one time with the therapist, or the physical activity, or being with an adult who truly understood that much of her behavior was out of her control moreso than the OT exercises themselves. I don't know.

My suggestion is try it. Set a realistic time limit for re-evaluating and if it's helpful, keep doing it. If it's not, move on to something else.

[Anonymous]

Nope.

[Anonymous]

Here is a review article. Mixed evid3nce, few good trials.
https://ajot.aota.org/article.aspx?articleid=1886247

[Anonymous]

Anonymous wrote:

Anonymous wrote:Can anyone point me to any randomized, controlled, peer-reviewed studies showing that occupational therapy is effective in treating sensory processing problems or fine motor delays in preschoolers? I work in research but can't seem to find these. Most of the studies I've located do not have research designs that enable observers to distinguish the effects of treatment from changes that would have occurred in children regardless as they matured. Are methodologically rigorous studies out there?

If there aren't, and you decided to go ahead and spend the money on OT, how did you make that decision? It seems like a ton of money to spend without being more sure about efficacy, but maybe worth doing because OT at least isn't harmful, and might help even if it hasn't been studied properly? TIA.

Well, most intervention research is crappy. So often the choice comes down to doing nothing or relying on the crappy research that is available.

We did OT for sensory sensitivities, motor planning, fine motor development, and picky eating. Our insurance paid for part of it. I liked our OT because she was very focused on teaching me what she was doing and giving us ideas for home and school. I don't think one hour of OT a week would have accomplished anything, but she helped me understand my child's sensitivities and needs better, and helped us develop better routines for our home. My kid enjoyed it at an age where few activities appealed to him. The OT was also just a decent, caring person who listened to me and gave me advice, and also advocated for changes for my child in school.

How much of my kid's progress is due to OT or due to development that would have occurred anyway? I have no idea. But it was worth it to me.

Also, I went through two other OTs before I found this one. The first was two serious and bossy, and the second was very passive. The right fit is important.

Agree with this. Wish there was more research. I think OT helped with my DC's fine motor skills, but marginally since he only got 1/2 hour week. I think the most helpful part was just the evaluation, the recognition that he was delayed in this area, and us at home gently encouraging him to do more to strengthen his hands and practice those skills (playdoh, beading, writing, drawing, squeezy toy activities).

The "sensory diet" that the OT tried did nothing. Whatever it was that it was trying to fix, he grew out of it.

[Anonymous]

No. I am a school psychologist and when I looked into OT for my child I couldn't find any peer reviewed, quality research supporting most things OT's do. My son had fine motor issues and some "sensory issues". I wasn't surprised because he went to a play based preschool in California where he never has to pick up a pencil or crayon if he didn't want to do so (and he never did) and didn't have to wear shoes. So. I surprise when he turned 5 he couldn't write or even copy letters. People on this forum really seem to dislike Kumon but for him it worked wonders because he was required to trace and then write letters every day for 10 minutes. Within a few months he had excellent printing skills and could effortlessly write letters and then words using the correct formation (top to bottom, etc). My son had awful fine motor skills because he never used his hand for writing. His grip was strong from playing on monkey bars or making play-Doh but he hadn't used and coordinated those muscles for writing.

[Anonymous]

I understand why you're asking this question.

I based my decision to start and continue with OT on a basic piece of knowledge that does not really require randomized controlled trials: physical skills can be taught, and kids respond best to good teachers.

My son pretty clearly had some physical skills that he needed to learn -- balance, climbing, proprioception, basic fine motor stuff. And it was pretty clear that OT taught him those skills.

The other stuff that's harder to see results on, I was more skeptical about .

[Anonymous]

Anonymous wrote:No. I am a school psychologist and when I looked into OT for my child I couldn't find any peer reviewed, quality research supporting most things OT's do. My son had fine motor issues and some "sensory issues". I wasn't surprised because he went to a play based preschool in California where he never has to pick up a pencil or crayon if he didn't want to do so (and he never did) and didn't have to wear shoes. So. I surprise when he turned 5 he couldn't write or even copy letters. People on this forum really seem to dislike Kumon but for him it worked wonders because he was required to trace and then write letters every day for 10 minutes. Within a few months he had excellent printing skills and could effortlessly write letters and then words using the correct formation (top to bottom, etc). My son had awful fine motor skills because he never used his hand for writing. His grip was strong from playing on monkey bars or making play-Doh but he hadn't used and coordinated those muscles for writing.

Please tell me you aren't actually a school psychologist? Or maybe I shouldn't be surprised ...

Preschoolers naturally develop fine motor skills, including writing/pre-writing, regardless of whether that is expressly taught in preschool or at home. If a 5 year old literally can't write a single letter (or isn't able to do pre-writing activities like scribbling or getting a strong mark on paper), then they have an actual fine motor delay. It has nothing to do with being in a play=based preschool. In fact, the whole idea of play-based preschool is that children acquire these skills through play; not that they don't acquire them at all!

However, assuming your child actually had a fine motor delay, I'm sure that Kumon plus a focused and sensitive teacher probably could do much of what an OT would do as far as handwriting goes.

[Anonymous]

Anonymous wrote:I understand why you're asking this question.

I based my decision to start and continue with OT on a basic piece of knowledge that does not really require randomized controlled trials: physical skills can be taught, and kids respond best to good teachers.

My son pretty clearly had some physical skills that he needed to learn -- balance, climbing, proprioception, basic fine motor stuff. And it was pretty clear that OT taught him those skills.

The other stuff that's harder to see results on, I was more skeptical about .

I agree with this. Teaching specific skills works. The most clear example for us is tying shoelaces. My DD could not do it no matter what we tried, but the OT taught her. I don't think this helped her much with other fine motor skills. Each one must be individually taught.

[Anonymous]

Anonymous wrote:

Anonymous wrote:No. I am a school psychologist and when I looked into OT for my child I couldn't find any peer reviewed, quality research supporting most things OT's do. My son had fine motor issues and some "sensory issues". I wasn't surprised because he went to a play based preschool in California where he never has to pick up a pencil or crayon if he didn't want to do so (and he never did) and didn't have to wear shoes. So. I surprise when he turned 5 he couldn't write or even copy letters. People on this forum really seem to dislike Kumon but for him it worked wonders because he was required to trace and then write letters every day for 10 minutes. Within a few months he had excellent printing skills and could effortlessly write letters and then words using the correct formation (top to bottom, etc). My son had awful fine motor skills because he never used his hand for writing. His grip was strong from playing on monkey bars or making play-Doh but he hadn't used and coordinated those muscles for writing.

Please tell me you aren't actually a school psychologist? Or maybe I shouldn't be surprised ...

Preschoolers naturally develop fine motor skills, including writing/pre-writing, regardless of whether that is expressly taught in preschool or at home. If a 5 year old literally can't write a single letter (or isn't able to do pre-writing activities like scribbling or getting a strong mark on paper), then they have an actual fine motor delay. It has nothing to do with being in a play=based preschool. In fact, the whole idea of play-based preschool is that children acquire these skills through play; not that they don't acquire them at all!

However, assuming your child actually had a fine motor delay, I'm sure that Kumon plus a focused and sensitive teacher probably could do much of what an OT would do as far as handwriting goes.

This. My DC's play-based preschool did not ignore development -- it was very "child-led" but they noticed if a child's fine motor skills were behind.

Also, a child's lack of interest in writing/drawing activities can mask a delay. I wish I had known that earlier about my younger DC. I thought that he simply didn't have an interest in drawing/writing, but it was a delay. Kids will try to avoid activities that are too difficult for them.

[Anonymous]

Anonymous wrote:No. I am a school psychologist and when I looked into OT for my child I couldn't find any peer reviewed, quality research supporting most things OT's do. My son had fine motor issues and some "sensory issues". I wasn't surprised because he went to a play based preschool in California where he never has to pick up a pencil or crayon if he didn't want to do so (and he never did) and didn't have to wear shoes. So. I surprise when he turned 5 he couldn't write or even copy letters. People on this forum really seem to dislike Kumon but for him it worked wonders because he was required to trace and then write letters every day for 10 minutes. Within a few months he had excellent printing skills and could effortlessly write letters and then words using the correct formation (top to bottom, etc). My son had awful fine motor skills because he never used his hand for writing. His grip was strong from playing on monkey bars or making play-Doh but he hadn't used and coordinated those muscles for writing.

If your story is accurate, then your child really didn't need therapy--he needed exposure and repetition. My kid had exposure and repetition -- in abundance -- and still could not write. Unfortunately for him, OT didn't help either--he was eventually diagnosed with very severe dysgraphia, but it was the logical place to start.

[Anonymous]

We did it as our insurance covered it and OT claimed sensory issues. We did it for a while and child enjoyed it but I didn't find it helpful. We stopped due to time but went back for targeted services like how to hold scissors and pencil as I had trouble teaching that and that was helpful Agree with repetition. We spent many hours working on handwriting.

[Anonymous]

Sensory integration/processing isn't a valid diagnosis, was invented by OTs and rejected by medical professionals.

[Anonymous]

Anonymous wrote:Sensory integration/processing isn't a valid diagnosis, was invented by OTs and rejected by medical professionals.

It's in the DSM. It's listed as a symptom, not a diagnosis. But it's there.