Written By: Debra Johnson, MS, OTR/L



As an occupational therapist for over 30 years, I have seen healthcare trends come and go. Some of the interventions we took for gospel back in the 80s are now deemed, at best, to be ineffective and, at worst, potentially harmful to our patients or clients. We are always looking for the “quick fix” to our problems. As therapists, we are always looking for the next great intervention that allows us to help those we serve. Our challenge is to parse out what is most relevant and impactful based on current research, using evidence-based practice to provide the best possible services.

Pediatric rehabilitation has seen many changes. Science has given us more knowledge of the brain, more understanding of development, and more awareness of human needs over the last three decades of my practice. Regardless of the pediatric population you work with, I believe the following areas of focus are of great value for enhancing outcomes based on current neuroscience and trends in pediatric rehabilitation. 


Trauma-Informed Care

The science is clear: trauma is more prevalent than you realize and has profound impacts on the brain and development. Using a Trauma-Informed approach is crucial in a therapy setting. You can start using a Trauma-Informed approach today by:

  1. Being aware that trauma exists and that almost everyone has had traumatic experiences that may impact their behaviors, skills, and relationships. 
  2. Recognizing behaviors in children that might appear challenging, such as defiance, acting out, shutting down, or self-injurious behaviors, may be the result of trauma. 
  3. Using principles of Trauma-Informed Care in working with ALL children. These include being honest, trustworthy, respectful, and empowering in treatment. 
  4. Avoiding re-traumatizing through therapeutic interventions. Respect the boundaries and rights of the child; stop forcing compliance; respond to the physical and psychological needs of the child throughout the intervention. 


Play-Based and Developmentally Appropriate Therapy

A child’s natural occupation is that of a player. All children are intuitively driven to play, in whatever form they can. Play drives self-exploration and awareness, social interactions, and skill development. It is a source of stress relief and connection for building relationships. Play is a powerful tool that we are crazy not to use, as Dr. Stuart Brown states in his book Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul (2009). But adults often forget how to play or don’t know how to play with children. Remember these tips for your therapy sessions:

  1. There is a big difference between play (spontaneous and fun) and “therapeutic activities” that are structured by a professional. Just because you found the activity on Pinterest or Instagram, doesn’t mean the child will consider it play. Children will be much more motivated to participate in PLAY rather than an activity. 
  2. Play can be many different things and will look different for each child. Some children are not developmentally ready for associative or cooperative play, so you start with socially interactive play. Games like peek-a-boo, “stinky feet,” imitating facial expressions, and “chase me” are wonderful socially interactive games that support relationships and shared attention. 
  3. Unoccupied, solitary, and onlooker play are acceptable forms of play because they are developmentally appropriate for young children. When older children are still in those stages of development, start there and help the child develop new play skills as they are able.


Strengths-Based and Neurodiversity-Affirming Care

All children, regardless of their diagnoses, disability, or disorder, possess a wealth of strengths. All individuals are on a continuum, with unique strengths and challenges that impact their participation and success in our world. Viewing individuals as inherently worthy and valued just by being human is a crucial step to altering your professional philosophy from one of a paternalistic “fix it” perspective to one that is affirming and empowering for all individuals. Start the shift today by: 

  1. Completing assessments with a strengths-based perspective to include not just a list of deficits, but all the strengths that can be used as scaffolding for learning new skills. 
  2. Writing strength-based and neurodiversity-affirming goals for your clients. Stop writing goals for children to “tolerate” sensations and start writing goals for children to self-advocate for their needs. 
  3. Use a child’s strengths to develop strategies and accommodations that truly work to empower success and make goals attainable. 


Relationship Focused

            The research is conclusive: children thrive when they are connected to caring and supportive adults who provide the safety, structure, and support they need to learn and grow. If you are still treating children in isolation from their caregivers (parents or other adults in the child’s life), start working toward reaching out to the adults for the most impactful changes you can make as a therapist. 

  1. Welcome adults into your therapy sessions whenever possible. Coach the adults in your techniques and strategies that are successful for the child. Model interactions, prompting, and scaffolding that they can carry over into other settings. 
  2. Support caregiver/child relationships. Teach adults how to play, educate them on the child’s strengths, facilitate positive interactions during sessions, and encourage 1:1 time between child and adult. 
  3. Understand the developmental role of co-regulation. With an ever-increasing rise in reports of poor self-regulation of children, adults need to know that a child requires co-regulation first. They learn to regulate by having a secure and appropriate model. The foundation of self-regulation is human relationships. 


Pediatric rehabilitation is a complex and specialized field that requires keeping up with the current trends and adapting your therapy strategies in response to the best practices supported by science. Embracing these areas of change is an important step to providing the highest quality and most effective treatment based on our current understanding of the pediatric brain and development.


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