Role of occupational therapy in the transition from childhood to adolescence

Adolescence is known as the period of transition between childhood and adulthood. During this period of life, children are quickly developing, and they may start to notice various changes in their physical appearance, emotions towards the people around them, and the way they interact with their family and friends. We often label teenagers as rebellious, notorious, risk-taking, or many other such adjectives. However, we do not see the turmoil that brews within the adolescent. This phase of growth brings a surge of hormones in the child’s body, and they experience various changes.

Children transitioning to adolescence may notice changes such as menarche (the beginning of the menstrual cycle in a woman), bigger breasts and hips in females, and an increase in height, the sudden appearance of facial & body hair, and growth of sexual organs in boys. Some teens may take out the frustration of these changes in the form of answering back to parents or teachers, picking fights with peers, putting themselves in risky situations for the thrill, and so on. Others may shy away from much social interaction, to begin with. They may be conscious of the changes being undergone in their bodies & minds and may worry about what others will think of them as these changes bring on new emotions related to self–image. It affects the person’s emotions, thoughts, and behaviors and influences both public and intimate relationships.

Many adolescents tend to be unsure of themselves and lack self-confidence. They look up to peers, celebrities, or other strong personalities when it comes to the way they dress, behave and present themselves to the world. They are inclined to glorify a certain type of look or lifestyle. This can be seen in the form of low self-esteem, fewer peer interactions, and general isolation from others.

These physical, sexual, cognitive, social, and emotional changes that unfold during this time can bring both anticipations as well as anxiety for both children and their families. Hence, proper education and an understanding of what to expect at different stages of the transition can promote a healthy development throughout childhood, adolescence, and early adulthood. It can especially be beneficial to those children who prematurely undergo the changes that come with puberty. It can help lessen their thoughts of confusion & fear and prevent isolation from their peers. Additionally, it can be of great help to parents. Although they might have gone through these stages themselves, proper education can help them better inform their children and gain better trust and understanding.

A child is said to have successfully transitioned from childhood to adolescence once all the physical, social, emotional, and sexual challenges have been overcome with the support of family, teachers, and peers. Due to various discrepancies in the developmental milestones, children with special needs have a greater extent of difficulty in achieving this successful transition. They often fall behind their typical counterparts of the same age. Furthermore, such adolescents experience severe social isolation and stigmatization. More awareness can create a more conducive environment for such adolescents to develop and thrive in society.

ROLE OF OCCUPATIONAL THERAPY:

Adolescents who have a disability may depend on others for their self-care, may not have their own discretionary money from part-time work, and may lack independence in community mobility. Therefore, their opportunities to participate in various activities are limited. For example, adolescents with disabilities are not always encouraged or offered opportunities to experiment with appearance (clothes, hairstyle, etc). Making choices about appearance and experimentation is part of the adolescent experience that contributes to self-identity, self-esteem, and healthy body image; the practitioners can find ways to facilitate experimentation for the adolescent with a disability and parents could give as much freedom as possible to such children to choose their kind of clothing.

They will have difficulty in learning basic life skills and the way they learn will be different from that of normal children. Self-care activities require good education and good planning to incorporate them into our daily life and must be done so regularly that it becomes routine. Breaking down any prearranged assignment into its small module parts, use of different kinds of attractive visual guides including photos, clip-art style images, smart art, etc., and involving physical and hand-over-hand support by providing verbal prompts can help them.

Every child is unique, and the approach to teaching certain skills will require the personalization of the child’s capabilities. Teaching by verbal instructions, demonstration, teaching step by step of the entire task, and repetitions to remember the skills to perform the task effectively. And they even need support from their family and friends and the availability of information will positively influence adolescents’ adjustment to their bodies’ physical and physiologic changes.

Apart from this, primary caregivers must also adjust to the adolescent’s physical growth and physiological maturation. Adolescence can be challenging, especially for parents/caregivers of adolescents with moderate to severe physical disabilities and/or mental retardation, because of the continued and, at times, increased levels of care required. For example, transferring small children in and out of vehicles, lifting them into the shower, and dressing them is relatively easy as the adolescent grows and gains weight, these caregiving tasks become more difficult. Significant household modifications may be needed to accommodate the changes, and additional adapted equipment, such as the use of commode chairs or hoists for transfer could be used to facilitate daily tasks.

For children with special needs, puberty can also present additional practical and psychosocial issues. We all know that misperceptions exist about the capacity of an adolescent with a disability to be in a sexual relationship, experience sexual desire, and reproduce successfully. So, to avoid this, they must receive education about contraception, STDs, and even how their disability may affect their sexuality.

Along with this, Social and behavioral skills are essential for lifelong success. Unfortunately, children with special needs often struggle with these skills. For example, some kids with certain special needs have difficulty greeting others properly. That skill deficit could later translate into occupational challenges. Other children have trouble interpreting and using facial expressions and gestures, which interferes with communication.

So, parents need to practice the appropriate social behaviors at home with their children and even encourage the efforts of the child and praise them instead of pointing at their mistakes. Teachers/ parents have to give simple and specific instructions when asking a child to do something and then gradually, start giving commands related to proper social behaviors like following certain rules, reminding him to ask permission before using others’ things, and sharing his/her things.

Following that, as the child grows, it is important to train them to behave appropriately with the opposite gender. Instead of keeping him/her away from the opposite gender, expose them to such situations under supervision so that he develops acceptable manners. Explain to the child and demonstrate that physical distance is maintained when one interacts with persons of another gender. This enhances friendly relationships.

Throughout this article, we have addressed the problems the child with special needs faces during the transition to adolescence and a few ways how an occupational therapist can help the child with special needs cope with these changes. Despite the social stigma, social norms, and being hesitant to talk about it, it’s important to understand these changes and apply these strategies in day-to-day life to influence their healthy growth.

Written by Sowjanya Nayak (occupational therapy undergraduate student), Susmitha (occupational therapy undergraduate student), and Asish Das (Assistant Professor), Department of Occupational Therapy, MCHP, MAHE