Occupational Therapy and school-related anxiety: what do I do and how can I help?


Many people, perhaps understandably, have never heard of occupational therapy and don’t know how we can help, especially in relation to children. So perhaps it is no surprise that I am often asked, ‘What do you actually do, and how can you help my child?’

When I mention the term, ‘occupation’ many people think I am getting them back to work, which we can do, but occupational therapists like to describe ‘occupations’ as activities that we do every day rather than actual jobs. This ranges from getting dressed in the morning to participating in leisure activities or going to school. Occupational therapists believe that participating in ‘occupations’ brings about wellbeing.

We also like to take a ‘functional’ approach to our assessment and intervention which means we like to consider how people do everyday tasks. For example, if a young person is having difficulty in brushing their teeth, what part is difficult? Is it holding the brush and coordinating movements or is it the strong taste of the toothpaste? Once we know this, we aim to provide strategies to support people to develop and promote independence.

As a paediatric occupational therapist, I have the genuine privilege of working with children and young people both within a hospital setting and also privately in their homes or schools, often in relation to school attendance or learning- related challenges. And since the onset of Covid, it certainly seems that increasing numbers of young people are experiencing difficulty in returning to, and remaining in, school. 

Challenges in attending school can be understandable, especially for some youngsters who have a particular profile of sensory, attentional, and social communication needs. Schools, after all, are sensory-rich and socially complex environments that have an added pressure and purpose that requires you to learn and perform. Perhaps it is no wonder some young people have genuine difficulty in attending or participating confidently in formal learning activities.

So, when working with youngsters who are unable to attend school or have anxiety learning, what are some of the aspects which I consider from an occupational therapy perspective?

1. I seek to understand the history of the young person’s relationship with school and if there have been any previous difficulties. Has there been a recent event that caused anxiety, for example, such as a change of school or year group? 

2. It is important to know is it just school or does the young person have difficulties with completing other daily tasks, such as getting themselves dressed, managing their room and/or organising themselves. If a young person is having difficulties completing these tasks, does this contribute to why they find going to school hard? 

If there are already established difficulties, I might assess the young person completing these tasks to help understand which part is difficult and then work with them to provide tailored strategies to assist. 

An essential part of working with young people is also to understand what their perception of their difficulties are. To help explore this, I often like to complete a goal setting activity with the young person which not only identifies what part of the school day is difficult but also what is important to them. For example, are they finding it difficult to maintain friendships but is this activity still important for them to participate in?  

An overarching assessment of the learning or school environment and its impact on the young person is also paramount. Can the young person identify what it is they don’t like, is it the noise, the smells, the crowds, or organising themselves and their belongings? As schools are sensory-rich environments, I often consider what environmental adaptations are needed and how I can best promote inclusion of the child at a pace they feel comfortable with. An example of this could be the lunch hall – is it a place where they feel comfortable to eat or is too loud or socially overwhelming? Adjustments which might help could include having an early pass to attend lunch, sitting in a quiet corner, or wearing discreet ear defenders.

If the young person is not in school, it is also important to consider how they fill their day. In such situations, continuing to maintain a routine of daily activities that includes learning, self-care, leisure, and socialising is very important, particularly for those who have sensory, attentional, or social communication differences. This is because maintaining a routine helps to create a purpose to the day which in-turn positively contributes to mental wellbeing. It is also essential to continue to work on those skills that may be contributing to difficulties with school attendance and/or learning, such as developing a good sleep routine, getting dressed, managing written work, or sensory responses to environments.

When working with young people, I consider areas such as these above, and more, to create a bespoke plan with them to promote their participation in a learning environment at a pace they can manage.

As I have seen over the years, and particularly in relation to school-based challenges, by working in a joined-up way and in true collaboration with the young person themselves, their family, and the rest of the professional team, real transformations can occur.

By Olivia Knight, Paediatric Occupational Therapist

Image Credit: Artwork by Ria Mishaal, using components by herself and GNANA SUNDRAM, Ground Picture, Ali Taylor /Shutterstock.com