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Thoughts on Therapy
By Colleen Tomko
One of the most important things to learn
about a child or anyone who has a disability,
is that no matter what disability they have, they are
always more similar to others then they are different.
The disability is "one part" of the person, "one
characteristic"it does not define who they are.
All children learn skills by interacting
and being nurtured in their natural environments. They also learn skills
by interacting with each other. When children happen to have
disabilities, they still have that same need to interact and be nurtured
in their natural environments. Natural settings being those settings
where the child would typically be in if they did not have a disability,
i.e., home, daycare, regular education, and community activities. Of
course, they may have some additional needs. Nevertheless, they remain
first and foremost children who have a need to experience the same
things other children do, or do not, for the same reasons.
Therapy designed to "fix" a child is not
as effective as therapy designed to empower a child to successfully use
their abilities. When the focus of change is on adapting regular
environments to meet the child's needs verses changing the child, it
reduces the barriers that perpetuate exclusion. Instead of attempting to
make all children be the same, a greater quality of life can be achieved
when the effort is on making valued experiences accessible to every
child.
Therapy and services benefit children
when they enhance their learning and functioning in natural environments
and at their individual levels. For children born with disabilities,
they are acquiring skills for the first time. There is no former
capacity. When their therapy emulates rehabilitation, which is the
process of restoring to a former capacity, it is essentially attempting
to restore to "other children's" levels of capacity. Instead of
rehabilitation, the goals of therapy need to support the family's and
child's vision of where it is desired for the child to live, work and
spend leisure time as an adult, as well as what types of friendships and
relationships are desirable.
Problems of learning how to reenter the
real world can be avoided if a child never leaves the natural settings
for "special" settings in the first place. Problems of generalizing
skills to the settings where the child needs to use the skills can also
be avoided if they are first learned in the natural settings. Children
with disabilities need even greater exposure to natural environments and
experiences so they can learn to function using their abilities. As with
any child, the less exposure to a situation, the less equipped they will
be to deal with it.
A child's needs are not determined by
what the system has to offer, or where the system has to offer it. A
trade-off of not experiencing what most children do, over having
specific needs met, does not provide children with as fulfilling of a
life as having both. Keeping children in natural settings with their
peers gives them appropriate modeling of desirable skills. It maximizes
the shared experiences with others that are critical to forming
relationships and friendships. When all of a child's needs are met in an
integrated way, it enhances every area of their life.
Simply because a person is labeled as
functioning at a certain age level, doesn't mean they should be treated
as if they are that age. That type of reasoning would lead to adults
still playing with preschool toys. Children need "age appropriate"
activities adapted to their level of functioning. Regardless how their
bodies function, they don't remain infants or young children physically
or emotionally.
If a child's disability limits their
potential to learn a skill then the child needs to be provided with
alternative methods of functioning and the necessary supports. The
generic answer should not be to remove the child to a "special"
environment. Therapy then needs to assist the child by adapting natural
environments, teaching skills to use assistive technology, and helping
him or her achieve interdependence with others. With interdependence
children learn how to interact with each other to meet their needs, much
like adult society where we depend on others to provide many of the
things we need. It leads away from being dependent solely on paid
professionals. Interdependence allows the child to have others who know
and care about them understand how to meet their needs and interact with
them.
As much as others desire to teach a child
skills of independence, the methods of teaching have as great if not a
greater significance then the actual skill being taught. If you think
about it, when an adult controls everything, what, when, where and how a
child will do something, it's not really teaching independence. When a
human being is taught to simply be moved around and controlled by others
there's a loss of respect and dignity. Children should not grow up
thinking it's "ok" for someone to simply undress them, push their bodies
around and do whatever is asked of them. If we truly want to teach
children independence, then they need to learn that they have control
over their lives, bodies and actions.
All children have teachable moments when
they are better able and highly motivated to learn. It is not likely
that a child's teachable moment will always coincide with their
scheduled therapy session. Incorporating therapy techniques and methods
naturally into a child's daily routines can increase effectiveness. This
way therapy can more likely be implemented at teachable moments, when
and where it is most effective and relevant to the child. Techniques can
be practiced at appropriate times when a child is naturally engaged in
activities that require the skills they are learning, and not just a few
times a week in a therapy session.
Activities that are meaningful and
purposeful to the child increase their attentiveness, motivation, and
desire to participate. Therapy becomes meaningful when it helps a child
interact and learn about the real world. When therapy is incorporated
into activities that are relevant in a child's life, they will be more
likely to use and practice those skills in their daily activities.
Ideally, children should not even be aware that they are receiving
therapy. When children lead the activities, they are doing what is
meaningful to them. If activities are led by an adult, they may or may
not be meaningful to the child.
If every person who interacts with the
child regularly is knowledgeable and consistent with the techniques and
methods practiced in each area of therapy, it will help the child learn
how to use the skills together. This way the child does not simply only
do speech when they are with a speech therapist or only do fine motor
when they are with an occupational therapist. They practice all skills
together throughout every day whenever and wherever it is most
appropriate.
The things that give value to any child's
life remain the same whether or not they have a disability. Respect,
dignity, relationships, friendships, and a sense of belonging are
stronger indicators of a quality life then are the quantities of
therapies and services a child receives. With that in mind, the purpose
of therapy and services needs to be kept in perspective, that is they
should remain an enhancement to a child's life, not a replacement.
Written by Colleen F. Tomko
Material Copyrighted 1996 Kids Together, Inc.
This material may be copied for non-profit use only. My not be
copied onto other websites, but may be linked. Please notify us of your
intentions.
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