Overview

About 10 to 15% of preschool children suffer from developmental delays worldwide.¹ The frequency of occurrence of developmental delay is unknown, but the World Health Organisation (WHO) data indicates that, 10% of any country’s population has individuals with a disability, with a 4.5% rate among those less than five years of age.² 

Definition of developmental delays

The WHO defines development as a complex process that comprises of physical (movements, both fine and gross), social/emotional, cognitive, and language aspects. It involves gaining and refining a range of skills, then gradually moving from total reliance on one’s parents to increasing independence throughout childhood and into adolescence. These processes have been grouped corresponding scientifically to the age at which the process is to take place, which is known as developmental milestones.³ 

Developmental delay is diagnosed when a child does not meet up to the developmental milestones, when compared to other children of the same age range, in the child’s region of origin.⁴ Developmental delays are seen to affect various aspects of neurological development. These aspects include:

• Cognitive skills: these include the process of thinking, learning, and understanding information. Children who have cognitive delays may have difficulties solving a problem or following directives⁸
• Social and emotional skills: these developmental skills involve social tendencies towards others, expressing one’s feelings, and communicating one’s needs. Children with social and/or emotional delays may have difficulties understanding social behaviours and discussions, or adapting to routine changes⁵
• Speech and language: this is a skill that children develop to speak and understand languages. Children who have speech and language delays may struggle to utter words or understand others
• Fine and gross motor skills: this refers to the ability to coordinate small or fine muscles and large or gross ones, respectively. In children who experience fine motor delay, they cannot hold objects in their hands, also colouring or writing becomes problematic for them. Children with gross motor delay may have trouble rolling over, sitting up, or walking^8,10

A child could have an isolated developmental delay, where just one out of the 4 abovementioned skills is delayed, or a global developmental delay(GDD) where two or more skills are being delayed.⁴

Occupational therapy

Occupational therapy is a series of activities planned by an occupational therapist that aids people with developmental delays, difficulties, or disabilities to better live their lives, carrying out their daily activities more independently.⁶ Occupational therapy may involve any of the following:

• Practising daily habits (dressing up, cooking food, cleaning the house, as well as other household chores)
• Studying and memorising skills necessary for school, work, or activities that you do in your free time
• Developing and trying out personal strategies to help you reach your own goals
• Movement and perception exercises
• Concentration and memory exercises
• Manual and creative exercises
• Help in structuring your daily routine
• Changing things in your home or workplace
• Using medical aids, for example, a walker or prosthesis⁶ 

Parents, caregivers, as well as the community at large, should all be involved in the occupational therapy plan drawn by the occupational therapist for better results in the child development.⁷ 

Why occupational therapy is a critical early intervention tool

Developmental delay is different from developmental disabilities. It can be reversible if detected at an early stage, and occupational therapy is started early.^2,7  

Role of occupational therapy in developmental delays

Occupational therapy is highly individualised, since each child has their unique needs, strong points, and weaknesses. First, an occupational therapist assesses a child to identify the particular areas in which the child has problems and then develops an individual treatment plan. This plan would address the child's deficits while building upon his strengths.

Key areas addressed by occupational therapy

Gross motor skills

Delays in gross motor skills involve any activities that require large muscle movements, such as walking, jumping, or balancing. The occupational therapist, accordingly, plays with the child through entertaining and interactive games that contribute to enhancing the child's muscles and coordination. Games involving climbing or jumping, or those that use stability exercises, can make a child more balanced and in control of his movements.¹⁰

Fine motor skills

Fine motor skills involve movements that are small and precise, such as grasping an object, using utensils, and writing. Children who have this skill delay will find drawing, tying shoelaces, or even holding a pencil a very hard thing to do. Occupational therapy intervention is usually focused on strengthening the hand and finger muscles, practising hand-eye coordination, and teaching the child how to control small movements. 

These tasks are made fun and exciting for children by their therapists. Fine motor skills are necessary in school tasks such as handwriting and others, like cutting with scissors. Feeding and grooming activities are also expected performance areas.⁹

Cognitive skills

Cognitive delays can have an effect on the way a child perceives, thinks, reasons, solves problems, and learns. Children may find it difficult to follow directions or put puzzles together, consequently making an understanding of cause and effect hard. Occupational therapists assist in developing cognitive function through activities that are organised, playful, yet challenging, which involves problem-solving and critical thinking. 

Examples of games that can be used to aid sorting, sequencing, or memory include those that could enhance attention span, planning, and organisational skills. Occupational therapy helps in developing a child's cognitive ability, making them independent in their daily routine and better equipped to face the challenges of academic life.⁸

Sensory processing

Children with developmental delays often have difficulties with sensory processing, which is the brain's way of processing sensations in an organised way and providing meaning. Some are over-sensitive to stimuli like noise, light, and texture; some seek out sensory inputs in intense or repetitive fashions.⁵

The occupational therapist uses sensory integration therapy to help modulate the child's response to sensory information. This can include swinging, jumping, or doing tactile exploration activities with different textures in a playful yet safe manner. Sensory processing often allows children to become more comfortable within an environment; this comfort enables them to focus and engage more appropriately in daily activities.⁵

Social and emotional skills

Delays in social and emotional areas can make the child have difficulties interacting with their peers, understanding social cues, or managing their feelings. Occupational therapy will help them learn how to express their feelings, take turns, share things, and engage in cooperative games.

They will be able to practise social situations, make friends, and therefore develop a healthy self-concept through playful therapy. Techniques that help regulate feelings may also help the child learn to cope with frustration or anxiety in an age-appropriate way, through breathing exercises or calming strategies.⁵

Promoting children’s readiness for school

Occupational therapy is most valuable to help children transition into school as they approach that age, or help children who are currently facing some challenges within the classroom because of developmental delays. The concept of readiness for school encompasses other variations of skills, including when one can sit still and listen in class, to fine motor use such as writing and handling various tools. 

Interventions within occupational therapy will enable children to develop their attention span, ability to follow directions, and participation in group activities. These are all basic building blocks of foundational skills that prepare a child for academic success.⁸

Benefits of occupational therapy for developmental delays

• Improves gross and fine motor skills, cognitive, emotional, and language skills⁶
• Early detection leads to the correction of developmental delays
• Improves the quality of life of the child⁶

Collaborative approach in occupational therapy

Occupational therapy tends to work at its best when therapists, parents, and educators can all collaborate. The therapist collaborates with the family to determine methods that can be applied at home, including keeping a daily routine or playing games to build fine motor movements.⁴ Likewise, teachers are integral for carrying strategies over into the classroom environment; this allows a child to be successful both in their home and school environments.

Parents and caregivers play an essential role in their child's development. Often, the occupational therapist involves them in the process by educating them, providing support, and equipment to aid in development at home. This frequent interaction and teamwork among all parties concerned will provide a comprehensive approach and consistency.⁷

Summary

Occupational therapy is a great avenue through which children with developmental delays can be taken care of, providing certain treatments that enable a child to be independent and lead a better life. Each child being different from the other in terms of requirements and strengths, occupational therapy aims to develop the particular skills that a child requires for daily living, socialising, and academics.

Occupational therapy gives hope to the parents and carers, that their child might be able to overcome their deficiency and be successful, as appropriate early intervention will eventually make these children confident and capable adults, and better at interacting within the world.