Saturday Seminar: The Impact of Personalized Tool Kits on Adolescents with Mental Illness

Jean MacLachlan, PhD, OTR/L’s November 4th 2014 Saturday Seminar was entitled: The Impact of Personalized Tool Kits on Adolescents with Mental Illness: How to Assess, Develop and Integrate into Daily Routines. A specialist in mental health and sensory processing, Dr. MacLachlan teaches at Salem State University, conducts research, and consults throughout the US. Her focus has been on the integration of sensory-based interventions into “non-traditional settings.”

Jean’s thoughtful and thought-provoking seminar revealed some surprising documentation about adolescent mental health including the statistic that about 20% of children and adolescents in the US have been diagnosed with a mental health disorder that impairs their lives (NIMH, 2010; Perou, 2013). Jean provided a summary of supportive literature that indicates that a sensory-based approach to treatment promotes positive behaviors. Jean’s research using individualized sensory tool kits yielded statistically significant results in 6 areas, 3 of which affected all study participants including an increase in self perception of sense of occupational competence; an increase in daily number of hours in the classroom; and a decrease in the number of PRN medications.

Jean offered a rich array of ideas for creating individualized sensory tool kits that target all sensory areas, depending on the adolescent’s needs. She added cautions regarding some client-specific personal issues including: allergies to certain materials, olfactory experiences that may elicit negative memories in trauma victims, visual responses that may trigger seizures, and vibratory stimulation for hypersexualized adolescents. She advocated building the use of sensory toolkits into a client’s routine to help improve function, which means devising a way that the client has access to his/her toolkit whenever it is needed, i.e. during transition times that might cause an outburst, like going from school to a job. Some Therapro materials that she recommended included:

In addition to individualized sensory tools, Jean discussed some interesting examples of sensory-based coping skills groups. One example she gave involved playing “Sensory Hopscotch,” where the client throws a beanbag on a sensory square and then identifies the tool in their sensory tool kit they use in that sensory category and why they use it.

With our understanding of sensory processing, occupational therapists can have an important role in providing sensory-based treatment for young people diagnosed with mental illness. Jean provided us with a dynamic seminar including interactive times for participants to share thoughts and problem-solve about tools that may be useful and accessible in their particular setting. Many offered helpful ideas on how to acquire those tools through creative funding. This seminar fulfilled all expectations for attendees who learned how to create and use personalized sensory tool kits with the adolescent population in individual and group settings.

Take a look at just a few of the positive remarks attendees made about this seminar:

“Excellent material, engaging presentation. Thank you!!” – Katherine C., Occupational Therapist

“Great ideas; really liked the built in discussion time.” – Maura M., Teacher

“Lots of ideas, suggestions. Opportunities to collaborate. And free!!” – Anonymous, Occupational Therapist

“Specific and functional activities! Direct and to the point!” – Susan J., Physical Therapist Assistant

“Well organized, informative, and applicable to my work.” – Anonymous, Occupational Therapist

Thank you, Jean!

Filomena Connor, MS, OTR/L

Helping Little Kids Cut: Set the Stage with Demonstration and Positioning

by Cathy Collyer, OTR, LMT

OT goals on IEPs and IFSPs for young children commonly include some form of scissor use.  There is a good reason for this: using scissors independently and safely is an important preschool classroom skill.  For OT’s, it is also a benchmark for bilateral control, dissociation of the sides of the hand, and the ability to control and grade force.  But what do you do with kids that aren’t interested or prepared to cut?

Many young children are eager to learn to cut with scissors. They are excited to control such a grown-up tool and they like to see the immediate effects of their actions as the paper bits fall to the floor.  Not all interest results in a good outcome.  At times, they are so enthusiastic that they act in unsafe manner or use scissors in inappropriate ways.

Some kids fear scissors; they are often the children who fear failure and shrink from a challenge.  And finally, there are children who have little interest or excitement in participating in any fine motor tasks.  Whether due to frustration or a preference to act on their environment with sensory-based or gross motor skills, their behavior suggests that they couldn’t be bothered by learning to use scissors.

Children that struggle to cut can become discouraged and lose their initial excitement for mastery of this important skill.  By allowing them to observe and practice pre-training skills before you introduce the act of cutting, you can improve your chances that they will develop and sustain enthusiasm and good safety skills with scissor activities.

There are children over 3 who have never been allowed to use a scissor due to adult safety concerns, lack of appropriate tools/assistance or developmental delays.  A child’s initial exposure to scissors can be as simple as directing a child’s visual regard to your use of scissors as part of a therapy activity.

  • Make sure that you narrate your actions in short phrases with emphasis on action words.
  • Use an enthusiastic tone and gestures that sustain the child’s attention and interest.
  • Make practice short: in fact, end practice before a child is frustrated or bored.
  • Finally, make it clear that you expect that the child will be able to use scissors as they grow and develop more hand skills.

Children benefit from being able to see an adult’s hand movements while cutting.   Your students may have been discouraged from being too close to an adult model due to safety concerns.  Some adults are unaware that children need exposure to develop interest and excitement in the use of scissors.  Use the safest scissors available with impulsive children who may reach for your scissor blades in their eagerness to learn about this exciting tool.

Ultra Safe Scissors
Ultra Safe Scissors

Once interest has developed, you may want to assist children as they open and close the blades.  Scissors that are spring-loaded or have finger spaces for an adult can help, or you could place your fingers between the handles to facilitate movement.  The sound of the blade movement is fascinating to young children, even without bringing the blades to the paper for cutting.  Practicing alternating opening and closing the blades may be your entire activity for the therapy session.  By breaking down the actions of scissor use into their precursor parts, you are decreasing a child’s frustration and increasing the likelihood of later success.  Hand-over-hand assistance can be helpful when combined with independent scissor use. Gradually fade out this assistance out to allow maximal proprioceptive and kinesthetic input.

Children with hand and wrist weakness or poor sensory registration and discrimination benefit from scissors that provide more support and allow more of their hand to be involved in cutting.  Create textured handles with tape on classroom scissors or use Fiskars Total Control Kids Scissors that provide more digital control and encourage activation of intrinsic musculature to support development of the horizontal and vertical arches in the hand while cutting.

Spring Action Blunt Tip Scissors
Spring Action Blunt Tip Scissors

Provide additional postural support to children with instability and core activation issues. They may require more proximal stabilization than they appear to need for other tasks. Well-chosen classroom chairs or even a corner sitter may give a child the motor support needed to achieve optimal stability for learning a new motor skill. Beanbag chairs diminish sensory-based distractibility while providing full-body support. Once the new skill is mastered, the degree of support can be decreased gradually.

Bean Bag Chairs

By focusing more on pre-scissor activities and thereby maintaining a child’s enthusiasm and attention to task, you will increase their ability to persist with practice, and have a more productive therapy session!


Cathy Collyer, OTR, LMT, PLLC

Cathy Collyer, OTR, LMT has treated children with neurological, orthopedic and sensory processing disorders for over 20 years. She is the author of The Practical Guide To Toilet Training Your Child With Low Muscle Tone. Learn more about her work at tranquilbabies.com.

Saturday Seminar: Syrian Boy with Bilateral Upper Limb Differences Learns to Negotiate Daily Life in America

Eleven year old Ahmad, who as an 8-year-old suffered trauma in Aleppo, Syria, that left him with bilateral transhumeral limb differences, captivated us. Today’s seminar, presented by Ahmad, his occupational therapist, Sheila Kearney, MS, OTR/L, and physical therapist, Julia O’Connell, PT, was entitled: Syrian Boy with Bilateral Upper Limb Differences Learns to Negotiate Daily Life in America. Attendees were spellbound by Ahmad’s story that took us from his and his dad’s arrival in the USA 3 years ago, his experiences to date, and plans for the future. His therapists work as a cohesive unit with his school and family with the goal of assimilating him into American life as a fully functional boy at home, at school, and in the community. Both Sheila and Julia have extensive experience in a variety of pediatric settings. They met Ahmad through the Sharon, MA public schools, where he is a student.

The therapists provided the framework for Ahmad’s journey through their PowerPoint and video presentation. Hearing about Ahmad’s experiences in his words and demonstrations on how he manages his daily life enriched the seminar infinitely and brought to life the reality of the challenges he faces on a daily basis. Behind the current functional capabilities were months of trial and error, frustration, and success guided by his therapists and sometimes, with his self-designed adaptations. Observing as he demonstrated donning a jacket, writing with Ferby Triangular Colored Pencils, cutting with a knife, scooping from an Inner Lip Plate, pouring himself a drink, and eating a peanut butter sandwich seemed satisfying for him. Ahmad uses a Slant Board to facilitate writing activities. He tried out and loved using Mounted Table Top Scissors today, which provided stability as the scissors were fixed to a plastic base with nonslip pads. Simple materials like Closed Cell Cylindrical Foam, and Velcro Self Adhesive Tape are simple materials that can be used in creative ways to facilitate function for Ahmad. Hearing about his PT treatment for strengthening his upper body in preparation for function was moving. Ahmad has tackled daily life issues along with a talented therapy team who are always exploring new ways to adapt materials creatively to ensure full participation with his peers and siblings.

Currently Ahmad is using primitive UE prostheses that require strength and muscle activation. He removed his shirt and demonstrated how he activates them using shoulder girdle musculature. Ahmad looks forward to the next step in gaining more fine motor control with myoelectric prostheses, which will provide him with increased power and control. He looks forward to using the device glove with fingers, giving him the ability to use a 3 jaw chuck for better fine motor control than his current prostheses offer. In addition, it was exciting to hear that he is eligible for bilateral upper extremity transplants in the near future, with the decision resting with him and his parents.

The commitment and care that Sheila and Julia have provided for Ahmad have been critical for his assimilation into his new life in the US. It was a pleasure for all of us to share his journey. His future is bright with his parents and four siblings now together in the US. Intelligence, confidence, kindness, and charisma are just a few of the qualities that we saw in Ahmad. Seeing how he, his parents, therapists, and school staff work as a team to help him achieve independence is truly inspirational. He is meeting his challenges head-on with determination and an indomitable spirit!

Here are a few appreciative remarks from attendees:

“The amount of adaptations are amazing. What a great team. I love how client driven it is.” – Patricia K., Occupational Therapist

“I would absolutely recommend this seminar to a colleague! This seminar was one of the best – especially because Ahmad was part of the presentation.” – Maura. M., Teacher

“I loved Ahmad telling his own story and supplemented by his therapists.” – Micaela C., Physical Therapist

“Very inspirational. Wonderful to see the student in action. So motivated!” – Beth M., Occupational Therapist

Thank you, Sheila, Julia, and of course, Ahmad!

Filomena Connor, MS, OTR/L
October 14, 2017