To parents of children who are on the spectrum, progress is made through milestones; however, sometimes the most significant achievements take place in those small steps that happen when a child is able to tolerate a haircut, express their needs, feel secure enough to play, and become a little bit more independent.
To appreciate such steps, one should not only observe a child’s abilities and disabilities but try to understand what may be going on underneath all these things. Here comes the point of using occupational therapy not only for skills improvement but also for creating comfort and confidence.
Dr. Manish Samnani, who has over 25 years of experience in this field, has been making his way through the world of these nuances for many years.
Also Read: Her Speech Was Delayed, Not Her Potential: Story Of 10-year-old Sanvika
He is a seasoned Occupational Therapist who works closely with children with neurodevelopmental disorders, like autism and sensory processing problems. He is the current Clinical Director of SOCH, Gurgaon, and the President of Haryana Chapter of the All-India Occupational Therapists’ Association.
He holds a PhD and a Master’s degree in Occupational Therapy in Paediatrics from Jamia Hamdard, where he secured a Gold Medal and is also internationally certified in Ayres Sensory Integration from the University of Southern California and Neuro-Developmental Therapy from NDTA, USA.
In this conversation with All About Inclusive, Dr. Manish Samnani talks about the changing role of occupational therapy in helping kids who have autism or any developmental disorders, the significance of understanding sensory needs, and the ways in which parents, therapists, and teachers can collaborate to make every child more independent.
Also Read: Genital Stimming in Autism: Dr. R. S. Bagga Explains the Behaviour
Question) Parents are often told what their child cannot do. As an occupational therapist, what is the first thing you look for in a child that parents themselves may have stopped seeing—their strengths, potential or a different way of experiencing the world?
Answer: I think parents sometimes forget about uniqueness of child and also about the very fact that every child is a child first. As an OT, I encourage them to not see child’s sensory issues as odd behaviours or as behaviours at all. I try and explain to them that the sensory repetitive issues can be a child’s unique way of playing and interacting with the world around him. A child might also use sensory and other behaviours as a form of communication especially when communication seems to be emerging as per age.
Question) Many parents say, “My child can do this at therapy, but not at home or school.” What do you wish families understood about progress—that it is not always linear and that a child may be trying even when it doesn’t look like progress?
Answer) Progress of a child in therapy is not just non-linear but is also to be seen as overarching a complete sense of development rather than discreet skills. As an OT I frequently tell parents that sometimes progress is not quantitative and is more qualitative. OT work with children first to improve their mental health, adaptability to person and environment, and to achieve “just right state”. We need to understand child’s development is not on the parameters of “achieved”, “emerging”, “not achieved”. Performance of child is dependent of child, task and but also on context. Handling and understanding the child makes him/ her to identify therapy space as safe and accommodating.
Also Read: Mud, Grass, Water or Noise: Understanding Sensory Needs in Autism and ADHD
Question) A mother may spend years helping her child hold a spoon, wear a T-shirt or tolerate a haircut—things other parents may take for granted. Why are these seemingly small milestones some of the biggest victories for families?
Answer) The activities mentioned are called Activities of Daily Living and are also called as Basic ADL. These activities are a part of triad of meaningfulness of life and independence beyond the other 2 areas of Work and Leisure. If a child is independent in Basic ADL it has a far-reaching impact on his self-esteem, and self-efficacy. Independence in ADL is a long-term goal for all children and ultimately align with independence in life skills and vocation too.
Question) When a child has frequent meltdowns, avoids touch, refuses certain clothes or struggles in noisy places, parents are often judged for being unable to “control” their child. What could be happening beneath the behaviour that society fails to see?
Answer) The society frequently fails to see through the behaviours and is quick to judge parents and the child too. Neurodevelopmental problems of a child are something that the child and parent is already trying to live with and might be OK to adapt and adjust with unless the society is supportive too. These behaviours are not “behaviours” as the unaware society tries to match the child to the norms in their mind for “normalcy”. These behaviours are signs that the child’s mind and body are sometimes not completely integrating and hence the child’s has to do something to cope with it.
Question) Do you think parents sometimes carry an invisible guilt—wondering whether they noticed the signs too late or did something wrong? What would you like to say to a parent who is exhausted from constantly asking, “Am I doing enough for my child?”
Answer) It is important for parents to understand that “good parenting” does not automatically mean “doing more” or doing something all the time. We cannot change what we did or did not notice in past, but what we can do as parents is to be there for them. “Doing enough” also simply means to let your child be themselves, let them play, connect and grow. Taking care of their biorhythms (cycle of sleep, eating, toileting) itself can be rewarding for their health and progress.
Also Read: How Home-Based Autism Therapy Helped Little Guru Thrive Against the Odds
Question) Therapy can sometimes become the centre of a family’s life—appointments, exercises, goals and constant worry about the next milestone. How can parents support their child’s development without losing the joy of simply being a parent and letting the child just be a child?
Answer) Child development is not supported by only therapy. Therapy is only one part of it. Parents can support, augment their child’s development by just being “present” and “responsive”. A parent needs to spend time as ordinary days doing ordinary things like eating together, playing, resting, even having an argument.
Question) You work closely with children during some of their most vulnerable moments. Can you share what a child has taught you—perhaps without words—that completely changed the way you look at therapy, disability or childhood?
Answer) I work mostly with children with autism. It is often said about them that they have frequent mood swings, meltdowns, aggression. What I have learnt from them is how very small simple petty things can really lift your emotions as they respond beautifully to such small things themselves. A particular colour chair should be at a particular place or my mumma should sit on this chair and keep her bag on that particular chair is enough to make them feel “in control”. I marvel how their thinking so simplistic, black and white with no elements of grey. What they lack is not communication but people who are willing to learn and understand them.
Question) For the parent who is reading this after a difficult day—after a meltdown, a therapy session that didn’t go well or another comparison with a “typically developing” child—what would you want them to remember about their child’s journey and their own journey as a parent?
Also Read: How to Develop Language Skills in Neurodivergent Children
Answer) Parenting of all children — whether taking therapy or not, is a journey and not a destination. The child and the parents are a unique ecosystem are we are not trying to prove ourselves everyday but rather making our own mistakes, taking our own time, giving space to children by just letting them know that we are always present, and growing with connectedness. The growth and connectedness do not show or become apparent on a day-to-day basis but it is something that is taking shape quietly in the root. We have to be patient with child’s progress and day to day performance and parents have to be patient with themselves too.
