Occupational Therapy in the Park: A Creative, Socially Distant Solution for a Child With a Learning Disability and ADHD

by Kimberly Bradley, MS, LOTR

This case study describes my work with Lucy, a 5-year-old child with working memory weaknesses, visual spatial difficulties, ADHD, and sensory processing disorder. Because Lucy struggles with attention, she finds it difficult to retain what letters and numbers look like. Before the pandemic, we had been doing a lot of multisensory work to help her retain letter and number recognition and formation, in addition to what sounds each letter makes.

In the virtual environment, her attention and sensory processing disorder made it almost impossible for us to make any progress toward those goals. Inside her house, her parents were not always available to assist due to working from home. Her sister was becoming a distraction, too. I initially proposed that she move outdoors during our Zoom sessions outside to escape those distractions, but that didn’t work much better.

With me “stuck” in the computer on our Zoom session, it was difficult to keep her attention on the lesson. She chased squirrels, ran off to pick flowers, and got distracted by just about everything in her backyard. It was incredibly disheartening: The skills we were trying to work on were ones she could do just fine two months ago. She had lost so much progress.

Her behavior at home during the quarantine also became a huge problem. She was exhibiting negative and avoidant behavior and shutting down completely. She and her sister were constantly getting into trouble on their own. In fact, the day before our first park session, she and her sister gave themselves haircuts without permission or supervision. Her parents were ready to lose it.

That’s when her parents and I decided to switch up my lessons by going to a park. We were socially distant. We wore masks, used hand sanitizer, and cleaned therapy items when necessary. I knew she would be distracted by her surroundings, so we incorporated the surroundings into the lesson. With me there in person, it was much easier to find ways to keep her attention and have a productive lesson.

Learning goals

  • Improve attention to task through multisensory learning strategies

  • Provide sensory input through functional proprioception and vestibular input to increase attention and meet sensory-seeking needs

  • Improve letter and number recognition and formation

  • Sequence alphabet and numbers 1–10

  • Follow one- and-two step directions

  • Improve basic executive function skills, waiting, and turn-taking

Keywords

occupational therapy, face-to-face, multisensory, ADHD, Grades K-2, writing, motor skills, letter and number recognition

Transition to distance learning

Activities

Face to Face

  • Sequence the alphabet using an ABC puzzle or therapy tools in the classroom

  • Walk around the school campus to find letters and numbers on a scavenger hunt

  • Form letter and numbers with shaving cream or other classroom tools

  • Use reference tools in the classroom to decrease reversals and recognition

At a Distance

  • Use sidewalk chalk to form letters and numbers

  • Count ducks and other park animals

  • Count steps up to a gazebo

  • Walk around the park to find letters and numbers on a scavenger hunt

  • Spray water on numbers and letters written in chalk to erase and clean up

Materials

Face to Face

  • Tactile and multisensory classroom materials (shaving cream, Wikki Stix, play dough)

  • Letters and numbers around the classroom and school (on clocks, etc.)

  • Letter and number line in the classroom

At a Distance

  • Rocks

  • Sticks

  • Sidewalk chalk

  • Park animals

  • Spray bottle full of water

  • Letters and numbers around the park (on signs, etc.)

  • Steps (physical)

Strategies

Face to Face

  • Incorporate following directions and letter recognition into cleaning up classroom materials (“Can you clean up L? Can you pick up K?”)

  • Provide sensory input by building movement into all learning tasks (“Hop on one foot to find A, bear crawl to find B”)

  • Multisensory methods to learn letter formation and increase attention to task

At a Distance

  • Preempt distractions by using potential sources of distraction as material for the lesson (“There are three ducks in the pond; spray the number 3”) (If I’ve brought my dog, “Feed the three dog treats”)

  • Build letters and numbers using nature items outside (sticks, rocks) to work on formation

  • Provide sensory input by counting movements in the park (“Count how many hops it takes to get to that tree”)

  • Use multi-step directions in a scavenger hunt to improve working memory (“Find three leaves, then find two pebbles”)

What worked well

The change in environment worked really well. Environment and context play a huge role in this type of therapy. At home, there are a lot of distractions from her parents, her sister, and anything that I can’t see from my vantage point in a Zoom session. Outside, where we can both share the same experience, I can incorporate into the lesson many things that would otherwise be distracting.

I was surprised by

Sometimes it wasn’t Lucy who was getting distracted, it was other kids in the park. There were a few times when other kids saw us playing with chalk and water and tried to come join us, and screamed and cried when their parents stopped them. It wasn’t a huge problem, but we did have to move a few times.

Next time I’ll try

Our school has started to move some therapy sessions back into a school setting, but our park sessions went so well that we’re still going outside for half of our regular therapy sessions. Part of the rationale is safety: There is less risk of the virus spreading in the open air than in an enclosed classroom. But we’re also still doing park sessions because they work so well. There are endless opportunities for new activities to try.

My big picture takeaways

It’s really important to follow the student’s lead. Pay attention to their interests, and build your therapy goals into what drives them. Especially when it comes to executive function and ADHD, OT is only going to work if they’re interested in it.

About the Author

Kimberly Bradley, MS, LOTR, received her bachelor of science degree in occupational therapy from Louisiana State University Health Sciences Center in 2001, and her master of science in health care management from the University of New Orleans in 2007. She is SIPT (Sensory Integration and Praxis Test) certified and has completed the Level 1 mentorship program at the STAR center, where she studied under Lucy Jane Miller, PhD.

Bradley is also certified in Therapeutic Listening, iLs, and Handwriting Without Tears. She has completed extensive coursework in sensory processing disorder and is an adjunct professor for LSUHSC’s occupational therapy program, educating OT students on the evaluation and treatment sensory processing disorder. She specializes in the treatment of sensory processing disorder, working closely with the client, families, teachers, and other professionals. She enjoys assisting the family in designing and finding the most effective sensory equipment for the child in the home.

She also specializes in treating children with fine motor coordination deficits and functional writing difficulties. She takes pride in her treatment planning, which involves ongoing parent and teacher training, education, and consultation.

Bradley has been an active volunteer with the Visiting Pet Program since 2001, and brings her golden retriever and Great Pyrenees for regular visits to Children’s Hospital and Magnolia School. She is also involved with Hogs for the Cause and the Louisiana SPCA.

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