When a child walks into a therapy room, the silence can sometimes be the loudest thing in the room. For many pediatric occupational therapists, parents, and even doctors, the biggest challenge isn't just knowing how to treat a condition, but understanding what the child actually wants from their own life. Communication is an art form, especially when the person you are talking to might not have the words to tell you what is wrong or what they hope to achieve.
Dr. Shovan Saha, a seasoned occupational therapist, learned this lesson through a powerful encounter with a young patient. A 14 year old boy had been electrocuted in a tragic accident, resulting in the loss of three limbs. When the boy was first brought into the clinic, the therapy team immediately focused on what they assumed was the most vital goal, teaching him how to eat by himself. They spent days developing adaptive devices and practicing strategies to help him regain this basic human function.
Finally, after nearly a week of intense work, the boy looked at Dr. Saha and asked a question that changed his entire perspective on practice: 'Sir, why are you so bothered about my eating? I am not interested in eating. My mother feeds me, and I am happy. Please do something so that I can play solitaire on the computer'.
The Trap of Assumptions
It is easy for professionals and parents to fall into the trap of deciding what is best for a child based on standard milestones or medical necessity. We see a child who cannot tie their shoes or use a spoon, and we set those as the primary goals. However, if the child does not value those tasks, the therapy becomes a chore rather than a partnership.
Rephrasing the Conversation
To understand a child's true needs, practitioners and parents must be willing to rephrase their questions according to the individual. A question like 'What do you want to do?' might be too broad or even overwhelming for a child facing significant physical or cognitive challenges. Instead, the goal is to help the child organize their thoughts and extract information piece by piece.
Here are a few ways to refine the approach:
- Observe first, ask second: Sometimes a child's actions speak louder than their words. Pay attention to what they gravitate toward when they think no one is watching.
- Use visual distance: Keep long term goals visible and relevant, but break them down into daily targets that the child can actually see and feel.
- Validate their choices: If a child says they don't care about a 'vital' task like eating independently, acknowledge that feeling. Understanding their current priorities builds the trust necessary to tackle harder tasks later.
Creating a Narrative of Change
The ultimate goal of any therapy is to restore human function, but that function must exist within the child's own context. When a child can see and experience small changes on a regular basis, they remain motivated to continue the journey.
By asking the right questions, we stop treating a set of symptoms and start treating a person. This shift ensures that every session is a step toward a life that the child actually wants to live, rather than one we have designed for them. Occupational therapy is about more than just recovery; it is about providing the security and confidence that an honest attempt at a better life is being made.
