Episode 5 – Skills for Life

Hosts Dr Lisa Interligi and Kristine Christopoulos welcome guest Nicola Millar, Occupational Therapist, to talk about helping young people with disabilities develop skills for life.

Speaker 1:                        Welcome to Loop Me In, the podcast community for parents and carers on raising children with disabilities. Join presenters, Dr Lisa Interligi and Kristine Christopoulos, and their guests, on sharing experiences, information and support ideas to help children with disabilities flourish. Loop Me In is brought to you weekly on platforms like Apple Podcasts, Spotify, and Stitcher, to name a few. You can learn more, connect with the Loop Me In community and listen to more episodes on our website, loop-me-in.com.au.

Kristine Christ…:             Hi Nicola, how are you?

Nicola Millar:                   Good, thank you.

Kristine Christ…:             Great. Today, we’d love to chat with you. I know you’ve been working in the OT of pediatrics for nearly 20 years now, haven’t you?

Nicola Millar:                   Yes, it makes me feel very old.

Kristine Christ…:             Well, I think I met you when Matthew was like 5 or 6 at Katandra School in Ormond, Melbourne, which was a very long time ago.

Nicola Millar:                   Yes, that was one of my first jobs as a pediatric OT.

Kristine Christ…:             What made you get into this field, Nicola?

Nicola Millar:                   It was a really hard decision, well, easy decision, I guess. When I was younger, I really enjoyed sport and I was a really creative teenager as well. And I knew that I didn’t want to have an office job, I was adamant that I wasn’t going to be sitting in front of a desk all day. And I didn’t really know what else there was that I could do though. So I was looking down the road of some sort of PE teacher, but didn’t know if I was quite into that. And I went to a careers expo as a Year 12 student in New Zealand, I did my study in New Zealand, and I saw this big banner and it had this little girl over the top of some soft play stacking blocks. And I went, “Oh, that looks like something that I could teach. That’s sort of sporty and kind of creative.” And I had no idea what it was, and I enrolled, and traveled down to Dunedin, to the South Island from the North Island, and started OT.

Kristine Christ…:             Wow, that’s a great story.

Nicola Millar:                   Yeah.

Kristine Christ…:             Can you explain to everyone what the role is of an OT?

Nicola Millar:                   Yeah, sure. So occupational therapy is actually really poorly defined. And I also remember as a new uni student, one of my first lecturers said to us, “If you can explain what an occupational therapist does at the end of your course, you’ve passed.” And I still talk to some of my colleagues and say, “So what do you say to people when they ask you what an OT is?” They’re like, “Oh, well, it’s so hard to explain.” We’re a little bit of a Jack of all trades. And we cross over with some other health professionals as well. But essentially, as a pediatric OT, we focus on activities that help a child master their ability to participate in their everyday lives and everyday tasks. So we’re very child-focused and we work towards each child’s skills and abilities to make those skills more appropriate, often more age appropriate. And if they can’t be more age appropriate, we make them more efficient for that child.

Dr Lisa Interli…:              I think OT was the most valuable therapies that we ever did with Louis. I think that there were so many things that when he was younger, and continues today, that they’re skills that you kind of take for granted. But when you’ve got somebody who struggles with acquiring those skills, the OT really understands how to break down the process, and actually how to develop, to acquire those skills in steps that make it build up to the end goal of having those things. And there’s lots of them, I think when Louis was younger, just getting around actually was really difficult. And so I think that of all the therapies, it’s actually been very practical and very helpful to have an OT on site.

Nicola Millar:                   Yeah. And it’s funny because we have a lot of parents ring us up, and say, “Oh, we need an OT.” And I’ll say, “So what are your main concerns?’ And they say, “Oh, we don’t actually know what you do. And we’ve been recommended you by our speech therapist, or we’ve been recommended you by our physiotherapist,” because we’re so underdefined because we can work on so many areas, I guess, that lots of people don’t really know and it’s not until they start the therapy with us, and they go, “Oh, this has been a lifechanger,” that they realize how beneficial occupational therapy can be for their kids.

Dr Lisa Interli…:              Well, you don’t really break down the skills to when you think about fine motor skills, for example, how important fine motor skills are for so many things that you need to do in life. And so yeah, I mean, I think that developing those skills, at a basic level, underpin just being able to live.

Nicola Millar:                   Yeah, 100%.

Kristine Christ…:             I think even when you guys also come into the house to see the way we’ve set up the house, just to make them more independent. When Matthew was 4 or 5, I remember there was a plan, okay, he’s got to put his bag away, or he’s got to put his shoes away, he’s got to go upstairs and put his… Things that probably I would’ve just done for him because it’s obviously a lot easier, but there’s a lot of skills in there that he needed, and to get him to where he is today.

Nicola Millar:                   Yeah, to break down those tasks. And that’s a big part of our job is talking to parents about what do you want your children to be able to do in the future? I know what we’ve got now, but what are our long-term goals? Do you want your kids to be able to get their own breakfast? Do you still want to be wiping their bottoms when they’re 15 years old? Or can we work on that now? I know it’s a long way off, but we need to practice those skills now.

Kristine Christ…:             Mm. So true, so true. What, Nicola, are the key developmental milestones that you look out for in early childhood?

Nicola Millar:                   There’s a huge amount of areas that we would look into. But I guess our main areas are our fine motor skills, what Lisa was saying. So we look at hand development, and how children use their hands. We look at them, and how they use their hands both together, so using scissors, opening containers, being able to get their lunch boxes open for school, and then we also look at them separately. So whether they’ve developed their hand dominance, and whether they can manipulate things within their hands. And that goes hand in hand with gross motor skills. So running, climbing, jumping, throwing, which then goes hand in hand with their posture and their ability to control their bodies and their muscles. And being able to sit at a table to attend for a task. We also look at self-help skills.

So we look at their toileting, their feeding and their dressing, being able to get themselves dressed in the mornings. And then we dabble a bit deeper and look at their thinking skills, their social skills and their play skills as well. So being able to follow instructions, being able to problem solve simple tasks, being able to play along or with others, and being able to understand social cues. So that’s our main area, but then again, there are lots of other areas that we also look into, but if you were to see a typical OT, that would be mainly what we would be evaluating.

Dr Lisa Interli…:              One of the things that maybe it’s just urban myth, I’m not sure, but I don’t think it is, is that having that gross motor and being able to use two hemispheres of your brain and cross over is really good for language development. And I kind of think that that’s not really understood and you don’t really necessarily link physical activity and coordination to language acquisition or development. Is that a true thing?

Nicola Millar:                   Yeah, so definitely. So being able to cross your midline, that you have three different types of midlines, and being able to cross your midline certainly helps you with a lot of other areas in your life, including language development.

Kristine Christ…:             Mm. And how do you look for an OT, Nicola? I mean, I was very lucky to find you, but what should you be looking for? Are there particular ones for autism, for cerebral palsy? How do you know which one to look for?

Nicola Millar:                   I think you need to do the research and ask the questions, when you are seeing an OT, what they’re trained in because even talking to colleagues of mine, we specialize in different areas. Even if I generally work with a wide range of children, but I have more interest and more knowledge in some areas because we are so broad. But if you’re looking for an OT, you’ll be wanting to maybe seek your GP or your pediatrician, and they can recommend a private therapist. Or you could go through the public wait list, which can be lengthy as well. And you can sometimes, through the public wait list, you might only get a short period of therapy. Or us, OT Australia is where we have, it’s a little bit like a subscription that OTs are a part of. And there’s a Find an OT tab in there. And you can seek OTs through that.

So you can find local OTs in your area, and they can also tell you what they specialize in, which is fantastic. The other great part is often, schools, kinders and childcares have OTs attached to them, not necessarily part-employed by them, but you might find that schools have particular therapists that visit that school. So you can ask your local area school who comes and visits, and they might be able to give you some good strategies. But definitely worth asking, “Are you trained in autism?” “Do you have strategies that will help my child with toileting?” if it’s toileting, and make sure that they have some expertise, because it is such a broad area and we do tend to focus on particular areas.

Dr Lisa Interli…:              How long does it take to develop a skill? If I’m thinking about engaging in OT, is it going to be a couple of sessions, or is that something that actually takes a little while to develop a particular skill?

Nicola Millar:                   That’s a big question. It really depends on the child. So it depends on their capacity, their working memory, their ability to process. And it also depends on how much work the parents or the school want to put in as well. So I find that my children that do have great success, children that have parents that are really keen to put the program in place at home as well. And that the school are on board as well. And that’s the beauty of as an OT myself, I work community-based, so I’m in the school, I’m in the home. So parents are seeing what I’m doing, they’re seeing how I’m modeling, so they can then follow that up at home as well. And they’ll get the best results.

Kristine Christ…:             Yeah, I think that’s the important thing, isn’t it? Showing the parents as well as obviously helping the child because they’re the ones that are going to be there the next 6 to 7 days per week, teaching them.

Nicola Millar:                   That’s exactly right. And one hour of OT a week is not going to transfer those skills across into everyday life, it really needs to be practiced every day. And we try really hard. As OTs, we know that everyone has busy schedules as well. So we try really hard to integrate what we want you to practice into the everyday routine. So whether it’s I need you to practice some upper body strengthening, so I’m going to get you to do animal walks from your kitchen to your bathroom to brush your teeth instead of making it, “Oh, we’ve got to do OT practice again,” because we know that that’s really laborious for parents and for children as well. So we try and embed it into your everyday routine, so it makes it a bit easier to remember, and also to be able to be consistent.

Kristine Christ…:             Yeah, so true. And moving on, Nicola, from early childhood, how does the focus changes the population group that you are teaching get older into their times? How does that change?

Nicola Millar:                   So we continue to focus on improving their independence and tasks that are meaningful to that individual. And again, it would depend on the person’s ability level and what their life is looking like moving forward. So it could be, if they’re a teenager, we might be looking at helping them support at high school, getting them ready for high school, managing, keeping a diary, organizing belongings, navigating the big campus from change from primary school to secondary school, breaking down their large projects that they’re getting, or even organizing their homework. Or it could go to getting them ready to attend a day program in the morning, or complete their hygiene tasks, meal preparation. They might have some goals around being able to make an afternoon snack.

We look at travel training, helping them learn how to read time, and read timetables, and manage maps. Mobile phone use is a big one that we look at, breaking down the steps and how to use a mobile phone, and how to communicate with friends and family, and what would happen if we needed to meet someone and they weren’t there when we met them, so all those incidental issues that they have. Community access, and then also looking at domestic jobs around the house, what sort of things are they going need to do if they might be living semi-independent or independent later on in life? Again, it’s really depending on the child’s goals and the child’s needs, and the future and their abilities.

Kristine Christ…:             I do remember that last year when we went through COVID, and I had carers, and I remember saying to you, I just don’t know what they can do with him because obviously they couldn’t really leave the house. And you had a schedule on him making a milkshake, and just breaking down, “Well, how does he make a milkshake?” And just because you’ve got to teach the carer as well what to do with them. And even you suggested Matthew grabbing the mail every day, just little chores around the house that he could learn and do around the house, which we probably wouldn’t, we’d just do those things. So we don’t know to teach them as parents.

Nicola Millar:                   That’s exactly right. And like I said before, it’s thinking about, “Right, if I’m not going to be able to do that in 10 years time, what can he do for himself? What do we want him to be able to be independent with? I don’t really want to be making him milkshakes every day, so it would be really great if that’s something that he loves to do, to be able to do that himself.” And that’s a motivating task for Matthew as well, so he’s keen to do it.

Kristine Christ…:             Mm, yeah.

Dr Lisa Interli…:              Yeah, because you want to be successful, don’t you? It’s part of it is about feeling like you are actually contributing and that you’re successful in what you’re doing. Everybody wants that. And so [inaudible 00:14:23].

Nicola Millar:                   That’s exactly right.

Dr Lisa Interli…:              Yeah, so if there’s a payoff at the end, there’s a milkshake and you feel kind of yourself that you’ve made it, and then you can drink it, you want to make another one.

Nicola Millar:                   And about that is, as they get older, is you can start developing these goals. It’s more of a development of goals with the client as opposed to the parents. So I’ve just had a client who we’ve learned to catch the bus to school, he’s in high school now, and he has been riding the bike and he really wanted to learn how to catch the bus. So now he can catch the bus with his mates. So yeah, just knowing what is important to the person as well.

Kristine Christ…:             Yeah. There’s really so much there, isn’t there, that forever and a day, they’re going to learn from an OT, aren’t they?

Nicola Millar:                   Yeah, it can often be a really long-lasting relationship with an OT.

Kristine Christ…:             And I think sometimes it’s also behavioral. I know there’s times when Matthew went through a stage where he was biting everything, and we did a sensory profile on him. Can you explain that, what a sensory profile is?

Nicola Millar:                   Yeah. So sensory profile, well, sensory is just your sensory needs and what your preferences are. So your touch, your smell, how your body moves, your oral stimulation, your auditory processing, what you see and what you hear. And basically what happens is sometimes we can’t regulate those sensors, so we’re heightened or we’re underaroused or overaroused. And we always want to be at an optimal arousal level. So we provide strategies and techniques for these children to be at optimal arousal levels. So sometimes, you might see that a child will be seeking out something. For example, Matthew was seeking out pulling things apart and biting and mouthing, so we need to provide them with something to give them that optimal arousal level to avoid doing those things. We found that massages with Matthew really worked really well. So when he has a massage from his massage therapist, we knew that deep pressure was really calming for Matthew, so we know that after those sorts of experiences he’s much happier.

Kristine Christ…:             Mm.

Dr Lisa Interli…:              Gosh, it’s fascinating, isn’t it, really? There’s so much to think about.

Nicola Millar:                   Yeah. And I guess with sensory, some of these sensory needs are not needed to be changed because we know that somethings, so for example, if a child likes to tap their legs constantly, and that keeps them aroused, it’s not really impacting anyone else. It might be noisy or it might be annoying to other people, but it’s not impacting anyone to the point where they’re going to get overly frustrated by them. But if they’re smearing their feces all over their bodies, obviously that’s not appropriate, so we need to change that. Yeah.

Kristine Christ…:             Yeah, really interesting.

Dr Lisa Interli…:              Where do you start? If you had a child with a developmental delay or [inaudible 00:17:20] diagnosis or a disability, a young child, what is it that you think you should start with?

Nicola Millar:                   In terms of what area we look at?

Dr Lisa Interli…:              Yeah, you call in an OT because you don’t really have an idea of what you should be working on it. Just kind of saying, “Well, I think I need an OT because it is so broad, the benefits that the child could have,” and find an OT and just get an assessment. Is that what you… Or do you wait for an issue that you think is problematic or needs working on?

Nicola Millar:                   No, definitely not. So you could easily get an OT in that stage, and you would have them come out, and I would go through some of the domains that we look at. So I’d say, “Okay, so self-care, Lisa, how does your son manage the toilet?” And you might say, “Oh actually, he doesn’t do poos in the toilet, he only does it in his nappy.” “Oh, well that’s something we can work on.” Yeah, so we’d go through everything. How does he eat? Does he use a fork yet? Does he scoop his spoon? So even if you don’t really recognize what the goals are, we bring up a whole lot of areas that we need some support or we need some practice in, and then we make some priorities out of that.

Dr Lisa Interli…:              Okay.

Kristine Christ…:             Interesting you bring up eating because I wanted to talk to you about your new program, Mealtime Matters, which both Louis and Matthew attend. How did that idea develop?

Nicola Millar:                   Yeah, that’s my new little baby project that I’ve been really enjoying doing. So I found that I’ve got a lot of clients like Matthew, who I’ve had for many, many years and I guess they’ve been overtherapised, had lots and lots of therapy as a younger child. And it gets to the point where sometimes I think that individual therapy isn’t as beneficial for these children because they need to have some socialization as well, but we still have lots of goals to work on. And we felt that there was a bit of a gap for these young adults, I guess. So we looked at creating this group called Mealtimes Matters, and it’s mainly a social skills and community access, but it’s a really big thing because it works on a therapeutic experience.

So they’re not just going out and having fun and socializing with their friends, but they’re actually working towards their goals for therapy. So every participant that attends this group has at least three goals that are individualized. So some might be working on socializing and ordering at the desk, their food, and others might be working on table manners and knives and forks. And that can be completely individualized to that participant, which is fantastic. But I guess the overall arching goal is that they’re building connections and relationships in a normal, typical, we’re actually at a pub, and around other people. So they’re socializing with patrons and they’re learning how to be part of the community without their families, which is fantastic.

Kristine Christ…:             I think it’s an amazing, even the dropping off outside so they don’t feel like they’re getting dropped off by their parent to go into a restaurant, they’re kind of walking in themselves. Well, they think they’re walking in themselves, but obviously you’ve got someone outside going in with them, I think it’s a fantastic concept.

Nicola Millar:                   Yeah. And we think that, well, we are really enjoying running it and we come out of the session saying, “That was so great.” And we’re seeing big improvements in a large number of their skills, even some of the skills that aren’t their typical goals. And the kids, well, the young adults seem to be wanting to come back every session, which is fantastic as well.

Kristine Christ…:             They just haven’t been able to though, have they?

Nicola Millar:                   Yes. COVID has prevented that unfortunately.

Dr Lisa Interli…:              I often think about funny things that Louis has done over his lifetime because they change. And I remember when he was younger, when he’d finish his meal, he’d throw his plate and his cup at us, and we just duck at the table. Have you got some funny stories, without naming names? We don’t want you to do that but where you’ve had success stories. I think that’s a funny one. Another one was when I gave him a boiled egg one day, and I turned my back and the whole egg was gone, including the shell. So there must be some funny stories where you’ve had some good outcomes, and it’s been a relief for the parents.

Nicola Millar:                   I’ll tell you a funny story. Well, it’s not a funny story, it probably was quite traumatic for the parents, but I was probably quite a young OT, I’d only been a therapist for a few years, and I had this little boy who used to smear himself with his feces, and it would happen every day. And I said to this mum, “Oh, I don’t know what we’re going to do.” And we did the sensory profile and I could see he was seeking this need for this feces all over his body. And he would smear it completely head to toe, all over himself.

So I said, “Oh, I wonder if we could try chocolate yogurt.” And she looked at me like I was absolutely insane. But anyway, the next week, you know what? I turned up with a kilo of chocolate yogurt, and I took him outside and I said to him, “Smear it all over you.” And he had the best time. And his mom said that he didn’t need to smear his poos anytime. So once a month, she’d go and buy chocolate yogurt and she’d take him outside and he’d sear it all over himself, and he never smeared his feces again.

Dr Lisa Interli…:              So he was happy with once a month?

Nicola Millar:                   Yeah because he got the need because obviously when he was smearing his feces, his mom would say, “Stop. You can’t do that, that’s disgusting.” So it wasn’t allowed. But when he was allowed to do it, he could get the satisfaction and the sensory need that he needed, so it decreased his need to do it every time he did a poo.

Dr Lisa Interli…:              Yeah, amazing.

Nicola Millar:                   Yeah. But there’s some parents that look at me when I suggest things and they go, “Oh really?” And then they’ll say, “Oh, you know how you suggested that, it actually really worked.” And sometimes it’s just trial and error, and I’ll say to parents, “Let’s try it, try it for a week, try it 15 times. If it doesn’t work, it’s fine.” It’s obviously not going to work, but there’s some things that you just have to try with these kids to see if it’s going to make a difference.

Dr Lisa Interli…:              The benefit or the relief that those parents would’ve had from that would’ve been immense.

Nicola Millar:                   Yeah.

Dr Lisa Interli…:              How [inaudible 00:23:37] would that have been?

Nicola Millar:                   Yeah.

Dr Lisa Interli…:              And there’s been periods of my life that we’ve had similarly stressful things that we’ve kind of had to work our way through, and thank goodness for OTs.

Nicola Millar:                   Yeah. And I think that no matter what the stress is, sometimes parents think, “Oh, this is stupid, but I need to mention it to you,” it’s really important that they do because there’s often solutions, even for little things that are causing your time in your house to be stressful or challenging.

Kristine Christ…:             Yeah. It’s amazing, after all that, OT, there’s just so much variety in there, isn’t there? There’s so much that you can do to help a family that probably wouldn’t have thought to call you, for example, for smearing their feces all over them. You might not have thought to do that, but so much in that because, yeah, I’ve definitely had my share of things with my son. And I’m sure a lot of people have out there as well.

Nicola Millar:                   Yeah, that’s exactly right. And we’re not going to cure everything, we don’t cure things, but we try and make things more functional and more appropriate, and make it easier for these children and young adults to manage life.

Kristine Christ…:             [inaudible 00:24:53], well, sorry.

Dr Lisa Interli…:              There you go. I was going to say thank you, it was so nice to talk to you.

Nicola Millar:                   Thank you for having me.

Kristine Christ…:             Thank you so much, Nicola. All the best.

Nicola Millar:                   Thanks very much, see you.

Dr Lisa Interli…:              Bye-bye.

Speaker 1:                        Thanks for being part of the Loop Me In community today, and joining our conversation on raising children with disabilities. Join us for the next episode on some of your favorite platforms like Spotify and Apple Podcasts. If you would like to support us, please recommend the Loop Me In Podcast to your network of parents, carers, and providers. If you would like us to cover a topic or invite a guest to chat, please email us at contact@loop-me-in.com.au or go to our website at loop-me-in.com.au. If you’ve got any feedback, please let us know so we can improve and cover issues you want.

And of course, if anything in the podcast today has raised concerns for you, you can contact Beyond Blue on 1300-22-4636, or lifeline on 13-111-4.


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