We're back today with Anika's story, Part 4, the last one in this series. You can go back and read part 3 [here] and part 2 [here]. Today we're bringing it all together and talking about what Anika's care team should look like moving forward, including whether OT belongs back in the mix.
Review of Anika’s Current needs
Here’s a quick reminder. In addition to Anika’s oral sensitivities, her parents also talk about the discrepancy of her being such a rule follower at school, but melts down easily at home– especially when she’s told “no”, or things just don’t go her way.
This combination of emotional regulation challenges, rule following/rigidity, and sensory sensitivities were a common profile I saw in the clinic, especially in girls Anika’s age. I told this to Anika’s parents not to diminish their experience, but to let them know that they were in the right place and that they’re not alone.
In my experience, working with a mental health therapist using a “child- centered play therapy” approach in combination with sensory-based occupational therapy was a great combination. Brownie points for finding an OT clinic that offered a girls social group. Let’s talk more about it below.
Let’s Revisit OT
Anika's parents already did a round of OT last year, and it was discontinued when the OT felt she'd gotten what she needed from it. That OT was likely doing real, useful work: naming feelings, practicing coping strategies, building a general toolbox for garden-variety frustration. Perhaps at that time, this top down cognitive approach to managing emotions was exactly what Anika needed. But now that we know the deep-rooted sensory based anxiety she experiences, it’s time to re-evaluate her status with OT.
When Anika's parents go back to OT, I'd encourage them to look specifically for a private-practice OT trained in Ayres Sensory Integration, and/or DIR Floortime approach. Both approaches work directly with how the nervous system processes sensory input, rather than only teaching coping skills on top of it. I also encouraged them to ask OTs directly how they'd handle her challenges, like "How do you approach oral sensory sensitivities specifically?". Don't be afraid to "interview" potential therapists and clinics to find the right one.
Where Play Therapy Fits
Play therapy is doing a different job, and a necessary one for this case. Anxiety that shows up after a scary experience, like being pinned in a freeze state with no words for it, often needs a space to get processed that isn't about skills at all. Play therapy gives Anika a way to work through what happened without needing to explain it directly, which matters a lot for a kid who couldn't access language in the moment it was happening. The catch is patience: this kind of work often needs to unfold at its own pace, and it can take a while before anything visibly shifts. That's normal, and to be expected.
