Occupational Therapy Frames of Reference: Pediatric Edition!

Commonly Used Occupational Therapy Frames of Reference: Pediatric Edition 

Within the profession of occupational therapy, frames of reference are concepts that aid in the therapist’s decisions on interventions to help the client reach their individual goals. Frames of references are utilized within occupational therapy to assist the therapist in decision making by using clinical reasoning based on theories.

Commonly used Frame of References in Pediatric Occupational Therapy Practice:

Behavioral Frame of Reference  

This frame of reference focuses on the behavior of the child and the surrounding environment.

• Can be used with children with:
  • ADHD
  • Developmental disabilities
  • OCD
  • Self- regulation difficulties 
• Focus on change and motivation: 
  • Using positive reinforcement 
    • Example: If a child doesn’t get what they want instead of screaming and crying they take a moment to themselves before returning back and every time they do this behavior they receive a piece of their favorite candy 
  • Decreasing the occurrence of unwanted behaviors (working on self-control) 
  • Forming new habits 
• Interventions:
  • Working on relaxation techniques for self-control 
    • Deep breathing, meditation, yoga poses, sensory corners (with bean bags, fidgets etc.)
  • Using rewards for wanted behaviors– helps to shape the child’s “want” to behave in that way due to knowing if they do they will receive a reward 
  • Positive reinforcement 
    • Allows for the wanted behavior to occur and a decrease in the unwanted behaviors 
    • Token economy
      • Helps increase wanted behaviors 
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Developmental Frame of Reference  

This frame of reference focuses on the developmental progress of the child and the individual needs of the child in order for them to continue succeeding within their development stages. 

• Can be used with children with:
  • Gross motor delays
  • Fine motor delays 
  • Decreased postural and balance skills
  • Decreased motor planning/praxis skills 
  • Difficulties with social participation 
  • Difficulties with sensory processing abilities 
    • Oral motor delays, feeding delays 
• Focuses on:
  • Cognition skills
    • Ability to take in and organize information 
  • Sensory processing skills
    • Ability to take in stimuli and respond 
  • Social interaction skills
    • Ability to start and maintain conversations, eye- contact, forming relationships, play skills
  • Self-identity skills 
• Interventions:
  • Core strengthening activities
    • Prone (on stomach) on peanut balls, scooter, platform swings, on wedge 
    • Crab walking
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• Obstacle courses, yoga, twister, Simon says– for motor planning, balance
• Role play or social stories– work on social skills 
• Fine motor strengthening 
  • Theraputty, Legos, weight bearing activities

Neuro-Developmental Treatment (NDT)

This frame of reference focuses on normalizing tone and improving mobility for independence. 

• Can be used with children with:
  • Cerebral palsy 
  • Low tone
  • Down Syndrome 
  • Other motor difficulties in terms of:
    • Posture 
    • Alignment 
    • Balance
• Focuses on:
  • Using a base of support
    • Smaller base of support– have child positioned higher off ground 
    • Larger base of support– lay child in prone (on stomach or on hands and knees)
  • Using key points of control
    • Which are areas to facilitate the movements
    • Shoulder, hips, pelvis 
  • Weight shifting
    • Example: Shifting from foot to foot when walking 
  • Rotation 
    • Through the trunk as you weight shift the child to help with tone normalization
    • If a child is tight– rotation helps to relax the tone
    • If child is loose and floppy– rotation in aid in activation of the muscles and using the tone they do have more effectively 
• Interventions:
  • Working on play skills, fine motor skills, or crossing midline while therapist facilitates movement of child 
  • Example of peanut ball: Amazon: Fun and Function – Peanut Ball for Kids
    • On peanut ball (straddled)
    • Sitting on exercise ball with hands at child’s pelvis 
    • Sitting on bolster (straddled) with child 
    • Sitting like chair– pelvic tilting 
    • Ball rolling on top of patient (pizza squishes) 
    • Laying on stomach over a bolster or peanut ball 
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Sensory Integration (SI) Frame of Reference

This frame of reference focuses on a child’s sensory processing abilities. This includes visual, auditory, tactile, vestibular, and proprioceptive inputs.

• Can be used with children with:
  • Autism 
  • Motor planning/ praxis difficulties 
  • ADHD
• Focuses on:
  • How the child takes in the information from the environment 
  • How the child responds to the stimuli 
    • Example: lotion or certain clothing on their body, loud noises in the classroom (pencil sharpener) 
  • Working on strategies to help with self- regulation in order to obtain more efficient functioning in different occupations 
• Interventions:
  • Reducing sensory defensiveness 
    • Lotion massage 
    • Wilbarger Brushing Program 
      • More information can be found at: The Wilbarger Protocol (Brushing) for Sensory Integration
    • Ball pits (finding treasure)
  • Improving tactical response
    • Crawling through tunnels 
    • Squeeze machine 
  • Using different types of swing for rotary, angular or linear movements
    • Mushroom swing (linear)
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• • • Platform swing (rotary)
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• • • Bolster (linear) 
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Motor Learning Frame of Reference

This frame of reference focuses on what the child is able to and the skills required for that task.

• Can be used with children with:
  • Developmental disabilities 
  • Gross motor delays  
• Focuses on:
  • Repetition 
  • Doing activities that repeat the same motion
    • Example: Using puffy balls to “feed the lion” 
• Interventions:
  • Plan and execute an obstacle course (going through it 2-3 times)
  • Having cones or other obstacles when trying to kick a soccer ball into the net (problem solving how to get to the net)
  • Sequencing of steps (how to get their pants on and fastened)

Biomechanical Frame of Reference

This frame of reference focuses on range of motion (ROM), balance, endurance, and positioning.

• Can be used with children with:
  • Limitations related to their ability to move and get around (joint immobility)
  • Severe burns
  • Physical limitations or delays
  • Cerebral Palsy
• Focuses on:
  • Maintaining movements and motion
  • Compensatory strategies for movements and motions lost
• Interventions:
  • Painting rainbow on large sheet of paper– ROM
  • Cuff weights & putting blocks on shelf– Endurance
  • Splints or orthoses– Positioning
  • Working with wedge, peanut ball, bolster, and bosu ball (if appropriate)-Balance
  • Propping body parts
    • Example: using an armrest to support stability when writing
    • ErgoRest Articulating Arm Rest