Neurodiverse Affirming Occupational Therapy and Family-Centred Care

It is lovely to see a swing towards the provision of neurodiverse-affirming therapeutic supports, with many therapy providers passionate about considering how they practice and provide support to individuals they work with.

The following is a summary of why it’s core business of Occupational Therapists to consider families and involve parents when supporting children and young people.

Parenting Behaviours Influence Child Development and the Parent-Child Relationship

Parenting behaviours can be defined as a range of actions taken by parents while raising their child (Rocha et al., 2022) and are influenced by the social and cultural contexts parents exist within (Dalimonte-Merckling & Williams, 2020). A parent’s awareness of, sensitivity towards, and responsiveness to an infant’s cues (Ainsworth et al., 1971, 1974; Pederson et al., 1990), have been extensively researched as an influencing variable on child development.

Parental awareness and sensitivity have been found to positively influence a child’s social-emotional development (Frick et al., 2018; Rosenblum et al., 2009), motor development (Ku et al., 2023), language development (Rivero et al., 2023; Vilaseca et al., 2023), and cognitive development (Vilaseca et al., 2023). Parental awareness of and sensitivity towards cues also influences the developing parent-child relationship (Ainsworth et al., 1971; Ainsworth et al., 1978), which can be protective of social-emotional development across the lifespan.

Parenting Behaviours are Influenced by a Range of Factors

This in no way means parents are to blame for any difficulties with their child’s development – not at all!

Parenting is a dynamic and complex occupation that can be influenced by a range of factors, including family socioeconomic status (Scherer et al., 2019; Siu & Hui, 2021), parental homemaker status (Siu & Hui, 2021), child temperament (Mangelsdorf et al., 2000) and reduced access to social supports (Falk et al., 2014; Weinberg et al., 2021). There are many moving pieces that shape how a parent experiences their role, and when providing support to families, it is essential that occupational therapists are aware of these factors to ensure supports are sensitive to the broader needs of the family.

Occupational Therapy, Co-occupations and Family Centred Care

Parenting can be considered a ‘co-occupation’, in that there are at least two people involved, sharing time, space and meaning while interacting. Co-occupation is defined as an activity where ‘the occupational performance of one member depends on that of the other’ (Humphry & Thigpen-Beck, 1998, p. 837). Co-occupations are considered the most highly interactive types of occupation, and can be conceptualised as ‘a synchronous dance back and forth between the occupational experiences of the individuals involved, the action of one closely shaping the action of the other in a close match’ (Pierce et al., 2003, p. 199). When a parent and child participate in co-occupations, the child is not a passive recipient of parental interactions, but an active partner influencing the exchange (Zemke & Clark, 2006).

Price and Miner (2009) suggest that parent involvement and support of co-occupations between the parent and child dyad is critical to providing sophisticated, family-centred, therapeutic care. Occupational therapists working in the child development space may consider that understanding and supporting participation in co-occupations is one way of providing support.

Why is this Way of Support Neurodiverse Affirming?

Autistic infants and children may have differences in thinking, sensing, moving, communicating, and socialising, which may result in them cueing their needs differently to their non-autistic peers in the (Palomo et al., 2006; Palomo et al., 2022).

These differences may make it difficult for parents to read and interpret their child’s needs, impacting on the ability to provide responses that meet their child’s needs at the time (Koren-Karie et al., 2009; van Ijzendoorn et al., 2007). Increased parental stress and poor mental health can also affect caregiver ability to accurately perceive and respond to their child’s signals (Ainsworth et al., 1971; Booth et al., 2018; Dau et al., 2019).

What if the focus of therapeutic support shifted away from ‘skill teaching of children’ towards supporting and reflecting about what a child’s needs may be? What if ‘skill teaching’ and ‘home programs’ actually added stress on to a child, which could make it harder for the family as a whole? What if, instead, there was thoughtful consideration of what might be happening in the family that made it harder to read and respond to a child’s needs? We know if a child is regulated, they are better able to engage in a wide range of functional activities. What if the progress towards self-regulation and other developmental milestones started with considering how co-regulation occurs in co-occupations?

Food for thought – I’m keen to hear what you think!

Your friend in neurodivergence, development and training

Kristy

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References:

***For APA references of the above in-text citations, please e-mail me at Kristy.Stewart@hctacs.com.au!