The Importance of Early Intervention


00:00:01    Alyssa

You're listening to Voices of Your Village. This is episode 163. I got to hang out with Amirra Johnson. She's an occupational therapist working in early intervention. Early intervention is such a gift and we broke down why it's important, what it is, when you might want to look into it and where the gaps in the system are, ways that you might have to advocate for your child. I'm a huge proponent of supporting kids early on if we're noticing that there's anything that's getting in their way. If there are any roadblocks that are keeping them from developing. Typically we want to support them because the brain is able to change so early on, that when we can give them these tools under 3 years old. It can be such a game-changer. I've seen it in my work over and over and over again. And you know how I feel about OT's, so I'm really jazzed that I got to chat with Amirra for this episode because the OT perspective is one that I truly cherish and it's one that in early intervention hasn't had a loud enough voice I think. And we dive into what that looks like and hopefully where we're moving, to better support kids and families in early intervention. All right folks. Let's dive in.  


00:01:31    Alyssa

Welcome to Voices of Your Village, a place where parents, caregivers, teachers and experts come to support one another on this wild ride of raising tiny humans. We combined decades of experience with the latest research to create the modern parenting village. Let's dive into honest conversation about real parenting challenges, so it doesn't have to be this hard. I'm your host, Alyssa Blask Campbell. 



00:02:01    Alyssa

Hey everyone, welcome back to Voices of Your Village. Today, I get to hang out with Amirra Johnson, Amira's a pediatric OT and you guys know how much I love OTS. I feel like I could get nerdy with OT's all day long. And so we're about to do that. How are you Amira? 


00:02:18    Amirra

I'm great. How are you doing this morning? 


00:02:20    Alyssa

I'm doing pretty well. Yeah pretty well, thanks. Can you share with our village a bit about your background and kind of what brings you to this work? 


00:02:29    Amirra

Yes, so where do I start by keeping this within a few minutes. So I have always always loved working with children. I became a big sister when I was 6 years old and I just knew from that point on whenever I do, whatever path I took in life, I wanted to work with kids. And just it was just on my heart, right? So I initially started out. I thought I wanted to be a pediatrician and then I thought I wanted to be a neonatologist. So I went to like this super nerdy medical camp when I was in high school and I got to shadow around with a neonatologist. I fell in love with the NICU setting and I was like, okay, this is what I want to do. And then I took chemistry and then I thought medical school is not for me. So at the time I was nannying for a mom who was actually a hand occupational therapist. And so I was like, hey, can you just tell me like what exactly do you do? I know it's something in the medical field and I'm kind of curious so she really just opened my eyes to the world of Occupational Therapy. She told me that you could do pediatric occupational therapy. You could even do NICU therapy, and so I was like, oh this is perfect. And there's no chemistry! So that is when I decided to go into OT because I knew that I could combine my passion for working with kids, my passion for psychology, even passion for just the sciences. So it was truly the perfect profession for me. So I started out and I went to OT school in Boston and at the time I thought I wanted to do the NICU right? So I got a clinical rotation I got to spend. A lot of time in the NICU I was at Seattle Children's Hospital for my doctoral rotation and I got to shadow a ton and just learn all about what it means to be a NICU therapist and I loved it but I kept hearing about you know, when the baby's discharged, they need more services, they need therapy and they need something called early intervention and I was like, huh? This is interesting. Okay, so I decided to dig into that a little deeper and that is what really brought me to early intervention was my initial love for the NICU and I still absolutely love the NICU. I think it's a fantastic setting but I wanted to be in a setting that I could make a difference when they got out of the hospital and I could help support parents as they transition from the NICU to home. So that is how I got into early intervention. 


00:04:42    Alyssa

So incredible and you know, there are bunch of NICU families, I'm sure tuning in who are like, I feel like every human that I know who has personal experience with the NICU is so grateful for all of the folks that support you when you're in the NICU. And so cheers. Thanks for being one of those humans in this world. Yeah, such a delicate time. And in a lot of states, I don't know if this is across the board in the U.S. you might know. But if you spend a certain amount of time in the NICU, if your child spends a certain amount of time in the NICU, that they automatically qualify for early intervention. 


00:05:18    Amirra

So every state is different in how they do early intervention services, but most States for the most part if a baby has a stay in the NICU for any period of time or is born premature, or they weigh a certain birth weight then they automatically qualify for early intervention services then they're typically referred to us. 


00:05:35    Alyssa

So when folks come to early intervention, there are a few different paths to early intervention. I'd like to chat a little bit about kind of what that looks like to come in and then I want to dive deep into the importance of and the challenges around early intervention because I think it's from a brain development perspective, is incredible, makes total sense. And it's one of those systems like so many systems that we have that could really use some reform and so I want to be able to kind of trouble shoot both of those. But first let's let folks know maybe if early intervention feels new to you kind of what is early intervention? What ages qualify for early intervention? And how would you go about seeking, say you didn't come out of the NICU and you don't have that support. How do you go about kind of seeking out support services? 


00:06:25   Amirra

Yeah. So early intervention is a federally funded program in most states, again it differs depending on what state you're in, but for most states, it is a free program to parents and you actually don't even need a pediatrician referral in order to start your early intervention process. You can just reach out to your state Early Intervention Program. So it is typically birth to three but there are some states that do birth to five. So I'm in Arizona. So our Arizona Early Intervention Program is from the ages of birth to three years old. So if you are interested in early intervention services, you can talk to your pediatrician and get a referral but you can also directly self-refer. So you start this process you get in touch with a service coordinator. They go through a screening with you to find out what are your concerns? What are the challenges? And then you receive an evaluation. So the baby will be evaluated by either a physical therapist, occupational therapist, speech therapist, developmental specialist or a combination of two. So where I am we have two evaluators but in some states, they only have one evaluator depending on what the concerns are. So you go through the process and then you are able to either qualify for the program depending on a certain score. So again, depending on what state you are. They have different qualifications of how much of a delay needs to be shown in order to qualify and providers use all kinds of different assessments that essentially just look at all different areas of development. So communication concerns, fine motor concerns, gross motor concerns, cognitive concerns, social emotional concerns or concerns in just how they're able to participate in their daily routines. If you have concerns and any of those areas, you'll receive an evaluation and they just look at all of all of those different areas of development. Some kiddos do also automatically qualify without an evaluation again going back to the NICU, if you are born premature or if you had a certain birth weight or really low birth weight, certain genetic conditions. So down syndrome, cerebral palsy, epilepsy, things like that, that might also automatically qualify you and then you wouldn't have to go through the evaluation process, but essentially early intervention is just a team of providers. So again, PT, OT, speech developmental specialist, we have some hearing and vision specialist, there's social work. You just have a whole team around you that's there to support the kiddo and the family. 


00:08:46    Alyssa

Yeah, and I think for folks who are tuning in like it can feel like whoa, like, how do I know that this is something that's necessary or something to seek out and I want to just note a statistic that I think is hugely important and shows the the importance of early intervention and the value of it. A child's brain the first three years of life, we develop 80% of that brain and 90% by the time they're five and so often when we're looking at support services, we as a nation tend to fund K through 12 support services at a pretty high rate. So I have a bunch of family members who work K through 12 in Special ed or Support Services there and it's wild how much when we look at the numbers we pour into K through 12 verses birth to five when we know a child goes into kindergarten with 90% of their brain developed and again by age 3 80%. So when we can get in and what that means is that like when we can get in and work with kids at a young age, working with infants and young toddlers to be able to support them. There's a lot of neuroplasticity we can help shape how brain is going to form before it's like formed and then we're helping them with their supports and there's some neuroplasticity still exists beyond age three. It's just easier to lay a foundation than it is to go back and tweak things or change things. And so when we're looking at early intervention, we're looking at like, okay, maybe we're noticing some flags and we want to make sure that we can help this kid as they're developing rather than they developed in a in this way and now we're going to go back and try and give them. Coping strategies for it. Just to clarify for folks tuning in kind of the difference in why it's so important. I think early intervention is incredible because we have we have access then to these kiddos to support them. When I was teaching I was in kindergarten. I was like, I wish I had this kid when they were in preschool and so then I was teaching preschool and I was like God, I wish I had this kid as a toddler. I kept going younger and younger until I was in an infant room, when I was like, this is it! This is what I wanted! Right? Because then I had kiddos where I would notice delays or challenges at like four, five, six months where we could say, all right, you know like I'm not overly concerned right now, but there are things I can do to support the nervous system right now or to support this development that were noticing seems a little delayed and there are signs of delay quite early when we can catch them that we can then support kiddos and sometimes when we support them early on they're leaving early intervention not needing services, as a preschooler or a kindergartener and beyond. So it's not, I think that there can be a stigma and fear around it that like, if I get my kid services as a one year old or a two-year-old this is something they're going to need in school forever and maybe they will need support but a lot of the times I'm when we're working in early intervention. We're working to support them in a way that they might not need services then down the road. So let's get into the nitty gritty. 


00:12:01    Amirra

Let's do it. 


00:12:02    Alyssa

You mentioned and this is one of the things that drives me bonkers about early intervention. You mentioned that there has to be like a certain level of delay, right? And so for example, I chatted with a gal our team before this interview to ask if I could share this story. She has a child who has a lot of sensory sensitivities and she's done a lot of awesome work with her kiddo like, 0-1 really supporting his nervous system and helping him regulate and it's her second kid. And so she had like, first kid, very different sensory systems. And then this kiddo she was like, what is this? And so a lot of support very sensory sensitive, and then we and I kind of let her know like in that first year. A lot of times our sensory sensitive kids because their brains are working so hard to filter information. It can be hard to do things like build language because they, it's really hard for them to focus in on what you're saying and repeat back something back to you or produce language in an expressive manner. And so we started to notice that this was happening for him really between 12 and 15 months. He didn't have any words and she was like eh I'm a little nervous and I told her from my experience. It's really hard to get a kiddo qualified for language under 18 months because the bar is so low for what we want them to do. And so she waited till 18 months and that was really hard. She's like I want tools but I'll wait and so we can hopefully get him qualified. She does the eval and the clinicians say he has a delay. He's not delayed enough if you come back and do an eval at two, he will likely qualify at that point. And that to me is infuriating. 


00:13:59    Amirra

It's very very frustrating. It's very disappointing that we have these kids who are essentially just, they're just falling behind and we're not catching them because of these very strict delay markers that are in place and that the issue that I have with early intervention is how different it is across the States, you know, so where one state might be a fifty percent delay qualifies another state might have a seventy percent delay and it's like, you know, it's almost like well who is making up these rules? And so we do have kids who come through the program and that does happen, now I am thankful that we have something in place called informed clinical opinion where we can qualify kiddos based on our own clinical judgment. However, we can't use inform clinical opinion all the time and there's all of these stipulations if you do use it and so we've, I've used it maybe a handfull of times in my practice and you know, you really have to justify. Okay. This kiddo was not, there delayed but they're not delayed enough, but either way when they get older and they start school whether they're delayed or not delayed enough. It's still a delay and it's still going to have some kind of effect, you know on their development or their school success. So I really find it so interesting that you know parents are being told. Okay, we'll just wait because I really don't like the wait-and-see approach, you know, I hear a lot of times parents who come into the program and they're like 2.4 and our program ends at 3 and it's like well we only have a couple of months to work with you guys. You know, why did it take you so long to get enrolled? And they'll say, oh the pediatrician told us to wait and see, we started having these concerns around 18-20 months, but they said to wait until they were two years old. And so now you have a very short amount of time and there's so much that we could have done between the months of 18 and 36 when they're going to eat out of the program. So it's really really difficult, you know, and it's like like I said, it varies so much that if you practice in one state and okay, you're like used to seeing this and you move to another state it might be totally different and it's very frustrating and I think the part that I also struggle with is sensory processing. So sensory processing is like really not evaluated. It's not, it doesn't qualify a kiddo if they have sensory processing concerns, now typically if they have sensory processing concerns, that will manifest itself in another area of development. So like communication they might have a communication delay, but like you were saying it might be because they have sensory processing concerns, or maybe they struggle with their body awareness. And so that's affecting their gross motor development or something like that or they have tactile sensitivity. So they're really picky eaters. So a lot of times I do see them coincide thankfully but there are some times when the kiddo is scoring great and those developmental areas, but I recognized the sensory processing concerns and there's no way to capture that on my evaluation because we're just looking at those domains of development that I mentioned earlier that don't capture sensory processing. So it's a combination of that wait and see approach of varying between the states of sensory processing really not being a strong focus when we know that that's such an important area that can impact all of those different developmental areas. So I feel like we could just talk about this like all day but I think that there is so much work that needs to go in to just awareness about what early intervention is, why it's so important and how there's so many different factors that we really have to take into consideration when we're qualifying kiddos for the program. 


00:17:42    Alyssa

We heard you loud and clear and are excited to announce a payment plan for Mama's Getaway this year. A bunch of you reached out and said you really want to be able to come and we're wondering if we could break up the payments into a few months. So we are offering a payment plan where you can do four installments of $159 a month. We want you to be able to join us in Watertown, New York, September 25th and 26th this year to dive deep into this work. Mama's Getaway is unlike any other thing that we do, it's our only in-person event. And in person is just so different than any other space. When we are in person we can dive into this work in a deeper way. We have guests that come and present. It's like a workshop for parenting we get to go into your patterns and habits from childhood and how they're informing how you're showing up today. We get to help you build some tools for yourself for your partnership for navigating boundaries with in-laws and parents and other folks in your village. We also go deep into what this work looks like with the tiny humans and how to support your unique child. It's a series of workshops on Saturday and on Sunday, breakfast and lunch are included and then we have a mama's mingle on Saturday night. It's totally optional, if you want to take off your workshop hat and come out and hang out and connect with other moms who are doing this work. Our villages have been in isolation for so long at this point and we are looking forward to connecting in person. I will be there with my little babe as well. It'll be the only in-person event that I am doing in 2021. So come join us, head over to and sign up today for $159. You are worth taking care of. 


00:19:53    Alyssa

Yeah, and it's interesting because the wait-and-see approach, I'm like that's the opposite of early intervention right? Early intervention is saying we're not going to wait and see we're going to get in while a kiddo is young and we can support this brain development and neural development. So it just like for me feels like they're contradictory for each other. You know, I taught infant-toddler for a while and I'm a huge proponent for early intervention and there wasn't a classroom that I had ever where I didn't support families in doing an evaluation. One thing that you brought up that I want to touch on here, a friend of mine is a pediatrician and she said to me she was like hey, will you early childhood folks stop putting things on our plate that we're not trained to do. She's like, I'm not trained in child development, I took one child development class, you know, like I'm not trained in sleep. I'm not trained in lactation or nutrition. I'm not a developmental specialist, I'm not an OT or an SLP, but that's the place, a pediatric office is the place where we often are screening kids. Where parents are trusting their pediatrician with their child's development because it's often the place they have to turn and I think it's really important to note it as you just said like the pediatrician with the wait-and-see approach. Of course this is not all pediatricians across the board. I have seen it so much in my work and as a teacher, where pediatricians would say, oh, I'm not concerned about that, let's wait and see, because they're not trained in sensory processing they're not trained in language development, they're not trained in child development to know like okay, yeah, this might change on its own but also if there's something that's causing this delay for me, the point for me isn't that like I want your kid to walk at a certain age, I want them to crawl at a certain age, I want them to have a certain number of words at a certain age. For me, it's if there's something that's coming in the way of that for your kid, I want to support figuring out what is that blockage? What's that challenge for them? So it doesn't come in the way in other ways down the road, right? That like I don't give a flying care how old your kid is when they walk. Like that, I've no skin in that game. What I do want to know is if your kid is 15 to 18 months and they're not walking yet, what's getting in the way for them? Because from a developmental perspective their body is naturally designed to be walking during that time. So if it's not happening, how can we support them on another level. 


00:22:29    Amirra

Right, and I think too something that we talk about in our little pediatric OT Community is pediatricians often look at, well can they do it? But they don't look at the quality of the movement or they don't look at the frequency of the movement. So the perfect example is like rolling. So kiddos who you know, can they roll? Yes, but they're only rolling to the right side, only rolling it to one side. So it's like okay. Well, why are they not rolling to the left side and then we find out, well like it's a strength thing or they have tightness in their hips or something. So it's like a lot of times too we get these kiddos who, oh well our pediatrician referred us, but I think everything's fine. And then we realized well, it's like, you know left or right sided issue or just the quality of the movement is decreased. Yes they're walking but their gait is a little off and you know the PT will pick up on that. So I think you're exactly right and I think that those milestone charts too in the pediatricians office are just not the best indicators of how a child is really and truly developing and you just need someone who has that lense to really look beyond, okay, they're rolling by this or they're walking by this but we need to look a little beyond that. You know what I mean and seeing like can they do X Y and Z before they get to this point. So I think that we just have that stronger lens to look at that area of development in a much deeper way that a pediatrician doesn't have. And that's okay, you know, they have strengths that we don't have it. So it's okay, but I totally agree with what you were saying about how a pediatrician is not always trained and so they might say wait and see and that's because they're just not trained to the level that a therapist is. 


00:24:05    Alyssa

Yeah and a pediatrician might see your kid for five, ten, fifteen minutes, you know, whereas in an evaluation, we're going to see your kid move in a different way and when you have both the Child Development training or whether it's OT, PT, SLP that specific training and then you've seen so many kids. You can see it really quickly right? Like you can evaluate like at this point I can hang out with a kid birth to three and be like at this age or stage like no, I'm not super concerned about this or yeah, just keep an eye on this. If this doesn't develop in the next couple of months might be worth checking in with early intervention you get a feel for that because you see so many kids and you're trained in it. And so when we're looking at pediatricians, I just want to note that like they're awesome and great to turn to for medical advice and they are often the place that our kids are getting screened. But if you're finding that your kid isn't hitting these developmental markers and you're having any concern or if it's affecting their ability to show up in the world. I had a kid who came into my classroom at 10 months and couldn't sit up and we were like, okay and if for at home, they're like, he's the jealous kid in the world. We're like, yeah, he was super chill and Oh my gosh, this smile on this kit like could just like capture your heart in four seconds. And then we ended up like exploring. I wonder why he's not able to sit up? And then we started to see and so if I want this kid to walk between 12 and 15 months, but he's not sitting up at 10 months. We got a lot of work to do to figure out what's going on here, right and and how might this affect him in other ways going down the road. And so we did we went through early intervention and qualified and all that jazz, but I think being able to say, this kid had gone to pediatric visits the entire time and that wasn't flagged right? Whereas day one in our class, we were like, huh what's going on here? Like want to dive deeper? And so part of it is being able to access support services and I think it's so rad that you brought up, you don't need a pediatric referral. You don't need a referral from anybody to access your state's early intervention. You could literally Google like "Arizona Early Intervention" and it's going to pull up for you. Whatever state you're in to figure out. All right, where do I go next? Who do I contact next? And maybe your kid doesn't qualify. Awesome. There's no like, it doesn't cost anything to apply, there's like no harm in applying and going through it and at the end of the day if they do qualify you get, in most states, free support services for your child early on.


00:26:48    Amirra

Exactly and even if they don't qualify a lot of providers are still amazing at giving you recommendations or following up in an email so I know if I have a kiddo and let's say I did see some sensory processing things going on, but they didn't qualify in any of those areas, I'll follow-up to that with some you know blogs or resources that I can find some infographics about what is sensory processing. So we still do give you some of those resources and yes, you could Google it, but it's nice to just have it come from someone who, that is our expertise is to provide you with that information. So worst case scenario, you do the evaluation the kiddo doesn't qualify, but then you're still able to at least talk to a therapist about what your concerns are and just get a couple of strategies, you know at the end of that evaluation or recommendations and then you know, of course you can always re-refer for an evaluation in a couple of months depending on how old the kiddo is but there's no harm in doing that evaluation, you know, it's not going to go on some permanent record that you have this evaluation. And I know you talk to you about the stigma that's attached to seeking out help and I think that's so important to touch on because there is this stigma to having to get your child help, you know for some people and there shouldn't be. Because we're just doing this to help the child grow and develop and be able to participate in their daily routines and there's nothing wrong with that and like you said, even if they need support from birth to three that doesn't mean they have to have support when they start, you know, preschool or school. Another thing about the early intervention process that I love is that we help you if you do want to start a preschool, like a special needs kind of preschool, you know, if your kiddo does have a lot going on maybe really medically involved, were there with you from that, you know point that you enter the program to the point that you age out and we help you with that transition so that you can start at a developmental preschool, that was the word I was looking for, a developmental preschool, who will have therapists there who are there to also support that child's development. So it's really nice that you just have this continuum of people who are there to support you and these first few years that are so crucial. 


00:28:47    Alyssa

Yeah. I love that, that like transition and support and you know what like the reality is that it takes a village to raise these tiny humans, you know in the same way that we turn to pediatricians, or we might turn to teachers, or we turn to other people outside of ourselves for support or help because we know hey, I wasn't trained in this and that's okay. It's the same here when we're looking at development for kiddos most parents weren't trained as developmental specialists, speech language pathologist, pediatric OTS, pts, Etc. And so it's, the expectation is not that you have all the answers the expectation is that that we can build you a village where you can turn to for support and to get help and answers. And just to be able to even say like man, we had somebody DM me the other day that was like, I don't know if something's wrong. But I feel like my baby just cries way more than most babies. And I was like, first of all that's exhausting and you know, when we're looking at something like colic which is again, like a pediatrician not knowing what's at the root of this and so we give a label like colic so that we can make a parent feel like okay, they have a diagnosis so there's some sort of label on this but it doesn't make it easier for you as a parent because then we're just saying, "Oh, just wait until they get old enough to stop scream crying at you all day." And that's exhausting. Versus, "Hey my baby's crying a lot and I can't figure out how to help them feel calm or how to help them regulate then we can turn to support, we can say like, ooh I'd love it, and what I suggested to her. I was like, I wonder if there is a pediatric OT or integrative OT that you could connect with in your area that could help dive into this kiddo sensory systems and kind of learn what might be going on for them from a neuroscience perspective that's making it hard for them to regulate and when we can build those tools in it can be a game changer for how not just for the kiddo. But for how we 


00:30:54    Alyssa

get to show up then in parenthood and as teachers and caregivers supporting these kiddos because it is exhausting. If you have a kiddo who is having a hard time with any area of development where there's a challenge, it can be exhausting for us as the parents and caregivers and teachers too. 


00:31:13    Amirra

Yeah, exactly and it's so interesting. I actually have a new kiddo now and this was the exact case is he cries, he just screams all the time and he's only you know, he's a little less than a year old. And you know, Mom said I just feel like I'm trapped in the house. I can't go anywhere, you know as I started, with Covid they're not really going anywhere anyways, but she just felt like, you know, we can't do anything because he cries and he screams and it was a case where his nervous system is literally having trouble processing all of that input. And so I was so happy that they got that referral to come to early intervention because this was impacting a couple of those domains because you know, he didn't want to play he didn't want to explore, he was a little bit behind in his gross motor development and I did the evaluation. I was like, oh, well, this is why you know, he's having trouble processing this input. So what can we do? So it's so important because like I said the sensory processing challenges, we're starting to recognize that so much earlier, especially in babies who come out of the NICU that is a whole different topic, but just a little something is that when babies have a stay in the NICU it's linked to, they're just at a much greater risk of developing sensory processing challenges because of that environment is so all or nothing. So I see a lot of babes who come in who have had that NICU stay and now we're seeing sensory processing challenges that are, that are directly affecting their development. So even if you think oh they're just crying it's just colic it could be so much more that a therapist will be able to guide you through that and I like that you said it takes a village because I always make it a point to say that early intervention is, you know, we're a team like the family, the therapist, the kiddo. We're all a team, we are there to work together. We're never going to come in and say you need to do that. You need to fix that. You need to change this. You know, I always I start with how can I help? What is the most difficult part of the day for you? Let's go from there. Let's strategize together. It's a very collaborative and supportive process. So I don't want parents to feel like it's just someone who's just going to come in and tell me how to be a parent because that's not what it is at all its us using our background and our knowledge and expertise to help you help your baby when we're not there because there's only but so much we can do one hour a week anyways, so it's really giving you the tools and giving you the confidence as a parent to be able to address those challenges in those difficulties when we're not there. 


00:33:40    Alyssa

Oh, I love that so much. It's you know, that whole concept of we are the expert in this area of development (OT, PT, SLP, Child Development) and you are the expert on your child. Right? Like we can come in and share things about their development. And we can only go so far if we're not on the same team as you if you aren't sharing like yeah, what are you seeing what's coming up for you? And I love that you said there's only so much we can do with an hour a week. The goal of early intervention isn't that somebody just comes in and works with your kid. It's really that we're working together as a team so that we can say alright. Yeah, these are some of the things that I'm noticing here are ways that we can support them for the other hours of the week that I'm not there as the clinician to support you, here are tools that you can have and I think it's so empowering as a parent too and I found that as a teacher as well. Where like, I would say all right. Hey, I especially in the classroom where there's like a million kids and you can't sit there with the therapist or be present with the therapist and the kid the entire time. I would check in every single time and say hey, what are you noticing like what are things we can do to better support this child in the classroom again all being on the same team here. 


00:34:57    Amirra

Exactly. Yeah, and the nice thing too about early intervention is we come to the home. Now pre-covid we also could go into like a daycare or preschool if your kiddo was there and work with them, but we come into the home. So what that means is we're showing you how to use what you already have. So it's very different from a clinic setting where you know, they might have fancy toys and really cool equipment. We don't have that. We just have ourselves and but we come in and we show you how can you use what you already have at home the tools that you already have and that just helps so much with carryover because then parents are like, okay, I can do this. I saw them pull the couch cushion off and show me how to promote, you know them crawling over it or something. And so it's so nice that we come in and we just work with what you have we work with the items that you have at home. And that is I think so empowering for parents because it's like I don't have to have all of the fancy equipment that I might see on Instagram or Pinterest like we can do this with a tupperware container and a couch cushion and we're still going to get that goal met. So I love that part of early intervention to that we're coming into the homes and showing you how to work with what you already have to meet those developmental milestones or those goals that you have for your child. 


00:36:04    Alyssa

I love it so much, if folks are like they're turning in and like I'm just not sure like at which point I should like are there certain mile markers or flags that you're looking for in that birth to three realm where you're like, yeah. If at this point this isn't happening, it's something I would seek out support for? Or is it instead like this is just like not working for us as a family right like the kid who scream crying. You're like, I don't know if it's affecting development, but I know it's not working for us, you know, like it what at which point should people be reaching out for support. 


00:36:46    Amirra

Well, I think you're exactly right if you feel like you know, let's say you are looking at that milestone chart and they haven't hit that milestone. I'm very careful to give out an exact milestone month because I don't want parents to you know, get anxious about it, so myself and also our physical therapist that I talk to you also says that she said, you know, give it a couple months on either side give it two months on either side, you know, I mean, so if they're not walking at 12 months, maybe they're going to walk at 10 months. Maybe they're gonna walk it 14 months, you know, I mean, but give them some wiggle room on either side to see that development now if they're like way outside, you know, there 16-17 months old and they're still not walking. So they're really far from that point of when we do want to see them taking their first steps. Then go ahead and reach out. But like you said if there's something that's just not working for your family. Like if you're not able to do bath time without them screaming or you're not able to get them to eat because they gag at the sight of food, which I just had a kiddo that we’re working through right now with that. So I would say especially think about your daily routines and your daily activities. How is your child participating in those, could it be better? Is that something that you want to work on in that area? Because if they're not participating it could all go back to an issue or a challenge with development. So at dinner time, how is that going? How is bath time going? How is play time going and so some of those are the things that we're going to talk to you about through the evaluation. You know, we're going to go through your day. We're going to talk about these big points of the day. How is sleeping going how is eating and feeding and dressing and if you're having difficulty in those areas, it could go back to how they're developing and that will be something that we pick up on so for a lot of parents they may not know that there's a challenge with development. But they know that mealtime is hard or they know that bath time is hard or they know that brushing their teeth is really hard and they're not sure why so I would encourage you to look through your day from start to finish. What is going. Well, what is really difficult? What is challenging and then let us help you figure out why and give you the tools and strategies to make that part of your day easier. It's all about function. It's all about participation. That's what OT and therapy in general is about we want our kiddos able to participate with their family or in these daily routines and activities and so we're going to help them on the back end kind of do what they need to do development wise in order to be functional and be able to participate in their daily routines. 


00:39:08    Alyssa

I love it, I love it so much and I like that you noted that there's a spectrum within what's developmentally appropriate that just as I was saying, I want a kid like walking between 12 and 15 months that if we get to 15 months and I'm seeing like we're still not walking and then I'm curious right but If you come to me with a 13 month old and you're like they haven't taken their first steps. We're going to wait and see for a minute, you know, and unless you're like, you know what they haven't taken their first steps and they can't sit up and like if there's other flags that I'm going to say. Yeah, okay, we should be crawling and pulling to stand at this point, right? So those sorts of markers but that it isn't like at this age your kid does this thing? It would be so lovely. I have, there are like apps and books that are like this week they're doing this developmental thing and people will reach out and be like, how do you feel about like this book? That's and I'm like, oh that's not how development works. It's not like at this week this thing starts happening or at this month this thing starts happening. That it is always a spectrum or a range within that and so somebody just reached out about she was like, well, I think that this is going on with object permanence, but they're only 8 months and the things that it won't happen till 9 months like yeah, it's not like on their nine month birthday, they're like great, I have object permanence now! 


00:40:32    Amirra

Yeah. I wish I wish it was that predictable. 


00:40:35    Alyssa

Oh my gosh it would be so nice right? Convenient, but that's not how it works. And so we do I'm glad that you noted that spectrum of between this range in this range. And that's where I was saying earlier when I see a kiddo and people come to us can say like Hmm Yeah by like eight months definitely want them sitting and so if they're not sitting yet, I want to see but if you come to me at five months and your like they're not sitting yet. We're going to wait and see right. So like figuring out those sorts of things and that's where those developmental checklists can be helpful. As long as you are giving that buffer on either side. And if you're looking at a developmental checklist that has hard markers of like walking by 12 months throw that checklist out the window and come ask us for another one, we'll help you find one. 


00:41:19    Amirra



00:41:20    Alyssa

Because it's not how it works, rad. One thing I've, because you're an OT specifically, one thing I'm just curious about is I've noticed in working especially in like preschool and then kindergarten and now with Seed we have folks who have kiddos who are K through 12 when, there's a definitely a spectrum and a huge range within occupational therapy and when we're looking at like OTS that are in elementary school. I see a huge difference in what they're focused on generally. I have found a huge focus on like fine motor skills, specifically. Versus OTS, I've had the privilege of working with in birth to three where it seems to be more focused on the sensory systems as a whole and sensory integration and sensory processing and I guess I'm wondering why why do we why do we move away from that? But I think of OT and like the magic of OTS is understanding the nervous system as a whole and if we're only siloing out like gross motor/fine motor, then I think we're losing a lot within the OT world's. What does that shift for you and your experience as an OT between early intervention versus as kids get older. Why do we move away from that? 


00:42:39    Amirra

That is an interesting point. So you're right OT we do a lot. We wear many hats. So in early intervention your OT might be focused on fine motor and they also might be focused on gross motor, they could work on feeding, they could work on sensory processing. I will say about About 75% of what I do is sensory processing strictly and the other 25% is going to be a mixture of fine and gross motor development. Just kind of typical, rolling, crawling, playing with containers in and out things like that. And I think that our roots with understanding the sensory system is so important because we truly understand how that impacts or how that can impact a kiddos function and their daily routines and activities, right? So think about communication or even fine motor skills if their bodies are not feeling grounded if they're not feeling regulated if they're over stimulated. It's going to be so much harder to work on anything whether it's communication or fine motor skills. So we truly have that understanding but I think that when you move into like the school-age setting it's like, okay. Well, we just have to work on handwriting right now or we just have to work on just paying attention in class. So it's I think that when we're in this birth to 3 we have a little bit more freedom and flexibility to really hone in on sensory processing versus when they move into the school age. So it looks very different when we are at home versus when they move into the school age or the school setting because our goals are a little bit different and they're not as flexible I think as when they're in the birth to 3, but I also think that OTS are doing some behind-the-scenes sensory work. So like and I'm not a school-based OT, but I have learned a lot from school based OTs that I know or on Instagram, so they'll do things like putting like a little wiggle seat in the chair to help with attention or any regulation or they might tie a rubber band around the leg so that they can push into it to get some of that input. So I think that they tried to incorporate it but like it's going to be very different than being able to do that sensory integration where we're going to do like a lot of high energy activity or going to be swinging jumping, you know, crashing in the crash pad because they can't do that in the school setting so I think that once they get into that age is just a little bit harder and the goals are a little bit different than they are when they're in the birth to three when we have more of that freedom and flexibility. 


00:45:05    Alyssa

I think that's a bummer, I think that sensory is, sensory regulation is at the core of our ability to function and across the board it to my work in emotional development cannot happen if your nervous system is dysregulated, right? Like if you can't access your whole brain to work on emotion processing, we are focused on nervous system regulation, you know, and we have what we call the triangle of growth that's sensory regulation, emotional regulation, at the very top language development that I can't have a kid either trying to retain language or produce language if they're emotionally dysregulated or their nervous systems dysregulated and so in that doesn't you don't age out of that right? Like it's the same for last night. I was really tired and I was trying to have a conversation that like I just didn't have the patience for because I was really tired because my nervous system was dysregulated. Right? Like what I needed was sleep in order to be able to do higher level thinking and so when we're, like you don't age out of it. It's not like well, once you're 3 you don't need nervous system regulation anymore. Like this is something that we're always going to be working on. So I think is a bummer for schools and for kiddos qualifying for OT in schools that OTS don't have the maybe the freedom or flexibility to say. Yeah, we I recognize that handwriting is the goal or them paying attention in class is the ultimate goal here, for us we're going to look at why that's not happening and maybe be able to focus on building awareness with kiddos. Right? Like I just had the opportunity to work with a family that has a third grader and they've been having these like behavioral challenges over and over and over in school and he was working with school psychologist and school OT and at the end of the day like everything was based on like getting them to be, to pay attention in class and really what we ended up pulling back and doing was teaching this kid what it felt like to not feel in control of his body and what are little things that he could do throughout the day that could help his body feel more regulated and in control so that those moments that would come up or he had to sit in class then that band that's at the desk that he can push on is great input. But in my experience with kiddos like the band's the tip of the iceberg, you know, and so I'm like man, I just I and I'm sure OT's feel this too in their work if they aren't given that freedom and flexibility to do more of this like broader work and I also wish frankly that every teacher had access to this training too because it's not just the kid who is like a behavior challenge in class? It's also the kid who's shutting down. It's all of us, it's me when I'm tired, right? Like it's all of us all the time and just how beautiful would be if there was more. Information and support for teachers caregivers and parents around sensory regulation in general and a bummer that for early intervention sensory processing still isn't a qualifier. You know what I mean? Like man, it's at the root of all these things. 


00:48:28    Amirra

Yeah, I agree. Yeah, I don't know, I mean you can do like a sensory profile but in this is again just for Arizona because I don't know how it works in every state but for us even if I do that sensory processing or sensory profile at that evaluation and they score, you know out of the typical range. I still can't use that to qualify them. I can use it to maybe justify inform clinical opinion along with you know, another delay in one of those categories but strictly on its own. I can't use that to justify but like I was saying it typically works out that because they have sensory processing challenges. It is going to affect one of those other areas of development but not always that's not always the case. Yeah, but just kind of going back to what you're saying about school-based. I think that there's a lot more awareness. There's a lot more research that's now starting to come out that is talking about it's not just behavioral. You know, there's this huge thing of is it sensory or is it behavior and it's like sensory is behavior. Exactly yeah. So but I mean, I used to hear that a lot, you know different places. Well, it's just behavioral or well, it's just sensory and it's like, well no it you know, it's a mixture of both. And so I think that because we're starting to shift our mindset to really understanding how our sensory systems can impact and behavior and how that can manifest itself in different ways in the classroom. I think that teachers and parents and caregivers and therapist. I think there is starting to be a lot more collaboration and that really makes me really happy even though I'm not in the school setting it something that I do just, you know, see floating out there of classrooms trying to be more just trying to be more mindful of sensory processing and how we all have our own unique needs. And yes, maybe the student might need a little bit more of it. But the whole class can benefit, you know, the whole class can benefit from a sensory break or not having fluorescent lighting. I mean, I'm sitting here with my little dim lamp on because I don't like fluorescent lighting. So I think that we're starting to just be more aware of sensory processing in general and how it isn't a bad thing, you know, we all process stimuli in our own different ways, but that a whole class can really benefit from making some adjustments and I think that is where OT comes in a lot of the times is talking to the teacher about you know, yes, maybe we're just going to work on handwriting with this kiddo. But this kiddo would also benefit from this and it might be something that the whole class would also benefit from too so I love that collaboration is starting to be a little bit more prevalent in schools. And I think that's just going to impact everyone really for the greater. 


00:50:59    Amirra

Yeah, that it's so huge and I agree. It is like more on the forefront. I just want it to speed up right with all programs. But everything with progression I'm like, let's just get there, right? Can we just pay women the same amount as men, can we just get there? Yeah, for sure. We created a SEED Certification program for early childhood and for child care centers and Home Care programs birth to five and when we were putting it together, we were putting together brought other experts in the field of early Ed in to do workshops. And the very first person that I brought in was an OT because I truly believe that at the core of this work is our nervous system and the ability to understand it and I had the privilege of working at a school where we had an OT that was contracted and she wasn't working with the kids. She was working with us. So she would come in and observe and we could say like I'm having a challenge with this kid. Could you just take a look and see like, is there anything I could be doing to better support them et cetera? But also she would just come in and observe and say hey, it seems like this part of the day is a little wild or this transition is really hard, what might it look like if we built in this activity before that transition started or things like that that just totally transformed my classroom and how I got to go through the day by building in sensory reg consistently throughout the day and so after my experience with that, I'm like everybody should have this. I want this for everybody, for parents, I want this for teachers everybody and I can't scream enough from the rooftops how important your work is. And just like vital for I think us progressing and both in schools. But also it we have more stimuli today than kids have ever had and I don't think we take that into account enough that when we're seeing these like huge emotions in meltdowns ETC that it's not coming from nowhere and we can work together to figure out what's at the root but that we have to account for the added stimuli. Whether it's, I mean even going from like a chalkboard to now a screen board or like it's a whiteboard I'm writing on that's a screen and we're bringing in different things like just the transition of that for your brain and the added processing that were adding into classrooms into everyday life consistently that I think we just have to I'm not saying we get rid of it, but we have to account for it. 


00:53:33    Amirra

Exactly. Yeah, and I think it's important to you that you know sensory processing is not a bad thing. We all we all have sensory systems, you know, we do yoga or Pilates or we drink coffee. We take hot showers all of those things are feeding your sensory system. Our kiddos just need assistance even a little bit more help. 


00:53:53    Alyssa

Totally or just some you know like that. We also see the day I was feeling frustrated and I like slammed my thing down that I was working and I was like and I was like, ooh Alyssa, like pop outside and I just like stood outside I didn't even walk, I didn't do anything, I just stood with no screen. No things and just breathed for less than three minutes. It was cold. I didn't last very long and it was I like came back in a more regulated state and being able to see this not just in kids but in ourselves and how it can fuel. So anyway, I hope that for early intervention. We are moving in a direction where sensory processing plays a greater role because I think it plays a giant roll in development and that we cannot do this work without it. 


00:54:45    Amirra

Absolutely. I agree and I think we are moving in that direction. 


00:54:49    Alyssa

I want it to go faster. 


00:54:53    Amirra

I know, research! We need more research. That's what it is. 


00:54:58    Alyssa

Okay, rad, you I feel like I could just do this with you all day. 


00:55:02    Amirra

I know! 


00:55:03    Alyssa

This is fun for me. I hope for folks that they were able to pull A. that it's a thousand percent normal and typical and to be expected that you don't have all of the answers by yourself that nobody does. I have a master's in early childhood and I reach out to OTs and SLPs and pediatricians and all these other support services to help me in this journey because I don't have all the answers and we're brought you on to have this discussion because this is your area of expertise and I think it's ludicrous to expect a parent to have all the answers and so give yourself grace and know that it's not your job to have all the answers. It's your job to seek out support and services and I hope that they were also able to glean like the importance of early intervention and why the wait-and-see model is something we discourage. Where can folks follow along with you, learn more about you, etcetera. 


00:56:05    Amirra

Yeah, so I'm on Instagram at marvelousmiracles.ot and that's kind of where I talk about what it's like to be a fairly new graduate and early intervention, different therapy tips and tricks, just really sharing my love for Pediatric OT and then I also have a website I have a couple of services on there for parents and for other therapists and just like a blog and then really exciting is I actually just went into a partnership with two phenomenal early intervention therapist, Sarah Putt and Danielle Delorenzo and we have formed the real OTs of early intervention. So we're on Instagram at The Real OT's of Early Intervention. And our website is And yesterday we launched our podcast. So we will be talking all things Early Intervention, really short clips. It's going to be for therapists, for students interested in early intervention and also for parents so really excited to just really build a community and a network of people who are interested or going through the early intervention process will be there to support you along the way. 


00:57:12    Alyssa

Oh my gosh. I love that. That's incredible. What a fantastic resource for folks. 


00:57:16    Alyssa

Thank you. 


00:57:17    Alyssa

Yeah rad. Well, I will have to go follow and tune in, I didn't know about The Real OT's and now I'm stoked, awesome. We will link to all of that in the transcript for folks if you are on the go right now or you're not able to jot all those things down. If you head to, you can access both the podcast episode but also the transcript for each episode that has links with in it. Thank you so much for hanging out with me and for the incredible work that you do. I mean it. I think it's at the core of us being able to function as humans. So, thank you. 


00:57:53    Amirra

Thank you for the work that you do. I absolutely love being a part of the Seed and Sew and listening to the podcast and it's awesome. I love that just Early Childhood. We just have our own little community now, and it's awesome. So, thank you and thank you so much for having me today. 


00:58:07    Alyssa

You bet. Thank you. 


00:58:11    Alyssa

Thanks for tuning in to Voices of Your Village. Check out the transcript at Did you know that we have a special community over on Instagram hanging out every day with more free content? Come join us at take a screenshot of you tuning in, share it on the gram and tag to let me know your key takeaway. If you're digging this podcast, make sure to subscribe so you don't miss an episode. We love collaborating with you to raise emotionally intelligent humans. 


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