Alicia Harris was my son Barrett’s elementary school occupational therapist for three years. I’ll never forget the first time I met her, which happened to be in an IEP meeting – never an ideal setting, in my experienced personal opinion. She was young and full of energy and I loved how excited she was about her job. Then she told me a “Barrett story” and I wanted to crawl under the table.   She shared with us how unhappy Barrett was after she changed her shampoo (see interview below). Then she reluctantly relayed that he’d hit her after smelling her hair. Yes, you read that right – hit her. I’d never heard of him ever hitting someone before, and I was appalled. Alicia insisted it was a gentle hit, like a “love tap.” I’ll never know whether or not that was true, but Alicia’s genuine smile never faltered in the meeting (and she continued working with him for years). She actually laughed about it, assuring us that it all been worked out.   Now that, my friends, is dedication.

It’s been a few years since Alicia was Barrett’s therapist, but I reached out to her for an interview because she did work with him through some pretty rough years. I respect her ability, dedication and patience. She’s now a mom herself and I’m confident that she’s a great one. I was also eager to inform her of Barrett’s progress, so she could know how her contribution to his therapy history has helped him get to where he is today. Alicia has been very faithful to her pledge to keep in touch, and is always the first one to comment or like something I write about Barrett. I’m grateful to her on many levels.

What made you want to go into Occupational Therapy?

When I was a senior in high school my grandmother told me I’d make a great occupational therapist (OT). She was recovering from a stroke and working with an OT. I had never heard of the field previously and planned on getting a degree in early childhood education.

What kind of degree did you have to get?

I have a Bachelor of Science & a Master of Science in Occupational Therapy.

What kind of certifications do you have?

All occupational therapists have to sit for a national board exam before they can practice. If you pass, you are then considered registered with the National Board for Certification in Occupational Therapy (NBCOT). Not all states require a therapist to continue to keep their registration up to date, but I do through continuing education classes. In Georgia, to be licensed (annually), you must complete the continuing education requirements. To practice in Georgia, you must be registered and licensed.

I’m also certified in Handwriting Without Tears.

For those who are unfamiliar with OT (I’d never heard of it before I had children who needed it), can you explain what it is?

An important and complicated question. What do we do?! The quick answer is that we help people with the occupation of living.  Our clients vary in age, gender and diagnoses. Many conditions require OT – spinal cord injuries, strokes, knee replacements, dementia, brain injuries, autism, loss of a limb, premature birth, Down’s syndrome and developmental delays. What our clients have in common is that they’ve lost the ability or need help developing the skills to lead an independent life. We help with dressing, bathing, cooking, eating, shopping, driving and occupational skills. We also support safe practices and injury prevention in the work place.

Since I work in pediatrics, the word “occupational” often strikes people as odd. Childhood is the time that kids learn life skills through education and play. It’s through these mediums that I help kids learn to overcome the challenges they’re facing, so they can lead independent lives that closely resemble that of their typical peers.

How long have you been an occupational therapist?

I feel like it’s been in me since birth. I graduated in 2005 and have been practicing for approximately nine years.

What age ranges do you work with?

My degree allows me to work with all ages and diagnoses, but I’ve spent my professional career in pediatrics, from birth (including premature birth) to age 21.

Do you work in a clinical setting, or just school based setting?

For most of my career, I’ve working in both settings – splitting my time with part-time positions. Since the birth of my son in 2013, I’ve decided to keep things simple and only work in the school setting, part-time. The flexibility allows me to love “my kids” and love MY kid!

In what ways is it different to work with a child who has autism, compared to your other patients?

Children with autism are my favorite clients. Even through the diagnosis code is the same, each child is unique and their needs vary. The thing that strikes me as the most challenging, yet the most rewarding, is dealing with the behavioral issues.  These kids are smart and know how to get what they want and need – which can often be contrary to what I’m working on! I love breaking through those challenges.

Do you have any personal experiences (outside of work) with autism?

Before I became a therapist, I don’t think I had ever met or worked with anyone who had a diagnosis of autism. However, my life is now full of them! I’ve remained close to many families I’ve worked with. I love that I can keep up with so many of my former patients through Facebook. I’m grateful for all the personal relationships I have with these families, and the love and support they’ve given to me in return. I also appreciate the ongoing education I get from them.

What is the best part of your job?

The love.  Hands down, it’s the most rewarding thing in the world to have a child who struggles to express their emotions show you that they care for you – especially when they step outside of their comfort zone to be near you. It’s not always in words, and you rarely get hugs and kisses, but just having them touch your arm or face makes the day amazing.

What are the challenges?

Recognizing the limitations of myself as a person and therapist. Accepting the diagnosis and the limits to which I can and should push a child. As much as I wish I did, I don’t have magical therapy dust to fix all problems and cure all that’s wrong. It’s very difficult to accept that everyone has limits to their abilities.

Also challenging is distinguishing between what’s appropriate for school based therapy verses private therapy.  Since I’ve worn both hats (most of the time within the same work day), it can sometimes be difficult to differentiate appropriate goals for each location.

Do parents drive you crazy? Be honest!

If you’d asked me this two years ago, who knows how I would have answered. I’m now a parent and I know that the combination of responsibility and love will make ANY parent crazy – regardless of your child’s functioning level. It’s the job of a parent to advocate for their child’s best interests.

What do you wish people understood about autism?

Children with autism are smart and they want to learn like all children. They might have a difficult time demonstrating their intelligence, but they want to shine like their peers. Children with autism may have atypical behaviors, but they’re no different, theoretically, then the strategies many of us use every day to deal with stress. We get tired at work, so we move in our chair, drink coffee or fidget with a pen. With the sensory issues many children with autism have, they need MORE input to get the same affect. This may result in getting out of their chair, putting items in their mouth or bouncing toys inappropriately in their hands. Most importantly, children with autism have feelings – they just might have a difficult time expressing them.

What have your students/clients taught you?

So much that it’s hard to find the words to express it all! The therapist I am today and the knowledge I have is based on the successes (and failures) I’ve experienced working with my kids. The biggest lesson I have learned is patience – with the kids and myself.

How can parents help?

Parents are the key to a child’s success. We do the work at school (or in the clinic), but they carry the torch at home. I understand that sometimes there just aren’t enough hours in the week to do all of therapy work and the normal chores/responsibilities of life, but any time spent reinforcing therapy at home is an opportunity to help the child. I’ve always appreciate the parents who ask questions and take a deeper interest in their child’s services (especially being in the school system where therapists rarely encounter parents), so that they can be the therapist at home.

I know over the years that you’ve used all sorts of methods and tools/technology with Bear. Where did you see the most success?

One thing stands out in my mind and it’s HUGE. Anyone who knows Bear is aware that he can be echolalic (repeats what he has just heard). Sometimes he flat out screams it back at you. We had a HUGE problem with this when I first met Barrett. He would scream back what I asked him to do and sometimes he would end up throwing himself on the floor or crawl under the desk. I’d never seen anything like it and I didn’t know how to stop it.

As I got to know Barrett and learned how to handle him, I realized that I could sometimes be loud, especially when I’m excited (which is a lot when a child is learning something new!). Barrett taught me that I’m one of the biggest tools of therapy. I controlled my voice when I was with him, sometimes whispering. Allie – you taught me to write instructions down (ß value of an involved parent!).

Barrett was still echolalic, but his screaming decreased significantly. He also stopped throwing himself on the floor. I was able to see growth in a variety of areas by not overwhelming him with my voice. The last year I was working with Barrett there were a couple of times he would even start screaming back a direction, but then he’d make eye contact with me and he’d stop.

****Allie Note: Happy to report that echolalia, although still present, has decreased significantly – especially with greetings! He no longer says, “Hi Barrett!” Also, screaming is all but gone (although the siren does occasionally still go offJ), and I can’t remember the last time he threw himself on the ground! This could be because the ground is now very far from his head, since he’s so tall.

Do you know of any therapy techniques on the horizon that you’re excited about?

The thing I’m most excited about is the technology available to our kids today. It’s not only functional, but more and more affordable. Tablets are changing our world and the apps that are available to our kids are being fine-tuned. Developers are making things our kids need.

Children with autism struggle with communication and we now have very portable communication devices. There are interactive therapy apps to help teach vocabulary and concepts. We have schedulers and behavior trackers. It’s exciting to know so much good stuff is out there, but as always you have to do your research before investing.

Give me your first impression of Barrett.

Our first moments together have bled into a tapestry of events and memories.  I recall hearing him repeating movie dialogue or songs, word for word. He used a doodle board in Cindy Pruitt’s class (Barrett’s elementary school teacher) , to write credits from one of his favorite movies and he was very attentive to every detail of the font. He didn’t want to make eye contact, but he was listening to everything – as proven by his echolalia. He had a Barrett way of doing things and initially hated when I rocked the boat.  I thought he was fantastic. He was so interesting. I looked forwarded to each time we worked together. It was never boring.

You’ve a treasure trove of crazy times with Bear – feel free to share some funny ones (the shampoo incident comes to mindJ).

This is why Bear is the perfect man – if you change anything about your hair, he will notice it. When I changed shampoos it really unsettled him and he became obsessed with smelling my hair. It didn’t last long, but it was just proof as to how sensitive his nose was to changes! Barrett made us laugh all time at Big Creek, but I’m the worst person to ask for details and stories. I can recall goals and progress, how we achieved certain successes, but I generally let the details of events fade away. I do remember being in the sensory room and having to turn around so I could regain my composure, because I was laughing at his silliness (this happened more than once).

During your time with Bear, or any child with autism, what frustrates you the most (aside from the obvious communication barriers)?

As you say, communication is the most frustrating obstacle. It’s probably highest on anyone’s list, because it’s the source of the meltdowns, which leave everyone upset. But since that frustration is removed from consideration, I’d have to say unrealistic expectations are next. In my experience, adult expectations can be as varied as autism itself. Some people allow a child to skate through life without being expected to participate in their education or in their self-care. Some adults (parents, teachers, caregivers, therapists, etc.) wear the diagnosis as a scarlet letter and spend the rest of their lives looking for opportunities to excuse themselves and the child from trying and expecting more. On the other hand, some fail to see the diagnosis and possible lifelong limitations that the child could experience. They push the child past their abilities, resulting in meltdowns and tantrums. The kids are overwhelmed by the unrealistic (and unfair) expectations being presented. They’re set up for failure, which heartbreaking.

What do you think was Barrett’s most significant accomplishment during the years you worked with him?

This may be maturity as much as therapy, but his behaviors evolved drastically during our time together. When we first started working together there was a lot of “crying” and throwing himself on the floor. He didn’t like me to correct him- heck he didn’t like anyone to make him start over on anything. When he was overwhelmed or we were talking too loud, he would scream out. Walking down the hallway was sometimes overwhelming and needed one-on-one support to get back to class or to an alternative location.

In my last year with Barrett he was a model student in so many areas. He was one of our “leaders” in the sensory room who could complete multiple requests with just a verbal prompt. I don’t have any memories of him throwing himself to the floor or struggling to get down the hallway – in fact, he was a line leader! I would even bring him to therapy as a peer model for activities when I had a child who was struggling with a task. I never worried about having Barrett with another student – I always knew Barrett would follow verbal directions if the other student needed more direct support. Even when he had moments of auditory sensitivity he would be calmed by visual prompting or move himself to a quiet place. Having mastered those initial concerns, the world kind of opened up to Barrett. He was able to take on pretty much any goal I could think of and be successful because our relationship had such a strong foundation.

****Allie Note – Alicia, today Bear often takes his class’s attendance sheet down to the front office – by himself! And he gets off the bus and to his class on his own, as well.

♦

Isn’t she cool?  Just this morning I brought Barrette to visit her, so I could get some pictures of them together.  Barrett looked at her for the longest time – right in her eyes, and he wore the biggest smile!  Of course it doesn’t hurt that Alicia is gorgeous.  It was very sweet, as you can see from the pictures.

Next week, I’ll be featuring a small excerpt that was cut from the original manuscript.  Alicia is very passionate about what she does and she provided me with some great material.  Her thoughts on inclusion in the schools blew me away and I think they deserve their own blog.  She’ll also share a story about one of her kiddos, who validated her choice to be an OT – it’s good one!

Please feel free to leave comments for Alicia.  Did you know what an occupational therapist was?  Have you ever worked with one?