The main goal of an occupational therapist is to improve the performance of a child with DYS disorders (dyslexia, dyspraxia, dysorthographia, dyscalculia…) to teach them to work around and compensate for their daily difficulties. To achieve this, they may use conceptual models such as the “Bottom Up” approach and the “Top Down” approach, or even both. Here’s an overview.
The “Bottom Up” approach, focused on the deficit
Under the “Bottom Up” approach, the occupational therapist considers the child’s abilities and skills and focuses their intervention on the deficient abilities, to improve performance. This analytical approach seeks to improve performance indirectly.
Among the therapies based on this bottom-up approach are those based on sensory integration, which rests on the hypothesis that there is a correlation between sensory deficits and the child’s motor-planning difficulties. There are also sensorimotor therapies, which assume that coordinating sensory and motor information is necessary for motor execution. The Bottom Up approach is also reflected in process-oriented therapy, which aims to increase motor skills by improving kinaesthetic awareness.
The “Top Down” approach
More recent, the “Top Down” approach is more direct: it aims to improve performance directly, by focusing the occupational therapist’s intervention on the problematic occupation itself, rather than on the underlying abilities that might affect it.
Among the therapies based on this top-down approach is Neuromotor Task Training (NTT), built around demonstration, verbal instruction, and final acquisition. There is also the CO-OP approach (Cognitive Orientation to daily Occupational Performance), which is person-centred and focused on activity and participation.
Are these approaches opposed or complementary?
According to ANFE (the French National Association of Occupational Therapists), occupational therapy aims “to maintain, restore, and enable human activities in a safe, independent, and effective way. It prevents or removes situations of disability, taking into account people’s life habits and their environment.”
With this goal in mind, the professional is free to use whichever approach seems best suited to their patient: while Bottom Up and Top Down are, admittedly, opposing approaches, they can prove complementary and compatible in achieving one or several shared goals…
The choice of one approach over another essentially depends on the patient’s profile (for example, Top Down for a child with dyspraxia), their age (younger children tend to respond better to Bottom Up approaches), but also their strengths and weaknesses. Finally, the occupational therapist’s sensitivity and experience naturally guide them towards the most suitable path…
Don’t hesitate to contact a professional on the Ora-Visio platform to discover how an occupational therapist can help your child with DYS disorders!
