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Helping Children’s Emotions & Behavior With OT Miriam Manela

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Pediatric occupational therapist Miriam Manela specializes in helping children and their families with behavioral issues. Occupational therapy may be utilized as part of a multi-disciplinary treatment plan or on its own to help with a broad spectrum of behavioral, emotional, and mental health-related issues.

Welcome, Miriam.

You work with many children with emotional and behavioral issues. The issue we’d like to start with, one that seems to be on the rise in children, is anxiety.

From the perspective of occupational therapy, is there a difference between anxiety in adults and children?

Yes, in adults you feel that anxious energy and you know that it’s not what adults should feel like. In children, you feel that anxious energy, and you may think, “Oh, this is just “kid” energy—they’re just being kids.”

So, it’s not always so easy to diagnose anxiety. Obviously a mental health professional will use specific diagnositic criteria.

From my perspective as an OT, behaviors are a manifestation of whatever is going on in the child’s whole system, not just his mind or emotions. If a child is biting an object or his nails, a psychotherapist might see this as a symptom of anxiety. I would evaluate the child differently than a psychologist would.

Sure, biting nails or a pencil might be caused by anxiety. But an occupational therapist will look to see if the child is using the biting to help keep his eyes focused forward so he can read during the school day, since mouth movements or gritting of the teeth can help us fixate our eye muscles so that we can use both our eyes together in a coordinated way.  Or, perhaps the biting is stemming from a breathing pattern that isn’t balanced—there might be decreased inner core strength, and the child might be taking shallow or erratic breaths.

Of course, I do look for major symptoms of anxiety such as:

Dilated pupils

Pale or flushed face

Shallow rapid breathing

Frozen look or shut down, ultra-quiet

I know you work closely with psychologists, social workers, and other mental health professionals. If you had to pick one area where occupational therapy radically departs from these mental health approaches, what would it be?

One thing I find is that some mental health professionals seem to reflexively respond to symptoms (especially symptoms of anxiety), by immediately suspecting abuse or trauma, even to the point of missing some other possibilities. Yet, most children I treat have not been abused or been subjected to trauma.

Emotional symptoms, especially but not only anxiety, aren’t always, or even most of the time, caused by trauma or drama!

(Richard) I have to agree. We (mental health professionals) are trained to look for an external and painful root-cause of a client’s emotional issues, perhaps especially symptoms of anxiety.

Right. I want to emphasize that I do work very closely on cases with a variety of experts from several disciplines. In fact, I regularly work with psychologists, social workers and other counselors. But, occupational therapy is about viewing the child as a whole system. The system may have some areas of weakness, but just focusing on the emotions is often not enough to alleviate the problem.

I learned a great metaphor for how occupational therapists see the client in a DVD by Robyn Cox called Get Ready for School. She says, if you have a pail (the child’s system), and the pail has holes (weaknesses in various functions), and you put water (information/life events) into the pail, what happens to the water? It comes pouring, squirting, or dripping out of the holes.

So, occupational therapy patches the holes?

Yes! We seek developmental causes for the apparent symptoms. We look for developmental patterns and work to strengthen them—then, the holes are patched and the pail is stronger. Now the child is able to face life’s challenges and adapt to them.

Also, we have to be aware that everybody has a hole or two. Whether or not to treat these holes is another question.

When evaluating, I ask: How much is this developmental weakness getting in the way of their life? Does it warrant treatment?

A typical scenario is when a parent brings in one or two children. I see they could use treatment, and it works well for them. Then she brings in another child with minor issues that are just ordinary occurrences in the developmental process, so I’ll advise not going into treatment.

How do you decide this?

I ask: Is this issue manageable? Do you have a good relationship with your child? Are they doing okay (average is just fine!) in school? Do they have friends? Are they an average kid, with appropriate but not necessarily perfect development for their age?

More with Miriam Manela, OTR/L soon. You can visit Miriam at to learn more about how pediatric occupational therapy may help with your child’s behavioral issues.

About Miriam Manela: Miriam Manela’s occupational therapy practice, Thrive!, is housed in a unique sensory gym, ‎and offers a safe space where children have the freedom to explore and grow. She uses a creative, integrated treatment approach and loves working closely with parents to help them achieve a healthy, responsive, and mutually satisfying parent-child relationship. Miriam is known for her exciting educational workshops for parents, teachers, college students, and therapists. She’s received advanced training in Attachment Theory and Reflex Integration, Sensory Integration, Neuro-Developmental Treatment (NDT), and is also certified in Therapeutic Listening™. She is the leader of the pediatric mental health group for the New Jersey Occupational Therapy Association, as well as the New Jersey state representative for the American Occupational Therapy Association (AOTA). In 2013, she won the WCBS women’s achievement award. Miriam’s new book, The Parent-Child Dance, written with C.R. from the Therapy Soup blog, is due out this fall.

Helping Children’s Emotions & Behavior With OT Miriam Manela

Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.

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APA Reference
& C.R. Zwolinski, R. (2019). Helping Children’s Emotions & Behavior With OT Miriam Manela. Psych Central. Retrieved on September 24, 2020, from


Last updated: 30 Mar 2019
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