Occupational Therapy Helps Children Cope With Holiday Stress


The holiday season is supposed to be one of joy, yet the holidays also produce tremendous stress and anxiety in many adults. In children, that stress is heightened because of their particular sensibilities – and it can be an even more difficult time for children with autism or sensory processing disorders.

Parents often don’t realize what is actually happening with their children during the holidays when the children resort to negative behaviors. They might try to avoid social situations, appear irritable, withdraw, and even have meltdowns and tantrums.

The holidays are just a difficult time for these children. But there are some tools, techniques and resources that can help your child cope and respond more positively to the fun and joy of the season.

A stress rating scale, developed by Paul Foxman, Ph.D., and published in his book, “The Worried Child: Recognizing Anxiety in Children and Helping Them Heal,” can be a useful tool in providing a measure of what children are experiencing.  In it, Dr. Foxman rates 50 common causes of stress in children, with a numerical value for each. Values range from 100 for the death of a parent, 73 for parents divorcing and 65 for separating, to 25 for losing a pet or getting a new pet, 17 for attending summer camp, and 12 for a birthday party.

Alongside the numerical values in the rating scale are blank spaces where you can assign a value to the level of your child’s stress resulting from changes that have occurred over the past year. Then total the score. A score below 150 represents an average stress level. A score between 150 and 300 indicates an above-average stress level. A score above 300 indicates that you should seek treatment, as research shows that with scores above that level, adults will see behavioral and health impacts of stress and anxiety in their children.

Note that some of these life events are positive things – getting a new pet, receiving a present, going to a party – but all are sources of stress in children, including Christmas and Santa. The holidays really become a stressful time for kids.

Canceling Christmas is hardly a practical option, but if your child scores above 300, help is at hand: An occupational therapist can provide expert treatment for your child, as well as support and guidance for you.

The National Institute of Mental Health explains that everyone experiences anxiety from time to time, regardless of age. Sometimes it’s not a bad thing – mild anxiety can help a young person get through an exam or term paper, for example. But when anxiety becomes a constant, presenting as an irrational fear of familiar activities or situations, it is no longer a coping mechanism, but, rather, a disabling condition.

The Diagnostic and Statistical Manual of Mental Disorders identifies five types of anxiety disorders: obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social or specific phobias, panic disorder, and generalized anxiety disorder.

What does anxiety look like in your child? During the holidays, you’re apt to see your child:

  • Avoid social situations because of fear of being in an unfamiliar setting.
  • Flee when uncomfortable.
  • Appear irritable and unapproachable to other children.
  • Withdraw as a way to manage symptoms.
  • Allow discomfort to interfere with enjoyment of social activities.
  • Unable to carry out routine daily tasks (bathing, toileting, dressing, eating).
  • Find it hard to relax and enjoy themselves.
  • Suffer headaches, stomach aches or other physical symptoms for no apparent reason.

Occupational therapy practitioners address anxiety disorders in children in three key ways.

  1. Environmental supports. Occupational therapists will work with parents to modify the child’s environment, focusing on maintaining healthy eating habits, maintaining the child’s regular sleeping schedule (nap times, waking up times), and incorporating other special supports, depending on their level of anxiety. An OT might recommend a communication system, or a behavioral chart that the child uses throughout the day. The OT also will take into account special considerations for children who have a diagnosis (e.g., autism, ADHD, sensory dysfunction) – it is important to maintain whatever special treatments already exist (e.g., a sensory diet, communication strategies, behavioral chart), especially during the holidays.
  2. Sensory strategies. In my autumn blog, I discussed mindfulness and meditation as important sensory strategies children can learn to use to help calm themselves. This is an area where OTs can be most helpful, in teaching children to use yoga, meditation and other activities to reduce stress and over-stimulation. Aerobic exercise (jogging, jumping jacks) can also help – as we do exercises or gross motor activities, the body releases natural chemicals and endorphins that help calm the body, and these techniques help to keep children regulated.
  3. Thinking strategies. As I mentioned in my autumn blog on meditation, in our clinic, we use three therapeutic programs that employ thinking strategies in the form of self-calming techniques. They are The Alert Program®, described as “Self-regulation made easy”; The Brain Gym® Program, “Moving with intention for optimal living and learning”; and The Zones of Regulation®, “A framework to foster self-regulation and emotional control.” ​These popular and readily available programs make children aware of how their body is feeling, teach kids simple language to identify if their body is in a state of high anxiety, and then give them a strategy for what to do to fix it. The Zones of Regulation offers a “check-in” chart kids can use to indicate how they are feeling. [LINK TO IMAGE] We also use a “Fearometer,” another tool to measure anxiety levels on a chart with ratings from “Piece of cake” to “Ballistic!” [LINK TO Occupational-Therapy-Tools-for-Anxiety pdf]

In occupational therapy, we also make a point of working with parents. As stress soars during the holidays, obviously parents are going to need some coping strategies – as well as some parental education to help their children manage their stress and anxiety – so that the entire family can enjoy the season.

December 2019


The Worried Child: Recognizing Anxiety in Children and Helping Them Heal, Paul Foxman, Ph.D., c. 2004, Hunter House, Almeda, California

The National Institute of Mental Health (NIMH, n.d.)

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)

Zones of Regulation check-in chart, The Zones of Regulation, Kuypers Consulting, Inc., 5532 Park Ave., Minneapolis, MN 55417, info@zonesofregulation.com

Occupational Therapy Tools for Anxiety, Elizabeth Yeaman, O.T., Reg. (Ont.) and Lyndsey Stevenato, Children’s Therapy Services, June 6, 2014