Out of the Box, Into the Busy Box

An OTA created this therapeutic tool full of sensory and motor activities for children.

Steve* sits on the floor and sees a magnificent castle door in front of him. There is something to be busy with on all sides of the door.

The therapist may let Steve choose a sensory-based activity, for example, pushing a button for a musical toy or ringing a bell (auditory), or squeezing an Elmo figure (tactile). Or Steve may be designated a specific activity, such as stretching and manipulating silly bands on a geoboard after sorting them by color, shape and object, or turning a key in a lock.

Afterward, Steve can enter the "inner chamber" of the castle, which is full of toys, gadgets and activities he can engage in. Steve glances around and decides to turn, pull and push the metal levers, locks, knobs and latches, or he may attempt to unscrew the caps off of the tops of plastic bottles that are mounted to the box.

Michelle*, who has been diagnosed with pervasive developmental disorder, enters the castle armed with the small colored pegs she has been given. She places the pegs into the Lite Brite toy mounted on the wall inside the castle. She can seek tactile stimulation from the toy by rubbing her hand across the top of it, as well as visual stimulation from the lights.

Mounted on the castle door are a polished doorknob, a cylinder fitted with a key like a lock, and a stars-and-stripes bicycle bell. The door was removed from a toy playhouse to make the Busy Box even more appealing to children.

Building the Busy Box
The "Busy Box" is a multi-functional unit consisting of many diverse fine- and sensory-motor toys, gadgets and objects. I originally conceived of and used the box when I worked at Francis of Paola preschool in Brooklyn, NY. The Busy Box has been a valuable tool in my work with children with a variety of diagnoses, including children on the autism spectrum, those who are medically fragile and those with developmental delays.

I have modified the Busy Box several times over the years. Initially I built the box out of Styrofoam, then created one out of cardboard. The latest one is wooden; a friend built it and I painted and decorated it. I glued heavy-duty foam on a wooden part on the castle door (cut out from a toy playhouse), then cemented the doorknob as well as a cylinder with a key. I pasted colorful pieces of blue and yellow contact paper to add color and cover up any smudges.

Kids can pull on the animal toys, attached to cords that stretch, that are mounted to the inside wall of the box.

The interior of the Busy Box contains a number of toys and gadgets designed to provide sensory stimulation and engage motor skills. Christmas-like ornaments are pasted to the back wall along with bells. The floor of the box consists of a comfortable car-type mat covered by a rubberized bath mat with brightly-colored ducks. A push light, lined with Velcro, is mounted near the ceiling. There are cut-off tops to plastic bottles for children to screw and unscrew to engage flexors and extensors in concentric and eccentric contractions and activate the MP and IP joints in the hand.

While I was working at Francis of Paola preschool, I identified a particular need to help children attend to tasks in a typical therapy-room setting that tends to be distracting and overstimulating. The walls of the box can block out visually distracting objects or people; however, I recommend building the box without a door so that the child is easily visible. Each activity or toy is covered with a piece of fabric or textured material to prevent the child from being distracted.

The box is not intended to be a permanent "home," but rather a temporary dwelling to decrease anxiety, stress or sensory overload prior to a therapy session. I have had parents comment that they wished they had a Busy Box at home.

The Busy Box can also enhance socialization skills. It works well with groups of children. I have seen two children on the autism spectrum interact with one another and engage in box activities together.

Children can manipulate the many locks, levers, bells and latches mounted on the Busy Box. Individual or groups of gadgets can be covered over with a Dycem or fabric flap to minimize distraction.

Benefits of the Busy Box include:

  • Activities/toys are placed at eye level or above, so children do not have to scramble on the ground looking for toys.
  • Engagement in activities mounted vertically on the box requires wrist extension and deviation, as well as shoulder flexion, to enhance shoulder and wrist stability.
  • The wide variety of activities in the box may enhance fine-motor skills including prehension, dexterity, grasp and release, hand and finger strength, and bimanual skills.
  • The activities use perceptual and visual-motor skills such as matching, grouping, sorting, discrimination and sequencing.
  • By reducing extraneous or distracting stimuli and involving the child in purposeful activities, the box may diminish or eliminate anxiety and/or overstimulation.
  • Box activities can incorporate socialization and interactive play skills, such as turn-taking with the Connect Four game mounted on top of the box, as well as eye contact.

A Lite Brite toy, mounted inside the Busy Box, offers both visual and tactile stimulation as well as an opportunity to use fine-motor skills.

If you're interested in trying your own version of the Busy Box, it does not have to be fabricated from wood. Cardboard is easier to work with and not as heavy. There are resources on cardboard carpentry available online. Another good resource is the Adaptive Design Association, a non-profit in New York City that builds custom adaptive equipment for children with special needs, and provides hands-on workshops. Visit their website at www.adaptivedesign.org.

Barry Katz is a COTA as well as a clown, using humor in pediatric and geriatric settings. Reach him at bkballistic@gmail.com. He would like to thank occupational therapists Raya Burstein and Orit Tanhuma-Malone, and speech therapist Susan Avelos for their encouragement and support.

*Children's names have been changed.


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