Thursday, May 27, 2010

Occupational Therapy Evaluation

We finally had a good private OT Evaluation.

This is a boring post that is really not worth reading except for those with kids with Sensory issues .

 Plus these type of posts are a good way for me to record our journey

DH and I often talk about how much Sensory Integration Disorder contributes to Autism symptoms.

He gets some OT from School but I have no idea of how useful it is

One thing I loved is that the OT evaluator wanted only the parents present at the Evaluation as "she does not want to talk about him in front of him"

Right then, I knew that she was someone who respected the child – very important criteria for us in selecting therapist.

Another astute observation from her - She had asked for eval from class-teacher and from DH.

She was very surprised that they came in right on top of each other. Usually most parents rate their child much more above their skill level than the school rates them. She concluded from this that his school is probably a place where he feels good and comfortable – this is true and quite an astute observation )

She commented several times on R's smartness and his sweetness and charm
This I loved – we really love therapists who look at  his strengths and not just weaknesses .
Her close friend is R's speechie and she talked about how speechie says R is her favorite Client in all the students she has ever had in her career ( high praise – how I love our private speechie )
She basically passed the three criteria that DH and I hold dear while selecting people who work with R
  1. Respect R
  2. Know your stuff
  3. Look at the complete picture of strengths and weaknesses not just at all the things that need to be "fixed"

Here are some main things we discussed
  1. Definitely qualifies for diagnosis of SID ( no surprise there )
  2. Hand dominance
He uses his right hand for writing – but does not have a fully established hand dominance just yet . however hand dominance needs to be established as usually it happens at 3-4. His brain needs to treat one hand as manipulator and one hand as stabilizer. She says he would probably be right handed as neither me not DH nor Grandparents were left handed

3. Crossing over the midline
Problem for R – she gave example of how this can be a problem for many kids ( the kind who write on a table – sitting sideways and not facing the table ) Will be very important for doing things like riding a bicycle , drawing things that come together ( like squares and rhombuses ) . We talked about how difficult it is for R to ride a bike when he does not have gravity helping him . I wondered aloud if he has " strength" but her hypothesis was that this midline thing contributes to it and maybe he just does not understand what to do .
She gave an example of "Big Wheels" as a sensory strategy so that the wheels would be right at his eye level and he could " see his feet"

4. Visual  Issues

she said that she would work at his eye level. That is instead of putting pen and paper on table she would ask him to write on things that were at his eye level ( example on the wall ). She showed us an example of him imitating a circle, a cross and a triangle while sitting on the table ( just squiggles ) and after placing paper on wall ( all perfect except for triangle)

5. Cutting Skills

She was big on scissors and on zoo sticks ( kind of like chopsticks but fatter ) and using salad tongs etc to develop pre-cutting skills

6. Other Sensory strategies
  1. She also talked about Wilbarger brushing and joint compressions and was big on it and said she would teach DH how to do it and give us a 3-times a day schedule. When we said we had one – she said it was VERY impt to keep it in a zip-loc baggie ( which we don't) otherwise it gets hard and can hurt the child. She said another interesting thing - oversensitive hands co-exist with oversensitive tongue. Kids who are squeamish touching things are also squeamish eating things. So you could reduce food-pickiness ( which R has in spades) through Wilbarger brushing.
  2. She asked us about the pressure vest ( we also have this but don't use it much as we saw no difference) She mentioned that even this was very important to do on schedule – an hour on and an hour off – for sensory modulation
  3. Instead of on the table – she talked about how to have "fine motor stations" throughout the house – she showed a small tent she has – which focuses attention as soon as you go in there to work with the child
  4. We gave some suggestions on some tactics that work well with R – music , loving and gentle manner, lots of praise and Junior mints
  5. She hesitatingly "broke the news" to us that in fine motor terms R measures at 25-30 months( less than half his chronological age ). I think she was concerned that we would be hurt. This however was no surprise at all and we took it in our stride with no fuss
We start private OT next week with her and are really hoping it will help R .
Keeping fingers crossed that insurance covers this


Niksmom said...

Sounds like you found a really good fit for your entire family. That is so important! Looking forward to reading all about R's adventures in private OT. :-)

Anonymous said...

Sounds like you hit the jackpot with this therapist.

R's fine motor skills sound like how Charlotte's were. Very similar. She was quite behind as well - very significant. The private OT did wonders and her fine motor skills test "normal" now.

I'm sure you'll see the same with R!

robin said...

She sounds wonderful!!! I hope your insurance covers it! I like her findings and love that she respects him (in that she would rather not talk about him in front of him.) Good luck!!!

Kim said...

It's always fabulous to find someone to work with your child that you feel really comfortable with! Yay for an awesome OT! Looking forward to hearing about his progress.

Lyndsey said...

She sounds perfect!! I hope R does well with her.

korin said...

sound fabulous! I have been on the fence about getting an OT eval (partly because I have friends who say it's worthless and partly money and partly because my heart isn't ready for someone else to tell me how she's behind).

Brenda Rothman (Mama Be Good) said...

Love it! Love that you found an OT you feel comfortable with. It's so important.

Jack has still not established hand dominance either. But that and crossing midline and all that are so affected by his visual and his motor skills problems. Things you probably already know: use a slanted surface for any writing, so instead of just a wall, use a whiteboard or art station that is slightly slanted (more ergonomic and easier for our kids). He might also need work on core strength (which is one reason why Jack doesn't have hand dominance).

BUT, man! Totally impressed he can do these on the wall!

More work for DH this summer, right?

Mr. Daddy said...

Thanks K, visiting your blog always makes me think...

"What lies behind us and what lies before us are tiny matters compared to what lies within us." ~Ralph Waldo Emerson

And I think it is beautiful that you and DH always look to see what is inside of R.
This new gal seems like a perfect fit for all of you...

Li said...

Congratulations on finding an OT! We really feel that OT has been the most effective therapy in helping our son's apraxia, even more than speech therapy.

I also think this part should be read by all parents with kids receiving services, no matter what their diagnosis:

1. Respect (the child)
2. Know your stuff
3. Look at the complete picture of strengths and weaknesses not just at all the things that need to be "fixed"

Our first speech therapist really failed on points 1 and 3 and it was such a relief when I finally fired her. She was highly recommended to us, too. But I don't care how experienced someone is, if they don't respect my kid or if they see him solely in terms of being broken, we're not working with them.

Hartley said...


I just stumbled onto your blog today and wanted to leave a note.

My son has Sensory Processing Disorder too, and I can totally relate. :)

If I can help you along your journey in anyway, please ask!

Thanks for sharing,
Author of This is Gabriel Making Sense of School

Alysia said...

Thank you for posting this - I'm in the midst of this decision myself (get the eval? pay the $$$? get private OT plus school OT?) Thanks for showing it's worth it, and I look forward to reading more.

(I blogged about my quandry here at and would love your thoughts!!

Heather said...

A great OT can make all of the difference. I love my son's OT! I hope everything goes well for you!

Janmomof2 said...

I'm so glad it went well. A good OT is critical ;-)

Kris said...

Wonderful that you found a great OT! Sensory problems are Alex's main issue and they are the reason he is "autistic-like". He has pretty much all the issues you listed for R, plus he is a serious sensory seeker. Good luck and hoping the OT will help a lot!

Martianne said...

What a fantastic OT it sounds like you found. Wishing you great success together!

Anonymous said...

My daughter also has some midline issues. And is dual handed! I am dual handed also and have always been sensory sensitive although I don't think it fits the "disorder" category. My daughter's definitely does. She is sensory defensive and has hypersensitive hearing - those tend to be her biggest issues. We finished AIT, so I'll write about our experiences with that soon. So glad you have a great OT.

Adoption of Jane said...

Is that headshot on your blog a pic of R? If so, he is so adorable!!! I am really glad you had such a great OT Eval. I never even thought of Hand dominance. I love reading other parents posts because I learn something new everytime! Hope your weekend is blessed!

Mia @ Finding Balance said...

So glad you found a person who really sounds like she will be an amazing asset to your Circle of Care. OT's, when you find a good one, are one of the most valuable members of the team!

BNM said...

There is a bunch of us on SKinny Jeans.. Adoption of Jane participates too
Thanks for reading

danette said...

She sounds like a great therapist who will be a really good fit for your family.

Bitty is still working on hand dominance, although he seems to be leaning toward right-handed (which surprised dh because he and our twins are all left-handed but I am right-handed so it shouldn't be a surprise, lol). He draws with his right hand mostly, but he goes back and forth when he colors (he has difficulty crossing the midline too).

Anonymous said...

Coming from an OT, sounds like you found a great OT!!

Trish said...

We just started private OT as well, and I am so happy we are!! We are working on self-regulation (calming strategies, flexible thinking) and lots of other fun stuff like riding a bike without training wheels (Michael is 8 and has been scared to try this).

I like the OT at school, but she has so little time with him, and the private route gives us a lot more options!

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