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
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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