OT what is it??

OT what is it??
Kids learning through doing!!

Sunday, October 3, 2010

Sensory Assessments As Part of a Unified Early Learning Testing Protocol

School based screenings for young children are common, but what do they test, and are they enough?  They are usually generalized for fine and gross motor, basic perception and social/emotional development.

All of this information is important and very valuable, but for some children essential insights into the quality of a specific performance are not addressed in what “TOTEMS”* used to call “quick and dirty” overviews. (TOTEMS and AOTA program Training Occupational Therapists for Educational Management Systems).

Some children just seem to be missing the ability to “stay with the group”.  (That is what I hear a lot of when parents call about their young children.) Discovering “why” often falls to the OT doing a specialized assessment.

Many preschool and lower school directors respond to these children by suggesting facilitators who stay with the child during school.  While in many cases these individuals do an excellent job, they are also expensive and make the child “stand out” from their peers within the classroom.

Screening for developmental issues can help both the parent and the school administrator decide on the best placement for the child.  While the majority of early learners do very well in traditional typical programs, the ones that do not suffer in the same situation.  That is when seeking an alternative modified program may be advised.

Learning should never hurt, and early learning should be joyous. For the child with sensory developmental issues school can be a scary place.  Try to think about going to the same place everyday but not being able to recognize it as familiar.  Think about going to a familiar place but finding noise, smells or light noxious.  Put yourself in the “shoes” of a child with postural instability and asking them to sit a table for any length of time.

Knowing these things before the child enters the classroom can make the difference success or failure for these young learners.  It is also good information for both parents and teachers to have on all children.  Therefore a unified assessment process should include a parent checklist and an admissions or early in the school year assessment.

The parent checklist should include items that address self-care, family participation, self-calming and interests as well as the standard motor/task areas. A sample of such a checklist is offered below.

Children's Special Services, LLC Parent In Take Checklist©

Dear Parent: Your child ________________________has been referred for an occupational therapy assessment/screening. As part of this process, you are being asked to please fill out this checklist and return it to the school prior to the screening. Thank you.


__Problems taking on/off coat
__Cannot tie shoes
__Cannot manipulate buttons, snaps, zippers
__Rejects going to the bathroom
__Cannot use utensils easily
__Spills drink often
__Needs reminders to keep track of belongings
__Rejects certain fabrics
__Resists toilet training
__Messy eater
__Picky eater (explain)
__Always wears socks, long sleeves even in warm weather
__Habituates wearing 1-2 specific outfits


__Poor motor learning (new skills)
__Mixed and/or no hand preference
__Does not attempt to initiate writing first name
__Does not like to (or never liked to) scribble
__Does not like to draw/write
__Frustrated with fine motor tasks
__Difficulty when trying to copy simple shapes
__Poor gross motor (Running, jumping, skipping)
__Looses place when looking at a book that is being read to him/her
__Walked early did not spend a lot of time crawling
__Poor grasp (awkward use of pencil/crayon)
__Poor writing pressure
__Motor performances seem unusually slow
__Cannot color inside the lines as needed
__Poor reproduction of shapes/forms/
__Poor cutting skills
__Shows no preference for his/her right and left handedness
__Holds back with gross motor games
__Rejects tasks that have multiple parts (figure-ground perception)


__Difficulty staying focused
__Overly dependent on teacher/parent
__Does not seem to hear when instructions are given
__Poor (task) sequencing skills
__Sloppy work areas
__Easily distracted
__Difficulty initiating tasks
__Difficulty transitioning from one skill/task to another
__Needs instructions repeated
__Gets confused easily
__Cannot sit easily in “circle time”
__Restless when riding in a car
__Work pace is much slower than peers
__Difficulty with instructions that are more than 1-2 familiar steps


__Not many or few friends
__Complains that “someone hit” them
__Difficulty with cooperative tasks
__Multiple somatic (physical) complaints
__Poor eye contact when speaking to peers, adults, new acquaintances (circle one)
__Seems fearful of new situations/places
__Difficulty with self-calming when upset
__Hangs of people or things
__Cannot tolerate things out of “place”
__Difficulty demonstrating affection
__Wants to but is hesitant to interact with peers
__Prefers to play alone rather than with peers
__Difficulty discerning personal space
__Poor verbal expression of thought, ideas, and feelings
__Overly sensitive to corrective remarks (criticisms)
__Avoids talking out in class, and/or participating in discussions
__Easily frustrated in social situations
__Not understand jokes
__Difficulty reading body language or facial expressions
__Uses oral language that is less mature than peers
__Does not wait to ask for help if an adult is talking
©Children’s Special Services, LLC 2006 revised 2010 (May be used with copyright designation only)

The teacher would also be asked to fill out this checklist and the results compared.  It is important to (gently) explain to the parent that life on “Planet Home” is very different than life on “Planet School”*.  It is often hard for parent to get that they have been “trained” by their children to anticipate areas that may be stressful for them and thus circumventing challenging situations.  This is particularly difficult if the child in question is number one! (*From Learning Re-Enabled, Mosby/Elsevier Books)

Parents of young children are often focused on are they “having fun” and are they “happy”, while teachers are focused on the physical, intellectual, emotional and the neurological actions and reactions impacting learning.  Unfairly, teachers are often deemed “unfriendly” by parents or having a “personality conflict” when issues are revealed. 

The Occupational Therapist can play a pivotal role in the assessment and learning environment by explaining development to the parent and the teacher so that increased understanding can be attained.  The OT can also help explain the crucial importance of early intervention and discouraging the “wait and see” attitude many parents may choose if they do not fully understand the issues. 

And we all can be reminded of the famous quote by Mel Levine, MD author of One Mind at a Time, “children do not outgrow anything but their clothes.”

As Occupational Therapists one of our many roles with children is to make sure they grow with their clothes.