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Special Ed 101
Occupational Therapist (OT) in the schools
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<blockquote data-quote="Babbs" data-source="post: 75317" data-attributes="member: 3820"><p>Sheila - you have many valid points. Unfortunately I have to head out to work so I will have to post further on some of them.</p><p></p><p>First - I am a parent of a child with AD/HD. You stated "There are some authorities who contend that fine and gross motor skill problems are almost always inherent with-ADHD. Sensory Integration Disorder (SID) is not an uncommon co-existing condition either. " My son does not have motor skill delays. This is not only my opinion as a parent, or a professional opinion, but I have had him tested by both Occupational Therapist (OT)'s and PT's. He scores within normal limits on every standardized motor assessment for his age. I've also had him seen for possible sensory processing dysfunction. Again, he shows up as having inattention problems and behavioral problems related to the inattention, but no specific sensory concerns. However, his handwriting is horrible and his 2nd grade teacher has mentioned already she feels he has fine motor problems. Does he?</p><p></p><p>When given a pencil to draw with he can draw elaborate dinosaurs, fairies, trains, etc. He definitely has the fine motor control to express himself through art. He can manipulate legos, tops, peg boards, etc, which indicates he has good manual dexterity. But he can't write legibly. When it comes to individual letters and numbers he is able to reproduce them upon dictation, from memory, with good formation, legibility, and control. But he reverses his numbers on math worksheets and takes 3 lines to write a 5 word sentence on 2nd grade paper. </p><p></p><p>Considering the evidence I have from testing as well as personal observation, his handwriting problems is from executive functioning and organizational problems not fine motor concerns. His ability to organize all the components of the writing task, from remembering sentence structure, to spelling, to grammar and punctuation, to the motor memory to form the letters and get them neatly on the page is significantly impaired. However, his teacher feels he has a fine motor delay. What is really going on for him is his disability is adversely impacting his ability to write, not just legibly but coherently and according to state educational standards. </p><p></p><p>I'm not saying that children with AD/HD can't and won't have fine, gross, or sensory motor delays. However, often it is not the fine motor skills which gets in the way of the writing process. As a school Occupational Therapist (OT) I have evaluated students who have AD/HD as a diagnosis but pass every standardized motor assessment that has been given to them. So do they have fine and gross motor impairments? Or is the problem with executive functioning and organizational skills?</p><p></p><p>My son's case is one in which I would never press an IEP team for Occupational Therapist (OT) services. The data that I have just doesn't indicate that Occupational Therapist (OT) would be required "to assist [him]... to benefit from special education..." I definitely do and will press for specially designed instruction in the areas of organizational skills, behavior, and accomodations for his problems with memory and executive functioning.</p><p></p><p>The above, in my opinion, is an example of where a full comprehensive evaluation needs to occur in order to see the full picture for a child's needs. I completely agree that all too often SD's interpret the law narrowly. What bureaucracy doesn't? Personally, if I were in the position of having to pay to provide services and I had an exceedingly limited budget, heck yes I'd interpret the law narrowly. That's why I'm in full agreement that as parents we need to educate ourselves not just about the law, but the interpretations of the law (which do vary state to state depending on the decisions handed down by state judicial courts), And be effective case managers for our children - know what the research is and how our child's disability impacts his or her ability to participate in life.</p><p></p><p>Unfortunately, IDEA is very quiet on the details for related services. In Wrightslaw Special Education Law 2nd edition, there are only three references to related services and 3 for occupational therapy. Three. The interpretation for the law then is left in the hands of the US department of education, 50 state departments of education, and thousands of LEAs. </p><p></p><p>Under 300.304(c) </p><p>"assessments...to assess specific areas of educational need..." and "the assessment results accurately reflect the child's aptitude or achievement level... rather than reflecting the child's impaired sensory, manual, or speaking skills"... </p><p></p><p>This is where the interpretation that a child's motor deficit must have educational impact.</p></blockquote><p></p>
[QUOTE="Babbs, post: 75317, member: 3820"] Sheila - you have many valid points. Unfortunately I have to head out to work so I will have to post further on some of them. First - I am a parent of a child with AD/HD. You stated "There are some authorities who contend that fine and gross motor skill problems are almost always inherent with-ADHD. Sensory Integration Disorder (SID) is not an uncommon co-existing condition either. " My son does not have motor skill delays. This is not only my opinion as a parent, or a professional opinion, but I have had him tested by both Occupational Therapist (OT)'s and PT's. He scores within normal limits on every standardized motor assessment for his age. I've also had him seen for possible sensory processing dysfunction. Again, he shows up as having inattention problems and behavioral problems related to the inattention, but no specific sensory concerns. However, his handwriting is horrible and his 2nd grade teacher has mentioned already she feels he has fine motor problems. Does he? When given a pencil to draw with he can draw elaborate dinosaurs, fairies, trains, etc. He definitely has the fine motor control to express himself through art. He can manipulate legos, tops, peg boards, etc, which indicates he has good manual dexterity. But he can't write legibly. When it comes to individual letters and numbers he is able to reproduce them upon dictation, from memory, with good formation, legibility, and control. But he reverses his numbers on math worksheets and takes 3 lines to write a 5 word sentence on 2nd grade paper. Considering the evidence I have from testing as well as personal observation, his handwriting problems is from executive functioning and organizational problems not fine motor concerns. His ability to organize all the components of the writing task, from remembering sentence structure, to spelling, to grammar and punctuation, to the motor memory to form the letters and get them neatly on the page is significantly impaired. However, his teacher feels he has a fine motor delay. What is really going on for him is his disability is adversely impacting his ability to write, not just legibly but coherently and according to state educational standards. I'm not saying that children with AD/HD can't and won't have fine, gross, or sensory motor delays. However, often it is not the fine motor skills which gets in the way of the writing process. As a school Occupational Therapist (OT) I have evaluated students who have AD/HD as a diagnosis but pass every standardized motor assessment that has been given to them. So do they have fine and gross motor impairments? Or is the problem with executive functioning and organizational skills? My son's case is one in which I would never press an IEP team for Occupational Therapist (OT) services. The data that I have just doesn't indicate that Occupational Therapist (OT) would be required "to assist [him]... to benefit from special education..." I definitely do and will press for specially designed instruction in the areas of organizational skills, behavior, and accomodations for his problems with memory and executive functioning. The above, in my opinion, is an example of where a full comprehensive evaluation needs to occur in order to see the full picture for a child's needs. I completely agree that all too often SD's interpret the law narrowly. What bureaucracy doesn't? Personally, if I were in the position of having to pay to provide services and I had an exceedingly limited budget, heck yes I'd interpret the law narrowly. That's why I'm in full agreement that as parents we need to educate ourselves not just about the law, but the interpretations of the law (which do vary state to state depending on the decisions handed down by state judicial courts), And be effective case managers for our children - know what the research is and how our child's disability impacts his or her ability to participate in life. Unfortunately, IDEA is very quiet on the details for related services. In Wrightslaw Special Education Law 2nd edition, there are only three references to related services and 3 for occupational therapy. Three. The interpretation for the law then is left in the hands of the US department of education, 50 state departments of education, and thousands of LEAs. Under 300.304(c) "assessments...to assess specific areas of educational need..." and "the assessment results accurately reflect the child's aptitude or achievement level... rather than reflecting the child's impaired sensory, manual, or speaking skills"... This is where the interpretation that a child's motor deficit must have educational impact. [/QUOTE]
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