Occupational Therapist (OT) mentioned functional communication

Discussion in 'General Parenting' started by Ktllc, May 21, 2012.

  1. Ktllc

    Ktllc New Member

    V has lost speech services because of lack of progress. I was talking to his Occupational Therapist (OT) about it, and he is due for a 6 months reassessment (Already! time goes by so fast). She said that she could work on functional communication with V as it falls into Occupational Therapist (OT). I really did not know that Occupational Therapist (OT) could work on communication.
    But it actually seems like good news.
    But what is functional communication??
    The Occupational Therapist (OT) is happy of his progress as the sensory issues are pretty much under control, he can now get dressed on his own and will fix his clothes with only 1 verbal prompt, he tolerates imposed movements and is somewhat safer in his behaviors (crashing, jumping,etc).
    But she thinks there are still some issues such as understanding that a big gym block simply won't go through a narrow pathway. Or finding solutions to the problem, ie. putting the block sideways on its narrow side and then pushing it through. Or coming up with an idea to execute a plan (ie: building a fort), knowing how to play with his toys (not just dumping it all and going back to the same scenario over and over), accepting and following a serie of directions.
    When I ask her what one should call his challenges, she keeps on talking about processing issues but admits not to be very sure of the roots of the problems. She calls it subtle but impairing.
    Her boss is coming Thursday and we will all talk and come up with a new plan/goal for the next 6 months.
    Any insights, ideas, suggestions?:)
    Occupational Therapist (OT) is the only successful intervention so far, so those goals are even more important!
     
  2. keista

    keista New Member

    Sounds great. I have nothing to input, but wish you continued progress with this.
     
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    What is the Occupational Therapist (OT) going to do for communication? I thought a speech therapist did that, including sign language.

    Can you legally be dropped for lack of progress? I never heard of that! Calling Buddy!!!! Buddy, you are needed!

    Does V. have an IEP? This sounds fishy to me. I mean, if they can help him, good, but he should still be getting speech.

    K, I do not really think this is just about processing issues. My daughter had both visual and auditory processing issues and she could still talk and play. She had a lot of trouble following directions, because she'd forget or not process, but she had a great imagination and always played right with toys and was very
    popular with her peers. Reading was her biggest nemesis.

    I think you need to look beyond what the Occupational Therapist (OT) is saying...she is not qualified to make a determination on what is going on. An Occupational Therapist (OT) should not be the main go-to person. She needs a neuropsychologist or psychiatrist. They have more knowledge than an Occupational Therapist (OT), who is specialized in one area.

    The school in my opinion is not doing it's job. You may need to get an advocate.
     
  4. Ktllc

    Ktllc New Member

    MW, these are private services. V does not have an IEP and I will not fight the school as of right now. I simply do not have a leg to stand on. (school testings don't reveal any issues, private psychiatric-educational evaluation reveal issues that are not severe enough according to NC standards and Occupational Therapist (OT) is not a stand alone school intervention in NC).
    The insurance (state chidren's insurance) is the one that is dropping V for lack of progress.
    I am honestly trying to focus on what we have right now and make this intervention as successful as possible.
     
  5. Malika

    Malika Well-Known Member

    Yes, what is functional communication?
    It sounds as if V has made real progress in lots of areas - this is very heartening and shows how much can be done with early intervention. The issues you mention - not understanding a big object will pass through a narrower space, coming up with practical ideas to solve problems, etc: what form of intelligence or cognitive ability does this rely on? Selfishly, I would be interested to know this because it is the kind of thing J is very good and quick at, where his intelligence seems to lie (whereas he seems so much slower when it comes to academic things like learning letters, etc). How is it a processing issue? Not to undermine the Occupational Therapist (OT) lady, who sounds great and you are happy with her, but I don't really get this. But then I may have processing issues myself :)
    What do you feel the goal over the next 6 months should be? What is realistic? I do hope you have a constructive meeting on Thursday.
     
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    K....did you go through the Early Intervention Services at Mental health? Have you had him tested at DEC? I may have asked these questions before. DEC is Developmental Evaluation Center. They have them at various places around the state. The closest one to me is in Fayetteville.

    Here are the ones I found for NC.

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    [FONT=Arial, Helvetica, sans-serif]Where to go for a Diagnosis
    [/FONT]​
    [FONT=Arial, Helvetica, sans-serif]NC has a wonderful system of Developmental Evaluation Centers or DECÕs. When you call one of the DECÕs below for an appointment, you can expect that your child will typically be seen by a psychologist, a speech pathologist and a physician. This takes about 3 hours. They will need to ask you to return in the afternoon and give you a diagnosis. Your written report takes up to three weeks to receive.[/FONT][FONT=Arial, Helvetica, sans-serif][/FONT]
    [FONT=Arial, Helvetica, sans-serif]NC Developmental Evaluation Center Listings
    [/FONT][FONT=Arial, Helvetica, sans-serif]Last[/FONT][FONT=Arial, Helvetica, sans-serif] [/FONT][FONT=Arial, Helvetica, sans-serif]Update 2/1/2000[/FONT]
    [FONT=Arial, Helvetica, sans-serif]ASHEVILLE[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Jayce Greene, MPH, Director[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Developmental Evaluation Center[/FONT]
    [FONT=Arial, Helvetica, sans-serif]49 Tunnel Road, Suite D[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Asheville, NC 28805[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Courier # 12-51-03[/FONT]
    [FONT=Arial, Helvetica, sans-serif](828) 251-8091 Fax # (828) 251-6911[/FONT]

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    [FONT=Arial, Helvetica, sans-serif]Doug Galke, MA, MPA, Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Melvin D. Levine, M.D., Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Palmer, M.A., Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Jane Minor, Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Ann Crane, M.S., Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Nancy Norman, M.Ed., Director,[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]GREENVILLE[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Dewane Frutiger, MA, MPH, Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]East Carolina University[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Irons Building, Charles Blvd.[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]J. James Hawjey, M.A., Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Newsom Williams, Ph.D., Director[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Developmental Evaluation Center[/FONT]
    [FONT=Arial, Helvetica, sans-serif]1405 S. Glenburnie Road[/FONT]
    [FONT=Arial, Helvetica, sans-serif]New Bern, NC 28562[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Timothy Pritchard, CPM, Director[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Developmental Evaluation Center[/FONT]
    [FONT=Arial, Helvetica, sans-serif]319 Chapanoke Road, Suite 101[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Raleigh, NC 27603[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Courier # 53-51-12[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Judye Bradley, MS, Director[/FONT]
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    [FONT=Arial, Helvetica, sans-serif]Kent Haywood, MSW, Director[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Developmental Evaluation Center[/FONT]
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  7. Ktllc

    Ktllc New Member

    Janet, I did not even know about this program. V will turn 5 this week, so I guess it is too late for it. But thanks for the info.
    Malika, I don't really get it either to be honest. I'll have to make sure to ask LOTS of questions thursday. It might be easier since 2 OTs will be there (our Occupational Therapist (OT) and her boss), one can be with V when I ask questions to the other one. It is always tricky during regular session as V is right there waiting to be taken cared of. He does not share attention very well! lol
    When I think of what the goals should be, I'm not sure. Maybe be able to come up with an idea to build a fort? Or come up with a novel plan for an obstacle course (not copy what the Occupational Therapist (OT) does)?
    If I had a better understanding of the underlying issues, it would be easier to help him.
     
  8. buddy

    buddy New Member

    Hi, I wonder if that program Janet mentioned would have a referral to the next level (probably will say schools but???)...what is one more phone call right??? LOL

    MWM, yes with insurance, because they are paying, there are guidelines/reasons they end services. you may meet the cap on spending and yes, another is not making progress over a certain amount of time. The question is though, were the goals and/or methods for working on them appropriate in the first place? I think one question with this therapist has been if his goals were a little off base to the problems and concerns, and also that his methods may not have been quite developmentally appropriate. I'd keep looking over time for an Speech Language Pathologist (SLP) who gets processing challenges etc....

    As for the functional communication, I would ask the Occupational Therapist (OT) how she defines it. Typically we think of functional communication (and behaviors too) in terms of people who are fairly lower functioning. However there are different meanings for it and it can easily be reasoned that we all have functional communication and need to use it. I was considering V and actually think this Occupational Therapist (OT) could be on to something. Not that he is low functioning but if we define functional communication and those communication behaviors that are done to get wants, needs met (not formal/systematic communication with words or signs or pictures) such as looking toward things, pointing, walking away from what they dont want, crying when a transition happens, rocking when nervous etc.... for kids who dont have any formal communication we would start to shape those behaviors into predictable communication so the individual can learn control over their environment. The things like looking toward a choice, touching a person for help, looking down to refuse....would be trained as "functional communication".

    So for one definition of functional communication you are training a client to use a predictable behavior that is socially appropriate and used across settings to replace inappropriate communicative behaviors (like tantrums, hitting, screams, etc) and for V that can be using words. Thinking of the videos you shared (so cute!) and what you have said are common concerns...this could be a way to view part of the problems.

    Yes, this should be the Speech Language Pathologist (SLP)'s area but if we have to accept that there has not been a good match with an Speech Language Pathologist (SLP) the Occupational Therapist (OT) may have been around enough to realize that these kinds of skills are essential and have teamed up on enough kids with Speech Language Pathologist (SLP)'s to do a decent job. So learning recognize when he needs help and then to ask for help in an appropriate way (example, not saying this IS one of his needs), to express feelings in an appropriate way, etc. may be what she is thinking of???? I actually think in an ideal program the therapists do run eachothers goals so I position a child and use sensory tools in my sessions to make the child in a better place to communicate....and the Occupational Therapist (OT) and PT use the communication strategies I have been working on in their sessions. (one advantage of the schools is you dont have to worry about double billing so you can work at the same time and pulll it all together....usually can't do that in p rivate, unless you pay one of them privately).

    Yes, what is missing here is that the Speech Language Pathologist (SLP) should be a nalyzing what those communicative goals should be and should be monitoring it but it will not hurt him to work on this if mom is monitoring and behaviors are not getting worse. Teaching non verbal communication could also be a part of this. (Quin has learned very directly what wide eyes means, or a frown, or a serious tone of voice, etc....)

    Another def. of functional communication is learning things like how to follow signs in the community (rest rooms,bus, street signs, exit, etc... things you dont even need to read but people can learn the symbols.... I suspect that is not the definition she may be thinking of.

    There are other specific functional communication programs and again, I dont think she would cross over into doing a formal communication program like that since that would clearly be crossing a boundary.

    Occupational Therapist (OT)'s do work on underlying reasons for behaviors....usually sensory or motor things but communication is everywhere so she may have lots of opportunities to pair these things and realize that being able to communicate discomfort or sensory challenges are often closely related. I wonder if that is what she is thinking of.

    Will be interesting to hear. For V, I agree you are at a point where any GOOD help is welcome. You are great at monitoring and nixing things if it seems not to be a help so (in my humble opinion...mommy to mommy here) just continue with that and see how it goes.
     
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    How about sign language? They were teaching that to sonic and it worked! Then he started talking so we just abandoned it, but it was a good idea (in my opinion). Also, there are cards with pictures on it to help the child point to what he needs, such as a toilet or food. We never got that far, but that was going to be our next step.

    Fortunately, Sonic always pointed and pulled us around, but it really wasn't always enough. Sometimes we didn't know what he meant and...whoa!!!...meltdown city!

    Buddy, I had no idea the school could quit if there wasn't enough progress. How very sad.
     
  10. slsh

    slsh member since 1999

    MWM - it's not the school quitting, it's the ins. co. Boo could get PT if he would make progress, but cannot get PT simply to maintain ROM, in spite of the potential cost of remedying contractures and other complications from loss of ROM. It's kinda really stupid. Insurance companies expect "progress" after an arbitrary amt of time, or they stop paying.

    Ktllc - has he had an assistive/augmentative communication evaluation? That might be a good option, especially if the focus is going to be functional communication, plus it will bolster your fight for an IEP if/when the time comes.
     
  11. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Ah, ok. Duh. Now I get it.

    Well, then I believe an IEP should be scheduled ASAP.Another big duh. I'm sure the poster has already done this.
     
  12. DammitJanet

    DammitJanet Well-Known Member Staff Member

    No...the DEC is outside of the Early Intervention. Call them and ask about getting an appointment. I just combined my questions into one question which was confusing. Im sorry. I know the last time I was at DEC they evaluated kids up to age 8 or 10, I cant remember which. Both Cory and Jamie went there and Cory was four and Jamie was six.

    The reason I asked about Early intervention at MH was because they had a program there that was different than the one that the schools do. That starts from about age 1 through age 3. Then they have a day treatment program that runs from age 4 to age 7. Or at least they did. You have to get hooked up with your LME and find out if you can access this help.
     
  13. Ktllc

    Ktllc New Member

    The thing about V: he is VERY verbal. He could talk in sentences at 12 months old. But yet, his communication is not always very effective. I often have to guess what he means. Formulating an idea is hard. He uses LOTS of gesture to compensate.
    His playtherapist played a game with him: he had to only use his words and tell her what to pick up and where to set the different parts of a plastic cheese burger. The end results was supposed to be a fully assembled cheese burger on a plate. When asked not to use his hands, he used his feet, when asked not to uses his hands or feets, he used his head! All she could get out of him was "take this, put it there. No take that, put it like this"etc. When it was his turn to listen and execute, he had no clue what to grab or how to position the elements. It was like a guessing game for him.
    He cannot express feelings and I just realized he has a hard time understanding other people's feelings. The latest example: V is soaked in pee this morning. He is just standing there next to his bed while I take the sheets off. I asked him a million times to takes his pj's off. I also used gestures, pulled a bit on his clothes to give extra clues. I really did not want to touch the soaked fabric and I think he is old enough to do it himself. He just stood there and I got upset. Then he starts crying saying I'm mad at him. I tell him that indeed I'm upset and ask him why. His answer: "I don't know. You're mad at me". He had honestly no clue why he was being yelled at! sigh... it is just baffling to me.
    I don't know how relevant augmentative communication systems would be for V as he can speak. It takes being with V for a while before one can realize something is off.
     
  14. buddy

    buddy New Member

    here is a tricky thing:

    If it is language based...then no matter the language, sign language, picture use, verbal...will all be difficultunless you work on the underlying language issues....vocabulary, structure, word finding, etc.

    If it is Auditory Processing Disorders (APD) based ....affecting the language use...visual language systems could be very helpful even with his verbal skills..... like sign language or use of sentence strips (arranging words or pictures on a sentence strip with velcro and using that to request, comment, express feelings, etc.), or electronic systems (which if they are dedicated language systems can be thousands and thousands of dollars and often insurance requires trials, reports from the Speech Language Pathologist (SLP) and signed off by the doctor and I have never seen that pass for a verbal child...except purely echoic kids)...but there are things like iPads and tablets that could be used to help formulate sentences.

    Some things cross over both issues (how anxiety influences access to the abilities to formulate ideas and requests, etc...)

    Sign Language wont hurt and you are already using it with Sweet Pea so it could be a natural thing to try with V too, the thing is in general a child will pick the most efficient method and he is so used to verbal language that he may resist something that at least at first takes more effort from his perspective. It would be great if you could up your use of sign language to a more conversational level to see how having that visual form of language impacts him.

    Young kids do have a very difficult time giving verbal directions, explaining what happened to them in details and the right sequence...they are still at a cognitive level where they assume you can read their minds and fill in the blanks. So the task with the play therapist may have been a little too hard for most four year olds, but you see this with V, even in simpler things and he has many communication frustrations so there is something going on there.

    Without a competent therapist, investigating how this would impact him could be tricky, but just try little things as long as you are doing it for sweet pea, why not??? (I am still hanging out hope you will get hooked up if they see what you are seeing in that evaluation you are on the waiting list for) How you put some of your concerns in the post here?? Copy that and add it to any future forms that say "what are your concerns"....in the communication section! It was worded well.
     
  15. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Has he had any physical done by a neurologist to make sure he has a healthy brain?

    I have to say I'm puzzled. My son has Autism Spectrum Disorders (ASD) and that affects the ability to communicate, but not sure it affects it in that way. My daughter had Auditory Processing Disorders (APD) and never had trouble answering a thought coherently. Maybe it is a medical problem.

    On top of the neurologist, has he seen a neuropsysch? I think I've asked before, but I don't remember :)

    If not, why not? :)
     
  16. Malika

    Malika Well-Known Member

  17. Liahona

    Liahona Guest

    Oh, school is going to be tough and I'm betting if you push for it he'll have an IEP by the end of kindergarten. If not then at least by the end of 1st grade. Don't give up. Sometimes it just takes everyone else years to see what mom sees.

    It does sound a bit like the communication issues difficult child 2 and difficult child 3 have. Both can talk great. Its just getting useful information out of them can be difficult. Especially to anything attached to emotions.

    You're doing an awesome job. Keep up the good work.
     
  18. Ktllc

    Ktllc New Member

    I don't dare hoping anymore. I have gotten so many conflicting information and feedback by various "experts". I honestly have no certainty anymore. How many times have I thought the issues were obvious, and then it gets overlooked or classified as "age appropriate". One parent I talked to (she had just obtained a firm Autism Spectrum Disorders (ASD) diagnosis) told me she could not hear the "age appropriate" comment anymore...
    Malika, it is an interesting article. And actually tackles one of my many questions. Are V's issues really part of an auditory issue or is it more due to some autistic issues as in V thinks differently and does not always relate to my way of thinking. This afternoon, I was asking what he played at daycare, with whom, etc... He said "I played with me a lot" and after many more questions and rephrasing he finally confessed that he played cars. I asked him what his story was about. He was completely puzzled by the question. I gave him an example (ie: were you a police car chasing a bad guy?) and he replied "No, the car is the story". In this specific example, I believe he heard what I was asking but simply could not make sense of it. The idea of making a make believe story was kind of strange to him.
    I had quite a few conversation with husband about V entering elementary school. We know it will be tough but we are hoping to protect him emotionally. IEP or not I will make sure the teacher don't draw the fast conclusion that V could if he only tried hard enough. We've decided to let him go this year since he is so excited about it but are ready to spend lots of time supporting V and helping the school understand the issues at hand. Hopefully it will lead to an IEP rather sooner than later.
    Liahona, I really don't know how you stay sane with 6 children including 3 with special needs. I have 2 special need kids and 1 easy child and sometimes I feel like screaming. Writing it even feels kinda of weird, almost unreal.
     
  19. Liahona

    Liahona Guest

    I homeschooled difficult child 1 for kindergarten. He has been in public school since. Before each school year I meet with his teachers and described some of the behaviors we saw at home and insisted on a back and forth notebook. They thought I was crazy. difficult child 1 was perfect in school. (They didn't realize the other kids in the class were scared of him. Or that his first hallucinations were at school in 1st grade.) All they saw was some separation anxiety at the start of the day. I kept being the crazy pushy weird mom. Then in 2nd grade everything hit the fan. I have never seen an aide approved that fast. School did a complete 180.

    School will eventually realize that V has a problem. It just might take them awhile. And of course you do all you can to support V until they do. And you do everything to support V after school gets a clue.

    And who said I was sane?
     
  20. InsaneCdn

    InsaneCdn Well-Known Member

    Lia - you are sane. It's the rest of the world that isn't... (been there done that)
     
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