What Parents Need to Know About School Based OT
First, what is OT?
American Occupational Therapy Association describes it as a health profession in which therapists and therapy assistants help individuals to do and engage in the specific activities that make up daily life. For children and youth in schools, occupational therapy works to ensure that a student can participate in the full breadth of school activities—from paying attention in class; concentrating on the task at hand; holding a pencil, musical instrument, or book in the easiest way; or just behaving appropriately in class.
How does it apply to school?
We work with kids of all abilities. Some diagnoses include ADHD, Autism Spectrum Disorder, Sensory Processing Disorder, and in general; children having a hard time participating in the classroom. We can work with children inside the classroom (push-in) or outside the classroom (pull-out). Most kids that I provide OT to will already have had an Individualized Education Plan (IEP) that has been receiving services from a young age, and has a system in place that will support them to succeed in schools. Others may receive OT because they are having a specific problem in school. We also work in a team based profession to collaborate with interdisciplinary members, providing consultation to teachers about how classroom design affects attention, why particular children behave inappropriately at certain times, and where best to seat a child based on his or her learning style or other needs. A child might also be referred for OT for other reasons like motor skills, cognitive processing, visual or perceptual problems, mental health concerns, difficulties staying on task, disorganization, or inappropriate sensory responses.
Occupational Therapists tend to be the handwriting experts in school based settings because we specialize in fine motor and visual perceptual skills. OT looks at the child’s skills and other problems (including behavior), in addition to his or her visual, sensory, and physical capabilities. We also take into account the school, home, and classroom environments to find ways to improve the handwriting.
Students with disabilities have been able to benefit from occupational therapy at school since the 1975 passage of the Individuals with Disabilities Education Act (IDEA), and even more recently In 2004, the reauthorization of IDEA extended the availability of occupational therapy services to all students, not just those with disabilities, in order to fully participate in school (AOTA).
The Real Deal with ADHD
We often hear people say that they think they may have ADHD if they are having trouble focusing on school or work. ADHD is a well known diagnosis that people may misinterpret or misdiagnose.
If you have ever wondered if you may have ADHD, it’s always best to speak to a doctor. However, here is some background on the topic in order to help those that are curious.
Etiology is unknown, however there are suggested contributing factors including:
Genetic factors - higher occurrence in monozygotic twins than in dizygotic twins, 2X the occurance in siblings of hyperactive children. This leads us to believe there’s a correlation in passing it down in families.
Neurological factors - possibility of minimal brain damage due to circulatory, toxic, metabolic, or mechanical effects during fetal development, and infection inflammation, and/or trauma during early childhood.
Neurochemical dysfunction related to neurotransmitters in the adrenergic and the dopaminergic systems.
Psychosocial factors - stress, anxiety, or predisposing factors such as temperament.
According to the American Psychiatric Association (APA) there are three types of ADHD as defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). There are three subtypes of ADHD; Predominantly Inattentive type, Predominantly hyperactive-impulsive type, and Combined type. Depending on the symptoms, your doctor will be able to diagnose your subtype.
Symptoms
Symptoms are often noticed during the early childhood years before 3 years of age. However, caution is advised on early diagnosis and will most often be made during elementary school years when behavior is interfering with school performance. Some other notes on symptoms:
Occurs in 5%-8% of elementary school aged children.
Prevalence in boys to girls is a 3:1 ratio, most common in first born boys.
Partial remission may occur in ages 12-20. Hyperactivity may disappear during these years to allow for a productive adolescence but distractibility and impulsivity can persist.
Symptoms persist into adulthood in 60% of cases.
Diagnostic Criteria
Presence of 6 or more symptoms are required in three Domains (or subcategories).
Symptoms in the inattention/hyperactivity domain that interfere with occupational activities are present for at least 6 months.
Inattention Domain Symptoms may include: lack of attention to detail, poor listening, limited follow through of tasks, difficulty with organization, and avoidance of tasks that require sustained attention, tendency to lose things, distractibility, and forgetfulness.
Hyperactivity Domain Symptoms may include: fidgeting, inability to remain seated, inappropriate activity level for a given situation, difficulty with quiet sedentary activities, frequent movement and excessive talking.
Impulsivity Domain Symptoms may include: answering questions before they are fully stated, difficulty with turn taking, and interrupting the conversations of activities of others.
Other symptoms that may be present: Visual-perceptual, auditory-perceptual, language, cognitive problems.
Some of the symptoms presented were evident before the age of 7.
Symptoms result in difficulty in 2 of these settings: school, home, and/or work.
Symptom management
Medication as prescribed and monitored by a doctor, Psychotherapy, behavior modification, parent and individual counseling may be indicated.
Impacts on function
Infants may be overactive, difficult to soothe when crying, and demonstrate poor sleeping habits.
You may see defensiveness to environmental stimuli, frequent irritability, aggressive behavior, emotional lability, and unpredictable performance. These are all in response to difficulty with attention, it creates a barrier to learning and performance.
There may also be disorders in school related tasks or learning disabilities, which can be assisted with a team approach to your child’s care at school.
Caregivers may also see an increased risk for depression due to frustration and difficulty with learning. Checking up and addressing your child’s self esteem is important during this time to avoid progression. Those with symptoms remaining in adolescence and adulthood are at an increased risk of antisocial personality disorders, and substance-related disorders.
Considerations for Occupational Therapy
Occupational Therapists will work with children and their families on behaviors that may contribute to difficulty in school, play/leisure, and social participation. This may include environmental modification for facilitated learning, training in social skills/self-management, promotion of sensory modulation. Consultations to family, teachers, and employees regarding strategies are also implemented for treatment.
If you have any questions, please feel free to reach out to me directly smplytherapy@gmail.ccom
References
Glanzman, M. M., & Nathan J. Blum. (2007). Attention deficits and hyperactivity. In M. L. Bathshaw, L. Pellegrino, & N. J. Roizen (Eds.), Children with Disabilities, 6th ed. (ppp. 345-365). Baltimore, MD: Paul H. Brooks
American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and statistical manual of mental disorders, text revision, 4th ed. Washington, DC: Author.
What is the difference between OT and PT?
This is a question I get asked a lot, and for good reason. What I’ve noticed is that, unless you have a child that received services, or a parent you have supported while at a rehabilitation center, it’s difficult to understand the difference. In many settings, the OT and PT will be working together on a case very closely because there may be some overlap in treatment. Academically, both professions require similar schooling- OT/PT students shared the same classrooms for Anatomy and Physiology. However, our differences come into play with the theories that define the outlook and goals for our treatment.
Theories refer to the outlook on treatment – think of it like choosing your political view. Physical therapy only uses a Biomechanical Model of improving performance. PTs focus on Strength, Range of Motion, and balance for improved gait (walking), and transfers (moving from one position to another). Occupational Therapists are trained in the Biomechanical Model, but also a range of other theories that reflects training in psychology, sociology, communication and the way we perform functional activities. A simple analogy - Physical Therapy are like body builders performing reps to build muscle, and Occupational Therapy are the Yogi’s or Dancers. Both groups are athletes and may look similar and work on the same muscle groups, but they have a different approach. The setting also determines the way Occupational Therapists perform treatment.
In Acute settings OT focuses on Activities of Daily Living (ADL’s). ADL’s are defined as daily occupations performed at home that are required to get back to your routine, typically it includes tasks in Toileting, Dressing, Hygiene, Bathing. Insurance companies and the Interdisciplinary team (nursing, social work, MD, etc) want to see that you can perform these tasks safely and independently before discharging to the home. Your Occupational Therapist is the person that will ensure your independent mobility with exercise and functional activities in treatment. Let’s say an 80 year old woman breaks her hip and gets a hip replacement, after a couple days in the hospital the doctor deems her unsafe to return home because she can’t go to the bathroom on her own or walk. Instead, they send her to a Sub-Acute Rehabilitation where an OT will work on her ability to perform ADL’s on her own, and PT will work on her ability to stand, walk and climb the stairs needed at home.
In Outpatient settings, or a Hand Therapy Clinic, there are specialists called Certified Hand Therapists (CHT) for injuries of the Upper Extremities. This is for those that may have had a work related injury like Carpal Tunnel (refer to the Ergonomics Blog Post!), and need surgery, or someone who fell on ice and broke their wrist. Believe it or not, 70% of Certified Hand Therapists are Occupational Therapists, 30% are Physical Therapists. In this setting, splints or devices to help the joint heal properly are made or fitted by your therapist. This is in combination with exercises specific to your needs to ensure safe return to daily activities. In this setting, the two are very similar. In some settings, people define OT as upper body specialists, and PT for lower body injuries, but there is a clear difference in the assessments we perform and the way we document treatment.
In Pediatric settings, Occupational Therapists have the best job in the world - to play with babies! This comes with strategic play. Just as in the other settings, we evaluate where a child is struggling or has a developmental delay, and plan an activity to focus on improving those areas of difficulty. The children seen in occupational therapy may have a diagnosis of Autism Spectrum Disorder, Down Syndrome, ADHD, or a Learning Disability, but many times they may go undiagnosed. That's where our specialty is our strength, we assess all different areas of the way your child processes their world from attention, the way they hold a pencil, how they process sound or vision, social communication, and we can differentiate behavior difficulties from sensory processing difficulties. OT’s in this setting will report on behaviors, abilities to perform fine motor and gross motor tasks, communication, visual attention and ability to perform ADL’s, PT’s will focus on strength, posture, and mobility. The two disciplines may overlap, especially in this setting, but the differences are more clear in the documentation and goals for treatment.
Occupational and Physical Therapists are the twins that keep getting confused with each other, not to mention our third sibling Speech Therapy. We’re all healthcare professions that are needed in similar settings, and get grouped together for insurance reimbursement. However, we each belong to different national associations and have different specialties.
I hope that helps those of you that were confused! If you have questions, please feel free to reach out to me at smplytherapy@gmail.com