Need Help-OT question

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The OT at school is recommending cutting back OT to once a month, with a once a month consult. I think I successfully convinced her to recommend it take effect 6 weeks into next school year,. We have a IEP meeting this week.

Her rationale is that she says that DS's handwriting is good when he put forth effort, and that he knows how to do the pincer grip, and how to form all the letters. This is true but he still defaults to the shovel grip at home (and I suspect at school when no one watches) and he doesn't try all the time when he can get away with it. He loves letters so I think it is still hard for him, but I guess they don't give "extra" OT for "not wanting to put forth effort?"

She feels like he is doing "great" behaviorally (I do not think the teacher agrees, but it is at the end of the year and will soon be someone else's problem,) and that stuff she thinks is more related to the behavioral person. She says it mostly has to do with issues with transitions. I agree with the transition part, but isn't like he doesn't have another issues too.

I also noted that he still needs help on self help skills (buttons etc.- which they have not even started helping him on, due to the teacher's emphasis on handwriting )and her answer was that he is "smart" and that he will pick it up fast. I don't see how smart has anything to do with that. He has apraxia. I asked about him crossing the mid-line (which he was diagnosed with, too.) That is miraculously fine, too. She added he is doing fine at gym (I am going to see if I can get info from others on that, because I really doubt it based on what I have seen.) He has not been getting any PT, anyway.

How much OT is it realistic to expect the school to give, and for what issues? I don't want him to be pulled extra for no reason---but aside from getting an indep eval, which we really can't afford, I do not know what to think.

I know I am asking kind of a ridiculously general question, but I want to be able to go in there with information, and whether or not it is beneficial/realistic for me to push harder on this. The school although not the teacher, has been pretty good this year and I don't want to piss the school off too much unless I need to because I am also trying to get them to give him an aide back for the beginning of next term until he understands what the new teacher wants from him, and she figures out what is not realistic to expect of him.

how old is your son? My son is 6 and is getting OT 2x a week, and will continue to get the same next year. he as well can use the correct grip, can form all letters beautifully, but has weak muscle tone, low stamina and defaults to an immature grip or other incorrect finger placement when writing. He also has issues with midline, VMI, things like not using his other hand to hold the paper when writing, cutting, etc...BUT his OT reccomended continuing services even though he CAN do those things. I dont believe it is lack of effort. It is HARD for our children,t hey have a defecit in this area, and will default to ways that compensate to make it easier for them. My son also get sspeech due to artic, and in therapy he CAN make all of the sounds perfect, but in conversation he loses a lot of his articulation. That therapist could have also said he is capable of making the sounds he just has to put more effort in...rather, she wants him in speech again to keep practicing so hopefullly in conversation he will carry it over.

I guess each therapist is different, but to view your child as not putting forth effort...OMG that would have me FUMING! I would say, NO, he has low stamina and tires easily, therefore defaults to the immature grip. he needs MORE practive, MORE OT not less. What are his %ile scores? Does he get any other related services?

I can see this scenario happening to my son, but luckily his therapists chose to ask for a continuation, but it could have gone either way for us. I hope that you get to keep his OT. Let us know what happens!

Don't let the school bully you into dropping the OT back to once a month. Are your son's OT goals measurable? Measurement of using correct grip independently should help make your case. Even though you can't afford it, I suspect you really need an advocate and an outside eval to make sure your son isn't shortchanged. Read From Emotions to Advocacy and visit www.wrightslaw.com for more info on how to navigate the system.

The only thing I would add to the excellent advice above, is to check with your health insurance - an OT evaluation might be covered! Many insurance plans cover a limited number of sessions per year, and prior to starting those sessions, an evaluation can be performed, under insurance, with a referral (if your insurance requires referrals). If you go this route, make sure you use an excellent OT, and tell her that you will want to bring the report to school.

I wouldn't agree to the cut back. As sympathetic as I am to school budget issues, it also means they have every reason to give as little in the way of services as they can get away with, and that isn't usually in your son's best interest. If a child crosses an objective standard and no longer qualifies for services in a particular area that is one thing, but cutting back voluntarily is another.

My son has graduated out of services several times (although sometimes he requalifies, the standards change by age) and they have always cited the objective standards and shown me my son's realted test results. In those cases I haven't always been happy about it, but I have been convinced it was a fair assessment. What you are hearing here ... not convinced.

When my son got OT, which was up through 6th grade, it was once a week. They graduated him after they taught him to type and he reached a set number of words per minute.

He is seven, (barely) and yeah, I really do think that he needs it. The interesting thing is this is being pushed as an OT rec (she called me to let me know she was doing this) that he does not need it as much to make it harder for me to counter, as they are not claiming they instigated it. (Which I would guess they did) At the ARD can I require they retest him on all this stuff again formally, or how do I go about saying I don't agree with this? They have to test him, again, formally next term anyway, to me it makes more sense to address it, then, anyway.

Edited to add: He gets speech, too, for pragmatics and communication/social issues. I really think they could do more in this as well.
I don't think his OT report even contained any percentiles. I will have to look. She noted which milestones he hadn't met, and what he had issues with.

I will definitely bring up the stamina issue(I brought up the strength issue, to her already) --- Are there any hard and fast standards (or will that be in the Wrightslaw material) about how bad it has to be for them to offer services, so I can see what the tests are and the baseline max of performance?

We had the same exact issues and the school refused to give OT at all. We had so many other fights to fight that we just dropped it. DS can write legibly, could be helped by an OT and probably should be getting services - but he MUST get pragmatic speech, so we put our energies there.

Much like with the pragmatic speech, he only has a partial deficit - meaning, he was perfectly capable of doing certain tasks that comprise about 50% of the test, but the remaining 50% he could not do AT ALL. The school is inclined to read this as though his glass is half-full, so we keep fighting because we know that being able to interpret communication correctly is only helpful if you can also effectively respond. I am guessing this isn't atypical in a school eval.

(ETA - realizing this may sound like the opposite of what I mean: fight for what you think is important, but pick your battles carefully. If you are seeing evidence of your child's needs, you are more experienced with this particular child than they are. Schools are generalists, not specialists)

Speech is more difficult, because there is always "more" that could be done, while the truth is the school is really only responsible for teaching the child enough to get through school. I was actually pleasantly surprised when the standards for high school speech included reading body language, so of course I jumped at getting that help for my son.

Hands down, other than the one year becoming proficient on the keyboard in OT, speech has been THE therapy that benefited my child the most.

But when I read how far Bloneambition's kids got with the things she was doing to help them with writing, I did wonder if my son could have gotten further with more and better help. Honestly, the OT did not noticeably get him very far until 6th grade, when he was ready to become proficient on the keyboard. If OT CAN take a child further, I am all for it, because as great as it is that my son can keyboard to effectively communicate in writing, the world remains full of forms that need to be filled in by hand, and that frustrates him. To me, writing IS, without a doubt, a SCHOOL issue.

ASDMommyASDKid, you don't sign anything that you are not on board with. You say you do not agree and then you do not sign. The objective standards by age exist in writing somewhere, but I am not sure how you get them. Perhaps request it from the district? Or the state? I believe the standards are set state by state.

yes they he to test him yearly, how did he score on his eval? I would ask for a hard copy of his latest eval. They are having the anual CSE but they had to test him before hand. ASK for a copy of his test, there will be precentiles and scores. What does his teacher have to say? Teacher input can be major in the decision...

I wouldnt agree at all and I would demand a hard copy of the recent eval showing his scores!
good luck:)

Make sure that any test that looks at your child's handwriting looks not only at the end product, but at the time it takes to produce that product. If your child's beautiful five-word sentence takes 2-3x as long to produce as the other children's five word sentences, it may look wonderful, but it will not be functional writing. Your child needs to be able to write legibly and timely, without hand fatigue, in order for it to be functional. You are looking for functional handwriting, not an art project. Unless your child can maintain functional handwriting, he has not reached his goals, unless they have "given up."

Thank you for all of this. They tested him earlier this term. I will ask if they tested him formally, since. My copy last time, did not contain percentiles of any kind. Do they have to calculate that? I will ask them, regardless. They do a lot based on subjective observation.

I wonder also, because they gave me the initial amount (which is what they want to reduce him back to) and then increased it to the current amount, based on the teacher requesting it for handwriting, so I am hoping that does not meant that the once a month is the minimum they need to give based on his eval.

They did not get around to testing for OT until a couple of months after the term started (long story) and then a month after that raised it to the current amount, and now want to drop it back down. I don't know if this changes anyone's answers.

He has only had OT less than 6 months and has had the current quantity for about 4. He has improved, but the numbers they give in his IEP are based on % of the time it is legible. I can't even take that too seriously because I am not sure if they are discarding when he "isn't trying," which is because it is hard and frustrating, and yes, I agree, probably a stamina issue.

I don't think I can rely on the teacher for this, because he won't be her problem next year, and she has been talking about how "improved" his handwriting is. It is improved, but I don't think it is wise to reduce help, just as it is starting to work. Also, no, it does not look in the same realm as his classmates.

Seek a diagnosis of dysgraphia and teach him how to use a keyboard.

I thought I would share a conversation with my son that represents why writing remians critical, even when a child can keyboard: math. My son's geometry grade slipped this semester and the reason is that more arithmetic is involved, which he certainly knows how to do, but one must write down numbers and track the steps, and he can't read his own writing well enough or align the calculations well enough to build the calculations without making mistakes. This is very frustrating for him, because he is an honors math student and loves the subject, has no problem at all with understanding the material.

When they increased the amount of OT did they put it in his IEP? If so, then they can't reduce it without your signature on the modified IEP.

Ask them this, "What evidence based method are you using to make the decision about how often he needs OT?" My instinct is that they aren't using any evidence based anything to make the decision to reduce his OT.

Not sure where you are located but every state should have no cost assistance available for families with children with disabilities. An advocate is likely available to you at little or no cost. You might start looking here. http://www.parentcenternetwork.org/.

I fully agree with all the others have said......
Ok....first of all I want to mention that most standarized tests can only be done every 6 months.....So if he had standarized tests, they will not be able to test now anyway....ask for the previous assessment scores and what tests has been used. Secondly....usually it takes between 6-18 months to treat normally.....it could be longer. Then also...I cant see the benefit of once a month OT except if she will be giving you a home program and the once a month is to adjust and grade the homeprogram that needs to be discussed with you?
You mention he has apraxia.....is this OT trained in sensory integration? Because usually this is underlying issues? Did she do a standarized questionaire to determan what sensory integration problems your child has....because this can contribute to the poor pencilgrip as well....for example....poor tactile integration....resulting in poor registration of handmovements and using of pencil....Or poor vestibular integration might result in poor muscle endurance, causing fatigue during writing....causing poor body posture at table and then causing poor handwriting.
You mention poor buttoning....this can be because of poor motorplanning, and poor bilateral integration.....did she work on this?
Poor transition.......this can be because of poor problem solving and poor planning skills.......did she work on this?
Ok......this is all I can think of for now.....ps....I am an OT myself......
Both my kids is getting OT at the moment with one great OT and one little bit less great OT at school.....for SI stuff.....Know the feeling!

Yes, they adjusted the IEP document to reflect the new amount that was added. This was based on a request by the teacher. They never even bothered to test him on self help because they mainly care about handwriting. I asked for new goals to be added (to the upcoming IEP document for self help) She has still not tested him on it. I suspect the reduction is based on subjectivity, just as I know the increase was based on a teacher request and not new testing. The reduced amount would however be what we had based on the original testing. However my testing results while filled with jargon etc didn't have nifty percentile/speed information. It was presented as "we tested child for x and he passed/failed", for each individual thing So it seems they have specific pass/fail tests for each grade.

I will have to ask more questions about this, today.

He did qualify for sensory integration, but this is done minimally. She is towing the school line, that his issues are more behavioral. I do not agree with that either.

The original report did mention the influences of his sensory issues and apraxia on handwriting. I did not think to ask her on the phone about all of that. I asked about the midline stuff (He also could not cross midline) and she said he can cross midline. So she fixed it already? I did not say that part, but I am having trouble believing this is so easily fixed.

Edited to add: It was never a home-based program. Occasionally the teacher would send handwriting sheets for home, but is was not a formal thing. It was unpredictable, which could have been very very bad. Luckily my son handled it fairly well, even though it was not on the schedule to have this homework. He knows what homework is to be assigned each week, so these little surprises could have been very bad. I would really not like it to be home-based because then we are on home brain and he really feels entitled to do his home special interest stuff.

I guess that is another thing I could be afraid of is them sending more stuff home. By the time he gets home he is done, and it is shovel grip and whipping through things fast time. So unless the exercise is very short and he likes it, he gets nothing out of it, at home. The Handwriting Without Tears stuff they sent home, worked well, but just regular writing, not so much.

Edited to add: She says she feels the once a month OT is sufficient because the teacher will be working on fine motor skill stuff too. There is no way she will have time to hover over him enough to make sure he is not doing a shovel grip all the time. I think I will make sure to add that into what I say.