Tag Archives: OT assessment

Why your child with Aspergers Syndrome May need an OT Assessment

24 May

Does your child with Aspergers Syndrome have difficulties with their fine and gross motor skills as well as that of their sensory processing.

If the answer is yes, you should consider getting an assessment from an occupational therapist (OT).

In Little mans case, this was highly recommended by an independent educational psychologist during an assessment in preparation for our pending tribunal hearing early last year. I’d always had concerns regarding some of his motor skills especially that of fine motor skills, handwriting mainly. I guess i wasn’t fully prepared for the final report, which admittedly came as somewhat of a shock!

However, knowing the true extent of these difficulties has allowed me understand why little man struggles within certain areas, plus since getting the statement amended he now has regular OT sessions within his special school.

The final report which was written by an independent OT based in Harley street London was a real eye opener, not only highlighting his motor difficulties but that of his poor sensory processing too.

It’s extremely important to think along the lines of OT when applying for a statuary assessment and beginning the process of requesting a statement of SEN. Once you have that statement and it’s all agreed, it will be a good year before the annual review, your next opportunity to request amendments!

Below I’m sharing some of the findings from Little mans OT report.

The report is sadly far to large to include everything so I’ve chosen some important factors that may affect others like little man.

Many see Aspergers as just a social communication and behavioural condition. This is simply not always the case!

Note I have Removed my sons real name and replaced this with the name you all know… Little man.

Behaviour during Testing
Little Man presented as a friendly young boy and was generally co-operative whilst completing table top activities during the first half of the assessment was and able to complete the assessment tasks with prompting and encouragement. However, Little man found the gross motor tasks during the second part of the assessment more challenging and needed constant prompting to complete the assessment.

Strength
Little man showed some difficulty with completing the given tasks of maintaining postures against gravity and practicing push-ups and sit ups. While practicing push-ups, shoulder abduction and pelvic tilt were noticed. It has to be noted that such activities apart from the strength, require a good level of motor planning sequencing of movements, and overall body awareness. Little man’s performance points to a mild difficulty in this area that is related to sensory input processing from joints and muscles.

Running Speed and Agility
Little Man scored below the average expected for his age group when tested on the subtest for Running Speed and Agility, showing some difficulty in this area. Items included a shuttle run and hopping activities. Little man managed appropriately with the shuttle run but showed some difficulty with hopping on one leg whilst stationary. He also struggled with items such as stepping sideways over a balance beam, and doing a two-legged side hop, which requires a high level of motor planning.

Results following a number of different tests

Little man presents with difficulty coordinating complex motor movements and higher level motor planning due to reduced vestibular-proprioceptive processing. These systems work closely together to give us a sense of where we are in space and of how our body works (strength, muscles, balance). He does not always rely on autonomic control and this means it will take him longer to complete tasks and need additional time to acquire new skills. His movements are not always refined and timed.This will directly impact upon his ability to produce handwriting at an age appropriate speed and develop more complex gross and fine motor skills that involve higher level motor planning and overall body configuration.

HANDWRITING

Little man held the pencil in his right hand with his thumb overlapping his index finger. He applied increased grip and writing pressure. He needed prompting to use his left hand as a stabilizer whilst writing. Little man sat on the edge of his seat with his trunk in flexion, leaning forward a lot.
Little man presented with some difficulty with handwriting, in particular letter formation and the spacing of his letters. His handwriting speed was also slow and appeared laborious. His increased writing pressure, poor knowledge of mechanical elements of handwriting and decreased planning suggests Little man must work extra hard to complete handwriting tasks, which involve fine motor control. It also indicates difficulties with sequencing and planning.This will impact significantly on Little man’s ability to complete written work in an expected time frame and to complete written tests on time.

Results of Little Mans sensory profile indicated difficulties with sensory processing and sensory modulation.
In addition the factor summary of the questionnaire indicated that Little man shows a Definite Difference with sensory seeking, emotional reactivity, low endurance/tone, oral sensitivity, inattention/distractibility, poor registration and sensory sensitivity.

Sensory Processing
Sensory processing refers to how we process sensory information from our environment and our bodies. We receive information from the following senses: touch (tactile); hearing (auditory); taste (gustatory); smell (olfactory); sight (visual); proprioception and vestibular. Little man has difficulty with sensory processing in all the above areas.

The auditory processing differences for Little man are apparent in the fact that he is distracted or has trouble functioning if there is a lot of noise around. It is reported that Little man appears to not hear what people say at times and that he enjoys strange noises.

The visual processing differences for Little man are apparent in the fact that he occasionally expresses discomfort with or avoids bright lights and becomes frustrated when trying to find objects in competing backgrounds. It is reported that he frequently has a hard time finding objects in competing backgrounds.

The vestibular sense allows a person to sense body movement, direction, and acceleration, and to attain and maintain postural equilibrium and balance. This then impacts on all areas of the person’s development and in particular, motor-co ordination. Little man’s difficulties in this area of processing are apparent in that he constantly seeks movement to the point where this interferes with his daily routine. It is reported that he spins or twirls himself occasionally throughout the day.

The touch processing differences for Little man are apparent in that he is sensitive to certain fabrics. It is reported that he expresses distress during grooming. Little man also has difficulty with standing in line or standing close to other people.

The multisensory processing differences for Little man are apparent in that he has difficulty paying attention and looks away from tasks to notice all actions in the room.

The oral sensory processing differences for Little man are apparent and that he will only eat certain tastes and prefers sweet food. It is reported that he is a picky eater and that he craves certain foods such as sugar drinks and coffee.

Sensory Modulation
Modulation is the ability to regulate/maintain arousal so that you can orient, focus attention on meaningful sensory events, and maintain an alert but relaxed state. It is this optimum level of arousal which allows us to function meaningfully within our environment. Some people have difficulty modulating sensory information. This can result in being over or under stimulated. We all have thresholds that need to be met by incoming sensory input. Without adequate sensory input we are unable to maintain an organised calm state. If an individual’s thresholds are too high they will need more intense input to meet their needs. If their thresholds are too low they will be easily overwhelmed. Little man is easily overwhelmed and becomes emotionally over reactive. It is reported that he easily becomes distressed at home and school when he finds situations difficult and overwhelming.

Conclusion
These clinical observations as well as the standardised assessments indicate that reduced sensory processing and modulation, and low muscle tone may be impacting on Little man’s ability to perform gross and fine motor tasks successfully.

Vestibular processing is our sense of movement and is closely related to the proprioceptive system. It tells us what direction we are moving, where we are in space and what speed we are moving at. Vestibular input can help to organise and refocus the body. Little man has some difficulty with registering and processing vestibular information, which is impacting on his co-ordination skills and ability to sit still for extended periods of time.

Proprioception is the understanding of where our limbs are in relation to ourselves. This information is provided by the stimulation of receptors in our muscles and joints. Proprioceptive feedback informs us where our arms and legs are without looking (e.g. being able to unfasten an apron that ties at the back).

When our proprioceptive sense works well, we make continual and automatic adjustments in our position. This sense helps us to stay in an optimal position in a chair; to hold utensils such as a pencil or fork in the right way; to judge how to manoeuvre through space so that we do not bump into things; to know how far to stand away from people so we are not too close or too far; to plan how much pressure to exert so we do not break a pencil lead or a toy; and to change actions that we are not successful with, such as the throwing of a ball that was off target.

Since proprioception helps us with such basic functions, difficulties in this system can cause many challenges for a child. Little man has difficulty with this and this is impacting on gross motor and fine motor tasks in all areas of daily living such as school work and play.

Low muscle tone relates to the tension of the muscles. A certain amount of tension is required to maintain positions and to allow co-ordinated controlled movements. For some children, the level of tension in the muscles is lower than other children of the same age, and so they require more effort to maintain the same positions/postures. Little man’s low muscle tone means that he would find it difficult to maintain a good seated posture for lengthy periods in the classroom setting.

Thank you WoodenToyShop Love Little Man

16 Jul

  It’s been a great first month, which is all down to the WoodenToyShop!

 For those who read the blog on a regular basis, will know that my daughter was featured as our first little helper in the blogs new feature, ‘ Santa’s Little Helpers’ that showcases some of the best and hottest toys form July to December! These little elf’s otherwise known as my three children will fully put all toys and gadgets to the test then give you their honest opinion and overall rating in-order to create the best Christmas wish list to be found online! Giving us her thoughts & inspirational craft ideas when reviewing the Melissa and Doug friendship stamp set from the WoodenToyShop, I found myself very proud of her professional approach when it came to being a toy reviewer (given that she’s only eight, over-excitement was kept to a minimum)

This week our Little helper is the one and only Little Man himself, sharing his thoughts on the… WAIT FOR IT…. DRUM ROLL PLEASE… “Children’s Large Wooden Cricket Set” from the fabulous online toy retailer, ‘WoodenToyShop’ I must state that  I did find this an odd choice what with the  fact he would have done almost anything to avoid a game of Cricket in the past! 

When the WoodenToyShop kindly invited us to pick something from the online catalogue I didn’t dream Little man would request they send him out a cricket set! It took him just seconds to score the content on the site before finally shouting, “Yes, this one please mum” I remember thinking, “What on earth…”For one I was stunned that he had spent so little time choosing! This is normally something that takes him some hours… admittedly he does get this from his mother, which only highlights my confusion that little bit more! The choice of a cricket set baffled me and for this reason I admit I didn’t email my choices right away giving it a few extra days convinced he would change his mind… If anything I would have bet money on it that this was going to happen sometime in the next few hours! However… realising that in-fact my son who has Aspergers syndrome, was in fact looking forward to the arrival of his new “Cricket Set” I got ordering, FAST… while secretly praying for a fast delivery given my delay he was already getting impatient. 

As his mother I then made the decision to embrace my sons optimistic attitude and over all willingness to try his hand at something new!

You may now ask yourselves, “What the hell has this got to do with the review of a cricket set?” when you go on to read the next part of this post, I promise, Its relevant, so stick with it! 

Some few months back I took the Little Man for an Occupational therapy assessment in London’s Harley street, where he was asked to perform a number of task requiring a demonstration of his ball skills. This would show the assessor how good he was at using his upper body “upper co-ordination” The Assessor would set a number of challenges to establish what difficulties if any, he has with both fine and gross motor skills and that of his sensory processing! Little man went ballistic, “I’m not doing this, its stupid!” he unpleasantly stated. I sat patiently as the assessor gave it her all trying to convince him to participate in the activities asked. I made a suggestion to which I so rudely received a one finger gesture before he slang me out the door. My son hated to be asked to do something if he knew it was something he struggled with. He would fall to pieces and panic. I could hear him so stubbornly  refusing, shouting, “You think because I have Aspergers I can’t do it! I hate all off you” Two hours passed before we finally left Harley street and headed home.

 All three toys arrived together I watched my daughter grab hers and disappear while I opened baby Harley’s (coming soon) However, Little man continued to watch the TV, he seemed to have lost interest… I feared this would happen! Two days later I came down and there it was hanging out it’s box, just as it was the day it arrived! Yes, I understood better then anyone that Little man could be an impulsive buyer, but he had continued to remain positive up in till the day the toys arrived.

Day 4… and the cricket set is still sat lonely and untouched in its box! Day 5 and movement was looking slim as I discovered it still sat there in its box getting dusty. With this I decided to leave it be for one more day, at a push two, then I would return the product, that or ask a family member or child’s friend to do the review, either way it seemed that little man wasn’t even going to look at the thing let alone review it. 

Day 6… I went into the hall to package up the cricket set and drop it at the post office before early closing in-order to send it back to it’s rightful owner but….

 “It was gone!”

 Following the faint sound of thumping I ended up in the garden where I stood, jaw on the floor and feet rooted to the ground… I saw my Little man stood there in his pyjamas swinging his bat back and forth, forcefully hitting the little red ball against the brick wall that was just about holding up this old house. He occasionally ran side to side as not to allow the ball out of his sight, trying hard not to miss. My little man couldn’t see me stood there tears in my eyes. The cricket set from the WoodenToyShop turned out to be so much more then a review of a toy, but it provided me with an insight and valuable lesson, “Have more faith in what your child can do!” I’ve always believed in him but from what I saw at the OT assessment and throughout the past I stupidly drew to the conclusion that he wouldn’t be that good a cricketer just as his mother isn’t! Shame on me!!

He was out there some hours, spending time on both his transport fascination and practising his ball skills. I kept going to the kitchen window to grab a peek and felt my heart leap with pride with every single trump of the ball against the rattling wall. He had a smile so huge, I melted… Deciding not to trigger any challenges I decided not to snap a picture in fear of being caught and didn’t even ask him to give any feed back on his new toy in fear of being told to sod off so I waited patiently just as I did at that OT assessment at Harley street. 

Day 8, I found this next to my bed…

“Dear Mangers of the woodentoyshop, thank you for sending me your cricket set. I really like it, its solid which is a good thing as I loath toys made of plastic, maybe that’s why mum thinks your a great toy shop. I didn’t like the colour of the ball and think you should make black ones. but that’s just an opinion rather than criticism. The ball did bounce off the way displaying amazing speed, I’m quite good and only missed a few times! My mum thinks I can’t do it because she has never seen me do it, she tells me I can do a lot of things and is always proud of me and my sister and brother but I’ve been practising for a long time with my school tutor who I miss because I now go to school, “The best school” The lady in London who mum took me to see, asked me to do this almost ruining my mum’s surprise! I even kicked her out the room, it was crazy! 

My score 1 Only joking 3… Joking again! 10 is my final answer, thank you WoodenToyShop Love XXXXXX XXXXX aka Little man.”

Shocked I grabbed my phone to call the OT but remembered it was the weekend which meant it wouldn’t be open! I checked my emails for her report  but was quite sure it wouldn’t be there as yet, it was to soon maybe! How could I possibly wait till Monday to make contact? Then right at the bottom of my inbox  I discovered an unopened email with an attachment, realising it was sat there unopened in my inbox… just like the cricket set and for almost the same length of time. 

I downloaded and opened it, It was the longest report I had ever read. My son had areas of difficulty in all seven of his senses, bilateral co-ordination, running speed and agility, fine motor precision, fine motor integration amongst others… I read that he had very low muscle tone, and was struggling to cope with his sensory processing mainly due to his extremely sensitive senses. This was of course a lot to take in as his mother I knew that this report was going to shock me and upset me a little… But then I noticed what I had first come looking for..

 “UPPER-LIMB CO-ORDINATION… This test comprised of eye-hand Co-ordination activities such as throwing and catching a tossed ball, dribbling a ball and throwing a ball at a target. XXXXXX displayed excellent ball skills and managed appropriately with throwing and catching a small ball using two hands and with one hand, and also managed well with dribbling a ball while alternating hands.”

This was said to be his strength, I was blown away! Yes, he will need a programme that is devised by his OT and implemented throughout his school day by teaching staff as well as six individual OT sessions a term from a professional OT each lasting 45 minutes each, Yet just this one thing above was all it took to prove that my little man had the ability to make me eat my own hat. 

For me it was fate, God delivered us this cricket set for my Little guy to display his skill while delivering my surprise (No, I’m not a big god person, but you have to admit this was as if he was being rewarded for all his hard work) If I could give this product a rating of 100 I would… The maximum ten is what it will have to be then. Perfect for any child who loves ball games, or just wants to improve and practice in the back garden. It’s simple design with just a small logo/image, but mostly plain… that for us was perfect, extreme colours or patterns would have sent Little man into a sensory overload. For all those artist, paint it, go crazy with a spray can, my daughter would! Of course the set allows you to Play alone or with others, it has four stumps allowing some good old-fashioned rounders. Little Man can build up his confidence and hopefully as his social skills improve he will start to challenge others. With the ability to build social skills, improve eye-hand co-ordination and healthy exercise… For under a tenner its got to be a winner.   The large wooden cricket set has an astonishing price tag of just £6.95 10/10

The woodentoyshop.co.uk is still right up there in my opinion and remains a 10/10 top marks for a site that is fairly priced, offers a discount day via a code from facebook page or twitter (Fridays) Best of all… A discount for nurseries and schools accompanied with the chance of winning all the returned but undamaged stock that can no longer be sold due to the fact its been opened (completely safe and usable condition, draw is done on a monthly basis)

 Be sure to return for the Competition to bag your child an awesome gift from the WoodenToyShop, while supporting my first ever give away!

Visit the WoodenToyShop blog for product reviews, new lines, guest post and more.

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