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Dss had their OT evals today

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And I am surprised *and* confused.


Ds8 has obvious visual-perception problems, which I thought were fine motor skills problems (handwriting, tying his shoes, pouring things, etc). The OT said it was all due to his visual perception and it makes sense to me.


Ds9, who *had* v-p problems when he was 5, now does *not* have them. ??? Does this sound valid? I mean, the way she explained ds8's issues, he would never "outgrow" them, but practice and learn how to cope better.


She said his reversals with reading and writing may be "academic" What does *that* mean? Does it mean, Mom isn't teaching enough? Or, ds may just have academic issues? I couldn't get a real detailed answer out of her.


Both dss had to write upper and lower case, the entire alphabet. Ds8 had trouble with a few letters, but got it all. Ds9 had to sing the alphabet song each time he went from letter to letter; couldn't remember how certain letters were formed; asked several times if a letter went "this way or that way" (meaning, backward or forward). The OT helped him with that, but then told me at the end that ds didn't have any significant reversal issues. ???? How could that be properly assessed if she gave him hints and clues?


I don't understand how ds9 *can't* track when reading, still reverses, but doesn't have significant v-p issues.


I was also disappointed because I had specifically said that ds9 had sensory issues. When the OT said the session was done, I asked "What about the sensory issues?" She said she didn't see any. ??? All he did was throw a ball, jumping jacks and a push-up, and sat at a desk and wrote with a pencil. What types of sensory issues did she expect to see with that? Am I missing something?


She said she didn't think his sensory issues probably interfered much with life. I said YES they do. And explained to her what was going on with him. She said we'd have to do the sensory evaluation another time, as it takes a while to do. ???? How did I not make myself clear about that being one of my main concerns?


I don't know... I have to admit, I haven't ever had this done before, so I know nothing. Ds9 spend a LOT of time doing three paper booklets for v-p issues, even though she didn't think he had any. She said he copied drawings that are aged for 14years.


So.... what am I missing, not understanding? What sense do you make of it? What else can I ask for? Etc., etc. And WHAT does "academic" mean, exactly?

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That is confusing.


"Ds8 has obvious visual-perception problems, which I thought were fine motor skills problems (handwriting, tying his shoes, pouring things, etc). The OT said it was all due to his visual perception and it makes sense to me."


Doesn't make sense to me. Difficulty pouring is likely a motor-planning problem, could also have to do with the vestibular sense. The problems as you list them are visual-motor problems.



"Ds9 had to sing the alphabet song each time he went from letter to letter; couldn't remember how certain letters were formed; asked several times if a letter went "this way or that way" (meaning, backward or forward). The OT helped him with that, but then told me at the end that ds didn't have any significant reversal issues. ???? How could that be properly assessed if she gave him hints and clues?


I don't understand how ds9 *can't* track when reading, still reverses, but doesn't have significant v-p issues."


It doesn't make sense to me either. The "might be academic" would have to implying lack of iappropriate nstruction; it couldn't relate to LD's because the LD would be in visual-perceptual, KWIM? Does he have symptoms of dyslexia? There is a kind of dysgraphia that actually isn't related to v-p issues, but is there because the kid has dyslexia and can't process EVERYTHING at once. It sounds like your son also lacks an "internal map" of directionality. OTOH, it is interesting that his ability to do the v-p drawings is so advanced.


It's not unusual that she couldn't evaluate the sensory issues at the same time; however, I'd be concerned that she so quickly pronounced him as "not having sensory issues."


imo, a good evaluation should square with your sense of who your child is. You are having warning flags go off about this eval. She helped him with letter formation, yet pronounced him free of difficulty with reversals. She didn't do what you would expect for the sensory piece. (She should have been able to observe some things from the ball-throwing, push-ups, and jumping jacks, however. The sensory integration stuff is usually dx'd by a parent checklist plus OT observations. With my son, one of the key things they did was to spin him around. They had him do all kinds of motor planning activities, do balancing things, go through tunnels, things that are like a roller for human beings, etc.


I would ask your specific questions. "I'm confused about how you said ds9 doesn't have reversal issues. I heard him ask you how to make certain letters--which way they went. How could ds 9 have recovered from v-p issues, but ds 8 never will? How do you explain that ds 9 is so exceptional in the drawings, but can't write well? What did you do to rule out sensory integration issues?


Or, if you really have no confidence at this point, try somewhere else. When someone's eval jives with your experience with dss, that's the sign that you've gotten a good one.

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I have just been on the verge of tears all night. This is *why*, if you remember my post a few days ago about taking my 14yo to be evaluated, that I am leery of this whole process. Some people can just make you feel "less than", you know?


To answer some questions: I filled out a two-sided sheet for each boy. It was basically geared towards: Is this an injury? kind of thing. I talked with the OT on the phone when she called to schedule and we talked during the process as well. But no, no long forms or anything like that.


When we first me this morning, she said, "The speech therapist filled me in a little and told me you homeschool...." and right away, the way she said "homeschool" just kind of set me on edge. It wasn't a sneering tone, but it was just "there". I'm sure you KWIM.


I don't really know what to do. This is a TINY therapy dept in a small rural hospital. There is one speech therapist, one sensory-ped. OT. There is also an OT asst, but I did not meet her today. The OT who did the evals today is leaving Friday and a new OT will be taking her place in August. Not sure there's much sense in even talking with her at all, since she's leaving. Though I would LOVE to call her and discuss the "academic" thing and assure her that my NINE YEAR OLD son does not need to sing the alphabet song because *I* do not teach him well enough. He sings it because it's the only way he can keep it in sequence when he's interrupted. And that he may not read at grade level, but he reads a WHOLE lot better than he did before, thanks to ME. Grrrrr.............


I am looking over ds9's eval from when he was 6y9mos (follows in blue). Main points then were: Ds maintains sporadic eye contact but speaks clearly; mood indifferent and affect blunted; struggles to understand and apply directions; no signs of impulsivity or hyperactivity; overall cognitive functioning falls in low average range with equally developed verbal, perceptual reasoning and spatial processing skills; poorly developed ability to visually manipulate objects into meaningful parts. (WISC-IV)


WIAT consistent with his overall cog. functioning in the low-average range. After a year of public school kindergarten, he was still at pre-kindergarten range in areas and they planned to detain him.


Visual motor abilities (Bender Gestalt Test) below average range = 5y3mo. Mild delay with difficulty spacing drawings, making sense of space, and perseverating. These difficulties strongly contribute to his poor handwriting, difficulty writing his name and letter reversals.


At that time, his AXIS I: was Academic Problem (V62.3)


So... now... 3 years later with only a little bit of language therapy, ds suddenly no longer has ANY of these issues?


Also, today while ds8 while having his OT eval, ds9 was being re-evaluated by the speech therapist. She told me now, somehow, ds9 has jumped SIX MONTHS in his lang. abilities (mainly, single word contexts and grammar). How did this happen? NOt that I'm not thrilled, but I gotta tell you, I'm scratching my head a little over that. He has seen the ST 2 or 3 times and we've been done with school over a month now (so we haven't been doing much that way). ????


I don't know... I'm thinking right now I'm going to wait till I go to the neuropscyh. in August and see what HE says. Question: Would you take along the OT and ST reports? I can't think they'd be helpful. Or would you wait and see what the n.p. finds?


*SIGH* If I knew what to do for them at home, I would. It's hard, too, because dh doesn't get it. I was trying to explain it to him again tonight and he said, "repitition" would be the answer to all of dss' problems. He's a kind, loving dad but he doesn't want to see it, I know.


If you read this far, THANK YOU! You're wonderful people here!! :):)

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The way the OT "tested" ds8's fine motor skills was to have him spell his name in sign language. He breezed right through. Unbeknownst to HER, his older sister has taught him some sign language and taught him how to spell his name.


She said that since he didn't have any problems forming the letters, it showed her that he does not have fine motor problems. Also, he held his pencil "correctly".


For motor planning, she said that since he dropped some things under the table and picked them up without banging his head, that showed her that he does *not* have motor planning problems. (I had shared with her that he often doesn't seem to realize where his body is... stands too close or if he's carrying a baseball bat on his shoulder and swings around, might not realize he's going to clobber someone... etc).


I told her that ds has trouble tying his shoes (takes him a long time, doesn't seem to be second nature by now, has trouble with knots), spills things, has trouble opening caps and jars.... She said nothing about trouble opening things but that shoe-tying is v-p as well. ?????


I've got to to stop now... It's making me almost sick to my stomach. *SIGH*

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If you were *me*, and considering that Friday is the OT's last day and a new one will be taking her place...


Would you call and discuss the whole thing with her? How about the "academic" inference?


I just think that I haven't really been super-happy with the ST (I've posted about that before) and now the OT there. Is it worth it or is it just time to move on (after the neuropsych evals)?


The n.p. is two hours away from us, but from his website it seems he has a "team" of ST, OT, etc. that he works with. Not out of his office, but for example, the ST is in a large University in their speech dept. So he has those he refers people to. It is 2 hours or so from us, so it would require travel. But perhaps it would be a situation where they could teach *me* what we need to do at home, and only go in once a month or less often, as needed?


And I have to say, I just HATE it when I feel like the 'professionals' think I'm lying, embellishing, or trying to make my dc have a dx. :confused:

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The evaluation you got with the reasons that you got would lead me to think that you got a poor evaluation by an OT without enough training.


I am really sorry for your experience, but don't read it as something about yourself. The OT honestly doesn't sound like she knows what she is doing. Given that she will be gone, I would wait for the next one. Go to the n-p and get the evals from his people (if you feel like he is good) and then come home and give those results to whomever you're working with.


As far as the jump in speech, those things can happen that way. I've noticed that time off can actually help those jumps happen, so I wouldn't discount it.:grouphug:

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that ds does indeed have some v-p issues (and whatever else).... How would you go about phrasing a request for a new evaluation? (I'm a chicken-little.)


I like to keep people happy and liking me. Since I struggle with my feelings of "lack" in the homeschooling area, I can tend to be a wimp when it comes to these things.


So... since I do not want to continue to be a wimp, but also don't want to be pushy, what are some ways you'd suggest asking for an eval? How much would you explain about *why* you want another one? And perhaps the n.p. eval will show many of the reasons why I would ask for a re-eval.


How will the new OT take the former OT's evaluation and recommendations? I'm sure a good, objective therapist would re-evaluate and come to his/her own conclusions, but that probably isn't always the case. How objective do you think the same office would be in re-evaluating if the initial evaluation showed no problems?

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I'd check out the background of the OT's where you're neuropsych is. OT's specialize in many areas, such hand rehab, adaptive driving for the handicapped, stroke rehab and sensory problems. But they aren't banned from working in other OT areas if they lack training. If you can, have an OT evaluation done by an OT experienced or certified in Sensory Processing problems. It would probably be easier for you to present the new OT in your community with new OT findings as part of the Neuropsych exam.


I have heard of one person who had a home-based OT program designed for her by an experienced OT. If the OT's 2 hours away aren't comfortable doing that, they may be willing to coach your community's new OT to help you out.

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When I called the OT dept., I made sure to specifically ask if the ped. OT was trained in "sensory integration" therapy. Yes, they said. Which is why I was REALLY surprised she "diagnosed" my son as having no sensory issues without any type of questionnaire at the very least.


What else should I have looked for?


Also, my dss are very polite, quiet boys in a new social situation. After ds8 got to know his ST better, he didn't mind so much telling her that he hates speech therapy or that he doesn't want to do a certain exercise. But, on first meeting, my boys will be compliant and not have meltdowns in front of a total stranger (usually....).


Perhaps that is part of the problem? I don't know... I've been told that *I* myself have a poker-face and can mask my pain well. Perhaps my boys have a "game-face" in new situations. I don't know.. Maybe that's just totally ridiculous... :D Just grasping at straws here. :001_smile:


I'll be leaving soon for a week's vacation, but I'm interested to know if you have any other suggestions for me. I'll check when I get back!

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I know many have mentioned filling out extensive questionaires for their OT, but my OT didn't have me fill out any questionaires, although I did talk to her a lot during the early stages of therapy. My ds's OT also used a formal SID testing program that normally took 2-3 hours. This test, not often offered from what I've seen here, can't be "poker-faced". It will reveal problems. I remember such activitites as block building, mimicing block construction, patty-cake-type activities and a sit-n-spin. Unfortunately I don't remember many details because it's been years, but I do remember there was no writing. My ds was 7.5 at the time and in the 2nd grade.


When checking out a new OT, I'd ask if she's certified in Sensory processing problems and get the details, what formal classes she's taken and how much hands-on training and work experience under a certified SID OT she's had. I'd also ask for SID patient references.

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