evaluating therapy goals

[srs]

I am meeting with DD7's therapists tomorrow to set goals for next year. Does anyone have any insight about how their goals changed as a child got older, or if there were any regrets/words of wisdom for deciding how to proceed? I am not really sure how to balance therapy with schoolwork, or how long it is useful to do OT and PT, or if at some point the gains are not worth the time and expense. Obviously seven years old is still young, but I think I would feel better if I had a better idea of what to expect going forward. For instance, do adolescents make any gains with handwriting, or at some point will it not get better, and what age is that? I have heard age eight mentioned for things like walking and gait pattern, but I'm not sure about fine motor ability.

[Julie of KY]

For instance, do adolescents make any gains with handwriting, or at some point will it not get better, and what age is that?

Every child and circumstance is different and you have to be the judge of your child's gains.

 

As far as IF gains can be made late, it certainly can happen. My oldest has been evaluated by multiple OT's who have said they cannot help him. Neuropsych eval diagnosed dysgraphia and has accomodations including a scribe. This year, at age 15, he is making great strides in handwriting now while in vision therapy.

 

I don't think you can plan too far into the future and it is hard to predict where you will be a year from now.

[Lecka]

I think you might be able to ask the OT and PT.  

 

My son was in OT for a year, in school and private.  They both agreed to exit him at the same time.

 

They told me they think he has dysgraphia, but that doesn't mean he won't continue to make improvements as he gets older.  They don't know how much better he will get, it varies.  But there is no reason to think he will not make improvements with maturity and stuff.  

 

But for him they had some guidelines for him exiting.  Part of it was that he was not seeming to make more progress, part of it is that he did get above the 10th percentile.  

 

He has not had anything where he would not make progress after age 8.  As for gait ----- if a professional is saying it specifically about your child, I would believe it.  My cousin with Aspergers has had improvements in his gait even as an adult, though!   He has just slowly gotten more fluid and less jerky, and he is more coordinated.  It has taken him longer, but I can tell it.  So I do not believe that as a blanket thing in every case, I am not sure if there is another meaning of gait, I just mean how smoothly he moves.  The way he places his feet and swings his arms may not have changed.  

 

In general, too, there are SO many people who have been told something will not improve, and then it does.  So I think there is a big middle ground between pessimism and optimism where it is good to be hopeful but also to think things will be okay.  

 

As far as a decision to discontinue therapy on your own, before OT/PT suggest it ---- I think if gains are not coming, or the child does not like it, those are reasons to really think about if it is worth it.  But I think you can see that when it is happening, and think about what to do.  But those are two things to watch out for I think.  

 

There is also logistics, if that is stressful, that is a possible problem.  Also, being too busy or too tired to be able to do other things.  When therapy is going well I think it is worth it, but if it is not going as well, I think those two things can be very important.  

[Jennifer-72]

We have tried to involve ds more in the goal setting process as he has gotten older. For instance ds wanted to learn to skateboard, but I knew given his motor planning troubles that was going to take a lot of persistence and time on his part. Our PT and myself suggested to him we start with inline skating and once he was proficient at that he would have lots of beginning skills towards his skateboarding. Our lovely PT broke down all the steps (who knew there were so many!) involved in learning in line skating and I hung it up for ds on his "goals I am working on now" poster. It was so helpful for him to see that he was making progress every week towards a longer term goal and was very motivating for him. He accomplished that goal much quicker then we anticipated and is doing great in working towards his bigger goal of skateboarding.

 

Even if your PT is working more on functional motor skills vs doing the skills through sport, linking them to goals your daughter has makes them far more meaningful for her. I think many people find therapy less effective for older children, mainly because many children are resistant to the therapy and don't buy in to how it can help them. So if you start now and help her towards her goals I think she will stay more motivated and ultimately get more out of it.

[srs]

We have tried to involve ds more in the goal setting process as he has gotten older. For instance ds wanted to learn to skateboard, but I knew given his motor planning troubles that was going to take a lot of persistence and time on his part. Our PT and myself suggested to him we start with inline skating and once he was proficient at that he would have lots of beginning skills towards his skateboarding. Our lovely PT broke down all the steps (who knew there were so many!) involved in learning in line skating and I hung it up for ds on his "goals I am working on now" poster. It was so helpful for him to see that he was making progress every week towards a longer term goal and was very motivating for him. He accomplished that goal much quicker then we anticipated and is doing great in working towards his bigger goal of skateboarding.

 

Even if your PT is working more on functional motor skills vs doing the skills through sport, linking them to goals your daughter has makes them far more meaningful for her. I think many people find therapy less effective for older children, mainly because many children are resistant to the therapy and don't buy in to how it can help them. So if you start now and help her towards her goals I think she will stay more motivated and ultimately get more out of it.

 

Thanks, this is helpful to think about. She has started to develop her own athletic interests (dance class has been a big hit), and I can see that being a good motivator.