occupational therapy

I read your message with interest. My son did receive services outside of the school setting at a private OT. Our doctor did approve it. We went for a check up and I presented my case to the doctor. He got an okay for the evaluation for OT services. Give it a try. The difference it made in his art work was tremendous. He now enjoys working in art. It also helped with his writing, too. He still has some written expression problems. These center mainly with spelling.

I was able to get a private occupational therapy evaluation from our HMO based on a referral from our GP. We have had the same GP for years, so all I had to do was call him on the phone.

Our HMO would have paid for therapy if my daughter’s problems had been more severe.

If you do get a private evaluation, the school has to take it into consideration.

One thing about a private OT is that often they will teach you how to do exercises at home that are helpful. You might also ask the school OT about this. Someone posted quite a few of these over on the Special Needs bulletin board at http://www.vegsource.com. Some examples I can think of offhand are working with modeling clay to strenghten hand muscles, picking up beans one by one, etc.

Mary

30 minutes is fairly standard for OT in schools and yes, it does help. If youa re concerned perhaps the OT could send stuff home with you or give the teacher some tips. Integrating into regular education actually does work better.

HMO coverage varies by state. Call and ask if OT is covered, if there are any restrictions (many plans state either medical necessity or restorative nature). An evaluation is usually covered regardless but always ask. Get it in writing. I cannot emphasize that enough. I work in a private therapy clinic and you need it in writing for your own protection. Don’t worry right away about the restrictions, talk to the OT who does the eval. if you have them. By and large you are better off with a PPO if you can get it and need long term therapy.

If the OT is conscientious, she should be supplying both the teachers and parents with strategies for this child. As a classroom teacher, I’ve learned a lot about OT from consultations about students under my care.

Continuing along with what Mary MN had to say, you might want to find a book which offers Montessori exercises at home. Many OT’s feel that the Montessori primary classroom offers all the right elements for both gross and fine motor practice. There are several books in print that explain these exercises. I’m sure a search of Montessori online will turn up a bunch of hits.

Just remember that Montessori materials are not meant to be used as “exercizes”, per se, but materials available to the child within a prepared environment. They hold the child’s interest during their “sensitive period” for that type of work, but they are never used for drilling a particular skill. There are also many, many diferent materials that are made available that exercize the mind and body in similar ways, so that children can move from one set of material to another and remain interested. It’s hard to use Montessori materials in isolation and achieve the same effect as the prepared environment of a Montessori classroom.

That said, a lot of the materials are easy, teacher-made activities. In Everyday Living, for instance, there are many pouring and scooping activities that work on eye/hand coordination and fine motor skills. Finding marbles in a big bowl of dried beans or rice, or moving pegs in a peg board or clothes pins from one rope to another help with pincer grasp. Playdoh is good for strengthening weak hand and forearm muscles. If you use a little imagination, a lot of this kind of activity can take place in your own kitchen.

Pre-writing materials (called “preparartion of the hand”) include sandpaper letters that children can trace with their fingers, or use to produce rubbings. Pin-punched shapes are a great way to work on fine motor skills, and are fun for kids that don’t yet have the skills to cut accurately with scissors. Metal insets are a Montessori material that are basically metal stencils that guide a child’s hand through basic geometric forms.

Karen

Sorry, I never meant anyone to take what I wrote as meaning that these should be drill exercises. I’m a Montessori trained primary and elementary teacher. But way before I ever became a Montessori teacher, I came across a book called “Montessori On A Limited Budget” at a tag sale. It’s full of ways to create a Montessori environment within the home. I used that book to set up my home ala Montessori and that was the beginning of a life-long love of Montessori.

The philosophy, of course, is the most important thing. While you don’t drill a child in any activity, you DO present the materials before allowing a child to explore on his/her own. This means that you demonstrate how to use them. Once a child has had that demonstration, then the child is free to choose that work over and over again. It IS important that it be presented however.

All the pouring, spooning, tweezing, sweeping, washing, scrubbing, etc. exercises (uh-oh, there’s that word again) are perfect OT work for young children and very easy to set up within the home. As young children, my kids loved those activities and when their friends came to play, they all couldn’t wait to get their hands on these materials. Nice and cheap too.

Virtually any of the ordinary home “practical life” experiences can translate into good OT work provided the items used are sized appropriately for the child. but I do strongly recommend getting any of the Montessori books available (Paula Polk Lillard has some good ones) that explain how to use this philosophy within the home. In the book, “The Clumsy Child: A Program Of Motor Therapy”, Daniel Arnheim and Wm. Sinclair strongly recommend Montessori for children who need gross and fine motor therapy.

I found something I’d recently typed up for a friend about setting up some Montessori activities within the home. Here they are:

Pouring and scooping activities are great but be sure the items used aren’t harmful, of course. Flour for a toddler, of course, would be dangerous unless you’re right there, because of risk of inhalation. Likewise, if your kid is the truly experimental kind who likes to put beans up her nose, you might want to wait a little longer on some of these or make sure your items can’t be inserted into a nostril or ear. (Throughout my years as a Montessori pre-school teacher, there was always one kid in a class who liked to try this).

Some pouring activities:

Aim: To develop large and small muscle coordination as preparation for reading and writing, develop some experience with volume, and to use as a sequencing activity.

Things to pour:

Dry beans like kidney or lentils
Rice
Small macaroni
Beads or pebbles

You want to start out with items that make a small sound when being poured for the auditory sense.

For each item to be poured, use a pair of small 1 cup attractive (if possible) pitchers or cups kept on a little tray. After a couple weeks, vary these, using other sizes and shapes of pitchers or cups - handles, spouts, or wide or narrow lipped, etc.

Demonstrate this to your child at first. Show her how to hold the pitchers when pouring. Stress doing it slowly. While you demonstrate, don’t say a word. Young children are very sensitive to the sound of the activity as well as the visual. They’re often riveted to these silent mini-lessons and can’t wait to try it themselves.

As your child develops, whenever possible, use something related to real life: pouring cereal, filling a sugar bowl, pouring coffee from the package into canister.

Eventually you can add a degree of difficulty by having the child transfer these same items listed above by using, at first, a Chinese ladle (perfect size for little hands), a little scoop, or spoon. Instead of pitchers, you’re now using small bowls. Initially you can use little pom-poms or nuts as the items to be scooped. Tongs are great for transferring nuts from one bowl to another. Colored popcorn can be sorted with tweezers as your child gets older.

Progress pouring activity to wet items such as colored water, juice or milk. Kids love to learn how to use a baster or eyedropper to transfer liquids.

Always keep a couple of these activities available to your child. They should be kept on a low shelf, with the pair of pitchers or bowls on a little tray. The pitcher holding the items to be poured should be on the left so the activity moves from left to right, the system used by our culture for reading and writing activities. This facilitates the visual eye development that’s necessary for reading and writing.

Always keep a little damp sponge (cut a regular one in half) on the tray of wet pouring activities so your child can wipe up her mess. The first time you put this sponge out, demonstrate how.

My kids’ favorite activity as toddlers was to run their hands through a huge Boston bean crock filled high with kidney beans. They’d stand in front of this pot kept on a low table and run their fingers through it for long periods of time. If you try it yourself, you’ll get a sense of what they feel. It’s very soothing. Listen to the sound of the beans running through your fingers, feel their smoothness. Tactile heaven.

Cleaning and scrubbing activities are really fun. Again, work from left to right in scrubbing. Use a small scrub brush, sponges, rags. Emphasize any pre-writing movements - large circular arm movements, lower case cursive “e’s”. Your child can scrub floors, tables, sinks, etc. Some kids can scrub for an hour at a time!

Dusting activities, sweeping activities are all good. I made a masking tape outline about one foot square on the floor as a place for my kids to sweep crumbs into. They really need that kind of focus or else they’ll just sweep any which way. Of course buy a small broom and small dustpan and brush.

My all-time favorite activity is baby-doll washing. I used to keep a plastic bin readily available. Inside it was a plastic baby doll, a little scrub brush, a small sponge, a little bar of soap on a soapdish, a pitcher, a bucket, and two dry towels. I modeled how to do this the first time, of course. One towel is placed on the kitchen floor and the bin is put on top of it. Child lays out all the supplies on the towel, uses the pitcher (with a masking tape line on it as a marker for how high to fill with water - kids don’t yet have this sense of fullness) to get water, pours water into the bin and proceeds to wash the baby doll with a scrub brush and soap. Kids love this! Child fills pitcher with more water to rinse doll, wipes doll with second dry towel, then (this part needs your help) child lifts bin and pours water into bucket and brings bucket to bathtub or sink to dispose of water. Child then proceeds to clean up by using sponge to wipe extra drops of water off bin, puts all items back into bin and, if you’ve got one handy, hangs now damp towels on little drying rack using clothespins, another great fine motor function.

Folding activities: My kids used to like folding cloth napkins and towels. I’d show them how to make just one fold. They esp. like to take towels they’ve used off the little drying rack and fold them up. It gives them a sense of ownership and orderliness.

Even the tiniest of tots want to feel useful so whenever possible, use real life experiences where they can “help”.

Sorting activities:

Briefly, anything you can think of. My kids’ favorite things to sort were old buttons. I have a canister filled with buttons of all varieties. Kids from tots on up to my 3rd. graders have always loved sorting buttons into piles based on color or size or both. Seashells also make good sorting activities. So do screws, nuts, bolts, nails, colored beads, a variety of edible nuts, beans or dry pastas. This is another visual and tactile activity that’s preparatory for reading/writing.

Hi Joan,

I’ve read enough of your posts that I didn’t think you were suggesting Montessori materials for drills, or use in isolation. I just wanted it to be clear to other people who were reading.

>>All the pouring, spooning, tweezing, sweeping, washing, scrubbing, etc. exercises (uh-oh, there’s that word again)<<

That’s the problem with Montessori seen from the outside. It’s so hard to describe from the outside what wonderful benefits there are. I live in a town that is fortunate to have Montessori as an option for our elementary aged children in the public school system. (although my kids went to a private Montessori pre-school) It still amazes me how many parents in our town don’t want their kids in Montessori, and the “reasons” amaze me even more. About half say that Montessori isn’t “structured” enough for their child… the other half say that it’s too “rigid.”

>>Virtually any of the ordinary home “practical life” experiences can translate into good OT work provided the items used are sized appropriately for the child. <<

I found it amusing (it was the only part that WAS amusing!) when I had months of OT after severing tendons in my right hand last year… I felt like I was in a Montessori classroom again!

>>In the book, “The Clumsy Child: A Program Of Motor Therapy”, Daniel Arnheim and Wm. Sinclair strongly recommend Montessori for children who need gross and fine motor therapy.<<

Since you are an educator, and Montessori trained as well, I’d be interested in your views of Montessori as an appropriate educational setting for NLD children, particularly in the preschool-lower elementary years. As I’ve mentioned my children have both attended Montessori classrooms since they first started school. When my older son was dx’d as NLD between 3rd and 4th grade, the neuropsychologist was aghast that he was in a Montessori classroom, which she felt taxed his weak areas too heavily.

Learning what I have about NLD, I can see where her concerns were. But I also feel very strongly that the Montessori environment with good, caring teachers who were flexible enough to address his unique approach to the environment is what has helped him function in many ways better than his testing might suggest. I think this is a direct result of the fact that his weak areas always HAVE been challenged in a supportive, “therapeutic” environment.

I look back on my son’s early reports, way before we knew anything about NLD and realize that his teachers were seeing, (and reporting, though they didn’t recognise the significance) some of the problems that would eventually lead to his dx. In particular, I remember a conversation with the head teacher in his 3-6 classroom. She told me that one of the other teachers had come to her and said that she wasn’t sure how to handle Robbie. She knew the Montessori philosophy, especially in the 3-6 period was to let a child use a paticular material until they wanted to move on, since this is one of the signs that they are in a sensitive period for that type of work. But she had noticed that Robbie NEVER moved on on his own. The head teacher told her that with this child they HAD to gently move him on to another type of work, because he seemed to get “stuck”. How prophetic those words turned out to be!

I’m sure it would have been easier for my son to sit at a desk in a traditional classroom and be handed work sheets to spit out one after another. But I don’t think it would have been as good for him educationally.

What do you think? Have you worked with any NLD children (or chidlren you suspected might be?) in the Montessori classroom?

Karen

This is very interesting indeed! My daugther is so tactile and cannot keep hers hands off of things even at times her food she wants to arrange a feel. My other two kids have never done this. With her LD I wish I had known more about this years ago. She sees an OT once a week for 30 mins too and I really don’t think it does much good. I would love to learn more about things I can do at home. I put her in ballet and the teacher is so wonderful with her. But I would like to know more about this part of my daughters disability. She is in the 5th grade this year. Are there any good sites I can check out? My HMO would not pay for it. They frenquently tell me “its the schools job”

JanineKay

My son was tested last year by the ps with a Visual-Motor Integration test. They reported his score as 50% percentile (which should be average). Well, since my 8 yr. old son cannot tie his shoes, can barely write, etc., I asked his pediatrician for a referral to a private OT. They tested him and found him to have a 2 year delay in visual-motor & fine-motor skills. I find it hard to believe that the ps testing was accurate. I don’t believe he had normal visual-motor skills 9 months earlier (acc. to the ps), and all of a sudden developed a 2-year delay.

Our HMO is now covering the private OT & we make a $10 copayment. Unfortunately, our HMO will only cover 4 weeks of OT for 2x a week. The OT said in her evaluation report, that he will need to keep doing home therapy afterwards, and is showing me what to do, has given me a dozen handouts on home activities, provided me with Theraputty, etc. I am always asking her when she uses materials, should I purchase this for at home & she explains what she is doing so I can do this at home. (We just finished up our first week.)

I would ask your OT to provide you with handouts, and information on things you can do at home, because I think most children probably cannot get as much OT time as they really need through ps or private.

Karen,

Yes, I’ve worked with some NLD kids as well as some whom I suspect fall into that category. I think you nailed it in your comments about the “good, caring teachers who were flexible enough to address his unique approach to the environment.” Even Montessori is only as good as its teachers. But Montessori is lucky because observant people gravitate to it since the hallmark of the program lies in the ability of the teacher to constantly make careful observations of individual students to see what their needs are and to find a way to stimulate them.

There are some ways that a Montessori environment works really well for NLD kids and some areas where it can be difficult without a whole lot of work and understanding from the teacher. I think one strength is with all the math manipulatives. A child can explore them over and over again. The NLD kids really respond to these materials and do well with them, often much better, in the earlier levels, than the other kids. Another strength is all the gross/fine motor activities at the preschool level.

As the work moves towards abstraction (end of third grade, beginning of fourth), that shift can make it harder for the student. At that point, yes, the student will do “better” in a traditional classroom but frankly, I think you’re right when you say that spitting out all those worksheets isn’t necessarily a real education. The NLD kids in the schools I’ve been associated with have continued to do well through their middle elementary years in large part because their teachers have always been willing to individualize the program for them.

In Montessori classrooms of all ages, we have the freedom to give individual homework assignments or none at all depending on the child. Same with classroom lessons. We might give everyone the same lesson but then the children have a follow-up assignment to work with the materials over the next week. During that time, one of the teachers can check in with the NLD child to give him/her add’l lessons or to clarify or adjust the lesson to the child’s development.

NLD kids often struggle in the visual/spatial/organizational realm. Because Montessori is all about students being in charge of their own work and taking initiative, one might expect -and this is what the neuropsyche was probably thinking - that an NLD kid wouldn’t find much success in such a program. Actually, that hasn’t been borne out in my experience with these younger age levels. Most of the NLD kids are “married” to their assignments and work records if their class uses them. These kids really like the satisfaction of ticking off their assignments and they do tend to get “stuck” in their daily routine. Some of this is really good in terms of work habits. They have an orderly flow to their days. They can repeat a lesson as much as they need to understand it. Some of the other non-NLD kids struggle with this and would benefit from such work habits.

Most Montessori classes in the elementary level have, somewhere in the classroom a calendar of the activities and lessons throughout the week. The NLD kids look at that calendar a lot. They know that, for instance, math lessons are on Mondays and they see to it that the teacher gives that lesson at the exact time it states on the calendar!

This is one area where an NLD kid might really have a hard time: flexibility in terms of the classroom ethos. I’ve known NLD kids who just don’t “get it” - why is it OK for so-and-so to talk now but it wasn’t OK three minutes ago? etc. They want the rules to be entirely consistent at all times and can’t understand when flexibility is needed. It can move some kids to tears. I’ve found that it’s best to provide a very concrete reason when they’ve come to me upset about such matters. They will accpet the concrete reason. They’ll have difficulty getting the “feel” of it.

Another area of struggle for NLD kids can be in the realm of reading/writing. Some Montessori schools don’t have learning specialists and some don’t have a reading program per se other than whole language. That’s changed a lot with all the current knowledge about the failures of whole language but I still know some schools and some individual teachers who don’t really teach reading. Many Montessori schools are adopting Reading Reflex or Lindamood-Bell as their reading program in the early elementary classes because both fit in so well with the Montessori philosophy. A child with NLD who isn’t in a school with a good reading program and/or a learning disabilities teacher would be at a real disadvantage.

Montessori teachers are generally pretty good at accepting kids for who they are and working with them at whatever level the child is at. The Montessori classroom is set up for this so it’s really beneficial for NLD kids. We generally keep copious notes on each child, filling them out daily. They include emotional and social as well as academic. Because kids usually keep the same teacher for 3 years, it gives the teacher the chance to really understand the child’s needs. I couldn’t imagine having a child for only one year as in traditional schools. One year is hardly enough time to really understand some kids.