OT - should I get an eval.?

My 11yo daughter is similar. We got an OT eval which showed some relatively minor problems, but nothing major. Your insurance will probably cover the eval. We have an HMO and it was covered with a referral from our GP. My neighbor is on a PPO, I believe, and her son’s was covered the same way — with a referral from her GP. Your best bet is to find a good OT clinic and call them. They are usually very aware of what is needed to ensure coverage, and can usually advise you exactly what steps to take — even so far as to what wording the GP should use on the referral form.

Actually, it seems to me your son’s major problem may be sequencing. I suspect that a lot of my daughter’s problems stemmed from very poor sequencing skills. Audiblox (http://www.audiblox2000.com) and PACE (http://www.learninginfo.com) are two cognitive training programs that work on developing sequencing skills, and they are usually very helpful for dyslexics. Audiblox is inexpensive and can be done entirely at home. We did PACE, and it was worth every penny, but it is quite expensive because of all the one-on-one work with a certified tutor.

Incidentally, an OT approach to teaching how to tie shoes is to use “reverse enchaining”. That is, he practices the last step until it is mastered. (You tie the laces except for the very last step, and he finishes.) Once the child can perform the last step, you tie the laces except for the last two steps. By the time he gets to the first step, the remaining steps have all been practiced many times. It’s best to make a little frame to hold maybe a dozen shoelaces at a time for practice, or line up half a dozen pairs of sneakers!

Mary

He could have problems with motor planning - sounds like an OT evaluation is definitely in order. You can also request one from school.

Doesn’t sound like an OT problem to me. That would, I believe, effect small motor. LD youngsters do frequently have difficulty recalling a sequence of steps. One way to deal with this is to complete all but the last step, let him take over and gradually work backward until he is doing each step.

I do not think an OT eval would hurt expecially if insurance would pay for it. If he does not need services they can give you things at home to help stregthen him. I just go and eval with my son and have learned a lot about him and his learning and growing body. I do not regret doing it.

What exactly are the small motor skills? Do you know who would test for this? Is this something to remediate?

There’s definitely something wrong in the motor area. He can’t seem to hold the laces correctly.

He has a lot of difficulty even bouncing a ball between his legs — he has to lift his one leg up over the ball.

He won’t play baseball with a glove — he prefers to catch with his hands.

Yet, he’s on the bowling team and has the coordination to be a pretty good bowler.

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I don’t think he has trouble with sequencing. Even in kindergarten when he had trouble learning the names of the letters, and with motor skills, he was exceptionally good at putting pictures in order. Yet, he sometimes reads on for no on occasion.

He was tested a year ago by an educational psychologist. Visual-motor integration (Bender Gestalt Test) was below average at the 12%. My report says that he has difficulty with visual-spatial organization and fine-motor production of written work and demonstrated significant tension and anxiety in his writing.

Do you know who could help with visual motor integration? Would this be related to his inability to tie his shoes?

You want an evaluation done ASAP, not tying shoes at 10 is a serious delay. I am also concerned about playing ball, that is a skill that can affect self esteem. It does sound like dyspraxia, problems in motor planning and coordination which often links to dyslexia and sequencing issues. Fine motor tasks involve handwriting, manipulating small objects such as beads, cutting, buttoning, and shoe tying among other thigns. An OT can tell you what is going on and will look at more gross motor (big movement) skills as well. Usually PPOs cover evaluations, often they cover therapy. Call and ask if they cover OT evaluations and therapy. If they do ask if they have any restrictions, do not tell them what is going on, they will find that out from your therapist. Good luck.

Thank you. I have never heard of dyspraxia. I searched for it on the web and my son had alot of the delays they described including articulation and fine motor. He also has sensory integration issues relating to clothing and certain sounds.

Wondering how the educational psychologist missed this. I just looked over her report (testing done a year ago) and his Bender Motor Gestalt Test was below average at 12%. She had no recommendations for this.

We do need an OT — thanks!!

Just got to say,
I am 37 years old. I was diagnosed dyslexic in kindergarten. I can finally tie my shoes, but they don’t stay tied.

Fortunately for me,I was burned at age five or so on my left hand. The scar is still the only way for me to qucikly tell you which side is the left side!

While I totally agree with OT,I do want to tell you that if your child is dyslexic these kind of things won’t stop him from growing up and gaining employment,they will always be a irritating part of his life:-)

Velcro strapped shoes was the BEST thing shoe manufactures did,and learning strategies to get around his very creative and intelligent brain will serve him his whole life!
Find an OT that is well versed with dyslexic children. Not all are.

Interesting you should say this. I just got back my Austic son’s recent psychological eval. In it it is noted that on the Beery he appeared to have difficulty planning his drawings and intergrating parts of design. On a clock drawing to command test he showed difficulty with planning and spacing. On the WRAML he had significant difficulties with performance on a mumber/letter repetition task. His visual recognition memory was good but ability to mimic visual sequences was signicantly below average. The other thing the psych found note worthy was that on a sentence repetition test he had odd repetitions the example she gave was: The sentence was MR. Davis was asked why he never wore a tie and shirt that matched. My son repeated it as “Mr. Tie never asked why he weared a shirt.” He had areas that were significantly above average such as math reasoning and ability to descriminate relevant from irrelevant. His IQ was in the normal range. I have felt that beside being austic he might be dyslexic just like his brother. He still can not tie his shoes and he will be 10 in April.

I agree with the Velcro!!!! Even better, the new shoes now have zippers..

I’m concerned about the tying because it’s a self esteem issue. He also has trouble cutting his food — this is something I have ended up doing for him and I’ve never made a big deal of it. He should be able to do it. It’s too hard for him. That’s why I think there’s a motor delay, along with dyslexia.

As far as the left and rights — we went to vision therapy last year. He tested in the impaired range for reversals. There was an exercise, I believe it was called Meyer’s arrows. There were arrows up, down, left and right. He had to use his both arms (like a clock hand) to point in the direction, and say the direction. Very quickly, he learned his lefts and rights, ups and downs and it stuck.

And after this, he learned to tell time really well.

I think dyslexics can learn anything as long as its taught multisensory.

Yes,your right,we can be taught and it can be learned,but if he is truely dyslexic,there will always be times that left and right escape him. He learned to disgiush by way of a repetetive strategy. He will always need to stop think of that exercise and use this in order to know left from right. Same as I, looking at my hands. I can cut my food,but I might always have that stray piece of meat fly off the plate:-) Hey,I know so will everybody. I guess what I am trying to say is,being dyslexic will be a part of him always. He will always have problems with this kind of thing. Thank god,only learning to read will be of greater importance:-) Not saying don’t pursue OT,absolutely,but remember self esteem wise,being okay with what’s important and what isn’t will be a good quality for your son to develop.

Now,tell me more about these exercises!
I too went through years of vision therapy,don’t know this exercise,of course this was back in the 70’s,but I would love to know more. I would try it for myself,and my boys have a terrible,as a matter of fact nonexistent sense of time,so maybe this exercise would help them learn to tell time?

The exercise was pretty simple.Arrows were drawn in rows across a sheet of paper spaced 1 or 2 inches apart, in the direction of up, down, left and right. (positions at random)

We taped the paper to the wall, stood about 5 feet away, and he had to hold his arms straight out with his hands together and point his hands in the direction the arrow was. He said the direction as his arms/hands pointed to it. His whole body was involved. We were supposed to do the exercise to the beat of a metronome and we tried, although keeping to the beat was difficult for him.

Another exercise we did — there were rows of images on a paper. Each image had a vertical line, and either a circle or a triangle was drawn to the left, right or on the line. eg. | o o| | 0 We had to put a piece of tape on the desk and he had to look at the image, and then place his hand either to the left, right on on the line and say where the circle/triangle was in relation to the line, (left, right, middle). He did this to the beat of a metronome.

It didn’t take very long for him to know his lefts/rights automatically. I think it was the multisensory way that he was taught.

I don’t know if directionality has anything to do with learning time. But it was at this time that my son (a 3rd grader) learned to tell time overnight. He had known how to tell time to the hour and 1/2 hour. One day he just got it. He was obsessed with time for a couple months, announcing to us all the exact minute he woke up and fell asleep. It was funny.

Socks,

I have seen different versions of this exercise and my son did one of them quite faithfully. It did help his sense of right and left but the funny thing was when he was subsequently evaluated by a different developmental optometrist. He got all the directionality questions right but hesitated for each one. He didn’t know how to rank him!!! So it still isn’t totally automatic. He can put N,S, E, W on a map though. But then directionality isn’t automatic for me either and I am not dyslexic.
I also taught him that he writes with his right hand. (I told him it was our secret since his father can’t imagine how this could not be automatic. I think that helped his interest—the right hand trick is how I remember.)

Anyway, for the exercise, you need a piece of paper with rows of arrows on it. You could probably do this with a word processor. Then have your son call out the direction, up, down, right , left. You can make it harder by using a metronome and making him do it in rhythm. This helps make it automatic. Once he has that down, have him do the same thing but use his arms. Have him do it every day until it is soooooo easy. You might have to make the arrows bigger so he can track and move his body at the same time.

Beth

Socks,

I tried a version like this—with pasted to the wall but it was too hard for my son. He had to learn to do it first without his body. But if your son isn’t as severe as mine, this would work.

Beth

Yeah Thanks we will try it. Any strategy is worth it. Ironicly enough my kids did interactive metronome. I believe they have left and right,it is me who doesn’t:-) but possibly the directionality would help with telling time. I will let you know how it works