Category: New Beginings

How Ms. Eleanor’s Apples came to be.

Posted in New Beginings

One of My Favorite Topics: Organization for Clients with ADD

Posted on by Eleanor Cawley

The easiest way to organize anyone with Attention Deficit Disorder (ADD) is to preplan!  Label each drawer with the item of clothing that should be in there.  For example, one drawer for pants, one drawer for shirts.  For any item to be put away, it must have a place to go that is easily accessible and easy to put a way.  A great way to organize underwear and socks is to use clear under bed storage boxes [no lids].  You can have one box for underpants, one for t-shirts or bras, one for white socks and one for dark socks.  Buy about 10-12 pairs of white socks and 10-12 pairs of dark socks [all the same].  Socks will never have to be rolled but will make it in to the right box.  In addition, they will be easier to retrieve in the morning when getting ready for the day.

Forget the coat closets; use a coat rack right by the door with an open basket next to it for keys and gloves.  Place a boot tray by the door, as well, for those bad weather days.  It is often too hard for the person with ADD to open a door, get a hanger, place the coat on a hanger, replace the hanger with the coat in the closet and then handle the keys, gloves, boots, etc.

Bathroom supplies should be equally as easy to retrieve and put away.  A hook for a towel replaces the cumbersome towel rack.  A clear plastic bin should be used for toiletries.  Most of all, an open shelf to put that plastic bin on will ensure that the items go back where they belong.

The worst thing that anyone can do to someone with ADD is over buy or provide him or her with too many items.  If you have the storage space, then go ahead and take advantage of a great sale, otherwise pass and buy only what is needed.

This may not be the prettiest home on the block but it will be an organized one.  Think first before you buy anything.  If you are not replacing a discarded item, don’t buy it.  If you cannot assign a specific place to put that item away, move on.  Your loved one, suffering from ADD, probably does not do well with clutter.  Don’t make it more difficult by creating it.  Remember that OT is “skills for the job of living!”  Organizing your home makes living in it better.

Posted in New Beginings

Civility

Posted on by Eleanor Cawley

Parents, Advocates and Lawyers, Oh My!

I am not sure why the CSE Meeting or the IEP have become such a battle ground for parents and school district administrators but something needs to change.  I have absolutely no doubt that parents, teachers, therapists and administrators have the best interests of the student at heart.  Everyone working with the student wants this child to succeed to the best of his or her ability.  What I don’t really understand is the lack of real communication between parents and school district staff.  

I do not know one teacher or therapist who would not try to incorporate the parents’ requests in a student’s educational plan.  Sometimes, for whatever reason, a second evaluation needs to be done.  Maybe the first one was conducted on a bad day for the student or even the evaluator and/or did not provide enough recommendations.  So the evaluation is performed again by a different evaluator.  It is not an insult to anyone.  It is just done.

I would assume that parents and district staff take notes during conversations and meetings-it helps us to remember what occurred during a meeting.  But we all need to follow the law about what is recommended and how it is recommended.  There is a referral process and a procedure that needs to be followed.  There are activities that can be performed based on the student’s educational placement.  For example: community integration and travel may occur at the alternate assessment level but not at the inclusion or resource room level.  

Activities of daily living that include self-care, should be done within the home unless the school is set up and approved to do this type of training [most, if not all, public schools are not].  As a therapist, I can provide some structure to the activities at home by picture prompts [showering, for example], task analysis and rubrics so that together we can get the job done-school staff and parents working together.  

The most important thing is that we need to listen to the student.  Sometimes the student says, “Enough, no more therapy.”  At that point we need to go into consult mode, reduce the therapy sessions to a very low frequency or discontinue therapy.  We must respect the student!

The most important thing that I hope anyone reading this blog takes away, is that we all need to communicate with each other with the student’s future in mind.  We all need to be able to ask questions and answer them, civilly, without threat of legal ramifications.  Unless the situation has degenerated to a point where no communication is occurring, parents and school staff should be able to address all the student’s needs through effective meeting strategies.  

We should be able to:

1.  Start any meeting in a timely manner [some might be a bit late for whatever reason-participation is the import thing]

2.  Set the ground rules.  This is often done with a parent receiving a handout of rights and responsibilities.  I think that this should go further and an agenda be provided prior to any meeting.

3.  Follow that agenda.  Agenda should be developed with the parent and possibly the student [if old enough and able] to ensure that all their concerns are addressed.  

4.  Monitor time spent.  Respect the time of the parent, the student and professional staff at the meeting.  There is generally another meeting that follows right after.

5.  Encourage participation of all those involved, including the student.  Both parents and staff should enable the student’s participation by either a portfolio or statement to be read.

6.  Approve any new follow-up assessments or actions by both parents and district staff.  Referrals need to provide good information about the reason for referral so that all the questions are answered in the report.

7.  Read a summary of the minutes taken before the meeting adjourns for clarity.  

8.  Minutes should be provided to all parties-all district staff and related service providers involved and parents, after the meeting in a timely manner.

 

The thing that I find that does not occur and should is an agenda.  The agenda provides a structure to the meeting and makes sure that all concerns listed are heard and addressed.  It limits the potential for disagreement during the meeting.  A new meeting can always be scheduled to address any new concerns.  It limits the “Uh Oh!” moments for both the parents and the staff.  

Posted in New Beginings

Is Occupational Therapy Overused?

Posted on by Eleanor Cawley

I recently read an article from the New York Times that appeared several years ago about parents in New York City, particularly in Brooklyn, hiring occupational therapists for preschool children.  The article states, “In affluent neighborhoods in and around New York, occupational therapists have taken their place next to academic tutors, psychologists, private coaches and personal trainers — the army that often stands behind academically successful students.” (TYRE, 2010)  There were 115 comments attached to this article, many commenting on overly anxious parents or parents pushing their children to get an edge.  Others commented on how observant some parents are, noticing small problems, and addressing problems early on.  Any of these comments may or may not be true.  What I do know is this, if small issues are not addressed early on, they can and often will become major issues later on and more difficult to address.

Children develop at different rates.  There is never a distinct day or time that your child will do something.  Take for example, walking.  According to the CDC, your child should be walking independently by 18 months.  Yet we have seen children walk at 10 months and 12 months.  Does that mean that your child is motorically gifted?  Probably not.  So from this we can assume that there is at least a range of time in a child’s life when we should expect a child to begin walking.  Once outside this range, we should be asking questions of the doctor.

This range of development occurs within fine motor skills, as well.  The CDC lists many of these items under the heading of Cognitive (learning, thinking, problem-solving).  Under this heading are motor skills that an occupational therapist would address, such as using one hand more than the other (handedness), sorting, pointing (finger isolation), stacking (eye-hand coordination), throwing a ball, copying lines, etc.  All of these items are listed in the 2 year old section of their developmental checklist.  What is also listed in this checklist is when to be concerned and talk with your doctor.  http://www.cdc.gov/NCBDDD/actearly/pdf/checklists/All_Checklists.pdf

Now look at the flip side of this issue, gaining an edge.  I was speaking with a colleague, a psychologist, at lunch the other day.  I had been considering writing on just this topic for my next blog post.  We both agree that there is a range in which a child should accomplish developmental milestones.  We also agree that pushing a child may backfire and frustrate the child because the brain may not be ready.  The brain will help a child accomplish a task when the brain is developed enough to handle the task.  While the basic structures are present at birth, the experiences [motor, cognitive, sensory] that a child has along with the actual physiological maturation of the brain further develop to increase the speed, efficiency, and complexity of signals in the brain which then allows the child to accomplish more difficult tasks.  In a fairly typically developing child, when the brain is ready, the task will occur and not before.

So as an occupational therapist, I might work on hand strengthening and finger isolation to help a young child to eventually develop a tripod grasp for a crayon.  Let’s just say that this did not occur adequately before kindergarten.  It may not be such an issue this year but when a student is challenged to keep pace with his or her peers in handwriting in subsequent years, it most definitely will.  Reaching middle school with handwriting problems just compounds the already difficult tasks, of taking notes at the same pace with peers, and writing legibly to express what they have learned.   Can you imagine, knowing that your child studied and knew this information but failed the test because his teacher was unable to read what was written?

Can you imagine thinking that your child is brilliant at an early age because he or she is ambidextrous? But in fact, has not developed a preferred hand which may be an early indicator of dyslexia.  Is it a sure sign of dyslexia?  No.  Only someone skilled in child development can determine if this is a problem or not.

So, I recommend that parents use the CDC Act Early Checklist to monitor a child’s development.  Keep in touch with your doctor and if concerned, ask the pediatrician to evaluate your child.  An occupational therapy evaluation does not require a prescription but services do.  Progress reports should be expected and shared with the pediatrician.

Acting early, helps your child be as successful as he or she can possibly be.  Once in school, having a child pulled from class for therapy can be embarrassing and frustrating.  He or she may be very receptive to services when young but very resistive when in a school setting, particularly middle and high school.  I have developed programming to address these needs.  We offer a free 30 telephone consult for any questions or concerns.   631-629-4699

Bibliography

TYRE, P. (2010, February 24). Watch How You Hold That Crayon. Retrieved from N.Y. Times: http://www.nytimes.com/2010/02/25/fashion/25Therapy.html?pagewanted=all&_r=2&

 

 

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Posted in Eleanor Cawley, M.S., OT, New Beginings, Occupational Therapy

Should Middle and High School Students Participate in the Evaluation and Annual Review Process?

Posted on by Eleanor Cawley

Should Students Have a Voice?

Absolutely!  Most students at the middle and high school level are looking for a sense of independence.  Students of this age are often at a point where they want to know why they should continue therapy, and if they continue, why they can’t decide what they need to work on.  In a school setting, the goals need to relate to a student’s educational and/or vocational needs.  There is so much more information that a therapist needs to know to determine a student’s perception of his or her abilities and further determines whether or not a student really needs to continue.  Standardized test scores, although important, are only a snap shot of the student’s abilities at the time the student participated in the assessment.  It is not a clear and thorough picture of the student’s ability to function in a classroom.

I have often found that a student will provide more information if the questions are presented in a written format, particularly with sensitive areas, like activities of daily living, presented in checklist format.  Students will review the document, quickly at first, check an answer [which the therapist or teacher can expand on later] and then move on.  The written format provides a canvas, if you will, to create a dialogue with the student.  For example, let’s say that the student checks off that he or she can make a sandwich, ask the student how he or she makes that sandwich and you will get a better idea if he or she really is capable of making that sandwich.

I have developed a written interview, which I began using with some of my students over the last few years.  I was able to better assess a student’s abilities and perceptions of being able to care for him or herself and support classroom skills.  It prevents that ‘oh no’ moment when something is revealed in a CSE meeting that you should know but don’t surfaces.  When interviewing a student verbally, many of those items are glossed over and the interview proceeds.  A written document is a bit impersonal and the student may just answer more truthfully and feel more comfortable in doing so.

Let’s go back to that sandwich; a student checks off that he is able to make a sandwich.  Later, when reviewing the interview with the student, you ask, “How do you make that sandwich?”  The student lists all the items that he needs for the sandwich but is unable to describe how to actually make that sandwich.  This may indicate that a student has a form of dyspraxia or apraxia that has been addressed in other areas through years of therapy, but not yet in the area of self-care.  In very basic terms dyspraxia (problems with) or apraxia (unable to) refer to sequencing the steps to perform a skill.

This is enlightening and indicates other areas need to be explored.  When evaluating a student, all methods of gathering information should be used.  Standardized and non-standardized testing is important but so is the interview of the student and the teacher and authentic assessments, such as a rubric, to provide a balanced assessment of the student’s abilities.

A school-based assessment includes a reason for the referral [the problems that the student is having in the classroom], and his or her motivation for educational activities.  In my opinion, motivation can be broken down in to at least two components:  skill and desire.  If a student has limited or no skill in a particular area, there will be no desire to engage in the activity.

Motivation becomes a particularly important factor in the middle and high school years.  In order to encourage participation in therapy, students need to participate in and feel part of the evaluation process.  For one reason or another, a student may become disillusioned with therapy.  Comments may be made by peers, making the student uncomfortable with being pulled out of class.  Pushing into the class may not be an option either and may further target the student for comments and potential bullying.  At this point, if the student is so resistant to the therapeutic environment, consults may be the only option other than discharge.

Bibliography

Cawley, M.S., OTR/L, E. (2013). Using Rubrics to Monitor Outcomes in Occupational Therapy. Huntington Station: Eleanor Cawley, M.S., OTR/L.

Posted in Assistive Technology, Eleanor Cawley, M.S., OT, New Beginings, Occupational Therapy

When Is It The Time To Recommend Assistive Technology For Note-Taking?

Posted on by Eleanor Cawley

I must state, before anyone reads this, that I am a HUGE fan of using assistive technology.

I recently read a comment about a piece of technology not being “cool.”  I realize that there are students who will never feel “cool” when using assistive technology.   I also feel that students must be taught touch typing and the basics of functional programing before being asked to take notes using assistive technology.  It always boggles my mind when some recommends a piece of assistive technology, such as an Alpha Smart, without ever considering if it will really work for the student.  Many students consider an Alpha Smart to be ‘uncool’ for the following reasons:

  1. Looking different from peers
  2. Not knowing how to use the device
  3. Still not being able to keep up
  4. Fumbling with the technology in front of others

In my humble opinion, students need time to learn how to use such a piece of equipment or a program.  One of the reasons that a student might need the technology is due to an inability to handwrite legibly.  Another might be difficulty organizing thoughts and motor movements.   Assistive technology needs to be worked on privately with the student or in a very small group with other students using similar technology.  Every aspect of using that device and the skill that it is supposed to support needs to be worked on prior to giving this device/technology to the student to use in the real world.  For example, when providing an alternative keyboard to a student to use to take notes the following needs to be explored:

  1. Can the student take notes without the device even though his or her handwriting may be illegible to others?
  2. Does the student know the verbal cues that would trigger him or her to start taking notes?
  3. Is the student capable of taking dictation either written or using a keyboard?
  4. Can the student use those verbal cues to format notes?  If a student hears the terms “Pros and Cons” or the word “conversely” does the student know that this may be a great time to use a T-Chart style of notes?
  5. Can the student attend to the instructor long enough to follow the lecture?
  6. Is the student familiar enough with the keyboard to type at least 30 words per minute over the length of the class for note taking?
  7. Can the student use punctuation to help the notes make sense with any degree of success?
  8. Is the student comfortable enough with keyboarding in a room full of other students, who are not using a keyboard, to be successful?

Obviously, I could ramble on and on.  We need to think, “When is an alternative device or program better than the low-tech copy of notes provided to the student?  The technology that we supply is only as good as the support that we give to the student.  If we jump to provide assistive technology to a student without looking at the student’s overall ability to succeed without the device, then are we sabotaging the student to dump the device or program and throw in the towel?

I feel that note-taking should be a skill taught in every school, to every student.   A task analysis of note-taking skills needs to be completed and the student assessed using that analysis before providing a device.  The organization of the page should come before the thought of using an assistive technology device or program.  The language that we use in the classroom should trigger a particular format of notes.

There is so much learning that needs to be done by each and every student.  Students are getting frustrated and need to have a place, a structure to go back to.  At that point, once the structure has been taught and reinforced and the student is not yet successful, then and only then should a device or program be considered for taking notes.

I know that every teacher that I come in contact with is working day and night to help all the students learn everything they need to.  I know that many provide notes, study guides and review materials to students, hoping that somewhere, sometime, something will work at some point.  I think that those of us working with students need the structure, the organizational hierarchy, to assess a student’s abilities just like our students need to learn.

Posted in Assistive Technology, Eleanor Cawley, M.S., OT, New Beginings, Occupational Therapy

Note-Taking from an Occupational Therapist’s Perspective

Posted on by Eleanor Cawley

Taking notes is a very complex skill rooted in abilities developed in infancy.  While sitting in a classroom, a student is expected to have appropriate cognitive and motor responses to the teacher providing the lecture.  That is easier said than done! 

As an infant, we are supposed to alert to a sound, respond to that sound with head turning in that direction, differentiate pleasant sounds from unpleasant sound and learn to express pleasure or displeasure.  Visually, we are expected to respond in a similar way: alert to a visual stimulus, respond by following that stimulus by turning our head to follow it, differentiate pleasurable from displeasing.  Infants are expected to demonstrate a motor response to the stimulus, i.e., eye opening, finger splaying, and activation of limbs.

Just as an infant is expected to display a motor response to stimuli, a student is also expected to respond motorically to stimuli provided by the teacher.  Students learn to respond to certain cues, i.e., “This is important,” “Conversely,” repetition of the information, etc.  It is very difficult for student to respond if he or she lacks the prerequisite skills.  Alternatives for taking notes should be offered to the student.  The least invasive is to have the student copy notes from the board (far point).  Some students have difficulty with visual skills such as pursuits and saccades (visual tracking and changing fixation from one target to another) making this difficult.  First a slant board (often a binder) can be used to address this issue.  If that doesn’t work then maybe copying from near point will work. 

The next more invasive intervention might be providing the student with some form of prepared notes, i.e., Cloze Notes.  Cloze notes are fill-in the blank notes.  Students are only required to add one or two words to a statement rather than copy the entire statement.  The next level might be providing the student with a copy of teacher generated notes prior to the class for the student to highlight during class.  The next level might be having the student attempt whatever he or she is able then giving a copy of notes to the student, usually a copy from another student who takes very good notes. 

Another strategy is to use on-line notes for a site like www.studyblue.com.  You may be lucky enough to find course notes similar to class notes with flash cards.  Kno.com is a site where you can buy electronic textbooks (usually at a reduced cost), this site also provides lecture (from the book), study materials and social networking for studying.  Kno.com is iPad friendly.  Along with programs like Evernote with Penultimate, this maybe all the student needs to be in class.  A student could photograph handouts and never have to carry another piece of paper.  Assignments could be entered into Everstudent (a digital assignment book/agenda). 

 

One of the last options would be to type notes on a laptop or a computer.  If the student lacks the prerequisite skills for note taking, they cannot be expected to be successful if you give them something to type on even though they can type at a good speed with good accuracy.  A sixth grader is expected to type at a speed of 25-30 words per minute with 93% accuracy.  If a student has only handwriting concerns, is able to meet all the prerequisite skills for note taking, can type 25-30 words per minute with 93% accuracy then maybe the option for using a keyboard or laptop is the answer.

Posted in Assistive Technology, Eleanor Cawley, M.S., OT, New Beginings

Assistive Technology Assessment

Posted on by Eleanor Cawley

Thinking in Terms of Developing Skill Sets Rather Than Compensating for a Disability

There are many types of assistive technology evaluations including:  mobility, seating/positioning, communication, computer access, switch-access, and aids for daily living, work-site modification, home modification, and recreational assessments.  While assistive technology should be considered in the typical ways; it should also be considered in other ways, i.e., development of skill sets.

From the use of smart phones to navigating the community, developing visual picture schedules to support a cooking or grooming task to the use of laptops and desk top computers for literacy programming, assistive technology supports the development of skills or skill sets.  [Assistive] Technology is here to stay.

Students who are unable to develop skills similar to their peers may very well be more capable with the use of technology.  The Cloud, iPads, iPhones and tablets make taking notes and organizing those notes much easier [with training] increasing a student’s ability to be independent.  Using literacy programming may actually provide a student a voice where he or she did not have one before.  Using technology successfully has the potential to help a student develop confidence and self-esteem.

What makes the addition of developing a skill set different from the typical assistive technology evaluation?  First the referral is targeted toward a specific reason for that referral.  All of the same criteria for that typical evaluation are assessed.  The same programming and devices are explored as is the student’s responses.  Each teacher working with this student is provided with a questionnaire and interviewed based on those responses.  This then gives the evaluator a picture of the student and the skills required to meet the demands in each core class.  A clearer picture of the student’s abilities to achieve the desired skill set is then established.

Based on the demands of that particular skill set, the student is observed discreetly in a core class.  For example, if the desired skill set is to take notes, the following skills will be explored and data collected:  responses to sight and sound, orientation to the teacher, motor response to cue words, quality of the notes taken (content, legibility and organization), etc.  Based on the data collected, recommendations are then made to help the student reach the goal of the desired skill set.  This may be almost a full day of assessment for a particular student.

Once recommendations have been made, and the report has been submitted to the district, the real work begins.  It is important for the evaluator to be in contact with the district’s technology team.  Together with the technology team, a device can be prepared to meet the student’s needs in each of his or her classes.  In the case of note taking, it may mean that a device must be in sync with the Smart Board in class so that the student can save the lecture notes.  Different programs, based on teacher preference, may also need to be learned by the student to ensure that the notes are recorded.

So after a full day of evaluation, and further consult with the technology department, it is prudent to set up additional consult sessions to train the student and the staff in the use of the device, develop future goals and assess whether or not this plan of action will be successful for the student.  In order for assistive technology to meet the needs of the student, it must be constantly assessed and re-assessed, with additional support to the student.

In a different scenario, a student may be recommended for an assistive technology evaluation to address poor handwriting skills.  In addition to the typical assistive technology evaluation where the student’s keyboarding ability is assessed, he or she may need additional support in keyboarding using a touch typing method to improve speed and accuracy.  Often a student with poor handwriting skills has been provided with a computer as needed but he or she has not learned the correct method of keyboarding.  This leads to greater frustration and disenchantment, with any device provided, due to a higher error rate.

A traditional assistive technology evaluation may be requested if the student has reading difficulties, for example, Dyslexia.  Options for assistive technology include text to speech programming-having text from a computer read to the student in a computer voice.  Once the student has been approved for assistive technology, depending on the programming chosen by the district, the voice in the test to speech program can be somewhat pleasing or definitely irritating.  It is difficult to train a student to to modify and use this type of programming during the initial evaluation.  Digital book sharing services require that the student have an account.  This account needs to have a completed application, parent consent and a sign-off by a professional to indicate a visual print disability.  It can take a day or two for the company to approve the application.  Upon approval, a Welcome e-mail is sent to access the account.  Often, an additional program needs to be downloaded before the student or parent can download books to read.

There is a significant delay in the student accessing and using this programming.  If the teacher has not had access to digital book sharing prior to this student, he or she also needs to learn how to use the programming.  So in addition to the evaluation and initial training, follow up and ongoing training is necessary.  This training can be done by the evaluator or district personnel knowledgeable in this area.

In general, assistive technology can only be considered successful if the student is using it to function within his school and home environments and is able to perform the activities with an increased level of independence.  This brings attention to another issue that arises with the use of assistive technology, which is caregiver training.  Frequently, in this training loop, the parent [or caregiver] is left out.  It is important to have the parent participate in at least one training session, once the technology, approved by the district, is in place.

It is ny goal to ensure that every student receiving assistive technology, either through the district or through private funding, receive the training that he or she needs to gain independence.  Once again, if the student is not comfortable with the technology or does not fully understand how to use it, the technology is wasted as is the money spent or the evaluation, purchase and training.  We must also be very careful in not allowing the assistive technology provided being considered another failure.  This can further undermine a student’s self-confidence and self-esteem.