While the Word Data has Only Four-Letters-It is not a Four-Letter Word

Data means a lot of things in this world, much of which is negative.  The bank collects your data; websites collect data on your interests and browsing habits; supermarkets collect data on your spending habits; and now schools are collecting data on what your child knows.  I recently published a book on using rubrics to collect data on goal progress in occupational therapy sessions.  Through my research, I have discovered that collecting data on your child is not a bad thing.  Using data collection strategies helps teachers and therapists research your child.  That word 'research' is very important.  It helps teachers and therapists learn what your child knows and what your child needs to know.  It helps us figure out exactly where the breakdown in learning is occurring.  Data collection helps us identify your child's strengths and limitations.  I have begun to use rubrics in my own practice, starting a few years ago with keyboarding.  There is at least 10 or more items that an occupational therapist will look at when assessing a student's keyboarding skills.  

Let's look at keyboarding speed.  The following items are skills that an OT would look at to determine what your child can do and what your child needs to learn to do:

Is Occupational Therapy Overused?

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 [http://www.mseleanorsapples.com/Fine-Motor-Skills.html] and offer a free 30 telephone consult for any questions or concerns.  

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&

Use What You Have!

I was having lunch with a colleague yesterday.  We were discussing networking with each other in order to “Grow our Business.”    Our discussion took many different directions, including personal and family concerns, how those concerns lead to our chosen profession and, of course, the effect of the economy on growing our businesses.  I was talking about my methods of helping students become more organized and things that I have seen on the internet about marketing. 

In my mind, there were two topics that intermingled and I could not separate the two.  One topic was issues with organization in clients with an executive function disorder and the other was gaining more clients without spending an enormous amount of money.  I happened to mention that I might be interested in a marketing course taught by a physical therapist.  His company, called IndieFree, explores a number of methods to increase our income.  One of his phrases is “Use what you have.”  In this economy, it makes a lot of sense to use the resources that you currently have without having to purchase more.  

So what does this have to do with executive function disorder?  Well, students with executive function disorder are very often disorganized.  They are often unable to locate assignments that were completed the night before.  These students are at risk of losing points on assignments that are simply missing.  This is one of those gray areas.  Students should have the opportunity to produce the assignment by the end of the day.  How can this be accomplished independently by the student?  It’s easy, “Use what you have!”  Or you can get free!  

Most of us have a G-mail account.  With the G-mail account, comes a whole compliment of resources that frequently go unused.  Google supplies free word processing, spreadsheet, and presentation software.  Not only does Google provide you with free software, they also provide you with free storage!  Using what you have becomes easy.  If a student has a handout to complete, once completed the handout can be scanned and uploaded to the Google Drive.  Most school districts allow students to have access to Google Drive during the school day.  Missing assignments can then be printed and delivered to the teacher on the day that the assignment is due.  Problem solved! 

Once a student has learned how to scan a document and upload it to the Google Drive, it only takes 1-2 minutes to complete.  A parent can check homework on the Google Drive at any time.  Of course, it would be optimal for the parent to supervise uploading to the Google Drive.  In the next day or two, I will post the directions on how to use the Google Drive to store homework assignments on my [Freebies] web page, www.mseleanorsapples.com.  You can also go to https://drive.google.com to check things out!  

Assistive Technology Assessment

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. Here at Ms. Eleanor’s Apples, it is our 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. For a printable copy: http://www.mseleanorsapples.com/Newsletters.html

Note-Taking from an Occupational Therapist’s Perspective

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 lack 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.