Many children who have an IEP receive Occupational Therapy (OT) as a related service to address poor handwriting. While handwriting referrals are an appropriate use of Occupational Therapy services and OT’s are well equipped to address handwriting challenges that impact learning, illegible or sloppy handwriting can be a symptom of more significant processing or motor challenges and poor handwriting is not the only type of symptom that educators and parents should be considering when determining the need for OT services. Occupational Therapy is an underutilized and often misunderstood discipline, that can serve as a valuable resource to address many IEP related goals.
Handwriting is a complex process of managing written language by coordinating visual, motor, and cognitive functions and being able to do so in an efficient manner. OT’s can evaluate the underlying components of handwriting or any academic task, to determine how significantly those components may or may not be impacting academic abilities. There are many “hidden” components to how children learn that can be addressed by OT’s trained to do so, including multisensory processing, emotional and behavioral regulation, arousal and attention, ability to transition, and cognitive skills such as sequencing and organization. Challenges in any one of these areas could significantly impact a child’s ability to learn. Additionally, challenges in any of these areas could impact a child’s consistency and/or efficiency in completing academic tasks and could indicate the need for OT services.
Given that OT’s have a unique understanding about how the brain and body interact to perform all range of activities, any time a student is struggling with an activity at school, the OT could be a valuable resource. A student does not need to qualify for IEP related services in order to benefit from an OT consult and many OT’s work in their respective schools at both the direct service and the program intervention level. OT’s may offer practical tips and strategies as well as direct intervention to address a wide variety of daily living tasks that come up at school like toileting and using the bathroom, putting clothing on or off, using fasteners, tying shoes, opening and closing containers, use of combination locks, getting around the school safely, use of a backpack, ergonomic design for work stations, and cafeteria struggles such as self-feeding, opening/closing containers, standing/waiting in line or staying in one’s seat at lunch-time. Occupational Therapists also address less motor based challenges like being able to tolerate various environments (like the cafeteria), transitioning to/from the classroom and other areas of the school, being able to remain in a classroom or at a workspace/desk or on the playground for functional periods of time, organizing & keeping track of supplies, organizing work on a page, being able to actively participate in class, active & safe participation in gym class, peer conflicts, frequent dropping/breaking of items, following verbal or written directions, paying attention, seeking assistance as needed and in appropriate ways, use of learning aids, and for older children any community living or vocational type tasks like money management, getting on/off the bus, the list goes on. Any time there are difficulties with consistency of performance, anxiety related to learning new tasks, avoidance of certain types of tasks, behavioral challenges triggered by certain types of tasks, or difficulties efficiently completing any of the above mentioned tasks, OT should be considered as a possible need in a child’s IEP.
The following are some things to keep in mind when considering Occupational Therapy or evaluating the efficacy of Occupational Therapy as a related service:
1) OT, as with any educational intervention, has limitations, pros and cons, risks and benefits.
2) OT, like any Intervention, should be tailored to suit each child. Intervention outcomes need to be measurable and closely monitored to determine efficacy for each child, not based only on standards and norms. OT intervention is designed to maximize the learning potential of each child, and may combine both traditional rote practice of skills as well as less traditional, potentially more medically based types of strategies and interventions, depending on the needs of the child.
3) Current research regarding interventions being used, should be offered and explained to parents.
4) Various school environments should always be taken into account when writing goals (classroom, playground, hallways, cafeteria, bathrooms, etc.). Just because a child can function in one setting, doesn’t mean they will be able to function in another, and adequate academic performance in the classroom, does not mean the child is able to function safely or successfully enough to reach their full academic potential OR to function across the entire school setting. In fact, challenges getting to the classroom (i.e. off the bus, through the hallway, from the bathroom) or challenges tolerating the classroom environment or school environment in general, can inhibit students from fully accessing their classroom curriculum.
5) There are different types of Occupational Therapy, as there are different methods of teaching or different curriculum for learning, and there are specialties within Occupational Therapy, just as there are specialties within the teaching profession. For example; there is OT with a motor learning approach, a rote skills training approach, a cognitive task skills approach, or a sensory approach. Sensory integration therapy is only provided by OT’s with advanced sensory integration certification and it is different than simply offering OT with a sensory approach. Additionally, OT with a sensory approach is very different from use of a rote skills training approach, but both approaches may be used to address multiple academic skills, including handwriting. Parents need to ensure that the OT working with their child has the expertise and specialized skills needed to adequately address their child’s specific challenges. Just as it doesn’t make sense to have a reading specialist teach a child with learning challenges in math, it doesn’t make sense to have an OT skilled in physical disabilities providing assessment or intervention for a child with an emotional disability and vice versa.
6) When making decisions about whether a student qualifies for OT services, the type of OT being offered needs to be considered along with the intensity, duration, and frequency of that service. Intensity, duration and frequency of service can significantly impact efficacy of that type of intervention, once it is initiated. For example, there is a misperception in many school systems that sensory integration therapy is ineffective and/or only suited to a non-academic setting. In fact, sensory integration is the most widely researched area of OT and while further research is needed, it is shown to be an effective form of intervention. That said, offering 30 minutes per week of sensory integration therapy or OT with a sensory approach may be insufficient to make significant functional gains in a school setting, or it may be that type of OT intervention is not what is needed to most effectively address the problems of a particular child. It does not necessarily mean that child does not need any OT. It could be that the 30 min’s per week frequency, is insufficient to adequately effect neurological change and improvement of motor patterns in a child of that age. Research now shows that the brain can change throughout the lifespan, with the right frequency, duration, and intensity of targeted activities.
7) Finally, OT as with any intervention, costs money. Just because a child can benefit from a service, doesn’t mean he/she will qualify for that service, and OT’s who work in the schools, can play a key role in determining the academic impact of any functional challenge on classroom learning. Some functional challenges while difficult to manage, do not necessarily impact a child’s ability to access their curriculum or progress academically. School-based OT’s are well suited to support families in accessing community providers who might be able to help with functional challenges that don’t negatively impact learning but are experienced by students and their families at home.
Occupational therapy is a valuable resource to many students with and without handwriting difficulties, and should be considered as a potential resource for children struggling with any learning related issues. By keeping in mind the various types of OT available, the multiple roles that OT can play in a school setting, and all the factors that may impact efficacy of OT services, parents and educators can make informed educational decisions and advocate effectively, for their students and family.
Kelly Beins is owner and Occupational Therapist at Occupational Therapy Consulting, LLC. Kelly is certified in sensory integration and integrated listening systems (iLs) and has been an OT for over 17 years. She specializes in assessment and working with children, adolescents, and adults, experiencing behavioral, emotional and mental health challenges, using a sensory integration approach. Kelly obtained her BA in psychology and her BHScOT degree from McMaster University, in Hamilton, ON Canada. She is a longstanding member of AOTA and NBCOT and is licensed in the state of MD. Kelly has written, published, and presented at both the state and National Levels regarding various topics of OT, child development, and function. Kelly may be contacted via her website and blog, “Glass Half Full”: www.otc-frederick.com or on twitter: kbeinsotc and facebook: Occupational Therapy Consulting, LLC.