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      Depression, Mental Health and Crisis Support   06/04/2017

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windylou

OT appointment

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windylou   

Hi I may (or may not of mentioned in previous posts) that my son was waiting for an OT assessment of his fine/gross motor skills? and just wanted to update you really as you have all been so helpful. Well he has just had his assessment and some of the tests involving his fine motor skills couldn't be scored because of the time it took him to complete them even though he did show excellent pencil control and completed the task. The OT noted that he used 4 fingers instead of 3 to hold his pencil and he was applying too much pressure to the pencil.The OT said she disagreed with standard tests when assessing a child with ASD because they do not give an accurate picture of the child's strengths and difficulties. She was more concerned about the way he processed things and he wanted things to be perfect which would affect him a lot in school.

 

One of the fine motor tests involved my son copying 12 different pictures into a box below each of them and he did them all in mirror image (this took 25 minutes because he was concentrating on getting each picture perfect instead of just quickly drawing them).

 

Another one was to draw a picture of himself wearing his school uniform, this was very detailed and it took him 20+ minutes.

 

When asked to read and copy 1 short sentence on a piece of lined paper he refused and turned away, wouldn't acknowledge any of us, said he just wanted to run out through the door but with lots of gentle encouragement and an extension of his computer time at home he eventually did it very quickly and neatly (while shielding it from everyone so he could write 'quicker') but continued to make comments about wanted to rip it up/punch it and run out of the room through gritted teeth.

 

He had a slight delay when timed to use each hand for tasks but the OT wasn't concerned because he favored the quickest hand when writing.

 

He avoided anything which involved balancing.

 

She didn't go too into detail about the tests for the gross motor tests, made a comment that he would catch up with regards to fine/gross motor delays- so I'm guessing he is delayed there???(she said she will make sure it's all in a very detailed report) but she gave us some ideas with helping him in other ways at school such as velcro on his shirts so it was one less thing for him to tackle while changing from PE or swimming right now she wants to concentrate on the written work at school and taking the pressure off him as he will already have too many demands on him due to his asperger's to begin with. So will be suggesting a laptop for all written work (this has been suggested before by the peadiatrician and both the school and EP said no so not sure how this will pan out).

 

She took lots of other information from us including his scout leaders full name!? annd we mentioned to her that we had been refused a SA for our son she said appeal and she will support us the best she can (she has recently been to tribunal), when she asked what his behavior at school was like and we said he has lashed out in the past but we haven't had any calls about it for a while she smiled and said that's definatley not his nature what I can see here today is that he has a very gentle nature-which brought a tear to my eye because she saw our son!! she will contact the EP, CAMHS, for more information and wants to do an observation in school now that she has met him to see what is being done and if there may be anything else causing issues.

 

PHEW! what a long post sorry! All in all I feel really positive, and when we left the appointment we noticed our son had a little spring in his step too. Now we are just waiting on an appointment with podiatry to check out his flat feet and see if that is adding to his difficulties too!

Edited by windylou

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windylou   

Yes, Sally NHS OT. She couldn't make it any more clear that she was here for our son and us as a family and nobody else.

 

Don't worry Sally, I (think I) remember what you said about fine/gross motor development delay and some not committing by not naming it as dyspraxia (I think that was what you said..that's off the top of my head so sorry if I got it wrong!) so once I get the report I will query further if needs be.

Edited by windylou

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Sally44   

The NHS OT will not specify provison/therapy for Dyspraxia or for Sensory Integration Therapy because the NHS does not fund it. But an independent OT will quantify and specify and you need your parental choice of school to be able to provide any therapy they specify [that applies to OT, SALT or EP recommendations].

 

This is the link to the college of OT's own report into Dyspraxia http://www.cot.co.uk/sites/default/files/publications/public/doubly-disadvantaged.pdf

 

They confirm that children "do not grow out of it".

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windylou   

Thanks for the link sally.

 

Well we received the OT report,

 

Manual dexterity-25th percentile (between 5th and 15th being some degree of difficulty)- he was reluctant to perform the lacing task but managed well with encouragement-no fine motor difficulties identified.

 

Aiming and catching-9th percentile-struggled to control force of movements, tended to catch against his body. sets his own agenda rather than abiding by rules of game/task.

 

Balance-5th percentile- refused to stand on the balance board so score particularly low-references of upcoming podiatry appointment noted.

 

Pencil skills (visual motor intergration)- not possible to score. Used sketched feathered lines rather than 1 line, mirror images of some pictures, should of taken 3 minutes but took over 20 although accurate no indications of visual perception difficulties but rather an in individualized interpretation and execution of what was required. commented it "had to be perfect".

 

Pictorial test- not scored although very detailed proficient picture was drawn- took a great deal of time.

 

Minnesota speed test- to copy a sentence- took a great deal of coaxing to complete 1 line, couldn't be persuaded to do more. Sentence was produced very slowly and carefully and a neat lower case print was achieved. spacing between words was poor. 4 point grasp was used to guide the pencil adequately...processing skills are having a large impact on his performance.

 

School observation to see how our sons processing skills are affecting his school work in the school enviro and also to see if there is anything else which could be causing difficulties.

 

Now for the podiatry assessment!

 

Dyspraxia was ruled out by several of the tests, think it was due to the vestibular tests. Excellent core strength. Our son is an isopathic(?) toe walker, rather than using the heel toe pattern while walking he is using toe heel...which explains why he seems like he is dragging his feet!.I hadn't got a clue what he meant until the chap demonstrated for me. He has stiffness of the ankle joints and tightness of the calf muscles. During one of the tests our son had to tip his head back and the chap said he was very flexible...after all of the tests had been performed he was pretty sure he was hypermobile. He made a note that his knees stuck out more (behind him) than most when he was standing straight, he could bend his little finger straight back when his hand was flat on a table, thumb went right back and touched his forearm, wrists flexed more than most, legs were more flexible at the hips, and also his elbows had a lot more flexibility.

 

Outcome; referral to physio and referral to paediatrics because he was concerned about the joint pains our son was experiencing without any signs of swelling so possible blood tests to rule out any underpinning issues. Insoles and exercises to stretch the calf muscle which our son really isn't happy about.

 

I have contacted the OT (I did ponder that maybe she should of picked up on this??) to just update and she will use this additional info when she goes in to observe and suggest other strategies.

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Sally44   

Not sure I agree with the 'not dyspraxic' comment. Have a look at this http://www.dyspraxiafoundation.org.uk/dyspraxia-adults/

He has some of those difficulties. And like every disorder, you don't have to have all the symptoms, just enough of them.

 

Also google autism and hypermobility. And also Elhers Danlos Syndrome.

Edited by Sally44

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