I am an community Paediatric Occupational Therapist AMA

[OTwithbthree]

My role is across LA and NHS so I deal with every situation from adaptations, posture, wheelchairs and end of life care. I don't specialise in sensory integration but do, do adaptations for Autism. Ask me anything. I'm 20 years in.

Just wanted to say that you have my dream job, OP (I'm a teacher). You do such important work. Are you one of a few employed by your LA / NHS Trust, or is it 'just' you?

Why don’t OTs on the nhs do sensory integration? What does adaptions for autism mean?

How do you get an appointment with an OT for autism? I found it easy to get one for my dc with physical disabilities but getting one for any of my autistic dc just hasn't happened, despite my best efforts.

What are your top 5 tips for adaptations of autism? Are they different for ADHD as there’s such comorbidity?

They do in some areas. I work in an NHS adult Learning Disability team, and some of our OTs have obtained additional qualifications in sensory integration.

It's a great job we are dual commissioned based in the community. We used to just be LA but joined forces wih our NHS colleagues so my background is LA but slowly learning some more of the NHS and OT skills.

Yes some of my colleagues do it, is just not my specific specialism. Sonwhilente service is provided it's not in my particular role.

I would assess each case differently on how they present to be honest. Some areas don't take ADHD alone seriously but we do, given as you say its co morbidity and the fact itself is a disability. So we would do things like provide high fencing for children who need somewhere safe ro play outdoors, install wet rooms for parents who are struggling to get larger children in and out of thr bath (unless the child needs a bath from a sensory point of view) we provide bedroom adapts to keep a child safe such as wall padding, window restrictions and specialist beds in some circumstances.

It depends on what you are asking for and where you are. Generally if you are looking for therapy input such as sensory integration or you need a child to be seen at school then Generally your NHS team covers this. School can refer or another professional involved with the child. If you feel you need adaptations for the child's safety then generally you can refer into your local authority. It depends where the OTS sit, some LAs have a combine adult and children's team. You can generally self refer to hr LA.

My DS has seen both LA/NHS OTs and private ones - the difference between the assessments is immense.

The private OTs seemed to have a great understanding of my DS whereas the LA OT seemed to be working as a gatekeeper to deny my DS of the support he needed.

Have you experienced this?

@elliejjtiny just to note he OT wouldn't assess a child for Autism that we need to be a Paediatrician although OT reports count toward any gathered information.

What hours do you work? What is your pay (ballpark)?

Sorry to hear that! In my purely OT role with LA we sort of assess and provide according to the very prescriptive DFG criteria and the assessment would then lead into environmental adaptations for safety. None of what I would write in an assessment would fees I to recommendations around provision at school or home " therapy". I have found it different across lots of settings and it depends very much on the OT. In some ways it's easier to assess a child with physical disabilities as there are equipment and adaptations that can help. With kids with neuroduvergence, I speak with parents, school etc do some observations of the child but ultimately think" if this was my child and I was tired and trying my best what would we need."

I work 37 hours, not in a management position although I'm a senor OT I earn around 40k.

Just a thank you for doing what you do.

In our area, it's really difficult to see an NHS OT. We have input from Physio due to DC's painful physical condition, but it's been impossible to see an OT to help with some day to day activities that DC struggles with.

My child’s difficulties came from dyspraxia as well as ASD/ADHD.

The first NHS OT we saw asked me a few questions and then decided DS was fine, he just needed to write on a chalkboard to build strength (this was only 12 years ago and the only place I’d seen a chalkboard for years). I then presented the private report he’d had just a couple of weeks before and suddenly she decided that DS did in fact have some difficulties.
A few years later an LA OT was asked to assess DS as part of the tribunal process for specialist school. He’d already had a private assessment, the LA OT report basically was a counter argument to the private report! The LA conceded and none of the LA report was used in his EHCP.

I find it so hard to believe that the same profession can provide such different support.

DS(10) had an OT assessment a few weeks ago for suspected Dyspraxia and we are waiting for the report.

Dyspraxia was suggested 18 months ago when he was first assessed by an EP at school due to very slow progress with spelling and grammar, messy handwriting, not good skills in PE/poor at team sports, a bit clumsy etc. He also ticks boxes for other symptoms that are not school-based ie poor cutlery skills, wiping after the toilet, low self-esteem as time has gone on as he has realised he is getting behind his peers, very fussy eater etc.

The OT did her assessment but wasn’t interested in any other potential symptoms outlined above, and while she said that “he probably does have it,” he is only being referred on to a paediatrician because she said some of his scores were at odds with his symptoms.

I’m just a bit confused as to who will look at DS as a whole picture and be able to make a diagnosis and suggestions to help him? If it wasn’t for his differing scores, as I understand it he wouldn’t be seeing the paediatrician (I could be wrong of course).

Thank you.

@Blueberryme in DSs experience the first OT we saw stated that although she was assessing for dyspraxia she couldn’t make that diagnosis it had to come from a paediatrician who would diagnose based on the report she’d written.
The paediatrician should make the diagnosis and the OT should write recommendations of support needed in the report. These recommendations can be written into an EHCP.

What does he struggle with, happy to make some suggestions?

Agree, although I think a lot of LA oTs will.make recommendations and assessments based of what is available and what they can provide rather than the child's needs. I attended a course by Michael Mandlestam and he said that OTs are selling themselves and the client short if the identified need is based on what an be provided. Basically that we should always identify a need even if we can't provide anything for that need. He child's needs still exist outside of legislation.

Our OT is nuts.... DS has severe complex medical needs. Including mental & physical. He's had a paediatric Kinderkey Bed since he was 2 years old. He's on growth hormone now & needs an adult sized bed. We've just asked fir the same Bed but larger......arrrggghhhh 1 year in, still waiting while our boy is scrunched up with a kyphosis scoliosis in a too small bed. He's 16 so the NHS have had thier moneys worth and it's in perfect condition, so it can go back out!!!
Why are we changing something that already works????
Arrrggghh.... when she calls my soul leaves my body!
Compare with my community.... asked to swap a triton for a tomato seat on wheels with a tray.... voila ... had to work harder for the tray as not normal stock...but working on it!!!
If this is you H.....I loves ya!!!

My heart is LA. You sound like a lovely mum although doesn't sound like my cases. It's fairly typical scenario unfortunately. I think we have to have lots of love and respect for the families we work with. This job ticks all of those boxes. Hopefully the bed situation with be rectified soon.

What adaptions do you recommend for asd?

Do you think the nhs should provide sensory qualified OTs? There's a huge need imo.

Hi Rudolph it depends on the child but we provide things such as window restrictions, higher level fences, locks, door alarms for elopers, stable doors, specialist beds if needed, secondary protective glazing.
The NHS do provide sensory qualified OTs we've found in out team that's it impossible to be qualified in everything, better to be an expert in your own area. Children are allocated based off their need and rhe most appropriate OT in our area. If the child's needs are mainly safety adaptations based but with some need for sensory input then I would co work that case with a suitably experienced OT.

I have seen some shit OTs in my time they all just seem obsessed with whether she can cut with sissors or do up buttons (she can do both of these) she has massive sessory issues (they don’t cover that) she regularly escapes our house (nobody seems to have any thoughts on that. I was told to hide the keys) her handwriting is a mess. (No thoughts)
Ive been told my 2 different nhs OTS that my daughter is compex and she needs a private sensory assessment. I cant afford this right now.
I’m at a loss what to do really.