Is it possible for an OT assessment to be redone in school/home?

[freddiefrog]

If you see what I mean

Sorry, posted this on the SEN board in education to start with as I didn't realise there was a special topic area, so apologies for posting twice!

My youngest daughter (7 next week) is being assessed for Dyspraxia at the moment.

She has a number of difficulties in day to day life with her learning, her co-ordination, spatial awareness, balance, sensory, etc, etc. She completely fits with a diagnosis of Dyspraxia.

She was initially assessed on an informal basis by an Ed Psych who works with our school. DD has already received a lot of help through school, but due to various reasons (monetary and an utterly useless LEA mostly), the school would prefer the formal statementing route.

She had her assessment with an OT/Physio in a health centre setting where she did everything she was supposed to do, so there's no physical reason why she can't do these things so they've discharged her

It was done under very test-like conditions in a very quiet room, with an audience (me, DH, OT, Physio), where she was fully focussed and concentrating on the tasks she was asked to do, so for example, she was asked to run so they could watch her, except she was running down a fairly narrow corridor, with everyone watching and she was totally concentrating on the task, so of course, she did it fine.

The problems start, when she's running in more natural conditions - i.e. running around in the playground with her friends and she falls over a lot, runs into things a lot, trips over her own feet or her friends, if she's running around at home she'll trip over the sideboard in the living room (the same sideboard that's been there for 10 years) or fall down the stairs, etc, etc

She was asked to colour in a star shape, again, she was fully concentrating and focussed on the task in a quiet room with only 4 other people in it, so she did it fine.

But at school, in a classroom with 20 other children, she gets distracted, loses concentration, fidgets about on her chair, stands up, sits down, fiddles with her pencil and generally forgets what she's supposed to be doing

Generally, her concentration span is very short, but in the assessment they did a lot of very short (apart from the colouring in tasks, they were generally timed for 10 or 20 seconds), very different activities so it appears to them that her concentration is OK, but in her more natural setting (for example, guided reading or an art activity at school) she is unable to concentrate for any period of time

Then there were things like catching a ball (she caught 1 ball out of 10 throws, and that was by pulling it up to her chest if you see what I mean), standing on one leg for 10 seconds (she managed 2) throwing a ball at a target (didn't hit it at all out of 10 throws), hopping for 10 seconds (managed 2 hops before falling over), bouncing a ball (didn't manage to bounce it at all), but she was able to ride a bike (she can ride a bike, but again, under more natural conditions she is fine when she's fully concentrating, but as soon as her attention wanders, she falls off or veers off into bushes), she could run fairly straight (albeit guided by the walls of a narrow corridor).

So yes, physically, there's no reason why she can't do this stuff, so they've discharged her.

They didn't look at any of the sensory things - hatred of certain clothes because they're 'spikey', won't sit on our new sofa as she hates the feel of the fabric (we've just gone from a knackered old leather sofa, to a new soft fabric one) hatred of loud noises (hates fireworks, loud music), hatred of busy places, hates going on holiday or out for the day or anything out of routine - if I take the kids to the park, or to the shop for an icecream on the way home from school she completely freaks out, or any of her other foibles. Coupled with all the other stuff, our SENCo felt they were flags for dyspraxia and should be investigated, but they weren't really interested.

So, we've been going through the report with her teacher, her SENCo and the Ed Psych who did the initial informal assessment and they completely disagree with the whole report and want another assessment done at school, and for her to be officially referred to the Ed. Psych.

Sorry, that's so long, but there are all sorts of difficulties and I wanted to give as much information as possible.

I'm totally fed up with fighting for this, and have no idea what to do next.

If she is struggling more because of sensory issues and distractions, then perhaps they need to look further than dyspraxia. Is she being assessed for anything else at all?

FWIW, DS2 has dyspraxia (among other things) and even with no distractions and fully trying to concentrate, he is unable to physically coordinate enough to do many of the tasks in the assessment.

Is it possible that she is having more issues with the sensory problems, and a byproduct of that is the other problems?

Just wondering if that's what they're looking at....

I was really disapointed with the NHS OT and totally shocked at the increased detail in a private optremetrists report recently.

From my narrow viewpoint and research the NHS seems to be woefully generally inadequate at assessing and supporting dyspraxics - to the point where the only child I know who got "good" support was the son of a GP who paid for the assessments privately.

Even the dyspraxia foundation - the national charity seems to be very underesourced compared to other national disability charities.

If you can afford it, I'd go for a private assessment. Sadly NHS OT's know they have too heavy a workload to adequately support children wit "just" sensory &/or dyspraxic issues so shy away from formally identifying them in the first place.

Sensory issues especially are underated yet can have a devasting impact on a child's ability to cope & learn in a mainstream environment.

To be honest, I don't really know. All this is totally new to me so I'm feeling around in the dark a bit. Our school have been fantastic with practical help, but not so good with communication

We've always had some difficulties with her. I suppose we're so used to her we've just dealt with it over the years, adapted to her, and put it down to "a phase" or eccentricities and just got on with it.

She seemed to be struggling at school in Reception, but that was put down to her being very young, then in year 1 she had an perfectly lovely and very nice NQT who assured us she was doing absolutely fine and would be finishing the year on target (but with hindsight she wasn't and perhaps the NQT just wasn't experienced enough to pick up her difficulties) and she's now coming to the end of Year 2 where she's had a very experienced SN teacher, who picked up more or less straight away that she was having problems and reassessed her and found her levels were all at what would be expected after the first reception term

We had a meeting with her teacher, the SENCo and the Ed Psych who comes into school to work with other children, and they asked for permission to assess her for dyslexia. We then got chatting about all the other things she struggled with at home, so she was also assessed for Dyspraxia and this was done in her classroom setting at school. The assessment came out as high dyspraxia, low dyslexia

I can't remember the actual wording the EP used, but the EP found things like, her actual IQ is 107, but she's only working at 81, her working memory is non-existant, her co-ordination, concentration, etc, during the informal assessment was also non-existant

So, she was put on School Action, then School Action Plus and she's recently started something called Activ8

They then applied to the LEA for a full assessment, and since then we've had her eyes tested (fine), hearing test (fine), a once over by a paed (fine) worked with a martial arts teacher (who also highlighted the co-ordination and concentration issues), has been doing this Activ8 thing (co-ordination and concentration also picked up) so was then referred to the physio/OT, who feel she's fine and have discharged her.

I just don't know what else to be honest, the school would like her reassessed in a more natural environment so they can actually see for themselves what her difficulties are, whether it's dyspraxia or something else, and an official referral to an ed psych for a more detailed assessment.

We spoke to the OT/physio about the sensory stuff, and about how she usually is when she's behaving more naturally but they didn't really seem interested, and no mention of anything we said is in the report

Just stuff like X hopped twice, X caught a ball 1/10, X ran 25 metres, X rode a bike for 25 metres, therefore we have no concerns

I don't know what on earth I'm supposed to be doing

Thanks!

Is it possible for you to get a referral from your GP to a paediatrician for further assessment? Seems obvious based on what you are saying that something is going on, but maybe a fresh evaluation that will take more possibilities into account would be helpful. And if need be, the paed could refer back to OT (or to different one) for further assessment.

Sorry, x-posted.

We have offered to go for a private assessment, but our LEA will not accept it.

We have to use their "pathway"

Thanks!

Also, I'm a bit confused, as my understanding is that the EP can assess, but not dx. She would need paed to dx.

Anyone else have the scoop on that one please?

Sorry Triggles, missed your post too. Slow typist!

We've been to our GP, we had to get him to refer to the hospital for her eye test - she needed more than the Specsavers-type test, and he refused to have anything to do with it. Said it had to go through the LEA via school.

Sorry, x-posted again

I have no idea, I have no real idea of what goes where, School have been dealing with all referrals so far

Oh, and the paed just looked her over really. Made sure her weight was ok, looked at her throat, ears, etc, etc.

Didn't really go into much more than that, he gave the impression it was just a box-ticking exercise before we could move on to the next step

Odd. Perhaps different areas, different approaches. Our DS2 had to have a very extensive eye exam - was done through referral of paed to eye specialist at hospital. Paed scheduled DS2 for further assessment at ASD clinic after asking tons and tons of questions re development and such. Paed also referred for OT and PT separately for assessments.

DS2's paed generally coordinates his care overall and refers him to other professionals as needed.

The only part of the assessments that went through the school was our initial referral to paed (by school nurse) because our GP at the time was pretty much useless (have since changed to different GP).

I think this is one of the things that makes it so difficult for parents - things are so different from area to area - there's no consistency in care, so parents just don't know which way to turn.

Do you have a written report yet from the OT assessment? It sounds on the surface that the OT reached some pretty contradictory conclusions if your dd failed or performed very poorly on a number of the tests but she is passed as needing no further support. DS performed much better on the tests than your dd but the report we received afterwards highlighted a host of useful interventions which we and school could apply to help him with the difficulties which did show up. Do you think you could go back to your gp and point out both the inconsistency between your dd's poor performance in many of the tests and the lack of follow up offered and also the fact that she actually performed better than in normal circumstances because distraction free. GP could perhaps refer you elsewhere for a 2nd opinion or support you in challenging puzzling conclusions of existing assessment.

To answer the 'can they do the tests at home/school question - yes. DS1 has been known to OT dept and paeds since he was 2. Input has been patchy - and only after constant chasing. When I asked for more OT input - after a year on the waiting list, we got a Sensory Integration and Praxis Test (SIPT) by an NHS OT - it was done at home. We are now having NHS Sensory Integration Therapy - based on this test.
Our LEA is reticent in accepting any non paediatric consultant NHS approved dx. So even if an OT dx dyspraxia, Sensory Issues etc, it is likely that this will need to be confirmed by a paediatrician to hold the weight needed for the LEA

It sounds like the paed you have seen is a general community paediatrician, and not a developmental specialist. Could you contact the paed again (or maybe your GP) and say you are concerned that while her 'health' is good you feel there are developmental issues? My DS was referred to the community paed in my PCT who specialised in neuro - developmental issues including ASD etc.

Thank you!

We haven't had the official written report yet, the school have a copy which we looked at parts of today, but ours hasn't arrived yet.

We all found that both the OT & PT were mainly focussing on what she could do, rather than what she couldn't do if you see what I mean - she could run, she can ride a bike there she's fine, rather than coming at it from, she can't hit a target, she can't bounce a ball, she can't hop

And it just wasn't performed in her natural environment so it wasn't reflective of her usual self

Yes, I think he was a community paed - he really just checked her general health, nothing indepth.

School have said there is a LEA 'pathway' which they have to follow, which doesn't necessarily seem the logical way of going about it, but all the boxes have to be ticked

I'm incredibly confused by the whole thing to be honest, I've got no experience of SN and communication from school hasn't been great.

If I'm honest, the thing that worries me most is her educational needs - she can't read beyond simple 3 letter words such as cat, dog, and even then she has to sound the word out every time, her written work is way below what it should be (stories are just lists and lists of random words, her spelling is way off - she doesn't even spell phonetically, just random letters), she can't concentrate in class, can't work out simple 1 + 1 sums without counting aids, and can't remember times tables, etc, etc, she's not made any improvement this year, nor is she showing any signs of improvement, she's had some 1 on 1 time with a TA but it's not a regular thing

I think I'll go back in tomorrow and try and work out what the heck is going on, I understood that she'd have her OT/PT assessment, then an Ed Psych assessment, then they'd work together with a dx and any support/statementing she may need.

We have spoken to our GP about this before and he just refused to have anything to do with it, as, according to him, all referrals had to go to the LEA via school. There are several in the surgery so once I get the report, I'll make an appointment to see a different one and see what they suggest

Thanks again

My DS had his initial assessment with OT in a green book. He came out average. OT was asked for another assessment at SA. I asked to be present and the results were totally different...1% and 5%

An OT told me that some of these tests use the normal range of DC in USA who may have had less schooling and these results do not always seem to be applicable in UK.

This info may not be relevant to you but I thought it might be worth mentioning

Ours filled in a little booklet.

I don't think it was green though.

They just recorded all her results in it, made no other notes, wrote down anything we said or anything like that.

Thank you!

can you possibly go private? and look at sensory issues along with her praxis? Since you are quite clear on your concerns (I hope I have understood you), you could be very targeted with who you saw privately.

DS has seen a number of OT's, all had varying understanding in sensory issues - but none were actually very clear about it, until we saw a Specialist OT in London, and things started falling into place.

We have looked at going private, but we were advised that the LEA will not accept any kind of private dx or recommendations for statementing. We have to follow their 'pathway' using their staff, or no statement will be given or honoured.

They won't even allow their Ed Psych, who is on site 3 - 4 times a week anyway working with other children, to assess her in school without going down the formal referral route

School advised us to save our money and put it towards a private tutor when we finally get to the bottom of what's going on. There's no point getting extra help with a tutor in the meantime as it would just be putting a sticking plaster on a boil if you see what I mean

The whole thing is just so frustrating

I had a chat at school this morning, they gave me her school report and she's been scored on Reception levels at a 6, below even the 1c/1b levels they use from year 1. She's finishing year 2 in less than 2 weeks.

The only advice the OT gave us was stuff we'd managed to work out for ourselves over the years - she can't follow more than 1 instruction at a time so we break everything down into seperate bits, i.e, getting ready for school, we've been following the same routine of breakfast/wash & teeth/dressed for years, but unless we break it down into seperate sections she still gets confused, can remember the 1st and last bits, but forgets anything that goes in the middle. We pile up her clothes in the order she puts them on or she gets in a muddle. With the "spiky" clothes, she puts old well washed and worn vests or t-shirts underneath, etc, so all in all, we found it pretty useless

To be honest, I don't really care that she can't hop or hit a target, or kick a ball in a straight line. I do care that educationally she's really struggling, is getting further and further behind with no chance of catching up. She's beginning to notice that her friends spellings include things like shuttlecock, or orchestra, while she's still struggling with cat, went, home. She's still on her 2 times tables, she just can't spot the pattern of alternating numbers, doesn't understand her 10 x tables, doesn't spot the pattern of adding a 0 and she's finding it frustrating and she says it makes her feel 'stupid'

I did ask school their thoughts private assessment again this morning, it may not be accepted by the LEA but at least we might get to the bottom of her problems quicker than we are by doing it officially. They're going to get back to me later with some names and phone numbers, and the Ed Psych is going to do some more indepth assessments on her own time after school this week

I feel like marching into the council offices and screaming until someone comes down and sorts this whole thing out, I don't think the left hand knows what the right hand is doing

Thank you!

Sorry, turned into a bit of a rant