Often times OT screenings are being done in private schools, by private practice therapists, to help identify those children who may be in need of Occupational Therapy services. This is very different from meetings and tests that may be administered in the public school system, so this episode is dedicated to explaining what a screening often entails and what parents should do when they receive the results. So many problems are overlooked by top professionals, including quality teachers and doctors because they are not trained to look at certain symptoms in the way that a sensory therapist has been specifically trained. So if your school is offering OT screenings you just might want to jump on the bandwagon and get an opinion straight from the professional!

Screenings are informal assessments that typically take approximately 15 minutes to complete by a licensed occupational therapist. The purpose of the screening is to get a quick overview of the child in order to see if any “red flags” present themselves, which would indicate the need for a full OT evaluation. An evaluation is a comprehensive assessment that includes standardized tests, which often takes an hour, and sometimes longer. This is a compilation of specific assessments that define the child’s skills to be “average”, “above average”, “superior”, “below average” or “poor” in all areas that were tested. The evaluation then ends with recommendations for treatment. Occupational therapy on average may be two times per week, 30-60 minutes per session over a period of 6 months, before another formal assessment is completed to measure gains made. This may be different based on your insurance policy or the severity of your child’s difficulties, so this information is just a guide.

It is extremely valuable to have an occupational therapy professional complete a screening on a child when the parents or teachers are not sure of what is going on for that child. A quick and inexpensive screening is an opportunity for the professional to review any concerns reported, to see whether OT services or even another type of service would be appropriate to pursue. Early detection of difficulties is “key”, as children can make great progress in a short amount of time with assistance. So why wait until your child is really unsuccessful in school, lacking behavioral control, unsuccessful with social interactions, behind in his or her developmental or coordination skills, and/or lacking self esteem?

Examples of categories that may be assessed in a screening include, but are not limited to:

1. muscle tone/strength- muscle tone relates to the amount of messages the brain sends to the muscles to activate over a period of time; low muscle tone is most common in children who have difficulty sitting still, holding a pencil, focusing with their eyes, and/or who are lethargic or get tired easily.
2. balance – i.e.- to stand on one foot, walk on a balance beam or curb, or walk on their tippy toes.
3. sensory processing – often relating to sitting still, paying attention, keeping their hands to themselves, not invading others’ space, demonstrating self-control verbally & physically, and responding appropriately to touch, sounds, movement, smells and the ability to remember and follow directions.
4. fine motor and visual motor skills – related to forming letters, writing words/sentences, staying within the boundaries of lines and having good sizing of letters, as well as age-appropriate drawing, or coloring, and ability to manipulate buttons, snaps, shoe laces, or food containers, etc…
5. ocular motor skills – related to moving their eyes smoothly to watch a moving target in all directions, which is needed for good writing, reading, attention skills and copying from a book or the board in a classroom.
6. visual perceptual skills – this is related to how the brain interprets what it sees versus how the child can control his or her hand/finger movements for eye-hand coordination activities (which would be considered visual motor skills, not visual perceptual skills) some visual perceptual activities involve drawing pictures or people, completing puzzles, and stacking blocks to match a model or an example.

Examples of common concerns that arise with children in the following age ranges include:

1. infants – colicky baby symptoms, always fussy, hard to calm down
2. toddlers – constantly on the go, very irritable, may not like being touched, more rough or withdrawn than other toddlers, fearful with a “deer in headlights” look when prompted to try something new, hyper, or very high-maintenance and may be generally very difficult to manage
3. pre-k – difficulty following directions, sitting still, touching peers without excessive force, may show resistance to following class routines or distress when changes occur in plans or routines (more so than his or her peers), may have a harder time than others with physical activities and/or fine motor activities
4. kindergarten – difficulty sitting at a desk without constant fidgeting or standing, holding a pencil correctly and keeping up with classmates with reading and writing lessons, over-reactive to touch, movement, sounds, easily upset with changes in plans or routines, may dislike school or feel self-conscious about doing certain activities if they are not as good at something than his or her peers
5. grade school – difficulty with sitting posture, sustained attention, academic skills are slow, unmotivated or resistant to going to school, having physical/verbal outbursts, uncoordinated, or being socially awkward
6. middle/high-school – lack of organizational skills, attention problems, uncoordinated for sports or physical activity, craves movement or sports, may like extreme sport activities, withdrawn, or socially awkward, can’t handle “change”, may not have any friends or may not have many friends, needs to be protected more than his or her peers

This is certainly not all-inclusive, it’s just a quick “cheat sheet” to give you an idea of what symptoms or challenges may present themselves for children in a school environment. These symptoms can happen and stand out in children of all ages, so don’t let the above categories fool you; they are just there to give you an idea.

I hope this information helps you to figure out what is needed for your child. You should be able to contact the therapist who screened your child if you have any further questions or concerns.

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Dr. Charlene Messenger has been so gracious to give us her time and share her expertise with us again. Today she agreed to come back on the show to explain how Psychoeducational testing is broken down in order to do different types of testing for various children, provide us with helpful tips on how to help work on memory; share strategies on how to reward children when working with them to prevent frustration, share a success story with us, provide tips for parents that are struggling to find answers and talk about some of the self-help tools she has created can be used as resources to help parents. She talked about how Psychoeducational testing is broken down into these 4 components:

1. Intelligence (IQ testing) which can cautiously be assessed as early as 2 years of age.
2. Achievement/Academic Testing- i.e. reading skills.
3. Process Testing- which looks at functions such as memory, and can assess auditory, visual, and perceptual-based difficulties.
4. Behavioral/Emotional Testing- which includes screenings for anxiety, depression, mood disorders, ADD/ADHD, etc…

She also talked about how “memory” problems are so easily misidentified and misconstrued these days. She stated that back in the 70’s they didn’t have treatment options for memory problems, but now there are many ways you can practice and strengthen memory skills, like you would strengthen a weak muscle. She encourages parents to check out library books that give 100’s of activities or find memory games on-line, such as subtraction games for your child to do in his or her head, or having them find 3-4 random objects in the house and bring them back to you using only their memory.

She also teaches us that when we challenge children, we need to make sure we are allowing them to have 2 successes for every 1 failure. This is a good balance to achieve so your child is not overly frustrated with tasks that are too easy or hard. Dr. Messenger used the great example of: Shaquille O’Neal practices what is “hard”, not what is “easy”. This is how we acquire difficult skills.

Dr. Messenger feels we can all make a huge difference in the world of a child when we use multiple approaches, and this can be the best way to address children who have sensory processing difficulties. She shared an example of when a parent brought her child into her office feeling like there was a mental disturbance and that medication would be beneficial. It turned out this child needed dietary changes, behavior modification techniques (a simple behavior chart), training in self-control with some play therapy used, exercises for home, and a supportive teacher.

As far as helpful tips for stressed parents…Dr. Messenger encourages parents to take care of themselves, and be patient (as hard as this may be) as nagging and scolding children are not highly effective parenting tools. She also encourages us to be aware of each child’s developmental stages and mental ages, so we are setting our expectations at an appropriate level for them to understand and feel successful. Dr. Messenger also has some great resources on her website including some self-help materials she has developed herself, including her long time book: Secrets of the Third Little Pig which you can find in an Orlando Public Library or on-line, and a game she’s creating for kids that comes with a higher level manual for parents- teaching self-help skills.

Thank you again Dr. Messenger, you are such a pleasure and we are so grateful for your time and expertise over the past 3 episodes.

If you would like to schedule an appointment with Dr. Messenger, find out more about her services, or benefit from the extensive knowledge and resources posted on her website, you can visit her web page at:www.brighterpathways.com or contact her office at 407-895-0540

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