Occupational Therapy Evaluation- Fine Motor Skill Development:

Occupational Therapy Evaluation- Fine Motor Skill Development:

INDENTIFYING DATA AND REASON FOR REFERRAL: Scott is having some difficulties with behaviors in the classroom, although his academics are average and in some cases are above average. He has some issues with hyperactivity, aggression, and some atypical behaviors that have his teacher concerned. He also has some refusal issues when asked to do tasks he does not want to complete.

SOURCES OF INFORMATION: Background information was obtained from his mother, his previous social worker, former psychologist, and numerous psychological, educational and medical reports. This information was obtained from interview, developmental history and rating scales as well as medical records. This information appears to be from reliable sources and valid. Current status of his learning and behavior was obtained from observation during testing and from standardized psychological, neuropsychological and achievement tests. The validity of his performance on most tests was deemed to be accurate due to his cooperation and motivation to perform the tests.

BACKGROUND INFORMATION:

Current Concerns: Scott was referred for behavioral concerns and refusal to work and comply with directions. Scott shows atypical behaviors, which have teachers and parents concerned.

Medical and Development History:

Pregnancy and birth history: Scott’s birth was typical after a 40-week pregnancy. He was an 8 pound baby with no apparent concerns at birth.

Developmental history: Scott experienced sleep difficulties as an infant, rarely sleeping for more than 2 to 3 hours at a time. His appetite was also reported as poor. Developmental milestones were reported as within normal range for language and gross motor development. However, he has poor fine motor coordination, especially for writing. Development of bladder and bowel control at night was also somewhat late.

Medical history: He had the usual childhood illnesses of chickenpox, ear infections and strap throat.

BEHAVIOR OBSERVATIONS

Testing Behavior: Scott appeared to be uninterested in testing, but was not particularly noncompliant. He came willingly and responded when asked, with the exception of the writing task.

Behavior Rating Scales and Interview: Behavior Assessment Scale for Children (BASC)

Clinically significant ratings in the areas of:

· Hyperactivity (excessive movement, acts without thinking, calls out in group activities, interrupts adults when wants something)

· Aggression (threatens to hurt others, hits others, breaks and wrecks things of others)

· Depression (e.g., moods change quickly, easily frustrated and upset, pouts, screams “That’s not fair”)

· Attention Problems (e.g., gives up easily, short attention span, easily distracted)

· Withdrawal (e.g., plays alone, refused to talk, avoids activities with others)

· Atypicality (stares blankly, seems out of touch with reality, repeats thoughts over and over, sings or hums to self, and hears or sees things that aren’t there)

Home: Scott’s mother and father state he is usually compliant and quiet at home. He enjoys video games and computers and has from an early age.

School: His teacher states he is rarely absent, frequently aggressive, and often noncompliant. Academically, she thinks he is on par with same-age peers. His refusal to do work does make it hard for her to gage, however.

TESTS ADMINISTRED: Standardized assessment targeted the domains of intelligence, learning processes, academic achievement and emotional/psychological development.

STANDARDIZED INSTRUMENTS: Wechsler Intelligence Scale for Children-Third Edition (WISC-III)

This test measures current intellectual functioning. Overall cognitive ability in the average range (FSIQ = 103; 58th percentile). Nonverbal ability is significantly better developed (77th percentile; 111) than verbal ability (37th percentile; 95).

Visual Motor Integration Scale

47th percentile; Age equivalent = 5 yrs. 10 months

The types of tasks in this assessment test perceptual and motor skills which are precursors for writing letters. Scott has shown improvement since initial screening at 3 years, 8 months when he was at the 25%ile. Given the right circumstances during testing session (e.g., cooperation, time, interest, motivation) Scott can perform the assessment task at levels commensurate with age norms. Scott can replicate lines, shapes, designs and figures.

Peabody Individual Achievement Test-R (PIAT-R)

Sub Test Range

General Info Above Average

Reading Recognition Above Average

Read. Comp. Above Average

Mathematics Average

Spelling Above Average

Total Test Above Average

Conclusions

He has acquired basic pre-readiness skills in reading (he can identify all upper and lower case letters in the alphabet, can identify pictures for word beginning with a, b, c, d, f, g, h,l, m, n, s, t, can retell a three event story and answer a comprehension question after a passage is read). In the math area Scott can orally count to 30, identify all basic shapes, say the names of the days of the week, and answer addition and subtraction facts to five.

Work Samples: Writing

· Only 3 samples were available because Scott refuses to write. Writing is very immature with large, gangly stick figures, no proportions, and very light.

· Pencil grip is incorrect and awkward – refuses to hold pencil correctly – even with cushioned grippers.

· Refuses to write name, letters or numbers

Occupational Therapy Evaluation- Fine Motor Skill Development:

Bruininks- Osteretsky Test of Motor Proficiency (a standardized battery of motor performance tests; used by OTs, PTs and sometimes P.E. teachers; assesses both gross and fine motor skills) 54th percentile

· Needed prompts and motivator to overcome refusal – did complete test.

· Response speed equivalent is 5 yrs. 8 months.

· Visual motor control equivalent is 5yrs. 5 months.

· Upper limb speed and dexterity age equiv.-7 yrs. 2 mo.

· Right hand preference with irregular grasp and tight hold. Demonstrates diminished strength in shoulders and arms. Complains of fatigue after one minute.

Sensory Processing Skills:

Areas of definite difference when compared to peers

· Touch processing (tactile defensiveness, craves touch)

Areas of probable difference when compared to peers

· Sensory seeking behaviors

· Oral sensory processing

· Auditory processing

· Vestibular (related to balance, orientation of the head, etc.) processing

· Multi-sensory processing

Conclusions:

· Fine motor skills are at a functional level with the exception of strength and endurance.

· Sensory processing is a concern. Difficulties interfere with participation in classroom activities, interaction with peers and staff, emotional and behavioral control and attending skills.

Observations:

· Day 1 – 9:00-11:00 a.m.

Students were engaged in circle time activities such as calendar (day, date, weather, etc.) Scott was asked to draw the weather symbol on chart—he refused…Said “no.” Refused teacher’s offer of help and ran to the table and sat under it. Teacher asked him to come out and join group. Refused and stayed under table until circle time finished (20 minutes).

Students engaged in various center time activities (e.g., making shapes with clay, alphabet activities, etc.).

· Scott refused to join in any of the activities. His off-task behavior consisted of shouting, yelling, screaming that he wasn’t going to do something, throwing things, knocking his chair over, trying to leave the classroom, hiding in the classroom, going under the table.

· He refused to participate in anything the class did 70 minutes of the 1.5 hour observation. Initially teacher tried to “coax” Scott into joining an activity. Then she ignored his behaviors and interacted with the other students (e.g., asking them questions about their center activity, etc.)

· During the last 10 minutes of the observation Scott engaged in a self-selected activity. Scott went to the Lego table and began to build a Lego structure.

· Peer behaviors included 1 “tussle” (both boys tugging at the same truck during free choice activity) over a toy truck with one boy saying, “I had it first.”

· Day 2 – 9:00-11:00

Schedule of activities was the same as Day 1.

· During calendar Scott sat outside the group but didn’t verbally yell or interrupt group.

· During center time Scott refused to join his assigned group for alphabet activity. When teacher tried to physically assist him to group Scott kicked and hit at the teacher when she approached him. Whenever the teacher tried to engage or assist Scott to join group (4 different times) he refused verbally with yelling (“I’m not going to!” or “No, no, no”) and threw himself on the floor and finally moved under the table.

· Peers followed teacher directions. No verbal or physical interactions (hitting, throwing, etc.) occurred with peers.

· Day 3 – 9:00-11:00

Schedule of activities was the same as Day 1.

· During calendar Scott sat outside the group.

· Didn’t join in any center activities.

· 15 occurrences of verbal disruptions (e.g., shouting out, humming, yelling, ”I’m going to kill you”) during the 2-hour observation

· 1 occurrence of tantrum (i.e., threw himself on floor and continued to scream and shout) with duration of 5 minutes.

· 3 physical threats (i.e., threw chair at another student who wouldn’t give him the Legos; pushed child to get out the door, threatened teacher with scissors (pointed scissors at teacher and made a jabbing motion)when she reminded him to be careful.

· There were 5 verbal outbursts (yelling, screaming) and 2 physical outbursts each day. On Day 2 Scott threw a book at teacher and pushed another child out of his way. On Day 3 Scott threw clay at another student, barely missing him, and kicked the teacher when she came over to ask Scott a question.

Recess Observations: Data was collected over 7 days for one 15 minute period each day. (One recess supervisor was assigned to watch Scott at all times and make sure he returned to the building.) Behavior included watching others play, running alone, or sitting on the ground singing and humming. There were no interactions with other students and Scott did not respond to supervisor prompts to join in.

Written permission acquired for the use of:

Wisconsin Department of Public Instruction (2002). DOING IT RIGHT: IEP goals and objectives to address behavior. https://sped.dpi.wi.gov/sped_sbiep

SUMMARY:

RECOMMENDATIONS: In order to best serve Scott’s needs there are several areas that may be targeted for intervention.

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