Tuesday, March 24, 2015

Occupational Therapy Evaluation 04/24/15

H. came from the same company that provides early intervention services for our son.

He was very excited to meet H. He was all smiles when she came over. The first thing he did after hugging her was to try to open her bags and he managed to rip a Post-It from deep within her bag and throw it on the rug. Being quite pleased with himself, he began diving deeper into H's bags. I told him he can't be doing that but she laughed and said its fine.

H. then handed me a questionnaire that was several pages long. The first section was demographic information about my son. The question that stuck out the most was about getting upset when their nails are cut. Every single time that is an issue.

While I was doing the questionnaire, H. attempted the test for my son. Parts of the test involved making a block tower. My son picked up one of the blocks and tried to eat it. Then he walked around the living room ignoring H. while giggling and trying to lick the block. There was also a puzzle of three simple shapes: a star, a square, a circle. He wanted to play with the pieces. She tried to direct him to put the shapes in the right place, but he got extremely agitated and started to cry because he wanted to play with the shapes. She then handed him a book and told him to turn the pages. He grabbed the book, sat with his back to her and started turning pages and looking at the book. She asked me if he likes to color. I told her that I can no longer give him round crayons because he likes to shove them up his nose but I will demonstrate what happens when he is given triangular shaped crayons. I set him up with some paper and his crayons. I already knew what would happen, but I wanted her to see this. My son took all the crayons out individually, held them up, and stared at them while rotating them and babbling to himself. I asked him to make me a picture and showed him how to make a squiggle. He dove into the pile of crayons again and started sorting them. H. said maybe we should only give him one. Then she and I made lines and squiggles and I attempted to help my son make a squiggle doing hand over hand. He was upset and just wanted to sort the crayons.  She told me that she could no longer do the evaluation because my son does not take direction or respond to verbal direction. I have known this for a while. She also said developmentally, he should be in the cause/effect and problem solving stage, but he is still in the exploratory stage. He does not understand that objects have an intended purpose or what they are. It is true. I can't argue or disprove that. 

We discussed my son's sleeping patterns. I know this is an issue. Right now he is "napping" which to him means laughing and bouncing on his back in the crib. I put him to bed every night at 8 pm. He then bounces on his back, or jumps up and down while laughing/babbling or lays in bed and babble/laughs. Sometimes he sings. He stays up until midnight-2 am. Due to the incredibly tiny apartment we live in, this means I am up till midnight-2 am.  Some mornings he is up between 6 and 8. If he doesn't get up on his own, I make him get up around 9/9:30 in the hopes he will sleep that night. He uses nap time as free play. There is nothing in his crib except a mattress and a crib sheet. He has a sound machine to help soothe. I believe in the cry it out method unless he is sick/screaming. He doesn't want to be in bed so crying is frequent and I make him work it out. She said that the set up I have and my not running in his room for every little whine is what she wants to hear.

My son sucks the index and middle fingers of his left hand.  She will order him an OT tool called a chew tube.

We discussed my son's eating habits next. I told H. that my son has a hearty appetite, but he eats with his hands. She asked if he uses spoons and I said although I put a utensil out with every meal he does not eat with it. It was discussed that I try to make him use utensils by doing hand over hand with him, but that he is not interested in doing it himself. 

According to her report, he has difficulty social referencing, limited joint attention, and inconsistent response to hearing his own name. Again, this is true. He lives in his own little world and doesn't like visiting ours. My son also rocks side to side and back and forth.

In addition to ot 3x a month, it was also recommended that my son get an eye exam and an optometrist was recommended

H. was very friendly and professional. Her assessment was dead on. .In two weeks I will hear from a COTA to start services.  I think we need this.