Dx and evaluation Flashcards by Carrie Will

most common dx in school based practice

Autism
Cerebral Palsy
Down Syndrome
Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)
Developmental Coordination Disorder
Specific Learning Disabilities
Trauma related conditions
Mood disorders

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ADHD

A persistent pattern of inattention and/or hyperactivity-impulsivity that interfere with functioning and development

Hyperactive/Impulsive Type
Inattentive Type
Combined Type

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incidence of ADHD

Approximately 9.6% of children ages 2-17

64% of children with ADHD also have mental, emotional or behavioral disorder

52% have a behavior or conduct problem

33% anxiety, 17% depression
14% ASD

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characteristics of ADHD

Fails to give close attention to details
Does not seem to listen when spoken to directly
Does not follow through on directions
Trouble organizing
Easily distracted
Often fidgets
Trouble waiting turn
Talks excessively
Always “on the go”

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Strengths of ADHD

Humor
Drive
Passion
Ability to channel attention into work (artists, scientists)
Brightness
Creativity
Compassion
Willingness to take a risk
Spontaneity
High energy

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OT assessments for ADHD

Movement ABC
Written Productivity Profile (WPP)
Sensory Profile
Behavior Rating Inventory of Executive Function

School Function Assessment

BOT-2

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Service delivery for ADHD

MTSS/RtI, IEP, 504 plan

Student must have educational needs

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Intervention needs for ADHD

Occupations:
Activities of Daily Living
IADLs
Education
Work
Play
Social Participation

Executive functioning, motor performance, self-regulation all impact variety of occupational performance

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Interventions for ADHD

Handwriting instruction
Sensory strategies
Token economy
Modify length of assignments
Allow short breaks between work periods
Play based (expanding our role)

Organization
Physical coordination
Activities of daily living
Self-regulation (Alert Program, Zones of Regulation)
Sensory Processing
Social Skills

Peer interactions shown to benefit acquisition of

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Cognitive Function (Cog-Fun)

Protocol addressing 3 major change areas:
1. Executive Strategy Acquisition
2. Enabling Therapeutic Setting
3. Use of Environmental Supports and Procedural Learning

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Evidence for Cog-Fun

Adults with ADHD
Statistically significant improvements in executive functioning, self-awareness, occupational performance and quality of life
Improvements maintained significance at 3 month follow up

Hahn-Markowitz, et. al. (2017).
RCT with 107 children ages 7-10 with ADHD
Statistically significant improvement in executive function and performance (COPM) children and parent responses.

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How does IDEA define specific learning disability?

What does this include

a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including conditions such as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

Dyscalculia
Dysgraphia
Dyslexia

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Dyslexia

Students who struggle with decoding, spelling and reading words.

Some researchers also separated students with difficulty with listening comprehension, reading comprehension and oral and written expression as having oral written language disability

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Dyscalculia

Students with difficulty with number sense, memorizing math facts, doing calculations accurately and demonstrating accurate math reasoning.

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Dysgraphia

Difficulties with producing legible writing automatically and consistently.

Present with fine motor, visual motor and handwriting challenges

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Evaluation for learning disabilities

Analysis of curriculum and grade-level/teacher expectations

Performance skills and patterns impacted:
- Behavior
- Memory
- Visual-motor skills
- Attention and hyperactivity
- Visual processing
- Self-regulation
- Social and emotional well-being

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Interventions for Dysgraphia

Strategy Instruction
Mnemonics, chunking, self-monitoring, self-evaluation, goal setting
Direct instruction in handwriting components
Multi-sensory approaches
Graphic organizers
Graph paper for math
Keyboarding
AT: pencil grips, slant boards, dictation software, word prediction

What is one of the five parts of the Occupation and Participation Approach to Reading (OPARI) that aim to increase participation in reading?

Participation and engagement
Self-generation of strategies
Use of various contexts
Collaborate with parents and teachers
Facilitate mastery and competence

Dyslexia

Organizational skill development
Adaptive equipment
Visual Perception skill development
- Visual Discrimination
- Visual Memory
- Spatial Awareness
- Eye hand Coordination

Multi-sensory approach
Visual prompts
Visual strategies
Visual modelling
Letter formation practice

Reflex integration therapy for learning disabilities

Reflexes may not be fully integrated
Typically look at 4 main primitive reflexes
- Moro
- ATNR
- STNR
- TLR

Research of retained reflexes

Study conducted with preschoolers
60% had retained reflexes (Gieysztor, Choinski & Paprocka-Borowicz, 2018)

Study conducted ADHD/non ADHD children
Statistically significant results for retention of Moro reflex paired with another and academic difficulties. (Taylor, Houghton & Chapman, 2004)

Developmental coordination disorder

A marked impairment in motor coordination development that significantly interferes with the child’s academic achievement and activities of daily living

Dyspraxia

An impairment of, or difficulty with the organization, planning and execution of physical movement with a developmental rather than an acquired origin

praxis

motor planning

what are the 4 steps of praxis

Ideation - cognitive process to create an idea or concept which allows for purposeful interaction with the environment - Motor Planning- ability to interpret the sensory information to plan for the motor response - Execution- The completion of the movement or carrying out the task. - Feedback- Information the body provides after the movement has occurred.

Waht is it like to get a dx for DCD

it's a diagnosis of exclusion so it takes a long time.

Symptoms that physicians will look for to dx dispraxia

motor difficulites are far below their classmates motor difficulties that interfere with everyday function.

onset of praxia issues are in ______ Why would this get missed?

early developmental period. If they aren't in pre-school and with other children

Motor milestones are often not delayed; the delay is usually in the acquisition of motor skills. Criterion D require the involvement of a medical practitioner to rule out other explanations for the clumsiness* In the province of Ontario, only a medical doctor or a psychologist is permitted to diagnose DCD.

TRUE

Dx criteria

A) Learning and execution of coordinated motor skills is below expected level for age, given opportunity for skill learning. B) Motor skill difficulties significantly interfere with activities of daily living and impact academic/school productivity, prevocational and vocational activities, leisure and play. C) Onset is in the early developmental period. D) Motor skill difficulties are not better explained by intellectual delay, visual impairment or other neurological conditions that affect movement.

incidence of motor praxia isues

5-6% of school aged children Most classroom have at least 1 child Males 4x more likely Premature birth or low birth weight 25% of those with DCD will be referred prior to starting school

characteristics of motor planning or praxia issues in pre-school

Clumsy Difficulty with fine motor tasks Difficulty with self-care tasks Avoids constructive play Difficulty with multistep directions Delayed language Behavioral issues Sensory needs

characteristics of motor planning or praxia issues in school aged

Difficulty following school routine Difficulty with multi step tasks Deficits in self-care Fine motor delays Handwriting deficits Difficulty in PE or recess Poor social skills Behavioral concerns

Keys to intervention to motor praxis issues

- Active involvement of the child - Address functional activities that are relevant to daily activities - Activities needs to specifically taught and skills need to be generalized - Evidence based strategies and approaches used - Use short, easy to remember directions - Repetition of skill - Accommodate intervention for family strengths and needs

what would be good assessments

one that addresses motor and the SFA

Which key feature uses “Goal, Plan, Do, Check?

C. Cognitive Strategies

coop was designed to used with

developmental coordination disorder

populations to use the coop with

Developmental coordination disorder (DCD) Acquired brain injury (ABI) Autism spectrum disorder (ASD) Pervasive developmental disorder (PDD) Asperger’s syndrome Attention deficit hyperactivity disorder (ADHD) Cerebral palsy Developmental disabilities Dyslexia Childhood-onset hyperkinetic movement disorders including dystonia Older healthy adults with cognitive complaints Stroke Traumatic brain injury (TBI)

Sensory integration and perceptual motor

Combined approach using both Sensory Integration and Perceptual Motor Approach Sensory Integration included vestibular, proprioceptive and tactile input Perceptual Motor Approach required fine and gross motor activities to improve skills Do it more than once.

identifying needs with CP Down syndrome Spina bifida muscular dystrophy

Pain and fatigue Mental health (anxiety, depression, frustration) Social isolation Decreased physical activities Learning needs Executive functioning

What would a top down approach look like in a school setting?

big picture, what the individual is interested in. school function assessment would help. look at environment. how

Interventions for physical disabilities

- Collaboration, Education and Training - Proactive prevention of pain/skin breakdown - Self-advocacy skills - Physical support and adaptations - Embed services into natural environment and activities - Assistive technology