DD & OT SCHOOL SYSTEM - INTRO

Developmental Disability

A severe, chronic disability attributable to a mental or physical impairment, manifested before age 22, likely to continue indefinitely, resulting in substantial functional limitations in 3 or more areas of life

3 or more functional limitation areas for DD

1) Self-care

2) Receptive/Expressive language

3) Learning

4) Mobility

5) Self-direction

6) Capacity for independent living

7) Economic self-sufficiency

Congenital Disability

A condition acquired during fetal development or birth as a result of hereditary or atypical circumstances

Acquired Disability

An illness or state of health that is not inherited but interferes with an individual's ability to be functionally independent

Examples of Congenital Developmental Disabilities

1) Down Syndrome (Trisomy 21)

2) Autism Spectrum Disorder (ASD)

3) Cerebral Palsy (CP)

4) Neuromuscular disorders

5) Intellectual Disability

Examples of Acquired Developmental Disabilities

1) TBI (Traumatic Brain Injury)

2) Fetal Alcohol Syndrome

3) Neglect/Abuse

4) Infections

Primary vs. Secondary Disabilities in DD

DDs affect many areas of life (onset = primary); DDs are chronic and lifelong — function can IMPROVE but there is no CURE

DD Assistance and Bill of Rights Act of 2000

Also known as the DD Act or PL 106-402; initially written in 1975; provided a broad definition of DD; intentionally avoided labeling; focused on the EFFECTS of disability, not the CAUSE

How DD Impacts ADLs/IADLs

Individuals may struggle with dressing, bathing, eating, and managing tasks at school, work, home, or community

How DD Impacts Motor Skills

Fine and gross motor challenges affecting handwriting, walking, or playing sports

How DD Impacts Cognition & Learning

Delayed or limited ability to understand, process, or apply information

How DD Impacts Social Skills

Difficulty developing and maintaining relationships with peers and family members

OT Practice Settings for Individuals with DD

1) NICU/PICU

2) Early Intervention

3) School System

4) Vocational Programs

5) Sheltered Workshops

6) Community-Based Living Facilities

7) Institutional Care

8) Medically-Based Programs

9) Intermediate Care

10) Work-Related Programs

PL 94-142 / Education for All Handicapped Children Act (EHA)

Passed in 1975; landmark legislation that mandated public education for children with disabilities; later revised and renamed IDEA in 1990

IDEA (Individuals with Disabilities Education Act)

1990 revision of PL 94-142; governs how states and public agencies provide early intervention, special education, and related services to students with disabilities

Primary Concern of OT in the School System

Supporting the EDUCATION of the child; helping students engage in learning, classroom activities, and school-related tasks

Medical Model (School-Based OT)

Identifies and intervenes to address disease or dysfunction using medical terminology/"jargon"

Psychoeducational Model (School-Based OT)

Addresses normal growth and development; works toward mastery of skills to function in the school setting and prepares students for functioning in society

Screening (School Service Delivery)

First step in service delivery; brief review to determine if a child may need further evaluation (e.g., kindergarten "round-up")

Evaluation (School Service Delivery)

In-depth assessment performed by a multidisciplinary team (teacher, special ed teacher, nurse, psychologist, OT, PT, ST, social worker, parents, etc.)

IEP (Individual Educational Program)

A written document committing resources and outlining special education and related services to meet a child's unique needs

Required IEP Components

1) Child's current level of functioning

2) Annual goals (LTGs)

3) Short-term objectives (STGs)

4) Criteria for measuring goals/objectives

IEP Update Requirements

1) Must be updated at least annually

2) Change in child's performance requires an IEP review meeting

3) Comprehensive re-evaluation occurs every 3 years

Required IEP Attendees

Parent(s), at least 1 general education teacher, at least 1 special education teacher, a school representative, and an individual who interprets evaluation results

Areas Assessed During School-Based OT Evaluation

1) Sensory/motor

2) Visual motor

3) Visual perceptual skills

4) Self-care

5) Assistive technology needs

6) Prevocational skills

7) Psychosocial functioning

8) Cognition

Key Intervention Area: Academic Skills

1) Handwriting

2) Reading (visual motor integration)

3) Math (hand-eye coordination, use of manipulatives, organization of work)

Key Intervention Area: Fine Motor Skills

1) Pencil grip

2) Cutting with scissors

3) Using a computer

Key Intervention Area: Gross Motor Skills

1) Balance

2) Coordination

3) Participating in physical education

Key Intervention Area: Sensory Processing

Addressing sensitivity to light, noise, touch, or movement that impacts a child's ability to focus and participate

Key Intervention Area: Social Skills

1) Developing appropriate communication

2) Understanding social cues

3) Forming peer relationships

4) Participating in group work

5) Following social rules

Direct Service Delivery

Hands-on, weekly OT sessions with the client for a set number of minutes established in the IEP

Indirect Service Delivery: Monitor

OT directly supervises a non-OT personnel who is carrying out the intervention plan

Indirect Service Delivery: Consultation

OT gives input to teachers, families, and others concerning the student's needs and strategies

Common Diagnoses Treated in School-Based OT

1) Learning Disability

2) Autism Spectrum Disorder (ASD)

3) ADHD

4) Sensory Processing Disorder

5) Physical Disabilities

Challenges in School-Based OT: Limited Time & Resources

OTPs often have limited time and must prioritize students based on severity of needs

Challenges in School-Based OT: Collaboration

Coordination with teachers, staff, and parents can be difficult due to differing perspectives and goals

Challenges in School-Based OT: Changing Environments

Adapting to evolving school structures, standardized testing pressures, and inclusion practices

Practice Competencies for Pediatric OT

1) Skilled evaluation

2) Communication with teams and families

3) Consultation skills

4) Knowledge of development

5) Understanding of service delivery systems

6) Advocacy skills