Teresa A. May-Benson, ScD, OTR/L, FAOTA, is a pillar in the field of sensory processing disorder (SPD). She is the Executive Director of the Spiral Foundation (Sensory Processing Institute for Research and Learning), whose stated mission is “To Increase Understanding and Acceptance of Sensory Integration and Sensory Processing Dysfunction through Education and Research.” Dr. May-Benson is an esteemed educator and researcher as well as a clinician at OTA The Koomar Center in Massachusetts. At today’s Saturday seminar entitled: ASHs to A/ASPs: Comparison of Assessment Tools for Adolescents and Adults with Sensory Processing Disorder, she provided a comprehensive review of available assessments for the adolescent and adult populations with accompanying research, as well as a detailed overview of her tool, Adult/Adolescent Sensory History (ASH), published in 2015.

Dr. May-Benson reviewed research studies conducted on adults with SPD and concluded that there is a paucity of research and more is needed. She outlined what we currently know about SPD in adults, including how it impacts all aspects a person’s life. A poignant example she described was a mother who is sensory defensive who had difficulty maintaining a family relationship with her child who is a sensory seeker. The challenge for therapists during the process of assessment is to explore what things are affecting the person’s ability to engage in life activities. Dr. May-Benson also cited the problem of an apartment dweller who is auditory defensive and lives in an apartment in between two apartments. Moving to an apartment end unit that has extra insulation from noise may be a good solution to explore with this client. These examples demonstrate the value of an interview as part of the assessment process because it helps the therapist gather information about the individual’s daily life experience, along with formal screening and direct assessment.

There are a number of tools available to assess SPD that Dr. May-Benson reviewed, discussing their positive aspects and their limitations. She cautioned that screening tools should be used only to determine whether a sensory-based problem is present that warrants further testing.

According to the Spiral Foundation, “The Adult/Adolescent Sensory History is designed as a self-report assessment of sensory and motor behaviors commonly observed in individuals with difficulties processing and integrating sensory information. The purpose of this assessment is to help identify adults and adolescents ages 13 to 95 who experience problems in sensory processing and integration as well as assist therapists in clinical reasoning when creating interventions for these individuals. Based on the conceptual model of sensory processing and sensory integration proposed by A. Jean Ayres, this measure is designed to identify difficulties in five key areas of functioning: Sensory Discrimination, Sensory Modulation, Postural-Ocular Skills, Praxis, and Social-Emotional Functioning.” The ASH has performed strongly on tests of reliability and validity. It is available at the Spiral Foundation www.thespiralfoundation.org This website offers many resources including webinars, courses, and free SPD education toolkits.

In her presentation, Dr. May-Benson provided the following implications for practice:

• Assessment of adults with SPD is complex and should be comprehensive.
• To determine sensory integration difficulties, assessment must include more than questionnaires.
• Be aware that different measures emphasize different aspects of sensory integration; be aware that we may miss vital information if we use one measure over another.
• Select measures with the particular client’s needs.
• Recognize that all measures are not created equal: some measures can provide better functional performance information than others and others may provide better psychometrics than others.

We were honored to present Teresa May-Benson’s seminar to spotlight her diligent work over the past 15 years to develop the ASH, which is a comprehensive, valid and reliable adolescent/adult assessment of SPD. Her research has illuminated the issues that clients with SPD as well as their families and practitioners face. Her research is ongoing and crucial.

Here is a sample of positive reviews about Teresa’s seminar:

“Excellent overview of Sensory Assessment tools.” – Teri B., Occupational Therapist

“I would recommend this seminar to a colleague if they work with an adolescent or adult population. The ASH appears to be a useful tool.” – Anonymous, Occupational Therapist

“Thank you for a well-organized and comprehensive seminar about the tools available for adolescent and adults with SPD. Teresa’s new assessment tool has great potential!” – Maria K., Occupational Therapist

Thank you, Teresa!

Filomena Connor, MS, OTR/L
December 15, 2018

Susan Little, OTR/L provided a fabulous seminar as part of Therapro’s Saturday Seminar Series on November 10th entitled: Handwriting Without Tears: Strategies for Success. She gave attendees a close look at a developmentally based curriculum for students from Pre-K through 5th grade and beyond, that uses a multisensory, fun approach to teaching skills for both printing and cursive. It includes three programs: Pre-K Early Learning, Handwriting Without Tears, and Keyboarding Without Tears (digital program). The program keeps expanding with additional products and trainings. The Pre-K program and elementary grade level programs include workbooks, journals, and Teacher’s Guides. Multisensory materials offer kinesthetic learning experiences for printing and cursive letter formation.

Susan is an experienced occupational therapist who has provided services to children aged birth through 21 years old in a variety of settings including school systems, early intervention, inpatient/outpatient rehabilitation, and neonatal intensive care units. As a certified handwriting specialist, she has worked extensively with children on penmanship instruction and remediation. She was first introduced to Handwriting Without Tears (HWT) as an OT student and found it to be a unique and targeted approach that meets the diverse learning styles of all students. Susan began working for Learning Without Tears in 2003 and now serves as Channel Sales Manager for the company. Her passion for educating others on the benefits of using the Learning Without Tears programs was evident in her presentation today.

The handwriting process was described in sequential stages beginning with pre-writing and finally handwriting. Susan identified the stages as follows: controlled scribbles; discrete lines, dots, or symbols; straight-line or circular letters; uppercase letters; lowercase letters. She focused primarily on early stages of handwriting, but also touched on the development of cursive and keyboarding skills using multi-sensory learning experiences.

The Print Tool is a comprehensive evaluation for students from kindergarten through grade 5 that includes student and school information, a review of school papers, and careful observation of the child’s physical approach and fine motor skills. Administered individually, the Print Tool evaluates uppercase letters, numbers, lowercase letters, and seven specific handwriting components: memory, orientation, placement, size, start, sequence, and word spacing.

A preschool student who is exposed to the Pre-K Learning program learns the readiness skills for handwriting (includes both letters and numbers). It consists of three components: 1.) Language and Literacy; 2.) Readiness and Writing; and 3). Numbers and Math. Susan identified some common struggles that occur at this level such as letter and number memory difficulties that might manifest themselves as omitting a letter, interchanging upper and lower case letters, or spelling phonetically. Another struggle a child at this early level may exhibit are letter and number formation problems including letter reversals, spacing, and sizing issues. Pencil grip is another area she discussed that may require simple modifications of posture or paper placement to build success. A fun fact Susan offered is that 50% of all 3 year olds have the ability to grasp a crayon correctly. LWT uses this fact by utilizing very small tools like pieces of chalk or Flip Crayons to facilitate development of the intrinsic muscles of the hands. Susan demonstrated a number of strategies and sequential activities to engage students as they transition to letter formation. The use of songs can help develop the motor plan for pencil/crayon use. Here’s an example:

Pencil Song
Pick up a pencil, Pick up a pencil
This is easy to do
Pick up a pencil, Pick up a Pencil,
I just tell my fingers what to do
My thumb is bent,
Pointer points to the tip, Tall man uses his side
I tuck my last two fingers in
And take them for a ride.

Now I’m holding it just right,
But not too tight,
Every finger knows what to do
And now I have a big surprise,
A big surprise for you
Let’s drop it and do it again!

Susan demonstrated a number of products that can be used in a variety of creative ways, including Capital Letter Kit to form letters in the correct order and position through teacher-directed play. It includes wood pieces and laminated cards that show the image of a letter on one side and activities on the flip side to help teach letter awareness and same/different discrimination. Roll-A-Dough Letters is a great companion to the HWT curriculum because it includes a multi-sensory tray that can be used to make letters in sand or shaving cream. Laminated letter and number cards and 12 oz. of modeling dough are included. The child learns the skills of size discrimination and visual integration. The Stamp and See Screen is a magnetic screen in a sturdy plastic frame. It includes 4 plastic magnetic letters to allow a child to stamp upper case letters. A tool that resembles chalk is used to trace or write letters. It can be used over and over because the slide eraser clears the board in one sweep. Blackboard with Double Lines helps teach placement on lines and spacing for uppercase and lowercase letters, and numbers. With repetition, a motor plan develops.

Handwriting Without Tears aims to maximize writing success for all students! This resource is fun and engages students as soon as it is introduced by providing the building blocks that are essential for handwriting in sequential steps. It is a rich program that takes into consideration the many components of learning handwriting skills throughout the school years and uses creative, engaging sensory activities. Be sure to check out the Learning Without Tears website for what Susan calls a “treasure trove” of free resources that includes screening and assessment tools: https://www.lwtears.com

Attendees had rave reviews about Susan’s seminar:

“As an OT student, I walked in with a limited knowledge of the topic. Walking out, I feel much more comfortable teaching handwriting skills and I am confident in the additional resources that were presented to me.” – Elizabeth W., OT Grad Student

“After 40 years of practicing OT, I wanted to be aware of other options I will try.” – Anonymous, Occupational Therapist

“I would recommend this seminar to a colleague because it provides the participant with the importance of the development of underlying components. Handwriting Without Tears is fun and brings back the joy of learning. It allows children to marinate in the learning process!” – Tara G., Occupational Therapist

“Lots of valuable information. Easy for students and teachers.” – Jenna R., Teacher

“I am an OTS and I believe this should be a required seminar. It was very informative and I feel as if I have a great resource to go to once I am an OTR.” – Tabitha C., OT Grad Student

Thank you, Susan!

Filomena Connor, MS, OTR/L
November 10, 2018

Therapro’s October 13th Saturday Seminar featured Margaret (Peggy) Morris, OTD, OTR/L, BCP, who presented her seminar, Pediatric Occupation-Based Assessment. Her review of a variety of pediatric assessment tools was comprehensive and enlightening.

Peggy has had a distinguished career as a pediatric occupational therapist, practicing in schools and private practice. Currently she is a faculty member in Tufts University’s Graduate Occupational Therapy Department. In addition, she is has presented workshops nationally and has been a Certified National Presenter for Handwriting without Tears.

Peggy contends that “occupational therapists have, at the heart and soul of their being, a focus on participation in meaningful occupations.” She distinguished between two assessment frameworks that current assessments occupy: International Classification of Function (ICF) and OT Practice Framework, 3rd ed. (OTPF3). Interestingly, assessments that are in the ICF category may not be occupational therapist designed, and focus on assessment of body function and structures that may limit function. The assessments in the OTPF3 category are occupation-based tools that assess function in “wanted and needed” occupations, and are being developed or have been developed by occupational therapists. The occupation-based tools have the added advantage that they can be used to determine progress versus only improved scores. Peggy noted that the very first occupation-based tool that requires clinic reasoning was the School Function Assessment. It appears that the OTPF3 group includes the important feature of attaining the student’s view of what he/she would like to focus on, i.e. student’s goal. Peggy pointed out commonalities between the two assessment categories to be considered when selecting an assessment tool. She mentioned the GOAL, Goal Oriented Assessment of Life Skills and Miller Function and Participation Scales (M-FUN) as hybrid tools.

A number of assessment tools were discussed that have empirical data associated with them. An interesting study highlighted the tools that therapists choose. The Beery VMI and the BOT-2 were at the top of the list. The Beery is a “bottom up” assessment that looks at student factors like body structures and function. On the other hand, a “top down” assessment tool offers an occupation-based way to provide services. A highly recommended tool was the COPM, Canadian Occupational Performance Measure, which was designed as an outcome tool.

Peggy discussed making an important distinction between “clinical reasoning” and “contextual or environmental observation” when evaluating a student. Clinical reasoning tells what you observe, i.e. convergence of the eyes, whereas contextual/environmental observation refers to observation of function in the classroom. She suggested that in the therapist’s assessment report that contextual/environmental observations be listed and discussed as the first tool used in the assessment to highlight its importance.

To gradually shift our focus to occupation-based and participation-based measures for assessments, versus only performance-based measures, Peggy suggested we review assessment results with parents and teachers by discussing qualitative results first, and then the scores the child received. With more occupation-based tools emerging, we can provide more meaningful evaluation of a student’s school function, and plan therapy that is also meaningful to the student!

Take a look at some of the extremely positive comments from attendees:

“This presentation reminds me of why I became an OT! This brings back the importance of connection & what is truly meaningful. Thank you.” – Tara G., Occupational Therapist

“It helped me to think more broadly about how to assess the students I work with. It also helped to think about keeping the student’s desires in perspective and a priority.” – Cindy M., COTA

“Fascinating to hear about new resources, (new/old?) ways to approach how we think and can change our practice! Thanks so much!” – Beth B., Occupational Therapist

“Well presented. Made me think about questions that I didn’t know I had.” – Trisha L., Occupational Therapist

“It brings our practice forward into a more function-based orientation by challenging old mind set.” – Marion S., Occupational Therapist

Thank you, Peg!

Filomena Connor, MS, OTR/L
October 13, 2018