All posts by Guest Blogger

6 FAB Strategies for Improved Behavior During Pediatric Therapy

September 5, 2019Activities, Life Skills, SensoryGuest Blogger

By John Pagano, Ph.D., OTR/L

Increase structure – Especially with students (e.g. sensory seekers) who trash your therapy room getting increasingly dysregulated, increase the structure. One way is by starting the session with all the toys locked up, and listing or assembling pictures of all the activities the client will do in order, before starting the session. Praise the client and check off each activity after they complete it and clean up, then unlock and begin the next activity. Another option for motivating clients when developing the activity list is to alternately have them choose the first activity and the therapist chooses the next one. Groups can also be structured with pictures listing the activities in order, or by having group members draw and review a praxis comic depicting the group activities in sequential order.
Preferred Activities & Choices – Clients will work better if given choices between 2 or more activities, and presented with tasks they like to do. To assure that therapeutic goals are addressed you can present 2 choices addressing the same therapeutic goals (e.g. for deep pressure to reduce arousal offer wheelbarrow walking or wall pushups).
Alternate seated with preferred gross motor tasks – For evaluation and treatment sessions it is often helpful to alternate seated fine motor writing tasks with preferred gross motor activities.
Intersperse Easy – Instead of giving 10 challenging tasks, help improve the client’s motivation and effort in trying challenging new tasks by presenting 5 new tasks (covering all the concepts in the original 10 tasks you were going to teach), and alternating so every other task is something the client likes to do and has mastered, then reinforce him for doing it correctly.
Reduce distractions – Especially in groups or the classroom, minimize problematic sensory distractions to improve attention. Study carols help minimize visual distractions, while noise canceling headphones are useful for auditory distractions. It often helps to give the teacher noise canceling headphones to help a student who has difficulty behaving appropriately due to the loud sound of fire drills.
Increase sensory stimulation of challenging therapy tasks – Particularly for students who are under-responsive it can be helpful to add sensory input that accentuates therapy and academic tasks. This can be done by highlighting important print, plus signs, emphasizing the guide lines of the paper, or simultaneously having the student listen to and read a story.
Getting clinic clients to leave – Many skilled clinic therapists who use sensory integration strategies have a problem getting clients to leave when their session ends. While it’s a compliment showing the client enjoys and can learn better during therapy, it’s a problem because the therapist has another client waiting and aggressive behavior in the clinic is bad for business. Think about this ahead, and if it is a problem structure the last task in a special room with only the door leading outside unlocked. Use this as a last activity room with their parent present (a good place to review home programs), give five and two minute warnings, do deep pressure calming sensory activities, then escort them out and give them a prize if they leave appropriately.

John Pagano, Ph.D., OTR/L is an occupational therapist who developed FAB Strategies® to help students with complex behavioral challenges. He just completed his first book called FAB Functionally Alert Behavior Strategies. Dr. Pagano has been presenting FAB Strategies® workshops internationally for over twenty years, and is known for his humorous interactive presentations and website www.fabstrategies.org

He will be offering a free Therapro webinar on Tuesday, 10/29/19: Integrating Behavioral, Sensory, & Mindfulness Interventions in your Pediatric Therapy and a seminar at Therapro on Saturday, 11/16/19: Advanced Treatment Strategies for Youth with Complex Behavioral Challenges. For more information about these events, please refer to the Therapro website at www.therapro.com and click on the News & Events tab.

OCALICON

January 14, 2019ConferencesGuest Blogger

Bhanu Raghavan, MS, OTR/L & Ginger McDonald, OTR/L
Therapro Authors

Sometimes OTs only consider conferences aimed at OTs for their CEUs, but there are other (and sometimes cheaper) ways to get your CEUS, and learn something new and different at the same time. In November 2018 we were invited to participate in OCALICON, the annual conference in Columbus OH, sponsored by OCALI (Ohio Center for Autism & Low Incidence). OCALI is a wonderful organization whose mission is to inspire change and promote access to opportunities for people with disabilities. OCALICON is directed towards parents, physicians, educators, therapists, administrators and other professionals working with children and young adults with disabilities especially autism. The conference is a dynamic and inspiring milieu that attracts attendees from all over the United States and even the world.

We had the pleasure of meeting this year’s keynote speaker- Christopher Gillberg, MD, PhD of the Gillberg Neuropsychiatry Centre at the Sahlgrenska Academy. Dr. Gillburg holds professorships at universities and hospitals in Sweden, Japan, the United Kingdom and Paris. His keynote speech was highly compelling.

Dr. Gillberg’s address was titled AUTISM AND ESSENCE, NEURODIVERSITY AND AUTISM: THE ESSENCE OF ESSENCE. ESSENCE is an acronym coined by Dr. Gillberg that stands for Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examination. The ESSENCE diagnoses include the ADHDs, Language Impairment Disorder, Developmental Coordination Disorder, Intellectual Disability, Autism/ASD, Tic Disorders/OCD, Selective Mutism and Reactive Attachment Disorder. Dr. Gillberg maintains that autism always coexists with one or more of the ESSENSE conditions. His major point is that pediatric practitioners should screen for these comorbidities early on or they may be missed. Dr. Gillberg asserted that correct diagnosis followed with early intervention leads to success. Lack of intervention results in negative outcomes including academic failure, social exclusion, substance use, psychiatric disorders, empathy problems, antisocial lifestyle and criminality later in life.

We were pleased to have 150+ people attend our presentation on Self-Care with Flair! Our audience consisted of educators, parents, social workers and OT/PT/SLP. The session was well received. We especially appreciated the parents who shared their children’s self-care challenges & successes with the group.

One of our favorite sessions was called Strategy Smackdown. This was a total audience participation session, where attendees shared their favorite resources/strategies/evidence. A summary was shared with all participants. OCALICON was a marvelously inclusive, collaborative experience that school-based practitioners could consider for CEUs from a different than the usual perspective.

Bhanu Raghavan, MS, OTR/L

A graduate of Indiana University and The Ohio State University, Bhanu has over 25 years of experience in pediatrics. She is certified in pediatric NDT and the READY Approach (Bonnie Hanschu) for Sensory Integration Disorders. Frequently, she presents workshops on topics related to self-care independence, sensory processing disorders and fine motor/handwriting skill development to therapists, teachers and parents/caregivers. She works at Centerville City schools, OH. She is a firm believer of the following Confucian principle: “I hear and I forget, I see and I remember, I do and I understand.”

Ginger McDonald, OTR/L

A graduate of the University of Wisconsin, Ginger has practiced Occupational Therapy for over 30 years. She is certified in SCSIT. With an eclectic background of working in hospitals, schools and geriatric settings, Ginger believes in promoting self-care independence at all levels. While working with Bhanu in the Centerville City Schools, they conceived the idea for Self-Care with Flair!

The DO-EAT: An Assessment of ADL & IADLs

May 10, 2018Life SkillsGuest Blogger

Answering the 5 Ws & How

by Allyson Locke

As a school based OT working in a high school for students with significant special needs, I spend a lot of time working on functional life skills. Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are a huge part of my job. My evaluations always include a detailed description of my student’s abilities in the areas of ADLs and IADLs and I often write goals centered on ADLs and/or IADLs. I have been on the hunt for a good measure of these areas for a while. When I came across the DO-EAT I was impressed at its potential but it took using the assessment to fully understand how useful it could be. Here’s what I have learned (so far)!

What is the DO-EAT?

The DO-EAT is performance based; students perform three tasks (making a sandwich, preparing a glass of chocolate milk, and completing a certificate of achievement). These tasks are performed in a sequence one right after the other. Within these three main activities, you have the opportunity to observe the student perform functional tasks that include putting on an apron, setting up the work area, washing their hands, using a knife, following directions, writing, and using scissors. While the student is performing each task you are observing their ability to perform the given task as well as sensory motor skills (like bilateral coordination, fine motor, and posture), performance skills (like attention, organization, and recall), behavioral and emotional components (like motivation and self-efficacy), and the number and types of cues that were given. There is a full description of the DO-EAT on Therapro’s website, DO-EAT-Assessment-Tool-for-Children.html.

What Is & Isn’t Included?

The Do-EAT includes all of the non-perishable materials needed for the assessment, see Therapro’s website for a full list DO-EAT-Assessment-Tool-for-Children.html.

The kit does not include the perishable items (milk, chocolate powder, and sandwich materials). What I have found helpful is to keep a stash of powdered milk and an empty milk jug on hand so that I can make milk when needed. The manual suggests the use of chocolate spread, cream cheese, or hummus for making the sandwich; I usually just keep a jar of Nutella on hand because it has a long shelf life. You will also need bread for the sandwich portion of this; I have access to a freezer so I usually keep a loaf in there but in a pinch I have also asked my very nice cafeteria workers for a slice (for this reason I keep an empty bread bag and clip on hand).

Who is this Assessment For?

The manual suggests that this assessment is “suitable for children with a chronological or behavioral age of five to eight years old” and that it can be used with children who have a variety of diagnosis including “Developmental Coordination Disorder (DCD), Attention Deficit Hyperactivity Disorder (ADHD), NLD (non-verbal learning disorder) and Learning Disabilities (Rosenblum P.h.D., Josman P.hD., & Goffer M.Sc., 2014)).

I work with high school aged kiddos that have a variety of diagnosis (including autism); all of my students have cognitive delays. The DO-EAT isn’t appropriate for all of my students but I can use it with my students who have the ability to follow basic directives and who have the physical ability to carry out the three tasks involved. When I write my evaluations I make note of the intended ages for this assessment and my justification for using it. There are three defined parts of this test so if I am on the fence about a student’s ability to test I start with the first task and see how it goes from there.

It is important to note that this a very language based test, there are no visuals used and the prescribed dialogue can get heavy. At times, I have found this to be a limiting factor but also a great way to support the need for accommodations including a visual rich environment. For example, I recently did an evaluation with a boy whose primary diagnosis is autism but who also has apraxia and word finding difficulties; he is generally very capable with routine self care tasks (using the bathroom, managing personal hygiene, preparing simple snacks, etc.) however, this was not reflected in the results of the testing due to the breakdown in language skills. With this, I was able to show how important visual supports were to his independence and was able to include that within the accommodations of his IEP.

Where Can the DO-EAT be Administered

The manual suggests that this assessment can be performed in a variety of environments. I have only had the opportunity to use it in the school environment (where space is not always easy to come by). I have been able to use it successfully in just about any room I find available as long as there is a table and two chairs. You will also need some sort of shelf/ bookcase/ high spot and a stepstool. Access to a sink is also crucial but it doesn’t have to be in the same room.

When: The Big Question on How Much Time?

The manual suggests that this assessment should take about 30 minutes to administer (Rosenblum P.h.D., Josman P.hD., & Goffer M.Sc., 2014); I would agree with that estimate in most cases. It definitely took me longer in the beginning as I was learning the assessment. Scoring on the other hand takes a bit and can be a little tedious; it does get quicker with practice! See below for tips on efficiency.

Why Do I Love the DO-EAT?

The main reason I find the DO-EAT so useful is that it is performance based. As a practitioner I feel I get so much more information when I watch students complete an activity. As OTs we are trained to analyze activities down to the minute detail. With the DO-EAT not only am I able to watch the student perform these activities; the assessment also gives us a structure to analyze the students approach and performance.

How Do I Use the DO-EAT?

I use two main assessments to address ADL and IADL function. Typically I use the PEDI- CAT or The REAL to give me an idea about the specific areas of ADLs or IADLs that a student may be struggling with. From there I use the DO-EAT to answer the “why”.

The observations and analysis of performance skills I gathered while administering the DO-EAT allows me to easily see where a breakdown in a student’s performance is happening (is it an issue with executive function?, is it an issue with decreased fine motor abilities?, etc.) I have a means to connect poor function in a specific ADL or IADL tasks with a cause thus answering the “why”. In addition, the DO-EAT measures the number and types of cues that a student needs in order to perform a task (does a gestural cue work?, can they figure it out with an indirect verbal prompt?, do they need a direct verbal cue?). With this information my evaluations and eventual goal writing become focused; in addition I now have a baseline.

Other Information & Helpful Tips

There is a parent questionnaire used as part of this assessment. The parent questionnaire is great in that it gives you a better understanding of the student’s function in environments that you may not necessarily be able to observe. What I appreciate however is that those responses are not needed to score the evaluation (in my experience, not every questionnaire that gets sent home, comes back!).
I would recommend practicing this assessment on a colleague/ friend/ spouse/ etc. before using it functionally. There is quite a bit involved with the observation piece of it.
The manual describes the set up very well; I have that page marked so that I can “check off” each piece as I go.
I put cards in each of my baskets so that the set up is easy and mindless.
When learning this assessment, I found it extremely helpful to record the student completing the assessment (I just took a quick video using my phone). There are a lot of details to observe; I found it overwhelming to simultaneously administer the test and also complete the observation checklist. I was able to get much more information by recording my sessions and then completing the scoring later while watching the video.

Works Cited

Rosenblum P.h.D., S., Josman P.hD., N., & Goffer M.Sc., A. (2014). DO-EAT Performance Based Assessment Tool for Children: Manual. (J. Hahn-Markowitz, M.Sc., Ed., & S. Veeder, Trans.) Wayne, NJ, USA: Maddak Inc.

Allyson Locke, MS, OTR/L
Allyson is an occupational therapist with a diverse background in both sensory integration and school based practice. She currently works in a school for children and young adults who have significant medical, mental health, and cognitive needs.