Saturday, 26 May 2012
Does your child with Aspergers Syndrome have difficulties with their fine and gross motor skills as well as that of their sensory processing.
If the answer is yes, you should consider getting an assessment from an occupational therapist (OT).
In Little mans case, this was highly recommended by an independent educational psychologist during an assessment in preparation for our pending tribunal hearing early last year. I’d always had concerns regarding some of his motor skills especially that of fine motor skills, handwriting mainly. I guess i wasn’t fully prepared for the final report, which admittedly came as somewhat of a shock!
However, knowing the true extent of these difficulties has allowed me understand why little man struggles within certain areas, plus since getting the statement amended he now has regular OT sessions within his special school.
The final report which was written by an independent OT based in Harley street London was a real eye opener, not only highlighting his motor difficulties but that of his poor sensory processing too.
It’s extremely important to think along the lines of OT when applying for a statuary assessment and beginning the process of requesting a statement of SEN. Once you have that statement and it’s all agreed, it will be a good year before the annual review, your next opportunity to request amendments!
Below I’m sharing some of the findings from Little mans OT report.
The report is sadly far to large to include everything so I’ve chosen some important factors that may affect others like little man.
Many see Aspergers as just a social communication and behavioural condition. This is simply not always the case!
Note I have Removed my sons real name and replaced this with the name you all know… Little man.
Behaviour during Testing
Little Man presented as a friendly young boy and was generally co-operative whilst completing table top activities during the first half of the assessment was and able to complete the assessment tasks with prompting and encouragement. However, Little man found the gross motor tasks during the second part of the assessment more challenging and needed constant prompting to complete the assessment.
Little man showed some difficulty with completing the given tasks of maintaining postures against gravity and practicing push-ups and sit ups. While practicing push-ups, shoulder abduction and pelvic tilt were noticed. It has to be noted that such activities apart from the strength, require a good level of motor planning sequencing of movements, and overall body awareness. Little man’s performance points to a mild difficulty in this area that is related to sensory input processing from joints and muscles.
Running Speed and Agility
Little Man scored below the average expected for his age group when tested on the subtest for Running Speed and Agility, showing some difficulty in this area. Items included a shuttle run and hopping activities. Little man managed appropriately with the shuttle run but showed some difficulty with hopping on one leg whilst stationary. He also struggled with items such as stepping sideways over a balance beam, and doing a two-legged side hop, which requires a high level of motor planning.
Results following a number of different tests
Little man presents with difficulty coordinating complex motor movements and higher level motor planning due to reduced vestibular-proprioceptive processing. These systems work closely together to give us a sense of where we are in space and of how our body works (strength, muscles, balance). He does not always rely on autonomic control and this means it will take him longer to complete tasks and need additional time to acquire new skills. His movements are not always refined and timed.This will directly impact upon his ability to produce handwriting at an age appropriate speed and develop more complex gross and fine motor skills that involve higher level motor planning and overall body configuration.
Little man held the pencil in his right hand with his thumb overlapping his index finger. He applied increased grip and writing pressure. He needed prompting to use his left hand as a stabilizer whilst writing. Little man sat on the edge of his seat with his trunk in flexion, leaning forward a lot.
Little man presented with some difficulty with handwriting, in particular letter formation and the spacing of his letters. His handwriting speed was also slow and appeared laborious. His increased writing pressure, poor knowledge of mechanical elements of handwriting and decreased planning suggests Little man must work extra hard to complete handwriting tasks, which involve fine motor control. It also indicates difficulties with sequencing and planning.This will impact significantly on Little man’s ability to complete written work in an expected time frame and to complete written tests on time.
Results of Little Mans sensory profile indicated difficulties with sensory processing and sensory modulation.
In addition the factor summary of the questionnaire indicated that Little man shows a Definite Difference with sensory seeking, emotional reactivity, low endurance/tone, oral sensitivity, inattention/distractibility, poor registration and sensory sensitivity.
Sensory processing refers to how we process sensory information from our environment and our bodies. We receive information from the following senses: touch (tactile); hearing (auditory); taste (gustatory); smell (olfactory); sight (visual); proprioception and vestibular. Little man has difficulty with sensory processing in all the above areas.
The auditory processing differences for Little man are apparent in the fact that he is distracted or has trouble functioning if there is a lot of noise around. It is reported that Little man appears to not hear what people say at times and that he enjoys strange noises.
The visual processing differences for Little man are apparent in the fact that he occasionally expresses discomfort with or avoids bright lights and becomes frustrated when trying to find objects in competing backgrounds. It is reported that he frequently has a hard time finding objects in competing backgrounds.
The vestibular sense allows a person to sense body movement, direction, and acceleration, and to attain and maintain postural equilibrium and balance. This then impacts on all areas of the person’s development and in particular, motor-co ordination. Little man’s difficulties in this area of processing are apparent in that he constantly seeks movement to the point where this interferes with his daily routine. It is reported that he spins or twirls himself occasionally throughout the day.
The touch processing differences for Little man are apparent in that he is sensitive to certain fabrics. It is reported that he expresses distress during grooming. Little man also has difficulty with standing in line or standing close to other people.
The multisensory processing differences for Little man are apparent in that he has difficulty paying attention and looks away from tasks to notice all actions in the room.
The oral sensory processing differences for Little man are apparent and that he will only eat certain tastes and prefers sweet food. It is reported that he is a picky eater and that he craves certain foods such as sugar drinks and coffee.
Modulation is the ability to regulate/maintain arousal so that you can orient, focus attention on meaningful sensory events, and maintain an alert but relaxed state. It is this optimum level of arousal which allows us to function meaningfully within our environment. Some people have difficulty modulating sensory information. This can result in being over or under stimulated. We all have thresholds that need to be met by incoming sensory input. Without adequate sensory input we are unable to maintain an organised calm state. If an individual’s thresholds are too high they will need more intense input to meet their needs. If their thresholds are too low they will be easily overwhelmed. Little man is easily overwhelmed and becomes emotionally over reactive. It is reported that he easily becomes distressed at home and school when he finds situations difficult and overwhelming.
These clinical observations as well as the standardised assessments indicate that reduced sensory processing and modulation, and low muscle tone may be impacting on Little man’s ability to perform gross and fine motor tasks successfully.
Vestibular processing is our sense of movement and is closely related to the proprioceptive system. It tells us what direction we are moving, where we are in space and what speed we are moving at. Vestibular input can help to organise and refocus the body. Little man has some difficulty with registering and processing vestibular information, which is impacting on his co-ordination skills and ability to sit still for extended periods of time.
Proprioception is the understanding of where our limbs are in relation to ourselves. This information is provided by the stimulation of receptors in our muscles and joints. Proprioceptive feedback informs us where our arms and legs are without looking (e.g. being able to unfasten an apron that ties at the back).
When our proprioceptive sense works well, we make continual and automatic adjustments in our position. This sense helps us to stay in an optimal position in a chair; to hold utensils such as a pencil or fork in the right way; to judge how to manoeuvre through space so that we do not bump into things; to know how far to stand away from people so we are not too close or too far; to plan how much pressure to exert so we do not break a pencil lead or a toy; and to change actions that we are not successful with, such as the throwing of a ball that was off target.
Since proprioception helps us with such basic functions, difficulties in this system can cause many challenges for a child. Little man has difficulty with this and this is impacting on gross motor and fine motor tasks in all areas of daily living such as school work and play.
Low muscle tone relates to the tension of the muscles. A certain amount of tension is required to maintain positions and to allow co-ordinated controlled movements. For some children, the level of tension in the muscles is lower than other children of the same age, and so they require more effort to maintain the same positions/postures. Little man’s low muscle tone means that he would find it difficult to maintain a good seated posture for lengthy periods in the classroom setting.