Gifted Issues Discussion homepage Forums Parenting and Advocacy Problem with OT because of giftedness?

Hi
Sorry this is longer than I though it would be!! I am not sure what is going on so I thought I would see if anyone had any insight. To recap, testing revealed a fine motor delay and possible vision issues for my DS 4.5, we decided to go forward with OT and haven't yet gotten him evaluated for vision hoping the OT aspects would deal with it for now since VT sounds tough for a little guy.

Here's the issue, the therapist is great, good rapport, but after every session she is telling me something that DS was unable to do that just sounds weird. She is convinced that all his issues are about core strength and from what I can tell from hearing other therapists and parents its a common thing - strength the core and arms and the writing will get better. Okay fine. So the first thing, she wants him to get PT because she doesn't like the way he goes down the stairs - this place has steep stairs and he takes them with 2 feet on the step, but not on other sets of stairs, but she doesn't seem to believe me that he doesn't normally do it and he is just being cautious because he fell down a set of stairs once. So that's just an annoyance - here is what I don't know what to do with. Either as part of an obstacle course or separate I am not sure, she game him a stacker - like the kind he had as an infant - with colored rings to put around a post. He could do it easily before 1, so she tells me he couldn't do it! He couldn't put it in size order. I said come on, he was messing with you, she said she asked him and he said he couldn't do it. So I said after to DS, what were you doing, he said a level was missing so he changed the order, then he said he put in color order. You can't lose the capability to tell size and shape can you? So this morning I got 4 legos, a 4 piece a 3 piece a 2 and 1. I said put it in size order, so he correctly but the 3 on the 4 and the 2 on the 3, then with the 1, he put it on the 4 next to the 3 to make the size of the 4. I said is that right, so he moved it up a level to do the same thing. Then I said what if we do this, and took the 1 and put it on top - then he turns it to the side and said look it makes a stair. So I asked him did you put it on that level to see it make it equal, he said yes. So I said but it wasn't completing size order. So when putting it awayn I said, next time a teacher asks you to do something, even something really simple, do what they want first and then you can play and move it around. He seemed to accept that.

So not sure what I learned I pulled out the tangrams jr and asked him to copy a pattern not on top of the picture but separate and he couldn't do it without the lines of the shapes being shown, the easy level. But he did manage to do it. And said you had to have all the magnets down, so turned them all so they matched. He does seem to have some slowness in recognizing when you need to turn a shape to get it to fit, but he does get it eventually.

But here is my question - its the same mistake he made on the initial OT testing - not completing the stair. Although on the initial test he had to copy a stair, here I just asked him to stack them with no picture. Is there something going on here or is he simply trying to make this horrifically boring task more interesting? On the testing it seemed like he could not do it which just struck us strangely. The reason I am asking all this is because she clearly doesn't usually work with the gifted. At this center there are a lot of kids with much more serious disabilities although there are plenty with just fine motor issues. But then maybe its me just refusing to accept this block he has? I am baffled.

On the positive side, he is now willingly writing and writing his name and doing much much better. I think the OT is helping but it might just be that at preschool he is expect to write and color everyday. I am so glad I talked to his teacher because I think she is gently requiring him to do it rather than letting him give excuses and by doing that initially it became habit and I think he might now be enjoying it. He is making more of the stuff in his head and more accepting that it doesn't look like what he wants it to. I think I will follow up with pre-k teacher and see what she thinks, maybe she can direct him to more block building?

Sorry so long, I am just not sure what is going on, whether this OT is right, whether we should do the VT eval, or just keep making him do things with shapes and sizes which just seems ludicrous to me.

DeHe

I'm not sure I understand what the shapes/sizes/stacking things have to do with OT (sorry to be dense). I would let the issue drop, if possible. It's not like the OT is performing an IQ test. I assume the OT is just doing OT, not an evaluation, right? Why doesn't she just worry about strenthening core and arms, which, as far as I can see, are not related to the stacking? Is she saying that the stacking/stair issue is a fine motor one or something? Or is she saying that has something to do with vision?

Most of my kids would not "perform" such a thing either - LOL, for example I don't know if they *ever* used the ring-stacking toy for its intended purpose, even as babies. (kind of reminds me of the evals they had when two of them were 3 y.o., with the school district - they were not interested in performing things like block stacking, etc. - the conclusion was that one of them was severely developmentally delayed.)

Having been through VT with a stubborn 6 y.o., I agree that it would be rather tough to get through it with a 4 y.o. However, it may be that they take a different approach with that age. I'd probably want to at least get the evaluation done, preferrably with someone who is experienced with that young age (e.g. our optometrist is not who I would go to; I know another one who has more extensive experience with the really young ones).

If you get the vision eval done, even if you don't pursue VT right now, you'll be able to see whether the OT is helping the vision issue when you repeat the vision eval in a year (or whenever). I do not trust the OT to correctly assess a vision issue via the simple copying of shapes - one of my kids, the one with the most fine motor issues, could not copy simple shapes. A few years later he took a particular test (Beary-something?) that had two compenents - something about visual perception, on which he scored in the 99th percentile, and a motor portion, which in contrast was at a very low percentile. It's clear that his problem is unrelated to vision (that reminds me, he's due for an annual vision checkup.)

FWIW, we did see improvement in vision due to OT with dd (we started VT, then stopped after a few weeks so that we could fit a short, intensive OT program into our schedule. when we re-started VT three months later, the vision therapist saw a dramatic improvement in her ability to do the exercises, and it was obvious to us as well. The OT had been combined with listening therapy, and primarily took place in an OT gym.)

The writing is a really good sign!

ETA: I just remembered something funny. At my 4 y.o.'s annual checkup with the ped (this child does not have SPD or any apparent issues), the ped asked him to draw a picture of a person. Per usual for my kids, he did not pass this test. But a few minutes later she looked down at his drawing - he had put his name on it, quite legibly. She was surprised, and as a result of the writing she had no worries about him.

I think and am just guessing here is that she gives him tasks to do as part of an obstacle course - like climbing a ladder and then doing something at the top. Or she has him lay on his stomach and do a puzzle or lay on some kind of scooter that he uses his arms for. So possibly, the stacker was just something she had for that - but yeah, I was kind of bewildered too - but then worried!!! We probably should get the vision testing done to see if there is a legitimate issue.

Sometimes the professionals get stuck on minute details; other times they pick up on something that is significant. Time will tell which this is. My bet is that it is the latter.

Both of my kids have had extensive OT, so I have just a few thoughts.

I have seen the OT use 6" diameter rings that the child places over a cone, but that was only part of the entire exercise. DS would be lying flat on his stomach on the "pizza swing"- a triangular board suspended from the ceiling that swings in all directions. The rings would be placed on the mat below the swing and the cones placed to one side. The therapist would pull the swing toward her and let go, DS would swing back and on the way forward again he was to pick up a ring, swing back again, and then on his way forward put the ring on the cone. This exercise took a loooooong time for him to master and they worked on it a little at at time. At first he couldn't even stay on the swing! Then he had to learn to adjust his body weight with the swinging motion. Then he had to only hold on with one hand so he could pick up the ring. Most importantly, he loved every minute of it. This worked on core strength, fine motor, coordination, proprioceptive and vestibular systems. My sons' days in OT were filled with these exercises.

My sons did not have fine motor skill issues, but I was present for both their evaluations and copying block structures is always included. I believe, but am not an OT so can't say for sure, the OT evaluation is looking at how the child manipulates the blocks with their hands and if they are able to copy the simple structures. It's different from an IQ test because the block patterns don't get that difficult. Perhaps she noticed your son struggling with one aspect of the test and suspected some visual hindrance.

I would agree with the previous post that you should get the vision evaluation to obtain a baseline and then see if the OT work helps that later on. I also always consulted our pediatrician when we were given advice from an OT or Speech person before proceeding.

One last comment, you know your child best. If you have any kind of uncomfortable feeling with your OT, I would look for another one. There are so many good ones out there. And, one OT who is perfect for one child might not be a good fit with another child. Good luck.

Thanks everybody for the calm and support! I think the Vision eval will be the next step but for right now we are ok not doing that. I do think I will start trying to do more puzzles and shapes things, but age appropriate and see how that goes. But as wonderful as your support has been, I feel so much better for another reason, for the first time, DS brought home written, in gorgeous green crayon, I love you. He did it all by himself! His teacher spelled it for him, he did anoer one without her which said I luv u, all by himself!! This is the kid who wailed about not being able to do it, not wanting to write. Today he brought home piles of stuff!!! So I don't know if it's the OT, our changed focus, or the combo effect of those plus school. But this was wonderful!!! And he was so delighted to see and feel our praise for sticking with it.

But I do think that Eleanor05 is right, I need to keep an eye on the OT in terms of not producing other problems or just making us both uncomfortable. But if it's just me, i can deal.