Paediatric Occupational Therapy Assessment Report

Paediatric Occupational Therapy Assessment Report Referral Reason: Sarah, a 7-year-old girl, was referred for an occupational therapy assessment due to ongoing difficulties with fine motor skills, handwriting legibility, and sustained attention during school tasks. Her parents and teacher have noted concerns about her ability to keep up with written assignments and participate effectively in activities requiring intricate hand movements. Sarah has also received a recent diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), predominantly inattentive presentation, which further impacts her academic performance and daily functioning. Background Information/Developmental History: Sarah lives at home with her parents, Mr. and Mrs. Smith. Both parents are actively involved in her care and development, providing a supportive home environment. Sarah was born at full term, following a 39-week uneventful pregnancy, weighing 7 lbs 2 oz. Her birth was spontaneous vaginal delivery with no complications noted. Key developmental milestones were met within typical ranges, though her parents recall some early clumsiness and a slight delay in developing a functional pencil grasp compared to her peers. She crawled at 9 months and walked independently at 14 months. Early concerns primarily focused on difficulties with buttoning clothes and using cutlery, which have persisted to some degree. Sarah demonstrates some sensory-seeking behaviours, particularly enjoying deep pressure activities like firm hugs and spinning. She exhibits good self-care skills for her age, managing dressing and feeding independently, though she sometimes struggles with fasteners. Gross motor skills are generally age-appropriate, but she can appear less coordinated during complex playground activities. Fine motor skills remain an area of challenge, affecting her precision and speed in tasks like cutting, drawing, and writing. Her family life is stable, and there is no known family history of significant motor development or learning difficulties. Sarah has not previously received formal occupational therapy input. She had a paediatric assessment at age 6 where the ADHD diagnosis was made. Her medical history is otherwise unremarkable, with no conditions relevant to motor function. School Information: Sarah is currently in Year 2 at Willow Creek Primary School, taught by "Ms. Eleanor Vance". She is performing at an average academic level overall, but her teacher notes significant challenges in tasks requiring fine motor control. Ms. Vance reports that Sarah often struggles to complete written assignments within the allotted time, and her handwriting is frequently illegible, making it difficult for her to express her knowledge on paper. Socially, Sarah interacts well with her peers and is generally well-liked. However, her fine motor difficulties sometimes lead to frustration during group activities requiring manipulation of small objects. Ms. Vance observes that Sarah's fine motor skills are below average for her age, impacting tasks such as cutting, colouring, and forming letters correctly. Her gross motor skills are reported as adequate for playground activities, though she sometimes avoids more complex climbing frames. Ms. Vance has noted that Sarah can be easily distracted by visual and auditory stimuli in the classroom, suggesting some sensory sensitivities. Current classroom accommodations include preferential seating near the teacher to minimise distractions and the provision of a slant board for writing tasks. Movement ABC-3: * **Manual Dexterity Score:** 6 (Standard Score), 9th Percentile * **Aiming and Catching Score:** 9 (Standard Score), 37th Percentile * **Balance and Locomotion Score:** 7 (Standard Score), 16th Percentile * **Total Test Score:** 7 (Standard Score), 12th Percentile Manual Dexterity: Sarah demonstrated significant difficulties in tasks requiring manual dexterity during the Movement ABC-3 assessment. Her standard score of 6, placing her in the 9th percentile, indicates performance well below age-expected levels. She exhibited a slow and often imprecise approach to manipulating small objects, such as threading beads and placing pegs. This suggests challenges with fine motor control, hand-eye coordination, and bimanual dexterity, which directly impact her ability to perform everyday tasks like writing, fastening clothes, and using cutlery efficiently. Aiming and Catching: In the aiming and catching component, Sarah achieved a standard score of 9, corresponding to the 37th percentile. While not as significantly impacted as manual dexterity, she displayed some inconsistencies in catching a beanbag with one hand and throwing accuracy. This indicates moderate difficulties with visual-motor integration and dynamic balance, which may affect her participation in sports and playground games requiring precise object manipulation and anticipation. Balance and Locomotion: Sarah's performance in balance and locomotion yielded a standard score of 7, falling within the 16th percentile. She showed challenges maintaining static balance on one leg and navigating a walking heel-to-toe pattern. Her movements during dynamic balance tasks appeared slightly uncoordinated. This suggests a mild underlying difficulty with postural control and motor planning, which could contribute to perceived clumsiness and impact her confidence in gross motor activities. Non-motor factors observed during the assessment included Sarah's occasional difficulty sustaining attention during tasks, often requiring verbal cues to refocus. Her parents reported that she can become easily frustrated when tasks are challenging, particularly those involving fine motor skills, and often seeks sensory input through fidgeting. Clinical Observations: During the assessment, Sarah presented as an engaging and polite child, eager to participate but quickly becoming disheartened when tasks proved challenging. She demonstrated some sensory differences, exhibiting a preference for deep pressure and appearing slightly overwhelmed by unexpected loud noises. Her motor planning and coordination difficulties were evident in her hesitant and sometimes disorganised approach to multi-step tasks. Despite these challenges, Sarah displayed good problem-solving skills when verbally prompted, indicating strong cognitive abilities. Her fine motor skill observations revealed a weak and inefficient pencil grasp, impacting letter formation and writing speed. She struggled with cutting along lines accurately and demonstrated a slow pace when performing fine motor manipulation tasks. These observations align with the Movement ABC-3 results, indicating significant challenges in tasks requiring precision and control. Gross motor skill observations showed Sarah could manage basic movements like running and jumping, but complex sequences or activities requiring sustained balance were more challenging. She exhibited a tendency to use more effort than necessary during some gross motor tasks, suggesting underlying motor control difficulties. Her sensory processing observations included frequent shifting in her chair and some oral-seeking behaviours, such as chewing on her collar, which are consistent with her reported sensory-seeking profile. Bilateral coordination and crossing midline observations indicated some difficulty with tasks requiring the coordinated use of both sides of her body, such as performing alternating hand movements or reaching across her body. Her handwriting was generally untidy, with inconsistent letter sizing and spacing, significantly impacting legibility. Socially, Sarah was observed to interact appropriately with the clinician, maintaining eye contact and responding to questions. Summary: Sarah is a delightful 7-year-old girl with many positive personal attributes, including her politeness and eagerness to please. She receives excellent support from her parents at home and generally positive support within her school environment. Based on the comprehensive occupational therapy assessment, Sarah presents with significant difficulties in fine motor skills, particularly manual dexterity, and mild to moderate challenges in balance and locomotion. These difficulties are consistent with a developmental coordination disorder (DCD) and are further compounded by her diagnosis of ADHD, which impacts her attention and task completion. Her challenges are impacting her academic performance, particularly in written output, and her overall participation in school and leisure activities. It is recommended that a medical review be sought to formally rule out any underlying neurological conditions prior to a definitive diagnostic confirmation of DCD. This report should be shared with the school to facilitate access to appropriate resources and accommodations, ensuring Sarah receives the necessary support to thrive academically and socially. Sarah's key functional difficulties include illegible handwriting, slow task completion for written assignments, and challenges with precise manipulation of objects. To address these, alternative methods of accessing the curriculum, such as typing for written tasks and the use of assistive technology like speech-to-text software, should be explored. These recommendations are supported by the Children and Families Act 2014, which mandates schools to provide reasonable accommodations for children with special educational needs. It is strongly recommended that Sarah receives touch typing training using programmes such as Nessy Fingers or Type to Learn, which can significantly improve her written output efficiency. Consistency in approach across home and school environments is crucial for successful implementation and skill generalisation. Furthermore, it is recommended that Sarah is allocated resource teaching time at school to address her specific fine motor and attention difficulties. This can be justified under the Education for Persons with Special Educational Needs Act 2004, which ensures that children with special educational needs receive appropriate educational provision and support. We invite her parents to contact us for a feedback session to discuss these findings and recommendations in more detail, and to collaboratively develop a comprehensive support plan for Sarah. 1 November 2024