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Wilson Pediatric Therapy & Learning supports Occupational Therapists, Physical Therapists, Speech Therapists, and Educational Interventionists in their pediatric practice.  

WPT Blog

Wilson Pediatric Therapy wishes to share valuable, transformative, information; this blog will be the vehicle for us to share.  

Filtering by Tag: occupational therapy

I.E.P. vs. 504 Plans

The Wilson's

As an alternative school guidance counselor, I have become very familiar with the different ways public schools try to accommodate students with disabilities.  The goal of these plans is to "level the playing field" and give all children access to a "free and appropriate" education.  Getting the appropriate accommodations for your student can be daunting at first, but once you're in the system, you'll see the hidden rules and play the game.

Rule #1:  Public education loves acronyms.

What is I.D.E.A.?
I.D.E.A. stands for the Individuals with Disabilities Education Act. IDEA covers students who qualify for special education. If a student is found to have a disability (i.e. "qualifies"), then they are eligible to receive special education and/or related services (e.g., speech-language therapy, occupational therapy, physical therapy, etc). Every child attending a public school program that is found eligible to receive special education services must have an IEP or an Individualized Education Plan.

What is an IEP?
According to the Department of Education, an IEP is an Individualized Education Plan that is created when a student meets the IDEA guidelines, qualifying them for special education because they have one of the specified types of disabilities.  The goal of the services on an IEP are to help a child succeed in the school setting.

What is a 504 Plan?
According to the Department of Education a “Section 504” is a broad federal civil rights law that protects all individuals with a handicap.  This law is often enforced through the creation of a 504 plan. Often times if a child does not qualify for special education services under IDEA (with an IEP), they may still qualify for assistance through a 504 plan.  504 plans are put in place to ensure that schools are non-discriminatory.  

Rule #2:  Follow the money

Five differences between IEP and 504 Plans:

    1.  An IEP is for children who qualify for special education services. To qualify, your child must have a documented learning disability, developmental delay, speech impairment or significant behavioral disturbance. Special education is education that offers an individualized learning format (e.g., small group, one-on-one). In contrast, a 504 Plan does not include special education services. Instead, a 504 Plan involves classroom accommodations, such as behavioral modification and environmental supports.

    2.  An IEP requires a formal evaluation process as well as a multi-person team meeting to construct the plan. A 504 Plan is less formal and usually involves a meeting with the parents and teacher(s). Both plans are documented and recorded.

    3.  An IEP outlines specific, measurable goals for each child. These goals are monitored to ensure appropriate gains. A 504 Plan does not contain explicit goals.

Funny, but read be sure to see Rule 4!

Funny, but read be sure to see Rule 4!

    4.  A 504 Plan does not cost the school or district any additional money to provide. On the other hand, an IEP requires school funds to construct and execute.  No additional money goes to the child's school for 504 plans so you're less likely to get services like speech, occupational, or physical therapy (although this varies from school to school).  

Rule 3:  No measurement, no management.

    5.  IEP's are more likely to be fulfilled because measurement and accountability are built into them.  504 plans are only reviewed once a year.  With either plan type, it's vital to have a student advocate.  

Rule 4:  Work with the system not against the system.

Advocate on behalf of your child, but also trust that the educators want them to learn.  Too often I've seen plans fail because parents become over-involved/defensive with the school.  When advocates burn relationships with educators the student suffers.

Rule 5:  A student cannot have both plan types at the same time.

Most students do not qualify for an IEP, but many can qualify for a 504 plan.  My suggestion is to meet with your child's teachers to decide which (if any) plan is necessary.  Most teachers will accommodate without needing an official education plan.

Posted by Joshua Wilson, MSW

picky vs selective eating?

The Wilson's

photo from image source

photo from image source

As a pediatric occupational therapist I encounter a large amount of children that have feeding disorders of all varieties. Of all the problems that I see and address, feeding is by far the most distressing problem to both the parent and the child. Because of the wide range of symptoms and problems, there is obviously no cookie cutter approach to addressing feeding. However, it is important as a therapist to determine an underlying cause. Is the behavior just typical picky eating? Is there an underlying physical problem? Is it sensory based? The purpose of this post is to help parents determine whether their picky eater may need additional evaluation or intervention.

Children can make limited food choices for a myriad of different reasons ranging from food allergies, sensory issues, or an honest dislike of a food.  While sensory issues can cause picky eating, not all picky eating is sensory based, but how do parents differentiate between the two? Nearly half of all children could be considered picky eaters, and it is an extremely common part of childhood. However, if you are a parent who is wondering if your child’s feeding behaviors go beyond picky eating and into the realm of selective eating or sensory related feeding disorders then consider the following information:

  • Children with sensory based food selectivity typically eat less than 10 food items. While your child may seem extremely picky, consider all the different foods that he/she eats. You may be surprised! You may even consider logging the food for 3 days to see the variety.
  • Children who are “picky” typically will eat a limited number of foods, but will eat something to represent each food group. While limited, they will often still have a well-rounded diet.
  • Picky eaters will have an expanding food repertoire even if it expands extremely slowly. It is common for picky children to ask for one food all the time, reject it, and then go back to it again. Overall, however, there will be an increase. Selective eaters typically will decrease their food repertoire and will never go back to a rejected food.
  • Children that are picky typically can tolerate watching other people eat food they don’t like, whereas selective eaters may gag or vomit watching another eat a food they don’t accept. (Warning: Not all gagging should be considered a warning sign for sensory based feeding disorder. Gagging is often a natural response to a strong dislike of a food and becomes a learned behavior to avoid something when reinforced by a caregiver).
  • Selective eaters may display more extreme patterns of behavior such as crying or extreme distress, head turning, spitting out food, throwing food and utensils, packing food in his mouth, coughing/gagging, and leaving the dinner table. Most kids will go through a phase of having tantrums at some point, and some tantrums could be related to picky eating. However, the extreme behaviors listed above are fairly consistent and will typically occur even when the child is through the “tantrum” phase and doesn’t tantrum for other reasons.
  • Children with food sensitivities may not properly digest their food, if a meal is followed by messy diapers or multiple trips to the toilet this could be a sign of a problem that is beyond picky eating.
  • Children with sensory based feeding disorders typically show patterns to aversions to food groups or certain textures or colors. These aversions can seem unusual or even extreme (i.e. avoiding ALL brown foods, ALL cold foods, ALL fruits, ALL crunchy foods, etc.). This kind of restriction is particularly dangerous as elimination of whole food groups is possible. This could compromise healthy growth and development.
  • Sensory based selective eaters may have intensified sensory perceptions of food. For example something served warm may seem unbearably hot, something mild may be described as “bitter”, something sweet may be perceived as extremely sweet or even sour.

If any of these warning signs sound too familiar to you, first go visit your family doctor or pediatrician. Come prepared with a food log of the past 3 days of eating, as well as a list of all behaviors that occur. Your physician may recommend further testing for food allergies and sensitivities or may suggest a consult/evaluation with a dietician or occupational therapist.

Written by Rebecca Smith,  Occupational Therapist

Potty Training advice from an OT

The Wilson's

Photo credit  thejbird

Photo credit thejbird

Of all the early childhood milestones not many are met with as much dread and apprehension as potty training. Graduating from diapers to undies can be an exciting and welcome change for parents, but it can also be stressful. As an early intervention therapist that works with 0-3 year olds I am all too familiar with this milestone and the vast variety of approaches that parents use. If you do a simple web search of potty training, you will find a multitude of different opinions of the matter.

One may claim that their approach is best, while swearing that another doesn’t work.

Another approach may promise to “change your life!”

While the next assures you that it is fool proof.

However, just like all children are different and have different needs - different approaches will work for different children. So how do you know which one to use?  Find one that makes YOU feel the most confident and that you feel comfortable using. Whether it is a book written by a world renowned child psychologist or a blog written by a mom, finding one that fits your family’s needs is most important. After all, you aren’t going to stick to a technique that you aren’t excited or confident about or isn’t a good fit for your child’s personality. You know your child best and have a better understanding than anyone on what type of approach is going to work the best. If your child has sensory processing disorder, autism, or a physical impairment, you may need some additional guidance from a developmental interventionist or occupational therapist. However, this post is to give general tips about the process, as well as to share the tips that my OT colleagues and I have found to be the most successful.

The first thing to consider before jumping into the process is readiness. Ask yourself the following questions. If the answer is “yes” for most or even several of these, then it may be time to begin the potty training process.

  • Does your child stay dry for at least two hours at a time during the day?
  • Does your child consistently wake up from naps AND mornings dry?
  • Can child identify touched body parts without looking?
  • Can child verbalize need to go?
  • Is he/she imitating mom or dad in the bathroom?
  • Can your child follow simple instructions?
  • Does your child seem uncomfortable with soiled diapers and want to be changed?
  • Is it obvious to you when your child is about to urinate or have a bowel movement?
  • Can your child walk to and from the bathroom, and undress himself?
  • Does your child express interest in wearing "grown-up" underwear?

Where do I start?

  • Start at home, use a small training potty or seat to go on the regular toilet.  Children feel more confident if their feet are touching the ground to give them support.
  • Consider all the sensory components of the bathroom:
    • Bright lights
    • Loud noises (water running, toilets flushing)
    • Cold floor, cold toilet seat
    • Mirror to see reflections in
    • Sound echo’s sometimes
  • If they are sensory sensitive and are overwhelmed by one of the things listed above, consider starting by putting the potty chair somewhere else in the house to start there.
  • Consider reading a potty book with your child such as “The Potty Book for boys” or “The Potty Book for girls”.
  • Have them watch their same gender parent go potty.
  • Practice by sitting on potty every time child wakes up dry.
  • Take your child shopping for regular underwear with character of choice – this will increase the intrinsic motivation and make it exciting for them. State “try not to pee pee on Minnie Mouse!”
  •  Have them drink plenty of fluids – take them to the potty 15-20 minutes after food or drink.
  • Develop a set schedule and have the child sit on the potty several times throughout the day.
  • Consider using stickers or small item (I’ve had some parents SWEAR by mini m&ms) for rewards each time they go. Praise them verbally after they use the potty. (Reward them for trying initially).
  • Use a couple sheets of paper towel folded and placed between the diaper and the child (or one of those thin wash clothes you can get at the dollar store) so that when they are in their diaper and they pee they will feel wet and uncomfortable but not ruin the carpet/furniture, etc. Diapers that are made today make it too comfortable for kids who are potty training which decreases the incentive for them to use the potty. If they pee in their diapers, they don't feel it. 
  •  Also try using a pair of preferred underwear under the pull-up or diaper to increase sensory awareness of wetness.
  • Social stories are great for increasing understanding of sequencing of task, predictability of process, and guidance of expected response behaviors. Matter of fact comments from the parent also help: "Oh your underpants are wet! You can put them in the hamper and then put on dry ones." Using simplified language in a sequential way also helps child with predictability.

Here are some examples of approaches that some parents have used:

The “All Day” approach (Works for many but not for all!)

Pick a couple of days when they will be home all day (if possible) and set a timer for every 30 minutes. Then they have to sit each time the timer goes off whether they think they have to go or not. Keep toys and books in the bathroom and let them play/"read" while they are sitting. Or keep a potty chair in living room/playroom. If possible, buy an extra potty chair and kept it in the back of the car.

The “Naked” approach

If it is warm out, there is always the old stand-by of allowing the child to go naked while playing outside, and they will soon dislike the feeling of the pee going down their legs. Many parents opt for this over a weekend and find it works really well. The child (if cognitively aware enough) sees what is happening and feels what is happening and is more aware of what "going to the potty" means.

Written by Rebecca Smith,  Occupational Therapist