#54 - What Happens During a Pediatric OT Evaluation?

Hello my friend and happy new year!!!! Welcome back, to our second season of the podcast, I started this podcast almost exactly a year ago, and so far we’re 54 episodes in, which is just so wild.

If you’re new here - hi, I’m Sam! I’m a pediatric occupational and feeding therapist and on this podcast I share with you my personal insights and research surrounding sensory processing, eating, and development. I want you to think of me as your OT bestie - answering those tough questions about occupational therapy. 

I try to keep these podcast episodes pretty short and sweet, because if you’re like most of my community your time is SUPER limited, and you’re listening in short bursts on the go, while folding laundry, or while on a walk.


Over this next year, I am focusing on working to bring you some guest experts on other topics as well. I’m not going to tell you who yet, just know I’m excited about them - and I think you will be too. I’m currently planning ahead for 2024, so if there’s a topic you would like to see, or someone you would love for me to interview - I would be so grateful if you could head over to Instagram and send me a personal message @DrSamGoldman. I want to make sure I’m bringing you information that really helps you, and letting me know what you’re looking for is the best way for me to do that! 

Ok, let’s talk about this week’s episode. With the new year, comes new goals. And I know many of you are probably thinking, OK it is TIME to address my child’s sensory, eating, or fine motor challenges. 

Maybe it’s been in the back of your head for a while that you need to book that OT evaluation, but you just haven’t done it yet, because you’re already overwhelmed just thinking about it. If you know me well, you’ll know that even though I provide online education about sensory & eating I will never tell someone that it’s a replacement for therapy. My goal is to provide education to parents to help them feel more empowered and informed, but that is not a replacement for 1:1 help from an OT. It’s a totally different ballgame. I truly believe you need both to thrive at home - as well talk about a bit more in next week’s episode.

Today, I want to help you feel just a little less stressed about booking that evaluation by walking you through exactly what might happen when you’re there.

I don’t know about you, but whenever I know what to expect, I do SO much better at appointments. And honestly, I think kids do too - so hopefully this helps you and them feel a little less apprehensive about taking steps forward to that evaluation. 

Of course, every single place you go for a pediatric occupational therapy appointment is going to be a little bit different, this is just based on my personal experience and the places I’ve been. 

Let’s start from the beginning:

1. First, you need to book your evaluation: 

To get started, you of course need to book your evaluation. I know this isn’t what you want to hear, but at most places, there’s a decent sized waiting list. Depending on the facility, you may need to wait anywhere from a week to 6 months. So if you’ve been considering it, I recommend getting the evaluation booked ASAP.

If you’re planning to use insurance, or if you’re located in certain states, you’ll need a referral from a doctor to book your appointment. I’m in Florida, where we do not require referrals for private pay, but other states do. 

Regardless, I always recommend speaking with your doctor if you’re considering occupational therapy, so it’s a good practice to ask them for a referral too. That will also give the therapist doing the evaluation a bit of information about why you’re there, since the doctor will write a code that indicates what your and their concerns are. 

2. Arriving for your appointment:

Whatever you do, PLEASE try to be early for this appointment. Not even just on time. When you get to the appointment, they are likely going to give you forms to fill out (they may have even sent them to you by email).

Really put thought into these forms. We really do use these to write our evaluations. Yes, of course on our evaluation we’re going to look at a TON of things. But you know your child best, so we care a lot about what you have to say. 

Here’s why I’m so adamant about being early for an occupational therapy evaluation. Most of the time, the therapist only has an hour to complete it. If they’re really lucky they get 90 minutes. And as you’ll see later in this episode, occupational therapy is a very broad practice. So we’re going to look at MANY areas. We need every single one of those minutes.

Most therapists are booked back-to-back. Which means, if you are late, we don’t have the ability to have you stay later and make up that time (as much as we wish we could). So if you arrive late, or even if you arrive on time and are filling out forms, you might be missing out on some valuable testing and information from the evaluation. 

3. Parent/Client Interview

Usually, when we start an evaluation, the kids are pretty nervous. The good thing is, the OT rooms are usually pretty exciting! If you’re walking into an OT gym, you’ll probably see swings, ball pits, slides, and more. All of which kids get pretty excited about. Our first goal is to usually start building a relationship with them and helping them feel comfortable. To let them acclimate and get used to me, I’ll usually start by asking the parent some questions about what’s going on at home. Personally, I always try to offer a child a toy to keep them entertained because there can be a lot of questions. But, you may want to bring a toy in your purse just in case. Then, I’ll try to involve the child as well once they’re a little more comfortable. Some of the questions I might ask include:

• Main concerns
• Child’s developmental history - when did they start walking, sitting, talking, etc
• What the child enjoys
• Their strengths
• Their dressing, toileting, grooming, and bathing skills
• Specific questions about sensory processing 
• How eating is going at home, especially if it’s a feeding evaluation (but honestly, we could do an entire different episode on what a feeding evaluation would look like)
• Their socialization with family and friends
• I’ll usually go further into different areas depending on what the main concerns are
• What your goals are when coming to occupational therapy

But be ready to answer a lot of questions. Again, you know your child best, so a lot of our evaluation is also based on what is happening at home on a day-to-day basis.

4. Standardized Assessment

From there, it’s time to evaluate! When it comes to insurance, we usually need to use a standardized assessment to determine whether or not a child qualifies for therapy. I have a love/hate relationship with these. 

To be quite honest, I’m not sure that these standardized assessments have truly changed with the times. 

There’s a lot of things on there - like lacing boards, that kids don’t really play with anymore, so to me, it’s not a realistic interpretation of skills. 

When you’re asking a child to do a task for the first time ever, there’s a good chance they’re not going to know how to do it. So to me, I get a bit frustrated here because kids score lower when it’s not really a functional task in today’s world. These assessments also have pretty strict rules. For example, we can present the task 2 times using only very specific wording, or the paper needs to be turned to a very specific angle when writing. This is what makes it standardized. Unfortunately, kids are usually pretty nervous when they’re at the office for the assessment - so they may just say no to a task, which would interfere with their score. A word to my parents - throughout the evaluation, you’re going to want to prompt your child and remind them how to do it. But again, the rules are pretty stringent for these assessments, and that also interferes with their scoring. Your well meaning help may actually cause their score to be lower. We need to see how they do it on their own, even if you know they can do it at home. If you see that your child struggles on the evaluation, but can do a skill at home, let the therapist know - because that does matter to us!

Additionally, these assessments were really created to assess typical development - meaning children without unique needs or diagnoses. So I often find that it’s not a great fit for many of the patients that we see - and it’s defeating both for them and their parents. Which I don’t love at all.

On the flip side, standardized assessments can be helpful. It keeps the evaluation organized, and makes sure that you hit and observe different skills. While kids are doing these tasks, I’m not really just looking at if they did the task or not. I’m looking at how they do it, how they try to problem solve when it’s hard, how easily they give up up and more. And for children without unique needs, it does give us some indication of how other children their age are scoring. 

Ok, so here’s some of the evaluations you might see a pediatric occupational therapist doing during an evaluation:

• The Peabody Developmental Motor Scales for kids aged 0-5. On this test, depending on your child’s age, the therapist will usually look at grasping skills, visual motor skills like stacking blocks, making shapes, & cutting, reflexes, and movement skills. Often, OT and PT will split the sections.
  
  
• The BOT-2, short for Bruininks Test of Motor Proficiency for kids aged 4-21. This test has 8 different categories ranging from small movements of the hand to big jumping movements. Your child’s therapist may do all or just some depending on time and your concerns. Again, OT and PT may split this test. I use this test a lot when a child has trouble with fine motor skills, gross motor skills (like keeping up in karate or gymnastics class), balance, coordination, or endurance. Some of the things that are assessed are precision with a pencil - like mazes, copying shapes, moving small objects in the hands, jumping jacks, sit-ups, push-ups, moving both sides of the body together and separate and more.
   
• The Beery VMI, short for the Beery-Buktenica Developmental Test of Visual-Motor Integration for people aged 2-99. This test really focuses on visual motor skills. I use this one a lot when a child is having handwriting concerns. It will have kids copy shapes, identify matching shapes when they are turned around, and connecting dots while staying in the lines.
  
  

• The Sensory Profile. The sensory profile is a parent questionnaire. In full transparency, it’s very long, but is used A LOT in clinics. Again, this is why I recommend showing up to your evaluation early. It asks you all types of questions about your child’s strengths and where they are struggling, and then the therapist scores it to get a result on which areas of the sensory system may be more challenging for your child. What’s nice about this one, is that it’s going to give us more information about your child’s sensory system, since time is so limited in the evaluation.

 
So this is a very condensed list of standardized assessments. There are so many out there that I just can’t cover them all today - but these are the ones I have seen used most frequently.

5. Observation

Along with the standardized assessment, your therapist is also probably going to have the child play in the gym a little bit and observe what they do naturally. Usually I’m looking to observe the skills you are most concerned about. Standardized assessments don’t cover all areas, so often we need to use observation time to fill in those gaps. For example, many standardized assessments don’t cover dressing, so if dressing is a challenge, we might ask a child to show us how they put on a shirt. (I recommend bringing a larger size for them to put over their clothes). Or if they’re struggling with ABCS, I’ll want to see them write their ABCS (however there are some good assessments out there for handwriting). If it’s a baby I’m also going to spend a lot more time observing how they naturally move around the room. But this observation part really depends on what your big concerns are when you come to therapy.

6. Results & Goals

After the therapist has completed all the parts of the evaluation, they’ll usually sit back down with you at the end and give you an idea of what they’re thinking. If they recommend therapy, they’ll talk about frequency and how long the sessions may be. They should also talk with you about formulating goals. This is where I really recommend you advocate for yourself. It’s really easy as a therapist to make goals based on the results of the standardized assessment, because that is what insurance is looking for when determining if a child qualifies for therapy. But whatever goals the therapist makes, is what they are going to focus on in sessions. So at the end of the evaluation, I highly recommend you speak with the therapist about what your goals are coming from therapy. Where would you like to be 3 months from now? How about 6 months? You showed up to this occupational therapy evaluation for a reason, what is that thing keeping you up at night? Let them know, so they can make this the focus of their sessions! 

Ok, we’re getting a bit long here so I’m going to start wrapping this up. Your therapy evaluation can vastly differ depending on the clinic you go to - especially if it’s a private pay clinic. These evaluations can be a bit on the lengthy side, but I always tell kids that this is going to be the most boring of our sessions - it just gets SO much more fun from here. In my opinion, kids should love OT and be excited for it each week. But the evaluation is a little less exciting, because there’s a lot we need to assess to get the information you and insurance need.

There’s also a lot you can do to help the evaluation go smoothly for you and your child. So I created an extra special free checklist for you to help: 10 Things to Prepare for your Pediatric Occupational Therapy Evaluation. Just click here, or the picture below to get your copy!

Let’s start 2024 with a bang! Go grab your copy and stop putting off that evaluation, remember it can take a couple weeks or months to get off that waitlist. 

 
Thanks for joining me today, and I’ll see you next week!

Sam

References: 

1. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Motor-Sensory/Bruininks-Oseretsky-Test-of-Motor-Proficiency-%7C-Second-Edition/p/100000648.html?tab=product-details
2. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Academic-Learning/Brief/Beery-Buktenica-Developmental-Test-of-Visual-Motor-Integration-%7C-Sixth-Edition/p/100000663.html
3. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Academic-Learning/Brief/Beery-Buktenica-Developmental-Test-of-Visual-Motor-Integration-%7C-Sixth-Edition/p/100000663.html
4. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Motor-Sensory/Sensory-Profile-2/p/100000822.html

Legal***This post/podcast is not sponsored. The opinions and content of this blog/podcast are unique to the writers/speakers unless otherwise stated. No compensation is received for the links shared. All contents of this episode are based on our personal opinions and experiences.Disclaimers: The information provided by SAMANTHA N. GOLDMAN, LLC (“we,” “us” or “our”) on theot4me.com, http://drsamgoldman.com , and http://samantha-goldman.mykajabi.com (the “Site”) is for general informational purposes only. The Site cannot and does not contain medical advice. Any medical information is provided as my/our personal experiences is not a substitute for professional advice. Accordingly, before taking any actions based upon such information, we encourage you to consult with the appropriate professionals. We do not provide any kind of medical advice.THE USE OR RELIANCE OF ANY INFORMATION CONTAINED ON THIS SITE IS SOLELY AT YOUR OWN RISK. Although this blog/podcast contains external links WE DO NOT WARRANT, ENDORSE, GUARANTEE, OR ASSUME RESPONSIBILITY FOR THE ACCURACY OR RELIABILITY OF ANY INFORMATION OFFERED BY THIRD-PARTY WEBSITES LINKED THROUGH THE SITE OR ANY WEBSITE OR FEATURE LINKED IN ANYINFORMATION CONTAINED ON THIS SITE IS SOLELY AT YOUR OWN RISK. Although this blog/podcast contains external links WE DO NOT WARRANT, ENDORSE, GUARANTEE, OR ASSUME RESPONSIBILITY FOR THE ACCURACY OR RELIABILITY OF ANY INFORMATION OFFERED BY THIRD-PARTY WEBSITES LINKED THROUGH THE SITE OR ANY WEBSITE OR FEATURE LINKED IN ANY BANNER OR OTHER ADVERTISING.