that have come from my career as a pediatric occupational therapist. Some of the key players in my work have grown up to become adults working in their communities or high school and college students, while others are continuing to work on their elementary school successes. And all of them are doing their very best at what they can do. But no matter where they are right now, every one of them still remains a treasure in my memories. There are some stories, however, that touch my heart in a way that I can hardly express in words. Those are the times that created a dramatic change in both the child and myself.
Our last blog post was an article by The Vision Rehab OT that discussed the importance of providing children with vision eye exams. Keeping that theme in mind, I’d like to share a guest blog I wrote for Dr. Anne Zachry, Ph.D., OTR/L, over at the Pediatric Occupational Therapy Tips blog, as part of a special series she hosted in honor of OT month. After you read it, I’m sure there will be tears in your eyes, too.
From Flapping to Function: A Parent’s Guide to Autism and Hand Skills – A book review
by Katherine J. Collmer, M.Ed., OTR/L
on the Handwriting is Fun! Blog
From Flapping to Function: A Parent’s Guide to Autism and Hand Skills advances the work of Barbara Smith, M.S., OTR/L, on the development of hand skills to a broader level and will serve as a relevant and worthy resource to both her profession and parents worldwide. Barbara’s landmark book, From Rattles to Writing: A Parent’s Guide to Hand Skills, won the National Association of Parenting Publications Award in 2011 and proved to be a valuable guide to parents and occupational therapists alike. In her continued drive to enhance family education, she has organized her newest contribution to serve as an excellent companion tool aimed toward understanding sensory processing disorders and their impact on hand skill development.
A journey through Barbara’s book reveals the caring and insightful manner in which she carries out her practice of occupational therapy. She has transformed what can be a perplexing disorder into a concise and parent-friendly outline of facts and definitions, linking them to the development of hand skills, and most importantly, providing easy-to-implement strategies to enhance the development of those skills. The concise introduction provides the basics in a clear and understandable breakdown of the medical definition of Autism Spectrum Disorder (ASD) including the other conditions that commonly occur with it. Barbara provides a list of key acronyms that will serve as a guide throughout the book. Part I dives right into the uniqueness of each individual with autism and defines the developmental factors that may impact their hand skills – sensory processing, functional vision and visual perception, and executive functioning. This section focuses on Sensory Processing Disorder (SPD) and defines the symptoms of the disorder itself, as well as three primary SPD types: sensory modulation, sensory-based motor, and sensory discrimination disorders. Each disorder is discussed relative to its symptoms and impact on the development of hand skills and is matched to a multitude of strategies that have been found beneficial to enhance hand skill development.
Perhaps my favorite chapter of the book is “Chapter 3: Functional Vision, Visual Perception, and Hand Skills.” Barbara provides not only the essential information about vision and its link to learning but also the critical red flags that can alert parents to the need for a vision assessment conducted by a developmental optometrist. The greatest asset of this chapter, however, is her link between the visual symptoms of ASD and the adaptations and activities that can stimulate the visual system. Very well done!
In Chapter 4, Barbara discusses executive functioning skills and their link to hand skills, providing adaptations that encourage and provide the “just right challenge” for “Getting Things Done!” One of the most critical and confusing aspects of any remedial program is the implementation of appropriate reinforcement strategies that will promote learning and generalization. Barbara does an excellent job of explaining positive reinforcers that use movement and sensory input to produce the desired response while meeting the child’s needs. Of course, the discussion of each type of reinforcement comes with its own list of possible interventions.
Part II focuses on Interventions and can best be described as the “go-to source” for teaching strategies. The book stays true to the occupational therapy perspective of linking the strategies utilized in skill development to the eventual functionality of a skill, defining generalization with familiar examples. Barbara provides parents (and therapists, too) with approaches for self-regulation, methods for grading tasks, the concept of “The 80-20 Rule” used in education (you must read the book to find out!), the effective use of nonverbal directions and “success-only adaptations,” and the backward and forward chaining strategies for breaking tasks into steps. Forever true to her Recycling Occupational Therapist’s mission, Barbara provides a treasure trove of activities that are created from items found in every home and that address the enhancement of skills in the most functional ways. And for many of them, she includes pictures!
The most important element of any book is the reader’s ability to understand the content and to reflect on its meaning. Barbara has achieved that goal by providing her readers with the opportunity to do that with Summary outlines at the end of each section. These bulleted reviews reinforce the key facets of the chapter and ensure the readers’ understanding of what they have just read while they guide them toward the next section.
Once again, Barbara Smith has delved into her vast bank of experience, both professional and personal, to present us with a guide that will become frayed at the edges and littered with yellow highlights as we put it to use in our family and therapy lives. Thank you, Barabara!
Technology comes in various packages, from the most expensive to the budget friendly. It has become a staple in our lives, as well as an effective means for adapting school requirements to meet a student’s needs. Rebecca Klockars, an occupational therapist and RESNA certified assistive technology professional, shares adaptive strategies that will not make a big dent on your therapy budget. Click on the picture below to learn more!
Pencil grip is the first visible sign of handwriting difficulties that can cause teachers and parents to ask for the assistance of an occupational therapist. But, as important as an efficient pencil grip is to handwriting skills, it is not always the cause of handwriting needs. Research studies have concluded that an efficient pencil may not always look like one – although it is functional, nonetheless. My article, “Should we worry about pencil grip?” shares important research conclusions and their implications for an occupational therapy assessment and remediation plan for handwriting development skills. Please share your feedback!
Handwriting and other fine motor tasks demand strength in the core body muscles to provide stability to the upper body and head so that the hands and fingers can engage with the eyes in the performance of precision tasks. An efficient analysis of handwriting development skills and the development of an effective remediation plan to address handwriting needs should begin with the assessment of the writer’s seating arrangements. Chair and desk sizes and heights are critical measurements that can provide the most basic and fundamental information about handwriting performance: How is the seating supporting or hindering handwriting success. In my book, Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists, I discuss this topic in detail. In my post, “5 Reasons Why Handwriting Needs a Good Seat,” I share guidelines that can assist in the assessment of seating, as well as adaptations that can provide stability for your young writer.
During the past two whirlwind years spent dedicated to writing my book, Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists, some of my gifted and experienced peers had graciously stepped in to help me share information and creative ideas with you, my readers, on the “Handwriting is Fun! Blog.” Needless to say, I am more than thankful for their dedication to my work. Their support of me and the profession played a major role in keeping the blog in the news and in your tool kit. As the project is nearing the final publishing date, I am going to take a writing break and set my sights on a few months of traveling and exploring with my patient and supportive husband. During that time, I am going to select some of the best-loved blogs from the past and roll them into a series designed to share therapy tips and research data with you. Here is the first in the Summer Series:
Kinesthetic Learning and Pre-Handwriting Skills
When I came into the profession, I brought with me the knowledge and experience I gained from my background in teaching. I am an avid follower of blogs and research sites that share information about teaching strategies and learning styles. I feel that the understanding of learning and teaching principles provides an occupational therapist with an enhanced ability to present an environment that encourages and motivates a person to work toward success. Kinesthetic learning begins naturally in infancy and, for some, becomes their preferred learning style. In my blog, Kinesthetic Learning and Pre-Handwriting Skills, I present information that helps us to understand the importance of including tactile exploration in our therapy sessions and shares activities that can promote kinesthetic learning in the toddler and preschool years.
My new book, The Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists, will be offered for the first time in Chicago at the 2016 AOTA Conference. It’s very exciting to be sharing my work with my peers! But, I know that many of you will not be able to attend the conference, so I wanted to let you know that the book will be offered through a link here and on my website after the conference. Please look for it! And, as always, thank you for reading and sharing my work.
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of handwriting skills and understands the link between handwriting skills and writing. She can be contacted via her website, Handwriting With Katherine.
Growth Mindsets: Their Implications in Pediatric Occupational Therapy
by Katherine J. Collmer, M.Ed., OTR/L
What is the element in therapy that transforms a goal from one focused upon performance to that which targets learning? What facet of our service approach drives motivation and addresses or prevents the client’s sense of “learned helplessness?” At what point do we, as therapists, influence the mindset of our clients and facilitate their growth in rehabilitation?
These questions lie at the foundation of our own growth as a profession as the health care reform initiatives align with our long-held principles of client-centered treatment. But, just as we are beginning to understand that the medical community is catching up to our perspective, we are equally becoming aware that a client-centered practice framework can produce outcomes that reflect the “shift toward value-based-reimbursement” and “challenge(s) occupational practitioners to demonstrate their unique contributions” (1) to healthcare. In turn, the quality of a framework that stresses the importance of individuality, holism, and a sense of self and one that values the development of both the individual and a client-therapist relationship is contingent in part on the (client’s) experience of care and his perspective of his involvement in the process. Toward that end, research and discussions have been directed toward the development of a “working alliance” and a stable relationship that foster a positive rapport with our clients and serves as a means for active participation in their service plans. (2)
Active participation implies motivation. And motivation suggests a belief that one can succeed in his attempts to learn and grow and to achieve his personal potential. Our ability to motivate our clients demands a certain awareness of the ways in which people are motivated and how their responses to failures can provoke either a helpless response or the determination to master new things and conquer challenges. Carol Dweck, author of Mindset: The New Psychology of Success, conducted research to uncover the factors that motivate and direct a learner’s pattern of success or failure. She concluded that children who were guided toward persisting in the face of challenges and encouraged to believe that failures were due to their lack of trying versus a lack of ability developed “mastery-oriented patterns.” (3) Their “attributions” toward success and failure reflected their judgments about the causes of events and behavior, as well as the recognition of the consequences of those attributions, and drove them to strive for learning versus performance. There is an important difference between performance-oriented and learning-focused goals. Dweck noted that performance goals focus upon demonstrating the ability to do something while learning-focused goals encourages the increase of ability. The difference lies in one being static and fixed and the other dynamic and malleable. The success of client-centered therapy relies upon the participant believing that he has the ability to increase his ability. It is based upon a growth mindset.
Fostering a Growth Mindset in a Therapeutic Environment
Mindset is defined as “a fixed mental attitude or disposition that predetermines a person’s responses to and interpretations of situations.” It is a frame-of-mind, a perspective, and a set of behaviorisms that become an inclination or a habit. According to the prominent dictionaries, a habit is a recurrent and often unconscious behavior that is acquired through frequent repetition and becomes an established disposition of the mind or character. Therefore, habits can be developed as well as broken. Fostering a growth mindset in our pediatric therapy sessions is a viable and applicable target in a client-centered service delivery model. The same assumptions about success relative to a child’s level of academic achievement can be applied to a pediatric client’s success toward therapy goals. A research team reviewed the literature that studied the “noncognitive factors” involved in student learning. These included both their Academic Behaviors, such as going to class, completing homework, active classroom engagement, and studying, and their levels of Academic Perseverance, labeled as tenacity or stick-to-it-ness. They both were determined to be indicators of how likely a child was to continue to pursue academic goals despite challenges. (4) The results of the review suggested that “one of the best levers for increasing students’ perseverance and improving their academic behaviors (was) by supporting the development of Academic Mindsets.”
The key mindsets that the research team defined as those associated with increased perseverance, better academic behaviors, and higher grades can be applied to our therapy services.
Belonging to a learning community. Our therapy sessions revolve around learning (or unlearning) habits and behaviors that will enhance a child’s opportunity for success. Our willingness to build a rapport that fosters trust and develops into a working alliance that encourages communication, and in the end becomes a stable relationship that incorporates the child’s opinions and ideas into the rehabilitation process, encourages a sense of belonging in the therapy environment. (2)
Belief in the likelihood of success. Studies have shown that self-efficacy was a strong determinant of success among similar-ability students. A child’s sense of his ability to succeed is “malleable” and can be influenced by feedback on performance and ability, as well as the provision of training and assistance with setting goals. (4) The core components of client-centered care (respect, collaboration, communication, support, and inclusion) and the part that hope and self-perception play in an occupational practice (1) foster the building of self-efficacy. It is our role as occupational therapists to help our clients to “celebrate” their willingness to take risks, to allow themselves to fail, and to learn from those failures. (5)
Belief that abilities and intelligence can grow with effort. Carol Dweck considers students with a growth mindset to believe that “the brain is like a muscle” that gets stronger with use. (6, qtd in 4) They are motivated by mastery and enjoy challenging themselves with new ideas and learning opportunities. (4) It is our role as therapy practitioners to provide the “just-right challenges” that will build brain muscle and encourage our clients to believe that they can learn and grow despite their personal challenges.
Belief in a sense of meaning and value surrounding the work. As we continue to interpret and make meaning of our experiences, our brains are looking for connections in order to process new information and ideas. (4) Tasks and information that do not represent meaning nor constitute any value to our clients will fall short of the mark and limit their potential for success. Purposeful activities are planned and directed tasks that are key to planning an occupational therapy program, while meaningful activities are those that achieve the program goals through an intrinsic motivation for the patient. (7) It is our role as therapists to offer our clients activities that are both purposeful and meaningful and that will bring them back to therapy to build the sense of belonging and self-efficacy that results from a mastery mindset.
Fostering a learning mindset in therapy begins with the principles laid out in the client-centered approach to our occupational practice that build rapport, a working alliance, and a stable relationship, no matter the age of client.
Mroz, Tracy M., Jennifer S. Pitonyak, Donald Fogelberg, and Natalie E. Leland. “Client Centeredness and Health Reform: Key Issues for Occupational Therapy.” Am J Occup Ther American Journal of Occupational Therapy 69.5 (2015): 1-8. Web. 3 Oct. 2015.
Collmer, Katherine J., M.Ed., OTR/L. “Client-centered Practice in Pediatrics.” Handwriting Is Fun! Blog. Handwriting With Katherine, 29 Sept. 2015. Web. 3 Oct. 2015. <http://blog.handwritingwithkatherine.com/client-centered-practice-in-pediatrics/>.
Farrington, Camille A. “Academic Mindsets as a Critical Component of Deeper Learning.” Hewlett Foundation News. William and Flora Hewlett Foundation, n.d. Web. 03 Oct. 2015. <http://www.hewlett.org/library/grantee-publication/academic-mindsets-critical-component-deeper-learning>.
Schwartz, Katrina. “What’s Your Learning Disposition? How to Foster Students’ Mindsets.” MindShift. KQED News, 25 Mar. 2014. Web. 03 Oct. 2015. <http://ww2.kqed.org/mindshift/2014/03/25/whats-your-learning-disposition-how-to-foster-students-mindsets/>.
Dweck, Carol S. Mindset: The New Psychology of Success. S.l.: Random House, 2008. Print.