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Are Too Many Kids Receiving Occupational Therapy?

When Dina Petringa’s son, Winston, was born, he was “definitely on the ‘floppy’ side,” she says. At ten months he was diagnosed with “hypotonia” – low muscle tone – which can present various developmental challenges. Through California’s early intervention program, at 18 months Winston began to receive occupational therapy (OT), a type of hands-on intervention designed to help children (and adults) perform the tasks that make up daily life, from writing to concentrating to motor skills to following classroom rules.

While Petringa, who lives in Los Angeles, is positive that Winston benefited from OT, she says her intuition tells her that Winston was just “a bit of a forest creature – a quiet boy with developmental delays” that he might eventually have “evolved” out of on his own schedule. But in navigating the system, she did encounter parents with children who, in a different generation, would just have been called “late bloomers,” she says, “and who now want OT to get extra help.” To be sure, the increased availability of OT has allowed us to identify and treat issues that might have left certain not-quite-special-needs kids floundering back when today’s parents of young kids were in school. But when we were in school we also weren’t expected to know how to add 3 + 1 by the time we were four. Is it today’s intense, achievement-oriented school culture or what some have called “the learning-disability industrial complex” – and not the eccentric, poky, or “different” kids – that needs an intervention?

What no one denies is that there has been a boom in OT in the past 20 years, as students with disabilities from mild to severe have received special education services, including occupational therapy, through the Individuals with Disabilities Education Act (IDEA) of 1975. Data from the Department of Education shows that between 1991 and 2001, the number of five-year-olds receiving special services under IDEA increased 31 percent; the number of four-year-olds increased 76 percent; three-year-olds by 94 percent. The numbers have continued to rise. But the prevalence of occupational therapy today is also measured more anecdotally: in the not-uncommon waits of several months for services, or even preliminary evaluations, both in schools and in private practices.

“OT is definitely on the rise,” says Shannon Roberson, founder of the Total Poss-Abilities pediatric occupational therapy clinic in Oklahoma City, who was inspired to go into OT when her first son, now 10, was diagnosed with autism at the age of two. Although Roberson ascribes much, though not all, of the intense demand she sees for OT to increased incidence (or at least awareness) of autism – according to the CDC’s 2009 figures, 1 in 110 8-year-olds had an autism spectrum disorder in 2006, up 57 percent since 2002 – OT is also commonly used to treat manifestations of ADHD, ADD and, more and more, sensory processing disorder (SPD). With SPD, the brain has trouble handling information from the senses, resulting, for example, in unmanageable aversion to certain smells, sounds, fabrics – even to sitting still. Where in the past the consequent restlessness, overstimulation, or total freakout might have been considered bad behavior, now kids with these issues may be evaluated for OT.

No one’s really questioning whether OT is legitimate or effective, for isolated delays or full-blown disorders. One thing that has come into question, though, is OT’s alleged misuse by uber-parents – as portrayed in a recent New York Times article, for example – whose kids, they fear, will flunk their interview at a fancy preschool if (God forbid!) at age three they still hold a crayon with their fist. “There was this pressure: if your kid is not making X milestone by X age, you need to ‘get evaluated!’” says Tawnya Gibson, now of Salt Lake City, of her experience while living in San Diego. (Her late-to-talk son, after OT in California, has now caught up with his peers.) “When you’re a first-time mom, it can really freak you out. I was even like, ‘What if his limitations are my fault? If I hadn’t scrubbed that tub that one time and inhaled fumes!’”

Still, the implication that OT is just a trendy tool of the Ivy-bound rankles experts and parents alike. “Parents do not want their kids ID’d as needing any kind of therapy,” says Paula McCreedy, a founding partner of New York City’s Special Programs in Occupational Therapy Services (SPOTS). “Parents want their children to be happy, to have fun, to play.” One Manhattan mother, whose 5-year-old daughter was recommended for OT (for an apparent brain-body disconnection that caused general “klutziness” and reading and writing delays) by her public school teacher, did not rush to get an evaluation until her daughter started to show signs of distress (“I’ll never learn to read and write!”) “In our school, at least, this is not some privileged white person trendy diagnosis,” says the girl’s mother. “This is not the fibromyalgia of the elementary school set.”

What some experts cite as a more pressing concern than fussy parents or fancy schools is the academic rigor of your average kindergarten. “There’s so much pressure to move them through the curriculum,” says McCreedy, speaking of today’s educational culture in general. “There is a developmentally appropriate rate and time for all these tasks. School is supposed to socialize our children to participate in society. But when we start pushing them too quickly we don’t realize that there are other foundational skills that are as important.” With school standards intensifying and school budgets shrinking, children are expected to accomplish much more, much sooner and often with less recess. If, for example, you need to know all your letters and numbers by kindergarten, you’re going to need to sit still at some point to learn them. If so many kids have trouble with that, do we need to evaluate them – or the ramped-up expectations?

“I’ve been in kindergartens where the kids are expected to sit in circle time for 30, 40 minutes – that is too long,” says Shannon Roberson, the Oklahoma City OT. “Then they’re cutting out recess and PE time which kids need in order to be able to go back and focus in class, whether they have sensory and attention issues or not.”

Likewise, when it comes to the 3 Rs, it seems they’re teaching too much of the 1st and 3rd, not enough of the 2nd. By many reports – and as kids spend more of their time typing or texting than writing – lessons in “penmanship” are rare. And when it comes to kids on the less dexterous end of the spectrum, more handwriting instruction could go a long way, experts say. (Kids these days are more likely to eat with their hands than with forks – hello, chicken nuggets and fries – which can also delay manual dexterity.)

Larger economic and societal issues, such as affordable childcare and family-unfriendly workplaces, mean many children are in school too long to begin with, points out one occupational therapist in Brooklyn, NY who spoke on the condition of anonymity. “Some kids are in school from 8 to 6, if you count the after-school program,” she said. “How frazzled are you at the end of a workday that long?”

This is not to say OT isn’t a godsend for those who need it or that all problems warranting OT would magically disappear if we brought recess and penmanship back and let kids read and add at their own pace. OT, McCreedy argues, should be part of a “wellness” as opposed to “deficit” model in which all children are given the best possible opportunity to function and participate in their world. But perhaps the explosion of OT is, in part, a symptom of an educational system that, in its focus on helping kids perform, may sometimes fail to help them flourish, quirks and all. There’s no more, “Eh, he’s a late bloomer,” says the Brooklyn OT. “That’s great for business, but it’s a little ridiculous.”

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