Schoodles Pediatric Fine-Motor Assessment

An OT Guide for Assessing Children Ages 3 and Up

written by Marie Frank, OTR/L & Amy Wing, OTR/L, illustrated by Kate Badger

I had heard good things about this fine-motor assessment and with a name like “Schoodles” I had to check it out. The publisher kindly sent a copy of the evaluation for my review.

I have always been a big believer in detailed evaluation narratives packed with clinical observations, with minimal focus on test scores. I have found that standardized test scores do not always accurately reflect the student’s classroom abilities and needs- afterall, sometimes students who would benefit from OT services score in the average range on standardized tests. On the other hand, sometimes students who score in the below average range on select fine- motor or visual perceptual subtests have adequate foundational skills, but may benefit from classroom adaptations (such as alphabet models to copy or color-coded paper) rather than direct OT services.

What Schoodles Assesses     

The Schoodles Fine-Motor Assessment provides a framework for occupational therapists who want to quickly screen or evaluate school-aged children (ages 3 years and up) for these basic classroom skills:  

·        Pencil grasp

·        Design and letter imitation and copying

·        Drawing a person

·        Coloring

·        Visual skills

·        Muscle tone, strength and postural control

·        Sensory processing ( tactile discrimination, body awareness, left/right awareness)

·        Self-care (i.e. dressing, feeding skills)

Additional standardized testing may be warranted but starting out with the Schoodles enables the therapist to quickly assess whether some classroom adaptations (such as positioning or strengthening activities) can increase skill acquisition. At the same time, the evaluator can detect what underlying problems are impacting function (i.e. decreased muscle tone, visual skills, motor planning etc.).

What I like about Schoodles

My favorite aspect of this tool is that the therapist scaffolds during the evaluation process. This means that she looks at a skill deficit and increases support to achieve it. For example, if a student is unable to copy a shape, the evaluator can try:

·        drawing the shape so that the student can form it from imitation

·        asking the student to trace over a shape

Then the narrative can include details of the student’s abilities when given the additional supports and describe possible OT objectives that would address the skill.    

Who Should Use Schoodles

I think that the Schoodles is an ideal resource for therapists who are relatively new to working in school systems because it guides the therapist in making clinical observations and address questions such as

·        why is the student switching hands during writing?

·        why is the student writing too rapidly with poor quality? or

·        are impairments in visual pursuit impacting performance?

Schoodles focuses on comparing the student with others in the same grade to determine reasonable skill expectations. The authors also use well documented resources (i.e. Beery’s Visual Motor Integration evaluation, Peabody Motor Scales and Hawaii Early Learning Profile) to provide ages children typically develop fine and gross motor skills. The evaluator can then refer to this data in the narrative when describing the student’s abilities or needs.

The Schoodles Package

Schoodles comes in a 3 ring binder with a zippered pouch to hold easy to find evaluation supplies:

·        scissors (regular and loop)

·        3 crayons

·        A pencil

·        A pen

·        A small rubber mat for the provided puzzles

·        A scarf or tissues

The assessment is divided into two groups of skills. The first consists of skills such as writing, cutting and completing puzzles that are easily observable in any classroom. The workbook portion provides reproducible tasks to perform these skills. The second group of activities  address supporting skills (also known as sensory integration clinical observation skills) such as

·        visual tracking

·        muscle strength

·        right/left discrimination

·        graphesthesia/tactile processing

·        finger touching

·        bilateral coordination and balance (i.e. jumping, hops, gallops, skips, jumping jacks)

All of the classroom and supporting skills are also listed in an easy to use chart that includes a description of the skill, observation guidelines and approximate age of skill attainment.

I have to add that after reading the Schoodles manual I marveled at how all of the assessed skills are described in my book From Rattles to Writing: A Parent’s Guide to Hand Skills. My book compliments the Schoodles assessment tool  by providing the detailed activities and teaching strategies that develop the sensory motor foundations required for reading and writing.  Both Schoodles and From Rattles to Writing are available to purchase at Therapro. Inc. and Schoodles is sold through the Schoodles.com website where you will also find a sample evaluation and answers to frequently asked questions.        

It is estimated that the Schoodles can be administered in 30-45 minutes and sometimes in as little as 20 minutes. A quick, efficient and reasonably priced assessment tool($65.00 for a printed version, $55.00 for a CD)- what’s not to like?  

July 4th Scratch Art

  I thought that it would be fun to make July 4th scratch art  with my little grand nephews and they loved it. I also made my own project on a paper plate first trying out the rubbing plates to see if I could press hard enough to see the texture show up on the paper.It did but not as well as it would have if I used regular paper.

Scratch art is very easy to do. Just make a first layer of colors. Next cover that layer with black crayon. Then use a pointy object like a toothpick or end of a paper clip to scratch into the top layer so that the bottom layer of color appears.

Scratch art helps children learn how much force to use because if they press too hard the bottom layer of color will be scratched away and if they do not press hard enough the top layer of black will not be removed. This is a fun way to controlling the writing tool with the tripod fingers (index, middle fingers and thumb) since the child really needs to control that tip in order to scratch a picture. At the same time there are no demands to form letters so the focus is on controlling the writing tool and having fun. Developing pencil control prepares children to form letters. 

 Scratch art

The Rebecca Moyes Library

The title of this article is misleading because I have only read 2 out of  5 of  Rebecca Moyes’ books. However, if all the books are as insightful, wise and packed with practical strategies as Building Sensory Friendly Classrooms and Visual Techniques for Developing Social Skills then I recommend reading them all.   

Moyes’s ability to zero in on what the child on the autism spectrum needs-seems to stem from her extensive classroom experience as well as being a parent of two children, one of whom has Asperger’s syndrome. Her approach is eclectic as she examines the sensory accommodations children need in order to  tolerate daily sensory challenges, use of a positive reinforcement behavioral programs and specific group training to learn about social expectations and build social skills (i.e. not touch other’s belongings).

Building Sensory Friendly Classrooms starts out with an explanation of the sensory systems and what happens when they are not working very well. Moyes next explains that the sheer number of students with sensory processing disorders (SPD) makes it impossible for an occupational therapist to treat each child. Therefore, it is critical that the classroom be “sensory friendly”. This may entail:

·        Preferential seating

·        A sensory diet packed with movement and heavy pressure input

·        Compensatory strategies such as head phones or transitioning to the next class 5 minutes early  to avoid a noisy crowded hallway.

I like how Moyes emphasizes the importance of data collection to share with the IEP team in order to design the best accommodations/ modifications integrated into a positive behavioral support plan. Data may indicate whether or not supports such as movement breaks, fidget tools or wearing a pressure vest decrease interfering behaviors such as outbursts or increase positive behaviors such as attention. Data may validate strategy carryover into other classrooms or indicate the need for modification.  Other beneficial strategies include:

·        Use of visual schedules

·        Deep breathing relaxation techniques

·        Guided imagery

·        Replacing socially unacceptable self-stimulatory behaviors (i.e. rocking or spinning) with a stress reduction object such as Velcro to rub under the desk.

·        Being a detective-for example, finding out that an offensive air freshener as the cause of aggressive behavior.

·        Creating a sensory diet, including respite spaces


 

Moyes describes how students can relax by  breathing in and out while watching the objects in the bottle slowly glide from end to end. It is filled 1/4 way with Karo syrup and whatever bright small objects I could find.


Some teachers need to be in-serviced and provided ongoing consultation in order to understand, create and successfully implement sensory strategies that level the playing field for students who would otherwise likely fail. Moyes’ continues with this theme in her newest book Visual Techniques for Developing Social Skills. This book is packed with specific group lessons designed to develop awareness of social expectations such as:

·        Maintaining personal space

·        Using or approximating eye contact (i.e. by looking between the eyes)

·        Turn taking

·        Controlling voice volume

·        Understanding privacy

·        Learning the difference between “helping words” and “hurting words”

Lessons  are designed to include reinforcement (such as praise or earning tokens) and further illustrated by using social stories. Teachers use visual/physical props such as a speedometer that illustrates voice volume and hoola hoops that demonstrate personal space.

Visual techniques used to develop social skills builds on the visual strengths students with autism often have-helping to develop self esteem and a foundation for friendships. The important lesson readers walk away with is that meeting the sensory and social needs of these students should be part of the educational plan so that students can grow up to lead both satisfying and productive lives. I recommend Rebecca Moyes’ books to educators, therapists, psychologists and parents.

Receive 15% off books purchased at Future Horizons by using code "Pedia".

Teaching the Moving Child: A Book Review

Teaching the Moving Child by occupational therapist Sybil M. Berkey is not an easy read but it is an essential resource for therapists and educators seeking an in-depth look at the research that supports the movement-learning connection and the OT interventions that address it. The traditional model based on OTs treating only students identified to have disabilities is transitioning into a teacher-OT relationship based on early collaborative problem-solving that includes Response To Intervention (RIT) and positive behavioral supports. In other words, the role of OT is expanding in general education to meet the needs of students who struggle in school.

Berkey beautifully articulates the stress created when young students are expect to read and write when not yet developmentally ready for prolonged sitting, attending and complex motor tasks. As a result, referrals pour in for OT services and to no surprise they are usually for boys.

Teaching the Moving Child is written to spread awareness that young children can only succeed when taught in a developmentally appropriate fashion. Berkey includes research that indicates:

·        Children are not ready to form letters until the second half of the kindergarten year.

·        Young children learn best using the near senses (proprioceptive, tactile, vestibular) as opposed to the distant senses (sight and hearing)

·        Evaluations need to be dynamic meaning that the therapist not only looks at what skills a child demonstrates, but how scaffolding (supports that enable success) helps the child to perform at a higher level.

·      Following a curriculum sacrifices opportunities to practice basic skills. For example, expectations to generate and spell words prevent children from spending time forming letters until they become automatic.

·        The focus on academic achievement  replaces  movement and play with  instructional  methodologies (i.e. sitting and listening) that should be reserved for older students

I learned that cognition (i.e. IQ scores) is modifiable and sensitive to changes in the environment and that stress caused by shrinking education dollars and growing classroom size impacts  learning and behaviors to the point where children are sometimes referred for OT evaluation because they refuse to write.  

Berkey provides the neuroscience behind movement beginning with the connection between cognitive and motor functions. Simply standing increases blood flow and additional flow produced by movement stimulates brain function. There is also the evidence-based good news that dynamic seating promotes attention- this might involve sitting on a ball, seat cushion, T-stool or rocking chair. Berkey describes many other environmental adaptation strategies (i.e. fidget tools, respite spaces) to support young learners.

Berkey provides an excellent lesson for teachers (and review for OTs) on the in-hand manipulation skills children must develop and shapes they need to be able to form (i.e. X and triangle) before being expected to form letters. Other aspects of this book I enjoyed were

·        Tips for teaching cutting skills (including how to make your own self-opening scissors)

·         learning the sequence involved in developing drawing skills and the importance of unimpeded and non-directed scribbling.

·        A variety of strategies to be used based on the students subtype of  sensory processing disorder

·        The appendix packed with strategies, rationales and benefits of various modifications such as an uneven chair with one leg shorter so that the child can rock.

·        A list of activities to “write” without “writing”, such as playing Red Light, Green Light with letters. Children advance when the target letter is flashed.  

Much of the material about the reading process was unfamiliar to me as an OT but will be review for teachers as Berkey describes terminology such as- orthographic knowledge, phonology, semantics, syntax, graphemic buffer and allographs.  This is where I wished there was a glossary as well as a page to look up the acronyms I had forgotten.  Another piece of interesting information concerned the importance of  Rapid Automatic Naming (RAN) of letters as a precursor to reading success and that children who struggle with RAN will struggle with printing automaticity.

I believe that this book should be beneficial for any school-based professional and that parents well versed in educational lingo will also appreciate the information. I realize that this is a long review for a book of only 186 pages including the index. But Berkey packs a lot of meat into this carefully crafted, detailed and insightful resource. I only hope that this book review does it justice.

Carly's Voice

I have read many books written by people who have autism.  In fact, I recently wrote a review of Temple Grandin's new book "Different...Not less"- which is a collection of autobiographical essays describing  the challenges and successes in the lives of people on the spectrum.

When I went to Temple Grandin's conference a few weeks ago- she highly recommended the book Carly's Voice. Now its my turn to recommend it! This is an exceptionally well written description of how disability impacts the whole family-told from her father, Arthur Fleischmann's perspective. Carly's emerging voice is shared throughout the story as we read her emails and other writings, but it isn't until the end of the book when she truly shines as the charming young lady with a sense of humor and a sophisticated understanding of social dynamics. In fact, I have to question the autism diagnosis of a person who reads social cues so well.

I vaguely remember hearing about Carly in the news a few years ago when the media latched on to the sensational story of a girl thought to have a severe cognitive impairment. But, one day Carly experienced tooth pain that was bad enough to make her type out a message for help.  The Fleischmann family has never been the same.......

 
As an occupational therapist, I searched for strategies to help Carly cope with her extreme sensory sensitivities as I read about her stereotypies (i.e.rocking), frenetic movement and sleep struggles. Sensations harmless to the average person intensely impact Carly's nervous system and she struggles to control her related behaviors in order to "fit in". Caring for Carly is more than a full time job. Arthur Fleischmann describes the heartbreaking conflicts that occur when a father loves his daughter, wants the best care possible, yet must place her in residential respite to cope with the stress. 




Diagnostic criteria for autism center around impairment in communication, social and motor skills and a sensory processing disorder often coexists. Once Carly starteds communicating with painfully slow one finger typing-she demonstrated a spunky personality, social savvy and understanding of language that is not expected in a person with autism. This is good news!

Regardless of diagnosis, I thank the Fleischmanns for sharing such personal details of their family's experience and Carly's exciting journey to find her voice. I look forward to following her many accomplishments on Facebook as this amazing young lady inspires, educates and mentors her many friends and fans.
http://www.facebook.com/carlysvoice?ref=ts

After dropping my son off in North Adams to spend 2 weeks on the Appalachian Trail, drove to the Museum of Contemporary Art. This museum is inside a former warehouse and has huge rooms filled with unusual large scale art.

I have to share these robots seen in the cafe/store located next to the museum.  This fish suspended in the museum's children's gallery is made of lots of awesome plastics....

Above is an example of a large scale piece in the museum with a texting art lover demonstrating the size scale. I have to admit I don't understand a lot of the art, but I love being surrounded by it. this piece reminds me of an ancient city perhaps one buried by volcanic ash and rediscovered.

Hippotherapy Clients using sensory pull toy

I described in my last post how I made a sensory pull toy. Today I videotaped a 2 year old using it while waiting for the horse and a 3 year old using it while on the horse. Another 2 year old who I did not catch on tape positioned in leg leg sitting to stretch her hamstrings- reached towards her toes to pull the rings. Another child did this activity while kneeling and another while standing.