Case Study: Ben (Year 4)

Reason for referral

Ben was initially referred to OT due to concerns with handwriting, specifically reversals of letter and number formations and self-reported “sore hands”. It was noted that Ben was also having difficulties with self-regulation both at home and in the classroom.

Goals

  • Ben will have improved participation and engagement in classroom activities as reported by his teacher, with the use of sensory strategies and tools to regulate himself recommended by the OT, by the review date.
  • Ben will write all letters of the alphabet (capital and lowercase) starting in the correct position and moving in the correct direction, by the review date.
  • Ben will write all letters of the alphabet (capital and lowercase) with correct sizing, spacing and line placement on 14mm dotted third lines, by the review date.
  • Ben will form all numbers 0 through to 10, starting in the correct position and moving in the correct direction, by the review date.
  • Ben will self-edit his work to correct letter and number formations, including reversals, with the use of an alphabet strip if required, by the review date.
  • Ben will develop his hand and finger strength to complete a fifteen minute writing task without reporting of “sore hands”, by the review date.

Outcomes

Ben has made progress with the above goals and is now using a ‘Calm Down Toolbox’ at home and in the classroom. His mother, Lisa reports that Ben is able to independently identify when he needs to calm down and then independently choose and implement a calming strategy or tool. In class, Ben’s teacher reports, with the use of his sensory tools and strategies in his ‘Calm Down Toolbox’, he can concentrate on given tasks for a longer period of time and can often complete work in the given timeframe. In class, he requires tools such as a wobble stool and noise-cancelling headphones to feel regulated and stay on task. Currently, Ben is learning about and using the ‘Zones of Regulation’ program to help identify his body and facial signals for different emotions, improve his reactions to problems and develop his perspective-taking abilities.

Ben is now using modified paper in the classroom which has significantly helped him to size his letters and place them on the line correctly. In his OT sessions, he is continuing to work on his letter formations using a sensory approach. Ben’s ability to write and edit a paragraph using a handwriting checklist is developing.

Plan for future therapy

Written expression:

  • Ben will  improve his written expression by using a variety of learnt strategies (worksheet planning, visual cards and technology apps) to plan, sequence and write a 10 min free writing task, with no prompting, by the review date.
  • Ben will independently think of, verbalise and write well-formed sentences based off different topics/pictures/stories, without assistance, by the review date.
  • Ben will self-edit his work to correct his letter formations, grammar and punctuation, by the review date.

Self maintenance:

  • Ben will independently tie his shoelaces during his morning routine, by the review date.
  • Ben will independently get himself ready for school with the use of various tools and strategies advised by the OT, advised by the OT.
  • Ben will fall asleep within 10-15 minutes of getting into bed and turning the lights off at night, by the review date.
  • Ben will have tried at least three new foods by using the see, smell, lick, chew, swallow method, by the review date.

Ben will demonstrate decreased tactile defensiveness by tolerating teeth brushing, hair brushing and hair washing without adverse reactions, indicating a lower score on a 5-point emotional scale and by reports from his parents,  by the review date.

Feedback

Feedback from Ben’s Mother:

My son Ben started his journey with OT when he was 3.5yrs old. The paediatrician suggested it would be good for Thomas due to his hypermobility, speech and muscle dyspraxia and sensory seeking behaviour.

When we began OT, the main focus was on strengthening for Thomas’s muscles, so that he could hold the correct posture when sitting on a chair at a desk at school, or on the mat when he was in pre kindy & kindy.

When Ben began pre primary it was noted that due to his dyspraxia and sensory seeking behaviour, the focus needed to change to work on his shoulder and hand strength and duration, letter sizing and figuring out which sensory tools would best suit Ben’s needs in the classroom and at home.

As Ben entered year 1 he was diagnosed with ADHD, which he is now medicated for. Ben has continued with OT and is now in year 4.

Since commencing work with his new OT Sophie in November 2017, the focus has needed to change in order to work on what triggers Ben’s sensory behaviour and mood changes and to get him to recognise what these triggers are and what he needs to do to help him stay at a ‘Just right’ level.

Sophie has worked with Ben to have him choose items to place in a ‘toolkit’ for home and school-different textured materials, fidget spinners, putty, sequin pencil case etc. Together with a wobble stool this has helped Ben immensely with his focus at school. He is able to ‘fidget’ with a tool from his toolbox and give eye contact to his teacher, answer questions, retain information and be less disturbing to his classmates. He still has bad days, but because there are strategies in place, there are different things to try and more often than not, a good solution.

Sophie has also been great at helping Ben with his mood regulation. As he has gotten older and the frustrations he has, Ben has struggled to keep his reactions to various incidences to an appropriate level. The Zones of Regulation have been a great help at home as it has helped Ben to work out what things may send him to the red zone, and things he can do to get him back to the green zone.

Sophie has recently put Ben on a ‘sensory diet’, with the idea being that there are activities listed for Ben to complete throughout the day, to help with his sensory behaviour and the distractibility this causes and keeping him regulated, so that completing daily routines aren’t such a struggle.

All of these things that have been put in place has been such a big help with daily life and I never thought that OT could help in this way. I thought it was all about strengthening, correct posture etc. With having gone right back to basics and figuring out what triggers Ben’s sensory behaviour, and having the tools now to help dissolve these behaviours, Sophie has been able to get better results with helping Ben with his letter formation, spacing and sentence writing. Although Ben still requires a lot of assistance and support, with strategies in place he is slowly becoming more and more independent and better equipped to understand his sensory needs and what he needs to do to help himself.

I highly recommend OT-even to those who are skeptical or unsure if OT is the way to go.

As Ben has grown, I have come to realise how many different ways OT can help. Not only with strengthening exercises, strategies and useful tools to help Ben in his daily life, but it has also given my family and I a better understanding of Ben. Why certain things affect him more than others, why he finds simple daily tasks challenging. We now have a better understanding of his needs, and the difficulties he faces with daily activities and how best to help him.

Feedback from Ben’s Teacher

The work that Ben has done with his Occupational Therapist this year has helped him to make progress in the classroom. Ben is working on producing writing that is spaced and sits on the line. He was provided with a green dotted thirds writing pad which he uses in class regularly. This has enabled him to present his work neatly. Using this writing pad has also helped to enhance his confidence during writing tasks. Ben has also been provided with a sensory tool kit. He uses this tool kit to help him to regulate his emotions and to maintain focus during class discussions. During these discussions, Ben has improved his eye contact with the teacher and he has begun to put his hand up to volunteer his answers. This has been very pleasing to witness. Ben also uses a wobble stool at all times in class. The wobble stool, along with his sensory tool kit, has helped to enhance his concentration when completing class work, especially throughout the afternoon. This also means he is completing most of his class work in the given time frame.

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