Leith Occupational Therapyleaf image

Leith OTleaf image

You’ve done the functional cognitive assessment. Now what happens?

This is a common question. So here goes – keeping in mind that each person, and each situation, will be different. It’s also important to remember that Occupational Therapists don’t tend to diagnose in New Zealand; the OT role is more to provide a holistic assessment which assists in coming to an accurate diagnosis. For many children and teens who have a functional cognitive assessment, there may not be a diagnosis; it may just be that they need a bit more support to match their skill level to the demands put on them by home and school.

Within a couple of weeks of the assessment, parents will receive a report outlining:

There is a wide range of strategies that Occupational Therapists draw on to assist children and teens to overcome executive functioning issues, and I will explore some of these specific strategies in later posts. The strategies tend to fall into three categories:

  1. Remediation – working with a child or teen to develop a skill.
  2. Accommodation – making adaptations to the way a child or teen carries out a task so that they can be successful. Alternatively, the environment may be adapted to assist the child or teen to be more successful, such as having a quiet place to hang their bag, or having adults learn new ways to provide instructions. This may be short-term, while they develop their skill, or long term.
  3. Compensation – While a child or teen is developing their cognitive skill set, or learning to implement strategies, or if a child or teen is unlikely to develop the skill to a level that allows them to be successful in tasks at home or school, compensatory techniques may be put in place. These include the use of technology (such as timers, iPad apps and keyboards), visual cues (for example calendars and visual schedules.

The recommendations provided for each child is tailored to their individual needs, taking into account their age and interests, and their home and school environments. Leith Occupational Therapy can either work with a child or teen to overcome their challenges, or put in place a programme for parents and teachers to implement. In some cases, further assessment by other clinicians may be recommended, such as Paediatricians, Educational Psychologists, Physiotherapists or Speech Language Therapists.

What about gifted children?

It is not uncommon for gifted children and teens to come into difficulty relating to executive functioning issues. This can include impulsivity, disorganisation, attention issues, and poor emotional regulation. These are often not due to executive dysfunction, but caused by the Overexcitabilities (OEs) of gifted children. These are the traits that are most often misdiagnosed, and it’s important that clinicians are careful not to pathologise normal gifted traits. The report for children and teens that are identified as gifted (formally and informally) will include a list of OEs and the cognitive issues identified by parents and teachers, as well as in the assessment. These will be compared and contrasted, ensuring that strategies are put in place so that children and teens can start to utilise their OEs as a strength. Where it appears that there may be a clinical or educational issue that is not appropriate for Occupational Therapy input, further assessment will be recommended.