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OT assessments and PDA children
552 Plays11 days ago
In this episode we're chatting to Faith Newton, highly specialist children's occupational therapist and parent of two PDA children, about how to approach OT assessments with PDA children - whether you're a parent preparing for an appointment, or an OT looking to adapt your practice.
You can hear us chat more to Faith about Occupational Therapy and PDA on our Training Hub.
For information and guidance about your circumstances, you can get in touch with our support service through our website.
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Transcript
Introduction to PDA Life Podcast
00:00:02
Speaker
Welcome to PDA Life, the podcast brought to you by the PDA Society, where we'll be exploring the highs and lows of pathological demand avoidance. I'm Rachel. And I'm Sarah, and we're your hosts.
00:00:14
Speaker
As the UK's only PDA charity, we're bringing together PDAers, carers, clinicians and researchers to answer the questions which matter to you most.
Focus on Healthcare Assessments
00:00:24
Speaker
Hello, my name is Rachel and I'm your host for today's episode, which is going to be focused on healthcare care assessments and in particular occupational therapy assessments. So whether you're an occupational therapist yourself working with autistic children or children with a PDA profile of autism, or whether you're a parent of a child with PDA who needs to have an OT or healthcare care assessments, then I'm sure you will find today's episode helpful.
00:00:49
Speaker
So like to introduce today's guest, Faith Newton. Faith is a highly specialist children's occupational therapist. She's also director of ND Kids Occupational Therapy and Consulting and School OT and author of the book Inclusive PE for Sends Children.
00:01:07
Speaker
And as well as all of that, she also has two autistic PDA children herself, so she has a wealth of experience. So welcome to our podcast, Faith. We're really pleased you're here.
Challenges and Alternatives in Assessments
00:01:16
Speaker
Thank you. Just sort of setting the scene, I suppose, really, if we think about OT assessments, why might they be difficult for somebody, for a child with pathological demand avoidance?
00:01:29
Speaker
Oh, many things. And I think back to both my own children going for an assessment and a sense of trepidation you have as a parent, you know, especially if you have to go to a clinic setting, you've got to get dressed, you've got to get out of the house. you've got to get on some form of transport. Before that, you've got transition from the activity they were doing. You have to go and see a random person in a random room who's going to ask you strange questions and make you do funny things. Like just from my experience, there's a huge amount of demands if we're not really careful and it can leave, if you actually get there, which isn't a given, and you kind of all get through it in one piece, just the recovery time afterwards can be quite intense for the whole family. um And I've certainly had my fair share of McDonald's afterwards, like you know, roadblocks credits, ice creams, kind of whatever we needed to get through it. um So kind of when I moved to independent practice, I was really keen to offer like a different way of doing assessments that would just be a much more positive experience for families.
00:02:37
Speaker
and just take away that awful sense of pressure you can have. If I've waited, I've waited months for an appointment, or I've spent a lot of money, and I have one chance, and if my kid can't do it, and I can't do it, it's all wasted. Like, that's just too much pressure for anybody, let alone our PDA kids. um So, yeah, so huge amount of
Shifting to Neuroaffirmative Practices
00:02:57
Speaker
demands. And I guess in this episode, we're going to be thinking about how can we reduce some of those demands, just to make it a much more positive, useful experience for everybody, really.
00:03:07
Speaker
Yeah, definitely. I mean, everything, as you were talking then, was thinking, yes, I felt like that. Yes, my child has done that. And certainly that whole focus on this is the appointment. I've got to make it work. This is my moment. I've waited months to get this appointment. And then the child's not engaging and you're like, oh, no. And it's like, honestly, they do do this and they do that, but you can't get it. Or the other way, if you have a child that masks a lot, they may look perfect in the appointment. Yeah. And you just feel like, am I making it up? What's going on?
00:03:38
Speaker
Like both of those can be really tricky and I'm very used to seeing both and actually there's a way to kind of be okay with all of it So let's think about the assessment then. So when you're assessing a PDA child, what sort of shifts in thinking do OTs need to make compared to maybe when they're doing more sort of traditional assessment approaches?
00:03:58
Speaker
Yeah, I really think it's a huge shift. And I think it kind of fits in with kind of neuroaffirmative practice generally. So really trying to move away from quite a medical model of how do we change the child?
00:04:11
Speaker
How do we fix the child? What's wrong with the child? And it's really tricky, isn't it? Because our whole kind of EHGP system as well. is still quite deficit-based. But it just doesn't work to look at all the things that are located within the child and how we're going to change it all, because a PDA kid is going to snarl that a mile off. um And actually...
00:04:34
Speaker
Because the kind of level of disability fluctuates so much for our PDA kids, you know, one context on one day, they can get dressed themselves, absolutely no problem. Another time, there's no way you have to do it all for them. And so as an OT, I'm not so much looking at do they have the physical skill to do something that's very static. I'm looking much more about their levels of regulation, what's going on sensory-wise for them. um I'm kind of thinking about the environment. I'm looking at the whole picture. and also things like, are they in burnout? Yeah.
00:05:13
Speaker
And do the adults around them understand burnout? And is that part of the equation? Because that will make an assessment completely different. And you very much and have to look at kind of pre-burnout where we are now well.
00:05:27
Speaker
a big kind of thing is looking at the whole kind of system around the child. So the parents, and I have some parents that are like, I have a PDA child. Some parents are like, I don't really know maybe, and some parents have never heard of PDA. And part of kind of my role is maybe like suggesting that that could be part of the picture, kind of educating the adults about it as well. um Yeah, I guess come that's a long answer, but it's kind of,
00:05:57
Speaker
you need to look at everything. We can't get pigeonholed as OTs into fine and gross motor skills and handwriting with bit of sensory. We're really looking at the whole picture because as we know, PDA affects every part of life. You know, it affects how you sleep and how you eat and how you get on with friendships and how you learn.
Parental Challenges and Professional Support
00:06:15
Speaker
um And so the role needs to be much more, much broader and kind of looking at the whole picture and not just on that child's individual skills at one point in time.
00:06:26
Speaker
Yeah, yeah. And i think One of the points you made there is it it it's very real for many parents in that a lot of parents haven't heard of a PDA or they've only just come across it and they have that full understanding and that the medical community doesn't necessarily suggest it very often for that what the the families we speak to that and And therefore, the parents are trying to work it out themselves, aren't they? OK, you know, is my child PDA or are they not PDA? So to have, you know, a health care professional who understands it very much like you do, because you live it, you know, with your children every day, that must be such a great comfort and a reassurance to the clients that you work with. Because you understand you understand their child. as you say, then you can take look at that assessment holistically rather than just the fine or the gross motor skills, as you were saying.
00:07:19
Speaker
i think so. You know, so many parents, we've like experienced parent blame, we've experienced gaslighting. you know, parents come to often at their wits end, just like, you know, my child hates going to school or something's really not working or they're fine at school, but we have like huge explosions and meltdowns every night. um And so, you know, I'm always thinking, you know, does this child have any diagnosis? Because again, they may not only have not had a PDA, they may not be diagnosed autistic either. So you may be getting a child with kind of no neurodivergence all the way up to, no, they've actually had a diagnosis with demand avoidant profile. um So kind of my starting point, I guess, as well as all the normal OT things, I very much look at um any kind of characteristics of autism and pda specific kind of behaviors as well as a really big mental health anxiety regulation piece so if you think about if your listeners are familiar with kind of the same code of practice in the ehgp four sections
00:08:23
Speaker
I sometimes get told that my place is a sensory and physical section to which I actually say OTs we we're actually dual trained in mental health and physical health and so I can speak to all of them so I very much put you know i talk about learning i talk about communication I talk about mental health and I talk about physical and sensory because
Flexible Assessment Methods
00:08:42
Speaker
all of those are really important part of the pieces yes and um um and it's the child that you're assessing, working with isn't it? It's not just one little, it's just not the physical aspect of the child, it's the whole child that you're working with isn't it?
00:08:54
Speaker
Okay so how should OTs then approach situations where a child's profile is highly variable day to day which therefore makes those standardized assessments difficult or maybe unusable?
00:09:08
Speaker
Yeah, I think you very much have to be curious and be detective and really be talking to parents about kind of their child over the whole day, over the week, over the month, even over the year. So, you know, I ask questions like, when is your child the most regulated and the most happy and the most chilled and when are they least? And often I get things like at the weekends or the evenings, but with one client they said, oh, actually it's in the autumn and the spring. and I was like, okay, because the impact of very high temperatures on them sensory wise and the cold and the rain affected their ability to go out, which meant they were less regulated and had less exercise. So kind of just thinking really broadly um about what is the activity they're most regulated in?
00:09:55
Speaker
Who is it with? So for my son, it's in the evening when his sister's in bed and he's got the two of us to ourselves. We've stopped work. There's no more demands of eating. There's no kind of more work or social demands. It's just kind of quite chilled. um So I think really being curious.
00:10:14
Speaker
And the same in terms of skills. So finding out with like self care skills, so like dressing, eating, having a bath and shower, like, is it always difficult or are there times when it's easier or manageable? um So kind of really um asking a lot of questions of parents and caregivers to kind of get that um bigger picture really.
00:10:39
Speaker
Masking, asking about masking is a really important part of that. And quite often, I'll ask after the assessment, you know, are they now? Because it might be they've held it together, but actually the rest of the day has been an absolute nightmare. And I need to know that because I want to put in my report, although they managed it, the impact of meeting an unfamiliar person and doing these demands was this. um And I also, you know, although I am familiar with masking and I can spot quite a few signs, the parent's the one that knows if they're masking or not. So I want to ask the parent,
00:11:13
Speaker
were they masking with me? How much were they masking? How typical and how comfortable were they? Not as a judgment on myself, just again, to kind of inform the assessment um to kind of really yeah know. So yeah, i think being curious, being aware of masking.
00:11:29
Speaker
And the third thing is seeing them different contexts. And I know that's not always possible, but even if you can't move location, you can still see different contexts. so if you're doing a school assessment,
00:11:42
Speaker
you know, seeing them in the classroom and at break time and one-to-one because they can be really, really different. So I saw a child recently who was quite dysregulated in the classroom, was kind of like throwing things, jumping on things, shouting, screaming, took her to the hall and I did like an obstacle course with her and she was super focused, super engaged.
00:12:06
Speaker
went home with sensory equipment and she started throwing stuff everywhere. And so it's really interesting just to see kind of this like different activities and context, just how different she responded. So I think if you can see in a child in different contexts, even like the garden and the house or different rooms in the school, Or, you know, if you're in a clinic, maybe what are they doing in the waiting room?
00:12:30
Speaker
You know, can you walk past on your way and, you know, quietly suss that out? Or can you have a five minute Zoom call with them before they come to the clinic? So you can just get a bit of a sense of how different they might be.
00:12:40
Speaker
yeah
Adapting to Unique Needs in Therapy
00:12:41
Speaker
So it's it's an awful lot more, isn't it, than that one hit point when you need to look. And and the fact that you you follow up, I can think, you know, you follow up afterwards to find out how the parents thought it went and were they masked and how they've been since.
00:12:55
Speaker
Gosh, that resonated with me so much because I've been with my PDA, I have been in so many medical appointments with him. he he has epilepsy and what have you. And so so he has lots of but medical appointments, but there's not...
00:13:06
Speaker
you know he often masks or will be complete opposite and have complete distressed behaviour in that medical appointment but nobody ever follows up afterwards to see what impact that appointment had um and ah so that's really i think that that's you know that's a great thing to do because it would you know it really is giving you that whole picture isn't it and that's that's what you need it is it is And it's really quick, you know, I send like a two sentence email, you know, it's not a big, yeah and again, mean, for busy clinicians, you know, you're getting an email back and so you can cut and paste some of that information. yeah um you know, you're not having a lengthy phone call, you know, it's very, but it's a really important piece of the puzzle, really.
00:13:46
Speaker
Yeah, yeah, no, that's great. Yeah. Okay, then. So what, what does a low arousal or low demand assessment actually look like then in OT practice? And how does it differ from maybe standard assessment models? Okay, so if you have, so a typical, if there's such a thing, OT assessment will often be a mix of standardised and non-standardised in observation. so with standardised, you have set equipment. So say I have beads and the child has to thread 12 beads onto a set piece of string. I have a script, I have a timer, I have a form, and the child has to do it in a set way or they don't get the points. So it's standardized because it has to be very precise and very prescriptive. um
00:14:37
Speaker
you can do standardized assessments in a non-standardized way. so you might have the same equipment, but you know you just kind of you don't have a script. um Often, because I don't know and kind of how a child's gonna be, I take all my kit with me. And usually within about two minutes, I realize if I can just standardize assessment or not. And then I might just open up my case and we make obstacle courses and the um beads become mouse cheese, you know when the kind of hoops are flung everywhere. um
00:15:08
Speaker
So, yes, sometimes there is a place for stand-by-side assessments, particularly if the child's been masking a lot and you've not seen any demand avoidance.
00:15:21
Speaker
And it's kind of in the child's best interest for you to be to see just a little bit. You don't want to be really distressed, but actually be really useful if you could see it So sometimes I like try a tiny bit of the standardized assessment or I'll be going along and then suddenly I see it. So, for instance, I was doing a throwing and catching test.
00:15:43
Speaker
um activity and when the child dropped it I was going on to the next one he's like no no we need to repeat it now you're not allowed to repeat it in Stanza's assessment but I let him because it's important to him and actually that told me what I needed to know you know he had to be right he had to be in charge he to be in control so that was really valuable information um So, but to be honest, if a parent says, my child's really anxious, I really demand avoidant, I'm not going to walk in there with a standardized handwriting assessment, a standardized this and that. I'm going to go with the child.
00:16:15
Speaker
And so with some young people, we've met at bowling alley. I've had no piece of paper in sight. We've done bowling. We've played pool and we've got burger. And actually in that hour and a half, I've seen loads. I've seen gross motor skills. I've seen, their communication I've seen seen self-advocacy, handling money, regulation, you know.
00:16:39
Speaker
So you can do it completely informally a park, playing with toys or standardised.
00:16:50
Speaker
And then I've actually made a scale. from kind of the most high demand assessment to the lowest demand, because for some young people, no matter how informal and play-based and fun you make it's still too much. And so for those children and young people, it might be that I do nearly all of it indirectly. nearly all of it is through parents and teachers, online questionnaires. It might be the parents can send me photos or videos or samples of work.
00:17:21
Speaker
I've had some young people that have managed five minutes on screen and that's great, you know, and so I think you almost like have to go with your toolkit and be prepared for anything to happen and for that to be okay and because you don't know what the assessment is going to look like. And I think, you know, initially it used to panic me because I used to think, man, what am I goingnna be able write? And now it's fine because I've done it so many times. I know one way or another I can get the information. It just might look different than what I kind of planned and expected. Yeah.
00:17:55
Speaker
yeah And I think think that's a very a common theme with many PDAs, isn't it? What you plan and expect isn't necessarily what's going to happen and you have to be flexible. and we have to adapt ah you know even as just parents we have to adapt if we're trying to work with and assess as you say if you can make it if do that informal way you'll see the true pda of them really won't you you know you'll see the child in their true self yeah and how they really feel and when they're not masking as much i think it's just a helpful tool as parents and ot's to think okay you know we can try here but how do we kind of come up and down the scale and I think like you said you know it's really there is a place sometimes for standardized assessment especially if you're wondering about kind of DCD dyspraxia or other things as well but actually the times when I've really seen the strengths of the PDA kids have been in that kind of informal play base and you you know kind of the creativity and the humour and the fun. um And then particularly a school assessment, you know, i've kind of seen them in the classroom where it's often been quite challenging. And then I'm able to say, but with me, they're amazing. You know, they like had this whole role play going on. They were really focused. They were really calm.
00:19:04
Speaker
And then that can kind of inform the advice I give to school as well. So, yeah, I think really trying to have, there's quite a bit of play-based training out there for OTs. And I find it really useful um just in kind of,
00:19:16
Speaker
You know, it's a very different way. You take a ah her bag or box of stuff and you see what the child does with it. It's a very different way. But that kind of autonomy does really suit kind of our PDAs as well as a way of doing things. Yeah.
00:19:29
Speaker
Oh, definitely. And i do you find sometimes then that the language that you use can alter, you know, if if you say things more in declarative language rather than ask a direct and or give a direct instruction? Have you found that helpful in assessments as well?
00:19:45
Speaker
Yeah, and if I remember, you know, I see children from like three to 19. So it really, really varies on the age of the child. So obviously the younger ones, they just, you know, it's just another person come in and that's fine. Sometimes with the older ones, they kind of, they want to know what I'm doing, what the purpose is, they kind of sussing out the agenda. yeah And again, this is where I would chat with a parent before, because some of them will say, you know, they don't really want to see you, but they know it's going to be useful because they don't want to go back to that school and they know you can help with that.
00:20:15
Speaker
And so I'll just be quite with those kids. I'll be quite upfront with others. And some of them, I do things like I've got some picture cards are called school well-being cards. And they talk about things like I feel like I belong. I feel like I don't belong.
00:20:32
Speaker
School is too noisy. I can trust my teachers. The work's too hard. And so with some young people, they do it without speaking to me and I just let them get on with it. And with others, they might say something or I might say, oh, you know, i wonder when that happens. And I just kind of leave it out there and they may or may not respond and that's fine. um So I try not to make it too dependent on just talking and use these different tools. and sometimes you know they might do five cards and be like i'm not doing anymore it's like okay that's fine um yeah so yeah i think the communication is really i try just be like really matter of fact really consent based so you know like i was thinking about doing are you up for this do you know should we do it should we leave it just um give them kind of as much control and really take the pressure off as much as possible amazing that sounds great
00:21:24
Speaker
OK, so if we think about then goal setting, because that's another aspect, isn't it, of the of the assessment process, then we need to be setting
Meaningful Therapy Goals
00:21:31
Speaker
goals. So how can OTs set therapy goals that are meaningful but don't trigger a demand of audience in the child?
00:21:39
Speaker
Yes, and this is really interesting because in my experience, when a PDA child wants to do something, they often just go and do it. um So when one of my children decided they were fed up wearing polyps at night, you know, within two nights, it was done. But before that, we had no chance. um And the same, like now, he my son started doing workouts, you know, several times a week. Well, if I'd come along with a lovely OT program exercises, would have got that thrown in my face, swearing before works. But, you know, he's pulling out the yoga mat, he's doing his planks because he's just decided to do it. Yeah.
00:22:18
Speaker
And I think this is like a very common experience. So again, I wouldn't be doing goals like they need to be able to thread 10 beads or um they need to be able to get themselves dressed independently, you know.
00:22:34
Speaker
I mean, they're not great goals anyway, and I think we're trying to move to much more kind of functional participatory goals. But, you know, I think it needs to be about, again, the adults around them and the support. So I might have an outcome in the HGP that says um Johnny is able to access an educational setting 90% the time with support.
00:22:55
Speaker
So that's my goal. so And it can look like quite traditional goal, school attendance. But actually in the provision, in my recommendations, I'm saying things like needs to be a small setting, think about flexi schooling, needs to be interest-led. So kind of all my provisions into that goal can be really kind of PDA friendly, but the goal is still there. So I think it's about chatting with the parents and teachers about what's important to them.
00:23:25
Speaker
The child may or may not be able to enter into that process. So they may be old enough and have, you know, I want to have a YouTube channel. I want to go to ride a bike. I want to be able to do whatever, which is amazing. And you can go with that. um They may not want to tell you, they may not be able to tell you, they may be in burnout and they're not in a place to do that. um So, yeah, I think the goals need to be a lot more about kind of putting that support in in the environment and help in the adults around them to kind of understand them and advocate for them. And, you know, the other thing is that it might be that our parents are PDA themselves as well, um or the teachers, although I've not found any yet, or none that have admitted it, I don't know.
00:24:09
Speaker
And so, you know, just the whole idea of a goal can be a huge demand, can't it? Yeah. And You know, as a parent, when everything can be so difficult, you know, just trying to get my kids to eat is really, really challenging and takes so long. I don't want a whole programme of goals, you know. and so I often will ask parents, you know, what's the smallest thing that will make a difference in your life? You know, the smallest thing. And so for somebody, she wanted to be able to eat toast on a certain plate.
00:24:41
Speaker
It's like, OK, we're going to start with that, you know. And again, I guess that also shows that it's about supporting parents because if we see PDA as a nervous system disability, where that child or young person needs a lot of kind of co-regulation, when we've got parents that are burnt out, stressed out you know, they can't, we're the best one in the world, you can't be there for your kids like that. So it's thinking about what does the whole family need yeah as well as the PDA-er? And is it that piece of toast on the plate? Is it actually as an OT, I'm advocating to the school so that the parents are not going to get fined because the absences going authorised? You know, so I kind of see my role not so much as how do I fix this individual child with individual goals and individual treatment, but how can I be an advocate for the whole family? How can I support? How can I educate? How can i come alongside?
00:25:41
Speaker
And with all the things around the child that would hopefully help. um Yeah. So it's it's really quite a different approach. Yeah. Yeah. And I think you're right in in the taking the, for the parents, not as as well as, you know, for the PDA child, obviously goals are to our demands, but it's that,
00:25:59
Speaker
thinking about for the parents as you say they are often you know we're juggling so many different things and yes I would love my child to be able to thread 10 beads whatever it might be but actually just to sit and eat or just to yeah as you say use a certain plate or be in a certain place that's what's causing more issues at the moment in the home so therefore that's the priority as the the target so um yeah yeah and I felt really useful to think about I often say you know what handwriting is really not the priority right now you know like you've got a very distressed child you've got a family in crisis who cares about the handwriting right now like that is not the issue and the same with schools so you know let's forget the homework let's forget this that and the other we want you know the mental health is number one and i often will talk particularly with schools about this you know if you've not got
00:26:50
Speaker
kind of basic felt safety you've not got regulation forget the learning and so I think some of the goal setting before we get to the goal setting is the priorities you know what are the family's priorities what are the child's priorities um and it may be I've done this before just saying you know what I'm not sure like OT is actually you know the main priority right now yeah maybe we can come back to this in a bit it might be you know The child has so many professionals involved. Now is not the right time. It may be that they're having some kind of mental health interventions or something else. And we can come back to independent skills later. You know, it's kind of really, again, being OK with that and seeing like, yeah, what are the priorities for everybody? And what you think are the priorities probably aren't.
00:27:37
Speaker
the family's yeah yeah ah definitely yeah when you mentioned handwriting it just triggered in my mind so my pda yeah is 14 but he's he's got severe learning difficulties his mental age is more three or four and um and his hat he's he's learning to write but it's still you know sort of reception age writing i would say And, you know, and it's like lots of, you know, we're working hard with this, working hard with that. As a parent, i was like, actually, my priorities are, ah you know, that he can get in and out of the shower or the bath at least a couple of times a week.
00:28:11
Speaker
When he goes to the toilet, it actually makes it into the toilet, For me, that's my priority. Do you know what mean? I'm not bothered at the moment about how neat his handwriting is.
00:28:22
Speaker
I need these functional things. that's And as you say, because that's what affects day in, day out the family as a whole, doesn't it?
Family-Centric Advocacy in Therapy
00:28:30
Speaker
Exactly. And if we look at it to a kind of demand lens as well the more we're putting demands on with the handwriting...
00:28:38
Speaker
or with the after school club or with the, you know, sit down still at the table and eat, then the child's going have less capacity for some of like the other priorities really. And so it's kind of also being mindful about kind of that. And that can be almost, some parents always need that kind of permission be like, you know, it's okay not to go out at the weekends. It's okay if you don't all sit down and eat together. It's okay if for your child's naked, wearing pyjamas.
00:29:04
Speaker
Most of the time, like it's okay. You know, and I think it's such a journey, isn't it, from maybe how you thought you were going to parent and how society tells you to parent to actually what your child needs and what your family needs. I mean, to rip up the rule book. And so sometimes part of my role and professional as well can be to kind of give permission for that and just say, you know what, this is really normal. We do it. Loads of my clients do it.
00:29:29
Speaker
yeah you know Yeah. Yeah. Yeah. Again, we a good example that we have with that one is eating, he still eats with his fingers. He loves to pick things up. And I'm like, I've never seen anyone eat a fried egg with their fingers. but it's It's like, wow, that's quite impressive to be fair. But you know, for him, that's it. The sensory stuff is important and that's what he needs to feel the food before he eats it. But yeah, it's that. And that's, that's okay. We go with the flow. We're, are you know, we have, it's that level, as you say, that level of acceptance, isn't it? For for the family first, but then the, work you know, the wider community as well.
00:30:03
Speaker
So i think I think we've covered most of the big collaborative goal setting, but was there anything else you wanted to to so to add to that one? i think it would just be when you think about collaborative goal setting as well, being really mindful about, again, what we kind of said about burnout and about how many of the demands are going on and kind of knowing the timing for things as well. And so sometimes payments come to me with five priorities. It's like, OK, let's pick one. What's the most important one for right now Because the child's going have capacity. The parents probably aren't going to capacity. And just really go in, not being afraid of those baby steps, being like, hey let's pick the one issue. Let's pick the first baby step of the one issue and kind of go from there. um If you're doing a one-off assessment, you don't, you know, always have the luxury of doing that. But I've actually, so I used to... um
00:30:55
Speaker
do you like my parent interview before the assessment but now I've changed it to after the assessment because I find that I can do more of that kind of chatting through outcomes and goals better when I've written my draft report and seen the child and then I can have a bit of that collaboration there so I know you don't always get loads of time to do it but I think it is really important just to make sure that kind of what you think the kind of goals and outcomes are And again, it depends, you know, you may be assessing because the parents are self-funding and they want help at home. You may be assessing any HGP report or tribunal. You may be assessing for NHS referral for paediatrician or school. um So kind of your involvement with the child and the family and the amount of time you'll do goal-setting intervention and kind of will really depend on kind of the context as well. So sometimes the goal-setting can happen organically over weeks and months. Other times you kind of get more of that one shot. But I think you can still, even if it's email collaboration, can't.
00:32:01
Speaker
you know, you can still invite in and do the best you can with a limited kind of time and capacity. Yeah, yeah, definitely. Okay, to finish off then, what would be your key piece of advice for OTs assessing PDA children? Okay, so my key piece of advice for OTs assessing PDA children would be be flexible and be confident. You know, I think if you can be calm and collected, even if it's not going well, you kind of project that the parents and the child and you kind of reduce that sort of pressure and panic. You know, you can always get stuff later. You can always have follow-up emails, conversations. if you If the child runs out after five minutes or tells you to F off, you know, it's okay. That gives you some information and you can get what you need.
Advice for Therapists and Parents
00:32:52
Speaker
So don't panic and take a whole load of different resources, toys, things they're interested in and then you can kind of leave the bag open, see where they go and see where that gets you.
00:33:03
Speaker
Brilliant. Yeah, great advice. And then for parents who are listening then, What would your top tip be and for parents of PDA children who are preparing to take their child to an OT assessment?
00:33:15
Speaker
So for parents, kind of my top Yeah, tip really would be when you're preparing for an OT assessment would be to try and communicate with the OT beforehand. Either have a quick phone call or email, share your concerns, you know, say, you know, my child's going find this really stressful and I'm not sure how they're going to engage. What's the backup plan? think Because I think if they're aware and you're aware there is a backup plan, again, that kind of takes the pressure off. you probably also need to just say I don't know if you're familiar with PDA and just maybe explain a little bit because not everybody is familiar with PDA and what you don't want is that the OTs read they're autistic and they come in with a highly structured a visual timetable you know everything that we know our PDAs don't like um so I think asking about PDA kind of sharing some of your concerns um and also find out what can be done outside of the session. so if your child's going to cope for 15 minutes max, you want that 15 minutes to be
Conclusion and Further Support
00:34:16
Speaker
used really well. You don't need the small talk, you don't need loads of questions to you
00:34:22
Speaker
Find out if that can be done at a different time so they can just kind of get done, you know, kind of the priority things with the child really. And then ask your child what would make it better. You know, I know you don't want to go. What could make it better? Is it McDonald's? Is it a toy? Is it wearing your hoodie? and Is it no waiting time? And kind of conveying that as well.
00:34:45
Speaker
Brilliant. Fantastic advice. Yeah. and ah Thank you so much, Faith. I've really enjoyed that. And there's lots of real, really good nuggets in there that OTs can take away and parents can take away as well for when they're working with OTs. So thank you so much for that. Pleasure.
00:35:00
Speaker
And, you know, please remember there's lots more information on our website and, you know, there's always support out there for you. So please take a look. If you need support, reach out to our website. So thank you once again, Faith.
00:35:12
Speaker
Really enjoyed that. And to our listeners, thank you very much for listening. And until next time, bye-bye.