Wednesday, February 18, 2009

Private Therapy vs. School Therapy vs. No Therapy

What to do? In Ellie's short 4 years of life, for a whole variety of reasons we've had our time in each camp. All in all I think private therapy is fantastic if you can afford it. For us - we do a combo treatment of PT which Ellie usually hates with Speech which she usually loves. This works well because the Speech Therapist distracts Ellie from the thing she hates that the Physical Therapist is insisting that she try to do "just one more time". I hear giggles and laughter down the hall. If it were just PT I can't imagine the fits she might throw.

The School District seems to think that Ellie doesn't need PT. According to their records she can walk down the hall, navigate her classroom and the playground so she's fine. Of course she can't manage the steps of the bus on her own, she can't balance on one foot, she only just started kicking a ball this week (Yippee), and she can't run, hop, skip, jump or navigate steep or rough terrain on her own. The list could go on, but I'll spare you. All of these are things that a 4 year should be able to do. So she receives no PT through the school. We are fortunate to have good insurance and we can manage the weekly co-pays. As a co-treat there is only one co-pay, so it does save us some money and gives us more bang for the buck as we only get 75 total visits covered a year.

Speech is the only therapy she receives at school. Of course her speech is so delayed I should hope so! She also receives the private Speech, and I am grateful for it. She is not so thrilled with the school therapist who focuses on oral motor, but she loves the private one. I am hearing an improvement (albeit slight) in her articulation. She talks a tin ear off you - but so much of it sounds the same that you have no idea what she said. We continue to use the sign language and have added so many new signs - including a push to use numbers and letters. It's amazing to see that she is learning to count and have letter recognition. I thank God for Sign Language every day! Our sign language has all be done at home. We were introduced to it through the Early Intervention group, but a friend introduced us to the program we use and love: Signing Time.

We had been on a waitlist for private Occupational Therapy for 9 months. We just got off the waitlist, but due to a rise in co-pays and a concern I have that we would max out our yearly limit of 75 sessions total I opted for every other week on the OT. We saw so much improvement over those 9 months without therapy that I am not totally convinced that Ellie needs or will benefit greatly from OT. She does have internal rotation of her wrists, but she does compesate well. She gets very defensive when I try to do hand-over-hand assistance. I keep trying :) and sometimes she allows my help. I don't know that there will be a much faster learning curve with therapy in this arena. She does need extra assistance in many self-care areas - of course the school doesn't recognize them - getting dressed isn't something you should be doing at school. So, perhaps we will keep Private OT, perhaps we will end it. Magic 8-ball says too soon to tell.

In my experience private therapy can be a great addition to what ever services the school does provide. but there 's a caveat. You have to look at the whole child and recognize that your child changes. What worked at the age of 2 doesn't work at 4 years old. Re-evaluate periodically and keep the lines of communication open with the therapists. We have done that when Ellie wasn't "clicking" with a therapist: we went through 3 Physical Therapists in 2 years in Alaska till we found the right one.

1 comment:

Beth said...

Juggling therapy is so difficult--trying to figure out what is best. I hear you! School's idea of therapy only covers what a child need to be functional in a school environment, which doesn't cover tons of other environments! It drives me crazy!

As far as speech goes, the other piece to the puzzle is starting on sight reading. We found huge gains in language once Hannah began to read (as a preschooler). Having another visual representation for language (along with Signing) really helps with language ability. I encourage you to look at the Learning Program (all free) or other sight reading programs to get started. I promise it doesn't take up much of your day (a few minutes max), and the rewards are invaluable!