Season 2, Episode 7: Let's Talk Occupational Therapy with Amanda Zecchin, M.S., OTR

Welcome to the podcast. Let's talk sped law, a podcast dedicated to discussing special education rights of children with disabilities. I'm your host and special education attorney. Jeff forte. Now let's talk sped law. Hi everyone.

And welcome to another episode of let's talk sped law today. We have Amanda Zakim on the podcast here and I'm so delighted to have Amanda here, because in this episode, we're talking about everything you want to know about occupational therapy and occupational therapy evaluation. So Amanda, welcome to the show. Thank you, Jeff. I'm so happy to be here now. Amanda is a licensed occupational therapist and she is the owner and founder of aide to see occupational therapy in Greenwich, Connecticut, and also as a mom that has children with a disability. So she is uniquely qualified, not only as a mom, but also because she is a licensed OT therapist and is often called upon in Connecticut to more fully inform a child's IEP in regards to occupational therapy needs. So Amanda, for the, for the benefit of our listeners that are, that are out there, right? Can you first go through what is an occupational therapy evaluation? Um, you know, we often times parents that are not necessarily in the know yet will confuse OT and PT or blend them together. Um, obviously there are two profoundly different things and they are related services under the individuals with disabilities education act as a matter of law. So can we first start with defining what an occupational therapy evaluation is? I'd love to do that. You know, first I I'd like to bring up that, um, within schools, there's this thought that's perpetuated oftentimes by, um, by the schools that occupational therapists are the handwriting people. And so we're sort of pigeonholed into that where the handwriting, when we are handwriting specialists, um, and that does differentiate my field from many other fields because we are able to look at a child's handwriting and look at the neurological component and the motoric, um, issues that might be holding a child back from being able to produce quality handwriting, but just because the child doesn't, um, have handwriting issues that doesn't necessarily mean that they don't need a comprehensive occupational therapy evaluation and occupational therapy, um, evaluation should

Incorporate a child's ability to function in a school classroom environment. From a sensory perspective, a comprehensive evaluation should look at a child's fine motor skills, gross motor skills, body awareness issues that might impact their ability to access learning. We are able to look at a child in a holistic light, um, looking at their visual motor skills, their visual motor integration skills and their ability to function in a classroom environment and not just in the classroom environment academically, but also in the physical classroom environment, moving from class to class transitions. And if a child is exhibiting behaviors that negatively impact their ability to access their education. Um, oftentimes there is a sensory component that occupational therapists can help with.

So you just really gave us a lot of, uh, uh, of information that parents should really, uh, break down and understand. And you started right out of the gate by saying, yeah, you know, it's more than just handwriting and writing. That is more often the case than not for parents that aren't in the know where they're asking for additional supports for their child. And then the district will just say, well, no, your child rights fine. So they don't need an OT assessment and unbundling all of these things. It's so important because you're, you're really looking at the child's ability to ambulate and successfully navigate the classroom. You know, the bus, right, uh, going from, uh, from room to room within the building, their, their range of motion, um, you know, their, their posture, their dexterity, their leisure activities throughout the day. All of this is what your called upon many times when a district is in comprehensively conducting an OT about right.

So occupational therapists are uniquely holistic providers. And often what happens is in a school and even occupational therapists who work within the school will tell parents, uh, and maybe, and, you know, sometimes the motives are, um, they're told by the school that if a child doesn't need, um, handwriting help, that they're not to evaluate, um, sometimes their case loads are overloaded and they can't act, they can't put another child on their caseload. So they'll screen a child by looking at them, right? And they'll say, you know, this child doesn't need OT services. Meanwhile, the child might be having behaviors on the bus, might be pushing other children away because the child is too close and touching them. And they don't like the feeling from a sensory perspective or maybe the classroom environment is too busy or overwhelming. And, and these are the things that occupational therapists are uniquely trained and qualified to address. There are no other clinicians that are qualified to address these issues. And so oftentimes the child will be getting psychological services and there'll be overlooking those neurological foundational elements that an OT kind of dress in the classroom. And, uh, you know, I hate that we're pigeonholed in that way, um, in schools. So, uh, I think parents really need to know that if you're hearing from an OT, we can evaluate the handwriting is fine. That's not true.

Right. Right. You know, one thing that is often overlooked is the, uh, as a related service under the individuals with disabilities education act is the ability to actually have daily living skills and activities. And that parents that are listening should be empowered to know that an occupational therapist within a school district is the person that should be informing a child's IEP with regards to ambitiously appropriate. Right. Cause that's the standard living activities. So can you go through what daily living activities are in the context of a school setting and how they should be generalizing those skills into the community setting for children?

Yes. So, you know, there'll be many children who their, their parents will be getting them dressed in the morning because they, they are unable to button zip, Don and doff put on and off clothing boots. So the minute you walk onto that bus and sit down and you come off the bus and then it's time to take off your coat, uh, unzip it, hanging in a cubby, organize your cubby appropriately, that things aren't all over the place. I mean, I have many older children who have executive functioning issues where they can't organize their cubby and they're, they're being reprimanded because their cubbies are messy, but they don't have the sequencing skills to know, or the spacial skills to understand. I have to put the bigger thing on the bottom and then the smaller thing on top and things are falling out. Um, so the basics putting on and off a coat for the younger kids, zipping, buttoning, being able to do your toileting, being able to tolerate, uh, flushing the toilet. Some children are really triggered by loud noises by echoing spaces. Those are all things OTs can look at, um, feeding, uh, feeding yourself, making sure that, you know, you're, you're not getting messy, um, being able to eat more balanced, uh, diet, if you're only eating crackers at lunch, that's something that an OT can address expanding the palette from a sensory perspective and a feeding, um, perspective. There's, there's just so many basic activities of daily living, tying shoes for the older kids that has a big social ramification. If you're unable to tie your shoes, you know, seven years old, that is something that involves a lot of fine motor control sequencing. That is something occupational therapists should absolutely be addressing in school because your shoe gets untied all the time in there. Remember, I mean, I was falling all over the place.

Right, right. And when I think about OT services that are in an IEP, they really cross over into a child's entire day. Uh, and, and your, your, the things that you're touching on are really important for the development and milestones of, of a child. So putting it into context, right. Um, what disabilities do you often find are associated with a child that is requiring an OT evaluation with OT services?

Okay. So, uh, many of the children that I see come to me before they're actually diagnosed, but if I am, I'm not someone who could diagnose children. I'm an OT, I'm not a doctor, but any child that's not functioning in the neuro typical spectrums. So that falls with children that have ADHD children that have autism children that are twice gifted and just not functioning quite, um, the same as their peers, children that have cognitive issues, learning disabilities. I mean, the fact is that there are many children that don't have a condition that can actually be diagnosed, uh, and perhaps they're even functioning at a level academically where they wouldn't even qualify for a learning disability per se, but they're having behavioral issues that are often related to underlying, um, challenges that are making things more challenging, like visual motor impairments, um, developmental coordination disorder or something. I often see, um, children with different syndromes. I mean, really it's, it's anything that would affect learning and motor torque control, um, and cognition and impulse control. So,

Right. So let's, let's talk about how we would go about a comprehensive OT evaluation. I mean, you, you were strictly, you know, indicated, right. You're often, uh, evaluating a child that might not necessarily even be diagnosed yet with a disability, but the parents are noticing that there are certain delays, you know, fine gross motor delays. There are certain milestones that are not being achieved. What are the assessments within your toolbox that you're often called upon to, uh, you know, conduct as an assessment and, uh, in what settings do you conduct them in? Well,

There are many tools in our toolbox and there are ones that I prefer, and I prefer, uh, tools that are standardized because, uh, you know, that helps give you a measure of where children are functioning. Um, I prefer to do tests that are, um, standardized and that you can look how your child is doing certain skills in relation to a sample of their peers. And the reason I like that is because oftentimes in a school environment, you'll hear, Oh, well, this person is young to be in this class. So we don't expect this child to be able to do that. And if I have that kind of test that says, well, no, compared to their peers of their age group, they should be able to do that. Then we don't have to have that conversation anymore. It eliminates that they're too, they're so young to be in this class. Um, so what you want to do is you, you want to find out where the child's having difficulty, where you're seeing usually it's behaviors, where are you seeing these behaviors, these avoidant behaviors, or these meltdowns, or these tantrums, or where is this child not excelling? And generally I'll want to find out in a school environment, I'll typically do a sensory profile. Uh, and the sensory profile breaks down where the child may be more sensitive or where the child may have a high threshold and may not be getting information. And that I do with almost every child, uh, in a school environmental always want to know what, how the child is functioning. Um, from a visual motor standpoint. I don't know if I should explain what, what exactly that means most parents don't know, but that's how your brain, uh, takes in the visual input and then creates a functional output. So I personally, I like the Berry boutiqueness SCA, um, test of visual motor integration, and that is a standardized test. And it, it, your child will be having to copy pictures, um, that get increasingly more difficult. And that shows how they're taking in the input and how they're doing an output. And there are sub tests to that. So you can look just at the visual perception and you can look just at the motor component. And that gives us a lot of information as to what's happening. Is it really just those fine motor skills? Or is it the way Johnny is looking at the information on the, and then recreating it is a visual perceptual. So I love that and I love for fine motor. I love the Peabody, um, for younger children and that also tests, um, visual motor skills and fine motor skills. And for the slightly older children, I like, um, the bot, which is the Bruininks ASTA risky task of motor proficiency. And that's also standardized. And that gives a lot of information about those fine motor skills and a lot of information about the gross motor skills. And oftentimes in a school setting, the PT will do more of the gross motor and the OT will do a lot of the fine motor in my practice. I do the whole test because I don't have a PT in my practice. And, um, you know, um, what other information are you looking for? There's a lot of tests we could go over.

Yeah. You know, this, this is, this is a great gateway of information for parents to now look up all of the assessments that you just provided to make sure that when they're requesting an OT evaluation for their child at school, they can get down to the specific vernacular of the assessments that they should be requesting. Okay.

To be requesting tests that are standardized. A lot of OTs, um, in schools will, will choose tests that might not be standardized. And you really need to make sure that they are standardized assessments. And also something else that I found happens in schools is they'll just do a sensory profile on a child. And just doing a sensory profile is not nearly a standardized test. And, and oftentimes schools will then say, well, the child can't qualify for services because we've done the sensory profile. And the sensory profile is you can't qualify just based on sensory needs. So it's sort of a game that, that is played often times.

Right. Right. You know, I wanted to ask you a question about actual direct OT service hours, an OT goals and objectives on an IEP that are specific and measurable, right. Versus a school district that might just say, Oh, look, we're just going to provide you with some accommodations and modifications instead of the formality of service hours and, um, and, and goals and objectives. Do you have any insight on that?

Yes. So in my personal opinion, I can't just give blanket recommendations on a child that I'm not really an expert in. So really it has to be in best practice, unless there's just like a really obvious issue where it's so obvious and the child isn't really having behaviors, but maybe they're squinting because they need alternative lighting. Okay. That's really obvious. I've never seen that happen with a child. It's always more complicated that especially if a child needs an IEP, so direct OT hours and the goals that we should be working on will impact the, the modifications that we are suggesting. And it should be an ongoing conversation between the occupational therapist and the teacher. And obviously, you know, the child, um, as to what's working in the classroom and what's not, um, and direct service hours and goals, you really want everything to be extremely measurable. If you're working on specific handwriting goals, you need to have those specific goals written in such a way that will challenge the child moving forward. And just because you're addressing handwriting goals doesn't mean that you shouldn't be having an ongoing conversation in the classroom as to there's too much glare from the window for PD to do this here, let's move him there. I don't know if I'm answering the question. I feel like I went off on a tangent. There's so much, you really want it to be an ongoing conversation if possible,

Right? Yeah, no, I think it's very informative, Amanda. I mean, often times we'll, we'll, we'll hear that a school team will deny an OT evaluation and perhaps just offer an OT console right. In bed, some standardized non individualized accommodations and modifications in a five Oh four plan. And what you're getting at is, you know, no, in order to actually even inform a five Oh four plan with accommodations and modifications, a formal, comprehensive OT evaluation is always more beneficial than an OT consultation itself.

How can you possibly make a recommendation without really understanding the child through that comprehensive evaluation and that comprehensive evaluation? And my opinion is the starting point of the conversation. But if perhaps they've scored in such a way where they're really functioning well, and they truly don't qualify for services because their visual motor skills and their fine motor skills are fine. And perhaps it is just a really, um, it's not affecting them that much, then you won't be seeing behaviors in the classroom surrounding handwriting and surrounding writing because they're able to do it. Right. And so it's the starting part of the conversation. I mean, you can't really know a child after, you know, a three hour evaluation anyway. Um, but, but you can have some, some good insight and, um, yeah, if they're not scoring really well on those tests, you should be fighting for those OT services. And the comprehensive level is, is the beginning beginning of, and if they don't qualify then great, then it's not an issue and you don't really need accommodations. Right. Right.

You know, I'll often, I'll often advise parents that if they're, if they're really adamant that their child is going to require an OT evaluation as a catalyst, they should be getting that support in a pediatrician saying that, you know, I I've evaluated my, my patient and my patient would benefit from an OT evaluation. I'm asking the school district to do it. I'll often find that when you get that pediatrician note, it's just an additional support that you can go to, um, an IEP meeting or an eligibility meeting, or a five Oh four meeting and ask for it. Um, I wanted to get a little bit more granular now and get into the, the areas of performance that a OT treatment plan would include. Um, and I'm thinking about, you know, the various types of skills from, you know, defining and informing parents about the differences between fine motor versus gross motor versus visual and oral. Um, and then from there, you know, let's talk about sensory, right? So can you, can you explain what all those types of sub set motor skills are for?

Yes, I kinda, and before I do, I just want to respond to it's so interesting what you said before about needing getting a pediatrician to support the OT evaluation. You know, what's really interesting is that I have chosen the profession, probably the only skilled profession where you need, you know, another profession to say, yeah, this is a thing that you actually need. I like attorneys, um, you know, psychiatrists, psychologists, you don't need that. Um, and I think a lot of that goes down to the fact that we haven't done a great job as occupational therapists, uh, of explaining exactly what we do. Right. And, and many, um, many pediatricians don't even really understand what we do. So I'm so glad you asked this question because now I get to explain to you what I do. So occupational therapist, you know, we're, we're, we're really well known for, um, looking at fine motor skills. And when I say fine motor skills, that that really is how a child is holding a pencil traditionally or cutting. I mean, really those motor, those small motor skills, how they're holding something. Uh, and if a child is not holding a pencil, are you, or are you tensile correctly? Generally? That's, that's the tip of the iceberg, right? Because you're not just not learning to do that naturally for no reason. And then you'll look at visual motor integration skills and that's like I said, what you're looking at and what you're taking in, and then how your body is moving, um, in response to that. So you'll look at, am I answering this question thoroughly? Okay, good. Um, and so then you'll look at, okay, you know, what is the handwriting output? You know, are they able to follow me as, is, are they able to do puzzles? Those are all visual motor integration skills that children, um, that don't have any, um, impairment will, will do fine with, um, often children that have the fine motor, um, issues of having difficulty holding a pencil correctly, or having difficulty cutting. Oftentimes they'll have some, they mom sometimes they'll have some gross motor issues, right? And so those will be honestly, a lot of coordinational issues. So sometimes children will have really, really good gross motor coordination, whether it be doing sports at a high level, but they can't bring that down, um, to when they're sitting still to get that fine motor coordination piece down Pat, and that'll often be tied to a sensory it's so tied into a sensory component because they're doing great with those gross motor skills because they're moving around and they're getting all that input into their brain, from the movement and the bouncing off their friends and all of that. And so those skills are really high level, but when it comes to sitting still and concentrating and moving those small muscles, they have trouble focusing. So then we would talk about, well, how can we incorporate some more movement? So that way that they could develop these fine motor skills and not be so uncomfortable, just having to sit for 15 minutes, doing this activity. So that brings us into the sensory component and a sensory motor component. And OTs are, we look at all of the sensory systems right through our assessments. So we'll be looking at the auditory system and the visual system, and then we'll be looking at the tactile system. And then we also look at the systems that have to do with movement. So that's called the vestibular system. So does a child get very over aroused when they're moving around? Do they need a lot of movement to stay focused? And then we look at the proprioceptive system, does this child need a lot of input into their joints to understand where their body is in space? I explain that to parents about, um, you know, when you do yoga and you just feel really grounded, um, that's giving your body a lot of proprioceptive input. Some children need a lot of that just to feel organized. Um, so we look at a child from that sensory perspective, do they get overwhelmed in a busy environment? Um, do they get overwhelmed when you get those, you know, those printouts with a hundred different things on them and the children have to figure out even where to write and sometimes that's overwhelming to a child. So can we just simplify the visual layout and get more of a functional output? So we really look at all of those things, you know, and then behaviorally the child's behavior is so linked to the way that they're processing their environment, the way all that sensory input comes into their brain and whether or not they're able to make a functional output. Um, that is an issue all of us have, but as adults we've learned to compensate for it, but some children, you know, they need some guidance.

Yeah. W and, you know, you, you, you brought the conversation to such a great point with behavior because behavior and OT really go hand in hand. You know, I often, you know, you know, look, I'm just a special education lawyer, right? I'm not a clinician. And I, I always tell that to my clients and prospective clients, but even as an adult, I know that if I'm going to get overwhelmed with something, I need to take a break, right. I need to, I need to walk away from something and for a child that may have a disability or deficiencies in a certain level of functioning, and they have to focus twice as hard, 10 times, as hard as their neuro-typical peer, they're going to require break much more so than a neuro-typical childhood. And you were mentioning a behavior, you know, let let's talk about the importance of a child's sensory diet, but let's, let's talk about what is a sensory diet and what are the building blocks that are necessary in order to have a successful sensory diet and why a sensory diet helps to more fully inform a child's IEP with OT related services. So I gave you a lot of questions there, but if you could unpack that.

Yeah. So, okay. Well first let me say this. Yeah. You know, what happens often to children who are not, uh, neuro-typical and not functioning, functioning exactly. Like their peers, uh, is that the adults around them, because psychology has been around for so long and is so well respected and such a part of just our framework of thinking that people will automatically assume that that behavior is a psychological behavior. It's a behavior for either they want negative attention, or oftentimes I'll hear educators and people in school saying, Oh, well, they get everything they want at home. And they jumped to these conclusions where they're, they're eliminating the underlying reasons for some behavior. So they're jumping to, to the last possible conclusion. So in my mind, I immediately, I first asked, is this a brain and body issue? Is there a neurological reason for this is the child overwhelmed from a sensory standpoint? And the reason I always ask that first is because the majority of the time, that is the reason, especially for younger children, they're, they're hungry, they're tired, they're overwhelmed. It's an overwhelming environment. Something is going on with their body that they're uncomfortable, it's too loud. There's kids touching them. So that's why they're acting up at circle time. It's not because they're not interested. Um, they're not necessarily looking for negative attention. They're just overwhelmed. And we want to address that first because it's easiest to address. And we address that through a sensory diet. And before I get into the specifics of the sensory diet, the only way that we can eliminate that is to give them the right sensory input and the right sensory diet. And if that's not working, then we say, where did we set the bar? Maybe this is a little too much, too much challenging. We're just going to lower the bar a little bit. Let them take breaks after five minutes, instead of Southern minutes, um, making that a little easier. And then after that, we can say, okay, what's the behavioral intervention we need here, but schools so often jumped to the behavior intervention, and then they, they don't understand why it doesn't necessarily work for the child. So the sensory diet specifically should be a dynamic thing that grows and changes with the child as the child's needs, grow and change. So having, uh, the same sensory diet all year, if it's working great, but if it's not working, it has to be tweaked. Um, and it has to be changed. And to be honest, it has to be changed likely because it will get boring to a child if it's the same thing, okay, do 10 walnuts, uh, that that's boring. But a sensory diet is really about, in my opinion, figuring out what the child needs more of and giving it to them in a functional way that won't disrupt them socially. Uh, won't disrupt their learning. And oftentimes if I'm giving a child, a sensory diet, the whole class is getting a sensory diet, which is generally beneficial for the whole class. So there are many things that you can do that, um, will not negatively impact the child. There are these bands that you can put around the legs of the chair, and if a child needs a lot of movement or a lot of deep pressure into their legs, they can bounce up and down on these bands without disrupting the class. And if a lot of children have it in their class, then everybody can get that as needed. Um, after, in between transitions from one subject to another, oftentimes I'll tell teachers do specific yoga moves that increase proprioception and increase movement. Um, a lot of teachers now are doing brain breaks with go noodle, and that can be really helpful to, um, some children, you have to say, okay, when you start, you can educate a child to when you start to feel antsy, you know, have a secret signal to a teacher and the teacher will give you maybe a task of bringing these two heavy workbooks down to the principal's office and come back. You really have to be so creative and figure how sensitive a child is to what their peers are thinking depending on the age of the child and what will or won't won't disrupt the classroom. Because, because it, it has to be an ongoing conversation. I don't love fidgets either just in general, a lot of, uh, educators throw fidgets at a child with ADHD and think that's going to help. And then the child hyper focuses on the fidgets. And, uh, uh, so that's one example of this, like one size fits all sensory thing that people try to do, and it almost never works. Right.

Right. So we talked a lot about what a sensory diet can embed. Um, and I'm thinking about certain activities that a child can have throughout their day, either in a structured formal way, or kind of as an add needed thing, as far as, you know, tactile type of activities, um, or oral or auditory accommodations. And can you talk about what those activities and those accommodations might look like and might include in a child's IEP?

Sure. Uh, so let's talk about, let's talk about what should we talk about first? I don't know why this is popping into my mind, but as we're talking about sensory diets, I'm also something that we don't. We always think of diets as you're taking in sensory input, but oftentimes children, especially children that are overwhelmed and very sensitive, they needed a break built into their IEP. So the ability to go to a, you know, a cozy corner where, you know, where there's lower lighting, um, when they feel overwhelmed taking that break and sitting in a beanbag chair, um, four or five minutes can, can make a big impact in their ability to access information when there's a loud and, um, a lot going on. So you can talk about having those breaks. You can talk about having, um, some people have like stickers on their desk and different things that they can, they can touch underneath their desk. Um, really, it can be almost anything depending on what the child's needs. I mean, they there's often obstacle courses outside of rooms with little areas where you could do, you could do pushups and do exercises. Um, I'm, I'm thinking, I mean, there's some children like to do puddy and take breaks and just do like a little putty and some children can walk to their, their cubby and take sips of water from a Camelback, uh, you know, thermos and just kind of knowing on that thermos for a couple of seconds. And then coming back, um, would be okay, some children are allowed to chew gum if they need to chew gum. Um, so,

So when you're called upon five parents, right, and you're conducting a comprehensive OT about what, what are the environments that you're going to assess? Um, and, and who are you interviewing? And what, what is the actual end result often look like when your clog, right. So we're talking about where a parent may have disagreed with the district's OT evaluation, or the district has refused to provide one on the district's dime. And now the parents are retaining you to conduct one

Often what will happen is that there will be an understanding. So I'm always talking with the teacher and a para if there's a power involved. Um, I find that the majority of my conversations are with the teachers and the paras are reframing their understanding of the child to understanding them from what we were talking about before asking themselves those three questions, questions is this a brain body issue? Is this the fact that the bar is too high and then going to, is this a behavioral issue? Those are usually if I'm truly feeling like a successful occupational therapist, I have educated those adults around that child to treat that child in a different manner where we're not necessarily re negatively, um, while we're not consistently negatively giving the child negative feedback on their behavior. Right. And we're addressing it from a neurological perspective. Um, and so oftentimes I will talk to a teacher about the environment. I try to be very gentle about it. They get very excited about setting up their environment, the way that they like it, oftentimes, especially for younger children, there's too much information on the walls. There's too much sensory overload and explaining that children, this particular child needs breaks, and this particular child needs movement generally though, it's that reframing of the way that the adults are seeing the behavior. That is the really the crux and my, my value and the specific, um, the specific strategies to help that child are. So individualized, it's hard for me to, to give you a, a list, but, um, I mean, there are specific papers that you can get for a child where the lowercase line is highlighted in yellow. And there's also paper where you can get, um, the lines are actually raised. So if a child is, is, um, needs that just that input they'll feel where their, their parents was pushing up against. There are, there are like millions of things that you can a child, but you only know to offer them if you're not assuming that it's just a behavior that they can control. Does that make sense?

He does. And, you know, I'm sure that a lot of the insight and recommendations that your individualized reports provide are not necessarily even known by, by, by school districts and the offerings that they could include. And you mentioned some just right now that are such simple fixes and simple accommodations, yet, if you don't know, you don't know what to be asking for. Right. So, um, that's where I think your level of expertise definitely helps to more fully inform a child's IEP.

The other thing is you have to feel so confident in, um, and suggesting these things that almost seem, seemed common sense. And so if you're a new grad working for a school district, and you're choosing IEP goals from IEP direct, they are not going to be individualized. And in my opinion, and you're sort of doing our entire profession, a disservice if you're doing that, because we're, we're, we're holistic providers and we're able to see things in a, in a different light than other than other clinicians. And so really things do need to be very individualized in order to assess because every child sees the world and functions in the world and processes their sensory information in such a different pattern.

Right. Right. Well, Amanda, I want to thank you so much for being on the show, Amanda, for, for families out there that are listening, that would want to get more information, um, or reach out and contact you, uh, what, what's your website information?

So I am at, uh, a to Z a T O Z therapy.net. I couldn't get the.com. So I'm a to Z therapy that night because I was late in the game to a website.

So, uh, Amanda's Aiken a to Z that's T O a to Z therapy.net. Um, Amanda is located in, in lower Fairfield County, Connecticut. And I want to thank you so much for being on the show. You know, I feel like we've just kind of, we haven't even, even really peeled the onion yet, as far as all the services that are encompassed in an OT evaluation, but I want to thank you for your time and thank you everyone again,

Again, for listening to another episode, what's ox bed law,