Sharp Rise in Occupational Therapy Cases at New York’s SchoolsFebruary 23, 2015
A class of first graders at Public School 503 in Brooklyn sat on the floor one recent Friday, cross-legged on an alphabet-themed rug.
But as their teacher began a reading lesson, two boys positioned near the letters C and D sat not on the rug, but in small plastic armchairs. One wore a tight blue vest designed to apply pressure to his chest, while the other drew his hands across a weighted, velvety blanket draped over his small knees.
“He really likes texture, and sometimes you’ll find him playing with the girls’ hair in front of him,” said Ashley Castaldo, an occupational therapist at the school. “It occupies his hands so his eyes aren’t on the carpet looking for things. Instead, he can attend a little bit more.”
These boys were using occupational therapy tools — the chairs, the vest, the blanket — to help them focus in class so they could absorb the day’s lesson.
And they had plenty of company. The number of children receiving such therapy in New York and elsewhere has shot up in recent years, the byproduct of increasing numbers of special-needs students, a new approach toward teaching them and, to a lesser extent, greater academic demands on all young children.
“They’re capable,” said Bernadette Fitzgerald, principal of P.S. 503. “We just have to figure out what kinds of support they need to get there.”
Occupational therapy is a treatment with an enormous wingspan. So called because it helps people with the tasks that occupy their everyday lives, it can be used to help a child manage sensitivities to things like noise or touch. It can be deployed to help a stroke victim recover certain functions. And it is widely used to give a boost to children who have trouble with their handwriting, typing or other fine motor skills.
And widely used it has been. Over the last four years, New York City public schools have seen a 30 percent increase in the number of students referred to occupational therapy, to nearly 42,000 students. The city covers the cost, which at $58 million a year is up from $38 million just five years ago. (That dollar figure does not include therapists in schools fully devoted to special-education students.)
In Chicago, 6,600 students now receive the therapy, up 20 percent in three years; in Los Angeles, the number has jumped 30 percent in five years, to 9,000.
The main reason, officials in New York and other cities said, is an increase in autism diagnoses among children, which have grown, at least in part, because of more accurate identifications of the disorder. That, coupled with a desire to integrate those children into regular classrooms when possible, has put a premium on strategies that help children pay attention and not disrupt their classmates. Cities and states are also making greater efforts to provide extra help to children who need it as soon as, and even before, they enter the school system.
“As more and more larger school districts are looking at inclusion practices, it becomes a more comprehensive program, versus just drop-and-pray or physical inclusion but not really integration,” said Kristie Patten Koenig, associate professor and chairwoman of the occupational therapy department at New York University’s Steinhardt School.
Some educators also point out that school for very young children is often more academic today than it was a generation ago. Four- or 5-year-olds must be able to sit still in class and grip a pencil to a degree they did not 30 years ago, and not all of them show up ready. The issue is most acute for boys, who also are far more likely to receive an autism diagnosis. Boys receiving occupational therapy in New York City outnumber girls three to one, according to the Department of Education.
Among private schools, there is no comprehensive data for how many children receive occupational therapy, but some professionals are reporting anecdotal increases there, as well.
At Grace Church School in Manhattan, an occupational therapist began consulting there about eight years ago, according to the head of school, George P. Davison. All kindergartners are observed in a classroom setting to see if they might benefit from the service.
Most parents, Mr. Davison said, are receptive to the idea of occupational therapy, especially if it is seen as an alternative to medication.
“If a kid needs Ritalin down the road, you get there, but let’s start with the bumpy cushion,” he said, referring to an inflatable textured seat cushion , which helps some children pay attention by requiring a bit of extra balance.
Victoria Goldman, an admissions consultant and the author of a guide to New York’s private schools, said she was seeing more young applicants whose parents had put them into occupational therapy.
“Here you have accelerated or demanding curriculums, so they put them in O.T. to bring them up to speed,” she said. “They want to enhance their basic skills. New York is a fast-paced city, and sometimes they don’t want to wait for the child to develop the skills they may need.”
While many parents welcome the intervention, there are some who resist, declaring, rightly or wrongly, that the therapy is unnecessary for their child.
“There are a lot of parents I’ve seen who just say, ‘My kid is fine; this is crazy,’ ” said Olga Garcia-Kaplan, a parent at P.S. 321 in Park Slope, Brooklyn, who has represented the families of children with special needs on the school leadership team. “You never want to hear that your kid has something different.”
Students attend therapy sessions in school, or sometimes off site, and while it all falls under the same umbrella, different applications of occupational therapy can look very dissimilar. To improve a student’s handwriting, for example, a therapist might have a child write on a slanted binder, which changes the extension of the wrist. Or, to improve balance and the strength of their core muscles, which allow one to sit up in a chair, children might do the wheelbarrow across the floor as an adult holds onto their feet.
In the hallway of P.S. 503, a little girl named Melissa, with a rainbow of rubber bands in her hair, scooched back and forth on a scooter board, arranging patterned blocks to match an illustration. It looked like a game, but in fact, she was working on strengthening her core and completing multistep activities.
“Does that match?” the occupational therapist asked, holding up the picture when Melissa finished arranging the blocks.
Thomas Hehir, a professor at the Harvard Graduate School of Education and a former director of the United States Education Department’s Office of Special Education Programs, said that while occupational therapy is indeed a vital service for many children, there may be students on the rolls who do not really need it.
“There certainly are instances where people add services without a strong justification for them,” Mr. Hehir said. While he emphasized that this impulse comes from a good place, a desire to help, the decisions are “often based on the fact that the child has a disability and therefore must need the service, as opposed to this service is needed for this specific reason.”
This kind of over-identification consumes the time of therapists, who then may not be available for the children who need them most, an alarming proposition in much of the country where there are shortages of occupational therapists. Special education advocates in New York City said there are not enough therapists to meet the demand, and that many students who are recommended for therapy are still waiting to receive it.
Harry Hartfield, a spokesman for the city’s Education Department, said the department had created incentives like loan forgiveness programs to attract service providers to underserved areas, “which has resulted in substantial improvements across the city.”
For some children, the therapy can be a game changer.
Leonard Lavorante, who wore the blue pressure vest in a P.S. 503 reading class, is on the autism spectrum. His mother, Francesca, describes his occupational therapy, one of a handful of services he receives, as invaluable.
Last year, Ms. Lavorante said, Leonard was in contained special education classes, but as a first grader, he started joining classes that mix general and special education students for certain subjects, like reading.
“He couldn’t focus for a minute or two minutes two years ago; now he can sit in a classroom and focus,” she said. “He’s raising his hand, and controlling his body in a different way.”
His mother hopes that by the end of the year, Leonard will be able to join the mixed classes full time.