Gateway Occupational Therapy Evaluation

Guests Name: L.L.

Occupational Therapist:
Parent: M.L.
S:

Dates of Assessments:
Robin Underwood, MS, OTR/L
DOB: 2/10/89

History: L.L. is a 13 year-old female who attends the Teen Group at Gateway House. Her mother,
her older brother, and she were residents of Gateway House a couple of years ago and since then
they have continued to attend the Gateway House groups.
L. presently lives in a subsidized housing apartment with her mother and her 14 year-old- brother,
D.L. She is in 7th grade at ___________Middle School. Her mother quit a full-time job in a supply
store several months ago and is presently working PRN as a substitute teacher. The family presently
receives Food Stamps and child support payments and both children are covered under Medicaid.
Mrs. L. is hoping to attend college in the fall with the goal of getting her teaching certificate.
Mrs. L. reports that L. was delivered at full-term and that there were no complications during the
pregnancy. However, there were complications during the delivery process. L. was anoxic for at
least 20 minutes; the umbilical cord was wrapped around her neck. L. stayed in the hospital for
observation several days following delivery. L.s brother was delivered prematurely and suffers
from a hearing impairment and an Enzyme Deficiency Disorder that affects his motor skills.
Reason for Referral: L. is having difficulties in school. She is presently failing all of her courses
except for Physical Education and Band and has been failing at least three classes since the fall
semester.
L. has also demonstrated difficulty paying attention and extreme problems with staying in one place
during the weekly teen group at Gateway. She often has to be redirected during task performance.
She has also demonstrated extremes high levels of energy and L. labels this as her being hyper.
However, at other times, she has put her head down on the table and has seemed like she has shut
down or is attempting to shut out all stimulation.

O:

Occupational Therapy Assessments: The occupational therapy assessments consisted of interview

with L.L. and her mother, multiple observations of L.L.s task performance in a group setting,
analysis of L.s school supplies and study habits, and completion of the Piers-Harris Self-Concept
Scale, Adolescent Role Checklist, Daily Schedule, a subtest of The Cognitive Assessment of
Minnesota (CAM): Moderate and Complex Problem Solving, Comprehensive Occupational
Therapy Evaluation Scale (COTE), and the Arlin Test of Formal Reasoning Applied (ATFR).
Assessments were completed at Gateway and at L.s apartment.
During all of the assessments, L. was constantly adjusting her position and moving around in her
seat. She appeared easily distracted. She would often get up and would state various reasons for
this, e.g., to throw something away or look at something in the room.
Assessments and Findings:
I.
Occupational Profile:
A Activities of Daily Living (ADLs): Interviews of L. and her mother indicated

OT Evaluation: L.L.

that L. is independent in all ADLs. However, L. intermittently demonstrates poor grooming.

When asked about this, L. stated that she doesnt want to ask her mother to buy the
grooming items that she needs because she doesnt want her mother to be stressed about
money.
B. Instrumental Activities of Daily Living (IADLs): L. is dependent upon her mother for
community mobility, health management and maintenance, home management, and
shopping. She presently performs simple meal preparation by preparing herself
microwave meals. She states that she often doesnt tell her mother when she needs
clothing or other items because she doesnt want her mother to get upset about money.
C. Education: L. states that she hates school and wishes that she didnt have to go to
school everyday. When asked about how shes doing in school, L. answers that shes
doing well. L. is currently failing most of her classes. Several months ago, when Mrs.
L. reported this to the OT, the therapist encouraged Mrs. L. to request that Lindsay be
tested by the school system for learning problems. Mrs. L. pursued this, and after a team
conference, she was told that the team wanted to wait to do the testing. Their
interpretation of L.s problems with her grades was that it was only due to the fact that L.
has not been handing in her homework assignments. Their recommendation was to place
L. in the After School Program where she could receive tutoring for her homework. L.
has been attending the After School Program since the beginning of the winter semester
and she has not demonstrated improvement with her grades. In addition, L. is reading
two grade levels below her current grade. L. has also reported to the occupational
therapist that she often gets lost while reading and has problems keeping up with the
music during band practice and concerts.
The occupational therapist looked at all of L.s school notebooks and school supplies.
The therapist also visited L.s home and analyzed the set-up of her room for studying
and for the completion of school assignments.
Findings: L. s room is very cluttered. Her room has a small desk, which she does not
use for studying or for completing her homework. L. states that her studying at home
takes place on her bed. She states that she usually tries to complete her homework at
school. When asked about what she does when she is unable to complete her homework
at school, L. did not share any steps or plans for getting it done. L. also states that she
rarely reads her textbooks because her teachers give her handouts that cover everything
that she needs to know. Examination of L.s backpack and notebooks indicates that both
are full of loose papers. L. currently uses two notebooks between all six of her individual
subjects, but her notebooks are not divided for each of these subjects. When asked about
the notebooks, L. indicated that she knew that she needed more notebooks, but didnt
want to ask her mother to spend the money.
D. Occupational Roles: Adolescent Role Checklist: The Adolescent Role
Checklist is a structured interview designed to assess behavior related to adolescent roles
in the spheres of childhood-play, family, school, peers, and work. The scores range from
Appropriate Behavior to Marginal or Borderline Behavior to Inappropriate Behavior. A
predominance of zero and minus scores indicates serious doubt concerning appropriate
role behavior and intervention should be considered. The occupational therapist decided

OT Evaluation: L.L.

3
to give this assessment to Lindsay to determine if she is demonstrating any inappropriate
behavior related to roles, as well as to examine her attitude and thought process when
she answered the questions.
Findings: On the Adolescent Role Checklist Lindsays scores indicated serious doubts
concerning occupational choice. She displayed inaccurate perception of her roles in
regard to her relationship with her father. She also gave very concrete answers to
questions and exhibited trouble with completing her ideas, such as making plans for
future goals.

II.

Task Performance and Social Participation:

A. Daily Schedule: The occupational therapist had L. complete a daily log of her activities
during weekdays and weekends to assess her sequencing, planning, time management,
and organizational skills.
Findings: L. required structure and verbal cues from the OT to accurately map out the
schedule of most of her activities. She indicated that she has difficulty completing her
homework when it is not completed in the after school program. She needed to be
reminded to include participation in church on Wednesday nights and almost all day on
Sundays.
B. Comprehensive Occupational Therapy Evaluation (COTE): The purpose of
the COTE is to track task performance in a variety of behavior related areas. Each area
is rated on a scale of 0-4, with a 4 indicating the greatest amount of problems with task
behavior.
The COTE was completed after several observation of L. during Teen Group. L.
received ratings of 1 in the following areas:
Behavior
Rating
Description of behavior:
Expression
1
Communicates with expression,
occasionally inappropriate.
Cooperation
1
Follows most directions, opposes
less then one half.
Interest in activities
1
Occasionally not interested in a new
activity.
Decision making
1
Makes decisions but occasionally
seeks therapists approval.
L. received a rating of 2 in the following areas:
Behavior
Rating
Description of behavir:
Non-productive behavior
2
Non productive behavior during half
of session.
Activity level
2
Hyperactivity attracts the attention of
other teens and therapists but
participates.
Conceptualization
2
Relevant concrete responses.

OT Evaluation: L.L.

L. received a rating of 3 in the following areas:

Behavior
Rating
Description of behavior:
Attention-getting behavior
3
75% of time spent in attention
getting behavior.
Concentration
3
Off task 75% of time.
Problem solving
3
Recognizes a problem but cannot
solve it.
Complexity and organ. of task
3
Can do only very simple activities
with organization imposed by
therapist.
L. received a rating of 4 in the following area:
Behavior
Rating
Description of behavior:
Negative response from others
4
Evokes numerous negative
responses from others and therapist
must take some action.
When L. gets around boys who are her age or older, she tends to act in a socially immature
manner and her activity level increases. She then exhibits extreme difficulties with paying
attention and with direction-following abilities.
III.

Psychosocial Client Factors:

A. Piers-Harris Self-Concept Scale: This is an 80-question assessment that assesses a
persons perception of behavior, intellectual and school status, physical appearance and
attributes, anxiety, popularity, and happiness and satisfaction. The purpose of the
assessment is to measure an individual childs self-evaluative attitudes and behaviors,
which have a bearing on self-concept. It was based on a norm of 450 public school
children, 237 of which were male and 248 were female. The normative sample consisted
of 279 elementary school students, 55 junior high and 151 high school students. The
occupational therapist decided to use this assessment to assess whether L. is
demonstrating problems with her self-concept and with her perceptions of her strengths
and weaknesses.
Findings: L. scored more than one standard deviation above the mean in the areas of
physical appearance and attributes, happiness and satisfaction, and overall self-concept.
She also rated herself at the mean for intellectual and school status, which is problematic,
because her school performance is currently poor. L. also rated herself slightly below the
mean in the areas of anxiety and popularity.

II.

Cognitive Client Factors:

A. Cognitive Assessment of Minnesota (CAM): The CAM is a standardized test that is
used by Occupational Therapists to screen for cognitive deficits, as they relate to task
performance. Normative data was gathered on 200 individuals without impairments and
an equal number of subjects with brain injury or right cerebral hemisphere stroke. The
concrete problem-solving sub-test of the assessment was administered with Lindsay. The
purpose of this sub-test is to assess the individuals ability to explore and analyze a
problem, and to formulate, execute, and verify the final solution in a tangible task.

OT Evaluation: L.L.

5
Mental flexibility or the ability to generate alternative solutions is assessed to determine
the individuals ability to shift rapidly between modes of thinking.
Findings: For the moderate level of concrete problem-solving sub-test, L.s score
indicated a moderate deficit in problem-solving skills and for the complex level of
abstract problem-solving, L.s score indicated a severe deficit.

B. Arlin Test of Formal Reasoning (ATFR): The purpose of the Arlin Test of Formal
Reasoning is to obtain a general assessment of cognitive development whether concrete
or abstract-formal with reference to Inhelder and Piagets eight formal schemata. The
test consists of 32 multiple choice questions that is organized into 8 subtests that
measures volume, probability, correlations, combinations, proportions, momentum,
mechanical equilibrium, and frames of reference. These 8 subtests underpin many of the
tasks that are presented to middle and high school students in their classes. The tests
ratings consist of concrete, high concrete, transitional, low formal, and high formal. This
test was normed on a sample of 6500 students ranging in age from 11 to 19 (6th-12th
grades).
Findings: L. scored at a high concrete level of cognitive development, which is two
levels below the level appropriate for her age.
A.

Strengths:

The findings from the occupational therapy evaluation indicate that L.s difficulties with her
occupational performance in the areas of school and social participation seem to be due to
following factors:
1.
A mismatch between her perception of her academic performance and her actual
performance
2.
A negative attitude towards school
3.
Poor planning, organizational, and time management skills
4.
Lack of insight into strategies, options, and multiple views of a situation
5.
Possible sensory processing deficits leading to hyperactivity or sensory shutdown,
inattention, and problems learning
6.
Immature social skills, including attention-seeking behavior
7.
Inattention to task and other deficits in task behaviors: non-productive behavior,
activity level, expression, conceptualization, cooperation, attention-getting behavior,
negative response from others, concentration, problem solving, complexity and
organization of tasks, interest in activities, decision making
8.
Delayed cognitive development: She is presently functioning at a high concrete level
of cognition versus the age appropriate formal cognition. This leads to poor problemsolving skills and lack of abstract reasoning.
9.
Worries about the familys financial situation to the extent where she will not
ask for necessities
10.
Possible Learning Disabilities and Attention-Deficit Disorder
L. is very friendly and outgoing. She states that she has many friends. She appears to be very
caring about her mother and her brother.

OT Evaluation: L.L.

Occupational Problems and Goals:

Problems
1. Ineffective educational
participation

Goals: By the end of the School Year:

1. L. will pass two of the four classes she
is currently failing

2. Poor social participation

2. L. will improve behaviors during

socialization as demonstrated by
improvement by at least one rating on the
COTE Scale during Teen Group in the
areas of negative response from others,
attention getting behaviors,
concentration, and nonproductive
behaviors
3. L. will consistently be well-groomed
and will problem-solve effective
lternatives to secure necessary items

3. Poor grooming

P:

Interventions
1a. OT will go with L.s mother to
meet with school guidance counselor
to discuss OT findings and to urge
receipt of psychological evaluation
within next couple of months.
1.b. OT will work individually with L.
on facilitating problem solving skills
related to organization of her
notebooks, backpack, and room for
more effective studying and
organization of assignments.
1c. OT will work with L. and mother
on alternatives to secure necessary
organizational items.
1d. OT will help L. establish realistic
academic goals that reflect her
academic performance.
2a. OT will assess L.s sensory
processing and if indicated, will
identify a sensory diet for L. to use
that will increase concentration and
attention and will decrease
hyperactivity.
3a. OT will work with L. and her
mother on identifying periodic
necessities and the budget and
strategies for securing the items.

Plan: Work with L. at Gateway, her apartment, and school at least once a week to achieve
academic, socialization, and self-care goals. The following are the immediate actions:
1. Schedule a meeting with her Guidance Counselor and her mother within the next couple of
weeks.
2. Meet with L.s mother and her teachers to discuss current academic issues and to develop plans.
3. Secure ongoing copies of class printouts that demonstrate status of Ls assignments so as assist
L. with getting assignments completed
4. Schedule monthly meetings with L. and her mother to discuss budget and personal item needs..

Robin Underwood, MS, OTR/L