Letting Go of Labels

by Sue Parry, OTR

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An unprecedented number of children are now receiving occupational therapy services in our nation's public school system.

The National Board for Certification in Occupational Therapy, in its fall 2004 newsletter, indicates that 26 percent of all occupational therapists are employed in the nation's public school system.   Commenting recently on the improving market for occupational therapy practitioners today, AOTA President M. Carolyn Baum announced, "I think we're at the best place we've ever been in history."

But is it the best place for the students, who are routinely being subjected to screening, observation, evaluation, labeling, diagnosis and accommodation?   Are these students being exploited?

Too Narrow a Mandate?

From all indications it appears to me that shortcomings in the public education system and the burgeoning growth of mental health and allied health professions in the schools have created a very lucrative market for therapy services.

The Individuals with Disabilities Education Act (IDEA), passed in 1975, mandates that schools provide a free and appropriate public education in the least restrictive environment (LRE) to all students who are eligible for it by virtue of their disability or who are entitled to it by virtue of their performance in the schools compared with age and grade expectations.

In an all-out, ongoing marketing campaign that was launched several years ago, occupational therapists have been encouraged to promote and create an awareness about why our expertise is absolutely essential in helping the children meet both the academic and behavioral challenges of their school day.   The result has been that the public school system has emerged as a very robust market for occupational therapists, 93-94 percent of whom are women.

It's been a "win-win" situation for OT's, who may find public schools in close proximity to their own homes, the school year compatible with their own family schedules, stable hours and itinerant or part-time work.   But it has burdened school systems with huge expenses and drained scarce resources to provide therapies of dubious value instead of improving and diversifying educational offerings that could benefit all students.

Myopic View?

The evaluations and tests being administered to the child rarely, if ever, take into account combustible social or cultural trends such as two-working-parent families, permissive parenting styles that lack consistent discipline, overburdened teachers, and educational curricula that is gender biased or developmentally inappropriate -- all of which migh be contributing to his inability to meet the demands and expectations being required of him.

Instead, the aberrant behavior or academic underperformance is always determined to be the child's fault.  When school personnel (teachers, school psychologists, occupational therapists etc.) collaborate and affix a label to a child, it affirms or bestows formal recognition of the child as a source of the behavioral or academic problem.

While many students have demonstrable or observable impairments such as cerebral palsy, muscular dystrophy, juvenile rheumatiod arthritis, Down syndrome and spina binfida, other children are found eligible for services with more ill-defined disorders.

Today, most students whose parents are clamoring for occupational therapy are afflicted with more evanescent disorders such as sensory integration dysfunction, pervasive developmental disorder, ADD/ADHD, perceptual disorders, Asperger's syndrome, etc.   These are more subjective, impressionistic and often not clearly distinguishable from normal temperament variations.

Labels Hurt

Many parents are initially relieved to accept a label for their child.   The negative aspects of that label are often minimized or not mentioned at all.   William Carey, MD, a developmental/behavioral pediatrician and author of Understanding Your Child's Temperament, states, "Too many children have been criticized, labeled, reprimanded, punished, isolated, ostracized, or otherwise harmed for behaviors that were expressions of their temperament...that was in conflict with a particular setting."

What parents probably don't realize is that labeling provides short-term benefits without realizing long-term consequences.   Dr. Carey also states, "Labeling their child, which seems so useful and comforting, may at a later time come back to plague the person.   ...It might be harmful for educational opportunities; employment; military service; security clearance; life insurance policies; licenses to operate machinery such as cars, buses, and airplanes.  Labels stick firmly."

It's time to stop trying to make children fit into a one-size-fits-all system.   Uniqueness and individuality should be respected and nurtured by offering a curriculum that's enriched with drama, music, art and physical education.

I hope this blame game will stop and all occupational therapists will realize it's often the system that's at fault, and not the children.

Sue Parry, OTR, graduated from Elizbethtown College in 1976 and has worked in adult physical rehab, home health and as a school-based occupational therapist.   This article was first published in Advance for Occupational Therapy Practitioners, April 18, 2005.