"Science of Reading" Is Important, But Can We Please Talk About Occupational Therapy's Role In Interventions?

The "science of reading" is a trending topic nationwide, as school divisions reevaluate what they thought they knew about reading and how they've instructed students.

However, being taught the necessary skills to read and write involves more than teaching children encoding and decoding. It involves learning how to hold a book and a pencil, tracking words on a page or screen, learning what strategies to use when fatigue or frustration overcome them, learning how to best advocate when they are struggling, identifying assistive technology to help them and teaching them how to use the assistive technology, and identifying and providing the specially-designed instruction needed to teach students this other side of reading and writing, and how to practice and perfect it.

For students who have convergence insufficiency and Dyslexia, as one example, such therapy can be the difference between reading being kin to slogging through a bog up to the student's neck and slogging through a bog up to the student's ankles. It won't eliminate the struggles with Dyslexia, but it has the potential to decrease the fatigue and other areas impacting the student's reading and writing.

Experts in the field of occupational therapy have for years advocated for occupational therapists being included in reading and writing intervention teams. In an April 26, 2016, article published in “Journal of Occupational Therapy”, Dr. Gloria Frolek Clark emphasized the role of the occupational therapist in working with reading and writing teams:

“Nationally, student proficiency in reading and writing is very low and requires ongoing focus from state and local agencies. With almost 25% of occupational therapists working in early intervention and school settings (AOTA, 2015), their role of facilitating literacy (e.g., reading, writing, speaking and listening) is critical. Occupational therapy practitioners support the development and growth of literacy at the system, home or school, and individual levels.”

A year later, April 27, 2017, in the article “OT and PT Support for Literacy in Schools”, Jean Polichino emphasized the importance of occupational therapy and physical therapy being included in reading and writing interventions. "Stamina" is one of the areas she suggests addressing:

“Interventions to Promote Access and Reduce Barriers: Development of physical stamina and balance, if these are interfering with the child's ability to make progress in literacy areas."

January 15, 2019, “The Open Journal of Occupational Therapy” published the article titled “The Role of Occupational Therapy in Functional Literacy”, by experts in the field, Dr. Lenin C. Grajo and Dr. Sharon A. Gutman. In the article, Grajo and Gutman focus on functional literacy and the occupational therapist’s role in providing therapy, and they cite U.S. Department of Health and Human Services “Healthy People 2030” initiative, which focuses on functional literacy:

“One of the foundational principles of Healthy People 2030, a U.S. Department of Health and Human Services (2017) initiative, is the achievement of health and well-being through the elimination of health disparities, the achievement of health equity, and the attainment of health literacy. Occupational therapists can have a critical role in eliminating health disparities by not only facilitating clients’ health literacy but also addressing functional literacy. As occupational therapists, we have traditionally supported clients in literacy development by addressing prerequisite skills, such as visual-motor and perceptual skills, fine motor skills, cognitive and executive function skills, and sensory processing skills. Given the impact of literacy challenges on health, well-being, and adaptation, however, our roles cannot end with supporting prerequisite skill development alone. A holistic approach to functional literacy must promote literacy from the perspective of occupational participation and the enhancement of resiliency in the face of literacy challenges.  “One example of this practice is the Occupation and Participation Approach to Reading Intervention (Grajo & Candler, 2016), in which occupational therapists work conjointly with clients to develop the literacy strategies of adaptation, compensation, and remediation. Examples of adaptation could include strategies to reduce the amount of screen/page words to enhance visual attention and organization, magnifiers to increase readability, replacing or coding words with pictographs and photos that enhance learning and comprehension, using tactile aids and colored highlighting to increase visual attention to important details, and teaching clients to take structured breaks to reduce cognitive overload. Compensation could include such methods as using mnemonics to assist memory and voice activated technology to interpret unfamiliar words and obtain needed information. Remediation would involve the practice of real-life occupations requiring functional literacy skills, such as check writing, bill paying, ATM machine use, transportation schedule interpretation, meal preparation using package directions, medication label interpretation, and written job application submission. In these activities, occupational therapists must continuously ask, “What strategies and tools does the client use to overcome literacy challenges?” “Are the client’s strategies and tools effective?” “How can I facilitate the development of new tools and strategies that may be more effective?”

In a separate “Occupational Therapy for Literacy Development” presentation hosted by Colorado Department of Education, Dr. Lenin Grajo further emphasized the importance of occupational therapists being a part of literacy intervention teams. In the powerpoint slides for the presentation, he includes some of the following examples of goals related to vision therapy:

“● Student will move eyes and head to visually focus on ELA materials in horizontal, vertical and diagonal planes __ % of the time. ● Student will maintain visual attention on the teacher or other visuals ___% of the time. ● Student will be able to break words into syllables by rhythmically clapping to represent at least two syllables in a word __% of the time.”

April 13, 2023, the journal “Applied Neuropsychology: Child” published the article “Effects of the Visual Praxis-Based Occupational Therapy Education Program on different kinds of reading skills: Single-blind randomized follow-up study”. The results of the study provide additional proof of visual-based occupational therapy helping students with reading:

“A total of 126 children with Developmental Dyslexia participated in the study. The participants were then divided into two groups (Intervention and Control groups) of equal sizes (n = 63) using a random number generator without replacement. The intervention group received VP-OTP in two weekly sessions for 8 weeks. All participants were assessed with the Oral Reading Skills and Comprehension Test-II (Sobat®-II) at three time points; pretest, post-test, and follow-up. The intervention group showed promising results as the Sobat®-II’s Reading Accuracy, Reading Speed, Fluent Reading, Reading Comprehension Total Score significantly increased after the intervention (p ≤ 0.05) and the scores were maintained at the follow-up (p > 0.05). The VP-OTP intervention provided a maintained improvement in reading skills of children with Developmental Dyslexia.”

When we talk about reading and writing, we must look at the complete picture and we must include professionals from a wide range of arenas—not just the English teacher—in reading and writing interventions.