What We Treat
Twenty minutes of homework that somehow takes two hours. Letters drifting off the line, and a hand that gives out. This is a stack of skills, and skills can be built. It starts with a comprehensive evaluation, one-on-one with a licensed occupational and physical therapist.
Sound Familiar?
Two or more? That is a skill problem, and skills can be built.
Why It Happens
Writing is the end of a chain, not the start of one. The eyes have to track a line and hold a shape in mind. The brain then turns that shape into a plan for the hand, which is the visual-motor part: eyes and hands agreeing on the same thing. The hand needs the strength and finger control to run the plan. And the shoulder and trunk have to stay steady underneath, because a hand cannot be precise on a body that is still holding itself up. If any one link is short, what you see at the kitchen table looks identical: slow, messy, tiring writing.
Which is why more writing practice usually buys effort instead of skill, and often locks in a grip or a letter habit that is harder to undo a year later. A comprehensive initial evaluation works back up the chain: how the eyes track and team up, how well eyes and hand cooperate, whether the letters are stored as automatic movements, and what the shoulder and core are doing while he writes. Then we start at the first weak link rather than the visible one.
The Honest Truth
Her teacher said it would come with time. You sat through the two-hour homework anyway, night after night, and kept it together for her. Deciding you have waited long enough isn’t impatience. It’s the same instinct that got you both through those evenings.
How It Works
Every plan has an endpoint. Here’s what the four phases look like when homework is the hardest hour of the day.
Starts at the evaluation
Pinpoint
What hurts is the two-hour homework and the tears at the end of it. The comprehensive evaluation finds which link in the chain is short, so we stop asking her to write more of the thing that is not working.
The early weeks
Prime
Core and shoulder stability, hand strength, finger control, and the eye-hand teamwork that has to be in place before letters can ever become automatic.
As the skills come online
Perform
Letter formation, spacing, staying on the line, and copying from the board without losing her place. Here first, then on the actual homework at your kitchen table.
Carryover and discharge
Prevent
You get a home program and we collaborate directly with her school, so the same approach carries into the classroom. Discharge planning starts once goals are being met with at least 80% accuracy.
The moment we walked in for our first session my son was completely comfortable, we felt so welcomed by Miss Ester! She is kind and caring, my son looked forward to his weekly sessions which had a big impact on progress.
Angela D.
Before: walking in for a first session, not knowing what to expect
After: sessions he looked forward to, which had a big impact on progress
Questions, Answered
Sometimes it does come with time, and there is a way to tell which case you are in. Writing sits at the end of a chain that starts with the eyes and the shoulder. If the links underneath are solid, ordinary practice usually finishes the job. If one link is short, more time mostly cements a workaround grip or a letter habit that takes far longer to undo than it would have taken to learn properly. The comprehensive initial evaluation, one-on-one with a licensed occupational and physical therapist, tells you which it is.
No. And in New York a pediatric occupational therapist can evaluate and treat without a physician referral for up to 30 days, for non-restorative services such as handwriting, learning and developmental skill training, when your child is not in acute care. What the evaluation gives you is more useful than a label anyway: whether the eyes track and team up, whether eyes and hand cooperate, whether letters are stored as automatic movements, and what the shoulder and core do while he writes.
Typing is a good tool and a poor substitute at this age. Most classwork, tests and note-taking still happen by hand, and the skills underneath writing, eye-hand teamwork, finger control, shoulder stability, are the same ones he needs for a dozen other things. So we build the skills and stay practical about accommodations while he does. The two are not in competition, and neither one should be the reason to skip the other.
Yes, directly. What happens here is meant to be complementary to school-based OT rather than a duplicate of it, and Ester Marcellin, M.S., OTR/L is an evaluator for the NYC Board of Education’s CPSE preschool program, so the school side of this is familiar ground. We collaborate with your child’s school so the same approach shows up in the classroom, which is where the writing actually has to happen.
You get a plan with an endpoint rather than an open tab of appointments. Your therapist reassesses regularly, and discharge planning starts once goals are being met with at least 80% accuracy, followed by a home program for maintenance and carryover. On cost, we are an out-of-network provider and submit claims on your behalf when your plan has out-of-network benefits. Self-pay, the comprehensive initial evaluation is $360, then $90 for 30 minutes, $135 for 45 minutes, and $180 for 60 minutes.
Book Your Visit
Tell us what you’re noticing at home. A real person calls you back to set up the comprehensive evaluation. No phone tree. No ‘someone will reach out.’
5.0 · 28 Google reviews
Ages 2 to 16, individual and group
Step 1 of 5
That’s the hard part done. We’ll call during business hours to set up the evaluation and answer whatever you didn’t get to ask.
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