Irvine, California
Frequently Asked Questions
Answers about getting started, evaluations, sessions, insurance, and how therapy works at our Irvine clinic.
If you do not find what you are looking for here, call or text us, or come in for a tour and ask our clinical staff in person.
Sessions are 50 minutes
Ages birth to 12
Serving families since 2016
Superbills for out-of-network reimbursement
Jump to a topic
Getting started
How do I get started at Tumble N' Dots?
Come in for a tour and meet our clinical staff. You will see the gyms and the rooms your child would actually use, and you can talk through what you have been noticing at home and at school. If your child does not have a valid evaluation from the last 10 months, we start with one. If you already have one that is less than 10 months old, send it over and we will work from it. Schedule a tour.
Do I need a doctor's referral to start therapy?
No. A referral is not required to start with us. Some insurance plans do require one for reimbursement, so it is worth checking with your carrier before you submit a superbill. After our evaluation, we are happy to schedule a call with your pediatrician to consult on your child's current development.
Can I tour the clinic before we commit to anything?
Yes. We invite you and your child for a 15-minute tour of the facility. You will meet our therapists and get a firsthand look at the space, including the sensory gyms and the rooms your child would be working in. Schedule your tour here.
Can I talk to a therapist before we start?
Yes. On a tour you talk with our clinical staff rather than a call center. They gather information about what you are seeing and give recommendations to support your child and your family, whether that is an evaluation, ongoing therapy, or something else.
What ages do you work with?
Birth through age 12. Our group programs are age-banded, starting with Curious Caterpillars for ages 2 to 4.
Do you see children who do not have a diagnosis?
Yes. Many of the children we see have no diagnosis at all, and a referral is not required to start. We work with autism, ADHD, sensory processing differences, Down syndrome, cerebral palsy, developmental delays, apraxia of speech, gestalt language processors, extreme picky eating, handwriting difficulty, anxiety and regulation challenges, learning differences, premature birth history, and motor delays.
What are your hours?
Therapy hours are Monday to Friday 8:30am to 7:00pm, Saturday 8:30am to 5:00pm, and Sunday 10:00am to 3:00pm. Office hours are Monday to Friday, 9:00am to 6:00pm.
Signs your child may need therapy
How do I know if my child needs occupational therapy?
If you notice challenges with balance, coordination, self-regulation, school skills, social interactions, self-care, play skills, or focus and attention, it is worth talking with an occupational therapist. Parents also tell us their child bumps into things or seems clumsy, avoids swings and slides or never gets enough of them, struggles with buttons, zippers, scissors, or handwriting, and tires quickly during play or schoolwork. More on pediatric occupational therapy.
How do I know if my child needs speech therapy?
If you notice challenges with vocabulary, pronunciation, limited expressive language, lack of social interaction, stuttering, or late milestones, it is worth talking with a speech-language pathologist. Parents also describe fewer words than other children the same age, speech that is hard for people outside the family to understand, repeating phrases or scripts from shows and books, difficulty joining or staying in play with other kids, and big frustration when they are not understood. More on speech therapy.
How do I know if my child needs feeding therapy?
If your child avoids foods based on texture or color, refuses entire food groups, gags on whole textures, or has meltdowns at meals, it is worth talking with a feeding therapist. A typical eater manages around 30 or more different foods. The children we see are often eating fewer than about 15, with a list that keeps shrinking. More on feeding therapy.
Will my child grow out of these issues?
We all change as we mature and develop, but sensory integration concerns are not something children grow out of. Early identification and treatment can make a real difference in your child's physical development and psychological well-being. When we understand how a child processes sensory information, we can create individualized activities that give comfort and support sensory processing. A child who feels understood develops lifelong confidence and self-esteem.
Evaluations
Why does my child need an evaluation before starting therapy?
After your tour, if your family does not already have a recent evaluation, we usually recommend starting with one. It establishes a baseline and the goals we work toward, which is what lets us track your child's progress from that point on. More on evaluations and consultations.
What happens at an evaluation?
The evaluation is done at our Irvine clinic. Your therapist administers standardized assessments and conducts clinical observations with your child. After that appointment, the therapist takes the data and observations and begins the analysis and report writing. Once the report is complete, the therapist meets with you virtually to go over the report, the results, the recommended plan, and the goals set for your child.
How long does an evaluation take?
The appointment at the clinic usually takes between an hour and an hour and 20 minutes. The full write-up is a comprehensive report and usually takes about two weeks to complete. The review meeting with your therapist happens after that, virtually.
What do we get at the end of the evaluation?
A comprehensive written report, plus a virtual meeting where your therapist walks you through the results, the recommended plan, and the goals established for your child.
We already had an evaluation elsewhere. Do we have to repeat it?
Not if it is recent. If your child has a valid evaluation from the last 10 months, send it to us and we can often use it to gather what we need and set goals rather than testing your child again. Past about 10 months, your child's skill level may be different enough that a fresh evaluation helps us target the right goals rather than outdated ones.
How long will my child need therapy?
We recommend a duration after the evaluation is complete and the therapist has become familiar with your child. Plans are typically written around three-month and six-month goals and refined along the way as your child changes. Following through with the activities your therapist suggests at home will expedite your child's therapy with us.
Sessions and progress
How long is a therapy session, and how often will we come?
Each session is 50 minutes of direct 1:1 treatment, with the last few minutes used to talk with parents and caregivers about how it went. Most children come once a week. The recommended frequency and duration are part of your evaluation report.
Can I be in the room during my child's session?
Yes. Parents are welcome in sessions. Watching and taking part gives you the tools to carry the same strategies into home, school, and the community, which is where the skills need to hold.
How will I know whether therapy is working?
Your therapist checks in with you regularly and gives you an update after each session, so you always know what happened and what to work on at home. Goals are typically written at three months and six months, and we review progress against the plan with you and set new goals as your child moves through them. We also repeat standardized assessment to measure what has changed, and the treatment plan is updated from there.
How do you decide when my child is done?
When your child has met their goals we taper rather than stop. Discharge includes a transitional period so progress is not lost, a final consultation with a formal re-evaluation, an updated home program you can keep using, and a written discharge summary for your records, your pediatrician, or your child's school. You are welcome to come back to us if something comes up later.
Can my child work with more than one kind of therapist?
Yes, and many children do. Our occupational therapists, speech-language pathologists, and feeding therapists all work under one roof and collaborate together on your child's care.
How do I cancel or reschedule an appointment?
Through your parent portal. Log in at tnd.theradots.com/client-login to cancel or make any changes to your schedule.
Our services
What therapy services do you offer?
Occupational therapy, speech and language therapy, feeding therapy, sensory integration therapy, gestalt language processing, animal assisted therapy, intensive therapy programs, social skills groups and camps, school collaborations and screenings, evaluations and consultations, homeschool enrichment, and IEP support and school observations. See all pediatric therapy services.
What is sensory integration therapy?
It is for children whose nervous systems over-respond or under-respond to touch, movement, and sound. Sessions use swings, crash pads, climbing walls, a zip line, and obstacle courses, along with coaching so the strategies work at home too. All of our occupational therapists are trained in sensory integration. More on sensory integration therapy.
What is gestalt language processing?
Some children learn language in whole phrases and scripts rather than single words. We use the Natural Language Acquisition framework to move from scripts toward flexible, self-generated language, and we treat echolalia as real communication. More on gestalt language processing.
Do you offer animal assisted therapy?
Yes. Summer, a professionally trained therapy dog, joins occupational therapy sessions to support regulation, motor skills, and social confidence. The program is led by Dr. Phoebe Yam, OTD, OTR/L, CPDT-KA, C-HAIS. More on animal assisted therapy.
Can my child receive therapy at home or in the classroom?
Yes. Depending on your child's identified needs, we will visit a classroom or home to provide insight and support related to the therapy your child is receiving. We also offer routine treatment within your home or in the classroom based on the needs identified.
Do you work with schools?
Yes. Our therapists work inside partner classrooms across Orange County, set goals alongside teachers so strategies carry into the school day, attend IEP meetings, run developmental screenings, and offer workshops for parents and staff. All of our therapists and providers hold a valid background check and comply with school requirements to provide services on campus. More on school collaborations.
Do you offer intensive or school-break programs?
Yes. We run concentrated blocks of therapy over spring, summer, and winter breaks, and year-round through Tumble-N-Grow. Several sessions a week with the same familiar therapists tends to move goals faster than a weekly schedule can. See our intensive therapy programs.
Do you offer social skills groups?
Yes. Small, age-banded groups for ages 2 through 12 where children practice social skills the way they actually use them, through cooking, board games, music, sports, and play. Group sizes are kept small on purpose. See our programs and groups.
Do you have programs for homeschooling families?
Yes. We run daytime classes built for homeschooling families, including art, cooking, all-ability sports and movement, and social groups, taught by our therapists during school hours. See our homeschool enrichment classes.
Insurance and payment
Do you take insurance?
Tumble N' Dots is an out-of-network clinic by design. We are not contracted with any insurance plan and we do not bill your insurance directly, which lets us focus on what your child actually needs rather than what an insurance company will approve. Payment is due at the time of service, and we provide detailed superbills you can submit to your plan for possible reimbursement. Read the out-of-network reimbursement guide.
How do superbills work?
You receive a detailed superbill twice a month, on the 1st and the 15th, with every code your insurer needs to consider reimbursement. Superbills are always available in your parent portal, so you are never waiting on us for a copy. You submit it and your insurer reimburses you directly rather than paying us. Rates vary by plan, so contact your insurance provider about your specific out-of-network benefits. What is a superbill?
Do you accept Regional Center or other third-party payments?
Yes, we accept third-party payments. If you are interested in using a third-party payment system such as Regional Center or a Financial Management Service (FMS), ask your case manager to reach out to us. We do not bill the FMS directly. All superbills go directly to the family, and you are responsible for sending them on to your FMS.
Can I use my FSA or HSA?
Occupational therapy and speech therapy are generally eligible FSA and HSA expenses. Check with your plan administrator for the rules on your specific account.
Visiting the clinic
Where are you located, and which areas do you serve?
We are at 15265 Alton Parkway, Suite 140, Irvine, CA 92618. Families come to us from Irvine, Tustin, Lake Forest, Newport Beach, Newport Coast, Costa Mesa, Huntington Beach, Long Beach, Mission Viejo, Rancho Mission Viejo, Rancho Santa Margarita, Coto de Caza, Aliso Viejo, and across Orange County.
What is inside the clinic?
Two sensory gyms with climbing walls and a zip line, a kitchen and dining area built for feeding therapy, a multi-sensory room, a dedicated group therapy area, and a comfortable waiting room.
Who will be working with my child?
All of our occupational therapists are trained in sensory integration, and our speech-language pathologists hold master's degrees and ASHA certification. Tumble N' Dots was established in 2016 by Avital Shuster, our founder and clinical director, who holds a BS and MS in occupational therapy from USC, post-professional Ayres Sensory Integration training through CLASI, DIRFloortime and HBCC training, and advanced SOS Approach to Feeding training. She has been working with children since 2000, including ten years as a pediatric occupational therapist in the public school system. Meet our therapy team.
Where to go next
See all pediatric therapy services for what we treat, or read more about how we work.
- The therapy process for what happens from your first call through discharge.
- Our signature approach for how the team works around your child.
- Our therapy team for who your child would be working with.
- Reimbursement guide for how families handle the insurance side.
Still have a question?
Come see the clinic, meet our clinical staff, and ask whatever you need to ask. If you do not have a valid evaluation from the last 10 months, we will start with one. If you do, send it over and we will go from there.