I am meeting w/ Psych. D. for DS tomorrow

[mctlaw]

Please bear with my train of thought, I have a meeting on behalf of DS tomorrow and I think this will help orgainize my thoughts. I would appreciate feedback on what I may want to ask the Dr. about or emphasize when we review the history.

DS has been having some major educational struggles this year, much of which I feel are related to his very disorganized teacher; however, I can tell he has some real issues going on and I don't want the issues to hold him back educationally or socially. Without going into excruciating detail, one of his main issues is following directions, whether it be at school, to do a simple worksheet or activity, or at home to do x, y, and z (simple tasks like get your shoes on) he will inevitably only do x, or x and y. He gets very simple worksheets all wrong, or does not finish them, and he also seems to get overwhelmed with a lot of visual stimulation (ex. if he were asked to copy numbers on a calendar or chart he would get the numbers all mixed up because he would not be able to keep several different lines with numbers on them differentiated from one another). Yet, the stuff DS gets wrong is all stuff he KNOWS, he just cannot follow the instructions or stay in the right place on his paper. The teacher has said that his classwork clearly does not reflect his ability (not saying he is "gifted," but he is a bright, extremely verbal child).

He is learning to read by spending one on one time with me. It is slow going, but we are getting there.

He also seems to have possible attention issues, but I am not sure if these are related to his ability to process oral language and thus his mind drifts. He will get stuck on a particular detail, either a sight or sound, that is intersting to him and completely tune out what is going on around. He is not hyper but does fidget a lot and loves physical activity like bouncing and crashing. He is not disruptive at all and his teacher described him as polite and mannerly. He is extremely empathetic and sensitive to what others think of him, as well.

One of the main issues I have noticed with him pretty much his whole life is that he has a very anxious personality. He has been worried about death since he could form complex enough sentences to get those thoughts out there. He has had other fears from time to time, but that is the big one. Most of his day to day anxiety is with unexpected happenings/transitions - he has a panicky, very physical response. Example - the carpool line is busy and there is a nearby parking space. If I were to tell DS we are going to park and walk in this would totally freak him out. Yet, he has no problem with changes in routine such as going on vacation. Since he has a very disorganized teacher he gets anxious at various intervals throughout the day.

He is social and likes other kids but prefers to play 1 on 1 or 1 on 2. He tends to get into rote activities that he enjoys and finds kids who will do his preferred activity, rather than joining in someone else's activity. This seems to be the main thing that holds him back socially.

When he was in preschool and pre-K, his teachers were concerned about him mainly from a social standpoint. At that point, in addition to the various anxieties, he would also flee large group activities. The school social worker suggested an OT eval. The OT people felt he was sensory overloaded and they thought the anxiety was a by-product of that. Also he had some dyspraxia, hence the reliance on rote activities. They ended up giving him about 8 months of OT but when we moved their discharge summary recommended for eval for anxiety and possible continuing OT. I did feel that DS improved and possibly also outgrew some of the sensory overload he was experiencing as he is definitely better in groups. However, DS's academics have never been at issue before, so this is a new concern. He has a very disorganized kindy teacher so I feel pretty sure this is not helping him. His pre-K teachers were extremely organized.

Also, I can tell he still gets himself stuck into the same patterns of play which I worry will limit him socially. Since the kids play at recess without their teacher, I think group socialization has not been on their radar or is pretty far down compared to their concerns with academics.

So, tomorrow, I am meeting with a child-specialist Psych.D. to give a history on DS. I was hoping to go with the developmental ped. route, as that seems to be the preferred route for many people on this board, but I could not find someone we could afford, who could also see him sooner rather than later, and since he is struggling I do not want him to wait more months for help. I found this Psych.D. who comes highly recommended for work with younger kids. She does educational testing and also does therapy, mainly CBT, which I know this board likes :) And she takes our insurance.

So, if you are still reading, I welcome any and all thoughts/ideas of things to ask, talk about, or things to explore. Thank you.

[inmypjs]

Well, I am no expert but here are a few of my thoughts...

I remember you posting that your DS sounded a a bit like mine, and I agree. My DS knows a ton, but has trouble doing things. He has trouble doing worksheets without assistance, is dyspraxic and has attention issues, but he is well mannered and not disruptive. My son has a few sensory kinds of things but all very mild. I do think he gets overstimulated more easily than other kids. I wonder if your DS experiences visual/perceptual disorientation like mine does. Have you ever looked at stuff about visual/spatial learners?

It sounds like you are meeting with the person alone? I think that is a good idea. Honestly I would just tell them everything you just posted. Before our testing I typed everything out about my DS in list format, and then took it with me. It was helpful in talking with the psychologist and in completing their intake form.

Just some basic housekeeping - I would definitely confirm what tests will be administered, how long they will take for your DS and when you can expect results (oral and written). I would also ask if they provide any assistance in making recommendations to the school.

Finally one thing our psychologist told us that I found comforting was that the test results are a picture of our child as he is doing right now. They are not his destiny and the scores/diagnoses often naturally evolve over time.

Good luck tomorrow! For me the hardest part was waiting for the results.

[crl]

I wish I had something useful to add, but I will just echo that I would go in with a list of things you want to make sure to mention, ask as much as you can think of about the evaluation process, and ask how the results will be presented. A written diagnosis and recommendations can be invaluable in dealing with schools, especially in the IEP process.

Good luck,
Catherine

[JTsMom]

I think if you go in with this post, or notes similar to what you've written here, you're going to be in good shape. Good luck!


******************************
A bit OT, but I also wanted to say that in my totally non-professional opinion, I think something like following directions could absolutely be ADD related, or it could be something like an auditory processing issue, or an executive functioning issue, or a bit of all 3 combined. I think I remember you saying that you've already done some hearing/vision testing, right? It's always good to rule out the physical stuff first b/c it's easy.

Following directions, and the situation you've described with worksheets was/is one of the issues we've addressed with Jason. It's something both of his speech therapists, and both of his OTs worked on with him, but I think that the stuff I've done with him has been more helpful for him.

I'm sitting here trying to figure out how I'm going to explain that without writing a novel... lol.

I guess I would say that I try to utilize, and teach him to use, strategies to compensate for his weaknesses. I try to encourage him to write or use lists, for example. If we're tackling a tricky math concept, I'll write out the steps I want him to mentally go through. i teach him to break overwhelming things into steps. I show him how to use papers to block out all of the other problems on a math worksheet so that it's not as visually distracting.

I'm betting your insurance wouldn't cover it, but a neuropsych eval might be helpful with that sort of thing. I think I told you that we ended up having one done for Jason. If it would be helpful, I could pull out the report and type out some of the relevant suggestions that were made. I remember that the neuropsych wrote it out in a way that he would be helpful for future teachers.

[mctlaw]

Thanks you guys! I did get your suggestions before the meeting, though I did not have a chance to respond - I went straight from classroom volunteering to new job to the psych. meeting today.

My initial impression of the psych. was really good and I think my DS will be able relate to her just fine for testing and CBT if warranted. I did write down the list of tests she is recommending but don't have it on me at the moment.

Inmypjs - I had really not considered the visual spatial learning style. In fact, I thought if he got overwhelmed visually, that he must not be a visual learner! If there are any resources you recommend I look at, I would love links to those.

JTsmom - if you have a chance to look at your DS's recommendations, that would be helpful, though it sounds like this psych. will be doing something similar, so no big deal if you cannot get to it. Funny, I had been doing things instrinctively such as covering up sections of his worksheets to only show him bits at a time. Sounds like I need to teach that as more of a skill and have it reinforced in the class, too. Hopefully this issue will also get easier to handle once he is actually able to read instructions for himself.

[crl]

I can give you the list of recommendations we got from our psychiatrist, who diagnosed ds with ADHD. I don't have the letter handy, but I think I know most of them from memory.

Preferential seating near the teacher
Instructions given in both written and verbal forms
Allowed to have a "fidget" at his desk
Tests given in distraction free environment (such as a separate room)
Instruction one on one or in small groups in academic areas of difficulty

HTH,
Catherine

[JTsMom]

:thumbsup: You're on a roll! Congrats on the new job too!

I'll pull out the report and see what else is on there- I'll probably post it here just in case it will help anyone else. It's great that you've picked up on some of the things that will help him. It's hard to beat mother's instinct! Another cool trick I saw, but haven't tried yet is to put something designed for sensory stimulation on their desk.
http://www.amazon.com/THE-SENSORY-UNIVERSITY-DESK-BUDDY/dp/B002X7BTBC/ref=sr_1_sc_1?ie=UTF8&qid=1329431039&sr=8-1-spell

I was thinking of making something myself- maybe a piece of sandpaper, something rubbery- like a stress ball material, something silky, etc.

Another thing I've been thinking about doing is swapping out DS's chair for an exercise ball. There have been some studies that show that they increase attention. Quicky read:
http://life.gaiam.com/article/how-sitting-ball-helps-kids-focus-and-do-better-school

For now, I bought one of the disks they show on the Amazon page I linked to-
http://www.amazon.com/Isokinetics-Brand-Exercise-Balance-Cushion/dp/B000WQ4Z7Q/ref=pd_sim_t_2

It should be here this week. A HSing friend with a SN child said it doubled the amount of time her son could sit and be attentive.

http://life.gaiam.com/article/how-sitting-ball-helps-kids-focus-and-do-better-school

BTW, how did the volunteering go? Dying to hear! lol

[inmypjs]

Glad your meeting went well!

Here is a great site on visual spatial learners:
http://www.visualspatial.org/
Check out the list of characteristics and the part where it says curious? learn more.

My son is a total visual spatial learner (or "picture thinker"). He learns words through images and whole parts, not syllables. Unless they are processed this way for him, he won't get them.

Also wanted to say thanks to the others who posted accomodations for their kiddos. Very helpful info!

[egoldber]

JTsMom, older DD uses one of these to sit on at school: http://www.amazon.com/Cando-Vestibular-Wedges/dp/B000BPWL6U/ref=pd_sim_sg_7

Her teacher last year suggested it and it made a HUGE difference for her being able to sit "still" in her seat. She can now rock, but it isn't disruptive.

Since it was so inexpensive, we bought it and sent it in, but the school would have provided one if we asked.

She also has the use of fidget toys in her 504 plan.

[mctlaw]

Thank you for the ideas! These vestibular cushions look really interesting to me. I cannot see a ball working, at least in kindy - the kids sit at shared tables, and I can envision the ball causing issues with other kids. But those products look totally doable.

DS already does get preferential seating. I bought him a fidget but he seems to have no interest in it?! Any ideas on how to introduce these or if he tosses it aside does that mean it would not be helpful to him?

JT's mom, volunteering went ok and I had an interesting conversation with the principal afterwards who happened to see me.

I went in and acted friendly and did not say anything about the whole incident. While we were cleaning up and she was about to take the kids to lunch, she showed me a video that accompanied a book and said she wanted to show it after reading the book next week. It looked educational , had a related plan, and not like pure entertainment like, so I said fine. If it's part of an appropriate curriculum, I have no problem with it.

When I spoke with principal he thanked me again for coming forward and asked how things were going. The indication I got from him was that he acknowledged that I had the power to potentially end her career regarding the cooking class nonsense, that I was aware of the rules and the proper channels to do so, and she knew it as well. So, I think she is going to stay on her ps and qs though I am going to stay on her. I think going in prepared lawyer style made all the difference in this case.

Oh and I passed the 3 hour glucose challenge so it has been a great week for me!

[crl]

DS already does get preferential seating. I bought him a fidget but he seems to have no interest in it?! Any ideas on how to introduce these or if he tosses it aside does that mean it would not be helpful to him?



Oh and I passed the 3 hour glucose challenge so it has been a great week for me!

We have found that a lot of things that seem to work for other kids don't help much with ds. I'd try a couple of different fidgets for a couple of weeks. If they don't help, they don't help. Have you asked him why he doesn't use it? His answer might be enlightening. Or not.

Congrats on passing the glucose challenge!

Catherine

[mctlaw]

We have found that a lot of things that seem to work for other kids don't help much with ds. I'd try a couple of different fidgets for a couple of weeks. If they don't help, they don't help. Have you asked him why he doesn't use it? His answer might be enlightening. Or not.

Congrats on passing the glucose challenge!

Catherine

OK, duh to me, I guess I should just ask him....I have not done so. I have a feeling he will say it is "boring," which is a favorite word as of late! I will look for something different to try though.

And thank you!

[JTsMom]

You really are having a great week! :cheerleader1:

A lot of times, things that "should" work for DS1, don't. We've thrown so much money down the drain on various therapies and tools, it makes me sick to even think about it. I tend to go through spurts where I feel motivated to try some new stuff, then I burn out for a while, b/c every time something doesn't work, I start to feel like we're never going to get anywhere. Then I'll hit on something (usually something I figured out on my own, and all of the pros have told me probably won't work), and it will work, and it makes it all seem worthwhile. Some kids just break every rule I guess.


I only have a couple of mins, but want to add some stuff from J's reports- please excuse crappy formatting.

1. Social skills training/outdoor sensory program
http://claywhite.us/outdoor-sensory-adventures.php

2. Food allergen profile and Fragile X/thyroid testing (I wonder if you could get your regular ped to do this sort of thing)

3. Board game- You and Me: A Game of Social Skills from addwarehouse.com, A card game called "What Would You Do at School If", Social Skills Picture Book, All Kinds of Minds book

4. Try passion flower extract or "PediActive"

5. Calm Kids CD

6. Music class

7. Karate

8. Sensory breaks during the day

From the neuropsych:

1. Minimize distractions (preferential seating, increased 1:1 contact with the teacher); reminders to attend, direct eye contact for any directions, place a hand on his shoulder. "Present material in small, successive units that can be mastered hierarchically. This will allow Jason to maximize his attention, assist in organizing the material to be learned, reduce the feeling of being overwhelmed by the material, and deelop greater self-confidence as he progresses through the material. Teachers that offer a higher degree of structure may be a better fit."; preview/pre-teach new material; Repeat exposure to new info over multiple sessions; pace the work- change pace/task frequently. Allow opportunities for movement.


(That is all really good info that does work for us)

2. I'm going to quote the next one too b/c we know it's relevant...

"Given Jason's potential for relative weaknesses in nonverbal reasoning and visual-spatial skills he may become easily overwhelmed when presented with a large amount of visula information on one page, as he may have difficulty determining how to systematically scan and approach information. Written information should be presented as simply as possible, with few sentences or problems on a page to reduce visual distraction. Also, any information that is presented visually, such as in graphs or charts, should be supplemented with verbal explanation."

I think I mentioned Ordinary Parent's Guide to Teaching Reading and Explode the Code- they totally fit the above rec, and are a great fit.

Have we talked fine motor? the next part is about that- basically, reduce writing, let him answer verbally, etc.

Then there's some other stuff that I don't think would be helpful for you.

[mctlaw]

Lori, thank you very much for those very specific suggestions. I will start looking into these. I think we are going to have 3 sessions of testing so it will be at least a month before we know the results, so I can start trying out some of these things in the interim. I also need to get high EPA fish oil which I have heard good things about for some kids.

[elliput]

For now, I bought one of the disks they show on the Amazon page I linked to-
http://www.amazon.com/Isokinetics-Brand-Exercise-Balance-Cushion/dp/B000WQ4Z7Q/ref=pd_sim_t_2

It should be here this week. A HSing friend with a SN child said it doubled the amount of time her son could sit and be attentive.

We have several of these for DD- one each in her regular classroom and the SE resource room, and one at home. Using these has lessened her need to rock her chair around on one leg for the sensory input.

[JTsMom]

Lori, thank you very much for those very specific suggestions. I will start looking into these. I think we are going to have 3 sessions of testing so it will be at least a month before we know the results, so I can start trying out some of these things in the interim. I also need to get high EPA fish oil which I have heard good things about for some kids.


No problem. Hope something in there helps. :)



We have several of these for DD- one each in her regular classroom and the SE resource room, and one at home. Using these has lessened her need to rock her chair around on one leg for the sensory input.

I'm so glad to hear several of you had luck with these or something similar. Can't wait to see if it works for us too!

[MamaKath]

I also need to get high EPA fish oil which I have heard good things about for some kids.
Just reading through your post. You have some great recommendations already! For omega 3, we use coromega. It is tasty so the kids are more willing to try.

I also noticed the wiggle cushion mentioned. We have found that really helpful. I got one in the fitness section of target similar to this... http://www.target.com/p/STOTT-PILATES-Stability-Cushion-Green/-/A-12090074#?lnk=sc_qi_detaillink By purchasing it we were able to have it used immediately instead of waiting for it to be ordered.