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  1. #11
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    This is a quick update to let y'all know what's happening with DD:

    At her well visit on 3/27, we discussed the big blowups, the conflicts with the boy at school, and other little things that were adding up.

    Her pediatrician gave us the names of two therapists in the area.

    As the visit was so close to both Easter and Passover, not to mention area schools' spring breaks, I didn't call right away, having had the experience of being blown off by a therapist several years ago because I'd called near the holidays.

    I didn't phone last week, due to other priorities.

    We received an email from DD's teacher yesterday describing some behavior that she hasn't had since kindergarten - throwing things, refusing to cooperate with teachers, being disruptive, etc. (and not always during days when the class had a substitute teacher) - and I checked both therapists' websites.

    One does not accept insurance, so we cannot take DD there.

    The other doesn't specify whether or not she accepts insurance, so I phoned today (4/18; left a message) and followed up with an email (through her website because she obviously doesn't know her email address, based on the two "undeliverable" emails I received after trying to send the follow up outside the website system.)

    DH is also supposed to ask at work (he's a marketing specialist who works in the mental/behavioral health care "industry" and knows people who have connections to decent therapists in the state system of care) to see if there's anyone recommended who also accepts our insurance.

    I have been told (by DH, who pays the bills) that we cannot go with an out-of-network provider. CANNOT.

    So, today's task is completed, with an expected follow-up call on Friday if I don't hear back. Unfortunately, I strongly suspect that the therapist I called is the same one who blew us off three years ago and I'm not optimistic about getting a response.
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  2. #12
    sariana is online now Diamond level (5000+ posts)
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    I'm so sorry. I hate dealing with insurance issues.

    Do you have to stick with the 2 recommended by your ped? Does your insurance have a web site where you can search for providers? Or a number to call to get some names?

    I know a lot of people don't like HMOs because they feel that their options are too limited. But I really miss our old HMO at times like this (we're trying to find a therapist, too). I would rather just call one number and get a name, the way our old HMO worked. Choices are great--when there really is a choice, and enough data to make an informed choice. But sometimes I just want someone who can help my kid, you know?
    DS '04 "Boogaboo"
    DD '08 "Lilybear"

  3. #13
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    Default ADHD and Tantrums

    I still think this could be a med issue or anxiety. From what you are describing, I donít think like therapy alone will help. At that age, itís going to be so so hard to self-aware enough to change behavior when sheís out of control emotionally. My son is about the same age (8.5) and weíve struggled a lot with his behavior. The adhd meds were never enough...or never enough for an extended period of time. In retrospect, Iím able to tell that so many of his meltdowns were actually anxiety related. Meltdowns during transitions are typical for anxiety. Weíve made progress by adding a mild anti anxiety med, but I think we need to increase it (we go in for a med check in a few weeks.).

    And I totally understand about not wanting to see someone out of network. We had a situation with that and paid a ton out of pocket and then stopped because I didnít want to shell out $100 for each weekly session.

    Adding: my DS was never diagnosed with anxiety during his eval. The psychiatrist suggested the anti anxiety med when I described some of his problematic behaviors. She suggested it sounded like anxiety and to try the anti anxiety med. and it helped! Then I googled adhd and anxiety in kids, and it really explained a lot. A lot of adhd behavior is similar to anxiety behavior. My DS is classic hyperactive/impulsive adhd, but doesnít really have focus issues. He canít control his emotions at all and his brain is in hyperdrive all the time. I think a lot of the emotional aspect is anxiety, not feeling like he can control the situation, not feeling safe, etc.


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    Last edited by georgiegirl; 04-18-2018 at 11:16 AM.
    DD (3/06)
    DS1 (7/09)
    DS2 (8/13)

  4. #14
    LBW is offline Sapphire level (2000+ posts)
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    The process of finding the right therapist can take a while. It would be sort of miraculous if the one guy you called is available and the right fit.

    In my experience, you have a long road ahead. I think you need to prepare for that mentally. You need to be her advocate, and you need to be pretty aggressive about putting together the right team to help her & about working with the school. I'd highly recommend getting a follow up appt with the team that did the evaluation. (at CHOP?)

    Some other suggestions for you to consider:

    1) As PP mentioned, go through your insurance co to find other local therapists. Also search on local FB groups and ask around to get recommendations.
    2) Work with the school:
    -request a meeting with the teacher and the school's psychologist/guidance counselor and the district/school behaviorist. They should be able to come up with some strategies for the teacher to use in class. Potentially, your daughter could also meet with the guidance counselor or psychologist on a regular basis.
    -Ask the school psychologist for a list of recommended therapists. They often have this info ready to give out.
    3) Books to use at home:
    -for you and your husband to read: Ross Greene's The Explosive Child and Lost at School
    -for you to use with DD:
    Christopher Lynch's Totally Chill: My Complete Guide to Staying Cool A Stress Management Workbook for Kids With Social, Emotional, or Sensory Sensitivities
    Dawn Huebner's What to Do When Your Temper Flares: A Kid's Guide to Overcoming Problems With Anger
    Last edited by LBW; 04-18-2018 at 12:26 PM.
    Tara
    living a crazy life with 3 boys

    One day you finally knew
    what you had to do, and began,
    though the voices around you
    kept shouting
    their bad advice.
    ~Mary Oliver

  5. #15
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Quote Originally Posted by sariana View Post
    I'm so sorry. I hate dealing with insurance issues.

    Do you have to stick with the 2 recommended by your ped? Does your insurance have a web site where you can search for providers? Or a number to call to get some names?
    ...
    No, I'm not committed to the people the pediatrician recommended at all; they're simply a starting point. One does not accept insurance and expects payments up front, so she is out. The other one doesn't list if she accepts insurance, and that's the one I phoned today.

    The insurance website kind of stinks - the ways in which providers are listed don't allow me to narrow search terms to "child therapist." They use checkboxes and none of the answers are what I think I'm looking for.

    I need DH involved with this, too, because I am freaking sick of being blamed for her issues. Her issues are her issues; I'm probably not helping because I don't know what I'm doing, but they're not MY issues transferred to HER. They're HER issues.

    Quote Originally Posted by georgiegirl View Post
    I still think this could be a med issue or anxiety. From what you are describing, I don’t think like therapy alone will help. At that age, it’s going to be so so hard to self-aware enough to change behavior when she’s out of control emotionally. ...
    And I totally understand about not wanting to see someone out of network. We had a situation with that and paid a ton out of pocket and then stopped because I didn’t want to shell out $100 for each weekly session.

    Adding: my DS was never diagnosed with anxiety during his eval. The psychiatrist suggested the anti anxiety med when I described some of his problematic behaviors. She suggested it sounded like anxiety and to try the anti anxiety med. and it helped! Then I googled adhd and anxiety in kids, and it really explained a lot. A lot of adhd behavior is similar to anxiety behavior. ...
    Yeah, it's less about not "wanting" to shell out the money and more about not being ABLE to shell out the money. Even with reimbursement paperwork, it's like pulling teeth to get stuff like this covered!

    Such a PITB.

    She does have focus issues, so I think the ADHD diagnosis is correct. But the meds may be exacerbating underlying anxiety or even ASD behaviors, since so many overlap! I can't make that call.

    Quote Originally Posted by LBW View Post
    The process of finding the right therapist can take a while. It would be sort of miraculous if the one guy you called is available and the right fit.

    In my experience, you have a long road ahead. I think you need to prepare for that mentally. You need to be her advocate, and you need to be pretty aggressive about putting together the right team to help her & about working with the school. I'd highly recommend getting a follow up appt with the team that did the evaluation. (at CHOP?)

    Some other suggestions for you to consider:

    1) As PP mentioned, go through your insurance co to find other local therapists. Also search on local FB groups and ask around to get recommendations.
    2) Work with the school:
    -request a meeting with the teacher and the school's psychologist/guidance counselor and the district/school behaviorist. They should be able to come up with some strategies for the teacher to use in class. Potentially, your daughter could also meet with the guidance counselor or psychologist on a regular basis.
    -Ask the school psychologist for a list of recommended therapists. They often have this info ready to give out.
    3) Books to use at home:
    -for you and your husband to read: Ross Greene's The Explosive Child and Lost at School
    -for you to use with DD:
    Christopher Lynch's Totally Chill: My Complete Guide to Staying Cool A Stress Management Workbook for Kids With Social, Emotional, or Sensory Sensitivities
    Dawn Huebner's What to Do When Your Temper Flares: A Kid's Guide to Overcoming Problems With Anger
    I searched the in-plan therapists and got something like 50 pages of names. That's overwhelming! Every time I tried to narrow the field, I wasn't getting results that were remotely manageable.

    The school psychologist met with us at our spring parent-teacher conference and shared some resources with us. I have to page through and see if she gave us individual therapists in addition to the group therapy/playgroup she recommended.

    CHOP's list of recommended therapists is really PA-heavy, which isn't necessarily a bad thing, but it does increase my stress level to get her to/from appointments. I think they offered us a few options at our "this is how we recommend you proceed" meeting, but DH turned them down.

    I don't know whether they'll allow her one-on-one meetings; I'll ask. She really loves the school counselor.

    Thank you for the book titles; I'll check to see if the library has the parent and non-workbook ones for sure.
    Last edited by lizzywednesday; 04-18-2018 at 01:49 PM.
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  6. #16
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    As our psychiatrist told us, sometimes meds fix one issue but bring to light another. If the adhd is properly medicated, then you can see all the other problematic behavior and not be distracted by the adhd. With my son, his impulsivity and hyperactivity drove us bonkers. We would always remind him to stop jumping on the couch, touching his brother, touching things, fidgeting constantly, etc. without all of those behaviors, we were able to see other difficult behaviors, in his case mostly emotional volatility.

    Could you look for a child psychiatrist to manage meds? They often have very good recommendations for therapists. At our first psychiatrist appointment, we had a long discussion about all of DSís issues. It sounds like your DD would be better managed by a psychiatrist than a pediatrician.


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    DD (3/06)
    DS1 (7/09)
    DS2 (8/13)

  7. #17
    LBW is offline Sapphire level (2000+ posts)
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    Quote Originally Posted by lizzywednesday View Post
    I searched the in-plan therapists and got something like 50 pages of names. That's overwhelming! Every time I tried to narrow the field, I wasn't getting results that were remotely manageable.
    You could take this list to your school psych or ped and ask them if they know any of the names and if they'd recommend them.

    Another suggestion would be to look at kids' OT facilities if any are covered in your plan. Some of them offer therapy, too. A lot of them work extensively with kids who have ADHD/behavioral issues.

    You could also reach out to NJ SPAN. They may be able to make suggestions.

    The most helpful resources to me over the years have been word of mouth and FB groups. I'm in one for ADHD, etc, that covers northern NJ. PM me if you think it might be helpful to you. Kids docs and therapists come up a lot in my town group and county moms group, too. You don't even have to ask the question -- just search old posts and you can often find great recommendations.

    Quote Originally Posted by lizzywednesday View Post
    CHOP's list of recommended therapists is really PA-heavy, which isn't necessarily a bad thing, but it does increase my stress level to get her to/from appointments. I think they offered us a few options at our "this is how we recommend you proceed" meeting, but DH turned them down.
    Honestly, it's sometimes worth a drive to get to the right person. I drive 45 min every 2 weeks to my 11-year old's therapist b/c he's the best fit we found in years of searching.

    Quote Originally Posted by lizzywednesday View Post
    I don't know whether they'll allow her one-on-one meetings; I'll ask. She really loves the school counselor.
    If she has an IEP this could be added as an accommodation. If she has a 504 or even an I&RS plan, I'm sure it could be added, too. I've seen this done in 2 districts in NJ, so I don't think it's uncommon.
    Tara
    living a crazy life with 3 boys

    One day you finally knew
    what you had to do, and began,
    though the voices around you
    kept shouting
    their bad advice.
    ~Mary Oliver

  8. #18
    niccig is offline Clean Sweep forum moderator
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    You and DH need to get on the same page and get more help for her. The psychiatrist and counseling sound like places to start. Call the school psychologist now, leave a message asking for referrals. The school needs to know youíre trying to get help. If she continues to have tantrums, throw things, they could say sheís a danger to herself or others and recommend moving her to a more restrictive class setting. Iíve seen this happen too many times. If childís behaviors improve (meds, counseling, maturity), we want to move them back into gen ed but theyíre behind on academics.

    Donít wait any longer to get more help.


    Sent from my iPhone using Baby Bargains

  9. #19
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    Has she been evaluated by the school district? Does she have an IEP/504? I would request one ASAP if not because you want disciplinary goals to be a part of that (going off of what niccig mentioned).

    Also, you may want to look at something like the Explosive Child and reconsider some of your current tactics. With a child who's struggling to maintain control for whatever reason, and especially a non-neurotypical child, she's not misbehaving for the fun of it. It's literally out of her control. Your job is to figure out her triggers and help her learn to maintain control or regain control. Threatening the tablet removal probably escalates things instead of de-escalates things in the heat of the moment. Stop looking at a tantrum as something to punish. It's something that's showing she's struggling. Sometimes empathy helps kids pull it together more quickly. Some kids need the big release. Maybe it's a buildup of anxiety. She's not going to be able to voice the why at this age. It's got to be teased out by you and whomever else is around her. Maybe the teacher can be of help, but you want her to know that you are actively working on this so she can help advocate for DD as a team member.

  10. #20
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    I'm just going to add in that my DS is 9.5 yo now and we have struggled over the years with his ADHD.

    One thing that struck me about your previous posts is that you are seeing some behavior that you haven't seen since kindergarten when you were led to seek an evaluation. I recently said the exact same thing about DS. Everything had been going ok with his medication until it suddenly wasn't. But what I didn't know, is that it wasn't "suddenly" not working. It had been not working for several months with low levels of symptoms until suddenly DS had enough and started exhibiting explosive behavior.

    I called a conference with his teachers and the school counselor to find out what was going on, because when I tried talking about it with DS he would cry and cry and just say how stressed and jumbled up he is. He would report knowing that his behavior was unacceptable and could not give a reason for acting out. The teachers reported (when confronted with a face to face conference) that DS had not been his normal self since January. They had been seeing symptoms but didn't think to notify me until it was so bad they were unable to manage him anymore.

    I scheduled an appointment with DS' psychiatrist. I was concerned about DS's anxiety levels and stress. The psychiatrist told us that the meds DS is on for ADHD are not doing the job they were intended to do. They weren't lasting long enough or helping to manage the symptoms and as such, DS was becoming extremely stressed at not being able to focus and control his impulses like he had previously been able to. He was confident that if we tweaked the medication dosage a little, we would see an improvement in DS's behavior.

    We saw DS' therapist the same week and the therapist had the same opinion. ADHD meds aren't working and are causing DS to not only exhibit ADHD type misbehavior and symptoms, but also adding stress and anxiety to the mix.

    The slightly increased dosage of the medication has helped DS get back on track and the therapist gave DS some worksheets about how to recognize stress and how to manage it (geared towards kids).

    It is not at all uncommon as children grow for the medications to need to be adjusted or changed altogether. For this reason alone it is important to pursue a psychiatrist. They are the ones best equipped to recognize typical behavior issues from symptoms of untreated ADHD.

    DS1 - 9!
    DS2- Expected 07/18
    ~Elle

    DS1: 10/08 (the ďtenagerĒ)
    DS2: 07/18 (the wild one)

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