Help with interpreting test scores and OT/VT questions

[Snow]

Ds was diagnosed with adhd, combined (impulsive and inattentive, not hyperactive). Can I post his results and get your feedback? What would you work on?

 

[edited scores]

 

 

He loves handwriting, probably because it's physical instead of just a mental task.

 

Math is mostly painful. Would it be too early to just give him an addition/multiplication chart? He's just turned 8. We would still keep working on facts, but oh man, it's just brutal.

 

Reading seems like it clicked earlier this year and now he's reading hardy boys, but he still flip flops letters and it takes effort to sound something out. We are doing LOE and I feel pretty good about it, even if it's not his favorite.

 

All throughout the report she says, he has intact ability or capacity in [fill in the blank area] but his expression is variable/limited by his inattention and impulsivity. However, in the area she calls Focus Execute (FE) she said he has a mild deficit. FE referring to "the ability to add a novel trait or behavior to a mastered or habituated behavior" It requires reasoning flexibility, processing speed and fluency of thought". How do I work on reasoning flexibility and fluency of thought?? Just reframing situations at every opportunity?

 

The NP recommended getting an OT and a VT eval. We've done the OT and had our first two sessions and I have to say, I'm less than impressed. The eval said he does have very low vestibular processing and given his affinity for diving/crashing into things on purpose, he probably has some proprioceptice stuff too, however, I have a call in to her to see if this is right for as at this point. My son is super sporty boy. He climbs rock walls, plays every sport, etc. And he loves OT! Can't get enough. Yet, she has him working on motor planning via an obstacle course. I don't know. I feel like that's stuff we do for fun at home anyway. I was happy to do it when they first told me it would be $40/ month but the lady misinterpreted our insurance and it's actually going to be $400/month. Now I'm thinking this might not be essential.

 

Also, VT...dh is not in favor since there's little to no evidence base for its efficacy. But both the NP and the OT said he had some ocular-motor issues. Any wise words for me here?

 

Ok, I'm on an iPad so my apologies for the strange punctuation and staggered sentences here, I'm too lazy to fix some of them, lol. Kudos to you if you've made it through this jumbled post and thanks in advance for any suggestions!

[OneStepAtATime]

No time right now, but with the VT in particular some things seem to improve with VT quite a bit, some just a little, some show improvement but it isn't sustainable unless you continue VT and for other things it doesn't seem to work at all.  But yes in some instances it DOES work.  Just like with a general diagnosis of dyslexia SOME kids will respond well with some programs while those are dismal failures with others.  People sometimes generalize a working program to mean it will work for all children or that a program that doesn't work for one won't work for any.  That just isn't realistic.  It is hard to know ahead of time what will and won't work with a particular child since each child has a unique combination of strengths and weaknesses.  I say if you can afford it you should at least look into VT.  There are many parents on here who have found it very effective.

[Heathermomster]

Was your DS diagnosed with any specific LDs?  

[Snow]

Not much time to respond right now, but thank you for reading an responding ladies!

 

Yes, it seems like a lot of people have had great results with VT. It certainly seems like it could be good, but getting dh to agree is going to prove more challenging, especially since it's not covered at all.

 

Hi heather, no learning disabilities. His wiat results were a little low in some areas, but no red flags for the NP, given how he scored in certain areas.

[PeterPan]

Well Kate, I did OT with my dd who, though older, was very similar in situation to your ds, and I can tell you I'm not repeating that mistake with my ds.   ;)  I'm all in favor of a thorough SIPT-certified sensory eval as part of the OT eval.  Did you get one or did you just get the short one hour eval?  The sensory eval is a longer thing, and that's why he's crashing into things.  I have my ds doing RAT Pack and Mini-Stuntmen at the YMCA.  You might see what yours offers.  It's part of the gymnastics program.  RAT Pack is all play-based and has lots of crashing, but it ages out at 5.  Mini-Stuntmen gets a little more focused, but they still get a lot of great sensory input. Ds' coach is figuring out that the crash is the reward part for him, so he builds in opportunities for it. I have my ds doing in those programs 3 days a week now because they just make him feel GOOD.  

 

My dd also had the vestibular issues.  The vestibular system is the first to thing to develop, so it's sorta like dominoes, where the vestibular has to get work so the rest can start working.  Our OT used single line swings, and frankly I couldn't afford to pay someone 5 times what my dh makes to swing my kid on a single line swing with a weighted collar, kwim?  I made a weighted collar with beans (it's not rocket science) and bought a single line swing.  I've had my ds on it since he was little btw, because it's definitely effective.

 

The thing gymnastics and the vestibular work *aren't* hitting is fine motor.  You mentioned motor planning.  Is the OT saying there's praxis going on?  I agree, our OT was sort of in the "OTs are "god" and you as the parent will screw it up if you do anything."  I realized in hind site we would have been much better off with someone who was willing to work with us once a month and assign homework.  I can't afford to pay someone to do what I can do myself, kwim?  Having the OT do it helps with compliance, consistency, etc.  Those can be definite issues, so I'm not saying that's the right decision for everyone.  You might talk with them though and just ask what the goals are, how much of it you could accomplish by enrolling him in xyz activity, and whether you could go to a less sessions/more homework approach.  

 

Does she have you brushing?  I tried brushing with my ds and it overloaded his system so much he ended up wetting his pants a ton.  Sigh.  So I know we need help.  I've been calling OTs and am in limbo sorting it out.  I'm *not* saying no OT, just acknowledging that you can work with them a bit to get the cost down.  Some will be more open to that than others.  

 

As far as VT, it CHANGED OUR LIVES.  Seriously, if your np told you to get VT, you WANT to get into a COVD doc and get that eval.  Get a good doc, and take your dh along when they do the developmental vision eval so he can see it for himself.  Seriously, it made SUCH a huge difference for dd.  We did OT and VT at the same time, and that was really breaking the bank.  Like I said, for us OT, while it made her feel good, was sort of the expensive way to accomplish things we could have done on our own.  It wasn't in the OT's interest to explain to us how to do things for ourselves.  Much better for them to make $100 an hour.  For some kids and situations it would have been WORTH it, but for us VT was the game changer and OT was merely informative. With my ds, my goal is to get the SIPT eval, target anything they say needs to be worked on, and get over to a homework-based model as quickly as possible. 

[Heathermomster]

Liz, can you recommend a particular booklet or OT manual to help with the sensory activities at home?

[LaughingCat]

OhElizabeth - When you say single line swing.... is the DC swinging as in a regular swing? or spinning? 

[PeterPan]

OhElizabeth - When you say single line swing.... is the DC swinging as in a regular swing? or spinning? 

When I've mentioned single line swings the past, some people have said their therapists had several kinds and rotated, picking the kind for the task.  Indeed, our OT had what I'm calling a single line swing but also platform swings and other things.  You know me.  I tried to watch the activities and find what the common thread was and why they were doing what they were doing.  Once you get the why, you figure out ways to do it with what you have access to.  If I couldn't install a single line swing in my house, I could do one on a tree or go to the park and accomplish the same thing.  

 

To answer your question, the main swing our OT used with dd, who was then 10-12 btw, my mind is slipping as to exactly when, was a Sky Chair.  It's around $100 to buy one, and therapy was $100.  So I was paying $100, and 5-10 min of that she was getting pushed in a $100 swing.  Thanks, I'll buy the swing and push her myself.

 

My ds is a contractor (for full disclosure) and I have raised ceilings in my basement with metal beams and wooden floor trusses above and ceiling tile to access it all.  He installed the swing with a swivel joint and a (pardon my inaccurate term) latch.  So the chain for the swing attaches and removes at that connection point on the swivel joint.  

 

My dd was extremely oversensitive, so with her we were working UP.  Ds is the polar opposite and under sensitive, so you can swing and swing and swing, introducing rotation, lateral, speed, on belly vs. sitting, etc. for as long as you want and nothing happens.  If I had done that to dd, she would have puked.  Actually she would have screamed and gotten off, after having a stress reaction and getting really flushed and dizzy and headachy and sick.  So with her, like I said, the OT started really gently, with just the slightest movement, eliminating all other variables.  As tolerance improved, you gradually increased the height of the swing and then added more variables and more complexity.  

 

Heather, that's an extremely good question!  Someone here had a book they had suggested.  Was it Wapiti?  I've been meaning to track down a copy for myself.

 

Here's a link to that swing.  SKY Chairs: Home of the original hanging chair  It's not the only kind OTs use, but it's what our OT used with dd.  

[PeterPan]

Here, was this the book?              No Longer A SECRET: Unique Common Sense Strategies for Children with Sensory or Motor Challenges     

 

[Snow]

Thanks for the feedback OhE. We just did the one hour eval not the sipt. It's difficult because when he was younger I knew something was up. At the time, both our pediatricians said, well some kids are more sensitive - he will outgrow it. Annoying. But, to be honest, a lot of things he has learned to cope with. I don't know. It's like, we needed this 3 years ago but now I'm not sure. He's sensory seeking in some ways, but it doesn't really get him in much trouble as a result. I will say though, they showed him the Zones graphic and have talked about it for 10 min both weeks...3 separate times in the last week ds has initiated his own calm down (!). "Mom, I think I'm in the yellow zone and I need to calm down". Shocking ladies. Shocking. Anyway, I'll talk with dh. But thanks for including the links to the book. Will go check it out.

 

VT. What other areas did it help?

 

Any other thoughts come to mind regarding the test scores? Would you describe him as "all over the place," or can you see a pattern here? Clearly processing speed is big. Anything else I should be focusing on? I'm trying to be more explicit, more direct and definitive during school but I think I need to be doing more. Maybe that's just a typical post-eval mom response, lol.

 

Thanks again all.

[Snow]

Oh and no praxis, just difficulties with motor planning. He only copied her position correctly 2/5 times. Jumping jacks are...umm, pretty far from standard. No low tone. She said his eyes only registered a tiny wobble after spinning (historically he' never gets dizzy) so that's something speaking to the vestibular thing. He was in the average range for fine motor skills but he still puts up a small fight about cutting his own food and occasionally can't open wrappers. Again, much for me to think about I guess. $400/ month. Yowza.

[Heathermomster]

A VT can perform a screening to determine whether therapy is really warranted. Maybe call and ask about that. A VT screened my DS and then sent us to OT.

 

When I asked about LDs, I fully expected you to state that your DS has a maths disability. My son's GAI is about 15 points higher but they share similar processing and WM scores. I am amazed that your DS has no issues with handwriting. Overall, I feel like the feedback you have received from the NP is a huge blessing. I can only wish my son had been seen an OT by 8 yo. Your DS is very bright. Just stay positive, give him plenty of think time, reduce his workload, and support him.

[Snow]

Thanks Heather! I hear ya in math and handwriting. Mysteries really.

[Heathermomster]

What have you used with math thus far?

[Snow]

We've used Singapore and Miquon. When he's feeling good, his mental math is actually pretty good, only a little slow. When he's having a rough day, he whimpers "I can't. It's too hard" etc. So it's really variable. He loves games though, and I think need to start adding more. Was going to check out soror's big math idea thread.

[PeterPan]

Kate, I think it's possible you're not yet feeling the full effect of the things they're finding because you're catching them early.  My dd didn't get a dyspraxia label but does have the motor planning issues you described.  At age 7 she was still masking a lot and able to cover over her weaknesses.  Ditto for the processing speed.  You're not realizing how much of an impact it has, because you're not yet into harder stuff.  

 

Heather is correct that you can go to a good COVD doc, do a regular appt, and just as them to *screen* him.  It's not like you have to start with the full, $$ developmental vision eval.  In fact that's something I often suggest, starting with the regular appt and a screening.  As for what symptoms it's causing with you, I can't say.  I know what symptoms it caused with us, but honestly they were things that we never realized were vision until after they improved about 2 months into the VT.  And most people you talk with will have their own lists of what changed with VT.  Anything vision related that is being hampered or is a response to developmental vision problems will improve.  Visual fatigue, seeming attention issues (that are actually a way of deflecting the visual fatigue), visual memory issues, stability issues and banging into stuff, how you catch balls, depth perception, peripheral vision issues (frustration with finding stuff), etc.  But you could have none of the issues we had and still get tons of benefit.  Your np must have seem something that flagged vision as a concern, so I'd encourage you to get it checked.  A reputable dev. optom. will let you start with that regular vision exam (you know, the $60 annual visit) and screen you to see if the longer developmental vision exam is warranted.  I think every kid ought to have his eyes checked, and that annual visit with the screening using a developmental optometrist is a great way to do it.  Then you have more info to decide what is needed.

 

 

[Snow]

Kate, I think it's possible you're not yet feeling the full effect of the things they're finding because you're catching them early. My dd didn't get a dyspraxia label but does have the motor planning issues you described. At age 7 she was still masking a lot and able to cover over her weaknesses. Ditto for the processing speed. You're not realizing how much of an impact it has, because you're not yet into harder stuff.

 

Hmm, an interesting insight, OhE. Thanks for pointing that out. I always appreciate your perspective.

 

There is a COVD fellow nearby. No idea if they're good, but that's probably where we would start.

[Storygirl]

I'lll chime in with a couple of thoughts to add to what others have said. DS10 has ADHD combined type and SPD, among other things.

 

First, ADHD combined type means both inattention and hyperactive. If he is just inattentive type, the diagnosis should not include the word "combined." Are you sure he is inattentive only and not hyperactive?

 

Secondly, DS just started OT. On the first day our OT gave me three or four pages of handouts with ideas of things we can do at home. Can you ask your OT if they have something similar? Also, our OT's specialty is SPD. She told me that often treating the SPD with occupational therapy addresses the issues that caused the ADHD diagnosis. In other words, sometimes what appears to be ADHD is really symptoms of SPD, since there is a lot of crossover in symptoms.

 

If you don't think that your OT is working on the things that are necessary to help your son, I'd have a conversation with them before deciding to quit. Either they can help you understand why their methods can help him (sometimes by working on one issues, they can actually be addressing multiple things that might not seem obvious at first glance) or you might see that they are not the right therapist. If possible, check out other options for OT and see if you can find someone who will work on the issues that you think are most important.

 

I've known that DS has SPD since he was two years old. He had some OT back then, and we stopped because he aged out of the program and also because I didn't feel we were getting enough help to make it worth it (he was attending a group play-style session). We learned a lot back then, and we kind of thought that just knowing that he had SPD helped us understand why he was the way that he was and helped us be more understanding of his issues; in other words, that he just was wired that way and there was not a way to change it much. Our thoughts on this were influenced by the OT who diagnosed him, because she said that his sensory issues were something that he would always have, but that he would learn to deal with it and it wasn't a huge problem to be concerned about (she gave an example of someone who always chews gum as a person who self-accommodates for a sensory issue). I think she was meaning to help me not be upset about the diagnosis (I wasn't), but it really made me kind of downplay the impact that SPD could have on someone and the helpfulness of treatment. We should have pursued private therapy. DS now has some great needs that the OT is helping us address. I can see now that his SPD impacts his entire life, academic and non-academic, and that therapy can help him overcome some of his issues. By the way, DS is also athletic and is a competitive gymnast, but sports and his regular high level of physical activity do not address all of his needs. If I were you, I'd ask the OT for some more information or guidance about what your son's specific issues are and how they are best addressed. If they are minor, perhaps the OT is superfluous, but there may be some more major things about your son that the OT sees but you do not. Did you get a written report from the OT outlining his issues? If not, can you ask them for one?

 

Thirdly, my son often would complain about his math, saying that it was overwhelming, and he just couldn't get started on it. We recently started him on medication, and not only is he completing his math quicker with less complaining, but sometimes he goes to the schoolroom first and starts it before anyone else gets to the room. I'm telling you, this is the opposite of what the used to be like. I'm sharing this not to advocate the use of meds for your son but to show you that it can be the ADHD that is causing his difficulty with working on his math. Knowing this, you might consider how you can accommodate him more. Maybe break his math time into two parts, which you do in the morning and the afternoon, so that it doesn't seem like it takes so long to him. I know there is other info on the forums about math and ADHD that could be helpful to you if you search.

[Jennifer-72]

Another thought about the OT. Your son is still quite young and one of the most important things your OT should be working on is building a trusting relationship. I know parents are anxious for meaningful change and to see stuff they can't be doing at home, but your OT is going to need to push your son out of his comfort zone and that does require trust. That trust takes time to build. He has to know that what she says is what will happen. Also, even with assessments she needs to feel things out over a few sessions to get the best idea. In all our dealings with therapists, it generally takes a good month to 6 weeks of sessions before they can really up the ante. The only one time things did not go this way was with the first OT we had. She was terrible! It was right as ds was been assessed and I was inexperienced with all this stuff. She pushed way too hard too fast, and did a terrible amount of harm to my then 2 1/2 year old. I am nearly in tears thinking about it now....

 

Anyway, all that to say that I would just try talking to the OT and get a better idea of her plan going forward. Motor planning in particular is hard to fully suss out just by assessment. You really need to put them in various novel situations like obstacle courses to see what is going on. Our PT runs group classes for kids with DCD and other motor planning troubles. I can not begin to describe how absolutely unique each child's struggle with motor planning differs. Some have so much trouble with the ideation part of motor planning, others with the sequencing, or just having their brain talk to their body etc. Plus it always seems so random what skills they have trouble with vs other more tricky tasks they seem to get without trouble.

[Snow]

Storygirl and Jennifer, thank you for your posts. I'm processing what you said; you both raise great points.

 

 

I'lll chime in with a couple of thoughts to add to what others have said. DS10 has ADHD combined type and SPD, among other things.

 

First, ADHD combined type means both inattention and hyperactive. If he is just inattentive type, the diagnosis should not include the word "combined." Are you sure he is inattentive only and not hyperactive?

 

I'll just quickly address this question and then be off to pondering stuff. He's adhd combined because he is Impulsive and Inattentive. From my understanding impulsiveness and hyperactivity are usually seen together but she specifically said she didn't see him as hyperactive just inattentive and impulsive. So he's adhd combined but without hyperactivity.

[Snow]

I think my real problem with OT is actually the lack of communication at this particular place. It was recommended by the NP and their web site has all the right stuff. But I guess I thought I would get more education about ds and his issues, even just from the eval and certainly as we've met them these past two times. Probably I just need to chill. This lady is supposed to call Monday and maybe that will make me feel better about it.

 

Jennifer, the way you explained the complexities of motor planning was brilliant and I'm so thankful. Geez! am just such a novice here.

 

We are going to explore meds for him, btw. Something I read somewhere raised a thought - if he never experiences focus and clarity of thought, how is he supposed to be aware and self monitor his inattention? And that's really stuck with me. Sometimes when we are working together I just feel like man, 50% of his brain is asleep most of the time. The NP said she thought his iq info was not an accurate reflection because he's just so affected.

 

Yes, we did get a written report from the OT. It's so vague compared to the NP report! There's not much definitive on it; "decreased fluidity of movement," "demonstrated difficulties with..."

 

Anyway...

 

Thanks again for everyone's thoughts. Navigating all of this would be ten times harder without your collective input.

[geodob]

Kate, you wrote: "She said his eyes only registered a tiny wobble after spinning (historically he' never gets dizzy) so that's something speaking to the vestibular thing."

Where his Vestibular issues could be the primary issue?

The Vestibular system is basically a set of circular tubes in each ear, which are partly filled with fluid.

Perhaps you could imagine holding a clear circular tube, partly filled with fluid?

Then as you raise one hand and tilt the tube.  The fluid will stay balanced at the bottom half of the tube.

But these tubes in the ears, have very hairs that detect any movement of the fluid.

So that essentially they keep the brain informed, about where directly above and below are precisely.

When you tilt your head, or lean your body to the left or right?

The fluid moves with the movement, to keep above and below precisely located.

To appreciate it, perhaps you could close your eyes, and then tilt your body in different directions?

Where you will maintain a sense of which way you are leaning, and where directly upright is.

 

But with 'spinning'? 

We have these tubes in both ears.  

So that if you imagine holding a tube in each hand, as you spin?

The pressure from spinning, will force the fluid in the left tube to rise higher on the left side.

While the fluid in the right tube, will move to the right side.

Which creates a confusion for the brain when spinning?  As the left V. tube is showing a lean to the left, while at the same time. The right V. tube shows a lean to right.

Though other tubes detect front and back?

So that what we feel as dizziness?

Is the brain trying to cope with information that tells it that we leaning, left, right, forward and back, all at the same time?

But as the fluid settles back down, then the dizziness disappears.

 

So that when you say the 'historically he' never gets dizzy'.

This indicates a lack of sensitivity to the movement of the fluid?

Though the 'tiny wobble of the eyes', is an important distinction?

If their was no wobble at all, then it would indicate no connection.

But this tiny wobble, indicates a primary connection.

Which has potential for further development?

 

Though the Vestibular system works together with other brain regions?

For example, it has a direct connection to the eyes?

With what is called the VOR Vestibular-Ocular Reflex ?

As you read this, your VOR keeps your eyes informed about where your head is?

Whether it is leaning to left or right, or straight up?

It uses this to direct the movement of eyes, as they read across the line.

 

But another crucial role that it plays, is with the 'vestibulospinal tract' ?

With motor control and motor planning, this keeps our body and limbs balanced as we make movements, and then maintains our balance as stand or sit in a position.

 

Though when the Vestibular system isn't working efficiently, then the motor system is deprived of this constantly updated information.

So that without this, their is a reliance on vision, to locate directly up and down.

Though their is also a gravity sensitivity system in neck muscles, which sitting in between the head and the body?

Tells the brain which way the body and head are leaning, in relation to each other.

 

But it is worth noting, how a Vestibular difficulty effects 'attention'?

The basic difference, is that the Vestibular system is a system that works automatically and doesn't require any conscious attention.

Though when it isn't working effectively?  

Then conscious attention needs to be constantly devoted to keep our head, body, limbs balanced ?

As we stay still, or make any movement.

 

So that I would suggest that his Vestibular difficulties,  could be the source of his difficulties?

Where the Vestibular system really need to be recognized as a 'sense', equal  to our other senses.

 

But a crucial factor, is that their was a 'tiny wobble' of his eyes after spinning?

The critical difference with this, is that indicates a potential for develop?

As opposed to 'no wobble', which suggests no potential.

[Snow]

Geodob, this was wonderful. Thank you.

 

It's probably not surprising, I guess, that he had multiple ear infections when he was little and had to have tubes.

 

It really is all connected, isn't it?

[Storygirl]

Kate, did the OT say your son has low registration, too?

 

I just did a quick internet search for low registration and vestibular system after reading Geodob's post (DS has multiple sensory issues, including these), and found a ton of information, some of which linked childhood ear infections to vestibular damage and vestibular issues to ADHD. Very interesting reading just by doing an informal search. If you haven't done this yet to find out more about your son's issues, I highly recommend it. My OT gave me some information, but there is a lot more out there for those who look.

 

I'm finding this fascinating. Last night DH read our OT's report for the first time (he has been out of town), and he his first comment was that maybe my son's ADHD symptoms were actually due to his sensory issues. Things can be so tangled together that one child can actually have multiple problems, or there can be a single major issue that causes symptoms that could lead to several different diagnoses. It can be hard even for the experts to pin things down accurately.

[PeterPan]

Storygirl, I'm wondering if what you're calling low registration is what ours called low stim?  

 

I was thinking about this a bit, that whole idea of whether *all* the adhd symptoms would be gone if you got rid of the sensory issues.  That's sort of a simplistic understanding or approach to adhd.  Their brains seem SO similar to what is described in DA (Dyslexic Advantage) and seem to follow what some of the writers (Gaddis, Freed, etc.) like to call "left-brain dominant" that I think in general you're talking not just the external attention symptoms but actual brain differences.  Those don't go away with OT.  You can work on the beta vs. whatever waves with neurofeedback, and STILL you've got a child who's fundamentally different.  They are who they are.  

 

And yes, we've had people on the boards get an SPD label with nothing else.  

[Storygirl]

Ugh. Just lost a long post. I don't think that the sensory symptoms totally account for all of the ADHD symptoms, but there are definite overlaps in the way that SPD and ADHD present. Which is why we didn't seek an ADHD diagnosis until recently -- we knew that a lot of DS's behaviors could be attributed to SPD, which we already knew he had. But now that we have the OT's initial report and see the extent of his issues (they are MANY), it makes us see the wisdom of a multi-pronged approach to address both issues.  It will be interesting to see if addressing the sensory has a greater impact on his behavior than the ADHD meds, which help but leave a lot of issues and behaviors unaddressed. The OT of course thinks that she can solve everything :)  and that drugs are not needed.

 

Which is really all to say that I should have said in my other post that DH wondered if *some* of DS's ADHD symptoms were actually due to the SPD. Didn't mean to imply that treating SPD somehow would solve all the ADHD issues (although, again, the OT suggested this very thing). It's complex, and it's all twisted together.

[Heathermomster]

Ugh. Just lost a long post. I don't think that the sensory symptoms totally account for all of the ADHD symptoms, but there are definite overlaps in the way that SPD and ADHD present. Which is why we didn't seek an ADHD diagnosis until recently -- we knew that a lot of DS's behaviors could be attributed to SPD, which we already knew he had. But now that we have the OT's initial report and see the extent of his issues (they are MANY), it makes us see the wisdom of a multi-pronged approach to address both issues.  It will be interesting to see if addressing the sensory has a greater impact on his behavior than the ADHD meds, which help but leave a lot of issues and behaviors unaddressed. The OT of course thinks that she can solve everything :)  and that drugs are not needed.

 

Which is really all to say that I should have said in my other post that DH wondered if *some* of DS's ADHD symptoms were actually due to the SPD. Didn't mean to imply that treating SPD somehow would solve all the ADHD issues (although, again, the OT suggested this very thing). It's complex, and it's all twisted together.

Story, I'm curious to know how long the OT thinks she will need to work with your child to see any effect.  Did she happen to provide a timeline?

[Storygirl]

Storygirl, I'm wondering if what you're calling low registration is what ours called low stim?  

 

 

I don't know -- you tell me! Low registration is when the person recognizes sensory stimulation much less than the average person. So the brain does not register that the sensory input has happened. They may appear to be less in tune with their surroundings, may not appear to hear what someone is saying at first, may have trouble shifting attention to what is important, may be less in touch with their bodies and have delayed motor skills. They may appear lethargic.

 

The OT demonstrated DS's low registration to me last week by having him swing in a sling type swing, facing down to the ground, and then walking a line on the floor to see if he was dizzy. Totally not dizzy. The spinning didn't "register" in his brain, even though his body experienced it. I brought it up because Kate mentioned that her son was not dizzy after swinging (though it showed a little in his eyes).

 

DS is an interesting case, because he has low registration but is also sensory seeking and has ADHD, so he doesn't really have the lethargy thing (although he can and does tune out and stare into space and need to have his attention redirected, which could be the ADHD -- which is another example of how it is all twisted together). And he doesn't have low tone, which can go along with low registration sometimes. He needs an intense sensory diet (the OT gave us pages of ideas) to help him focus well. On the other hand, when he gets overstimulated, it can be counterproductive and make it impossible for him to focus. Sigh. I already know some things that do and don't work for him, but I'll have to experiment with others to make sure they help his focus and do not derail it.

 

He's just an enigma. My main hope is that we can find the tools that help him be the best HIM that he can be. I can see how all of this STUFF is getting in the way of him performing to his best abilities. I don't mean to keep going back to the gymnastics thing, but when I think about how much he has been able to achieve with all of these things impeding him, it makes me sad. It makes me wonder what might have been, if you know what I mean. He's obviously talented but his issues hold him back.  I can't dwell on that. I know he is the boy that he was made to be. But if we can help him remove some of these impediments, I can see that he will be able to go farther in life.

 

Kate -- don't mean to derail your thread! Maybe some of this is helpful to you?

[Storygirl]

Story, I'm curious to know how long the OT thinks she will need to work with your child to see any effect.  Did she happen to provide a timeline?

 

She did not. I just said to DH last night that what her report does not do is outline what she plans to do with him and how long it will take. She is so open to questions that I know I can just ask her this.

 

Sometime in the near future, we are going to be moving. At first I was hoping that we could get a good chunk of OT done before leaving the area, but I think we may be in for a longer haul and will have to find a new therapist after we move.

 

I was encouraged when I was doing my informal online research (because as we all know, everything on the internet is true and helpful :laugh: ) to find the website of an OT who presented some anonymous case studies. There was a child who sounded a lot like DS (though she had CAPD and he does not, everything else was similar). After her OT, her visual processing scores moved up from something like the 6th percentile to the 26th percentile. All her other scores increased as well, but I was especially noticing the visual processing, because DS was in the less than 1st percentile for almost everything that the NP did to test it. This is just a side note, but it gave me hope that OT might be able to help DS with a host of issues.

 

Which brings us back to the main title of this thread, after all! OT and vision issues! Now I don't feel as bad for digressing from the OP's topic. :o

 

ETA -- I'm not expecting DS's test scores to go up in this way, of course, because he is a totally different child than the case study girl. It's just that it showed me that OT can help visual perception.

[geodob]

To untangle this, we really need to separate ADHD from 'attention difficulties'?

With this thing called Attention?

The brain actually maintains multiple points of attention, at the same time.

But a crucial factor here, is that our frontal lobe creates and maintains a hierarchy, to prioritize them. 

Though with ADHD, the issue is with managing and maintaining the hierarchy?

 

But in terms of issues that OT's are addressing?

The crucial factor here, is with the development of 'automatic motor control'?

It can then be shifted to and maintained at a lower level of attention.

 

Where the critical issue here, is that it frees up primary attention at the top of the attention hierarchy.

So that basically it is reducing attention distractions.

[Heathermomster]

Fascinating...The OT told me that 50% of children with motor planning issues are diagnosed ADHD.

 

Why would motor planning issues affect reading?

[wapiti]

Fascinating...The OT told me that 50% of children with motor planning issues are diagnosed ADHD.

 

Why would motor planning issues affect reading?

 

Developmental vision stuff, specifically ocular motor. 

[Snow]

This is great discussion...keep going! Not sidetracking at all and this is all very eye opening.

 

She didn't say anything about low registration and I haven't heard of it before. She said he is hypo-responsive to vestibular input and "has difficulties with" proprioceptive. She then said in summary that Ds has "difficulties with sensory processing affect his motor planning and coordination which make it difficult to perform novel tasks and to generalize familiar tasks. This in turn can impact his attention because he is required to focus more attention and cognition on tasks that come automatically to others. Additionally, it can lead to increased frustration affecting his self-regulation."

[Storygirl]

To untangle this, we really need to separate ADHD from 'attention difficulties'?

With this thing called Attention?

The brain actually maintains multiple points of attention, at the same time.

But a crucial factor here, is that our frontal lobe creates and maintains a hierarchy, to prioritize them. 

Though with ADHD, the issue is with managing and maintaining the hierarchy?

 

But in terms of issues that OT's are addressing?

The crucial factor here, is with the development of 'automatic motor control'?

It can then be shifted to and maintained at a lower level of attention.

 

Where the critical issue here, is that it frees up primary attention at the top of the attention hierarchy.

So that basically it is reducing attention distractions.

 

So this automatic motor control would be helped by working on proprioceptive sensing, correct? The OT mentioned that working on the proprioceptive would show improvements in many areas.

 

Your thoughts help me see how the SPD and ADHD, while different, can result in similar behaviors. The sensory seeking child may be loud and active and have trouble processing and acting on sensory stimuli, which may present as having trouble with inattention, impulsivity, and executive function. Could look like an ADHD child, even if the child does not have ADHD.

 

The child with ADHD has trouble prioritizing what stimuli to pay attention to or creating a hierarchy. I can see this in my son. When the OT was talking to me about his low registration, I said something like, "his brain isn't organizing the sensory input correctly," and she corrected me, saying that it was "registering" the input, not "organizing" it. Although I saw her point, your post helps me see why I said it in that way. I see both issues in DS; he does have trouble organizing. Hence the double diagnosis for him, I guess!

 

We're finding that with our son that the ADHD meds are not as effective as the ped hoped (even though they do make a difference, as we can tell when we forget to give DS his afternoon dose). I'm speculating that some of these residual behaviors that remain unaddressed may actually be his SPD issues showing up.

[Storygirl]

 

She didn't say anything about low registration and I haven't heard of it before. She said he is hypo-responsive to vestibular input and "has difficulties with" proprioceptive. She then said in summary that Ds has "difficulties with sensory processing affect his motor planning and coordination which make it difficult to perform novel tasks and to generalize familiar tasks. This in turn can impact his attention because he is required to focus more attention and cognition on tasks that come automatically to others. Additionally, it can lead to increased frustration affecting his self-regulation."

 

So here is what the OT said about my son, so that we can see where the issues overlap and where they might be different.

 

Developmental coordination disorder (dyspraxia)

Modulation disorder

Possible sensory defensive disorder (he lacked one main diagnostic thing but had the rest)

Possible difficulty receiving and/or interpreting vestibular and tactile input

Definite difference from the norm in:

    Sensory seeking

    Inattention and distractibility

    Registration

    Auditory processing

    Vestibular processing

    Multisensory processing

Probable difference from the norm in:

   Emotional reactive

   Fine motor perceptual skills (he definitely has an issue with this, which is why we sought OT to begin with)

   Visual processing

   Touch processing

   Modulation related body position and movement

   Modulation of movement affecting activity level

   Modulation of visual input affecting emotional response and activity level

   Emotional/social response behaviors

   Threshold for response.

 

:sad:

[Snow]

Story girl, did you have the SIPT done? It's the more comprehensive assessment.

[PeterPan]

Story, I like your OT!  When you move, bring her along.  Just pack her right up in a suitcase and tell her you'll give her bonbons.  :D

 

Here's the link to find a SIPT-certified OT.

 

 http://www.wpspublish.com/store/Training/TherapistIndex 

[Jennifer-72]

I think my real problem with OT is actually the lack of communication at this particular place. It was recommended by the NP and their web site has all the right stuff. But I guess I thought I would get more education about ds and his issues, even just from the eval and certainly as we've met them these past two times. Probably I just need to chill. This lady is supposed to call Monday and maybe that will make me feel better about it.

 

Jennifer, the way you explained the complexities of motor planning was brilliant and I'm so thankful. Geez! am just such a novice here.

 

We are going to explore meds for him, btw. Something I read somewhere raised a thought - if he never experiences focus and clarity of thought, how is he supposed to be aware and self monitor his inattention? And that's really stuck with me. Sometimes when we are working together I just feel like man, 50% of his brain is asleep most of the time. The NP said she thought his iq info was not an accurate reflection because he's just so affected.

 

Yes, we did get a written report from the OT. It's so vague compared to the NP report! There's not much definitive on it; "decreased fluidity of movement," "demonstrated difficulties with..."

 

Anyway...

 

Thanks again for everyone's thoughts. Navigating all of this would be ten times harder without your collective input.

Hopefully, your phone call with the the OT gives you a better idea of her direction going forward. For every therapist involved with ds we have always set at least three main measurable goals that we check on every twelve weeks to see how we are doing progress wise.

 

Our psychologist told us that in his experience even if medication ultimately didn't work for the child it in many cases he found it often lead to a much better ability to self monitor. Not that it matters, but I would say our psych is not big on medication. I thought that his point made so much sense though. If the child doesn't know what a fully attentive and regulated state feels and looks like, how can they make that happen. Of course, it is only one other piece to the the self monitoring piece since you need good self awareness of your strengths, weaknesses, passions and interests to be able to put it all in place. I am really trying to focus on that self awareness this year with ds in order to build on all the other executive functioning skills.

[Storygirl]

Story girl, did you have the SIPT done? It's the more comprehensive assessment.

 

 

Story, I like your OT!  When you move, bring her along.  Just pack her right up in a suitcase and tell her you'll give her bonbons.   :D

 

Here's the link to find a SIPT-certified OT.

 

 http://www.wpspublish.com/store/Training/TherapistIndex

 

She didn't do the SIPT. I checked the link and couldn't find her name as a certified tester. I'll ask her about it, because with so many issues, I think we could probably use a more thorough investigation. She did the SII-R and the Sensory Profile, as well as the Beery VMI and the Developmental Coordination Questionnaire. So these results are the tabulation of those tests, which she did during the first couple of sessions. After the last session, she said she could see in action what the questionnaires indicated. She's just beginning to work with him, so I'm sure we'll get more info from her observations as we go along.

 

It's probably a good idea for us to seek out an OT with the SIPT certification when we move. Thanks for the link, Elizabeth!

[Storygirl]

Hopefully, your phone call with the the OT gives you a better idea of her direction going forward. For every therapist involved with ds we have always set at least three main measurable goals that we check on every twelve weeks to see how we are doing progress wise.

 

Our psychologist told us that in his experience even if medication ultimately didn't work for the child it in many cases he found it often lead to a much better ability to self monitor. Not that it matters, but I would say our psych is not big on medication. I thought that his point made so much sense though. If the child doesn't know what a fully attentive and regulated state feels and looks like, how can they make that happen. Of course, it is only one other piece to the the self monitoring piece since you need good self awareness of your strengths, weaknesses, passions and interests to be able to put it all in place. I am really trying to focus on that self awareness this year with ds in order to build on all the other executive functioning skills.

 

Jennifer, a lot of great thoughts in this comment!  I love the idea of setting measurable goals, so that one can see exactly what is being worked on.

[Snow]

Storygirl, that's a lot for you to soak in. Hopefully the OT gave you some narrative in the report, describing how each of those areas differs from one another and how she proposes to address them. To Jennifer's point, I would really be curious about her broader plan via goals. Our report is pretty short but very goal focused. I copied a couple of them here. He has five in all.

 

 

"It is recommended that DS receive medically based Occupational Therapy services 1 time(s) per Week for 6 months to address the following goals.

1. Ds will improve motor planning as demonstrated by completing a 5 step obstacle course with at least 1 novel component on 3 of 4 sessions

 

2. Ds will improve bilateral coordination as demonstrated by

a. completing 10 fluid jumping jacks on 3 of 4 trials

b. completing 10 symmetrical cross strides on 3 of 4 trials"

 

I like that she included measures for success in the goals. But again, the overall report is very vague. I asked her if he has an official diagnosis for anything and she said no, just areas of improvement. Which makes it hard to get a sense of urgency or priority, that's for sure. I did talk to her again today and I'm still a bit unsatisfied. So, I asked how significant his issues are and she said, well he definitely has some difficulties, but then turned it around and asked me, how much are they impacting his day to day life? Oy. Not much at this point, as I've mentioned, but I know enough to know this stuff doesn't just magically disappear.

 

Dh is going to call insurance tomorrow since we might be closer to meeting our deductible than we thought.

 

Sorry, this isn't adding much to the broader conversation here.

[geodob]

It might be helpful to understand a bit about this thing called 'Proprioception'?

With every muscle that we have.  At both ends of each muscle, are what are called 'Proprio-Receptors'.

 

Then in our mid-brain, is a region used for spacial processing?

Which is made up of something called 'place cells'.

Where the brain recieves input from all of the Proprioceptors on each muscle?

Then links it to these place cells, and forms a mental spacial representation of all of our muscles.

 

But mixed amongst the place cells, are what are called 'grid cells'?

What they do, is locate the place cells in relation to each other.

To appreciate this, perhaps you could reach under your desk, and touch your knee?

 

Though as you do this, consider how you know where your knee is, you reach to touch it?

But you can probably be more precise than this?

Reach down and with a finger tip, touch an ankle, or a big toe?

 

So given that this was done under the desk, and out of sight?

As you move your hand to touch your knee, or finger to touch your ankle?

Perhaps you could think of the place cells for your finger and ankle?

Using the grid cells, for your finger to locate your ankle.

 

But an important thing about this spatial conception of ourselves with place and grid cells?

Is that this is internal, and doesn't locate up and down?

While it locates our head and feet as opposing ends.

It wont recognize that we might be upside down and doing a hand-stand?

 

This is where the Vestibular system comes in, and uses fluid to locate up and down.

In the same way that you can look at a glass of water, to precisely identify where up and down are.

 

Though the key to developing the proprioceptive and vestibular systems?

Simply involves doing various activities with the 'Eyes Closed'.

 

When vision is removed, we are totally reliant on our proprioceptive and vestibular systems for 'motor control'.

So that simply removing vision, forces one to focus on and become more sensitive to our proprioceptive and vestibular systems.

 

 

[Storygirl]

geodob, that was awesome!  Thanks for all of the information! It is super helpful.

 

Kate, It sounds like the reporting and communication style of our OTs is opposite -- ours gives a ton of diagnostic information but no goals, and yours gives goals without the diagnostics. Too bad they can't learn from each other how to make a perfect report!

 

There is quite a bit of narrative in our report, but it summarizes the intake information and test results without actually saying how OT will help address the issues or what the therapy process will be. I'm sure she has a lot of plans and ideas; she just didn't write them down for me. She did give me several handouts explaining things that can be done at home for Modulation Disorder (two pages), providing a balanced sensory diet (1 page), and activities for tactile stimulation, proprioceptive stimulation, and vestibular stimulation (one page for each). Tons of information about what we can do at home, but not a lot about what she will be doing in their sessions together.

[Snow]

geodob, that was awesome! Thanks for all of the information! It is super helpful.

 

Kate, It sounds like the reporting and communication style of our OTs is opposite -- ours gives a ton of diagnostic information but no goals, and yours gives goals without the diagnostics. Too bad they can't learn from each other how to make a perfect report!

 

There is quite a bit of narrative in our report, but it summarizes the intake information and test results without actually saying how OT will help address the issues or what the therapy process will be. I'm sure she has a lot of plans and ideas; she just didn't write them down for me. She did give me several handouts explaining things that can be done at home for Modulation Disorder (two pages), providing a balanced sensory diet (1 page), and activities for tactile stimulation, proprioceptive stimulation, and vestibular stimulation (one page for each). Tons of information about what we can do at home, but not a lot about what she will be doing in their sessions together.

Yes, it sounds like our two OTs need to get together, lol. Glad to know you've received such comprehensive info though. That will be great to take with you. Does this OT know of anyone where you are moving? Sometimes they have contacts through various associations, schooling, etc.

 

Geodob, again many thanks. So interesting how this all works and how connected everything is. I'm going to ask ds to do some activities with his eyes closed more often, for sure!

[geodob]

Kate, I've been reconsidering what you've written, which makes me question whether your DS has proprioceptive difficulties?

Given: 'My son is super sporty boy. He climbs rock walls, plays every sport, etc.'

 

Where I wonder if it is his Vestibular difficulties that are the real issue?

With Vestibular difficulties, as people don't have a precise sense of where up and down are?

They use 'visual cues' to provide this information.

So for example, with the 'jumping jacks' exercise?  

It would be interesting to do a comparison test?

Firstly, to do them in front of a blank wall?

Then to do them with the edge of a door frame, directly in front of him?

Where the importance of the edge of the door frame?  Is that it would provide a reference to locate up and down.

 

So that it would be interesting to know whether having a 'visual cue' makes a difference or not?

[kbutton]

Storygirl, that's a lot for you to soak in. Hopefully the OT gave you some narrative in the report, describing how each of those areas differs from one another and how she proposes to address them. To Jennifer's point, I would really be curious about her broader plan via goals. Our report is pretty short but very goal focused. I copied a couple of them here. He has five in all.

 

 

"It is recommended that DS receive medically based Occupational Therapy services 1 time(s) per Week for 6 months to address the following goals.

1. Ds will improve motor planning as demonstrated by completing a 5 step obstacle course with at least 1 novel component on 3 of 4 sessions

 

2. Ds will improve bilateral coordination as demonstrated by

a. completing 10 fluid jumping jacks on 3 of 4 trials

b. completing 10 symmetrical cross strides on 3 of 4 trials"

 

I like that she included measures for success in the goals. But again, the overall report is very vague. I asked her if he has an official diagnosis for anything and she said no, just areas of improvement. Which makes it hard to get a sense of urgency or priority, that's for sure. I did talk to her again today and I'm still a bit unsatisfied. So, I asked how significant his issues are and she said, well he definitely has some difficulties, but then turned it around and asked me, how much are they impacting his day to day life? Oy. Not much at this point, as I've mentioned, but I know enough to know this stuff doesn't just magically disappear.

 

Dh is going to call insurance tomorrow since we might be closer to meeting our deductible than we thought.

 

Sorry, this isn't adding much to the broader conversation here.

 

If bilateral coordination is a big issue with your son, he might find that VT works on that in ways that are similar to OT, and then you could find out how to work on motor planning at home, maybe. Our son needs an OT evaluation (we're in the middle of lots of developments with him and had put off an OT eval). He is receiving VT--at first he was borderline for needing VT, but as the print size decreased, and the pages become more crowded, he started showing symptoms. Our COVD doc was surprised that he has compensated as long as he has. Anyway, now that we are doing VT, I was pretty surprised at how many exercises work on bilateral coordination. He has had trouble with bilateral coordination for a LONG time (shows up in swimming big time). It's too early to tell how it will all work out, but I am really stoked that his VT could potentially help his trouble with bilateral stuff. The woman trained to do the VT said there is quite an overlap with OT in this regard.

[PeterPan]

Kbutton, remember, VT is a crock and you MUST NOT say that it did anything good for your kid.   :lol: 

 

Seriously, congrats on the progress!  :D

[Snow]

If bilateral coordination is a big issue with your son, he might find that VT works on that in ways that are similar to OT, and then you could find out how to work on motor planning at home, maybe. Our son needs an OT evaluation (we're in the middle of lots of developments with him and had put off an OT eval). He is receiving VT--at first he was borderline for needing VT, but as the print size decreased, and the pages become more crowded, he started showing symptoms. Our COVD doc was surprised that he has compensated as long as he has. Anyway, now that we are doing VT, I was pretty surprised at how many exercises work on bilateral coordination. He has had trouble with bilateral coordination for a LONG time (shows up in swimming big time). It's too early to tell how it will all work out, but I am really stoked that his VT could potentially help his trouble with bilateral stuff. The woman trained to do the VT said there is quite an overlap with OT in this regard.

Thanks for mentioning this and I hope it continues working for you. Keep us posted!

 

I said it earlier, but it really is mind boggling how connected everything is and how complicated it gets.