How important is to get a Neuro-Psych eval? ADHD

[ForeverFamily]

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[OneStepAtATime]

Hugs, Mom.  I know this is hard.

 

The advantage to getting a Neuropshych eval is that they should be able to find out not just if there is an ADHD issue but where her overall strengths and weaknesses lie.  You want the big picture and as many of the little components that make up that picture as possible.  This is not about getting meds.  This is about finding the most productive and successful path possible for you and your child, not just for the short term but for the long term.  A neuropsych exam may help give you more of the answers for getting on that better path.  In most instances, as far as I can tell, peds just don't have the background knowledge or experience to genuinely help with that, KWIM?

[wapiti]

I think it's difficult for peds to have the amount of specialized experience that I'd want.  (I know more than one kiddo IRL who was misdiagnosed by a ped.)  There are so many overlapping symptoms and additional possible comorbid issues that may go unnoticed without more complete testing.  My understanding is that adhd is supposed to be a diagnosis of exclusion, i.e.,  other possibilities are excluded first, possibilities that a ped may or may not be equipped to handle (e.g. peds typically are not qualified to perform IQ testing and the like).  Then there's the treatment angle - I'd be looking for extensive experience choosing meds.

 

Outside of the NP world, there may also be alternatives to meds that may be worth trying, depending on how far outside the box you are interested in going, but even there, it would be imperative to know exactly what one is treating, i.e., adhd and not something else, like auditory or vision issues, etc.

[Arcadia]

It depends on the pediatrician. My kids' pediatrician would not diagnose, he would refer. The one my kids see is also used to extreme cases of adhd, autism, SPD so if it is "mild" he won't refer (that's what he told us). Our insurance does allow going directly to a psychologist though so we didn't need a referral.

[MomatHWTK]

IMO, there are lots of conditions that look like ADHD or can be comorbid with ADHD so I'd go with a step up from the pediatrician. 

[OneStepAtATime]

IMO, there are lots of conditions that look like ADHD or can be comorbid with ADHD so I'd go with a step up from the pediatrician. 

:iagree:

[ForeverFamily]

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[OneStepAtATime]

I say this with the greatest sympathy but as mentioned upthread, you don't really know WHAT may be happening or if there are multiple things happening.  Please don't target ADHD as THE thing when you don't really know.  It may very well be that you are facing ADHD.  It could be co-morbid with something else.  If you only focus on one thing, assuming it must be that (and many peds seem to do this, too, not just parents) and miss the others you may not get the answers you actually need to be able to help her.  I think you would be better off seeking a more thorough evaluation and while she is still young and more pliable.   As she gets older it may get harder and harder to help her, especially once she hits the pre-teen years.  Some kids get VERY resistant to help at that point.

[OneStepAtATime]

And hugs....

[kbutton]

I say this with the greatest sympathy but as mentioned upthread, you don't really know WHAT may be happening or if there are multiple things happening.  Please don't target ADHD as THE thing when you don't really know.  It may very well be that you are facing ADHD.  It could be co-morbid with something else.  If you only focus on one thing, assuming it must be that (and many peds seem to do this, too, not just parents) and miss the others you may not get the answers you actually need to be able to help her.  I think you would be better off seeking a more thorough evaluation and while she is still young and more pliable.   As she gets older it may get harder and harder to help her, especially once she hits the pre-teen years.  Some kids get VERY resistant to help at that point.

 

I think I am inclined to agree with OneStepAtATime.

 

Your situation is your situation--you do not need to feel bad for being worried over it just because you think someone else might have a more life-altering set of challenges. It's okay to want support and answers for your situation.

 

:grouphug:

[ForeverFamily]

I say this with the greatest sympathy but as mentioned upthread, you don't really know WHAT may be happening or if there are multiple things happening.  Please don't target ADHD as THE thing when you don't really know.  It may very well be that you are facing ADHD.  It could be co-morbid with something else.  If you only focus on one thing, assuming it must be that (and many peds seem to do this, too, not just parents) and miss the others you may not get the answers you actually need to be able to help her.  I think you would be better off seeking a more thorough evaluation and while she is still young and more pliable.   As she gets older it may get harder and harder to help her, especially once she hits the pre-teen years.  Some kids get VERY resistant to help at that point.

 

I will definitely keep an open mind.  Thank you, for reminding me to do this!  Honestly, I really don't care if it is ADHD or something else, I just want some answers of how to help her.  From my unprofessional opinion ADHD just seems to fit, so this has been my starting point.  ;)  But I just know that compared to the same age peers, or her older and younger siblings, her behaviors are becoming less of a "she will just grow out of it" and more of inappropriate behavior for her age that needs to be addressed.  Thank you all for being so understanding.  This has been very helpful! :)

[PeterPan]

Coming in a little late.   :)  It's really not about whether your ped has experience with ADHD.  OF COURSE he has experience with ADHD.  The real question is whether having behavioral surveys done and getting a label will change how you teach her and work with her, and they won't.  You already know what that label would be, and if having that label would have helped you solve your problems you already would have done it.

 

The reason you go to some kind of psychologist for thorough, proper, COMPLETE testing is 1) to make sure there's nothing ELSE going on and that the diagnosis is correct and complete, and 2) to give you info and hard data that you can use to change how you work with her.  That's what a psych does.  The ped will do behavioral surveys and eventually offer a scrip.  That won't change your teaching.  If you want to change your teaching, go to the psych.  

 

The more you pay, the more hours of testing they do.  So if you go to say a clinical psych, that will typically be the lowest priced option.  They'll typically do 2-3 hours of testing (maybe more, maybe less) and it will be WISC (IQ), WIAT (achievement), and maybe a couple other things and EF screening tool.  Psychs vary obviously, but that's sorta the jist.  When you go to a neuropsych, you'll AT LEAST double the number of hours of testing.  Many psychs will do 6-10 hours of testing.  This is especially important if there are developmental delays, motor planning issues, or just oddities that need to be explored.  But it's also money because you're getting BILLED for that.

 

If you have insurance and you can get the more extensive testing, by all means do it, mercy.  But with an eval by a clinical psych ballparking $800 around here and a neuropsych eval at $1800-2100, that's a huge difference.  You'll really want to know *why* you're doing it.

 

Remember too the local ps can run that psych eval.  You just never know how they'll do.  I've talked with people in our state who got minimal help and people who got way longer reports than I got from my fancy neuropsych.  Now the school won't tell you how to apply it.  I'm just saying you have options on how to go about getting that information to affect your teaching.  That label from a ped doesn't really do that.  You also don't need a ped referral to schedule with a psychologist, at least not in our state.  You would only need it if you require it for your insurance.  So definitely work through all that, but if your insurance requires a referral for the psych eval that would be an excellent thing to pursue.

 

Now a couple questions.  this is a 7 yo 1st grader who's saying she's bored.  She's surrounded by 3 little ones while she works???  I'm a little blunt, but I'll just say it.  If she's ADHD, that needs to change as that's not workable.  Put somebody in preschool or give her a room of her own to work in or something.  I can't help you with multi-child dynamics obviously.  Thing is, my dd has ADHD (she's 15 now) and she was, well she was a pistol but we didn't have other kids underfoot.  At that age we'd work to a timer then send her to run laps.  We did ice skating every day for 1-2 hours.  Literally.  My ds just got his label, so his butt goes into gymnastics.  

 

What I'd be interested to know is what happens when you *don't* have the distraction of the other littles going on.  Do you have a granny you could send the others to for an afternoon just to see what happens if you have just her and no distractions?

 

You said she's unusual compared to your other kids. There are some other diagnosable issues that *look* like ADHD on the surface and commonly get misdiagnosed or missed entirely till the parent pushes for better evals.  Remember that ped eval is just behavioral surveys.  One thing I'd be wondering about is CAPD.  You've said no flags for it, so I'm not saying it is.  I'm just saying when you have NO other kids with ADHD symptoms, that's pretty odd frankly.

 

I don't know, I'm saying you have no flags, then I reread your post.  I don't know, I'm not there. You are catching the working memory deficits but that doesn't explain "doesn't hear the 2nd step."  I never had a problem getting my dd to read through her words as long as I allowed her to be in motion and even my ds, same deal. You're saying she can't even pull it together to read 2-4 words in a limited distraction environment? I'm just saying to me what you're describing is a little extreme.  I would demand the psych eval.  You need to know you have the RIGHT labels and explanations.  

[susanfh]

I don't really have anything to add regarding Neuro Psych testing other than to say that I had it done for my DS and it was a huge help! I had it done because I was suspecting dyslexia.  We already suspected ADHD and weren't planning to medicate b/c we school at home and figured we could modify as needed for him.  But the NP testing really opened up my eyes to how much his ADHD affects his learning.  He didn't get a firm dyslexia dx but he did get a firm ADHD dx.  And we have chose to medicate and it is like night and day how much of a difference it makes for him.  

 

As far as what OhElizabeth said about distractions, that is very true for us, even with medication.  My littlest one is 20 months now and we call him Destructo.  He is crazy.  So we save all our really hard stuff for naptime.  As soon as he naps, we do math and phonics.  I set a timer for 20 min (we have worked up to this and sometimes this is still too long for him) and then it's his sister's turn.  They alternate so that they get brain breaks.  We always start with phonics because that is the one thing that is impossible for them to do with distractions going on.  Then math. If we finish that before he wakes up then we do handwriting and anything else.  We do science and history (very lightly) sometimes while my little guy is awake and sometimes we use bedtime stories for those readings.  Juggling kids is hard.

 

I am strongly considering a halfday preschool a few days a week for next year even though he will only be two.  If that's not possible/something you would consider.  I'd say give the 3 and 5 year old some type of learning video and get them in the habit of not interrupting you during this time and do the intense stuff with your 7 year old during the 1 year olds naptime.  For us it's a trade off because I'd rather get this stuff done in the morning, but its just too chaotic to do it then.  

 

I hope this isn't too off topic and somewhat helpful.

[Storygirl]

I can't write much right now, but I have a couple of things to add that I'm not sure others have touched on.

 

1) Kids with ADHD are not always constantly active/figety/etc. My son has definite calm moments and hyper moments; there are times when he can hyperfocus on something, and times when he can't focus on anything for even a minute. So I'd caution you about watching other kids with ADHD and comparing your child to them. First, you are only seeing the other child at one moment in time, so you aren't getting a whole picture of what they are like. Secondly, every child is different, so two children who both have ADHD can behave very differently from one another.

 

2) It took us awhile to get our son's ADHD diagnosis, because our pediatrician couldn't see it. DS would be very calm and withdrawn in his office (he also has anxiety and is an introvert, so he tends to close down in those situations instead of appearing hyper). So if your ped seems unconvinced and doesn't seem to see the problems you are facing, don't hesitate to go somewhere else for a second opinion. And I love our pediatrician. He is on board with it all now, but it took some time.

 

3) Our pediatrician also said he didn't think a full NP exam was necessary or worth the cost. We did it anyway. And we got a ton of useful information about DS that we did not know before, including an unexpected diagnosis (non-verbal learning disorder) that was both devastating and extremely helpful, because it finally dug into the root cause of some of DS's issues. So it was worth it for us.

 

4) If your daughter gets an ADHD diagnosis, then you can tackle the question of medications. Each family has to tease this out on their own. We were against medicating but then decided to consider it a tool that could help DS reach his highest potential as the person that God means him to be. It hasn't been all sunshine and roses. He's had side effects and has tried many different medication options. BUT the meds dramatically affect his ability to function better both academically and socially. If you do decide to medicate, it does not mean that you have failed in your parenting.

 

5) And on a related note, I understand perfectly feeling like a parenting failure and also the pressure of being both parent and teacher and not having that outside person to give a perspective on what you are seeing. I've been there. I'm still there at that point some days. But if what you are dealing with is ADHD or another such issue, you can't make it go away with even the best parenting. I gave it my all and wore myself out and felt like I was having zero impact on DS's behavior and character. Now in reality, all of the effort I gave, and all of the effort that you give DOES make a difference. Don't let those nagging feelings convince you otherwise. But the thing is that sometimes we need more help and different resources than we have at our own disposal. There is help out there, and you don't have to go it alone. Realizing that you need to talk to your pediatrician is a great first step. You may find that you don't get all the answers that you want or need. Don't let it discourage you. Sometimes it takes awhile to figure things out. And by awhile I mean months or maybe longer. Just take it one step at a time and keep moving forward until you find that you and your daughter and your family are in a different and hopefully better place.

 

So, I'd say that while an NP evaluation to screen for ADHD may not be entirely necessary (and perhaps may not be covered by insurance), it could end up being a good thing to at least look into. It would give you a lot of information that can then help you shape and direct what you do for homeschooling and parenting. I might also suggest asking your pediatrician for the name of a child psychologist who specializes in these kind of issues. We found our psychologist to be invaluable as we navigated through everything.

 

:grouphug:

[geodob]

I was going to agree with having a general psych evaluation to start with.

But after reading your observations in post #8.

I would suggest that this would be a waste of time and money, and not provide accurate information.

As their is no way that your DD will be able to sit down for a few hours and cooperate with doing all of the tests?

So that any report, wont provide accurate results.

 

But the developmental process of attention needs to be understood?

Where the ability to maintain a focus of attention?

Is a later development.

The first stage of development, that is typically formed by around the age 7 years?

Is the ability to control and regulate 'Impulses'.

 

If you look at everything that you have observed, in terms of an inability to control and regulate Impulses?

I couldn't see anything that wouldn't be explained by this?

Where she has no control over these Impulses.

 

But in terms of a diagnosis and ADHD?

It is the H: hyperactive/ impulsive that needs to be identified and understood.

[PeterPan]

Hogwash. Our psych worked in 45 minute blocks with 15 minute breaks to go outside and run and stretch.  He further broke the 45 minutes up and would move from room to room and give them snacks and drinks.  And he had assistants for some of the testing, which kept it fresh (new person, new tasks) too. My ds is off the wall busy when he's not sick and he had NO problems complying with the testing doing this.  

 

Now dd's psych just took them back and did 3 hour blocks, presumably with breaks.  Dd was 12 and she survived.  Wore her out, but she survived. That would have been really rough for ds. She's now jealous and wants to use ds's psych next time.  :D

 

They definitely vary, so just talk with people, find out their reputation, ask how they were with their kids.  They have their routine on how they test and this is not an uncommon issue.  They already have a plan.

[ForeverFamily]

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[kbutton]

1) Kids with ADHD are not always constantly active/figety/etc. My son has definite calm moments and hyper moments; there are times when he can hyperfocus on something, and times when he can't focus on anything for even a minute. So I'd caution you about watching other kids with ADHD and comparing your child to them. First, you are only seeing the other child at one moment in time, so you aren't getting a whole picture of what they are like. Secondly, every child is different, so two children who both have ADHD can behave very differently from one another.

 

Yes, yes, yes. My older son is mostly impulsive and distractible (to varying degrees). My second one is less easy to pin down--wider variety and variability in symptoms. And everyone gets used to their own "normal." We do have some identified (and some likely) ADHD on my side of the family, but I have a very large extended family, so it doesn't seem very pervasive--we dilute the overall effect (and it seems to be impulsivity more than anything). OTOH, DH's very small family is like a menagerie of (mostly not identified) ADHD of all kinds, lol! I think they've left no family member un-ADHD'd.  

[PeterPan]

Thank you so much for taking the time to type all that information out. It is very helpful, and is giving me a lot to think about. Yes she just turned seven in December, and is in first grade. I have tried doing her school at different times throughout the day. The best that seems to work right now is when my 1yo is down for a nap, and everybody else is off playing in a separate room. This has made a big difference for her, but I can still only get her to concentrate for so long. Really I am just focusing on the three Rs with her right now. It is typical for her to read about 3 words and then her mind can be off and wandering or she looks at the rest of the words on the page and gets overwhelmed. So I have to redirect her back to focusing on reading. Sometimes it takes a lot of effort to get her through her reading time. I typically have her read through about 4 pages from her AAR level 1 readers, so that equals about 4-6 sentences ( I.e. This is a rug for his bed, but cobweb cannot nap.). So she is progressing but she hates every minute of it and it takes her a lot of work to get through. I sometimes let her hold a toy or object which sometimes helps. Right now we are just progressing at her pace, but I am concerned about the years ahead, her being able to handle more than just basics of reading, writing, and math. Because that is about all she can handle right now.

 

I do need to be better at giving her a physical outlet. Our girls do ice skating as well, but we don't get to the rink nearly enough. It has been more difficult to just get outside because it has been cold. But I do know this is an area I need to make some improvement in.

 

Compared to my others kids she is most similar to the level of my 3yo in her impulse control. She has bad days and good days with impulse control, but she has always struggled in this department. She does best when she is busy doing something, but it is not always easy to find things to keep her busy. When she's bored she often gets in to trouble. Her attention span is longer than my 3yo, but not quite as long as my 5yo (kindergarten).

 

Forgive my ignorance but what is CAPD? As far as a family history of ADHD we don't really have an official family history of ADHD. However, I can think of a couple possible members of my family and/or husbands family that could very well have ADHD but have not been officially diagnosed. And come to think of it there are a couple members that have some pretty obvious battles with impulsive behaviors. I have also wondered a bit about my oldest, she is becoming more and more of a day dreamer and will often forget what she is doing. So it is possible that it could run in the family, but I don't know. Again I am not seeking this diagnoses just answers of how to help. This is something I never expected for life to hand me, but isn't that true for most things :-).

 

You have forced me to think through all these things, which has been very helpful. Thank you!

CAPD=Central Auditory Processing Disorder.  The symptoms will be almost like ADHD. Look for the book When the Brain Can't Hear if you think that's on track. You can also google it of course.  You'll find articles discriminating them.  They can be comorbid.  Usually the dc will have issues when there is background noise and that becomes a defining characteristic.

 

Does this anxiety and turning away from work occur only with reading or with other subjects as well?  

Does she have phonological processing issues?  Is the AAR actually HARD for her, as in she's slogging and slowly sounding out each word over and over with no fluency, or is it totally a focus issue?

Have you had her vision checked by a developmental optometrist?  My dd's attention symptoms for school work get worse when her eyes are bugging her.  She has done VT and now wears bifocal contacts.  Vision is very important to get checked.  COVD is where you find a developmental optometrist.

 

You might try putting those sentences into Quizlet and have her read just one at a time.  That way you can alter the font size, let her hang upside down, read at night in the dark after she's tucked in (we love to do that!!).  My dyslexic, VERY adhd ds does well reading a sentence at a time on the quizlet app.  We do it at night as he's going to bed, because that's when he's most worn down.  One night I was in there on the floor beside his bed reading, the lights were off, and all of a sudden SHOOP! out he somersaults out of bed!  I have no clue how or why.  I think he may have been doing handstands and decided to be more in-motion.  He climbed back in bed and went back to reading, lol.  

 

I just typed his newest reading stories into little booklets where each sentence is on a separate page for him to read and illustrate.  I think this will break things up, bring a different kind of kinesthetic/tactile element, and help with his comprehension.  I don't know what's going on with your dd obvioiusly, but I'll tell you I was SURPRISED the kinds of things that turned up in my kids.  My ds turned out to have a 28th percentile single sentence comprehension vs. his gifted IQ.  In other words, when you say a sentence to him, he doesn't UNDERSTAND it at all the way we think he does.  He understands in the *aggregate* and his comprehension goes up as he gets more material.  

 

I'm just saying you don't know what those evals will turn up!  

 

You may or may not want the psych your ped would refer you to.  Our ped just refers to the children's hospital, so that's uber expensive for people paying privately.  You'll want to look for someone with a good reputation with homeschoolers, someone known for giving helpful feedback.  

 

Ok, I'll explain something.  Lecka challenged me on behavior with my boy on some things, and she's right that it IS possible to have low expectations.  It's also important to find out what in the WORLD is going on before we assume it's ONLY a behavioral/volitional thing.  So, with all that said, I want to say that an ADHD dc *can* do their work.  They might do it while upside down or in motion, but they CAN do their work.  So when a dc of a very young age where kids are generally given to want to please is having trouble complying, I think it's really important to figure out why.  If it's ONLY adhd (as in no vision or language processing problems, no retained primitive reflexes, no undiagnosed food intolerances, no issue of not getting enough exercise, etc. etc.), I want you to know that it *is* reasonable to expect attention.  I don't expect attention to things that are slow, boring, dull, fixed, and motionless, but if I do everything I can on my end to keep it brief, interactive, fast-paced, large-font, the best time of day AND I've eval'd to look at all those physical issues, I would have no problem with doing some behavioral training.  And that's sort of my caveat I need to fess up, that my ds has a LOT of motion (the psych even said so) but he sits and does Barton with me an hour a day without fussing.  When he was 2 he started speech therapy and we picked those battles.  He had to learn to do what he was supposed to do.  And I had to learn how to pick up the pace and be at the lead end of that.  If my energy drops or I'm not fully prepped or I stop pouring it on, it's over.  

[geodob]

Impulse control uses a part of the brain called the Basal Ganglia.

Which has to be trained to 'inhibit impulsive responses'.  Which are more like reflexes.

That takes around 7 years to develop control of.

When the ability to inhibit impulses has been developed.

Then without these distractions, the focus can begin to shift to developing the ability to focus attention.

 

But it is important to understand 'impulse regulation' as a separate process from 'attention control.

Where it is rather a foundation.

While attention issues can be addressed with medications.

Medications aren't suitable for 'impulse regulation',  as they just suppress it totally.

Which is a problem, as these impulse responses play a major in personal safety.

 

Though their is ongoing research and trials into addressing this?

Which basically involve carrying out a task,  while at the same?

Something else randomly occurs, that can cause an 'impulsive response'.

Where it basically provides an opportunity to practice 'inhibiting the impulse'.

[PeterPan]

Geodob, so they're thinking the impulsivity can happen *without* the ADHD?  It does seem like some kids are much more dangerously impulsive and some are milder.  I thought the thought process of meds was it was speeding up processing speed so they *would* think and be less impulsive?  But it doesn't work out that way?

 

On a functional level, I like that our gymnastics program does relay races, working on the impulsivity and inhibition.  So it's definitely something you can carry over into life and work on in fun ways.

 

 

[kbutton]

Impulse control uses a part of the brain called the Basal Ganglia.

Which has to be trained to 'inhibit impulsive responses'.  Which are more like reflexes.

That takes around 7 years to develop control of.

When the ability to inhibit impulses has been developed.

Then without these distractions, the focus can begin to shift to developing the ability to focus attention.

 

But it is important to understand 'impulse regulation' as a separate process from 'attention control.

Where it is rather a foundation.

While attention issues can be addressed with medications.

Medications aren't suitable for 'impulse regulation',  as they just suppress it totally.

Which is a problem, as these impulse responses play a major in personal safety.

 

Though their is ongoing research and trials into addressing this?

Which basically involve carrying out a task,  while at the same?

Something else randomly occurs, that can cause an 'impulsive response'.

Where it basically provides an opportunity to practice 'inhibiting the impulse'.

 

I am not sure I am understanding this correctly. My son is impulsive, but not usually in a dangerous way (he's actually pretty cautious). Meds help his impulsivity somehow. Are you saying that meds suppress impulsivity totally or totally suppress the ability to inhibit? But, meds help tremendously, and my son isn't hyperactive. He's either attending totally or not attending at all. While not attending, he will move from task to task without reflecting on whether he has actually completed it properly, etc. He either realizes the quality of his action, or he does not. He doesn't really act hyper unless he is needing serious sensory input, and then it's not so much hyperactive as major sensory seeking (walking into walls, falling onto the floor, spinning, etc.). He does stim with noise (sometimes constantly for hours) while off meds. I feel like maybe his issues are purely executive functioning issues and maybe not even really attention--I know some people are really trying to show that it's all EF, and not really attention. I don't know. 

 

I guess I'm wondering how useful it is to break things down and say what meds regulate and don't regulate. I am not sure people even use the terminology the same across the board.

 

My main point is just to say that ADHD looks different on individual people. My son has a lack of self-control (over stims, where his mind goes, etc.), inability to suppress impulsive thoughts and actions (again not usually dangerous stuff), and an inability to reflect effectively on things (to learn them, to judge his own work quality, etc.) for any substantial amount of time without meds, whatever the reason behind it. Maybe I am not using impulsivity as a term correctly.

[kbutton]

geodob, are there games that work on impulse control? 

[geodob]

Some just published research, has identified that the brain has what they term as a 'Safe' region?

Where through experience, it locates 'things/ events' that are safe to react impulsively/ instantly to.

Which is primarily for dealing with 'dangerous situations'.

 

But for other different things/events, we define and recall various responses.

Which use Executive Function and are sent to the pre-frontal cortex, for reflection before responding.

With varying degrees of reflection, that develop into a common response to a thing/event.

 

An example of this, is the way that people respond to a call or message on their cell phone?

Their has considerable discussion about teenagers who respond impulsively to their cell phone, and are unable to reflect on whether to answer it now?

 

So to work on impulse control?

It is a generalizable skill, and therefore pausing before either commencing or completing any activity could be used?

It could be as simple as when eating?

At the stage after chewing the food, when are about to swallow?

Chew the food another 5 times.

 

Where anything that we do automatically?

Could be used to practice pausing, and then deciding when to continue,

[kbutton]

Interesting information. I couldn't re-explain that yet, but it make sense to me. I'll have to reflect on it and try to map it to real life a bit more. FWIW, my son has been able to verbalize the fact that his meds are making him more self-conscious (aware of others, what they are thinking about him, etc.). It has inhibited him in some regards. So, whatever portion of impulsivity or part of the brain related to this discussion is in play here, the meds are helping that portion. And it's been a very good thing.

[ForeverFamily]

 

 

And thank you so much OhElizabeth for your thoughts on reading. She understands the lessons from AAR just fine, and most often than not can get through the games with not much struggle (lots of hands on stuff seems to work best for her), but when it comes down to actually sitting and reading words from a book she struggles. I love the idea of using that app to help with reading, that may really come in handy as the number of words/sentences is about to increase now that she has just hit level 2. She does do a lot of wiggling while reading, which I allow as long as she is still reading. I will be reading and re-reading through all of your thoughts. Thank you so much! :)