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Impulsivity/mild aggression in my 2E DS?


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There are forms that the professional you see will have you fill out, there is also a computer based test that is indicative but not conclusive.  Your DS is approaching an age where the brain is beginning to change and NT also are making some behavioral adjustments.  If you want to look into something you can do while waiting for evaluation, I would recommend the Mind Up curriculum.  http://thehawnfoundation.org/mindup/mindup-curriculum/

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In our area, the Vanderbilt survey is the gold-standard for diagnosis. Some forms of it contain indicators for ODD and OCD as well. Docs here will have the parent fill it out, and then teachers or other people who see the child in other settings. It's meant to be something you don't deliberate over--you answer based on first impressions.

 

This is the parent version: http://www.uwmedicine.org/neighborhood-clinics/Documents/03VanAssesScaleParent%20Infor.pdf

 

We found that some symptoms changed over time; my kids both started out as primarily inattentive, but I think my older son would qualify as combined type now. From the comments I've received, I guess that is unusual. It led us to believe (for a time) that the sensory issues were causing the ADHD behavior, but we do have both (as well as other stuff!). I think the biggest thing with 2e kids is that they can appear to be very typical except when they suddenly aren't, and there isn't always a lot of consistency or reason for it (and it can make it harder to diagnose or feel confident with a diagnosis at times).

 

You don't have to exhibit every problem to have the label apply or to find ADHD strategies helpful.

 

I also think that ages 7-9 are when a lot of things come out of the woodwork for boys. They change so much, and my older son was incessantly hungry during that time period, which affects mood as well. My younger son gets very irrational if he needs to eat.

 

2e--Shellagh Gallagher has some great stuff on 2e kids. These are presentations, so you just get notes, no audio, but they are good: http://www.rfwp.com/pages/shelagh-gallagher/downloads/

Bright not Broken podcast on The Coffee Klatch network has some good ADHD information.

http://www.wrightslaw.com/info/2e.gifted.adhd.pdf--thishas some great information 

Late, Lost, and Unprepared is a great book--it focuses on problems and strategies, not so much diagnosis. 

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I'll flip this and suggest you find a new OT.  What is the OT doing for the impulsivity?  Basically going to a psych gets you a label and a trip to the ped for meds.  Is that what you want, or do you want options?  I'm getting neurofeedback for my (very similar, crazy impulsive and unpredictable, sometimes volatile) ds.  Might want a different OT to get neurofeedback and work more on self-regulation.  They only know what they know and each one knows something different.  I've been to 4 OTs with my kids, and when I exhaust what this one knows I'll move on.  

 

Did she do the BRIEF or a similar screening?  Our first OT did.  It's the same thing a psych will do.  If you did, you already know the answer.  I mean, sure I'm all in favor of evals.  You learn a ton through evals.  Is she giving you covert signals she thinks something MORE is going on?  Like bipolar or ASD or something?  

 

Evals are great, awesome, and good, do 'em.  But still you get back to the question of what kind of CHANGE you're wanting to effect because having an ADHD label alone won't change anything.

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Because I'm reactionary.  :)  Nah, because usually when they have therapies they think can help they're usually gung-ho on the value of it.  So I was just connecting dots and saying if the OT *isn't* offering you things that can help (because OTs differ) then move on to an OT who does.

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I'll flip this and suggest you find a new OT.  What is the OT doing for the impulsivity?  Basically going to a psych gets you a label and a trip to the ped for meds.  Is that what you want, or do you want options?  I'm getting neurofeedback for my (very similar, crazy impulsive and unpredictable, sometimes volatile) ds.  Might want a different OT to get neurofeedback and work more on self-regulation.  They only know what they know and each one knows something different.  I've been to 4 OTs with my kids, and when I exhaust what this one knows I'll move on.  

 

Did she do the BRIEF or a similar screening?  Our first OT did.  It's the same thing a psych will do.  If you did, you already know the answer.  I mean, sure I'm all in favor of evals.  You learn a ton through evals.  Is she giving you covert signals she thinks something MORE is going on?  Like bipolar or ASD or something?  

 

Evals are great, awesome, and good, do 'em.  But still you get back to the question of what kind of CHANGE you're wanting to effect because having an ADHD label alone won't change anything.

We've been with her forever - since he was 18 months old. I've wondered now and again about trying someone else - it feels almost like we're outgrowing her, if that makes sense?  She was fabulous with his OT-related speech/feeding problems... but I'm less pleased with the progress on the SPD (which she sent else elsewhere to diagnose - the developmental pediatrician - instead of doing an eval herself), and in general anti-meds unless it's last resort....

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See, I bow to you...   :)   But seriously, I've used four OTs with my kids so far.  These people are NOT omniscient.  They learn things in their grad programs and they learn more programs that they pay to get trained in.  They only know what they know.  These providers are all typically very niched and pigeon-holed.  It's why NILD and some of these more global approaches gain traction, because there you have everything under one roof.

 

I think it's perfectly reasonable to ask questions.  If he has SPD diagnosed (which the OT could have done herself, yes?), then what are your optimal therapies?  Well, uh, anything for sensory, but I'd go further.  Were there retained primitive reflexes?  Around here the OTs do RMT for retained primitve reflexes, but that's additional training that not all have.  If you can find it online for free, it's not RMT.  Neurofeedback is another.  Metronome work is another.  BalavisX.  Ask for these things, kwim?  If she's not offering them to you, they're not her gig.  It's OK to want more.

 

We have used our SLP since ds was newly 2.  She's very dear to us and bends over backward more than anyone I've ever met (I kid you not) to help us.  And I STOPPED therapy for months when I decided, against her opinion, that ds had more issues from his dyslexia and poor phonological awareness than actual motor planning at that time.  Sure we could have kept going, but I needed MORE than what she could offer.  And my point is NO ONE PERSON is everything our kids need.  We have to figure out what we need and find the people who do it.  It's not personal and it's not emotional.  It's just what do we need and who can do it.  

 

So I say again, I am ALL FOR psych evals.  Dude, you know my ds has had *3* psych evals, seen 4 SLPs, and 3 OTs in the past year, right?  I'm all for evals, lol.  But I'm saying there are things some OTs do that could help this too, and you need to look into it.  Find someone who has a good reputation for SPD if that's your concern.  See what you can get, how someone else would approach those aspects.  This is not personal.  This is business.  

 

Fwiw, my ds started with this OT, and in 3 weeks of therapy he was noticeably calmer and easier to work with it.  You can't even put your finger on it, because it's so subtle.  It's just like wow, we're having less meltdowns, he's easier to live with, life is a little easier with him, kwim?  That's balavisX and RMT for retained reflexes and that infinity wood 8 thing, all done by the OT twice a week, and daily RMT homework.  Mid-August I'm using my funding to start him on neurofeedback, which I'm REALLY psyched about.  I'm hoping it may smooth out the anxiety and brain stuff.

 

Ok, I'm rereading your comments and thinking.  I want to make sure I said this.  You really ought to be getting a full, proper neuropsych eval from someone who can sift through ADHD, ASD, etc.  I don't know if she's giving you code talk or what, but you really ought to be.  My other advice is true too (to be willing to add to your therapy team if she's not hitting enough on sensory), but I'm just saying yeah with that mix it's time.  You may end up learning more than you anticipate.

 

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