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Some preliminary OT results. Any idea what this might mean?


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Anna had her second OT appointment this morning. The therapist checked only one primitive reflex (it was normal, but I assume she'll check more.) She said that Anna's a little low tone, and that she had a little difficulty with coordination on a hand to nose-then-to-finger test, more pronounced on one side. She's also a little behind on fine motor, but not all that out of line for age. (She had Anna duplicate shapes, and she did them in strange ways...Like for a 3-line star made with lines crossing, she created it by looping the lines so that she did a horizontal curve on top, then a curve on the bottom, then a vertical line straight through the curves. There was also an X with arrows at each end, and instead of drawing the v's for the arrows she made little feet at each end. No idea what that means, if anything.)

 

Could all of this mean anything? If they work with her on these few things could it affect other areas?

 

Also, on a form they filled out they labeled her a little more of an avoider than average, but much more of a seeker than others. How could she be both?

 

I asked why they'd suggested The Listening Program since she doesn't seem to have an auditory processing issue, and they said it might help her learn to modulate her always overly loud speaking voice. Really? I mean maybe it could, but I haven't seen that referenced as one of the uses.

 

From working with Anna this week, it seems like most heavy work ramps her up rather than calming her down. She's calmed by all the swinging and spinning equipment there and they "brushed" her and she melted, it was pretty awesome...Just put a couple brushes in my Amazon cart. :)

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Kids are complex.  Many of these kids very complex.

 

They can seek some forms of stimulation but avoid others.  One of mine LOVES swinging and heavy work but avoids loud noises, certain tones, and anything with heights.

 

Has she had a full auditory evaluation?  Any chance she has a slight hearing loss which makes her speak louder?

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My kid is a mixed sensory kid---sometimes craving/avoiding even within the same category of sensory work. We spent yesterday's OT session working on adding stuff to our sensory diet protocol.  It takes a while to sort everything out, and that's ok.

 

I agree with Ottakee that if you haven't done a baseline hearing test, I'd put that on the list of stuff to do as part of your due diligence in sorting out issues.

 

We chose not to do the Listening protocol, just because it's lower on the list of stuff to focus on.

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She said that Anna's a little low tone, and that she had a little difficulty with coordination on a hand to nose-then-to-finger test, more pronounced on one side.

..

Also, on a form they filled out they labeled her a little more of an avoider than average, but much more of a seeker than others. How could she be both?

 

 

Ask your child to do the hand to nose-then-to-finger test with one eye closed/covered then the other eye, than both eyes.  I have strabismus (cross eye) and my focus is off centered if I use both eyes. My SIL's twins had lazy eye (amblyopia) and the kids have similar issues with the hand to nose-then-to-finger test.  An eye patch would help either issue. 

 

My DS9 is both a sensory seeker (taste, texture) and sensory avoider (noise, light) with no neutral. DS10 on the other hand is a sensory avoider or neutral.

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I'll try that today Arcadia, thanks.

 

I just did a test where I whispered sentences facing away from her, and she repeated them perfectly so I'm pretty sure hearing isn't an issue. I think the loudness is just like the talkativeness, part of her ADHD and an inability to realize when she needs to modulate.

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My son was identified as mixed when he was in pre-school.  They said he was observed as either being totally sensory-seeking or totally sensory-avoidant.  In the observation it said something like, he was observed either to be running around and trying to touch things and bump into things, or else he was sitting very still and not responding to people trying to talk to him or engage him.  

 

More recent sensory inventories do not show him as sensory avoidant, but he can still have times he is overwhelmed with sensory stimulation.  But it seems like that has improved a lot with him as he has gotten older.  

 

But, um, when I said it took me a long time to get a handle on some of the sensory stuff with him?  It just takes time.  

 

But yeah -- you have to try to watch, and also keep in mind, her outward manifestation may not match what "makes sense."  She could be "acting" in a "sensory seeking" way either b/c she is understimulated and seeking sensory stimulation (or in my son's case -- stimulation in general), or she could be "acting" in a "sensory seeking" way b/c she is overstimulated and cannot control how she is acting so well.  

 

So at this point I think my son, overall, just swept back and forth at times between "overstimulated" and "understimulated" with the "understimulated" times sometimes *really* coming b/c he had gotten overwhelmed and was trying to recover by blocking things out (and avoiding them and appearing as a sensory avoider).  But really I think he was overstimulated for a lot of reasons, only partly sensory.

 

But overall -- I think see if the OTs can be helpful (I have had them be both incredibly helpful, and not helpful at all, for my two sons).  Keep in mind you may not be able to reliably tell if she is over- or under-stimulated by her outward behavior -- as in, it could be the opposite of what it seems like it could be.  And also, if something is new or difficult for other reasons besides just sensory, that might be playing into it for her.  You can just try to observe her over time and listen to recommendations, and keep trying to piece things together.  

 

You may also be able to talk to her about how she is feeling at certain times, afterward.  Maybe she is not that self-aware or insightful at this time, but hey, maybe she is.   

 

We call the "middle place" "ready to learn" locally.  Everybody calls it "ready to learn."  We want kids to be in a state where they are "ready to learn" and not prevented from learning by being either over- or under-stimulated for whatever reason.  "Ready to learn" includes even being able to listen and take in what someone is saying -- in a state of over- or under-stimulation a lot of kids will not be able to listen and take in what is being said. 

 

One person in my town says it is like talking to someone who is drunk -- they are just not in a state where you can discuss something with them productively.  You want to be at "ready to learn" and then try to talk.  

 

 

 

 

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Mine is a mix of seeking and avoiding as well. And to make it more confusing, he has changed overtime with his therapies. Learning what revs up and calms down sensory kids can be hit or miss and is largely trial and error. We were in OT for 6 weeks before we started talking sensory diet. We've been in OT well over a year now and still most weeks I feel like there is a new tool that we should be using. But it is good because it means we've made progress. And there are days that feel like we've taken six thousand steps back! But you learn what things help and what just complicates things. So for instance my boy avoids sound, but seeks visual stimulation. We don't do crowds without earmuffs to block sound and something that lights up for him to look at.

 

Mine has low tone too and mostly I see it when we try to do seat work. He slumps over instead of sitting up well. As a baby/preschooler he never sat....he would stand, crouch, or lounge. Sitting up is hard for him and sitting still is impossible. He had some retained reflexes and we did lots of patterning /crawling and it seemed to help. We disguised it as games with a younger sibling.

 

OT has been really great for us! It helps us with ideas on how to work on new skills.

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Wanted to add, mine is and excited/loud talker and his first OT suggested modeling volume with a hand (up for loud, down for soft) and if he comes in loud , return his talk in a very soft tone/whisper to help him regulate the volume. I find that and sing-song directions help him.

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LOL Heather, I know, I know. I just can't sit and do nothing while we wait, it makes me feel like I'm going to jump out of my skin. I am also 90% sure the results won't show us anything we don't already know, the neuropsych basically suggested the attention issues were masking everything else that might be going on. So I'm doing my own research...

 

Thank you all, this is very helpful! She does seem to respond differently at different times, activities that calm her down one day will rev her up the next. But bear hugs, massages and joint compression have always been calming for her, they're the only heavy work type activities that have a consistent result. It seems now like brushing might be a similarly good tool...So, soothing proprioceptive work only, I guess, no wrestling, no animal walks, no tug of war. (I've also realized this week that having her push the shopping cart keeps her from bolting while we shop, probably the most useful discovery I've made through all this.)

 

I also feel like I need to get some kind of indoor swing, they had a hammock made of some kind of spandex that made her lie still and silent for over 5 minutes, which must be some kind of record for her!

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Look at the Fun and Function site.  Runs in my mind I saw that hammock there, and all of a sudden I'm wishing I had one, wow!  5 minutes!!  :D

 

OT is an unfolding process.  Every time you talk with them, you're telling them more that they can use to give you more ideas.  This is not going to be like one trip, the answers, done.  I've been OT with my ds for months now, and each session she's teaching me more things, expanding my vision.  I'll tell her shopping is hard, and she'll tell me WHY shopping is hard.  Then we'll compare ideas on how to approach it and she'll refine my ideas.  Oh, hard there means impossible, lol.  

 

So it's SPD with ADHD, maybe a little farther.  Not rocket science, very much in need of treatment.  But it's not one session but rather an unfolding process.  It sounds like your OT is doing a good job with that.  

 

I don't see any reason to turn down things the OT thinks would help.  That's why you're paying them $100+ an hour, to know things you don't know, kwim?  I've read some things on listening therapies that made me really interested for ds, so I was bugging his OT about it.  She says sure, I'll dig them out.  It's just not her first thing she turns to.  I'm thinking give me the tapes, I do it at home, it's basically free to me to try and costs you nothing, might as well.  And apparently you know relatively quickly if it's on-track and worth the effort or not.  

 

Some of these OTs are like super gestalt.  They get the big picture and aren't so much on the things are the 6 steps and this is why it works and I can make you a list thing.  And for a list-maker like me, that's really rough.  So I'm just pointing out that it is a big picture kind of approach.  After a month, my ds got a little easier.  Then we had a month off.  Then another month on we're like wow, we're actually making some progress, this could turn into a child I could work with and maybe survive.  So it's an unfolding process, adding things, getting them more stable.  Sigh.  

 

Our 1st psych eval was like that, $2100 to be told stuff that wasn't completely accurate, and dh goes we learned NOTHING.  Well it has taken me almost a year to unpack the *consequences* or implications of that testing.  I didn't know what I had in my hands.  So don't rush to assume.  This is NOT just about that pat label.  There's going to be GOLD in that report when you learn enough to mine it.

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If pushing the cart works, also try having her "help you carry things" if she seems like she is getting antsy.  She has a job to do!  She has a focus!  It can be helpful.  

 

I also sometimes will have my son wear his backpack to carry water bottles for us.  It is not a 100% thing but it can be helpful, too.

 

It can also be a distractor to say "let's stop and have a drink" and plus sometimes he is getting thirsty without realizing it.  

 

Alternately -- she could cross things off a list, or follow a map of the store as you go, or you could have pictures of things and you put the pictures on a paper as you find them (for this people use laminated pictures with velcro).  All those are a little more complicated -- but just other ideas, I know work for some kids.  

 

 

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LOL Heather, I know, I know. I just can't sit and do nothing while we wait, it makes me feel like I'm going to jump out of my skin. I am also 90% sure the results won't show us anything we don't already know, the neuropsych basically suggested the attention issues were masking everything else that might be going on. So I'm doing my own research...

 

Thank you all, this is very helpful! She does seem to respond differently at different times, activities that calm her down one day will rev her up the next. But bear hugs, massages and joint compression have always been calming for her, they're the only heavy work type activities that have a consistent result. It seems now like brushing might be a similarly good tool...So, soothing proprioceptive work only, I guess, no wrestling, no animal walks, no tug of war. (I've also realized this week that having her push the shopping cart keeps her from bolting while we shop, probably the most useful discovery I've made through all this.)

 

I also feel like I need to get some kind of indoor swing, they had a hammock made of some kind of spandex that made her lie still and silent for over 5 minutes, which must be some kind of record for her!

Woman, listen to OhE on this...You concern me because you are questioning results that you haven't even seen in writing yet.  

 

Yeah, do the sensory stuff and purchase the swings and equipment. Just try not to speculate too much unless you have some extra training and education that you haven't previously mentioned.

 

Did you see OhE's thread about duct tape?  An OT used sports tape on her son and it worked like a sensory vest.  Who knew that would be effective?  I am constantly in awe of the therapies that work with these kids.  

 

Both of my kids are low tone.  My DS has some tested left side weakness and major balance issues that have shown significant improvement with a ped PT.

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You concern me because you are questioning results that you haven't even seen in writing yet.  

 

I share this concern and have kind of heard it coming through overall in your threads...be open to hearing things again and again. I say this as someone who (at first) heard a lot of stuff I thought I already knew and had hears (and I sort of had). If someone is saying something, and I think "Duh, I know this," I try to slow down and figure out why they are saying it (or saying it again). It might be that i'm hearing it over and over because there is still some aspect others are trying to get me to see, but we haven't hit on the right aspect of it for the light to dawn. Sometimes a person will change just one word or add one piece of context, and it's like a whole new world just opened up. 

 

I probably sound like I'm trying to get you to swallow some kind of LC board Kool-aid, lol!  :lol:

 

Keep us posted. 

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Just me, but I wouldn't buy anything too fast.  Things change and the OT will try things.  Let it unfold.  Go to the park and enjoy the rest of summer and the warm weather.  

 

If the OT is able to integrate certain things (like vestibular input, for instance), your daughter's need for certain types of activities an input could greatly diminish or even disappear. (Really!) You'll have a much better idea of what you want and need down the road.

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I was told by our fabulous OT who had specialty training in sensory integration, that your classic SPD kids are virtually always both seekers & avoiders. She stated that this was pretty much the textbook definition of SPD. These kids are not able to regulate their sensory system in a neurotypical fashion but instead swing between over-regulated and under-regulated with their behaviors seeking or avoiding depending on the situation.

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I was told by our fabulous OT who had specialty training in sensory integration, that your classic SPD kids are virtually always both seekers & avoiders. She stated that this was pretty much the textbook definition of SPD. These kids are not able to regulate their sensory system in a neurotypical fashion but instead swing between over-regulated and under-regulated with their behaviors seeking or avoiding depending on the situation.

 

I have not heard this stated so clearly, but it is what I have heard, too, and it fits with what I have seen.

 

  

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FairProspects, I hadn't heard that either. I am not terribly surprised that it's true, but I am surprised that it's been stated. The literature seems to offer the seeker/avoider profile as a "if you can't figure it out, they might be both," not, "this is a common pattern." And the literature (for parents) seems to read, "Do this for seekers; do this for avoiders," but maybe I'm just slow...

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