Psychiatrist input--is this appropriate?

[cintinative]

Maybe it is just because I operate pretty much constantly at a low level of overwhelmed, but yesterday when we met with the psychiatrist for the first time and she mentioned OT and replacing out his SLP therapy with OT for executive skills I felt like she was leaving her "lane."  Am I wrong to think this? I might be too sensitive about it. 

Really my intention in meeting with her was only a second opinion/advice on meds.  I have an educational psychologist, a counselor, and an SLP professional for him.

[PeterPan]

On the constantly overwhelmed, we could talk about that. 🙂 There's sort of the reality of what comes with kids and then the take care of yourself first, run some genetics, find the root cause to treat kinda thing too. 

On the psychiatrist, um, yeah that's not *our* pdoc's style to be pushy, but that's because she handles us in the truest sense. So maybe you have some miscommunication going? Yeah it's coming across wrong, but you sound like you kinda walked into it with your insecurities. I have a psychologist early on with ds who really did us wrong. Like he was, well he set us back a long way both with incomplete diagnoses and with UNDERMINING MY SENSE of how to proceed.

There's no replacement for your own deep breath, suck up your boots, find your peaceful place, know in your soul you're on the right track. You can let someone else think for you, which is sometimes the right call, but it doesn't sound like that's what you want. 

The most obvious thing to do here (besides taking care of yourself) is to just say AND. Is there something she meant or was seeing that you could take in as good advice with AND rather than having it be instead? I've never found any one practitioner who knows everything and it's a pretty interesting take to say an OT is good at EF. They sort of work on it sideways and integrate it sometimes if they have unusual interest in that area and work on it. And if by EF the pdoc was meaning emotional regulation (which is a part) and planning steps to a task, sure OT would be spot on for that. But I assume you were using your SLP because they were bringing something to the table as well. On the flip side, there are some SLPs taking on stuff now that is just NOT in their wheelhouse, so it's a totally fair criticism to say you might be using someone who isn't bringing the most training to the task.

For complex situations, the answer is usually AND. I would never release one worker on a hope or theory. You add the new person, see how it goes, see the new mix, see what they're bringing. I'm kind of an 80/20 person with therapy. Keep what is working and tweak at the fringes to try something new. I don't go upsetting the apple cart with huge wild swings. Just isn't a good plan in our house. 

This is for a high schooler? Ok, I'm gonna disagree with any professional on this, haha. Working on self awareness will probably, in the long run, bump EF *more* than trying to explicitly teach it as splinter skills. When you work on interoception/self awareness, the person realizes what they were feeling, WHY they were doing certain things, WHY they were being held back, and they develop the skills to PREDICT what problem solving method might work for them. When you teach EF in isolation, it's a bunch of splinter skills, the skills to do each task. When you work on self awareness, it's not a replacement for explicit instruction but it gives them this deeper intuition how how/why to apply it. 

I've done two teens now, 10 years apart, and I really like what working on interoception brings to the table. It creates this deep undercurrent of awareness and self-advocacy for problem solving. So if the pdoc is saying get an OT to work on that, I'm all in favor. But good luck finding an OT prepared to work with a 16 yo, mercy. Do you have someone in mind? What would they be bringing to the table?

[cintinative]

That makes sense. She was talking about using OT for executive skills like notetaking, organization, etc. and that just seemed odd to me.

Being overwhelmed has a little to do with my son, but also there are 10,000 other things here.  Thanks for the encouragement. I am not inclined to drop anything at this point. 

It is hard because (obviously) all professionals are going to have their own POV.  The ed psych thought perhaps my son would do better with an executive skills coach than an SLP. This psychiatrist thought maybe OT. I don't know. All I know is that the SLP seems to be working for now and I don't like to mess with things that are working. We might pursue an IEP (if I can ever get a report from our SLP), so there is a lot in flux right now.  

[PeterPan]

14 minutes ago, cintinative said:

The ed psych thought perhaps my son would do better with an executive skills coach than an SLP.

Sure!! The answer is AND. You want the licensed educational therapist AND the SLP AND the OT. It sounds like getting the IEP will open some doors for you, depending on the diagnoses. Your frustration will be if it's 504 instead of IEP, sigh. With a 16 yo, they may try to plunk you 504. 

These people seem to be living in theoretical land. The question is who has the skillset, not just what the label on the door is. You're hiring the person, not their acronym. I hire people and I have them do what they do well. That seems to work best. So if you find an AMAZING licensed educational therapist, use them! They'll definitely bring something to the table. If your SLP is kicking butt, keep using them. Anything that is language is their wheelhouse and it makes NO sense to ask an OT to work on language. That is just completely confusing to me, like the pdoc was having a moment or something. We get weird crossover, but that's some pretty weird thinking. Anything language is going to be an intervention specialist or SLP. A lot of time intervention specialists are doing that language work in the IEPs, so I wouldn't underestimate them (interventionist, educational therapist, etc.) as a category. Licensed educational therapists can pull together a bunch of domains and help you coordinate/manage your approach, which can be really handy too. 

My ds is close in age to yours and we haven't tried OT in a while. If I could find a gem using our funding, I would in a heartbeat. I actually really like our ps IEP team OT. He seemed to get ds' # in a very practical way and have lots of practical ideas. Just couldn't make the funding work. A lot of OT is nice women doing sensory with little kids, sigh, not at all what you need for a growing teenage male with functional issues. That's a whole other ballgame. My ds still could probably use some more bodywork, so I may have to work on this, sigh. We had a good OT for a brief while during covid and she changed to a ps job. Lucky them. 

[KSera]

50 minutes ago, cintinative said:

That makes sense. She was talking about using OT for executive skills like notetaking, organization, etc. and that just seemed odd to me.

I’m sensitive about people overstepping their lane as well, so I hear you on that, but I’ll also add that my dd had an OT at 19 that worked on things like that. Even communication skills like writing emails to her boss. Those are all necessary activities of living as someone gets to those ages, so it can fall under the OT umbrella. However, since you have an SLP who’s working well for you, I wouldn’t take that away either. 

[Lecka]

I think it’s fair for them to share an opinion, but it does not mean you have to do it.

 

You could ask “why do you recommend that” the next time you see them.  
 

Also, maybe in 1-2 years it will turn out it does seem like a good idea, it could happen.  
 

I definitely think you have the big picture of what is going on, plus the reality of changing things or adding new things.  There is a lot of detail and I think people often understand that.  
 

For context — a lot of kids have been in speech therapy for years and then as they get older talk turns to discontinuing speech even though there are still speech goals, and looking at life skills.  Or, changing goals to be more of life skills.  Not exactly life skills, but — just a different focus.

 

It’s appropriate a lot of times, but it’s not always, and I think you could be getting caught up in that.  
 

I think rapport with a therapist is huge and important, if that is something he has with a speech therapist.

 

I also think, to some extent with older kids, maybe they still need a therapy but have somewhat plateaued, and it’s taking up time and maybe there are other goals to work on.  This is very related to the other thing I said, but a little different.  The thing is, a lot of kids are in different situations and are not plateauing, but a lot of people will just assume that maybe kids have plateaued.  
 

If it’s more like “ugh I don’t want to deal with figuring this out” — I think just give it time, there’s no rush.  Think about it for a while.  It’s not urgent.  In the scheme of things this is not a crisis.  

[kbutton]

3 hours ago, PeterPan said:

These people seem to be living in theoretical land. The question is who has the skillset, not just what the label on the door is. You're hiring the person, not their acronym. I hire people and I have them do what they do well. That seems to work best.

This

16 minutes ago, Lecka said:

You could ask “why do you recommend that” the next time you see them.  

And this—it could be that she thinks OTs that do this are a dime a dozen and good at it when, in reality, she has an experience of one who did this well or read it on a blog.

18 minutes ago, Lecka said:

I think it’s fair for them to share an opinion, but it does not mean you have to do it.

Also this. It’s taken me time to learn that the pro’s don’t know it all, and you can ignore some stuff. I was so terrified that it would make them think I was oppositional.

I think the AND is a reality here. Don’t quit language work that is working. Ask around for someone good with EF. Maybe ask that person if they have worked with someone who shares your son’s characteristic make it or break it needs. As PeterPan said, if a therapy/style requires self-awareness, and that is not present, not a good fit even if the person is qualified.

Some behaviorists are good at this too—they are used to people with iffy self-awareness and sometimes have workarounds for that. It really depends again on individual strengths of both the person giving services and the person getting them.

[PeterPan]

1 hour ago, kbutton said:

it could be that she thinks OTs that do this are a dime a dozen and good at it when, in reality, she has an experience of one who did this well or read it on a blog.

yup, which means you just ask for the name.