advice for first OT session? (post-appt update)

[flitters]

We are scheduled to begin OT for ds (5) on Wednesday. Our hope is that it will help him with sensory integration, particularly with tactile and auditory overresponsiveness but some other areas as well.

After speaking with several OT's I'm feeling pretty good about the therapist and clinic we decided to go with (if you read this Lynn, same place you used, not sure about the therapist though).

We have already spoken pretty extensively on the phone, and she made some accommodations for some of my concerns, which I greatly appreciated. There is a 7 or 8 page sensory history form we still need to fill out as well.

Beyond that, I was wondering if anyone has recommendations for questions or things to do before or during that first session.

One other item is that I'm still figuring exactly how to present this to ds... I'm thinking of framing it as going to see a fun coach to help him with "skills" (he associates "skills" with cool things he does, not like boring rote stuff as most people would). He would not take well to the notion of "therapy" (he believes things that trigger his sensitivities are environmental problems, not his own overresponse), is anti-teacher (long story), and I'm reluctant to introduce it as just a place and friend for play (concerns about him simply opting out in future... hmmm...). Any advice on that?

Thank you all so much for helping us reach this decision. So far, it feels right.

[beachbaby]

Is he going for the initial eval? Or is this the first OT session?

Not sure from your post if you have the sensory profile to fill out ahead of time, but if not, I'd ask if they can either send it to you so you can complete it ahead of time or if they give it to you that day, if you can take it home and bring it back next time. I was given it during the eval and asked to fill it out there. I wish I would've asked for time to take it home...it was not only hard to fill out on the spot, but I wanted to be able to observe and ask questions. Instead, I was busy filling out the paperwork.

I'd also ask if the OT plans to discuss your child's eval results in depth with you that day or not. You might want to bring another adult along who can take DS to the car or something if you want to speak privately to the OT.

ETA: I like the idea of working on skills...that's basically how we presented OT and play therapy to DD. DD can be pretty skeptical and resistant, but she loves her OT.

[flitters]

Thanks for the reply!

This first visit is actually a combination of eval/assessment and therapy. I had considerable reluctance about how ds would respond to a full session of evaluation type activities because he is extremely perceptive to when people are doing things to elicit any kind of performance from him. I understand they structure the assessment as play and are trained to make it as fun and interesting and motivating and natural as possible, but ds is extreme in that particular sensitivity and he responds to the feeling of examination with resistance... always has. So she is going to integrate assessment type activities with therpeutic activities based on our conversations and the history forms. I am more optimistic of this approach for ds than focusing the first session(s) on evaluation. Since some of his issues are so classic, we feel she will have things to work on while we wait a bit longer for the complete picture. We are fortunate that our insurance does not require a large write up to qualify for coverage.

Yes, we do have the sensory profile form (and some others) at home to fill out. I'm going to try to get them completed and sent back to the therapist tonight so she has time to go over it before the session.

I will ask her in an email (along with a couple other things I remembered I'd like to tell her in advance) about how she will discuss with us her thoughts after the session. Thanks for mentioning that - I definitely do not want ds to listen to that discussion. I will be there with dh, so there will be two of us, but I suspect when we're finished ds will want us all to head out together.

[Kailey's mom]

My dd was in OT for a little over a year *and would still be going if her OT still took our insurance )

What I learned, is that it's more benefical to my dd, if I were to sit back, and let the O.T. do her magic. I would only get involved if her OT wanted me too. Of course, ask questions about how you can impliment the things you learn at home. Also, bring video of behaviours that you need help with, that way the O.T. can SEE exactly what is going on =D

[LynnS6]

If it's the same place we went, the first appointment will be the assessment, but it won't feel like an assessment to him.

I think presenting it as skills is a good idea. I presented it as a 'teacher', and we called the therapist "Mrs. B" because that's what the teachers in his life are called. Ds loved his teachers. But if your child has issues with teachers, what about the word 'coach'? Coaches work on skills after all. I would say "she's like a 'coach' who's going to help you learn some skills to be more comfortable with how your body works.

I have to say that I was amazed at what the OT could get our son to do, even on the initial assessment. Ds would never do things on 'command', and yet they were able to gently get him to do things he would never do for me.

[beachbaby]

Originally Posted by flitters

Thanks for the reply!

This first visit is actually a combination of eval/assessment and therapy. I had considerable reluctance about how ds would respond to a full session of evaluation type activities because he is extremely perceptive to when people are doing things to elicit any kind of performance from him. I understand they structure the assessment as play and are trained to make it as fun and interesting and motivating and natural as possible, but ds is extreme in that particular sensitivity and he responds to the feeling of examination with resistance... always has. So she is going to integrate assessment type activities with therpeutic activities based on our conversations and the history forms. I am more optimistic of this approach for ds than focusing the first session(s) on evaluation. Since some of his issues are so classic, we feel she will have things to work on while we wait a bit longer for the complete picture. We are fortunate that our insurance does not require a large write up to qualify for coverage.

Yes, we do have the sensory profile form (and some others) at home to fill out. I'm going to try to get them completed and sent back to the therapist tonight so she has time to go over it before the session.

I will ask her in an email (along with a couple other things I remembered I'd like to tell her in advance) about how she will discuss with us her thoughts after the session. Thanks for mentioning that - I definitely do not want ds to listen to that discussion. I will be there with dh, so there will be two of us, but I suspect when we're finished ds will want us all to head out together.

That sounds like a good plan. Sounds like the OT is pretty good at communicating via phone and email. Maybe you can set up a phone appointment to discuss the eval/appt.

You got some other good ideas from the PPs. Please let us know how it goes.

[flitters]

Hi,

Thanks for the ideas! I spoke with the OT again yesterday, and asked some more questions based on the feedback here - very helpful.

Let's see... she said that usually at the first session the parents come into the gym and other areas, and basically hang out or get involved if the child asks for it. We'll try to follow her lead in terms of how much space she wants with ds.

I also asked about when/how we will discuss her findings after the first (and subsequent) visits. She said we'd probably mostly do it over the phone, but that usually the kids run off to play in the gym area with one parent at times, and she can sneak in a word with the other on the side. And email. She was very understanding about not wanting to have those conversations in front of ds.

Oh, and I like the video idea, but I'm not sure what exactly we'd video at this point, since most of his reactions are pretty easy to describe and don't tend to happen w/o a trigger... I'll definitely keep this in mind though as we continue.

Lynn, based on initials, I'm guessing we have the same therapist that your family used as well. Because of my concerns about how ds would respond to the assessment, she is making some adjustments to the normal pattern of evaluation a bit. I expect a lot of it will be played by ear, depending on how ds responds. Hopefully ds will respond to her as fondly and willingly as your experience w/ your ds.

Unfortunately, my introduction of the subject of Wednesday's upcoming session with ds did not go particularly (or even moderately) well. I thought I had such a good "in" too (corresponding to a book we're reading). I told him we were going to go meet a coach to work on skills (he liked the skills part, not the coach part) and that it should be fun and if it's not he should tell me so. Anyway, I said it perhaps a bit better than that in terms of wording, but I think he still picked up on the level of... whatever it was that changed my manner between telling him about that and about a regular playdate or something.

He basically said he'd never want to go there, or some such. I said again we were going to go and it would be fun, or let me know, etc. The good bit was that I think there was acceptance and it was not a prolonged conversation (which would definitely lead to more resistance). I'm not going to mention it today at all. Wednesday should be better anyway since he likes it when I work from home, which will be the case, so then we'll head out all together as a family... I guess at that point I'll probably just say we're going to go check out an interesting place and meet someone we think we're going to really like, or something like that, and then have a good lunch afterwards.

Sigh. I really want this to work, but I'm feeling much less optimism right now than I was before telling ds. I sure hope the OT can work some magic in terms of helping him *want* to come back. Right now that feels like a very significant feat.

[flitters]

Post-appointment Update

I just wanted to give a brief update about our appointment today.

Ds was in good spirits last night and this morning because he knew I'd be working from home today. When mentioning the upcoming appointment as part of our plan, I just did so very casually, saying we were going to a gym to meet and play with Lynette (the OT). He was fine with that description, so at least there wasn't an issue with going there this time.

When we got there, we almost didn't make it inside. I didn't see anything that looked particularly new, but just at the entrance it had the slightest smell of "new" (that off-gas type odor). It was very faint, but ds turned and walked right back out the door, covering his nose. He almost wouldn't go in at all, but it turned out to be a very good thing that the entrance is into the big gym, with lots of neat looking stuff, so eventually, with the agreement to leave the door open for fresh air, he came in. After a few minutes, the smell was no longer an issue and he began exploring. Phew.

He seemed to like the OT right away, which obviously was a good thing. The facility is really neat and he went right to exploring with her. We hung out (literally, at times) and joined in as they requested. His issues are not with gross motor, so this basically was a session of (a) making sure he would go inside and be comfortable and (b) relationship building with the OT. She didn't do any therapeutic work with him yet, which really was fine, because I think all involved could tell he wasn't ready to push himself yet (he wouldn't walk on the water mat and despite a handful of attempts on her part, she didn't get ds up into one of the hammocks)... although I think he did push himself ever so slightly... he did do a very large jump off a high platform which was bigger than he will usually attempt (and he did it twice), and some bigger trapeze swings too.

The other indicator was that afterwards, he melted down when we were walking from the car to his favorite restaurant (it was barely raining but a couple rain drops hit him). He wanted to go home, but after talking about it for awhile, he regrouped (that used to be almost impossible, btw) and we headed in and had a great lunch. I think that he was more tired than we realized from the activity, and perhaps more brain-tired than he would have been from a comparable time running around at a park.

So, we are going to see where this leads. It will be particularly interesting next time as she plans to introduce some activities to begin work on the tactile sensitivities which currently top the list of intolerables for him.

She also showed me about brushing, which sounds like something from which he would really benefit, but at the same time, I seriously doubt he'll let me do it to him.

We'll see, on many counts. Fingers crossed.

And thanks to everyone who helped guide us through this process - now that we've made the decision, it definitely feels like the right thing to make a go of therapy.

[LynnS6]

Great! Lynette was ds' therapist too and I love her. I hope she works as well for you. For us, she did the brushing with him for a few weeks before she asked us to try it at home. So he was already used to the idea. Ds was amazingly OK with it, and it made a huge difference for his tactile sensitivities.

OT is tiring - both physically and mentally.

[beachbaby]

Glad to hear it went well, flitters! Come join us on the SPD support thread if you'd like.

[flitters]

Thanks! I've been lurking in the SPD support thread, but I have a hard time keeping up with big conversations - it's hard to keep everybody straight! There is lots of good info shared there though, so I'll keep reading and maybe soon I'll feel familiar enough to join in.