Just don't know what to think or feel...

[Holland73]

I need some help... some perspective about my 7 year old ds.  I am too close to the situation and my emotions are way too heightened to look at these issues with my ds very objectively. 

So, I am really hoping some of you might be able to give me some perspective... some kind of objectivity.  This is really, really difficult for me.

My experiences with ds:

*frustrates VERY easily

*very explosive (mostly just screaming/yelling, a very nasty attitude and a few times breaking his toys/pencil or throwing a pillow/knocking over a chair) when asked to do something he doesn't want to do, such as doing his homework, turning of the TV, etc. 

*worries a lot, almost obsessively about certain topics

*severe dental anxiety, seriously it has been almost 2 years of 4 visits a year AND we still haven't worked up to a complete cleaning.  It took up 3 visits just to get him to sit in the chair.  Granted, he did also have a pretty traumatic dental visit with another dentist. 

But, he is also very, very worried about any kind of bodywork.  When he is sick, which thankfully is very rarely, he is SUPER dramatic and excessively worried.

*SUPER picky eater, beyond just typical picky eating kids.  And, for the past couple of months, a serious lack of appetite.    

*Lots of handwriting issues.  He didn't choose a dominant hand, which ended up being his left hand, until halfway through 1st grade.  He HATES writing and is super conscious about his handwriting.  We have been doing Handwriting Without Tears for the past month together and he is doing very well with the program.  Very focused, positive and excited to do the lessons. 

*low self-esteem.  I hear a lot of "I'm not smart," "idiot," etc. 

*he does have a few close friends that he gets along well with.  He does make friends pretty easily and is very outgoing, but his inflexibility can often frustrate the other kids.

*he does have a therapist he has been seeing for a little over 2 years.  She doesn't consider him to have ADD/ADHD, but finds his anxiety to be more of an issue.  Although, she does notice that he often gets very overly focused on getting things absolutely perfect.  We are meeting in 2 weeks to discuss these recent school issues and to discuss what is going on for him. 

Experiences in school, according to teachers:

*overwhelms very easily

*very distracted with paper/pencil tasks

*gets frustrated and will lash out, verbally, towards his classmates.

*when looking at a problem, he will just automatically say he can't do it and not even try.

*a bit inflexible, but does fairly well with transitions. 

*struggling academically in 2nd grade.  All of his tests come back failing, but they also consist of a lot of writing and are very busy, oversized papers from a textbook with a lot of instructions on them.  But, he also really struggles with spelling.  Granted, she assigns anywhere from 15-20 words a week, which in my opinion as a teacher, is way too much!

He was at grade level in both K & 1st, though.  But, his teachers in K & 1st were absolutely amazing and made a lot of modifications to help him. 

His 2nd grade teacher basically teaches ALL subject straight from the textbook and there is a TON of worksheets from those textbooks.  It is crazy how many worksheets they do each week.  As a 1st grade teacher, this really angers me.  In fact, it is his 2nd grade teacher that is asking me to consider ADD/ADHD, based on his constant distractions during paper/pencil tasks. I have told her about his handwriting struggles.  I have also shared with her the various modifications that his former teachers have used with ds.   

I just don't know what to think.  I am super angry that his teacher suggested ADD/ADHD based on my own personal beliefs as a teacher.   But then, when I look at everything going on with him... I begin to wonder, "Am I missing something?"  What am I doing wrong?  Sometimes, I wonder if this is a direct reflection of my parenting skills? 

Does anyone have any thoughts/insights?  Any book recommendations? 

[Rose-Roget]

He could have a couple of separate issues - anxiety with perfectionistic tendencies and fine motor delay.  Both of those can lead to the lower self esteem in different ways, and most that you mention could fall to one or the other category, I think.

Speaking from my own experience, my ds is 6 and has some seemingly unrelated difficulties, many which overlap with your ds.  I had him evaluated recently for SPD and he is now in therapy for it.  His impulsivity and distractiblity is often related to sensory overload.  His extreme reactions to teeth brushing or minor scrapes is because his sensory system interprets those sensations differently than most people's.  His difficulty calming himself to go to sleep or when he's "wound up" is, again, because his body interprets those calming sensations differently (he asked me over the summer why it felt tingly, like ants, on his tummy and back when we go to sleep  - it's not a comfortable, relaxing feeling like it is for most people).  His fine motor difficulties are also related to sensory.  I think it can also lead to some anxiety (or that could be separate - I don't know).  I can only imagine how it would feel to never be quite certain what kind of sensations were going to be coming at you - that's possibly why order is preferred, transitions are hard, etc.

It may be worth researching a bit more about SPD to see if you think it fits your ds.  I never even considered it until I started reading bits on this board last year, and then it all started falling into place.  OT has helped significantly so far.  A good starter book, if you're interested, is "The Out of Sync Child" by Carol Stock Kranowitz.

 

[LynnS6]

I would also consider an SPD evaluation, with perhaps OCD/Anxiety. Actually what I'd really do is see if you can seek an evaluation by a developmental pediatrician. His inflexibility, anxiety and sensory/eating stuff might be hallmarks of asperger's, or they might just be separate. It's so hard to tell whether the anxiety is causing the inflexibility, or the need for everything to be the same causes the anxiety.

SPD evaluations performed by an occupational therapist. Unfortunately, schools don't  usually recognize SPD as a diagnosis so you have to look privately for someone who knows what they're doing. Occupational therapy was really helpful for our son as well.

The handwriting stuff should be handled by the school, and I'd start the process now (in writing) of asking them for an evaluation.

[joensally]

Ditto PPs, I would definitely look at SPD.  Anxiety, OCD-type thinking and SPD can go hand in hand.

I would also have his eyes checked by a developmental optometrist.  A lot of those behaviours and challenges could also be related to vision issues.  For example, the behavioural manifestations of something called strabismus/convergence insufficiency mirror those of ADHD (distractability, inattentiveness etc), and vision can affect how a child processes the info on work sheets and writing.

An OT can check SPD and dysgraphia/handwriting.

The above all have remediation strategies.

[Holland73]

I had initially scheduled an OT evaluation on my own, due to ds' handwriting issues.  Then I canceled the appointment and decided to just do the handwriting without tears program and see how things went after a few months.  I will definitely call them next week and get him in for an evaluation.  My biggest problem with OT, and one the big reasons why I canceled the initial evaluation, was the cost.  The evaluation alone is $500 and if he needed regular OT sessions, I would have to pay for it out of pocket @ $125 per session.  My HMO doesn't cover anything related to OT, I've already checked. 

SPD was something that has crossed my mind from time to time, as he is also very particular about tags in clothes, seams in socks, etc.  I always just considered him 'quirky' that way.  I'll research SPD a little more.

As for the anxiety, I am a little more worried about such a diagnosis.  What would be recommended for a child with an anxiety disorder?  

I'll see if I can find a developmental optometrist.  I live in the Bay Area with a fabulous children's hospital, so perhaps they'll have one?   

[joensally]

Here's some SPD books with previews from google books:

http://www.google.com/search?tbs=bks%3A1&tbo=1&q=sensory+processing+disorder

DS was diagnosed at 4 with SPD and we did no formal therapy, just a lot of stuff at home.   He was re-assessed at 7 and did a brief run of therapy sessions, and we continue to work at home.  If your DS does have SPD what's great is to know what he's sensitive to (it can be really subtle), and what strategies help him regulate.  DS has made unbelievable progress when I look back.  He's done really well through the stuff we do at home, swimming and SN gymnastics.

This is about to be released and I have it ordered:

http://books.google.com/books?id=xdJf7F2NpSUC&printsec=frontcover&dq=sensory+processing+disorder+workbook&hl=en&ei=vT_fTLCcJ4zEsAOitujbCg&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDwQ6AEwAg#v=onepage&q&f=false 

For anxiety, Cognitive Behaviour Therapy is considered the foremost approach.  There are at-home resources for that, too.  Both of my kids have anxiety issues and we've done brief rounds with a CBT/play/art therapist who's really exceptional and has provided insight and strategies that have really helped.

These are good anxiety books:

http://books.google.com/books?id=QMYr7kib3I4C&dq=child+anxiety&hl=en&ei=TT_fTK6SD4OisAOd6vS6Cg&sa=X&oi=book_result&ct=result&resnum=3&ved=0CEAQ6AEwAg

http://books.google.com/books?id=ArNYszn5orgC&dq=child%20anxiety&source=gbs_similarbooks

My kids like this one, but preview as you don't want to give him new things to worry about!

http://books.google.com/books?id=kmklAQAAIAAJ&q=little+mouse+afraid&dq=little+mouse+afraid&hl=en&ei=kT_fTNrXJYW4sQPk-b2fCg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCsQ6AEwAA

Another angle would be to use some of the social thinking materials.  These two are great to help kids understand their own and others' perspectives:

http://www.socialthinking.com/books-products/featured-products?page=shop.product_details&flypage=flypage.tpl&product_id=147&category_id=9

http://www.socialthinking.com/books-products/featured-products?page=shop.product_details&flypage=flypage.tpl&product_id=147&category_id=9 

Have you read Spirited Child?  I didn't get it the first time I read it, but have found it a good starting place in terms of understanding the many ways being particularly sensitive can affect a person's life.  I also really like Kids, Parents and Power Struggles in terms of working with kids when they're emotions and/or senses are ruling.

[LynnS6]

My favorite SPD book is: Sensational Kids by Lucy Jane Miller. It's got a good discussion of what it is, with some very practical suggestions on how to address it, and it acknowledges that most kids won't get all the OT they need because of insurance.

The other thing to check though is whether your HMO will cover OT if it's part of another diagnosis. So, we got our health insurance to cover 70% of ds' OT by getting him diagnosed with a delay of the nervous system, not with SPD. (I've got the insurance codes somewhere, if that'll help you.)

[Rose-Roget]

$500 is a LOT of money for an OT evaluation.  I would look into another place, if possible.  We went to 2 different places, and they both charged about $150-$200 for an evaluation (we didn't get a second eval, just started up in tx, but I checked the price). 

I second the rec for Sensational Kids - also a good read with a nice layout of the different ways SPD can present.

[Holland73]

Thank you all so very, very much!

You have given me some great resources to start with and I really appreciate it. 

$500 is a lot, but just found out that for private pay clients they lower it to $250.  I'll also look around too.  They were just quick to respond to my emails and phone message, very compassionate and incredibly helpful.  

Ds and I were talking about anxiety this evening and identifying how it manifests itself in our minds and bodies.  He was surprised at how I also feel anxiety/worry sometimes.  We shared some ways that we both use to try to calm ourselves down and I mentioned that perhaps he might like to try some meditation with me, as I have a daily meditation practice.  He said he'd think about it. 

Funny, as I am sitting here typing this... he has asked me 3 times,  "I swallowed some of my mouthwash, do you think I will be OK?"  "Am I healthy, mom?" "Remember how I get sick all the time?"  Honestly, the kid is probably one of healthiest kids I have EVER met.  Besides some allergy issues in the spring and a runny nose from time to time, he has never been truly sick since a double ear infection at 2.5 years.   But, it is one of his greatest worries.  And he asks repetitive questions about it over and over and over again.  When he is dealing with sinus issues from allergies, you would seriously think he was dying.  

Yeah, anxiety is a HUGE issue for him.