Questions about different types of therapy. - Mothering Forums

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#1 of 16 Old 04-16-2014, 06:38 PM - Thread Starter
 
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Hi mamas. I don't really know about the different types of therapy. Such as OT, behavioral therapy, cognitive therapy etc. I'm just stating the different types I've heard today.

We had our well visit today for my ds who is 6 years old. He's had nervous tics for about three years now. I mentioned it to the doctor and she recommended we see a pediatric neurologist and possibly cognitive behavioral therapy?

My question is, what will these therapies help my son with? It what have they helped others with? We're homeschooling for kindergarten right now and because if that, I'm not even sure what he would need help with. I hope this is all making sense to you, because it's all jumbled up in my head! Lol

I'm not sure we want to see a pediatric neurologist and that route because we don't want to give our son a reason to worry more than he already does. We don't want him to feel different. And on the flip side, if therapy can help him in any way, then perhaps he would feel more normal.

Please guide me!
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#2 of 16 Old 04-17-2014, 10:41 AM
 
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Well between my 2 kids, we see lots of therapists, so I can give you a very loose overview based on what would be typical for a 6 year old..

Physical Therapy - usually works on gross motor control (walking, standing, etc)

 

Occupational Therapy - usually works on fine motor control - handwriting, tying shoes, manipulating objects - some work on feeding.

 

Speech Therapy - work with speech - some work with feeding as well

 

Behavioral therapy - work on your childs actions - things like helping them communicate their needs, deal with situational anxiety, develop appropriate methods to deal with intense emotions.  My son has done this.  It has really helped him learn to recognize his emotional state, and react.  It has also helped him verbalize what he is feeling & what he needed, which was difficult when he was in school.  I did not really realize how much of a problem it was, since it did not manifest as much in the home environment.

 

It is pretty normal for a doctor to want you to see a pedi neurologist for tics.  (We did too).  DD actually sees a movement disorder specialist as well.  I would make the appointment, and bring video of your child exhibiting the tic (it helps the doctor to actually see it).  Depending on the severity and type of the tic, the neurologist might also order an EEG or video EEG, an MRI, and a dilated eye exam.  

 

The EEG is just electrodes attached to the head for a set period of time.  If they want to do a prolonged one, many cities can have them done in your home (we had a company come out and hook up the EEG (DD wore a turban to cover the leads and a backpack with the monitor in it), they also installed 2 video cameras.  Then for 48 hours we had to keep her in the rooms with the cameras as much as possible.  It may seem like a lot, but it was better than being in the hospital for 2 days.  An EEG will verify that the tics are not epileptic in nature.

 

An MRI or CT scan will verify that there is not another cause for the tics (ie a tumor or malformation in the brain).  DD's tics were very violent, so this was necessary for us, but not necessary for everyone.  The eye exam is to check the status of the optic nerve.  We do this every year, so did not have to do it again for Neuro.  

 

DD's tics are controlled by medication.  Life has been much better since we got to the right dose.  If the tics are caused by anxiety rather than a medical reason.  The behavioral therapist may be able to help him deal with the anxiety and thus lessen the tics.  Either way, I would go to the neurologist just to make sure that everything else is OK.


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#3 of 16 Old 04-17-2014, 12:44 PM - Thread Starter
 
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Great info, thank you! In thinking a behavioral therapist would be quite helpful for ds. Our doctor mentioned cognitive therapy. Where does this fall into? Is it just another word for behavioral therapy?
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#4 of 16 Old 04-18-2014, 06:27 PM
 
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The term is usually Cognitive behavioral therapy - it differs from usual therapy in that it is usually goal focused and will have homework/things to practice at home.  This is what we did with DS.  It is very effective when dealing with emotional responses or inappropriate behaviors.  It also works well for situational anxiety.  The most important thing is that you trust the therapist.  Generally, you will meet the therapist for the first time with your DS, but subsequent therapy will be one on one with the therapist and your child.  We always had a 5-10 minute session after therapy where the therapist would update me on what they did and what our homework was.


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#5 of 16 Old 04-18-2014, 07:08 PM - Thread Starter
 
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Is this therapy something that we need a referral from a doctor? Do most public schools offer these services? Or is this something we just search for ourselves?

We're trying to decide I we need to see a neurologist or not. The tics at this point, don't really interrupt his daily life, and they're not every second of the day for the most part. We're almost positive it's anxiety and genetics. I know I wouldn't do medication at this point. Though I think a therapist would be a great help for our whole family.
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#6 of 16 Old 04-18-2014, 07:10 PM - Thread Starter
 
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We're also most likely moving in six months, so I'm wondering if it would be beneficial to start therapy now and make progress hopefully before he starts public school, or if we should wait until we're settled in our new city and stick with someone.
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#7 of 16 Old 04-19-2014, 12:11 PM
 
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Quote:
Originally Posted by nycmom18 View Post

Is this therapy something that we need a referral from a doctor? Do most public schools offer these services? Or is this something we just search for ourselves?
Cognitive behavioral therapy is generally not offered through schools and is something you need to look for through other paths. You need to call your insurance to find out would is covered, if you need a referral, etc. 

We're trying to decide I we need to see a neurologist or not. The tics at this point, don't really interrupt his daily life, and they're not every second of the day for the most part. We're almost positive it's anxiety and genetics. I know I wouldn't do medication at this point. Though I think a therapist would be a great help for our whole family.
Ignoring any type of special need because you feel it doesn't matter since you homeschool is not, IMHO, a good idea. Homeschooling can be wonderful in many ways, but it can also mask the severity of special needs. Both the tics and the underlying anxiety WILL impact his life, and you need to deal with them to the greatest extinct possible, whatever venue you decide is best for his education.

 

 

Quote:
Originally Posted by nycmom18 View Post

We're also most likely moving in six months, so I'm wondering if it would be beneficial to start therapy now and make progress hopefully before he starts public school, or if we should wait until we're settled in our new city and stick with someone.

 

We've moved a lot for my husband's job, and my vote is start now, and then get started again when you move. Anxiety can be very debilitating, and moving will make things worse for him. It can take a while to get things started in a new city, so deciding to wait for a move that is six months away could easily put off any help for year son for 9 or more months.


but everything has pros and cons  shrug.gif

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#8 of 16 Old 04-21-2014, 08:57 PM
 
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As usual, I have to agree with Linda.

I am a behavioral therapist (not CBT, but ABA - applied behavior analysis) and not to brag - I have helped some clients made tremendous progress in 6 months and paved the way for the development and progress that came after that. So I definitely wouldn't put off starting therapy.
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#9 of 16 Old 04-22-2014, 04:29 AM - Thread Starter
 
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I guess the thing for us is that it never seemed to be a problem, and now we're just starting to wonder. Can therapy help with tics? We believe his are genetic.
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#10 of 16 Old 04-22-2014, 04:54 AM - Thread Starter
 
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Sorry, I was interrupted;) I was saying how I thought tics were involuntary. He's a very bright and happy child. He doesn't talk about things that he's worried about often, though I believe he does have a little anxiety such as when he's going to meet a new family member that he's never met. But other than that, he's the most social person I know, always wanting to go places and talks to everyone he meets. It just seems as though he has better social skills than most adults.

We did do speech therapy for a year when he was three because of stuttering it didn't help at all and it did go away. We again, believed the stuttering to be genetic. If anything, I think the tics are from an overactive mind. We have a family member who was extremely similar to ds. He's now a doctor and has been guiding us through all of this. He says that he had therapy as a child and he doesn't recommend it at all for ds because he believes there's nothing wrong with him. And he's a psychiatrist!

So not that we're still not pondering if any therapy might be helpful, I'm still trying to figure out if there really are issues or not. At this point, I'd really rather not go to a neurologist. Is there any other way to be evaluated to get a professionalisms opinion on what we're dealing with?
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#11 of 16 Old 04-27-2014, 04:49 PM
 
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Can you share more about the tics with us? What do they look like and when do they appear? Do they bother your son or are they are barrier to him socially now or in the future? And are they related to anxiety? If so, those would be reasons to seek therapy and a reason to see a doctor for at least an evaluation even if your son doesn't end up needing therapy for them.

What do you mean by "an overactive mind"? Without knowing the form of his tics, do you think that he can think faster than his body can move and that's why they are coming out? I've seen that in stuttering children where their mouths can't keep up with their thoughts. And if it's genetic, than that would be why he has them rather than an overactive mind.

They can be involuntary but they can also be compulsions that are involuntary but the behavior of acting on them can be controlled. And from my experience with children, many tics and compulsions started out as a genuine physical need or way to avoid discomfort and then become entrenched in the muscle memory and turn into tics.

I'll give a few examples from my life so you can understand:

1. I began a shoulder-lifting tic when I started first grade at a school with a pinafore uniform and it was a bit too big and kept slipping a little bit off my shoulder. I developed the habit of shrugging to put it back on, and this became a tic that I was doing often regardless of the clothing I wore.

2. I don't like when I wear clothing or shirts that have necklines resting on my collarbone. It is very uncomfortable and if I wear clothing like that, I used to do a wierd grimace (unvoluntarily) with my neck muscles that is very off-putting to others. So I have trained myself to notice when I am about to do the grimace (by paying attention to what happens in my muscles right before I do it) and to adjust the clothing instead of the grimace. Now I might adjust the clothes many times in a day but it doesn't look wierd to other people!

3. I have a student who finger-spells what he is reading or others are saying. This can be very distracting to others and off-putting when he does it big with his pencil. So I've taught him that he can do it with small letters on his leg under the table, and then no one notices or makes comments but he can still fulfill that need.

4. I lip pick. But I've trained myself to notice my arm reaching up to my lips and to reach for chapstick instead. So now I am about 75% successful at redirecting from picking to applying chapstick.

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#12 of 16 Old 05-01-2014, 06:31 AM - Thread Starter
 
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Pikkumyy, this was very valuable info. Thank you! It seems similar to my son. He started off with stuttering a couple of months before he turned 3. We did speech therapy for a year which didn't seem to help. It stopped around 5 years old. Both my brother and father are stutterers. My son also did eye blinking which lasted for a month or so, throat clearing that is still present, but does seem to show in spring and fall with no other signs of allergies. Doc said she could see mucus. Though my brother who is very similar to ds says that even the slightest bit of mucus bothers him.

He's bothered by his socks when they slide down and pulls them up constantly, so now that's it's warmer out, we've started to use ankle socks which help. If his shirts too big, he adjusts the shoulder, but he does that sometimes too when the shirt seems to fit well. He swipes his hair out of his face often. His newest tic is sniffing his fingers. He seems to do it when he's excited. Like when he's in soccer class and the teacher tells them to try some new drill, he'll do it before he's going to try it, and then after wards once he scored a goal or whatever the task was. Same with some new idea or thought.

These are my interpretations of course. I think that the throat clearing and sniffing of fingers are the most noticeable and will set him apart socially when he starts public school. He's aware of them and he's expressed that he doesn't do them for any obvious reason such as a need. He plays drums and has watched videos of himself and can notice when he fidgets and gets off beat.

I do believe it's genetic based in my brothers history. Ds is a very bright boy. The overactive mind thing was something my brother stated, he's a psychiatrist as well.

Given all of this, do you think CBT or a child therapist would be helpful? I guess I don't want to cause a complex in him or give him a reason to feel different in a negative way.

Thanks for taking the time.
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#13 of 16 Old 05-01-2014, 01:01 PM - Thread Starter
 
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I just noticed a pattern with his tics while we were playing chutes and ladders. Before and after a spin/turn he would do an ear swipe, nose swipe, and then shoulder shrug that looks like it fixed his shirt. Does this sound like tics or OCD?
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#14 of 16 Old 05-01-2014, 03:02 PM - Thread Starter
 
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I meant in my second to last post, that the doctor said she doesn't see any mucus. Just type it incorrectly;)

Again, I'm wondering what other type of professional, aside from a neurologist, would be able to give us a diagnosis and then guide us into the direction that is best suited for ds.
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#15 of 16 Old 05-03-2014, 10:24 PM
 
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Hi,

I just attended a workshop on childhood OCD today but it's bedtime for me, so I will post more tomorrow. Thanks for answering my questions! I will give you some ideas tomorrow.

Best!

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#16 of 16 Old 05-04-2014, 10:16 PM
 
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My son had tics that did not interfere with his ability to participate in normal childhood activities from age 4 to 9. His tics included lip-licking, chewing his sleeves (long) and shirt collars, and grimacing. His very laid back, but always on the money,pediatrician said they were developmental and should disappear by age nine. She was right. I wouldn't bother with CBT unless he has other cognitive-behavioral symptoms. Exercise helped my son's tics.
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