Help, could this be ADD?

[funschooler5]

My 8 yr old son has been diagnosed with mild to moderate Sensory Processing Disorder, and coordination disorder. He just finished 3 months of occupational therapy, where they worked mainly his motor skills, and handwriting. They didn't really do much for his sensory issues, just gave me tips for things to do at home. I also own a few books that deal with SPD (Out of Sync Child Has Fun, etc), and we do activities out of those. Some things help a little, and some things don't help at all. My son is a "Crasher-banger". Here are some of the things he does (this isn't all of the time, it mainly comes out when he's doing schoolwork):

-Bangs his hands on the desk
-Pokes holes in his papers with his pencil
-Scribbles and draws on his papers
-Constantly drops his pencils
-Breaks the tips of his pencils while writing
-Constantly makes noises (nonsense words, singing, etc)
-Tips his chair forward (and falls out of it frequenty)

He seems to be getting worse. He can't sit still to finish one page out of his math workbook, even easy addition problems that he knows. I never thought he had ADD before (I was thinking it was all SPD), but I was just watching him today--sitting in the living room, away from his sisters, no other distractions, wearing his weighted vest, chewing gum....and he was STILL fidgeting, unable to concentrate at all.

Does this seem like ADD? If so, where would we go to get him tested?

[Kathy in MD]

These behaviors are all typical of SPD. What type of excercises did your OT do with him? I would expect a brushing routine for about 8 weeks, a lot of swing work, motor planning, and maybe some ball tossing and racquet work.

You might also look into finding another OT for a second opion that has both training and experience in SPD. My ds had very severe SPD and had therapy for about a year. At the end, he could stay in his chair, could hang onto things, banged his head or hands only when he was frustrated, and stopped making noises (ST may have helped here). He prefers pens to pencils, so breaking tips isn't much of an issue. He was also able to sit without needing to support his head on his hand, however it was only after years of horseback riding that he was able to sit straight.

Something else that helped my ds with not constantly making noises was discovering that he had a dairy sensitivity. The result was that he didn't have much control over his impulses. It also made it difficult for him to concentrate on his work.

We uncovered these problems when we saw a dev. pediatrician. She ran blood tests, did a physical, had us do an elimination diet and ruled out ADHD because ds didn't display enough symptoms of ADHD.

[cillakat]

I think ADHD is often misdx'ed as SPD. Or more likely.....most that have/are ADHD have some level of SPD symptoms to go along with it.

There's really no evidence that OT works for SPD when that's the only set of issue (ie when there are no motor issues)

Certainly I feel that the $5,850 we spent on OT was a big fat waste of money and that diagnosing and treating the ADHD *first* would have been a better use of our time and money.

An educational psychologist would be the person to see.



K

[Kathy in MD]

I think ADHD is often misdx'ed as SPD. Or more likely.....most that have/are ADHD have some level of SPD symptoms to go along with it.

There's really no evidence that OT works for SPD when that's the only set of issue (ie when there are no motor issues)

Certainly I feel that the $5,850 we spent on OT was a big fat waste of money and that diagnosing and treating the ADHD *first* would have been a better use of our time and money.

An educational psychologist would be the person to see.



K

I'm sorry that OT didn't work for your dc.

However I feel I must correct a few assumptions that you implied in your post. SPD often, if not usually, includes some problem with motor control and reaction to touch (they're related). It also often includes problems with the inner ear which can affect both balance and language. There is one other area it can affect, but I can't find my copy of The Out-of-Sync Child to refer to it. The first two problems I've have seen in most of the SPD dc I have met and and read about on the boards.

GOOD therapy does treat the first two problems, and I believe the 3rd as well. My ds is a prime example. I've also known too many other dc who have benefited from it to say it doesn't work. So has my ds's developmental pediatrician. It's the only therapy she recognized as legitiment that she didn't understand the scientific reasoning behind it. But she had seen too much anectdotal evidence both in her practice and in the literature to ignore it.

But the secret to successful therapy is GOOD therapy. OT's specialize in a large variety of areas, but they do not need any special education or on the job training to start practicing new specialty. Therefore an OT could read an article on SPD and decide to start treating it. However good SPD therapy requires hands on training, especially when it comes to the brushing techinique. I've seen my ds's OT reject half of a shipment of brushes sold for "brushing" SPD children because they were either too stiff or soft. That takes hands-on experience. I've also read on the boards about an OT that just gave her client a copy of an article on brushing and told her client to just buy a brush - any old brush. I know from experience that using the wrong brush is worse than skipping a brushing session. I once forgot my ds's brush and bought one that was a little bit stiffer. It was immediately an obvious mistake.

7 years ago, when my ds was diagnosed, the area I live in was a hot bed of SPD OT's, yet the demand outstripped the supply of trained OT's. Since that time, knowlege of SPD and the demand for therapy has increased. I strongly doubt that the supply of trained SPD OT's has kept up with it.

Also you need to realise that there are diagnosises besides SPD that display almost all if not all of the symptoms of ADD. These include food sensitivities and developmental vision problems. I feel that APD should also be added to that list. Other problems such as heavy metal poisoning or nutritional deficiencies can display a few ADD symptoms. All too often these problems are ignored in the rush to diagnose a child. To further complicate the difficulties in diagnosis, a child may have multiple issues including ADD. By treating all the issues, often the need for ADD drugs can be reduced. This is why a good diagnosis should include a physical, blood tests and several other specialists in areas such as speech and developmental vision.

Once again, I'm sorry that your dc was misdiagnosed. Such problems can be a major waste of money and, more importantly, time. But that it why I suggest that the initial diagnosis include a complete physical work-up and a lot of time in doing the diagnosis. I went to a dev. ped who spent 3 appointments with us plus her time in analyzing questionaires and writing up her findings and plan of action. Others have been happy with neuro-psychs, yet others have gone to large clinics with all the major specialties under one roof and involved in the initial diagnosis.

[Laurie4b]

If your OT didn't address the sensory processing issues, then I'd go look for one who could. Our son's life was changed radically for the better during OT when his sensory needs were addressed. The types of things they could do with the equipment they have in a good OT office far exceeded little things we could do at home.

I agree with Kathy that the brushing was big factor. For our son, though, the amount of bashing-crashing he could do on the equipment at the OT office really, really helped. We took him twice a week for the first couple months. The change was huge.

Our son's coordination issues were not helped nearly as much as his sensory issues. The OT treatment nearly corrected his eye tracking (to just outside of normal limits.) It decreased his hyperactivity hugely, as well as his impulsivity.

Bangs his hands on the desk : this is giving him proprioceptive input
-Pokes holes in his papers with his pencil
-Scribbles and draws on his papers--if his drawing is hard (thick, dark lines) this is proprioceptive input.
-Constantly drops his pencils: this is likely from lack of moderating the strength of his grasp. It's both a sensory and fine motor issue.
-Breaks the tips of his pencils while writing Same as above--only too much pressure. Again, it's a problem of being able to sense the force going through his fingers. You may want to try one of the vibrating pencils that write normally, but vibrate. You can find them in OT catalogs
-Constantly makes noises (nonsense words, singing, etc) This can be a sensory processing issue for a kid who can't screen noises from the environment--they make their own "white noise."
-Tips his chair forward (and falls out of it frequenty) This is likely a balance issue, a vestibular issue, and a lack of core muscle strength. Give him some appropriate ways to move while seated (again, there are many cushions, T-stools, exercise balls, etc. for seating in OT catalogs) and work hard on developing his core muscle strength.

OT for these kinds of problems would last longer than 3 months.

[funschooler5]

These behaviors are all typical of SPD. What type of excercises did your OT do with him? I would expect a brushing routine for about 8 weeks, a lot of swing work, motor planning, and maybe some ball tossing and racquet work.

They didn't really do anything for his sensory issues as far as I could tell. They worked mainly on his handwriting, tying shoes, upper extremity strengthening, core strengthening, bilateral coordination, and finger strengthening. They gave me some sensory activities to do with him at home, and that was it. This was through Easter Seals. We don't have health insurance, and we were able to apply and get a discounted rate for therapy through them. I'd been hoping that doing things with him at home would be enough, but I think he needs therapy for his sensory issues.

Unfortunately, I had to search a lot just to find the Easter Seals. Our family doctor saw him once and said ADD...I'd been researching SPD a long time before this (I read several books, websites, and attended a conference about it) because the symptoms totally fit my son. My doctor had never even heard of SPD and said I "might want to stop reading books":glare: . (That is a completely separate issue, we don't like our doctor but w/o health insurance it's hard to find a new one).

[lovelearnandlive]

Have you tried therapeutic listening (http://www.sensory-processing-disorder.com/therapeutic-listening.html)? My dd2 has some sensory issues but hasn't been diagnosed withe SPD. She has OT, though, and during her sessions she has listening therapy. It does make a difference, during the therapy and afterward as well. She is much more focused while she is listening to the music and will sit still for longer periods. She is also much calmer for the rest of the day. I think I am going to ask her therapist if there is a program I can use at home because I think it would be good for her to get this kind of therapy in every day.

Just wanted to bring this up because I've seen good results with it. I hope that you find something that works for your ds. :grouphug:

[JFS in IL]

Did they send you home with the surgical brushes and instruction for the brushing technique? Give you a supply of thera-putty to mess with? recommend a bouncey seat or a mini-trampoline for breaks? If not - you may need this stuff. http://www.therapyshoppe.com/ can give you ideas on stuff - depending on his sensory issues you can get or create items to help him get through his day. My kid for a long time needed to take breaks and jump on a mini-trampoline, and had a mildly bouncey seat thing on his chair for desk work, also a vibrating pen and theraputty (the green stiff stuff) to mold with his fingers AND out of which he had to dig beads. Plus the brushing. Oh - and with the brushing our OT had us doing joint compression - sounds like this would be helpful to your kid BUT you need a trained therapist to show you how to do it!!! One appointment back at Easter Seals to be shown how to do the brushing/joint compression might be in order.

[Kathy in MD]

Unfortunately money is always a problem, especially if you don't have good health insurance.

The strengthening excercises your OT included are needed for many SPD children, but they are usually performed in a swing. The swing works on sensory problems (inner ear problems primarily, though some touch problems also) at the same time.

I'll list a few activities my OT did to help my ds. You may find some of them useful. Many of them don't seem to address sensory issues but they do affect typical SPD problems. She always used a net swing (hammock type chair) with a variety of pillows, boards and toys. At first. he sat in the swing, well padded from the net. They would play catch, with the OT sometimes forcing him to catch across the midline, sometimes to move and twist the swing. She would also twist it a little to to help him deal with rotating motion (inner ear problem). She had to be very careful with my ds because he was so sensitive to rotational movements and would become sick. The OT slowly reduced the pillows (less sensitive to textures) and amount of backsupport with the net. He advanced to laying on his stomach on a small board (2'x2'?), while playing catch and picking up small objects scattered around the room. This invovled a lot of building core strength, balance and hand-eye coordination. Finally he had to announce what item he was going to pick up before he did so, working on motor planning which is another major problem for SPD children. One thing to remember if you get a swing, make sure the swing is securely anchored into a large beam in your ceiling.

She also played catch and racquet games without the swing. She found a raquet with a solid plastic film instead of netting at a toy store. The raquet would "boom", using sound to reinforce the pressure his hand and arm felt as his racquet hit the ball. she also used a varitety of things to bat back and forth to change both the souund and the hand pressure.

She had him play with many types of textures - shaving cream, finger paints, squishy balls, clay, beans, thera-putty or silly putty, etc. Use your immagination.

At home, she had him wear heavy shoes, sleep under heavy blankets and wear as much tight, stretchy clothes as I could get for a boy. Translation, girls often wear leggings, but boys just don't. Therefore for ds it was tight, knit boxer briefs. If I could, I would have snuck long under wear on him in winter, but he becanme hot easily and wouln't wear pants and long sleeves most of the time.

I do agree with another poster, that if your OT didn't do brushing and joint compression, you need to scrape up the moey for a consult to be taught how to do it.

I'm not surprised that your doctor hasn't heard about SPD. As much as we talk about it on these boards, it's still not that well known. I don't think my reg. ped knew anything about it. I learned about it only from my dev. ped, who investigated all types of alternative treatments in the hopes of improving things for children with developmental problems. Also many doctors who have heard about it think it's a bunch of milarky.

[cillakat]

I would love to see any evidence that OT is effective for SPD when SPD has no motor component. I'm not saying that it doesn't have that component....but saying *for the times it doesn't*. For the person who has no vestibular, proprioceptive, motor planning/coordination issues. Heck, any evidence that it works at all.

I was it's biggest fan.

It didn't work. And our OT was great. She did all the right things. We did all the right things.....

I think the things we were willing to call sensory were simply ADHD and her temperment. Here's a blog post by the director of the 504 School (Atlanta area ADHD school) that succinctly states how I happen to think about SPD/SID at this point in time:

http://the504school.blogspot.com/2008/07/sensory-integration-disorder-answer-and.html
<<The person who actually marketed sensory integration disorder to the general public is Carol Stock Kranowitz. She was a preschool teacher who collaborated with an occupational therapist to expand and explain Jean Ayres' theories. Carol is from Bethesday, MD where I lived in the 90's. As an early childhood teacher I was familiar with her ideas since she presented at various teacher conferences in the D.C. area. Carol’s most successful book, The Out-of-Sync-Child was written in 1998 for the general public.

With the rise of the autism diagnosis, sensory integration disorder took another turn in its journey. Raising A Sensory Smart Child written in 2005 by Lindsey Biel, an OT, has a forward by Temple Grandin; a very high functioning autistic woman who is a prominent voice of adults with autism.

The most recent books on the subject, all written by occupational therapists, aim to replace other diagnosis with sensory integration disorder. The American Occupational Therapy Association, Inc. (located in Bethesda, MD) is now petitioning the American Psychiatric Association to recognize sensory integration disorder as a diagnosis in the Diagnostic and Statistical Manual. It's not currently recognized. This is why your pediatrician and psychiatrist look blankly at you when you mention that your inattentive, hyperactive, and impulsive 6 year old really has sensory integration disorder and not adhd. (I need to write about 10 more blogs to expand on the complexities of this major diagnostic difference!)What a parent might not know is that under age 8, pretty much all kids by definition have some sort of sensory integration issue. Jean Piaget, the quintessential observer of children, stated that “seven or eight years of moving and play are required to give the child a sensory-motor intelligence that can serve as the foundation for intellectual, social, and personal development.” Until age 8 typically developing children are not yet “set” in this development. This is why playgrounds have always had swings.

I’m not in any way discrediting the theory. I’m not sure I’ve met a child with a developmental delay that doesn’t have sensory issues. I just don’t think this is the foundational problem for most atypically developing children. Most of the sensory symptoms decrease markedly in the middle childhood years; even for kids with delays.

My fear here is that everyone will forget about the symptoms of less sexy but recognized diagnosis. ..…..like the anxiety, depression, ocd, and negative behavior symptoms that can increase as time goes by in children with ADHD. The social and emotional bits and pieces are super important to attend to and keep an eye on.

You may think that sensory integration disorder is now the answer and occupational therapy the solution for your child. It may not be in a couple years.

http://the504school.blogspot.com/2008/07/sensory-integration-disorder-answer-and.html

** Sensory Processing Disorder (SPD) seems to be the most recent term that practitioners are using to describe this phenomen>

[Kathy in MD]

I would love to see any evidence that OT is effective for SPD when SPD has no motor component. I'm not saying that it doesn't have that component....but saying *for the times it doesn't*. For the person who has no vestibular, proprioceptive, motor planning/coordination issues. Heck, any evidence that it works at all.

I was it's biggest fan.

It didn't work. And our OT was great. She did all the right things. We did all the right things.....

I think the things we were willing to call sensory were simply ADHD and her temperment. Here's a blog post by the director of the 504 School (Atlanta area ADHD school) that succinctly states how I happen to think about SPD/SID at this point in time:

http://the504school.blogspot.com/2008/07/sensory-integration-disorder-answer-and.html
<<The person who actually marketed sensory integration disorder to the general public is Carol Stock Kranowitz. She was a preschool teacher who collaborated with an occupational therapist to expand and explain Jean Ayres' theories. Carol is from Bethesday, MD where I lived in the 90's. As an early childhood teacher I was familiar with her ideas since she presented at various teacher conferences in the D.C. area. Carol’s most successful book, The Out-of-Sync-Child was written in 1998 for the general public.

With the rise of the autism diagnosis, sensory integration disorder took another turn in its journey. Raising A Sensory Smart Child written in 2005 by Lindsey Biel, an OT, has a forward by Temple Grandin; a very high functioning autistic woman who is a prominent voice of adults with autism.

The most recent books on the subject, all written by occupational therapists, aim to replace other diagnosis with sensory integration disorder. The American Occupational Therapy Association, Inc. (located in Bethesda, MD) is now petitioning the American Psychiatric Association to recognize sensory integration disorder as a diagnosis in the Diagnostic and Statistical Manual. It's not currently recognized. This is why your pediatrician and psychiatrist look blankly at you when you mention that your inattentive, hyperactive, and impulsive 6 year old really has sensory integration disorder and not adhd. (I need to write about 10 more blogs to expand on the complexities of this major diagnostic difference!)What a parent might not know is that under age 8, pretty much all kids by definition have some sort of sensory integration issue. Jean Piaget, the quintessential observer of children, stated that “seven or eight years of moving and play are required to give the child a sensory-motor intelligence that can serve as the foundation for intellectual, social, and personal development.” Until age 8 typically developing children are not yet “set” in this development. This is why playgrounds have always had swings.

I’m not in any way discrediting the theory. I’m not sure I’ve met a child with a developmental delay that doesn’t have sensory issues. I just don’t think this is the foundational problem for most atypically developing children. Most of the sensory symptoms decrease markedly in the middle childhood years; even for kids with delays.

My fear here is that everyone will forget about the symptoms of less sexy but recognized diagnosis. ..…..like the anxiety, depression, ocd, and negative behavior symptoms that can increase as time goes by in children with ADHD. The social and emotional bits and pieces are super important to attend to and keep an eye on.

You may think that sensory integration disorder is now the answer and occupational therapy the solution for your child. It may not be in a couple years.

http://the504school.blogspot.com/2008/07/sensory-integration-disorder-answer-and.html

** Sensory Processing Disorder (SPD) seems to be the most recent term that practitioners are using to describe this phenomen>

Unfortunately I don't know of any double blind tests to prove or disprove that SPD can be treated by OT. Such experiments are expensive and are generally reserved for things that are patentable. But as I mentioned in an earlier post, there is a lot of anecdotal evidence that it does work. Even 7-8 years ago, my dev. ped said she had both read about and seen in her practice the positive results of OT on SPD.

But I do disagree with your blogger on many accounts. Not all children outgrow SPD by the time they are 7 or 8 years old. I know 2 adults IRL who still suffer from SPD. I know of several others through conversations with my ds's OT. (she probably had 20-25 years of experience when my ds recieved therapy from her) The blogger mentioned that children will outgrow SPD by the time they are 7 or 8. Once again, I've known several dc IRL and even more through the boards that didn't outgrow it by that age. My ds didn't start OT till he was 7.5 years, and he still has some symptoms, however they are now manageable. The OT with follow up sports changed his life for the better. (Note, he did have very severe SPD).

I also take issue with the blogger's opinion that SPD isn't a foundational issue for some other problems. Not all, but some. Before Carol Kranowitz came out with her revised The Out-of-Sync Child tying SPD to some dev. vision and language problems, my OT and I speculated on that possiblity. After all, in the early days of SPD treatment, the OT's actually treated dev. vision problems. Even recently Laurie4B's son's vision problems were mostly cured by SPD OT. And many dc with SPD also have language problems (associated with inner ear SPD problems)

Unfortunately, I don't know if OT does or doesn't work for individuals with only sensory problems. As far as I know, all the dc that I've known with SPD also had motor control, balance issues, weak core muscles or some of the other associated problems. I do know that my ds's sensory problems did become less severe with therapy.

I have no doubt that SPD is being overdiagnosised as it becomes better known. Unfortunately it seems that many new diagnosises and treatments go through a fad stage. ADHD definitely did, and many parents now deny that it really exists because of all the misdiagnosises. It's a pity, because as you know, it is a real problem for many indidviduals.

[cillakat]

<<Not all children outgrow SPD by the time they are 7 or 8 years old.>>

Might want to read it again. You're misunderstanding.

She's not saying that everyone that has it outgrows it. She's saying that virtually all children, by developmental definition could be diagnosed with it. And that the normal developmental phase will be outgrown by 7-8 years of age in the population for whom it simply a normal developmental stage.

Much of what is being diagnosed is not pathological. It's simply normal development and in some other cases normal developmental needs for certain kinds of stimulation/movement not being met.

I see so many parents claiming improvement (like with vision therapy) yet as I stand back and watch, the improvement that is claimed simply isn't there.

One of the little girls in our carpool is in OT for hand strength issues. Apparently, the OT and the mother think her the muscles controlling fine motor issues are 'weak' and 'need strengthening'. This is the child who will color beautifully for long long chunks of time, draw exceptionally detailed mermaids that look like they've been drawn by a teenaged art student, beads detailed jewelry with tiny beads......and yet has fine motor skill problems? it's simply fiction. She has *handwriting* issues. The kind that won't be solved by OT no matter how long it goes on and no matter how much $$ they spend.

SPD and other issues that are treated by "OT" will simply not be the foundational problem for most kids. Some definitely....and will OT help? IMO yes if there are motor components as well.....and maybe for some who 'just' have sensory issues.

But people are starting with OT, calling SPD the main foundational issue and missing valuable time targetings the more likely issues like dyslexia, ADHD etc.

Ditto for vision therapy.

Imesho, we're putting the emPHAsis on the wrong syLLAble.

:)
Katherine in atl

[Kathy in MD]

<<Not all children outgrow SPD by the time they are 7 or 8 years old.>>

Might want to read it again. You're misunderstanding.

She's not saying that everyone that has it outgrows it. She's saying that virtually all children, by developmental definition could be diagnosed with it. And that the normal developmental phase will be outgrown by 7-8 years of age in the population for whom it simply a normal developmental stage.

Much of what is being diagnosed is not pathological. It's simply normal development and in some other cases normal developmental needs for certain kinds of stimulation/movement not being met.

I see so many parents claiming improvement (like with vision therapy) yet as I stand back and watch, the improvement that is claimed simply isn't there.

One of the little girls in our carpool is in OT for hand strength issues. Apparently, the OT and the mother think her the muscles controlling fine motor issues are 'weak' and 'need strengthening'. This is the child who will color beautifully for long long chunks of time, draw exceptionally detailed mermaids that look like they've been drawn by a teenaged art student, beads detailed jewelry with tiny beads......and yet has fine motor skill problems? it's simply fiction. She has *handwriting* issues. The kind that won't be solved by OT no matter how long it goes on and no matter how much $$ they spend.

SPD and other issues that are treated by "OT" will simply not be the foundational problem for most kids. Some definitely....and will OT help? IMO yes if there are motor components as well.....and maybe for some who 'just' have sensory issues.

But people are starting with OT, calling SPD the main foundational issue and missing valuable time targetings the more likely issues like dyslexia, ADHD etc.

Ditto for vision therapy.

Imesho, we're putting the emPHAsis on the wrong syLLAble.

:)
Katherine in atl

You're right. I did misread it. And I agree totally that SPD isn't the cause of all dev. problems.

There's a very true phrase, "If a person has a hammer, the entire world is a nail." That can be a problem when you go straight to an OT with a problem. Their toolkit only consists of therapy and they want to help people. And they view the world through the lens of SPD and OT. This goes for other specialties as well.

That's why I advocate initially going to a "generalist" who specialises in all types of dev. problems. They have a larger toolkit from which to diagnose and to see if there are multiple problems.

And I also agree that some people go looking for problems. Or they want just a slight edge on the "competition". Or they aren't happy because their children aren't as perfect as the parents want them to be and the parents go looking for a physical cause.

[funschooler5]

That's why I advocate initially going to a "generalist" who specialises in all types of dev. problems. They have a larger toolkit from which to diagnose and to see if there are multiple problems.

When you say generalist, do you mean a pediatrician? My son was only diagnosed by OTs...I don't want to go to our family doctor, because he doesn't seem to know very much about SPD. I think someone mentioned something about a developmental pediatrician? If I had a specific job title, I could search and see if there's someone in my area.

BTW, thanks everyone for your help! All of these suggestions have been very helpful!!

[Kathy in MD]

When you say generalist, do you mean a pediatrician? My son was only diagnosed by OTs...I don't want to go to our family doctor, because he doesn't seem to know very much about SPD. I think someone mentioned something about a developmental pediatrician? If I had a specific job title, I could search and see if there's someone in my area.

BTW, thanks everyone for your help! All of these suggestions have been very helpful!!

No, I meant a someone who specializes in all types of developmental problems. A regular pediatrician has some background in developmental milestones and problems, but generally it's too light of a background to really help a variety of problems.

A dev. pediatrician is whom my ds saw. She is now a DAN doctor (Defeat Autism Now, they take a wholistic approach), though she does still see other problem types. Other posters have been happy with dev. neuro-psychs. Others have gone to large clinics with a large variety of specialists who all join in the evaluation. Unfortunately our phone book doesn't list dev ped as a category, so a dev. ped may be hard to locate, but you could contact your local hospital or children's hospital for help in locating one.

But still, try to explore the doctor's web site, if he has one, to try to get a feel for the practice. Try to avoid doctors who are wedded to one theory. Unfortunately I've never been able to come up with a good list of questions to ask about a practice. Maybe others could help with this.

[Laurie4b]

You are clearly saying that OT did not work for your child with ADHD but something else did, and you wished you had tried that first. However, some of the rest of your points are confusing and some are misleading.

OT's do not diagnose ADHD. To do that correctly, you need a good neuropsychologist or a developmental pediatrician. Too many regular pediatricians overdiagnose it, using only checklists by parents and teachers, not doing recognized tests, and without differentiating from other potential causes for the distractibility.

SPD has nothing to do with dyslexia, other than that having one disability of any kind raises the probability that there is another. One often sees clusters of problems rather than a stand-alone diagnosis. I've never seen on these boards anyone recommend OT as the first step when a poster says their child has reading problems. I've never seen it IRL either, but maybe you have. I totally agree that if the signs of a reading problem are there, the first step in treatment is to use research-based intervention methods and to keep using them, even if you try something else like vision therapy.

You also say that you've seen "many people" claim that OT for sensory processing works for their children, but you don't see the results, then you cite one case that wasn't for spd, but for fine motor issues where there aren't any. Hand strengthening is not part of treatment for SPD. It is part of treatment for fine motor skills.

This statement is confusing: " I would love to see any evidence that OT is effective for SPD when SPD has no motor component. I'm not saying that it doesn't have that component....but saying *for the times it doesn't*. For the person who has no vestibular, proprioceptive, motor planning/coordination issues. Heck, any evidence that it works at all."

For one thing, the OP mentioned that her son does have a coordination disorder. SPD is often co-morbid with that. So by your own sentence, I'm not sure why you'd be warning her off of SPD treatment. Another thing that is confusing is that vestibular & proprioceptive issues are sensory processing issues. So your sentence actually says something like "If they don't have sensory processing issues, they shouldn't be treated for sensory processing issues." Then you end with "Heck, any evidence that it works at all."

The professionals whom I know in psychology (one at a university center with a nationwide reputation for treating autism spectrum) and neuropsychology think that there is research evidence that sensory processing issues contribute to several childhood diagnoses and that treatment for the sensory processing issues is effective and helps the child's functioning. They do not generally believe that it is a stand-alone diagnosis, but that it underlies other issues. As far as research goes, OT treatment it is not on par with vision therapy. Vision therapy truly does not have an accepted research base, but only anecdotal evidence. Our neuropsych would not recommend vision therapy because she said there was no research evidence. On the other hand, she said that OT does have a recognized research base and she strongly recommended that we continue with it.

I know in our experience, treatment for sensory processing disorders was life-changing for my son. The results were dramatic and visible within the first couple months. He had severe vestibular & proprioceptive issues, motor-planning issues, eye focus and tracking issues (both were visible to me as the parent, not the result of some questionable test). He had many ADHD like symptoms, which did indeed go away with treatment for SPD. I thought the whole thing was voodoo when we started until I saw the dramatic results. He still has some ADD issues( distractibility and inattentiveness) but has not had a return of the level of hyperactivity and impulsivity that he had when we started OT. What looked like hyperactivity was sensory-seeking behavior. His relationships with everyone changed once that was eliminated Everyone we knew from grandparents who rarely saw him, to his regular babysitter, to an occasional babysitter, etc. said spontaneously, "He's like a different kid." Everyone used almost the same words. Some had no idea we were doing OT. I had no idea the first time I did the brushing protocal what was supposed to be different, and then saw his arousal state change literally before my eyes from very hyper to calm and focused. I was very surprised. You weren't here to see that, but the people who were here certainly did see it. On the other hand, the treatment for the coordination issues was not as effective. We're still working on that those issues. Treatment for coordination disorders is, I think, very slow and long-term. There are some things ds just won't do that well in, and other things he will have to think through very carefully, rather than just "do" like other children.

On the other hand, I've not seen results yet from vision therapy. I'm not a "true believer" about that and was not about OT for sensory processing either. However, that did have clear results.

[funschooler5]

I know in our experience, treatment for sensory processing disorders was life-changing for my son. The results were dramatic and visible within the first couple months. He had severe vestibular & proprioceptive issues, motor-planning issues, eye focus and tracking issues (both were visible to me as the parent, not the result of some questionable test). He had many ADHD like symptoms, which did indeed go away with treatment for SPD. I thought the whole thing was voodoo when we started until I saw the dramatic results. He still has some ADD issues( distractibility and inattentiveness) but has not had a return of the level of hyperactivity and impulsivity that he had when we started OT. What looked like hyperactivity was sensory-seeking behavior. His relationships with everyone changed once that was eliminated Everyone we knew from grandparents who rarely saw him, to his regular babysitter, to an occasional babysitter, etc. said spontaneously, "He's like a different kid." Everyone used almost the same words. Some had no idea we were doing OT. I had no idea the first time I did the brushing protocal what was supposed to be different, and then saw his arousal state change literally before my eyes from very hyper to calm and focused. I was very surprised. You weren't here to see that, but the people who were here certainly did see it. On the other hand, the treatment for the coordination issues was not as effective. We're still working on that those issues. Treatment for coordination disorders is, I think, very slow and long-term. There are some things ds just won't do that well in, and other things he will have to think through very carefully, rather than just "do" like other children.


Thank you for this post, it gives me some hope! :001_smile:

How often was your son's therapy? I'm wondering because my son's therapy was only once a week for one hour (this was just for his motor skills and coordination problems). He did improve quite a bit, but we were working with him at home also. Is it more often for sensory therapy?

[Laurie4b]

My recollection is that it was twice a week for about 2 months, then we dropped back to once a week. The OT recommended the twice a week to get things really kicked off and it did. It totally changed his outlook on life, and changed interactions in the home. He may have been more out of control hyper than your son, so the gains may have been more visible faster. But I well remember all the falling out of chairs issues! (The OT said that was a combination of disturbances in processing info from the vestibular system plus lack of core muscle strength). We did do a sensory diet at home. Additionally, the thing that was helpful was the "How is your engine running?"
language that the OT's used and taught ds: high (hyper), medium (Just right--able to attend to tasks and be focused) or low (dragging, low alertness, low energy.) They taught us how to help him assess where he was functioning and what to do to alter the state of arousal. (Generally proprioceptive input will organize the system whether the arousal level is too high or too low.) Here is a quote from ds weeks after starting OT. We had taken him for prayer at church. The pastor asked, "Tell me what is happening." DS: "I used to be high all the time. Now I'm high, medium, high, medium." Pastor: "Which do you like best?" DS:medium. PAstor: "What's it like when you're high? " Ds: "I never know what I'm going to do next." That line really got me. I knew what it was like to be the mom of someone of whom I never knew what he was going to do next, but to imagine that you yourself didn't know....brought tears and empathy for what he'd endured himself for 7 years. OT changed that. It was changed permanently. That doesn't mean that he doesn't sometimes still get "high" but we can modulate it when we need to and it is much less frequent. But stuff like finding him on the outside of the balcony at the beach house... .stopped after OT. IT didn't cure everything. Like I said, ds still struggles with distractibility and impulsivity is evident in small things, like saying the wrong answer first and immediately correcting himself. But it really did take a big chunk off of the in-your-face hyperactivity and impulsivity.

[cillakat]

<<OT's do not diagnose ADHD.>>

oh c'mon Laurie. Show me where I said that. I'm saying what Kathy said. An OT isn't the place to start. It's best to start with a generalist approach and narrow down, rather than decide what it is, have that specialist look at it, confirm it then treat it. Because of this approach, too many parents are hanging their hat - so to speak - on the hook of OT. (and to a lesser extent, vision therapy).

<<To do that correctly, you need a good neuropsychologist or a developmental pediatrician.>>

Or educational pyschologist. I'd love a developmental ped but at least in my area they are few are extremely far between. There are two that I can find who are taking patients. One is a DAN doc, takes no insurance etc etc. The other tends to diagnose everything as asperger syndrome. Everything.

<<Too many regular pediatricians overdiagnose it, using only checklists by parents and teachers, not doing recognized tests, and without differentiating from other potential causes for the distractibility. >>

Second that.



<<SPD has nothing to do with dyslexia, other than that having one disability of any kind raises the probability that there is another. >>

Bingo. Exactly.

<<One often sees clusters of problems rather than a stand-alone diagnosis.>>
Exactly.

That's why it's a problem to start with OT or other narrowly focused field rather start wtih broad testing that gives a clearer picture of what exactly is at work in the individual situation.

<<I've never seen on these boards anyone recommend OT as the first step when a poster says their child has reading problems.>>

But vision therapy is. I'm saying that vision therapy and OT are similar only in that people tend to go to OT's and behavioral optometrists *as a first step* when what they really need is a developmental pediatrician, neuropsych or educational psy to do full batteries of testing.

If there is a reading problem, behavioral optometry isn't the first step. If there is a behavior or developmental problem, OT isn't the first step yet it happens *all the time* by recommendation here on these boards and in what I see going on around me in Atlanta.

After thousands are spent on OT (for what looks like spd but ends up being adhd or anxiety etc) and vision therapy(for what ends up being a reading disability), parents later face the fact that they still have unanswered questions.

Again, just for the sake of clarification, I am not saying that OT has no value. It absolutely does.....known value for motor issues. Possible value for other issues. And I'm not saying vision therapy has no value (though I am highly highly skeptical of vision therapy)

What I am saying is that OT and VT are not starting points. A comprehensive evaluation is a starting point. The OP was saying that she sees signs of ADHD in her child......things that many, probably most especially the OT are wanting to attribute to SPD. I'm simply saying again, I think we're putting the emPHAsis on the wrong syLLAble;p The emphasis should be on initial comprehensive testing which moves towards treatment that gets the most significant results quickly.

:)
Katherine

[cillakat]

For one thing, the OP mentioned that her son does have a coordination disorder. SPD is often co-morbid with that. So by your own sentence, I'm not sure why you'd be warning her off of SPD treatment.

I'm not. I'm saying that she should be cautious of attributing the ADHD traits to SPD when they simply could be ADHD in addition to the other issues.


<<So your sentence actually says something like "If they don't have sensory processing issues, they shouldn't be treated for sensory processing issues." >>

Let me state it differently. When sensory issues are occuring on their own, with *no* motor skills issues and no motor planning issues, I have not seen OT treatment *for those issues*, on their own be successful. I know that by some they are perceived to be. But it's very possible that there is a powerful (and expensive) placebo effect at work. And it's also very possible that the child is simply outgrowing the issues.


<<As far as research goes, OT treatment it is not on par with vision therapy. Vision therapy truly does not have an accepted research base, but only anecdotal evidence. >>

I'll absolutely concede that this is true. OT has a much broader base of evidence wrt motor issues and feeding issues (which, true, have a sensory component but also almost always a motor component as well).

<<I know in our experience, treatment for sensory processing disorders was life-changing for my son. The results were dramatic and visible within the first couple months. He had severe vestibular & proprioceptive issues, motor-planning issues,>>

Exactly. When that is a component, it does seem to work. When that's not one of the issues though.....



<<He had many ADHD like symptoms, which did indeed go away with treatment for SPD. >>

But as you state next, he still has some ADHD issues wrt distractability/inattention. Again, though, I refer to your statement about motor planning issues. OT is helpful much of the time when there is a motor planning issue present so I would expect that OT would be helpful to your son. And I'm so so very glad it was.

I'm totally not anti-OT. I'm anti-OT as a starting point and as an initial diagnositic framework when there is anything going on in *addition to*, motor/co-ordination issues.

That's all:)
Katherine

[funschooler5]

Additionally, the thing that was helpful was the "How is your engine running?"


Thanks for the info! I sent you a pm about this.