possible ADHD 4 year old-- OT and preschool question.

[Anonymous]

My ds is a kind and smart 4.5 year old who is very sensory seeking and may have a dx of ADHD. We have an evaluation scheduled as well as an appt. with a developmental pediatrician soon. He is very active, has difficulty "stopping," and is physical (likes to tag, body bump etc). He has been in play therapy for a short while and we are thinking of doing OT.

For those of you with similar experiences... Do you find that OT generalizes to every day situations. While I think it's great to have the ability to work on his modulation/regulation, it is very expensive and sometimes I wonder if it generalizes to other situations. Sometimes I think that if I just get him out every day on the playground (to play hard), then that will suffice as much as OT. Does anyone have thoughts on this? I am open and do not mean to sound critical re: OT...

The other issue is that our son is in a very nice preschool, but it is pretty unstructured. I wonder if he needs to be in a more structured preschool. When I say this, I do not mean a "preacademic" school b/c I worry he would get into a lot of trouble there too. Does anyone know of preschools that are structured (not just free play) that would help support a kid with ADHD (I am really thinking he will get this dx).

Any suggestions would be wonderful. He will be going to public school (or at least we think so-- if he can handle it) in Fall of 2012 and we are hoping to help him as much as we can now. Thanks for any suggestions re: OT and schools.

[Anonymous]

I would be interested to know how OT relates to ADHD. My DD has ADHD and no one has ever mentioned OT.

[Anonymous]

OP -
FYI - The National Child Research Center did a great symposium in 2010 on "including every learner. The slides from the symposium are still available on the web. This link takes you to strategies for kids with self-regulation difficulties.
http://www.ncrcpreschool.org/site/files/ncrc_including_every_lear.docx. The top recs being a highly structured environment– (consistent routine, visual schedule, preparation, and support for transitions...). It also recommends teachers who are both structured and interpersonally flexible. I read that to mean teachers who have a great playbook, but understand how to tweak it to allow different children to be successful. So, yes to moving to a more structured environment if you feel that it will aid your child in developing skills he needs. Also – perhaps share the strategy sheet with your current preschool.

On OT, I think that the best part of OT is watching how a good OT challenges your child – and the OT’s specific communication style. I have learned a lot about being a better parent from simply watching how effectively my OT communicates with my child – always a firm pleasant tone, getting down to her level, clear instruction, gentle guidance back to the task.... For me, a nice unexpected side benefit of OT is that is seems like a parenting tutorial detailed for my child. It helps me figure out what is a “just right challenge” for my child and how to structure our days so my child is more successful at school, at home, and at play. Finally, in terms of generalizing it is hard to say. What I can say is that activities that previously were uncomfortable for my child (&/or made her over stimulated) no longer do so. That is a good thing. Perhaps it was age or OT or some combination. I believe that if I can reduce the sheer number of sensory experiences that lead to discomfort &/or overstimulation, I exponentially increases the likelihood that my child can focus on the task at hand and be better at self-calming. Is OT the final solution? Nope. Just one strategy in our whole child approach.

Finally - a question for OP - can you tell us a little more about the play therapy you are using.

[Anonymous]

My DS is constantly in motion, has a diagnosis for SPD, and it has been recommended to us that he be tested for ADHD (we've declined thus far). We started him in a structured preschool when he was 3. Our experience, for him, was that it did not go well. He could not sit during quiet time, he quite often tackled the kid(s) in front of him in line without intending to, he wanted to be up when it was seat-work time, etc. They called in the school psychologist etc and made a huge deal of his inability to "regulate" himself. We moved him the following year to Montessori, where he could get up and walk around whenever he wanted, do physical work (washing windows, mopping floor) when necessary, and do many activities that satisfied his sensory-seeking impulses. It was a great fit for him and he excelled there. He's now in a private school where he can get up when he wants, do math while sprawled on the floor, read in a rocking chair, etc. He is thriving there. I have no doubt that he would do abysmally in a structured setting - while I'd love the think that the structured setting would somehow make him more structured, I think it would simply emphasize the places where he is not structured and make him feel bad about himself and school.

We did OT for 9 months. I noticed absolutely no difference from beginning to end. He does swimming year round, which strengthens his core and gives him lots of sensory input. It also helps him feel as though he is a good athlete, which for us is important bc he is not going to excel in any sport that requires hand-eye coordination. For these reasons, I personally, I think this is a much better use of time and resources.
good luck.

[Anonymous]

Thanks so much for your responses. I will definitely look up the National Child Research Center's info. I always hear that structure is hugely important, but I can also see (as the latter poster mentioned) that totally backfiring. What if he can't sit in the chair? What if circle time is hard for him? It's difficult. But then again, I wonder if the free play all day at his school is hard for him... all the down-time when all of a sudden he wants to bump into somebody etc. Confusing.

I am also on the fence re: OT. I have heard that it is very helpful for some and others who say they saw no difference. I have heard that swimming and karate are good for kids with SPD and ADHD, but he rejected karate (after trying it) and is currently scared of the water (we will work on that this summer).

Re: the question about the play therapy... it is a a combination of play and more direct therapy (how to work on frustration tolerance, deal with losing a game, transition to a new task etc.) He enjoys it.

We are hoping to send him to public school. What is the private school that the PP mentioned? Are there private schools that would accommodate a child like mine (with smaller classes etc.)?

[Anonymous]

Op - can I ask who you do the play therapy through? Our 5 yo son was recently diagnosed with ADHD, and he could benefit from something like that.

[Anonymous]

The link I posted might not be working. If you google the following phrase you should pull up a page that gives you all the handouts including two great power points ---Special Needs Symposium, "Including Every Learner: How schools, families and experts can better educate children with challenges."

On the structure - the key is the concept of INTERPERSONALLY FLEXIBLE with structure. The PP's example of structure without flexibility being a clear example of how mindlessly applied structure can backfire for kids with extra challenges. So, when you examine a school, try not to think so much about the particular philosophy or name brand but on (1) experience of teachers and administrators - rookies can lack the confidence and finesse necessary for a challenging kid, (2) how class is conducted over the course of the day, (3) the specific experience of school/teachers/administrators with extra challenging kids, and (4) how open are they to taking guidance from your experts on effective strategies for your child.

Additionally - on OT - it also helped me find other activities tailored to the specific challenges my child faces. I hope to graduate from OT as soon as possible. In the meantime, we leverage it with gymnastic classes, lots of family trips to fun pools, soccer team.... Of the many things we could do - the OT helped me narrow in on the specific extras we should prioritize. That, I feel, is one of the more lasting benefits.

Anyway, best of luck.

[Anonymous]

My experience is similar to 13:22. It also doesn't sound dissimilar to what OP's play therapy is. Our sessions with the OT involve a lot of play as does what we do at home. My DS also has some low muscle tone and motor coordination issues and OT provides a safe environment for him to try new things with little pressure.

I also what to clarify some things about 'structure'. Have a good structure doesn't mean spending more time in a chair or doing more worksheets. It's about predicitability - routine and knowing what's expected. Example of good structure in a preschool/daycare setting would include a visual schedule that is reviewed with the kids in the morning and before transitions, it would be always lining up to wash hands before snack/meal, cleaning up after a meal/activity, designating line leaders and table wipers, circle time is always after snack time, nap time is after lunch, it's flicking the lights 2 minutes before a transition, etc. It provides kids with a sense of stability and boundaries but it isn't about rigidity. There are always opportunities for flexibility within it. Some schools/teachers are better at it than others.

[Anonymous]

Not sure what county you live in. My DD is also very sensory seeking and is likely headed toward a adhd diagnosis. Her issues have caused her delays, and those delays qualified her for fcps special ed preschool next year, probably 3 days per week, half days. Might be something to look into. It's free and I don't get the sense that it's super academic -- more like structured play designed to help kiddos get used to the classroom enviornment. I'm not sure what the other counties in the area offer.