4-year-old potential ADD or anxiety---where to go first---also IEP question

[Anonymous]

ADD and some minor LDs run in our family. DD had some motor delays and saw a developmental pediatrician when she was younger (told there was no immediate need to return at just under 2). Had PT and is currently in speech. Her preschool teacher is concerned about her lack of attention span and her lack of frustration tolerance (I've also noticed both at home, especially lack of frustration tolerance). She will start Kindergarten in September. Her motor skills are still a little behind but not horrible. Is the best first step to go to our regular pediatrician or to try to see a child psychologist or developmental ped (I know it's a long wait). We saw Dr. Kozma at Georgetown when she was small who I know is not popular on this board, and I think we'd likely wait for Children's this time.

Another question--we have an IEP and she currently gets speech therapy through the public schools. Her IEP meeting is coming up in February but her IEP is based on hearing loss (due to fluid in her ears). I don't think I can just introduce other issues immediately into her IEP, can I? There has to be screening first? Just concerned since she'll be starting K and will into the year before her next IEP expires.

[Anonymous]

How are her fine motor skills? In our child, lack of fine motor skills/motor planning skills contributed to lack of frustration tolerance and attention span. If you think that's an issue, you can ask for her to be tested. The fine motor tests are really pretty objective, so going through the schools is OK in my opinion, no need for an outside assessment. I'm not sure how this works into the IEP meeting process, but I'd request any screening ASAP and definitely bring it up in Feb.

We've been seeing an OT for our child's fine motor/motor planning and he is doing GREAT. I was a skeptic, but it's really working.

We also have a small preschool class with teachers that are working really hard on building focus and attention. Are your preschool teachers working on her to improve, or just complaining to you?

[Anonymous]

Where do you live?

Best case scenario, what services or supports would you propose to add to her IEP now since she isn't in a public school setting?

[Anonymous]

OP here. We are in APS (S. Arlington). I wouldn't want anything now, but would like to look at support in September when she starts K. Maybe OT type skills or whatever is appropriate for working on the issues that are identified (specifically improving attention span and working on coping with frustration). I would not be surprised if fine motor skills and motor planning are causing the frustration. I can tell they are issues. They are issues for me. I had OT as a child.....

[Anonymous]

And yes our preschool teachers are working with the kids and not just complaining but I don't think it's the ideal situation (larger class than she originally had with lots of younger kids who are still a year out from K). I think our lead teacher is good, but not the absolute strongest or most experienced if that makes sense. I appreciate her bringing this to my attention. She's not running to me to complain but sharing observations, especially after I ask.

[Anonymous]

Child psychologist will give you the information you need to get services in school and through private healthcare experts. They will also help point you in all the directions you need to go. 4 is young to get an ADHD diagnosis, but you could get the testing now and then also when older and from that they will be able to make a better finding of what the issues are.

[Anonymous]

Anonymous wrote:OP here. We are in APS (S. Arlington). I wouldn't want anything now, but would like to look at support in September when she starts K. Maybe OT type skills or whatever is appropriate for working on the issues that are identified (specifically improving attention span and working on coping with frustration). I would not be surprised if fine motor skills and motor planning are causing the frustration. I can tell they are issues. They are issues for me. I had OT as a child.....

Talk to your case manager now and ask for an evaluation for the concerns you described.

I'd also get them done privately if you can afford it.

Once you have the data, if it indicates she needs adjustments to the IEP ask the K school principal for an IEP team meeting (either in spring to plan for fall, or beginning of next year).

[Anonymous]

Anonymous wrote:OP here. We are in APS (S. Arlington). I wouldn't want anything now, but would like to look at support in September when she starts K. Maybe OT type skills or whatever is appropriate for working on the issues that are identified (specifically improving attention span and working on coping with frustration). I would not be surprised if fine motor skills and motor planning are causing the frustration. I can tell they are issues. They are issues for me. I had OT as a child.....

Go check out OT now!! Sounds very similar to my child -- his motor planning/fine motor/attention trifecta are clearly inherited in part. You can make a lot of progress before K. We started in Sept and I'm very glad. Also nervous about K, but feel much better situated now. I think there's value in starting K already understanding the challenges better and being able to communicate them to the teacher, instead of just waiting for problems to arise.

[Anonymous]

Go check out OT now!! Sounds very similar to my child -- his motor planning/fine motor/attention trifecta are clearly inherited in part. You can make a lot of progress before K. We started in Sept and I'm very glad. Also nervous about K, but feel much better situated now. I think there's value in starting K already understanding the challenges better and being able to communicate them to the teacher, instead of just waiting for problems to arise.

PP---did you get OT without a prescription? Are you paying fully out of pocket? Not sure if I can just find an OT or need to see someone else first.

[Anonymous]

Anonymous wrote:

Go check out OT now!! Sounds very similar to my child -- his motor planning/fine motor/attention trifecta are clearly inherited in part. You can make a lot of progress before K. We started in Sept and I'm very glad. Also nervous about K, but feel much better situated now. I think there's value in starting K already understanding the challenges better and being able to communicate them to the teacher, instead of just waiting for problems to arise.

PP---did you get OT without a prescription? Are you paying fully out of pocket? Not sure if I can just find an OT or need to see someone else first.

NP. That totally depends on your insurance. We didn't need a prescription but if you do, even your pediatrician could do it.

[Anonymous]

Get a private evaluation and give it to the school so they can integrate it into the next IEP meeting. If you have an IEP it should continue in K.

If you are not in private speech, I would add it once a week.

[Anonymous]

Anonymous wrote:ADD and some minor LDs run in our family. DD had some motor delays and saw a developmental pediatrician when she was younger (told there was no immediate need to return at just under 2). Had PT and is currently in speech. Her preschool teacher is concerned about her lack of attention span and her lack of frustration tolerance (I've also noticed both at home, especially lack of frustration tolerance). She will start Kindergarten in September. Her motor skills are still a little behind but not horrible. Is the best first step to go to our regular pediatrician or to try to see a child psychologist or developmental ped (I know it's a long wait). We saw Dr. Kozma at Georgetown when she was small who I know is not popular on this board, and I think we'd likely wait for Children's this time.

Another question--we have an IEP and she currently gets speech therapy through the public schools. Her IEP meeting is coming up in February but her IEP is based on hearing loss (due to fluid in her ears). I don't think I can just introduce other issues immediately into her IEP, can I? There has to be screening first? Just concerned since she'll be starting K and will into the year before her next IEP expires.

Email the principal at local elementary school for which she's slated to go. Ask for an evaluation to update her IEP outlining the teachers concerns and the educational impact they may entail. She may need OT and behavioral supports in the classroom for next year in addition to speech. (For ideas of what these might look like, search Writghts Law or understood.org) The school can evaluate her b/f the end of this school year and update her IEP.

In the meantime, get on the wait list for a developmental pediatrician at Children's and/or KKI to assess for the ADHD (whichever would be covered by your insurance). These appointments inevitably have a waitlist, so don't worry if it's a way off. If ADHD is diagnosed, you can discuss with the developmental pediatrician about options for medication if you think it's necessary.

Lastly, most OTs don't accept insurance. Usually if it's covered, you submit for reimbursement after the fact. Check with your insurance about your coverage.

Sounds like your getting your ducks in a row. Good job.

[Anonymous]

Def get a detailed private evaluation and present those findings to the school in order to adjust the IEP as needed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Go check out OT now!! Sounds very similar to my child -- his motor planning/fine motor/attention trifecta are clearly inherited in part. You can make a lot of progress before K. We started in Sept and I'm very glad. Also nervous about K, but feel much better situated now. I think there's value in starting K already understanding the challenges better and being able to communicate them to the teacher, instead of just waiting for problems to arise.

PP---did you get OT without a prescription? Are you paying fully out of pocket? Not sure if I can just find an OT or need to see someone else first.

NP. That totally depends on your insurance. We didn't need a prescription but if you do, even your pediatrician could do it.

I didn't need a prescription for my insurance, but I'm sure my pediatrician would have done it. I ended up getting an OT evaluation covered by insurance, but we are seeing an out of network OT closer to home for therapy, for which I expect to be reimbursed about 50-70%. Where we live (DC) there just are not that many in network OTs.