Should we see Dr. Greenspan?

[Anonymous]

My son is 6, very smart, and not happy right now in school. Some people think he has sensory issues, and he is receiving OT for that as well as for handwriting. The OT documented some motor delays, and we are working on those. The psychologist is quite sure he doesn't have Aspberger's or ADHD. I think he has a super-sensitive personality and very strong opinions about what he does or does not want to do. So, for example, he hates music class and feels overwhelmed by lots of kids dancing near him. Some kids might just suck it up, but my DS can't or won't. Ditto PE - he doesn't like it, doesn't want to try, and isn't much good at it. The school is working very hard to encourage him, with mixed success.

Anyhow, I could go on, but the bottom line is that DS is definitely atypical, but so far not diagnosable. He seems to be in an environment that isn't bringing out the best in him, but I do think the school has done a lot to try to help him be comfortable and happy, and I don't know that other schools would offer him any more.

SO, should he see a developmental pediatrician? Dr. Greenspan? What would we get from such a visit, given that the major diagnoses either have been ruled out or are currently being addressed?

I would be tremendously grateful for all advice, as I'm just not sure what to do now.

Thank you!

[Anonymous]

It's so hard, isn't it? What really struck me was your sentence "he can't or he won't". He probably can't really articulate what it is about those things that he doesn't like and you really do need to know. We were in a similar position with our DS but we were lucky that OT addressed many of those issues (problems with novel physical activities and refusal to even try) and we're working on the rest. DS does have an ADHD diagnosis but it's still hard sometimes to tell if the issue is ADHD, SPD or behavioral - or it can start out as one and morphs into another. Reseach indicates these disorders are part of a foundational neurological disorder and while we might like to name these things as if these were distinct and separate, they probably aren't. My advice is to continue to investigate. Your DS's situation clearly troubles you and while you may not be able to get a definitive diagnosis, you can at least get some guidance that may help you get him on the right path. We've seen Dr. Conlon but I've heard great things about Dr. Greenspan. You might also see if you can find any research studies. We've participated in several and have had great experiences. We're participating in one now related to ADHD. All the teams we've worked with have been thorough and my kids have really enjoyed them. I also learned a lot about my kids, their development, things to watch for and areas to further investigate. Good luck! I know how difficult this is.

[Anonymous]

PP here - I meant to say the current research seems to indicate a foundational disorder.......it's not definitive and more research needs to be done.

[Anonymous]

I would avoid Dr. Greenspan. I say this as someone who thinks he is a visionary, in his books. In practice he is highly flawed as a clinician. First of all, he has no interest in the life of teh family. He will insult mothers who continue to work, or anything about your family that interferes with what he thinks you should be doing -- which is usually devoting huge amounts of time to floortime. I think this is terribly unfair to parents. Second, he does not believe in giving autistic spectrum diagnoses to parents because they will then lower expectations for their children (again, contempt for parents). While you seem to rule out an ASD, you don't want to see a clinician who has. I'm not saying he does but there are several red flags in your description (poor motor control, sensory sensitivity, rigidity). You need someone who will rule in or out.

Finally, he's really expensive and I'm not sure he's worth it. He's so wedded to his own theories that I think he is, well, rigid.

Find someone who is more approachable, a developmental pediatrician. And good luck.

[Anonymous]

Anonymous wrote:I would avoid Dr. Greenspan. I say this as someone who thinks he is a visionary, in his books. In practice he is highly flawed as a clinician. First of all, he has no interest in the life of teh family. He will insult mothers who continue to work, or anything about your family that interferes with what he thinks you should be doing -- which is usually devoting huge amounts of time to floortime. I think this is terribly unfair to parents. Second, he does not believe in giving autistic spectrum diagnoses to parents because they will then lower expectations for their children (again, contempt for parents). While you seem to rule out an ASD, you don't want to see a clinician who has. I'm not saying he does but there are several red flags in your description (poor motor control, sensory sensitivity, rigidity). You need someone who will rule in or out.

Finally, he's really expensive and I'm not sure he's worth it. He's so wedded to his own theories that I think he is, well, rigid.

Find someone who is more approachable, a developmental pediatrician. And good luck.

I have to say that I think this is true. I think Floortime is a wonderful concept and that Greenspan is a brilliant man but in terms of actual help, I'd look elsewhere. I say this as someone who owns many of his books and who found them tremendously insightful and helpful. Wish I had some of that consultation $ back, when you take a break from all the Floortime you may realize that your child has made no progress at all.

[Anonymous]

Yeah-we didn't go the Greenspan route because we heard it wasn't worth the expense. I think he has helpful insights, but we don't have lots of money to burn. We went to Conlon who isn's cheap, but we thought he was worth it. (He left Children's and is no longer on insurance panels). The report takes forever, but we felt that he really understood our child. There is a developmental ped still at Children's who is supposed to be good, but I can't recall the name. That would be convered by insurance. There are a few to avoid there as well.

[Anonymous]

I agree that you should avoid Dr. Greenspan. I feel like it was a waste of money. The whole experience reminded me of the Wizard of Oz behind the curtain.

[Anonymous]

My DC sounds very similar to yours and he had the textbook case of SPD (or SI). You said your child is getting OT, but is he getting the right OT? The OT in school did not have the equipment and a limited amount of time to deal with him.

We took him to Lynn Balzer-Martin in Bethesda for an real evaluation with an eye to the SI since we strongly suspected that was the issue - not all OTs understand SI. There are different tracks in the profession.

She then led us to some fine practitioners, most notably Lynn Israel and Associates in NW DC, though there are others in the region and she'll try to recommend you to those closer to your home. They really work on SI issues and not just motor deficits. They were able to teach my then 4 year old how to manage his sensory inputs through various techniques. It's a slow process, but we saw good improvement in 10 months and ended OT after 2 1/2 years, initially going 2x a week and then once a week with a home plan of activites to be done everyday. Then their was an acquaintance of mine: she got a doctor to put her SI kid on prozac. It worked too. But my kid, now 10, is handling is SI. He will always have it, but recent testing shows he has ameliorated many of his reactions. In coping better, he felt better about himself. Please know though that this was just the start of the adventure since we discovered later that he has an auditory processing disorder and other speech language issues. But the foundation for a better self-esteem was the right kind of OT.

[Anonymous]

I was just about to post the exact same question. My son is 4, but otherwise sounds very similar to yours, OP. Do many parents find that Floor Time is not effective? I, too, have been debating that path.

OP, may I ask what kind of school your son attends? Have you thought about other kinds of schools?

[Anonymous]

Anonymous wrote: I was just about to post the exact same question. My son is 4, but otherwise sounds very similar to yours, OP. Do many parents find that Floor Time is not effective? I, too, have been debating that path.

OP, may I ask what kind of school your son attends? Have you thought about other kinds of schools?

Floortime can be very effective but it's just one tool in the toolbox. But, Greenspan fantatics would have you believe it's the end all be all.

[Anonymous]

I hate to pile on, but I have to say that Dr. Greenspan seems to have a cult following among some on DCUM ... while his ideas are interesting and useful for parents to pursue up to a point, I think it would be a mistake to drink the koolaid without a pretty serious second opinion from someone NOT associated with this doctor's practice.

[Anonymous]

We had a positive experience with Dr. Greenspan. Floortime did work wonders for our child. But it took hours of work every day and it took about two years. I just saw a mother at DIR Support Services (OT office for Dr. Greenspan) whose child is classic autistic. She is engaging in pretend play for the first time in her time. The mother said she was convinced her child could not produce an abstract thought before. When you go to DIR and sit in the reception area you end up meeting a lot of parents and you begin to share your story with them and they with you...He is expensive. I would see Jake at DIR if Greenspan himself is too cost prohibitive.

[Anonymous]

19:59 again, the poster who first said you should avoid Greenspan. We did floortime with my DS, who has Aspergers, and it was enormously helpful. But I think you can do this without the sinkhole of seeing Greenspan yourself. And kids should not be put into a one-size-fits-all mode, as Greenspan does. Floortime may not be the best approach for everyone, and your child may benefit from a combo of approaches.

Plus I am greatly skeptical of Greenspan's promiscuous diagnosing of kids with "sensory integration disorder," or whatever they are calling it now. I'm not saying kids don't have sensory issues, mine certainly does, but this is a symptom and an OT diagnosis, not a medical diagnosis. This approach, coupled with his reluctance to diagnose kids as being on the autistic spectrum (cause their parents can't handle the truth) makes me wonder if there are parents out there who have been literally lied to by a medical professional about what their children are facing. Or maybe Greenspan just doesn't see it, but I can't imagine anything more patronizing. Above all, I want the truth about my child.

[Anonymous]

Anonymous wrote:I agree that you should avoid Dr. Greenspan. I feel like it was a waste of money. The whole experience reminded me of the Wizard of Oz behind the curtain.

Ha! I hadn't thought of it that way, but you are right, lol.

[Anonymous]

What a wealth of detailed responses! Thank you all so very much. I'm feeling so overwhelmed that I'm almost at the point of paralysis, so I really appreciate all the detailed guidance.

To answer the questions (in hopes of getting more good advice!): DS is in an independent school in NoVA. Not sure if he will be invited back for next year. Public school is not an option because the high class size would be overwhelming for him. I've looked at two other smaller independent schools so far, and neither seems a perfect match but the smaller sizes are very appealing and would help him a lot, I think.

Our OT is so-so. She doesn't seem to have a very scientific approach to suggesting modifications. Her approach seems to be more "throw a bunch of stuff at the wall and see what sticks." That makes it difficult for me to follow because I'm not sure what is important to follow through on and what we can reject immediately as not working. Also, she made some suggestions to the school, which the school (to its great credit) immediately implemented. However, I think the suggestions were not a good idea for my son and I don't think they're helping him any at school. So we're in the position of the school's thinking that it's done a lot to accommodate my son, without results. BUT this is the OT recommended by the school, and I felt we needed to play ball with the school. If DS isn't invited back, that may well change. The OT isn't horrible, but I would like a more targeted prescription.

I am a SAHM, don't particularly want my son tagged with a spectrum label at this age, and can afford the consult fee, so Greenspan would work for us ok in those respects. But our appointment is set up with an automatic floortime session afterwards, and I have been wondering, what if floortime isn't what he needs?

Does Dr. Greenspan evaluate for other issues, like anxiety, enzyme deficiencies, etc., or does every kid look like a nail for his floortime hammer?

Does Dr. Conlon evaluate for issues other than spectrum and ADHD? My son shows symptoms of both, but I agree with our psychologist that he doesn't have the classic diagnostic criteria for either.

Anyone else I should consider?

Sorry for the long post! I really appreciate all the thoughtful feedback you all have given me. 14:27 got it right - this really does trouble me!

Thank you!