Occupational Therapy

The OT's report is done (although I don't have it yet), but she called and recommended that we begin once-a-week therapy sessions. That won't start until Friday October 12 though. She'll be sending me the report in the mail this week. I'm not sure whether to go ahead and schedule the meeting with his teacher and school counselor and resource director or wait until he starts therapy. I guess I'll see how helpful the report itself is.

Ryan got a bright green card again today!! His certificate said it was because he was a calm and quiet worker today. :-) Two chips, because his daddy is out of town and unable to play Wii with him.

Gattiland!

Ryan got not only a GREEN card yesterday, he got a BRIGHT GREEN card! (Again, that means he did something especially nice/good/helpful, etc). We had told him that when he gets bright green cards, he can either have 2 poker chips or a poker chip and a weeknight session of Wii. He came out of the school building and immediately told me "MOM! I got a bright green card today! And I know what I want! I want a poker chip and Wii!!" So he got a poker chip, which gave him enough to go to Gattiland this weekend too.

Mrs C called me on Wednesday night because he had two really bad days this week. On Wednesday he was so defiant with his music teacher, and he ended up throwing a carpet square at another student, getting her in the eye. And then he hit her in the face later in the afternoon (the girl, not the teacher). So Mrs C and I decided that it was time to separate him as much as possible. I didn't want to do this too soon, as I didn't want to make him "stand out" to the rest of the class, but I guess he's doing that to himself. So she brought in a desk for him, where he sits right next to her. It's one of those desks that you put books in from the open-ended front, rather than a lift-top. So inside the desk he now has two stress-ball type things, that he can use when he feels the need and miraculously he is using them and not *mis* using them! She thinks it's making a difference in his ability to do his work without disrupting the others. He seems to be fine on the playground. He got the "bright green" yesterday because he was able to walk, in line with his classmates, all the way down to the cafeteria and back without bumping, pushing, etc. She said that she can really see that he's making an effort! She also told him that he could have the little car prize that he'd chosen as an incentive, if he got just 3 green cards this week...and he did! She had let him keep it in his pencil box the last 2 weeks, just so he'd know it was still there. He gets to choose another incentive on Monday. I am *thrilled* that she is working with him "where he is", rather than expecting him to behave as well as the other kids are able to right now. And that she is able to see his improvement and comment on it. His academic work continues to be top-rate....and his writing is really improving.

I am back on hopeful end of things!

I don't know where to go from here.

I am soooo frustrated. Ryan had another terrible behavior day at school today. I'm actually starting to think that pulling him out of school would be less stress for me. He had many, many warnings today about personal space and still couldn't keep his hands off of other kids. He spit on someone again. He tripped another child, he poked someone in the eye with a carpet square, he slapped someone in the face, and he was blatantly disobedient. When he got home from school, he got a small dab of soap in his mouth, and was told that it would happen every time I got a report from school of him spitting. If he's going to do something disgusting with his mouth, it's going to be "cleaned out". I am NOT a fan of doing these kinds of things, but this has GOT to stop. I made him sit down and write an apology note to one classmate, and he will write another one this evening. His teacher is going to call me tonight...I can't wait.

Short days = good days

Half-day of school yesterday, so Ryan managed to come home with a green card!! One poker chip away from Gattiland. It'd sure be nice not to have to cook tonight...

I saw some real maturity from Ryan a couple of times yesterday. (Backstory: while he was at school, I took Max and Lily to the grocery store, and picked up 3 helium balloon/lollipop give-aways as we walked out. I discussed with M&L why we had to keep the balloons inside, and that they could play on the screened porch with them or in the basement. I reminded them again once we were in the house. Three minutes later the phone rang, and during my 5 minute conversation they managed to take their balloons outside and of course L let go of hers and it promptly took off for heaven.) Ryan came home from Grandma's house and saw his balloon, but once he heard about Lily's, he told her right away that she could have his. !!! He just wanted to make sure he got to keep the lollipop! He told her again later on in the evening that the balloon was hers, he didn't need it. :-) For the record, Max also kept insisting that he share his balloon with her. What great brothers she has!!

Oh, and at soccer practice, while he still had a couple of problems, he DID show some maturity. One of the other boys playfully tackled him and dragged him to the ground, but instead of getting up and trying to do the same to the other kid, Ryan just laughingly got up, brushed himself off and went back to paying attention to the coach. Yay!! On the other hand, he did keep throwing the ball *at* people...at their backs, especially, from short range. The first time I let go because it was one of the dads who kept playing around with Ryan, the second time it was the sister of one of his teammates and I didn't see it happen (she came and told me...I apologized for him); and the third time it was one of his teammates and he hurt her hands. I made him sit out for 5 minutes during his favorite game, and told him if it happened again we were going to leave. Fortunately for him, it was only 10 minutes from the end of the session, so he was able to behave!

I was reminded yesterday and today of something the OT mentioned. Kids with some of Ryan's SPD's don't do a lot of creative imaginative play, and they are often TV watchers/video game players. I've always been aware of it with Ryan, but especially so during the last 6 months or so. Max and Lily are *ALWAYS* playing pretend...pretend bakery, pretend store, pretend birthday party, pretend whatever. Ryan will join in on occasion, but he rarely initiates it. He will play pretend NASCAR races, but that is about all. Also, Ryan would watch TV all day long if we allowed it, and/or play computer games, Leapster, and video games. Max and Lily could really take it or leave it. They do like to watch a couple of short shows, but there have been mornings that I've inadvertently left the TV on and they haven't watched it at all. They enjoy computer games once in awhile, but never ask for it more than once or twice a week. It's just interesting to notice the differences!

Call from school

Yikes, not only am I going to have that stomach-clenching feeling everytime I pick Ryan up from school, but now it's going to be every time the phone rings while he's at school. I just got a call from the assistant principal, who has Ryan in her office this morning. He slapped the girl next to him (hard enough to leave a mark) and he stuck his foot out and tripped someone. I just don't know what will get through to him. We are trying to reward good behavior. We even went so far as to let him know that if he manages to get "bright green" cards, he will get to play Wii with his dad that very night...which is his very favorite thing to do right now, but is restricted to an hour total on the weekend. Plus all green cards get a poker chip, and 8 chips gets a trip to Gattiland. He's only 2 chips away right now, so obviously the incentive of getting those last two chips is not having any affect on him. I guess it's back to the psychologist pretty quickly. My head hurts. And my heart hurts too.

My diagnosis

Finally finished reading The Out-of-Sync child. And here is what *I* think Ryan has issues with. We'll see how close it is to the final report!

Modulating auditory sensations - we cannot take him to movies due partly to the loudness (even with ear plugs); no fireworks; Max and Lily screaming/crying makes him crazy; even as a baby, I could never use the blender, mixer, vacuum or hairdryer with him being in hearing distance.

Modulating visual sensations - again, no movies on big screens; hides from bright light, especially sunlight.

Proprioceptive Sensory Seeking - (MAJOR) - deliberately bumping and crashing into things; was a "head-banger" as a toddler; bites his nails; loves to jump from furniture to the floor (will do it over and over again)

Grading of Movement (proprioception) - uses a lot of force when writing on paper; seems unable to tell how much force he uses in touching people.

Tactile Sensory Seeking - (MAJOR) - asks for back rubs; need to touch and feel everything in sight-has "gotta touch" items that other children understand are not to be touched; always takes shoes off; "dive" into food, often cramming mouth with food; drinking water has to be ice cold/chews on ice; shows "in your face" behaviors, getting very close to others and touching them, even if unwelcome; eats almost exclusively with his hands rather than utensils.

Gravitational Insecurity (vestibular) - at times fearful of heights/falling - won't go within 2-ft of the edge of 2nd floor railing that was substantial enough and solid enough that there was no room to fall through it; becomes anxious when feel leave the ground not of his doing; will not go upside down doing gymnastics tricks.

And then, I know the OT observed issues with motor planning; upper trunk/postural weakness; and bilateral coordination, but those are things I haven't personally noticed.

There was a paragraph in the book, that had I read it a year ago, I would have said YES! This is what it is!! Here it is:
"By the time Rob was two...He required constant attention. Time-outs didn't work because I couldn't contain him. He was defiant, disobedient, disrespectful, and demanding. He was always busy, always talking (great verbal skills!), strong-willed, contrary and easily frustrated."

That is/was Ryan to a "T". But to just read that, it sounds like a behavioral/strong-willed child problem, right? There was nothing there that to me, pointed to anything other than a challenging child and a parent (me) who wasn't dealing with it effectively. If, at age 2, someone had told me that Ryan had a neurological issue, I would have said "Yeah, right. He's neurologically fine, he just doesn't want to behave." Now, to be honest, he does have behavior issues that are likely beyond this sensory processing diagnosis, but until we have this under control we'll never know if the other behaviors will cease.

Now I'm off to read The Out-of-Sync Child Has Fun". And pick up more reading materials at the library. And pray for Ryan to get another green card today....I so hate that stomach-clenching feeling when I pick him up, and his wonderful teacher motions me over to talk. Will I ever get over that??

Sparkle Card!!

Somehow, someway, Ryan managed to come home with a "bright green" card (some classes call them "sparkle cards") today!! That's a step ABOVE the normal good behavior green card. What it means is that Ryan did something special today and then managed to have good behavior the rest of the day. He told me that he helped his teacher sharpen pencils. I wonder if it was an old-fashioned pencil sharpener that he'd have to crank the handle...muscle work...?? He was SO proud of himself! He got a certificate too, and I may just have to frame it. :-)

I emailed the school counselor and the resource director about his diagnosis. They were both right on top of it, and both want me to schedule a meeting with them to discuss details and plans of action, and to find out what they could do to help Ryan. I don't have the full report from the OT yet, so I'll need to wait until I have it, but I felt really relieved at how quickly they responded to me and how willing they are to help. It sounds like the resource director knows her stuff too, she recommended some books for me (although I already have them...) and specific chapters to read in them.

All in all, a good day!

This week, part of Ryan's trouble in school is that he tries to be silly with the other kids. His pushing, punching, spitting (more like raspberries) is in an effort to make the other kid laugh or get their attention. I'm trying to help him find a more acceptable way to be silly, like making a funny face or snapping his fingers...anything that isn't touching another person (especially with spit...ewwww!) It hasn't caught on with him yet, but I'm hoping.

More of the sensory stuff as I'm recalling it: His therapist said that she thinks he doesn't realize how much force he puts into things. Like, he might actually think he's touching gently but it's actually hard enough to hurt. He presses into the paper so hard when he writes, also, which could be the same trait. Another one...he almost never uses utensils, unless it's something wet and slimy like yogurt or pudding. He eats everything else with his fingers until we remind him to use his fork or spoon, then he'll comply until he forgets and again uses his fingers. Then he always always wipes his hand on his shirt, even if we've tied a napkin around his neck! He just can't remember to use it. So every single day, no matter what (unless we've not had any slightly-messy-foods at all), his shirts are so dirty.

I'm starting to doubt that this is going to change his worst behaviors though. Some of the things he does I cannot see how they could be sensory related at all. Tonight, Ryan and Max were outside playing soccer when I called them in because we were heading out to dinner. Max came right away, but Ryan wanted to keep playing. He kept trying to get Max to go back out into the yard with him, pleading and cajoling, but Max told him no, he wanted to go to dinner. All of a sudden, as I was heading down the porch steps towards them, Ryan ran up and shoved Max in the back HARD, knocking him flat on his face, up against the chain-link fence. Max barely BARELY missed the fence post with his face; he could have had a tooth knocked out or broken his nose, as hard as he fell. Fortunately he ended up with just a scare and a couple of small scrapes on his elbow and forearm. I scooped him up so fast, comforting him audibly and leaving Ryan behind as we went into the house. Ryan *knew* he'd done a terrible thing, and he didn't even wait for me to tell him to go to his room....he walked by me with huge eyes and went there immediately (probably waiting for me to explode!!). He ended up not getting to go out to dinner with me and the twins, I left him home with Don because I told him I couldn't let him be near Max for awhile. Now he can't play outside with either of the twins until this weekend, unless I'm out with him. Otherwise, if M&L are outside, R has to stay inside with me. But back to my point...I can't see that this is sensory related, that was just anger/temper/hurtfulness. And he's done that very thing before with both M&L, pushed them hard from behind in an "I'll show YOU!" kind of way when he's angry, and we've dealt with it in various ways but it's obviously not sunk in. And it's the kind of thing that I'm very afraid he'll do at school, although he's only done it in great anger so it's probably not likely to happen in Kdg. But I do worry, and I'm already cringing when the phone rings when he's at school. I just don't know what to do for him. He doesn't seem to care that it's wrong, that he'll suffer consequences of any kind, that he is hurting someone, etc.

He's working one earning a trip to Gattiland, land of racing video games (it's kind of like Chuck-E-Cheese). One green card at school = one poker chip. Eight poker chips = trip to Gattiland. That means he can earn one every other week, with one "off" day each week. But at the rate he's going, we'll be having our Thanksgiving turkey-pizza there.

There is hope!

Ryan's OT evaluation was this morning. It was *very* eye-opening. His therapist kept up a running commentary as she had him doing certain tasks, letting me know what everything "meant". The verdict is that he definitely has sensory problems that are holding him back and causing the behavioral problems. He still has a couple of reflexes that should have been gone shortly after birth. He has trouble processing loud sounds and bright lights and background sensory stimulation. He has some bilateral coordination and motor planning delays. Most of these things aren't so delayed that they are obvious to untrained observers, but they can be frustrating enough to him that he acts out when he doesn't "get it". He has upper trunk weakness that makes it difficult for him to hold a pencil correctly...it's mostly correct, but he hyperextends his pointer finger and wraps his thumb around which apparently shows shoulder/chest weakness. And it will make it difficult for him to write for any length of time. We did confirm that he is pretty much unable to control the impulse to bump and push and pull people (and things!). Because of the sensory issue, his body seems to need that stimulation to calm itself down. It's a need for "heavy muscle work", and it can be helped out by giving him acceptable heavy motor work to do occasionally, as well as teaching him ways to cope with that feeling/impulse cognitively. So the plan for right now is to ask his teacher to find some heavy motor work that he can do at points during the day, whether it's carrying a stack of books down the hallway or pulling a boxful of toys across the room, and making sure that he's working some muscles during recess/outdoor playtime. If he gets that stimulation in these acceptable ways, then he's likely to be less apt to hit someone or be a human bowling ball when walking down the hallway. This isn't treating him "special", it's helping him to learn ways to help himself. His therapist is going to score all of the evaluation components and come up with a definite treatment plan, and in a couple of weeks we'll begin sessions with her once a week for awhile. The evaluation was 2 hours long, and she really worked his mind...it's mental work to try to coordinate motor skills...I could see him trying to process it all. He was very tired when I took him to school at 10:30, and I almost didn't take him in. He started crying in the car saying he was too tired and didn't have any energy...this from a kid who rarely cries except from temper...but I talked him in to going inside to see if they would let him have his snack. The office assistant was fabulous with him, getting him to sign in and letting him know that they would find a drink to go with his pretzels, if his class had already had snack time. He seemed really pale but he walked with her willingly as she took him on a "secret shortcut" to his room.

How am I feeling with all this? Very mixed emotions. I am feeling very hopeful, because these are things that we can really work on, they are tangible skills that we can check from time to time. And I'm glad that we're doing this in Kdg, where one big purpose of school is to learn social skills and how to work on learning. So he's not going to be "behind" or working extra hard to catch up. I'm also feeling a bit guilty that I didn't go this route before. It could have really changed the dynamic of our relationship if I hadn't worked so hard and gotten so frustrated trying to change his behavior. Yes, the behavior had/has to cease, but knowing that it is as much a physiological issue as it is a cognitive one has already changed the way I look at him...in just a couple of hours time! For awhile I was so sure he was just being defiant. I mean, he's so smart about so many things, why could he not understand simple social rules other than because he didn't want to? Oh, so wrong. I'm also overwhelmed. I have so much to think about and process with this myself, books to read, my own behaviors to change, getting the word out to the people that matter (husband, grandparents, teachers, psych). I just feel like my head is spinning. Which isn't surprising since his therapist asked me a few simple questions and she (and I) are pretty sure I have sensory processing issues too....but have learned to cope with them in my 39+ years. So I have my own enlightenment to deal with!

But mostly I'm hopeful. Very hopeful.

Hopeful, hopeless

I've felt both emotions today with Ryan.

He did get his green card today...but with an asterisk. Mrs C said she worked very hard with him today, because she wanted him to come home with a green card. And he still had some behaviors that on a normal day would pull a card. But I did have a nearly-40-minute conversation with her this evening. I have a clearer picture of how he is acting in class. I'm hopeful, because my biggest fear was put to rest. I was very afraid that he was unable to focus at all and that even as smart as he is, he'd start falling behind. But she told me this evening that he very much IS able to focus, that he understands the lessons, that he is listening to the stories and answering appropriately when asked questions, and responding appropriately in his work. His main problem seems to be personal space and the need to be touching, moving, swinging his arms and legs. And regulating his mood...once he gets to that place where he's negative or being silly or whatever, he's unable to bring himself back to center. He can and will remain there the rest of the day. That gives me hope that this truly is a sensory issue and that we might be able to get this worked out through OT and psychological/cognitive work.

Oh and the best news...:-) He was the only one in his class to get a perfect score on their baseline testing. Mrs C was way impressed! *I* know he's smart, but I love to hear it when other people notice it as well. Vain, I know!!

Then came soccer practice. He had a complete meltdown near the end of practice, during which he punched me, kicked me and slapped me, then tried to run away from me when I announced we would be leaving. He cannot seem to control himself when he gets this way, and it makes me CRAZY. I'm truly afraid he will do this at school, and he'll get himself suspended or even expelled for really hurting someone. I just feel like we haven't made any progress with that aspect and it makes me tired. I came home feeling defeated and like things were never going to change with him.

Monday is his evaluation.

Fingers crossed for tomorrow...

I'm keeping my fingers crossed that Ryan has a good day at school tomorrow. I'll consider any day that he doesn't get a red card as good!!

He has been in kindergarten for all of a week and a half. Their first three days were practice days, as far as behavior is concerned. The next full week he had two green cards (no problems), one yellow card (a couple of problems) and TWO red cards (too many problems). And his teacher really is pretty lenient. I've had a lot of comments about this from people who think it's pretty bad that a teacher is either using this system so early, or using it at all. But I honestly don't have a problem with it, I don' t think she mis-uses it like some teachers I've heard about. It has definitely let me know that Ryan is having difficulties with his behavior. That's really not a surprise at all, I just didn't expect it this early or to this extent. His first red card was because he deliberately pushed a child down on the floor so hard that he almost flipped over. And then he punched the same child in the stomach on the playground. Ryan said that the other child kept trying to hug him but I don't know if it was an affectionate hug or a wrestling-type-bear-hug. Either way it's not something she could just let go. His second red card was for several things, including constantly getting up out of his seat and literally running around the room and disturbing the other kids. She said they get several warnings each time before she pulls a card unless it's physical aggression.

The bottom line is that we are pretty sure Ryan has some mild sensory problems that are making him agitated and unable to sit still at school. It's different than ADD, although it may end up that he has ADD and not a form of SID. He has so many little sensory type problems. We can't take him to movies, because the combination of darkness, sound and close-quarters makes him terrified. Terrified, as in sobbing with his head on my lap, asking me over and over again if we can please PLEASE leave, too scared to get up and run out by himself (not that I would want him to). And this is soooo not the way he is with anything else. He always seems to need to push people, run into them as he passes by, reach out and touch (or shove or punch). When he gets upset it immediately turns into physical aggression, no matter the upset. Sunshine and water on his face make it hard for him to want to open his eyes. Often when he eats he stuffs his mouth full to the point of almost choking (although this has gotten lots better recently). Each of these things by itself is not really that abnormal, but all of them together in one child can be indicative of sensory disorder...definitely on the mild side though. So I researched and called a pediatric occupational therapy office and we'll have him evaluated in a week. Then we'll know for sure. If it is a sensory disorder, they will help us with physiological methods of helping "desensitize" him. And we're also seeing a wonderful child psychologist so that we can go at it from the cognitive angle as well.

I did ask Ryan how he felt about school this weekend, and he said he loves it! So he's not discouraged yet with the red cards. We've talked and talked about it this long weekend, and I'm hoping he'll have some strength to reel himself in a bit. We can hope anyway!