Sensory integrative dysfunction in 4-year-old boy

[elizabeth70]

My son just turned 4 years old on January 1.  For the past 1.5 years we have encountered numerous behavioral problems, both at home and preschool.  He has a very short attention span, is unable to focus on tasks, is easily frustrated, and knows no boundaries.  By a very "brief" evaluation by a neurologist, he was started on Adderall (adderrall) XR 5 mg q.a.m. with a dx of ADHD, and has shown slight improvement with focusing; however, he is now easily angered and is becoming physically aggressive at times.  Upon recommendation of the preschool, he was evaluated by county preschool screener who suggested sensory integrative dysfunction.  This eval will be forwarded to a committee for review and results submitted within 1-2 weeks.  After reading about SID, I note he does show some signs; however, he started talking at a very young age, forming whole sentences by the time he was 14 months old, walked at 12 months, and has above average gross motor skills and fine motor skills are normal for age. How is a diagnosis of SID made and what are alternative treatments?  Does this go hand-in-hand with ADHD?  If early intervention, can he proceed with a "normal" life as a teen/adult?  He does seem to be under-sensitive and always talking louder, running faster, hitting harder than other children his age, so does this sound consistent with the dx?  He is very bright, but shows little interest in learning in a normal classroom setting.  I always joke that he is a "carry-out learner" because he absorbs info as he goes, even when it seems he is not paying attention, he can reiterate an entire story ready to the class upon questioning.  

One physiological question I have is regarding his birth.  There was CPD and a nuchal cord x2, but was not delivered via c-section, so his Apgars were 3 and 5 at birth, with a large cephalohemoatoma due to vacuum extraction.  We have always been concerned about this affecting his development, so could this be a factor?  

Thank you.

[Kevin Kennedy, Ph.D.]

To begin with your last question, yes. The circumstances of his birth and neonatal condition can definitely be contributors to some of the neurointegrative problems he is now displaying.

A child who displays all the assets you delineate can, nonetheless, display sensory integration problems. The diagnosis is reached via an evaluation by an occupational therapist. Occupational therapy is the discipline responsible for the diagnosis and treatment of SI conditions. SI covers a wide spectrum of problems, with varying degrees of severity. So it's beyond the scope of this Forum to discuss specific treatment. This will likely be explained in the evaluation you're expecting in the near future.`It is probably fair to say that many children who display ADHD also display SI problems; they are both, generally speaking, neurointegrative conditions. However, this is not to say that the two conditions co-exist in the majority of children who display one or the other.

Be sure to monitor the treatment of the ADHD. While psychostimulants, such as Adderall (adderrall), can be quite effective in treating symptoms of hyperactivity and inattention, in some children they do promote aggressive behavior. Be sure to discuss this possibility with the prescribing doctor.

[joy_october]

A related discussion, Sensory Integration issues in 4 years child was started.