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My daughter is 4.5 years old. She is incredibly smart and delightful alot of the time but she has always had incredibly strong emotional reactions. I have 2 younger children (nearly 3 and 8 months old) and I although I feel guilty comparing my daughter with the 2 younger ones I find myself constantly doing it. My 4 year old is always the one we struggle with. She is always the one I worry about and search the internet for answers on! The biggest problem at the moment is she is having difficulty wearing clothing especially underwear. She will have huge tantrums, throw them off, wail and scream that they are giving her 'wedgies'. She will even avoid going out to events that she would really love to go to because she cannot wear underwear. She will also not wear pants as they are 'too itchy' and has been reluctant to wear socks for a long time. Previous issues have included refusing to poo and holding on to the point of significant discomfort (lying in bed with tummy pains for large parts of the day), thankfully she doesn't do this anymore. She also used to poo in the corner of the room for 18 months after being toilet trained. She will sometimes refuse to let a tiny scratch get wet (has led to her refusing to have a bath or shower for over a week). She has an incredible sense of smell. She can seem very fussy... eg - if she doesn't like a type of food and spits it out she cannot pick it up without a wipe or something because she can't stand the 'yucky' feel of the food (even if it is just a piece of apple or something). She has also always played very roughly with sibling and her dad and I. We are constantly telling her to be less rough with the baby. Even when she is trying to make him laugh and enjoying playing with him it always involves getting right up in his face/being very loud/moving him about very roughly etc. She seemed to have little idea about personal space, if she was trying to show someone something she would often put it right to the person's face. We also noticed as a baby/young toddler she refused to touch flowers and would shiver if we showed her one. She was also the same with strangely textured balls. If things aren't going right for my daughter she can be very tiring to manage, with lots of full-on emotional breakdowns. But on the flipside she can be so kind and enthusiastic and just delightful. She is also incredibly smart and had very early language development and drawing skills. She is also very social. In the past she was regularly rough with other kids in social situations but she now makes friends easily wherever we go and plays really beautifully with other kids. Do you think my daughter has a problem that needs to be diagnosed? Thanks in advance.
Thankyou for your replies! Sorry it took me so long to post here again, I actually forgot I wrote a question on this site until I found my old post while 'googling' another question about my daughter!! She is now seeing an OT weekly and has been diagnosed with SPD. She is going well and things have improved quite a bit. She still has days when she finds her clothing uncomfortable and will have meltdowns but she is wearing long sleeved tops and pants for the first time in a year. And we have bought some 'boy leg' underwear that she finds ok most days. I think she is definately benefitting from feeling more understood.
Thanks for your message special mom!...I wrote out a reply and it didn't send and now I can't find your msg again :(.
My next question is can anyone recommend a good book for me to read and possibly a children's book to read to my daughter to help her feel more understood. My daughter's main issues are the tactile defensiveness in relation to clothing and sensory seeking behaviour -eg - rough behaviour (pushing, charging) and difficulty calming down, being too loud etc. Thanks alot.
I have two kids with sensitivity issues. One, now in college, had very difficult times with clothing that he wore and also with the feel of the fabric of clothes and upholstery. He liked to be dressed down to his shoes, even sleeping in shoes. We cut out or bought tagless whenever possible. I laundered everything several times before him ever wearing an item. He only wore silky feeling athletic shorts (year round) until about fourth grade when he transitioned to silky athletic pants. By sixth grade, he began wearing jeans. He couldn't touch fabrics with a nap such as corduroy or velvet, didn't like the feel of denim, too stiff, didn't like the feel of some paper such as newsprint. Even now, he buys tagless, wears only very lightweight denim jeans, loves flannel because it is soft. He wears very, very expensive undershorts because it is the only fabric he can tolerate. He sleeps on jersey knit sheets, no top sheet, soft quilt. For us, we took an "if you can't beat 'em, join 'em" approach and have never had a problem accommodating his clothing issues. I think the more involved in your daughter's care plan she can be, the better. Help her articulate what it is she likes about something so you can find ways to making that available to her.
For the sensory seeking, my son wasn't rough, but he was/is always in motion. He liked group sports, but did best/met less frustration, in individual yet group activities such as gymnastics, golf, fishing. He was most successful when participating alongside peers as opposed to say, baseball where he had to read other peoples actions. Perhaps this will be helpful for you to consider when finding activities for your daughter.
My other child, has noise aversion issues so rather than being "in your face", she tends to just get out of anything that is deemed too much. She also hyperfocuses on skin things like your daughter. At times, it has been difficult to accommodate skin quirks because we have to have some measure of hygiene. Broken skin needs to be cleaned and covered. We go through a lot of bandaids!
For your daughter's sensory seeking, you might try putting a couple of jingle bells on her shoes and play a green light/yellow light/red light game. She starts across the room/farther away outside. Green light means she runs and she can hear the bells jingle loudest. Yellow light means she walks and tries to not really let the bells jingle. Red light means she stops and the bells don't jingle at all. You can hold up a green, yellow or red sign while giving instructions. This might help her learn that she really does have control over her actions and it will give her concrete visuals and auditory reminders. When coming into a situation, you can front load her with reminders that...as we walk into the baby's room, we have to walk like we do when we play the game. You could put a yellow sign outside the baby's room, so on.
How does she like to calm down? What helps? If you can give some ideas, maybe we can help you tweak a plan.
On being too loud, you could approach this like the above game, but using a tape recorder or video. She can practice being loud and being soft and then playing it back to her. Once she can hear the differences in her intensity/loudness, she may be better able to master when she chooses to scream, whisper, sing, etc.
You said your daughter likes to draw. Has she ever drawn with shaving cream? Just spray it on a plastic table top, let her draw, write letters, etc. If she won't touch it at first, she could use a paintbrush. A sand/rice table might be fun too. She might like to draw enough to overcome some textile issues. Does she like to play in water? My daughter did when she was younger. We'd set up a tub of water and give her things to wash (her brother's golf balls). She loved this and it gave her a sense of purpose to her play.
It's been such awhile that my kids were your daughter's age so I can't recall any specific books geared towards her nor do I recall the names of books I devoured, so I hope others comment. I do know though that Arthur shows have a number episodes with characters who have differences.
Hope some of this is helpful in some way. Good luck.
One more thing, is it possible to request OT more than once a week? Might you be able to request SLP for food/texture issues? I know OTs work this area too, but often, speech and language therapists do too. How is her speech and language? Have you had that tested? Is her receptive and expressive about the same level? If expressive is behind receptive, language therapy might help her with expressing herself verbally rather than physically.
Yes, OT can be requested more than once a week. Usually the OTR will do the initial evaluation, and set up the treatment schedule and goals at that time. They then should go over everything with the client and their parent/adult guardian. Formal reassessments are usually done every 4 weeks. Of course the OTR or COTA is also assessing during the treatment sessions, too. Goals can also be revised as needed prior to the formal re evals.
SLP definitely works with feeding issues, including hyperactive gag reflex, texture sensitivities, weak swallow issues, etc. I have also done co treatments with SLP and PT; we each work on specific goals at the same time. For instance, I may be working with adaptive feeding utensils at the same time SLP is working on the actual feeding issues. With PT, they may be working on standing balance while I work on fine motor activities that the patient can do while standing.
There is also the possibility of therapy being provided during school, and also privately after school hours. Depending on the individual needs, Dr's order, therapist's assessment, insurance, etc. It's a fine balance to not over stimulate the patient, too. Lastly, all therapy services require a Dr's rx and the Dr is usually also involved in the treatment plan outline, including how many visits are scheduled.
In truth, we went private and while we kept our doctor in the loop, we made all the decisions, sought the therapist on our own without help from our doctor after my own research, etc. Our insurance did not require our pediatricians involvement for our services and our doctor just let the specialists do their job. so, you will need to work within your own situation. It worked out for us to go to the therapist that I personally chose and to let the private OT guide us from there rather than the doctor doing so. Our doctor really has never had anything to do with treatment plans in the different specialists we've seen and that is not common here. Usually the therapist works on that plan and determines how many visits. good luck
In my state, OT, PT, SLP all require a Dr signed order to eval and treat. If we don't get one, it is considered illegal and could cost us our licensure. Usually it's a pretty standard "OT eval and treat as necessary...". After the initial evaluation, therapist sends the Dr a Clarification Order, which is basically letting the Dr know how many times a week treatment will be for 30 days. The Dr signed order is not necessary for insurance reimbursement, as there is the option for "Private pay". Which is what you describe, you paying and not your insurance,for the treatment. But it is necessary legally for the therapist to treat the patient.
I guess all should check what pertains to their own situation. And really, for most with insurance, their insurance company will tell you what they need. some insurance companies actually do need a doctor signed order for specialist type of treatment.
We are not doctors or lawyers here so I think everyone needs to check on their own situation. I never had to have a doctor signed order to treat my son in my state. The doctor wasn't involved at all other than what I personally relayed at our once a year check up.
so perhaps, this isn't the best place for anyone to give specifics for protocol such as this. Best to make some calls in your own state and city to understand what you need to do. I personally looked up OT's in our area and called them. I put my son on their waiting list of the one I wanted to go with and he was evaluated and then treated. That is how it worked out for us where I am at. But others have had a different experience. So, you will need to research what the protocol is in your own area. good luck
I also once again say that I'm the community leader on the sensory integration forum here at med help and would love to discuss any issues you have with sensory and your child or treatment options on the forum. Here is the link:
I absolutely agree! Everyone should monitor their own situations regarding any and all health care situations. Probably most clients may not even know their doctor has signed an authorization for OT, PT, SLP. I imagine that varies due to the treatment settings...in patient, out patient, skilled nursing facility/long term care setting, etc. I originally replied just to give an overview so to speak when the question was asked about requesting OT more than once a week.
Usually, and this is my experience only, if it isn't an in patient setting, the client may choose a Rehab company. The company who employs the therapists is the one who makes sure the orders to eval and or treat are signed by the client's physician. It's not the client or their parent/guardian's responsibility. Sorry if there was any confusion on that.
I am also so happy to see this forum, and see the support for kids and their families regarding sensory processing/sensory integration disorders! Therapy can really help, and I am especially happy to see that people are more familiar with what OT can do. For a number of years, many people would ask me if we (OT) were the aides for the PTs...so it is great to see OT being known for all that the field has to offer.
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