I am pleasantly surprised that the occupational therapy interventions with Grace are producing pleasing results. In the previous post (the one with all of the bunny trails that is really, really long and no one probably read to the end) I wrote about some of the specific interventions we are to be using with Grace. This post will be about what we are seeing.
ADHD and sensory issues are such multi faceted issues. Even though I had read about and had training regarding ADHD I still did not know enough about it until I got to deal with it day in and day out. In 7 days I get to attend a day long training for Psychologists by the world renowned expert on ADHD. I am curious how it will go:)
For so long the primary issue with Grace was hyperactivity. For years we just tried to calm her down enough that she would not be hurting herself or others. We tried all kinds of interventions and finally used Ritalin. We did get effects from other interventions but the Ritalin finally slowed her down to manageable levels:) We did an increase one time, but with dietary and nutritional changes we were able to reduce it again.
At that time, once she was a bit slowed down, we noticed how bad the concentration problems were. She was in Kindergarten and her lack of ability to attend to the lessons was causing her to really lag behind. We were happy to keep her from hurting herself, others, or wrecking something - forget about math facts and reading! In the spring we switched her to a different medication, Vyvanse. That medication, administered below the recommended start dose, helped to control both her hyperactivity and poor concentration. She made significant strides in school over the summer.
The 3rd issue we have with her is impulsivity. She never stops talking, loudly, without listening for answers. She is seeing something interesting and running for it without regard to it potentially being dangerous or belonging to someone else. She is ever seeking to pin blame on others and not be found at fault herself. We found that this also improved with the medication change. Today we tried a no-med day to see how much of the improvement is from the meds and how much from the occupational therapy (OT). The main problem from the day was impulsivity again. Constant talking and inability to respect others' boundaries led to many sibling conflicts that we have enjoyed not dealing with as frequently (as in, a good day is perhaps 1 - 2 conflicts an hour).
Those issues are primarily dealt with by the medication. So, you ask, what else is there that the OT could even help? The mornings and bedtime have been the worst times for Grace. She wakes up at the crack of dawn, wakes up her sister who needs more sleep, wakes up the house, and essentially bounces around like Tigger creating chaos before people can even open their eyes. Bedtime usually involves at least 30 minutes of out of control screaming, if not longer, that means that no one else can be going to bed. She doesn't stay in her room (much less her bed) and is verbally and physically out of control. 90% of the time we have to remove her sister and have her sleep in her brother's room (in JJ's bed, which means that JJ is still in out bedroom). Her waking and going to sleep have come to be the most dreaded part of my day.
Grace potty trained very quickly at 21 months (I am glad that was easy lol!) She loves to go to the bathroom...and wash her hands. We only use bar soap (which is healthier anyway:) as she will go through a pump bottle in a day. She is forever playing in dirt, sand, water, anything messy. She spins and spins and spins - preferably upside down. She sits upside down during meals - hitting her head on the table for added drama when told to sit up. Superman has to be placed between Grace and Faith at the table and in the van as he is able to defend Faith better. She picks the drywall mud off of the wall. She is the messiest eater alive as she plays in her food rather than eat it. When told no, well, we say it to her countless times a day but it is almost always a battle. She is smart and uses it to be sneaky. If she sees it, she wants it and she goes for it.
Occupational therapy has reduced most of these issues! She is sleeping at night without screaming! Faith actually gets to sleep in her own bed, and Grace is VERY CAREFUL about not waking her in the morning when she gets up. Just so you really get the effect, I said that Grace was CAREFUL! We have only had to removed Faith from the room 2x in 3 weeks and this was not due to screaming! Grace has always been very fearful of the dark (or, more realistically, she wants the closet light on so she can play with her toys since it takes her awhile to wind down and fall asleep). This has hindered Faith from falling asleep as well. Last week Grace announced to us that she wanted the closet light off and has done this successfully! She has a long history of nightmares, and has only had one in the past 3 weeks! Then, when she came to us she came QUIETLY so as not to wake JJ (it used to be that she would charge into our room numerous times during the night as loud as she could be - she now seems to understand quiet) and was quickly calmed and able to go back to her bed. It is quite amazing!
In my mind I am trying to categorize and conceptualize what is really going on with her. We have nutritional issues with digestion that we are still in the process of correcting. We have a ton of food allergies - that we are dealing with nutritionally and via diet. We have ADHD (hyperactivity, concentration, and impulsivity) that has been adequately controlled with medication at a minimal dose and very watchful eyes of my husband and I who try to ward off any "dangerous" triggers. And now the issues that I thought were part of ADHD that seem to be sensory processing issues are being addressed with the OT.
I am so thankful for being able to wake with the sun and not a child screaming or jostling me or slamming doors or running all over the house waking everyone else. I am SOOOOO thankful for bedtimes that do not include out of control screaming. I am so thankful that the girls are sleeping well in their room...and maybe we can have JJ in he and Superman's room...perhaps by the time he is 3? I am so thankful that there are fewer injuries to siblings from her impulsiveness. I am so thankful for calmer days where she is not nearly as impulsive spiraling out of control where the only intervention is to have her scream in her room until she exhausts herself before we can reengage her. Now she is better communicating to us and having a more quiet spirit. She really likes the interventions (like brushing, being wrapped tightly in a blanket and rolled on a big ball, etc) and will ask for them when she is feeling out of sorts. I dare say that life, at least as far as she is concerned is a bit calmer and..quieter! I know we are only 3 1/2 weeks into the interventions (messy eating issues are next!!!) and we have months and months ahead of us. But, we sure are enjoying what we are seeing so far:)
Showing posts with label Occupational Therapy. Show all posts
Showing posts with label Occupational Therapy. Show all posts
Saturday, September 15, 2012
Thursday, August 30, 2012
Occupational Therapy: how it applies to our family and a few bunny trails:)
I am writing this post not to bore you with details of our lives, but to encourage those out there who may be dealing with similar issues and looking for some options. I did not know of the benefits of OT and wish we could have started this several years ago...
I have come to understand and accept that most people do not understand most other people. There are so many issues in this fallen world and we just don't have the time to get to intimately know all of the ins and outs of everything. Unfortunately that usually breeds distrust and misunderstandings of those things which we do not understand. It has been a painful journey for me to know that people do not agree with much of what we believe in and do, but we continue to forge ahead. When we first started the adoption process we were trying to adopt from Liberia, West Africa. Most of the people adopting from our agency at that time were on the same closed group. We encouraged and supported and prayed for one another. It was a precious connection. When we were not able to bring any of our 4 kids home from Liberia, and other things happened we no longer were on that group. I desperately missed the connection. Foster care (3 of our adoptions) does not promote strong connections between foster parents and the foster parents themselves vary so much that connection is difficult. I have joined several yahoo groups specific to our kids' needs such as one on home schooling adopted kids, trouble with reading, dyslexia, etc. I was very excited (although also saddened) to be asked to be on a new group of the same women I had connected with 6-7 years ago who are now, unfortunately, dealing with all of the struggles of parenting adopted children. The struggles are many. Adoption is still VERY worth it. However, adoptive parents NEED support (and NOT to be told, "well, you chose this") and this is a way for us to get support. I appreciate fb and technology that even though there may not be people geographically near us to support us, we are able to receive support from around the world:) People who are looking into adopting need to know what they are about to experience.
Via one of these groups one the mom's started talking about some of the issues that I see with Grace in particular. (I don't wish to not include dad's, it is just usually mom's who are doing the leg work and seeking connection/relationships for support lol!) That confirmed what I had learned last fall from Karyn Purvis, PhD and TBRI (yes, I know I promised a year ago to start blogging about what I have learned. I promise that I will blog about it, I have the posts running around my brain, I just have not done it) that all kids who come from trauma need to have full educational, OT, and PT evaluations to assess their needs and strengths. I am tired of the people who tell me that if we just disciplined more we would have better results. I am tired of the people who say we don't discipline enough. I am tired of people not understanding. I am thankful for the One who always understands:) It is so, so much bigger than just discipline! So armed with new hope I took Superman and Grace in to pediatric OT and PT therapists for evaluations. (Bunny Trail: medications have helped, the allergy testing/treatment/weird stuff has helped, the nutritional stuff has helped, different disciplines have helped, TBRI has helped...I think that each of those issues are just dealing with a different part of the elephant and this is another part of the elephant).
I had always thought that Occupational Therapy was what people did when they had a stroke or a accident and needed help with some type of fine muscle skill, and that PT was about gross motor skills. I was wrong!
Both of the kids sailed through their general OT evals. Grace did very well on her PT eval. Superman came back with some PT areas to work on - primarily core muscle issues that contribute to his "floppiness" and lack of endurance. Grace, however, was found to have many sensory issues that can be helped through Occupational Therapy.
Permit me another bunny trail/soap box. One thing that the vast majority of people do not understand is the utter vital role of prenatal health. People will constantly tell us "Grace came to you at 4 months though, right?" as if getting her so early, or getting JJ at birth for that matter, somehow means that since we have had them all of their lives and have been responsible for their "nurture" we are at fault somehow for their issues or that we are making their issues out to be bigger than they are. Prenatal exposure to drugs and alcohol are not the only prenatal elements that can negatively impact a child. What the mother eats (or fails to eat), antibiotics that she takes, a normal and stress free pregnancy but a traumatic delivery/NICU, and cortisol levels from her stress levels can all have the SAME IMPACT AS DRUGS AND ALCOHOL on the developing baby. Just take a moment to let that sink in! It is a wonder to me that any baby turns out ok! Only by the grace of God! The impact is neurological one. Many times it is permanent or at least requires intervention. Three of our kids have prenatal exposure to drugs/alcohol. The effects are very different in each child. Then we have JJ who has no known drug/alcohol exposure but born to a mom who was very sick vomiting most of the time, did not gain much weight, had very poor nutrition, and had stress levels THROUGH THE ROOF getting pregnant with a 6 week old baby at home, no help from the birth father, a family who was condemning her, and, well, her lifestyle isn't great. Neurological insults abound. And sensory issues are neurological.
OK, back on track. Grace's issues are sensory. Essentially she it utterly over stimulated by visual and auditory sensory feedback. Isn't that the core of ADHD symptoms lol! Conversely, she is totally under-stimulated in the areas of tactile, proprioceptive (deep muscle pressure), and vestibular (balance/inner ear) stimuli. The under and over stimulation war against each other in her brain where it doesn't know what to be processing. Also, when she is overstimulated in one area, she will gravitate toward trying to stimulate the other areas.
In practical terms, the ways that I have seen this are:
Auditory: Grace will cover her ears and not like sounds. When she is in an area with many sounds she cannot discern what she is supposed to pay attention to.
Visual: again, when she is in an area with lots of visual stimulation she misses the forest for the trees so to speak. She is forever noticing what everyone else is doing rather than what she is supposed to be focused on.
Tactile: Grace is the messiest eater EVER! She is the messiest everything always! She is always washing her hands and playing in water until her hands crack and bleed all of the time. She is always chewing her hands, hair, etc. She digs out the sheet rock mud from on top of the screws on her bedroom wall with her bare fingers. She has ripped all of the wall paper border off of her walls, again with her bare fingers. She is forever dirty playing in sand, digging in dirt, pulling apart anything she can find. She wants to fully feel and physically experience everything. No personal boundaries? Craves physical touch/tactile stimulation to connect. She has a bed so full of toys that I cannot imagine how she sleeps! She needs the "feel" of them and their textures.
Proprioceptive: When grace is getting overstimulated she will stomp her feet or walk as if flat footed so it seems like she is stomping her feet. The OT explained that kids like her have a strong need for keep joint/muscle compression so while she "knows" how to walk heel/toe stomping flat footed will give her sensory input that is soothing to her. She is not just doing it to be rebellious. I was worried she was going to blow out her knees!
Vestibular: another huge one for Grace. When overstimulated Grace will spin in circles a lot (remember her first black eye??!), hang upside down off the couch/ottoman (2nd story railing of my parents deck), and swing/rock. She much prefers circles to back and forth. Again, when visual and auditory are too stimulated she will go to the 3 areas that are understimulated to self-soothe.
Whew! We had the week of vacation between the eval and the first appt so I had a chance to just sit back and watch her behavior. Putting a different framework on the "why" of what she was doing was so helpful! I was able to have hope that one day it will be better:) The problem was that I still didn't have any tools to make it better as vacation is VERY stimulating lol!
Interventions we are starting:
First, I am to really think about all of her environment and her responses in terms of the 5 categories of stimulation that we are dealing with. Second, I have been asked to do, as interventions, things with Grace that we have totally, totally, totally removed from our lifestyle due to the issues she has. For example, can you IMAGINE her with PAINT! eeee gads!!! Ok, but I can do this...
Visual: we are to get a lava lamp, bubble maker, or fiber optic tree/something to give her something to look at that is visually stimulating but in a calming, methodical, and structured manner. Meaning, it will keep her attention but keep her calm. We are to have a place for her to go in the house that is visually calm.
Auditory: unfortunately there is not much that can be done for this sense other than graded exposure until she is able to handle it - and the use of headphone/earplugs.
Tactile: this is the one that scares me the most. We are to give her lots of controlled sensory input. Playing in rice (beading string but she had to pull the beads out of rice to give her the tactile stimulation), painting (again, imagine me physically cringing!), playing in sand (same cringe!), fidget toys, play doh (arrrgggg! the mess!), squeezing clothespins, sorting items that she finds in a bucket of beans, etc. This one will take the most creativity and patience from me. I was also horrified that I have been removing the very things that she has so desperately needed because of the huge messes that she makes (do you remember just for a moment what our bars of soap look like lol!) Sugar free candy for oral stimulation.
Proprioceptive: We are to get a bean bag and have her lay in it, enveloped by it, with a heavy blanket over it. Rolling over the top of a big bouncy ball (the kind you sit on), pushing against walls, sweeping, carrying various heavier items, stretching, etc. Anything that will give deep muscle stimulation/joint compression. Wheelbarrow, bear crawling, jumping jacks, etc.
Vestibular: swinging, rocking, listening to/feeling drum heavy music (African or native American) where she can feel the beat.
Finally, we learned the Wilbarger brushing technique. Karyn Purvis, PhD talked about this one a lot. It is a mixture of brushing her skin with a soft brush alternating with keep joint compression. Grace LOVES it, it relaxes her, and she gets to do this every TWO hours.
We have a schedule of what to do every 2 hours with her. Even though this is a time commitment it will hopefully take up less time than the hours of screaming we get when she is overstimulated. These techniques are supposed to help to sooth over stimulation and stimulate what is under stimulated so that she can regulate better. We are ALL ABOUT having a better regulated Grace!!
I know this post is very long, for those of you who have read it to the end I hope it has been helpful:) Feel free to ask me any questions that you may have about this, or you just read The Connected Child by Karyn Purvis, PhD or The Out of Sync Child by an author I can't remember right now:)
I have come to understand and accept that most people do not understand most other people. There are so many issues in this fallen world and we just don't have the time to get to intimately know all of the ins and outs of everything. Unfortunately that usually breeds distrust and misunderstandings of those things which we do not understand. It has been a painful journey for me to know that people do not agree with much of what we believe in and do, but we continue to forge ahead. When we first started the adoption process we were trying to adopt from Liberia, West Africa. Most of the people adopting from our agency at that time were on the same closed group. We encouraged and supported and prayed for one another. It was a precious connection. When we were not able to bring any of our 4 kids home from Liberia, and other things happened we no longer were on that group. I desperately missed the connection. Foster care (3 of our adoptions) does not promote strong connections between foster parents and the foster parents themselves vary so much that connection is difficult. I have joined several yahoo groups specific to our kids' needs such as one on home schooling adopted kids, trouble with reading, dyslexia, etc. I was very excited (although also saddened) to be asked to be on a new group of the same women I had connected with 6-7 years ago who are now, unfortunately, dealing with all of the struggles of parenting adopted children. The struggles are many. Adoption is still VERY worth it. However, adoptive parents NEED support (and NOT to be told, "well, you chose this") and this is a way for us to get support. I appreciate fb and technology that even though there may not be people geographically near us to support us, we are able to receive support from around the world:) People who are looking into adopting need to know what they are about to experience.
Via one of these groups one the mom's started talking about some of the issues that I see with Grace in particular. (I don't wish to not include dad's, it is just usually mom's who are doing the leg work and seeking connection/relationships for support lol!) That confirmed what I had learned last fall from Karyn Purvis, PhD and TBRI (yes, I know I promised a year ago to start blogging about what I have learned. I promise that I will blog about it, I have the posts running around my brain, I just have not done it) that all kids who come from trauma need to have full educational, OT, and PT evaluations to assess their needs and strengths. I am tired of the people who tell me that if we just disciplined more we would have better results. I am tired of the people who say we don't discipline enough. I am tired of people not understanding. I am thankful for the One who always understands:) It is so, so much bigger than just discipline! So armed with new hope I took Superman and Grace in to pediatric OT and PT therapists for evaluations. (Bunny Trail: medications have helped, the allergy testing/treatment/weird stuff has helped, the nutritional stuff has helped, different disciplines have helped, TBRI has helped...I think that each of those issues are just dealing with a different part of the elephant and this is another part of the elephant).
I had always thought that Occupational Therapy was what people did when they had a stroke or a accident and needed help with some type of fine muscle skill, and that PT was about gross motor skills. I was wrong!
Both of the kids sailed through their general OT evals. Grace did very well on her PT eval. Superman came back with some PT areas to work on - primarily core muscle issues that contribute to his "floppiness" and lack of endurance. Grace, however, was found to have many sensory issues that can be helped through Occupational Therapy.
Permit me another bunny trail/soap box. One thing that the vast majority of people do not understand is the utter vital role of prenatal health. People will constantly tell us "Grace came to you at 4 months though, right?" as if getting her so early, or getting JJ at birth for that matter, somehow means that since we have had them all of their lives and have been responsible for their "nurture" we are at fault somehow for their issues or that we are making their issues out to be bigger than they are. Prenatal exposure to drugs and alcohol are not the only prenatal elements that can negatively impact a child. What the mother eats (or fails to eat), antibiotics that she takes, a normal and stress free pregnancy but a traumatic delivery/NICU, and cortisol levels from her stress levels can all have the SAME IMPACT AS DRUGS AND ALCOHOL on the developing baby. Just take a moment to let that sink in! It is a wonder to me that any baby turns out ok! Only by the grace of God! The impact is neurological one. Many times it is permanent or at least requires intervention. Three of our kids have prenatal exposure to drugs/alcohol. The effects are very different in each child. Then we have JJ who has no known drug/alcohol exposure but born to a mom who was very sick vomiting most of the time, did not gain much weight, had very poor nutrition, and had stress levels THROUGH THE ROOF getting pregnant with a 6 week old baby at home, no help from the birth father, a family who was condemning her, and, well, her lifestyle isn't great. Neurological insults abound. And sensory issues are neurological.
OK, back on track. Grace's issues are sensory. Essentially she it utterly over stimulated by visual and auditory sensory feedback. Isn't that the core of ADHD symptoms lol! Conversely, she is totally under-stimulated in the areas of tactile, proprioceptive (deep muscle pressure), and vestibular (balance/inner ear) stimuli. The under and over stimulation war against each other in her brain where it doesn't know what to be processing. Also, when she is overstimulated in one area, she will gravitate toward trying to stimulate the other areas.
In practical terms, the ways that I have seen this are:
Auditory: Grace will cover her ears and not like sounds. When she is in an area with many sounds she cannot discern what she is supposed to pay attention to.
Visual: again, when she is in an area with lots of visual stimulation she misses the forest for the trees so to speak. She is forever noticing what everyone else is doing rather than what she is supposed to be focused on.
Tactile: Grace is the messiest eater EVER! She is the messiest everything always! She is always washing her hands and playing in water until her hands crack and bleed all of the time. She is always chewing her hands, hair, etc. She digs out the sheet rock mud from on top of the screws on her bedroom wall with her bare fingers. She has ripped all of the wall paper border off of her walls, again with her bare fingers. She is forever dirty playing in sand, digging in dirt, pulling apart anything she can find. She wants to fully feel and physically experience everything. No personal boundaries? Craves physical touch/tactile stimulation to connect. She has a bed so full of toys that I cannot imagine how she sleeps! She needs the "feel" of them and their textures.
Proprioceptive: When grace is getting overstimulated she will stomp her feet or walk as if flat footed so it seems like she is stomping her feet. The OT explained that kids like her have a strong need for keep joint/muscle compression so while she "knows" how to walk heel/toe stomping flat footed will give her sensory input that is soothing to her. She is not just doing it to be rebellious. I was worried she was going to blow out her knees!
Vestibular: another huge one for Grace. When overstimulated Grace will spin in circles a lot (remember her first black eye??!), hang upside down off the couch/ottoman (2nd story railing of my parents deck), and swing/rock. She much prefers circles to back and forth. Again, when visual and auditory are too stimulated she will go to the 3 areas that are understimulated to self-soothe.
Whew! We had the week of vacation between the eval and the first appt so I had a chance to just sit back and watch her behavior. Putting a different framework on the "why" of what she was doing was so helpful! I was able to have hope that one day it will be better:) The problem was that I still didn't have any tools to make it better as vacation is VERY stimulating lol!
Interventions we are starting:
First, I am to really think about all of her environment and her responses in terms of the 5 categories of stimulation that we are dealing with. Second, I have been asked to do, as interventions, things with Grace that we have totally, totally, totally removed from our lifestyle due to the issues she has. For example, can you IMAGINE her with PAINT! eeee gads!!! Ok, but I can do this...
Visual: we are to get a lava lamp, bubble maker, or fiber optic tree/something to give her something to look at that is visually stimulating but in a calming, methodical, and structured manner. Meaning, it will keep her attention but keep her calm. We are to have a place for her to go in the house that is visually calm.
Auditory: unfortunately there is not much that can be done for this sense other than graded exposure until she is able to handle it - and the use of headphone/earplugs.
Tactile: this is the one that scares me the most. We are to give her lots of controlled sensory input. Playing in rice (beading string but she had to pull the beads out of rice to give her the tactile stimulation), painting (again, imagine me physically cringing!), playing in sand (same cringe!), fidget toys, play doh (arrrgggg! the mess!), squeezing clothespins, sorting items that she finds in a bucket of beans, etc. This one will take the most creativity and patience from me. I was also horrified that I have been removing the very things that she has so desperately needed because of the huge messes that she makes (do you remember just for a moment what our bars of soap look like lol!) Sugar free candy for oral stimulation.
Proprioceptive: We are to get a bean bag and have her lay in it, enveloped by it, with a heavy blanket over it. Rolling over the top of a big bouncy ball (the kind you sit on), pushing against walls, sweeping, carrying various heavier items, stretching, etc. Anything that will give deep muscle stimulation/joint compression. Wheelbarrow, bear crawling, jumping jacks, etc.
Vestibular: swinging, rocking, listening to/feeling drum heavy music (African or native American) where she can feel the beat.
Finally, we learned the Wilbarger brushing technique. Karyn Purvis, PhD talked about this one a lot. It is a mixture of brushing her skin with a soft brush alternating with keep joint compression. Grace LOVES it, it relaxes her, and she gets to do this every TWO hours.
We have a schedule of what to do every 2 hours with her. Even though this is a time commitment it will hopefully take up less time than the hours of screaming we get when she is overstimulated. These techniques are supposed to help to sooth over stimulation and stimulate what is under stimulated so that she can regulate better. We are ALL ABOUT having a better regulated Grace!!
I know this post is very long, for those of you who have read it to the end I hope it has been helpful:) Feel free to ask me any questions that you may have about this, or you just read The Connected Child by Karyn Purvis, PhD or The Out of Sync Child by an author I can't remember right now:)
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