View Full Version : Seeing psych for behavior modification therapy


mcpforever
03-17-10, 02:23 PM
Today was our first appointment for this. Our nearly 8 yo son was diagnosed with ADHD-IA in December and is now on 10 mg Focalin XR (with improvement reported from teacher). Knowing that both BTM and meds are the best way to go, we had our first appointment with the lady in the group who is treating/evaluating him.

I was less than impressed. I understand that this was more of a "get to know you" type session, but the information that she shared/techniques she recommended we are already know or are implementing. (behavior charts, one task at a time, structure, routine, etc.) And she also was recommending us helping him in areas where he doesn't need help. My son is a great speller. He comes home with his spelling words on Monday, I call them out to him, and he has missed 5 out of this entire year. He still is required to do his busy work with them, but I don't see why I should make him go through the 4 extra steps if he already knows them and his spelling tests reflect that as well. :confused: He is reading well above his grade level and has no trouble with reading for hours on end. And he comprehends what he's reading.

He just has trouble staying on task when it comes to writing something down. He's doing great in math. His handwriting isn't stellar, but that doesn't bother me as in this day and age, most everything is typed anyway. He loves science and just soaks it up like a sponge. He's not struggling in school, except to stay organized and write everything down. He pretty much needs someone to hold his hand and take him from task to task.

I tried to communicate this to her, but I didn't feel as though she was hearing me, but that she was rather just going through her spiel of sorts. She recommended a book (Driven to Distraction ) and to read things by Barkley (duh) yet didn't write it down for me.

We are supposed to have another appointment with her next week. Not sure what I think of going back, but I'll go a few more times before I come to the conclusion that she is pretty redundant.

I hope I don't come off as condescending or arrogant. I've just been lurking around here long enough to have a clue without it being all spelled out for me.

Thanks for letting me share/vent. If you made it all the way through that, you rock!

LynneC
03-17-10, 02:43 PM
Hi MCP,
Your son sounds quite a bit like my 7 1/2 year old regarding his academic performance.
I have absolutely no advice for you :) , but I hope you keep posting as to how your son is progressing.

I think your plan of a few more sessions and then a decision to continue or not is a good one.

What do you think you (your son, I mean) will gain from the counseling? I ask because this is something that may be a possibility for us in the future. We are not medicating him at the moment, but are using behavior modification techniques in the classroom and at home. This has worked well so far, but I fear that 3rd grade will require so much writing that my son will not be able to cope.

Do you have an IEP?

tessmesser
03-17-10, 03:30 PM
I had a similar experience with the psychologist we used. I eventually settled on a play therapy and another Occupational Therapy group that seemed to me to be more applicable and helpful. I did not get the sense that our psychologist was going to address my son's specific issues. Do you have a University in your town?? Sometimes, ADHD experts affiliated with a University are better resources for Behavioral Therapy. We have had to wait 4 months but will soon meet with a psychologist that comes highly recommended with lots of ADHD experience. I will post on how it goes.

Tess http://primarilyinattentiveadd.com

ADHDTigger
03-17-10, 04:44 PM
MCP- the thing that jumped out at me was your mention of writing. Has dysgraphia been considered? If that is the source of the problem, there are things that can be helpful for him. LynneC, that may apply in your situation as well.

Dizfriz
03-18-10, 04:07 PM
MCP- the thing that jumped out at me was your mention of writing. Has dysgraphia been considered? If that is the source of the problem, there are things that can be helpful for him. LynneC, that may apply in your situation as well.
Good call. This or something similar is a real possibility.

Dizfriz

ADHDTigger
03-18-10, 05:52 PM
Diz- I tend to pick up on dysgraphia. That and dyscalculia are the two LDs that I got in my ADHD package. An inventive teacher taught me to 'draw' letters. It seems to have worked... but writing by hand is a chore. I type faster!

mcpforever
03-18-10, 10:17 PM
MCP- the thing that jumped out at me was your mention of writing. Has dysgraphia been considered? If that is the source of the problem, there are things that can be helpful for him. LynneC, that may apply in your situation as well.

I started to think about this possibility based on several of your recent posts. He was never attracted to coloring with crayons as a preschooler the way most are. When he did color, finally around 4-5yrs, he would press very hard and fill in ALL of the white space.

Handwriting is legible but pretty sloppy compared to his classmates. His letter formation was never formalized-he was allowed to draw his letters in whatever fashion he chose as long as they looked like the letters. So he does a lot of bottom to top writing rather than top to bottom.

I have spoken to him about his writing and he doesn't say it hurts. His grip looks perfect to me based on the pictures that I have looked up online. (he does use 2 fingers to stabilize instead of one but that is an accepted grip) In fact, MY grip is poor! :p

But...he LOVES LOVES LOVES legos. He builds with them all.the.time. They are his go-to toy and he truly enjoys building with all of the tiny (eeeek with two young toddlers in the house!) pieces.

And yesterday he drew and colored an airplane using MS paint. On a laptop. With the trackpoint button rather than the touch pad. This is obviously different than writing, but I was just impressed with his patience and dexterity.

I will bring this up at his next appointment though.

I am curious though as to this "drawing" of letters. I am interested in knowing more about it. :)

ADHDTigger
03-19-10, 02:35 AM
Mcp, I make most letters and nearly all numbers bottom to top. I always have done.

What I recall from my teacher was that I was drawing a picture. She gave me my name inside of a square in heavy black lettering and got me to color the white space. After that it was mirroring my name so that it created a more complex picture. I was still coloring the white space.

Using my colored in drawing and probably correction tape or something similar (?) to cover where my name had been in heavy lines, she had me draw my name in.

It's hard to explain the process and the woman was a saint to have gone through it with me- the rest of the class was printing and some moving to cursive while I struggled- and I am MUCH older now. Recall gets hazy with age. I remember that lovely woman, though- Mrs Joiner- and how pretty she looked in blue.

Dysgraphia has degrees just as any of the LDs do. He would likely flourish with an occupational therapist to guide him in pencil and pen use.

I think I may be able to create some samples to give you an idea of what I recall. Keep in mind- I couldn't use a pencil on a bet as a kid.

I taught myself calligraphy as an adult. Even though it natively lends itself to drawing rather than writing, I had to find my own way in learning nib strokes. I still write bass-akward... from bottom to top. I am told that I have very pretty penmanship.

qanda
03-19-10, 06:32 AM
Can you talk with his teacher about the homework. If he does not need spelling practice, but does need handwriting practice, maybe you could subsitute a handwriting lesson for the spelling. One program comes to mind - handwriting without tears. If you do see a professional to help with handwriting, maybe you could explain this to his teacher and that extra therapy could substitute for his spelling. You hate to see a kid waste his time on something he knows well when he needs to work on other things.

mcpforever
03-19-10, 09:57 AM
Can you talk with his teacher about the homework. If he does not need spelling practice, but does need handwriting practice, maybe you could subsitute a handwriting lesson for the spelling. One program comes to mind - handwriting without tears. If you do see a professional to help with handwriting, maybe you could explain this to his teacher and that extra therapy could substitute for his spelling. You hate to see a kid waste his time on something he knows well when he needs to work on other things.

Yes! I'm glad to know I'm not the only one who has had this idea. I pretty much tell my son that his spelling homework (when it is written, one of the options involve typing it on a computer) should be about handwriting since he knows how to spell the words already. I try to take the opportunity to gently remind him of this and be accepting of work that he has clearly taken the time and effort to make neat. I don't look for perfection, just the effort. If it's obvious that he is not putting forth the effort, I let him know that I see it and "reject" the work. (I try to do this before he gets it all done to lower the level of frustration!)

At first I was trying to help him get into the habit of forming his letters according to all of the "right steps" (top to bottom, clockwise, left to right) and then decided that he had been doing it so long the non-traditional way that it really didn't matter that much as long as the writing was neater than when he was not focused on the writing. I came to this conclusion after reflecting that his teachers never taught nor emphasized the traditional way to form letters and haven't addressed it as an area of weakness (other than to say his writing wasn't up to grade level) to correct.

And, in the grand scheme of things, he will more likely use electronic devices as he gets older just as a matter of course.

Tigger, unless you are just wanting to create some samples for reference to share with others with dysgraphia, please don't go to the trouble of making them for me-just yet. I do have a question specifically for you though. Since DS is heading into third grade where they teach cursive, would it be a good idea to give him a gentle head start this summer with it? If so, any recommendations you have I would love. I want to help my darling with what he really needs without making life miserable for him. He moans and groans about doing handwriting as an isolated activity, but is ok if it is incorporated into something like his spelling. Oddly, one of his most often picked options is to write the words in "curly"-which means adding little swirls and curls to the beginnings and ends of the words. For him, he writes the words and then goes back to add on the embellishments.

JenE
03-22-10, 02:23 PM
my 2nd grader also has horrible handwriting. He fights me sooo hard over doing sentences and I truly believe it is because of the handwriting issue. I've seen that so much of his frustrations (which easily transform into meltdowns) are due to handwriting issues. I may need to look into the dysgraphia myself.

MGDAD
03-22-10, 04:04 PM
My oldest had the hardest time with writing when she was younger. I did a lot of writing for her on her homework. It was just so difficult for her. I did not think it was such a big deal for her handwriting to be a bit delayed. She is 12 now and writes just fine.

mcpforever
04-12-10, 10:36 PM
So we have been back twice since the first post. It's gotten better, but I still feel as though she is only half listening and is giving route answers I have already looked up or just know from being a parent.

The second time we went, she seemed to be aware that I had a clue. She took my son in and they played a board game for a while and talked I suppose. (He beat her and she made a big deal out of telling me that.) Then she got some paper out for him to draw on while she encouraged me to make a simple behavior chart for home. She wanted it to be things he does every day and things that he could do successfully in order to build self esteem, show him he could do it, etc. She made it sound like this was only the foundation and that we would gradually begin to do more and raise the bar, so to speak.

So for two weeks we did the behavior chart business. Chose 3 things that he pretty much does every day and does fairly consistently. I think in the entire 2 weeks (he was rewarded on a weekly basis) he might have missed 2 things on his chart of 21. (3 things per day)

Went to see her today. She took him back and played shoots and ladders with him. (he won again and she made a big deal out of telling us) Then he played with the checker board while she and my husband (his stepfather) talked. She went through the exact same litany of what she went through with me with him. Pretty much he said, "Yes. My wife told me about that, too." the entire time.

The behavior chart was looked at. She congratulated my son on doing so well and that was it. She doesn't want to change it or add to it, because it would be too much. Honestly, his behavior hasn't changed, because we weren't targeting behaviors that actually needed improvement. (for the sake of success) So really, what's the point of using this chart in its current form?

She asked my husband what the most frustrating behavior our son has in his opinion. (thumping and bumping and stomping) Then she had my son promise to look his stepfather in the eye when he was speaking to him and my husband promise to work on not yelling at him. Seriously? Cause that is something that is measurable and will be a dependable way to give him feedback.

And she has yet to say anything concerning extinguishing behavior. "Act don't yack" is the closest she ever gets. He has been randomly hitting his younger siblings this week. It was brought up and the dr started in about how he says he doesn't like to play with them, but he does it to keep them from crying. That's great, but he isn't forced to play with them. He has opportunity to play with other boys his age away from them. He doesn't particularly enjoy taking out the garbage, but he doesn't beat on the garbage can!

I am still feeling very frustrated here. I understand that this stuff takes time and all, but it seems to me as though none of this is stuff that I hadn't already been doing in some form or another.

And I don't understand the 30+ minutes of talking/playing with him. I was under the impression that we were there for BMT, not play therapy (which has not been proven for helping kids with ADHD-comorbid conditions like anxiety and depression, yes! but he doesn't have those as a diagnosis).

Sorry. I am really at a loss here as I am finding the trips to be far far far more trouble and headache (for both myself and my son) than they seem to be worth.

MuscleMama
04-13-10, 09:27 AM
Sounds to me like you know in your gut that this isn't the right fit. Are there any other therapists in the group you can switch to? I know it can feel awkward and uncomfortable, but can you call her (when your son isn't around) and discuss your impressions with her?

JenE
04-13-10, 11:04 AM
You know, we have had a similar experience with psychologists. He really didn't give us any options/ideas we hadn't already tried--mostly based on rewards systems but they really don't work that well for us. We dropped our last psychologist (after about 9mos) b/c it was ~ a 30 minute drive, it impacted my work because I had to leave early, they didn't take our insurance AND we really didn't see much improvement coming from it. The only thing it did was reassure ME that we were doing the right things so it was more beneficial for me than my son. I will say that it can take many sessions for the counselor to develop a relationship with the child so the early sessions may not be as good as the later sessions.

I have recently seen a local counselor who does take our insurance but he basically said he would be doing the same things as the other guy so I've not been in such a hurry to try him. But I will do it for a few sessions and see how it goes.

I'm just not sold on therapy for kids this age. They just aren't mature enough to use the skills and when you factor in the maturity deficit of ADHD, then it REALLY shows!

ADHDTigger
04-13-10, 02:00 PM
Tigger, unless you are just wanting to create some samples for reference to share with others with dysgraphia, please don't go to the trouble of making them for me-just yet. I do have a question specifically for you though. Since DS is heading into third grade where they teach cursive, would it be a good idea to give him a gentle head start this summer with it? If so, any recommendations you have I would love. I want to help my darling with what he really needs without making life miserable for him. He moans and groans about doing handwriting as an isolated activity, but is ok if it is incorporated into something like his spelling. Oddly, one of his most often picked options is to write the words in "curly"-which means adding little swirls and curls to the beginnings and ends of the words. For him, he writes the words and then goes back to add on the embellishments.

Sorry MCP- I hadn't gotten back to this thread before now. Thanks, Jen!

If he is starting cursive next year, I would absolutely start him this summer. I believe another poster mentioned "Handwriting Without Tears" and can recommend it. An example book and paper with dark lines were both VERY handy for me- the paper with the dashed line to show the midline was a godsend.

http://www.first-school.ws/theme/handwriting.htm is young for your son but has printable paper with the dashed midline. You may find other resources there that are workable for him as well- they have printable mazes that are excellent for ADHD people (I do them all the time) because they are good spatial drills as well as teaching kids to draw in the open space to figure out the maze.

http://abcteach.com/directory/basics/handwriting/ This is a site that will allow you to use their pre-made writing worksheets. You may also choose to register with the site and you can make your own.

LynneC
04-13-10, 02:50 PM
Hmmm, Mcp, this doesn't sound like a good fit at all. Perhaps her clientele are not as educated as you are about ADHD, but you'd think she'd be able to see that and adjust her therapy accordingly. Does your son like her?

Do you follow Barkley's recommendations re immediate consequences and short punishments to extinguish negative behavior? And acknowledgements for good decision-making?

My son's an only child (he'll be 8 in June), so I don't have to deal with sibling interactions, but I have found the acknowledgements have been making a difference. Sometimes he says to me 'Mom, that was a good decision, wasn't it?!', if I forget to say it.

I am trying really hard not to yell at him (I see him cringe when I yell, and I know it negatively impacts him), and instead give him a short time out or loss of privilege. If we both lose it, I will come back a few minutes later, sit him on my lap, give him a hug and suggest that we both start over. It helps...

ADHDTigger
04-13-10, 03:37 PM
Excellent stuff, Lynne!

Immediate consequences are a must- we forget in mere seconds. But positives are like sunshine on our faces. ADHDers LOVE positives.

I love the sitting on your lap and agreeing to start over. That is so powerful for kids in general but even moreso for the ADHD kid.