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    #234598 10/29/16 11:58 AM
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    Ocelot Offline OP
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    I am curious about people's thoughts and experiences with OT strategies for self regulation? DS5 with DCD is having a positive experience with OT focusing on motor issues. His teachers know he is in OT and keep asking for OT input on self regulation. When he is upset you can see it in his body (more movement, more tension), and he tends to get in other students personal space and bother them. He is not being aggressive and this does not happen with kids that he trusts, and overall things have improved as he feels more comfortable with the kids in his class. He is not having outbursts or melt downs. We agree that psychomotor activity and personal space infringements when upset are things he needs to work on. Our pediatrician and OT have recommended games to practice inhibition, like red light green light and what time is it Mr Fox, and as we have started playing them at home we can see they are sometimes challenging for him (stopping his body can be hard!) and he has made improvements as we play these regularly. I like the play approach because I think it is a natural way kids learn to practice inhibition. The teachers keep asking for an OT intervention to calm him when upset, and that maybe they can apply to the rest of the class too. My gut feeling is that they are asking for a non- evidence based quick fix, and I am uncomfortable. What are your thoughts/experiences with OT calming interventions? What did you use? Did it work? Did it contribute to long term improvements in self regulation?

    Last edited by Ocelot; 10/29/16 12:47 PM.
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    When we have done OT in the past there seem to be 2 types available. The medical type we have gotten through a branch of the local children's hospital and the for profit type we have gotten from a large OT chain in the area. Both require a medical script and take insurance, but otherwise they are pretty dissimilar.

    Our dev ped (also with children's hospital) has frequently referred us to the OT department for regulation stuff/alert program. When we go to the OT they say they don't know why the dev peds keep referring people, OT does not do therapy that is focused on regulation/behavior management. They recommend cognitive behavioral therapy.

    For years we used a local for profit OT business that assured us they would fix all of DS's troubles through sensory therapy. They put him on swings, forced him to follow direction in a chaotic room, dragged him around on scooters, pushed him through tunnels, made him play in shaving cream, insisted he jump into beanbags, etc. In the end he went for 3.5 years and never saw any improvement in regulation. He did see a drastic decrease in compliance though.

    I'd love to know if there is anything out there that helps with regulation. DS has none. Actually, his meds help, but nothing else ever has. It seems a lot of professionals are of the opinion that OT is the solution to just about every problem. I highly recommend a medical based OT if you do see one. They will likely be more honest with you. They also did help us with some sensory issues. Very focused, task specific programs that got my DS brushing his teeth and dressing himself in addition to being less tactilely defensive in general. None of that helped with regulation in any way though.

    Compression vests, fidgets, wiggle seats, etc. did nothing for my DS. They might help some kids, but even if they do they aren't going to treat any underlying issues actually causing the problem behavior. For my DS it turned out to be ADHD, but when he was younger we were told autism and pursued the sensory stuff a lot. I also worked for years with kids with autism and honestly never saw a lot of benefit from the OT side of things. Yeah, if you have a kid chewing up shirts the OT can help find a better chewing solution, but they can't change a child's neurology (the child will still need to chew). Anyone claiming they can go into a classroom and fix a kid with OT is lying, IMO. If a special seat or a new light fixture solves all of the child's problems, there probably wasn't a problem to begin with. Not saying these things can't help, just that there is no OT miracle cure out there despite what the current trends might be.

    We have also had some experience with OT's from the school district. I have found they know no more about sensory than I have learned reading on the internet. They pretty much say try a sensory diet and buy lots of sensory things and see if they help. I made my own sensory diet that probably didn't help my son, but didn't hurt either. Just some basic exercises that he enjoyed that were designed for certain types of input. We did it twice a day. I also spent a ton on special equipment: compression vest, special inflatable seat thing, noise cancelling headphones, chewelry, etc.

    In the end I recommend making sure you aren't using OT just because it's currently the popular choice to treat everything. Find out what's going on and pick something evidence based. OT is obviously a real medical profession that treats real issues. Just don't believe that it treats every behavioral problem for every kid. It doesn't. But professionals and teachers push it and the less honest places are glad to take your money even if they can't help you.

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    So over the years, there have been periodic big fads in using OT for self-regulation, among other things. Like many other anecdotally-based treatments, it helps some children, not necessarily for the reasons promoted by its practitioners, but has negligible research foundation. BTW, not all practitioners who push unfounded interventions are shady; many are just poor consumers of research. The program I've referenced below has had some media attention in education circles; some variant of this is probably what your teachers are clamoring for. You'll notice that there has been exactly one peer-reviewed article (exploratory study with 7 experimental and 5 control students) regarding its actual effectiveness--and this is based on the list of research posted at the publisher's own website.

    Summary of the sole peer-reviewed article: https://www.aota.org/-/media/Corpor...ed-CAPs/12-5-CAPs/153BarnesSadlowsky.pdf

    List of research: https://www.alertprogram.com/documents/AP%20Literature%20and%20Research.pdf


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    I have three DS with sensory issues. All have language disorders, but have had speech therapy and OT since they were 2. Some of the self soothing needed to be gained because DSs were not able to effectively express their wants and needs either verbally or manually.

    A lot of the therapy DSs received involved play both 1:1 and in groups. I feel OT and speech therapy has been beneficial to teach DSs social norms, fine motor skills, learning how to lose graciously, to help DSs were I fall short, etc. DS15 swears by Perfection and scoring a 99% on the groove pegboard versus a 21% on the pen-to-paper subtests

    I have very see-it, touch-it, hear-it, smell-it, feel-it DSs. All DSs have a really tough time if they "feel" anything is unjust. Some more than others. It has me running a lot of interference. Games include perfection, table pool, jacks, shuffling cards, arts & crafts w/ scissors. Not sure where you are located but seasonal holidays are great for DSs. Tomorrow we have a neighbor's pumpkin carving party, so we went looking for neon green Elmer's glue today and will bring ingredients to make green sparkly slime (thinking sensory stimulating) to go with carved pumpkins. DSs frustration also stems from not being able to make projects look the way want. They can see the project, but cannot execute it. Not being able to write neatly when they really want to and then an uninformed teacher taking points off for sloppy handwriting. Knowing that their gifts, are because of their weaknesses also helps. When they are able to have those moments of embracing a team environment for other team members to pick up their weaknesses and finding their strengths at the same time it can be amazing. For instance two years in a row DS12 has been monumental in his team winning summer camp color war. It's a big treasure hunt. Each team must find a camp determined hidden object. The first summer I thought DS12 had good luck and stumbled on the object, but two years in a row made me sit up.

    Not sure if that is what you are looking for, but hope that helps.

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    Ocelot Offline OP
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    Thanks to everyone for their input. It helped me feel brave enough to push back against the school's request.
    Our OT (based at a Peds hospital) said she was not enthusiastic about OT approaches to self regulation, that they were anecdotal, and that their safety was not determined. She told me there was now a professional society statement saying weighted vests had a potential for harm, for instance. I was really impressed by her evidence based approach. She also said some of the core stabilization activities she did with him were also used in sensory integration approaches, and they really didn't seem to impact his mental state one way or the other.
    The school psychologist observed him and her first recommendation was that they arrange pull-puts for him to spend time "with a cognitive peer." So they will be doing one on one work with him and another kid. They even asked what content areas he would enjoy and said they were excited when I asked them to do science activities with him. The second recommendation was a social skills class, which looks like it will be a good fit for a verbal kid with DCD. I'm much happier with this approach!!!!


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