Thanks - this is all so very helpful. It is a real relief to hear, for example, that the neuropsych and OT assessments are not necessarily inconsistent.
I am uncomfortable with all these professionals blithely giving advice outside their specialties - the therapist and OT who are sure it's not ADHD, the neuropsych who spends most of her session giving parenting advice. It truly feels like a mess. And everyone wants to talk to me at length about fish oil. Which we're already taking.
I think our goal with the 504 is to codify this year's informal accommodations (FM system, preferential seating, reduced homework or scribing help, anything necessary for fine motor), in case next year's teacher is not such a good fit. Last year his teacher was very kind, but he was seated next to the A/C and later told us he was always guessing what she wanted from him - no wonder he was anxious. The neuropsych believes we can also build in differentiation (ideally a different math program) which it will be tough to get otherwise. He's cheerful and compliant in school but bored, unchallenged and beginning to check out.
It sounds like he licked the neuropsych's couch - very unusual and I would guess quite deliberate. He was certainly trying to annoy her as much as possible (it worked) and "run out the clock" on the assessment. At the break, I told him she had a shelf full of assessments and we could keep coming back every day if necessary until we got what we needed, and he shaped up. She said he was like a different child after the break. (And, it turned out the CBT therapist, in the same office, had been encouraging him to leap around on the furniture to "work out his energy." Completely unacceptable, he knows, but he had been encouraged to do it there.)
Fast ForWord has helped. Perhaps not exactly in the ways they promised - I wouldn't recommend it as an absolute for auditory issues - but it challenges him enough that he's developing new problem-solving strategies and improving his attention. He can follow much more complex directions now; he stops and repeats them under his breath and then chooses the right answer. And it's much-needed practice in working towards a longterm goal.
I saw a great deal of anxiety in the spring. Walking home one day, I asked what he was thinking and he said he was trying to figure out what to do if the sun went supernova. I called the therapist the next day. We have been in a period of high stress (both parents suddenly changing jobs, among other things) and have worked hard to turn that around. With the decline in household stress and increased structure I am really not seeing anxiety from him.
The sudden, disproportionate outbursts of anger and opposition (yelling, sarcasm, slamming doors and throwing stuffed animals) are troubling, but seem to be decreasing. We're working through the Nurtured Heart program. My gut is to end the CBT sessions which are clearly exacerbating bad behavior, continue to talk about how we all have big feelings in this family and we can all work on managing them, and hold off to see if other improvements mitigate this.
He has never been a good sleeper - we have just added melatonin which seems to help him sleep more deeply. Gave him nightmares when he was younger, but this time, so far so good. I may talk to the lifestyle-focused neurologist about whether she thinks a sleep study would help, but I don't need a sleep consultant to do that.
My gut says there's some kind of fine-motor issue. I'm less sure about a vision issue. His ophthamologist pronounced him perfect in August, FWIW, and did an extra convergence exam at my request since I had convergence issues as a child. My one concern - he reads easily several years above grade level yet absolutely refuses to read books that are straight text, as opposed to Captain Underpants-level books with illustrations on most pages. He has no trouble with small type or concentrated text (something like the Marvel Encyclopedia) as long as there's an illustration on the page. This is frustrating to both of us, as he blows through the illustrated books and complains of nothing to read, while rejecting stacks of books because "they don't have any pictures." Yet it feels more like a control issue than vision-related.
Our big global issue is rigidity and I do think it's becoming limiting. Very picky about food - eats a decent variety including many vegetables, but very specific brands/preparations of each. Will detect a different brand of organic cheese stick (unwrapped) or macaroni that is "too straight," and will excuse himself politely from the table and go hungry rather than eat it. Very reluctant to go outside his comfort zone - had a tough time getting him out the door yesterday though we were going out to buy a swingset. Very tough time with transitions. Resists even the most tempting new activity (afterschool robotics class with his two best friends) and then is upset when they have fun without him. As far as DH and I can tell this seems to be about control. None of the assessments seem to have useful insights on this front. I will read up on Applied Behavioral Analysis.
Thanks for your patience as I talk all this out.
