gone

Woah, that sounds like a full schedule for a 5yo - not surprising she's melting down! Is there a reason you couldn't cut back to say one playdate a week, say on the one day she doesn't have something later on?

I would praise her for this insightful observation and the discuss the positive reinforcement techniques that the teacher uses. My daughter found it so interesting to learn about the negative reinforcement techniques that were used 'back in the day', and it helped her learn to appreciate her teachers.

I would also praise her for reflecting back on her behavior each day.



This would be a good opportunity to make a a chart that shows the "levels of transgression". Make a list with her of all kinds of possible classroom transgressions, and then give each one a rank of 1 (minor) to 10 (really bad). Point out that a day with only a few 1's or 2's is a good day. She's falling into the trap that my daughter did at that age of strong emotions leading to 'black and white' thinking. By using cognitive strategies like this, we were able to slowly override the emotional black and white thinking.

The more tired she is, the more likely she's going to have these kind of emotional problems. Down-time and free time are so valuable and so underrated, in my opinion. If she's doing that well at play dates, I don't think she needs the social skills group, (but maybe they won't tell you that because they want your money). OT is not a proven therapy; it's possible running around and climbing on the playground is just as good. I couldn't afford OT for my DD - now at age 7, her sensory issues have mostly resolved themselves, and she's much more comfortable in the classroom environment. As for CBT, (which I assume is Cognitive-Behavioral Therapy), I wish I could have afforded this for my DD... but it all depends about the particular therapist. If it's a good one, your DD will probably enjoy going to him/her and will feel that it's helpful. If not, you may want to drop it, or find someone else. Since I couldn't afford CBT, I did what I could myself using books, such as "Freeing your child from negative thinking", and "What to do when you grumble too much". Great books. Highly recommended!

Downtime and freetime are the best medicine, but since they don't cost anything, no one is trying to sell them to you. I would strip down her schedule as much as possible and see what happens. The other thing I noticed was at that age, she needed to eat more often that she does now, and that fatigue along with hunger would really mess up her brain.

Good luck! Five was such a difficult age, but for me it has gotten so much better!

It is possible to take a break from OT so that your child can have some down time. My OT gave us tons of activities to do for a home program during a break plus I found some additional activities in books and online...I didn't call it OT home program. Just, hey, let's do this fun thing together. And then when she is less fatigued pick back up with OT.

I wouldn't drop the social skills class IMO or the CBT if it is going well. Possibly move some of the play dates to the weekend?

As a therapist, I would recommend two things:

1. If your state has Targetted Case Managers or another type of Care Coordinator, get connected with this type of service. They can help you hash through what is helpful therapy interventions and what is just overkill. Twice a week of CBT for a 5 yr old sounds like overkill. Realize that a provider does have the dual investment of wanting to do good, but also wanting to make money.

2. Rest time is equally as valuable as therapy and skills practice time. It gives kids time to process all the new skills they've learned. Even blanking out in front of the TV can be incredibly therapeutic when there are lots of social experiences to process.

My instincts on this situation are in agreement with yours. Play is a wonderful and highly-valuable component in child development, so that needs to be protected. And it doesn't sound like your DD is getting much value from the professional services at all. Cutting those out and letting your DD have some downtime before bed could make all the difference in the world in her behavior.

As for the school... if they already know you've sought professional services for your DD... is there any reason to tell them you've stopped?

I would keep the CBT above all. This is obviously my outsider's perspective, but my sense of your DD is definitely that she has anxiety and that it could perhaps be her primary diagnosis. I am no expert, but we have been told that anxiety can create a lot of other issues, including apparent social skills problems, etc.

My anxious DD LOVES playdates but is also worn out by them. Also, she is on the SPD side of things but has continued to outgrow the behaviors without any treatment.

I would at least ask for a home program for the sensory OT and reduce your sensory OT to just once in a while (whatever the OT thinks is appropriate...once a month, ever other month?)....those activities can be done at home and really shouldn't be just once a week but throughout the day each day.

Maybe the gross motor could be reevaluated for helpfulness?

I do agree that I would keep the social skills and CBT in place....maybe the two providers could coordinate because it sounds like she has the actual social skills, just interprets situations differently so her reactions are off. You are lucky to have those.

I would consider eliminating the sensory OT, and scheduling more playdates at places where kids will naturally have sensory stimulation - parks with monkey bars, etc.

I would go with your instinct and cut out all of the professional services, since you don't seem to have much faith that they are helping.

Through her playdates, she's learning social skills naturally, through play with other kids. If she has challenges, you can work through these with her as they happen, with love and empathy. Plus, with the playdates, she's building REAL relationships and REAL friendships, which is the ultimate goal of building "social skills".

Are those the social issues that they work on in the Thursday social skills class? If they're not working on the specific skills she needs, then I don't think it's very helpful.


Reading between the lines, it sounds like the therapist really doesn't know how to help her. As a parent, though YOU are best able to learn to apply these skills by discussing her day with her every day, praising the positives and helping her learn to reflect in a positive way. Patience and maturity will help a lot.

It takes a lot of courage to go with your instinct, but if your only reason for keeping these services is because you think the school will be less likely to work with you, I don't think that's a good reason, as these services seem to be doing more harm than good because of her lack of downtime.

If it ever comes up, I'd just tell the school that you couldn't afford the services anymore. Where I live, these sort of things cost over $100/hr and are not covered by insurance unless you have a diagnosis.

moomin, I agree that looking at everything in your dd's schedule and cutting back where you can is a good idea. I'd also suggest simply looking at *when* her different therapies etc take place. Trying to "work" (which therapy can be) at the end of a long day, especially for a child who has to put in effort to fit in at school, is tough. I think from what you posted above she's going on her playdates before the OT etc too - so that's even more energy she's drained of before going into therapy. I know you work, so I'm guessing scheduling OT etc earlier in the day is out of the question (?) - but if it's an option, I'd seriously consider it. She's still so early on in school that I can't imagine it would be a concern to take her out of school during the day for her therapy appointments. I still do that with my dds who are going through vision therapy, and they are much farther along in school. The way I see it, the gains they are making from therapy are more important at this point in time than what they miss out on at school.


Sensory OT is something that you can fill in a lot of at home. My suggestion here is to talk to her therapist and consider possibly stepping back to every other week for awhile, with you adding in some sensory work at home. For anyone who balks at that word "work" - the sensory "work" my dd did in therapy was actually a lot of fun and calming for her. I'd also, before cutting back any of the sensory OT, look at how she seems to feel and act *after* each session - is she exhausted, or is she happy, calm, etc? Have you watched her during the sessions? That might help give you an idea what the goals of the therapy are and whether or not they make sense. I was allowed to sit in the room with my dd during each of her sessions and her OT explained everything to me as well as making suggestions for things we could do at home.


I'd be really careful to assume she's just physically careless. She must have had some type of gross motor challenge or deficit to have qualified for an OT course of therapy, and you've noted she's made progress. It's possible there may be something else behind it other than simply gross motor delay etc - my dd who has a vision challenge looks completely klutzy and careless at times - but she's not, it's due to her vision. She also had low muscle tone in her trunk when she was your dd's age.


I think that I'd drop a therapy that you aren't seeing progress in unless you understand the goals of the therapy and feel there's a reasonable explanation for sticking with it longer (for instance, perhaps the CBT therapist predicts it usually takes 6 months to see improvements in a child similar to your dd, but she's only been in CBT for 3 months).


It's a bit tough for me to understand, given what you say your dd is working toward re social skills, how she is "socially precocious". From what you've written here and in previous posts, it sounds like social skills is an area that is worth focusing on. It's possible this isn't the ideal group for that work, but it's not something I would let go of without some serious consideration of finding another way to work on her social skills.


What about saving a few of the playdates for weekends? I'd also consider whether or not you're really seeing benefit at school from having the school playmates over for frequent playdates.

My last piece of advice is to look carefully at where and when stress is showing up and/or meltdowns are occurring. Is she a mess before therapies, or after playdates? Has she had a snack recently? Is it before dinner? If a therapy follows a playdate and she seems to be having a tough time transitioning into therapy - maybe therapy isn't the problem but the *timing* of therapy is the problem. It might be that overscheduling in and of itself isn't the issue, but instead the challenge is finding an order to the activities that makes transitioning easier. I'd also question - if she's going into her therapies already worn out from school and possibly a playdate, and you're questioning whether or not the therapies are working - it's possible she's not getting anything out of the therapies simply because she's tired.

Hope some of that helps!

polarbear

I would be inclined to drop the therapies, except maybe the social skills. But would frame it with school (and your DD) as a "break" (4 weeks?), and unless that is a grain success then try re-introducing the ones you miss most and pruning the play dates. Though I'd possibly prune the play dates a little too.

From my perspective the play dates sound important to maintaining school success, for the reasons you've stated, so I'd try dropping them as he second experiment.

Good luck!