Follow up with peciatrician today

ME: My husband and I took Daughter back to the pediatrician today. We covered quite a bit of ground. Let me just break down into the major categories:

Medication
First of all, her weight is holding steady. We haven't had any negative side effects with the Concerta, but we told the doctor we don't really feel like it's helping either. He said that is likely because he has her on such a low dose--in fact he said the 18 milligrams she has been on are really about half what he thinks she ultimately needs. But because she reacted so poorly to the Daytrana, he had wanted to start her out very low on Concerta. The bottom line is that we're upping the Concerta to 27 milligrams. We'll start that tomorrow. It does make me really nervous to change her medication on a week day when I can't be with her to see for myself how she's reacting. But I know that her teacher will watch her closely and let me know how it goes.

Anxiety
We discussed our concern for her anxiety level over the last couple of months. Even her teacher says it seems that anxiety is a bigger factor than the ADHD right now in her behavior. She gets very upset if everything isn't just so ... just how she expected it to be. He basically just wants us to keep pursuing that issue with her counseler and he wants feedback from the counselor on what's going on. He indicated that we could use some medication if we needed to. But he would rather -- and so would we -- try to deal with it in counseling. We still need to get to the bottom of what is causing the anxiety.

Occupational Therapy
I showed him the report from the O.T. at the school, and he really wasn't concerned. Given her history with O.T. and P.T., he said the results weren't different than what he would expect and they didn't raise any red flags for him. He offered to refer us to an O.T. if we wanted, but at this time we're not going to bother with that. She's already missing enough school for counseling appointments, and I just don't want to put anything else on her. I really just needed to know that the doctor wasn't concerned about the results.

I guess for now I don't know much more than I did before going in, other than having a new medication dose to try. As the doctor explained (and I know from the research I've been doing), ADHD treatment is not an exact science. We just need to keep working it until we find the best balance for her.

Discouraged

MOMMY: I feel like I am failing her in so many ways, and I'm not sure what to do. She needs me to show her the way, and I honestly don't know the way.

After receiving the report from the OT, clearly her fine motor and gross motor skills are still a problem, but the school won't be able provide intervention in that area. This is the report we received:

Occupational Therapy Screening
2-10-09

[Daughter] was seen for an Occupational Therapy screening on 2-10-09 by [school district's OT], MS, OT/L. In the area of self help skills, she was able to manage buttons and snaps, but had difficulty engaging a zipper and was unable to tie. [She] is able to manage bathroom and lunchroom needs independently. [She] demonstrated weak proximal muscle strength while attempting the prone extension (superman) position. She was only able to hold this position for 10 seconds after practice, where the norm is >30 seconds.

She was unable to balance in the Rhomberg position (one foot in front of the other) with her eyes closed. She was able to cross midline during Brain Gym activities and reports she has no tactile aversions.

In the area of fine/visual motor, [she] demonstrates a thumb wrap grasp using her right hand during writing tasks. She is able to copy from the board using adequate sizing and spacing. Finger individuation and serial opposition are within normal limits. She had difficulty visual tracking in diagonal planes.

Recommendations:
-Hand strengthening exercises with theraputty
-proximal strengthening using superman position to improve posture and
attention
-allow [her] to chew gum during class if needed to help with attention
-try a disc seat at desk to allow for movement without disruption
-balloon volleyball, or any other eye hand coordination exercises to
improve visual tracking

Meanwhile her grades are not getting any better, it doesn't seem like the medication is helping and she shows increased signs of anxiety at home and at school. We go back to her pediatrician this Wednesday, so we'll see what he has to say about all this and go from there I suppose.

Occupational therapy?

MOMMY: A note from the teacher today:

She did finish her morning work but I had to have her check over it. It seems that the mornings are still her most difficult time with focusing. That may be something to mention to her pediatrician. We do really well from about 10:00 to 1:00 and then you can tell her mind is starting to wander. She is doing so much better with staying in her seat though. I rarely have to redirect her anymore!!!! YEAH!! I am seeing positive progress though. I don't notice any signs of depression etc that sometimes goes along with it.

Daughter is being evaluated by an occupational therapist at school today. I asked the school if there was any way that an occupational therapist might be able to help teach her some skills for impulse control in the classroom, and we also wanted to have her fine-motor skills evaluated. Her writing is very sloppy and that really seems to be affecting her math accuracy (as she gets her numbers out of place when adding columns). I'm not sure what, if anything, the school can do to help. But we're checking into it. It's obvious just watching her that she holds the pencil all wrong -- in fact she had a real power struggle with her third-grade teacher over that issue and never has "gotten it" regarding how to hold that pencil.

Daughter received occupational and physical therapy when she was 5. Her gross-motor skills were about two years behind at that time, and we did the therapy through the hospital and the school until she caught up. She still has poor muscle tone and strength ... and the mommy-playing-doctor-therapist in me is wondering if this isn't all connected to the ADHD issue. At the time we went through that before, her fine-motor skills tested right on schedule. I just wonder if she hasn't been progressing as she should in that area.