DD's anxiety worsened last week--rough days at school (long)--UPDATE at top

funchicken

I thought I'd give an update since Auntie gave me so much helpful advice last week

UPDATE:  The school scheduled the Child Study Team meeting for Tuesday.  DH and I are working on how to frame our concerns in a way that show educational impact.  Auntie, your insight has really helped with this.

As it turned out, DD did/does have a UTI.  That's the thing about her SPD.  She's over-responsive, so she'll start to feel symptoms before they show up on tests.  On more than one occasion, I've taken her to the doctor when she complained of severe ear pain and her ears look clear only to have her develop a raging fever two days later.  When the doctor re-checks, sure enough, they're infected.  I'm relieved that it was discomfort that was contributing to her anxiety and not the other way around.  She only went to school on Monday and Tuesday because she developed a fever at school on Tuesday, but she held it together on Tuesday even though she didn't feel well (she got a bad ear infection on top of the UTI   ) I asked the teacher to send home her work for the rest of the week, so that's been a good chance for me to observe her while she's working on her schoolwork.

OP:
After talking it over last weekend, DH and I decided to pull the trigger on the special education evaluation, and as it happened the shit also hit the fan with DD1's anxiety (she has ADHD, SPD, and fine motor delays, and she's in half-day kindergarten).  She had two really rough days at school last week.  In the teacher's eyes I think Wednesday was worse than Thursday, but as far as DD was concerned both days were really bad.  The good news is, the teacher is now on board with the evaluation, and she's helping to move things along.  The bad news is, we don't have any support in place for DD right now.

Here's a recap:  Wednesday they had a book fair instead of their regular library day.  The teacher said DD wasn't listening and following directions, and she had to speak to her a number of times.  Same story when they were in the computer lab.  When they got back to class DD wasn't doing her work (not refusing, just spacing out).  The teacher gave her a warning, and when DD didn't start working, the teacher told her she had to move on to her next activity.  DD lost it.  She was yelling and crying and very disruptive for about 20 minutes.  The rest of the class moved onto an art activitiy, and DD had to sit at a table by herself and finish her worksheet.  The teacher ended up sending the worksheet home because DD still hadn't completed it by the end of the day.  The teacher called me after school and told me about the day. 

Thursday was back to the regular routine (I didn't get a call from the teacher, so this is what I pieced together from DD).  DD was okay for the first part of the day.  The guidance counselor comes and does programs with them on Thursdays, so as far as I can tell everything was okay until the guidance counselor left.  At the end of the guidance counselor's presentation she told the kids to come and get a puppet project from her to work on after she left.  DD didn't hear her and just went back to her seat.  When the kids started working on the project DD didn't have one, and she got upset about that.  The teacher had her work on her other work instead.  At some point DD was also talking too much at her table and the teacher again moved her to a table by herself.  This seems to be the thing that upset DD the most.  She was very upset about having to sit by herself and being left out of the puppet activity.  Apparently, she was also kept in from recess that day to complete work that she hadn't finished. 

I emailed the teacher later to try to get more information, but the teacher told me she didn't know why DD was upset on Thursday.  Both days DD was in tears when she got off the bus.  She expresses a lot of remorse about "not being a good listener" and "not following directions," and she has been practicing schoolwork at home (totally unprompted by me).

In addition to the difficulties at school, DD has been feeling like she has to go to the bathroom more.  It started at the beginning of the week.  I took her to see her pediatrician yesterday to rule out a UTI, but we won't get the results until Monday.  She had to miss school, which wasn't ideal, but I really wanted to see her regular pediatrician and not someone else from the practice.  The pediatrician said the frequent urination could also be from anxiety and that if we rule out a UTI, we really need to get a handle on the source of the anxiety because the frequent urination could take a few weeks to resolve.

Right now I think DD feels very discouraged.  Even though she knows she's supposed to listen to the teacher and not talk when she's supposed to be working, in the moment she's really struggling.  I want to try to give the teacher some ideas without sounding like I think she's been taking the wrong approach with DD.  I'd appreciate any suggestions about how to approach this situation.

funchicken

I just wanted to add that DD has had anxiety flare-ups a few times in the past two years.  One was after we moved to our new house, one was when she developed gastritis after having two stomach bugs back-to-back, and one we weren't exactly sure what the trigger was.  My gut is telling me that this one is from school stress rather than a physical issue.

funchicken

-auntie- said:

mrszee2b said:

After talking it over last weekend, DH and I decided to pull the trigger on the special education evaluation, and as it happened the shit also hit the fan with DD1's anxiety (she has ADHD, SPD, and fine motor delays, and she's in half-day kindergarten).  She had two really rough days at school last week.  In the teacher's eyes I think Wednesday was worse than Thursday, but as far as DD was concerned both days were really bad.  The good news is, the teacher is now on board with the evaluation, and she's helping to move things along.  The bad news is, we don't have any support in place for DD right now.

Now that the teacher sees the difficulties your DD is experiencing, perhaps you can all sit down together and come up with a plan to bridge the time between now and when/if an IEP is written. It could be March or April before an IEP is completed, so it's really critical to build some relief into the day. Maybe the guidance counselor could also participate.

Thank you for such a detailed reply, Auntie.  The teacher has reached out to the guidance counselor for advice, so I think that trying to involve her in a meeting is a really good idea.

How was your LO's preschool experience? Did she have difficulties there? Following directions or transitioning? Was it a sit down/seat work preschool or more of a play-based school?

When she was three, she had frequent outbursts in preschool, but the teacher was really good at diffusing them.  The teacher was a funny, loud, former phys ed teacher, and she really liked DD, so in spite of the outbursts DD did well and enjoyed school.  As a four, she almost never had an outburst.  She wasn't disruptive, didn't have out of seat behaviors, and she had lots of friends who we still get together with every other month or so.  It was a play-based preschool.

Here's a recap:  Wednesday they had a book fair instead of their regular library day.  The teacher said DD wasn't listening and following directions, and she had to speak to her a number of times.  Same story when they were in the computer lab.  When they got back to class DD wasn't doing her work (not refusing, just spacing out).  The teacher gave her a warning, and when DD didn't start working, the teacher told her she had to move on to her next activity.  DD lost it.  She was yelling and crying and very disruptive for about 20 minutes.  The rest of the class moved onto an art activitiy, and DD had to sit at a table by herself and finish her worksheet.  The teacher ended up sending the worksheet home because DD still hadn't completed it by the end of the day.  The teacher called me after school and told me about the day. 

I'm not a doctor and don't know your kid, but so much of what you describe is very like kindie for young kids on the higher end of the spectrum. My own DS had many of the same issues in kindie after rocking preschool. Even down to the alphabet soup she's been labeled with- attentional difficulties, sensory differences, anxiety, poor fine motor/graphomotor skills could all be subsumed under ASD.

I know.  After the SPD and fine motor delays were diagnosed we started the process of finding out what else was going on. DH and I felt pretty sure she was going to get an HFA diagnosis, but the "experts" kept telling us she wasn't on the spectrum.  Our pedi said she didn't think it was ASD.  Child Find found no educational disability, and our dev. pedi has told us after both visits that she doesn't think DD has ASD.  Our OT used to call DD her "Monday morning mystery" because it was so hard to tease out what was going on.  I'm not trying to bury my head in the sand--I'm just trying to work with the information I have right now.

For us, it was critical to examine a behavior closely before making an assumption about why it existed. One theme I see in your own DD that I lived with when DS was younger was the sheer amount of rigid thinking he did. When a day deviated from what DS held in his mind- good or bad- it was difficult for him to reconcile which led to him shutting down. This is a bit like the running gag on Big Bang Theory where Sheldon has a schedule that includes Comic Book Night and a Thursday Night Hamburger. I wonder if the substitution of book fair for library was more than she could manage in the moment.

She knew about the book fair ahead of time, and she loves book fairs.  They had 4-5 of them at preschool each year.  Books are a preferred activity, and I feel like she could easily tune out what was going on around her if surrounded by a roomful of shiny new books.  I'm wondering if she was just thinking about the books for a good part of the day, and since they don't even have time for recess on Wednesday, she didn't have an opportunity to clear her head and refocus.  When they got back to the classroom the teacher was prompting her to do her work, and she wasn't doing it.  The teacher said she was just sitting at the table with the work in front of her.  She told DD she needed to finish her work or she wouldn't be able to do the art project, and I think this is what triggered the outburst.  The class was making dreamcatchers with rainbow-colored yarn.  She really wanted to make one.  At the end of the day, the teacher told her she would get to make her dreamcatcher the following day but that didn't happen.

Part of the problem with this lack of being flexible is that once they get stuck around a deviation in what they expected they tend to stay stuck which could explain why the rest of your DD's day was sort of pointless. Anxiety exacerbates this because your DD will spend a lot of bandwidth thinking about "what ifs". Not only does this extract an emotional toll, it interferes with her ability to attend to the here and now. 

It is entirely possible that a lot of what everyone is called ADHD is actually anxiety. DS has both, so I am familiar with how hard it can be to determine what is an external distraction, what is ruminating on something because of anxiety, what is living in his head (an Asperger thing where he thinks about his special interests) and what is the unholy trinity working together to basically make him unavailable for learning. DS was older than your DD when he started meds. I will share that his SSRI for anxiety did more for his ability to pay attention than his ADHD meds did.

One strategy that could help would be a daily schedule for your DD to follow, so that she can reset her expectations ahead of time and more easily follow the class through transitions and changes.

I will definitely ask the teacher if transitions have been problematic.  DD doesn't normally have trouble with them at home.  She enjoys going new places.  She's never been the type of kid who needed progressive warnings that we were leaving the playground.  If we go to the mall it doesn't bother her if we have to make a quick trip and skip the merry-go-round and the toy store.

Thursday was back to the regular routine (I didn't get a call from the teacher, so this is what I pieced together from DD).  DD was okay for the first part of the day.  The guidance counselor comes and does programs with them on Thursdays, so as far as I can tell everything was okay until the guidance counselor left.  At the end of the guidance counselor's presentation she told the kids to come and get a puppet project from her to work on after she left.  DD didn't hear her and just went back to her seat.  When the kids started working on the project DD didn't have one, and she got upset about that.  

I get that your DD isn't a "good listener", but is she so checked out of what is going on around her that she didn't notice every other kid get a puppet kit? She's a bright girl, so one would expect her to be more aware of what's going on around her even without the soundtrack. KWIM? And since your DD seems oblivious to what is going on around transitions, why is the teacher not facilitating this and prompting her individually?

I don't know.  I'm not sure how it played out, as I said, the teacher didn't mention anything specific with regards to DD getting upset on Thursday.  That said, in a class of 20 kids how do you not notice that one kid didn't get a puppet kit?  I don't know if the teacher thinks that DD needs to experience the negative consequences to learn or what.  More individual prompting is something I definitely plan to talk to her about.

DS has this Asperger glitch that sounds a bit like what your DD might be doing. He doesn't always intuit himself as a part of the group. Hell, at 5 he didn't realize he wasn't an adult. The fix for this is a verbal prompt- by name. It's funny, this "accommodation" is one that really separates the great teachers from the good ones and the mediocrity. An awesome teacher will just intuit that DS needs to be prompted by name and do it without being told- the best teachers, the ones who really "got" DS did this. The fabulous resource teacher, the remarkable middle school IEP custodian, the band director, most of the math and science teachers and good old Mr. Johnson who taught sex ed/health in 4th-6th, 8th and again in 10th as well as driver ed. When good teachers would ask and I explain this, they'd say "that's it?" and report back that it was effective. Bad teachers would launch into a diatribe around DS "needing a persona invitation" to which I would threaten to reopen the IEP to have this included which would piss the adminstration off.

The other thing I'm reading here is a common ASD trait of a heightened sense of justice. These tend to be very sensitive kids, especially around consequences the don't deem "fair". Unfairness of any kind is DS's krytonite whether it's aimed at him or someone he's never met. If he missed out on an activity and was singled out to sit alone and do worksheets it would be the worst thing ever.

Yes, this is spot-on, and I definitely think this was the case here.

A lot of kids who are distractable get preferential seating as an IEP or Sec 504 accommodation. She should probably be seated up front from where the teacher does most of her talking- arms length is good. A couple teachers DS had pulled his desk right up to hers or the classroom aides for seat work.

The kids don't sit at desks.  They sit at tables, so another piece to this is that she was recently moved to a different table.  I guess the teacher just rotates them around periodically.  I think the teacher and her aid circulate around while the kids are doing these activities, so I'm not sure what preferential seating would look like in this scenario.

The teacher had her work on her other work instead.  At some point DD was also talking too much at her table and the teacher again moved her to a table by herself.  This seems to be the thing that upset DD the most.  She was very upset about having to sit by herself and being left out of the puppet activity.  Apparently, she was also kept in from recess that day to complete work that she hadn't finished.  

No kid with an ADHD dx should be kept out of recess. That's all kinds of wrong. If she really has ADHD, she needs the break and could probably benefit from movement breaks in the day.

ITA, and I am really really pro-recess for all kids.  The way the day is set up at our kindergarten is that the kids are there from 7:50am to 10:50am.  They eliminated the milk break this year (which was touted as an opportunity to add 15 minutes of instructional time) , so recess is the only break they get.  If they don't have recess the kids are expected to be attending to classwork for three hours straight.

I emailed the teacher later to try to get more information, but the teacher told me she didn't know why DD was upset on Thursday.  Both days DD was in tears when she got off the bus.  She expresses a lot of remorse about "not being a good listener" and "not following directions," and she has been practicing schoolwork at home (totally unprompted by me). 

This is trending into OCD-like territory which isn't good. It's unfortunate that the teacher isn't more capable and aware of what is triggering your DD.

I frigging hate the term "good listener". It's too vague and it puts the onus of communication on the receiver which is screwed up. If your DD isn't processing information on the auditory channel because of ADHD, anxiety or CAPD then the teacher needs to find and use another platform to engage your DD. The graphic organizer, rubrics, Social Stories, whatever it takes. 

The other piece to this is that sometimes kids like mine, and maybe yours, have potentially awesome auditory skills that are blunted by anxiety. If she takes away the notion that she's a poor listener, she may not appreciate this strength later. One issue I had given DS's dx, is that teachers often bought into that whole "thinking in pictures" crap. "Oh, you saw Temple Grandin interviewed? Woopie! Please forget what she said, she doesn't speak for all people with autism."

Related to this, sometimes kids with ASD or anxiety don't give the appropriate feedback that signals a speaker that they are engaged. When DS was little, he could listen or look like he was listening. Not both at once until we worked on it. His preschool teacher found it amazing that he could rabbit back whatever she said even though he was wandering or drawing, but his kindie and first teachers weren't as amused. They were old school and more rigid than he was.

This also sounds very familiar.  It's something that the OT has been helping us work on.  We don't worry about eye contact, but we're working on having her face the speaker and keep her body still when someone is trying to tell her something.

In addition to the difficulties at school, DD has been feeling like she has to go to the bathroom more.  It started at the beginning of the week.  I took her to see her pediatrician yesterday to rule out a UTI, but we won't get the results until Monday.  She had to miss school, which wasn't ideal, but I really wanted to see her regular pediatrician and not someone else from the practice.  The pediatrician said the frequent urination could also be from anxiety and that if we rule out a UTI, we really need to get a handle on the source of the anxiety because the frequent urination could take a few weeks to resolve.

I've known a couple kids with OCD and ASD to have this. You both have my sympathies. My guess is the clean catch will come back clean. This is probably a function of anxiety. The kids I know who were successfully treated for this used a behavioral approach where they held out for longer and longer periods- some of them were in the bathroom every 10 minutes. A few were also treated with antispasmotics. The other piece is that sometimes kids ask to use the bathroom as an escape, sensory or movement break. DS did this- like when he hid to avoid wasps on the playground or was overwhelmed his first year of band camp.

I'm kind of side eyeing your pedi. It sounds like he has the impression that this anxiety is directly attributable to a specific situation- that would be a fear rather than a more global anxiety where the child can't really articulate what it is that is unsettling her. She could have both, DS did/does. Fears are a lot easier to address because you can desensitize around them using CBT. Learning CBT strategies can really help a person work through anxiety more effectively.

Thank you so much, Auntie.  I'm trying to take one thing at a time.  Hopefully, we'll be able to meet with the Child Study team before Thanksgiving.  The special education director said she's setting up the meeting and will notify us.  And we'll see how the bathroom stuff goes next week.

Right now I think DD feels very discouraged.  Even though she knows she's supposed to listen to the teacher and not talk when she's supposed to be working, in the moment she's really struggling.  I want to try to give the teacher some ideas without sounding like I think she's been taking the wrong approach with DD.  I'd appreciate any suggestions about how to approach this situation.

funchicken

Auntie,

In response to some of your above questions.  I don't think books would qualify as a special interest, but she does love them.  She has enjoyed being read to since she was three months old.  She started sounding out words herself at about 4.5 (so not super-early), and she has progressed at a very rapid pace.  At her initial evaluation with the developmental pedi she was reading at a late kindergarten level.  At her follow-up visit (five months later) she scored at early second grade, and her reading has improved even more in the last two months.  She was reading me the instructions on how to clean a pomegranate the other day and sounding out things like "arils" and "floating membrane" unassisted.

I'm sure you're right about the scaffolding, and she used to be very resistant to stopping in the middle of something that she was working on, so DH and I started sabotaging her at every turn.  She rarely protests if we ask her to stop drawing, playing, etc.  Another example of going with the flow:  at her doctor's appointment on Friday I decided right before we were about to leave that I should get the girls' flu vaccines.  She had no advance warning, and it really didn't phase her--I even made her go first, so she could show DD2 how fast it was.  Granted, she did the nasal mist and not the shot, so she probably would have put up more of a fight if it had been the shot.

I know the whole three hours isn't devoted to instructional time, and they're getting up and down for circle time, doing their classroom jobs, etc, but it is three hours of "behaving."  She's a jumper.  She needs some physical activity to help her focus and body awareness.

All the kindie classes at our school have assistants.  The maximum number of students is 25, but the classes are all closer to 20 students.  We're holding off on meds for now.  DH and I are going to keep pushing to make sure we get an accurate diagnosis.  It's hard--the whole process moves so slowly.

Thank you so much for your advice.  I started reading "It's So Much Work to be your Friend" and it's very helpful.

funchicken

I updated at the top of the OP.