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Special Needs
MrsT0514
member
When to question the opinion of a therapist (long)
MrsT0514
member
Considering we've only been involved with EI/any type of therapy for just over 3 months, I thought maybe some of you with more experience could offer some insight. Forgive me if I dont make perfect sense here, this is the result of me mulling a lot of information over in my brain repeatedly for the last week almost.
We were originally referred to EI for speech. Our recent speech eval (done by the SLP) revealed only a mild expressive delay, but receptive skills were beautiful/age appropriate. Her comments were that he is communicating very purposefully, even with the lack of actual words at this point, so they aren't recommending ST at this point, but that shes not convinced there isnt an ENT issue going on. Currently, DS has qualified for what they call "family training and counseling" which is basically a therapist (she is an OT asst) comes out 2x/month to do general play therapy, giving us techniques to enrich his language and overall skills as needed.
Since he's been walking for 3 months now and still is having balance issues, we did a recent PT eval and qualified for 1x/week PT to work on balance/coordination. We also had the full neuro eval to r/o neurological causes, and the neuro was not overly concerned at all. She did not see anything glaringly concerning and therefore did not suggest further testing (besides a 2nd ENT opinion due to balance issues/constant congestion/pulling at ears) at this time. We follow up with neuro next month after the Ent appt... so i plan to ask more questions and see if she suggests that we take a wait and see approach since he is so young still, or if we should go ahead and maybe see a dev pedi.
The OT asst (our service coordinator) had briefly mentioned before that we could do an OT eval if we wanted to, since DS seems to show some sensory seeking behavior, but we havent set that up yet. The PT has been the one really pushing the "sensory seeking" stuff on us though. The OT asst was more wishy washy, stating "ehh, could be sensory, but could also be typical active 19 month old".
I guess I'm just confused. After DS' s initial eval, the only concern mentioned was a mild expressive language delay. he scored beautifully in all other areas. Even after the follow up PT eval, the remaining balance issue was the only thing brought up. But all of a sudden within the last 2 weeks, the PT seems dead set on "this is sensory related", even though a sensory eval has never been done. Is a PT qualified to make this type of observation? I guess I'm just having a hard time buying it right now.
The only sensory-related "behavior" we're seeing is just high energy levels (but he sleeps wonderfully- 12hrs straight at night with 1-2hr nap during day), constantly on the move, and he's a bit rough with the cat and dog (which could also be attributed to age/personality/activity level, correct?). But hes only like that at home. If we're out somewhere, he'll sit quite content or explore his surroundings like any other kid his age does. He isn't sensitive to sound, touch, texture, anything like that. No repetitive/abnormal behaviors, and when we sit down with him to do a focused activity like read a book, play blocks, puzzles, etc he engages and focuses well on that task for the most part. Although I guess the balance issues could partly be attributed to sensory, but it's hard to say.
I plan to have our service coordinator educate me more on this and set up an actual OT eval, but in the mean time I guess I'm just feeling like this came out of nowhere. When the PT came out this week, she focused primarily on sensory, when I was under the impression we'd be working on balance/coordination. Either way, I know the therapy will only help and can never hurt, but I cant help but feel like the PT may be rushing to "put a label on it" when there very well may not be one.
TIA for anyone who got thru that mumble jumble. It felt good to get my thoughts out in writing.
We were originally referred to EI for speech. Our recent speech eval (done by the SLP) revealed only a mild expressive delay, but receptive skills were beautiful/age appropriate. Her comments were that he is communicating very purposefully, even with the lack of actual words at this point, so they aren't recommending ST at this point, but that shes not convinced there isnt an ENT issue going on. Currently, DS has qualified for what they call "family training and counseling" which is basically a therapist (she is an OT asst) comes out 2x/month to do general play therapy, giving us techniques to enrich his language and overall skills as needed.
Since he's been walking for 3 months now and still is having balance issues, we did a recent PT eval and qualified for 1x/week PT to work on balance/coordination. We also had the full neuro eval to r/o neurological causes, and the neuro was not overly concerned at all. She did not see anything glaringly concerning and therefore did not suggest further testing (besides a 2nd ENT opinion due to balance issues/constant congestion/pulling at ears) at this time. We follow up with neuro next month after the Ent appt... so i plan to ask more questions and see if she suggests that we take a wait and see approach since he is so young still, or if we should go ahead and maybe see a dev pedi.
The OT asst (our service coordinator) had briefly mentioned before that we could do an OT eval if we wanted to, since DS seems to show some sensory seeking behavior, but we havent set that up yet. The PT has been the one really pushing the "sensory seeking" stuff on us though. The OT asst was more wishy washy, stating "ehh, could be sensory, but could also be typical active 19 month old".
I guess I'm just confused. After DS' s initial eval, the only concern mentioned was a mild expressive language delay. he scored beautifully in all other areas. Even after the follow up PT eval, the remaining balance issue was the only thing brought up. But all of a sudden within the last 2 weeks, the PT seems dead set on "this is sensory related", even though a sensory eval has never been done. Is a PT qualified to make this type of observation? I guess I'm just having a hard time buying it right now.
The only sensory-related "behavior" we're seeing is just high energy levels (but he sleeps wonderfully- 12hrs straight at night with 1-2hr nap during day), constantly on the move, and he's a bit rough with the cat and dog (which could also be attributed to age/personality/activity level, correct?). But hes only like that at home. If we're out somewhere, he'll sit quite content or explore his surroundings like any other kid his age does. He isn't sensitive to sound, touch, texture, anything like that. No repetitive/abnormal behaviors, and when we sit down with him to do a focused activity like read a book, play blocks, puzzles, etc he engages and focuses well on that task for the most part. Although I guess the balance issues could partly be attributed to sensory, but it's hard to say.
I plan to have our service coordinator educate me more on this and set up an actual OT eval, but in the mean time I guess I'm just feeling like this came out of nowhere. When the PT came out this week, she focused primarily on sensory, when I was under the impression we'd be working on balance/coordination. Either way, I know the therapy will only help and can never hurt, but I cant help but feel like the PT may be rushing to "put a label on it" when there very well may not be one.
TIA for anyone who got thru that mumble jumble. It felt good to get my thoughts out in writing.
This discussion has been closed.
Re: When to question the opinion of a therapist (long)
I realize I'm not the one with clinical training here, but idk..at what point do your gut instincts come into play? My gut is telling me a lot (if not all) of what's going on is ENT related, and I also want to be proactive about getting him any help he may need, but eh, this just kind of feels off base a little.
If I wasn't KU at the moment, I'm positive that a drink (or 3) would be in order for me.
Idk. I guess, the more I read/research about it, the more I wonder where they draw the line with sensory stuff. To some extent, wouldn't one say that every toddler/young child has sensory issues then? Its just not enough for me to quite buy into it yet (given that an ot eval hasnt been done yet either). In theory it all makes sense to me, and if it turns out that some of this is sensory-related, I'd feel better with the determination coming from a dr or an OT.
I apologize if I came off insensitive, I didn't intend to. I absolutely believe SPD is a real thing (one of my great aunt's granddaughters has pretty moderate SPD and has been in all types of therapy and now receives accommodations in kindergarten for it), I guess I just dont exactly see how it applies to my DS right now, considering he does not struggle with transitions, sounds, touch, textures, etc, he can and does engage/focus on a task when needed, and the only setting he seems to be sensory-seeking type behavior is at home. To me, that doesnt signify an "issue" per se (but like in your situation he's only 19mo, so I guess there'd be room for it to either become an issue or not). I guess I really just feel like our last PT session was off track, but again, I'm not the one with clinical training, so I could be wrong i guess.
Of course an actual OT eval will shed more light on it, so I guess that would really be the best course of action to distinguish whether or not its truly an issue.
I guess its just hard for me to buy into something that a PT is insisting when an actual OT eval hasn't even been to prove its an issue.
DD1, 1/5/2008 ~~~ DD2, 3/17/2010
I plan to talk to the service coordinator next week and see what can be done about making sure the PT sessions are focused on the task at hand (which would be better balance/coordination). Bc I feel like spending an entire session on sensory stuff isn't benefiting him as much as a more focused PT session would, even if the 2 might overlap. Especially without having confirmation from an OT that there actually IS a sensory issues present.
The part that frustrates me (and I think she said this in the PT's defense) is when she said "well I know it can be difficult to work with a child on balance if they are falling over so frequently/unsteady on their feet so much". Ummm...correct me if I'm wrong here, but this is the exact fucking reason he qualifies for PT in the first place. For BALANCE issues...not sensory issues. We have absolutely nothing confirming sensory issues, bc we havent had an OT Eval yet.
She also said that since there is such a strong suspicion that this is Ent related, that I should be firm and really push for them to do what they need to do to figure out the cause (like I havent been doing so already? K thanks). I mean, we've seen quite a few doctors already at this point (our pedi, neuro, ent, and now getting a 2nd ent opinion), and as much as we'd like to get answers and a solution, both neuro and the pedi said sometimes there isnt an exact cause or diagnosis..that its just a developmental hurdle and some kids just grow out of this stuff by age 2 or 3 and its no longer an issue. Obviously I will still ask the neuro at our next appt if she feels we should pursue further testing.
So I asked what they do in a case where an actual medical diagnosis isnt given and she replied "well we rely heavily on the medical professionals to guide the direction of services and create goals for your sessions". Okay, well even thpugh we're strongly suspecting an ENT issue and are hoping for a concrete solution...sometimes there just isnt an answer when it comes to development (according to the neuro and pedi), so what happens with services then?her response didnt exactly answer my question.
Idk..im sure these pregnancy hormones arent helping matters any, but that conversation left me a little frustrated. hopefully we can iron all of this out at our session this week. And I really hope we can get some answers from ENT on the 10th.