Occupational therapy evaluation and an update on Anna

Dominic has his OT evaluation this morning and what a suprise! It looks like he has proprioceptive issues caused by sensory integration dysfunction. I would never have guessed. Anna has very intense sensory issues but they are the opposite of what Dominic has. Dominic needs to move his body constantly to know where his body is in space. This could be the cause of his impulsivity, hyperactivity, and even poor fine motor skills. It takes practice to learn how to color and write and he needs to move too much to sit still. The OT has recommended therapy twice a week initially so we are going to start that as soon as possible. There are many things his teacher can do to help him prepare for desk work; I’m excited to see what changes will happen once we implement some new strategies.

Anna is continuing to struggle at school this week. Last week, Anna left her classroom without permission three times on Tuesday once making it to the library before being intercepted and once she picked up another student and actually left the building to go to a portable at the back of the school property to see her resource teacher. We thought at the time that was because the 2nd grade class had a walking field trip that morning and the change in routine disrupted her. Well, she has continued to leave her class several more times and she has gotten physically aggressive with her teachers and peers. Anna is refusing to do any work, insisting that she wants mommy. She wants to call me and continually is asking for me. Her poor teacher looked so defeated yesterday.

Last night, I took Dominic out to dinner as a reward for really turning things around at school. He is no longer chewing on his shirts and he is following the rules and not getting in trouble. I also wanted Anna to have a break from me since she is getting so incredibly dependent. My mom kept both kids for a sleepover on Saturday and Anna actually cried when I left, kind of like separation anxiety. Curtis had to take some work calls while Dominic and I were gone and when he was finished, he realized that Anna had disappeared. He discovered his car door open and the car running! Anna was down the street. When he asked her why his car was running, Anna said that she was going to try to find me. I nearly threw up when I heard this. Anna was in her room crying when I got home since daddy sent her there for the rest of the night.

I’ve emailed her neuro just now to talk about what might be going on. We have several theories…
~ She is pre-ictal and might have a seizure soon.
~ She is spoiled and is manipulating everyone to get what she wants.. or is just simply being attention-seeking.
~ She is dealing with anxiety and fear, and that is driving her perseveration with seeing mommy and wanting a wheelchair. Having the routine change last week at school crossed her threshold for coping.
~ It’s a combination of these issues.

We think the third scenario is most likely. It takes a lot of her coping skills to deal with school and such a large classroom of children. If we operate under the assumption that she is anxious, then we can intervene in several behavioral ways. First, lots of reassurance. Break the day down into small chunks. The teacher can say, “I know you want to see mommy and you will see her at 2:45. First we need to do ___, then we will do ___.” If she begins acting badly, ask her, “Anna, are you scared? Do you need a break? When I see you make a better choice, you can have a break. Can you try that in a different way? Can you ask me in a different way?” etc. I think the wheelchair issue is driven by a 2-year fear/fascination of a little girl who is in FLS… this has been a long-standing issue for Anna.

We are obviously pretty freaked out about her safety right now. Thank goodness she didn’t figure out how to put the car into gear… I shudder to think what could have happened. I think she is capable and determined enough to leave school to try to walk home to find me. She will really need intense supervision for the short-term until we can figure out what is really going on with her. The car keys will be kept hidden. I’m worried that she is not capable of learning right now and is disrupting her classroom too much. We need to find a good balance between expectations and reality. This could be a big cry for help; she is a people-pleaser by nature and all the people around her are not happy with her right now. I think going through the day feeling overwhelmed and anxious could cause all of these symptoms. It may be time to try an anti-anxiety med. We’re not sure what to do next. Hopefully her neuro will have some advice.

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