Evaluating a kid for possible attention, sensory, & motor issues
December 27, 2013 2:26 PM   Subscribe

My son's teacher, my spouse, and I have concerns about a few different, but possibly related, issues with my 9 year old son. What kind of place should we bring him to for an evaluation? I'm looking for suggestions either about general kinds of places you might bring a kid to get an evaluation or for specific places in Portland, Oregon. Any other input on these individual issues, including how they might be related, is welcome as well.

My son, "Jake," just turned 9 and is in third grade. Cognitively and socially, he seems fine.

We want to get him evaluated for a range of things, including possible delays in gross and fine motor skills, attention issues, and sensory issues, and I'd like to find a professional who can address this all comprehensively rather than trying to deal with each issue individually, in case we're missing something. Bonus points for a practitioner who understands how all of this can manifest differently in kids who were adopted.

Physical - large motor skills:
My son is pretty aggressive on his bike and scooter and has always been a climber, scaling the chain link fence in the yard at the age of 2. He's also always been a slow walker, even relative to his peers. The big concern is his awkward running gait. Even the least coordinated kids on his soccer team are more fluid than he is. His run looks more like younger kids. Maybe he's just not a runner? Or could this be a delay?

Physical - small motor skills:
His handwriting is pretty bad, even relative to his classmates. It's improved a lot this fall, and his teacher says she's seen big improvements with handwriting in third grade. However, he still starts his letters at the bottom of the page rather than the top. He will always eat with hands rather than a fork. Is this a possible delay? Or does he need more instruction and practice with writing? He's crazy about Legos and can make incredible pieces with lots of interesting little details, but I don't know if that's relevant.

Letters & numbers:
In addition to his poor handwriting, Jake sometimes writers letters and numbers backwards. The specialist at school said this isn't unusual for his age, however.

Jake is incredibly sensitive to seams in his socks (I have to buy special smooth toe socks) and tags in his shirts (we cut them out). If something is askew/doesn't feel right, he gets incredibly stressed and will pretty much freak out until it's fixed.

His second grade teacher basically told us he was an underachiever -- he didn't try very hard except on topics that interested him. This can happen with kids who aren't challenged enough, but this year he's in a full-time gifted program he just tested into, and he's still not trying hard. Now it seems like it's too hard to him. His current teacher says it takes him forever to get started on anything in class, and he's often off chatting with friends instead. She's having to spend a lot of time to get him to focus. We see a lot of typical ADD behavior at home as well. His current teacher is the one who suggested we get him evaluated for attention issues.

And an extra bit of complication: my husband and I adopted Jake (internationally) when he was one and half. I've read that kids who were adopted are more likely to be misdiagnosed with ADD and other things. So I feel like I need to make extra sure to get a comprehensive evaluation that covers a range of these issues, preferably with someone who has some experience with children who were adopted.

So, where do we go? What kind of facility or practitioner could best help us figure this all out? Our primary care physician recently left the practice and we haven't established a relationship with our new physician. We have worked with a therapist who specializes in adoption, but this isn't the kind of work she does (I will ask her for a suggestion too).

Suggestions for the kinds of places to go, or specific people/organizations in Portland, Oregon, are welcome. I'd also love to hear from parents or others who have experience dealing with any of these issues individually or together.
posted by bluedaisy to Health & Fitness (15 answers total) 1 user marked this as a favorite
My 7yo son was diagnosed with Aspergers when he was 4. It is not the same thing, but I think the general course of action is similar. For diagnosis, you'll want a psychologist who focuses on children and developmental issues, and for regular treatment you wil want an occupational therapist - the psychologist wil likely have recommendtions. I am not in Portland so I can't make any suggestions local to you.
posted by cCranium at 2:48 PM on December 27, 2013

Also not in Portland, but when our child was in third grade, he had a comprehensive evaluation by a neuropsychologist. The evaluation served as a basis for establishing school-based accommodations.
posted by merejane at 2:56 PM on December 27, 2013 [3 favorites]

If you have a good pediatrician they should be able to give you a referral, but as cCranium said, you'll probably want to take your boy to a clinical psychologist who specializes in working with children.

While there are certainly standard tests that are commonly used, a good practitioner will take into account things like history, environment, social systems, etc. when evaluating your son.
posted by BigHeartedGuy at 2:58 PM on December 27, 2013

If you were in Seattle I would point you to towards Rosemary White, who I can't recommend highly enough. She has a clinic in Portland, too; I don't know the therapists who work there, but if they were hired by Rosemary I'm sure they're great.
posted by The corpse in the library at 2:59 PM on December 27, 2013

This is something you're going to want to do through your regular medical channels because each system handles it a little differently, but cCranium is right; Psychologist is probably where you're going to end up fo. Talk to your GP or his pediatrician and ask for a referral. You might have to dig a couple levels deep and go to a couple different specialists; there isn't necessarily one practitioner you're going to go to to handle everything all at once, but providers are getting better (especially around here) to be aware of overlapping diagnosis.

My wife works in the mental health field (We live in Portland too, but she works in another county), and she gets referrals from GP's and pediatricians all the time.

Unfortunately, you'll need to expect a fair amount of bouncing around, if the diagnosis is a little difficult to pinpoint. These things can sometimes take a couple years to diagnose (certainly not always, but sometimes).

If you're interested, memail me, and I'll try to get a couple references...but really, working in-network with insurance is your best bet here.
posted by furnace.heart at 3:01 PM on December 27, 2013

When I had concerns about my daughter (spurred into action by a concerned teacher), our pediatrician recommended Children's Hospital of Michigan. They did very thorough evaluations and in-depth testing over several days and I felt confident they were doing a good job. Perhaps you have a similar medical facility near you? I didn't have to get a referral, just contact the Psych Department and explain the circumstances.
posted by notaninja at 3:07 PM on December 27, 2013

Following up with a little more detail from my earlier answer: we got the referral to the neuropsychologist from our pediatrician. The evaulation took place over a few days and involved numerous tests.
posted by merejane at 3:09 PM on December 27, 2013

The Child Development and Rehabilitation Center at OHSU does interdisciplinary diagnostic and developmental follow along assessments. The good news is that they will generally do all the testing one one day, and that they accept almost all insurances. The bad news is that they have ridiculous waitlists. Like really ridiculous. (disclaimer: I have a relationship with this organization)
posted by lilnublet at 3:14 PM on December 27, 2013 [2 favorites]

Go to a developmental pediatrician. But, in the meantime, you could arrange for a sensory assessment by an OT. Your extended medical may cover this (I'm in Canada and my benefits cover it, but it is not covered by our universal healthcare).
posted by Chaussette and the Pussy Cats at 3:55 PM on December 27, 2013 [1 favorite]

No dealing with Drs. info, but some anecdotal data points:

Physical - large motor skills:
Mmm, could go either way. Might be something to it, might not. My (not an anything) guess would be that if there's something of concern here, it might be physical, or even a (poorly) learned behavior, even something like bad shoes when he was little.

Physical - small motor skills:
One of my sons writes from the bottom up. He was taught correctly, and can do it - it just doesn't feel "right" to him, and isn't as fluid, so he does it his way. He's now 15, and his handwriting actually is pretty nice-looking - though I wouldn't have said that at 9, or even 12. Might be something else going on. I would guess his Lego ability may indicate there probably isn't anything drastically wrong with the writing or small motor, just in too big a hurry, doesn't consider it important, etc. Eating with his hands... well, that might be a learned behavior from a very young age, might not.

Letters & numbers:
Reversing characters *is* pretty common, though at some point, it may be a good idea to consider dyslexia, etc... depending on how his reading is going. Otherwise, some very light (a sentence, once) copywork each day might help solidify those characters without overwhelming him. Consider whether it's happening when he's copying things, or when he's thinking and responding without concentrating on presentation. If it's the second, it's likely time and practice will help - but don't overwhelm.

Okay, *this* sounds more like my 13yo. son. At this point, I believe he was misdiagnosed with ADHD, partly on the basis on my 15yo's ADHD, and that it's much more likely that he's actually very high functioning Asperger's or has many Aspergers traits. (We've been homeschooling him since mid-Kindergarten, and I've chosen not to pursue more labeling, as he's flourished at home.
Sock seams and tags are pretty common bothers - my daughter's best friend (we also suspect she's somewhere on the Asperger's scale) also deals with them. Certain sweaters and sweatshirts, and oh my goodness, food issues. My 13yo does not drink anything carbonated, and won't touch marshmallows or those candy peanuts with a ten-foot pole. Peanut butter was a no-go til he was in middle school. Say someone made PB & banana tortilla wraps - he would painstakingly scrape EVERY SINGLE LITTLE SMIDGE of peanut butter off everything, and then calmly eat the food he'd dissected.

Ah, yes. Got to the ADHD part. Yeah, so far, you're describing what my 15yo, ADHD child was like at age 5 and 7 and 9 pretty well... IMO, strong possibility you've got a gifted ADHD kid. Now, that doesn't mean you have to medicate. But then, in our experience, public schools are terrible about appropriate instruction and classrooms for any child that is not of the shut-up-sit-down-and-let-us-drone-on variety. Both of mine have literally thrived since I got them out of it. And my ADHD child had made little progress through 5th grade on reading, and HATED it. After four years home, he loves books and wants to be an English teacher. And this is the same kid that couldn't do bare minimum in his kindergarten classroom until I gave in and tried medication - and I only gave in because he truly believed he was give 200%... and what we were seeing as results what about 1%. It was changing my child into an frustrated, angry little monster who lashed out because to him, it felt like we weren't acknowledging how much actual effort he put in.

Then again, we had better years in public school and worse. Had a great 3rd grade year with an experienced teacher who *got* him, and 4th was a mess with an almost-newbie teacher that decorated her room like it was a circus. Then, 5th grade was an absolute mess. The teacher was disorganized - she called it "flexible" - and wouldn't give the kids a routine to rely on.

Telling a kid - or his parents - the equivalent of "he's lazy" and "get him evaluated" often translates to "he's not worth putting my time and effort into" and "hurry up and medicate him so I don't have to deal with him and can just write him off as a lost cause".

I can't really help with the referrals, even though I'm almost-local, I'm down in the Gorge, which is just far enough to be useless. (And the little bit of info I've heard regarding doctors and specialists in the metro area makes me glad I'm not there!)

As some sort of sideways recommendations, even though he's a public schooler, consider looking up ADHD/whatever special needs/adoption x homeschool. Homeschool parents, especially ones reaching out online in blogs and various media, tend to be a chatty, friendly, helpful bunch. And they spend a LOT of time with their kids, and often come to homeschool via the route of "public school wasn't a good fit".

And I'm not suggesting this to push you in the direction of homeschooling - that's not for every family - but because you're likely to find a lot more useful resources that *are* homeschool connected than if you rule them out as being irrelevant, whether it's for managing home behavior, dealing with homework, suggestions about what did and didn't work for them in connection with public schools, etc.

Oh. And SizzleBop and Carol Barnier. If what she writes rings true, well... let's just say her books have been the ONLY books about ADHD that I believed were written by someone who had actually experience in-home WITH an ADHD child! Even if you later determine your child doesn't have ADHD, it's a strong possibility that there's some things in How to Get Your Child Off The Refrigerator and On To Learning that you would find helpful homework-wise.
posted by stormyteal at 4:46 PM on December 27, 2013 [1 favorite]

Anecdata: my 9yo son has terrible handwriting and terrific Lego skills. Sound familiar? He has minor dysgraphia (i.e., poor motor processing), and one-on-one work with a tutor on Handwriting without Tears has helped, though he'll never have enviable handwriting or write more than the minimum without stress.

Here's our path:

In second grade, writing issues got difficult and no one told us. Son had an inch thick pile of "unfinished work", all requiring sentence writing. He's clearly very bright, but his young teacher essentially wrote him off.

After some thought and consultation, we saw a psychologist who did psycho-educational evaluation, which wouldn't cover your large motor issues. The testing arsenal probably includes good tests for sensory issues. We picked one with expertise in dyslexia, because it was related enough and his practice got good references and was close. The results of the evaluation are insanely detailed and very useful.

Based on that analysis, we went through the 504/IEP process with the school. We couldn't get an IEP (Independent Educational Plan, which has services) because he was working at "grade level" though below expectations and mental capacity. But, we did get a 504 - extra time on assignments, attention from the teacher, a special stool to encourage him to sit correctly, and most important, a really good relationship with his 3rd grade teacher.

Also, we found The Mislabeled Child to be good, non-pop-psych discussion of the different learning and behaviorial disabilities.
posted by Measured Out my Life in Coffeespoons at 5:58 PM on December 27, 2013 [1 favorite]

I have friends with non-adopted kids in similar circumstances, which has really helped me separate out what's adopted-related and what's not. It's hard because the first 18 months do have a huge impact - our kid has lingering speech issues from months of untreated ear infections and malnutrition, and had a deep phobia about water from an early near-drowning, that if we hadn't known about from his history, would have freaked us out. But the anxiety, the terrible handwriting and other stuff, is not adoption related.

In the end, it doesn't matter so much how it started but figuring out what to do with the issue and help your kid. Just watch out for professionals who either totally dismiss any adoption issues, or who blame everything on adoption.

The best help my friends with sensory issues had was from occupational therapists. Things like knitting and skateboarding and so on can make a big difference for helping with fine and gross motor control, outside of specific excercises.

I wouldn't worry about handwriting if he's good with tiny things - my kid wrote drunk chickenscratch and did finely detailed drawings, because he didn't see the point in writing neatly.

The ADD thing is such a huge gnarly problem with young distracted boys. A good teacher can spot an issue - I have a relative who was diagnosed that way and it took a while for everyone to go oh so that's what's happening - but it can also be a cop out for an overwhelmed teacher. If the school environment doesn't work for him, you have to decide if you can change it or if you need to change him. Your best help is going to be other parents in the same school.
posted by viggorlijah at 8:38 PM on December 27, 2013

Yeah, I'd either start with an OT or CDRC. Your school district will have an OT in staff and you might want to start by asking for a consultation-our district just had our OT meet with my second grader to assess her writing grip. My sister is a pediatric OT and the list of issues you describe are almost all things that she worked with on a daily basis. A psychologist won't have information for you on the motor skills stuff.
posted by purenitrous at 7:55 AM on December 28, 2013

I second Measured Out my Life in Coffeespoons's recommendation of the book The Mislabeled Child, and further recommend considering having your child evaluated by the book's authors, the Eides.

The Eides are in Edmonds, Washington. I live on the East Coast, so I don't know if that is just too far for you. But I do know that people travel great distances (including from other states) to have their kids evaluated by this husband-and-wife team. They have a special interest and expertise in dealing with "twice-exceptional" children, meaning kids who have been identified as gifted but who also have learning difficulties.

Years ago, when my now-adult son was a student at Stuyvesant High School in NYC, the Eides were on a book tour for The Mislabeled Child. I contacted them and asked if they would be willing to come speak at a PTA-sponsored event. They agreed, and so I met them. They are absolutely wonderful people -- smart, kind, empathetic.

Although the distance and the expense (depending on your insurance company's policy) might be daunting, I do think that having your child evaluated by the Eides is worth considering.

UPDATE: I just checked their website, and I see that at the moment, they are not accepting new patients. But it might be worth giving them a call to get an idea of when they might be accepting new patients again. And maybe they can recommend someone in your geographical area.
posted by merejane at 9:08 AM on December 28, 2013 [1 favorite]

We recently had our son evaluated by Dane Borg here in Portland. He did a very thorough work-up on our 13 y/o -- we got a 30 page report at the end. He also speaks about non-neurotypical kids. I would recommend him.
posted by elmay at 4:05 PM on December 28, 2013

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