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new here - medication monitoring?
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<blockquote data-quote="cdngrl" data-source="post: 556771" data-attributes="member: 15367"><p>Thanks so much for the replies and input! </p><p></p><p>InsaneCdn - yes, I am Canadian too... and strangely despite lurking here for a bit and reading your posts, I did not even realize that you had Cdn as part of your username! </p><p></p><p>I am not at all surprised that the question of diagnoses and what is underlying the anxiety came up from my post... clearly it is not *just* straightforward anxiety. So far he has had a Psychological Assessment, Speech-Language Pathology Assessments, a telepsychiatric consult, and has seen a Pscyhiatrist locally (and was hospitalized by him when he was at his worst this fall). He is also followed by a Pediatrician, who has been involved for over 4 years (and yes, here she can and does prescribe and monitor psychiatric medications and diagnose Autism Spectrum Disorders (ASD)'s although for more complex cases a consult with a specialist is requested). No formal Occupational Therapist (OT) involvement, but informal consults have been done and I am addressing the sensory issues at home and school is accommodating for these at least somewhat (allowing him to leave the room for a break or work in another area if it is too noisy, allowing him to sit where he is less likely to be bumped, option to take movement breaks as needed, etc.). As for diagnoses, there is a bit of disagreement among the professionals involved... </p><p></p><p>At this point, here is what is known:</p><p>- ADHD ruled out - all professionals in agreement at this point</p><p>- Auditory Processing Disorders (APD) ruled out (although one subtest was on the low end of normal, I think it might have been auditory figure ground but I'm not positive right now)</p><p>- no language delay (receptive and expressive both average to high average, but relative difficulties noted with pragmatic and non-literal areas of language processing; does stutter and has previously received therapy for this)</p><p>- no significant gross motor, fine motor or graphomotor delays</p><p>- definite sensory processing disorder (SPD), but of course not "diagnosed" as such; sensitivity to/avoidance of smell, taste/texture, touch, noise; some seeking of movement</p><p>- IQ scores have significant discrepancies between composite scores, with perceptual reasoning being at the 98%ile, while verbal comprehension is at the 48%ile and processing speed/working memory are both in between. Additionally, within the verbal reasoning he scored very low on the subtest for comprehension, which involves understanding basic social situations.</p><p>- Academic achievement subtest scores all within low average to very superior range and he does well in school, however given the level of variability in scores it has been suggested he be monitored for Learning Disability (LD)'s that may show up more clearly as he gets older.</p><p>- the Psychologist who did a comprehensive assessment about 1.5 years ago diagnosed him with an Autism Spectrum Disorders (ASD), with the final diagnosis being Aspergers. 2 Psychiatrists have disagreed with this diagnosis (one of whom I consider to be completely useless and put no weight in whatsoever). Pediatrician has not commited to whether or not he truly meets the criteria or not, but we have discussed his "spectrumy tendencies" for years... I think in her opinion it is a questionable diagnosis for him although he does have many traits, and that is why she has not commited one way of the other.</p><p>- Psychologist also diagnosed "Anxiety Disorder not otherwise specified with depressive features"; Pediatrician and current Psychiatrist both believe that anxiety is a primary issue that needs to be treated, but have not put a specific diagnostic label on it. (on the other hand, the first Psychiatrist who did a telepsych consult thought not even the anxiety was a problem... since the primary issues were at home and he managed to hold it together at school, obviously the problem was us... meanwhile our pediatrician and a mental health worker we had been involved with both attested to our strong parenting skills and stable home during that telepsych consult, but she didn't listen to anything that was said as her mind was made up).</p><p>-the anxiety waxes and wanes, and is often fairly generalized although social anxiety is pretty much always present in some form and often prevalent. Often when the anxiety really ramps up we won't know exactly why but will later find out that there were some incidents of social misunderstanding that have been very upsetting to him but no one was aware of as he kept it all inside until everything finally came out after a "meltdown" (which often involves physical aggression toward us). He frequently thinks someone is mad at him/mean to him if spoken to in a loud voice or corrective manner, and does not like situations where he does not know what to expect or what to do.</p><p></p><p>There are times where I do believe that he is on the spectrum. But then, when he is doing well he displays almost none of the characteristics outside of the sensory issues and a bit of difficulty with nonliteral/pragmatic stuff. At those points in time I feel that, although he has some characteristics he does not meet all the criteria for diagnosis. I think once he has been "stable" for a while, we will have another psychiatric ax done to look again at Autism Spectrum Disorders (ASD) and possible Learning Disability (LD). Right now I guess I am ok with treating the anxiety and then gradually working on the other areas as hopefully he will become more receptive to working on these. However, obviously I'd rather know exactly what is going on in order to be sure our approach is right...</p><p></p><p>As an aside, tonight he was crying and very upset and practically hyperventilating because he is starting up swimming lessons again tomorrow. He likes swimming, but does not like being in lessons with other kids (though he used to be fine with it)... doesn't like being bumped, the noise, the potential that he might be "yelled at" by a teacher, and now he is catastrophizing... says he might bump someone else and go underwater and drown. We have worked hard with the facility to try to set him up with a very positive instructor (who is aware of his challenges) in a smaller group, he had a successful visit to the pool today and we were able to do a re-test to ensure he is being placed in the correct level so he won't be overwhelmed, and of course we made sure he is aware that his swimming teacher is a lifeguard and will make sure he will not drown... and still this level of distress in anticipation of it. I really thought he was doing well enough now that he could handle trying this now with a little work done up front, but of course I am second guessing my judgement tonight. Why can nothing be easy with him??</p><p></p><p>Wow, this ended up being a much longer post than I intended... thanks again everyone!</p></blockquote><p></p>
[QUOTE="cdngrl, post: 556771, member: 15367"] Thanks so much for the replies and input! InsaneCdn - yes, I am Canadian too... and strangely despite lurking here for a bit and reading your posts, I did not even realize that you had Cdn as part of your username! I am not at all surprised that the question of diagnoses and what is underlying the anxiety came up from my post... clearly it is not *just* straightforward anxiety. So far he has had a Psychological Assessment, Speech-Language Pathology Assessments, a telepsychiatric consult, and has seen a Pscyhiatrist locally (and was hospitalized by him when he was at his worst this fall). He is also followed by a Pediatrician, who has been involved for over 4 years (and yes, here she can and does prescribe and monitor psychiatric medications and diagnose Autism Spectrum Disorders (ASD)'s although for more complex cases a consult with a specialist is requested). No formal Occupational Therapist (OT) involvement, but informal consults have been done and I am addressing the sensory issues at home and school is accommodating for these at least somewhat (allowing him to leave the room for a break or work in another area if it is too noisy, allowing him to sit where he is less likely to be bumped, option to take movement breaks as needed, etc.). As for diagnoses, there is a bit of disagreement among the professionals involved... At this point, here is what is known: - ADHD ruled out - all professionals in agreement at this point - Auditory Processing Disorders (APD) ruled out (although one subtest was on the low end of normal, I think it might have been auditory figure ground but I'm not positive right now) - no language delay (receptive and expressive both average to high average, but relative difficulties noted with pragmatic and non-literal areas of language processing; does stutter and has previously received therapy for this) - no significant gross motor, fine motor or graphomotor delays - definite sensory processing disorder (SPD), but of course not "diagnosed" as such; sensitivity to/avoidance of smell, taste/texture, touch, noise; some seeking of movement - IQ scores have significant discrepancies between composite scores, with perceptual reasoning being at the 98%ile, while verbal comprehension is at the 48%ile and processing speed/working memory are both in between. Additionally, within the verbal reasoning he scored very low on the subtest for comprehension, which involves understanding basic social situations. - Academic achievement subtest scores all within low average to very superior range and he does well in school, however given the level of variability in scores it has been suggested he be monitored for Learning Disability (LD)'s that may show up more clearly as he gets older. - the Psychologist who did a comprehensive assessment about 1.5 years ago diagnosed him with an Autism Spectrum Disorders (ASD), with the final diagnosis being Aspergers. 2 Psychiatrists have disagreed with this diagnosis (one of whom I consider to be completely useless and put no weight in whatsoever). Pediatrician has not commited to whether or not he truly meets the criteria or not, but we have discussed his "spectrumy tendencies" for years... I think in her opinion it is a questionable diagnosis for him although he does have many traits, and that is why she has not commited one way of the other. - Psychologist also diagnosed "Anxiety Disorder not otherwise specified with depressive features"; Pediatrician and current Psychiatrist both believe that anxiety is a primary issue that needs to be treated, but have not put a specific diagnostic label on it. (on the other hand, the first Psychiatrist who did a telepsych consult thought not even the anxiety was a problem... since the primary issues were at home and he managed to hold it together at school, obviously the problem was us... meanwhile our pediatrician and a mental health worker we had been involved with both attested to our strong parenting skills and stable home during that telepsych consult, but she didn't listen to anything that was said as her mind was made up). -the anxiety waxes and wanes, and is often fairly generalized although social anxiety is pretty much always present in some form and often prevalent. Often when the anxiety really ramps up we won't know exactly why but will later find out that there were some incidents of social misunderstanding that have been very upsetting to him but no one was aware of as he kept it all inside until everything finally came out after a "meltdown" (which often involves physical aggression toward us). He frequently thinks someone is mad at him/mean to him if spoken to in a loud voice or corrective manner, and does not like situations where he does not know what to expect or what to do. There are times where I do believe that he is on the spectrum. But then, when he is doing well he displays almost none of the characteristics outside of the sensory issues and a bit of difficulty with nonliteral/pragmatic stuff. At those points in time I feel that, although he has some characteristics he does not meet all the criteria for diagnosis. I think once he has been "stable" for a while, we will have another psychiatric ax done to look again at Autism Spectrum Disorders (ASD) and possible Learning Disability (LD). Right now I guess I am ok with treating the anxiety and then gradually working on the other areas as hopefully he will become more receptive to working on these. However, obviously I'd rather know exactly what is going on in order to be sure our approach is right... As an aside, tonight he was crying and very upset and practically hyperventilating because he is starting up swimming lessons again tomorrow. He likes swimming, but does not like being in lessons with other kids (though he used to be fine with it)... doesn't like being bumped, the noise, the potential that he might be "yelled at" by a teacher, and now he is catastrophizing... says he might bump someone else and go underwater and drown. We have worked hard with the facility to try to set him up with a very positive instructor (who is aware of his challenges) in a smaller group, he had a successful visit to the pool today and we were able to do a re-test to ensure he is being placed in the correct level so he won't be overwhelmed, and of course we made sure he is aware that his swimming teacher is a lifeguard and will make sure he will not drown... and still this level of distress in anticipation of it. I really thought he was doing well enough now that he could handle trying this now with a little work done up front, but of course I am second guessing my judgement tonight. Why can nothing be easy with him?? Wow, this ended up being a much longer post than I intended... thanks again everyone! [/QUOTE]
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