After the visit with the counselor last night, I thought it worth a quick update if anyone is interested.
I do believe it's one of the first times that I have ever met a professional that "understood" my son outside of our psychiatrist. I'm truly hopeful for the first time in a long time that I might have stumbled across something; although I will always view everything related to difficult child with extreme caution.
I've been very concerned about difficult child for sometime; although he is doing very well; they are all managed environments and set-up for him to do good. He still can't function in the day-to-day world.
The general theory seems to be that some kids have "islands" of capabilities; but then can't make the connection to other situations. The very simplistic example given to me was a baby that is getting hungry and starts to fuss; versus some babies that don't cry for a bottle/food until they are starving. Since they don't recognize early hunger, they never learn what a little discomfort feels like (just one example). They don't learn many sensory and emotional skills - they just blow-up - or shut-down because they don't know how to respond; identify emotions, sensory seeking behavior, etc. Obviously, I have my own homework to do so that I can better understand everything.
Sounds too simple, I know, but on the other hand - simple doesn't mean easy.
It sounds like the general idea of therapy (after trust is established) is to put difficult child in situations that are uncomfortable and teach him the proper response; identifying where the deficits are and employing methods at home, school, and therapy to help him make the necessary connections; in ways not necessarily obvious to him.
The end goal is to eventually have to stop changing and structuring the environment to suit/fit difficult child so much; he learns to adjust to the environment/situation around him instead.
What I did find particularly interesting was how many of the types of activities that were mentioned yesterday that we stumbled on ourselves.
I'll update as time goes on if it really looks like there will be some benefit. difficult child is also asking for homework and more challenging work at school now too. All in all, a good week for a change with some real promise for my family.