P.S. The original OT eval was at about 16 months and the developmental pedi was at about 20 months.

If she were my child, I would want to work on the attention and "behavioral" issues before they impact the academics. You currenty have the luxury of time to try out some different methods and see which ones work or not versus putting out fires later.

It may be that she needs a more structured learning environment. If you are starting to have behavior problems it may be because the academic expectations, have now pushed her out of her comfort zone. That is where the learning about how to attend has to happen.

I think Montessori will just feed into a "spirited" child's inability to focus on one thing at a time. I did my thesis project on Montessori and I really dig it. The loosie goosieness is awesome for an NT child. I don't have an NT child so he will need a lot of structure and a clear understanding of expectations.

I would rather iron out these issues now so when the academics really matter she is ready and able to access learning. It is awesome that she is smart, but if she can't attend to the lessons what is the point of being smart? There is a lot about life that is boring and you HAVE to do. Even really smart people need to wait in lines, balance their checkbooks and go grocery shopping.

I would also rather do this now than have her carry a 'rep' around of being difficult from kindie on up.

ETA: The other thing to consider is that what they are learning in Kindie these days is what we were doing in 1st and 2nd grade. There isn't time to learn how to sit in a circle and line up. It is crazy. I remember kindie vividly. There was lots of art and singing with chocolate milk and a nap. What heaven!

It confuses me when people refer to Montessori as unstructured or loosely goosey; I don't find it to be that way at all. The students choose the activities individually, but past that it's very structured. Materials must be retrieved, laid out, and usedand then put away again in a very specific manner including the order in which items are retrieved and returned, the way the student holds the material while carrying it to the table or mat, right down to making sure they remember to push their chair back under the table when they get up. My kiddo has some issues with not wanting to follow the specific instructions; for example the broad stairs are supposed to be put back from largest to smallest, where it's more challenging for my kid to return them in reverse order and leave exactly the right amount of space on the shelf for the largest block; however she has to "get another lesson" because she "forgot" what order they go in. Or, in more realistic terms, my LO thinks she's always right lol.

Still, some of the skills require a longer attention span or more willingness to follow directions that I definitely want to address. Are there good resources for this? Would OT be helpful? Am I barking up the wrong tree with sensory issues and should be looking in the "A" aisle instead?

All that said, you'll have to trust me that it was at least four times worse in regular daycare with a "preschool curriculum". THAT environment was all wrong for her. The Montessori is at least peaceful and does provide more sensory input.

So is Montessori an option for elementary, high school and college curriculums? I get how the envrionment is best for her behavior at this time, but at what point will she need to work within the educational "norm" for lack of a better term? Did you try more than one non-montessori classroom environment?

I got a square peg too. Eventually he is going to have to somehow fit himself into a round hole. If I don't push him to at least round out his corners it is never gonna happen.

You seem concerned enough to want to do something about it. Right? How willing is the Montessori school about working with her? Is there any wiggle room in that curriculum for learning differences? The way your are describing it sounds like there is only one rigid path to success or the ability to move on to the next thing. I mean the whole having to carry it a certain way and stack it on the shelf a certain way as a measure of success? I totally get the theory of why it is done this way, but my kid would be doing that until the end of time to get it "right" while everyone else is off learning their ABC's. He would be one pissed off and frustrated kid.

fredalina:

Sorry this will be long.

I'm about to make it longer with abuse of the quote function.

BACKGROUND: LO was born withdrawing from several illegal substances and was our foster child until DH and I adopted her at 13 months. She was always a very busy baby. As a young toddler she was VERY busy, and she started biting. Her teacher felt the biting was out of the norm and suggested sensory issues as a cause. I had noticed some sensory differences as an infant, such as crying when she touched grass, but hadn't worried too much. I pulled out my old copy of the Out of Sync Child and reviewed the checklists, which made me concerned.

I contacted an OT for an eval and got my pediatrician to put in a referral to a developmental pediatrician. My pedi wasn't worried though. The OT had us do a questionnaire/checklist and did an observation in a small room as well as the sensory gym. Her conclusion was that she saw "definite sensory issues" in most areas and "significant sensory differences" in other areas. The only thing she wasn't different in was taste/smell. However, she meets/exceeds milestones in all areas so they felt the differences weren't interfering with her ability to function and they said she wouldn't quality for a dx of SPD or anything else. (Autism is not a concern as she has no social differences). The developmental pediatrician agreed with the assessment a few months later. We did 6 weeks of OT and she was released, and e have kept up a sensory diet since, especially lots of climbing/crawling/jumping/vestibular and proprioceptive activities, and heavy work.

I have some second hand experience with children who were drug exposed. My younger niece is a substance abuser; I have a greatniece G who is 7 1/2 and a greatnephew A who is 5 1/2. One of my older niece's friends was a heavy user working the streets when she became preganant at 28. This girl had been led to believe she'd never be able to become pg because of chronic health issues. My greatnieceG was a foster to adopt situation and g'nephew A was adopted by his grandfather and his soon to be former 3rd wife. Friend's baby, 2 year old S lives with his mom who has turned her life around and has an entourage of assorted grandparents, aunts, uncles and family friends who worship her as the gift she is.

Niece was on methadone during both pregnancies with some non-compliant self medication. G was treated with morphine for withdrawl which took a few months; A was treated with phenobarb because the plan was for him to go home with mom and phenobarb is less risky with a user. He was on phenobarb until he was at least 12 months old because he was behind on his vax schedule and they don't like to risk fevers newly off phenobarb. S didn't require meds though she definately was drug exposed until about 6 months into the pregnancy when her mother finally figured out she was pregnant.

I was a very hands on adult in niece's life during both her pregnancies- I was the one driving her to the various appointments- sometimes 3 and 4 a week in the last trimesters. She allowed me to sit in on them because she didn't understand most of what was being done and why, so my information is first hand. S's mom shared some of her story with me; she's pretty honest about what she was up to.

In addition to the drug exposure, I think you can get a lot of information from birth family pedigrees. Many people who use drugs are self medicating for behavioral health concerns. If you have access to such information, it would give you some general areas to in context with Charlotte's unique blend of strengths and weaknesses.

For my "unholy trinity", what the birth parent brought to the table (or bedroom) is reflected in the child. (you should see it when these three get together for a playdate- OMG!)

My niece has some significant mental illness. She was always an impulsive and "spirited". My husband would say "feral". She was a wild child. Like your Charlotte, she was very bright. Her IQ at assessment was just over 130. Niece's mom died when she was 9 which was about the age some of her bahvioral stuff started. Most professionals insisted on writing it off to losing her mom, but one of them saw through that and suggested bipolar with ADHD. He wanted to medicate; but my idiot BIL took custody of her to access her social security checks- he refused meds (he's a recovering addict) and stopped taking her to the psychologist who wasn't taken in by her drama. Fast forward 10 years- niece is full on mentally ill and has a criminal record of theft, drug dealing and bad choices. A few months ago she was in an accident in a stolen car and gave the police her sister's indentification- still working to clean that mess up.

As for the men who fathered her kids, we don't know much. G's dad was German and a drug user; I met him once and he seemed pretty dull but he was probably using, so? A's dad was from the DR, he seemed a little more on the ball but again, sort of thuggy. S's dad was a low level mobster who comes from a lovely middle class family.

She's not an "easy" kid. Not that any are but she definitely qualifies as "spirited". She doesn't do well in daycare settings because she gets bored. We moved her into Montessori last winter and she did/does great there in general. Since the time change she's gotten less exercise and her behavior has been tanking. As a coincidence, it was time for the school to bring in speech/occupational therapists to do mini evaluations. We had them evaluate Charlotte at a cost of just $10.

I've read your posts in the past. Your Charlotte (my favorite girl's name by the way- one of my favorite aunties is a Charlotte) sounds a bit like my niece or her son at that age. It's not that they're "bad" or even "willful"; it's like they just can't settle. And you're right, they're more work than a typical kid but worth it because of their sweetness and potential.

Call me cynical, but the school allowing an outside professional to offer mini-evaluations in house bothers me. Maybe I've been living in Spedworld too long, but what's in it for them? The school gets to look proactive to the parents and the service providers gets access to the sort of parents who are prescreened for really caring about their kids, having a fair amount of disposable income and likely excellent insurance. I am always leery of a situation where a professional is both evaluator and service provider. It's a situation I have chosen to avoid where possible. I have seen so many parents waste time and money on marginally effective therapies in similar situations.

If Charlotte's issues are of a concern enough to suggest a mini-consult with a clinician you didn't choose, then they're significant enough to request a full multifactored evaluation from your school district in all areas of suspected disability.

I want to note that Charlotte's teachers are concerned that her short attention span and unwillingness to follow directions are starting to get in her way academically. Which sounds dumb just writing it out because she's 3. But skills build on each other and she is mentally able to do advanced work but not... neurologically?... able to. They have had to purposefully hold off on some lessons she should be ready for.

Kids develop physically, socially, emotionally and academically at different rates. For a really bright kid, intellectual, cognitive or academic maturity may be precocious making things like emotional domain skills like self regulation look more delayed than they actually are. She's 3 1/2, no?

Your descriptions of her sound like every little kid I know who went on to get an ADHD dx later. Given he family hx, ADHDers are notorious self medicators, this is fairly likely. Assuming for a moment that's what you're seeing, ADHD can be thought of as a delay in emotional maturity which would make the disconnect between a LO ready to read and not ready to sit still. If this is the case, you may find her behavior more like a younger kid

The bolded would bother me. They're ascribing motive without really examining whether she has the emotion bandwidth to go along with the cognitive piece. She needs to have both. It's great that she's bright and has the potential to be a high acheiving student, but she's isn't there yet.

This sort of reminds me of one of my old car pool kids. James was attending DS's reading lab school because he was a really bright kid who had wicked sensory issues and dysgraphia as well as what his mom called "ring-of-fire" ADHD. This was pre-Conserta days and he had a hard time with old school Ritalin which exacerbated stuff. Frankly, he wasn't a very likeable kid at times. I'm pretty chill, but I was tempted to throw him off the Scudders Falls Bridge more than once.

James was in 4th grade and reading at college level and doing middle school level math. He was in the school because his particular issues frustrated the crap out of his public school teachers who ascribed his inability to write to a willfull choice. When they started down the path of "presents consistently with symptoms of ODD" mom pulled him, went to due process and got a $80K settlement for 2 years of theraputic school and legals fees.

At any rate, since James was an advanced reader in a school where most were struggling, he took RELA with the high school kids and was given Tom Sawyer to read. Now James could read, as in decode, the text but he lacked the social and emotional maturity to really get the conext and content. To him it was just a book with the n word in it. When he read it again as part of a literature based history class in high school, he got it. He always had the potential to make sense of the material, but he needed to grow into it emotionally. I think that might be a little of what you are living.

The OT who did the school eval wrote essentially the same sort of eval as the first OT. Her observation at school was that she was observed moving around the classroom without prompting and shared a work station with another child without incident. However, "her teacher shared Charlotte's difficulty participating in a group instructional activity: she can't stay in one spot, can't keep her hands to herself and talks out of turn." She also graded the checklist/questionnaire: Typical performance in the areas of Taste/Smell sensitivity; Probable Difference in the area of Auditory Filtering; Definite Difference in the areas of Tactile Sensitivity, Underresponsive/Seeks Sensation, and Visual/Auditory Sensitivity. She recommends a full OT eval and OT.

Which basically puts us right back where we already knew we were. Parent/teacher reporting equals a difference but observation not so much so, or at least less obviously so. I'm beginning to think I'm crazy (though DH filled out the form this time and the teachers added input without me...). On the other hand if it's starting to interfere with her ability to learn/advance, maybe it's worth pursuing. Or maybe it's something I should leave be until she's closer to school age.

I think you'll have more information as she gets older. For an "older" kid, a decent school district evaluation would include a school psychologist observing several times in different settings- maybe circle time, recess and math or music- to get an idea of how she does in different levels of overt structure. You might want to pull the trigger on this before she transitions to kindie if she'll be attending a traditional school. If she'll be staying with a Montessori program, closer to 1st might make more sense. Even if you stay with a private school, you are entitled to the eval.

I wanted to add some information about the three I know.

G, who probably had the highest drug exposure of the three, is doing well. She attended a traditional nursery school at her church. She transitioned to a mainstream kindie without any supports and is doing average work. She's a shy kid with adults, but has lots of little friends at school and in the neighborhood. She has a sister 10 years older who dotes on her. He parents are very thoughtful and consistant.

A isn't doing as well. Boys often suffer more damage from drug exposure than girls do, I'm told. He's in a mainstream kindie with an IEP for speech, attention and behavior. He has an ADHD dx now and takes meds which seem to be helping him to make better choices but he's still a handful. He's much like his mother and grandmother before him, reading and doing math ahead of his class and using his spare time to get in trouble. Last month he was writing bad words on his spelling paper.

My older niece who used to babysit DS as a LO claims A is much more uncooperative than DS ever was. He is also prone to destructive outbursts. ( His little brother's Chritmas gift was delivered to my house. I offered to wrap it for my niece because I have some Thomas paper and my niece said "NO, A will lose his shizz if his little brother got train paper and he didn't. It would ruin everything) I don't know how much of this behavior would be improved by parents who were better at parenting, but he's just a tough kid.

S is great. She's the youngest in her preschool class and doing everything she's supposed to. She'll be running it before long at the rate she's going. She spends an inordinant amount of time with adults and it shows- she's a funny and confident kid. She doesn't appear to have any ill effects from her drug exposure. Maybe things will look different once she starts with real academics and having to sit still, but for now she's doing great.

Auntie, don't get hung up on my use of the word "unwillingness". Inability may have fit there just as well. Point is, she doesn't follow directions well, and it's getting in her way. She CAN understand directions, as in there's no receptive language delay, but she doesn't follow directions when doing so interferes with her personal preferred agenda.

I can tell you nothing substantial about LO's birthparents. She has some aunts/uncles on each side, but none can pass a background check to care for their neices/nephews, which is so sad. Her birthfather has been arrested a few times; we pulled some strings to get a mug shot and saw his rap sheet, which is a bunch of stuff like "stole a case of beer from a convenience store" and "stole 12 dollars in meat from the grocery store." Non violent stuff, not that I condone it, but nothing that makes my hairs stand up.

Charlotte has a teenaged half sister I secretly watch on Facebook because her father is a Nazi and I'm not about to invite that shiit into my life. She seems like a pretty typical teen. She also has two full brothers, one of whom I'll likely never find, but the other of whom we have contact with his adoptive family. He just turned 5 and is doing GREAT. Also a sweet kid, not nearly as active as Charlotte. He is already reading, and reading well. Charlotte has started to read but isn't progressing because of her attention span; she can sound out 3 sound words and then feels proud and runs away lol. So reading a sentence or a page isn't gonna happen. Which seems stupid to say because, again, she's THREE. I'm definitely not pushing her because she's three, but the point is she is ready otherwise, just not in the ability to sit still. Anyway, back to the brother. He is bright, and when he was younger he was pretty impulsive and active, but seems less so now. I would not guess him ADD/ADHD. He has never shown signs of sensory issues. So there's hope Charlotte will grow into it some.

It's taboo to say "gifted" on the Bump, but whatever. I have had people, including her teachers and her pediatrician and a gifted tester who happens to be a parent observing a school we were observing at the same time who just met Charlotte for a half hour or so, suggest that she is likely gifted. And from what I've read, gifted kids often exhibit many of the same behaviors that she does, and has, exhibited in early childhood, so it might be a fit. She certainly has some really impressive problem solving skills.

Assuming nothing major changes and I continue to see it as the best learning environment for DD, I hope to continue Charlotte in Montessori through at least 4th grade. Her current school is newer and only open through K right now; they are in a county with good schools near my work, so they may have trouble going beyond K. My county has less desirable schools, and my zone or whathaveyou is even worse. There are a number of Montessoris that go through 3rd, 4th, or even middle school. The middle schools are a drive, though, so we'll have to see, but grade 3/4 shouldn't be an issue. However that's not really an excuse for not doing what I can to help meet her needs either. I see no point in pushing her into an environment where she won't be as successful when she probably won't see a mainstream school for several more years. Oh, to answer the question about whether we tried more than one child care; YES. Let's just say that finding the right care has been a really difficult journey for us and she's moved around more than I like. In home care to 6 weeks, daycare center to a year, Montessori daycare until she was kicked out for biting a few months later, nanny, then part time preschool, then daycare with preschool curriculum, now this Montessori. She has had issues with all, but the tiny crowded classroom at the center was the worst behaviorally. I hated picking her up and hearing how she ignored the teacher and got in trouble again at naptime and wouldn't sit still at lunch... EVERY single day. At least at her school now I know they appreciate each child for the individual they are and will let me know of ongoing issues they need help with, without just venting that my kid is the annoying one who makes their job difficult.

Sorry so long again... so is the school district the way to go at this point for a full eval? Or talk to my pedi again? I'm not sure where to go.

In most (if not all) areas there's a child outreach program. You can get her evaluated through there and bring up your OT concerns/issues with them. You may get her some OT that way via your school district.

Definitely set up an appointment with your pediatrician to address your concerns as well. She'll be a good resource to decide what to do moving forward as well. Private OT where they come out and work on strategies with her teachers/in her current classroom would be ideal but I can't say if that's a possibility or not.

I would definitely address the OT concerns now since they're affecting her ability to function in a classroom setting. My son is a sensory seeker and lacked the ability to tend to an activity for even a minute. He's in preschool now and has an above average attention span than his peers after a consistent year of OT.

I had lunch with DH to talk it over. He is naturally more hesitant to seek out help than I am; to him seeing a doctor is like admitting an imperfection. Apparently I married my mother, not my father, but I digress. He was asking me when kids typically start doing better at attention spans and energy, and I said I've heard that it's usually by age 4. I read that on more than one ADD/ADHD website, FWIW.

Over the past month or so we built LO a sensory gym in our bonus room, and I've been really working with LO to make sure she gets plenty of exercise in the evenings. As a result, she has had more success at school. She is still challenging, but much less so. Her teachers have even given her a lesson she was begging for and they had been holding off due to attention span and impulsivity. So things are improving, with a lot of effort. DH wants to wait until LO has her four year well child appointment and really talk it over with her pediatrician to see if we should get a full eval and through whom. Meanwhile we'll continue the at home sensory diet and emphasis on exercise and limitation of screen time that goes with it.

Thoughts on that approach?

Your DD always reminds me of my DS. You've had the upper hand in knowing there was some sensory stuff longer than we have, though. I think the gym for her is absolutely awesome.

Where we're at with the school situation is this--DS was expelled from DC at 3. I stayed home with him for the better part of a year and then DS started 4K last year. It was a half-day program, 4 days a week, through the local elementary school in our district. He had a hell of a time behaviorally, even with a saint of a teacher and a classroom aide that devoted a lot of her time to him.

Before we even enrolled him, we had him tested through the district with the hopes of having an IEP placed for that school year. He didn't qualify. He was basically borderline like Char where there were significant issues, but not enough to push him over the edge to qualify.

They did unofficial accommodations during that school year, and around March/April the teacher pulled me aside and said she'd done everything she could do and would be submitting a referral for him to be evaluated again. By this time, we had pursued therapy and different evaluations on our own, and finally had keyed in on it being sensory stuff.

When they did that round of evaluations, coupled with the year of evidence they had that the unofficial stuff didn't suffice, he had enough to be approved for an IEP.

This year is going very well for him. He has an in-class aide, and the SN/early childhood lady is in his class several times a week to keep on top of him. He also goes for OT 2x/week and has in class things like a weighted blanket to help him stay calm when he's supposed to be sitting and working.

IDK much if anything about Montessori. I can tell you that DS thrives on a lot of structure and consistency. He does much better if he has an adult that can be more focused on him, even if it's just so he knows they're watching. He has a lot of difficulty with impulse control, but it definitely has improved with age. Also, he does have a hard time following rules, so he's definitely a pick your battles kind of child. He would never be able to thrive at a place where there were seemingly nitpicky criteria about how to put things away or carry things.

FWIW, we live in a great and proactive district.

I really hope you can get it sorted out. I don't think it would hurt to have the school district evaluate. 

fredalina:

I had lunch with DH to talk it over. He is naturally more hesitant to seek out help than I am; to him seeing a doctor is like admitting an imperfection. Apparently I married my mother, not my father, but I digress. He was asking me when kids typically start doing better at attention spans and energy, and I said I've heard that it's usually by age 4. I read that on more than one ADD/ADHD website, FWIW.

It could just be that she's on the less mature side of typical. Time will tell. We found a lot of DS's quirkier out-of-seat behavior and blurting faded as he became a stronger student rather than the other way around.

ADHD is something more often considered closer to 5 or 6. For DS he matured and settled with time, but his typically developing peers did as well. And sometimes at a faster rate. So while he got "better" they did too and the bar was raised each year.

Over the past month or so we built LO a sensory gym in our bonus room, and I've been really working with LO to make sure she gets plenty of exercise in the evenings. As a result, she has had more success at school. She is still challenging, but much less so. Her teachers have even given her a lesson she was begging for and they had been holding off due to attention span and impulsivity. So things are improving, with a lot of effort.

That's great that she's responding well to the sensory diet and work. This time of year can be hard with the lack of daylight.

DH wants to wait until LO has her four year well child appointment and really talk it over with her pediatrician to see if we should get a full eval and through whom. Meanwhile we'll continue the at home sensory diet and emphasis on exercise and limitation of screen time that goes with it. Thoughts on that approach?

I agree with your DH about testing. If she's not at risk of being asked to leave for behaviors, and it doesn't sound like that is a risk now, I would wait until she's closer to bridging to her next class. Most Montessori schools locally here, go preschool through kindie and then start a new cycle. This is when I would pull the trigger on an eval if you still feel there's more to know.

Getting a private neuropsych eval would be awesome if there's someone qualified in your area and it's not a financial hardship. IMHO, every family would be better served if they knew their child's learning style and areas of strengths/weaknesses. You could do the district eval first and use the private eval as a second opinion. It's always a good idea to have a district eval in your pocket if your child attends a private school. This way, if they close or ask her to leave you have the means to advocate for services in a public setting.

Hi. Usual lurker here who sometimes has something to say.

I was much like your daughter. No biting, but unable to sit still or follow directions. I was advanced, an early reader and writer but was easily overwhelmed by instructions or group activities. As late as junior high I would choose not to take tests but would instead read in class. It was only the threat of not graduating from high school that made me do all the work set before me. 

 It wan't until college that I was diagnosed with ADHD. If I was born in the '90's or '00's  I might have made it through toddlerhood without a diagnosis but would have been diagnosed by 2nd or 3rd grade.

I've heard that there is a genetic component to ADHD so have been keeping an eye on my boys. I wouldn't hesitate seeking therapy for them if I thought they needed it. I tend to play the 'I made it through school without a DX and I was just fine' card, but the only way I managed was by being a badass at language skills. Spatial and quantitative learning was nearly my undoing.

 Sorry, I'm rambling. My point is, as you said, that skills build on each other and it would be unfortunate if your DD struggled later because of something she could be helped with now.

 Good luck!