Directing attention

[waverly]

DS has a wandering off type of an attention issue. It's minor, and we aren't at the point of thinking ADHD at this time anyway.

What are some good ways to redirect his attention? Sometimes I feel I have to grab his body and physically move him which he is fine with, but I would like something more subtle. I try to do some sign since he is hard of hearing, so I'm not yelling across the room, such as no or stop. His eye contact isn't the greatest though so that's not always successful. Working on eye contact and attention in OT.

Sometimes I feel like we are saying you are 7, you should ... or pay attention... but I feel there are more positive phrases than that. Or just repeating myself.

His teacher is good and has whole classroom techniques. His OT and PT haven't really shown any major methodology except making a list for motor planning. We do write out some tasks before we do them like packing lists and PT exercises. But not everything.

[akafred]

Is this a function of hearing loss? It seems like it could be. DD has ADHD and also APD, so I can't say which drives that behavior, but I'm sure the APD isn't helping. If she isn't fully "hearing" what we are saying, she isn't going to pay full attention.

Physical touch is powerful. I probably wouldn't recommend physically aiming their faces, but a hand on the shoulder as they are looking away helps. Also minimizing sound and other distractions, like turning off the tv or setting the iPad aside when instruction or information is going to be given. Keep instructions short and emphasize a key word, like if I HAVE to give multiparty instructions I will say something like "Go brush your teeth then get your pajamas. Teeth, pajamas." Then I ask what she's supposed to do and have her repeat it to me. "Teeth, then pajamas."

Try not to bother too much about where he isn't and instead meet him where he is. Meaning, don't get frustrated because he is 7 and should be able to pay attention or whatever. He is 7 and still has trouble in this area. It's great and important to teach him those lagging skills, but you stressing about where he isn't won't be helpful.

[waverly]

Thanks, I know it's not helpful to say you are 7.. so I'll work on H with that.

I'll try the hand on the shoulder. We do the other techniques you mentioned. It's very possible it's hearing related when he doesn't respond to me. I don't know if it's hearing related when he loses focus on a task though.

We typically have to pause tv to get his attention.

I don't know if a one word drawing attention to his inattention is helpful or hurtful like telling him to focus.

[akafred]

I'm not an expert in the area of hearing loss by any means, but I have been thinking I need to see an audiologist for myself for the past couple of years, and just haven't. So there are times that a meeting, seminar, training, church, etc are a little fuzzy in hearing. Also I work in an international company so there are sometimes speeches given by people with thick accents that are more challenging to hear. I really have to work hard to focus on those situations, and my mind wanders even more easily than usual. In a 7 year old, listening skills are still emerging even in typical kids, and especially if they have other issues that can effect executive functioning, my instinct is that hearing or processing issues could really affect listening/attention skills. It is a given that Auditory Processing causes listening issues. It seems likely to me that hearing issues would do the same. You could ask his doctors, of course. They may have some useful suggestions also.

[auntie]

What do you mean "wandering off"? Like physically getting up and leaving the scene? Or do you mean more of his attention checking out? If it's the former, movement breaks taken proactively should help.

Do the inattention come with specific non-preferred activities? Do teachers report seeing it? Does he have an FM system in class?

When you say you have to mute the TV for attention, do you mean if he's watching and you need to tell him something- that would seem normal to me.

Does it happen at a certain time of day? Like in the evenings when you're trying to do homework? Perhaps he's listened enough for one day and is fatigued- processing auditory input is hard work.

I would kind of expect a kid with hearing loss to have less than average auditory processing ability, which as akafred, pointed out is an emerging skill through puberty. Perhaps you are too wordy. Best advice I got from DS's psych was that once you have reached a dozen words, your kid isn't listening anymore.

[waverly]

Jan 10, 2018 10:01:48 GMT -5 auntie said:

What do you mean "wandering off"? Like physically getting up and leaving the scene? Or do you mean more of his attention checking out? If it's the former, movement breaks taken proactively should help.

Do the inattention come with specific non-preferred activities? Do teachers report seeing it? Does he have an FM system in class?

When you say you have to mute the TV for attention, do you mean if he's watching and you need to tell him something- that would seem normal to me.

Does it happen at a certain time of day? Like in the evenings when you're trying to do homework? Perhaps he's listened enough for one day and is fatigued- processing auditory input is hard work.

I would kind of expect a kid with hearing loss to have less than average auditory processing ability, which as akafred, pointed out is an emerging skill through puberty. Perhaps you are too wordy. Best advice I got from DS's psych was that once you have reached a dozen words, your kid isn't listening anymore.

He wonders off physically. Like he will be clearing the table and start playing with something on the counter or wander into the living room type thing. OT does movement breaks but I am not sure how to do a movement break in a task that only lasts 5 minutes anyway.

I am not really talking to him when he wanders off. When I do have to talk to him I have physically get his attention.

[akafred]

Jan 10, 2018 10:47:04 GMT -5 waverly said:

Jan 10, 2018 10:01:48 GMT -5 auntie said:

What do you mean "wandering off"? Like physically getting up and leaving the scene? Or do you mean more of his attention checking out? If it's the former, movement breaks taken proactively should help.

Do the inattention come with specific non-preferred activities? Do teachers report seeing it? Does he have an FM system in class?

When you say you have to mute the TV for attention, do you mean if he's watching and you need to tell him something- that would seem normal to me.

Does it happen at a certain time of day? Like in the evenings when you're trying to do homework? Perhaps he's listened enough for one day and is fatigued- processing auditory input is hard work.

I would kind of expect a kid with hearing loss to have less than average auditory processing ability, which as akafred, pointed out is an emerging skill through puberty. Perhaps you are too wordy. Best advice I got from DS's psych was that once you have reached a dozen words, your kid isn't listening anymore.

He wonders off physically. Like he will be clearing the table and start playing with something on the counter or wander into the living room type thing. OT does movement breaks but I am not sure how to do a movement break in a task that only lasts 5 minutes anyway.

I am not really talking to him when he wanders off. When I do have to talk to him I have physically get his attention.

Specific to the "wandering off" thing and the example of setting the table, I have a kid with ADHD so I can't say how much of that is normal, but I strongly suspect this is one of those things where all kids do this, but kids with executive function deficits (ADHD, ASD, etc) would do this with a higher frequency. Remind me: I know your son has hearing issues and some tone issues; does he have any dx other than hearing loss? He may have something that hampers EF...or perhaps your husband's expectations are a bit high in that area. I don't feel like a kid having to be reminded to finish even a short duration chore would be really out of the ordinary even for an NT kid, once in a while.

I find with Char she is just starting to remind herself "oh I was supposed to be doing X". Occasionally. Most of the time she just gets off task and needs reminders. I would say MOST of the time. As opposed to occasionally.

[waverly]

No other diagnosis except a heart valve we are watching. I think I'll try counting the frequency.

I know it's more than his sister who is 2 years younger but boys and girls are different in this area, so I may need to compare him to other 7 year old boys.

[auntie]

waverly,

I think you are wise to be keeping an open mind about this. I think "charting this" could bring clarity. Look at what the task is (in terms of relative preference for doing it), what he was doing before (set the table when he was enjoying Legos would probably be more of a trigger than if he was doing homework), how often, and time of day (this could be a physical or behavioral fatigue issue).

Maybe this isn't really a "thing". I mean, the situation "set the table for dinner" would look very different if the child came home from school at 4pm, had a snack, played a bit, did a worksheet, and was asked to set the table at 5:30 vs being asked at 6:30 by parents who just got home from work and are scrambling to feed everybody when the kid has been at school and then aftercare and holding it together all day without a moment to just not think.

I don't know that I would assume that this is driven by gender, boys and girls- as a group- do vary a bit in development but sometimes that is a function of socialization and expectations more than genetic variances. Sort of like those families who glom onto boys talking later than girls as a truth and aging out of EI with a kid who could use it. Charting, and giving him a chance to self-direct- will allow you to see if this is just an occasional thing that annoys the crap out of a parent or something bigger.

Curious how and why the OT is the one working on eye contact and attention. The notion of bolstering eye contact is very controversial in the autism community even as it overlaps with those with hearing loss. Normally this work is done by a SLP under the umbrella of pragmatic language and social skills. Attentional skills are normally the domain of special educators and psychologists. IME, and YMMV, OTs are the professional most likely to expand services beyond their actual area of training and expertise. A little of this can be useful, but it's generally best to seek out the person with the background if this is a real issue.

[waverly]

It's not so much eye contact as it is his eyes following an object. Good points auntie.

[auntie]

Jan 11, 2018 16:50:20 GMT -5 waverly said:

It's not so much eye contact as it is his eyes following by an object. Good points auntie .

Has anyone suggested a developmental optometrist for the tracking issue? 

[waverly]

Jan 11, 2018 17:11:04 GMT -5 auntie said:

Jan 11, 2018 16:50:20 GMT -5 waverly said:

It's not so much eye contact as it is his eyes following by an object. Good points auntie .

Has anyone suggested a developmental optometrist for the tracking issue? 

No. They seem to think it's minor, but I'll keep it in the back of my mind and ask his regular eye doctor and OT.

As far as attention goes the only thing I've seen the OT do yet is movement breaks and redirecting him when he is at the table.

I don't think the attention thing is occasional but it also doesn't seem nearly as frequent as what akafred described.

[agedsubaru]

Developmental Optician have a bit of controversy associated with them. If you look at the NYT article, the script is a bit fishy but the science is there. We did (and still need more) vision therapy with a Developmental Optician. When we were debating about whether to pursue vision therapy (in office), we also scheduled an appointment with a neuropthamalogist at the Wilmer Clinic at Johns Hopkins. It took 4 or 5 months to get in the door.

He looked at dd and confirmed what the developmental optician had found. He is also currently doing research into dd's diagnosis. What was different was the script? He wasn't downplaying dyslexia or adhd or anything else? I had rebutted the script (without much argument) when we first met with the developmental optician.

We have since had to go into other doors. Vision therapy is poo poo'd in many places (neuropsych, school, etc). You may not find support across board. Also there is only one study to show that in office therapy shows greater gain than in home treatment. It is worth an evaluation before ruling out. 

Also if you are concerned about Dyslexia, pursue the OG tutoring no matter what. 

[waverly]

Sounds like I will have to do more research. I am not sure what all is entailed in vision therapy and if he really needs it.

The regular eye doctor and OT just says practice tracking. I did ask the OT about seeing a developmental opthamalogist and she just said it couldn't hurt. She was neutral in it neither pushing and thinking it's necessary nor saying no don't go.

I don't see any indications of dyslexia.

[agedsubaru]

I have to apologize. I wrote developmental opticians, it is developmental optometrist. Sorry. A google search should help you find some leads.

Here is a study at Wilmer. Probably others... www.hopkinsmedicine.org/wilmer/research/dana-center/research/breds/index.html

[waverly]

His reading is really good. I think a grade level or two above.

I did drop off his OT exam which mentioned the eye stuff and will see the school OT next week. I can ask her about the eye stuff as well to see if the school has anyone they refer kids to for eye stuff.

Otherwise there are eye doctors at the children's hospital which would likely have the most expertise. Not necessarily seeking out or rejecting vision therapy just more wondering on the eye in general at this point and therapy if needed perhaps tack on after he finishes PT.

[agedsubaru]

I found this group on fb. It could be a place to lurk for more information. I haven't been on the group as of yet for vetting purposes.


www.facebook.com/groups/VTparentsunite/