Fighting the insurance "catch-22"--and other issues.

Dear D.C. Mom:

Fighting insurance companies is often a long road that takes a lot of persistence.

But I think your first step is to get an evaluation by a developmental pediatrician. That is usually covered by insurance especially if you can get your current pediatrician to refer you.

From what you describe, Tanner is definitely "running" the house and that, generally, is not wise. This bridges into control issues as he gets older.

He might benefit from the Listening Program, and you may want to ask his speech therapist about this. (The person doing speech therapy should be a speech pathologist, not just a therapist, and make sure he or she has "CCC" certification.) Tanner is definitely experiencing developmental and emotional issues, but it sounds much more complex than just sensory integration.

Most children's hospitals have therapies that are covered by insurance. That is another avenue to explore. The reason so many private therapists do not process insurance is that it is enormously cumbersome and then the "reasonable and customary" reimbursement is less than most therapists get per hour!

Speaking is another issue. He is making choices, and his choices are stressing you out.

Sensory friendly or not, Tanner is exerting control and has you jumping through hoops.

As for a "shadow," I would call the local colleges and universities in the area and speak to the psychology department, the education department, etc. and ask them to post a job for a "shadow." That is how I get shadows for the children I work with who need one.

An idea for bathing might be to put his favorite toy in the tub and use different kinds of wash cloths of various textures. Use bath tub crayons and "draw" on him and the tub; turn it into a game. Have your husband help you get him in the tub, if needed.

If he allowed the OT to brush him, and you did it at the clinic and are doing it correctly then his refusal at home is a control issue!!! You might want to ask the therapist to use baby lotion, as part of his occupational therapy, on his arms/hands with your participation in the activity and then try it solo at home. That way you can ease into the brushing. My question is whether it calms him during therapy or is it just something he tolerates there. If it is the latter, do not pursue it.

A social skills class that uses sensory-based games would probably be very helpful for Tanner to learn acceptable social skills. (We have the P.O.P.[TM] program here; you can look at it on my website and see if there are similar programs in your area.)

Obviously, financial concerns have to be part of the program equation. If you cannot afford two times a week for two hours, how about two times a week for 45 minutes?

Clearly, there is a need for structure. What it sounds like from this end is a child who is, for whatever reason, experiencing multiple sensory-motor delays and then is retreating at home. This may be because the OT is a stranger who has given him boundaries, and Tanner knows he will be leaving that setting at the end of the session. Home, on the other hand, is permanent, and you are not going to "leave." For that reason, he feels like he can "let lose." Helping him learn boundaries is essential to his emotional maturation.

I hope that this has given you some direction.

You are being very Brave, and I worry that you are not taking care of YOU.

Regards, Susan

Dear Ms. Schriber Orloff:

I am the mother of three-and-a-half-yearold, Tanner, who has sensory integration disorder (SID). I have read many of your articles. We are having difficulty with our insurance as they keep saying treating his disorder is not "medically necessary." Can you explain "medically necessary"?

Tanner goes to a private nursery in Washington, D.C., which specializes in kids with SID issues. He has been going two times a week and receives pragmatic speech therapy. In addition to the above expenses, he also needs listening therapy and in school OT facilitation several times a week. We just cannot afford these services without insurance reimbursement. We are thinking of selling our house and moving into a much cheaper house to continue to fund therapies for our son.

It was also suggested to us that he get a "shadow" in school. Do you know how to go about finding one? His behavior in preschool is escalating, and I am afraid they will not let him stay there. In OT the OTR used a brushing technique, but he screams when I try it. The OT has shown me how to do this technique and watched me do it so I know I am doing it correctly. I am trying to find sensory friendly environments for him, but the ones I find do not seem to be working over the long term. (After a few weeks, the behaviors return.) I also think he needs some kind of situational social skills training. What can you suggest?

In addition, he has outbursts that are wearing on our entire family. Everything is a struggle; bath time, in particular, is getting to be one fight after another. I need help!!

Thank you in advance!!

Susan N. Schriber Orloff, OTR/L is the author of the book, Learning RE-Enabled, a guide for parents, teachers, and therapists. This title is a National Education Association featured book. Susan is also the CEO/Executive Director of Children's Special Services, LLC, an occupational therapy service for children with developmental and learning delays in Atlanta, GA. She is available nationwide for seminars and can be reached through her website at www.childrens-services.com or at [e-mail].