Dyspraxia and Detailed Therapy Costs

Jam is currently 5 years old. 

I thought I had posted this way back in April, but just now saw it sitting in the Draft folder. Which is what I get for not actually looking at my site after I post something- oh well!

Here are the details of our therapy costs in case they're helpful. Though now we're in August and, since then, we've dropped occupational therapy and soccer so our costs are somewhat reduced right now. Though I've already got something else in the works, of course....

*********************************************

In a recent post about Jam's various therapies and activities, I vowed details on costs and here they are, along with how we manage to afford it:

Occupational Therapy- twice weekly   We are so extraordinarily fortunate to have good insurance coverage. For neurodevelopmental therapy, they cover up to 60 appointments a year until Jam turns 7. Each 50-minute OT session cost is $125 and we pay a $25 co-pay per session. Unlike previous years, this year we won't be paying out-of-pocket for additional sessions past the covered 60 as our therapist is retiring.

Cost: $25 x 60 sessions = $1,500 out-of-pocket annually


Hippotherapy- once weekly   Due to the generally high cost of this service, our therapeutic riding center generously subsidizes every student, bringing our cost down to $115 per 50-minute session.  I'm not even sure any insurance carrier covers hippotherapy. Ours doesn't but it would cover the physical therapy portion of our session (roughly $34) though it would count against our 60 NT appointments a year so we don't run this through insurance.

Cost: $115 x 42 sessions= $4,830 out-of-pocket annually


Integrated Movement Therapy- once weekly   $60 per each 45-minute, one-on-one session.  Definitely not covered by insurance, but worth it.

Cost: $60 x 48 sessions= $2,880 out-of-pocket annually


Soccer- once weekly   Offered through our local community center, sports classes are somewhere between $11 and $18 per class. We may switch up between soccer, tennis and t-ball throughout the year so I averaged it.

Cost: $14.50 x 24 classes= $348 out-of-pocket annually


Gymnastics- bi-weekly    Normally, $6 for a one hour visit. We attend on a very regular basis so I buy the 10 visit punch card in order to get three free visits to bring the cost down.  A great deal!

Cost: $4.62 x 24 visits= $110.88 out-of-pocket annually


Swimming- bi-weekly   Normally, $9.75 per visit up to 5 hours. Like gymnastics, we attend on a very regular basis so I buy the 10 visit punch card in order to get one free visit to bring the cost down. Another great deal!

Cost: $8.89 x 24 visits= $213.36 out-of-pocket annually

So there you have it- about $9,882.00 a year. Or $823.50 a month. Or $190.00 a week. Out. Of. Pocket. And that doesn't even include gas, wear on the car, holiday gifts, etc.  Sigh...

How do we do it?

Well, it's tight. My car is 10 years old. And, being dyspraxic with the attendant sensory issues myself, I loathe everything about shopping. So no shopping for me. (Thank the sibling gods for my sister and her hand-me-down clothing gifts for Jam and me!) Living in the already amazing place that is Seattle, we don't need to vacation a lot and because Jam has such a limited palate right now, we don't eat out much. Also, I recently started back working 10 hours a week at my 'before-Jam' job (which I love!) and it helps a tiny bit. And finally (and most sadly) our dog of 10 years died recently and that freed up a bit of money a month. So there you have it.

I look at this outlay of money right now as an investment against spending more, bigger money down the line. Hooray for early intervention!

If our financial situation changed for the worse and I had to make decisions on what to cut, here's how I would rank our current therapies and activities in terms of progress and value for the money for where Jam is right now:

1. Occupational Therapy
2. Integrated Movement Therapy
3. Swimming
4. Gymnastics
5. Hippotherapy
6. Soccer/ group sport classes

Hope that helps!

Dyspraxia, SPD and Discontinuing Occupational Therapy

Jam is 5 years old!

A while back, I wrote here about our dilemma of whether to continue with occupational therapy after Jam's therapist closes her home practice and retires at the end of July. Well, the end of July is fast approaching. And we don't have a replacement therapist lined up. In fact, I've decided it's a good time to end OT. At least for now. Maybe forever. Who knows? I'm a little nervous. But also a whole lot excited.

We've been attending occupational therapy for 2.5 years- that's half of Jam's life! And I mean attending religiously. At minimum once a week, regardless of holidays and vacations. And there's been more than a few long stretches of going twice a week. We initially started doing that because Jam, when younger, was so SPD avoidant and dyspraxic slow and so little was getting accomplished, he needed two appointments a week just to cover one appointment's goals for any hope of progress. Then later, due to preschool anxiety issues, we'd attend semiweekly appointments the month before school started through the month after just to keep him manageably regulated. And now, since our therapist announced her plans to move on, well, we're getting in all the appointments our insurance will let us cram in!

Jam doesn't remember a time before Miss S and visiting her home for work and play. OT has been a huge component of Jam's life. And of mine these past years. So why do I feel now is a natural time to stop?

OT is time-consuming

It's not just the OT sessions themselves that are time-consuming, but the whole routine before and after the sessions. Traditionally, Jam had been very resistant to transitions so we developed a ton of routines around these transitions to lessen his anxiety and increase his comfort level so that he could actually learn things and do things and progress on things. And while Jam doesn't need as many now that he's older, weaning him from some of these routines has been a very gradual process. And he's kept a few of them, like playing in the therapist's outdoor sensory playground for upwards of 40 minutes after each session. By the time we actually get home, it's time for lunch already. Except that Jam usually requires time to transition peacefully from the car to the house and so ends up playing in the car or outside in the yard for another 20 minutes before finally coming in. OT has never been a 'get in, get it done, get out' sort of thing.

We need more unstructured time

I'm always looking for ways to balance Jam's structured activities with his (and my) need for downtime. We have a lot of structured activities/appointments. And this kid is only 5 years old! Breaking from OT now would free up some time. Especially morning time which is Jam's best time of the day. Unfortunately, his 'best time' is also the best time for him to actually be in therapies learning and practicing new skills. Right now, he has four 10am appointments a week. Soon, we'll be down to one.

OT is expensive

Need I say more? And that's with great insurance coverage. Co-pays add up.

I want a turn

I've been attending those OT sessions right along with Jam. I'm in the room. I'm paying attention. I'm doing my research. And Miss S has taught me so much about how to observe Jam and figure out what he's needing and why. She knows we will not be continuing with OT at this point and has spent a lot of time these past months in helping me put together a game plan on how to work with him. I've always had so many ideas of things he and I would love to do to practice his skills if we just had the time. But he's always so tired and with what little uninterrupted free time he actually has, he just wants to play. Because, well, he's 5! And I haven't wanted to take that away from him. I'm really looking forward to getting to spend even more one-on-one time with him.

Priorities shift

Now that Jam has made solid gains in his motor skills and SPD coping strategies, it's a good time to evaluate priorities. One being 'social skills building'. Whereas Jam was initially terrified of kids as a group, now he wants to be around them in social settings and to make friends. A great measure of the progress Jam's made, I now need to make sure those opportunities are available. A bit challenging given our current schedule balanced against his need for downtime.

So discontinuing occupational therapy is not to say that Jam's been 'cured' or that he's 'graduated' out of the need for OT. In fact, I feel that the therapy has gotten Jam on the upward spiral he's been on for awhile now. And it's that upward spiral that is actually enabling us to end formal OT at this time. If that even makes sense.

And it's not like he's dropping hippotherapy or integrated movement therapy or swimming. He's still got a lot of therapy happening. Plus, if I've made some huge mistake and he plateaus or plummets downward, it's not like we can't start OT up again elsewhere. I've got the referral info.

And, above all, I'm realistic. We might be seeking OT again later. Jam's dysgraphia is an issue he and I very well may need assistance with down the line when he's ready to tackle handwriting. Which is not now.

Right now, he's five. And I want him to have some time to do as many five-year-old things as he can.

Good News, Bad News and a Dilemma

Jam is currently 4.75 years old

So at today's therapy session, I got some good news and some bad news. And now have a dilemma.

I'm a 'bad news first' kind of girl, so here goes...

The bad news is that Miss S, the occupational therapist Jam has been seeing since being diagnosed over two years ago, is closing her private practice and moving across the country. The end of July is the end of therapy with Miss S.

Super sucky for us. Super awesome for her. She's spent 30 years in her field and wants to do something new. And she deserves it. And I'm genuinely very happy for her.

Still...

I was really hoping she would be around when it came time for my sweet little dyspraxic, dysgraphic, left-handed boy to learn handwriting. Because, due to my own dyspraxia and crazy spatial issues, I'm not sure how a strongly right-handed person such as myself is going to be able to do it. Thankfully, it's a little ways off.

The good news, on the other hand, is that I finally got a small sliver of validation for the work I've done in developing Jam's new motor skills-focused therapy strategy. Jam's been doing really well and making huge progress on so many fronts over the past year. And part of that strategy was to drop him out of preschool. Not a popular decision with some, including Miss S, who is a strong proponent of early education for social skills development, especially for special needs kids.

Given his dyspraxia and SPD, the problem for us was twofold: 1) Jam needs a lot of downtime to operate well and, with his new schedule, there wasn't enough time for everything, and 2) he'd already been experiencing high anxiety and stress in preschool settings over the past two years. And that high anxiety and stress would carry itself over into everything.

So, for me, it wasn't a hard decision. School had to go for now so that maybe he could handle and enjoy it more in the future.

And today Miss S. told me she thought I'd made a really smart decision a year ago in pulling him from school. That she saw the results that came from reducing his anxiety load and allowing him to spend more of his energy on learning to use his brain and body. Yeah!

And now for the dilemma.

Being the awesome OT that she is, she's using the next two months evaluating and placing her clients. Finding them new, well-matched services for their needs. So, of course, she asked me if I wanted referrals for two therapists, in particular, she felt would work well with Jam.

And I hesitated. Because I'm not sure, at this point, it'd be worth continuing with a new therapist. Or... not that it wouldn't be worth it, but that we could spend our limited supply of time and energy trying something else beneficial.

So I took the referral contact info and, waiting lists in this city being what they are, I should probably figure something out soon.

Dyspraxia, SPD and a Child's Work

Jam is currently 4.75 years old

Traditionally, it's been put forth that a child's work is to go to school. But my son does not go to school. Instead, Jam's week is filled with various formal and non-formal therapies like OT, swimming, hippotherapy, gymnastics, yoga, etc. All of these, together with his regularly scheduled playdates with a few good friends, make up his week. And this week makes up his schooling. And while swimming and gymnastics and yoga all sound like great fun, in actuality, it's also a lot of hard work for him.

When Jam was younger, I referred to his occupational therapy appointments as 'play' because, from his point of view, that's what they were. Lots of fun and games. And, back then, I was still trying to get buy-in from him. Today, it still is fun and games. But as he's gotten older, I've been making the shift to praise him for all of the effort and energy he puts into his 'work'. His 'work' at therapy, at the pool, at the playground.

"You've been working so hard!'

"You did amazing work at Miss S's today!"

And here's why-

I want him to see that work can be fun. Too often, 'work' carries a negative connotation- that it's, by definition, not fun, certainly not to be enjoyed and not something we'd be doing if given a better choice. That's not an association I want Jam to make, especially as a dyspraxic and given that he's going to be working hard at many things for much of his life.

I also think that using the word 'work' helps get Jam in the mindset that, while much of his life is pleasant and fun, there are also times when he needs to focus and put in serious effort because, in the end, we're spending all of this time and energy trying to accomplish something very serious.

And, lastly, by acknowledging all of the time, energy and effort that he puts in-  I want him to recognize that what he is doing is hard work and that it is legitimate and real and that he should be proud of himself. To call it anything else would be to dishonor him.

Dyspraxia, SPD and Things We're Not Going to Try (But Probably Should)

Jam is currently 4.75 years old

Recently, I posted on some things I'd heard about for a long time and eventually tried with success. But there are also some things I've heard all sorts of good things about that I'm not going to try. At least not now and maybe not ever.

I promise I'm not just trying to be controversial- these are big ideas in the SPD world and many people have tried these things with great success. And yet I've never been compelled enough to attempt them.

And here's why: these things are too organized, too formal, and too much work. And dyspraxics already work harder and get tired faster. One of the most important things a dyspraxic can do is learn when to expend and when to conserve their energy. And these things take a lot of energy.

Sensory Diets-   I've known all about sensory bins and sensory activities for over two years now and I confess I never made them a focused part of our day. The sensory bins- they just seemed like a lot of work with all the planning and acquiring of sensory items and rotating and dedicating time to play with them. And all the sensory exercises and activities- well, they were all just things my kid would fight tooth and nail to not do and I was not really into amping my kid's stress levels more than I had to since they were already pretty amped. And, finally, I've got big perfectionist tendencies but tempered by acute self-awareness. I'd want to do an awesome and perfectly organized job of it using some well-researched prescribed method I picked up somewhere in a book and I knew I'd never follow through on that long-term.

So I didn't even bother. Instead, I came up with my own low-stress version of a sensory diet- play a lot with a lot of things and some sensory stuff is bound to get in there somewhere. I mean, it's all 'sensory' anyway, right? I do think, though, that if Jam had been a sensory seeker rather than a sensory avoider, I would have made this more of a priority.  But now that he's older, he's coming out of his avoider behavior on his own terms. It's just taking some time. Which is fine because he's four and time is what we have right now.

Listening Therapies-   Too expensive, too complicated, too time-consuming. We've done a tiny bit of  listening therapy with our occupational therapist and only very sporadically. Very seldom with headphones, it's mostly music through the office speakers while Jam's working on gross motor skills. He seems very easily affected and has said he prefers to not listen to music while playing at home because it distracts his brain from playing. Plus I didn't want the twice-daily battles of keeping the headphones on for 30 minutes. The kid won't even wear a hat. So we just never did it. Maybe when he's older. It's a bit scary how manipulative the music is to his brain. So maybe never.

Food Diets-   Aaahhh, food diets. Gluten-free, casein-free, additive-free, sugar-free. It is so over-whelming I'm getting a headache already. Especially when food has been a huge issue in this house since the day Jam was born. We're finally at a place where he has food he'll eat. It's not a super huge  variety of food and it's a bit heavy on the carbs and it's not often he'll add a new ingredient and he's still very texture sensitive but we'll get there. I'm not too worried because I was exactly the same way when I was young and now I eat anything.

Still, I can't ignore the mounting evidence showing a connection between gut flora and dyspraxia, SPD and other conditions. I think maybe possibly trying the GAPS diet might be in our future but not anytime soon. Maybe when he's a bit older and better able to understand what we're doing and to willingly participate. And, again, if he had been a sensory seeker I might have considered this more of a priority.


Jam is on an upward spiral right now in increasing his motor skills and decreasing his SPD issues. Who's to say we wouldn't have reached this point earlier had we devoted the time, money and energy to the things above. There's no way to know. What I do know is that the path we've taken seems to be working while keeping his anxiety levels down and keeping his self-esteem up and that's how I'm measuring success these days.

Dyspraxia and Our Current Therapies

Jam is currently 4.75 years old

About a year ago when I fully realized that both Jam and I had dyspraxia and knowing, from personal experience, that the effects would be lifelong, I immediately moved our therapy focus from sensory issues to motor skills. Don't worry- the sensory issues are still being worked on and are coming along nicely, because, obviously, this is a condition that needs to be treated holistically, but I view our therapies through the motor skills lens now. Since then, we've seen big improvements in both his motor and sensory issues.

Jam's current schedule is this:

Occupational Therapy- twice weekly  For the first year of OT, we went once a week with quarterly goals towards sensory defensiveness, gravitational insecurity and body awareness. As he's aged (and building on the progress of the first year), he's gained some muscle tone and flexibility (in body and, more importantly, in mind) so now we're able to work at a higher level of gross and fine motor control and spend more time on his major challenge, motor planning. He loves going to his therapist's house to 'play' and always has.

Hippotherapy- once weekly   Physical therapy on a horse! Great for strengthening core muscles, improving muscle tone, balance, coordination and motor planning. Fortunately, Jam's taken to it more than I thought he would. I even gave him the choice of opting out during his therapist's maternity leave but he wanted to continue.

Integrated Movement Therapy- once weekly   A yoga-based therapy approach, in it's infancy as a treatment. Great for sensory integration, sequencing, body awareness & strengthening, as well as increasing stamina and endurance. I'll be honest- Jam loves his teacher but until recently fought against going because it's hard work. Fun, but hard work. That kid is sweating when he's done.

Soccer- once weekly   A 30 minute class for 3-4 year olds offered through our local community center. It's so low-organized it's a bit generous to call it an actual soccer class. But it's Jam's only small group activity that he gets to be around other kids with. The 'coach' is great and it's right next to the playground for afterwards. And, while Jam may be amongst the oldest in the group, his skills and stamina are in the middle. And that's only for the first half of the class- after 15 minutes, he gets lost as to what he's supposed to be doing and kind of tunes out. But it's obvious he's having a good time!

Gymnastics- bi-weekly   This isn't a formal gymnastics class, per se. Our local gymnastics academy offers an hour-long indoor playground daily where 5 and unders can use their equipment with adult supervision. So Jam just moves around jumping on trampolines, going through obstacle courses they set up and trying to get out of their giant foam block pit. More sweaty hard work. It can be a bit loud and chaotic (not great for SPD kids) depending on who shows up, but we just decompress with snack and books in the car afterwards. Even though we live 2 miles away and could just as easily go home. He seems to need that immediate decompress time.

Swimming- bi-weekly   Like gymnastics, this isn't a formal swim class. We just go to the community center pool on a weekday when most kids are in school and 'swim' around for a few hours. It's a great warm water pool with a sectioned-off shallow area for the young kids and also a looped area with a current so he can just float along with a safety vest. And it's taken a year to even get to the point of wearing a vest. And for him to not be overstimulated afterwards. Actual swimming classes are much further down the line, if ever. But in the meantime, the water has been great for sensory integration, improving muscle tone and muscle development.

This doesn't even include at least three weekly trips to various playgrounds to practice those motor skills and two playdates a week to practice those social skills. (The kid's got to have some regular kid fun!)

Sound like a packed schedule?  It is. Especially for a highly sensitive, introverted kid who needs a lot of downtime. Fortunately, to Jam, it's all fun and games. Preschool used to be added to the mix and got dropped (at his request). And originally he was doing both gymnastics and swimming weekly but he was really wiped out by the end of the week so we switched to trade them off bi-weekly. I also stopped dragging him along on errands like grocery shopping and the library (both of which he, as an SPD kid hates going to) in order to increase his downtime at home. We've constantly adjusted around Jam's abilities and energy levels to get to the right balance we have now.  But those are always changing.

Sound like an expensive schedule?  It is. Each day I remember how fortunate I am to be in a situation where I can be at home with Jam and also take advantage of the great variety of therapies and activities available to us. But I'll be honest, it is expensive.

Next time, details on therapy costs!