CLINICAL EDITOR’S COMMENTS:


family strengths and vulnerabilities, child health and wellbeing, and any events or ongoing issues that may present stressors to the child or the family system. In so doing, the presenting problem and the child’s psychosocial stressors can be understood within a broader family context.


Psychosocial stressors affect everyone, especially children, and the child’s perceived stress from all areas of his or her life likely will manifest in his or her behavior. The parents’ educational background, family dynamics, the child’s personal resources (e.g., talents, accomplishments, hobbies), and other events over which the child has no control (e.g., parental separation or divorce, frequent family moves), may influence how the child engages 


Developmental history and current information about the child’s habits may give clinicians a better idea of the child’s general wellbeing. Historical information about developmental milestones, eating and sleeping patterns or changes (including sleep disturbances and nightmares), and medical history (including head injury) may offer ideas about the child’s baseline characteristics and dispositions. Therapists also should ask about different emotions and behaviors that manifest regularly or occasionally, such as fears or anxiety; tearfulness, sadness, or depression; irritability, anger, or explosiveness; and any sensory hypersensitivities the child may have to hearing, touch, taste, smell, and sight.


Additionally, screening for the family’s history of psychiatric illness, suicide and suicidality by the child, trauma or abuse, recent or past deaths  system will give clinicians a better idea of what stressors the family has endured and potential vulnerabilities the child may have. Asking about domains that may affect concentration and social engagement, such as caffeine intake, compulsive behaviors, socialization, play behavior (e.g.,         and concentrate on tasks, in general, will help clinicians understand how the child interacts with others and invests in different settings.


Once this anamnesis has been explored, play therapists can work closely with parents during this initial stage to formulate therapeutic objectives for their child’s care. Treatment planning together raises the potential to achieve the best possible result for the child.


Multidisciplinary Approach to Assessment,


Diagnosis, and Treatment Planning Caring for and treating a child with ADHD involves interdisciplinary cooperation and alliance. Obtaining signed parental consent and releases of information allows the clinician to interface with schools, pediatricians, neuropsychologists, occupational therapists, psychiatrists, and other professionals who may have insight into the child and his or her level of functioning. This enables the clinician to gather additional information about the child,


further enhancing a clinically holistic,


thoughtful treatment plan centered on an understanding of the child and his or her world.


The author provides comprehensive suggestions for treating ADHD through a multi-layered, child- centered, and interdisciplinary team approach.


Occupational Therapy Evaluation An occupational


therapy (OT) evaluation may be warranted due to


pronounced sensitivities in all or some sensory domains, such as touch, sight, smell, hearing, and taste. The OT evaluation is needed if the child dysregulates emotionally or behaviorally in the presence of or after exposure to a particular sensory domain. For example, some children may be acutely sensitive to various fabrics, or their behavior may become     children cannot tolerate certain tastes or food textures, so they may eat 


Occupational therapists are specially trained to work with children to help them desensitize these overactive sensory areas. Although OT may be supported at school as time and availability allow, parents should also consider OT from a private agency because children often are embarrassed about being pulled out of their classroom, the child may miss a segment of learning that is integral, or he or she may not want to miss classroom activities. Additionally, private OT may be more comprehensive because sessions are often longer. School-based occupational therapists have limited time to see each child. In some cases, both school-based and private OT is needed. OT at school for some children helps them regulate their body during the school day, which enhances their concentration capacity and ability to learn and retain information.


Neuropsychological Evaluation If parents report incongruities in academics, such as increased anxiety and poor grades in math, yet excellent grades and facility in English, this may be an indicator that a neuropsychological evaluation is needed. Some children exhibit high anxiety and dysregulation when receiving information from the teacher and trying to take handwritten notes. Other children display social awkwardness, have trouble maintaining eye contact, or have a very high IQ but have trouble spelling words. A neuropsychological evaluation will spectrum disorders,


help diagnose possible autism learning disabilities or weaknesses, and clarify


diagnoses of anxiety and depression, any of which may co-exist with ADHD (Ray et al., 2007). A therapist’s introductory letter to the neuropsychologist with referral question(s) may be provided as a professional courtesy that initiates this process, but the parents should make an appointment with the neuropsychologist to set up the evaluation.


Educational Evaluation and Accommodations Once diagnosed, protecting students’ rights and ensuring their access to free and appropriate education in the school setting is important (U.S. Department of Education, USDE, 2010). Therefore, it is critical to send school personnel a copy of the recommendations section from the


www.a4pt.org | March 2019 | PLAYTHERAPY | 11


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