Okay...well now that I lost my original reply...I'll try again:
Whatever you and/or the provider can do to keep up with OT will help keep things moving forward.
I assume the provider is aware of the diet...are you sure he/she is not unintentionally giving illegal foods or products? This would include such innocuous things as art supplies, playdough, temporary tattoos, etc. Do you provide all the food? Apologies if you are already up on all this...when "meeting" someone for the first time, it's always hard to know how experienced a parent is when it comes to the diet...
Is the antifungal topical or oral? Some of the recent behavior sounds like a die-off reaction. If this is oral I would definitely look into a yeast/bacterial problem as one of the underlying issues behind the behavior in general.
The impulsiveness and especially the hyperactivity could be related more to his inability to process salicylates, phenols or other compounds in food. Have you heard of the Feingold or Failsafe diets?
http://www.feingold.org
"Why Your Child is Hyperactive" by Ben F. Feingold
http://www.plantpoisonsandrottenstuff.in...lsafe.aspx
“Fed Up†by Sue Dengate
One way to figure out if any of this is an issue is to put his foods into rotation, having a food group every 4 days. Keep a food journal as you do this and you may find that certain days are worse than others. An inability to process the salicylates "typically" shows as red ears/cheeks and/or hyperactivity after eating. It can also show as poor behavior.
Have you tried epsom salt baths? These add an easily absorbable form of magnesium to the body and can help the body process the salicylates/phenols. Starting low and slow, it should be a very calming experience for the child. Typically, it's one-quarter cup salts to a tepid bath filled to the belly button and soaking for as long as the child is willing. Consider it bathtime playtime perhaps. (Some people can soak their feet but a 4yo is unlikely to comply with this option!) You can rinse him off at the end or not...each person is different.
http://legacy.autism.com/medical/researc...gstudy.htm
http://www.enzymestuff.com/epsomsalts.htm#3
If he is a positive responder to the baths then you have a clue that phenols may be a problem. This can be addressed by reducing his phenol load during the day, adding digestive enzymes specifically targeted to phenols (there are a couple that I know of), adding magnesium to his daily supplements and making ES baths part of your routine.
You may also find these books helpful. While they both talk about autism, children with just SPD suffer from some of the same systemic failures and benefit from the same treatments. The parents of one of the sensory forums I'm on really relate to Bock's book. I personally find Jepson's book highly informative. Bock's book is also informative on the systemic relatedness.
“Changing the Course of Autism: A Scientific Approach for Parents and Physicians†by Dr. Bryan Jepson with Jane Johnson
“Healing the Childhood Epidemics:Autism, ADHD, Asthma, and Allergies†by Dr. Kenneth Bock
What packaged foods is he getting?
Lastly, a deficiency of magnesium and B6 are common in children with hyperactivity. Pulling gluten further reduces an easy source of the B-vitamin group as a whole. You might want to consider adding a B-vits in addition to his daily supplements. Not that I am paid by or a spokesman for Kirkman Products, but they do sell a multivitamin that is higher in the B-vitamins than most others. You can get a trial size.
http://www.kirkmanlabs.com/
Anna in MD
