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Will med help ADHD emotional control?


beishan
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DS is 9 attending 4th grade in public school. He was diagnosed with ADHD PI subtype last year. Neurologist said it was minor and medication should be last source so we did not consider medication at first place. I was originally requesting 504 from school but it turned out that he can be evaluated by child study team as I mentioned his struggling in expressive and written language seem causing a lot of frustration and emotion on him. He is sweet child. He is motivated, so eager to please us, hard working kid and so wanted to do good at school but something is holding him back and causes frustration. His reading and math are on grade level at this moment. Spelling and writing are one grade level behind. We did spend a lot of time catching up reading in the past three years. He worked very hard in school (Wilson reading 5days a week) and at home (OG tutor once a week and I worked with him on DB fast track 4 days a week). He seems very tired everyday and often has emotion outbursts on Friday. His teacher thinks might be due to he was trying so hard to hold it up for the whole week. His teacher has a ADHD son with IEP (her son's issue is visual processing speed is extremely low) so she really wants help my son. According to teacher and school psychologist, his emotion trigger is often a snowball effect. Once small thing triggered him on that day, every little thing went wrong. His emotion outbursts often connected to school works such as bad grading due to careless mistakes on quiz or being called to go intervention program while he wants to finish his reading. Yesterday, his outburt is related to sub he had. He got upset as they cannot watch movie as planned due to sub and he did not understand what sub was talking about in writing time which he needs a lot of help in order to complete the assignment.
Now we are in the process of setting up meeting with school to discuss what evaluation is needed to sort his problem. Meanwhile, I am also wondering if medication will also help to loosen up his frustration and improve on his emotional control. At least help on his focus so he does not need to spend so much energy just to hold up through the day. He has low grade anxiety due to school achievement and his ability to write (we suspect dysgraphia). Will medication side effect worsen his anxiety? Any one who has similar situation, please share you experience with us. TIA.

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It could help. It can be so hard for these kids to have to work extra hard and hold it together.

 

I kinda liken medication to my glasses. Right now I have a minor prescription and am legal to drive without them.....BUT having the glasses makes this gs so much easier, clearer, less strain, etc. Which means less headaches for me. Yes, I can function without the glasses but why not wear them when they really help.

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Even though meds can help, you also have options through the school.  The school should have an OT or SLP (usually an OT) trained in Zones of Regulation.  If they don't, get them to get the training!  There's Zones also the 5 Point Scale.  Your school should have some kind of system like this that they can bring into the classroom.  He can do regular check-ins, have a few minutes of pull out each week for instruction, a schedule to practice his tools, and then the reminder from the teacher to USE those tools.  

 

What you're describing, btw, sounds like some rigidity.  I'm surprised they didn't give you a dyslexia label, given that he's requiring Wilson and SO much extra reading intervention.  At some point you might do fresh, private evals and see if that label gets changed.  Rigidity, perfectionism, visual processing issues, ADHD, you've got a complex situation going.  Absolutely advocate for some intervention by the school.  There's no reason why he can't have BOTH if you want, both meds and Zones.  Or you could start with Zones and see if that gets you where you want to be.  It doesn't sound like his peskiest problem is the ADHD or impulsivity.  It's more self-regulation.  Zones, breaks for mindfulness, their OT should have options for this.

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Even though meds can help, you also have options through the school.  The school should have an OT or SLP (usually an OT) trained in Zones of Regulation.  If they don't, get them to get the training!  There's Zones also the 5 Point Scale.  Your school should have some kind of system like this that they can bring into the classroom.  He can do regular check-ins, have a few minutes of pull out each week for instruction, a schedule to practice his tools, and then the reminder from the teacher to USE those tools.  

 

What you're describing, btw, sounds like some rigidity.  I'm surprised they didn't give you a dyslexia label, given that he's requiring Wilson and SO much extra reading intervention.  At some point you might do fresh, private evals and see if that label gets changed.  Rigidity, perfectionism, visual processing issues, ADHD, you've got a complex situation going.  Absolutely advocate for some intervention by the school.  There's no reason why he can't have BOTH if you want, both meds and Zones.  Or you could start with Zones and see if that gets you where you want to be.  It doesn't sound like his peskiest problem is the ADHD or impulsivity.  It's more self-regulation.  Zones, breaks for mindfulness, their OT should have options for this.

 

I really agree with this. The situation seems very complex and ADHD may only be part of the picture. If they are going to start evals, push for them to be as thorough as possible, including an ASD screening. Once you get into fourth grade, the load and the pressures increase, and that's when some kids with more mild issues will start to have more obvious difficulties. 

 

And, yes. Medication completely helped with emotional control. We went many years without it, but once we started it there was a very obvious improvement. It's the primary reason for using it here.

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Wilson is awesome but five days a week would have been too much for my DS.

 

Your DS sounds overloaded. As OhE stated, it sounds like he has dyslexia and written output issues, which means he should have a reduced workload and silly spelling errors should be overlooked or the teacher should provide an opportunity to correct. You also need to be thinking about some sort of therapies to help him handle his frustrations so that these outbursts don't become a habit or turn him off utterly from school. Meds are an option, but they're won't fix his environment. I am not anti meds by any stretch, just so that you know.

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Wilson is awesome but five days a week would have been too much for my DS.

 

Your DS sounds overloaded. As OhE stated, it sounds like he has dyslexia and written output issues, which means he should have a reduced workload and silly spelling errors should be overlooked or the teacher should provide an opportunity to correct. You also need to be thinking about some sort of therapies to help him handle his frustrations so that these outbursts don't become a habit or turn him off utterly from school. Meds are an option, but they're won't fix his environment. I am not anti meds by any stretch, just so that you know.

 

5 days intensive Wilson (30 minutes each) was provided in 2nd grade and second half of school year in 3rd grade. Now he only gets two 30 minutes reading support session per week. He finds it very easy and he doesn't mind to go as it's not hard for him. Sometimes he did complain it's boring as he knows everything already. I have his tutor work on REWARDS intermediate with him at home and that challenges him a lot. I do think he may have some level of dyslexia. However, when we went to neurological evaluation during summer after 2nd grade, doctor did not find him having disability on reading. She had him read through a list of words and he was able to decode it without issue. He knows phonics very well but does not apply the skills all the time because he wants to rush through it. He has good rote memory with sight words as well (his sight word spelling is also good). His reading issue is mainly on oral reading. It seems that his brain reads faster than his mouth can keep up so he skips little words and ending sounds sometimes which his tutor believes may cause downgrade on his level when school administrates the reading assessment. Also his performance is not consistent. One day he can read above grade level and next day he may be tested below grade level. Not sure if it's the characteristic of dyslexia or causing by his ADHD.

 

He has been going to social skills group with therapist on weekly basis and we do individual counseling with same therapist who has two ADHD children herself whenever he has situation like this. His therapist is trying to address his coping skills through group or individual sessions. He is fully aware of the choices he has to calm himself down but he has not been able to initial the action by himself when he is in the situation.

 

I also worry about the 4th grade workload at school. For writing, the learning disability teacher consultant has advice his teacher to provide more clear step by step guideline on writing requirement, break down the writing assignment into smaller pieces and scribe for him if needed. His teacher has been nice to work with him one on one during writing time. She also crossed out explanation question on his math assignment and homework. The sub he had yesterday probably was not aware of this so she did not help him on writing. He called out for a break this time as he felt frustrated. School psychologist took him in her office and calm him down. He finished his writing there yesterday.

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There are some similarities with my son (but specifics are different).  Now it is 5th grade, and we are going to an IEP meeting on Nov. 4th, and my son is probably going to get some para support (during parts of certain class periods I guess).  I would not have expected this back in 3rd grade (worrying about 4th), but now it seems like, yeah, he needs this.  I do not know the ins and outs, but his only diagnosis is dysgraphia, and his teacher thinks he will qualify for it with that.  

 

Maybe you could ask about that as a possibility.  I also expect for him to get typing for some assignments, and he has already started typing in one class when they have a longer assignment.  He is using the teacher's computer.  

 

Your son sounds really frustrated.  It is not a good situation.  I think he needs to have supports to lessen his frustration.  Maybe medication is one part of that.  It doesn't sound like the only piece of the puzzle, but it could be an important piece.

 

I have been told medication would not help my son, but sometimes I wonder, or wish that it would.  But since I have been told it wouldn't hold, that means I have to get going on all those other little things.  Do what you can.  Ask for more supports, look up supports and see if he can have them.  There are things you might be able to get just by asking.  You might be able to get typing or something like that, you might be able to get "prompts to use his strategies" or you might be able to get movement breaks.  It is hard to say what you can just ask for and get, where you are, but these are all things that might be really easy if you ask.  

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What you're describing, btw, sounds like some rigidity.  I'm surprised they didn't give you a dyslexia label, given that he's requiring Wilson and SO much extra reading intervention.  At some point you might do fresh, private evals and see if that label gets changed.  Rigidity, perfectionism, visual processing issues, ADHD, you've got a complex situation going.  Absolutely advocate for some intervention by the school.  There's no reason why he can't have BOTH if you want, both meds and Zones.  Or you could start with Zones and see if that gets you where you want to be.  It doesn't sound like his peskiest problem is the ADHD or impulsivity.  It's more self-regulation.  Zones, breaks for mindfulness, their OT should have options for this.

 

I will do some research on Zones you mentioned. I will definitely bring it up in our next meeting with child study team next Monday. School psychologist also mentioned that they will review his schedule to see if instruction review is still necessary for him (or too overwhelming him at this point) during meeting.

 

I brought him to COVD two years ago and the only thing found was slightly farsighted on left eye so the reading glasses was prescribed.  He is bilingual which is masking his language issue. It's not like he cannot talk or communicate. In fact he is very talkative and likes to share what he knows. It's just sometimes he seems having trouble to retrieve certain words quickly enough to continue with conversation smoothly so he has to repeat the sentence few times. It does not happen to all his oral speaking language though. In addition, his expressive language has been improved with age so it's not really alarm me till now. Just to be safe, I have asked for SLP evaluation from child study team.

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Maybe you could ask about that as a possibility.  I also expect for him to get typing for some assignments, and he has already started typing in one class when they have a longer assignment.  He is using the teacher's computer.  

 

 

Yes, his tutor has suggested Dragon Speaks software for the time being and she can train him to use it if school is willing to accommodate him with it. Typing may not be very feasible at this moment as it is new to him and he cannot type fast enough to keep up the thoughts.

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That is why my son is going to have para support for scribing, also, I think.  

 

You can ask about para support for scribing, or look into it.  It is another option.  It is an option where it is not "the kid does it on his own," it is an option where you are needing the school to provide it, but it is a possibility.  

 

You can also look on google for "supports for handwriting" "supports for dysgraphia"  "supports for this and that"  (executive function) and you can google "IEP goals" too sometimes.  

 

You might get some ideas that way, too.  

 

Edit:  The OT is going to try Dragon with my son, but they have said they don't know if it will work, that it is hit or miss with kids his age.... also, since my son is officially diagnosed with dysgraphia now, he does qualify for an IEP, so the school can't go, "no, we don't feel like accommodating him, sorry."  But they can have ways that they prefer.  If they prefer something and it works, then that is great.  

 

But, um, we haven't had the IEP meeting yet, so I don't know what will happen.  I have just had some things mentioned to me in conversation at this point.  But I am not going to sign it if I don't like it, b/c I am kind-of annoyed it has taken so long.  

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Leka

 

Please do keep me updated whatever support you can get from IEP meeting. Since my son does not have formal diagnose on dysgraphia, he does not qualify for IEP at this moment. That's the main reason I push for evaluation through school. Good luck on your IEP meeting. We are meeting with Child Study team on Nov 2.

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I will do some research on Zones you mentioned. I will definitely bring it up in our next meeting with child study team next Monday. School psychologist also mentioned that they will review his schedule to see if instruction review is still necessary for him (or too overwhelming him at this point) during meeting.

 

I brought him to COVD two years ago and the only thing found was slightly farsighted on left eye so the reading glasses was prescribed.  He is bilingual which is masking his language issue. It's not like he cannot talk or communicate. In fact he is very talkative and likes to share what he knows. It's just sometimes he seems having trouble to retrieve certain words quickly enough to continue with conversation smoothly so he has to repeat the sentence few times. It does not happen to all his oral speaking language though. In addition, his expressive language has been improved with age so it's not really alarm me till now. Just to be safe, I have asked for SLP evaluation from child study team.

That's good that you're asking for an SLP eval, since there's more detailed testing they can do.  Don't *assume* being bilingual explains everything.  Give specific examples of things you're worried about and require the testing.  For instance, you mentioned trouble retrieving words, but that can be processing speed (which will show up with IQ testing), rapid naming (which is tested in the CTOPP for dyslexia), and even more complex issues with language processing that they would catch with the CELF5.  Your school can run all these. 

 

They may also ask for RTI (response to intervention).  That's actually a proper use of RTI, but they still must complete the RTI *and* the IEP within the timeframe of the law.  Legally RTI cannnot delay the IEP process, not if you make a formal written request.  So if they ask for RTI, you can tell them to fit it within the IEP process.

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He sounds gifted to me. Have you considered homeschooling?

  

 

 

He is bright in some area and has relative strength on nonverbal/figural reasoning but not sure if it's to the gifted level. That's how much I know now. Hopefully we will get some more information after evaluation. Both of his girl cousins on father side are gifted. They ace school works without much efforts and both are in gifted program in PS. It's really heartbreaking to see DS struggling.

 

DH and I first heard about idea of HS few years ago. We do like the idea of homeschool and think it has great benefit. However, we both are not native speaker and don't have our primary education done in US. I have no confidence to teach his language art subject especially if he has some kind of disability in this area.....I can do after school or supplement if he needs but I don't think I can be the main teacher to teach him LA.

 

That's good that you're asking for an SLP eval, since there's more detailed testing they can do.  Don't *assume* being bilingual explains everything.  Give specific examples of things you're worried about and require the testing.  For instance, you mentioned trouble retrieving words, but that can be processing speed (which will show up with IQ testing), rapid naming (which is tested in the CTOPP for dyslexia), and even more complex issues with language processing that they would catch with the CELF5.  Your school can run all these. 

 

They may also ask for RTI (response to intervention).  That's actually a proper use of RTI, but they still must complete the RTI *and* the IEP within the timeframe of the law.  Legally RTI cannnot delay the IEP process, not if you make a formal written request.  So if they ask for RTI, you can tell them to fit it within the IEP process.

Great info. Thanks a lot.

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I just had a thought. 50% of kiddos with ADHD will suffer from motor planning issues. Maybe consider an eval with a private OT that will evaluate your son's vestibular, developmental motor, pincer and core strength, visual perception, handedness, and motor planning. Trust me when I say that if any of those issues exist, you want to deal with them now. The OT evaluation is easy enough and should take about an hour.

 

I expect that your child really benefited from the explicit and multisensory phonics instruction of Wilson. I know several bilingual children locally that required direct O-G instruction. Your child is not unusual that way.

 

 

Good luck!

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You  might have options for language arts, if that is the only or main barrier.  I am not homeschooling, myself.  

 

But, I try to watch my son really carefully to make sure he is not losing his self-esteem.  It is a very real danger.  

 

But some options you might have for language arts:  trading tutoring with someone -- maybe you could tutor math to a child whose mom is weak in math;  hire a tutor;  look for a co-op class where you could make sure he had really good accommodations.  Maybe video instruction or computer instruction plus a tutor or class.  

 

These are all things that I think would make up for you not being a native speaker.  

 

If he is getting frustrated, either it is going to get better, and he will get less frustrated.  Or, it is going to get worse (b/c 3rd grade gets progressively harder during the year, too -- and then there is 4th grade, etc) and he is going to get more frustrated.  

 

It is only October for 3rd grade to be getting hard, 3rd grade is going to get harder over the year.  

 

If your son is doing well, happy, not too frustrated in the scheme of things, then that is one thing. 

 

If he is getting more and more frustrated and it is starting to effect him -- then that is really a problem, and I think that is a much worse problem than just having a parent who is not a native speaker of English, because there are a lot of options that could make up for that.  

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It is only October for 3rd grade to be getting hard, 3rd grade is going to get harder over the year.  

 

If your son is doing well, happy, not too frustrated in the scheme of things, then that is one thing. 

 

If he is getting more and more frustrated and it is starting to effect him -- then that is really a problem, and I think that is a much worse problem than just having a parent who is not a native speaker of English, because there are a lot of options that could make up for that.  

 

His frustration is our number one priority to address now. Honestly, I think he has too many extracurricular activities. He takes violin lesson (30 minutes) on Monday evening, tutoring (1hr) on Tuesday evening, Social Skills group (45min-1hr) on Thursday evening, Swimming (30min) on Friday evening, Chinese school (40min+40min) on Saturday afternoon and ice skating (30min group+30min individual+30min free play) on Sunday afternoon. Besides going to lesson, Chinese and Violin require daily practice as well. Even I as an adult, I already feel tired driving him to and from those activities after work for these two months (starting Sept).Ice skating and swimming will end next week and hopefully it can release a little bit of stress on us.

 

Last year when he was 3rd grade, things were going pretty smoothly. He was more organized and productive on his reading/writing. Even he still had his emotional "moments", his teacher was easy to redirect and calm him down. She rarely need to call me to address anything. DS loves his 3rd grade teacher so much. I do feel that he is overloaded this school year which may also increase his frustration level especially on subject that he feels hard (writing) and weaker emotional control.

 

After outburst on Tuesday, I decided to cut out his Chinese homework completely this week and get him on bed early. I also told his Chinese school teacher to waive his bi-weekly quiz which usually makes him panic. I feel Chinese homework has become burden for both of us in the evening hours but DH does not want him to drop it. I told DH that I can HS his Chinese (on his own pace and without HW/exam to make him panic) if he really cares about that.

 

His emotional control improved after he got plenty of good sleep (9pm to 7:30am) on Tuesday night. He went swimming on Tuesday evening instead of having tutoring session. I also put him back to special formula multi-vitamin supplement which contains more B6 and B12 in it along with calcium, magnesium and fish oil he takes daily. He has a great day on Wednesday and seems happy today when he woke up by himself this morning. I will keep my finger crossed......

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I just had a thought. 50% of kiddos with ADHD will suffer from motor planning issues. Maybe consider an eval with a private OT that will evaluate your son's vestibular, developmental motor, pincer and core strength, visual perception, handedness, and motor planning. Trust me when I say that if any of those issues exist, you want to deal with them now. The OT evaluation is easy enough and should take about an hour.

 

 

I've never thought about motor planning as he seems not having issue with motor skills as far as I can tell. I will put this on my list and ask during meeting. Thanks

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Without reading the responses, if his emotional issues are directly due to problems with focus; for example, if he has a hard time controlling his frustration because he can't get his work done, and the meds make it easier for him to finish his work, then yes, the meds will definitely help. You should see short term and long term results. I saw this effect with my younger son, who has ADHD. 

 

That said, sometimes kids with ADHD & Autism have such significant issues with emotional regulation that they will need continual support/therapy to help with this regardless of medication. This is the case with my older son, who has Autism. 

 

Lots of sleep, supplements, and a calm, predictable schedule all help.

 

Eta: to add more information

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Just had parent teacher meeting last night. Since teacher and we met two weeks ago along with principal and learning disability teacher consultant to discuss his progress and did the referral. We've already gone through his academic progress. Main problem is on language art. She said both reading and writing are below grade level. Learning consultant has suggested her to step back on language art components to reduce his anxiety level. Before evaluation result coming out, she will reduce the workload and try to accommodate as much as she can in the classroom. So far DS is doing fine at classroom and emotion control has been steady. We will see how he is doing today because his moment typically happens on Friday.

I also spoke to our tutor last night about assessment she did. She said his reading part will be well oo grade level if we don't consider the writing part of assessment. He can answer question that you can find directly in the story but it's hard for him to answer comprehension questions that go deeper. That will bring down him to below grade level which matches what school has. She said he does not have classic dyslexia or dysgrapgia symptoms as far as she can tell. His reading is progressing even though we need intensive support to get him going at first. At least now he feels comfortable and confident doing reading works. Two years ago, he was crying when she asked him to read one chapter from simple chapter book. Now we see the same resistance with his writing so she believes he will eventually overcome it. She also mentioned executive function and suggested to go to local college to do neuorpsychological evaluation if school evaluation does not find descrpancy.

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Just got back from meeting with child study members. Below is the list of evaluation that they agreed:

 

Educational Evaluation

Psychological Evaluation

Social History (parent interview with social worker)

Speech/Languiage Evaluation

Psychiatric Evaluation (referred to outside psychiatrist and fee will be reimburse by school)

 

I mentioned executive functions to School psychologist and she said it will be part of her test. None of them heard about Zone of Regulation bu will look into it.

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  • 4 weeks later...

Yesterday we had psychiatric evaluation. Psychiatrist suggests psychotherapy to address frustration issue. He said he does have some symptoms of ADHD but nothing serious as far as he can see now. He does not think it's to the point that medication is needed. However, he will need to wait till other evaluations (educational, psychological and speech) in place and then he can make final conclusion. Doctor thinks his frustration mainly coming from academic struggling as he is generally calm and rarely has completed outburst outside of school. At home, he still argues and has bad emotion sometimes but not as bad as what school reported. I normally can convince him and calm him down easily. Comparing with some clients I am dealing with at work, DS is much easier to handle in my opinion.

 

We also started Zones at home. He adapts the skills right away. He is very good at telling Green and Bule Zones. He normally handles blue zone very well. Yellow zone is the one he has issue with. It's harder for him to initial action by himself without proper adult intervention when he is in this zone so quickly he will go into red zone. I think that's what happened in school. We will try to read more from the curriculum and see if we can dig further to help him. Thanks for recommendation. DS social skills group therapist just ordered the Zones curriculum and poster for herself as well.

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I just had a quick note on the university route. I called our local university, UF, and they are a teaching hospital ( medical school and other schools in that feild). From my personal experience my former neurosurgeon went to work there teaching. He was sought out from patients across the country. He was just that good.

 

When I lamented he was leaving private practice , he told me, shands/UF employs the top professionals from across the country. That's why UF's medical schools are so hard to get into. They are GOOD.

I feel like I will get a better assessment there having top professionals overseeing.

 

I have had some really inept professionals work with my kids and ...that's been at the good places. So...point is:

 

You just never know how good the university maybe until you call.

 

I had a procedure many years ago at....John Hopkins do believe it was. Was 30 yrs ago. I'm from D.C. memory fading. Anyway. Was teaching hospital and awesome. They were the ones most qualified to take my case. Kinda like the Mayo clinic for D.C. lol

 

Jus never know til ya try.

Just my 2 cents :)

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