post removed

[Linnet]

post removed

Edited August 26, 2016 by Linnet

[Targhee]

First, I want to extend some empathy. I have three with ADHD, and my third (dd9) sounds very similar to yours, right down to social butterfly and gym rope swinging. She's predominantly hyperactive. DS is combine type, and oldest DD is predominantly inattentive. Also, judging by your descriptions I think I can empathize with your feelings of anxiety over being next to the microphone during church. DD9 took advantage of the microphone during her first primary program (age 4) with a goofy noise and a giggle after saying her part. Next, I think I can empathize with some of your anxieties/emotions surrounding labels and the potential to hold her back or cause her to be treated differently. I think many people think along those lines when considering diagnosis.

 

I think you are doing a great job of being an attentive and proactive mom. IF you are fairly certain she would get an ADHD diagnosis I would go ahead and get it though her pediatrician. This shouldn't cost you much (just Doctor visit fees). You wouldn't believe the value of a name - at least, for me that value of a name meant that I could take less pressure off me, and my kids, for things not being "normal." You don't need to start behavioral therapy necessarily, or meds or anything else. But having a health professional helping you track behavior (and keep things in perspective) can be a real asset. It's just like getting a professional on your child's team.

 

As far as IEP, it is unlikely she would get one for ADHD anyway. Most often ADHD kids don't get them (even if they really should) and end up with a 504 if lucky. Even then, you need documented response to intervention before getting a 504.

 

I would suggest you continue to do what you are doing. Sometimes token economies work great, and sometimes kids get bored of them and the effectiveness wears out (boredom is a whole different thing with the ADHD mind). Use your economy as long as it is working, but be prepared to shift away from it if it is no longer effective or if the behaviors become more intrinsic. I highly recommend Superparenting for ADHD by Hallowelll as another resource for your TOOL kit. Zones of Regulation wouldn't hurt anyone to use - do you notice her having a hard time regulating emotions? You might save this one unless you notice real diisregulation.

 

If it is ADHD no early intervention is going to change that - it is the way her mind is physically and cognitively and developmentally. The most important thing you can do early on is to love your child, advocate for your child, set firm but loving limits for your child, and know kids will do well if they can.

 

HOWEVER, there are a few things that make me think it may not be ADHD. The most obvious things are she remembers every night to do her routine, and she takes her own initiative to do work for delayed reward. Those are executive skills that are usually very behind or lacking in kids with ADHD. Heck, I am still getting after my oldest to get her night time routine done every night - she still needs reminders - after roughly 8 years of the same basic routine. And it wasn't until DS was 10 that he could pull it together enough to complete his chores so that he would have more time to play outside or watch a movie or whatever. It could be that you simply have a very bright, active, vivacious kids on your hands that's just going to push limits and live a little wilder than most. I think your best option is to continue supporting her right now as you have been. Pray about it - about you having the insight and the direction and the capacity to do what you need to as mom.

 

Best wishes!

[PeterPan]

I agree with Targhee that you've done a lot of good things!!  I also agree that some of her EF skills are striking compared to her impulsivity.

 

Here's an article on using tokens.  Maybe it will give you some ideas. I use motivators with my ds, but our goal is to dispense 20 in 2 hours and maybe only remove ONE.  And if he has one removed, our goal is to create a scenario where he can earn it back immediately. If she can understand natural consequences, I think you might like to consider them instead for your negatives/removals.

 

 DOs and DON'Ts of Using Fines or Response Cost to Reduce Challenging Behavior - Autism Classroom Resources

 

I know she has an article on there about extinguishing behaviors by differential, and I couldn't find it quickly.  Lecka can, because she always knows the right words.  Anyways, I think one way to do positive behavioral supports in your gymnastics setting would be to count how many times she's having the behavior and then try to decrease that by one.  So if she normally has 4 incidences of not listening, then try to get it to three and reward with a nice reward (ice cream cone on way home, whatever).  When that is stable go down to 2, and so on.  But don't be generic about it.  Pick one behavior, like obeying the teacher OR waiting in line behavior.  I would probably start with waiting in line behavior (if that's an issue for her), because that's one that just plagues the whole class and affects everyone.  

 

A few more thoughts.

 

-Look at antecedents.  Log behavior for a week and actually write down the antecedent (what was going on before), the behavior, and the consequence (how people responded).  When I did this, I found patterns in my ds' behavior that I hadn't realized.  I found that a LOT of his challenging behaviors were occurring during transition times.  I'm *guessing* that with your dd a lot of these behaviors are occurring when she's waiting.

-Teach replacement behaviors or strategies to use in those situations.  Once you have the data to figure out what the pattern is, you can teach a strategy or replacement behavior.  My ds went through a stage where he would hold his arms REALLY TIGHTLY at his side.  I asked the OT what in the WORLD he was doing and whether there was something wrong with him, and she says Oh, he's just HOLDING IT IN...   :lol:   

-You could talk with the head of your gymnastics program and ask about replacement behaviors or strategies or what would be acceptable.  They might want to have a talk with their teacher to give the teacher more strategies.  At our gym, that behavior, while not desired, is worked through in a positive way (ignored, provided with more structure) in lower classes.  It's only if she moved to pre-team that she would get a sit-down with her parents and the coach and a quick talk about expected behavior and how it's time to step it up.  Given her age, they're probably trying to keep it positive.  There's LOTS of ADHD in gymnastics.  She's not the first one to do this.  ;)

-Look for situations with more STRUCTURE.  You can pay $1-2K for a psych eval, and one of the major things (s)he is going to tell you is STRUCTURE.  

-Yoga, mindfulness, etc. improve EF by 30%, so yes those would be good.

-Increase the physical.  My ds takes classes at the Y, and at the team level they have fund raisers to bring things in reach for kids.  As you go through the levels in sports, they're going to step up the requirements (gradually!) for attention, self-control, etc.  She'll have a variety of teachers, so it will click in her mind that she obeys ALL the teachers.  My ds was like your dd two years ago, and now he's on team gymnastics and starting swim team as well.  He's doing Crossfit, but we'll drop that when we start swim team.  With his amount of energy, he basically never wears out!  Sports have been AMAZING for him.  Gymnastics is the ultimate sport, so I'd HIGHLY, highly, highly recommend pursuing it.  Our kids' profile is what becomes a good gymnast.  That energy gets funneled a good way, and they don't burn out from the hard work.  I try to keep my ds in the gym 3-4 days a week and in the pool 3-4 days a week.  Our Y has been really good, helping me to have options for that.  LOVE our Y.  More affordable than private and they're focused on CHARACTER.  So our gymnastics coach is way more concerned about who you become as a person than whether you win or lose.  The sport is jut the foil to grow.  So if you can increase her access to sports, connect her with good coaches who will work with her and help her grow, that will be good.

 

Hmm, thinking about interventions.  I did the Zones of Reg training.  It's good stuff.  If you had it lying around I'd have you do Incredible Flexible You instead.  Zones of Reg is really more appropriate for older kids (3rd and up), because younger dc are really not ready to be *accountable* for applying the material to change their behavior.  So she would learn the words but it's not developmentally appropriate for her to be accountable for applying it.  IFY has all the basic social thinking concepts, and given how bright she clearly is I think you could use it to go to the next step.  For instance, book one covers Thoughts and Feelings.  So you're going to explore the idea that you have thoughts and feelings, I have thoughts and feelings, and they can be DIFFERENT!  Huge applicability.  When we have unexpected behaviors, people have weird thoughts and feelings.  So when she's in gymnastics, what is expected behavior, what is unexpected behavior, how does the teacher feel about her behavior...  It would just give you more *positive* ways to teach and work through this.  

 

The free option would be to go to the Social Thinking website and read any articles she has.  Winner has TONS of stuff on there.  Therapy is kind of a catch 22.  It's slow, and you're basically paying for someone else to use those materials.  I pay $75 an hour for a behaviorist to work with my ds.  Frankly, I'm about burnt out.  I have a kid going into college and am dealing with 3 SLDs, apraxia, ASD, ADHD.  It's too much.  I hire help.  But if you want to buy the materials and just use them, they would give you the foil to discuss these things and engage her cognitive.  IFY is targeted at ages 4-7, so she's PERFECT for it.  She doesn't have to have autism or anything else.  I think you'll find that that set alone would give you enough discussion points to tackle these behaviors with not listening, not being in the group, having unexpected behaviors, etc.  

 

Don't view it as a fix or a sprint.  Take a step, do some things, then later take the next step and keep plodding, kwim?  

 

Has she had an OT eval?  Will your insurance cover one?  Sometimes these kids turn out to have retained reflexes and things you can actually work on.  The OT can talk with you about mindfulness, calming strategies, sensory tools, etc.  One of the major concepts of Zones is that it's PRO-ACTIVE.  So you set up a box of calming choices, make a pick 4 board, and practice them.  You could do this daily, twice a day.  Not only does it help them stay regulated in a pro-active way, but then it gives you a way to say oh my motor is REALLY FAST right now, let's make some calming choices!  There's a different kit that is actually a bit better for this.  Name slips my mind.  We've talked about it here on the boards.  It shows a speedometer/tachometer and you turn it to show how fast your engine is going.  Then you make choices for that speed.

 

I think you could go either way about evals.  You know she's likely to get the label.  If the psych is one to really sit and TALK with you and help you, you might learn a ton.  I used one psych who was very empowering and who gave me good advice that has helped me for years.  I used another psych who was an arrogant jerk.  You just never know.  You might have some issues with low processing speed, etc.  I would want her eyes screened (just an annual check-up) by a developmental optometrist.  I would want an OT eval by someone who can discuss sensory issues, self-regulation, and check for retained reflexes.  

 

A lot of adults harness their ADHD.  You might study how it works out for them and carry those strategies down.  When I go to the Y, I see a LOT of adults successfully harnessing their ADHD.  Just saying.  Do you drink tea in your family?  If you do, maybe she's getting some benefit from that.  You're doing a LOT of good things.  Keep doing them.  I think when you need evals, you'll know and get them.  Sometimes there are things people are trying to distinguish or the ADHD is causing problems with academics.  You'll probably want them later, but for now it's really your call.  

 

Adding: Neurofeedback and Interactive Metronome both can help with the impulsivity component.  My ds has been getting neurofeedback this year.  Heathermomster has some hack/free metronome work instructions.  You could try them, just to see how she does.  For my ds, even to do a single clap was hard, and he'd go into hyper-clap.  For him, we just added in some clapping to our day, hand-on-hand, one clap at a time.  That was his starting point and it's free.

[Crimson Wife]

It sounds like maybe she has sensory processing issues and that might be exacerbating the hyperactivity. I would recommend finding an Occupational Therapist who is familiar with Sensory Integration to do an eval and help devise a "sensory diet" for her. Even if her fine motor and self-care skills are within the typical range, an OT who is knowledgeable about SPD could prove very helpful to her.

 

The inattentive issues you may not see at her age if she's in a play-based preschool & not doing much "seatwork" at home yet. My DD didn't really start to show the inattentiveness in a major way until K. That is when we started pharmaceutical treatment for the ADHD.

 

I was very leery of meds and had seen an integrative neurodevelopmental pediatrician who literally wrote the book on non-pharmaceutical treatment of ADHD. We exhausted his long list of suggestions and my DD still was experiencing symptoms that significantly impaired her daily functioning. At that point, he agreed that we should try meds. He is not opposed to using them but feels they are WAY overprescribed and should be a "last resort" rather than the first thing tried.

 

My DD is like night-and-day better on the medications. We wound up using a combo of a stimulant in the morning (started out with a 4 hour one for the 1/2 day of K and then switched to an 8 hour one) and a non-stimulant (clonidine) in the evening. The stimulant helps with focus and the non-stimulant helps with the hyperactivity. They work better together than either one alone.

[Linnet]

post removed

Edited August 26, 2016 by Linnet

[Linnet]

post removed

Edited August 26, 2016 by Linnet

[Crimson Wife]

If she does better in quiet than noisy group situations, I would recommend getting an updated audiology exam (even if she's had normal ones in the past). Most likely her hearing is fine, but it's possible that some of the symptoms attributed to ADHD might actually reflect difficulty hearing. My DD was "spacing out" at preschool in 2013 and when the EEG came back normal, everyone chalked it up to ADHD. It wasn't until two full years later that we discovered the progressive hearing loss. I regret that I didn't have another hearing test done but none of the doctors or therapists suggested it and it didn't occur to me.

 

You want a full booth test not the quick screening at the pediatrician's office. The screening is only a few frequencies and it is at a loud enough intensity that it won't catch a mild loss. But even a mild loss can cause significant problems for a child.

[Linnet]

post removed 

 

Edited August 26, 2016 by Linnet

[Terabith]

What strikes me is the expectations. She's sitting in church for three hours. I know it's mixed up some, but that is a LONG time.

 

It definitely sounds like there is some impulsivity, but her overall executive functioning sounds quite good for her age. She really sounds like a lot of fun, to be honest. Does she get a lot of positive feedback from peers? I wonder if she is feeling self conscious? I have a kid who will act bizarrely when she feels uncomfortable or self conscious.

 

I know a lot of five year olds can sit appropriately at church for three hours, but there are a lot that can't.

[Linnet]

post removed 

 

Edited August 26, 2016 by Linnet

[PeterPan]

Structure is clear expectations.  So clear beginning, steps and end.  Clear plan.  Delineated expectations. It can even be really child-led, with the child having choices, but it still goes back to let's make 3 choices and here's our plan.  Increased structure can reduce anxiety.  If she's in a school environment with low structure, you might see an increase in behaviors that could decrease in a higher structure situation.

 

There's a book Helping Your Anxious Child that the Social Thinking people recommend.  I got it through the library.  

 

Are you connecting the animal sounds and animal behaviors to anxiety?  

 

Have you checked to see what your insurance will cover, how high your deductible is, etc.?  Some states even have disability scholarship and coverage.  

 

Like the others, I'd be doing something draconian about that church schedule.  Make an executive decision and cancel and hour that you and she attend.  Or show up an hour late.  Or take her out and color in the foyer while listening, so she can move.  Create some definition to it.  Or go into a cry room so you can hear/see but have movement in a defined space.  My ds has a bag with a rotated picture Bible, paper to draw, quiet snacks, etc.  But that's 2 hours broken up, not 3.  Or take her out between 2nd and 3rd hour and go do something to burn off some energy, killing maybe 15-20 minutes of it.  Then just sneak in.  

[Crimson Wife]

Like the others, I'd be doing something draconian about that church schedule.  Make an executive decision and cancel and hour that you and she attend.  Or show up an hour late.  Or take her out and color in the foyer while listening, so she can move.  Create some definition to it.  Or go into a cry room so you can hear/see but have movement in a defined space.  My ds has a bag with a rotated picture Bible, paper to draw, quiet snacks, etc.  But that's 2 hours broken up, not 3.  Or take her out between 2nd and 3rd hour and go do something to burn off some energy, killing maybe 15-20 minutes of it.  Then just sneak in.  

 

If the OP is the denomination I suspect, that's not going to work as they are very strict. And it's different enough theologically from other denominations that switching to a different denomination church that has a SN ministry wouldn't work. 

[PeterPan]

Crimson, I guess we could rant (about inflexible leadership, etc.), but we won't   :D

 

Edited May 9, 2016 by OhElizabeth

[Linnet]

post removed

 

Edited August 26, 2016 by Linnet

[Tiramisu]

Just throwing this out there. One of my girls was exactly like yours with the impulsivity and making people laugh. It was extremely obvious by age two. She was also very good at some things you wouldn't expect with adhd and she had no problems in school until middle school. She was very social but not always appropriately so, like making fake burps and laughing uncontrollably. Anyway, her differences, her social and EF difficulties became more obvious in puberty and she eventually got an ASD diagnosis.

 

I'm bringing this up because I wish someone had brought it up with me when she was five.

[Tiramisu]

If she does better in quiet than noisy group situations, I would recommend getting an updated audiology exam (even if she's had normal ones in the past). Most likely her hearing is fine, but it's possible that some of the symptoms attributed to ADHD might actually reflect difficulty hearing. My DD was "spacing out" at preschool in 2013 and when the EEG came back normal, everyone chalked it up to ADHD. It wasn't until two full years later that we discovered the progressive hearing loss. I regret that I didn't have another hearing test done but none of the doctors or therapists suggested it and it didn't occur to me.

 

You want a full booth test not the quick screening at the pediatrician's office. The screening is only a few frequencies and it is at a loud enough intensity that it won't catch a mild loss. But even a mild loss can cause significant problems for a child.

The DD I mentioned above did not have the typical sensory avoidance behavior until she got older. When she was young, she was a sensory seeker. I really think her humorous antics were part of the sensory seeking.

 

Also, this DD had a full CAPD eval since her sister has CAPD and I saw some similarities with a lot of what?" But her auditory processing was fine. FWIW, I think the np would tie those "what?"s in with EF and attention shifting.

 

Anyway, we finally discovered that DDs major processing problem is visual. I would never have figured it without the np testing. Since then I've wondered if her over-the-top behavior was related in some way to her poor visual processing causing her to miss more subtle cues of disapproval and instead going all out for a big laugh.

[Linnet]

post removed

 

Edited August 26, 2016 by Linnet

[Tiramisu]

Are you planning to get her checked by a covd optometrist?

[Linnet]

post removed 

 

Edited August 26, 2016 by Linnet

[Tiramisu]

Is that the same thing as a developmental optometrist? This thread is the first time I have heard of that.

 

Yes, it's the same. You can find one be going to the covd.org website where there is a directory of providers.

 

The article linked was interesting, and I wonder what the perspective of a developmental optometrist would be, especially because there is a strong link between ADHD symptoms and very treatable eye muscle issues. Research is being done on convergence insuffiency, which is very common, how its symptoms mimic those of ADHD and what happens when it's treated with vision therapy.

 

(ETA: I was just thinking if methyphenidate gives my dd control over her general impulsivity, it makes sense that it could give a child better control over their eye movements. At the same time, if vision therapy could improve eye muscle control that would then influence overall behavior, I'd rather do that. That's really the reason I took a couple of my kids to the covd guy, hoping I could find a treatable reason for some of the issues and avoid meds. Now, of course, I'd like to take a video of my dd's eyes on and off meds.)

 

I think the eye movements would be worth looking into, especially if they are enough for a regular optometrist to notice, because the more common scenario is a child struggling and an optometrist or ophthalmologist saying, her visual acuity is fine so it's not a visual problem.

 

From my experience, there are different possible scenarios. My first kid was found to have a problem but my covd guy said it was deeply neurological and not something her could fix, and it's true she has multiple issues we later found with np testing (but she's a college senior now following her passion with accommodations). Second and fourth dc did vision therapy for clear eye muscle related conditions and it helped them with a clear difference before and after, even though both of them seem to have other subtle stuff going on. My third kiddo, the one like the OP's DD doesn't have an eye muscle problem but a visual processing issue, probably in part related to an ASD processing style of not being able to process a lot at a time.

 

The visual stuff is not simple and it's rarely one discrete problem but a good, honest covd doctor can help you identify the issues and tell you what he can help with.

 

(ETA: Can I say again how much meds helped with impulsivity? I wouldn't want to push them, but if I had the chance to do it over again and use something that could help her control her behavior more, I would have done it differently. The thing is, her behavior started to get to people, especially at home. What was cute in a small child wasn't as cute or easy to overlook in an older kid. And it wasn't all funny, there were meltdowns, too. The other kids began to resent her. Dh and I were on edge around her and she felt it. She felt awful about herself and hated by everyone else. And that stuff can do more damage than anything else. So my words of caution are to keep close watch on her emotional state and don't wait to get help with whatever therapy works for you. For bright girls, it's very easy for anxiety and depression to take over. My dd had a couple of bad experiences when she was five and she went from silly and happy to dark and angry very quickly. Treatment has helped immensely, but I wish things didn't get as bad as they did.)

Edited May 10, 2016 by Tiramisu

[Crimson Wife]

It's definitely worth having a screening by a developmental optometrist. My DD was able to get the screening done as part of a normal eye exam covered by our vision insurance. They won't unfortunately cover the binocular vision exam, but if we go to the UC Berkeley School of Optometry clinic, we might be able to get it covered under our health insurance. DD was originally going to do the first part last week and then the second part this week, but then her cochlear implant surgery got scheduled for last Friday. So I had to cancel the BV exam and we'll most likely do it in the fall.

[Linnet]

post removed

Edited August 26, 2016 by Linnet

[PeterPan]

Cool!  Let us know how it goes.  Lots of people here have done VT, OT, etc. with our kids, so we love to talk about it.  :)

[Linnet]

post removed

Edited August 26, 2016 by Linnet

[PeterPan]

I would get the VT, no matter what.  CI responds very well to VT.  Literally with 2-3 months of treatment you could have it FIXED.  

 

My dd wears bifocal contacts and likes them a lot.  She had VT, and because she is low tone overall her eyes just fatigue more easily.  For her, the bifocal contacts are a perfect solution.  They're flawless to implement.  

 

I'm just thinking that's a lot of money for bifocal lenses, mercy.  Are you filling them through Zenni or Walmart (cheap) or at the optom?  Just putting in my two cents to go easy on that.  CI should respond very well to VT and be corrected.  If her eyes are not converging properly, her visual processing has been affected.  It's sort of a domino process, a cascade.  So to say oh it doesn't matter, we'll just do bifocals, that's like saying your toe nail is ingrown but don't bother to fix it.  Of course you do, kwim?  You do because you actually need the function and because it's a doable thing to fix!   :)

 

The glasses can be useful to reduce strain during VT.  Did she need a scrip anyway so this was like oh let's just throw some power in it?  Because your other option would be to fill the normal scrip nice and to fill the support scrip (the bifocal part) with something cheap like Zenni or Walmart.  Zenni is not as good, but they're adequate.  That way if you only need the lenses a while or occasionally you're not like wow we paid $$ for them, kwim?  Just another way to approach it.  

 

Adding: Did they check for retained reflexes?  If they didn't, you still want an OT eval to get that checked.  OT issues can cause the midline issues that cause the convergence issues.  They go together, sigh.  

 

Not trying to frustrate you, btw.  Just trying to keep you from being frustrated.  When my dd started a scrip like that, it exaccerbated her CI and made it WORSE, not better.  So sometimes that's why they're doing it, because they think they won't convince you to do the VT so they're like ok then lenses.  But really, if the CI is there, just treat it, kwim?  So easy to treat, responds quickly, especially once you treat the underlying OT issues.

 

Edited May 12, 2016 by OhElizabeth

[kbutton]

I am with OhE on this one, BUT you have time to decide and options. It's not an irreversible decision today. VT fixed FAR, FAR more than vision with both of my children, including things that are part and parcel of ADHD. The visual issues exacerbated the ADHD and any other issue they had going on. VT organized my kids' brains, and it shows. They still have ADHD, but we are actually starting to doubt it about my second one. He's gained skills rapidly that we thought were impossible. It may turn out that his disorganization has been largely visual.

[Linnet]

post removed

Edited August 26, 2016 by Linnet

[PeterPan]

Just ask the OTs as you call around whether the check for reflexes, what therapies they use to integrate them, etc.  You could ask the dev. optom. if she has anyone they refer to.

[Tiramisu]

I am with OhE on this one, BUT you have time to decide and options. It's not an irreversible decision today. VT fixed FAR, FAR more than vision with both of my children, including things that are part and parcel of ADHD. The visual issues exacerbated the ADHD and any other issue they had going on. VT organized my kids' brains, and it shows. They still have ADHD, but we are actually starting to doubt it about my second one. He's gained skills rapidly that we thought were impossible. It may turn out that his disorganization has been largely visual.

 

We had the same experience with VT. It did organize their brains. My second dd is a rather organized person to begin with by she became calmer and less stressed with VT, and I think it's because her brain was just working better so life was easier for her. My fourth dd became much more organized in her daily life. Her sensory symptoms became less of an issue so she started wearing a greater variety of clothes and showering on more of a regular schedule, and she started really organizing her own things for the first time. It was DRAMATIC. Everyone noticed.

 

It sounds crazy but I almost wish my other two could do VT even though there is so eye muscle issue that would warrant it. It just helped the other two so much that I'd like to see how it could help them. Quite a lot of the VT exercises had a timing/rhythmic component that reminds me a bit of Interactive Metronome. IM helped my one dd so much, I think VT would continue the same type of improvement...even if she doesn't need it!

[Linnet]

post removed 

 

Edited August 26, 2016 by Linnet

[Tiramisu]

You might want to read up on Ehlers Danlos Syndrome HYPERMOBILITY TYPE, which basically means the connective tissue of the joints in particular is lax. This affects how one perceives sensory feedback from the environment, because there is less overall stability.

 

I remember seeing a research article that indicated those with lax joints are more likely to deal with things like ADHD and ASD. I suspect it is because the tissues throughout the body have more laxity and this affects the nervous system as well.

[Tiramisu]

http://www.ncbi.nlm.nih.gov/m/pubmed/25821094/