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ADD, anxiety, both or neither?


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My DS2 has always been my "easy" boy. Both of his older and younger brothers have ASD, dyslexia, and dysgraphia so admittedly, they have been the ones we have focused therapy on for the last several years. My youngest also has Apraxia which has added a whole other level of complication to life. I left my full time job to homeschool all of them 4 years ago.

 

My DS2 has always been shy and relatively easy going, but the last few years we have really noticed a few other things we are concerned about:

 

- he worries A LOT! He is upset at bedtime many nights worrying about getting sick, not dong well at something, or about something bad happening.

 

- he has a hard time concentrating. This really impacts his school work and it upsets him. He tells me he just can't concentrate and it really bothers him.

 

-he is very nervous going into any situation he hasn't been to before. He will ask a MILLION questions, needing to know every detail about where we are going or what might happen etc.

 

-he has started having diarrhea when he gets nervous - which is a lot. He plays on a competitive basketball team (and he is good!) but he will get diarrhea before most games. Sorry if that is TMI.

 

-he thinks he isn't good at most things -despite being very good at a lot of things. School comes fairly easy to him, he is a natural athlete, and just a really great little kid. He is a great friend, treats others kindly all the time (something that doesn't come as easy to my ASD boys) and is really compassionate and sweet but is really hard on himself.

 

I just have this gut feeling that his worrying is more than what is typical. I am feeling worn out from all the testing and therapy for his brothers over the last 6 years so I may have dropped the ball with him and I feel awful that we haven't paid more attention to whether he is struggling.

 

Anyone with a child dealing with anxiety or ADD I would love to hear your thoughts? I know he obviously struggles with worrying but how do you know when it crosses the line to anxiety or at what point do you seek an outside opinion/help?

 

Thanks.

Edited by Lots of boys
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Anxiety is definately there.

My mom stopped working when I was 8 and the financial stress of only having half the usual family income plus my only sibling (baby) being needy means it was a stressful home environment. I was already a latchkey kid but I was going home late at night to avoid the stress of being the "babysitter". My mom did went back to work part time because she was depressed staying home. I am wondering whether he sees himself more as a caregiver than a sibling and worrying as a caregiver.

My dad has anxiety triggers while working but was otherwise okay. He saw a psychologist which was covered by his insurance. Now he is retired.

My DS11 has social anxiety from being isolated, he wanted to be with age peers. He say a psychologist when he was 8 who understood why we homeschool but told us to put him in more outside activities to buffer the isolation. Insurance covered part of the testing and we use HSA funds to pay for the rest.

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Don't feel bad about not catching it before now. I have a houseful of complicated kids and it is impossible for some things not to fall through the cracks. We moms just aren't superhuman, much as we would wish to be.

Edited by maize
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Anxiety is definately there.

My mom stopped working when I was 8 and the financial stress of only having half the usual family income plus my only sibling (baby) being needy means it was a stressful home environment. I was already a latchkey kid but I was going home late at night to avoid the stress of being the "babysitter". My mom did went back to work part time because she was depressed staying home. I am wondering whether he sees himself more as a caregiver than a sibling and worrying as a caregiver.

My dad has anxiety triggers while working but was otherwise okay. He saw a psychologist which was covered by his insurance. Now he is retired.

My DS11 has social anxiety from being isolated, he wanted to be with age peers. He say a psychologist when he was 8 who understood why we homeschool but told us to put him in more outside activities to buffer the isolation. Insurance covered part of the testing and we use HSA funds to pay for the rest.

You're looking for situational triggers; anxiety disorder is a thing that exists on its own, it does not need a situational cause though it tends to find situational focuses. It can have a strong genetic component.

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I would absolutely get him evaluated. I'm no expert,but your description screams anxiety to me. Certainly there may be something else there, too, or it could be all anxiety. Your post actually reminds me very much of myself as a kid except that I kept my worries to myself. It sounds ignorant now, but back then I was either afraid to articulate my worries or I didn't really know how to. In hindsight I really wish the kid me had gotten some help. Don't worry one bit about not having seen it sooner or pursued help sooner. Now you've realized and you're doing something about it. That's what matters.

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Clearly *something* is not OK, right?

 

With my kids, even though we do already work with diagnosises, I still always always always do a health habit check and a gut-check for me.... Is he sleeping enough? Is his life interesting enough? [This one is too frequently overlooked imo...But kids like all people need to have something they LOVE to do with their time!] Is he eating sugar on too-regular a basis? Is he getting in nature enough? Is he moving around enough? Drinking enough water?

 

...Have I fallen into a habit of speaking negatively unnecessarily around the kids? Have I been distracted overmuch, or grumpy?

 

 

 

Disclaimer: obviously some people's problems aren't touched by these things. I live that too.

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Thanks. He definitely has/does things he enjoys. He is a green belt in karate (5 years so far), a competitive basketball player and a recreational tennis player. He gets out of the house for these activities almost daily and I know he enjoys them (even if he gets nervous prior to attending the competitive ones).

 

He requires (or prefers) more sleep than my other two boys and regularity gets 10 hours or more. I actually find he says he is tired when he is struggling more.

 

He is very forgetful and this causes him worry as well. He can't seem to hold multiple requests in his brain for very long. If I need him to to do something, I often have to break up the tasks into singular requests or he will almost always forget what I have asked him.

 

Can I speak to a therapist or psychologist about these concerns without doing a full neuropsych eval like I did with his brothers? We definitely don't have the $2500 it cost us each with our other two. I don't have ASD concerns with this son, and I don't think he has any SLD's so I just don't want to put the money out for a full eval if it isn't necessary.

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You know, because you mention tiredness and needing more sleep--ask your pediatrician for a sleep study referral. If he is not getting good quality sleep because of apnea or something else that could be impacting both his anxiety and other mental functioning such as memory and focus.

Edited by maize
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We were posting at the same time. You don't need a NP evaluation. I recently had DS11 go through full evaluations, because we wondered if there might be some additional underlying root issues. DS also has trouble holding a list of instructions in his head without forgetting part of it. He tends to miss the first or last bits in a series of information.

 

In his case, he has a lot of inattention, but not enough to get an ADHD diagnosis. He also has lower working memory and fluid reasoning, and those issues definitely cause stumbling blocks for him, though he has no LDs. I'm glad we have the info we received from the NP testing, because it helps us understand him better, but his only official diagnoses is anxiety. A psychologist could have diagnosed that for us, if we had not wanted to go through all of the NP testing.

 

In fact, my older son was diagnosed with anxiety by a psychologist, who worked with him on learning calming techniques. We have a referral for younger DS to get counseling as well but haven't started that yet (it takes awhile to get in to see someone around here). A clinical psychologist cannot prescribe meds, but there are other approaches you may try first before deciding meds are needed.

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One thing that is really hard is that anxiety, ADHD, and CAPD (get to why I mention that later) all have overlapping symptoms and can cause symptoms of the others to get worse. So, ADHD tends to be associated with lower working memory, but anxiety also lowers working memory. We found that a NP really couldn't tease that apart for us. It's frustrating.

 

Our younger son is similar (and has an older sibling with ASD). We are getting more physical issues looked at more closely, but one thing that we already confirmed is that he has central auditory processing disorder--CAPD or APD, depending on what site you are viewing. It can have a sensory component that looks like anxiety. Anxiety results sometimes when they can't keep up with the auditory demands, etc. Inattention for the same reasons or inattention comes up because they aren't even on the same page to begin with because they didn't catch something (and that causes anxiety). It's frustrating. Not being able to hold things you say in auditory working memory is a really big flag for CAPD.

 

To be clear, unlike ADHD, more symptoms does not mean more likely to CAPD. You can have one single symptom of CAPD but have it badly enough that you get a diagnosis. It is very unlike other disorders in this regard. Also there are a lot of different presentations of CAPD--it would be unusual for any child who has it to have all the symptoms because they tend to group according to the child's particular deficit. My son's biggest symptom right now is remembering things spoken aloud, having a negative sensation inside his own body/brain when speech gets too backed up, and hearing things on a time delay (his rate for taking in speech he hears was tested at the 2nd percentile!). He used to have absolutely HORRIBLE ability to hear speech in a noisy environment--he was functionally deaf in a noisy place. Most of the time he could not hear us talking to him from the front seat of the car over the road noise, for instance. That got a lot better after vision therapy (really, I am not kidding--the optometrist who does the vision therapy has heard of other practices doing exercises for localizing sound before beginning vision therapy for better VT results too, but I digress). 

 

http://www.smartkidswithld.org/first-steps/what-are-learning-disabilities/central-auditory-processing-disorder-an-overview/

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A clinical psych can handle adhd + anxiety, and it will cost you 1/3 the amount. 

 

I got my dd (ADHD) screened for APD at the university for only $35. You might check into that.

 

The low working memory you're describing is something that is easy to work on. Yes, if they have retained reflexes, etc., then working on that lets some of the more complicated neurology (dichotic listening, etc.) improve. I think Kbutton's ds was also doing quickshifts with someone, yes? The PT gave dd Quickshifts to listen to, saying it would dramatically help the dichotic listening issues.

 

The unusual sleep is something dd did. I've seen two theories. One is they're working so hard to attend that they fatigue more easily and require more sleep. This is true. The other is that they have more of the sleepy waves (I forget, beta, gamma, whatever) and that as they go to sleep they get even MORE. So you might notice, not only how much sleep he needs, but how *long* it takes him to become functional when he rises.

 

I also agree on the question of sleep quality, breathing, etc. Oxygen going low at night due to mouth breathing, congestion, etc. can definitely be an issue! 

 

*If* the issue is fatigue from attention, the meds will help. If the issue is the brain going deep deep into the sleepy waves, the meds can help. Also, the meds have the effect of letting the brain slow down and chill enough that the dc can go to sleep more readily. You might find he's up very late trying to fall asleep, with the net effect that he's getting less sleep than he should.

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A clinical psych can handle adhd + anxiety, and it will cost you 1/3 the amount. 

 

I got my dd (ADHD) screened for APD at the university for only $35. You might check into that.

 

The low working memory you're describing is something that is easy to work on. Yes, if they have retained reflexes, etc., then working on that lets some of the more complicated neurology (dichotic listening, etc.) improve. I think Kbutton's ds was also doing quickshifts with someone, yes? The PT gave dd Quickshifts to listen to, saying it would dramatically help the dichotic listening issues. He listened to them during therapy, but we didn't get any for home. I am thinking there was something about special headphones, or else I could find downloads but not a CD. Can't remember. I will have to look into it again.

 

The unusual sleep is something dd did. I've seen two theories. One is they're working so hard to attend that they fatigue more easily and require more sleep. This is true. The other is that they have more of the sleepy waves (I forget, beta, gamma, whatever) and that as they go to sleep they get even MORE. So you might notice, not only how much sleep he needs, but how *long* it takes him to become functional when he rises.

 

I also agree on the question of sleep quality, breathing, etc. Oxygen going low at night due to mouth breathing, congestion, etc. can definitely be an issue! 

 

*If* the issue is fatigue from attention, the meds will help. If the issue is the brain going deep deep into the sleepy waves, the meds can help. Also, the meds have the effect of letting the brain slow down and chill enough that the dc can go to sleep more readily. You might find he's up very late trying to fall asleep, with the net effect that he's getting less sleep than he should.

 

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I had what was probably General Anxiety as a kid and I had a lot of the same problems your DS does.  I had hives when I was nervous and I stayed up quite often until 3 am worrying about burgulars, murderers, rapists, etc.  I also forgot things a lot (e.g., I was an A+ student - National Merit  - but I forgot to fill out mandatory community service forms, or anything else not explicitly written down on my planner).  I had a zillion phobias.

 

My parents just let me sleep on the couch until I was 15 (I was afraid of my room) and brought me my flute or homework or lunch or whatever at school.  Now I have more maturity and accommodating practices but my DH still puts up with a lot.

 

My anxiety has abated a lot; I'd say 80% of it is gone.  I was very hard on myself and am still to an extent.

 

My parents, imo, did the best thing possible: they just dealt with me as a human being.  They didn't try to fix me (which might have been helpful, but might have been debilitating); instead they just accommodated me.

 

My issues were accommodatable, though.  I graduated in the top 1% despite my executive function problems, and I slept on the couch okay - at least 5 hours a night.

 

 

 

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