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ADHD med concerns -update 3/15


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So... my son is 9. We had a full neuropsych eval done and she raised concerns of ADHD. He is pretty impulsive, which is why I sought out the referral. His impulsivity was causing some issues with relationships in the family and I believe was the root of a lot of temper tantrums. So we decided to try meds. He was given 18mg of Concerta. The first day I told him it might help him focus or pay attention more. It was a great day. (Now I wonder if it was somewhat psychosomatic?) On the meds, I noticed that he listened to me a bit better. He did impulsive stuff still but was willing to slow down and talk about things. He was more open to correction. He did have trouble falling asleep and was more irritable in the afternoons after a couple of days. His doc upped him to to 27mg and told us it was fine to give him melatonin.

 

Then we realized that his swim time at meets were getting longer and longer. When I asked he said he was just feeling tired. So I wondered if it was his meds. So we dropped the meds and at the next meet (3 weeks from dropping meds) his times were back to where they were. We did give him meds when he wasn't swimming and now I'm starting to see him get worn out when the meds kick in. Besides being tired and maybe a stomach ache, he doesn't seem to have any side effects. He doesn't give consistent answers to what his meds feel like or when they work so I'm not even sure he knows. He does get a bit meaner when they should be wearing off.

 

Obviously we need to try something else but I'm not quite sure where to go from here. The doctor mentioned adderall, but I'm hesitant to try that since it was so hard to tell the bad side effects until the results had already happened...

 

I just want him to stop and listen to instructions without rolling his eyes and doing what he wants anyways because his brain is already three steps past being asked not to and it's easier to follow those steps than to stop the steps that are already in his mind.

Edited by blondeviolin
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His pedi upped the dose because it was wearing off quickly we thought.

 

The tired I'm seeing is that he felt like it was exhausting for him to lift his arms to do his math.

 

We do have a referral in for some behavioral therapy and I'm really hoping it will work out for the best.

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I would talk to the doctor about trying a different med. During the first six months that DS was medicated, we tried many. One worked well but exacerbated tics. One just seemed to make him angry (we had a very short trial of that one, because it was unbearable). One only seemed to make him sleepy. We ended up with an effective med after a time, but it took some time to figure it out. Our pediatrician was very positive and interested in figuring it out and sought feedback from us.

 

I think it's pretty typical to have to try a few things before you land on what works best. You can also get short acting or extended release versions of some meds, so there is an ability to adjust that as well. DS currently takes an extended release to get through the school day and has an additional short acting dose to use in the evenings when he needs a bump to get through homework or other activities (his daily dose wears off around 3 pm).

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Stimulants really affect my son's sleep, and his sleep medicine doctor indicated that is common. Melatonin doesn't fix it here. So we landed on using two short acting doses--one just after breakfast and another just after lunch. He isn't able to dose any closer than 7 hours before bed. Not ideal, but better than entirely unmedicated or not sleeping due to longer acting forms. My son does say the medication makes him tired. I plan to talk to his doctor about that when I get some data to share. I guess my point is that there are other options beyond the long acting meds, and sometimes it takes a while to find the right medication--we've tried four different meds now.

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It seems that your concern is with his 'impulsivity', rather attention.

But with impulsivity, their are 2 basic types; Impulsive Choice, and Impulsive Action.

 

A simple example of Impulsive Choice. Is how he responds to being offered, 1 piece of candy now, or 2 pieces in 10 minutes?

Which uses what is called the 'reward system in our nerve cells and neurons'.

This is what provides us with 'motivation', and enables us to carry a task through to its conclusion.

Which keeps our attention focused, when learning.

Concerta and similar medications can help with this.

As they increase the production of Dopamine in our neurons and nerve cells.

 

But with Impulsive Action, this is a separate process in our nerve cells/ neurons.

Which selectively controls our actions.

That uses Serotonin, instead of Dopamine.

 

Our Neurons/ Nerve Cells, connect with each other in 'loops'.

Where the Dopamine provides the motivation, and the Serotonin controls the response.

 

So that this is why it is important to look at his impulsivity, in terms of Impulsive Actions and Impulsive Choices?

As Concerta and similar med's, will only help with Impulsive Choices and dopamine.

 

If his problems are with Impulsive Actions, then this could be helped with raising his Serotonin levels?

Which could actually be done, through a dietary approach.

As Serotonin is produced in the body and brain, from Tryptophan.  Which occurs in many foods.

It can also be bought as a supplement, but only used at the Recommended Daily Allowance.

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I'd never heard of that before, Geoff, so that's interesting to ponder...But my DD had both impulsive choices and actions, and both were helped greatly by meds. We've also done therapy and used parenting techniques recommended for ADHD kids, and that's helped improve her actions to some extent, but the biggest change came once we started meds.

 

Actually, I'd say impulsive actions were actually affected more. Her behavior improved so much, there's no more bolting, it used to be impossible to take her shopping because she wanted to climb shelves or stack yogurts, etc. That's 100% better now, whereas she still isn't very motivated to work, even when there's an explicit reward attached. And her teacher says that although she can stay on task when work is put in front of her, much better than before meds, her focus during spoken lessons isn't as strong as neurotypical kids. (I'm guessing that not being able to choose what to focus on in the face of distractions falls into the Impulsive Choice category.)

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A quote from the US National Library of Medicine, found here:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/

 

"Although purified tryptophan increases brain serotonin, foods containing tryptophan do not.71 This is because tryptophan is transported into the brain by a transport system that is active toward all the large neutral amino acids and tryptophan is the least abundant amino acid in protein. There is competition between the various amino acids for the transport system, so after the ingestion of a meal containing protein, the rise in the plasma level of the other large neutral amino acids will prevent the rise in plasma tryptophan from increasing brain tryptophan. The idea, common in popular culture, that a high-protein food such as turkey will raise brain tryptophan and serotonin is, unfortunately, false. Another popular myth that is widespread on the Internet is that bananas improve mood because of their serotonin content. Although it is true that bananas contain serotonin, it does not cross the blood–brain barrier."

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Oh he exercises plenty! And he always comes back happier and even keel. But his swim team practices in the evenings and I can't seem to motivate him much on his morning walks. He's too busy looking for giant icicles. :P

LOL!

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I agree with a PP about considering doing two short-acting doses. And also about really looking at sleep. I have one kid who can sleep with just melatonin, but the other needs more help. He has used Clonidine for years and it helps a ton. It's also only like $0.22 at the pharmacy for a 90-day supply. :)

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He's still doing the Concerta. He had sworn to me more agreeable to bed time and stop trying to stay up late. We have been consistent about melatonin. Next week, we are going to do a time trial at swim and see if his times have tanked again. If not, we'll keep with the Concerta. If they do, we'll try adderall or Ritalin.

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UPDATE:

 

So we kept with the Concerta. I'm noticing he get annoyed/angry easier. Still the same differences from 18mg to 27mg. We've been really diligent with his sleep as well. On Monday we timed his 100 free and it was within his time standard so I think we're doing okay there.

 

BUT! I keep asking him what he's feeling and he tells me more focused. When I ask him when it wears off, he gives me wildly varying times. It makes me skeptical. And we're still having impulsive issues. SO, tonight we were talking about a poor choice he made and he told me he did it because what we were doing (reading scriptures) isn't fun and we never have fun here (hogwash). His problems really all stem from the fact that he knows what he should be doing but he can't not do whatever he shouldn't.

 

Anyway, all of that to say that he broke down and told me he doesn't notice a change with the Concerta AT ALL and he only reason he told me he did was because he wants to make me happy. This checks out because every time he would answer questions about when it kicks in or wears off he would be completely off from the last time.

 

So now the question is if the dose of Concerta is too little or if we need to switch meds completely...

 

It would have been so much easier if he would have told me from the beginning. 🤔

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Are you making data here? Because, to me, asking a 9 yo whether his meds are working is like asking the ocean how much water is in it. ;)

 
With my ds, the behaviorist has us track percentages on compliance and attention. So we have a row with the percents (10, 20, 30, ...) and another row with % attention (10,20, 30,...) and we just circle. We do that for 3-4 hour shifts, so morning shift, afternoon shift, evening shift.
 
That's some pretty good social thinking if he's trying to fudge and give you the answer you want, kwim? Has he had an OT eval for sensory and retained reflexes? If he has sensory issues, you may to use additional strategies to help his body stay in a good place where he's ready to work. Have you thought of getting a behaviorist to help with the non-compliance and self-regulation? Studies show that people who do behavioral therapy *before* meds are more satisfied with the results. They could do Zones of Regulation with him.

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Edited by OhElizabeth
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My son has very little sense of whether his meds are working or not. But we can tell. Your son may be self-aware enough to evaluate how the meds make him feel (consider whether he is self-aware in other ways), but some kids are not. So I'd be wary of making that the deciding factor.

 

With that said, we tried four or five different meds before finding what works for DS, so there may be room for improved effects if you try something else.

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Are you making data here? Because, to me, asking a 9 yo whether his meds are working is like asking the ocean how much water is in it. ;)

 

With my ds, the behaviorist has us track percentages on compliance and attention. So we have a row with the percents (10, 20, 30, ...) and another row with % attention (10,20, 30,...) and we just circle. We do that for 3-4 hour shifts, so morning shift, afternoon shift, evening shift.

 

That's some pretty good social thinking if he's trying to fudge and give you the answer you want, kwim? Has he had an OT eval for sensory and retained reflexes? If he has sensory issues, you may to use additional strategies to help his body stay in a good place where he's ready to work. Have you thought of getting a behaviorist to help with the non-compliance and self-regulation? Studies show that people who do behavioral therapy *before* meds are more satisfied with the results. They could do Zones of Regulation with him.

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A behaviorist is not an affordable option for most people, and insurance does not typically cover their services in the case of an ADHD diagnosis.

 

Having the perspective of some outside person really can be helpful though. My mom noticed a real difference in my son on days when he had taken medication compared to days when he hadn't.

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Our behaviorist is, private pay, $60 an hour, which is cheaper than an hour with the pediatrician. And around here, an "hour" with the behaviorist is actually one hour of them working with your kid plus 1/2 hour of talking plus emails and emergency help.

 

So around here, a behaviorist is cheaper than OT, SLP, ped, or almost all the other people we regularly suggest. But, I get it that money is real.

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The whole reason we started with the meds was not because of focus/attention.  He's always been pretty decent with focusing, except when something preferred is also an option.  If he's talking with me and the TV is on, he will cover that side of the face to prevent being distracted by the TV.  If we're doing something that is not "fun" he creates problems trying to make it fun. I am constantly reminding him that "X is not the time for that."  He basically hates to be bored with a fiery passion.  He'd rather get in trouble than be bored.

 

So we started meds because I had anticipated that a lot of this was stemming from impulsiveness.  He knows what is right, but he can't make himself not do something else, if that makes sense.  Like, if he's already dreamed up the idea then it's a good 85% chance it's going to happen.  It's dumb stuff too: cutting his bedspread, writing his name on his bed frame, sneaking snacks, hitting someone because they teased him, etc.  I have other kids that I talk to just as much, but the big glaring problem is that he makes a mountain out of a molehill.  He wails, he whines, or more frequently he gets stubborn.  And I feel like "kids do well if they can" so something else was off.  And we started meds to maybe see if we could curb the impulses so then I didn't have to remind him about things and then he gets angry because he has to do something that he wasn't planning on doing.  He was starting to feel like he was the only one in trouble, which isn't true.  In fact, he's not even the one I correct the most.  He's just the one that makes a huge deal out of it all and fighting against everything/everyone.  I was hoping the medication would help in this arena so we could stop having to tiptoe around him and he could feel a bit more in control of himself so he didn't have to control everyone else.

 

Unfortunately, the Concerta doesn't seem to do ANYTHING for this part.  We do have a referral in for a therapist.  I THINK his PCM mentioned a behavioral therapist, but at this point, even a psychologist/psychiatrist who can talk to us and him more regularly and help us get to the bottom of what's really going on would be helpful.  I talked with his pediatrician this morning.  We have a script for ritalin as well.  He told us to have him take 10mg and see if there is any difference. If not, he's more than willing to prescribe adderall, which I guess is a different stimulant...

 

We use a non-stimulant medication for some family members, caffeine for another. For both, a change occurs within 30 minutes. There is a noticeable difference in irritability and focus. 

The one that I keep reading about that I really want to try is Intuniv.  It's supposed to help with emotional regulation?

 

DS was given a TOVA both on and off medication to determine whether it had any effect.

Objective data would be good.  Asking what he feels or how I perceive things is really difficult...

 

My son has very little sense of whether his meds are working or not. But we can tell. Your son may be self-aware enough to evaluate how the meds make him feel (consider whether he is self-aware in other ways), but some kids are not. So I'd be wary of making that the deciding factor.

 

With that said, we tried four or five different meds before finding what works for DS, so there may be room for improved effects if you try something else.

When he first started taking the meds, it was a good day.  BUT! He's had plenty--PLENTY--of good days without medication in the past.  So how am I to know that this wasn't one of those? Or that it wasn't a psychosomatic response?

 

Are you making data here? Because, to me, asking a 9 yo whether his meds are working is like asking the ocean how much water is in it. ;)

 
With my ds, the behaviorist has us track percentages on compliance and attention. So we have a row with the percents (10, 20, 30, ...) and another row with % attention (10,20, 30,...) and we just circle. We do that for 3-4 hour shifts, so morning shift, afternoon shift, evening shift.
 
That's some pretty good social thinking if he's trying to fudge and give you the answer you want, kwim? Has he had an OT eval for sensory and retained reflexes? If he has sensory issues, you may to use additional strategies to help his body stay in a good place where he's ready to work. Have you thought of getting a behaviorist to help with the non-compliance and self-regulation? Studies show that people who do behavioral therapy *before* meds are more satisfied with the results. They could do Zones of Regulation with him.

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Attention has never been a problem for him really.  He focuses and gets schoolwork done faster than my other kids.  He's carrying a pretty full load and completing it in just about two hours.  This is why we went with the neuropsych because I wasn't sure if he was doing things out of boredom (case of the gifted kid gone bored) or if he just couldn't stop the impulse.  

 

Interestingly, the neurpsych (who is well-respected in the area) did not find him gifted even though he had previously tested as so with another, shorter evaluation.  She did find issues with attention and he was rather negative with all of the testing; apparently he found it REALLY boring.  He scored in the gifted range for several subsets, but not as a whole.  She flagged him for a few things based on her perception, but some of them really don't fit.  For example, at the intake appointment, I mentioned maybe dyslexia as well.  He took three whole phonics programs to get to the point of fluent reading.  It was way more than I had anticipated knowing how his verbal language skills were.  And way more than I had ever had to teach any kid I've since taught to read.  His spelling skills were markedly low.  But she said he couldn't be dyslexic because he was reading at grade level and could decode some nonsense words.  She did, however, flag him for dysgraphia because he couldn't draw a picture properly or something even though he's NEVER had a problem holding a pencil, regulating letter size, using the proper letter formation, etc.  Stuff like this makes the whole neuropsych testing suspect, you know?

 

He did a short round with an OT.  She worked a bit with the How Does Your Engine Run? program and gave him the language to understand and express things.  He also did Interactive Metronome and ILS, both of which he detested.  I'm not sure if she tested for retained reflexes.

 

And WRT to marking percents, I am marking it and not showing much improvement.  He's not having GREAT days like he has in times past, but he's not at the bottom of the well either.

 

That is tough.

Unless the dose he is on is still very low for this med I would be inclined to switch meds, it seems to me that you have given this one a fair chance.

 

He's on 27 mg.  It could possibly be raised a bit, but I just haven't noticed a whole lot of great to want to have him continue to take it.

 

 

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Intuniv and Wellbutrin can help with behavior regulation but the side effects are much greater, from my experience, than from concerta. Intuniv is best given at bedtime b/c it made my kid really tired. Wellbutrin had way too many side effects for my kid, but I've heard it can really slow down thoughts and thus reduce impulsive actions.

 

 

Sent from my iPhone using Tapatalk

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I might suggest that you consider trying some SSRI medications, which will raise his Serotonin levels.

As with Concerta and Adderall, they raise Dopamine and Epinephrine levels.

But a lack of change, indicates that Dopamine and Epinephrine aren't the problem?

 

Serotonin, Dopamine and Epinephrine.  Are molecules created by different enzymes.

These enzymes, are actually located around every single neuron/ nerve cell.

So that when neurons/ nerve cells send signals, it is these molecules that create the signal.

When the next neuron recieves the signal, it in turn creates the molecule and the signal keeps being passed on.

 

But a crucial part of this, is that the signal will keep being sent. Until the particular molecule is removed.

Which is done by another enzyme.

Where each enzyme uses one of our 'genetic codes', as an instruction manual.

 

So that various problems can occur, that breakdown this signalling process?

One significant one, is with the enzymes that 'remove the molecule', after the neuron recieves it?

Where the problem is, with it being removed. When it needs to be left in place, so that signal is repeatedly being sent.

As when a signal is being repeatedly sent, it causes us to 'hold our attention'.

 

With these different medications for ADHD, what they are actually doing?

Is to change the way that certain enzymes work.

So for example, with Concerta and Adderall?

They act on enzymes that remove Dopamine and Epinephrine molecules, so that they are left in place.

 

Enzymes take the molecules apart, which can then be reused.

This taking apart, is termed as 'Re-Uptake'.

I note this, as ADHD medications are often defined as; 'Re-Uptake Inhibitors'.

So that a 'Dopamine Re-Uptake Inhibitor'?

Simply means, that it will Inhibit the enzyme from removing the Dopamine molecule.

 

Epinephrine, is what we sense as 'Motivation'.

Dopamine, is what causes us to 'Take Action'.

While Serotonin, is like a 'Pause button' on our neurons?

Which allows us to reflect on an action, before it is carried out.

It also acts as a filter, for other 'distractions'.

 

Though basically what I'd like to do, is to reframe the discussion of ADHD?

So that with a diagnosis of ADHD?

That the symptoms are used to define issues with any of Dopamine, Epinephrine, Serotonin ?

 

Then medications could be prescribed, that specifically effect Dopamine, Epinephrine or Serotonin ?

Instead of simply providing you with Concerta?

It could be explained as trying some medications that effect levels of Epinephrine and Dopamine.

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Well in our area neuropsychs bill at $250+ an hour, regular psychs or psychs doing counseling (even phd) at $100-180, and behaviorists at $60-100. So when I say behaviorist, I'm saying it because it's the cheapest way, at least where I live, to get real behavioral intervention.

 

Yes, an OT can get training in Social Thinking materials, ALERT, Zones, blah blah. You can too for that matter. Going once a week to ANY of these people won't be enough. You have to be in the loop enough that you're carrying it over at home. If he were in school, they would do an IEP and have goals. They might have him do check-in's several times a day where he marks his Zone and does appropriate choices. Since he's not in school, you're stuck making stuff happen.

 

We found an OT who is really, really good with ALERT and self-regulation stuff. She has a lot of tricks! Still, the behaviorist is better help overall, because that's what the behaviorist does, their gig. But I like them both, yes. They're complementary. The behaviorist is going to look at ALL the antecedents and social thinking, the big picture, and the OT is going to look at what his body was doing. Different perspectives on the same event.

 

Yes, they can hyperfocus and engage and pass attention tests. I will say though, you're saying it's not attention. Like you're saying it's not an attention issue and your data (the amount of work he's completing in a short time, etc.) is saying it's not an attention issue. I would have described my ds as impulsive, but actually the data doesn't support it. He's 76th percentile on impulsivity on an objective test (the Quotient). That's not clinical and something you medicate for, kwim? That's how our ped concluded that my ds' non-compliance and aggressive behaviors were due to the autism, social thinking issues, and sensory integration. My ds can focus for an hour, then he just needs to MOVE. If he decides not to be there, he won't be there. If he decides to be there, he's all the way there.

 

Whatever, rabbit trail. It's hard stuff. Concerta to Ritalin. Same med, just extended to 3-4 hour. Or he went with an extended Ritalin. I don't know, I'm just asking where the data is. Our ped, similar scenario, wouldn't even give out the meds. Flat refused. And I really think it's cautionary. 

 

I wouldn't put a kid on amphetamines without data. I'm sorry. I just, well I'm not a doc. I just don't see a lot of data going on here, and not every doctor would handle it that way. Your neuropsych may have gotten it very wrong. Did she do a GARS? Did she run the Social Language Development Test or anything for Pragmatics? Did she run anything for behaviors? Because frankly, with the amount of oppositional behaviors you have, the rigidity, the unexplained reading problems, the wildly varying psych results, the social thinking deficits, etc., you're talking NVLD or something else. 

 

Our first neuropsych totally missed it. You should have seen our ped. He had the file in front of him with the letter from the ped and he sat there crossreferencing it with his Quotient data and what I was saying about what was happening. He just kept saying "But what you're describing is autism" and I'm like yeah, that's why we were diagnosed with autism later. But the first psych report, the one he had, said ADHD-inattentive, SO laughable. Even $$$ neuropsychs can get it wrong, very wrong. And to put a kid on serious stimulant medications, especially those amphetamines, without a 2nd opinion from a psych, without in-home behavioral observation by a behaviorist, that's just really scary. Maybe you need meds! I'm not anti-meds! But I would get a 2nd opinion from someone who will spend enough time in your home and gather enough data that you can be sure of the best path. 

 

And maybe the others saying they had to crank it up will be the right answer for your kid. There are just multiple explanations, and getting a 2nd opinion, getting in-home observation, getting someone to SPEND TIME WITH HIM so outside eyes are seeing what you're seeing, till the honeymoon is over and the non-compliance and the behaviors start, that could really help fine-tune your approach here. And frankly, per the data, that behavioral work FIRST will yield better results. There doesn't have to be a rush to meds. You could do the behavioral work first, then decide as a team, based on data.

Edited by OhElizabeth
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Well in our area neuropsychs bill at $250+ an hour, regular psychs or psychs doing counseling (even phd) at $100-180, and behaviorists at $60-100. So when I say behaviorist, I'm saying it because it's the cheapest way, at least where I live, to get real behavioral intervention.

 

Yes, an OT can get training in Social Thinking materials, ALERT, Zones, blah blah. You can too for that matter. Going once a week to ANY of these people won't be enough. You have to be in the loop enough that you're carrying it over at home. If he were in school, they would do an IEP and have goals. They might have him do check-in's several times a day where he marks his Zone and does appropriate choices. Since he's not in school, you're stuck making stuff happen.

 

We found an OT who is really, really good with ALERT and self-regulation stuff. She has a lot of tricks! Still, the behaviorist is better help overall, because that's what the behaviorist does, their gig. But I like them both, yes. They're complementary. The behaviorist is going to look at ALL the antecedents and social thinking, the big picture, and the OT is going to look at what his body was doing. Different perspectives on the same event.

 

Yes, they can hyperfocus and engage and pass attention tests. I will say though, you're saying it's not attention. Like you're saying it's not an attention issue and your data (the amount of work he's completing in a short time, etc.) is saying it's not an attention issue. I would have described my ds as impulsive, but actually the data doesn't support it. He's 76th percentile on impulsivity on an objective test (the Quotient). That's not clinical and something you medicate for, kwim? That's how our ped concluded that my ds' non-compliance and aggressive behaviors were due to the autism, social thinking issues, and sensory integration. My ds can focus for an hour, then he just needs to MOVE. If he decides not to be there, he won't be there. If he decides to be there, he's all the way there.

 

Whatever, rabbit trail. It's hard stuff. Concerta to Ritalin. Same med, just extended to 3-4 hour. Or he went with an extended Ritalin. I don't know, I'm just asking where the data is. Our ped, similar scenario, wouldn't even give out the meds. Flat refused. And I really think it's cautionary. 

 

I wouldn't put a kid on amphetamines without data. I'm sorry. I just, well I'm not a doc. I just don't see a lot of data going on here, and not every doctor would handle it that way. Your neuropsych may have gotten it very wrong. Did she do a GARS? Did she run the Social Language Development Test or anything for Pragmatics? Did she run anything for behaviors? Because frankly, with the amount of oppositional behaviors you have, the rigidity, the unexplained reading problems, the wildly varying psych results, the social thinking deficits, etc., you're talking NVLD or something else. 

 

Our first neuropsych totally missed it. You should have seen our ped. He had the file in front of him with the letter from the ped and he sat there crossreferencing it with his Quotient data and what I was saying about what was happening. He just kept saying "But what you're describing is autism" and I'm like yeah, that's why we were diagnosed with autism later. But the first psych report, the one he had, said ADHD-inattentive, SO laughable. Even $$$ neuropsychs can get it wrong, very wrong. And to put a kid on serious stimulant medications, especially those amphetamines, without a 2nd opinion from a psych, without in-home behavioral observation by a behaviorist, that's just really scary. Maybe you need meds! I'm not anti-meds! But I would get a 2nd opinion from someone who will spend enough time in your home and gather enough data that you can be sure of the best path. 

 

And maybe the others saying they had to crank it up will be the right answer for your kid. There are just multiple explanations, and getting a 2nd opinion, getting in-home observation, getting someone to SPEND TIME WITH HIM so outside eyes are seeing what you're seeing, till the honeymoon is over and the non-compliance and the behaviors start, that could really help fine-tune your approach here. And frankly, per the data, that behavioral work FIRST will yield better results. There doesn't have to be a rush to meds. You could do the behavioral work first, then decide as a team, based on data.

 

I feel like I need a degree in neuropsych myself to really work with all of this.  I got a report from the evaluation but it's not very helpful and I feel like it's laced with her leanings rather than actual data, if that makes sense.  And I'm really, REALLY disappointed they couldn't engage him be more kid-friendly so he would have put some effort into this.  I'm highly considering taking him to the developmental pediatrician my 3yo sees.

 

The tests the neuropsych (or had her person do since she didn't spend much time with him) are:

 

WISC-V

NEPSY

CLVT-C

CFT

Woodcock-Johnson IV

Beery VMI

D-KEFS

CPT-II (They did this one twice)

TOWRE

Incomplete Sentence Blanks

SRS-II

BASC-II

ABAS-III

 

And while I feel like he has a good pediatrician, he's also still a military pediatrician who is looking to check the boxes...  Continuity of care isn't there nor would I even dream of embarrassing my son by getting down to all of his nitty gritty issues with him in the room.

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Uh, not to point out the obvious, but if a psych who works successfully with hundreds of kids the rest of the year is having trouble engaging your kid, that tells you something. It's not them.

 

Does the report say they had trouble with non-compliance or you assumed?

Edited by OhElizabeth
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Uh, not to point out the obvious, but if a psych who works successfully with hundreds of kids the rest of the year is having trouble engaging your kid, that tells you something. It's not them.

 

Does the report say they had trouble with non-compliance or you assumed?

Well, that my be my fault. I told him it would be a bunch of puzzles and activities because that's what I remember from my IQ testing. Some he was a bit put off because it was all work. And his tester required him to be quiet while did things.

 

He was compliant. He just complained of it being boring and I'm assuming he did not put in his fullest effort.

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Blondeviolin, I would see the developmental ped like you said and go from there. If he/ she is a person you trust, and obviously you do if you are taking your 3 yr old there, start from there.

I also agree with Maize that you should look at anxiety and auditory/ sensory processing issues.

I'm not against meds. I know that sometimes they may be necessary, and I respect every parent's right to make that decision for his/her own child. The meds alone, though, are not going to teach him the strategies that he needs. He needs strategies that work for him.

Edited by Guest
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Blondeviolin, I would see the developmental ped like you said and go from there. If he/ she is a person you trust, and obviously you do if you are taking your 3 yr old there, start from there.

 

I also agree with Maize that you should look at anxiety and auditory/ sensory processing issues. I never realized how much my 13 yr old's anxiety was affecting his behavior until first our GP and then the ped pointed it out. It was when I started looking at mindful parenting resources and CBT that I started reaching him more.

 

I'm not against meds. I know that sometimes they may be necessary, and I respect every parent's right to make that decision for his/her own child. The meds alone, though, are not going to teach him the strategies that he needs. He needs strategies that work for him.

This child hasn't really ever exhibited behavior that looks like anxiety. I know that's not going to rule things out, but his personality is too happy-go-lucky, I'm-awesome, everyone-should-think-I'm-the-best to seem too anxious iykwim.

 

I will call and have a referral made.

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I get what you are saying. Just to explain to you though, what you see may not necessarily be what is going on inside. I'm not trying to say that your child has anxiety or anything else. Just trying to say that with some kids, these things get masked with behaviors that may not appear to be directly related.

Edited by Guest
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I would ask around and get referrals if you decide to see another psych. Lists are useful but credentials don't make the person. I would go with referrals from people you trust.

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Sensory Processing Problems in Children with ADHD, a Systematic Review:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149116/

 

A quote:

"Specific sensory symptoms are correlated with particular behavioral problems such as aggression and delinquency in ADHD. The higher level of sensory problems in ADHD predicts the higher levels of aggression and delinquency.19 The impairment of receiving and processing of sensory information in children with ADHD may cause inappropriate responses at different settings such as school, home and in the community.25

 

In addition, sensory functioning has a strong correlation with academic achievement and cognitive processing in ADHD.26 Earlier detection and management of sensory processing problems can play an important role for the performance improvement in children with ADHD. The early assessment of sensory-motor skills is suggested to be used for the prediction of academic performance deficits."

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