Update on my possibly ADHD kid with a temper

[blondeviolin]

First of all, I'm posting this update just in case there is someone out there now or in the future with a similar kid.

 

We've been working with the book What to Do When Your Temper Flares and it has been somewhat eye-opening for him. I think he's starting to get the idea that he can choose to not be angry and he can control his emotions. The pediatrician said his self report papers showed that he feels that these jusy come up and he doesn't have any control over them and counseled us strongly to make sure not to reinforce that.

 

He also self-identified as hyperactive with some attention issues.

 

HOWEVER, the dev pedi also said that his report for the neuropsych was not completely interpreted in a way that was at all helpful. She wrote that he was "above average intelligence," however he had some clinically significant issues with visual processing and writing skills. The large majority of his WISC placed him falling firmly in the gifted-to-highly gifted range. So we really are looking at a 2E situation with some dysgraphia or dyslexia.

 

The developmental pediatrician agreed that his tendency for temper tantrums is concerning, however, because it is infrequent (once a month or so) and he holds it together in any other setting besides home, it's highly indicative that he can hold it together but it's REALLY hard. Couple this with the fact that those skills are behind for his age, let alone for his abilities in other things, and it makes a huge disparity.

 

SO... with all of that said the pediatrician so he would not work with medication since the one we've tried had bad side effects and he doesn't seem to have attention related issues that prevents him from completing schoolwork or other required things. He really wants him to work with a cognitive behavioral therapist, which is absolutely what I wanted. He also listened to me about the importance of a full night's sleep and the fact that this kid snores so he wil refer us for a sleep study.

 

Of course, he recommended The Explosive Child, which I have on my shelf. However, I was unaware of the huge helps on Dr. Green's website.

 

We were also told to watch for signs of Intermittent Explosive Disorder (which is just like it sounds) as he nears his teenage years. He said he's ambivalent about this being totally ADHD.

 

I really have appreciated this board and all of the help trying to puzzle this kid out. Out of all of my kids, he's the one that I feel could maybe go the furthest with a passion.

 

The dyslexia/dysgraphia thing has me a bit hesitant. I haven't had a strong spelling curriculum for him until this year because we were working so hard on being a fluent reader. (LOE Foundations is finally where it clicked.) I have had him doing Sequential Spelling this year knowing that he could not retain/remember he ruled when he was learning to read. I have seen some of those patterns transition over to his other writing so I'm hoping as he continues writing more other patterns will transfer over. And now, at least, he's more apt to use an appropriate phonetic option if he doesn't know how to spell something. So my plan was to keep using SS; I want to pick something and stick with it the whole way. But knowing that his visual bit was so wonky, do I move him to something like Spelling You See that really reinforces the visual stuff?

Edited May 6, 2017 by blondeviolin

[PeterPan]

Hmm... If his visual processing is an issue, you would take him to a developmental optometrist. As far as dysgraphia and dyslexia, those aren't really the same. Did the psych say one or the other or both? 

 

You might be really wise to do an OT eval for retained reflexes, etc., before you see the developmental optometrist. There are often retained reflexes in ADHD, and that plus the visual processing issues would indicate possible retained reflexes. So then you'd go to the root problem before you'd treat the symptoms. It really varies with the OT/PT and sometimes you have to search before you find one who's really good at them. As in I burned through 5 OTs before I found someone, and that someone is a PT. ;)

 

So I would get the visual processing problem fixed before using a vision-based spelling program, yes. And I would get the OT eval and make absolutely sure you've screened for and treated all retained primitive reflexes, vestibular issues, etc., before you even do therapy for the vision. Then, when you've got all that done, you could work on the spelling. 

 

Does he type? That gets you kinesthetic memory. He can type the SS if you want. If he actually has dysgraphia, linking spelling to handwriting might be exceptionally frustrating for him. More typically you'd try to go at that another path (auditory, visual memory using visualization which is done with your eyes closed, kinesthetic by typing, etc.).

 

Interestingly, some kids like this turn out to be VERY visual spatial (VSL) after their vision therapy work. So I'm not saying not do that. My dd was like that, very VSL but not able to show it completely till her VT. So it's definitely worth doing. I'm just saying don't frustrate him by going into things that work on that high level stuff without fixing the foundation. Retained reflexes, vestibular issues, etc. will totally glitch stuff up. *Some* developmental optometrists are conversant on retained reflexes or even treat them. Sometimes they have an OT/PT they refer to. And sometimes they're idiots and do therapy anyway.

 

Yes on using CBT or meta-cognitive methods with a gifted dc. Socialthinking - Articles Just for your trivia, you might want to read this article and see if you see your ds in there. These are profiles that cross diagnoses, and that could be informative if there's something underlying why he's exploding. All the Social Thinking stuff is based on CBT and aimed at near average to gifted individuals who can work on their problems in a meta-cognitive way. They/recommend the book you're using and are going to have other things as well. Personally I think it's less helpful to think up more labels for the behavior and more helpful to figure out the thinking process underlying why it's happening. 

 

To me, that's such a schooly thing when they go oh he gets it and can hold it together but it's just really hard. The deficits are there and that's saying oh don't bother because it's not happening THAT much. It's just really strange. It really fits with one of the social communication profiles at that link, so you really might like to read that article, scanning till you find the section that clicks in your mind to you. What they're saying is they have high expectations, which is noteworthy. So he has deficits, but they fall into a pattern that doesn't get him a social pass. People go wow, you could do better. That dc is more likely to be perceived as bad, willful, not having deficits but just not wanting to, etc., even though there are real deficits going on. It's a really sticky zone to be in. 

 

They can refer you to a counselor for the CBT, but also someone trained in Social Thinking materials would work. I personally wouldn't want an approach that didn't *include* Social Thinking materials. 

 

What do you mean by him being ambivalent about IED behind totally ADHD? You mean your ped doesn't think this will escalate as hormones kick in? Or that he thinks he'll later push over to another label because that's not indicative of straight ADHD? Or?? I can tell you nobody *I* work with with my ds takes the teen years lightly. I'd be banging it out with the Social Thinking materials, self-regulation, and figuring this out. I'd want that OT eval. Getting that body under control, getting his self-awareness up and self-regulation up so he knows WHY stuff his happening and can own it, will be HUGE. He's going to have a hard time holding a job if he's exploding like that. It's a really serious thing. It will affect his family. The goal is to make sure our kids have well-being, are able to contribute, are stable. Holding a job is part of that for most people. 

 

If this were just an "oh he'll outgrow it and when he's 24 it will click and not be an issue anymore" he'd already be controlling it now. I'd emphasize that intervention for the social thinking, the meta-cognitive work way more than the spelling. The spelling won't cost him a job.

 

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Edited May 6, 2017 by OhElizabeth

[blondeviolin]

 

 

Hmm... If his visual processing is an issue, you would take him to a developmental optometrist. As far as dysgraphia and dyslexia, those aren't really the same. Did the psych say one or the other or both?

The neuropsych flagged dysgraphia based on some test where they have to copy a picture with it there...and then a few hours they say, "hey, remember that picture? Can you draw it again?" And he couldn't do very well remembering it without the aid. For ME, dysgraphia wasn't even on my radar until the neuropsych suggested it. He never had trouble learning letters, printing, holding a pencil, etc. He's got a strong grammar sense and he doesn't have problems with punctuation or run-on sentences. He DID take forever to learn to read, he's still a poor speller. The pedi yesterday said in the case of a diagnosis, it's still a language-based learning disorder. And if he were in school, it'd be pretty important to track it down. But since I'm aware and he's homeschooled, it's not as big of a concern.
 

 

You might be really wise to do an OT eval for retained reflexes, etc., before you see the developmental optometrist. There are often retained reflexes in ADHD, and that plus the visual processing issues would indicate possible retained reflexes. So then you'd go to the root problem before you'd treat the symptoms. It really varies with the OT/PT and sometimes you have to search before you find one who's really good at them. As in I burned through 5 OTs before I found someone, and that someone is a PT. ;)

Would I just have to call each OT to see if they work with retained reflexes or...? He did OT for a while last summer because he's a chewer. That did stop him from chewing his shirts and stuff.
 

 

So I would get the visual processing problem fixed before using a vision-based spelling program, yes. And I would get the OT eval and make absolutely sure you've screened for and treated all retained primitive reflexes, vestibular issues, etc., before you even do therapy for the vision. Then, when you've got all that done, you could work on the spelling.

I didn't even think vision therapy and I probably should have because when he saw the OT last summer she did mention he had a hard time tracking... I do know our insurance doesn't pay for it and our funds are tight. Maybe I can see if his school charter would reimburse...
 

 

Does he type? That gets you kinesthetic memory. He can type the SS if you want. If he actually has dysgraphia, linking spelling to handwriting might be exceptionally frustrating for him. More typically you'd try to go at that another path (auditory, visual memory using visualization which is done with your eyes closed, kinesthetic by typing, etc.).

He just learned typing this year. He's slow at it, but can do it. He hasn't seemed to be frustrated writing the 25 words a day with SS, however I had planned to move him to SS Online next year because it'll open up space and time for me to work with my younger kids.
 

 

Interestingly, some kids like this turn out to be VERY visual spatial (VSL) after their vision therapy work. So I'm not saying not do that. My dd was like that, very VSL but not able to show it completely till her VT. So it's definitely worth doing. I'm just saying don't frustrate him by going into things that work on that high level stuff without fixing the foundation. Retained reflexes, vestibular issues, etc. will totally glitch stuff up. *Some* developmental optometrists are conversant on retained reflexes or even treat them. Sometimes they have an OT/PT they refer to. And sometimes they're idiots and do therapy anyway.

Yes on using CBT or meta-cognitive methods with a gifted dc. Socialthinking - Articles Just for your trivia, you might want to read this article and see if you see your ds in there. These are profiles that cross diagnoses, and that could be informative if there's something underlying why he's exploding. All the Social Thinking stuff is based on CBT and aimed at near average to gifted individuals who can work on their problems in a meta-cognitive way. They/recommend the book you're using and are going to have other things as well. Personally I think it's less helpful to think up more labels for the behavior and more helpful to figure out the thinking process underlying why it's happening.

The pedi didn't tell us anything about IED, but it was in the report. He did give us some good ideas about how to handle the temper stuff, but a lot of it is what we were doing. And I do feel like the book is helping. And I also feel like being more aware of his sleep has really helped. I got him a Garmin tracker and if I check his sleep and see it's been cruddy, I can allot some grace.
 

 

To me, that's such a schooly thing when they go oh he gets it and can hold it together but it's just really hard. The deficits are there and that's saying oh don't bother because it's not happening THAT much. It's just really strange. It really fits with one of the social communication profiles at that link, so you really might like to read that article, scanning till you find the section that clicks in your mind to you. What they're saying is they have high expectations, which is noteworthy. So he has deficits, but they fall into a pattern that doesn't get him a social pass. People go wow, you could do better. That dc is more likely to be perceived as bad, willful, not having deficits but just not wanting to, etc., even though there are real deficits going on. It's a really sticky zone to be in.

They can refer you to a counselor for the CBT, but also someone trained in Social Thinking materials would work. I personally wouldn't want an approach that didn't *include* Social Thinking materials.

He just meant that since it's only at home, is a good sign and more likely that it's not something like ADHD since it would happen everywhere. And because he can control himself even at home to not go completely postal/beast mode, that's also a good sign. But he also said those skills seem to be lagging and so we should do what we can to help them catch up.

I've bookmarked the link and will read if today. I'm hopeful it will be helpful. Thanks!

 

What do you mean by him being ambivalent about IED behind totally ADHD? You mean your ped doesn't think this will escalate as hormones kick in? Or that he thinks he'll later push over to another label because that's not indicative of straight ADHD? Or?? I can tell you nobody *I* work with with my ds takes the teen years lightly. I'd be banging it out with the Social Thinking materials, self-regulation, and figuring this out. I'd want that OT eval. Getting that body under control, getting his self-awareness up and self-regulation up so he knows WHY stuff his happening and can own it, will be HUGE. He's going to have a hard time holding a job if he's exploding like that. It's a really serious thing. It will affect his family. The goal is to make sure our kids have well-being, are able to contribute, are stable. Holding a job is part of that for most people.

If this were just an "oh he'll outgrow it and when he's 24 it will click and not be an issue anymore" he'd already be controlling it now. I'd emphasize that intervention for the social thinking, the meta-cognitive work way more than the spelling. The spelling won't cost him a job.

That was total typo on my part. It wasn't "ambivalent behind" it was supposed to be something about him being ambivalent towards an ADHD diagnosis all together. He didn't discount it, but he said it may not be too. Regardless, we are addressing the behavior needs and that's what I really went there for. And I feel like I was heard and had some good advice tossed out.

Edited May 6, 2017 by blondeviolin

[Storygirl]

That test is called the Rey-Osterrieth Complex Figure Test. You can find interesting information about it online if you search.

 

Did they run the WISC? How did he do on the Coding subsection? The coding subtest is what our NP referred to when she diagnosed dysgraphia.

 

Dysgraphia is interesting. DS13 scores in the 1st percentile for the coding subtest and for the Rey Complex Figure Test. Yes, 1st. He's right down there at the very bottom. And he does have problems with fine motor, overall. His handwriting is wonky, but not illegible unless he is scribbling very fast and doesn't care. You would think it would be worse, given his scores.

 

Dysgraphia is not all about handwriting but also is about getting thoughts onto paper. Being able to organize thoughts into meaningful writing. Which is related to executive function.

 

I know nothing other than what I've read on my own and what the psychologists have told us after testing. Both of my boys had trouble with the Rey Complex Figure Test.

* DS13 has dysgraphia and couldn't really do that test at all, even when copying right from the design.

 

* DS12, on the other hand, does not have dysgraphia. His trouble with the test was attributed to weak executive function, and was complete different. He had trouble deciding how to do about copying the figure the first time (which end to start with and how to proceed), but after the waiting periods, each time he drew it from memory, the drawing improved. We got to see his drawings, and it was amazing to see the difference.

 

I think the dysgraphia suggestion is interesting in your son's case. Do you see him struggling with writing? Executive function weaknesses, which could affect writing, often go hand in hand with ADHD. If you don't see that he has trouble with the motor aspect or writing or the organizational aspect of getting thoughts on paper, perhaps his trouble with the test is related to visual memory?? The test can indicate many different things, which is why the psychs like to use it, and visual memory is one.

[Storygirl]

I find it weird they didn't tell you outright if it is dyslexia. That is something they should have been able to say YES or NO on. What you describe about his writing sounds more like dyslexia than dysgraphia to me (I have kids with each). Did they run the CTOPP?

[sbgrace]

Can I make a maybe weird sounding suggestion for the anger?

 

I purchased a book, Tap Into Joy, to try to help with my son's sleep. It's EFT for kids (well, he's 13). 

 

It turns out it has been fantastic for dealing with strong emotions, particularly anger and frustration, for him. My son can be at a "10" in anger/frustration and get down to a 2 with the EFT script and routine in this book.

 

It's been a really great, unexpected, tool. I don't know why it works--but it does. It's even helping other members in the family--hubby and even myself.

 

I'll add that my son's emotional regulation/anger issues are very controlled when he's sleeping well. He's had major sleep issues for the last several months, which I'm actually thankful for because I would never have purchased that book except in desperation for sleep help. I feel what I have now is a great life tool for my son. I mention because getting the sleep piece in place may really help. 

[blondeviolin]

That test is called the Rey-Osterrieth Complex Figure Test. You can find interesting information about it online if you search.

 

Did they run the WISC? How did he do on the Coding subsection? The coding subtest is what our NP referred to when she diagnosed dysgraphia.

 

Dysgraphia is interesting. DS13 scores in the 1st percentile for the coding subtest and for the Rey Complex Figure Test. Yes, 1st. He's right down there at the very bottom. And he does have problems with fine motor, overall. His handwriting is wonky, but not illegible unless he is scribbling very fast and doesn't care. You would think it would be worse, given his scores.

 

Dysgraphia is not all about handwriting but also is about getting thoughts onto paper. Being able to organize thoughts into meaningful writing. Which is related to executive function.

 

I know nothing other than what I've read on my own and what the psychologists have told us after testing. Both of my boys had trouble with the Rey Complex Figure Test.

* DS13 has dysgraphia and couldn't really do that test at all, even when copying right from the design.

 

* DS12, on the other hand, does not have dysgraphia. His trouble with the test was attributed to weak executive function, and was complete different. He had trouble deciding how to do about copying the figure the first time (which end to start with and how to proceed), but after the waiting periods, each time he drew it from memory, the drawing improved. We got to see his drawings, and it was amazing to see the difference.

 

I think the dysgraphia suggestion is interesting in your son's case. Do you see him struggling with writing? Executive function weaknesses, which could affect writing, often go hand in hand with ADHD. If you don't see that he has trouble with the motor aspect or writing or the organizational aspect of getting thoughts on paper, perhaps his trouble with the test is related to visual memory?? The test can indicate many different things, which is why the psychs like to use it, and visual memory is one.

Thanks for the test name. I will looking it up. She noted he could not recall gestalts when asked to redraw the picture.

His lowest score on the WISC was picture span at a 5. Coding was next lowest at 8 and the letter/number sequencing at 9. His vocabulary, however measured 16 and both scores in fluid reasoning were 15. So obviously a giant disparity.

 

He doesn't seem to have problems writing. He writes his own summaries for history. They're not huge tomes, but he does a good three or four sentences. I will say, however, that we have followed SWB's methodology well and so he had lots of practice with copywork and dictation. Mostly he doesn't struggle with words to paper, but if he does, I have him give me the summary and then dictate it back to him.

[blondeviolin]

Can I make a maybe weird sounding suggestion for the anger?

 

I purchased a book, Tap Into Joy, to try to help with my son's sleep. It's EFT for kids (well, he's 13).

 

It turns out it has been fantastic for dealing with strong emotions, particularly anger and frustration, for him. My son can be at a "10" in anger/frustration and get down to a 2 with the EFT script and routine in this book.

 

It's been a really great, unexpected, tool. I don't know why it works--but it does. It's even helping other members in the family--hubby and even myself.

 

I'll add that my son's emotional regulation/anger issues are very controlled when he's sleeping well. He's had major sleep issues for the last several months, which I'm actually thankful for because I would never have purchased that book except in desperation for sleep help. I feel what I have now is a great life tool for my son. I mention because getting the sleep piece in place may really help.

Thanks! I'll check this book out for sure. I think the sleep thing definitely compounds it.

[blondeviolin]

I find it weird they didn't tell you outright if it is dyslexia. That is something they should have been able to say YES or NO on. What you describe about his writing sounds more like dyslexia than dysgraphia to me (I have kids with each). Did they run the CTOPP?

No on the CTOPP.

 

They ran a TOWRE and the psych noted that his ability to read stems was average, but under time pressure his results were low average, his sight words were in the 19th percentile and his phonemic decoding efficiency 42%. She did tell me she could not diagnose dyslexia because he wasn't below grade level or sufficiently behind. 😒

[Storygirl]

So, DD12 has dyslexia, diagnosed by a neuropsych. I'd have to look back to see if he ran the TOWRE. I'm only superficially knowledgeable about various tests used; I tend to look them up to understand more about the results, and I don't remember reading about the TOWRE before. But I've had three kids go through NP testing, so I don't remember everything. Because dyslexia is a phonological impairment, the CTOPP, Comprehensive Test of Phonological Processing, is a standard tool. I don't know if the TOWRE tests quite the same things or not.

 

It seems to me that someone could sort out the dyslexia/dysgraphia thing for you and give you better answers., if you wanted to dig into it further. Of course, the hope is that NP testing will sort everything out, but we've found that sometimes there are questions that are insufficiently answered. We are continually adding more information to DS13's file (he had his NP at age 9).

 

The thing about not being able to diagnose because he is not far enough behind....that is frustrating. We have run into that not with the dyslexic DD or DS13 but with my third child, DS12, whose NP testing showed a lot of weaknesses but nothing far enough below the curve to diagnose a disability. It's really frustrating, because the struggle is still there, even without a diagnosis and the help it might bring.

[PeterPan]

No on the CTOPP.

 

They ran a TOWRE and the psych noted that his ability to read stems was average, but under time pressure his results were low average, his sight words were in the 19th percentile and his phonemic decoding efficiency 42%. She did tell me she could not diagnose dyslexia because he wasn't below grade level or sufficiently behind. 😒

 

Our SLP runs the TOWRE. It's more for dysgraphia. The sight words could be explained by the vision problems. The convergence would mess up his visual memory. A 42%-ile decoding, while maybe low relative to IQ, isn't objectively low and isn't going to get him to dyslexia. Not a psych myself, but I'm just saying.

 

Sometimes it takes a while for things to become obvious. I had that with my dd, where she was struggling (actually very similar, with an ADHD label and vision problems from convergence, visual memory, etc.). Her spelling was so crunchy, I thought surely it's dyslexia. It wasn't. The psych didn't diagnose it, but I tortured myself for a good while thinking maybe it just wasn't obvious because I had used SWR. You know the way we torture ourselves, lol. 

 

Now I have a ds who *does* have all three SLD labels, and it's pretty clear the first psych for dd got it right. There's also a lot of window there where something can be nasty hard and NOT get them an SLD label. It's sorta like the difference between hard and impossible, if that makes sense. Like not that some things are impossible for my son, but honestly they really are. Like something can be really, objectively, obscenely, inappropriately, not expected for IQ HARD and not get an SLD label in a kid. The SLD is, at least in our house, when it moves over to the downright seemingly impossible status.

 

I think it's really good to support things that are hard! Just because they're hard doesn't mean he won't want to do them or that they won't be good areas for him. There's sort of this perverse irony in life, that some of the people form whom writing is HARDEST also have the most profound things to say! The very thought process that makes it hard for them to get from A to B (widely spaced mini-columns in the brain, etc.) also makes them inter-connected, insightful thinkers.

 

I forget where this was going. You're at a crunchy stage post evals. Just accept the labels and roll with what you got. In general psychs usually get it right. I've also seen psychs not get it right. There's a lot of this weirdo land where things are wicked hard and need support, and you're right that the scores give you a lot of insight into WHY they're hard, physically hard, even if they don't give you a consoling label to slap on it.

[ealp2009]

Can I make a maybe weird sounding suggestion for the anger?

 

I purchased a book, Tap Into Joy, to try to help with my son's sleep. It's EFT for kids (well, he's 13).

 

It turns out it has been fantastic for dealing with strong emotions, particularly anger and frustration, for him. My son can be at a "10" in anger/frustration and get down to a 2 with the EFT script and routine in this book.

 

It's been a really great, unexpected, tool. I don't know why it works--but it does. It's even helping other members in the family--hubby and even myself.

 

I'll add that my son's emotional regulation/anger issues are very controlled when he's sleeping well. He's had major sleep issues for the last several months, which I'm actually thankful for because I would never have purchased that book except in desperation for sleep help. I feel what I have now is a great life tool for my son. I mention because getting the sleep piece in place may really help.

Can I ask how your use The book, Tap into Joy? I just bought it and we are trying it out but I feel like in the moment of anger, there is no way he could compose himself enough to do one of the scrips even with assistance.

 

Thanks!

 

 

Sent from my iPhone using Tapatalk

[sbgrace]

Can I ask how your use The book, Tap into Joy? I just bought it and we are trying it out but I feel like in the moment of anger, there is no way he could compose himself enough to do one of the scrips even with assistance.

 

Thanks!

 

 

Sent from my iPhone using Tapatalk

I'm sorry I missed this until tonight.

 

I think the tapping is ideally used throughout the day--when the emotions just start or, even better, to keep regulated. 

 

In times of strong frustration/anger, I do have to sit with him and it can take a lot of encouragement--when he does it, he feels better--but deciding to do it in those moments is hard, very true. I think it's pretty powerful, though, to know you have a tool when those emotions are so strong.