Pediatrician troubles?

[Mamaski]

Has anyone ever had trouble with their child's pediatrician or developmental pediatrician tell them that their child needs to go back to the public school system?  I recently had a run in with my son's developmental pediatrician; told me that my son's acting out is because his schoolwork is too difficult for him (we are working on a kindergarten level with most subjects) and that we needed the protection that an IEP provides.

 

During my son's 3rd grade year, he learned a grand sum of nothing.  He was constantly acting out in class, getting in trouble, and barely met the minimalist goals outlined in his IEP.  The whole point of me homeschooling him is that we CAN give him the individualized attention he needs to excel in his learning. We have been homeschooling for a year and a half and he is displaying the same behavioral issues at home as he did when he was in public school since kindergarten. 

 

I just don't understand how this professional can state that he needs to go back to the public school system.  I wasn't there to ask his opinion as to where he should receive his education, I came to him with an issue about my son's DIAGNOSED ADHD and looking into restarting/changing the medication.  To which he stated, "...his issues cannot be medicated away."  Implying that he needs to go back to school in a way that is not homeschooling.  

 

What would you do in this situation? 

[Tokyomarie]

How long has he been home and what grade is he in now? Has he ever had a private educational or neuropsychological evaluation to more closely identify his strengths and challenges in learning? Especially what information processing weaknesses underlie his difficulty? If not, that would be one good step you could take.

 

Behavior is communication. When a child is acting out, it usually means there is something or several somethings that are creating stress for him. Cognitively, it can be information processing differences or a mismatch between content and/or teaching style and the child. There can be biological stresses such as sleep, nutrition, and exercise routines. Social communication difficulties can lead to stress, as can emotional regulation challenges. Finding some way to get  a deeper understanding of what is behind the behavior would be a high priority. It doesn't seem like this developmental pediatrician understands the need to look holistically at the child before drawing conclusions about how to handle challenging behaviors. Sometimes working with a behavior analyst can be part of the solution- OhElizabeth can tell you more about her experience. 

 

 

[PeterPan]

I feel summoned. :D Seriously, um, I've been on the receiving end of a good chunk of criticism myself. I GET that it's really, really not fun to be blamed when your kid is having problems. Thing is, as Tokyo said, at some point you have to actually solve the problem. 

 

What I find is that everybody who sees my ds has a piece they're seeing, maybe something they're good at, and that I have to look for WHY they're saying it and not take it personally. Like guaranteed, just guaranteed, one of the things he's thinking about is structure. It's just a known gig that ADHD responds well to structure, and you're saying you're having behavioral problems stemming from ADHD. 

 

Now is autism on the table? Frankly, I didn't think anybody went to a developmental ped just for ADHD, so is there SPD or something more going on? Why are you there? Have you had a full, private psych eval, or was this ADHD diagnosis only a ped diagnosis? Easiest way to get a MISDIAGNOSIS is to have a ped diagnosis. So you want to know your explanations are COMPLETE. When you have the right words, then you can connect with the right answers.

 

Yes, Tokyo is correct that we brought in a behaviorist (whom we still use) and ABA workers. It was pivotal for us. You shouldn't need that level of support for straight ADHD, which is why I'm wondering if you've had complete evals and gotten things sorted out. You should be getting OT, checkig for retained reflexes, a full psych eval, etc. etc. The more flags you tick (language issues, sensory, etc.), the more evals you need. Eval, eval, eval. 

 

What are the homeschool laws in your state? Did your dc *not* have an IEP before, even though he was enrolled? My ds has an IEP, because in our state it's the gateway to the disability scholarship system. It's a big pain in the butt and we took two years advocating in it. Reality is they're nice people wanting to do a good job but not always adequately funded or trained. Maybe you'll be stellarly lucky. The well intentioned part is really important. I've had SO many nasty things said, ugh. I try to figure out the good part and blow off the idiot part. Like the ps SLP who tried to tell me I should be on an antidepressant because she was on one.  :lol:  :lol:  :lol:

 

If you have compliance laws and have to meet certain test scores to homeschool legally in your state, then I can see why your ped is encouraging you to get documentation. You need to figure out what protections you need, step one. It's ALWAYS important to comply with the law and be safe and know you're complying with the law. I comply with the law. Everyone should comply with the law. 

 

Two, you want to do things that get you access to services. In our state, an IEP gets you access to a disability scholarship. You might research to see if your state has one.

 

Three, your ped is correct that ADHD is not a medication deficit. Honestly, it sounds like y'all aren't communicating very well. He probably had a lot of things in his head, was miffed, and wasn't saying them very nicely. There are a BUNCH of things he was getting at there were not merely about going back to school. The ps can put into an IEP positive behavior supports. They can put in sensory diet and movement breaks. They can put in language work and social skills. They can increase STRUCTURE. They can bring in executive function supports.

 

YOU can do all those things too!! But because you don't know what any of that stuff is (and the school does), the ped just looks at that and goes ok, kid gets appropriate services if he has an IEP at school and kid gets a higher dose of ritalin at home. And the ped is saying you ought to have more than just meds, that the behavioral supports and the other interventions are essential too.

 

It's a rare, rare parent who takes the time to learn all these things. It's a pain in the butt to do them, depending on how challenging the kid is. If you want to learn them, you can, sure! You know what you might do, just for sake of argument, is go ahead and go through the IEP process, make the formal written rquest for evals, see what the ps would do with him, and see what you learn through that. I try to go to training and workshops and read books. *I* learned things in the IEP process. They were not idiots. These are people who work with kids all day, and they had TONS of useful observations and things they pulled together. Just their efficiency is good. I realized there were patterns to things, that the issues were predictable, that there are structures to interventions that work, and that SOMEBODY has to get onboard with evidence-based interventions for behavior and academics. It can be me or them, but just somebody has to do the hard work.

 

And your ped is correct that the studies show that parents who receive behavioral counseling and behavioral interventions BEFORE meds have better outcomes (they themselves are more satisfied) than if they do meds first or even meds + behavioral concurrently. In other words, your ped is right that you need a full picture solution, not just one thing. It's teaching methods plus behavioral supports plus structure plus sensory regulation plus social thinking instruction plus meds plus plus plus...

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Edited November 3, 2017 by OhElizabeth

[Sandwalker]

Has anyone ever had trouble with their child's pediatrician or developmental pediatrician tell them that their child needs to go back to the public school system? I recently had a run in with my son's developmental pediatrician; told me that my son's acting out is because his schoolwork is too difficult for him (we are working on a kindergarten level with most subjects) and that we needed the protection that an IEP provides.

 

During my son's 3rd grade year, he learned a grand sum of nothing. He was constantly acting out in class, getting in trouble, and barely met the minimalist goals outlined in his IEP. The whole point of me homeschooling him is that we CAN give him the individualized attention he needs to excel in his learning. We have been homeschooling for a year and a half and he is displaying the same behavioral issues at home as he did when he was in public school since kindergarten.

 

I just don't understand how this professional can state that he needs to go back to the public school system. I wasn't there to ask his opinion as to where he should receive his education, I came to him with an issue about my son's DIAGNOSED ADHD and looking into restarting/changing the medication. To which he stated, "...his issues cannot be medicated away." Implying that he needs to go back to school in a way that is not homeschooling.

 

What would you do in this situation?

I would change doctors. He sounds ill-informed.

[laundrycrisis]

I would find a new doctor.

[Mamaski]

Ok, so I was trying to be brief in my original post.

My son has been diagnosed as having a mild intellectual disability (neuropsychologist testing). Obviously it is hard to separate his attention issues from his impairment but he does still meet the requirements for an ADHD diagnosis. We have tried a couple of different medications that had too many side effects to continue. This particular doctor does not want to use stimulants with my son because he has heart problems (his cardiologist has OK'd). 

 

I understand what the Dr. was saying about him acting out because things are hard for him and it is a learned coping behavior to get out of the work. What I fail to understand is how it is different when he does this at a school and when he does it at home.

 

My son had been in the public system since he was 3 (he was at an early intervention facility). He has received therapy since he was 6 months old. He had an IEP since kindergarten. He was making slow but regular gains in kindergarten and 1st grade. His behavioral problems really started causing problems towards the end of 1st grade into 2nd and 3rd where his progress really slowed down. I started homeschooling him for his 4th grade year (and 3 months at the end of 2nd when we moved) and we are now 3 months into his 5th grade year. 

 

We have completed an ILS program at therapy. He has been referred for vision therapy but insurance does not cover. Unfortunately, his early therapists (or me) did not know about retained reflexes, but he is getting that attention now.

 

Normally I would not hesitate to just change doctors but it seems to be the consensus around here that this particular doctor is quite good. It just struck me the wrong way when he mentioned several times that he was concerned about me and also my relationship with my son even though I did not raise any concerns with him about that. I would rather deal with him at home than send him to school to always be in trouble there. He did mention structure but again I fail to see how the structure at school helped him in any way. They would have to interrupt his schooling to deal with the behavioral problems at school just like I have to at home. I have each school day scheduled in half hour increments. I have consulted a behavioral therapist and her only input was to adjust my schedule slightly to provide rewards after schoolwork. My son can be frustrating in the way that when something seems to work as far as motivation/rewards it may work for a few weeks or just that day and it may never work again. Again, this is not new for me, but what we have been experiencing in public school also. 

 

The doctor also mentioned how the professionals at school could work with him on the basic foundational skills he needs to progress higher. I don't understand how it gets more basic than kindergarten level. 

 

What point am I missing?

 

 

[PeterPan]

It's hard, sigh. Big sigh. There's sort of an expectation of behavioral problems in struggling learners, yes. My ds has a gifted IQ with SLDs and ASD, and we got the SAME LINE about how the behavioral problems were normal because things will be hard.

 

It's sorta both.

 

You need a new behaviorist. If that's all she gave you, move on. I agree that I would keep the ped. He's abrasive and bugging you, but he's making you think. To me, I'm not looking for someone I agree with, only someone I can work with.

 

Behaviorist, SLP, OT, somebody who is trained in Zones of Reg. 

 

I understand why you pulled him, because it's like watching a train wreck, sigh. 

 

You know what you might try? You might see if you can find an Intervention Specialist who would consult with you. A behaviorist is not an education expert. An IS is the person who would be teaching your ds for intervention in the ps. I've had several to my home, and we sit down and talk about how we're working together, look at stuff, etc. It helps stretch my vision while being very realistic. 

 

I need to scat for a bit, but I'll come back. The other challenge you have here is that psychs, peds, etc. think that ADHD is environmental, that homeschooling is magical and would solve everything. So it would be interesting to determine whether the behaviors had ADHD or something ELSE underlying them at school. It's stuff to think through, whether it's attention, whether it's self-regulation, what it is. 

 

Do you behavior log? ABC, antecedent, behavior, consequence. If you could log for a few days, you can start to see what is causing what. 

 

You're probably going to need several things, not just one thing. If your data shows it's an attention issue, in a variety of environments, irrespective of preferred vs non-preferred, I would find another ped to write the scrip. But really, I think you could probably even get this ped to write the scrip. Was this your first visit? You have no history of problem solving together. He's RIGHT that meds are not the sole issue here. My guess would be that if you go through other steps, do other things (bring in an IS, find a new behaviorist, begin Zones of Reg, etc.), and then have data where you can say what is causing what, he's gonna get on board. I just find, in the practitioners I see, there's an across the board initial reluctance to script for meds, even if the people ARE in favor of meds. They really, really, really want you to have done everything else first. 

[PeterPan]

More foundational means using either printed or custom intervention materials. What are you using?

[PeterPan]

I'm back. Intervention materials have tiers, but there are also things sold by Evan Moor, Carson Dellosa, Scholastic, etc. that maybe aren't *labeled* intervention but that are being used for intervention. For instance, with my ds I'm using a Spotlight on Reading series that has separate books for inferences, summarizing, cause/effect, and compare/contrast. Way slower and way more detailed that traditional materials would be, and when you read the reviews you'll see intervention specialists saying they're using them. When I've had IS in my home, they'll tell me either that they use the kind of stuff I'm using or that they would write custom to have high interest material on his level. 

 

So really, really targeting the level and having materials that are meant for that level of intervention *can* help. Some of this stuff is wicked expensive. I spend time at the local teacher's college, going through their lending library. They'll let me check out things. They don't necessarily have everything, but they have good stuff. 

 

So it's so easy to get offended. The doc is showing he doens't know a *lot* about it but that he knows just enough to know there's more that could be done. And it's a lot of work to find these things. You're essentially becoming an IS, sigh. I only have my one ds to deal with now. My dd is off in college. If you have more kids at home or other distractions, it's really rough. 

 

You might start a thread on ID as well, just on LC. We've got other people dealing with it, quite a few. They could give you ideas. At least you wouldn't feel like you're the only one.

[PeterPan]

There's a Zones of Regulation Facebook group with both parents and professionals. If you post there, they could maybe give you some sense of how it works out with ID+ ADHD+SLDs. What you're talking about is a common, common issue.

 

For my ds, he couldn't put his feelings into words, so he would have behaviors and leave (escape, elope, pick your word). Or he'd melt down or go under tables or... So we spent a lot of time, in a lot of ways, working on calming strategies, working on things that help him stay calm all the time (setting him up for success before the hard thing), and validating the power of his words. Like I was working with my ds this morning and he says "I feel tired. After speech therapy, I feel tired." So I said thank you for telling me, we'll be done and you can go now. 

 

You know how HUGE that is? Not running off, not flipping out. But that's working on it for two years identifying what zone he is in, empowering him to use his words, letting him be confident that if he uses his words whoever is in charge WILL listen and WILL help him problem solve. 

 

So Zones of Reg is how you get there. It isn't a magic pill that makes everything go away, but it's a part of the process. And if you talk with behaviorists who are trained in it, teachers, psychs, they're going to say they want the dc to learn strategies like this BEFORE they go on meds. Now sometimes that's not SAFE and so that's not what you do. Safety first, always always. But if a dc can learn the strategies and go through this level of behavioral intervention FIRST, then they have something that is there for them even when their meds wear off, even when they aren't on meds, kwim?

[PeterPan]

Mighteor is another tool you could look into. Easy to implement and got us a lot of ground. Works on mindfulness and self-regulation. Just 10 minutes of mindfulness can give you a 30% bump in executive function. That's HUGE for these kids! So doing mindfulness, doing these strategies before he ever starts his day, can set him up for things to go better. 

 

There's a lot like that you can do, and it kinda miffs me that your behaviorist didn't give you ANYTHING. You could have come here and gotten better help for free, mercy. Was she BCBA???

[kbutton]

This particular doctor does not want to use stimulants with my son because he has heart problems (his cardiologist has OK'd). I am somewhat confused--the ped doesn't want to use stimulants, but the cardiologist is fine with them? That would bug the heck out me! (I have a kid on stimulants ok'd by the cardiologist, lol!)

 

I understand what the Dr. was saying about him acting out because things are hard for him and it is a learned coping behavior to get out of the work. What I fail to understand is how it is different when he does this at a school and when he does it at home. I would turn that question right around on him.

 

Normally I would not hesitate to just change doctors but it seems to be the consensus around here that this particular doctor is quite good. It just struck me the wrong way when he mentioned several times that he was concerned about me and also my relationship with my son even though I did not raise any concerns with him about that. I would rather deal with him at home than send him to school to always be in trouble there. He did mention structure but again I fail to see how the structure at school helped him in any way. They would have to interrupt his schooling to deal with the behavioral problems at school just like I have to at home. I have each school day scheduled in half hour increments. I have consulted a behavioral therapist and her only input was to adjust my schedule slightly to provide rewards after schoolwork. My son can be frustrating in the way that when something seems to work as far as motivation/rewards it may work for a few weeks or just that day and it may never work again. Again, this is not new for me, but what we have been experiencing in public school also. 

 

The doctor also mentioned how the professionals at school could work with him on the basic foundational skills he needs to progress higher. I don't understand how it gets more basic than kindergarten level. 

 

What point am I missing?

 

Everything you've said here is stuff that I've heard come out of my mouth of the mouths of other SN moms. Some kids are difficult regardless of setting. 

 

I think that OhElizabeth is giving some great suggestions about resources you can utilize if you didn't know about them already. There is no guarantee the school was using them or having success with them either, but it's good to have more tools and more information. 

 

Regarding the ped, I think it's probably something your ped should BUTTON UP about unless he has (real) reasons to think you aren't doing the right things. He probably means to be informative, but when you spend so much effort working with your kids, you don't want to go to the ped and hear "advice" that implies you are not doing it right. If he prefaces this with something like, "I tell all my patients x, and I want to make sure you know that y is an option..." that would be less irritating, IMO. That gives you a chance to note his concerns without having to defend yourself. If he's just throwing all of this out like he's a gift to mankind, well, return to sender. 

 

I would probably give him another chance, but I wouldn't just let myself be a lamb to the slaughter either. If you don't like him, you can find someone else. Or, you can ignore the parts you don't like, but maybe unload to someone afterwards for a reality check. Don't let him talk you into or out of decisions through a lack of confidence.

[OneStepAtATime]

:grouphug:

 

Yes, I definitely encountered this.  And it stinks.  It is so frustrating and annoying and hurtful and maddening.  As OhE and others have said, though, try not to take it personally.  (I realize that can be exceedingly hard to do.)

 

Is what the pediatrician saying logical?  In a way yes and in a way no.  From his perspective he probably has had VERY little if ANY practical experience with homeschooling in any detailed way.  Meaning he probably did not homeschool his own children or work directly with kids being homeschooled in an academic way.  All he knows is the brief amount of information he hears from you and possibly a smattering of other parents in his practice that might be homeschooling.  He hasn't lived this or studied this. 

 

Think about it from his perspective.  You are coming to him with concerns and a wish to try changing his medications in a way that have the potential to cause additional health issues (even if the cardiologist says it is fine, this doctor has concerns about following this path and as a medical professional he is obviously going to value his own concerns).  Those concerns you have regarding your son's behavior are honestly not easily addressed.  There is no quick, clear fix, no pill he can take that will cure all.  Your child doesn't have a bacterial infection or a broken leg.  Now add in that you are educating your child in a way that is outside the norm (and yes homeschooling is becoming more popular but in most areas it is still not the standard way to educate a child).   He has no practical experience with this type of educational environment.  No basis of knowledge to inform him in a reliable way as to whether homeschooling is still the better fit.

 

So what does he do?  He defaults to something KNOWN.  Does that make sense?  It is simply where his comfort zone is.  Most people are conditioned to think of public school as where the professional teachers are, not parents teaching at home.  Because of that, if teaching at home is not going swimmingly then even if the public school had been a bad fit, if homeschooling is also not working really, really well, most professionals that I have run into see public school as the better option.  They believe that ps should at least have resources to help.  In reality does a school have more resources to help?  Sometimes yes, sometimes no.  

 

As you experienced when your child actually was in school, for your particular child's needs, it was a really bad fit.  You KNOW this because you experienced it first hand.  You saw the results daily.  So you made the decision to homeschool and probably did a lot of research to come at this from a basis of knowledge even if you did not yet have the experience.  Now you have been at this about a year and a half.   Has homeschooling actually worked out really well?  No.  It is still a struggle.   Many of the same issues he had at school are still there.  Is it a better fit than when he was in school?  Probably, based on what you have posted.  It certainly seems so.   But it is still a struggle.  Your doctor is simply taking that information and assuming that if neither worked well, he would be better off in a school where theoretically there are more resources and trained professionals to help navigate this situation.  Is he right?  Well, in my neck of the woods I would have to say no.  Sadly, the school system here is not set up to genuinely help kids that are outside the norm.  Since you already went that route I think you can say that actually no it won't help your child either, at least not right now. 

 

So what do you take from what your doctor has said?  That you need to keep seeking a broader range of tools to put in your tool box to make homeschooling a better fit than it currently is.  Walk away from any other implications and hurt feelings if you possible can.  Are changing medications an answer?  Maybe.  It can certainly help, depending on the child and the circumstances.  Would Cognitive Behavior or Dialectical Behavior Therapy help?  That is also a very distinct possibility.  Especially if you find a good one.  Would a combination of the two be a good option?  Actually, that usually works better than just medications alone.  Keep seeking answers, but accept that this is going to be a long journey.  And things will change.  What works for a while may cease to work later on (as you have already experienced).  

 

I also wanted to address your statement about structure.  You stated that the structure of school did not help your child so why does the doctor think that more structure at home or returning to public school for structure would help?  Public school structure is different from structure provided in a home environment.  In school there is virtually no flexibility (at least the way the vast majority of schools are set up).  Classes are for a set time, regardless of how much material is to be covered each day or how intense/challenging/time consuming that particular lesson/concept, etc..  Also, nowadays most teachers have very set requirements and materials they are allowed to use.  Not a lot of flex there, either, within the structure of a school day.  For some kids this works amazingly well.  For others it is TOO structured.  It does not provide for the individual student's needs.

 

In a homeschool environment structure can be provided (and for some kids they will flounder and fail without it) but can be set up to provide for the needs of that particular student.  It doesn't have to be an arbitrary system created by people that never met my child.

 

For instance, my kids are VASTLY different.  Night and Day.  They both need some structure to their day but that structure is different for each of them.  DD needs a list and a framework of things to do each day but she is good at working through that list based on her mental and physical needs at any given moment.  If she has just finished some really intense math lessons (her hardest subject) she knows she needs something lighter afterwards and probably some down time to go outside and swing (she needs movement to think and to unwind).   She is old enough now that she is aware of these things and can usually choose when to do what.  We work as a team but she frequently picks which topic to tackle next.  She also needs quiet to think and prefers me nearby but not yammering in her ear.  In other words she has structure, but it is loose structure.

 

DS was different and I did not provide for him the intense structure and feedback he needed when we first started.  He needed not just daily lists but a fairly rigid schedule that repeated the same way on most days, lots of direct feedback on every single thing, and VERY clearly laid  out collaboratively created expectations for short term and long term goals.  I did not initially provide that and he floundered.  In other words, DS would have done better if we had kept to a more traditional public school type of schedule but it didn't have to be so rigid.  He did better with each subject done at roughly the same time each day, but unlike in ps we wouldn't have to sit there until 45 min was up.  Some subjects he couldn't stay focused for more than 10 minutes.  Therefore that is what we scheduled.  I also realized I needed to incorporate more physical activity and more interest led learning but with a framework to keep within.  And he needed a LOT more positive feedback and cuddles and discussion and smiles and hugs and laughter and positive interaction UNRELATED TO SCHOOL on a daily basis than DD ever did.

 

So in other words, yes, the structure in school did not seem to work for your child.  That doesn't mean that there isn't a need for structure or that structure will not work for your child.  He may need a different kind of structure from what was available in school.

 

Hugs and best wishes.  I hope you find a path that will help both of you.  This is not an easy journey.   :grouphug:

[Mamaski]

Thank you everybody for your valued input. It has given me a chance to step back and think objectively about things. I will check out all of the resources that were listed to see if we can put them to use. 

 

Thanks again!