ADHD, ODD, dyslexia, dysgraphia - woah.

[blondeviolin]

My 9yo just had a full neuropsych evaluation.  We had the results appointment today.  She noted concentration issues and said she could safely diagnose him ADHD.  So we have at least that.

 

She noted that his executive functioning skills are low.  He thinks in details but cannot put together the big picture.  He can't formulate a plan.  She said that he scored low with fine motors and might have diagnosed him dysgraphic, however his handwriting was "too good" for a definitive diagnosis.  Similarly, she might have diagnosed dyslexia, but he was within grade level for his reading and was able to sound out nonsense words.  But his spelling is SO POOR.  She said rules-based spelling and phonics would be good for him.  So basically, all of the phonics work that I have drilled him through (for YEARS) has allowed him to be on-grade-level while all of his other results were far above average.

 

I mentioned to her that he argues with me and does not take correction well.  She said there is some potential ODD there (which sounds scary from the small snippet I've read) and handed me a book (The Defiant Child: A Parent's Guide to Oppositional Defiant Disorder).  She told us that it was very good that he is not in public school because there would be lots of medication, accommodations, and still re-teaching at home.  She said if we were willing to try medication, it could be beneficial and to speak with our pediatrician about it.  She also referred us to a therapist for the ODD.

 

SO... My questions here: 

 

Firstly, because he's on grade level with his reading, do I continue what I'm doing?  What about spelling?  We are using Sequential Spelling and I feel like he's doing pretty well with it.  I was happy to see that he did remember how to spell "dinner" on one of the assessments because that is a word that has been reviewed with SS.  FWIW, he has done SWR (he could never get through remembering the phonograms), LOE, and now SS for spelling.  I also have him reviewing his sister's R&S spelling words.  He still bombs those.  Do I move to Apple and Pears spelling?  Fast Track Dancing Bears or whatever?  I have no qualms dropping anything related to spelling and/or reading to really shore up these skills if we need to.

 

What do I do about the possible dysgraphia?

 

For the EF issues, I've got Smart But Scattered that I have read through half-heartedly.  His dad struggles with some of this so I've read it with him in mind, but I guess I'll be rereading.

 

For the ADHD - we are pretty solid with our routine and schedule.  He does school 40 minutes on and 20 minutes off.  He doesn't really struggle with his schoolwork and I allow plenty of bouncing, verbal outbursts, gum-chewing whatever.  He knows that if he doesn't complete his schoolwork, he is not allowed to do ANYTHING (outside, iPad, TV, whatever).  He does not take correction very well, though.  If I make him come back and fix a problem, he is irritated because that takes more time and it's "good enough," right?!

 

I'm hoping that if we do some medications for the ADHD and get some impulsivity under control, that it will mean he is less argumentative.  I am not ruling out the ODD as of yet.  Even if he doesn't quite meet all of the requirements for ODD, seeing a therapist for it is sure to help regardless.

 

Book recommendations?  Websites?

 

And of course, I'll continue to research and read up...

[PeterPan]

It's super late, so I'll be fast.  First, congrats on getting full evals.  It's going to take you a long while and a lot of time rereading to let all this sink in.  If you're having lots of feelings (being overwhelmed, etc.), that's normal.  I would like to suggest you go ahead and get his eyes checked by a developmental optometrist, if you haven't yet.  Does he ever have issues with understanding you in noisy environments?  Have you had his hearing checked?  Even ADHD doesn't explain why he doesn't know the SWR phonograms yet.  Either you haven't been consistent (your end) or he has some processing glitches.  So I'd want to check those eyes to see if there could be an explanation there.

 

In general, kids with ADHD can have crunchy spelling, etc.  Did your psych run a CTOPP?  I get your angst on the dyslexia thing, because I felt that with my dd.  She was very similar, with strong reading, abhorrent spelling, and she turned out to have developmental vision problems and poor (very poor) visual memory.  Personally, before I bought more curriculum, I would get the eyes checked and maybe his hearing.  Around here I can get an audiology eval at the university, including a SCAN3 screening for APD, for only $35.  Seriously.  And there's so much overlap, to me those are just things you do and eliminate, kwim?

 

In general, SS should be pretty good for you to stick with for spelling, as long as his visual skills are intact.  Have you tried using visualization?  I would read the Freed book on Lazy/ADHD (name slips my mind, it's late) and do visualization techniques for the spelling to see if it helps you bypass whatever isn't working right now.  I would do dictation in context and not focus on lists.  I would get him typing.  When he types, spell check will auto correct, improving his spelling.  

 

On the attitudes, you're going to need some positive systems there where you reward good behavior, praise good behavior, and attempt to increase the good.  You can even use an extinction goal.  So, if, for instance, he complains 3 times every day about having to go back to work, you reward for him only complaining twice, that kind of thing.  

 

It's appropriate to bring in social thinking materials for ADHD, yes.  Might give you an additional way to talk with him, because then you can have as part of your shared vocabulary concepts like group plan, how the thoughts we're having, how our actions are making other people feel, etc. You can go to SocialThinking.com to find things, and you can either do them yourself or in concert with whoever you choose for behavioral work.

 

For ADHD, there are lists we've had on the board before.  Anything by Holloway like Superparenting.  

[Faithful_Steward]

You have my kid! :) My ds is younger and doesn't have odd, but he does struggle with emotional regulation. Sleep and meds were a game-changer for him.

[Storygirl]

:grouphug:

 

I know it's a lot to take in. I felt that way after DS12's NP evaluation. Three years later, I have a clearer picture of his needs, but that came over time, not all at once. When we got his report, we picked a couple of easy to address areas to tackle first, and then just took things step by step. Once we had a better handle on one thing, I would re-read the report, review information about his various diagnoses, and make a plan to address the next thing.

 

If he is doing well with Sequential Spelling, I'd stick with it for now. Be sure to read the suggestions about how to make it multisensory, though. I found it easy to just go through it like a daily spelling quiz (which is how it is set up), but you can round it out by explicitly teaching the rules that apply to each day's list. And I wouldn't move on from that group of words until he knows the rule. Practicing the spelling patterns in a multisensory way is what will help him be able to memorize them. If you find the program moves forward at a pace that is too fast for him to grasp the rules, you could cut each of the spelling lists in two and spread each day's list over two days.

 

DD11 is dyslexic. Years ago, I tried AAS with her, because it is based on OG principles, but we couldn't get past the first part, where she was to memorize all of the sounds each letter makes. She just couldn't seem to memorize things, which is common for dyslexia. BUT, she is now in a private dyslexia school, and they DO memorize and practice all of the spelling rules. It's the multisensory process that enables her to memorize things I never thought she would be able to.

 

With DD, I think that her spelling is likely to always be horrible. She's going to have to rely on her spelling tools. But knowing the spelling rules is key for her ability to decode well and be able to read.

 

So don't give up on the spelling. But don't be discouraged if it is always a struggle for him. Knowing the spelling principles will help him with reading, which  is key.

 

I wouldn't move to Apples and Pears, personally, because it is not OG based. If you think he needs more than a beefed up Sequential Spelling, you may want to look at Barton or hiring an OG tutor.

[Storygirl]

I also think that you might want to tackle the ADHD piece as your first step. Meds do help with impulsivity here, and when he is less impulsive, DS is less argumentative. DS was flagged as ODD by one of the people who evaluated him, but we consider to truly be an aspect of the ADHD instead.

 

Working on the ADHD has made other intervention strategies easier. Meds are not your only option. You can teach mindfulness and self-calming techniques. We got help from a psychologist, our OT, and our pediatrician with aspects of this, so there is more than one avenue for getting help and training with the behaviors. Since your son has fine motor difficulties, the OT can help there, too. Some insurance will cover OT, so it's something you might look into.

 

Meds are incredibly effective for many, though, including DS. I'm not anti-med (though I was resistant early on). But meds COMBINED with other therapy may be better than either approach on its own.

[Innisfree]

I have to be quick, but I couldn't let that recommendation for The Defiant Child by Riley pass without comment. My child was diagnosed with ODD when she was five, before we later got a more accurate diagnosis of ASD. In our experience, that book was not on target, but actually contributed to more problems.

 

Riley assumes your child actually has the capacity to do what you want, when you want it. Many of our children do not. Riley's approach is to pile on more punishments and bigger punishments until the child finally yields. He thinks the problems are caused by willful disobedience. *That is very likely not true.*

 

Our kids have a variety of brain-wiring issues which make it much more likely that what looks like defiance is actually a product of frustration because they can't do as well as they'd like. Alleviating that frustration and providing problem-solving tools will be more helpful than thinking of bigger and better consequences. Rewards are better than punishments, and understanding goes farther than meeting the child's rigidity with your own.

 

I'd return that book and, instead, find a copy of The Explosive Child. There's another I am trying to remember as well which focuses on rebuilding a relationship with your child by spending uncritical time with him, just appreciating his interests. Maybe someone else knows it. It was very helpful to us.

[Innisfree]

Your Defiant Child: Eight Steps to Better Behavior, by Russell Barkley.

 

So much better than the Riley book!

[displace]

I also think that you might want to tackle the ADHD piece as your first step. Meds do help with impulsivity here, and when he is less impulsive, DS is less argumentative. DS was flagged as ODD by one of the people who evaluated him, but we consider to truly be an aspect of the ADHD instead.

 

Working on the ADHD has made other intervention strategies easier. Meds are not your only option. You can teach mindfulness and self-calming techniques. We got help from a psychologist, our OT, and our pediatrician with aspects of this, so there is more than one avenue for getting help and training with the behaviors. Since your son has fine motor difficulties, the OT can help there, too. Some insurance will cover OT, so it's something you might look into.

 

Meds are incredibly effective for many, though, including DS. I'm not anti-med (though I was resistant early on). But meds COMBINED with other therapy may be better than either approach on its own.

ITA. I would encouraging a focus on this first, if you're looking into treatment/meds at the moment. Control of ADHD will help immensely with all things (reading, spelling, recall possibly, focus, etc).

 

As you're working through that, continue with what you're using for curriculum to see if there's progress. Continue for 6 weeks while treating ADHD to see if it's improved. Then consider more structured plans or a change in curriculum.

 

Dysgraphia can be diagnosed in someone with neat handwriting, it affects other things too, like speed or content, even spelling, grammar, etc.

 

ETA - another vote for formal OT eval by a pediatric therapist. They cannot diagnose, but if there's something physically wrong, they can find and treat it.

Edited November 9, 2016 by displace

[blondeviolin]

I started the Riley book, but not all of it agrees with my son.  I will probably work through most of it, but I'm still very hopeful that medication will really help with the argumentative/angry outbursts.  He has an appointment with his pediatrician this afternoon.  I also have messages in to a few people I know IRL who have ADHD children.  The ADHD piece is the first thing I want to tackle.

 

So, books I've read:

 

The Strong-Willed Child

The Explosive Child

Strong-Willed or Dreamer?

The Out-of-Sync Child

Smart, But Scattered (Re-reading)

Setting Limits with Your Strong-Willed Child (working through this one now)

 

Sitting on shelf:

The Impulsive, Disorganized Child

The Myth of the ADD Child

Overcoming Dyslexia

 

Last year I ran him through LOE Foundations and he made great gains reading-wise with that.  None of the spelling stuck.  (And I don't love the layout of Essentials.  He doesn't need all of the extra LA stuff...just the phonics.)  SS doesn't seem to bother him and I think it has helped him stop being afraid of the bigger words.  I am hesitant to switch at the moment because I'd like to give it a valiant effort.  He's only got a few weeks left in WWE 2...I'm debating moving his writing block to reviewing the phonics from LOE Foundations via dictation or taking LOE Essentials and working through the word lists and rules.  I have no problem putting a pause on writing to shore up some of these foundational skills.  He does narration and comprehension questions when the story is read to him no problem.

 

I also am planning on taking him to a COVD optometrist.  He actually did a round of OT due to an oral chewing thing.  The OT tested his fine motor skills and said they were within normal limits (and the NP testing agreed, it just was low compared to everything else) and his handwriting is pretty decent for a boy.  BUT, she did mention he might have convergence issues so I think having the eyes tested will help too.

 

I am reading so opinions, thoughts, and recommendations are always helpful.

 

And, if by chance, anyone knows what ADHD might look like in a 3.5yo (as in your son was maybe diagnosed then or later, but you saw it at 3.5), could you lemme know what that looks like?  I'm wondering if we are looking at this with my 3.5yo who also is language delayed, but every time I google I get stuff telling me that 3yos can't generally focus on stuff anyway so it's very hard to diagnose and almost never happens.

[BlsdMama]

 

 

I am reading so opinions, thoughts, and recommendations are always helpful.

 

And, if by chance, anyone knows what ADHD might look like in a 3.5yo (as in your son was maybe diagnosed then or later, but you saw it at 3.5), could you lemme know what that looks like?  I'm wondering if we are looking at this with my 3.5yo who also is language delayed, but every time I google I get stuff telling me that 3yos can't generally focus on stuff anyway so it's very hard to diagnose and almost never happens.

 

I've just begun Amen's book and one thing that jumped out at me was that most three year olds are "hyper" but by four it's down to 10% and so 4-6 is usually when you can get a diagnosis.  I have a DD who is off the charts hyper...  It's a bit like having a baby monkey, imo.  She loves hot, spicy, new foods.  She climbs higher, runs faster, and jumps farther.  She gets disappointed in her impulsivity, i.e., touching things and didn't mean to. (And I can tell the difference between disobedience and impulsivity, kwim?)

 

My second son is diagnosed ADHD (inattentive) and potential ODD (I don't think you get that diagnosis officially until teens but I could be wrong on that.)  He looked entirely different.  With no H component, it's a whole different ballgame.  

 

I wrote a post on meds this morning.  You could check it out.  I was in your shoes three years ago and opted to try other options than meds.  I'm very sorry that was my choice.

[PeterPan]

Personally, I say go with your gut.  My kids' issues were very obvious when they were young, and they were obvious contrasted with their peers, even at that age.  I think the whole can't tell because all kids are like that at 3 is a red herring.  They'll say it, but I'm saying you know.  Your gut meter goes off and you see there's a qualitative difference.

[Mom28GreatKids]

Meds will not make the behavior go away. . . but they will make him more receptive to teaching him appropriate behavior. For most kids with adhd, the world is coming at them at mach 3 speed with no ability to filter. . . once on meds, their brain is better organized which makes them more teachable. It does not, however, make the years of bad habits disappear. That takes work and skilled experts to help you unpack and rewire. Glad you are getting some answers.

Edited November 10, 2016 by Mom28GreatKids

[blondeviolin]

Today was his first dose of Concerta at the lowest dose. And I feel like angels are singing!!! For the last couple of days, he complained and argued when things didn't go his way. I couldn't even get him to LISTEN for me to explain why I wanted him to do something else. If someone bothered him, he'd yell or whack without thinking.

 

Today he did everything I asked. When I corrected, he immediately adjusted with nary a murmur. It could be just the day (because his issues are cyclical - oh, you know, like HORMONES), but the last couple of days had been somewhat hairy so maybe not. I'm optimistic.

 

And the big thing!!! He took a math test this afternoon. Towards the end, My oldest was talking to me and rubbing her hands on the table and my other daughter was whistling. He looked at each of the distractions. Then he got a bit of a crazy look in his eyes and said calmly, "Could you all please stop? Because I'm really trying to focus and you guys are sort of distracting me and my medicine is wearing off." :)

 

Today, I liked my son. I liked homeschooling.

 

If this is medication, we will take it. It should be a positive thing towards relationships with him.

Edited November 11, 2016 by blondeviolin

[OneStepAtATime]

So glad things are going well.  Just take things one day at a time.  You might start a journal and track meds/behaviors/external situations happening at the same time.  It will help with being more objective and may help the doctor, too.

[Mom28GreatKids]

So glad things are going well. Just take things one day at a time. You might start a journal and track meds/behaviors/external situations happening at the same time. It will help with being more objective and may help the doctor, too.

This is really good advice. Often the first few days are REALLY great followed by a settling in period. . . we were told that it takes 10 days to see if a dose is right. That seems to be about the time it takes them to adjust and settle . . . and there could be several cycles of adjust and settle before you hit that sweet spot.

Edited November 11, 2016 by Mom28GreatKids