How to have a compelling case for the pediatrician *little update in first post!*

[MrsRobinson]

Anyone that knows my dd well would say my suspicion of adhd was crazy. She is a social butterfly and charms the pants off everyone she comes across whether she's just met them or known them her whole life. She doesn't see age either. One of her self proclaimed best friends is 65 and another bff is 6. She literally gets along with everyone.

 

If I were to add that I think she has a learning challenge possibly in the form of Dysgraphia, everyone would REALLY think I'd completely gone off the deep end! Her reading level and reading comprehension are super high. She rattles of all kinds of history and science info and "teaches" people all sorts of things whether they wanted to "learn" them or not! :lol:

 

Her pediatrician falls into this same category with everyone else in her life. He's treated her since birth, he knows her and all of us well. We see him in other non clinical situations regularly. Sit down restaurant, grocery store, street fair, on and on. (Small town life)

 

We have the first appointment next week to get the ball rolling on evals and I am so nervous that he's not going to see what I see at home all.the.time. I am afraid he is going to think I am trying to fit her into a diagnosis because it would explain why she is so different from me and why we struggle to communicate well and work well together. Or that it's all going to come down on homeschooling allowing bad habits to develop or go unchecked. She needs more structure and accountability than I can provide at home, blah, blah, blah. He's not necessarily against hs but he's not an advocate either.

 

So what can I do to be prepared for this appointment and give him a compelling case? Bring samples of her writing? Have her do some sort of learning assessment online? Do I acknowledge the positives first before addressing the concerns?

 

What is he going to ask her or do with her at the visit? I am going to talk to her about the appointment today. I was planning on just saying something like "we are checking in with your learning abilities and seeing where we are on track and where we can improve." Is that appropriate?

 

Tia for any suggestions!

 

****Here's a little update in case anyone cares. Our visit with the pediatrician went pretty well. I just just stated my case. The behaviors, writing issues, etc. He asked a bunch of questions, which I was happy about because I felt like he was invested in finding out what's going on.

 

His conclusion was let's do neuro psych testing, here's a referral. Let's also get an OT eval. Here's a referral. I was thrilled he came to those decisions without me asking. Restored my opinion of him. He was dismissive a bit about adhd concerns but I think he was sooooooo concerned about the writing issues that that's what he focused on and asked all his questions about and looked at the samples I brought. But that's ok. The testing will reveal it if the adhd is there anyway, right? And if it's not, great! Testing isn't until the end of summer so the wait begins.

 

I just wanted to come back here to thank you all once again for all your thoughts and suggestions. I took to heart a lot of what you all had to say and I think the appointment was smoother for it. I am sure I will be back as we navigate evals. :scared:

 

Take care everyone!

Edited April 26, 2017 by MrsRobinson

[Crimson Wife]

I'm confused by why being a social butterfly would rule out a diagnosis of ADHD- did you mean to write ASD for Autism Spectrum Disorder? Many people with Attention Deficit Hyperactivity Disorder are "life of the party" types and that gets them into trouble because they are so susceptible to peer pressure as their impulsivity hinders their judgment.

 

I would take in a symptom checklist like this one.

[EKS]

I wouldn't bring your daughter to an appointment like the one you describe.  You are going to want to be very frank with the doctor, and that won't happen with your daughter in the room.  

 

I would bring anything you think will help you make your case.  If you want to acknowledge positives, I would say something like: "I know that when you see my daughter she presents as [insert appropriate positive adjectives here], but I wanted to talk to you about what's going on at home."  Or something like that.

[MrsRobinson]

I don't think the social butterfly personality trait would rule out adhd. Maybe what I meant was more along the lines of when she is out and around people she is "on." Her alertness and attentiveness in social situations is amazing when compared to her extreme inattentive behavior and distraction at home. She has dirty dishes in her hands after a meal and will walk out of the kitchen and down the hall with them before realizing it every single time. She will go to the bathroom to brush her teeth and when I check her teeth she says "oh I forgot why I went in there so I emptied my bladder." :huh: School time is so hard to get through with her constant spacing out. But she doesn't do that out and around other people.

 

I talked to the nurse today. Unfortunately, it's the office policy that she has to be there. But the nurse said she could sit at the nurses station and color or read for part of the appointment.

[zarabellesmom]

Are you seeing the pediatrician because you need a referral? He/she isn't really the one to see when it comes to learning difficulties except when they set themselves up as experts on ADHD (which even then is suspect in my opinion) since learning disabilities aren't really a medical issue.

[MrsRobinson]

Yes, we need him to refer us to a pediatric neuro psych team near us that will bill our insurance. A teacher could also make the referral but we don't have that option so the team sent us to our pediatrician. They were also hoping the pediatrician could come up with some ways to fill in the gaps that would typically be filled by teacher questionnaires.

[MerryAtHope]

Talkativeness is actually one way the "H" part commonly presents in girls. Your examples are good (walking down the hall with dirty plates etc...), and a handwriting sample would be good too. I'd come with a list of common example/struggle spots that make you want to do evals. Bringing a checklist with is good too.

[Storygirl]

If the doctor doesn't see the ADHD symptoms, he won't be the right person to fill out the forms for the evaluation. Does she have a Sunday school teacher, dance teacher, babysitter, etc., who could fill out forms for you? We used a gymnastics coach once.

 

Unfortunately, even teachers don't always "see" the issues. We had two teachers fill out forms for the doctor this year, and only one teacher reported seeing ADHD behaviors. The doctor mentioned that it was as if they were evaluating two different students. Those form are subjective, and so the answers can vary widely.

 

Some pediatricians may run their own ADHD testing. There are evaluation forms they can score, and there are computer tests (TOVA or Quotient) that they may utilize. Be sure to ask them to run some screening tests before they decide she doesn't have symptoms. Our pediatrician didn't think DS had ADHD, but when he ran the Quotient test on him, DS tested in the severe range.

 

I think it's not uncommon for pediatricians to brush off concerns, because they think the parents are being worried a lot over little things. If you go in with a list of problems and point out that these are happening daily, constantly, it might help. Be prepared with your concerns written down, so you don't forget anything you want to say.

 

If the pediatrician seems uncertain, ask them to refer you to a pediatric psychiatrist for evaluations. Some pediatricians prefer to outsource ADHD diagnosis and treatment (others like to do it themselves).

 

 

[Crimson Wife]

I don't think the social butterfly personality trait would rule out adhd. Maybe what I meant was more along the lines of when she is out and around people she is "on." Her alertness and attentiveness in social situations is amazing when compared to her extreme inattentive behavior and distraction at home.

 

I'm pretty sure the diagnostic criteria for ADHD in the DSM requires symptoms in multiple environments (the concern being distinguishing between reacting to a poor school environment and a true disorder). So if she's only showing symptoms at home, you're likely to run into trouble getting a diagnosis.

 

Now if she is showing primarily inattention at home and other symptoms like interrupting people or fidgeting while away from home, that would still be showing signs across multiple environments.

[MrsRobinson]

I'm pretty sure the diagnostic criteria for ADHD in the DSM requires symptoms in multiple environments (the concern being distinguishing between reacting to a poor school environment and a true disorder). So if she's only showing symptoms at home, you're likely to run into trouble getting a diagnosis.

 

Now if she is showing primarily inattention at home and other symptoms like interrupting people or fidgeting while away from home, that would still be showing signs across multiple environments.

She does interupt and jump around on furniture when she's comfortable with her environment. Like at grandma's house or auntie's house. And she is very inattentive at piano lessons. Her instructor has started having her do some midline crossing exercises to get her brain to focus for lessons. He said he is willing to fill out a teacher questionnaire.

[OneStepAtATime]

Yes have the piano teacher fill out a form.  Is there anyone else in a capacity to observe her where she is comfortable that could fill out questionnaires?

 

As for the dysgraphia, what are you seeing to think dysgraphia?  Poor letter formation/spacing between letters/spacing between words/erratic sizing of letters/lack of ability to write within lines/lack of ability to write legible on blank paper/etc.?  Or is it getting ideas out, whether written or verbal, such as in analysis of something she has read?  Or something else?  Or all of the above?

[PeterPan]

Hmm... My dd was diagnosed kind of late (age 10), so I hear you on the seeing things but missing how it fit together. Or maybe ADHD is just very normal in our home? :D

 

Anyways, I would not assume the ped will blow you off. It sounds like he has seen her in multiple settings which, as Crimson says, is actually part of the diagnosis. He may not think of you or the situation quite like you think of it. After my dd's diagnosis, THEN people started saying things. ;) Unless he has an overtly anti-ADHD diagnosis for anyone position, you have no reason to assume he'll blow you off. People around the kid sometimes see ADHD before the parents. The parents are too close to it or have other excuses for the behavior.

 

On the dysgraphia, odds are you won't get that diagnosis. Sure it could be. I'm just saying statistically it's unlikely. Just in general, I'd encourage you to approach this very openly saying this is what we're seeing (list symptoms) and we think it's time to get explanations and options. Don't tell the ped what the diagnoses are. He can't diagnose SLD Writing anyway. He might want to refer you for an OT eval. There are other things that might explain what you're seeing. You're going to want to be more open-minded. And maybe you're right, but even so (or especially so), you ought to have more evals. My ds has a bunch of labels, and I made sure he got OT and audiology evals. Especially because these things are less common in girls, it's really wise to make sure you have the correct explanation. If audiology (APD) hasn't been on your list, it should move up, at least as a consideration.

 

You said he'll blow off your complaints as being caused by homeschooling and mention structure. Structure is THE number one recommendation for ADHD. It's the number one recommendation whether she's homeschooled or ps or private school or whatever. So eliminate that as an issue and up your structure! 

 

I'm looking at your sig and seeing rowdy boys and that you're saying she can't work. Are you sure you have a workable situation? I tried to keep my dc in the same room. They're 10 years apart almost, so you'd have thought she'd be able to do her gig. It was AWFUL. 

 

At some point you have to get really realistic about what is going on. Sure meds can help, but meds plus structure plus motivators plus plus plus, kwim? That's what they'd be doing in school, and it's all stuff you can do at home. School only solves the problem if they're willing to go to lengths and bring in supports that you aren't willing to do. If you're willing to bring in that level of support, then the differences shrink. There are still differences, yes, but they shrink.

 

And would it be so awful to put her in school? I'm just playing devil's advocate here. It's not going well and she's distracted by two rowdy boys. Your attention is divided and you may or may not be up for providing the level of structure and support she would need. She might actually really enjoy the stimulation level at a school, which would match her level of creativity.

 

I chose to keep my dd home, so obviously I think that's ok too! But we did a LOT to up supports and structure, a lot. Personally, your situation sounds like a losing battle. Just being blunt. My dd would have wilted and died in that, couldn't function in that.

 

Sorry, I've made a lot of assumptions there. If they're not what is going on, fine. I'm just trying to play devil's advocate and show you some more takes on things. 

 

What strategies are you using with her that work?

If you were to list your three biggest problems with her you need to solve, what would they be?

Edited April 18, 2017 by OhElizabeth

[MrsRobinson]

One Step and Oh Elizabeth: Thank you for your thought provoking questions. I am too tired to think or answer coherently tonight. I will be back tomorrow! :D

[OneStepAtATime]

One Step and Oh Elizabeth: Thank you for your thought provoking questions. I am too tired to think or answer coherently tonight. I will be back tomorrow! :D

:grouphug:   Hope you get some rest.  "See" you tomorrow.  :)

[MrsRobinson]

Yes have the piano teacher fill out a form. Is there anyone else in a capacity to observe her where she is comfortable that could fill out questionnaires?

 

As for the dysgraphia, what are you seeing to think dysgraphia? Poor letter formation/spacing between letters/spacing between words/erratic sizing of letters/lack of ability to write within lines/lack of ability to write legible on blank paper/etc.? Or is it getting ideas out, whether written or verbal, such as in analysis of something she has read? Or something else? Or all of the above?

There is a cousin that has mentioned how much like her dd, my dd is. She babysits for me when there are medical appointments and things like that. I can ask her if she'd be comfortable filling out a questionnaire.

 

As far as Dysgraphia goes, the problems are all in your first question combo. Analysis of something she has read or that has been read to her is fine. Verbally. If you asked her to write her answer, she'd have a meltdown. She does everything in her power to get out of writing. Unless it's something she wants to do.

 

Example: The other day she made labels for our vegetable garden. She copied from the seed packets to get spelling correct. She had 2 spelling errors and I think 4 random uppercase letters. She totally disregarded the printed lines on the labels but her words were pretty straight where she randomly put them on the label. This was 15 labels. Basil, tomatoes, etc. I raved and raved about the project and the first thing she said was "this is my writing for the day, right?" :rolleyes:

 

We did the writing 8 exercises 2 to 3 times a day for about 6 weeks. She was really sick of it by the time we stopped. I haven't seen any improvement. She still starts her letters at the bottom right and circles numerous times and backtracks to add stems to h and n and tails to g and p and all the rest. Because of this, her hand fatigues quickly and her brain is working way faster than her hand and she gets frustrated and breaks down.

 

I have started giving her and her brother the same copywork. A one or 2 sentence verse. She has been doing it all in one sitting with no complaining. I give her brother the option to take a morning and afternoon session to complete one verse. So she is determined to get hers done all at once because "I'm in THIRD grade and you are just in kindergarten" she tells him. I think that peer pressure has been good for her. She also makes me circle which letter she formed the best. :D

Edited April 18, 2017 by MrsRobinson

[MrsRobinson]

I'm looking at your sig and seeing rowdy boys and that you're saying she can't work. Are you sure you have a workable situation? I tried to keep my dc in the same room. They're 10 years apart almost, so you'd have thought she'd be able to do her gig. It was AWFUL.

 

At some point you have to get really realistic about what is going on. Sure meds can help, but meds plus structure plus motivators plus plus plus, kwim? That's what they'd be doing in school, and it's all stuff you can do at home. School only solves the problem if they're willing to go to lengths and bring in supports that you aren't willing to do. If you're willing to bring in that level of support, then the differences shrink. There are still differences, yes, but they shrink.

 

And would it be so awful to put her in school? I'm just playing devil's advocate here. It's not going well and she's distracted by two rowdy boys. Your attention is divided and you may or may not be up for providing the level of structure and support she would need. She might actually really enjoy the stimulation level at a school, which would match her level of creativity.

 

I chose to keep my dd home, so obviously I think that's ok too! But we did a LOT to up supports and structure, a lot. Personally, your situation sounds like a losing battle. Just being blunt. My dd would have wilted and died in that, couldn't function in that.

 

Sorry, I've made a lot of assumptions there. If they're not what is going on, fine. I'm just trying to play devil's advocate and show you some more takes on things.

 

What strategies are you using with her that work?

If you were to list your three biggest problems with her you need to solve, what would they be?

Ok, I think I'm ready to reply to this one! Whew, you really gave my brain a workout! But that's good. That's what I need.

 

I wasn't expecting a diagnosis from the ped. But I just figured he needed the account of what we are dealing with to decide whether or not to refer out for evals. He doesn't really like to refer out. He likes the kids and likes seeing them. It took me a year to convince him to refer us to an allergist for ds and when we went to get an embedded splinter out recently, he said right to ds, "now that you are seeing Dr. ______ for your allergies, I never get to see you anymore! I miss your funny jokes." Which is sweet but also confirms in my mind that he likes his patients and he doesn't like to see them go elsewhere. Maybe I'm misreading that or over thinking it. I don't know. Just explaining why I'm jumpy I guess.

 

As far as the rowdy boys issue, ugh, I don't know. She used to get distracted and want to play blocks or play dough with them rather than do schoolwork. But I changed to letting her play with them or outside for an hour before schoolwork. I also switched to more interactive, hands on science and history which she loves and is always really engaged in. (As long as I scribe for her, of course.) So with those changes she doesn't feel the need to play with the boys all the time. I also got her some noise canceling headphones which work great when she wears them. She busts through her math in no time. But she doesn't like the pressure they put on the sides of her head so she doesn't use them much. We have good days and not so good days.

 

Yes, I am willing to increase structure and use whatever supports are necessary to help her thrive. I am having a hard time visualizing what that looks like in a homeschool environment. For instance, we unexpectedly had to handle some small business issues and wound up at the bank for almost 2 hours this morning. So the whole day's plan got shuffled around. Another example: we shift our daily family walk/outside time based on when the weather will be nicest that day. Some days that's 2pm, other days it's 10am. Another day we went hog wild making slime, play dough, kinetic sand, and more. It ate up most of the day but everyone had so much fun. To me these are the good things that come with homeschooling but also don't seem very structured. Unless I'm misunderstanding what everyone means by "structure" when applied to a kid with adhd.

 

To the question of school possibly being better for her... I don't know the answer to that either. I think it would exhaust her. She has a hard time falling asleep at night so she sleeps in until 8:30am or later. She needs quite a bit of down time. On the 2 evenings per week that we have outside activities, she gets a solid 2 hours of quiet time in the afternoons before we leave the house and she doesn't complain about it. She craves it. I also won't see her up before 9 am the following mornings.

 

Even though she is distracted at piano lessons, she does pretty good at home during practice time. Her piano world really opened up when I split her 30 min practice in to 2 15 min practices am and pm. And she's out paced me so practice feels like she's in charge and showing me what it's all about. She loves that. She also attends a once a month art class at a local gallery and does a once a week art class during the summer months. She loves those too. We do a mostly weekly play date or park day rotating among her 4 similar age friends, all of whom also homeschool.

 

So while we do have challenges with her attention and her school lessons run long because of that, I think she's reasonably happy with her learning environment. **** I don't know, should I just ask her? :huh:

 

I think I've already answered what strategies are currently working. 3 biggest problems that need solved?

 

1. Writing stamina

2. Willingness with writing as a part of school lessons (like writing out answers to questions or writing a brief summary for a documentary or book)

3. How do dh and I approach parental roles of training, discipline, support (and probably more things) with adhd? (I realize I'm making the assumption there.)

 

 

****I just want to add in here that one of the reasons I think she is happy with her situation is because of the accommodations I make for her with writing. I transfer all her grammar pages to the white board because she prefers that over paper and pencil. We do a lot of math aloud. I try to make spelling fun by letting her practice with shaving cream, finger paint, sidewalk chalk, a drawing app, pretty much anything goes. Pretests and final tests are pencil and paper and the complaining and tears over that mostly stopped when I brought out the fun stuff for midweek practice. For persuasive paragraph unit, descriptive paragraph unit, etc. I always double the amount of days the curriculum says it should take. So we usually are able to stop the lesson about 30 seconds before the tears would show up.

[myfantasticfour]

I have an oldest DD and 3 younger boys (DD12, DS9, DS6, and DS2) and could almost say your DD and mine were twins, and DH has had to be reminded when growling that DS9 needs medication, that DD12, at that age, was also distracted to the point of lunacy, and such a space cadet that he was sure something was wrong with her. She is now competing prominently in martial arts, and doing amazing things in academics, though she still has "ditzy" spells now and then that flabbergast me (can't put a hairbrush down in the bathroom, but has to carry it to another room and then lay it down randomly, for instance, and also cannot seem to stop dropping clothing on the floor).

 

When DS9 followed in her footsteps a bit earlier than she did (he was an early bloomer, hormonally) we didn't freak out quite so much when he became a basket-case right about the time he started getting armpit odor.

 

Not saying your child doesn't have a problem, but hoping to reveal what I went through, in searching about the issue, which was that everyone I consulted in homeschooling circles and out, confirmed that their child on the threshold of adolescence (age range 8 to 13!) was so sloppy, careless, inattentive, irresponsible, and spacey, that they all thought at the time there must be something wrong with them. Some quoted Maria Montessori (I think it was) that the peri-adolescent period was wasted time, and that they should even cease academics and focus on handicrafts instead, until it passed. hehe. Being perimenopausal now myself, I can believe it. If this is going through puberty in reverse, it stinks. I sat there waiting at 3 green lights yesterday. Seriously.

 

The rowdy little brothers are definitely a problem for my DD. I have offered to have her go to the library for some peace and quiet, or to her room (which is the only room in the house from which household noise can't be heard) but she doesn't like that much quiet, so I still don't have a solution.

 

For my DD12, martial arts competitions are an outlet, plus knowing that she's on the waiting list for an arts-based charter high school year after next. If the local school weren't such a dismal social environment (among the worst in our state) I would have sent her to school for her own sanity, by now.

 

On the other side of the coin, one of mine might actually be what you'd call dysgraphic. DS9 has always been very gross-motor oriented, was talented at kicking a ball, running, balancing on one leg at a young age, but fine motor really lags for him, and at 7, his handwriting was really poor, more like toddler scrawl. I also haven't been the most consistent teacher, with a toddler and a preschooler meanwhile, but finally at 9.5, he is learning cursive, in large form, using Peterson Directed Handwriting's Rhythmic Motion Method, with chants, and not going small until large-form gross motor patterns are internalized. It's finally working. He may actually be writing in large, but legible, form, by 10.

 

I just couldn't prioritize that as a hill to die on, at any point in the last few years, and since his keyboarding was good, and his speaking/reading/typewriting ability were great, I let it go, even though I think handwriting is important at some point. For him, it had to be later rather than sooner. Practice makes progress, and perfection isn't required.

 

Hope you don't think I am belittling your situation with your daughter, because I don't pretend to know the intimate details. Just sharing some baseline similarities, saying I feel your pain in certain areas, and giving some perspective. I now fully expect DS6 to go spacey in 2 to 3 years, and stay that way for a few. Other moms assure me that it passes, and that our kids aren't crazy, and that a glass of wine in time, saves nine lives or something to that effect. hehe.

 

<hugs>

[Storygirl]

I think some kids do get spacey around puberty. My experience with my kids with ADHD is that they have ALWAYS been this way. It's not something that came on at a certain age, though it can become more noticeable when peers mature in ways that the ADHD child does not.

 

[Heathermomster]

If you are concerned about dysgraphia, maybe get a ped referral to seek an OT evaluation. An OT eval takes about one hour and examines visual perception, motor planning, balance, pincer/core strength, handedness, and developmental motor. Exercises may be performed to improve core/pincer strength, developmental motor, and balance. Both of my children have benefited from working with an OT and ped PT. According to our OT, 50% of children with motor issues will also suffer with ADHD/ADD.

 

My DS was diagnosed with dysgraphia on his 8th birthday by a PhD Neuropsychologist. Dysgraphia affects both his physical handwriting and sequencing of written output. DS learned to type in 5th grade and started typing everything but math by 6th grade. Handwriting practice made no difference, and he struggled with both cursive and print.

Edited April 19, 2017 by Heathermomster

[Heathermomster]

Eta: If your child works with an OT and is given adequate time to improve but does not, seek a full np eval. Speak with testers and use one that supports homeschooling and is accustomed to working with gifted children.

 

With a diagnosis of SLD written expression, you accommodate by allowing extra time for tests and assignments, scribing, using speech to text sw, taking answers orally, and by teaching how to type. When she takes standardized tests, use the diagnosis to get a scribe and extra test taking time to establish a history of testing accommodations.

[PeterPan]

Ok, I keep trying to reply and keep getting pulled away. Now I'm back. :)

 

You're doing a lot of things really well! Seriously, you really are. Some of the things you're doing ARE structure, whether you know the buzzword or not. Structure means clear expectations, rails, where they go ok I know the plan, can see the plan. You can have structure and unschool! You could say every day we work at our unschooling from 11 am -3pm, you do what you choose, and from 3-5 pm we gab and you tell me about it. That would be structure. Clear plans, clear expectations, she knows the plan.

 

So no, having structure doesn't mean the plan has to be rigid or inflexible or look like some hyper-planned MOTH calendar arrangement or something. It just means clear expectations, a knowable plan, consequences, so she knows what she's working with and finds it dependable and consistent. It will lower anxiety and increase predictability and productivity.

 

You're also doing really well with the noise canceling headphones, love! Sorry they're uncomfortable, oy. Are they shooting headphones or something upgraded? I know there's a huge pricepoint difference there. We have active noise canceling headphones from the hunting store, and indeed they're kind of clunky. We have noise canceling earbuds (some passive, some active I think, dd uses them). And we have a couple pairs of the really nice Bose active noise canceling headphones ($$$$$$). I use them when flying, because the noise gives me migraines.

 

So if you're at one point in the tech, you could move along and try other things (the Bose, earbuds, combo like earbuds under noise canceling, etc.). But just the fact that you're recognizing how her environment is impacting her is really good! You've probably taken a lot of steps you aren't listing out, so this is all really good! :)

 

I like how you're teaching her to *structure* her practice sessions for piano. And then the way she's taking ownership, that shows you that when she CAN do the work she WILL! That's fabulous! That's the kind of empowerment you want to keep happening. Like that's really where it's at with these kids, when you see that click and they can own it. Keep going with that and working in that kind of way. She's going to have to live in her body a long time, so the more empowered she is to make good choices and understand what works for her, the better.

 

Has she had her vision checked by a developmental optometrist?

 

Honestly, the stuff you describe is *so* similar to my dd at that age. I really don't remember how much she hand wrote at that age. If you know how to google site search, you could try to look for my old posts. My memory is foggy, but basically I recall my dd as being about as pencil phobic as you would ever hear any boy described around here, and she NEVER got a dysgraphia diagnosis. She has some mild praxis that doesn't get her a DCD diagnosis. She has some mild APD stuff that isnt' enough to put her over on that to a diagnosis. Writing was very hard for her (handwriting not automatic till 9th gr, great drops of blood, STILL hard and something she avoids in classes when she can), and yet no dysgraphia diagnosis. 

 

And I wish I could you I got why she didn't get a dysgraphia label and my ds did. My ds' handwriting, for what he can write, is actually better than my dd's was at this age. My dd could write words and do some words say for spelling or write a sentence. For her writing was HARD. For my ds, it's more like writing just doesn't work. Like it's literally just not a functional option for him to get anything out. Even for him to copy something is astonishingly tedious. He will have to have a worker with him to compel him, and it will take 20-30 min to get out a few words (maybe 8) to make 1-2 simple sentences like from a Draw Write Now page. And it will look so bad you wonder why you paid money to make that happen. Even the worker is like let's just stop this, this is awful. It's not a functional thing for him at all.

 

So that's all I know, that it can be very *hard* and not get you a dysgraphia label. But I'm not skillful enough to say what will happen with your dd. I can say that I would want to know, in your shoes, if she has retained reflexes. You mentioned hand fatigue. That's an OT issue. She may have low muscle tone, core issues, or something else going on. I would be EXTREMELY vigilant on this and find out what is going on there physically. It's MUCH more likely to be a physical explanation than an SLD. I'm just saying statistically, that's the higher probability. Or some combo of things like an OT/PT issue plus developmental vision. So I would get those eval'd pronto.

 

Some people will say it's overkill to want a neuropsych for ADHD. I say it's not, because my dd's first eval was with a neuropsych. I really liked the level of testing I got and the nuanced info. A shorter eval with a clinical psych will be enough to diagnose ADHD, yes, but it won't go into motor planning our help you eliminate these questions you have about SLDs or turn up things you aren't expecting. We found issues with my dd's word retrieval that explained part of why writing is so hard for her. That's in testing that a neuropsych would do but not a clinical psych. They can do screening for motor planning issues, APD, etc. 

 

So yes, I would go ahead and get your psych eval referral. I would also want a good OT/PT eval. Find somebody who is stellar with retained reflexes and get them checked. Get her eyes checked by a developmental optometrist. There are retained reflexes that can affect writing. I think that even though two of your three areas of concern are writing, I would not stress them until you get the reflexes checked and worked on. Odds are some are retained. She may have other physical issues going on. Personally, I'd just scribe for her for a while and stop beating that horse. The world will not end. Work on typing. Typing was really hard to get on my dd. I finally switched her to an alternate keyboard layout (Dvorak) and paid her BIG TIME. Until you have an explanation, stop dying on the hill of writing. 

 

Does she color? Will she do dot to dots? Mazes? That will be really, really telling if she shies away from some of those things and not others. They are other ways to work on handwriting besides handwriting. 

 

Your #3 was discipline. I probably know what you mean, but you want to elaborate? 

 

Not to state the obvious, but I'd get a new ped. I'm really nasty like that. I'm not there to entertain someone. I use a really professional ped and he never wastes my time or disrespects me or blows me off. I don't have enough character to put up with that.

 

 

Edited April 19, 2017 by OhElizabeth

[eternalsummer]

Have you tried cursive?  DS8 has very poor and labored handwriting and no amount of remediating print or doing hand exercises really helped much (we did a lot of things, too).  We started cursive this year just on a lark and not only is his cursive much better than print (and easier for him, judging by the amount of complaining) but somehow print has become easier and clearer too.  He writes his own video game guides willingly in his spare time now.

[eternalsummer]

I would either get a new ped or insist on a referral.  That's nice that he likes to see the kids for everything, etc. but the truth is he can't be the best (or even very very good) at every aspect of care for every kid.  There are some things that someone specifically trained in and practicing a different discipline will just be better at doing, and more worth your time and money.  I mean, would you let him do your kid's heart surgery?  No.  

[PeterPan]

I do put stock in the puberty thing. My dd really sort of lost a year in that fog. But once you say she has fatigue with writing, that really needs a referral for OT/PT and an explanation. You really don't want to fail to catch what is going on there. That's not puberty.

 

The needing excess sleep and having a hard time falling asleep are both the ADHD. Both would respond to meds. You'll find that if you put her on meds she'll actually go to sleep more easily at night and wake better. If you want to see, try a super, super low dose of caffeine on her. You can find suggested dosing in articles online.

[Heathermomster]

I put no stock in the puberty issue wrt handwriting.  Both of my kiddos have struggled with motor and attention issues long before the body hair and smelly armpits began.  What is interesting is that hormone-addled pre-teens and teens have no problem whatsoever focusing on things they care about.  Dysgraphia is a cognitive processing issue.

Edited April 19, 2017 by Heathermomster

[MrsRobinson]

To answer myfantasticfour, yes, this child has been like this her whole life. Since she is our oldest, dh and I always just talked about how shocked we were that it is so constant, this parenting thing. Constant reminders, constant redirection. I guessed kids just literally don't hear or remember anything you say, ever. Then ds turned 4. And for that whole year we were fighting the comparisons because it felt wrong. But he was sooooooo much more capable than his 7-8 year old sister. We've seen another huge leap for him at 5.5 and we've stopped fighting it. We started researching what we could be looking at with dd. She has never had a noticeable jump in maturity. We still do so much hand holding. She is very exhausting for us and at 9 is still our most challenging child with 2 rowdy brothers.

[PeterPan]

When you say don't hear, is that connected to background noise? Any time you have the not responding thing, there are several explanations that would be on the table. For us, the explanation was autism, but we went to an audiologist and did not only your basic hearing (an obvious explanation) but also had some APD screening to make sure that wasn't part of the issue.

 

She sounds very challenging. I hope you get your referrals and can get some explanations soon! :)

[MrsRobinson]

To answer OhElizabeth:

 

I just bought some $20 cheapie headphones on Amazon. They were hot pink and I thought that would get her on board. :lol:

 

I am so glad that we don't have to abandon our flexible school environment! What a relief!

 

If she doesn't get a diagnosis for the writing issues, that's ok. I just really want to know what I need to be doing to help her gain some ground there. It seems like the younger we do that the better, right? I am happy we have the ability to accommodate but the feeling that I'm not actually doing anything to help her improve creeps in.

 

Retained reflexes could definitely be in play. She is a toe walker. She can walk on her feet. She does when she is wearing shoes. But in bare or sock feet, she walks on her toes. Always has. I would be thrilled if we could get her some OT that could help.

 

She does color. She loves those relaxation coloring books and soft colored pencils. She goes in waves with them. She'll be really into them doing a page a day for a few weeks then doesn't touch them for months. She has a Highlights subscription and does all the dot to dots and mazes in those. The problem is really just in letters, words, and sentences.

 

Elaborate on discipline? I'm not sure I want to, lol. :leaving: I think dh and I just need to learn the ropes better if it is adhd. I think he's too harsh on her and expects too much. Expects her to fit into a re gulag kid mold and then I'm too easy on her to make up for it so she takes advantage of me. We need to find a balance.

[PeterPan]

Did you look for explanations for the toe walking?

Edited April 19, 2017 by OhElizabeth

[MrsRobinson]

When you say don't hear, is that connected to background noise?

When I say don't hear, I mean I will say "close the car door." She will walk away from the car and up 5 porch steps then stop and ask me "wait, what did you say?" Or multi step directions. She cannot do multi step directions at all. I don't know if she only hears part of it or if she forgets. Even just getting her attention. I have to say her name several times, my voice naturally raising each time before she responds.

[MrsRobinson]

Did you look for explanations for the toe walking?

Years ago the ped said it wasn't a deformity or anything because if it was, she wouldn't be able to walk on her feet at all. One of her same age bff's has the deformity. Achilles tendon thing I think. She couldn't walk on her feet at all. She wears braces on her legs. So that lined up with what the ped said and nothing else was pursued.

[PeterPan]

Anything else going on? Have you actually written all this out? You might want to behavior log for a few days. Just write down all this crunchy stuff you're seeing. It's very significant. 

 

I don't think you're going to like your ped very much when you get done. He sure has missed a lot.

[MrsRobinson]

Have you tried cursive? DS8 has very poor and labored handwriting and no amount of remediating print or doing hand exercises really helped much (we did a lot of things, too). We started cursive this year just on a lark and not only is his cursive much better than print (and easier for him, judging by the amount of complaining) but somehow print has become easier and clearer too. He writes his own video game guides willingly in his spare time now.

What cursive program did you use?

[nature girl]

As far as discipline, from everything I've read (and from firsthand experience) we saw the most improvement when we started working on shaping behavior based primarily on rewards rather than consequences. We use short time outs when behavior is extreme (very rare these days) but give small tokens for pretty much everything, including stopping a negative behavior on her own, and using tools to curb her own frustrations. I've recommended Kazdin's Everyday Parenting Toolkit here several times (I think OhE was the one who first recommended it to me.) We saw a huge shift using his methods. 

Edited April 19, 2017 by nature girl

[Crimson Wife]

When I say don't hear, I mean I will say "close the car door." She will walk away from the car and up 5 porch steps then stop and ask me "wait, what did you say?" Or multi step directions. She cannot do multi step directions at all. I don't know if she only hears part of it or if she forgets. Even just getting her attention. I have to say her name several times, my voice naturally raising each time before she responds.

 

Has she had a full audiology evaluation (not the screening at the pediatrician's office) within the past 12 months?

 

At the risk of sounding like a broken record on this topic, but symptoms of partial or mild hearing loss can get chalked up to ADHD. My daughter was spending so much of her brainpower on trying to understand the distorted auditory input that she didn't have much left over for everything else. She never seemed like she had any trouble hearing because she was such a good lip-reader and could fill in a lot of the gaps from context clues. She had enough hearing at certain frequencies to pass the pediatrician's screening.

 

Getting the hearing aids and later the cochlear implant reduced a lot of the "spaciness" and difficulty following directions that had previously been chalked up to ADHD. Now she *DOES* still have other ADHD symptoms like hyperactivity, impulsivity, fidgeting, etc. and medication makes a noticeable difference. But you definitely should have full booth testing by an audiologist just to check her hearing.

 

[eternalsummer]

We use Handwriting without Tears - we used their print programs to no avail but we tried their cursive anyway (he is left handed) and it has been a major win.

[MrsRobinson]

We use Handwriting without Tears - we used their print programs to no avail but we tried their cursive anyway (he is left handed) and it has been a major win.

Did you just use the workbooks or did you get the kit?

[eternalsummer]

just the workbooks

[myfantasticfour]

If you haven't yet checked it out, there are at least two websites for support for gifted and twice-exceptional kids (2E) who are often mislabeled because most people have a certain image of what giftedness looks like, that is not at all what the reality is particularly the farther the person gets from the norm.

 

Think Hermione Granger versus Luna Lovegood. Most people would assume Hermione to be the poster child for giftedness, and dismiss Luna as just plain weird. At any rate, hoagies and gifted homeschoolers forum are two search terms that can help you see whether you might want to look further into something, that often co-occurs with many of the problems you listed. 

[OneStepAtATime]

Thanks for the update. Good luck!

[MerryAtHope]

Appreciated the update! Hope testing goes well.

[Guest]

So wonderful to hear your doctor is being supportive and giving you the referrals you need! Hope all goes well with the evals and that you get the information and services needed to help your child.

Edited May 22, 2017 by Guest