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evaluating for adhd: pediatrician or psychologist?


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Title pretty much says it all. I can't really find online a recommendation on which one might be better for evaluating for and diagnosing adhd. A neuropsych report from two years ago when ds was 7 ruled out adhd, but it was solely on the basis of how ds did on one tapping test, and the rest of the report is full comments about how other input (from parents and friends) all point to hyperactivity and inattention... So I'd like to revisit this point.

I have better rapport with our ped, but ds gets on really well with his psych, and she probably knows him better as she sees him more often. Is there any reason to choose one over the other? I see them both this week anyway. ?

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I'm far from an expert, but this is what we were told in regard to DS19's autism spectrum diagnosis -- His psychiatrist (who was treating him for anxiety) said she could give him a medical diagnosis of ASD, but that for any educational accommodations we'd need to have a psychologist do the psycho-educational evaluation/testing. So I guess it depends on what you're after. Of course a psych will be better at sorting out any possible co-morbid issues.

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Actually, cough, cough, that's how you get to an ASD diagnosis, is those funky kids who are passing tap tap tests but still having issues in real life.

A ped does his gig to decide whether you've crossed his barrier for meds or not. Each ped will have his gig in his mind on what he wants, but that's the only reason to bother. He can't give you IQ, can't run genetics, can't tell you whether you have methylation defects, can't tell you processing speed, can't tell you whether there are other comorbid things, and probably won't catch all the screenings. You need a psych for all that. (except the genetics, then you need a genie in a bottle or a biomed person or something)

This was a ds? And what tools did that psych run? Let's just say I've got bad things to say about almost any professional these days, and there is at least one neuropsych on the list. They can be expensive idiots too. Sometimes the hardest problem, the reality, is that as homeschoolers we're not giving them enough data. They don't have lots of other people spending extended time with the dc in the situations that the forms are scaled/scored/normed to reflect. So like the GARS for instance assumes someone hangs with your dc in 6 hour chunks? How many people are doing that??? Therefore, the forms are worthless. 

I went to one of the authors of the BRIEF, a major EF questionaire used by almost anyone evaluating for ADHD. I'm shocked your np didn't run the BRIEF or another EF tool, and if he did you should dig through your (presumably swanky, lengthy) report and find the results. It would be interesting to see how those results pair with what you see. It would be interesting for you to RE-VISIT that tool now, how many years later, and see how it has changed. I can tell you that as demands have changed how I mark that form has changed. It has been pretty radical in fact. When I first did the BRIEF on my ds years ago (age 6), I flagged hardly anything. Now, at age 9, he's pretty much straight down the line, everything. In other words, disabilities become more obvious with time.

So, living in real-ville, my personal cents is that if there is ANY suspicion, possibility, etc. etc. that ASD is part of the picture that you get somebody who is kickbutt at the ADOS, somebody who will spend a lot of TIME observing the dc and working with the dc, like AT LEAST 6-8 hours of solid contact, do those psych evals, then revisit with the ped about meds if meds should be put on the table. The meds are methyl donors, so when you have bipolar on the table (possibly due to methylation, you can run the genetics), meds can make it worse. So then, if you ran the genetics, sometimes you put the dc on niacin and the excess vavoom AND the emotional stuff settles down. 

Guess I don't see what the ped gets you, unless you want meds, and the only way meds are safe (in your case) is with genetics to know you're not setting something off. 

Looking for a good psych is a total pain in the butt. Oh you're using a psych?? Well, hmm, I don't know how that rolls. I would have thought that if someone had a counseling relationship that then they would want someone else to do the evals. Like we're using for counseling now the psych who eval'd ds. The psych is incredibly sharp and it was a good plan. But when we need our evals updated in a few years, I don't know whether at that point she'd have someone else do it for fresh eyes? I really don't know how that rolls.

The reason I'm mentioning the spectrum thing when you didn't ask is because the psych you pick for ADHD might be worthless for ASD, where the ASD psych can deal with the ADHD, cherry on top. The harder diagnosis is the ASD and it's the bigger picture question anyway, especially if your results are a-typical. My ds' tap tap tests are totally atypical like that, and so every psych who has seen him has said something different about ADHD. Personally I think it's all crap. It just is. None of them look at biology and the DSM is equally superficial, incomplete, and don't get me started. If you think it's ADHD, you'll get somebody to say it's ADHD. Do you want meds? Does that actually encapsulate what's wrong, or is there something beyond that?

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Well I omitted lots of info abt might have been relevant, but we did talk with the psych about it today.

He has an ASD2 dx from someone else and she wants to revisit that bc she thinks he may only need level 1 support right now. But she did say that she’s the one to tease apart the ASD, giftedness, and possible anxiety and adhd, and not the Ped. A neuropsych was supposed to evaluate for adhd two years ago but the current psych said that the np didn’t actually do that, based on the report that was written. So the ball is rolling and we’ll see where it goes!

 Thanks!

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Ps I’m not sure if I want meds or not. DH thinks that if they help, we should try them. Basically, our old psych who retired wanted him evaluated for adhd but the np said no, he has a tendency to hyper focus. But In this last 6-8 months, I’ve asked a lot of unrelated questions on these boards (handwriting, organization, writing out math thoughts, etc, etc) and folks keep asking if adhd has been considered. I don’t see a common thread in these questions I’m asking, so I find it’s odd that adhd is somehow coming up over and over again. So it seemed time to investigate it a bit more thoroughly. But I’m not sure to what end I guess, other than to help ds in half a dozen areas where he’s struggling, possibly?

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Perfect. That's exactly what you should be doing. And just my two cents, but you might want to run genetics. Seriously. That anxiety can be genetics and actually treatable by treating the underlying deficits. The ADHD, well when you run genetics it just isn't as tidy as other stuff. Like I'll find lots of things that flag as suspected as being connected to ADHD, but there aren't these genes that are like oh wow they've pegged this and when yu've got that gene then BOOM you're super-powered. There just isn't. Or there is and I haven't seen it? If there is, let's have that discussion. I can go pull up the files.

So ADHD is this functional discussion and needs to happen, sure. It lets you start talking EF deficits. It lets you ponder meds. Absolutely have those discussions. 

On the ASD2 vs. 1, it's support level and language. Sounds like she's going at it the right way, wanting to collect a lot of data and see. My ds was always at the super high end of 1, like right on that line where people would go back and forth. We were having those discussions at 6/7. Now at 9 NOBODY is confused or perturbed by calling him 2, because things have panned out and become more obvious. He has significant language issues (ASD1 shouldn't), and he continues to need SIGNIFICANT support to function. So, for instance, he has an extremely hard time in church. Even with everything we can do he's having dangerous episodes averaging once a month. He's not your roll along with it, go to mainstream classes, shows up at church and people look surprised when you mention he has ASD. He's the one who doesn't get asked back to playdates, is going to need help to problem solve, on and on. Significant support. And he continues to qualify with our county board of developmental disabilities. He does not use mainstream homeschool curriculum at all, only things that are either meant for intervention or that I modify. He could not be left with a babysitter who had more people to watch and who was not prepared to meet his needs. We never leave him with anyone who is not prepared to handle him, and it's blood in the water with a novice therapist even. For comparison, in our ps ASD1 kids mainstream and ASD2 and 3 do not. 

So yeah, it's kind of a profile. Our psych, when she bumped ds, gathered a lot of data and compared him to her files and how she had gone with other kids in similar situations. It's language and then the total picture. And if he goes down to level 1 support, that would be AMAZING!! That's what you want to hear! That's awesome that she's thinking that!! And if she's thinking he's still at level 2, that raises questions too like what other services he needs, what can be done to meet those needs, because that means he needs significant support. And if he's level 1 now, that's exciting and raises questions like what doors could be open that aren't open. Either way, really good that your updating evals. Sounds like your psych is totally on it.

 

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9 minutes ago, 4KookieKids said:

Ps I’m not sure if I want meds or not. DH thinks that if they help, we should try them. Basically, our old psych who retired wanted him evaluated for adhd but the np said no, he has a tendency to hyper focus. But In this last 6-8 months, I’ve asked a lot of unrelated questions on these boards (handwriting, organization, writing out math thoughts, etc, etc) and folks keep asking if adhd has been considered. I don’t see a common thread in these questions I’m asking, so I find it’s odd that adhd is somehow coming up over and over again. So it seemed time to investigate it a bit more thoroughly. But I’m not sure to what end I guess, other than to help ds in half a dozen areas where he’s struggling, possibly?

That's baloney on the hyper-focusing meaning not ADHD. ADHD is technically mis-placed focus, not an inability to focus. The meds question though really needs to back up and be asked in light of the genetics. If you put the dc on meds and his methyl levels go up and bring out the bipolar, not so cool. It happens. We go around in circles with it for my ds, and the psych this time was like please please and the ped was like never never. They KNOW stimulant meds bring out the aggression and we now have enough cheap and easy genetics to know WHY. So it's a touchy question.

Your dh is super onboard with the right question when he's saying WHAT CAN WE DO TO HELP. And he's being super helpful when he's saying WHAT WOULD WE CONSIDER IF WE PUT EVERYTHING ON THE TABLE. That's also the right thing to be saying! So maybe what you do is refresh the evals, see what the psych is finding, run some genetics ($69) on the side, see what you find out... Some people do the stimulant meds even with the tendencies and then they add a mood stabilizer. It's not like there's one right option. The psych might have some more options. Like when ASD + ADHD is on the table, you can also have behavioral support questions, like what more could be done on the behavioral side.

Fwiw, doing behavioral intervention BEFORE the ADHD meds is actually an evidence-based approach. We've posted studies about this in the past. Studies are finding, just for ADHD in general, that parents who get behavioral intervention support THEN meds are more happy with the outcomes than parents who do meds first or begin both concurrently. I know that sounds screwy, but there you go. And when we began with our behaviorist, her goal was to see how far we could get with behavioral, with self-control, with UNDERSTANDING. Once autism is in the picture, you have both gaps of social thinking/understanding AND what their body is doing to them. So for my ds, he has fast twitch muscle fibers (I kid you not, like an Olympic sprinter) and he doesn't have the social thinking to understand WHY it's right and ok for the OT to ask him to rewrite a word. So then does he have behaviors because of ADHD or simple ready to move biology or the autism or ALL THREE?!?! It's all three. But if we could get his brain understanding more, maybe he could use strategies and control his body more. His body isn't THAT bad all the time. It's that judgment call on what is worst, how far could we get with behavioral, where is the line. And then of course his genetics and the minor detail that we can't do anything that provokes aggression, which in his case the meds would ped says. So we HAVE to work on that understanding piece.

Meds should be on the table, sure. It ALL can be on the table, and that's what your psych can help with, helping you make a list of ALL the things that can be on the table for a total package solution. Things work together. Working on the bio side helps him receive the good teaching of the counseling. It works together.

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3 hours ago, 4KookieKids said:

Well I omitted lots of info abt might have been relevant, but we did talk with the psych about it today.

He has an ASD2 dx from someone else and she wants to revisit that bc she thinks he may only need level 1 support right now. But she did say that she’s the one to tease apart the ASD, giftedness, and possible anxiety and adhd, and not the Ped. A neuropsych was supposed to evaluate for adhd two years ago but the current psych said that the np didn’t actually do that, based on the report that was written. So the ball is rolling and we’ll see where it goes!

 Thanks!

 

I would agree with the psych eval, especially if you are going to go ahead with meds. Some psychologists can prescribe meds, otherwise you can see a psychiatrist for that. I personally would not have a ped administer meds. That's just me!

We have decided against meds (ADHD meds have been recommended for my youngest) for now but that is purely our decision and it is not based on fear of bipolar (or aggression) since there is no mental illness in our family history on either side. 

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On 9/4/2018 at 7:37 PM, Moved On said:

 

I would agree with the psych eval, especially if you are going to go ahead with meds. Some psychologists can prescribe meds, otherwise you can see a psychiatrist for that. I personally would not have a ped administer meds. That's just me!

We have decided against meds (ADHD meds have been recommended for my youngest) for now but that is purely our decision and it is not based on fear of bipolar (or aggression) since there is no mental illness in our family history on either side. 

 

For now, I am glad that the Psych we are seeing is just interested in trying to help us figure things out, and continuing to give us strategies and skills to make our lives more pleasant. ?

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   3 hours ago,  PeterPan said: 

That's baloney on the hyper-focusing meaning not ADHD. ADHD is technically mis-placed focus, not an inability to focus. The meds question though really needs to back up and be asked in light of the genetics. If you put the dc on meds and his methyl levels go up and bring out the bipolar, not so cool. It happens.  

Yes, this is something I will need to look into more since we do have a family history of that.

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In our case, meds is just not something I want to consider for a child, especially a young child. If we need to, we will revisit the possibility when he is an adult. At this point, other than slowing our schoolwork a bit for the need for movement, I don't see it hindering anything else in his life. Yes, I have to keep my eyes open at all times, but you know, impulsivity is not always something that changes with ADHD meds, and I am not looking to slow his creativity or curiosity. Also, they have yet to study the long-term effects of ADHD meds on a child's developing brain. I would only consider meds in extreme situations, and since we are not at that level, I am fine with revisiting the idea if we need to. 

I am glad to hear your psych is more interested in trying strategies instead of going the meds route from the start ? .

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2 minutes ago, Moved On said:

 I am glad to hear your psych is more interested in trying strategies instead of going the meds route from the start ? .

 

Yes, she’s never even brought it up. Only DH has so far, and that only to say that he may be willing to consider it at some point. ? which of course begs the question of why were even looking at evals, but oh well. More understanding of the situation can’t hurt, right?!

Our issues do seem to go beyond a need for movement, or I probably wouldn’t bother with the eval. I’m fine with putting trampoline breaks on the schedule every half hour and doing math upside down while practicing head stands, you know? There are just other things that I could use more help managing. ?

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I am currently in the middle of reading several teacher's guides and other books but this is among them:

https://www.amazon.com/Emotional-Intensity-Gifted-Students-Explosive-ebook/dp/B008XKBHRO/ref=sr_1_4?s=digital-text&ie=UTF8&qid=1536116557&sr=1-4&keywords=gifted+children

I was going to mention it before but I know you are already busy reading. I stuck around when I saw your thread; I will be going soon. It will probably be a while before I finish it as I am also reading Developing Talents by Temple Grandin (for my oldest son) among other things. I can come back when I do and share what I think, though. I don't know if giftedness is on the table with this child (you had mentioned it about your girl) but I'll let you know anyway ?.

I come from a culture that is very animated and lively. Let's just say that he does not have negative behaviors ?! He is a very lively and animated boy. He has sensory issues coming from my side of the family. I have them too. He has very strong opinions (wonder where he got that from LOL!) and knows what he likes and what he wants. There are so many things that ADHD meds do not have an affect on when it comes to ASD, especially when there is giftedness also in the mix! Strategies is my thing. I like psychs that do strategies! I have yet to find one I am happy with or that will accept our funding. Anyway...

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1 hour ago, 4KookieKids said:

Yes, I am still extremely unlikely to consider meds, but that comes mainly from watching people I cared about be overmedicated to the point of sedation, because they were easier to manage in that state.

If this was in your childhood, are you sure you know what meds they were on? I too saw people medicated at that level, and the LAW has changed since then. Bill Clinton may or may not have been on your favorite pres list, but the Patient's Bill of Rights that passed was a BIG DEAL. If you go, as an adult, into mental health services, they are much more upfront about what your RIGHTS are, including your right to refuse care, to understand your care, etc. This was not the case before, and the way people were treated then is not how it has to be now. 

I agree, there's an ethical responsibility when you're treating a dc with a language disability or developmental disability, because their ability to give feedback and self-advocate is affected. It was a major concern to me and one of the reasons I was glad we waited until dd was a teen. However there are safety concerns and other reasons that could trump that. There *are* ways to get feedback, be collaborative, and be responsive. I don't think anyone wants children zombified with overmuch meds, and the typical thing they'll say is that kids on the spectrum who go flat on ADHD meds would have gone flat anyway, that it's their flat affect showing. So, for instance, when we began my ds on the niacin, he actually seemed MORE autistic. His genes didn't change, nor did his health or anything else. It's that some of the most distracting behaviors began to drop and then we were left with the stimming, repetitive and stereotyped behaviors, etc. 

So challenge your assumptions on how it would be. You can probably find answers to these concerns. Some of it is starting small, starting with doses that have a short half-life, using number scales and making DATA to make decisions rather than going on impressions, etc. A behaviorist can help you make data to make better decisions. 

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3 minutes ago, 4KookieKids said:

Ha ha. Well now I’ll juat have a shelf full of books to read while you’re gone. ? yes, giftedness is in the mix too, so there’s a lot of 2e stuff to tease apart. And lots to read!! 

Our behaviorist says the gifted + ASD kids are the hardest. 

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3 minutes ago, 4KookieKids said:

Ha ha. Well now I’ll juat have a shelf full of books to read while you’re gone. ? yes, giftedness is in the mix too, so there’s a lot of 2e stuff to tease apart. And lots to read!! 

?

Giftedness also runs in families.

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The best way to determine if you want meds or whether a behavioral approach could help with the behaviors is to bring in a behaviorist and make data and start doing things. If the data improves, you know you're going in the right direction. Sometimes it's really hard to make headway till you bring in the meds. In those cases, you've given it the college try, you've seen the data, you know it's not working, and you go ok we need to try a different approach. 

The challenge with behavioral approaches is they tend to shut down the kid's mind. They don't really encourage thinking, just endurance and compliance. So the kid goes into survival mode and does it, but the gifted mind has this other bent, this need to question. But when you pursue that questioning and collaboration, it's not as quick and tidy to the compliance. That's why our behaviorist says the gifted ASD kids are the hardest to work with, because you WANT them alive and questioning and challenging and thinking and innovating, but it's really hard to deal with what happens and the energy that takes to keep up with and keep on track and the depth o the gaps in understanding. 

The half life of meds is very short. You can research it. There are time-released meds that hang longer, but a single dose med is super tight. Caffeine is a low-power stimulant that also happens to be a methyl donor. If you want to know what *might* happen with meds, a low dose of caffeine will do. That's what we did with my dd before she switched to meds. Meds are better, but sure many ADHD adults self-medicate with caffeine. My ds is extremely challenging on caffeine. It's a methyl donor, and he can get pretty cantankerous. So yeah, that's a way to play around with it. Some chocolate milk, caffeinated tea, see what happens. Not a crazy large dose either. I had a chart I used to determine the dose for my dd. It was *tiny*.

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18 minutes ago, 4KookieKids said:

I know they were on Ritalin and Lithium

There you go. One person I know was on lithium back when lithium was experimental (we're talking 30+ years ago), or at least that's how it was told to me. Anyways, yeah zombified. It was the lithium. The docs were just so disrespectful, taking the doses WAY too high in the name of this and that. Lithium will tank your thyroid levels, so that could have been part of what you were seeing. And yeah, I'll probably never forget what I saw then. But I can assure you now it's more respectful. I didn't say the psych meds don't have side effects. Ritalin, etc. will be pretty low on the side effects gig for the most part. They'll say something like 75% will tolerate any ADHD med they take, just take it and it works, boom. And if you don't want meds for the bipolar, then run genetics. I mean, I keep going back to this rant about the idiot DSM and how they look at symptoms and the surface and not reality and chemistry. It's stupid, stupid.

We have access to things people couldn't have DREAMED of having access to even 5 years ago. Think about it. I can pay $69, find things that are deficient on my ds, and keep him of psychiatric meds that would be extremely hard on his developing brain. It's a MIRACLE. 

So there is no fault for anyone who did things in the past, because they were dealing with hard situations. It's still hard, because once people are on that path it's pretty hard to go a different way. Life isn't perfect and we can't make everything perfect. BUT we have access to more data now that we can innovate and do something with than they've ever had in history. If it CAN be done that we can help our kids without psychiatric meds, we've just got to dig in and try. And then, if it's not enough, we go do the meds and say life sucks, life is hard, and we make it work. Psych meds are better than prison, better than a lonely life, better than a lot of things. 

You really might like running genetics. We have the opportunity now to open up options that weren't there even 10 years ago. Even now there are people running genetics in the autism community who are IDIOTS, utter unintellectual idiots who should have their heads examined. There's this dude who I think is going to be speaking at a TACA conference, WHAT A MISSED OPPORTUNITY for actual intellectual answers. His answer for kids on the spectrum who are aggressive and have COMT defects?? Lithium and GABA. Yup, you got it baby. Barbarism. Take a kid who can't self-advocate, pump up with stuff that whacks them out, and then go whoa that stuff is great cuz my kid is so compliant!! And maybe somebody is here and using it and their dosage levels aren't doing that, fabulous. But it sure is tricky to get there, and some kids are gonna go there with very low doses. I have a friend who tried GABA (per a doc) and 2-3 days and this friend was SO looped out. How in the WORLD is that ethical??? And this guy is saying he's using genetics to get there!!! He's just a little shy on his diploma power. He needs to think harder. (You can run bloodwork on the lithium, rather than assuming, the that gene was showing a need for other things to be checked for ways to take the methyl levels down.)

If the gene is defective and causing a deficit or overage, you treat the deficit or overage, you don't just MASK THE SYMPTOM. What an idiot. But he's gonna be speaking at TACA so he's an expert. 

I haven't found a single doc yet running genetics whom I'd take my kid to. Actually, I have. There's *one guy*  (or gal?) running a blog Epiphany. That person actually thinks. But beyond with them, I don't know. And I only have to solve one problem, my ds. Some practitioner is thinking about hundreds of kids and going all over, whereas me I'm digging in on this one area with my ds. But the reality is there aren't any answers yet that connect it to just go yeah this dude is trained and he'll nail it. We're innovating just as much as they are. They're guessing just as much as we are. But if my ds is not on a very strong med and is calm and going forward and his data is improving, then we're winning. Right now, we're winning. And he's calm enough we're getting into his head.

My two cents is let people help you make steps. No one person will get you all the way, but the more you reach out and ask for help, the more you learn things. So the psych will help you learn things and the ped and the SLP and each person. Just keep talking and learning and reaching out and letting people in so they can see what's going on and help you make steps. I don't think a school team necessarily does better, but they just have more eyes, more chances to have vision, more people to catch things and challenge the status quo. I try to surround myself with people who keep doing that, because for me that's my weakness.

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21 minutes ago, 4KookieKids said:

results staring me in the face that I asked why it took me so long to get to this point, and she gently pointed out all my baggage regarding labels and meds and that it was clear I just needed time to process everything.

The best part is, after going through this on a few kids, you'll be an expert. :biggrin: No seriously, it's no crime to be learning. We're all learning. I'm doing way better (maybe?) with my 2nd dc than my first. There's just such a learning curve on this stuff, and you have to go through it. Maybe while you're at it run genetics on yourself. It can be kind of interesting. When I starting digging in on my kids, I figured some things out about me that I used to improve my own care. We're all growing and changing, and you're just going through the process. 

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33 minutes ago, PeterPan said:

The challenge with behavioral approaches is they tend to shut down the kid's mind. They don't really encourage thinking, just endurance and compliance. So the kid goes into survival mode and does it, but the gifted mind has this other bent, this need to question.

 

This is not accurate at all! This is a description of ABA, not CBT or cognitive approaches. ABA is based on Operant Conditioning. 

Quote

But when you pursue that questioning and collaboration, it's not as quick and tidy to the compliance. That's why our behaviorist says the gifted ASD kids are the hardest to work with, because you WANT them alive and questioning and challenging and thinking and innovating, but it's really hard to deal with what happens and the energy that takes to keep up with and keep on track and the depth o the gaps in understanding. 

And this is not at all what ABA does. There is no collaboration. Cognition is not factored into ABA. I think your behaviorist needs to read up some more on psychology and behavioral therapy history. Some may choose to use it for HF kids, but that is entirely up to the parent.

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4KookieKids, have you tried nature walks and sensory activities? I can imagine with 4 little ones it must be a challenge, but nature walks is something you could do as a family, if you aren't already. That is what we do and it is really centering, especially for my 9-year-old. Also, we still do sensory activities. I still have a small sandbox outdoors and kinetic sand indoors. I have a ton of art supplies and will be incorporating more art to our school day this year. We are DIYers and love making things with our hands. Another thing to look at is gardening, if you have the space. All these activities are great for centering and it's the way I like to incorporate mindfulness. You can get tons of ideas for sensory activities for your little ones on Pinterest. I would not recommend having them working together at this stage, but you can do small activities with each one and incorporate OT into it. 

I was thinking of you with 4 so close in age. I don't know how you do It! You will be in my prayers while I'm gone and I'll come back and let you know if I find the book useful.

Blessings,

M

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6 hours ago, Moved On said:

4KookieKids, have you tried nature walks and sensory activities? I can imagine with 4 little ones it must be a challenge, but nature walks is something you could do as a family, if you aren't already. That is what we do and it is really centering, especially for my 9-year-old. Also, we still do sensory activities. I still have a small sandbox outdoors and kinetic sand indoors. I have a ton of art supplies and will be incorporating more art to our school day this year. We are DIYers and love making things with our hands. Another thing to look at is gardening, if you have the space. All these activities are great for centering and it's the way I like to incorporate mindfulness. You can get tons of ideas for sensory activities for your little ones on Pinterest. I would not recommend having them working together at this stage, but you can do small activities with each one and incorporate OT into it. 

I was thinking of you with 4 so close in age. I don't know how you do It! You will be in my prayers while I'm gone and I'll come back and let you know if I find the book useful.

Blessings,

M

 

You know, my initial reaction was to say that yes, we do nature walks and other sensory activities. But I wonder if maybe we don't do them consistently enough. We're part of a local CM group, but we haven't be going consistently, so I feel like some days and even weeks, we do miss it. I'm not sure why we miss it sometimes, since we really love being outdoors and hiking together... Busyness of life? I need to be more mindful. We like to do yoga as a family, since dh has back problems. Yoga with 3 and 4 year olds is pretty funny. ? We do lots of kinetic sand and sandbox play as wells, but now that I'm actually thinking about it, I think ds may disappear to do legos often when we pull out the kinetic sand, so I'm not sure if he actually does it with us.... We have a sensory bin/table of stuff that we put together ourselves, but again, I'm not sure if he actually participates during those play times. Hmmm... I guess I need to think about this more. 

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Your oldest might be outgrowing some things. If you're doing an activity with the youngers and it draws him in, fine. But it's not like you have to force or compel him to do something he's not into. Legos are a totally normal thing to be doing at age 9, mercy. My ds will play legos by the hour, oh my. My ds will stay play in the sand area at the park, but that's pretty big scale (huge), with funnel tables and diggers and all sorts of stuff. Around here we have what they call a natural park, and it's a park that has tree limbs instead of park equipment. It has stations and they can go along and arrange them into teepees, etc. There are log bridges to cross, a zipline. That's really good with 9 yo boys, and little ones at 4/5 will try to keep up, lol. We go there for playdates, because it's a guaranteed winner with rowdy boys. :biggrin:  

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4KookieKids, I was trying to find previews of a book I own (Sensory Processing 101) but the previews I saw on Amazon were not showing the activities. So I found you this, instead:

https://lemonlimeadventures.com/join-the-sensory-processing-101-launch-team/

It was this type of sensory activities that I was referring to; purposeful and skill building. You could check your library or you could look online for free activities. You could find tons on Pinterest. There are other books with activities too. The OT book has activities also. Check your library online. Just do a search for "sensory" and see what pops up. 

We use sand for its calming effect. My kids and I love textures and the way they feel. Even better when they are from nature! You could go hiking and pick up things like rocks, pieces of bark that have fallen off trees, pine cones, leaves in the fall, etc. Put them somewhere where the kids can observe them. Use a microscope if you have one. Create smelling, feeling, tasting activities. You could incorporate small music instruments, maracas, bells, triangles. Use the items from nature to create art. You get the idea! 

Group nature walks would never work for us. We go at our own pace and try to connect with our environment, the smells, the textures, what we see. I always connect everything back to our Creator. 

Just some ideas to get you started on some of your own brainstorming ?.

Apologies for the choppy response! Time is limited today. 

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Here's another good one to check your library for, also from an OT. 

https://www.amazon.com/Everyday-Games-Sensory-Processing-Disorder/dp/1623157005/ref=sr_1_1_sspa?ie=UTF8&qid=1536268510&sr=8-1-spons&keywords=everyday+games+for+sensory+processing+disorder&psc=1

And here's her site:

http://www.gameslady.com

Also, think of things like... the trampoline doesn't just have to be for jumping. My 9-year-old and I will go out and lie on it and look at the clouds, observe birds and insects flying by (we are rural), etc. The other day I told my oldest, instead of reading his book indoors, to go out and read while lying on the trampoline. I am building on his reading focus with sounds around him. He really enjoyed it and you could tell it had a calming effect on him when he came in. Anyway, again, just some ideas for you to inspire your own ☺️.

All the best,

M

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1 hour ago, Moved On said:

Here's another good one to check your library for, also from an OT. 

https://www.amazon.com/Everyday-Games-Sensory-Processing-Disorder/dp/1623157005/ref=sr_1_1_sspa?ie=UTF8&qid=1536268510&sr=8-1-spons&keywords=everyday+games+for+sensory+processing+disorder&psc=1

And here's her site:

http://www.gameslady.com

Also, think of things like... the trampoline doesn't just have to be for jumping. My 9-year-old and I will go out and lie on it and look at the clouds, observe birds and insects flying by (we are rural), etc. The other day I told my oldest, instead of reading his book indoors, to go out and read while lying on the trampoline. I am building on his reading focus with sounds around him. He really enjoyed it and you could tell it had a calming effect on him when he came in. Anyway, again, just some ideas for you to inspire your own ☺️.

All the best,

M

 

Yes! My ds loves to read on the trampoline in decent weather! He definitely finds it super calming and he’s so much more likely to enjoy his reading and less likely to get distracted. ?

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1 hour ago, 4KookieKids said:

 

Yes! My ds loves to read on the trampoline in decent weather! He definitely finds it super calming and he’s so much more likely to enjoy his reading and less likely to get distracted. ?

It wouldn't work for my 9-year-old at this stage. I don't think so anyway, LOL! He's more like me, especially when in research mode. He'll be between his bedroom bookcase, schoolroom bookcases, his computer desk, his project/ school table, my desk, the floor, his bed... I was like that; pacing book in hand, body up against the wall with book over my face, crossed legs on the floor with book on my lap... This is why I try to help them find strategies that work for each of them. It's why I'm a strategies fan ☺️.

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Kookie, I'm glad your brother seems to be functioning well as an adult. My experience with my kids has made me think back more to my own childhood and living with my brother, who was not at all an easy child/teen and (I think) probably has undiagnosed ADHD. My own childhood can enhance my understanding of what is going on with my kids, but at the same time, everything is different for my children than it was for my brother, so there are limits to the comparison. Your brother's negative experiences with taking ADHD meds does not mean that your own child would also have a negative experience. There have been many developments in the drugs themselves and their administration over the past decades.

I have two children with ADHD. One is diagnosed and medicated. The other is undiagnosed officially (though the NP gave an unofficial opinion) and unmedicated. What is right for one child is not for the other, even in the same household. It can be hard to figure these things out! I hope you get good help from the psych.

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6 hours ago, 4KookieKids said:

Nope, I haven’t... one more to add to the list! ?

I put it on my list to reread. She stopped ABA as I recall and just did her own thing at home with him. This is her son at the top of the list:

https://www.rd.com/culture/highest-iq-in-the-world/

Not everyone is going to have his high IQ but like the mother says in her book, she wrote it to inspire others to nurture their autistic kids' talents. That was a book I couldn't put down. One that is uplifting instead of doom and gloom.

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Storygirl, I just wanted to say that while I understand what you are saying, when it comes to kids in the school system (I believe yours are in school, right?) the situation sometimes necessitates the use of meds by default. For a homeschooled child that has giftedness in the mix the cause of the hyperactivity is not always the ADHD or just the ADHD. At age 5 my 9-year-old son was not like this. Every situation is different and newer studies are showing something different than what the original studies did, which supports the effectiveness of cognitive behavioral therapies and other cognitive therapies in the long term in many cases, instead of meds. There may be some cases that require both but starting with meds right off the bat is not the best or most desirable approach for many psychs these days.

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 This thread was really not intended to be a discussion of medication versus not… I’m sorry that I brought it up in the course of discussing evaluations! ?  my general feelings  are very different when the person in question is mature enough to be able to give appropriate feedback and is a decided part of discussions on how their care is managed and whether or not they want to be medicated. As an adult, DH went on ADD meds for a while, and the differences he described in how he could finally think clearly were nothing short of astonishing. He ended up going off them after a while for his own reasons, but I’m certainly not arguing that meds don’t have a place. There are obvious differences between my husband and my children, however. ?

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3 hours ago, Moved On said:

Storygirl, I just wanted to say that while I understand what you are saying, when it comes to kids in the school system (I believe yours are in school, right?) the situation sometimes necessitates the use of meds by default. For a homeschooled child that has giftedness in the mix the cause of the hyperactivity is not always the ADHD or just the ADHD. At age 5 my 9-year-old son was not like this. Every situation is different and newer studies are showing something different than what the original studies did, which supports the effectiveness of cognitive behavioral therapies and other cognitive therapies in the long term in many cases, instead of meds. There may be some cases that require both but starting with meds right off the bat is not the best or most desirable approach for many psychs these days.

My son started meds a few years before he started school. We were homeschooling at the time. He didn't start meds until he was almost 10, so we had almost a decade of dealing with the ADHD unmedicated at home.

His meds help him dramatically in his interpersonal behaviors, so meds are not just about schoolwork here, although they do greatly help him focus. His profile is complicated and not just about ADHD -- there are other factors that impact his behavior and thinking --  but ADHD is a piece of it that medication definitely helps.

It is not only the gifted kids who have multifaceted needs to consider.

Yes, I agree that all kids have different needs. I said as much in my post. We make different choices for different children, even in our own family.

I would never tell another family that they needed to use meds, but it can be helpful for those who are considering the issue to hear from people who have found medication to be a successful tool, among other strategies we may use.

Just as a point of interest, we did counseling first, before starting meds, and have also done it since then. We've approached things from many angles.

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Storygirl, my post was not meant to sound argumentative (if it came across that way to you) or judgemental. I was commenting in the form of discussion (exchange of thoughts) while sharing information from a study that is not often talked about. My apologies if it somehow came across that way.

I respect 4KookieKids comment about not wanting her thread to turn into a meds argument, so I am dropping the meds subject on my part.

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4 hours ago, Moved On said:

I put it on my list to reread. She stopped ABA as I recall and just did her own thing at home with him. This is her son at the top of the list:

https://www.rd.com/culture/highest-iq-in-the-world/

Because I don't like misquoting information, I looked it up in the book and found that Jake did have some ABA therapy temporarily, before switching to DIRFloortime.

Quote

The year before he turned three, Jake had state-funded speech therapy for an hour every day, five days a week. He also had an occupational therapist, a physical therapist, and a developmental therapist coming to the house once a week, each for an hour or more. Independent of his work with First Steps, we started doing another therapy protocol called applied behavior analysis (ABA), which required forty hours or more a week—an ordinary person’s workweek!—on top of all the other therapy. On the recommendation of Marilyn Neff, a wonderful therapist who worked with Jake, we later settled on a different type of therapy called Floortime, which is more child directed and more closely modeled on natural styles of play. Floortime required less drilling, but it was still inordinately time-consuming. It was almost impossible to squeeze those additional Floortime hours in on top of all the other appointments and therapies and interventions. The calendar on the kitchen wall was so jam-packed that nobody but I could read the microscopic handwriting I used to cram it all in. A friend who worked as the secretary to a busy executive took one look at it and commented that my little boy’s lightest day made her boss’s worst one look like a walk in the park.

ETA: This is before she ended the therapies.

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2 hours ago, Moved On said:

Storygirl, my post was not meant to sound argumentative (if it came across that way to you) or judgemental. I was commenting in the form of discussion (exchange of thoughts) while sharing information from a study that is not often talked about. My apologies if it somehow came across that way.

I respect 4KookieKids comment about not wanting her thread to turn into a meds argument, so I am dropping the meds subject on my part.

I'm not arguing, either. But I needed to point out that some of your assumptions about my family and my knowledge were inaccurate.

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1 hour ago, Storygirl said:

I'm not arguing, either. But I needed to point out that some of your assumptions about my family and my knowledge were inaccurate.

Now I'm completely dumbfounded! I have no idea where in my post you saw any assumptions about your family or your knowledge. I'm sorry you feel that way but I will not be engaging in this either.

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7 hours ago, Storygirl said:

I would never tell another family that they needed to use meds,

Hahaha, I would! And some people here on the boards I had that chat with WELL before we ever even started using meds! 

They told us in counseling to be careful about driving your car by looking at the ditches. In other words, you look at stories from your life and you THINK you know what happened and you make these reactionary decisions, and sometimes it just leads you to driving into more ditches. You have to look straight ahead, at the GOAL. 

So the goal is a functional child who is safe, who is able to do what they are cognizant that they are trying to do. That's the goal. I think there can be a lot of in-between with parents' goals that are not yet kids' goals, that kind of thing. I think SAFETY matters. It's a REALLY HUGE ISSUE if the dc is not safe. If the dc is not safe, then the age doesn't matter and it's time to find answers that work. Homeschooling does not necessarily keep some kids safe. And the people who've btdt know what that means. If the dc isn't safe, then it's time to do get some answers that help them be safe. And if the dc is to the point where they are cognizant of their inability to do what they want to do, then it's time to give them the help they're wanting. That is my humane hindsight, my strong advice, and I think it varies with the dc. When the dc realizes and wants the help, it's time to do it.

And how did we get on this? I don't know. I just know I had a long post that I totally deleted this morning, because I think it's so dangerous to make our kids' decisions by looking at other people's ditches. It seems so right, and I get it. I'm just saying we have so much more information than someone had 30 years ago. There was no patient's bill of rights then. You cannot fathom the importance of this in the mental health community. We didn't have genetics to be able to look at root causes. People were just going why is this behavior happening and looking for help. And sure, someone who was having that behavior can look back and be all upset, but the reality is the parents had to deal with it and they dealt with it the best way they could. And on the idea of self-treating, well personally I'd like to think that self-treating means you're actually treating the underlying problem, which in this case may not be the case. You're treating the symptoms, but how is that so different from all the other psychoactive drugs on the market? It's not, it's just the drug you chose. Fine, that's fine, it's legal and your right. But since almost NO ONE is treating the underlying causes of bipolar (etc etc) in the medical community, I feel free to get really (remove whatever words) myself. 

I don't know. Mental health stuff sucks. I wish I could make it perfect. I just know you won't get there by looking at ditches. They can be sorta cautionary, but learn the REAL lessons. The real lessons are think hard, research hard, and advocate for things that really solve root problems and leave you feeling safe, healthy, and whole. That's the goal. That's the point of the patient's bill of rights. I think it's challenging to advocate for someone who, by definition, is unable to tell us what's wrong, what those side-effects are, etc. I've taken a lot of risk over the last while with my ds pursuing things without meds. We were able to find some underlying causes and get to a place of peace. For some reason the psych community doesn't seem to give a rip about underlying causes so it's all fringe, with the Walsh Foundation and weirdos and quacks. I have no clue why they don't care. I mean, I can postulate, but it just makes the whole system seem so barbaric.

So it's fine for someone to say they hate the care they received and the side effects, but they're just lucky they are in a situation where it's panning out for them. For the next person with the same issues it might not pan out so well. And if that person ends up in jail, destroys their career, harms or traumatizes children (which Jesus kinda had strong words about), then those are bad outcomes. And those are just as likely outcomes. It matters that what we're doing WORKS. 

Totally unrelated and unsolicited, I'll just say that the teen years are much more difficult for the individual to go through than I realized. Like I knew mine were tough, and I thought it was because I had extenuating circumstances (which I did!). But I think about other teens who have intact families, good lives, and just the sort of angst they go through, this ugly duckling stage, a birthing stage, sometimes pretty nasty. They can have opinions on their rearing and maybe they're colored by their angst. Just saying. I knew someone who blamed EVERYTHING on having been on ADHD meds. I was like dude girl, why is everything always the fault of your parents or meds? Why not just you weren't the smartest or couldn't do this or that? 

So anyways, it's hard enough getting our kids safely through the teen years and whatever angst they're going to experience by making it worse with our own self-doubts or worries. Make good decisions, evidence-based decisions, and just roll with it. Most of the time, almost anything we choose will probably be fine. I know people who've chosen lots of ways, and their kids turn out FINE. Seriously. Like some chose no meds, and though there were consequences the kid is fine and making and work. And some chose meds and the kid is fine and making it work. And some chose evals and the kid is fine and making it work. And some chose no evals and the kid is fine and making it work. Those aren't necessarily identical outcomes, but in the providence of G*d it all worked out. You can make a decision now, change your mind later if a different decision is needed, and it will all be FINE.

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