Updated Evals/ Dyslexic kid whose relative strength is reading

[Terabith]

She was diagnosed with mild ADHD by the neuropsych when she was seven, but I don't recall any ADHD specific tests that he did.  I think he based it on pattern of subtest scores on WISC and maybe the NEPSY.  She's never had any symptoms of ADHD in her real life.  She has zero impulsivity.  She's actually very inhibited.  To me, it seems like she's got pretty good executive functioning, other than a genuinely terrible memory.  None of her teachers have ever reported any concerns with attention.  Her psychiatrist has not diagnosed her with ADHD.  But, the BRIEF self report she did for the school indicated pretty severe concerns that SHE has about her executive functioning.  The school psych at the meeting said that could be a result of her anxiety or ASD rigidity, that she's aware that she has trouble shifting attention quickly.  It also could be a function of her anxiety leading her to have an overly harsh self concept.  Her psychiatrist isn't familiar with the BRIEF and is reaching out to the school psych to find out more about it.  So honestly, I don't THINK she has ADHD.  But the low working memory and the relatively low processing speed could have similar effects, regardless of whether or not she actually is struggling with attention.  

I actually think she needs to get her permit as soon as she is legally able.  I think the logical thing is for her to get as much practice driving as she possibly can.  It may make sense to wait on her license and independent driving.  Currently, neither of my kids wants to drive.  I didn't want to drive.  But unless you live in a part of the country with a functional public transit system, you're REALLY handicapped if you cannot drive.  I am really hoping that with instruction and scaffolding, she will be able to navigate that safely.  

[PeterPan]

I'm not a huge fan of the BRIEF, but one of the co-authoring psychs sucks dirt in my book. Yeah, it means she has EF issues. 

So here's the thing. ADHD is a construct. What you could do is ignore that and just ask what effect the meds would have and whether the effect would be good? 

-speeding up processing speed-good

-improving her functionality, thereby decreasing her anxiety-good

-improving her ability to handle things, making her more confident taking on challenging tasks like driving-good

It's really your ped's decision on meds, though yeah a pdoc could do that too. For my dd they improve processing speed and reduce anxiety by improving her ability to function. She pretty much would never want to drive without them. But I have no clue if they'd be good for your dd or not. What's interest is my dd flunks in grand spades the Quotient (tap tap with multiple types of sensors) test our ped uses. My ds PASSES it with flying colors. Like it's totally crazy. I have psychs all the time so adamant ds is clearly ADHD and should be on meds, and the ped is like hello, I ran the test. And one of the two psychs who did tap tap tests found the same thing. So even those results can be screwy. Around here the peds then go back to, you got it, the BRIEF and just real life. 

To them, if it's having an effect on education, they're willing to try. Except with my ds, but yeah for everyone else.

[Terabith]

Yeah, that's the question, is would it improve her functionality.  And right now, with school and life, her functionality is pretty good.  I don't think she needs them.  But that might change as demands change.  I don't know.  I'm a little nervous about them, because she's on an asthma inhaler, an SSRI, and buspar for anxiety.  I get nervous about teens and polypharmacy.  There's not tons of evidence out there.  And her anxiety is really problematic, even when it's well controlled.  And ADHD meds can exacerbate anxiety.  So it's not one of those things that's an easy, no brainer thing to add.  

But my bigger concern is we DID try them, back when she was seven.  After the neuropsych dx her with mild ADHD....at that point she was struggling to learn basic skills (reading, spelling, math).  We were just really slogging and not making much academic progress.  So we tried some nonstimulants, to see if they helped, and there was no effect.  So we tried stimulants.  Once.  She had one dose of a four hour ritalin, and whoooeeeee.  It was like we'd put crystal meth in her oatmeal.  She was MANIC.  She definitely processed faster, but she was so distractible, it didn't really help.  And it was a radical personality change.  She was extroverted and talkative.  It was really freaky.  We did do more writing that morning than I think she had in two years previously, but it was very weird.  So we never gave her another dose.  But, she's a whole different person now than she was at seven.  And much bigger.  She wasn't even on the growth curve at seven, and she tops it out now, post puberty.  (She actually developed a weight problem when she went to school.  When we homeschooled, she ran around all the time, and I mandated physical activity as part of the day.  There's a lot less activity at school; she hit puberty, and by the time she finished school, emotionally she had no stamina for swim lessons or gymnastics or anything not extremely preferred.)  So I'm willing to try them again, but I'm not enthusiastic about trying them.  

[PeterPan]

At least the EF is stuff you can help without meds. Heathermomster had a source she used that was stellar.