Tuesday

DadSeekingHelp

OPINION
I posted a comment a few days ago about my son and his discipline problems that led to his nanny resigning. http://isawyournanny.blogspot.com/2012/10/dads-defiant-son-needs-discipline.html

This weekend I read several parenting books pertaining to defiant children. I think that my son might show symptoms of having ADHD. Most notable of these is his impulsivity, difficulty finishing homework or tasks to which he is assigned, procrastination, difficulty awaiting his turn, frequent interruption into other peoples' conversations. I've asked his pediatrician to schedule an evaluation. She sent over a questionnaire for me and his school to complete, and that will form one aspect of her diagnosis. I saw a pretty dismaying article in today's NY Times about ADHD drugs being prescribed to kids with disadvantaged backgrounds to help them get ahead in school, rather than to medicate any actual ADHD condition. http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html

Apparently ADHD is a spectrum, rather than a "yes or no" condition. If he does have something of an ADHD condition, I imagine it is mild - because he has been pretty functional before. The symptoms I describe have had a relatively recent onset, in the past few months. This brings the question: for non-medical people who work with kids every day. How would you differentiate between a mild ADHD and some form of behavioral or environmental issue that is transient? Any experiences in helping kids with "apparent" ADHD in non-medical ways? To what extent can these be helped with approaches like more structured discipline, protein-rich diet, more exercise (especially for hyperactivity, which my son doesn't seem to show)? - DadSeekingHelp

27 comments:

RBTC said...

i really have much respect for you for the brilliant questions you have asked, you are a good dad - i look forward to the responses!

ericsmom said...

Awww, have you considered a consult with a development pediatric specialist? If you live in NJ I know some good ones. Let me know

ericsmom said...

I know you are scheduled to meet with your son's ped. Still I suggest to meet with a specialist. Check out your local hospital in the chidren's dept. What is nice is that they spend at least an hour with your child. They will work out a plan with you. If they feel like your child can benefit from other services, they will try to guide you. A neurological ped. evaluation is usually recommended as well. Trust me I know all about this

Lyn said...

I am again impressed by your level of questioning and your aptitude with parenting skills.

Unfortunately, I do not have the experience to answer your question but I'm sure you'll get the answers you need from someone on here today! Good luck OP!

EastBayNanny said...

great NYT article! thanks for sharing! your doctor sounds excellent, as a quick turnaround of paperwork is rare. Nice work!

Bethany said...

My hat goes off to you I wish every kid could have a parent like you.

Good work!

Lyn said...

Wow, Ericsmom, for some reason your comments didn't show up for me until just now. You have some excellant ideas! A developmental specialist would be able to help SO much!

Erica said...

I couldn't help but get upset when I read your NY times link. When my kid was in pre-k they tried to tell me then he was ADHD, just because he was a bit more hyper than others. I refused. Now though, he's such a great listener, good at school and home. He's just a busy little kid is all. I hope everything works out for you, you seem like such a wonderful involved father! Good luck and please keep us updated with what happens. :)

Anonymous said...

I have ADHD as an adult and I am medicated. That being said there are some coping mechanisms you can put in place for your child to assist without medicating.

Chewing gum during class. It helps to have something to focus on "doing" while you are sitting still in your desk. Taking a 10 min break every 45 minutes just to move around ad get some energy out. Positive reinforcement over and over and over. And the last is neuro feedback, it is a biofeedback training program that actually assists in re routing and shaping the brain. It focuses on erasing the problem not putting a band aid on it

Future nurse (iPhone)

Astral Plane said...

You seem like a good father. I hope you figure out ways to help your son behave. A lot of people would be quick to medicate their child. I think that should be the last option. You seem to be on the right path.

Aria said...

Wouldn't most kids especially active boys qualify for having ADHD when they're five? Too much time indoors, poor diet and too many video games and time spent with electronics that provide instant gratification. I think a lot of the ADHD is just the result of the childs environment. And that can affect the way their little brains grow. Id be upset if someone wanted to medicated my five year old boy! So glad you passed on the medications.

ericsmom said...

We see a developmental spec. every year. Sometimes, two times a year.

My son benefits from frequent breaks in the day. Getting to run around outside, doing jumping jacks in the hall. His neurological system craves alot of input.

Jules said...

I've read this blog for quite a while, but this will be my first comment so here goes nothing..

First of all, please know that you are asking all the right questions and that medication is just one option in helping a child with ADHD. As a school psychology intern who frequently works with children with ADHD, I can say that there are several "interventions" or strategies that can be used to help a child who is struggling with inattention or hyperactivity.

How is your son doing in school? Are his attention issues affecting his education? If yes, then you may want to get the school involved. If no, then be thankful and attempt to help and control his ADHD at home. Positive reinforcement and structure are both excellent starting points.

Children with ADHD often benefit from being made aware of their inattention. We often recommend self-monitoring strategies where a child "checks-in" on their own behavior. For example, you can set a timer for every five minutes- when the timer goes off the child checks to see if they are off task or on task and what exactly they are doing at that time. This can be done in a classroom or at home during more structured activities such as homework time.

Another specific strategy is to create a behavior contract that outlines what you want your son to do and what he can earn when he complies.

You can also implement a daily/weekly "report card" system for the home and school.

More general strategies include giving clear directions, having explicit house rules, having your son repeat what you said/asked of him back to you, limiting the number of steps in the directions/requests, provide frequent breaks, and schedule difficult activities for his most alert/focus time of day.

I hope this information is helpful!

Belle Vierge said...

I would agree that ADHD is a spectrum. My twin brother would be on the high ADHD end of the spectrum, my younger brother would be on the low end, and my mother would be in the middle. My younger brother took Concerta growing up, but asked if he could go off it in high school. Since then, he's only taken it around exam times (he's now a junior in college). He's not noticeably different with/without the meds.

My twin brother and my mother take Concerta if they have to go to work or school. My twin brother drives the rest of us absolutely insane on the days he doesn't take it. The holidays are the worst because it's days on end of hyperactivity. My mom isn't annoying when she's off it, but she changes subjects quickly, gets distracted easily, and can't always finish tasks.

I agree that the NYT article is disturbing, but it's hardly surprising. I constantly see tweets and fb statuses about people asking for Adderall or thankful for Concerta because so many students use them to get through tests and exams. Not gonna lie, it pisses me off personally. I worked my ass off for my grades K-12 and then in college. I could have borrowed Concerta to help me focus, but I earned my grades the old-fashioned way: studying. Students taking it for an advantage are just lazy.

OP, I applaud everything you're doing for your son. Yes, be cautious of the overdiagnosis, but keep in mind that ADHD is a *real* disorder and correctly-prescribed stimulants can be a positive thing. My mom went undiagnosed for 40+ years. Yes, she still got by in school and in her career, but she struggled so much, not just with the effects of ADHD, but the feelings of inadequacy and failure.

Caring Mom All Day said...
This comment has been removed by the author.
BrooklynMomma said...

OP, you mention that the behavior has begun within the last few months. Have there been any changes recently (addition of a sibling, a pet or person passing away, change in routine, a recent move, new caregiver)? What is the child's relationship with their mom? Its been my experience as a teacher that when a new behavior occurs, its sometimes linked to life changes (some minor, some major).

Caring Mom All Day said...
This comment has been removed by the author.
aregular said...

I am a therapist who has worked with kids diagnoses with ADHD; that being said, if your son is not experiencing hyperactivity he would not fit the diagnosis of ADHD. The three components of the disorder that are considered with diagnosis are: inattention, impulsivity and hyperactivity. I personally believe that the disorder is overdiagnosed, and I also believe that stimulant medications are overprescribed. Let's face it- any of us will show for focus when taking a stimulant.
I would recommend a seeing a therapist who specializes in using behavior modification techniques, and who will work closely with the family and the school. Therapy for kids should include close work with parents- individual therapy for children is less effective than family based treatment. I have absolutely seen great results with non-medical interventions- and the only way to know if they will be effective in your case is to try. Just know that much of the "work" may fall on you in increasing the structure in his environment, setting clear expectations and consequences, and following through each time- but it will be worth it. Also know that when implementing changes in structure and discipline, often the behavior worsens before it gets better; that can be a sign that you're on the right path. Stick with it and good luck!

Jules said...

BrooklynMomma brings up excellent questions to consider- those types of questions (has there been a move, a divorce, a separation, a death, an illness, etc) are the environmental things that can effect behavior- if none of those things have occurred then more information regarding ADHD may want to be explored.

Also- I just want to address a common myth concerning ADHD- a child does not have to be hyperactive in order to be diagnosed with ADHD. There are three types or diagnoses for ADHD: 1: ADHD-Combined Type, 2: ADHD- Inattentive Type, and 3: ADHD-Hyperactive-Impulsive Type. See the following website for the exact diagnostic criteria if you have questions.

http://www.cdc.gov/ncbddd/adhd/diagnosis.html

aregular said...

Jules you are correct about the inattentive type and I should have thought before I wrote the above. I will say that typically for treatment we see the hyperactive/impulsive ADHD kids as they tend to present with more of the behaviors that would drive caregivers and teachers to look for help (such as the disruptive behaviors people generally associate with the disorder). Often the inattentive types are diagnosed later on. Thanks for pointing that out though :).

Nicola and Juerg said...

Hi I have just come across your blog and saw this Post. Has there also been a change in what he has been eating? I have been doing a lot of research into food and its effect on children and their behaviour and it can have a huge effect. There is some great information on the web and one such thing is the GAP Diet which has been very useful in helping children. They believe that a lot of problems start in our gut and the fact that we don't have the right balance of probiotics and floras in our gut

Melanie Raye Castor said...

I have a little bit of experience with children who have been diagnosed with some level of ADHD... a clear routine, clear behavioural boundaries, and lots of patience and positive reinforcement seem to help, as well as daily medication, in some cases.

Anonymous said...

I just want to urge you to at least consider medication. I completely agree that the first step seems to be medication with far too many kids, but some truly need it. I can't function with my ADHD medicine, I am hyperactive and I honestly cannot sit still and focus at the same time. As an adult I know how force myself to sit still, but if I focus my energy on that I'm not learning or retaining anything. I think ADHD drugs have gotten a horrible rep since so many people abuse them, and it has detracted the attention away from the positive changes it can offer. If you choose medication I would strongly suggest going to a pediatric psychiatrist instead of your pediatrician, they have just spent more time focusing on psychiatric drugs and seem to be more effective in diagnosing and medicating. They also as a group tend to start with lower dosages, and stay away from turning the child into a zombie. I've been on adderall and Ritalin for many years, and I will say it is not all bad. For the children and adults who need it, it is a complete god send. It's at least worth considering medicating. It seems like parents almost feel guilty for medicating, because of the stigma attached. But every child is different, and there is nothing wrong with getting your child the held he or she deserves


Future nurse (still havent registered sorry!!)

Canadian Mom said...

Does your son seem tired? You may want to consider seeing an ENT in case he needs his tonsils/adenoids out. http://well.blogs.nytimes.com/2012/04/16/attention-problems-may-be-sleep-related/

Psyber Chica said...

After reading about inattentive add, I think my 10y old daughter may have it. She does fidget a bit when sitting, but overall is not hyperactive. Anyone have experience with a child in this category? Do people normally go to a pediatrician about this? I liked the suggestion above about using a timer to keep her on task. Any other suggestions. I am against medicating her, that will be a last resort for us.

Melanie Raye Castor said...

that is a great point, Canadian Mom. I hadn't thought of that, but definitely agree that it may also be a possibility.

Savannah Nanny said...

I have dealt with several children that are just a little more hyper than usual. I wouldn't necessarily label them as ADHD. Try eliminating sugar, especially corn syrup, and artificial dyes from his diet first.