ADHD - what else should we try?

[redheadbaker]

DS began medication for ADHD in 2019. His pediatrician started him on Focalin. It worked well that year, let's skip over 2020 and 2021. This year, I've gotten at least three emails from his teachers about his behavior, and we've met with his doctor each time, and decided to increase his dose each time. 

I'm STILL getting behavior emails. Do we try another medication? Is there a behavior therapy we should look at? 

[twilightmv]

Is there a school OT who can observe? Is there a 504? How old is your son? Does he have any thoughts on what's going on from his side? What is the behavior specifically? Impulsivity?

[redheadbaker]

He has a 504. He's 10. Talking to other students while the teacher is giving instructions, making loud non-word noises during quiet time, hopping on all fours when he should be walking, taking apart pens ...

I've noticed the noises at home, too. And just talking NON STOP, like he feels the need to narrate his entire life at all times. And if you ask him to stop, he does for a minute, and goes right back to doing it.

[pooh8402]

Maybe worth trying something different. Maybe Focalin just doesn't work like it used to. Adderall used to work for me, until it didn't.

[Deleted]

Have you done incentives at all? Rewards for staying quiet for some amount of time?

My 10 year old DS has ADHD. He’s on the max dose of Concerta. I don’t get emails home anymore because his teachers fill out a Google sheets behavior log daily. Then I can choose whether I want to hear the complaints of the day or not. That sounds awful, but it gets to be really difficult to hear so much negative stuff about your kid day in and day out. And think how awful it is for the kid to be hearing all that negative stuff about themselves. Anyway, the behavior log helps because DSs therapist also wrote a letter to the school highlighting the absolute necessity of including positive comments about DS as well.

We have done therapy. DS, in general, wasn’t participatory, but it was somewhat helpful for him to work through some of his issues with all those negative messages a kid with ADHD receives.

We’ve done various incentive plans through the years. Currently he can earn certificates for small amounts of v bucks for doing things that impress me like stopping a behavior when asked or getting all positive notes in the behavior log for a week, or going to the doctor and actually speaking to the doctor instead of being a pain to get weighed and then mumbling (he hates going to the doctor so it currently needs to be incentivized to get decent behavior out of him). I think incentivizing the behaviors you want to see more of is general the most effective. In order for DS to do therapy at the childrens hospital they also had us do a parenting class, and incentivizing the behaviors you want more of was a big part of it. You can do a free class on coursera that’s really good and covers the same concepts : www.coursera.org/learn/everyday-parenting

[mainelyfoolish]

Apr 26, 2022 14:34:58 GMT -5 redheadbaker said:

And just talking NON STOP, like he feels the need to narrate his entire life at all times. And if you ask him to stop, he does for a minute, and goes right back to doing it.

My 9YO DS with ADHD does the exact same thing, but it’s mostly a problem in the evenings when his meds have worn off. It drives us crazy. When it gets too bad, we tell DS he needs to find somewhere else in the house to be for a while.

For my DS, every time we have received feedback from the teacher about a trend of poor classroom behavior, it indicated that he needed a med adjustment. Since you recently made a change and it isn’t helping, I would go back and ask for another dosage change or to try a different med. 

[dulcemariamar]

Do they offer any other types of interventions at school to help him? Do they offer alternative seating for him? I have seen in my school seats that come with bike pedals and they are quite helpful for students with ADHD but there are loads of different seating options out there. Also noise canceling headphones or having breaks put into his schedule (not breaks he has to earn but breaks he gets to help regulate his behavior) And I would have a honest conversation with the teacher because the behavior is disruptive but focusing on the negative is just going to lead to more negative behavior so I would see what other techniques the teacher uses in class.

[redheadbaker]

Apr 26, 2022 15:55:44 GMT -5 dulcemariamar said:

Do they offer any other types of interventions at school to help him? Do they offer alternative seating for him? I have seen in my school seats that come with bike pedals and they are quite helpful for students with ADHD but there are loads of different seating options out there. Also noise canceling headphones or having breaks put into his schedule (not breaks he has to earn but breaks he gets to help regulate his behavior) And I would have a honest conversation with the teacher because the behavior is disruptive but focusing on the negative is just going to lead to more negative behavior so I would see what other techniques the teacher uses in class.

He's supposed to get "preferential" seating. I asked him about it today, and he says he's seated near his friends so it's harder for him to suppress the impulse to talk. The problem is, he's a social butterfly so EVERYBODY is a friend. 

[julygal]

Regarding the taking apart pens, is there a fidget the teacher would approve that is not as "destructive" or bothersome to the teacher? Stress balls are quiet. We also have one that looks similar to a mini bike chain and a marble one. Fidgets are very helpful for my 10 year old, but we know there are certain times that they not allowed by the teacher. We have received "marks" during those times (ie, another kid presenting), so we just discuss while the fidget is helpful, it can be interpreted as rude or not listening to some. I have also sent in chair bands in classrooms that don't have alternative seating. It helps with excessive movement and focuses the energy.

[dulcemariamar]

Apr 26, 2022 15:59:19 GMT -5 redheadbaker said:

Apr 26, 2022 15:55:44 GMT -5 dulcemariamar said:

Do they offer any other types of interventions at school to help him? Do they offer alternative seating for him? I have seen in my school seats that come with bike pedals and they are quite helpful for students with ADHD but there are loads of different seating options out there. Also noise canceling headphones or having breaks put into his schedule (not breaks he has to earn but breaks he gets to help regulate his behavior) And I would have a honest conversation with the teacher because the behavior is disruptive but focusing on the negative is just going to lead to more negative behavior so I would see what other techniques the teacher uses in class.

He's supposed to get "preferential" seating. I asked him about it today, and he says he's seated near his friends so it's harder for him to suppress the impulse to talk. The problem is, he's a social butterfly so EVERYBODY is a friend. 

Preferential treatment is a bit of a vague term and there has been at least a noticeable increase of kids with IEPs in the last 3-4 years that there could be several kids in one class with preferential treatment in their IEP that is becomes really hard to give everyone preferential seating. (I am talking about where I work so I don’t want to generalize)

But I would definitely join some parent support groups for kids with ADHD and find out interventions/techniques that could work for him at school and bring it up to the teacher because it sounds like she expects the medication to be the answer and if it isn’t working so well now then there needs to be a plan in place to help him during this transition until the meds can be increased or a different type

[niq]

I'd +1 setting up an incentive system where good behavior at school produces rewards at home. You should be able to get that written into a 504, though some districts may want an IEP for it.

There are a bunch of different parent coaching programs, I would check with your pediatrician for recommendations in your area. The short version is "purge no/don't/stop" from your vocabulary and get the teacher to do the same.

Goofball behavior, interrupting, hijacking conversations, etc. ... does get better, it's just slowwwwwww.

ETA: just in general, tween behavior is a shared responsibility between children and adults in their lives. You can try just sending him to therapy, but success probably requires behavior modification on the part of parents and teachers.

[kdubs923]

You’ve received a lot of good feedback. We also work on rewarding good behavior. I have not figured out how to cut back on the constant talking. DS has to put his two cents in for every freaking thing, even if he has no idea what we’re talking about and it drives me nuts.

One thing I wanted to throw out, for DS, we noticed Guanfacine (non-stimulant) made the most difference with his impulse control. It seems to give him a pause button to think through his decisions (most of the time, lol). He’s also on Adderall, which has helped focus. But Guanfacine was most effective for his impulsive behaviors (shouting out the answer in class vs raising hand). Might be worth discussing with the pediatrician that his current med might be doing what it’s intended, but he could use a boost in other areas.

[redheadbaker]

Apr 26, 2022 17:44:27 GMT -5 kdubs923 said:

I have not figured out how to cut back on the constant talking. DS has to put his two cents in for every freaking thing, even if he has no idea what we’re talking about and it drives me nuts.

OMG YES.

[redheadbaker]

We have a televisit with his pediatrician on Thursday, so I'll bring up trying another medication! Thanks, everyone!

[AdaraMarie]

Rewards and incentives do pretty much nothing for my kid, but sometimes when she gets like that it is because she isn't getting enough sleep. We have also considered changing the time when she takes her medication but haven't tried it yet.
Unfortunately from spring break to the end of the year is pretty much always hard due to the increase in "fun" activities and schoolwork.
You could also try "heavy work" activities which sometimes helped when my kid was really sensory seeking-jumping, wall pushups, gum chewing.
But I also have to send her away sometimes when she won't-stop-talking.

[browneyedgirl9]

I agree with others on incentivizing good behaviors. My 8 year old has ADHD and earns breaks to do a preferred activity (Legos or card game with friends) throughout the day. Which has been a help.

Also wanted to chime in and commiserate with you all about the constant non-stop talking. Ugh. It can be so irritating. My son seems to always have a constant commentary going on.

[jaycee]

When is his 504 up for renewal? If it is not anytime soon, you could ask to call a meeting with his 504 team and ask for some more interventions - like maybe he could have some fidgets, or maybe he could be given errands to walk to the office and back, or maybe he can have a standing desk away from others for part of the day, maybe a wiggle seat, incentives for good behavior, etc. The school must have a long list of all the accommodations they can add.

[vmars]

I would ask about a non-stimulant to add with his stimulant. Our developmental pedi told us the stimulant helps with his focus but a non stimulant will help with impulse control. We are currently waiting to hear if we can start DS on one because he is also being impulsive during class. Also, his teacher told us the best seat for him is actually in the back of the class so he can see what is going on but is not turning around all the time to see what is going on etc.

[redheadbaker]

Apr 26, 2022 20:24:40 GMT -5 jaycee said:

When is his 504 up for renewal? If it is not anytime soon, you could ask to call a meeting with his 504 team and ask for some more interventions - like maybe he could have some fidgets, or maybe he could be given errands to walk to the office and back, or maybe he can have a standing desk away from others for part of the day, maybe a wiggle seat, incentives for good behavior, etc. The school must have a long list of all the accommodations they can add.

Not til December -- thanks for reminding that this is an option! I had forgotten.

[1yeartogo]

I would ask the school to do an FBA (functional behavioral assessment) and as the observer to talk to the teachers too. At the school level they should be coming up with ideas on how to more effectively address this for him. Then at home as mentioned you could talk to the dr about changing his medication m, maybe he is just not responding to this one any more.

[CrazyLucky]

When my son was diagnosed, he was going to a therapist and continued until we moved. I think the combination was a big help. The therapist was able to help DS talk through what he's feeling and was really especially helpful with giving him some coping mechanisms. Also, and this may be too obvious, but have you given him a silent fidget he can play with?

[redheadbaker]

His teachers are permitting him to use a fidget toy, and we'll get it written into his 504 plan, and his doctor is switching him to a non-stimulant medication.

[redheadk]

Apr 28, 2022 17:00:24 GMT -5 redheadbaker said:

His teachers are permitting him to use a fidget toy, and we'll get it written into his 504 plan, and his doctor is switching him to a non-stimulant medication.

That sounds like a great plan. You got some good suggestions on things to try so I'll just add that in my time teaching 5th grade, it seemed very common for kids to need to switch ADHD meds because the old one was no longer working. More than one parent said their dr mentioned it was common with puberty. I was often asked to keep a close eye on kids and provide feedback. For some kids, they found a good fit quickly. For others, the process involved more trial and error. I hope you are in the first group and are able to identify what works best for him quickly so he can have a good school experience.

[redheadbaker]

Apr 28, 2022 22:23:10 GMT -5 redheadk said:

Apr 28, 2022 17:00:24 GMT -5 redheadbaker said:

His teachers are permitting him to use a fidget toy, and we'll get it written into his 504 plan, and his doctor is switching him to a non-stimulant medication.

That sounds like a great plan. You got some good suggestions on things to try so I'll just add that in my time teaching 5th grade, it seemed very common for kids to need to switch ADHD meds because the old one was no longer working. More than one parent said their dr mentioned it was common with puberty. 

That's good to know, thanks!    

[momof2ms]

This sounds a lot like my stepson. We added an additional medication to stop tics and it seems to have helped with “extra noises “

I wanted to add that even once a child is on the proper dose, there is still a learning curve to be socialized adequately to a situation. Basically, before they were unaware of a specific situation and now all of a sudden they are aware of certain nuances existing and are not yet socially smart about it yet. You may have to be very granular about what they should be doing at different moments and what they should be thinking about what to do next. For instance, if they finish an assignment early, that’s a good time to check it over, maybe start packing up, Check the time, etc.

[somersault72]

DS takes Adderall but all also did some therapy sessions, which I also think helped. They taught him several coping mechanics for various situations. He was able to do these sessions through the school at no charge to us.

[redheadbaker]

His doctor is switching him to Adderall, but we're still waiting on the prescription due to damn gov't regulations -- pharmacy had run out of the med, and they only get so much each month, and even if a patient needs it, they can't get more til the next month.

[ellipses84]

This can be relatively common as kids age, especially as they are going into puberty and growing a lot. Just know you may have to be adjusting med dosage and type frequently for a few years. I know a couple kids who were diagnosed to be on the autism spectrum at that age but it hadn’t been obvious as they were dx’d / medicated for ADHD. One has both. The other was misdiagnosed and the meds never seemed to work well. Do any of the frequent noises seem like tics? Tics or Tourette’s can be very mild and not like what you see it mimicked as on TV. I think some autism spectrum behaviors present very differently in introverts vs. extroverts and he seems very extroverted.

[redheadbaker]

May 4, 2022 10:19:27 GMT -5 ellipses84 said:

This can be relatively common as kids age, especially as they are going into puberty and growing a lot. Just know you may have to be adjusting med dosage and type frequently for a few years. I know a couple kids who were diagnosed to be on the autism spectrum at that age but it hadn’t been obvious as they were dx’d / medicated for ADHD. One has both. The other was misdiagnosed and the meds never seemed to work well. Do any of the frequent noises seem like tics? Tics or Tourette’s can be very mild and not like what you see it mimicked as on TV. I think some autism spectrum behaviors present very differently in introverts vs. extroverts and he seems very extroverted.

He is TOTALLY extroverted. He used to have a tic, and grew out of that. These noises aren't like his old tic.