Hi. New here.

[hi725]

I've got two boys, S (5) and E (2). I've always had a gut feeling that something wasn't quite right with S. He was a very sweet little boy, but very hyperactive, very quick to melt down, and had tons of sensory issues, particularly with noise and food. I had a lot if people tell me that boys are wild and it was all normal. I wanted to believe it, so we didn't do much until right after his little brother was born. When E came along, the atypical behaviors demonstrated by S became even more obvious. I hate to say this, but I have done a lot of child comparisons and "oh, so this is what normal/typical should bes". We got him OT and SEIT services, but his behaviors have been worsening instead of improving.

We saw a developmental pediatrician today and we got our diagnoses ADHD, oppositional defiant disorder, and anxiety. The doctor thinks that once the ADHD is controlled, the other issues will resolve themselves. I have to admit, I am hesitant to medicate him at such an early age, but he just started kindergarten this year and it's already a nightmare. I feel like this is the best chance we can give him right now. We start focalin XR tomorrow. I also have calls in to behavioral therapists and after a little prodding from me a few weeks ago, the school has started the RTI paperwork. I'm hoping this will be the start of a huge improvement. I feel like I've been living under fire for the last few years and I just need something to work.

[litebright]

*waves hi*

I hope this is a step in the right direction for you guys.

[auntie]

Oct 13, 2014 16:03:20 GMT -5 hi725 said:

I've got two boys, S (5) and E (2). I've always had a gut feeling that something wasn't quite right with S.


Good for you for following your gut. Moms have a sixth sense around this ksind of thing.


He was a very sweet little boy, but very hyperactive, very quick to melt down, and had tons of sensory issues, particularly with noise and food.


Did they rule out ASD with ADOS, GADS, GARS, and or ADI? Did a psychologist run BASC2 and Vineland?


Sometimes hyperactivity, inattention, meltdowns, sensory issues, anxiety and what looks like ODD is higher functioning ASD. IMHO, it needs to be considered and R/O. I know a lot of boys with AD who were incorrectly given ODD/ADHD by the first person they saw. It's interesting that you went to "sweet" as an adjectve- there is a sweetness that shines through in these kids despite all of their challenging behavior. Not saying he is, but it is something to look at in the perspective of the alphabet soup you were given. ODD is tough to live down in a school setting; I'd want a second opinion on this at some point.


Getting the correct/complete dx matters because the tx is different. Normally I wouldn't put this out there, but I am suspect of a dev pedi who dx who would give a child a dx of anxiety and a stimulant on the same day. Stimulants are contraindicated with great anxiety as a rule. Some docs prescribe them if they're also giving a med for anxiety and the child is getting talk therapy as well. In the interest of full disclosure, my own DS has an ASD dx with ADHD and GAD comorbid. He does really well on a stimulant but he also takes an SSRI to dial down the anxiety.


I had a lot if people tell me that boys are wild and it was all normal. I wanted to believe it, so we didn't do much until right after his little brother was born. When E came along, the atypical behaviors demonstrated by S became even more obvious. I hate to say this, but I have done a lot of child comparisons and "oh, so this is what normal/typical should bes".


I know. We got a lot of "he's just all boy" and "you can't expect him to act like your nieces".


We got him OT and SEIT services, but his behaviors have been worsening instead of improving.


Certain undesirable behaviors require a certain amount of bandwidth that comes with age and maturity. The other piece is that his ability to behave in a manner comparable to his peers is falling behind. It may be that his behavior isn't really worse, but that more is expected of him as a five and as an older sib.

We saw a developmental pediatrician today and we got our diagnoses ADHD, oppositional defiant disorder, and anxiety. The doctor thinks that once the ADHD is controlled, the other issues will resolve themselves.


Sometimes when you manage the symptoms/behaviors of one condition, you will see some improvement across behavior associated with other behavioral conditions. But if he truly has ODD, a stimulant won't cure that. Plus, a well known side effect of stimulants is to exacerbate anxiety. Just out of curiosity, how long did it take you to get in to see the dev pedi? The best ones near me, a pretty well served area, have wait lists of 6-12 months. Is this person associated with a pediatric hospital clinic? Do they work with a team of professionals like SLPs, OTs, PTs and clinical psychologists?


I have to admit, I am hesitant to medicate him at such an early age, but he just started kindergarten this year and it's already a nightmare. I feel like this is the best chance we can give him right now. We start focalin XR tomorrow.


I feel for you. It's hard to make the choice as a parent. Especially for kids as young as your son is. On the plus side, if the medication is a bad fit, you'll know very quickly and can stop giving it immediately. If it works well, it can be life changing. 


What so of behaviors are they seeing in school?


I also have calls in to behavioral therapists and after a little prodding from me a few weeks ago, the school has started the RTI paperwork. I'm hoping this will be the start of a huge improvement. I feel like I've been living under fire for the last few years and I just need something to work.

Have you shared your written report with the district? I'm usually all about sharing, but I don't know that I'd share paperwork that had ODD on it. Schools can be sometimes see all behaviors in that context and use it to turf students to self contained settings. 

Is there some reason you are doing RTI instead of an IEP or Section 504? Given the dxs, an IEP could offer him services as well as accommodations and the protection of manifest determination is he has challenging behaviors that could result in suspension. A Section 504 can offer accommodations, but is not enforcable as an IEP is. 

DS did talk therapy privately for years. He did a lot of CBT which was a very useful tool around both general anxiety and more specific fears. 

Good luck.

[hi725]

I'm trying to remember all of your points, so hang with me. My head feels a little like it might pop, lol.

The teacher is seeing the exact same issues we see at home. We speak frequently and she is aware of his struggles to date. We started the RTI paperwork weeks prior to his doctor's appointment yesterday. Now that we have official diagnosis, I will start the process for the IEP. ODD will not appear on any paperwork submitted to the school. I had the same concerns and asked her (developmental pedi) to leave it off. She agreed.

We have another appointment with her on November 10th, which is the second part if the evaluation process, we will get all paperwork then. There was a 5 month wait to see her, bumped up from 7 because there was a cancellation.

I had ASD concerns, possibly aspergers. I have to be totally honest though, I was so overwhelmed at the first appointment that I outlined all of his behaviors and issues for her, but completely blanked on asking about ASD. I will voice my concerns on the 10th.

As for the meds, she thinks he is anxious because he can't focus and that if he is able to control his little body and brain, then some of that anxiety will disappear. I will be watching him like a hawk and if I feel that the medicine is aggravating any of his issues, we will seek other solutions.

I guess I'm lucky (or unlucky) enough not to be going into this completely blind. I have ADHD and have been medicated for it at multiple points in my life. I'm also an OT, and while I don't work in peds, I did my fieldwork affiliation at my son's school. I'm sure it's still going to be a learning process, and I'm grateful for any guidance. Thank you so much!

[auntie]

The interplay of ADHD and anxiety can be tough to parse out.

DS has both and it's really interesting to see how medication plays out. On the surface, he looks pretty classically inattentive but a lot of his distractions take the form of internal thoughts on which he gets stuck- sort of an OCD-lite, if you will. While stimulants can slow him down, and he can have preferential seating for testing and movement breaks you can't move him away from the internal dialog that interupts and distracts him. For that an anti-anxiety med and CBT were necessary.

It's funny, a lot of DS's anxiety was around not having the self regulation to act in the manner expected of his age (he was about 8 when we decided to do meds) which made him hyper-vigilant around making an ass of himself. Relieving that calmed him down. He describes it as having a 5 second tape delay in which he can think about his next action.

We expected the SSRI to calm the anxiety, but it also had the effect of getting him unstuck around the "what ifs" which improved his ability to attend at least as much as the stimulant.

I hope you med trial is successful. Good luck with the school stuff, you want to start working on the self regulation and also the early executive function stuff. Speaking of which, DS accidently locked his keys in his car and I'll have to meet him off the train with my keys. Still working on it.