Need some feedback please. ADHD, GAD, ODD...

[friendlyfarmer]

Hi there, it's time for me to pop in again for some advice.

Background for those who don't know: DD2, adopted from FC (mentioned because it has an effect on what we are dealing with), 7.5yo, has a number of mental health dx.  Our current list includes GAD, PICA, ODD, and ADHD.  We will probably be getting another dx on Friday when we get the results of her psychometric testing, we are expecting bipolar or schizoaffective disorder.

Anyhow... 1) We had her on varying doses of Methylphenidate for awhile but it didn't help, her behavior changed for the worse and her focus wasn't getting any better so we took her off of it.  The psych has suggested we try Tenex and told us to research it to see if we think it's a viable option.  It's a hypertension med but has proven to be a successful stim free med for some ADHD kids.  It's not FDA approved for ADHD use but is accepted, it's also not FDA approved for use in kids under 12.

Has anyone here had experience with this med?  Thoughts?

2) She is a fidgety kid, her hands specifically.  She is constantly playing with or picking at her fingers, or she has to be touching something.  She is constantly getting in trouble for touching stuff, going to the store is horrible, she touches EVERYTHING.  If told to put her hands in her pockets, she'll use her elbows or face to touch stuff.  We've resorted to putting her in a shopping cart and keeping her mid aisle so she can't touch.  Her teacher mentioned that she had given DD2 a pencil grip and that she fidgets with that most of the day.

Would it be worthwhile to reserve a fidget to take on outings?  My concern is that once she gets past the newness of it, that we'll be back where we started.

3) I had a meeting at her school last week to update her 504, the team is great and we all agreed that she needs to have an IEP eval.  I'm not sure what to expect out of an IEP for her.  Her misbehavior and acting before thinking need to be addressed but I don't know if that is something the school can help with.  Also, she is failing school.  She is very smart, can do all of the grade level requirements but won't/can't apply herself at school.  Her teacher admitted that she isn't concerned about DD2 doing classwork or really participating in class as long as she stays in her seat and attempts to pay attention.  I really like her teacher but my expectations are higher and I don't know if I am wrong in having those higher expectations.

4) Her therapist doesn't know what to do with her anymore and is now having sessions with DW and I to find different ways to parent her.  The therapist was doing play therapy with her, but DD2 only wants to do the play part, she refuses to talk about the issues at hand.  The therapist she has been seeing is an intern so I'm not sure if it's lack of experience with a child like DD2 or what, but her supervisor, a licensed and very experienced therapist, also has no idea how to proceed.  The current therapist will be leaving the program soon and I believe we will be given someone else.  I plan to ask if she can be seen by someone who has more experience.

I need some guidance in how to deal with all of this.  I know I may not have specific questions but I'm lost on how to deal with the school and therapy problems.  We've gotten to the point of calling the probation department and asking if they have any programs for kids her age, we fear for her future.

ETA: I'm also concerned about her spatial awareness and social skills. 

She has become known as "The Bird" or "The Airplane" for the way she approaches hugs.  She has her arms spread wide and slightly behind her way before approaching someone to give a hug.  With people who are seated, she then drops her chest into the person, lays her weight on them, and hugs with just her forearms, elbows tucked in to her sides.  People who are standing get the same thing without her full weight on them.  I'm not sure if this is just her way of hugging but it's very awkward. 

She's also a toe walker and drags her feet, we have to replace her shoes every couple of months because she's worn holes in them.  She is in track/cross country and we've noticed some differences between how she and her teammates carry themselves.  Her limbs seem to do their own floppy thing and she bobs her head as she runs (we think it helps her with pace but it slows her down considerably).  I'm not sure if all of that has to do with spatial awareness.

The social skills are a whole other thing.  Back to the hug approach, she doesn't wait to be invited for a hug, she goes for it no matter what the other person is doing or if they've acknowledged her.  Again, this makes hugs very awkward.  She doesn't have many (if any) friends at school, her teacher has said kids avoid her because she likes to argue and if things don't go her way she turns physical.  She seems slow to pick up on social cues.

Another concern is hard to talk about because I don't intend to offend anyone but I suppose it could be misconstrued to be offensive.  We are an interracial family, I am white, DW is Mexican, DD1 is white/Mexican, and DD2 is black.  I do not care what color friends my children have, I care about the quality of the friends.  DD2 has shown poor judgment in her choice of "friends".  In particular, she is attracted to other black kids (yay for community!) but she gravitates toward one girl in her after school program and another girl on her track team that don't have very good behavior.  She mimics what she calls "how black people act" from the girl in her after school program, she's picked up some unsavory advice from her on how to be black.  The girl on her track team is better but she encourages DD2 to goof off and DD2 seeks her out in order to do so.  We've encouraged her to find community with kids who have behavior in line with what we'd like to see in DD2 but she continually gravitates toward the opposite of that.  We have important figures (godmother, Dr, Pastor, etc.) in her life who are black and set great examples for her but she doesn't think they act "black enough".

That may be an adoption/racial issue only but I thought I'd bring it up since it may be due in part to lack of social skills.

I think I'm done with this novel, any advice would be appreciated.

[auntie]

Mar 26, 2015 10:56:42 GMT -5 friendlyfarmer said:

Hi there, it's time for me to pop in again for some advice.

Background for those who don't know: DD2, adopted from FC (mentioned because it has an effect on what we are dealing with), 7.5yo, has a number of mental health dx.  Our current list includes GAD, PICA, ODD, and ADHD.  We will probably be getting another dx on Friday when we get the results of her psychometric testing, we are expecting bipolar or schizoaffective disorder.

Anyhow... 1) We had her on varying doses of Methylphenidate for awhile but it didn't help, her behavior changed for the worse and her focus wasn't getting any better so we took her off of it.  The psych has suggested we try Tenex and told us to research it to see if we think it's a viable option.  It's a hypertension med but has proven to be a successful stim free med for some ADHD kids.  It's not FDA approved for ADHD use but is accepted, it's also not FDA approved for use in kids under 12.

Has anyone here had experience with this med?  Thoughts?

Stimulants aren't a great option for a kid with GAD unless you're also doing something for the anxiety. This is complicated if there's a family hx of bipolar because the SSRIs aren't a good choice in this instance. 

Tenex is an old HBP med; it's been used off label for ADHD for at least 20 years. There's a long acting formula of the same active ingredient called Intuniv that is FDA approved for ADHD. DS trialed Tenex when he was much younger. It didn't bring anything to the party here. TBH, most kids I know who take Tenex use it as part of a multi-medication tx plan.

2) She is a fidgety kid, her hands specifically.  She is constantly playing with or picking at her fingers, or she has to be touching something.  She is constantly getting in trouble for touching stuff, going to the store is horrible, she touches EVERYTHING.  If told to put her hands in her pockets, she'll use her elbows or face to touch stuff.  We've resorted to putting her in a shopping cart and keeping her mid aisle so she can't touch.  Her teacher mentioned that she had given DD2 a pencil grip and that she fidgets with that most of the day.

Would it be worthwhile to reserve a fidget to take on outings?  My concern is that once she gets past the newness of it, that we'll be back where we started.

Makes sense to me. You might want to carry a couple items that are reserved for such times. If she's a sensory seeker, thera-putty could be a good choice. Or something that's compelling to manipulate like a Tangle-Mini. WE used a handheld gaming device when we needed calm in places like restaurants, planes and waiting rooms.

3) I had a meeting at her school last week to update her 504, the team is great and we all agreed that she needs to have an IEP eval.  I'm not sure what to expect out of an IEP for her.  Her misbehavior and acting before thinking need to be addressed but I don't know if that is something the school can help with.  Also, she is failing school.  She is very smart, can do all of the grade level requirements but won't/can't apply herself at school.  Her teacher admitted that she isn't concerned about DD2 doing classwork or really participating in class as long as she stays in her seat and attempts to pay attention.  I really like her teacher but my expectations are higher and I don't know if I am wrong in having those higher expectations.

Hard to say whether the teacher's expectations are dumbed down or if you're wearing mommygoggles. TBH, if you have to contain a 7 1/2 yo to a shopping cart, the teacher's goal of having your DD learn the etiquette of the classroom as a first step doesn't seem far-fetched. She may need to learn to be a student ahead of learning academics.

4) Her therapist doesn't know what to do with her anymore and is now having sessions with DW and I to find different ways to parent her.  The therapist was doing play therapy with her, but DD2 only wants to do the play part, she refuses to talk about the issues at hand.  The therapist she has been seeing is an intern so I'm not sure if it's lack of experience with a child like DD2 or what, but her supervisor, a licensed and very experienced therapist, also has no idea how to proceed.  The current therapist will be leaving the program soon and I believe we will be given someone else.  I plan to ask if she can be seen by someone who has more experience.

I wonder if this is a function of feeling badly to admit she even has things she needs to work on. CBT might be useful for the anxiety piece rather than more generic play therapy. IME, there are certain kids who get burned out on the very female-centric culture of elementary who respond better to therapy when done with a male therapist. I noticed both DS and my niece with bipolar were more cooperative and less manipulative with male therapists. 

I need some guidance in how to deal with all of this.  I know I may not have specific questions but I'm lost on how to deal with the school and therapy problems.  We've gotten to the point of calling the probation department and asking if they have any programs for kids her age, we fear for her future.

It's sounds like you're doing all you can for now. A new dx may bring clarity to the tx plan including medications. Good luck.

[friendlyfarmer]

Mar 26, 2015 12:07:20 GMT -5 auntie said:

Mar 26, 2015 10:56:42 GMT -5 friendlyfarmer said:

Hi there, it's time for me to pop in again for some advice.

Background for those who don't know: DD2, adopted from FC (mentioned because it has an effect on what we are dealing with), 7.5yo, has a number of mental health dx.  Our current list includes GAD, PICA, ODD, and ADHD.  We will probably be getting another dx on Friday when we get the results of her psychometric testing, we are expecting bipolar or schizoaffective disorder.

Anyhow... 1) We had her on varying doses of Methylphenidate for awhile but it didn't help, her behavior changed for the worse and her focus wasn't getting any better so we took her off of it.  The psych has suggested we try Tenex and told us to research it to see if we think it's a viable option.  It's a hypertension med but has proven to be a successful stim free med for some ADHD kids.  It's not FDA approved for ADHD use but is accepted, it's also not FDA approved for use in kids under 12.

Has anyone here had experience with this med?  Thoughts?

Stimulants aren't a great option for a kid with GAD unless you're also doing something for the anxiety. This is complicated if there's a family hx of bipolar because the SSRIs aren't a good choice in this instance. 

Tenex is an old HBP med; it's been used off label for ADHD for at least 20 years. There's a long acting formula of the same active ingredient called Intuniv that is FDA approved for ADHD. DS trialed Tenex when he was much younger. It didn't bring anything to the party here. TBH, most kids I know who take Tenex use it as part of a multi-medication tx plan.

Is the multi-med approach due to multi-dx or is this just for the ADHD?  The psych is saying we need to get either the ADHD or the ODD under control to make some progress.  The ODD seems to be the main problem but it isn't something that can be medicated and she is refusing to do therapy so our best choice is to work on the ADHD.

2) She is a fidgety kid, her hands specifically.  She is constantly playing with or picking at her fingers, or she has to be touching something.  She is constantly getting in trouble for touching stuff, going to the store is horrible, she touches EVERYTHING.  If told to put her hands in her pockets, she'll use her elbows or face to touch stuff.  We've resorted to putting her in a shopping cart and keeping her mid aisle so she can't touch.  Her teacher mentioned that she had given DD2 a pencil grip and that she fidgets with that most of the day.

Would it be worthwhile to reserve a fidget to take on outings?  My concern is that once she gets past the newness of it, that we'll be back where we started.

Makes sense to me. You might want to carry a couple items that are reserved for such times. If she's a sensory seeker, thera-putty could be a good choice. Or something that's compelling to manipulate like a Tangle-Mini. WE used a handheld gaming device when we needed calm in places like restaurants, planes and waiting rooms.

3) I had a meeting at her school last week to update her 504, the team is great and we all agreed that she needs to have an IEP eval.  I'm not sure what to expect out of an IEP for her.  Her misbehavior and acting before thinking need to be addressed but I don't know if that is something the school can help with.  Also, she is failing school.  She is very smart, can do all of the grade level requirements but won't/can't apply herself at school.  Her teacher admitted that she isn't concerned about DD2 doing classwork or really participating in class as long as she stays in her seat and attempts to pay attention.  I really like her teacher but my expectations are higher and I don't know if I am wrong in having those higher expectations.

Hard to say whether the teacher's expectations are dumbed down or if you're wearing mommygoggles. TBH, if you have to contain a 7 1/2 yo to a shopping cart, the teacher's goal of having your DD learn the etiquette of the classroom as a first step doesn't seem far-fetched. She may need to learn to be a student ahead of learning academics.

4) Her therapist doesn't know what to do with her anymore and is now having sessions with DW and I to find different ways to parent her.  The therapist was doing play therapy with her, but DD2 only wants to do the play part, she refuses to talk about the issues at hand.  The therapist she has been seeing is an intern so I'm not sure if it's lack of experience with a child like DD2 or what, but her supervisor, a licensed and very experienced therapist, also has no idea how to proceed.  The current therapist will be leaving the program soon and I believe we will be given someone else.  I plan to ask if she can be seen by someone who has more experience.

I wonder if this is a function of feeling badly to admit she even has things she needs to work on. CBT might be useful for the anxiety piece rather than more generic play therapy. IME, there are certain kids who get burned out on the very female-centric culture of elementary who respond better to therapy when done with a male therapist. I noticed both DS and my niece with bipolar were more cooperative and less manipulative with male therapists. 

Agreed, she doesn't like to take responsibility for her actions so she refuses to talk.  What is CBT?  She had a male therapist last year who started with play therapy but ended up not allowing any play because she was doing the same thing she is now.

I need some guidance in how to deal with all of this.  I know I may not have specific questions but I'm lost on how to deal with the school and therapy problems.  We've gotten to the point of calling the probation department and asking if they have any programs for kids her age, we fear for her future.

It's sounds like you're doing all you can for now. A new dx may bring clarity to the tx plan including medications. Good luck.

I added to my original post, would you mind taking a look and giving me more insight?

[auntie]

friendlyfarmer said:


She has become known as "The Bird" or "The Airplane" for the way she approaches hugs. She has her arms spread wide and slightly behind her way before approaching someone to give a hug. With people who are seated, she then drops her chest into the person, lays her weight on them, and hugs with just her forearms, elbows tucked in to her sides. People who are standing get the same thing without her full weight on them. I'm not sure if this is just her way of hugging but it's very awkward.



She's also a toe walker and drags her feet, we have to replace her shoes every couple of months because she's worn holes in them.

These two behaviors sound very like a kid with Sensory Processing Disorder. She's not hugging people so much as crashing into them slowly. The toe walking is also a sensory behavior- it produces a major joint compression with the full weight of her body on the major joints on her foot. If she's not been evaluated, it might make sense to see an OT with expertise in this area. There are strategies like weight vests, Sit'n'Fit Cushions, a sensory diet, Therapbands strung across desk legs that could allow her to get sensory input and settle without stigmatizing behaviors.

She is in track/cross country and we've noticed some differences between how she and her teammates carry themselves. Her limbs seem to do their own floppy thing and she bobs her head as she runs (we think it helps her with pace but it slows her down considerably). I'm not sure if all of that has to do with spatial awareness.


It could be related to motor planning or knowing where her body is in space. She could also have hypotonia and lax joints. If she's always toewalked, that could impact her gait as well as her tendons may be shortened.


The social skills are a whole other thing. Back to the hug approach, she doesn't wait to be invited for a hug, she goes for it no matter what the other person is doing or if they've acknowledged her. Again, this makes hugs very awkward. She doesn't have many (if any) friends at school, her teacher has said kids avoid her because she likes to argue and if things don't go her way she turns physical. She seems slow to pick up on social cues.


She should really not be hugging people. Period. A lot of kids on spectrum don't get this; for them there's a visual aid that addresses various degrees of intimacy in relationships. It's usually a set of concentric circles with strangers on the outside, people we see regularly but don't know (mailman, grocery clerk), acquaintances (seen regularly in some context- we might know a name but little else), school friends/teachers (we know, but still not appropriate or welcome to hug), BFFs and family in the center- can hug but must ask first.


Another concern is hard to talk about because I don't intend to offend anyone but I suppose it could be misconstrued to be offensive. We are an interracial family, I am white, DW is Mexican, DD1 is white/Mexican, and DD2 is black. I do not care what color friends my children have, I care about the quality of the friends. DD2 has shown poor judgment in her choice of "friends". In particular, she is attracted to other black kids (yay for community!) but she gravitates toward one girl in her after school program and another girl on her track team that don't have very good behavior. She mimics what she calls "how black people act" from the girl in her after school program, she's picked up some unsavory advice from her on how to be black. The girl on her track team is better but she encourages DD2 to goof off and DD2 seeks her out in order to do so. We've encouraged her to find community with kids who have behavior in line with what we'd like to see in DD2 but she continually gravitates toward the opposite of that. We have important figures (godmother, Dr, Pastor, etc.) in her life who are black and set great examples for her but she doesn't think they act "black enough".


There might be a couple things going on. There seems to be an almost restricted interest around race. Maybe that is a function of a biracial family and adoption. Maybe she's just trying to make sense of what the other kids have told her; especially if she looks up to them. I get wanting her to befriend "nice" kids who demonstrate appropriate behavior. But what often happens is that the more well behaved kids are probably wary of her and the other kids who have less regulated behavior so they bond with other well behaved and predictable peers leaving your DD and the others with each other as a default option. 


That may be an adoption/racial issue only but I thought I'd bring it up since it may be due in part to lack of social skills.





Read more: pandce.proboards.com/thread/432583/feedback-adhd-gad-odd?page=1#ixzz3VWIFlec9

[friendlyfarmer]

Mar 26, 2015 14:36:30 GMT -5 auntie said:

friendlyfarmer said:


She has become known as "The Bird" or "The Airplane" for the way she approaches hugs. She has her arms spread wide and slightly behind her way before approaching someone to give a hug. With people who are seated, she then drops her chest into the person, lays her weight on them, and hugs with just her forearms, elbows tucked in to her sides. People who are standing get the same thing without her full weight on them. I'm not sure if this is just her way of hugging but it's very awkward.



She's also a toe walker and drags her feet, we have to replace her shoes every couple of months because she's worn holes in them.

These two behaviors sound very like a kid with Sensory Processing Disorder. She's not hugging people so much as crashing into them slowly. The toe walking is also a sensory behavior- it produces a major joint compression with the full weight of her body on the major joints on her foot. If she's not been evaluated, it might make sense to see an OT with expertise in this area. There are strategies like weight vests, Sit'n'Fit Cushions, a sensory diet, Therapbands strung across desk legs that could allow her to get sensory input and settle without stigmatizing behaviors.

Who would be the best person to ask for a referral to an OT?  I worked with a wonderful OT for another child a while back but that referral came from the foster care social worker.

She is in track/cross country and we've noticed some differences between how she and her teammates carry themselves. Her limbs seem to do their own floppy thing and she bobs her head as she runs (we think it helps her with pace but it slows her down considerably). I'm not sure if all of that has to do with spatial awareness.


It could be related to motor planning or knowing where her body is in space. She could also have hypotonia and lax joints. If she's always toewalked, that could impact her gait as well as her tendons may be shortened.


The social skills are a whole other thing. Back to the hug approach, she doesn't wait to be invited for a hug, she goes for it no matter what the other person is doing or if they've acknowledged her. Again, this makes hugs very awkward. She doesn't have many (if any) friends at school, her teacher has said kids avoid her because she likes to argue and if things don't go her way she turns physical. She seems slow to pick up on social cues.


She should really not be hugging people. Period. A lot of kids on spectrum don't get this; for them there's a visual aid that addresses various degrees of intimacy in relationships. It's usually a set of concentric circles with strangers on the outside, people we see regularly but don't know (mailman, grocery clerk), acquaintances (seen regularly in some context- we might know a name but little else), school friends/teachers (we know, but still not appropriate or welcome to hug), BFFs and family in the center- can hug but must ask first.

She doesn't hug strangers fortunately, this happens with family members.  Hugs and kisses on the cheek to say hello and goodbye are an expectation in my DW's family, it's a sign of respect.  DD2 will hug the person doing dishes from behind without first announcing that she's there or asking for a hug, she drops herself into a hug on the person who is finishing up a text on their phone, squeezes herself between the person grilling and the grill to give a hug rather than asking and waiting for them to step away from the heat. 


Another concern is hard to talk about because I don't intend to offend anyone but I suppose it could be misconstrued to be offensive. We are an interracial family, I am white, DW is Mexican, DD1 is white/Mexican, and DD2 is black. I do not care what color friends my children have, I care about the quality of the friends. DD2 has shown poor judgment in her choice of "friends". In particular, she is attracted to other black kids (yay for community!) but she gravitates toward one girl in her after school program and another girl on her track team that don't have very good behavior. She mimics what she calls "how black people act" from the girl in her after school program, she's picked up some unsavory advice from her on how to be black. The girl on her track team is better but she encourages DD2 to goof off and DD2 seeks her out in order to do so. We've encouraged her to find community with kids who have behavior in line with what we'd like to see in DD2 but she continually gravitates toward the opposite of that. We have important figures (godmother, Dr, Pastor, etc.) in her life who are black and set great examples for her but she doesn't think they act "black enough".


There might be a couple things going on. There seems to be an almost restricted interest around race. Maybe that is a function of a biracial family and adoption. Maybe she's just trying to make sense of what the other kids have told her; especially if she looks up to them. I get wanting her to befriend "nice" kids who demonstrate appropriate behavior. But what often happens is that the more well behaved kids are probably wary of her and the other kids who have less regulated behavior so they bond with other well behaved and predictable peers leaving your DD and the others with each other as a default option. 

Good point!  I hadn't thought of it like that, she might be taking whatever she can get.


That may be an adoption/racial issue only but I thought I'd bring it up since it may be due in part to lack of social skills.





Read more: pandce.proboards.com/thread/432583/feedback-adhd-gad-odd?page=1#ixzz3VWIFlec9

[auntie]

Finding an OT will depend on how you're paying for it. If your insurance will cover it, your child's PCP may be a resource. If you're playing OOP, I'd contact the one you saw previously.

Some schools will evaluate for SPD if it has an educational impact. It's kind of a controversial dx, not in the DSM-5, so a lot of districts pretend it doesn't exist. Either way, the person should be well versed in sensory issues and not just motor skills.

The hugging sounds like she doesn't get the point. Her behavior around it seems very awkward, almost as if it makes her uncomfortable and she's looking to get it over with quickly. I'd explore this with her if she is articulate around sharing what she feels. I'm not wild about forcing children to hug/kiss people if they're not comfortable doing so; kids should have some autonomy over their bodies.

[moolarkey]

I can't address 99% of what you said and what I am going to address, I may be wrong on. Have you talked to her doctor about her toe-walking? My kids did this or something similar to it, we first noticed it with DS and I was alarmed with it. Our Ped told us it was because he has a shortened achillies tendon and that people with this condition tend to be faster runners. He told us we could have it "fixed" but it would make him a less faster runner and that it wasn't actually causing him problems or discomfort. DD also had it.

And yes, they are both exceptionally fast runners. What you are seeing might be something much more serious than what my 2 were diagnosed with but maybe it is the same thing.

[ilovetacos]

Have you seen a therapist who specializes in attachment disorders?
All the things you are describing scream attachment disorder to me which is often misdiagnosed with ADHD and the like.

Edit: I just realized you posted this back in March so you may not see this but please do some research on Reactive Attachment Disorder. Everything you are describing is very much an attachment disorder and handling of issues is 100% different than handling a nurtured child so finding someone with specific attachment disorder experience is crucial. Things like behavior charts don't work with these kids. Their self esteem is so low they gravitate towards the misbehaving children. It is a tough, frustrating situation but the right kind of help really could make things so much better. Good luck!