Introduction

[lauralala]

Hi! I've been reading this board for months and recently started a job where I have a lot more free time to stare at a computer screen, so I figured I would introduce myself instead of lurking. 

This got long, feel free to skim! Our story is a bit complicated. DS (age 8) is my biological nephew, my brother's son. We adopted him through kinship/foster care. He has lived with us since he was 22 months old, adoption was finalized just before he turned 4. Prior to moving in with us, he lived with my mom for a year (beginning at age 10 months). He has biological twin brothers who are only 8 months younger - they were all removed from the home when the twins were born at 26 weeks with drugs in their system. My sister and BIL adopted them, and they live about 3 hours away. It is probably not an ideal solution, but that is how things are.

DS began having behavioral problems at about 3.5, mostly consisting of violent angry outbursts. He was kicked out of preschool for biting when he was 4. We went to different behavioral therapists over the years, but teaching things like breathing methods and counting to 10 did no good - DS can tell you a dozen different breathing methods, but if he is angry, he is not going to use them. Last year, after a really rough 1st grade year, we finally got a diagnosis from his pediatrician of ADHD-combined and anxiety. Most of the anger issues come from the anxiety, which makes sense once we understood more about how that works. The first half of 2nd grade was awful. He was having outbursts multiple times a week and his teacher had basically decided not to even try to teach him (that is a longer story). The school did a full evaluation and diagnosed him as being on the Autism spectrum.

We moved him to another school over Christmas break - still a public school in our district, but with better supports. He has had an awesome semester. He has only had 4 incidents at school total, and he has been able to calm down from each one, apologize and end his day well. He is in a mainstream classroom with a daily pull out for social skills work. He has had a one on one aide during specials (PE, music, computer) and lunch, but is doing so well that the school is recommending dropping that for next year. 

Anyway, I am an open book, so feel free to ask any questions. 

[sahara78]

Hello and welcome! Long posts are appreciated on this board, because the background is useful when people ask for advice.

My DD is 5, with Autism and born at 29 weeks.

Glad to hear your school situation is working out well now. Were you surprised by the school diagnosing Autism, or do you think it fits?

[lauralala]

Mar 29, 2018 17:46:36 GMT -5 sahara78 said:

Hello and welcome! Long posts are appreciated on this board, because the background is useful when people ask for advice.

My DD is 5, with Autism and born at 29 weeks.

Glad to hear your school situation is working out well now. Were you surprised by the school diagnosing Autism, or do you think it fits?

Thank you - it's nice to meet you!

The ASD diagnosis was not a complete surprise. He still runs on his toes, he struggles with eye contact, social cues are very difficult for him, and he has a habit of speaking in a very condescending tone of voice and correcting people, including teachers, without understanding that it is inappropriate. These are all things we were aware of, of course. Because he is also very bright, a lot of this has been written off as being a "quirky smart kid" by past teachers and even counselors.

There has been some discussion/disagreement among professionals about whether or not he actually has Autism - most of his symptoms can also fall under the ADHD/Anxiety diagnoses. But ASD is the diagnosis that really opened doors for us within the school system, and the interventions that he has received have made a huge difference in the way he sees school, his behavior there, everything. I'm honestly not sure if the diagnosis is 100% correct, but for now I only care that he is getting the help that he needs to be successful.

[sahara78]

DH was surprised when DD was diagnosed with ASD, but I “knew”. Think that made it a bit harder for him.

Funny you mention the condescending tone; I just talked to DD today about how she needs to be nicer when I make a mistake. Ugh, can be very frustrating sometimes.

[auntie]

lauralala, said:




This got long, feel free to skim! Our story is a bit complicated. DS (age 8) is my biological nephew, my brother's son. We adopted him through kinship/foster care. He has lived with us since he was 22 months old, adoption was finalized just before he turned 4. Prior to moving in with us, he lived with my mom for a year (beginning at age 10 months). He has biological twin brothers who are only 8 months younger - they were all removed from the home when the twins were born at 26 weeks with drugs in their system. My sister and BIL adopted them, and they live about 3 hours away. It is probably not an ideal solution, but that is how things are.


It's great that you were able to keep the family as close as you have. That's awesome.


DS began having behavioral problems at about 3.5, mostly consisting of violent angry outbursts. He was kicked out of preschool for biting when he was 4. We went to different behavioral therapists over the years, but teaching things like breathing methods and counting to 10 did no good - DS can tell you a dozen different breathing methods, but if he is angry, he is not going to use them. Last year, after a really rough 1st grade year, we finally got a diagnosis from his pediatrician of ADHD-combined and anxiety. Most of the anger issues come from the anxiety, which makes sense once we understood more about how that works. The first half of 2nd grade was awful. He was having outbursts multiple times a week and his teacher had basically decided not to even try to teach him (that is a longer story). The school did a full evaluation and diagnosed him as being on the Autism spectrum.


As I was reading your post I wondered if anyone had done an eval for ASD because your description sounded so familiar. It's not unusual for kids with a more Asperger-like presentation of autism to start to have behavioral issues around 3 1/2-4; cognition takes a huge leap forward around this age which drives the anxiety. Social and emotional immaturity become more obvious around this age as well. Kids with ASD typically have the social and emotional maturity of someone about 1/3 to 1/2 their age which will factor into impulse control, executive function, etc.


We moved him to another school over Christmas break - still a public school in our district, but with better supports. He has had an awesome semester. He has only had 4 incidents at school total, and he has been able to calm down from each one, apologize and end his day well. He is in a mainstream classroom with a daily pull out for social skills work. He has had a one on one aide during specials (PE, music, computer) and lunch, but is doing so well that the school is recommending dropping that for next year.


It's great that he's doing so well with the supports. On one hand, I am not a fan of a 1:1 para for my own child- there's a stigma associated, there's the risk of learned helplessness and paras tend to be a barrier between a student and his peers- but it's not uncommon for bright mainstreamed kids on spectrum to really struggle with the less structured parts of the day. And then there's the sensory piece to the cafeteria, PE and music. DS found them loud and smelly when he was in public elementary. 


Be careful not to let the school flatter you out of services. Sometimes a kid is doing really well because of the supports- it can be like taking away a kid's glasses because they're seeing so well now they must not need them anymore. Maybe do a trial of weaning the para out of one special or lunch for a couple days and see how it goes before you jettison her/him. 

Not sure what grade you're looking at for next year, but be aware that well developing kids make a big leap in social and emotional maturity around 4th grade. This is an age when their social world becomes more complex and subtle and they start to become more hardwired for conformity. It's also an age when teachers raise the bar on executive function expectations and the academic piece shifts from rote learning to more abstract reasoning. 


The ASD diagnosis was not a complete surprise. He still runs on his toes, he struggles with eye contact, social cues are very difficult for him, and he has a habit of speaking in a very condescending tone of voice and correcting people, including teachers, without understanding that it is inappropriate. These are all things we were aware of, of course. Because he is also very bright, a lot of this has been written off as being a "quirky smart kid" by past teachers and even counselors.


What curriculum is being used in his social skills work? I really like Michelle Garcia Winner's Social Thinking materials. Ideally, he should be working with a SLP on pragmatics of language in addition. Given his age and tendency to be the rule police/unaware of how his behavior makes others think about him- "Thinking About You, Thinking About Me" could be very useful to help him understand and empower him to behave in ways that are less off-putting to peers and adults. The book "Parenting Your Aspergers Child" by Grayson and Sohn has a lot of good parenting tips for managing this tendency in brighter kids. 


There has been some discussion/disagreement among professionals about whether or not he actually has Autism - most of his symptoms can also fall under the ADHD/Anxiety diagnoses. But ASD is the diagnosis that really opened doors for us within the school system, and the interventions that he has received have made a huge difference in the way he sees school, his behavior there, everything. I'm honestly not sure if the diagnosis is 100% correct, but for now I only care that he is getting the help that he needs to be successful.


Have you considered having him evaluated medically by a developmental pediatrician? IMO, it's important to know as much as you can going forward. DS has ASD (Aspergers), ADHD-combined, and, GAD. While much of his IEP in late elementary and middle school dealt with ADHD and executive function issues, the ASD is the more critical piece in terms of giving him the skills to thrive as an adult. A medical dx could be useful going forward if he needs SSI as he transitions to adulthood. The reality is the many on spectrum do not make a seamless transition at the start of adulthood and may need governmental support programs- unfortunately it's hard to predict which kids will need additional supports in adulthood- a late dx (suggesting a milder presentation) and even high IQ are not necessarily predictive of a fully independent adulthood. 


What sort of strategies are in place for the ADHD and anxiety?

[lemonberry]

Welcome! 

Mar 29, 2018 16:15:53 GMT -5 lauralala said:

He has had a one on one aide during specials (PE, music, computer) and lunch, but is doing so well that the school is recommending dropping that for next year. 

Instead of dropping completely, could they maybe slowly ease the aide out? Ditto what Auntie said about it.

[akafred]

Hi! I'm Fred, mom to a daughter my husband and I adopted from foster care. She was exposed en utero to (at least) marijuana, cocaine, opiates (they said most likely methadone because her bio brother was tested for which opiate - and it was methadone - but DD was not tested), as well as an antidepressant and cigarettes, but according to bio mom not alcohol. She came home at 2 days old weighing 5 pounds, and the adoption was finalized at 14 months.

DD is a bit of an anomaly because she has no developmental delays and actually hit milestones pretty early, both physical and verbal, but clearly had sensory issues even as a baby. It was in preschool that the collection of diagnoses began . To date she has dx of SPD, ADHD, APD, and anxiety. I have wondered about dyslexia and OCD as well, but it's a bit challenging to find appropriate diagnosticians for those as she refuses the paychoeducational tests (extremely impulsive in her responses) and she's a closed book about her anxiety and emotions so it's hard to tell if there are compulsions or just preferences etc (there are definitely obsessive thoughts), and I can't find any OCD experts who deal with kids and accept her insurance. She doesn't seem to have any significant ASD traits. Her anxiety comes out like anger and defiance so I am sure some would label her ODD, but it really seems to be anxiety because she isn't that way when her anxiety is well controlled. She currently takes a combination of Strattera, Ritalin, and guanfacine, along with the supplements PS-100 and l-theanine which really seem to be helping her anger and emotions lately. We did try Prozac, but it made her even more impulsive and caused her obsessiveness to spike and caused intrusive thoughts.