Monday, October 21, 2013

Just for the Record: What I’m learning about ADHD

If you have any inclination to be judgmental this is probably a post you shouldn’t read, or maybe you should read it so that you can get a glimpse of the other side of the fence in this case.   I’m not looking for feedback on what we have chosen to do. In fact, Josh didn’t want me to share this information with anyone, but he doesn’t read the blog, only a hand full of people do, so I thought I’d create a record of one of the major things that have happened in our family over the last six month.  Maybe it will clear up some misconceptions about ADHD, and I think that someday I’ll wonder how this all went down and be glad that I made a record.  Maybe someone will read this and be inspired to get help with their child so that he or she can reach their full potential too. 

To put it lightly, Caleb has not been an easy child to parent.  The academic in me has studied a bookshelf full of parenting books.  I have attended parenting classes offered by the church and the community.  I have enlisted the help of caring friends and teachers, soliciting advice and help.  All this felt like it was to no avail because I continued to be at a loss for how to parent Caleb.  When he got kicked out his after school language class for repetitively asking what time it was I decided it was time to get professional help. 

I decided to go to a Psychologist who’s parenting classes I’d attended, Dr. Bruce Johns.  I liked what I knew about Dr. Johns and when we had to wait about 6 weeks to get in for the initial evaluation I felt validated that he was a sought after child and adolescent psychologist.  It was June, after Caleb finished 3rd grade, that we got in.  Honestly I didn’t even know who I was making the appointment for.  I knew that I needed strategies for parenting Caleb.  I needed ideas that I couldn’t find in any book.  I wondered if Josh and I needed the session more than Caleb so that we could better parent him.  In fact, I honestly told Caleb that we were going to figure out how we could be better parents and to learn how to get along better.  I was really looking for a mediator between the three of us.  My idea was to push Caleb harder and give him tougher consequences and rewards for compliance, and Josh felt like he just needed more attention.  To my displeasure Josh would reward him with attention for acting up.  Caleb was fighting with me about everything I asked him to do.  I felt like we were going to be getting professional help now or when he was 16 so I opted for NOW. 

At the first session Josh and I describe the following, some of which is taken from Dr. John’s initial evaluation report:  Caleb is intelligent, but he has problems at school because he lacks in follow through and self-motivation.  For example, he reads a few books each week (due to his inability to fall asleep), but he refuses to take the AR tests because he would have to miss a few minutes of recess.  He is relentless when he wants something.  If he has one dollar he can’t wait to spend it.  He won’t stop talking about going to the store until he goes.  He makes friends very easily, but he has difficulty maintain friendships.  Many of the children he plays with are significantly younger than him.  He is athletic, intelligent, and emotionally immature.  Caleb is always looking forward to the next activity.  We can be at an awesome party or event and he begs to know what we are doing next.  On the way home from his last football game he was talking about basketball and baseball.  He is obsessed with knowing what time it is and what is going to happen next.  He cries extremely easily.  His teacher has gotten after me for reinforcing that behavior which makes me crazy because I don’t reinforce it at all, but he still seems to cry when things don’t go his way.  It appears to be a manipulation strategy.  Adjectives describing him would be: talkative, adventurous, anxious, stubborn, distrustful, impulsive, reckless, playful, aggressive, and easily bored. 

Going into the session with the above description of Caleb, I in no way anticipated what we heard, which was that this sounded like a classic case of ADHD.  My impression of ADHD was children that were always bouncing off the wall.  That they couldn’t concentrate on anything or sit still, that they were behind in school or not as ”advanced” as the other students.  This is one of those times as a parent I had the opportunity to eat my words and make some decisions that seem so obvious to an onlooker, but to a parent who is living with a child with ADHD the solutions seem much less clear. 

To one looking on it is easy to think, “can’t they just create more savior consequences, if it really mattered to the child he would comply.” 
“If they were more consistent in their parenting this wouldn’t be a problem.” 
“If they would just follow this program or that program . . . “ 
“All kids are like that, they are just looking for an excuse for their child.” 
“They are just looking for a diagnosis so they don’t have to parent.”
I admit thoughts like these have crossed my mind too. 

I very specifically told Dr. Johns that we were looking for parenting strategies, and that we did not come looking for a diagnosis. He did not mix words in telling me that if Caleb indeed had ADHD then this was more about a chemical imbalance then about how we have been parenting.  He said that the best parenting strategies in the world couldn’t compensate for the imbalance of chemicals in ones brain, although good parenting helps, it will not solve the problem.  On the one hand I felt relieved that it wasn’t something I had done wrong, on the other hand I know that there would be big decisions about how we would treat the chemical imbalance.  Rather than talking stagey, Dr. Johns wanted to spend time educating us on ADHD and begin some testing. 

It has been five months, so I don’t remember a lot of details about what he taught us, but there were a few things that stood out to me.  First, ADHD is due to a lack of dopamine.  It is dopamine that creates the sense of satisfaction.  That is why Caleb is always anxious to know what is next.  He isn’t satisfied with the moment.  That is also why he is obsessed with the time.  (Hence asking his Chinese teacher what time it was when he didn’t have access to a clock.)  Next, ADHD is almost always genetic and ADD runs in my family.  They are related.  This chemical imbalance more often shows up in boys as ADHD and in girls as ADD.  Josh was also tested for ADHD in his early 20’s but not diagnosed.  He insists that he doesn’t have it, but I still wonder.  Either way, genetically it is coming at least from my side of the family.  I have two sisters that were diagnosed and treated for ADD when they were in college. 

There are many more indicators for ADHD than what I have always thought of, the inability to concentrate or sit still.  Caleb’s third grade teacher and I both completed a questionnaire, of nearly 100 questions, about Caleb’s behavior. The test called the Behavior Rating Inventory of Executive Function, looked at his behavior in three categories and his metacognition in five arias.  He had a clinically significant score in seven of the eight categories making his diagnosis of ADHD quite clear.  His test results were as follows:

                                                 home               school
Behavior Regulation                   76*                  68*
            Inhibit                              78*                  62*
            Shift                                 53                    52
            Emotional Control           71*                  88*

Metacognition                             72*                   73*
            Initiate                             72*                   66*
            Working Memory           65*                   74*
            Plan/Organize                 77*                   66*
            Organize Materials          58                     73*
            Monitor                           78*                   76*

Composite                                   77*                   72*
*= Clinically Significant Score

If I remember correctly an average child his age would score 50 on any given section so his scores indicate a significant deviation from what would be expected.  Behaviorally he can move from one activity to another like would be expected, but he is struggling emotionally, especially at school, as compared to his peers and with his ability to exhibit self-control.  Cognitively I don’t notice a problem with organization of his materials at home, but it might be because I micromanage him and insist on organization.  He is struggling with initiating responsibilities, remembering what he needs to get done, seeing the future and planning for anything that is not immediate, and self-monitoring.  I had no idea that these were all indicators of ADHD.  I would consider myself an educated person, but I was clueless on the reality of ADHD. 

One sad thing is that ADHD has a reputation for being over diagnosed. That is part of the reason Josh didn’t want to share Caleb’s diagnosis with anyone.  It is hard to understand if you don’t live with someone who is struggling with it.  We also didn’t want Caleb to be judged negatively because of his diagnosis. He is a wonderful person, he will be successful in life.  He has so much potential and now we will know better how to help him reach that potential.  

The first month of school this year has been a huge success.  I wanted to do a happy dance after parent teachers conference when he received all “excellent” on the behavior portion of his report card.  In the past he always received mostly “needs improvement”.  Each Friday his teacher gives a behavior score for the week.  The first week of school he got a 10/10.  I almost wanted to cry.  He was not capable of receiving that score in the past.  I am so grateful we got help so that we could move in this positive direction.

After prayerful consideration we decided that we would create a benchmark of “the best it can get” using a combination of modern and alternative medicine.  We did decide to put him on Ritalin.  The side affects pale in comparison to the chemical imbalance he has been experiencing.  We have noticed no negative side affects.  He is still his persistent and busy self.  I have not noticed a “personality change.”  What I have noticed is that he doesn’t cry nearly as easily.  He can hold a little more still, for example, he seems better at keeping his hands to himself and not pestering others during church. Prior to using the Ritalin we would barley survive sacrament meeting.  I would prefer sitting with the three younger kids than just Caleb alone with his constant talking and pestering. (There is a major difference between when he takes his medicine and when he doesn’t.)  He seems to have a better comprehension of consequences and more self-control.  It is hard to describe, but he is just doing better.  It feels great!!

We are using some essential oils.  We use a blend to help with focus.  He is also drawn to Wild Orange and Lavender to calm his nerves and to assist him with his ongoing battle with falling to sleep.  I’d like to get him taking my company's amazing supplements, but I have yet to convince him that he can take capsules that big.  We will experiment with going to straight alternative medicine in the summer, but for now we are having success using both.  If that is what it takes for us to happily live together and for him to reach his full potential then it is worth the exchange of potential side effects and cost.  I am so grateful that we acted on the promptings to get professional help and for the options we have to assist us on this journey of life.  As parents there is always something to humble us and this is just another one of those things.  

Wednesday, October 16, 2013

Football Season #1

Caleb and I have been battling about him starting football for a few years.  He finally agreed to play flag football when he realized his choice was that or soccer.  (I feel like he is still a little young for the time commitment associated with tackle football.)  Flag football has been a joy for all of us.  It was like he was living a dream when the season started.  There was even a rainbow over his first game.   

He loved everything about playing football.  He would like to be a little more physical, but flag football seemed to be a great compromise.

This is a portion of his team.  He's too happy to make a game face, but he was really fun to watch.  He as fast on his feet and even better with his arm. 

He was a fantastic quarterback.  He seems to be gifted with his arm.  He took pride in being known as the passing quarterback of the team.  He's teammates even gave him the nickname of Manning, some big time quarterback. 
Hike . . . 

Running-back taking position . . . 

Pass. . . 

And Touchdown!

It was a really fun season!!

Saturday, October 12, 2013

Andy's Soccer

Andy played his first season of soccer this fall.  I had forgotten how cute five year olds are when they play.  It was so great to participate with him as the coach. 

When they needed a coach for his team I asked what he would think I was the coach.  He very matter-of-fact asked, "would you bring treats?"  When I told him I'd make sure there were treats there he was all for it.  That is a very important part of coaching the five year olds.

We learned sportsman ship, a few soccer vocabulary words and a little coordination.  Thank goodness for google.  It was really pretty easy and fun.

I think Andy had a great time.  He isn't a super aggressive player, but he does enjoy participating.