Gifted Issues Discussion homepage Forums Twice Exceptional Gifted and ADHD?

I rarely ever cry but I actually did feel a little better yesterday for it.

I've found a neurophsych but the wait time is forever. Meanwhile, we've decided to try the Strattera. That will give us a chance to see if it works and also give me a chance to get my husband on board with another evaluation.

We spoke to the psychiatrist (who turns out to be a neuropsychiatrist) this morning and he explained the ADHD to husband and what the medicine might do. When he asked what we wanted to talk about, I looked at husband (who's the one who wanted the appointment!) and he just shrugged and said "she wants him on medication". Argh! So, the doctor reviewed notes and went over it all and told me I looked worn out (I wasn't sure whether to be offended or relieved that someone noticed!). He thinks the Strattera can help and doesn't think we need more evaluation but I'm not convinced. At this point, I'm ready to just try it and see what happens while we wait for the NP.

I also asked him about ASDs and he said that even if my son is diagnosed with Aspergers, he would treat it the same way. Medication and then organization and planning help, as well as behavior modification. He did caution us not to try any new behavioral modifications for a while since we'll just be digging the hole deeper until the medicine starts to kick in. He encouraged positive reinforcement and limited time to video, computer, and TV (which we already do).

It's funny, though, on the way to the appointment I had made up my mind that I didn't like this doctor and that I'd find someone else to administer medicine. After we left the office, though, I thought "that makes a lof of sense, maybe he's on to something". Weird.

There is something to what Zen says but I don't think I could let go of that much control. (Maybe the whole problem is that I'm a control freak!!!)

So, to sum up, next steps:
1. start the Strattera
2. talk hubby into NP eval
3. do lots of positive reinforcement
4. try to implement more structure and organization
5. look for a behavioral therapist
6. consider an OT eval

Thank you all again for your input and responses.

Those are good steps. I might put 5 before 3, but that's me. 2 still seems really crucial.

Think I said this a ways upstream, but Strattera is at least the right med to try first with an anxious kid. I wouldn't try a stimulant ADHD med with a kid who tends to be anxious and act out unless other options are exhausted first and there's a plan for addressing the anxiety.


Do they run a cancellation list? People often cancel, leaving them with evaluation slots open. That's how we got DS's done relatively quickly.

Also: try the autism center of a children's hospital. They will at least have several clinicians.


Well, yeah, the general outline is the same-- except that the kind of behavior modification that you need may be different with an ADHD vs. an ASD diagnosis. The particulars are quite different.

In addition, if you are treating an ASD with meds (keeping in mind that there is no med that is specifically approved for that) it is more typical to start with an anti-anxiety med (often an SSRI unless there is a family history of bipolar or other contraindications)-- so knowing what you are dealing with definitely matters. IMHO.

This is in part a difference of professional discipline. In general a psychiatrist's first line of attack is medication. In general a psychologist's first line of attack is behavior modification strategies, talk therapy, that sort of thing, depending on their training and expertise. For my money, the psychiatrist's perspective is a little limited here.

Hang in there. I think you're on the right road.
DeeDee

ETA: this is not to suggest that the Strattera is a bad idea. In fact, I think it could be a good thing to try given what you have said here so far. Only to suggest that the psychiatrist isn't spot on about treating ADHD and ASD being the same.

I would assume the Dr meant even with a diagnosis of Asd he'd still prescribe the Strattera, and which makes sense. You don't medicate ASD, but you do sometimes add medication for specific behaviors - anti-anxiety, mood stabilizer, etc.

Thanks, DeeDee. I did ask about the cancellation list and was told that there are already "multiple people" on it but there's a chance we could get something sooner. I did call one children's hospital but was told that they don't deal much with higher IQ kids, mostly with lower end. There's another children's hospital, though, that I just remembered that I should call.

I'm holding off on the behavioral therapist because I have to have knee surgery and need to focus on getting ready for that and then recovering.

The dr. did talk about using a mood-stabilizer or an SSRI but son is already taking Prozac for ODD so he thought the combination might be helpful, with the goal of getting off the Prozac at some point.

And, Amy, you're exactly right - not medicating the ASD per se but medicating the behaviors.

At least hubby agreed to try the medication. I truly don't understand why he was resistant. He did tell the dr that "son is so much like me that it doesn't really bother me that much" and "I just want the two of them to stop fighting". Neither of which made me feel very supported but that's another story (he's probably both ADHD and Asperger, if you get right down to it).

One hard part is that the Strattera takes 4 - 6 weeks to kick in so that'll be hard on my patience. At least, we're doing something, though, and it's not permanent and there doesn't seem to be any harm in it.

Whoa, you do have a lot on your plate. I hope it all goes smoothly.


That makes good sense to me. Prozac ought to help manage the anxiety, I would think. (Note for full disclosure: I am just a mom, not a doc.)


Sometimes dads aren't the ones managing the behavior all the time, so they have a different view of the child. And dads do have hopes and dreams-- they like to think of their child being successful, and they don't like to imagine disabilities getting in the way. That combination can mitigate against a clear view of the difficulties.

DH has been very helpful in our process, in part because he frequently saw DS in the context of Sunday school and Cub Scouts, where DS's challenges were clearly apparent.


I hope you get good mileage out of it.

DeeDee

I don't know, but I found the raw scores in the report. The only ones that seem to fall underd the extended norms criteria are in the Verbal Comprehension, but I don't know how to read the chart. Here's the info, if anyone can tell me anything:
Similarities: RS 38, SS 18, PR 99.6
Vocabulary: RS 60, SS 19, PR 99.9
Comprehension: RS 39, SS 19, PR 99.9

And what would it mean if we used extended norms? Would that make his IQ higher? We did apply to DYS and were accepted so that's good news.

It's really academic but in the context of the school saying he can't handle more advanced language arts work, his extended VCI makes this claim even more starkly absurd. It looks to me like his Vocabulary scaled score would go up from 19 to 20 no matter his age but his Comprehension subtest would go up to 21 or 22 depending on exactly how old he was when he took the test. There are three different tables for 11 year olds according to years and months. If he is below 11 years 8 months then he is a 22, otherwise a 21.

This makes his extended VCI around 160, way off in the tail of the bell curve. It raises his FSIQ too. These numbers are really only useful if you want to change the level of his LA work though. Otherwise they are just a footnote.

Hmmm ... it's something to think about. I've wondered the same thing myself sometimes, but then shrug it off as too "out there". I don't know what we'd DO about it though. I can't see skipping him another grade or homeschooling or sending him to college. What options are there?

What path did you take? You can PM me if you want.

Forgive my skepticism, but for a child diagnosed with pretty severe behavioral issues, and already accelerated, it seems unlikely to me that addressing the giftedness alone will get the child where he needs to be.

It's lovely to think that these problems can easily be solved by focusing on the child's strengths, but it is frequently the case that a child has both giftedness and something else going on, and that both need to be addressed.

Petunia said her DS is already not taking GT language arts because he can't comply with homework demands. The likelihood is that further acceleration will mean a larger quantity of homework. That doesn't sound like a great solution to me, for Petunia or her DS, at least until the behavior issues are improving. YMMV, of course.

DeeDee