Gifted Issues Discussion homepage Forums Twice Exceptional Cart before horse??

We were very disappointed today to meet with our new local, not gifted-specialist but otherwise seemingly good psychologist, only to have her ask whether we would consider trying medication for our DD9, who is having various social issues in school. What disappointed me most is that I discussed with this psychologist at our intake meeting that we aren't sure whether DD is gifted + ASD (I think most likely), or gifted + ADHD, or gifted +ASD +ADHD, or also +ODD (don't think so), and how we had gotten what we thought were incorrect suggestions in the past, and had even given her several printouts of summaries of the James Webb (-type) discussions of these issues (I think even from the Davidson's site, thanks Davidson!). So the question, aside from anything else is, is it proper to suggest trying (ADHD) medication and seeing what happens, as opposed to trying to figure out what the 'diagnoses' actually are and then trying to treat them accordingly? I just think that probably any kid (even a 'normal' one) would become more pliable on ADHD medication and that the teacher would be likely to report 'improvement' (i.e., kid's not causing as many problems now) regardless of what disorders they did or didn't have. We aren't going to do it at least for now because I don't think that DD's ADHD-ish-ness comes from ADHD--at least not until somebody who is in a position to know evaluates and explains it, which we are working on. But very disappointed to keep running into this kind of thing locally, especially after we've made efforts to raise awareness and to discuss it. (ETA--just wanted to add, we're not necessarily opposed to medication in the right circumstances, just that DD fits with the James Webb-type differential description of gifted as opposed to ADHD, so what's up with psychologists not listening to us???>>>!?)

She is your kid. You have no obligation to put her on medication until you are convinced it is the solution. If you believe there are other options that should be explored, don't let them pressure you.

I know there is a culture of try it, see if it helps, but it has been shown to also "help" the general population, so that one doesn't fly for me. ALL medications have side effects and risks, so the throw stuff at the wall and see what sticks has never been something I've been willing to entertain when it comes to medications.

I'm not saying she might not need it. I'm saying you should be convinced it is the right choice - not doing it under these conditions.

Just my opinion. YMMV

I might be facing this same issue at some point once DS4 enters school. For now our view is NO meds unless he becomes violent or dangerous ... and we would consider meds if he became unhappy with himself and miserable ... medicating as the easy way out (for doctors, teachers, etc) is not our way of doing things.

That said, I was very anti meds yet had to give up on it when DS4 started having serious sleep issues ... as in going on 2-3 hours of sleep per day (or night). He's now on a serious dose of Melatonin and sometimes Hydroxyzine (strong antihistamine) to get him through the night. So, all my good intentions of non-medicating have already gone out the window.

We went in to see a Psychiatrist in August officially seeking to confirm or rule out ADHD but also with suspected Asperger's or other form of Autism. The Psych for now ruled out the ADHD and is going with PDD-NOS but we will be doing further testing regarding where on the Autism spectrum DS really is. In line with the current diagnosis, I wouldn't want to medicate for something that may be presenting as ADHD but very likely is NOT.

Dbat, both of my older two daughters have been trialled on ADHD medication. One is HG+ and we thought had innattentive ADHD but did not feel had any other LDs, and did not suspect ASD in any of it's forms. Medication works in the classic "magic switch" manner for her, there are multiple easily measurably differences in her. She's MORE herself, not less, more creative, engaged, more everything. She wants to take her medication, wants to take it every day and for it to last all day. It's not 100% side effect free but it's very clear, for now, that medication is worthwhile for her.

My older daughter, who is somewhere between bright and MG (variable IQ test response), and clearly has multiple LDs and some combination of ADHD/ASD did not have nearly such a clear response and after a decent trial we stopped medication as there seemed no point in giving a fairly serious medication for no definitive gain, from our perspective or hers. It is possible she had some mild improvements of the sort you are worried would show up in any child, but it was a completely different ball game to her sister.

I tend to agree with you that the medication trial should come after a clear diagnosis of what is wrong. But I have to say that my eldest daughter is an onion that no-one has found easy to peel. She's got a little bit of everything going on, when I say little I mean "almost diagnosable, or just barely diagnosable levels", but is not absolutely clearly any one thing. So despite having seen what seems like every possible person we could trott her out to see she did in fact trial medication before we came to any final conclusions (we still aren't there although Aspergers is now looking likely).

What problems are you seeing, both at school and in other contexts, and what is the severity of these problems? That is, to what extent do these problems interfere with your DD's life, and, if the problems meet the severity threshold, are they also the problems that these meds are designed to treat? That, to me, is the question that determines whether meds would be appropriate or not.

Our DS (2E, autism) improved his behavior significantly with the help of both a med for anxiety and one for attention. This was not something we leapt into, but something that we gradually became desperate enough to try. The biggest win was in DS's self-esteem; with the decrease in negative behaviors he felt much more able to manage himself, and he stopped feeling so awful about his own behavior. He was also much more able to access the other kinds of therapeutic teaching we were doing with the help of the meds, so they started a virtuous cycle for him.

One has to be careful in medicating kids who are on the autism spectrum with stimulant-type ADHD meds because they can sometimes increase anxiety, and therefore can also increase the negative behaviors that are associated with anxiety. We use an expert prescriber (not our regular pediatrician) who really knows both our kid and the med options. We started DS on Strattera, which is non-stimulant; now, at age 10, he can handle the stimulant med and it is more effective in helping him manage himself.

ADHD meds don't necessarily make a child more pliable; they increase focus and decrease impulsivity. I wouldn't be that worried about a "false positive" from these meds; if they help, they help.

Hope that helps.
DeeDee

Mine too, and mine's based on having been a researcher on the pharmacology and drug-mechanism side of things with SSRI's, several stimulant classes including tropanes and analogs thereof in the midbrain. Those drugs are nowhere NEAR as 'harmless' to try as many clinicians believe.

Dbat, I think there is an ethical issue of offering a drug in lieu of diagnostics. No more appropriate than a doctor giving out antibiotics to everyone with a runny nose.

But there clearly is such a thing as a false positive from ADHD meds, at least in terms of academic achievement.

I'm quite haunted by this article:

http://www.nytimes.com/2012/10/09/h...s-to-help-in-school.html?pagewanted=1&hp

Is the psychologist NOT suggesting pursuing further diagnostic work about ASD? I know you had been skeptical about diagnosing for a variety of reasons. To me, your best path would still be to seek a diagnostic rule-in / rule-out from someone who specializes in ASDs and has seen a lot of girls in their practice.

DeeDee

Woah, woah, woah. Are you sure you saw a PSYCHOLOGIST? Because psychologists do NOT dispense medication, nor should they be recommending it. If anything, they should refer you on to a psychiatrist or other medical doctor who CAN prescribe meds. A psychologist should be diagnosing and possibly doing therapy of some sort.

Personally, I would RUN from a psychologist who attempted to suggest meds for a child without a diagnosis.