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    #246311 - 11/14/19 12:41 PM Functional difficulties caused by ADHD?
    readermom123 Offline
    Member

    Registered: 09/22/14
    Posts: 71
    Hi all,

    My son is 8 and in 3rd grade at a highly-rated public school. He's participating in their pull-out GT program and also leaves class twice a week for speech therapy (articulation difficulties, although he's about to graduate from speech). We've only done gifted testing through the school district - in first grade he qualified with Cogat scores (Verbal 153, Quantitative 139, and Nonverbal 121) and an Iowa test (98th percentile for reading, 95th Language, and 99th Math) as well as some sort of Creative Product and Parent/Teacher survey.

    During our parent-teacher conference for the beginning of the year I learned that the teachers feel he has a lot trouble with focus. He needs lots of reminders to listen to instructions, stay in his seat, finish work, not talk to his neighbors etc etc. Talking to other students is probably the most common (and has been an issue every year, to be honest). He's a very sweet boy and they feel he is doing his best so the teachers have so far been pretty lenient with consequences (I have to admit I'm not sure this is the right approach...). They both said he's very intelligent and so far his grades are fine (A's and B's although realistically he 'should' be getting all A's). He has lots of buddies and doesn't seem to be having any major social difficulties. In fact, he's been paired up with another gifted boy in his class that is the 'difficult one' (angry outbursts, breaking things, etc) and my son does a great job of helping him stay calm, doesn't react, etc etc. He's not particularly athletic but loves to be outside and play pretend games, climb trees, etc. He also loves video games and reading. He's a bit 'immature' in some ways, although it's hard for me to express it exactly. He tends to enjoy playing with younger kids, doesn't like more mature movies, etc. On the other hand, he has a great sense of humor and can be quite wily socially in certain ways - he's never mean or defiant but is still good at pushing certain boundaries in very subtle ways.

    Based on the parent-teacher meeting, I've already started talking to him a bit about some of the major issues. I decided to start by asking him to work on sitting and listening to instructions quietly and respectfully. We've talked about fidgets that are socially acceptable and won't distract his friends or teachers (twiddling thumbs, tapping fingers against each other, etc). I've also started to be a bit more structured at home since we'd lost track of that over the summer.

    However, I'm trying to figure out what other steps we need to take if he's having trouble with focus. I'm trying to figure out what needs to be done to find out if ADD/ADHD is in play vs. immaturity vs. discipline issues vs. a bad classroom fit. Here's a couple of questions I have.

    1. How do you determine that your child is having enough of a functional problem to pursue testing? What do functional difficulties look like?

    2. What sort of testing is most important? Is it necessary or recommended to get detailed IQ tests done when dealing with a gifted kid?

    3. Any practical suggestions to help my son learn to focus before we aim for testing/medication/etc?

    Thanks for any input you might have.

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    #246316 - 11/16/19 06:55 PM Re: Functional difficulties caused by ADHD? [Re: readermom123]
    puffin Offline
    Member

    Registered: 12/11/12
    Posts: 2026
    I read somewhere the other day that if your child is having problems at school it is usually the school that is the issue not the child.

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    #246322 - 11/18/19 06:43 AM Re: Functional difficulties caused by ADHD? [Re: Portia]
    readermom123 Offline
    Member

    Registered: 09/22/14
    Posts: 71
    Portia, I'm sure this is part of it. It's a great school and a pretty challenging school district overall, but I'm fairly certain the rate at which they introduce new material isn't 'perfect' for my particular kid. It's a hard thing to bring up with teachers though. During the PT conference I ask if he could be a little bored with the material and they both dismissed the possibility. And maybe they're right, who knows...

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    #246323 - 11/18/19 06:46 AM Re: Functional difficulties caused by ADHD? [Re: puffin]
    readermom123 Offline
    Member

    Registered: 09/22/14
    Posts: 71
    Puffin, yeah, school is tricky. With 20 (or more!) kids in a class I'm sure it's never perfect for anyone.

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    #246342 - 11/21/19 08:54 AM Re: Functional difficulties caused by ADHD? [Re: readermom123]
    readermom123 Offline
    Member

    Registered: 09/22/14
    Posts: 71
    I'm feeling a bit frustrated with this situation up at the school. I ask my son how things are going and he says he just got 'a warning'. Then if I ask the teachers they say no he got a warning because he was up and running around the room. However, since he sits down the first time they remind him, they're not really giving him any discipline or reprimands other than the initial correction. I feel like they want me to take him in for testing and get him put on medication but they aren't really giving me any detailed feedback about his behavior or trying any serious discipline strategies. I'm not even sure I could give a medical professional an accurate description of his problems at school since I've gotten so little feedback. And I feel like by putting my son on the spot each day I'm just letting him practice lying and stretching the truth (already a bit of an issue this year, we've had lots of 'I forgot' or 'I didn't realize' about things). Maybe I should just quit worrying about it until they give me some more solid feedback? Blergh.

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    #246347 - 11/22/19 06:34 AM Re: Functional difficulties caused by ADHD? [Re: readermom123]
    Old Dad Offline
    Member

    Registered: 07/30/12
    Posts: 423
    While it certainly won't hurt anything to have your son assessed for ADHD, I would ensure that if you do the person doing the assessment is well versed in GT issues. GT kids are often misdiagnosed otherwise as ADHD when the issue is being bored.

    I think it's also important to note, he's an 8 year old boy, that's the nature of young energetic boys for heaven's sake. As you've mentioned, he respects authority when he's instructed, he's doing good work, this isn't an issue that is degrading much of anything it appears. A lot of teachers aren't very good at taking enthusiastic energy and directing it in a positive manner. Discussing ways to do that would seem a good start, it appears you've already started that. Now the same needs to be discussed with his teacher. See the link below for a start.

    http://teachtrainlove.com/20-teaching-tips-high-energy-students/

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    #246462 - 12/12/19 06:39 PM Re: Functional difficulties caused by ADHD? [Re: readermom123]
    readermom123 Offline
    Member

    Registered: 09/22/14
    Posts: 71
    Just a quick update. In the past hearing problems have been an issue and I think that's cropping up again. He'll be getting new ear tubes over the Christmas break (as well as another surgical procedure that he's kind of nervous about) and I'm hoping that will help.

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    #246477 - 12/14/19 06:03 AM Re: Functional difficulties caused by ADHD? [Re: readermom123]
    Platypus101 Offline
    Member

    Registered: 10/01/14
    Posts: 664
    Loc: Canada
    readermom, I'm just noticing that while there is some great advice above, we kinda went around your original questions. So looping back, here's some thoughts from a house full of ADHD (albeit the inattentive kind).

    Originally Posted By: readermom123
    However, I'm trying to figure out what other steps we need to take if he's having trouble with focus. I'm trying to figure out what needs to be done to find out if ADD/ADHD is in play vs. immaturity vs. discipline issues vs. a bad classroom fit. Here's a couple of questions I have.

    1. How do you determine that your child is having enough of a functional problem to pursue testing? What do functional difficulties look like?


    With most issues, I've found you usually know you have a problem when the child starts showing signs of misery or anxiety - and those signs include avoidance and lying, both super common ADHD (mal)coping mechanisms. If the child is unhappy or having negative impact on family/ friends/ class, then there is a problem that needs investigating. I have especially seen children who can't control their own impulsive behaviour even when they try and really want to, and they find it a huge relief to get help being the person they want to be.

    If your child is just happily bouncing around being super energetic but distracting others, and not actually harming themselves or anyone else in any way, then the problem is probably more about channeling that energy, burning more of it, and finding acceptable ways for them to keep moving enough at school. Is the child's behaviour really problematic, or is he an energetic 8 year old boy with a teacher who expects developmentally-inappropriate levels of compliance?

    Next question is do you see these problems happening in only one, or one kind, or environment? Where does the child thrive, and what's different there? As many note below, a bad environment match can cause similar issues as ADHD, as a busy mind desperately seeks ways to stay busy. If the class is not meeting his needs, he should not be disciplined for behaviour that is caused by that mismatch. However, I've found that there is nothing that sets off the ADHD like a bad classroom match. Except - the huge exception - work that is too easy but also makes big demands on an LD or other learning issue. So if he's having trouble hearing and following what's going on in class even when he really tries, AND he's trying to put in all that effort for work that is inappropriate and doesn't meet his needs - well, in my kids that combo creates a perfect ADHD storm.

    The TL/DR version: it may be bad match of classroom environment, or ADHD, or both feeding each other.

    Originally Posted By: readermom123
    2. What sort of testing is most important? Is it necessary or recommended to get detailed IQ tests done when dealing with a gifted kid?


    Full IQ testing isn't required for it's own sake, although it would be part of any full-scale psycho-educational assessment. While any doc can diagnose ADHD, with a kid who has more complex learning needs, getting a bigger picture and putting their weaknesses and strengths into better context can be really helpful. An awful lot of things can look like ADHD. And ADHD can mask/ distract from lots of other things, too. If you are able to access full testing, it's certainly worth considering.

    With respect to the IQ testing itself, you already have some basic info from the Cogat, so the big question would be whether that info feels reasonable accurate and complete to you. The Cogat is less reliable for kids with learning issues (and more highly gifted). If the Cogat results match your reality, good. But if they don't quite make sense when you look at the kid in front of you, it's helpful to use a higher-quality instrument.

    Originally Posted By: readermom123
    3. Any practical suggestions to help my son learn to focus before we aim for testing/medication/etc?


    The most important thing I've learned about ADHD is that it is not actually an inability to pay attention. Rather, it's an inability to control where your attention goes. The brain loves the new shiny object, but lacks the normal over-ride mechanisms that enable most people to deal with the drudgery. One of the best descriptions I've found posits that it is fundamentally a deficit in extrinsic motivation. ADHD brains respond to that which is intrinsically motivating. Which is crazy-making for people around them, because it looks. so. volitional. You can pay attention to the stuff you like, so clearly you are choosing not to pay attention to this other stuff. Except they aren't choosing: they genuinely can't.

    Which leads to two points. First, figuring out "can't" vs "won't" is really, really hard as a parent. I still struggle with this every day. But if it's a genuine "can't", then seeing it as a discipline issue just makes it worse, in every possible way. So I try to approach every problem hunting for the potential "can't", or the "missing skill" in Ross Greene-speak. What are we asking this kid to do that's triggering this behaviour? Can we change the ask? Can we teach/ scaffold/ work around this missing skill so the child can do this task?

    Which doesn't mean there are never discipline issues. Avoidance and lying are problems that need to be addressed - but understanding how and why they are the ADHD go-to helps me figure out how to address the upstream causes of the behaviours, and not just deal with them as something to be punished, after-the-fact, and in isolation.

    So taking this back to teachers, I have been told over and again that life sucks, kids near to learn to deal with the boring stuff, and life can't just be new shiny objects. OK, granted - but can we talk just a little about my child's ratio of new shiny objects to drudgery? Because if school is almost entirely the latter, we have a school environment problem, not a behaviour problem.

    Bottom line: First, look at how the school environment is or is not meeting your kid's needs, and if there is a severe mismatch, see what can be changed. What's different in environments where he thrives, and how can more of that be incorporated into his everyday reality?

    Keep both brain and body as busy as possible. Some teachers realize that some kids need to move to think, and encourage it. Others see it as inherently disrespectful and punish it. Find the former if you can. Work wth the teacher to identify the times/ tasks most likely to set him off, and try to come up with ways to keep him busier at these times - with meaningful tasks, not busywork. Find the stuff that is intrinsically motivating for him, and get as much of it into him as possible. Also note that ADHD brains don't tend to do time well. Make sure he gets immediate and meaningful rewards - hard math! a good book! whatever drives him - for doing the right thing.

    And always start with appropriate work first. Appropriate work leads to better behaviour. But most teachers go the other way - they try to use appropriate work as a reward for compliance with inappropriate work. I've found the big difference between gifted kids without vs with ADHD/ LDs, is the former can whip through the boring stuff and get their good stuff reward. Mine never, ever got to the good stuff. They genuinely could not complete the inappropriate work. I myself was the former too, and this has been hard for me to understand. It will take 2 minutes, just GET IT DONE AND MOVE ON! Nopity nope nope. Did I mention crazy making?

    Meds can help kids become capable of exerting more control over their own attention and choices. However, meds don't magically create skills where those don't exist (like executive function, or flexibility, or social awareness); they don't fix LDs; and they definitely don't fix a poor educational match. So in my experience, it's important to do everything you can to fix those other three things first, and keep at them on an ongoing basis. And then, if the child is still struggling, meds in addition to the coaching is considered the optimal therapy.

    oy - thought I could be quick here, and as always I've gone on and on (and on). Hope this helps!

    Two great resources:

    ADDitude magazine:

    https://www.additudemag.com

    Lives in the Balance (Ross Greene):

    https://www.livesinthebalance.org

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    #246556 - 01/06/20 08:16 AM Re: Functional difficulties caused by ADHD? [Re: readermom123]
    readermom123 Offline
    Member

    Registered: 09/22/14
    Posts: 71
    Hi Platypus,

    Thank you so so much for your long reply! I'm sorry for the delayed response, we got busy with holiday preparations and then my son had a bone graft surgery right after Christmas that kind of kicked all our butts. I think his school experience is going to be much better next semester just because he has that done and out of the way. Plus we got a new ear tube placed so he should have good hearing in both ears.

    Your response was so incredibly helpful and has given me a lot of good things to think about. It is incredibly hard to tease apart 'can't' and 'won't' with my kiddo - he's quite socially savvy. He has been a bit more talkative about school lately though and I've been getting more good information. One thing he said is that I think they're requiring kids to write for longer periods of time this year compared to last and my son is finding it difficult (handwriting has been a consistent issue, not idea generation).

    Luckily, we seem to have gotten some of lying and excuse-making tamped down when he realized that I could check in with the teacher and confirm his story and that he wouldn't get to play on the playground after school if he deliberately left things out. I will start trying to think through good rewards and what parts of school he finds the most rewarding though (mostly getting to read from what I can tell).

    I think it's good for him, but he seems to mostly be in the 'happily bopping along' category. I'm the one introducing angst because the constant reminders are bugging his teachers! I got a few ADHD books to look through and I'm going to start thinking about our executive functioning skills and how to build a few scaffolds for him.

    Thank you so so much again. I really very much appreciate all your input.

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