Gifted Issues Discussion homepage Forums Identification, Testing & Assessment ADHD and Gifted - To medicate or not?

My 6 year old son is in first grade. He is underachieving and disengaged from school. However, at home (and in class) he reads constantly and displays all of the GT traits. We had him assessed and his testing is very scattered. ON the DAS II he was gifted verbally at 134 but average on the other domains. On the WIAT III his scores were higher- 140 total reading, 140 reading comp, 144 basic reading, total math 136, etc.

His school testing is equally scattered on tests like the SRI, DRA, QRI, etc.

He has a diagnosis of ADHD - mild, inattentive type.

We have tried 2 meds - XR Adderall and Metadate. The adderall was ok - tolerated fine, mild improvement. The Metadate was awful.

Bottom line - he functions fine at school and in life without medication. But there is NO question he can focus better and perform better at school on medication. He was not on medication for the neuropsych testing cited above.

So, the question is - is it worth to put him on medication to improve the quality of his education? He wants to be on the medication but I am reluctant. I am confused. It feels wrong to medicate him to improve performance but on the other hand, he has the confirmed diagnosis, maybe he needs it to get more out of school?

Or conversely, does he need a better school environment (faster pace) to keep him engaged? Am I fooling myself to think a faster pace will "cure" his ADHD? We are looking at a school change that has a higher level curriculum.

Sorry for the long post. I am pretty lost

His cognition and achievement both look pretty good, with achievement consistent with his verbal ability. I'm going to mention a few thoughts:

1. Until the level of instruction is matched better with his ability, it will be difficult to tease out how much is ADHD and how much is boredom.

2. It is not unusual for children with NVLD to be mis- or co-diagnosed with ADHD. Many of them do not show substantial improvement on psychostimulants, because their apparent distractibility is based on inefficiencies in visual/nonverbal processing, not dopamine-associated inattentiveness. The relative weaknesses in mathematics that are often associated with NVLD would not be readily apparent at this age, when simple arithmetic fact knowledge will be more than adequate for earning a 136 in math on achievement testing. OTOH, he appears to feel better about himself on the medication, which suggests there are additional benefits beyond the attention and behavior improvements that are visible on the outside.

3. If he actually has ADHD, a faster instructional pace will not cure the ADHD, but a too-slow pace will definitely exacerbate its symptoms. Personal relevance, challenge, and opportunities for creative extension are even more important for students with ADHD than for NTs.

I don't have any idea what the answer for your ds is, but fwiw, I would put weight on your ds' observation that he thinks the medicine helps.

Re functioning fine without the meds - I'm not sure I understand why you say he functions fine at school without, but also say the meds improve his performance at school? Re functioning fine at home, does home include other situations where he needs to be on top of things, group activities like scouts etc? Or is home mostly truly home? I think that it's easy when we're at home with our families to make accommodations without even realizing it - which is ok! The difficult thing is the world isn't going to morph to suit our kids' specific needs... so if a child truly does function better with meds, I'd consider keeping him on then, even if he can function fine at home.

Best wishes,

polarbear

Thank you aeh! Very helpful input.

What does a NVLD look like in a 6 year old? Are visual tracking and convergence issues considered NVLDs?

We had him evaluated by a behavioral optometrist after the testing scatter (gifted verbal, average other domains) and he was diagnosed with convergence and tracking issues. We tried VT for 6 weeks but he was non compliant so we stopped.

Personal relevance, challenge and creative expression are important to him. He really only puts forth effort with meaningful material.

So, do we give VT another shot, go back to meds or wait to see if he is more engaged with the new school and faster paced curriculum?

Thanks Polar Bear. Good advice. I knew I came to the right place for guidance!

Well, by fine I mean he is not having major problems at school. He has good days and bad days. He doesn't seem to have many in the middle days. But he has good days and bad days on and off medication.

His teacher noticed an improvement on medication. He was able to do mundane first grade tasks.

And yes, I do take his input seriously. But before putting him back on meds I want to try a school change to see if that helps.

The tracking and convergence would definitely be something to consider for treatment. They are not exactly the same as NVLD, but it would be very reasonable to see overlap in the areas affected.

FWIW, if he really can function well without medication, I would postpone the medication as long as possible while you investigate other things. At age 6, his brain is still developing. I'd hesitate to medicate unless you are sure he needs it. Also, once he really goes on the medication, he likely will be on it for life. The likelihood of stopping medication after a childhood on it is very low.

What SAHM said.

Lots of the behaviors of ADHD are still quite appropriate in a 6 year old. In fact I thought for a diagnosis the behaviors were supposed to persist past a certain age which I thought was 7.

puffin, the American Pediatric group (can't remember their name lol!... but basically the professional association that represents pediatricians in America) came out with a recommendation within the last few years that children can be diagnosed earlier.

To the OP, I am actually pretty much an avoid-meds person myself.. but was struck by your ds' comment that the meds helped.

One thing I feel very confident in is that as a parent, it's really important to trust your gut instinct. Seek out and listen to all the advice you can get, but also trust what your own head is telling you, because you are the expert on your child.

polarbear