Trouble persisting at tasks: ADHD or ...?

Posted by: SLO

Trouble persisting at tasks: ADHD or ...? - 09/21/19 03:22 PM

Our very social and fun- and action-loving child has always had trouble maintaining focus during longer work sessions at school and during extended periods of directions/instruction before a task/project begins.

Here we are at the start of a new grade and both he and teachers have reported issues with focus this week. What he said to me on the way home yesterday was that he doesn’t understand the point of 10-minute explanations before a task. He thinks it should be 30 seconds and then go do the thing!

He tested as having a high processing speed (and it shows IRL); prefers movement and collaboration to sedentary, solitary pursuits (except loves reading). He has no learning issues, at least that show up in his academic achievement. I will say that sometimes he does the minimum.

When I asked the school at the end of last year if we needed to do anything to support him heading into a new year, where demands on EF will be higher, they had the school psychologist observe him for two hours on one day. He suggested ADHD, and recommended getting the ADHD rating scales administered.

I’ve contacted a few local psych offices including through the university, and no one seems keen to just administer ratings scales.

We’re struggling between thinking this is *just him,* a kid who likes things to be fun and prefers action), and thinking that maybe he does have a disorder that keeps him from being able to persist, and therefore we need to get him some professional support.

Anyone have a kid with a similar profile who has been diagnosed (or not)?

Thank you for reading!
Posted by: aeh

Re: Trouble persisting at tasks: ADHD or ...? - 09/21/19 07:00 PM

I hesitate to put this forward as a suggestion, as a solid diagnosis really requires quite a bit more than just a handful of rating scales, but if this is truly of value to you, I think the direction the contract psych at the school is indicating is actually to have his primary care physician originate the Vanderbilt ADHD Rating Scales. That should cost you no more than whatever your office visit co-pay is, and would put the rating scale information in the hands of the medical professional who would be principally responsible for managing ADHD, should that be relevant.

I'm more interested in whether there are IRL functional concerns, other than being a bit bouncy and impatient with lengthy directions, or if he feels any distress about his own attention and activity level, independent of impressions he may have picked up from adults. Having ADHD-ish qualities (even ones that meet many diagnostic criteria) does not necessarily equate to pathology. FWIW, we have one with many similar characteristics. As it happens, I have access to many of the rating scales used for ADHD, and ran through the items one day on my own child, for my own interest. Not at all to my surprise, the scales indicated a fairly high likelihood of ADHD. That has not, however, translated into functional impairments. Having small classes (when in school), with at least moderate academic challenge, and teachers willing to view the profile as charming and fun, rather than disruptive and distractible, have all been significant factors in outcomes for this child, while we worked together to develop EF skills and compensatory strategies. (Which, of course, we all need to work on, to varying extents, with our children.)

In the case of your child, I would probably start from examining the appropriateness of his level of instructional challenge (paradoxically perhaps too low, if he feels he can put the bare minimum of effort into tasks), and possibly have the 3rd grade team (who didn't view him as disordered) pass some insight into effective teaching strategies for him on up to the 4th grade team.

Bottom line: if it ain't broke, don't fix it.
Posted by: Platypus101

Re: Trouble persisting at tasks: ADHD or ...? - 09/22/19 03:44 AM

It's hard to add a lot to aeh's excellent advice, but I would just emphasize two questions. How situational is this problem? And, does your son himself feel like he's experiencing a problem?

It really comes down to whether he's having trouble responding appropriately to situations, or whether he's responding perfectly appropriately to inappropriate situations. Is he missing any instructions he actually needs, or just impatient with unnecessary repetition? Does he experience these problems when appropriately challenged, or only when dealing with teaching that doesn't meet his needs? If he is allowed to move during instructions, does that solve the problem? (Sometimes that's all a kid needs, but unfortunately, some teachers see that movement - which actually helps the child think and focus - as tuning out and disrespectful).

My BTDT advice is it's time to go for an ADHD assessment when the child himself is frustrated or upset with their own behaviour. When they want to make choices or do things, and they feel like they can't control their own mind and body to make those choices.

If the child is happy and functioning well in other environments that meet their needs, and only having trouble with this one particular classroom, then I'd look to fixing the environment, not the child. On the other hand, if they are having trouble accessing environments and activities they want to access, then consider looking to what also can be done to help the child respond differently.
Posted by: indigo

Re: Trouble persisting at tasks: ADHD or ...? - 09/22/19 09:55 AM

You've received EXCELLENT advice above.

I just want to emphasize this point as I believe it is often overlooked:
Originally Posted By: Platypus101
... having trouble responding appropriately to situations, or... responding perfectly appropriately to inappropriate situations.
Posted by: aeh

Re: Trouble persisting at tasks: ADHD or ...? - 09/23/19 08:01 AM

I'll add one clarification to my own comment: if you should choose to have rating scales completed, make sure they are completed by both last year's team and this year's team, for two reasons: in order to have some reasonable confidence of validity, the rater needs to have had daily, substantive contact with the child for a minimum of a month, preferably two or more. I typically go back to the previous year's teaching team for ratings completed during the first two months of school. (But I also work in a secondary school, with fewer minutes of teacher contact daily.) And in your case, you would probably want representatives of both sets of teachers because their perceptions are so contrasting.
Posted by: SLO

Re: Trouble persisting at tasks: ADHD or ...? - 09/24/19 02:16 PM

As Indigo said, this is EXCELLENT advice. I'm deeply grateful for you taking the time to consider and respond with BTDT experiences. My son is not at all frustrated or upset by his behavior. Happy kid. In fact, he's proud of some of the parts of himself that are found on ADHD checklists. Interesting note about the rating scales being administered by his doctor. The psychologist didn't say this, but explains the response I've been getting from the clinics I've reached out to. If we decide to have them administered, I'll request through his doctor. Thank you, thank you!
Posted by: MumOfThree

Re: Trouble persisting at tasks: ADHD or ...? - 09/25/19 05:22 PM

I have just recently attended a lecture on ADHD which suggested that ratings scalesa re actually much more reliable in identifying ADHD than psychometric testing. So that does seem like useful path to go down with your dr, as recommended above.

The other point made in this lecture is that the person with ADHD will often not consider (some of) their impairments to be a problem, their only problem is that YOU think it's a problem... And I certainly see this with my child who has ADHD. She has researched ADHD herself and feels that the shoe fits (wholeheartedly). There are things that go wrong for her that DO bother her; However, there are many functional areas of impairment where she just DOES NOT CARE, and THAT is part of her impairment....

For example, she's not motivated to do a particular homework task, and she doesn't care if she fails it, because she thinks it's a stupid task anyway with no meaning or learning opportunity. She has no long term perspective on the impact failure to comply with stupid tasks will have on her school or life success. Her only problem with this situation is that I think it's a problem. Sometimes I might agree with her that the task is fairly pointless, but I don't agree with her that there is no problem with her not doing the task anyway. When we have conflict over an issue like this, in my mind the issue is her inability to focus on a boring/meaningless task and in her mind the issue is my unnecessarily making it into a problem. So I would be cautious about only evaluating for ADHD when the child in question decides they have a problem or is bothered by their impairments.
Posted by: aeh

Re: Trouble persisting at tasks: ADHD or ...? - 09/25/19 05:57 PM

Agreed: functional impairments OR personal distress. It's only a disability/disorder if it impairs major life functions.
Posted by: Emigee

Re: Trouble persisting at tasks: ADHD or ...? - 09/26/19 01:38 PM

Originally Posted By: aeh
I hesitate to put this forward as a suggestion, as a solid diagnosis really requires quite a bit more than just a handful of rating scales,

Aeh, would you mind commenting on what else a solid ADHD diagnosis requires? I was going to start another thread to ask this exact question, but it seems relevant here too.
Posted by: aeh

Re: Trouble persisting at tasks: ADHD or ...? - 09/26/19 05:04 PM

I do like rating scales, as they have the most relevance to how a child actually functions in the settings in which they spend their time, but they also don't tell you much about why they present the way they do. (Many different factors can disrupt attention and executive function, including transient, acute and chronic causes.) For example, a depressed child can look quite similar to a child with ADHD on a rating scale, depending on the scale, the rater, and the exact presentation of the child, but treatment should be quite different.

Similarly, there is value in the direct measures of some of the core deficits or profiles generally considered to exist in ADHD (most of the EF areas: impulse control/inhibition, sustained attention, regulation of attention, switching, etc.), but having a profile associated with a high likelihood of ADHD doesn't necessarily translate into functional impairments. So if possible, I prefer evaluations that include both direct and indirect measures of attention, impulsivity, and other executive functions.