Hi, Elsie.
neurologist, who ordered an EEG (normal) and an audiology screening (significant figure-ground and attentional difficulties) and diagnosed ADHD. Given his WISC scores and anxiety, she said we should on no account consider medication
That is unusual. For elementary-age children, medication is a usual part of ADHD treatment. While it is true that stimulant ADHD meds can make anxiety worse, there are also non-stimulants, some of which may actually reduce anxiety (depends on the kid). More below.
; rather start Fast ForWord for the auditory issues, start lifestyle interventions (Omega-3s, protein, martial arts, etc.), get him happier in school and see her in November. All of that has been on target; we are seeing good results from Fast ForWord, from the lifestyle changes, and from increasing structure and reducing stress in our home.
Increasing structure can indeed reduce anxiety.
Can't comment on FastForWord-- an audiologist told us that there is no scientifically proven treatment for auditory processing issues, so I'm skeptical of all of them as a rule.
When that didn’t irritate her enough he apparently started licking things in her office.
I don't think I'd rely on the accuracy of those scores, given the way he was behaving during the testing. But I would also say she saw some really unusual behavior. Is that a typical response to stress for him?
That he absolutely needs private school intellectually, but “they wouldn’t keep him a week.” That he is showing severe ADHD symptoms, this is unquestionably the umbrella issue and we should immediately see a psychiatrist about medication. That he also has a severe fine-motor deficiency and we should immediately consult the OT to whom she refers. His low WISC score was coding (8) which does seem to fit; she sees no other signs of a processing speed issue and says the fine motor deficit explains it fully. To my eye his writing is slow, awkward, and at the low end of normal among his peers, though he has repeatedly said it doesn’t hurt when questioned.
It doesn't have to hurt for there to be a problem. In addition, not all writing problems can be explained through fine-motor deficits.
This week we saw her recommended OT -- who says he does not have a fine-motor deficiency at all, nor does he have ADHD, so we should certainly not medicate.
An OT is not qualified to make or rule out a diagnosis of ADHD. And certainly not to give advice about medication. This is a serious, unprofessional over-reach. Personally, I would not use an OT who overstepped in this way.
She feels he has a visual-motor integration issue plus sensory-seeking behavior, and after 4-6 months of twice-weekly sessions to make him more comfortable in his own skin, the ADHD-like symptoms will be mitigated and they will release him to the developmental optometrist they work with for likely vision therapy.
I am well aware that OT helps for some kids with behavioral issues, but IME this is best used as a second-, third-, or fourth-line defense, not as a starting point. The science behind it is weak and you've already seen the tendency of OTs to explain all issues they see as "sensory" in origin, whether or not this is true.
Meanwhile, after several attempts to refocus the therapist, and several diagnosis-of-the-week guesses from him (ADHD! defiance! social skills! victim of bullying! needs prizes from the dollar store as an incentive!), we are ending our sessions with him.
What kind of therapist is this? Garden-variety talk therapist? And yes, it sounds like this person does not have the expertise you need.
FWIW I am a huge fan of Cognitive-Behavior Therapy and Applied Behavior Analysis as well-targeted, proven means of changing anxious thinking and behavior.
At home, he is happy, loving, and cheerful as long as not pushed outside his comfort zone. We still see unexpected explosions once or twice a week, but we seem to be on a clear upward trend.
How restricted is the comfort zone? That is, to what extent are his anxieties limiting him or your family?
I ask because IME, catering to anxiety can produce a semblance of peace but not serious long-term gains. This post is getting long, but I can say more about this if you like.
While we are not opposed to medication, the gap between the professionals saying “on no account medicate” and “medicate immediately” is troubling; every expert seems to be sure their issue is the foundational one and must be addressed posthaste.
My DS (2E/Asperger's) was really severely anxious at that age; we decided to medicate him for anxiety and he was pretty much transformed. It's not an easy choice, but it's an option. We have found that attention and anxiety are sometimes related (if you can't pay attention, you're anxious because you don't know what's going on; but if you're anxious you miss things because you worry so much that can't pay attention). We ended up medicating for both issues and addressing behavior through ABA and CBT.
We see a developmental pediatrician whom I really trust to work through med options. I would not let the neuropsych make this recommendation; I want to talk to someone for whom prescribing or choosing not to is their major line of work, someone who's seen lots of kids like mine and who does the routine management of complex issues. And I did find one who doesn't automatically recommend meds, which helps me trust her judgment too.
You don't have to do ANYTHING if things are going well. Truly. You are the one who gets to decide if these problems are severe enough that remediating them would improve DS's or your quality of life.
If things are not going well, note what those things are, and choose the one that is most conspicuous first. Are there particular issues to solve at school or home? Things that you've gotten used to "structuring" things at home around to avoid a blow-up, that would be better worked through?
Since you're at a point where the over-arching diagnostic process is this messy, I'd look at the particulars and watch them over time. Keep a notebook. That data is going to tell you more than a professional who has seen him only once.
HTH.
