Well, the appointment went well. The plan at this point is to definitely pursue counseling as well as a med change. DS7 took 27mg of Concerta this morning, and while he's not hyper, he's definitely not focused. She commented that in the absence of anxiety, she'd certainly recommend an increase in his Concerta dose to 36mg.
However, she feels that anxiety is a definite, and she spent a lot of time with me and with my son. She also had the teacher, my son, and me fill out questionnaires to help narrow down anxiety triggers and to rule out other diagnoses, such as OCD, OCPD, Social Anxiety, etc. She feels confident in a diagnosis of generalized anxiety. I asked about OEs, and she's of the philosophy that it doesn't matter what you call it. It's still anxiety. She also differentiated between intensities and anxiety and stated that he had both. She said some kids are intense, but it doesn't necessarily cause them anxiety that interferes with function. We also talked about the fact that anxiety and perfectionism are very common with gifted children and can be exacerbated by the ADHD. She recommended some good books as well.
She said we can try the 36mg Concerta for a few days or a week to see if that helps or makes things worse. If this doesn't work, she wants us to try the lower dose of Concerta with Straterra. Of course, he'll be getting counseling as well. She said we can just start with the Straterra and the lower dose Concerta if we are not comfortable with increasing the Concerta. Personally, I'd like to try to increase the Concerta first (small changes before big changes are more comfortable for me!) and then try the Straterra if that doesn't work. I'm not overly optimistic about this, but it's worth a try. At least with stimulants, you know right away whether or not they're going to work and whether or not they're going to cause major side effects.
The doctor thinks that counseling and anxiety management strategies will work well for ds b/c he is bright. She thinks he'll be able to learn the techniques and put them to use. If not, she did say an SSRI could be a next step. However, she also said that studies show that SSRIs are only effective for about 50% of people who take them for anxiety. She believes the success rate is actually even lower than that due to placebo effect. So, we're open to the idea if it's needed, but for now we're going to take baby steps. If we jump to the SSRI, we won't know if it's the medication or the counseling that's helping.
She's not prescribing Straterra for the anxiety. It's to enhance the stimulant if ds is unable to tolerate a higher dose of the stimulant.
So, basically the anxiety treatment will consist of counseling and implementing anxiety management strategies at home and at school.
The doctor loves Montessori education, but she did caution us to be aware of their level of flexibility with skipping steps in the Montessori process. She said even if they allow him to work at an increased rate but still go through every step, this probably will not satisfy him because of his resistance to do things he already knows. Of course, as we know, she said this is typical with gifted students.
She did say, though, that because we live in a less-than-ideal world, it might not be a bad lesson for ds to learn that at times he will be required to go through mundane steps to accomplish a task. Her measuring stick with regards to how much of this he can tolerate is to see whether or not he wants to go to school. If he's happy, likes school, and continues to want to be there, then that's a good sign. If he begins not liking school and not wanting to be there, that's a red flag, and we might want to consider other school options. I will be talking to the teacher, counselor, and administrator (headmistress) about acceleration, however.
Now, speaking of acceleration and neuropsych testing, what would you guys recommend? We are open to a complete battery of tests if that's what it takes to get ds the education he needs. Public school is not an option here unless we can move. And, in this market, that's not happening anytime soon.
I'd like to do more gifted testing as well. It's been a couple of years since his last testing, and he was not on medication at that time. Also, I'd love to know if there are any LDs going on. I really don't think so, but I know sometimes with bright kids, it's not immediately evident.
What do you think about achievement testing to help with grade-level/academic-level placement? Any suggestions? I feel like the teacher is probably thinking it doesn't make sense to increase the challenge if he can't do the easy work. I know that logic makes sense with many children, but not with my ds and not for most gifted children. I don't know how they will be able to know what level he is in any given subject. Is there some kind of test?
For example, he can add and subtract, of course, but he's not super fast with it, so he hasn't been allowed to move on to multiplication or division. When I was homeschooling, he was able to do multiplication and long division. "After-schooling" is a nightmare b/c by the time he gets home in the afternoon, he's very resistant to anything academic. Plus, we're paying out the nose for this school; my son needs to be learning something. This was something I had a hard time with when homeschooling. I didn't know how to move in any kind of logical order, especially with math, because he's capable of so much but limited by his interest level. Does that make sense? Ok, I'm rambling. Long day...
Thanks guys for all the support and advice. It's been a huge help.
