Gifted Issues Discussion homepage Forums Twice Exceptional Thoughts on ADHD medication

Short background, DS8 was grade skipped last year and started 3rd grade this year at a HG school in a neighboring school district. About 3 weeks into the year, we got an email from his teacher with behavior concerns some of which he had in the past but we chalked up to poor placement and lack of mental stimulation at school. The first several weeks at the new school they were doing assessments that were extremely writing focused. He cannot sit at a desk and write for long periods. After we got the email about his behavior, I started giving him Omega 3s, I started using the Nurtured Heart Approach and we started a daily behavior chart that focuses on eliminating the problem behaviors but also includes one thing about his day that we could celebrate at home that night. We also decided to go ahead and have further neuropsychological assessments and he did get an ADHD diagnosis - the neuropsych believes that the physical act of writing is extremely tedious for him (did I mention that his VCI is 42 points higher than his PSI).

This week was his parent teacher conference. He is working well above grade level in all subjects � even writing. His behavior is markedly improved - he even got an A in citizenship. He has gotten a week of all greats on his daily behavior sheet. We talked with the teacher about how difficult the transition was for him and now how he seems more comfortable at school. It was nice because the teacher seems to see him as the kid he is (creative, funny, curious, exuberant) not as the frustrated, overwhelmed boy he was less than a few months ago. We also talked about keyboarding and she said that when he is proficient at keyboarding, she always has one laptop in the room, so that will not be a problem with him using it if that helps him. We have been working on keyboarding at home.

I have also been working diligently on EF skills with him at home. I have provided some stronger organizational structure and set up systems that help him succeed in accomplishing things like initiating homework, cleaning his room, getting ready in the morning, packing his backpack, etc. I am striving to acknowledge all the good behavior I see (which actually is a lot). He is getting more mature and the impulse control issues while still there are diminishing as he gets older. In short, I have been trying very hard to help him ramp up his compensation strategies.

Nevertheless, I still see issues that I can�t help but think that medication could possibly help him with. Like I said, the impulse control still needs work. His written work, while good, is sometimes poorly organized and visually inconsistent and his ability to initiate tasks or focus on difficult or boring tasks will need work for some time. I feel medication will make it easier to work on behavior therapy for impulse control and EF skills and we can address those skills more successfully with meds.

Alternatively, I think we have some good strategies in place now and that we may be able to make some more headway (therapy, accommodations at school, work on EF at home/school, etc.) and delay medication for a few years until having stronger EF skills becomes more crucial and see how he is doing at that point.

I would be interested in any thoughts, especially from those who have grappled with this and decided one way or another and how that worked out.

Our son received an official diagnosis of ADHD just this last month. We knew he was ADHD from the time he was a toddler, but didn't want to medicate, so we managed it as best we could. This year was the tipping point and we could no longer manage it with diet and positive reinforcement at home.

We are pursuing meds for our son, but that is only because he reached a point where his behavior was impacting every area of his life, not just school. That said, the one nice thing about ADHD meds is that you do not need to take them for weeks/months to see if they have an impact, nor do you have to wean the kids off of them. If a med isn't working you simply stop taking it. I would discuss this with the psychologist.

My son's been on concerta now for about 5 days and he hasn't had a 'tantrum' in class since he started it. He still struggles, but now he's able to control himself.

Good luck!


ETA: If you want to try something before meds, I'd recommend altering his diet. Basically, nothing pre-packaged, nothing with dye and strictly limit sugar (including 'natural' sugars.) We do rice krisipies or cheerios for breakfast (or eggs if there is time), ham and cheese sandwhich with chips and sugar-free pudding for lunch, and then a homemade dinner.

Did the neuropsych do any further testing to determine why the large discrepancy in VCI vs PSI? Just to be clear, I'm guessing PSI = Processing Speed Index here? The reason I ask is that my ds has a similar magnitude discrepancy and has a diagnosis of Developmental Coordination DIsorder, with one of the primary impacts of his DCD being a neurologic fine motor disability impacting his ability to use handwriting. He was first diagnosed at age 8, when he was referred for neurospych testing because his classroom teacher was convinced he had ADHD. His neuropsych testing also included a diagnosis of mild inattentive ADHD, but as he matured and as we worked through getting accommodations for handwriting and organization at school it eventually became clear that he really didn't have ADHD - the symptoms that we were attributing to ADHD were actually related to DCD and also to giftedness. It helped me to read through the book that is titled something like "Misdiagnosis and Dual Diagnosis of Highly Gifted Children" (sorry I can't remember the exact title - but there is a list in this book describing characteristics due to ADHD vs characteristics observed in kids with high IQ). We also went through an ADHD eval with our pediatrician to follow up on the neurospcyh eval and ds didn't meet the criteria set by the ped's office for a medical diagnosis of ADHD.

Anyway, this might not apply to your dd, but much of what you describe in terms of writing and organizational challenges are very similar to challenges my ds has. If your ds has ADHD, then meds are probably worth a try - I'd just fwiw want a little more info first re why the PSI index is so signficantly lower than the VIQ.

I'd also add one note about proficiency at keyboarding - did you ask the teacher to define "when he is proficient" - does she have a specific target goal? In our school district, for children who are neurotypical, "proficient" at keyboarding after a certain grade level/age is defined as "can type faster than they can write"... so fwiw, your ds might already be proficient.

Best wishes,

polarbear

My daughter is in college and is just now being diagnosed with ADD. She has started on Ritalin and is seeing real benefits to the problems she's been dealing with in college due to the ADD.

In the lower grades, she played a musical instrument, competed very seriously in a sport - and I think the exhaustion she "attained" from sports and music helped her not have issues that needed addressed until now.

On the other hand, my youngest is twice exceptional, and the psychologist who tested him ruled out ADD and ADHD. I have had to argue with more than one teacher who wanted to medicate him so that he wasn't a hassle in the class when he was bored.

There is a difference between needing medication to help a child overcome issues that are preventing learning and the ability to function in his environment and a teacher wanting medication because a highly gifted kid is a pain in classroom.

The medications are not without side-effects, so my daughter opted to try organic options, dietary options, etc. before deciding the medication's benefits were worth the medical risks.

Best wishes - it's a tough decision, often without any real black or white answers.

@polar - well even with the discrepancy in the VCI/PSI, his PSI is still average. But, to answer the question - yes she did about 4 hours of testing. He does not have DCD - he is just slow at writing and has quicker thoughts than fingers. He is actually really athletic and plays multiple sports pretty well. Plus there is a family history of ADHD.

epoch - my DS eats a good balanced diet - he eats little packaged foods but he loves fruit and it would be incredibly difficult to eliminate that from his diet.

ABQ - I would never medicate my DS just because a teacher wanted him to be less of a pain. His teacher has not said word one about medication and I don't think she finds him a pain. She initially contacted us because his behavior at that time was effecting his classroom performance and she was concerned about his interaction with his classmates. Some of that has been addressed through accommodations and him getting used to the transition to the class. My DS also gets exhaustion from his sports - he just finished fall baseball, basketball starts this weekend and wrestling next month (he just practices 2 nights a week but does not do the tournaments.) We also ski in the winter, hike/bike in the summer or until the weather gets bad. I try very hard to make sure he gets the optimum amount of physical and mental stimulation each day.

I feel like we are doing a lot of the right stuff for him but I am still trying to work out my thoughts on the medication. Thanks for all the input.

I realize my comment sounded like I was implying that you might - far from it. I just couldn't believe in my own experience how much the teacher put pressure to bear - constant emails complaining, etc. to try to get me to medicate, even after we provided her with the psychologist's report saying he didn't have ADD.

Best wishes!

Deonne, I didn't mean to imply that your ds has DCD - but wanted to point out that there may be a reason that is behind the discrepancy in processing speed vs VIQ which would be helped with accommodations that have nothing to do with ADHD. FWIW, my ds, with DCD and the similar discrepancy in scores, has a PSI above average, and the first time he went through IQ testing the pscyh who did the eval thought nothing of the discrepancy other than that he was a young kid who "liked to take his time". When he had his full eval with neuropscyh testing beyond IQ and achievement testing it took approximately 8 hours. The additional tests that he had were called NEPSY, Beery VMI (visual motor integration), and a bunch of other tests that I can't remember the names of!

I'm not against ADHD meds at all, and I am a firm believer in parents knowing their children best. At one point our ped suspected my oldest dd of having ADHD, and her words of wisdom were that it wouldn't hurt to try ADHD meds because you would see a change relatively quickly if the person really is ADHD, the meds would help. If the person wasn't ADHD they wouldn't help. I wouldn't give the meds a try without having a diagnosis, and our dd, like our ds, ultimately didn't have an ADHD diagnosis so we never tried meds. But if she'd been diagnosed with ADHD, I would have been willing to give them a try.

Best wishes,

polarbear

Thanks for the replies. I hope that my responses did not seem defensive - they were not intended to be. It is just that I have thought much about many of the issues brought up and we are confident in the diagnosis and our efforts so far. My DS is doing really well in school right now but a few months ago he was struggling and we were worried about his ability to make friends and to adjust to a the new environment. I just want him to be in the best position to take advantage of all of his gifts so that is why I am still pondering whether to try medication. Thanks again for your thoughts and input.

Deonne, I have recently posted about my struggles on whether or not to medicate my DS9. Similar to your son, his grades are great and he is functioning fairly well without the medication. I could not help but wonder though, could he do even better without medication? This past summer, we started the medication merry-go-round. It has been very difficult, but we have finally found something that works for him without any side effects. His ability to organize his thoughts on paper has improved somewhat, but otherwise I don't see a big difference academically. Where I do see a big difference is in what I would call the "wierd kid" behaviors. Without the medication, he is constantly fidgeting, making funny faces, just plain acting strange. On the medication, he is much more appropriate and stands out less from the rest of the crowd.

Great answers to tough questions!
This part I found curious - is he working above what 'grade level' - grade level for his school? grade level for a non-gifted school? grade level for kids of his age?

If it means that he's working well above the level of his classmates, that can be part of the reason why he doesn't seem to 'need' medication. Which isn't to say that he needs more from school or more afterschool, but it just seems familiar to me. As long as my DS wasn't working near the upper reaches of his ability level, his ADHD-I was mostly an irritant to others and to his self esteem, not an academic handicap. It was only when he got old enough that the organizational demands were quite beyond him and the material finally started getting into his readiness level(8th grade with a single skip) that we started the medication. Part of me wishes we had done it sooner, because he got some longstanding impressions of his 'wrongness' that I think would have been avoided. On the other hand, things are wonderful now, he's blossoming in so many ways, so who am I to play the 'if only' game? Still we pay a high price to keep him at his school, economically and not getting to see him daily.

I'll let you borrow my crystal ball as soon as it arrives!
Smiles,
Grinity