Gifted Issues Discussion homepage Forums Twice Exceptional Treatments for ADD?

DS12 (2e - Asperger's) is having a terrible time with school, and I am taking him to the doctor soon. He has close to zero executive functioning (organization, time management, prioritizing, focusing), cannot keep his mind on what he's supposed to be doing for two seconds, and is getting depressed about how far behind he is getting with school work and the way he can't seem to do what he needs to be doing.

I really think he has ADD -- not ADHD, as he's not hyper in the least -- does this fit with anyone's experiences in the matter?

Of course, if he's playing Minecraft or his other games, he can sit there all day, so I don't know if it qualifies. But I can ask him to look something up, and by the time I get across the kitchen he's gotten sidetracked and forgotten about it. And even when he's not getting lost playing a game instead of working, he can just be sitting there staring at the computer, having forgotten what he was going to work on. And I understand all of this perfectly, because I'm exactly the same way, which doesn't help.

If it is ADD, what treatments does anyone here recommend? What have you used?

I have the same issue with my son although he can play mine craft or do science projects and karate no problem he's suffering at school too so I have a doctor appointment set up for him on Thursday to discuss this.

I'm not telling you to medicate, since that's a personal choice that doesn't work for everyone, but in our case it has helped tremendously. There is a very obvious difference in terms of focus, and everyone can see immediately if DD is not medicated. We could try all the therapies in the world and they would only make a small difference in comparison (IMO)

Hyper focusing on areas of interests is a symptom of ADHD. Have you ever had him evaluated for ADHD?

DD (who has ADHD) isn't unfocused with everything either, she could also sit and play Minecraft all day as well. She is also usually very focused with reading, for whatever reason, even if she is not medicated. The main question is if you see the lack of focus in various different settings. If it is only at school, (for example) then something else may be going on like a learning disability or another disorder.

My nieces have ADHD and my SIL used to say that they were capable of hyperfocusing on things that were interesting to them, but otherwise were very distractable. Medication worked well for them--the older one at about age 8 was shocked by how much it improved her quality of life. However, they did have issues with the medication's efficacy during puberty and also had some issues with side effects (lack of hunger, etc.).

On a separate note, during the evaluation last year for my 2E son with Asperger's, the evaluator could not decide if his ADHD-like characteristics were just part of the Aspereger's or not. She said that she couldn't tell if he was distracted because he was focusing on his special interests or was just distracted. For example, I can tell when he's not listening to me, but sometimes he will say something that shows he was thinking very deeply about something totally unrelated to homework or chores or whatever.

So what is the difference between ADD and ADHD, then? I thought the H (being "hyperactivity") was the one where they bounce off the walls. Which would be my daughter, rather than my son. Her teachers have been commenting this year that she seems to be upside down a lot, and she falls out of her chair regularly. She's always rocking and bouncing and rolling around upside down when I'm trying to get her to do her homework, and apparently it happens a lot at school, too. But my son isn't like that at all. He's more of a lump.

There are different types of ADHD. The inattentive type, where the kid just isn't focused and acts like a space cadet, the combined type, where they aren't focused and also hyper, and the impulsive type where the main problem is the impulsivity or hyperactivity. So a kid with inattentive type ADHD will look completely different than one with hyperactive/impulsive type, but they are all still called ADHD. ADD used to be the inattentive type but now it's categorized as ADHD--inattentive type. Wikipedia has a good ADHD page.

So what's the difference between true add and a gifted child with excitabilities?

DD needs to be reminded what to do all the time and she doesn't stay on task. So this morning, I think I had to tell her to change her clothes about 3 times before she actually did it. Typical for a 3 year old but not a 9 year old. It's really hard to get her out the door with everything she needs, and on time. She is disorganized, misplaces things, forgets things, etc. She is very distractable and stays on task only when she is interested in something.

The first one will be diagnosed by a doctor and the second one will be diagnosed by a teacher?

LOL. Also, once "over excitabilities" become a functional problem they aren't over excitabilities they are an issue that needs to be assessed by an expert.

Blackcat - my DD is 8 not 9, but it causes me no end of frustration that I would only have to tell her once to get dressed at three and now at 8 she needs to be told way more than 3 times, and I have to physically do it myself somedays (if she's not had her medication)... It peaked for awfulness at about 6-7, it is improving a little now. At 2-3 getting dressed was still and challenging and interesting task so her brain stayed with her body.

My daughter is 10 and was diagnosed with ADHD combined type at 5 years old. However, her symptoms never fully fit the diagnosis and she had many other symptoms that weren't being captured fully under the ADHD umbrella. She was medicated for a few months with Focalin XR. She never had improvement of inattention symptoms with medication, and she was very agitated and irritable while taking it. She was later diagnosed with Asperger's Syndrome. I think both diagnoses have an executive dysfunction as part of their core symptoms. I think the reasons for inattention come from a different place for ADD or ADHD vs. Asperger's. ADD or ADHD kids are distracted by external stimuli and have trouble focusing in noisy classrooms. I think kids with Asperger's are more internally focused and thus inattentive (as in lost in their own thoughts). As someone with a child with Asperger's, I can tell you that ADHD medication is hit or miss with autistic kids for this reason. It will either help them or make their symptoms worse. I do see a lot of improvement with focusing on organizational skills, use of routines, and lists. I find that if I make a list for a task and hand that to her, she will complete it every time. Also, she tends to not be focused on time or completing tasks in a timely manner. I try to use a stopwatch and give her time prompts like "five more minutes" to keep her moving. This is really a struggle. If your son does have Apserger's, and not ADHD, medication is not likely to be a treatment option for you. You may have to focus on behavior modification and improving organizational skills.

Good Luck!

I think this morning I was actually putting her coat on her out of desperation and then realized what I as doing and said "I refuse to dress you!" and she went out without her coat. One day she went to school unmedicated (I think she must have spit it out) and the teacher said she actually wandered out of class without permission or saying anything and didn't come back for a long time. It's like she's on another planet. He pulled her aside and asked her what her problem was and she burst into tears and told him she didn't take her medication that morning.

kitkat - I also have a daughter with Aspergers, who did have a trial of ADD medication and it didn't cause any particularly troubling side effects, but it didn't do much for her either so we stopped quite quickly (as compared to my daughter mentioned above with ADHD-i, for who medication was really quite like a magic switch). However, despite it's ineffectiveness for my child with Aspergers and ADD like symptoms (and yours), I also know a number of children with both Aspergers and ADHD for whom stimulants have had a profound positive effect (and most of them now that I think about it, are boys).

Interesting, thanks! Now I see why I haven't been able to find what I was looking for about ADD, if it's been rolled into ADHD. I guess we'll just have to see what the doctor thinks, and go with trial and error if they want to try medication. If it works for him, I should get me some. In fact, I should just get a family bulk discount.

Blackcat - are you sure you aren't talking about my DD??? My DH and I joke about how we can ask DD9 to go upstairs and take a shower, and we KNOW that unless we go up there and propel her into the shower that we will find her laying half dressed on the floor with a book in front of her!! And it's amazing how homework "vanishes" on the way to school. How in the world can DD lose things while sitting in the car? Our DD was diagnosed with ADHD inattentive type last Spring. Until then all I knew of ADHD was the hyperactive type. DD is definitely the space cadet sort. She has argued that I did not tell her to do something when I explain that I told her THREE times! She honestly thinks I am lying. Big sigh. On the other hand, she has incredible focus on things she likes - drawing, journaling, Minecraft, reading. She does do well in school which is pretty amazing. She just isn't to be trusted to get things back and forth from home to school.
Question to anyone with a child with ADHD, inattentive type - I hear quite often that meds don't often work with ADD in. type. What have you found that works? We have not tried meds so far.

Greenlotus - medication absolutely works for our inattentive type DD, it's not without complexity and issues but it continues to be the best a all able choice we have. I do note that my space cadet girl is on a higher dose of concerta than hyperactive/impulsive boys we know (when they were her age). She's still not on a high dose, but a very small dose seems to go a long way for a bouncing off the walls boy...

There are some great articles on the particular risks for in attentive girls. And also research (that I can't remember where I read) that found hyperactivity/impulsive behavioural cause a great deal of disruption and difficulty in the classroom, but have far less impact on the actual child and their achievement and success in life than the inattentive behaviours that no-one notices in the class...

I read somewhere that meds actually work best for inattentive type and don't help as much with kids whose main issue is impulsivity. I think DD is combined type and DS7 is inattentive type (but very mild/borderline). We did do a trial of meds with DS and he did act more focused and motivated when medicated (even on a tiny dose, like 5 mg. per day). Usually what happened was he started talking about cleaning things and doing work about an hour after being medicated (without being asked) and would go about doing those things, whereas otherwise he acts kind of like a slug (playing minecraft all day). We also saw improvements in his speech and some of his motor behaviors (he is dyspraxic). I just don't know if meds are worth it when he's not seriously impaired without them. His teacher doesn't have a problem with him, but she doesn't have him doing much work either (compared to the last one). It's a judgment call. I'm actually going in to talk to his IEP manager about this issue tomorrow...should be interesting to see what she says about medicated vs. unmedicated.

MumOfThree and Blackcat-
A big concern for our family is the size of our daughter and the issue of meds and appetite. It's a real concern as she is very tiny and only in the 20th percentile for weight. The psychologist is going to do behavioral work with her to see how that works before trying medication. I just finished reading an article about gifted kids and ADHD, inattentive type, and it made me wonder if we should not revisit the idea about meds. DD may be grade accelerated and face more need for executive functioning skills.

Is appetite a part of ADHD inattentive? We've really been worrying about DS lately (always, but more lately), because he doesn't seem to want to eat. He can just totally not notice that he hasn't eaten anything, and it doesn't even bother him.

I think the issue is that appetite loss is a common side effect of many ADHD meds. We worried about it before starting DD10 on Concerta, but she seems to be fine with it. She may eat a little more at dinner and a little less at lunch, but she's still getting enough calories as far as we can tell.

I think loss of appetite is a common side effect (but not with everyone), and we see it with DD, but she is growing fine anyway. She makes up the calories later in the day after the meds wear off.

My DD has experienced loss of appetite twice, and neither was related to ADHD. The first time was when, as a toddler, we were providing too much access to milk and juice, and she was getting all her calories from that. We curbed that access, and she immediately began eating normally.

Recently it's happening again, and it's related to a finding of hypothyroidism.

Oh, dear. We definitely wouldn't want to add any more loss of appetite to what he has already!