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For anyone not familiar with our situation, DS7 is in 2nd grade in Montessori school. It's the first time ever he's enjoyed school and loves to go every day.

His preschool (PK-3) situation was a nightmare. He was in trouble constantly for not staying seated, talking out of turn, and emotional outbursts.

Next, we went to PK-4 at a Catholic school who had him repeat the "grade" for all of the same reasons, although they admitted he was academically advanced and would likely be bored. Went to KG at the same Catholic school, same issues...pulled him after a couple of months into the school year and homeschooled. (The school basically encouraged this as they didn't know how to "handle" him.)

We completed KG in one semester at home and then enrolled him in 1st grade for the 2nd half of the school year at the Montessori school. Same issues...had him evaluated...he was diagnosed with ADHD and put on medication.

So, here he is in 2nd grade, and more of the same. His focus has improved significantly, however the emotional regulation issues have not resolved, nor have they improved substantially.

My son has been through 6 medication changes, and that is not including all the dosage changes for each of those meds. He is sensitive to side effects, has not gained weight, and has increased anxiety on certain meds or higher dosages.

Public school is not an option. Regardless of whether there's more going on here than ADHD, I am not willing, at this point, to add any extra medications to the mix. So, that said, would you please read the following email from the teacher and share your thoughts? I am afraid the school is going to tell us they can't deal with him. If that happens, I am prepared to homeschool again, however it would be difficult financially. Do you think this email indicates a poor school fit, and would you be inclined to pull him out? Do you think this email is a lead-up to asking us to take him out of the school? His emotional meltdowns (last about 2-3 minutes and occur several times per week) are taking a toll on him socially and in terms of self-esteem. He loves school, but is showing signs of depressed mood, according to the therapist he sees.

Email from teacher:
"While trying to cut out a tracing of his hand, N became very frustrated. He kept shouting ,� I cant do this I cant do this. He then threw the scissors in disgust.. At this point, I kicked into action and asked him to sit and breathe.. I had to take him out of the room to calm him down. I was concerned about his physical reaction, which seems to be happening more often. Luckily no one was hurt�but� it could have been bad.

N�s coping mechanism is not working very well and I am thinking that the medication is not ideal. These situations seem to be happening more often and more severe.

There were a few other cooperation activities that N became frustrated with today� One while out at recess and one during free time at the end of the day. (shouting)

It may be time for N to revisit the ADHD doctor and his medication options.

Take care."

If you made it through this entire post, thank you! Sorry it's so long!

I don't know the answer, but wanted to wish you good luck. I guess the only thing I could think of to try, without reading up on the subject, would be exposing him to failure more often at home and using generally useful techniques like modeling the right response, plus convincing him that failure is no big deal. At the first opportunity possible, if that comes, I would reduce his meds.

Jen, I can't answer your question specifically because my son (DS7 also) has not been diagnosed with ADHD and has never been on medication. He has, however, had outbursts such as you describe throughout his schooling. My son's diagnosis was autism, now asperger's, and we have used behavior therapy with him to help with frustration, perfectionism, and emotional self-regulation. Have you considered non-medication therapy like ABA or cognitive behavior therapy? From your description of your son, it sounds like it might help.

We have found a school that is a really good fit this year and one reason is that DS's current teacher would have "kicked into action" at the first hint of frustration instead of waiting until the scissors were thrown on the floor in disgust. By then (for our DS) it is too late, the meltdown is occurring and there is not much to be done. A perceptive teacher can often recognize early signs of impending problems and nip them in the bud before it is too late.

Hope that helps a little! Nan

Hi Jen,

If I remember correctly, you upped the stimulant recently, right? That can increase anxiety. The demands of school also gradually increase, and we're in the "honeymoon's over" phase of the school year. That can make this a tough time of year.

I would suggest being open to exploring the possibility of adding another med; as you know, for our DS, an SSRI was necessary to treat the anxiety and really reduced these meltdown situations at school.

I don't think teachers necessarily always have a good handle on the issue of meds, but if they feel something's not right, I suspect you should pursue that question with your DS's doctor.

Feel free to PM.

DeeDee

We changed medications, but we didn't increase the dose. We are just using a short acting/instant release stimulant rather than the extended release. With the instant release we see less anxiety, less personality changes, and increased appetite. We actually see fewer meltdowns at home, and interestingly, this is the first he's had all week. So, he just completed three full days without any incidents at all, and he has been completing all of his work for over a month now. I don't know if the teacher is reacting to an emotionally charged situation, or if she truly feels things are getting worse. I actually thought they were getting better to a degree. I certainly didn't think they were getting worse.


I know, but I'm so scared to give my 7 year old an SSRI before we've even done the neuro-psych testing. I'm not opposed to helping him in any way that make sense, but I'm so afraid of giving him something that makes it worse. Plus, I know trying to stop taking an antidepressant can be quite difficult. It's definitely on the list of things to consider. Our doctor has said it will be the next course of action if the emotional regulation issues do not improve.

Thanks for responding. I feel like pulling my hair out.

Jen, I know what you mean. This is harrowing stuff.

As for whether things are getting worse, I can think of a lot of scenarios:

--He's "worse" at school in that they are seeing more ups and downs, but more level at home because you are so attentive

--The teachers are watching all the other kids mature, learn to deal with expectations, etc., and your DS is not mastering these skills at the same rate, so even if he's making progress it still looks "worse" to them

--He's melting down less, but when he does melt down, it's more severe. Possibly because he's so disappointed in and surprised by his own bad behavior, when he was hoping he had it under control. BTDT.

If you keep collecting information you may be able to get a grip on the pattern and figure out what he's really going through and how to change the pattern.

Yeah, we were not thrilled with medicating a little kid either. For us it came down to relieving suffering, and I'm a little shocked to say that I have not regretted doing so even for a minute. YMMV.

DeeDee

Hi Jen, my son was having outbursts at home last year, and really bad irritability. Everyone was pretty miserable. We eventually took him to see a therapist, and we determined that the outbursts were related to a really bad K fit, and that he was spending the day in a state of unrelenting anxiety, due in part to (probable) SI issues. The play therapy has really helped. The therapist has helped us understand him better, appreciates his giftedness and sensitivity, and has helped us manage his behavior more effectively, in terms of self regulation. She has also advocated for him at home, and linked us to various services. My DS still has frustration issues, and occasional outbursts, but nothing like the continuous irritability and tantrums he had last year.

Jen, I have this book called "skillstreaming" for teaching kids how to act if it doesn't come naturally. �I think it's for shrinks and teachers. �I just looked up "dealing with feeling mad" to see what it tells you. �

1. Stop and think
Discuss the importance of stopping and not doing anything. �Talk about the negative consequence of acting out this feeling in an aggressive way. �Also discuss that stopping and thinking give a person time to male choices.
2. Choose
a. �Turtle
Instruct children to act like turtles, curling up in their shells where they can't see the person (or thing) with whom they are angry.
b. Relax
Refer to relaxing (skill 32).
c. Ask to talk.
Discuss people children can talk to. �Refer to asking to talk (skill 23) as needed.
3. Do it.
Children should make one of these choices.

Suggested situations:
School: the teacher won't let you have free play.
Home: its raining and a parent won't let you ride your bike.
Peer group: a friend has taken your basketball and won't give it back.

Skill 32: relaxing
1. Think about how you feel.
Talk about how children feel when they are tense (jittery inside, getting a stomachache, tight or warm all over, etc.).
2. Take three deep breaths.
Teach the children how to take relaxing breaths: take a big breath in slowly, then let the air out through an open mouth. �Have everyone practice this step.
3. �Squeeze the oranges.
Pretend to give each child an orange in each hand. �Have children tighten their fists to squeeze all the juice out of each orange in turn, then both oranges together. �Finally, have them drop the oranges and shake the rest of the juice off their hands.
Comments: children may need a great deal of training before they are able to use this skill effectively. �Having them practice this skill each day before they rest may help them to fall asleep more easily.

I know you can't tell who you're talking to online so let me be clear i'm not a shrink. I found these books skimming Amazon and bought them so I could learn to teach my boy how to not get in trouble, I hope!
I'll add one more skill suggestion- reading others (look at the face. Look at the body). Show a variety of pictures cut from a magazine. Have children describe the facial expressions and body postures shown in the pictures. When you read an illustrated story (heck, even watching tv commercials) draw attention to the charachters' facial expressions and body postures as clues to how the characters might feel. When reading stories to the children, ask how they think the charachters in the story feel and why.

Jen,

I'm so sorry you're having to reevaluate everything again. This rollercoaster ride is exhausting and it's so disheartening when, when you think you've finally gotten things in a good place, the school starts pointing out problems again.

The first thing I would say is try to talk to the teacher in person. I know I've often gotten upset when a teacher has e-mailed me about a seemingly gigantic problem only to talk to the teacher and just find out that she was "concerned." Sometimes, but obviously not always, teachers just feel like they are constructively sharing so you can work on a problem together. They don't realize how much we take their comments to heart and how much what they say can rock our worlds. So, just in case, I'd try to talk to her face-to-face.

That being said, there is always a need to work on a child's response to disappointment, especially since your DS is just 7. He's not the only kid to have a problem with this. If his response to frustration and disappointment is stronger than most, I would think the same basic behavioral techniques that LaTexican wrote about would still be helpful. This may be a naive and simplistic suggestion, but have you tried incentives for good behavior at school (e.g., stickers, candy, money, saving up for a fun outing)? I've seen it work, albeit very slowly, for some kids. Obviously, though, it's a complex issue that has many variables that need to be examined and possibly tweaked.

Please talk to the teacher now or when you get a basic game plan/response set in your mind. She may think it's a big deal worthy of removing him from school or she may have just been "sharing" in an attempt to be helpful. Either way, ((HUGS)) to both you and your DS, who is just a sweet, smart little guy.

Hi Jen,
I think that things go in waves like this. Sorry to hear that you are on the hard part of things. I think a face to face meeting with the teacher is a good idea. Worrying about where this is leading isn't a good idea - even if it's bad, it's too early to tell, so what's to gain?

My guess is that the teacher is responding to a change from baseline. Humans are good at getting used to baseline, and then getting excited when things get worse unexpectedly.

Do you have some kind of communication note or email set up between home and school? It's key to getting a good picture. The teacher herself may be overestimating the size of the problem because of the human tendency to ignore the good and highlight the bad. If you get a brief note passing back and forth with attention on the little victories, it will change everyone's perception of the situation.

We get what I call 'the marias' about once a semester. It's when the teachers start to sound like this


and the truth is, that not only do our kids do it, and we do, but our teachers do it to. So the first thing to do is to try to get a realistic picture of the situation, and then try to help everyone else see the same realistic picture. Since there is no crystal ball, we can only do our best.

Hugs,
Grinity

Marias - what a perfect way to put it. Love it.

And of course, my son acts out in 'all boy' ways, so there is a bit of humor picturing him doing acting out more traditionally associated with a girl. But the frustration and bewilderment and judgement and fear is so 'the same.'

Yes, we have considered this and are looking into it. DS is currently seeing a therapist (LMHC) to address these issues. He's using a variety of approaches, but we are definitely looking into something like what you mention. Thank you for the suggestion.

Definite possibility! He even describes one reason for not being able to stop the meltdown this way: "Once I start having a meltdown, I get so mad at myself, and then I start crying and yelling because I'm so frustrated at myself for doing it again."


We know the triggers are frustration with himself (perfectionism) and inability to tolerate even the smallest infraction from another kid, often perceiving an injustice when it wasn't intended. However, we have been unable to find a pattern to when he's going to have a bad day or a good day. There is no pattern. Some days he handles those things well, and other days, he's a complete mess.


I completely understand what you are saying, and that just might be what puts us over the edge. I can't stand seeing him struggle so much emotionally. It is literally breaking my heart. I might be a race to see which one of us starts taking an antidepressant first!

Rosapina,
Did your son like going to school? Did he want to be there? Did you have an indication that he was unhappy at school before you uncovered the poor K fit with the therapist?

I did this, and she definitely thinks that, overall, things are getting worse for him emotionally and socially. We have had a pretty rough weekend with him as well, as a matter of fact, so maybe she's on to something with the medication thing. I'm just not sure medication is the answer for any of this emotional stuff, at least not a stimulant ADHD med.

Actually, we use a star chart (iPhone version) to earn stars for certain responsibilities and behaviors. It works quite well for everything EXCEPT the emotional outbursts. In fact, when we tried to tie specifically to a reward system, the meltdowns became more frequent and more severe because he was putting so much pressure on himself. We do have a "behavior" listed on his chart that says, "Managing Frustration Positively". Anytime he feels like he wants to melt down and stops himself from going into full breakdown mode, we give him stars and praise him A LOT. Even if he comes home from school and tells me about an incident where this happened (even if no else observed it) we give him stars because he's extremely honest that way. Once we tried rewarding him for having "no meltdowns" at school on a daily basis, and that was just too much pressure. During that week, he had many, many more outbursts that usual. It seems to be something he simply can not control, no matter how badly he would like to be able to.

On Friday, I asked to have a meeting sometime in the next couple of weeks, and they scheduled it for MONDAY! The administrator, school psychologist, and teacher will be in the meeting. I'm trying to feel positive and hope that they are going to be supportive and help us problem solve, but I'm afraid that they'll also be giving us a time frame to get this under control. If that happens, I could see my dh wanting to pull him immediately. I think that would not be a good thing for ds, because he loves the school. He needs to, at least, finish the school year, in my opinion. Otherwise, his self esteem is REALLY going to plummet.

Thanks for responding and for sharing your thoughts.

Sanity from having a plan? I don't know; I just want to fix it!!!!!

Yes, but the teacher has been a little hit-or-miss on sending the emails. We tend to get them when there's something negative going on, but I can't assume that just because she didn't send an email one day that everything was good. In our meeting tomorrow, I need to reiterate how important daily written communication is. I've suggested a notebook that we can send back and forth, but she preferred email.

I was going to suggest CBT as well, but I see that has already been put out there.

It does sound like there is some difficulty with this particular teacher fit as well, though. Does he have any other options for teachers or is this it at this school?

Maybe it's just my frustration coming through that gives this impression. This teacher is wonderful. She's been so supportive and amazing for ds. It's definitely not her that's the problem. If anything, it's just a poor school fit for ds. He has issues that have to be addressed, which they are, and I'm just not sure if this school is equipped to handle it. Thus far, however, they have been pretty incredible compared to our previous school experiences. My fear is they're close to reaching their limit with what they are able/willing to handle. I could be very wrong about that and should know more tomorrow.

The stimulants make lots of anxious kids more anxious. For ours, they were a terrible fit. For some, they work splendidly.


That's really important information, and I hope you are conveying all of it, in detail, to your doctor.

At that age, ours always responded this way too-- and it really made him feel terrible about himself because he wanted so badly to behave and earn the reward, but the pressure to succeed made him anxious, and he'd blow up, and then feel worse, which made him more anxious. Vicious circle.

I don't want you to give up on behavior modification strategies-- there are ways of helping a kid this dysregulated get a handle on his own behavior-- but it will be more complex than a star chart, and anti-anxiety meds may be necessary for a while.

An ABA therapist or a CBT therapist may be able to help you design self-regulation tasks that are small enough that he can actually achieve them, gain confidence, and then make bigger gains. Leaving it to him on an all-day basis is too hard right now, and I would find ways to take the pressure off rather than increase it, expressing understanding-- "This is hard for you right now."


I hope it goes well!

DeeDee

Do you know if the teacher is consistently good about praising your son throughout the day when he is not having outbursts? I ask because, if she's not good about telling you about the good things, maybe she's not good about telling your DS about the good things either. Perhaps sharing with her some of the Nurtured Heart techniques would be helpful. Maybe suggest a trial of concerted Nurtured Heart techniques as a specific plan to implement for a certain period of time (2 weeks? 4 weeks?) to see if they start noticing an upward trend toward better stress reactions as a as a result. That way you would be suggesting something specific and perhaps measurable, and as a side effect, would buy him more time in the class he really likes.

That reminds me, btw, of a technique I heard from a teacher on tv the other night. She would draw a smiley face on the thumbs of her students when they'd have a good day so that they could go home, give mom or dad a thumbs up, and let their parents know they'd had a good day. What about suggesting a variation on this theme for your DS. Throughout the day when the teacher catches him controlling his responses to frustrating situations, she could draw a smiley face on one of his fingers (starting with his thumbs) and he could see how many smiley faces he could collect during the day. He wouldn't lose anything when he wasn't controlling himself, but he would gain something when he was. And it would just take half a second for the teacher to silently respond in a positive way.

There is another technique/program that worked with my son called "how does your engine run" and it is usually offered via OTs. But you can look it up online to get the general idea. It is supposed to make kids more self aware of building frustration before an actual meltdown/overload occurs. Nan

Rosapina,
Did your son like going to school? Did he want to be there? Did you have an indication that he was unhappy at school before you uncovered the poor K fit with the therapist?


In hindsight, he had all of the signs of being miserable at school, but he was so miserable at home, that we actually thought he was doing great at school comparatively. He started off the year really well, making friends, and enjoying the work. After winter break, things started to go south, and by March, he was crying or just looked despondent whenever I would leave the classroom, and started to beg me to stay in the classroom every day. He also started making up stories about school that showed how anxious he was. He became so down at home that he barely played, and would get frustrated by any minor thing. It came to the point that he no longer made jokes (from a kid with a great sense of humor), and no longer pondered the big complex questions and ideas that have been the hallmark of his giftedness. After he had been in therapy for a few weeks, he gradually began to return to baseline, and we were able to advocate for him with the school so that things were at least tolerable most of the time...

Nan, some time ago we ordered the teacher's manual for How Does Your Engine Run via Interlibrary Loan. I used several ideas from there...

Dee

I think she does this, but I doubt she is able to remember to do it like we do at home. At home, we are two parents and one child. It's easy to notice times when we can praise, praise, praise. In a Montessori classroom, there is a lot of independent work time, so I don't know if she's in a position to praise like we'd suggest with the NHA.


I LOVE this idea! It is totally something that would work for ds. Immediate positive reinforcement works so well with him. I'm going to suggest it tomorrow, and I'm also going to look in to the ABA or CBT therapist.

Thanks so much!

We have this program, given to me by one of my OT friends and colleagues, and we used to use it more when he was younger. I will pull it out again, and take a look again.

Jen, I can't remember if this might have been mentioned elsewhere--does he by any chance have poop problems? DS8 (Asperger's, no ADHD) had similar meltdown difficulties for years of school, and he is a whole different kid this year since we got the poop straightened out.

I love the smile thumb too. I disagree that there isn't much to Energize in a Montessori class. Remember that energizing can be as simple as: "I see that you have your book open to page 4 and your pencil in your hand."

I know it doesn't sound flashy, but that can be enough. Remember that from the teacher every little bit is going to go a long way.

If the teacher agrees to a daily email, and then doesn't follow through, I would take matters into my own hands by sending the teacher a daily email. Of course I would use my 'perspective-taking glasses' to energize her positivity every single school day, no matter how small:
"DS was so excited about learning X in your class yesterday. We plan to praise him at the dinner table tonight. Is there something he did today at school that was positive? Thanks so much for your cooperation, this approach has really done wonders for our homelife."

Good luck with the meeting. I'm thinking of you today!
Grinity

Yes, he has had chronic constipation since birth. He is doing much better with this now though (just over the past 6 mos) and is no longer taking medication for it. He usually goes once every day or once every other day.

Grinity-thanks for the ideas. I will talk about that with the teacher.

We had our meeting today, and it actually went very well. Dh and I are soooo relieved after attending this meeting. The administrator, who has a master's in child development, basically said that ds is struggling emotionally and socially (which we knew, of course), and she wants to help us get to the bottom of it. She feels there is definitely more going on than ADHD, and she does have a lot of experience with lots of children, many of whom have had ADHD. She said that with the medication, the gap between social/emotional development and intellectual development should be closing to a degree. She seems knowledgeable about giftedness and understands asynchronous development, but thinks there's definitely more going on that that.

She said immediately that she didn't want me worrying that they were going to tell us ds was a poor fit for the school. She said, "We are here to support you and ds and help your family."

She suggested a child psychiatrist that she took her son to for similar issues. Also, other parents from the school have used this doctor and had a positive experience. My mother has some experience with her as well through her job, and she said good things about her as well.

Also, the administrator recommended that we see the child psychologist from the same practice who specializes in the issues that we are dealing with, including ABA and CBT! She recommended individual therapy for ds and family/parent therapy for us. She said she or the teacher would go with us to the initial psychiatric appointment if we wanted them to. That way, we can make sure the doctor gets a complete picture of what's going on. Also, she wants to make sure that we are all using the same techniques from home to school, so that ds has that continuity.

She also recommended their school psychologist do the neuropsych testing, but I think we'll stick with the neuropsychologist. Her thought on that was that we'd all be working together, and these are all people from the same team who work closely together. I like the idea of the neuropsychologist rather than school psychologist for this testing though.

They definitely think there is some mental health component going on, and the administrator specifically referred to depression. She was definitely knowledgeable and knew the signs to look for. She did say she was not qualified to diagnose anything, but she thought the child psychiatrist was the best place to start.

She and the teacher expressed concern that the current ADHD medication (Ritalin) could be contributing to the increased anxiety, aggression, and anger. Over the weekend, we observed some definite negative changes in behavior. Ds just seems angry.

I called the developmental behavioral ped today, and she said that these symptoms are on the list of "serious side effects" for stimulant meds and that maybe ds is just not going to tolerate stimulants. We can try Strattera, but I am inclined to do nothing until we see the psychiatrist. She will do blood work as well, which our doc never did. Not sure if it's necessary, but we'll take all the info we can get.

Overall, dh and I feel so relieved because we finally have a cohesive plan with lots of support. This way, we have an entire team working to help ds. Not one time was there any indication that they had their own interests in mind. They even suggested a guide (helper who is a psychology student) to be available in the classroom to help ds. We'd do this after he is evaluated and specific goals are set up. Again, this would help to make sure he gets the support he needs and the continuity of "treatment" and behavior techniques between home and school.

I can't believe we're getting all this help through a private school! Of course, we have to pay for some of the services, but it's nice to have the help coordinating it all.

I was floundering and about to fall apart myself. I needed someone to take charge and say, "Ok, this is what we need to do. We're going to figure this out together and address it." We are really grateful as this meeting went so differently than we expected.

As for now, we are going to stop the stim meds and continue to give the B12, B6, Folic Acid, Omega-3 Fatty Acid supplement, and vitamin supplement formulated for attention and concentration. We'll see how it goes. If all hell breaks loose without the medication, I'm not sure what we'll do. We can't see the psychiatrist until Dec. 2.

Thanks for all the ideas and support. If you made it through this novel of a post, thanks, and I'd love to know what you think!

That's great news!! I love having a team to support our DS also. It does make a big difference. It sounds like you are moving in the right direction. Nan

Jen: that's awesome. You are on the right track! And I'm glad the school is stepping up to help you more. You will figure this guy out, and he will flourish with the right help.

DeeDee

I can't wait to read the sequel!
More seriously, this seems like a good time to stop the Ritalin and see how things go. Anger can be from so many things, from medication, to an often overlooked symptom of Depression.

I'm so pleased that the school is working with you. Yippee!
I would still persevere with the daily emails. In the begining you can simply express your appreciation for the teacher and not even ask her for a positive - just report on a positive your son did at home and how he just glowed when your praised him for it.

Just a thought - you are going to need some prop to get you through the next 6 months, yes?

Love and More Love,
Grinity

Thanks everyone!

No meds today: inattentive, lots of frustration resulting in meltdowns, however, no anger or yelling at others and no aggression. Continuing with B12, B6, Folic Acid, Omega-3, and "attention vitamin supplement". I'm considering giving him his medication tomorrow because he gets so frustrated when he can't focus and do his work.

We were able to get an earlier appointment with the psychiatrist. In fact, we are going Thursday of this week! Not much time to prepare, but so glad we're getting in there. I need to call the doc tomorrow to find out if we should give ds his Ritalin before the visit or not. I'll update after the appointment. Thanks again for all of the support and advice. You guys are amazing!

Jen, in your shoes I'd hesitate to go back to the Ritalin dose you were using-- yes, it's short-acting, but extreme swings may be just as irritating and confusing as lack of focus. Do you have a smaller dose available? Have you talked to the doc about off/on dosing?

What is "attention vitamin supplement"? Is it FDA-approved? Do report everything, not just prescriptions, to the psychiatrist when you go.

I'm glad you got in so early!

Best,
DeeDee

Yesterday, I gave a slightly smaller dose. These are instant release, so you can cut them in half. He still had 5 meltdowns at school and was cranky with me after school. I definitely think the Ritalin helps with focus, but I also have no doubt that it's contributing to the emotional mood swings. He tends to get frustrated easily and have crying fits (gets down on himself) when un-medicated. When medicated, he still does this a good bit, but not quite as often. With medication, however, he has more angry outbursts and is irritable and extremely touchy (goes off at the drop of a hat). Someone can bump into him, and he thinks they did it on purpose. When not medicated, he is still quite sensitive, but he doesn't blame others. His negativity and anger is more self-focused, which isn't good either. If I go lower on the dose, it doesn't help with the focus, but it still seems to make him cranky. I think we need something else altogether, maybe a non-stimulant like Strattera! Haha, go figure, Deedee. Where have I heard that? : )


No, it has not been FDA approved. It is similar to multivitamin; it's just in liquid form. It has extra of a few vitamins and is loaded with fruit and green vegetable extracts. I ran it by the compound pharmacist who does my HRT and vitamin supplements (all based on my blood work). I will ask the doctor about it today as well. It's called Liquid Health Attention Dietary Supplement. I know several people who RAVE about it.

For anyone who is interested, the Omega-3 supplement we use is called Barlean's Organic Oils-Omega Swirl Lemon Zest. It tastes YUMMY!

Also, the B vitamin is called Superior Source B-12, B-6, & Folic Acid. We know someone who's daughter uses this and Omega-3 exclusively for ADHD, no ADHD meds at all. It is effective. Of course, that's one child, but it's interesting. This is a child who had to be hospitalized because of violent behavior related to Vyvanse. She had toxic levels of amphetamine in her body when tested.

I'll let you know how it goes after the appointment.

I don't have much time to add lots of details right now, but basically here is the doctor's opinion:

Official diagnosis right now: Gifted, ADHD, Anxiety

Possible diagnosis according to the doctor: PDD-NOS(pervasive developmental disorder, not otherwise specified); the doctor says he meets some of the criteria for a spectrum disorder on a very mild scale, but not enough to diagnose Asperger's (at least not at this point). He feels ds's anxiety is a result of his rigid thinking-thinks things should be "this" way, and when they are not, ds melts down. He also referred to the fact that ds was colicy, has sensory issues(both sensory seeking and sensory avoiding together), atypical responses to ADHD medications, difficulty reading social cues (ex: thinks people are being mean when they are not and doesn't know when to stop correcting people even when they are not being receptive to his "help".), extreme sense of justice, and adherence to rules. I just can't think of everything right now, but it make some sense coming from the doctor. I don't know if we'll end up with an Asperger's diagnosis at some point or not. I hope not, but I guess it's a possibility.

The more I read, the less convinced I am, however. Especially reading the DSM diagnostic criteria. I am willing to accept this diagnosis if it is, in fact, accurate. BUT I'm NOT willing to squeeze him into the ASD box if it doesn't fit.

Right now, we are using Ritalin IR, Prozac (starting very slow), and we are considering CBT. He may also have a "guide", or helper, at PE and possibly in the classroom if needed. We are really hoping to see a difference in the emotional regulation issues with the SSRI.

Will update more later. Thanks again for all of the support.
Jen

DS7 is improving significantly (especially at home) with the addition of the SSRI (prozac). He is on day 3 of Focalin, a stimulant med we have not yet tried. It's extended release and supposedly very smooth, so hopefully ds will have fewer ups and downs throughout the day. It doesn't last more than 6 hours, however, so he'll probably need it twice daily. We tried not giving stimulants at all, but EVERYTHING got worse...focus, emotional regulation, concentration....

So, we'll see how he does with this. The more time we've all spent talking with the psychiatrist and psychologist, it's looking more and more like we're dealing with gifted/adhd issues and not a spectrum disorder. DS does have anxiety, likely due to perfectionism and frustration with asynchronous development. Not to mention, anxiety and depression occur in both sides of his family. His emotional regulation difficulties are very typical of kids with ADHD, and it's not unusual for stimulant meds to NOT help as much with these types of symptoms. This is an aspect of ADHD I was less familiar with, but I've learned a great deal recently about the lack of emotional regulation skills in children with ADHD.

Hopefully we'll find the right combination of medication/counseling to help ds. He starts CBT tomorrow with a pediatric psychologist. I've met with him, and he is really wonderful. I like the fact that we are going to get some hands-on practical strategies to try at home and at school. The psychologist will go into the school to observe and demonstrate implementation of the strategies in the classroom setting. We'll all be able to use the same terminology and encourage use of the same techniques/strategies.

Thanks again for the support and advice.

Great news Jen It is such a relief when things start to work! Nan

Hey Jen,
I'm so glad you posted and that things are going sort of better. I missed a few of the other posts (sorry)

Soon the holidays will be upon us, and there is the advantage of less school, but the disadvantage of less structure/more parties/more stress. In other words - it's going to be hard to tell what's going on until Jan 2011. Unless of course, things are better, which is great too!

Anyway - Hi!
Grinity