My 6 year old son is in first grade. He is underachieving and disengaged from school. However, at home (and in class) he reads constantly and displays all of the GT traits. We had him assessed and his testing is very scattered. ON the DAS II he was gifted verbally at 134 but average on the other domains. On the WIAT III his scores were higher- 140 total reading, 140 reading comp, 144 basic reading, total math 136, etc.

His school testing is equally scattered on tests like the SRI, DRA, QRI, etc.

He has a diagnosis of ADHD - mild, inattentive type.

We have tried 2 meds - XR Adderall and Metadate. The adderall was ok - tolerated fine, mild improvement. The Metadate was awful.

Bottom line - he functions fine at school and in life without medication. But there is NO question he can focus better and perform better at school on medication. He was not on medication for the neuropsych testing cited above.

So, the question is - is it worth to put him on medication to improve the quality of his education? He wants to be on the medication but I am reluctant. I am confused. It feels wrong to medicate him to improve performance but on the other hand, he has the confirmed diagnosis, maybe he needs it to get more out of school?

Or conversely, does he need a better school environment (faster pace) to keep him engaged? Am I fooling myself to think a faster pace will "cure" his ADHD? We are looking at a school change that has a higher level curriculum.

Sorry for the long post. I am pretty lost

His cognition and achievement both look pretty good, with achievement consistent with his verbal ability. I'm going to mention a few thoughts:

1. Until the level of instruction is matched better with his ability, it will be difficult to tease out how much is ADHD and how much is boredom.

2. It is not unusual for children with NVLD to be mis- or co-diagnosed with ADHD. Many of them do not show substantial improvement on psychostimulants, because their apparent distractibility is based on inefficiencies in visual/nonverbal processing, not dopamine-associated inattentiveness. The relative weaknesses in mathematics that are often associated with NVLD would not be readily apparent at this age, when simple arithmetic fact knowledge will be more than adequate for earning a 136 in math on achievement testing. OTOH, he appears to feel better about himself on the medication, which suggests there are additional benefits beyond the attention and behavior improvements that are visible on the outside.

3. If he actually has ADHD, a faster instructional pace will not cure the ADHD, but a too-slow pace will definitely exacerbate its symptoms. Personal relevance, challenge, and opportunities for creative extension are even more important for students with ADHD than for NTs.

I don't have any idea what the answer for your ds is, but fwiw, I would put weight on your ds' observation that he thinks the medicine helps.

Re functioning fine without the meds - I'm not sure I understand why you say he functions fine at school without, but also say the meds improve his performance at school? Re functioning fine at home, does home include other situations where he needs to be on top of things, group activities like scouts etc? Or is home mostly truly home? I think that it's easy when we're at home with our families to make accommodations without even realizing it - which is ok! The difficult thing is the world isn't going to morph to suit our kids' specific needs... so if a child truly does function better with meds, I'd consider keeping him on then, even if he can function fine at home.

Best wishes,

polarbear

Thank you aeh! Very helpful input.

What does a NVLD look like in a 6 year old? Are visual tracking and convergence issues considered NVLDs?

We had him evaluated by a behavioral optometrist after the testing scatter (gifted verbal, average other domains) and he was diagnosed with convergence and tracking issues. We tried VT for 6 weeks but he was non compliant so we stopped.

Personal relevance, challenge and creative expression are important to him. He really only puts forth effort with meaningful material.

So, do we give VT another shot, go back to meds or wait to see if he is more engaged with the new school and faster paced curriculum?

Thanks Polar Bear. Good advice. I knew I came to the right place for guidance!

Well, by fine I mean he is not having major problems at school. He has good days and bad days. He doesn't seem to have many in the middle days. But he has good days and bad days on and off medication.

His teacher noticed an improvement on medication. He was able to do mundane first grade tasks.

And yes, I do take his input seriously. But before putting him back on meds I want to try a school change to see if that helps.

The tracking and convergence would definitely be something to consider for treatment. They are not exactly the same as NVLD, but it would be very reasonable to see overlap in the areas affected.

FWIW, if he really can function well without medication, I would postpone the medication as long as possible while you investigate other things. At age 6, his brain is still developing. I'd hesitate to medicate unless you are sure he needs it. Also, once he really goes on the medication, he likely will be on it for life. The likelihood of stopping medication after a childhood on it is very low.

What SAHM said.

Lots of the behaviors of ADHD are still quite appropriate in a 6 year old. In fact I thought for a diagnosis the behaviors were supposed to persist past a certain age which I thought was 7.

puffin, the American Pediatric group (can't remember their name lol!... but basically the professional association that represents pediatricians in America) came out with a recommendation within the last few years that children can be diagnosed earlier.

To the OP, I am actually pretty much an avoid-meds person myself.. but was struck by your ds' comment that the meds helped.

One thing I feel very confident in is that as a parent, it's really important to trust your gut instinct. Seek out and listen to all the advice you can get, but also trust what your own head is telling you, because you are the expert on your child.

polarbear

We have an eight year old with ADHD- we're trying to keep him off of meds for as long as possible because of what SAHM said. I don't see getting off of them. Our son's ADHD is mild/moderate- it means good days and bad days.

I will revisit the meds question each year and not make a snap decision on a bad day or a bad week. There are a few things that would tip the balance In favor of medication, but we're not there yet.

As for potential-- sure, DS is performing below his potential. It has yet to make him unhappy-- and we're trying to work it through therapy for now. If/when therapy isn't enough and DS is struggling and not getting to where he would like to be, we'll see.

As for your question- a faster pace won't cure ADHD, but a slower pace will make the symptoms worse. We know this from first hand experience. I will involve my son in a discussion to take medication when he is older. Now, I wouldn't give meds to him unless I thought it was necessary, and if I thought it was necessary for safety and functioning, it wouldn't be his choice.

That explains the increase I have seen on the forums. I would be worried that I had medicated a child who if left may have turned out to be a very mildly ADHD or may have been misdiagnosed. I think I would always wonder. Unless the improvement is large and life changing I would delay a few years.

We have 2 kids...one probably has very mild ADHD and the other more severe. We tried meds with the mild child and the side effects outweighed any benefit (he wasn't eating lunch even on a really low dose). With the other child it makes an obvious difference and even she can tell when her meds kick in, when they wear off, etc. I've timed her numerous times doing simple math problems on and off meds and there is a huge difference. With the other kid, there was no major difference (although his IEP manager claimed there was but I just didn't see it).

This is such a personal decision and it depends on each individual kid/family. Some people are clearly pro-med, anti-med but it's not black/white like that, it just depends on so many factors.

I think the research shows that the majority of kids who start meds are no longer on them after a certain amount of time, and that in many kids (like half) they no longer meet the diagnostic crtieria of having ADHD once they hit adolescence. Whether or not they had been medicated or not does not play a role in how they function later.

DS9 was recently diagnosed with ADHD. We have tried two different meds; the first had horrible side effects, but the second seems to be much better.

Without meds, DS can function adequately (we homeschool). But it is difficult, and he has to work hard to focus on work he doesn't absolutely love. We have had to drop out of activities because he was unable to control his impulsiveness. He would get in trouble, frequently, which led to him to thinking he was a bad kid.

He is on meds just a few times a week: on those days when he has a class, or we have an academic-heavy day at home. It makes a huge difference in his ability to focus, to listen, and to not be distracting/annoying to other people. I believe his self-esteem has improved, because he doesn't have people (kids and adults) telling him he is being annoying all the time.

I still have mixed feelings about medication, but right now I think we are making the right decision. It's a tough one, though.

Thank you Knitting Mama. I have taken in all of the wisdom given to me on this thread and I am still confused. He has a great week and I think he is fine without meds. Then he has a rough week (getting emails at work from his teacher saying he is a mess) and I think he does need meds. Back to back weeks that are so different.

Yesterday we tried something different. We told him we were giving him his medication (but gave him a placebo). He had a much better day at school and said he was happy.

What to make of that???? I feel badly deceiving him but when we are contemplating stimulants as an alternative I rationalize that it is ok.