My son has been diagnosed with ADHD and will probably end up being diagnosed with a 'mood disorder' of some sort as well (the pediatric psychiatrist isn't overly concerned with labels) and we are working on having him tested (the woodcock-johnson) in the near future.

I'm curious, does anyone's child have major problems relating to the child's perceived idea of fairness/rules and perfectionism? My son has been having a lot of trouble with throwing tantrums/having fits at school, and in nearly every single case the root cause is something was, in his eyes, unfair - someone cut in line, someone touched his stuff, etc - or perfectionism/fear of failure - he's not going to finish his work or start on time, thus he's going to get a zero and fail second grade! We are starting on medication for his issues (Trileptal for the mood disorder and Concerta for the ADHD. The concerta is having zero effect so far!) but I'm wondering what else I can do to help him prevent these tantrums/fits?

Sounds familiar. We have similar problems during sports. Not at school as far as I know.

~raising hand~ Yes, same thing here with my son (age 7) with school and with extra-curricular activities. He's been diagnosed ADHD with anxiety (but which is more prevalent? good question!) and we have been working with a therapist for a little over a year and he's been on meds since spring. It is getting better, but it seems to come and go in waves.

I'm not sure if your evaluation is a full neuropscychological evaluation, but there could be a number of things going on such seeing shades of gray, difficulty with empathy or seeing things from another's point of view, anxiety and a need to have complete order and so on. These difficulties can be related to or as a result of ADHD or other mental health diagnosis.

Often times a child can be taught strategies to deal with these things. For instance how to label problems as very important, medium, and not important so that he can actively think about how he should respond.

Be sure to ask your evaluator to look into this and to address it in the recommendations.

He did not have a full neuropsychological eval, we've only been to see the ped. psychiatrist and a counselor. We are about to get on the waiting list for the Child Study Center where he will get a more thorough exam/assessment. He will be seeing the counselor on a regular basis, and I'm hoping that will help.

The labeling of problems sounds like a great thing to try!

My DS has Asperger's and has struggled with black/white thinking about fairness and having a hard time taking another's viewpoint (it was an accidental bump but felt to him like an attack, etc.).

We see anxiety especially in areas where he can't clearly see what the consequence will be (if I forget to turn this in, will I still get into college?). This can easily turn into a tantrum.

DeeDee

This sounds somewhat like my internal emotional world. Some of it, for me, is standard issue moral anger (improper violation of the ideal absolutist moral order):

"Joan's always fighting for a cause. Whatever it is, she's certain she's on the side of justice. She gets furious with people who disagree with her. She feels she has a right to be angry when someone has broken a rule. She feels outraged and wants to punish.

She suffers from black-and-white thinking, and refuses to understand people who are different from her. She has rigid ways of thinking when compromise and understanding would work better."

Random anger link:

http://www.invisiblecows.com/Download27.html

Of course, as an adult, I generally don't throw tantrums, being that they are frowned upon by polite society. I merely choke down the anger until it goes away.

It also depends on how much sleep I am getting. More sleep seems to equal less emotional storm.

I also talk myself out of vigalantism as an avocation. Yeah, it would be fun and I would feel really, really good about it, but I don't think the result would be pretty.

Just a thought, but what would happen if you the parents role-played gently regarding perfectionism issues. Imho, the perfectionism and seeing things black/white are related. The anxiety of not finishing, etc etc

Role play a lot of what-ifs with him so that he is prepared to see unfairness, that it is ok to not get a a perfect mark -- e.g. "oh horrors" what if I got that *all* wrong -- oh well, at least I think I'll learn something new, etc etc So if he responds to the role-playing. You know he is when he tells you that he thought about something differently.

Also try, as the parent, showing very clearly (slightly exaggerated way) how you're learning not to be a perfectionist. So when you make a mistake, so how disappointed you feel, then show how you will re-assure yourself that it is ok and how you'll move on from that... etc.

He needs to experience small successes and to see role-modeled to him ways to deal with knowing what *should/can* be versus what reality really looks like -- that is, full of mistakes and issues -- but "that is ok"

don't know if that helps, best wishes!

This sounds a lot like some of my PG Asperger's/NVLD son's behavior when he was younger. He also meets the Conner's scale criteria for ADHD (but primarily for behaviors related to his Asperger's /NVLD).

You might want to take a look at the book Bright, Not Broken: Gifted Kids, ADHD, and Autism which discusses numerous issues common in 2E kids, and make sure your clinician is familiar with Misdiagnosis and Dual Diagnosis of Gifted Children and Adults.

One more thought. "Not overly concerned with labels" strikes me as a little odd. I don't think labels define the child, but they sure do help both in getting the correct supports and services and in determining what and how to medicate. The therapeutic strategy would be quite different if it were a mood disorder vs. Asperger's vs. OCD. This is, to my mind, worth sorting out.

My instinct would be to get to a neuropsych and do a proper workup, because you'll be a better advocate for him if you know what he's dealing with.

DeeDee

This, this, a thousand times this!!!!

Thanks guys for all the feedback. I think the child study center is probably the only place around here where we are really going to get all the info we want, but the waiting list is quite long.

Just an update, day 2 on concerta and no negative behavior reports today! I am cautiously hopeful.

Interesting, the discussion here focuses on this as a 2E issue, but it was my understanding that over investing in "right" and "wrong" and outrage at injustice was an overall common gifted characteristic? Perhaps the extreme responses of some kids may be a consequence of ADHD, Aspergers, or other problems, but the concern for these issues itself seems to part of the gifted constellation, from what I've read. Too much emotional intensity combined with overdeveloped reasoning abilities in someone who doesn't have the world experience to put the "injustice" in proper context?

My DS age 7 has learned to better control his responses despite his ADHD. One avenue we have used is chess. In chess, there are clearly outlined rules, and there are actions and consequences. The Susan Polgar "win with grace, lose with dignity" adage also applies.

Before our interventions (therapy and meds), DS would react in an extreme manner to what DS perceived as not following the rules. Now, with lots of effort and practice, his reactions are more calm and measured. Some of this is likely maturity, but I think lots of it is due to the steps we have taken together.