As aeh notes, there is significant overlap in the symptoms for AHDD-inattentive and auditory processing disorder (APD). Our DD when 7 was assessed by a specialist audiologist to rule out APD before confirming ADHD. The audiologist explained in detail exactly how the combined tests allowed her to separate out whether task performance was affected by auditory issues vs. attention. It was (fascinating and) highly informative.
By the end of grade 2, DD, though not the most self-aware, was able to articulate fairly clearly how much she herself was frustrated by her struggles to maintain attention in the classroom.
So would APD also lead to impulse control issues and physical hyperactivity symptoms? I guess maybe I should have a more specific open discussion with DS. We have had discussions about how he feels when he gets in trouble for things, and touched on his difficulty keeping his hands to himself, but you are right, he is getting old enough I can probably start to get more information out of him on how his experiences are affecting him.
I guess it would be helpful to describe some of the problems we are actually having/seeing. Now originally he had a PDD-NOS diagnosis, he has since been assessed as not being on the spectrum, but his current psychologist is factoring in ASD possibilities as well, although the current thought is that it is more an impulse control issue than a lack of social understanding . . .
At school, there is trouble with him blurting out answers, wanting to talk incessantly and not listen to peers, getting out of his seat and getting into his peers space, getting very emotional and upset, having angry outbursts when he gets frustrated,
At home we have problems with staying on task, we have been working on the morning getting dressed routine since he was in ABA therapy at age 3, currently he has a laminated checklist for the morning, but he will swing his socks around his head, or start playing a game when he is halfway dressed, I continuously redirect him to the task. We have tried a number of reward systems and timers over the years, and he gets really excited for a couple of days or maybe a week, but then its like he gets bored with it as it is no longer novel, and it stops working. We always make the expectations and steps very clear. And sometimes I just think, how can we have been working on this for nearly 4 years, and still its such a big struggle. How are we supposed to tackle everything else if we can't even get this one thing sorted? Even if he is really excited about where we are going, like to a birthday party, if I send him down for a pair of socks from his room, I will find him reading a book.
We are finding homework a real challenge. He will spend about a minute on it before he wanders off to do something else. This is okay this year, but he will be going to year 3 next year . . .
He also has a lot of difficulty keeping his hands off of things. this is at home, or when we are out. In doctor's offices he will get up, and start grabbing at things in the office, he will be told by me and the doctor to leave them be. We have found a countdown to be quite effective to get him to stop a behaviour, but he cannot stay still for long before he starts grabbing for something else, or the same thing again. My parental instinct on this one is not that he is intentionally ignoring, but rather that he has a really hard time controlling his actions.
As far as hyperactivity, he is always on the go. In the evenings he can be focused on reading a book, but his body is never still, he will be kicking his legs up and down as he reads. When I was sitting next to him and asked him could he stop as he was bumping me, his legs stopped, but at the same time he started humming to himself as if he needed some outlet for the energy, then the humming stopped and the legs started again. Or if we have a family movie night, he sits next to me then starts climbing on me or rolling over me. Lots of times I think he is doing the pee dance, but he is actually just bouncing around.
His psychologist recommended I take a look at a book entitled Smart but Scattered, and it breaks EF down into 13 or something categories, and you can find your child's areas of strength and weakness, I was a bit disheartened when he scored in the low range on every single category.
All this being said, in so many ways he is such and affectionate, thoughtful little fellow, he definitely has strong emotions, and he can be quite empathetic. I know our management at home could be better, but I think we do a lot of positive things, and sometimes it just all seems to be falling apart despite our best efforts. It seems like hard work most of the time, and I know it is exhausting for him as well as us. He really conceptually grasps all the interventions we have done with him over the years, but he struggles to apply them day to day.
But he has managed to do fairly well in year 2 with his grade skip, and I know he puts a lot of effort in at school to try to behave well. His teacher is very good for him I think.
