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This happened to us as well (sort of). The difference is that we have an ADHD diagnosis from one psychologist and another psychologist who thinks DS8 is ASD suggested using the ADHD meds diagnostically, and "when you see that they don't work, you'll see that it's ASD and not ADHD." I just smiled politely while I was shoveling everything he said into my brain's trash bin.


I'm not sure if this is true, although you hear stories of people trying to buy meds so they can score better on tests. I don't know. I would think that if the medication wasn't right there might be side effects?



We haven't done it either. We are also not opposed to meds in the right situation, and if DS's diagnosis was clear cut we may have tried them. However he's a bit of an enigma, and I'm not a fan of medicating diagnostically.

Yes! This sums it up nicely for me too

Thanks for all the thoughtful comments. We thought this year was going well until a couple of weeks ago and so are the more disappointed to find out it's not. epoh, I simplified the explanation--the psychologist showed us a questionnaire from the teacher, which indicated 'clinical' levels of I think inappropriate physical activity (can't remember the technical term) and suggested that we consider medication--for which I assume she would refer us to a physician, so I'm not worried about that part of it. DeeDee--I agree; we are going to go forward with seeing a specialist, particularly now that DD is still having difficulty with school behavior. We're just working with this local psychologist at the teacher's request to try to help improve DD's behavior and help the teacher deal with her, which I think is helping the teacher somewhat even though she's not seeing the improvement in DD's behavior we had all hoped for. I'm in the process of trying to arrange further appointments with a specialist, but it's an eight-hour drive (or a 3-1/2 hour drive, if I can hook up with another new one, which I may need to do if it's going to take more than one or two sessions). I just liked this psychologist and thought we were kind of on the same page more or less and plus I had shared our concerns about 2e stuff not being handled well at all last year, so I was disappointed when she seemed to jump over all that and suggest medication--without a formal diagnosis. And as I've said, I'm really not convinced DD has ADHD--I think she's 'gaming the system' to get out of stuff she considers boring by, for example, going to the bathroom or going and getting a book to read. I wish the teacher would try some kind of 'point system' or something with DD because I think that would work well, but the teacher is being as nice as possible and is really trying in her own way, so we really can't complain. But it's still very frustrating, especially because we have had some great teachers in the past and so I really think DD can succeed in the right environment, without medication. I guess we'll tell the teacher and psychologist that we need a diagnosis and will be seeing a specialist about it before considering medication, but I bet that won't make either of them very happy. Thanks again for all the thoughtful comments--it really helps to bounce this off other people besides DH, who is also somewhat upset by all of this.

So she gets up and moves around, and/or tries to leave? What else?

The specific kind of psychologist is important. A talk therapy type of psychologist isn't going to be able to do much about this. A behavior therapist would get some traction by helping your DD get any missing skills and incentivizing her to change her habits, preferably after observing her in the classroom and strategizing with her teachers.

Behavior therapy is notoriously ineffective for ADHD in elementary-age children; if that *were* the problem (not saying it is) meds would be the likeliest strategy for the medium term while working on building other skills.


That would also be a classic autism spectrum move: not valuing the activity for its own sake, and not feeling the social cues that suggest that one should do it anyway, one just leaves. (Again, not saying she has ASD either-- I don't know.) One can learn to stay checked in, but lots of positive reinforcement and skill-building may be needed.


It is not your job to make them happy.

I'm glad you are pursuing a diagnosis-- if you see the right expert, it will make a huge difference in your (and the school's) ability to see what your DD needs.

DeeDee

My DD has spent a LOT of years using both of these things as avoidance tools. There's absolutely no pathology going on-- she's just figured out that these are generally techniques that result in at least SOME intrinsic reward in addition to the primary goal of avoidance, and tend to be less readily called out for what they are... and therefore, they are more successful in terms of manipulation of the situation to what she sees as her advantage (wheee-- I didn't have to do math today! Bonus!).

I mention that because of this statement:



That seems like a real red flag to me, though I'm admittedly no expert on either ADD or ASD. If she responds to some environments and people with completely appropriate behavior, then it doesn't seem very likely to me that this is either thing. Or am I misinterpreting that you've had prior placements that worked well?


Is it possible that your child has just figured out that this particular authority figure is especially amenable to this kind of manipulation?

Does your DD tend to manipulate adults in other situations when it suits her?

(Mine does, though it's very deft and very subtle-- it takes someone who REALLY knows her well to see it for what it is.)

DeeDee--she also has difficulty making friends with some kids and behaving in socially appropriate ways (although she has a handful of BFFs--if she gets along with a kid, they usually get along great and can resolve disagreements without help). She usually overreacts if there is a change in plan so that she doesn't get, or get to do, something she was really looking forward to (i.e., pitches a fit)--but not all the time; she doesn't have a problem in changes with routine. So there are definitely some ASD-type issues, but we only see social issues, not the repetitive/restricted stuff in the "B" part of the DSM list. But these social issues can be managed, and we manage them at home with reminders and incentives/disincentives--to Howler's point, she very definitely can and does try to get away with doing what she wants, and explores the limits with every adult she knows. So the teachers she had in the past who called her on her behavior right away and had some incentives saw (from what we heard) much better behavior overall although there were still some problems with her hugging other kids too much, overreacting to joking/teasing, etc. that needed guidance and correction. She has an excellent abstract understanding of what is appropriate, but seems unable to put it into practice in the moment, which I think can easily be confused with what I think is the other part of just not caring about other people's priorities and wishes--which I kind of think of as the 'gaming' behavior, because she often gets more of what she wants that way. It's kind of funny, too, trying to explain this in a polite way to babysitters--but at least that's only for a couple of hours, so she can't do too much damage This discussion has been really helpful, though, in crystallizing what I think we need to do next, although it doesn't really solve our problems with finding a good school for her--we don't have too many options here.

Hi Dbat--

I can see why she's hard to diagnose, yet I can also see where it would be beneficial to have school actively and systematically working on these issues, which probably only will come with an IEP.

The social misunderstandings tend to get worse approaching teenagerhood, where the rules become less black/white and other kids get more subtle; if you can get help in addressing this in the elementary years, it's a good idea.

I know what you mean about the manipulation/gaming. In my DS's case it's not so much that he sets out to be manipulative; it's just that what he wants is so much more present in his mind than what we or teachers want that it sometimes takes a big effort for him to stay on track.

DeeDee

ultramarina

Thank you for posting this article!


http://www.nytimes.com/2012/10/09/health...pagewanted=1&hp

I saw that a couple of weeks ago when it was just published. I was HORROR-stricken. I think that article may be one of the most chilling things that I have read in a long, long, LONG time.

This gets to what I have been saying for years, by the way-- that 'trialing' drugs is just very seldom as clear cut as clinicians would like to think, precisely because they do impact pretty much everyone in quite predictable ways. There is no such thing as "paradoxical" effect in terms of the pharmacology involved, in spite of popular mythology. What is also true is that underlying cardiac abnormalities can be catastrophic with ANY of these drugs. Many drugs have seeming paradoxical effects in pediatric populations, too. But that doesn't reflect the underlying pharmacology, per se. That's just pediatrics-- it's known to be goofy. Probably the reason has a lot to do with undeveloped neurological function, at least in psychotropics.

These drugs will help with certain executive function just as anabolic steroids will "help" just about anyone in terms of building physical endurance and muscle mass, not just those people who have a "need" for steroids to treat medical conditions. Also similar is that such a truth does nothing to diminish the real conditions that require steroid treatment.

Anyone that uses caffeine should know better than to think that: a) there's no observable benefit unless you are "deficient" somehow, and/or b) they aren't really addictive, so it's fine to just "try" them and see. Docs who think that, IMO, probably ought not have the ability to prescribe things that they don't understand. I realize that sounds pretty harsh, but physicians who hand out stimulants and SSRI's (among other catecholaminergics) like candy are really playing with fire, IMO.

Dbat, I hope you find the right provider for dd. It sounds like this psychologist really broke your trust. It is so difficult to pull apart the small nuances of ADHD vs ASD while keeping in mind giftedness. You may find that there is no "exact fit " and that her diagnosis nay change over time even as she matures. You've mentioned hoping the teacher would set up an incentive system. I wouldn't worry to ask the teacher about this. A well-planned system will hopefully decrease the amount of correcting/reminding/reprimanding a teacher needs to do. It can also be very helpful to see how much influence a child really does have over their behavior. Kids who are extremely hyperactive/impulsive may not be able to suppress their symptoms even if motivated to earn a reward.

As for the article, 15 years working in the mental health system leaves me jaded. There are many, many things (overprescribing meds to kids, using psych hodpitalization as respite, faking ADHD to get drugs to sell them)
that no longer surprise me. That in itself is sickening.