Gifted Issues Discussion homepage Forums Twice Exceptional New, and you'd think I'd have a clue...

I'm new to the forum and don't entirely know what I'm looking for at this point other than reassurance and guidance. I was tested and placed... somewhere in the highly gifted range in my younger childhood years. I have little information on this, but I know what it is like to live as such and go through the public school system. My son's father, who was homeschooled, has been recently diagnosed and treated for ADHD.

I shouldn't be terribly surprised that our DS4 is showing signs of being both.

DS4 has a history of seizures from early infancy, tethered cord syndrome, and sensory processing difficulties. As such, he was referred by his neurologist to a developmental pediatrician who diagnosed him as ADHD -- coincidentally, one week after his father. (So bear in mind that this is all fresh for everyone.) He was also referred out for OT to address fine motor delays and sensory processing.

Now any adult who meets DS is immediately smitten. He's a charming little chatterbox with an inventive mind, and it genuinely is fun to hear him share his thoughts and ideas. Sometimes he seems more like a 4th grader than a 4 year old. But there is another side to him that has been particularly troubling; I was forced to take him out of preschool at the end of 2016 due to a loss of control with his classmates and a series of aggressive outbursts. He's a cannonball. Whether it was over-stimulation in the classroom, impulse control, or a simple overreaction from a determined little boy, I don't know.

Now his dad and I, though we've broken up, have stayed united in parenting -- until now. His dad sees everything DS does through the ADHD lens and wants him put on stimulants. (DS is currently on a non-stimulant medication for impulsivity after a few episodes of running out in the street last month.) I, however, am concerned that his dad is overreacting. Sometimes I look at our son and think, "There's nothing ADHD about what he is doing right now. He's just being a goofy, random, energetic little boy." Or I think, "All of this emotional intensity is just how he feels and experiences his world. What's wrong with that?" He responds well to comfort in many cases.

We both want the best for our son, and each of us has concerns. I don't want the overflow of potential giftedness (or even, let's be real, normal childhood) to be mislabeled as a product of ADHD because my ex is suddenly hyper-aware of how his own disorder has impacted him. My ex doesn't want his son to go through decades of internal chaos when there are treatments readily available that could help him better tap into his many strengths.

This is not to say that I do NOT think DS has ADHD. What I am more concerned about is over-labeling in such a way that it stifles our son's ability to be a little boy with a big personality.

Most importantly, we don't want to do anything to hinder his social and emotional development by action or inaction. Even now we're trying to get him re-enrolled for school. We want him to feel his best in whatever environment he's in, and though there were difficulties with classmates before, DS needs to be around people to feel his happiest. We want to make that happen for him.

Thoughts and feedback welcome. Thank you for taking the time to read!

Hi astronomama,

I would only be speaking from very limited experience, so instead I would ask the question to others who will hopefully respond:

Isn't it terribly early to diagnose a child with ADHD at age 4? And isn't there at least a chance that his behaviour has more to do with overexcitabilities rather than ADHD? There's at least one book on misdiagnosis as it relates to giftedness, I wonder if it might be worth questioning. I don't want to offer false hope, but it seems awfully young for a diagnosis.

We had some serious concerns with DS7 when he was around 3 and 4 years old. Luckily for us, his emotional intelligence has essentially caught up to his "big feelings" (as we all call them). In his case, it seems that it may have been an issue of asynchronous development more than anything else. He is doing significantly better now.

In any case, good luck!

Welcome!
You've received great advice above.
I'll just add a roundup of a few links to resources which may be helpful if you wish to explore some of the ideas further:
- Understood.org: ADD/ADHD
- Understood.org: 5 things not to say to your child about ADHD
- Understood.org: The Difference Between Sensory Processing Issues and ADHD
- Wrightslaw: ADD index
- SENG video: The Misdiagnosis of Gifted Children
- book: Misdiagnosis and Dual Diagnoses of Gifted Children and Adults

Can I suggest www.addforums.com ?

Dizfriz's corner especially:
http://www.addforums.com/forums/showthread.php?t=60130

I agree with RRD. I think it IS really early to diagnose with ADHD for a 4 year old. I would get a second or even third opinion just to be sure. Personally, I would not feel comfortable put my kid on stimulant at this young age. I would want to be 100% sure of the diagnose and only use stimulant when it is absolutely necessary.

Making decisions about whether or not to medicate a kid with stimulants can be agonizing. I totally get where both you and your son's father are coming from - and the concerns above about labelling - never mind medicating - a four-year-old as ADHD.

I guess the way I would try to come at it is - - - does your son find that he does things that he can't control, can't explain, and is this behaviour making him unhappy? Could the meds help him be the person he wants to be?

Or is he happy being who he is, and the meds would just try to make him into the more compliant, normal person that others - say teachers - want him to be for their convenience?

Would meds help him access and thrive in an appropriate, challenging educational environment that is meeting his needs? Or would they be to get him to stay still and quiet in an environment full of inappropriate behaviour expectations and/ or insufficient engagement?

Could you make a deal with his father that you won't let him suffer through school but you would like to wait a few more years because it could be he is just a 4 year old. They used to not diagnose before 7? For this reason. I remember seeing checklists where behaviors had to persist past 6.

Welcome to the forums astronomama. You've received great advice above already, I have just a few thoughts to add. I'll also mention up front - I'm not a professional, only a parent with two children who are identified as 2e.

Re giving meds at a young age - I've worked with a few kids who were obviously ADHD and who obviously benefited from taking medication. I know medication works when administered appropriately. As a parent, I'd want to know the possible side effects of any meds before agreeing to them - for instance, one of my children is extremely anxious, and we were cautioned against letting a dr prescribe stimulants because they could potentially ramp up anxiety. I would also, from personal experience, want to first exclude any other possible diagnoses which might be presenting symptoms similar to ADHD.

Both of my 2e children were thought to have ADHD by professionals (either teachers or doctors) who observed them in one setting, but after being evaluated through neuropsych evals, were found to not have ADHD, but instead have different challenges which exhibited some symptoms in common with ADHD. For both of my children, had we first gone with the ADHD diagnosis, we would have missed valuable time accommodating and remediating the actual challenge, and now looking back in time, my one wish is that we'd had a correct diagnosis much earlier in each of their lives.

There are a few mentions re age of diagnosis above - my children are almost grown up, but back when they were young ADHD wasn't diagnosed until children were in school - prior to school age, children were thought to be too young, and diagnosis also depended upon the child exhibiting the same behaviors in two settings (typically school and home). At some point in time (I don't remember exactly when), I believe that the organization which most pediatricians belong to in the US (also can't remember the name of the org!)... came out with a revised set of guidelines re ADHD diagnosis and recommended diagnosing before school age was ok and also appropriate, because it allowed children to receive help before they went through needless years of dealing with untreated ADHD.

I wonder if, in part, if your ds' eagerness to treat is related to his recent discovery that he has ADHD (I hope I read the info you posted correctly). One thing I found when my children were young and we were in the process of trying to figure out what was going on with them - was that, at least in our local area, there were doctors that we could go to who would diagnose ADHD. That was the sole center of their practice, yet most professionals at the time felt ADHD should be a diagnosis made only after other possible diagnoses had been ruled out.

Last note - you mentioned he's been kicked out of a preschool. While 4 year olds can be crazy, quirky, wild, etc - most 4 year olds don't get kicked out of preschool. It sounds like he's had a big challenge of some sort. Have you tried a different type of preschool setting? For example, was his first preschool academic or play-based? Were the teachers kind and caring or not-so-much? Have you observed him having trouble getting along with children his age outside of preschool? We don't need to know the answers to those questions, but they are questions to consider. One thing I found as the parent of a 2e child early on is that I didn't see that there were actual challenges, I only say the "different" behaviors as cute, quirky and part of his personality. Often I attributed them to his intellectual gifts, which were obvious when he talked. I didn't realize a child could be extremely high-IQ and also have very real challenges... and I wish I had. By the time my ds was diagnosed he was in the second half of second grade, and he'd been through so much internal anxiety over the things he was struggling with that went unrecognized by the adults in his life... he was having panic attacks and on the verge of a serious depression. Had we recognized his challenges at 4, we'd have been able to transition him into elementary school with proper support and accommodations, and that would have made a *huge* positive difference in his life. He's very close to heading off to college now, but the fall-out from his years of early struggles has left a lasting impact that he's still struggling with today in spite of having made amazing strides.

Sorry I've rambled on so long - I wish you much luck with getting a better understanding of what's going on with your ds.

Best wishes,

polarbear

FWIW, the AAP now endorses diagnosis of ADHD down to 4 years old, but meds are not first line treatment in this age group:

https://www.cdc.gov/ncbddd/adhd/guidelines.html

ETA: AAP = American Academy of Pediatrics

I guess because I forgot I ever posted this and someone might stumble upon it with a similar situation, I should provide some updates.

1) Son was tentatively diagnosed ADHD at 4, definitively at 6, and has been on a non-stimulant Rx for impulse control specifically since that time. We've experimented with stimulants but have never been able to find the right one at the right dosage. (They all destroy his sleep which is already a delicate matter since infancy.)

2) Son was later determined to have sensory processing challenges, but not autism, after an evaluation at age 9.

3) Son tested into his school's gifted program at age 8. He was recently retested at the school's request and his scores on the CogAT were 152 Composite (132 Verbal, 148 Quant, 151 NV). His TerraNova scores were much less impressive and we're currently trying to understand the source of the gap between aptitude and achievement.

4) Still wants to be an astronomer after 8 years, but also now an aerospace engineer so he can use his knowledge of astronomy to better design spacecraft and technology suited for deep space exploration.