Question about possible ADHD

[macchiatto]

I have posted here about our son with special needs, but I am wondering now about his theoretically typically developing twin, "Oliver." Oliver has always been high-energy, spirited, intense, talkative, and a handful. I think he has some sensory seeker tendencies although he wouldn't meet full SPD criteria. I have thought for a while that he is probably in the normal range but I wouldn't be shocked if he ended up with an ADHD diagnosis at some point. Recently I've been wondering more if I should be looking into that more seriously.

He had 2.5 years of preschool and is now in Kindergarten. He did pretty well in preschool other than in his 3's class, when he got off on the wrong foot with his teacher and was frequently in trouble all year (mostly for "play fighting"); she even made an idle threat that spring about kicking him out of preschool if his Bx didn't improve. In K, he has come home on "green" most days (it's a green/yellow/red system), with 2 each of yellow and red days. However, he does tell me quite frequently that he had to walk laps at recess for various infractions, which seems to be an intermediate punishment.

He usually finds a best buddy or two at school who's also high-energy and early in the school year they have to be separated. We've gotten feedback several times from his K teacher that he needs reminders to wait his turn to talk during circle time, keep his hands to himself, focus on his work rather than on other children, etc. They do have recess twice a day and frequent movement breaks during instructional time (which we looked for when choosing a school, knowing his energy level).

This winter he played basketball for the first time and while he did want to play, it jumped out at us during practice/games that he seemed a lot more distractible and less focused than the other children. For context, his league was ages 6-7 and he had just turned 6 so this may have been just an age/maturity thing. Then his teacher mentioned last week that he's not as focused as she would like, that he pays attention pretty well during whole-class instruction but when they're working in their seats, he tends to lose focus, wander, socialize and need frequent redirection. I asked her if she thinks he's in the normal range and she said, "Definitely in the normal range; he's very active and interested in everything." 

I also have a friend who's a child psychologist and has spent a good bit of time around my boys. I asked her recently if she thought he might have ADHD (which was her specialty during her dissertation and she said) she thought it was possible; that to her (without formally assessing him, of course) he seemed possibly borderline between normal high-energy and ADHD and it might be worth looking into. Leo's EI, who was around both boys weekly for 3 years at our home, had the same opinion.

My question after this very long post: Given this information, would his Kindergarten teacher's response completely ease your mind? She has 30 years of experience and has had DS in her classroom for 7 months now. (The teachers he's done well with all had a few decades of experience; the 3's teacher had a year or two.) I don't want to see a Dx behind every corner but I also don't want to take my theoretically "typically developing" child for granted. I think we may struggle more with his behavior at home than the teachers do at school, but I'm also wondering if he's going to struggle more in 1st grade and beyond when it's less play-based, only one recess a day, more homework, etc., or with a less experienced and understanding teacher.

[hopecounts]

Given that his current teacher feels he is in the norm I would wait and watch.

IME most teachers don't hesitate to be honest if they feel ADHD needs to be explored if a parent asks, though they may phrase it carefully 'it might not hurt to talk to his pediatrician' 'if you are concerned it's probably a good idea to speak with a specialist' etc
It maybe he is normal for kindy but next year it becomes an issue, it may also be that he is just a high energy kid and as he matures it'll remain a mild issue but within the norm and fade a bit as he grows up.

[mrsbuttinski]

Mar 25, 2015 13:26:12 GMT -5 macchiatto said:

I have posted here about our son with special needs, but I am wondering now about his theoretically typically developing twin, "Oliver." Oliver has always been high-energy, spirited, intense, talkative, and a handful. I think he has some sensory seeker tendencies although he wouldn't meet full SPD criteria. I have thought for a while that he is probably in the normal range but I wouldn't be shocked if he ended up with an ADHD diagnosis at some point. Recently I've been wondering more if I should be looking into that more seriously.

That could be the description of a kid with a potential ADHD dx in his future or not. "Spirited" is often dx'able as ADHD down the line.

He had 2.5 years of preschool and is now in Kindergarten. He did pretty well in preschool other than in his 3's class, when he got off on the wrong foot with his teacher and was frequently in trouble all year (mostly for "play fighting"); she even made an idle threat that spring about kicking him out of preschool if his Bx didn't improve. In K, he has come home on "green" most days (it's a green/yellow/red system), with 2 each of yellow and red days. However, he does tell me quite frequently that he had to walk laps at recess for various infractions, which seems to be an intermediate punishment.

He usually finds a best buddy or two at school who's also high-energy and early in the school year they have to be separated. We've gotten feedback several times from his K teacher that he needs reminders to wait his turn to talk during circle time, keep his hands to himself, focus on his work rather than on other children, etc. They do have recess twice a day and frequent movement breaks during instructional time (which we looked for when choosing a school, knowing his energy level).

That's great that they get 2 recesses plus movement. The "laps" catch my eye. That sounds like my MIL's old school approach to "getting the wiggles out". FTR, she didn't believe in ADHD, just that some kids were immature, fidgety and dreamy by nature. She used to brag to all who would listen about how DS's the the most social of her sons and grandsons. WTF? Despite her arcane ideas on the subject, she was a good teacher who did whatever it took to help a kid be successful in the classroom.

This winter he played basketball for the first time and while he did want to play, it jumped out at us during practice/games that he seemed a lot more distractible and less focused than the other children. For context, his league was ages 6-7 and he had just turned 6 so this may have been just an age/maturity thing.

This would concern me. Well developing kids will take their behavior cues from the behavior of kids around them. Even if he was one of the youngest, a fully typical kid would raise his level of behavior to meet the other kids.


Then his teacher mentioned last week that he's not as focused as she would like, that he pays attention pretty well during whole-class instruction but when they're working in their seats, he tends to lose focus, wander, socialize and need frequent redirection. I asked her if she thinks he's in the normal range and she said, "Definitely in the normal range; he's very active and interested in everything." 

I kind of side eye that. First she describes behavior consistent with ADHD and then she dismisses it as a concern. If it's so "normal" why is she reporting it as she is. How many other kids are red/yellow and walking laps?

I also have a friend who's a child psychologist and has spent a good bit of time around my boys. I asked her recently if she thought he might have ADHD (which was her specialty during her dissertation and she said) she thought it was possible; that to her (without formally assessing him, of course) he seemed possibly borderline between normal high-energy and ADHD and it might be worth looking into. Leo's EI, who was around both boys weekly for 3 years at our home, had the same opinion.

This is interesting information. Based on this, I would consider an eval if he doesn't mature between now and first. A lot of kids make a big leap emotionally and in terms of self regulation around 6; he could look different by the fall.

My question after this very long post: Given this information, would his Kindergarten teacher's response completely ease your mind? She has 30 years of experience and has had DS in her classroom for 7 months now. (The teachers he's done well with all had a few decades of experience; the 3's teacher had a year or two.)

The teacher wouldn't ease my mind at all. Not saying I think your kid has ADHD, but I think you should keep it on your radar given what your friend and EI person have shared. I also wonder if your teacher is one of those old school teachers like my MIl who doesn't "believe" or thinks ADHD is over-diagnosed or an excuse parents give for challenging behavior.

I don't want to see a Dx behind every corner but I also don't want to take my theoretically "typically developing" child for granted. I think we may struggle more with his behavior at home than the teachers do at school, but I'm also wondering if he's going to struggle more in 1st grade and beyond when it's less play-based, only one recess a day, more homework, etc., or with a less experienced and understanding teacher.

Could happen if behavioral expectations ramp up. DS's first grade transition really revealed his impulsivity and inattention compared to kindie. I would also be concerned because kids who have differences such as you describe Leo's often have sibs who have subtle differences too. I expect this would be more likely since thy're twins, especially if they were preemies.

[akafred]

I can't really answer the question about whether to do an eval or not, but it sounds like he isn't having any real behaviornissues. It seems like a kid who is over the line in the ADHD category would be getting more yellows and reds.

At this point, given it is too late to get an IEP in place for this year anyway, I would probably wait and see how the first 6-8 weeks of first grade go before pulling the trigger. But I would watch for sure.

[macchiatto]

Mar 25, 2015 15:32:16 GMT -5 mrsbuttinski said:

Mar 25, 2015 13:26:12 GMT -5 macchiatto said:

I have posted here about our son with special needs, but I am wondering now about his theoretically typically developing twin, "Oliver." Oliver has always been high-energy, spirited, intense, talkative, and a handful. I think he has some sensory seeker tendencies although he wouldn't meet full SPD criteria. I have thought for a while that he is probably in the normal range but I wouldn't be shocked if he ended up with an ADHD diagnosis at some point. Recently I've been wondering more if I should be looking into that more seriously.

That could be the description of a kid with a potential ADHD dx in his future or not. "Spirited" is often dx'able as ADHD down the line.

He had 2.5 years of preschool and is now in Kindergarten. He did pretty well in preschool other than in his 3's class, when he got off on the wrong foot with his teacher and was frequently in trouble all year (mostly for "play fighting"); she even made an idle threat that spring about kicking him out of preschool if his Bx didn't improve. In K, he has come home on "green" most days (it's a green/yellow/red system), with 2 each of yellow and red days. However, he does tell me quite frequently that he had to walk laps at recess for various infractions, which seems to be an intermediate punishment.

He usually finds a best buddy or two at school who's also high-energy and early in the school year they have to be separated. We've gotten feedback several times from his K teacher that he needs reminders to wait his turn to talk during circle time, keep his hands to himself, focus on his work rather than on other children, etc. They do have recess twice a day and frequent movement breaks during instructional time (which we looked for when choosing a school, knowing his energy level).

That's great that they get 2 recesses plus movement. The "laps" catch my eye. That sounds like my MIL's old school approach to "getting the wiggles out". FTR, she didn't believe in ADHD, just that some kids were immature, fidgety and dreamy by nature. She used to brag to all who would listen about how DS's the the most social of her sons and grandsons. WTF? Despite her arcane ideas on the subject, she was a good teacher who did whatever it took to help a kid be successful in the classroom.

Yeah, I'm not sure what I think about the laps. FWIW it sounds like the laps are a school-wide thing or at least Kindergarten-wide.

This winter he played basketball for the first time and while he did want to play, it jumped out at us during practice/games that he seemed a lot more distractible and less focused than the other children. For context, his league was ages 6-7 and he had just turned 6 so this may have been just an age/maturity thing.

This would concern me. Well developing kids will take their behavior cues from the behavior of kids around them. Even if he was one of the youngest, a fully typical kid would raise his level of behavior to meet the other kids.


Then his teacher mentioned last week that he's not as focused as she would like, that he pays attention pretty well during whole-class instruction but when they're working in their seats, he tends to lose focus, wander, socialize and need frequent redirection. I asked her if she thinks he's in the normal range and she said, "Definitely in the normal range; he's very active and interested in everything." 

I kind of side eye that. First she describes behavior consistent with ADHD and then she dismisses it as a concern. If it's so "normal" why is she reporting it as she is.

Good question. FWIW, I had asked her if he was starting to fall behind in reading (she said he's right on track but lacks confidence) and she brought that up as part of her response. She was kind of describing how he is overall as a student.

How many other kids are red/yellow and walking laps?
It does sound (from Oliver's reports and my observations when chaperoning, etc.) that there are 3 other boys in their class of 17 who get in trouble a lot more frequently than Oliver does. 

I also have a friend who's a child psychologist and has spent a good bit of time around my boys. I asked her recently if she thought he might have ADHD (which was her specialty during her dissertation and she said) she thought it was possible; that to her (without formally assessing him, of course) he seemed possibly borderline between normal high-energy and ADHD and it might be worth looking into. Leo's EI, who was around both boys weekly for 3 years at our home, had the same opinion.

This is interesting information. Based on this, I would consider an eval if he doesn't mature between now and first. A lot of kids make a big leap emotionally and in terms of self regulation around 6; he could look different by the fall.

That makes sense; thanks. What kind of professional would you recommend for an eval specifically for ADHD concerns? Child psychiatrist? Devel pedi? (Based on our frustrating, disappointing eval experience with Leo in this district last year, I would want to at least start with the private eval route.)

My question after this very long post: Given this information, would his Kindergarten teacher's response completely ease your mind? She has 30 years of experience and has had DS in her classroom for 7 months now. (The teachers he's done well with all had a few decades of experience; the 3's teacher had a year or two.)

The teacher wouldn't ease my mind at all. Not saying I think your kid has ADHD, but I think you should keep it on your radar given what your friend and EI person have shared. I also wonder if your teacher is one of those old school teachers like my MIl who doesn't "believe" or thinks ADHD is over-diagnosed or an excuse parents give for challenging behavior.

I found myself wondering that, too.

I don't want to see a Dx behind every corner but I also don't want to take my theoretically "typically developing" child for granted. I think we may struggle more with his behavior at home than the teachers do at school, but I'm also wondering if he's going to struggle more in 1st grade and beyond when it's less play-based, only one recess a day, more homework, etc., or with a less experienced and understanding teacher.

Could happen if behavioral expectations ramp up. DS's first grade transition really revealed his impulsivity and inattention compared to kindie. I would also be concerned because kids who have differences such as you describe Leo's often have sibs who have subtle differences too. I expect this would be more likely since thy're twins, especially if they were preemies.

Good points! (They were at least full-term.)

Thank you for your response!

And hopecounts and @akafred, thank you for your responses, too!

[akafred]

I know this isn't worth much since DD almost certainly DOES have ADHD, but her teachers make her run laps too, before she sits down to read. She thinks it's hilarious.

I know this ALSO isn't worth much but we went for a private eval since DD is in private school. The dev pedi did nothing except apparently "6 month" us to death, and finally after a year the psychiatrist in the same office said, "I told the dev pedi that we will not consider an ADHD dx or treatment until she fails in public school." Never mind she isn't going to GO to public school and "failure" seems like a pretty strong standard.

[KC thepouchh8r]

As someone with ADHD who wasn't diagnosed until adulthood I wouldn't let a teachers opinion convince me one way or the other. I'm not trying to discredit an experienced teacher just that it's best to ask the professionals who are at liberty to diagnose.

[NariaDreaming]

Mar 25, 2015 21:08:48 GMT -5 KC thepouchh8r said:

As someone with ADHD who wasn't diagnosed until adulthood I wouldn't let a teachers opinion convince me one way or the other. I'm not trying to discredit an experienced teacher just that it's best to ask the professionals who are at liberty to diagnose.

This. I also wasn't diafnosdd until adulthood, as I typically did well in structured classroom settings.

The thing that jumped out at me was the distractability at basketball. I played softball, and I was the kid picking dandelions in the outfield

[mcribster]

I wouldn't let anything that anyone says completely ease my mind. Ever. It's a moving target- he may look good today in her class but a year from now under different circumstances it may be a whole other ball game. I would also look carefully at his diet. A lot of the things you are describing may be managed by pulling certain foods that are excitatory (sp!) to his nervous system. Red dye, preservatives such as BHT, sugar. Something to consider. We went a bit further with my DS (gfcf) but the focus/engagement/attention span and sensory issues all improved Hugely with a few simple diet tweaks.

[bubbalicious]

Mar 25, 2015 13:26:12 GMT -5 macchiatto said:

I have posted here about our son with special needs, but I am wondering now about his theoretically typically developing twin, "Oliver." Oliver has always been high-energy, spirited, intense, talkative, and a handful. I think he has some sensory seeker tendencies although he wouldn't meet full SPD criteria. I have thought for a while that he is probably in the normal range but I wouldn't be shocked if he ended up with an ADHD diagnosis at some point. Recently I've been wondering more if I should be looking into that more seriously.

He had 2.5 years of preschool and is now in Kindergarten. He did pretty well in preschool other than in his 3's class, when he got off on the wrong foot with his teacher and was frequently in trouble all year (mostly for "play fighting"); she even made an idle threat that spring about kicking him out of preschool if his Bx didn't improve. In K, he has come home on "green" most days (it's a green/yellow/red system), with 2 each of yellow and red days. However, he does tell me quite frequently that he had to walk laps at recess for various infractions, which seems to be an intermediate punishment.

DD has ADHD and for kindie she was on green a lot. It was a honeymoon period for her. She could sustain behaviors. Kindie was a great year for her. SHe also has specific learning disabilities (dyslexia) and as the academics increased and she became aware of the differences, her behaviors increased. This was mid year 1st grade. 2nd Grade, she has a behavior intervention plan.

Laps. I have seen two flavors through friend. One is used as a reward with tangible rewards and is optional. It is fabulous use of laps. The 2nd at a private school is used as discipline (really a punishment). It is not fabulous. I would side eye discipline as laps. We have used exercise (running errands or a quick lap) to refocus dd.

He usually finds a best buddy or two at school who's also high-energy and early in the school year they have to be separated. We've gotten feedback several times from his K teacher that he needs reminders to wait his turn to talk during circle time, keep his hands to himself, focus on his work rather than on other children, etc. They do have recess twice a day and frequent movement breaks during instructional time (which we looked for when choosing a school, knowing his energy level).

Use these examples during your private evaluation.

This winter he played basketball for the first time and while he did want to play, it jumped out at us during practice/games that he seemed a lot more distractible and less focused than the other children.

Team sports can be difficult with attentional disorders. But I think a go work if they love it and get social stuff from it.

 For context, his league was ages 6-7 and he had just turned 6 so this may have been just an age/maturity thing. Then his teacher mentioned last week that he's not as focused as she would like, that he pays attention pretty well during whole-class instruction but when they're working in their seats, he tends to lose focus, wander, socialize and need frequent redirection. I asked her if she thinks he's in the normal range and she said, "Definitely in the normal range; he's very active and interested in everything." 

I also have a friend who's a child psychologist and has spent a good bit of time around my boys. I asked her recently if she thought he might have ADHD (which was her specialty during her dissertation and she said) she thought it was possible; that to her (without formally assessing him, of course) he seemed possibly borderline between normal high-energy and ADHD and it might be worth looking into. Leo's EI, who was around both boys weekly for 3 years at our home, had the same opinion.

My question after this very long post: Given this information, would his Kindergarten teacher's response completely ease your mind?

No. The school psychologist in kindie in a formal evaluation stated dd does not have adhd. A medical evaluation and a school evaluation (formal or informal) are completely different. Go for a medical eval. Dd's most recent eval resulted in an impact statement with four line devoted to adhd.. Two years later.

She has 30 years of experience (not relevant for your purpose) and has had DS in her classroom for 7 months now. (The teachers he's done well with all had a few decades of experience; the 3's teacher had a year or two.) I don't want to see a Dx behind every corner but I also don't want to take my theoretically "typically developing" child for granted. I think we may struggle more with his behavior at home than the teachers do at school, but I'm also wondering if he's going to struggle more in 1st grade and beyond when it's less play-based, only one recess a day, more homework, etc., or with a less experienced and understanding teacher.

DD puts on a good face for school. It is hard to maintain over a long period of time. Proper interventions make a difference. Also dd's behaviors were always present at home. We would talk about them with the school. They would blow us off. This year...they saw the behaviors.

[mrsbuttinski]

bubbalicious said: Laps. I have seen two flavors through friend. One is used as a reward with tangible rewards and is optional. It is fabulous use of laps. The 2nd at a private school is used as discipline (really a punishment). It is not fabulous. I would side eye discipline as laps. We have used exercise (running errands or a quick lap) to refocus dd.

I'm of two minds around the bolded.

So long as the consequence is fairly assigned, it does seem to serve a dual purpose of helping a child remember the rules and give them more movement so they can settle themselves. DS's band teacher was big on physical consequences for infractions- not knowing your music, being out of step, talking during rehearsal, not paying attention. It also built a kind of esprit de corps. Sometimes it was calisthenics in place, sometimes a lap around the field with your instrument over your head. I could have made this go away for DS via his IEP, but chose to let him learn from the consequences.

[hopecounts]

the other reason I'd hold off is partly due to mrsbuttinski point about old school teachers.
I'd be slightly concerned that her bias might affect her scoring of the paperwork which could affect the result/treatment plan.
I'd wait until a next year with a teacher who may see it differently.

[mrsbuttinski]

Mar 26, 2015 12:51:49 GMT -5 hopecounts said:

the other reason I'd hold off is partly due to mrsbuttinski point about old school teachers.
I'd be slightly concerned that her bias might affect her scoring of the paperwork which could affect the result/treatment plan.
I'd wait until a next year with a teacher who may see it differently.

The best way around that kind of teacher is a classroom observation by a psychologist. Our district evals always included this; we've sent DS's psych in to observe when we weren't sure about the validity of what teachers were reporting. I wonder if the friend could observe.

[macchiatto]

Thanks for the additional responses!

mrsbuttinski, if we do get him evaluated (and I think seeing how things go as he gets into 1st makes sense), who would you recommend if possible ADHD is the one concern? Child psychiatrist, devel pedi, etc.?

[mrsbuttinski]

It's hard to say.

You might share your concerns with your PCP and ask for a referral. A clinical psychologist or psychiatrist could dx a simple ADHD presentation- probably no need to bring in a dev pedi. The school could also evaluate him, either instead or after you'd done so privately. A psychiatrist can write scripts, but that doesn't have to be your first line of tx if he should get a dx.

It sounds like this is one of those things to be aware of, but not that you'd need to act on asap. He could have a huge leap in maturity over the summer or respond more favorably to more structure in a more academic 1st grade setting.

[macchiatto]

OK, thanks! That makes sense. I will wait til fall and see how things go and then (if necessary) see who my pedi recommends seeing.
Based on our experience with Leo's school district eval last year, I really wouldn't want to request the school to evaluate him unless his teacher is saying it's a problem.

[princesslily]

Sounds a lot like an average day for our little boy too - who was dx'd with ADHD - combined (moderate). Educationally he is doing fine, however he needs a lot more redirection than the neuro-typical. Its behavorial issues, minor ones, but they are present.

If you have concerns, I would request for a school eval to get supports in place as soon as possible. Maybe he can skirt through his school years without an eval, but I did and I always thought I was a bad student...I wasn't, I just needed to learn in other ways in certain subjects from the typical.





As far as running laps, for me as a kid my gym teacher was big on laps were consequences for minor infractions. I didn't love them as I wasn't very physical (always the last one huffing and puffing around the corner) however looking back, it was a good form of discipline. The only place I question the validity of that form of discipline is at home. I think its because I grew up in time outs, confiscation of possessions & groundings.

[macchiatto]

Thanks for your thoughts, too, princesslily!
Our school district will honestly be useless--or worse than useless--unless his teacher is reporting concerns. Especially since they blew us off with Leo last year. Despite delays in several areas and a positive ADOS on their own eval, his (private) Pre-K teacher said she wasn't concerned about him so at the IEP meeting, the psyc and SLP made us feel like neurotic overly-worried parents and refused to give him an IEP. No matter what we said or pointed out, they kept coming back to, "But his teacher says he's doing OK with the classroom. There are other students who are where he's at so he doesn't need special instruction." It was an incredibly frustrating and disappointing experience. So I'm definitely not going that route again with this district if his well-respected teacher is saying he's "definitely in the normal range." We'll see what next year's teacher thinks though!