ADHD questions

[hopecounts]

Both DD's CSS team and her BCBA have brought up ADHD which is the opposite of surprising, she's pretty much a classic presentation of it.

No one thinks we need to pursue diagnosis/meds yet but I'm wondering at what point we bring this up/address this.
her annual with the Dev. Ped. is usually in June so I'm wondering if we should address it next year shortly before she transitions to kindy, she'll be just shy of 6 and it would give us some time over the summer to trial meds if appropriate and she will have been with her current teachers for almost a full year so they should be pretty aware of her behavior in terms of filling out the reports. 

Or should we hold off and get her transitioned to kindy and go from there?

Totally over planning/thinking but it crossed my mind so wanted to see if anyone had info/thoughts for me to ponder over.

[mirandah]

I brought up ADHD a couple times at our annual developmental pedi appointment. Both times our doctor kindof shrugged it off. I didn't have any specific concerns- I knew he was jumpy, fidgety, and impulsive, but I thought these were more attendant to his ASD and not something else. It was his kindy social worker who was more pointed about it and recommended a psych eval, which is where we were able to separate out the issues and treat with medicine. I was slow to get on the train though and didn't seek out the appointment until first grade started off so horribly. I wish I had done this over the summer prior to first grade. I feel like we basically lost the whole months of Sept-Dec while we were trialing. His behavior has changed pretty dramatically. Just my own experience.

[hopecounts]

Yeah, it's fairly obvious with DD, though one of the reasons for waiting is to give her another year to give it some clarity as to ASD vs. ADHD stuff (along with her being so young and wanting to work on behavior mods while she is in a very supportive environment)

I'm afraid of the getting off horribly thing which is why I'm leaning towards doing it over next summer so that she goes into kindy set up for success as much as possible.

[bubbalicious]

I trialed meds in prek. DD's meds made her available for learning in kindy. It worked for us. Just b/c you have a dx doesn't mean meds. We did behavioral therapy first.

[mrsbuttinski]

Feb 19, 2015 14:24:09 GMT -5 hopecounts said:

Yeah, it's fairly obvious with DD, though one of the reasons for waiting is to give her another year to give it some clarity as to ASD vs. ADHD stuff (along with her being so young and wanting to work on behavior mods while she is in a very supportive environment)


Good luck with that. DS is 21 and there are times when I just can't untangle symptoms from ASD, ADHD and dyslexia. And I have a better shot than most since I have a seriously ADHD mother and niece and have a pretty good idea what ADHD looks like in isolation.


DS got his ASD and ADHD dx at the same time- both his psychologist and dev pedi who are independent clinicians agreed on both. Even with the dx, you don't have to medicate. We did behavior mods first and concurrently with medication. This is something I have been trying to explain to my niece who is newly dxd and medicated- the meds only allow one to access the learning opportunities in the moment- they don't autimatically make the condition go away. 

I'm afraid of the getting off horribly thing which is why I'm leaning towards doing it over next summer so that she goes into kindy set up for success as much as possible.

What do you mean? The emotional impact of the meds leaving the child's system?

[hopecounts]

I mean her having a harder time transitioning to kindy.
Bit of a type there the=her (don't know what was up with
My phone on that one)

If meds are appropriate I'd rather she start kindy on them to help her get a good start then spend the first months working on it.
Again I maybe overthinking here which is why I'm posting to see if I am better off waiting it out and seeing how things go in kindy

And behavior mods are being worked on and will continue to be a part of the plan just wondering about when to take the next steps.

[jmski]

My son started meds before kindergarten. The medication makes all the difference for him. He needs it to be able to learn and to stay out of trouble, so I am glad to give them to him. There are high demands in kindergarten so I would talk to your doctor before K.

[mrsbuttinski]

Feb 19, 2015 16:00:28 GMT -5 hopecounts said:

I mean her having a harder time transitioning to kindy.
Bit of a type there the=her (don't know what was up with
My phone on that one)

If meds are appropriate I'd rather she start kindy on them to help her get a good start then spend the first months working on it.

What's being done to make the transition? What sort of program will she be attending- a self contained classroom for ASD? A mainstream class with minimal supports? A hybrid of both? Something else entirely? 

Is kindie a new building with all new teachers, aides, nurse and physical plant? Or is it just down the hall with the same SLP and OT and the robust exchange of ideas between the preschool and their elementary counterparts? 

Are you sure what you're all seeing is ADHD? Are you seeing hyperactivity? Impulsivity? Inattention? 


It's really hard to extract ASD out of the ADHD presentation. Really hard. Sometimes professionals see horses when they should be seeing zebras. 


A child who is bouncy and all over the classroom could have ADHD, but could also be a sensory seeker under the ASD umbrella. The kid who behaves in unexpected ways might not understand the rules of the classroom or may not know they apply to him as a student. And the student who seems distracted and unfocused may not be watching the breeze ruffle the flag, they may be ruminating on the possibility of being stung by a bee on the playground or that "bully kid" tripping him in the hall which may have been a total accident and ToM Fail. 

Meds aren't going to fix that. Certain ADHD meds- the stimulants could actually make it worse. Stimulants are contraindicated for those with anxiety. Some docs will prescribe with something for anxiety. Typically an SSRI but sometimes an atypical antipsychotic if the child is especially moody, aggressive or has a family hx of bipolar disorder.

IME, a lot of DS's "ADHD" in terms of focus is helped by his SSRI. Impulsivity and executive function is better addressed by the stimulant he takes. A lot of his anxiety is around his impulsive behavior and his EF/organizational stuff, so the stimulant dials that back in a roundabout way.

Again I maybe overthinking here which is why I'm posting to see if I am better off waiting it out and seeing how things go in kindy

Not over-thinking. But you have to consider that these are powerful medications with the potential for side effects with may be permanent. And your child is young to be able to share how the meds make her feel.

We made the choice closer to 8. If I got a do-over, I would probably have started the SSRI at about 7 and found a better school placement by 7 1/2 when it was clear what we were doing wasn't working. If I had done that, I might have been able to put off the stimulant until 9 or 10. DS wasn't the sort of kid who was in imminent danger from his impulsivity; if he were, I might have chosen differently. 

We've transitioned to schools lots of times. Preschool to indie mainstream to therapeutic reading lab school to mainstream in the intermediate grades, to middle, to high school, to community college and finally to the university. I planned preschool-8th, high school and college; God said "hah!".

It's really hard to predict which moves will go swimmingly and which will be awful. Some kids have their own style, others like DS are unpredictable. DS generally does OK so long as the new school is a better fit for him at the time than the one he's coming from. 

The other thing is that different kids transition differently.

Some kids do pretty well. Others start off OK and actually do better as time goes on. A third group starts well and then goes to shit once the honeymoon is over and they're more comfortable.

And behavior mods are being worked on and will continue to be a part of the plan just wondering about when to take the next steps.

[hopecounts]

Feb 20, 2015 8:54:29 GMT -5 mrsbuttinski said:

Feb 19, 2015 16:00:28 GMT -5 hopecounts said:

I mean her having a harder time transitioning to kindy.
Bit of a type there the=her (don't know what was up with
My phone on that one)

If meds are appropriate I'd rather she start kindy on them to help her get a good start then spend the first months working on it.

What's being done to make the transition? What sort of program will she be attending- a self contained classroom for ASD? A mainstream class with minimal supports? A hybrid of both? Something else entirely? 
She will be transitioning from her ABA based private Pre-K program, the program is very used to making this transition and we will begin discussing the details roughly this time next year to put together a transition plan.
The program for kindy is still undecided, it may be a regular classroom with supports (maybe with an aide which my district is fond of doing), or in a ASD lab program. Her team is thinking she'll likely be placed in a reg. room with supports and an aide based on what they have seen the district do but it's a year a way so who knows what will be the best fit for her in a year. 


Is kindie a new building with all new teachers, aides, nurse and physical plant? Or is it just down the hall with the same SLP and OT and the robust exchange of ideas between the preschool and their elementary counterparts? 

Yes it'll be all new school/staff/team, she'll be going from a program that is private to the public school system, there will be some communication from her current IEP custodian/team but that is also at a completely different location.

Are you sure what you're all seeing is ADHD? Are you seeing hyperactivity? Impulsivity? Inattention?
Me, no not 100% sure, but I do consider the opinion of her very experienced BCBA who feels this is leaning more into the ADHD then ASD area but am completely open to this being a zebra not a horse scenario. 
Hyperactivity is huge even with supports/behavior mods/ABA work/OT and sensory work, impulsivity is there, inattention has improved and is minimal through behavior mods/ABA work on it.

It's really hard to extract ASD out of the ADHD presentation. Really hard. Sometimes professionals see horses when they should be seeing zebras. 


A child who is bouncy and all over the classroom could have ADHD, but could also be a sensory seeker under the ASD umbrella. The kid who behaves in unexpected ways might not understand the rules of the classroom or may not know they apply to him as a student. And the student who seems distracted and unfocused may not be watching the breeze ruffle the flag, they may be ruminating on the possibility of being stung by a bee on the playground or that "bully kid" tripping him in the hall which may have been a total accident and ToM Fail. 

Meds aren't going to fix that. Certain ADHD meds- the stimulants could actually make it worse. Stimulants are contraindicated for those with anxiety. Some docs will prescribe with something for anxiety. Typically an SSRI but sometimes an atypical antipsychotic if the child is especially moody, aggressive or has a family hx of bipolar disorder.

IME, a lot of DS's "ADHD" in terms of focus is helped by his SSRI. Impulsivity and executive function is better addressed by the stimulant he takes. A lot of his anxiety is around his impulsive behavior and his EF/organizational stuff, so the stimulant dials that back in a roundabout way.

Again I maybe overthinking here which is why I'm posting to see if I am better off waiting it out and seeing how things go in kindy

Not over-thinking. But you have to consider that these are powerful medications with the potential for side effects with may be permanent. And your child is young to be able to share how the meds make her feel.

We made the choice closer to 8. If I got a do-over, I would probably have started the SSRI at about 7 and found a better school placement by 7 1/2 when it was clear what we were doing wasn't working. If I had done that, I might have been able to put off the stimulant until 9 or 10. DS wasn't the sort of kid who was in imminent danger from his impulsivity; if he were, I might have chosen differently. 

We've transitioned to schools lots of times. Preschool to indie mainstream to therapeutic reading lab school to mainstream in the intermediate grades, to middle, to high school, to community college and finally to the university. I planned preschool-8th, high school and college; God said "hah!".

It's really hard to predict which moves will go swimmingly and which will be awful. Some kids have their own style, others like DS are unpredictable. DS generally does OK so long as the new school is a better fit for him at the time than the one he's coming from. 

The other thing is that different kids transition differently.

Some kids do pretty well. Others start off OK and actually do better as time goes on. A third group starts well and then goes to shit once the honeymoon is over and they're more comfortable.

And behavior mods are being worked on and will continue to be a part of the plan just wondering about when to take the next steps.

Great points and things to consider thanks!

[leroybrown]

Feb 20, 2015 8:54:29 GMT -5 mrsbuttinski said:

Feb 19, 2015 16:00:28 GMT -5 hopecounts said:

I mean her having a harder time transitioning to kindy.
Bit of a type there the=her (don't know what was up with
My phone on that one)

If meds are appropriate I'd rather she start kindy on them to help her get a good start then spend the first months working on it.

What's being done to make the transition? What sort of program will she be attending- a self contained classroom for ASD? A mainstream class with minimal supports? A hybrid of both? Something else entirely? 

Is kindie a new building with all new teachers, aides, nurse and physical plant? Or is it just down the hall with the same SLP and OT and the robust exchange of ideas between the preschool and their elementary counterparts? 

Are you sure what you're all seeing is ADHD? Are you seeing hyperactivity? Impulsivity? Inattention? 


It's really hard to extract ASD out of the ADHD presentation. Really hard. Sometimes professionals see horses when they should be seeing zebras. 


A child who is bouncy and all over the classroom could have ADHD, but could also be a sensory seeker under the ASD umbrella. The kid who behaves in unexpected ways might not understand the rules of the classroom or may not know they apply to him as a student. And the student who seems distracted and unfocused may not be watching the breeze ruffle the flag, they may be ruminating on the possibility of being stung by a bee on the playground or that "bully kid" tripping him in the hall which may have been a total accident and ToM Fail. 

Meds aren't going to fix that. Certain ADHD meds- the stimulants could actually make it worse. Stimulants are contraindicated for those with anxiety. Some docs will prescribe with something for anxiety. Typically an SSRI but sometimes an atypical antipsychotic if the child is especially moody, aggressive or has a family hx of bipolar disorder.

IME, a lot of DS's "ADHD" in terms of focus is helped by his SSRI. Impulsivity and executive function is better addressed by the stimulant he takes. A lot of his anxiety is around his impulsive behavior and his EF/organizational stuff, so the stimulant dials that back in a roundabout way.

Again I maybe overthinking here which is why I'm posting to see if I am better off waiting it out and seeing how things go in kindy

Not over-thinking. But you have to consider that these are powerful medications with the potential for side effects with may be permanent. And your child is young to be able to share how the meds make her feel.

We made the choice closer to 8. If I got a do-over, I would probably have started the SSRI at about 7 and found a better school placement by 7 1/2 when it was clear what we were doing wasn't working. If I had done that, I might have been able to put off the stimulant until 9 or 10. DS wasn't the sort of kid who was in imminent danger from his impulsivity; if he were, I might have chosen differently. 

We've transitioned to schools lots of times. Preschool to indie mainstream to therapeutic reading lab school to mainstream in the intermediate grades, to middle, to high school, to community college and finally to the university. I planned preschool-8th, high school and college; God said "hah!".

It's really hard to predict which moves will go swimmingly and which will be awful. Some kids have their own style, others like DS are unpredictable. DS generally does OK so long as the new school is a better fit for him at the time than the one he's coming from. 

The other thing is that different kids transition differently.

Some kids do pretty well. Others start off OK and actually do better as time goes on. A third group starts well and then goes to shit once the honeymoon is over and they're more comfortable.

And behavior mods are being worked on and will continue to be a part of the plan just wondering about when to take the next steps.

I'm so grateful you are here.

I just had this same conversation with a nurse in a developmental clinic who was shocked that our pedi gave us the ADHD and didn't explore the ASD possibility since they can overlap and it's hard to distinguish in some of the behaviors. She instantly said we needed a proper eval and sent us information on the m-chat and Stat tools.