Post by leroybrown on Jan 19, 2015 11:05:25 GMT -5
So my MIL is a peds PA at the clinic we take our kids to. The doc there is wonderful, he listens to our concerns, the fringe benefits are nice, and he's very thorough. It's 98% great, except when I don't agree with something MIL thinks. For example, she thinks Tess has ADHD and needs meds, like, now. She just turned 4 in October. I don't disagree with ADHD as a possibility, but I also recognize there could be and probably is, more than just straight ADHD. I want a referral to a peds psych for a proper eval beyond the DSM-V questionnaire (because most of those lit up for SPD and ODD, as well as ADHD). She thinks it's unnecessary because "they can make those diagnoses there". They aren't trained in that and I'm not wanting to throw meds at my 4 year old without knowing exactly what she has and what we can do about it. I'm going to bring it up at the baby's six month appt at the beginning of February, but I'm struggling here with how to advocate for my kid without pissing off MIL who does so much for us.
Post by mrsbuttinski on Jan 19, 2015 11:22:07 GMT -5
Wow, that's a tough situation.
Can you talk to a pedi privately and share your concerns about MIL being all up in your business over this? I would think HIPPA would protect your confidentiality.
If you see a FP yourself as a PCP, s/he probably knows who the best psychiatrists/psychologists in the area are. Other parents who have older kids are generally a resource, too.
TBH, four is a little young for an ADHD dx according to many who work in the field. A few will dx earlier, but only if the child is so challenged that they are at great risk of harming themselves. Likewise, meds aren't generally considered until later unless the child is so impulsive they're escaping the house regularly.
Can you talk to a pedi privately and share your concerns about MIL being all up in your business over this? I would think HIPPA would protect your confidentiality.
If you see a FP yourself as a PCP, s/he probably knows who the best psychiatrists/psychologists in the area are. Other parents who have older kids are generally a resource, too.
TBH, four is a little young for an ADHD dx according to many who work in the field. A few will dx earlier, but only if the child is so challenged that they are at great risk of harming themselves. Likewise, meds aren't generally considered until later unless the child is so impulsive they're escaping the house regularly.
Absolutely. She was evaluated when she was 3.5 by AEA at daycare because of numerous issues there, and they said that she is challenging and listed off quite a few "issues" but then followed up with 'but she is developmentally where she should be so we don't recommend anything further at this time."
Insurance won't even cover meds until they are 6, and I struggle daily going back and forth between "maybe she'll outgrow some of this" and "OMG get her a tranquilizer". I don't want to medicate her at this point and am doing everything I can do avoid it (though we did trial Intuniv and that was an epic fail) but I also don't want to do a disservice to her and wait until she falls behind or is disliked in school because her social awareness is nonexistent.
Post by leroybrown on Jan 19, 2015 11:37:56 GMT -5
She's such a sweet kid, and yet, she's so awful behavior and energy wise that I put myself in timeout almost daily. She'll spend hours a day jumping from the ottoman to the floor, off the bed, from the couch to a stack of pillows. She bites herself and others. She is constantly moving and chewing on things (most often, her sleeves or her pant leg). She runs into traffic. She runs away from us in the store, at the mall, etc. We still put her in a stroller everywhere we go because she runs away. Transitions are so hard for her, even with multiple warnings and countdowns. She goes from zero to rage and gets violent and can't calm herself for 20 minutes or more. She can't/doesn't listen, won't help doing anything in the house (cooking with me, picking up, helping with the 2 younger siblings, making meds, sorting socks, ANYTHING!)She talks constantly, interrupts,is always fidgeting or squirming or moving something.
It becomes glaringly obvious when she's around other kids her age, including our niece and DH's BFF's kids. There's just such a stark difference between other 4 year olds and her, and it makes me so sad to watch that I want to help her and fix her.
That's tough. I completely agree with you that you should see a specialist not a PCP for this. I have ADD (dx'd as an adult), and at that time, a PCP couldn't even issue my medication refills much less give that dx. I don't know why that changed, but in many ways, I don't care for the change because I do think it opened the door to a few PCPs feeling okay to dx and treat. Don't get me wrong, it is so much nicer to be able to get the rx renewal each month and do a 5-minute med check appointment locally instead of having a 2- to 3-hour round-trip drive, but I am also very established on my med and current dose. I would want more expertise for trialing meds, etc as well as for initial dx to make sure the whole picture is examined carefully. Also, a newish 4yo is on the VERY young end to be getting a dx of ADHD. Most specialists want some school experiences. Not to say you can't get an appointment set up now as there likely is a wait time, but in terms of a PCP giving a dx now, that is an extra side-eye (more to your MIL because who knows if the PCP actually would or not; also not saying anything bad about your MIL, but even people in the right fields to have an opinion can be biased by the relationship). Perhaps a "We value your input and thank you for your assistance. We would still like to get the evaluation from the specialist just to make sure the whole picture is accounted for and there are no other issues that tie into the potential ADHD." type of approach would be reasonably received. Good luck!
She's such a sweet kid, and yet, she's so awful behavior and energy wise that I put myself in timeout almost daily. She'll spend hours a day jumping from the ottoman to the floor, off the bed, from the couch to a stack of pillows. She bites herself and others. She is constantly moving and chewing on things (most often, her sleeves or her pant leg). She runs into traffic. She runs away from us in the store, at the mall, etc. We still put her in a stroller everywhere we go because she runs away. Transitions are so hard for her, even with multiple warnings and countdowns. She goes from zero to rage and gets violent and can't calm herself for 20 minutes or more. She can't/doesn't listen, won't help doing anything in the house (cooking with me, picking up, helping with the 2 younger siblings, making meds, sorting socks, ANYTHING!)She talks constantly, interrupts,is always fidgeting or squirming or moving something.
It becomes glaringly obvious when she's around other kids her age, including our niece and DH's BFF's kids. There's just such a stark difference between other 4 year olds and her, and it makes me so sad to watch that I want to help her and fix her.
After seeing your follow-up post here, I would say it sounds like more than a case of ADHD could be at play. I would highly recommend seeing a specialist sooner than later. You will want a full work-up to r/o ASD and other disorders (or perhaps not r/o one or more of them). It sounds like some impulse control issues (which all young kids have, but perhaps it is beyond that level), wandering and running concerns, sensory seeking behvaiors, etc. If you want any tips on any of those things, let me know because we deal with all of it (not all expressed in the same manner as your LO, but we still have those types of issues here, so maybe some of what works for us can help you too).
Post by leroybrown on Jan 19, 2015 13:41:39 GMT -5
Thanks, Cam! I mean, I was a hyper kid, I was "spirited" as they say, but this seems like more. Which makes it more difficult because my parents and family are always commenting about how I was just like this and I turned out fine. Sure, yes, that's true. But if I can make my kid's road to "fine" easier than the one I had, why wouldn't I?
Post by mrsbuttinski on Jan 19, 2015 13:53:37 GMT -5
It does sound like she has red flags for conditions other than ADHD.
You describe a lot of sensory seeking behavior that could be SPD. ASD should be ruled out given the sensory behaviors in the context of poor transitioning, poor self regulation and the way you describe her as being "unlike" her peers.
Instead of just a psychologist, she might be better served by a developmental pedi with a team.
I agree with the PP about looking further into it than just evaluating for ADHD. I also sounds to me like she has some symptoms that could be attributed to SPD and ASD.
My daughter was evaluated at a children's hospital that has a children's psychiatric clinic. They had a whole eval team and she was seen by a psychiatrist, psychologist, speech therapist, and educational specialist (that was our second opinion, the first eval was at an autism center and she also saw an occupational therapist and audiologist at that eval...it was not a great experience though).
My son who was diagnosed with ADHD was first evaluated in 1st grade and they said they were not ready to give him that diagnosis at that time but we should follow-up in a few years if things got worse or didn't get easier. When his 4th grade teacher mentioned him being challenging and wondering if he may have ADHD we knew it was time to get him reevaluated. He was on medication for two years and we have recently taken him off of it and he's doing pretty well. We still have challenging times but he's nowhere as challenging as he used to be and we are working with him on learning how to keep himself focused.
I agree that you need to be more assertive. I think your child's health is more important than your MIL's feeling. She may be upset at first, but if she loves both of you, she should want what is best for your daughter.
This sounds like deja vu. You pretty much nailed 3/4 yo DS. He's 7.5 now and definitely has ADHD. There was much more SPD stuff when he was younger but a good portion of that has faded. We trialed Adderall last year and that was a colossal failure. We recently started Ritalin and it's been night and day. It's been a huge game-changer for us. But we were no where near medication at 4 and I don't think I'd have appreciated someone pushing it for a "diagnosis" that he wasn't even really ready for yet.
I like PPs wording about just wanting to make sure you have the full picture, and ultimately, you're going to need a specialist for that. And it may not be the first specialist you see, either. We've been through 4! If you ever want to talk, I can definitely relate. LMK.
one more thought. Do you need the referral for your insurance to cover the eval? If not, a lot of places will take you as a self-referral.
Through insurance, no. But some specialty peds clinics won't let you just call and make an appt, they make the doctor call and refer you and then they appoint you a time. That's what we had to do for our neuro consult with the baby.
This sounds like deja vu. You pretty much nailed 3/4 yo DS. He's 7.5 now and definitely has ADHD. There was much more SPD stuff when he was younger but a good portion of that has faded. We trialed Adderall last year and that was a colossal failure. We recently started Ritalin and it's been night and day. It's been a huge game-changer for us. But we were no where near medication at 4 and I don't think I'd have appreciated someone pushing it for a "diagnosis" that he wasn't even really ready for yet.
I like PPs wording about just wanting to make sure you have the full picture, and ultimately, you're going to need a specialist for that. And it may not be the first specialist you see, either. We've been through 4! If you ever want to talk, I can definitely relate. LMK.
Post by mrsbuttinski on Jan 19, 2015 17:43:35 GMT -5
If your pedi won't give you a referal, you need a better pedi. Trust me, s/he doesn't want "family" turning up at the competition.
One of DS's classmate's moms who is a friend of mine from DS's coop preschool and scouting took a position with DS's pedi about 10 years ago- it was a double edged sword.
Don't expect a lot from the specialists. We got exactly no beneficial information or help from either. They don't sven want to consider ADHD until she is 7, and specifically until she "fails" in school. I'm sorry but that's crap. I work HARD at keeping her from failing. That doesn't mean she doesn't need extra help. So far the only professional willing to dx and treat DD has been her pedi, because she knows us. The psych also did a lot of blaming of us and other stuff I found to be unprofessional. Probably you won't have that experience but so far that has been mine.
Thanks, Cam! I mean, I was a hyper kid, I was "spirited" as they say, but this seems like more. Which makes it more difficult because my parents and family are always commenting about how I was just like this and I turned out fine. Sure, yes, that's true. But if I can make my kid's road to "fine" easier than the one I had, why wouldn't I?
I have said similar myself as far as wanting to provide L with an easier path. My LO is very much a little version of me in some ways and a little version of MH in other ways, so put it together and it takes things to another level. I also see our traits amplified. For example, I am annoyed by certain noises like when the windshield wipers click on delay mode or when someone is tapping their fingers loudly, but I have not been bothered to a level where it significantly impacts my life (MH gets "the eye" once in a while or I crank up the radio to drown out the wipers - no big deal), not even as a child. My LO is like that most days too (asks for volumes to be adjusted, requests a warning before the garbage disposal is turned on, or gives a look), but he has bad days where I just can't run the vacuum or he has to cover his ears at some places (has asked to leave places too just because of the noise from a air handler or something basic). Not sure if that is the case for you and your LO, but if that is the case, it is easy for the grandparents and other family members to see it as being "just like you" because they see enough to see the similarities but not enough on the day-to-day level to see the differences. Even if LO is "just like" a parent down to every last detail, the world around them has changed. Yes, we may have turned out fine, but perhaps we could have had an easier path as you said or perhaps our LOs will have a harder path without help because of increased academic expectations, changes in socialization norms and customs, etc. I also think some people minimize the struggles and differences as a way that they see as providing loving support (even though it is actually often more frustrating to us as the parents because we may then feel the need to "prove our case" so to speak), not because they would ever want to truly deny someone they love from getting needed help. I had many people say things like LO is "just a late talker" or he is "all boy" or "enjoy the peace and quiet while it lasts" or any of the other typical retorts to try to make me not worry about him or to feel better (like that would actually help?!) when I had really already had virtually no doubt that he was wired differently. Follow your gut. Also, many of us had to push for the referral, so don't feel bad for doing so. Despite your LO's PCP perhaps having a bit of extra background information regarding your child as compared to most (my situation was similar as LO has a grandparent who works with his PCP), they still only see a snapshot of what your child is like (where she is developmentally, how she interacts with others, her behaviors, etc). Good luck!
Oh yes to being told that it's just normal and all kids are different. And the whole, "when we were kids we didn't have [insert neurological disorder here]! We just got spankings." I can't tell you how many times I wanted to throat punch some family members.
Post by BostonKisses on Jan 20, 2015 6:01:50 GMT -5
I agree with the others with getting a full work up just to be sure, and getting a deelopmental pedi to do it. Once you have any DD's, then you can do the child psych for various management things.
As for the situation with your MIL, can you use your PCP as the scapegoat so you don't have to deal with any fallout? I'd probably give a firm, yet tactful response that your PCP wants her to see someone more specialized for a full work up so you can get a better handle on things, then take it from there.
I fear the pedi doesn't take me seriously because of MIL, but I know I need to be more assertive and just tell him we need a referral.
I know it can be easier said than done, but try not to let that intimidate you. Lay it all out on the table to them, and say you want a referral. Let your mama bear come out if you have to.
Don't expect a lot from the specialists. We got exactly no beneficial information or help from either. They don't sven want to consider ADHD until she is 7, and specifically until she "fails" in school. I'm sorry but that's crap. I work HARD at keeping her from failing. That doesn't mean she doesn't need extra help. So far the only professional willing to dx and treat DD has been her pedi, because she knows us. The psych also did a lot of blaming of us and other stuff I found to be unprofessional. Probably you won't have that experience but so far that has been mine.
This is what is so frustrating! I'm so sorry they are doing this to you, Fred.
Family keeps saying it's behavioral and she needs structure and discipline. Sorry dad, not going to beat the shit out of her. Didn't work on me, won't work on her.
I don't buy it's all behavioral and I've left providers who've suggested as much. I'm probably the most consistent person I know and my ds still struggles from one day to the next. I've tried all the systems from one extreme to another. Some may work better than others but none are particularly successful. This SN parenting takes a lot of tenacity. Stick to it and don't be afraid of what anyone else says or thinks because at the end, you're her mom. You know you're right.
Post by bubbalicious on Jan 21, 2015 7:56:27 GMT -5
Your little one sounds similar to dd at that age. DD was dx'd just shy of three with adhd. Medication is a tough issue and a personal one.
MIL needs boundaries. A specialist could really give you that physical separation. A developmental pedi is a good start. They could recommend a neuropsych eval but probably after 6. Getting in the door to a dev pedi can look at diagnosis and you will have one in place to help with meds.
Safety was and is a huge issue for us. At 4 she ran into traffic, busted through screens to leave the house, walked on the roof, ran into the street.
We did start medication. But it is not a fix.Allows her to be available.
Besides the developmental pedi...a behaioral psychologist can help you as well. Behavioral mods are your first go to with adhd.
I don't buy it's all behavioral and I've left providers who've suggested as much. I'm probably the most consistent person I know and my ds still struggles from one day to the next. I've tried all the systems from one extreme to another. Some may work better than others but none are particularly successful. This SN parenting takes a lot of tenacity. Stick to it and don't be afraid of what anyone else says or thinks because at the end, you're her mom. You know you're right.
Even if it isn't all "behavioral", a behavioral approach can give the child tools to be more resilient in situations that are difficult for them. CBT, for instance, can teach a child to reframe how they think about something and give them alternate ways to react in the moment that could be less atypical and help them be better included and expand their world.
I think sometimes parents hear "behavior" and feel it carries a negative conotation or reflects on them as a parent. It shouldn't. Behavior is what you see a kid do- whether it's developmentally approppriate by challenging (think a twos temper tantrum) or dyslfunctional. It gives clues to what is impacting the child and may help you give them the tools to be more comfortable and exhibit behavior that is more regulated.
TBH, while I trust my gut most of the time, there have been instances where DS's team- mostly his psychologist- have suggested behavior mods that were 180 degrees from what felt right to me. I might have known DS better, but he brings a lifespan perspective and context for ASD that I just don't have as a parent.
Kind of related to this is the Boy with ASD and the Kirby Vacuum Cleaner Salesman. It was all over FB and GBCN with people having all the warm and fuzzy feels over it. The sound you hear from the East Coast is DS's psychologist's head exploding. When DS was 6 and 7 his life was taken over by trains. It was an anxiety driven cycle that was limiting his interests in what his peers like to do which isolated him. DS's psych had us take the trains away for a time during which DS's social and play skills really blossomed. He also developed other interests and found other subjects that he found amusing and could leverage into building social connections. At the time DS's psych laid out this plan I was very upset with it and initially unwilling to consider it.
On the surface it's a sweet story, but if this young man is restricted to entertaining himself with vacuum cleaners, how is he going to learn to connect with peers who have less restricted interests? What sort of other interests might he not develop and enjoy if left to immerse himself only in vacuums. What if his interests morph over time to something less wholesome that could harm him or others and he's not been taught strategies to be OK without access to his current special interest?
Auntie, what you say about "behavior" is true, but most often when a family member says it's "behavior", the DO mean ineffective parenting. And sometimes even a professional.
I think it's going to require you pissing your MIL off, but I agree that getting her a full eval is important. Yeah, she may have ADHD, but it's good to know the full story of what you are dealing with. You don't want to write her off as ADHD. And what's the harm in getting a further opinion. I would recommend a developmental pedi, if you have one near you.
Auntie, what you say about "behavior" is true, but most often when a family member says it's "behavior", the DO mean ineffective parenting. And sometimes even a professional.
This is how my step mom and family treat Addie. She's a wild child and it's not for lack of discipline or trying on our behalf. She is just wired like that.
Auntie, what you say about "behavior" is true, but most often when a family member says it's "behavior", the DO mean ineffective parenting. And sometimes even a professional.
I have been there. Particularly with a former pediatrician. Someone you would expect to be apart of the rodeo...instead of supporting a mom they would make judgmental comments in my son's medical record/chart. Needless to say I switched...
But I have been down the route of nonjudgment with behavioral psychology. My dev pedi who I like and don't agree with her stance on spd...gets the rodeo.
Behavioral interventions are about helping the parent work with their kid in the early years. Shop around...the right team can be a powerful thing in both yours and your child's life.
Auntie, what you say about "behavior" is true, but most often when a family member says it's "behavior", the DO mean ineffective parenting. And sometimes even a professional.
Right. And I know that's what they mean when my family says it. It's behavioral= good job fucking up your kid, dumbass. They think it's a parenting problem, not that my child has something actually wrong with them.
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