Trying everything before meds, when to do meds?

[crl]

I am 99 percent sure we will be getting an ADD/ADHD dx for ds early next month. The psychiatrist said at our meeting that he is waiting for the teacher's input but given what he had so far he was just debating the H. I subsequently saw the teacher's form and her answers were pretty consistent with ours.

So now we have to figure out where to go next. The psychiatrist suggested that we should consider meds. I am willing to do that. But I also want to consider whether we/school can make sufficient accommodations for ds to succeed without meds.

When people say they tried everything before going with meds, what is "everything?". How did you approach deciding whether to go with meds?

Thanks for any input!
Catherine

[pinkmomagain]

For us, basically everything came together all at once. We sought out a dx with a psychiatrist when we saw her really suffering with self-esteem issues. On the verge of being depressed. The constant corrections in behavior (calm down, pay attention, etc.) at school and at home were really taking a toll on her. She was struggling to do what typical kids could do seemingly without effort. Socially the behaviors were also affecting her. Keeping focused on topic with conversation, game playing, etc.

She received therapies for plenty of other things (ot, pt, speech, social, anxiety) and I just didn't see how therapy was going to address these adhd-related issues. We did not try diet...she is pretty self-limiting with diet already and was not prepared to fight that battle with two other kids around plus health issues with one of them. I do know that many people like to try Feingold first. Also tried things like fish oil...didn't see any change.

So when she did get the dx, we put her on meds and got accommodations in a 504 for things like preferential seating and help with organizing/planning (as the meds don't help too much with this aspect of ADHD) all at the same time.

After reading the book "Driven by Distraction" I became more comfortable with the idea of medication for ADHD.

Best of luck deciding. I know it's not easy and we all arrive at our decisions differently.

[missym]

At the advice of our psychologist and ped, we tried accommodations first and gave it some time before trying meds. We had concerns about meds because DD is super, super skinny to start with and she is very sensitive to the amount of sleep she gets. In our case, classroom adaptations + a wonderfully understanding teacher have made a huge difference.

But I'd say we have close to an ideal situation right now. If things had continued the way they were last year, I don't know that we'd still be med-free. She was having a lot of anxiety, starting to show esteem issues related to school, etc. Even with some accommodations last year such as preferential seating, constant correction on the part of the teacher ("Gwen, pay attention!") was really wearing her down. And this was with an "excellent" teacher.

I feel like we're in a delicate balance, and it wouldn't take much (like a less understanding teacher next year) to tip us back the other way.

[crl]

Thank you! DS likes school. He is generally happy. He is not struggling socially. I think he is being corrected some at school, and certainly some at home, but I don't feel like it is constant. BUT he is falling behind academically. That is the big concern at this point. DH is worried that if we wait too long to try meds, ds will be turned off of school and we won't be able to change his mind. I am worried about weight as ds tends toward skinny anyway. Are sleep difficulties another side effect? He is a terrible sleeper. . . . .

Catherine

[pinkmomagain]

Ironically, DD was not doing badly academically....because she had all those wonderfully flexible, accommodating-type teachers. Unfortunately, we are seeing academic effects now (despite meds) because of the organizational/planning piece and the amount of work in middle school along with the independence that is expected at that level. I can understand your DH's concerns. I was afraid that the damage that was happening to dd's self-esteem would become unreversable. What grade is your ds in?

As far as weight: DD was/is skinny and when she was on a stimulant (Focalin XR) she was megaskinny. People commented. But both her pediatrician and psychiatrist did not feel like it was severe enough to be concerned. She is now on a non stimulant (Intuiv) and she is at a more normal weight.

As far as sleep: DD never really had an issue luckily with the medications affecting sleep. The stimulant had worn off by bedtime (she took the meds maybe around 7am and would go to sleep at around 830/9pm).

If you do end up having a discussion about meds with the dr, I'd mention the weight and sleep. Maybe he/she will suggest trying a nonstimulant first.

[crl]

He is in second grade. For whatever reason, I think of meds as being more appropriate the older the child is. I guess it just seems like with early grade school kids the environment ought to adapt more to them. I don't know. I am certainly not saying kids should not be put on meds in grade school, just my general inclination.

I did mention the weight issue and the psychiatrist agreed that it was a legitimate concern, but felt that most people worked around it, for example providing a substantial breakfast before giving the meds and allowing post-dinner snacking to make up for not eating at lunch. . . .

Thank you!
Catherine

[pinkmomagain]

Yeah, dd didn't start meds until around 3rd grade (or 4th...I can't remember exactly).

If I were you, once I received the dx, I would definitely give accommodations/strategies a try before meds. Especially, since your ds doesn't seem to be suffering globally (right now academics only seems to be the concern)...keeping a close eye on his mood, self-esteem, attitude towards school, etc. JMHO

[HIU8]

My DS just started meds 2 months ago. We were going ONLY with accommodations in the classroom and behavior therapy and dietary changes. We would have stayed where we were, however DS came to us and said he just could not do it anymore. He asked for more help (Note: he was working so hard to keep it together during the school day, He simply could not function anymore). DS is combination type (hyper and innatentive--mostly innatentive at school though). I have to say, meds have so far made a HUGE difference.

[egoldber]

We sought out a dx with a psychiatrist when we saw her really suffering with self-esteem issues. On the verge of being depressed. The constant corrections in behavior (calm down, pay attention, etc.) at school and at home were really taking a toll on her. She was struggling to do what typical kids could do seemingly without effort. Socially the behaviors were also affecting her.

This pretty much sums it up for us as well. DD's diagnosis is not ADHD, but the anxiety and impulse control issues were making things very hard for her. I made the call when I watched her at a school function meant to be fun, struggling so hard to hold herself together. We started the process for a referral to a psychiatrist soon after.

But at that point we had had her in therapy for a long time (over a year) and tried as many other avenues as we felt were feasible for us and her before medication. She was also older, 4th grade, and I knew that vs. her peers she was quite delayed vs. just being a little immature.

[crl]

Thanks everyone!

Catherine

[inmypjs]

Thanks OP for asking this question. I have wondered about when meds are appropriate for attention issues too. My DS is in first grade and does not have an ADD diagnosis, but he will be tested soon. His teacher told us that he is off task a lot, but without disturbing others. We did not hear this last year in kindy - although maybe he was, who knows. When I asked his teacher what can we do, she very nicely told me to talk to my ped. I feel like this is code for - get him an ADD diagnosis and medicate him. I'm not sure if he has it or not, but I wonder if he is diagnosed, will there be pressure to medicate him. I'd rather not, because like the OP stated he is young and does not seem to suffer globally.

As I posted about in another thread, DS has some learning issues and some of his off task behavior happens because he avoids things he struggles with (like writing). His teacher was the one who commented on that. Other times he is just more interested in something else. His teacher says she can see that his mind is always working. One example she gave is that during some instruction time, a boy who has asthma raised his hand and asked to get his inhaler. The teacher said yes and continued with 5-10 minutes more of instruction. At the end, she asked if there were any questions. DS raised his hand and asked what is an inhaler and how does it work. I realize that you can't diagnose my DS, but do these kinds of behaviors sound like ADD? And if so would they be helped by meds? OP, I'm sorry if I am hijacking your question. I can start a new thread if needed - your question just echoed some of the things I have been thinking about too.

[crl]

Honestly I know rather little about diagnosing attention issues. My ds has had a long series of issues and we have been playing the diagnosis game for years now, although we had not gotten an up to date evaluation in four years, with the last eval at age four resulting in tentative ADHD and general anxiety disorder dx.

For us the tipping point was that ds has been struggling with reading comprehension and math this year. In K he was fine, probably near the top of his class, but he was a year older (we did an extra year of preschool) and had had a lot of preschool so he pretty much knew everything they learned that year going in. In first he sank to the middle of the class. Now in second, he is falling behind. At our conference, his teacher mentioned that he is chatty in class (this is a change) and very disorganized and careless with his work (those things have always been true). These are pretty much classic AD/HD hallmarks and I knew that much. Given his history I felt we needed to get a current eval and move forward with getting him some help (whether that is accommodations, services or meds, or mostly a combination of all three).

I know there are screening tools online for some learning issues, maybe if you google you can find a screening tool to help you determine if AD/HD could be a possibility. I will say that I would not go to a regular ped for a dx, just for a referral. I would go to a developmental ped or a psychiatrist. I also will say that I have often been told that most doctors won't dx AD/HD before age seven. I'm not sure if your son is seven yet, or not.

[inmypjs]

He just turned 7 this month. I do like his teacher and believe she wants to help DS succeed. But I guess it just annoyed me that the only response I got to how to help him with the behaviors she described was "talk to your ped." I have not talked to the ped about it because I knew she'd just give us a referral. And we do have testing scheduled with an educational psychologist in December, so I guess we'll get an answer then...