ADHD and Tantrums

[lizzywednesday]

Let me preface this by saying that DD had a lot more tantrum-like behavior without her meds, so it may simply be a sign of a bad week (or a lousy night's rest because she did refuse to go to sleep when I sent her at 8:30p ... and was still up messing around with her toys & window blinds at 10:30p) but here goes:

Over the past several weeks, DD has had a few destructive tantrums both at home and at school.

At home, she has broken her bedside lamp (I still don't know how, but she snapped the bulb socket out of a PBK lamp), had a fit about not understanding a new subtraction task at school (broke a pencil & tore the cover of her math book), acted out for 90 minutes at a Girl Scout meeting with another troop (apparently, she was upset that another child was "yelling" in the space - DD's school cafeteria), acted out for 20 minutes at another off-site meeting (while visiting a food bank to hear the charitable organization's director speak, DD proclaimed she was bored after being told off for trying to head to a 2nd floor because she was "just so curious" then she started head-butting me and flipping the lights on & off until she finally asked to use the restroom) and had another fit where she detached the glass cover of her ceiling fixture and dropped it (it shattered on her bedframe, spewing glass all over her bedding, her detritus-covered floor, and most of her room.)

Today, she got into an argument with a child (who has been a problem for her for at least a week, perhaps more) about a board game she and another classmate were playing, which resulted in both boys teasing her ... and the original child who'd begun the issue ended up with a bite. (He claims DD bit him. While I'd like to believe that she didn't, and she says she didn't, I wouldn't put it past her to bite or scratch this kid.)

Most of her tantrums seem to happen when things change from her expected pattern - the new location for the Scout meetings, taking her tablet (or a game/app on the tablet) away, being taunted/teased, having a substitute teacher, etc.

We have been trying to help her feel empowered enough to speak with whoever the on-site grownup is when incidents happen at school.
For things at home, I try to lay out clear expectations for her behavior BEFORE we go into a new situation, but she isn't always a great listener. (And, well, she sometimes can't help it if her meds have worn off.)

DH and I are trying to decide if these are enough evidence to call her doctor and try to tease out if this is a medication issue or just a disrupted schedule issue. She does have her physical coming up in a couple of weeks, and it seems that a lot of her acting out has to do with being kept indoors (it's been bitterly, dangerously cold outside lately), so it may just be excessive energy.

How do other folks deal with this?

[georgiegirl]

DS1 (8) has adhd and he had way worse tantrums on Vyvanse. It made him very irritable. It could be a med thing. (Concerta is better for him.). Also, starting an anti-anxiety med (buspirone) really helped tone down Ds’s emotions and irritability. He’s better able to manage frustration (which was what often caused tantrums) on the buspirone.


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[mikala]

Who is prescribing her meds now? Pcp or child psychiatrist? I'd put a call in and at least make a future appointment.

In the meantime I'd try to make sure she's getting enough sleep, eating well, not too much screen time, etc. If staying up late is an issue you might try a low dose of melatonin.

Is she receiving any other therapies? If so, I'd also talk to those therapists and see if they have any suggestions. If she isn't in OT this might be a good time to look into it because they can work on emotional regulation and transitions.

Have you been through full neuropsych testing? If not, that might also be another angle to pursue to help figure out what other services she could benefit from. The meds can help slow her negative reactions and give her a second to think but they won't reach her flexibility and other underlying skills to deal with stressors or minor changes in her routine.

[lizzywednesday]

Who is prescribing her meds now? Pcp or child psychiatrist? I'd put a call in and at least make a future appointment.

In the meantime I'd try to make sure she's getting enough sleep, eating well, not too much screen time, etc. If staying up late is an issue you might try a low dose of melatonin.

Is she receiving any other therapies? If so, I'd also talk to those therapists and see if they have any suggestions. If she isn't in OT this might be a good time to look into it because they can work on emotional regulation and transitions.

Have you been through full neuropsych testing? If not, that might also be another angle to pursue to help figure out what other services she could benefit from. The meds can help slow her negative reactions and give her a second to think but they won't reach her flexibility and other underlying skills to deal with stressors or minor changes in her routine.

Her pediatrician is the prescribing doc for her meds; we have her 8-year-old well visit coming up in a couple weeks, so I'd rather not take her in if it's not an absolute emergency. It doesn't feel super-urgent, but it *is* concerning.

She's not allowed tablet this weekend due to her tantrum last weekend.

She is not receiving other therapies but we haven't gotten any recommendations to put her into anything like OT or whatever. She does receive speech services at school and we just re-started private speech therapy which will run through late May or mid-June (I haven't counted the number of sessions we've been to.)

She has been through a full workup at the cognitive & behavioral health clinic of the children's hospital where she was born/treated for her heart issues. They gave us an eval that DH dismissed as "overly general" and he was tuning the doc out (DH has ADD/ADHD himself, diagnosed as an adult; I haven't been evaluated, but maybe I ought to be, since some of my hindsight analysis of my own behavior points to ADHD-inattentive) and, even though complementary psychotherapy was recommended, we did not pursue it because DH decided against it.

[lizzywednesday]

DS1 (8) has adhd and he had way worse tantrums on Vyvanse. It made him very irritable. It could be a med thing. (Concerta is better for him.). Also, starting an anti-anxiety med (buspirone) really helped tone down Ds’s emotions and irritability. He’s better able to manage frustration (which was what often caused tantrums) on the buspirone. ...

She's on Adderall XR, but has been having late nights and a bit too much media time because it's been bitterly cold outside.

We haven't discussed any anti-anxiety or other types of medications for her.

[cuca_]

I would discuss a change of medication with her pediatrician. One of my kids had a horrible tantrum while we were trying Adderall. We changed the medication and the meltdowns practically disappeared.

I would also suggest seeing a psychiatrist. I think their expertise is helpful in finding the right combination of medications that a child needs, including anxiety meds if she needs them. I would also look into Melatonin if she is having a hard time falling asleep.

[StantonHyde]

1. Make an appointment with a psychiatrist, not your pediatrician. It will take a while to get in. Call now.

2. Was your DD evaluated for anxiety? My DS was diagnosed with anxiety and ADD. First we put him on anti anxiety meds because that was causing the biggest problem. A couple of years later, we added Concerta. We have to watch the anxiety because Concerta (almost any stimulant) increases anxiety. A lot of what you are describing sounds like anxiety.

3. Get a recommendation for a child therapist. Your DD NEEDS therapy to learn how to cope with her ADHD. Just meds is not going to do it. She also needs therapy for the anxiety if that is what is happening.

4. Was your DD evaluated for autism/being on the spectrum? It is pretty interesting to look at the number of girls in the 9-11 yo age range who are diagnosed "late" because they are able to cope socially up to a certain point and then they can't. And their behavior gets called into question.

You absolutely need to re-evaluate the meds and get your DD into therapy. Having that many tantrums in one week and at school is an issue. You want to address that now before things get out of hand and you have to do a ton of work to get back to functioning well.

[lizzywednesday]

I would discuss a change of medication with her pediatrician. One of my kids had a horrible tantrum while we were trying Adderall. We changed the medication and the meltdowns practically disappeared.

I would also suggest seeing a psychiatrist. I think their expertise is helpful in finding the right combination of medications that a child needs, including anxiety meds if she needs them. I would also look into Melatonin if she is having a hard time falling asleep.

She's been on the Adderall for a year now; it's been fine until this month. The weather has greatly reduced our outside time, and she hasn't had outdoor recess in a while (except during the freak warm weather the other day) so it's hard to gauge whether this is meds or not.


1. Make an appointment with a psychiatrist, not your pediatrician. It will take a while to get in. Call now.

2. Was your DD evaluated for anxiety? My DS was diagnosed with anxiety and ADD. First we put him on anti anxiety meds because that was causing the biggest problem. A couple of years later, we added Concerta. We have to watch the anxiety because Concerta (almost any stimulant) increases anxiety. A lot of what you are describing sounds like anxiety.

3. Get a recommendation for a child therapist. Your DD NEEDS therapy to learn how to cope with her ADHD. Just meds is not going to do it. She also needs therapy for the anxiety if that is what is happening.

4. Was your DD evaluated for autism/being on the spectrum? It is pretty interesting to look at the number of girls in the 9-11 yo age range who are diagnosed "late" because they are able to cope socially up to a certain point and then they can't. And their behavior gets called into question.

You absolutely need to re-evaluate the meds and get your DD into therapy. Having that many tantrums in one week and at school is an issue. You want to address that now before things get out of hand and you have to do a ton of work to get back to functioning well.

(1) I have to see who's nearby and in-plan. The last time I looked, one had a lot of "as seen on TV" lines on her website, which put DH off ... and the remaining one in-plan blew us off, so I don't really have a favorable opinion of the local psych community right now. I cannot go out-of-plan.

(2) Anxiety wasn't a concern at the time, so I don't know if she was evaluated for anxiety.

(3) I used to have a list of names; I'll have to check our insurance to see who's in-plan and cross-check with the pediatrician. I agree that meds alone aren't helping. I don't know enough about ADHD to help and I am frustrated that I don't know where to start. DH's know-it-all attitude makes me feel even more lost.

(4) The eval was comprehensive; I will have to check her workup record to see whether they evaluated for autism in addition to ADHD. We've been learning that a lot of ADHD and autism behaviors overlap. (Also, she wasn't really coping socially before this, but the ADHD meds have helped a great deal with the way she presents herself. She's always had a larger-than-life personality, but she doesn't read body language as well as I'd like ... and she also seeks out much younger children.)

ETA: I re-read what I wrote, and it looks like she had multiple tantrums/meltdowns over the course of a week. She did not.

She had the broken bedside lamp tantrum on/about January 28th. (We'd taken the tablet away.)
She had the issue with the other child at Scouts on Feb 2nd. (She was upset/acting out because the other child was "yelling." Normal caf rules forbid yelling.)
She had the distracting/acting out behavior at the off-site meeting on Feb 13th. (She claimed to be bored/curious, but calmed down after she used the bathroom.)
And she had the broken ceiling fixture tantrum on Feb 18th (we took one of the games on her tablet away.)
The school/biting incident happened on Feb 23rd. (Disagreement over a board game, kid needling her, she was accused of having cheated at the board game, leading to the outburst. It's actually the first time that the vice principal has called since the time she bit the substitute teacher in kindy, which kicked off the whole eval cycle.)

So, it's all been building up over the course of about a month.

[StantonHyde]

"She's been on the Adderall for a year now; it's been fine until this month. The weather has greatly reduced our outside time, and she hasn't had outdoor recess in a while (except during the freak warm weather the other day) so it's hard to gauge whether this is meds or not."
All the more reason why you need a psychiatrist, not a pediatrician. When you say you didn't have many options in your area--how big of an area? I drove DS an hour each way to get a good, low cost neuropsych eval that I knew our school district would accept. I would look up to a 2 hour radius to find a good psychiatrist. Ask your pediatrician for a recommendation. The psychiatrist can also help with determining if evals are needed for anxiety or spectrum issues.

Go back through her eval--see what all it covered. If you don't entirely understand it, ask the pediatrician. Or, make an appointment with a therapist who will be able to read and explain it to you. (I had to have a professional co-worker explain it all to me despite having had it explained it to me by the person who did the eval)

Therapists: check people out. They don't have to have experience just with ADHD, this is getting help for your DD to get some coping skills etc. This needs to happen now for your DD. Even with all of those outbursts over the course of a month--not ok. They were pretty intense. She needs support and help. Ask the therapist about evaluations for anxiety and spectrum behaviors. They often look alike. I am saying this as someone who has a best friend with a daughter who still tantrums at 13 and it is HARD. Her inability to function socially is having a huge impact on her academics. huge. I also see these issues where I work (psychiatric hospital with day treatment programs for kids and teens) Getting help early is key.

Gain Knowledge: Your DH's attitude is not helping and I can tell you that it seems to be a very common attitude of the husbands of moms and professionals I talk to!! It's almost as thought they are uncomfortable not knowing something so they cling to what they do know and won't consider anything else. My DH can be the same way. So I read up on Dyslexia and Anxiety and got it down. I just checked amazon and they have "The Everything Parents' Guide to ADHD in Children". That't the books series I started with for Dyslexia. Very good place to start.

Good luck. It's a long road and it changes a lot! I put in a ton of time in the trenches but DS really started coming out of it in 6th grade and has been doing really well in MS. Next year is HS and I am buckling in for another round!!

[lizzywednesday]

...
All the more reason why you need a psychiatrist, not a pediatrician. When you say you didn't have many options in your area--how big of an area? I drove DS an hour each way to get a good, low cost neuropsych eval that I knew our school district would accept. I would look up to a 2 hour radius to find a good psychiatrist. Ask your pediatrician for a recommendation. The psychiatrist can also help with determining if evals are needed for anxiety or spectrum issues.

Go back through her eval--see what all it covered. If you don't entirely understand it, ask the pediatrician. Or, make an appointment with a therapist who will be able to read and explain it to you. (I had to have a professional co-worker explain it all to me despite having had it explained it to me by the person who did the eval)

Therapists: check people out. They don't have to have experience just with ADHD, this is getting help for your DD to get some coping skills etc. This needs to happen now for your DD. Even with all of those outbursts over the course of a month--not ok. They were pretty intense. She needs support and help. Ask the therapist about evaluations for anxiety and spectrum behaviors. They often look alike. I am saying this as someone who has a best friend with a daughter who still tantrums at 13 and it is HARD. Her inability to function socially is having a huge impact on her academics. huge. I also see these issues where I work (psychiatric hospital with day treatment programs for kids and teens) Getting help early is key.

Gain Knowledge: Your DH's attitude is not helping and I can tell you that it seems to be a very common attitude of the husbands of moms and professionals I talk to!! It's almost as thought they are uncomfortable not knowing something so they cling to what they do know and won't consider anything else. My DH can be the same way. So I read up on Dyslexia and Anxiety and got it down. I just checked amazon and they have "The Everything Parents' Guide to ADHD in Children". That't the books series I started with for Dyslexia. Very good place to start.

Good luck. It's a long road and it changes a lot! I put in a ton of time in the trenches but DS really started coming out of it in 6th grade and has been doing really well in MS. Next year is HS and I am buckling in for another round!!

Thank you for the book recommendation; I have a list in the eval, but I keep misplacing my printout.

It's not that we're in a small or inconvenient area; we're in a decent metro area for services, but the list we got from the pediatrician was very short and we haven't checked outside that list. (Again, DH kept insisting the therapy wasn't something DD needed. Because he didn't need it when he was diagnosed with ADD. Also, his professional life involves dealing with the local psych community and he's not impressed with them.)

[lizzywednesday]

This is a quick update to let y'all know what's happening with DD:

At her well visit on 3/27, we discussed the big blowups, the conflicts with the boy at school, and other little things that were adding up.

Her pediatrician gave us the names of two therapists in the area.

As the visit was so close to both Easter and Passover, not to mention area schools' spring breaks, I didn't call right away, having had the experience of being blown off by a therapist several years ago because I'd called near the holidays.

I didn't phone last week, due to other priorities.

We received an email from DD's teacher yesterday describing some behavior that she hasn't had since kindergarten - throwing things, refusing to cooperate with teachers, being disruptive, etc. (and not always during days when the class had a substitute teacher) - and I checked both therapists' websites.

One does not accept insurance, so we cannot take DD there.

The other doesn't specify whether or not she accepts insurance, so I phoned today (4/18; left a message) and followed up with an email (through her website because she obviously doesn't know her email address, based on the two "undeliverable" emails I received after trying to send the follow up outside the website system.)

DH is also supposed to ask at work (he's a marketing specialist who works in the mental/behavioral health care "industry" and knows people who have connections to decent therapists in the state system of care) to see if there's anyone recommended who also accepts our insurance.

I have been told (by DH, who pays the bills) that we cannot go with an out-of-network provider. CANNOT.

So, today's task is completed, with an expected follow-up call on Friday if I don't hear back. Unfortunately, I strongly suspect that the therapist I called is the same one who blew us off three years ago and I'm not optimistic about getting a response.

[sariana]

I'm so sorry. I hate dealing with insurance issues.

Do you have to stick with the 2 recommended by your ped? Does your insurance have a web site where you can search for providers? Or a number to call to get some names?

I know a lot of people don't like HMOs because they feel that their options are too limited. But I really miss our old HMO at times like this (we're trying to find a therapist, too). I would rather just call one number and get a name, the way our old HMO worked. Choices are great--when there really is a choice, and enough data to make an informed choice. But sometimes I just want someone who can help my kid, you know?

[georgiegirl]

I still think this could be a med issue or anxiety. From what you are describing, I don’t think like therapy alone will help. At that age, it’s going to be so so hard to self-aware enough to change behavior when she’s out of control emotionally. My son is about the same age (8.5) and we’ve struggled a lot with his behavior. The adhd meds were never enough...or never enough for an extended period of time. In retrospect, I’m able to tell that so many of his meltdowns were actually anxiety related. Meltdowns during transitions are typical for anxiety. We’ve made progress by adding a mild anti anxiety med, but I think we need to increase it (we go in for a med check in a few weeks.).

And I totally understand about not wanting to see someone out of network. We had a situation with that and paid a ton out of pocket and then stopped because I didn’t want to shell out $100 for each weekly session.

Adding: my DS was never diagnosed with anxiety during his eval. The psychiatrist suggested the anti anxiety med when I described some of his problematic behaviors. She suggested it sounded like anxiety and to try the anti anxiety med. and it helped! Then I googled adhd and anxiety in kids, and it really explained a lot. A lot of adhd behavior is similar to anxiety behavior. My DS is classic hyperactive/impulsive adhd, but doesn’t really have focus issues. He can’t control his emotions at all and his brain is in hyperdrive all the time. I think a lot of the emotional aspect is anxiety, not feeling like he can control the situation, not feeling safe, etc.


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[LBW]

The process of finding the right therapist can take a while. It would be sort of miraculous if the one guy you called is available and the right fit.

In my experience, you have a long road ahead. I think you need to prepare for that mentally. You need to be her advocate, and you need to be pretty aggressive about putting together the right team to help her & about working with the school. I'd highly recommend getting a follow up appt with the team that did the evaluation. (at CHOP?)

Some other suggestions for you to consider:

1) As PP mentioned, go through your insurance co to find other local therapists. Also search on local FB groups and ask around to get recommendations.
2) Work with the school:
-request a meeting with the teacher and the school's psychologist/guidance counselor and the district/school behaviorist. They should be able to come up with some strategies for the teacher to use in class. Potentially, your daughter could also meet with the guidance counselor or psychologist on a regular basis.
-Ask the school psychologist for a list of recommended therapists. They often have this info ready to give out.
3) Books to use at home:
-for you and your husband to read: Ross Greene's The Explosive Child and Lost at School
-for you to use with DD:
Christopher Lynch's Totally Chill: My Complete Guide to Staying Cool A Stress Management Workbook for Kids With Social, Emotional, or Sensory Sensitivities
Dawn Huebner's What to Do When Your Temper Flares: A Kid's Guide to Overcoming Problems With Anger

[lizzywednesday]

I'm so sorry. I hate dealing with insurance issues.

Do you have to stick with the 2 recommended by your ped? Does your insurance have a web site where you can search for providers? Or a number to call to get some names?
...

No, I'm not committed to the people the pediatrician recommended at all; they're simply a starting point. One does not accept insurance and expects payments up front, so she is out. The other one doesn't list if she accepts insurance, and that's the one I phoned today.

The insurance website kind of stinks - the ways in which providers are listed don't allow me to narrow search terms to "child therapist." They use checkboxes and none of the answers are what I think I'm looking for.

I need DH involved with this, too, because I am freaking sick of being blamed for her issues. Her issues are her issues; I'm probably not helping because I don't know what I'm doing, but they're not MY issues transferred to HER. They're HER issues.


I still think this could be a med issue or anxiety. From what you are describing, I don’t think like therapy alone will help. At that age, it’s going to be so so hard to self-aware enough to change behavior when she’s out of control emotionally. ...
And I totally understand about not wanting to see someone out of network. We had a situation with that and paid a ton out of pocket and then stopped because I didn’t want to shell out $100 for each weekly session.

Adding: my DS was never diagnosed with anxiety during his eval. The psychiatrist suggested the anti anxiety med when I described some of his problematic behaviors. She suggested it sounded like anxiety and to try the anti anxiety med. and it helped! Then I googled adhd and anxiety in kids, and it really explained a lot. A lot of adhd behavior is similar to anxiety behavior. ...

Yeah, it's less about not "wanting" to shell out the money and more about not being ABLE to shell out the money. Even with reimbursement paperwork, it's like pulling teeth to get stuff like this covered!

Such a PITB.

She does have focus issues, so I think the ADHD diagnosis is correct. But the meds may be exacerbating underlying anxiety or even ASD behaviors, since so many overlap! I can't make that call.


The process of finding the right therapist can take a while. It would be sort of miraculous if the one guy you called is available and the right fit.

In my experience, you have a long road ahead. I think you need to prepare for that mentally. You need to be her advocate, and you need to be pretty aggressive about putting together the right team to help her & about working with the school. I'd highly recommend getting a follow up appt with the team that did the evaluation. (at CHOP?)

Some other suggestions for you to consider:

1) As PP mentioned, go through your insurance co to find other local therapists. Also search on local FB groups and ask around to get recommendations.
2) Work with the school:
-request a meeting with the teacher and the school's psychologist/guidance counselor and the district/school behaviorist. They should be able to come up with some strategies for the teacher to use in class. Potentially, your daughter could also meet with the guidance counselor or psychologist on a regular basis.
-Ask the school psychologist for a list of recommended therapists. They often have this info ready to give out.
3) Books to use at home:
-for you and your husband to read: Ross Greene's The Explosive Child and Lost at School
-for you to use with DD:
Christopher Lynch's Totally Chill: My Complete Guide to Staying Cool A Stress Management Workbook for Kids With Social, Emotional, or Sensory Sensitivities
Dawn Huebner's What to Do When Your Temper Flares: A Kid's Guide to Overcoming Problems With Anger

I searched the in-plan therapists and got something like 50 pages of names. That's overwhelming! Every time I tried to narrow the field, I wasn't getting results that were remotely manageable.

The school psychologist met with us at our spring parent-teacher conference and shared some resources with us. I have to page through and see if she gave us individual therapists in addition to the group therapy/playgroup she recommended.

CHOP's list of recommended therapists is really PA-heavy, which isn't necessarily a bad thing, but it does increase my stress level to get her to/from appointments. I think they offered us a few options at our "this is how we recommend you proceed" meeting, but DH turned them down.

I don't know whether they'll allow her one-on-one meetings; I'll ask. She really loves the school counselor.

Thank you for the book titles; I'll check to see if the library has the parent and non-workbook ones for sure.

[georgiegirl]

As our psychiatrist told us, sometimes meds fix one issue but bring to light another. If the adhd is properly medicated, then you can see all the other problematic behavior and not be distracted by the adhd. With my son, his impulsivity and hyperactivity drove us bonkers. We would always remind him to stop jumping on the couch, touching his brother, touching things, fidgeting constantly, etc. without all of those behaviors, we were able to see other difficult behaviors, in his case mostly emotional volatility.

Could you look for a child psychiatrist to manage meds? They often have very good recommendations for therapists. At our first psychiatrist appointment, we had a long discussion about all of DS’s issues. It sounds like your DD would be better managed by a psychiatrist than a pediatrician.


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[LBW]

I searched the in-plan therapists and got something like 50 pages of names. That's overwhelming! Every time I tried to narrow the field, I wasn't getting results that were remotely manageable.
You could take this list to your school psych or ped and ask them if they know any of the names and if they'd recommend them.

Another suggestion would be to look at kids' OT facilities if any are covered in your plan. Some of them offer therapy, too. A lot of them work extensively with kids who have ADHD/behavioral issues.

You could also reach out to NJ SPAN. They may be able to make suggestions.

The most helpful resources to me over the years have been word of mouth and FB groups. I'm in one for ADHD, etc, that covers northern NJ. PM me if you think it might be helpful to you. Kids docs and therapists come up a lot in my town group and county moms group, too. You don't even have to ask the question -- just search old posts and you can often find great recommendations.


CHOP's list of recommended therapists is really PA-heavy, which isn't necessarily a bad thing, but it does increase my stress level to get her to/from appointments. I think they offered us a few options at our "this is how we recommend you proceed" meeting, but DH turned them down.
Honestly, it's sometimes worth a drive to get to the right person. I drive 45 min every 2 weeks to my 11-year old's therapist b/c he's the best fit we found in years of searching.


I don't know whether they'll allow her one-on-one meetings; I'll ask. She really loves the school counselor.
If she has an IEP this could be added as an accommodation. If she has a 504 or even an I&RS plan, I'm sure it could be added, too. I've seen this done in 2 districts in NJ, so I don't think it's uncommon.

[niccig]

You and DH need to get on the same page and get more help for her. The psychiatrist and counseling sound like places to start. Call the school psychologist now, leave a message asking for referrals. The school needs to know you’re trying to get help. If she continues to have tantrums, throw things, they could say she’s a danger to herself or others and recommend moving her to a more restrictive class setting. I’ve seen this happen too many times. If child’s behaviors improve (meds, counseling, maturity), we want to move them back into gen ed but they’re behind on academics.

Don’t wait any longer to get more help.


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[BunnyBee]

Has she been evaluated by the school district? Does she have an IEP/504? I would request one ASAP if not because you want disciplinary goals to be a part of that (going off of what niccig mentioned).

Also, you may want to look at something like the Explosive Child and reconsider some of your current tactics. With a child who's struggling to maintain control for whatever reason, and especially a non-neurotypical child, she's not misbehaving for the fun of it. It's literally out of her control. Your job is to figure out her triggers and help her learn to maintain control or regain control. Threatening the tablet removal probably escalates things instead of de-escalates things in the heat of the moment. Stop looking at a tantrum as something to punish. It's something that's showing she's struggling. Sometimes empathy helps kids pull it together more quickly. Some kids need the big release. Maybe it's a buildup of anxiety. She's not going to be able to voice the why at this age. It's got to be teased out by you and whomever else is around her. Maybe the teacher can be of help, but you want her to know that you are actively working on this so she can help advocate for DD as a team member.

[Reyadawnbringer]

I'm just going to add in that my DS is 9.5 yo now and we have struggled over the years with his ADHD.

One thing that struck me about your previous posts is that you are seeing some behavior that you haven't seen since kindergarten when you were led to seek an evaluation. I recently said the exact same thing about DS. Everything had been going ok with his medication until it suddenly wasn't. But what I didn't know, is that it wasn't "suddenly" not working. It had been not working for several months with low levels of symptoms until suddenly DS had enough and started exhibiting explosive behavior.

I called a conference with his teachers and the school counselor to find out what was going on, because when I tried talking about it with DS he would cry and cry and just say how stressed and jumbled up he is. He would report knowing that his behavior was unacceptable and could not give a reason for acting out. The teachers reported (when confronted with a face to face conference) that DS had not been his normal self since January. They had been seeing symptoms but didn't think to notify me until it was so bad they were unable to manage him anymore.

I scheduled an appointment with DS' psychiatrist. I was concerned about DS's anxiety levels and stress. The psychiatrist told us that the meds DS is on for ADHD are not doing the job they were intended to do. They weren't lasting long enough or helping to manage the symptoms and as such, DS was becoming extremely stressed at not being able to focus and control his impulses like he had previously been able to. He was confident that if we tweaked the medication dosage a little, we would see an improvement in DS's behavior.

We saw DS' therapist the same week and the therapist had the same opinion. ADHD meds aren't working and are causing DS to not only exhibit ADHD type misbehavior and symptoms, but also adding stress and anxiety to the mix.

The slightly increased dosage of the medication has helped DS get back on track and the therapist gave DS some worksheets about how to recognize stress and how to manage it (geared towards kids).

It is not at all uncommon as children grow for the medications to need to be adjusted or changed altogether. For this reason alone it is important to pursue a psychiatrist. They are the ones best equipped to recognize typical behavior issues from symptoms of untreated ADHD.

DS1 - 9!
DS2- Expected 07/18

[theriviera]

I have no advice, but just wanted to offer hugs. So much of this sounds like what we are going through with DD1. It's hard.

[lizzywednesday]

Has she been evaluated by the school district? Does she have an IEP/504? I would request one ASAP if not because you want disciplinary goals to be a part of that (going off of what niccig mentioned).
...

She has an IEP for speech. We didn't have the ADHD diagnosis until October 2016.

DH was reluctant to add the ADHD to her IEP initially. His SIL is a special-ed teacher (not in our district) and recommended that we add it to her IEP for DD's protection. (Which is what I was saying to DH.) And he changed his tune. A little. But only recently okayed pursuing counseling.


I'm just going to add in that my DS is 9.5 yo now and we have struggled over the years with his ADHD.

One thing that struck me about your previous posts is that you are seeing some behavior that you haven't seen since kindergarten when you were led to seek an evaluation. I recently said the exact same thing about DS. Everything had been going ok with his medication until it suddenly wasn't. But what I didn't know, is that it wasn't "suddenly" not working. It had been not working for several months with low levels of symptoms until suddenly DS had enough and started exhibiting explosive behavior.

...

The slightly increased dosage of the medication has helped DS get back on track and the therapist gave DS some worksheets about how to recognize stress and how to manage it (geared towards kids).

It is not at all uncommon as children grow for the medications to need to be adjusted or changed altogether. For this reason alone it is important to pursue a psychiatrist. They are the ones best equipped to recognize typical behavior issues from symptoms of untreated ADHD.
...

She's only been on medication for a year and her in-school outbursts have typically coincided with days when there's a substitute teacher in her homeroom.

It could easily be the meds, or it could be something else. I've got an appointment set up with one of the therapists from our pediatrician's list (she's covered by our insurance) for Tuesday. I'll be bringing DD's diagnosis paperwork as well.

[lizzywednesday]

You and DH need to get on the same page and get more help for her. The psychiatrist and counseling sound like places to start. Call the school psychologist now, leave a message asking for referrals. The school needs to know you’re trying to get help. If she continues to have tantrums, throw things, they could say she’s a danger to herself or others and recommend moving her to a more restrictive class setting. I’ve seen this happen too many times. If child’s behaviors improve (meds, counseling, maturity), we want to move them back into gen ed but they’re behind on academics.

Don’t wait any longer to get more help.


I have a meeting set up with one of the psychiatrists on Tuesday. On Monday, I'm going to call the insurance company with a couple of questions as well, like how many sessions we get and whether we need pre-authorization.

[lizzywednesday]

I met today with the therapist and we have DD scheduled to go in next week.

We'll see what happens next; hopefully, it's another baby step in the right direction!

[lizzywednesday]

2nd Update (June 2018):

We've seen the therapist 3 times.

In between the 2nd and 3rd appointments, DD had a Really Bad Day where she threw fits (substitute teacher), ran away from teachers (who she doesn't normally see), and fought with classmates.

The therapist wants to see if we can note any pattern to these kinds of outbursts because DD is showing what could be anxiety-expressed-as-OCD symptoms in her (the therapist's) opinion.

So, does anyone have any recommendations for note-taking apps that could be linked to my calendar? (I have an iPhone 6S.)