neuro psych eval results - zoloft? ADHD, Anxiety, Intermittent Explosive Disorder

[tabegle]

We finally got the neuro psych evaluation back for my son and the results were not what I was expecting. Per other posts, my 5yo son was moved from his general education kindergarten to a special ed classroom (for "emotional disability") with, currently 5 other kids ranging from kindy to 2nd grade. I only met 3 of those kids, and they were all also cognitively challenged as well (where my son easily outperformed his gen ed kindy peers).

Anyway, I was very upset at the recommendation to move classrooms, but we kind of felt "we'll play what they want until we get the neuro psych results". I had very high hopes for the neuro psych eval to come back with recommendations to move him back to the gen ed classroom asap. And then I got the results.

I again, wrongly expected my son to come back with a high functioning Autism diagnosis. Instead, he was diagnosed with ADHD, Anxiety, and Intermittent Explosive Disorder, with the recommendation to medicate. And honestly, the "explosive" part really only happened in his general ed classroom. Not at daycare, not at home, and not at the special ed class. Though, to be fair, the dx does seem to fit. Add to that, my son is one of the youngest kids for his grade with an August bday and a September cut off. There is no way we would have held him back because thrives academically, often doing his sister's work and she's a grade ahead.

So, long story short, does anyone have experience or advice? The recommendation is to medicate with Zoloft and keep him in the special ed class (and amp up the academic portion of his IEP) with a gradual reintroduction to gen ed. His outbursts happened at school one out of 5 to 10 school days. And I have high hopes the ADHD will lessen with time and maturity. I'm hesitant to go with Zoloft, though, we are on a wait list to see the pediatric neurologist to even get that filled. Currently, the appointment is in September.

Does anyone one have any advise, recommendations, words of wisdom, experience with any of this?

[hillview]

when he is explosive is he violent? is he in public or private? Have they done a Functional Behavior Assessment (FBA) to see what triggers him? who did the eval you (private pay) or the school? What were the other scores of the neuropsych eval (IQ etc?). If he is only having IED episodes in ONE environment 5-10 days apart I'd look more carefully at that environment and what is triggering him. I wouldn't do the zoloft just yet. The anxiety could be what is triggering the behavior issues IME. At age 5 I kind of ignore the ADHD dx.

[tabegle]

Thanks for your response.

I don't have the full report available to me yet, we just had a meeting to go over the results. The report will be mailed in about 2 weeks. It was a private evaluation done at a smei-local children's hospital, not done through the school.

The explosive incidents, over the course of the school year did increase in aggression, eventually leading to kicked over tables/chairs and elbowing teacher. Per eval, none of this is done maliciously. I'm not sure if and FBA has been performed.

The school IQ test put him at 116, superior intelligence. I don't have the hospital report back yet and they did their own IQ test.

Thanks for your advice, and good questions. I'll have to look into what an FBA is and see if it was done at the hospital. At this point, I doubt it.

[hillview]

I sent you a PM. A FBA is something the school would do. They'd observe him during the day at times when he is more likely to act out and determine root cause of his outbursts. They would then work to develop a plan to avoid these outbursts. Example
He is acting out when they line up because other kids are pushing or touching him, he is line leader or goes to open a door ahead of the class as his class job to avoid the line issues
He acts out just before lunch because he is hungry, he gets a snack before lunch to tide him over
He acts out when he has to do independent work in math because he is anxious about math, he sits with a teacher or aide during math work to help him
He acts out in music because the sound is overwhelming, he wears ear plugs or skips music because he is 5 and that is fine

[tabegle]

Thanks, Yes, I guess the (public) school did do an evaluation to determine his triggers. It mostly came down to when he was singled out to correct him (hold your pencil this way instead of that way) or a change in routine that he wasn't prompted for. If the teacher redirected the whole class, or all the kids at the table, he did much better. Some of his incidents did come just from pure miscommunications/misunderstanding and him being 5 and supposed to be doing what the adult says regardless of the 5 yo's questions or not understanding the why behind it.

I tried replying to your pm, but your inbox is full. ds has been in behavioral therapy since the end of December. Executive functioning has peaked my interest for my son, but I think I should wait until I can actually read the full report that comes back. Overall, I've not been impressed with therapy, though the neuro psych evaluator said the therapist was a good fit based on the therapies used and willingness to work with the schools. I want to cancel therapy all together. DS loves it, as eh thrives on individual attention and I'm paying someone to literally play games with him.

[hillview]

Thanks, Yes, I guess the (public) school did do an evaluation to determine his triggers. It mostly came down to when he was singled out to correct him (hold your pencil this way instead of that way) or a change in routine that he wasn't prompted for. If the teacher redirected the whole class, or all the kids at the table, he did much better. Some of his incidents did come just from pure miscommunications/misunderstanding and him being 5 and supposed to be doing what the adult says regardless of the 5 yo's questions or not understanding the why behind it.

I tried replying to your pm, but your inbox is full. ds has been in behavioral therapy since the end of December. Executive functioning has peaked my interest for my son, but I think I should wait until I can actually read the full report that comes back. Overall, I've not been impressed with therapy, though the neuro psych evaluator said the therapist was a good fit based on the therapies used and willingness to work with the schools. I want to cancel therapy all together. DS loves it, as eh thrives on individual attention and I'm paying someone to literally play games with him.

I cleaned out my box. He sounds a lot like my son. Nonverbal signs are lost on him (the NLVD is a nonverbal learning issue so lots of subtleties are lost on him) so it leads to a lot of misunderstandings. The game playing does seem silly BUT it would be to help your son take turns. how to lose basically social pragmatics work with corrections (no you only role one die on this move) sort of things.

[jse107]

I, personally, would not avoid addressing the anxiety or ADHD medically. It sounds like when he is in an environment that he can't control the way he would like to, or if there are unexpected changes, he is unable to use appropriate coping skills. Daycare and the special ed room are likely much smaller settings and have somewhat less stimulation. 3-5 outbursts a month is too many for any student--even if it's not done maliciously.

Therapy can be super helpful, but a person has to be "available" to use the strategies. If one is overwhelmed with anxiety or ADHD, it can be hard to slow the brain down and think through possible solutions.

As a mom to an 11 year-old with SPD, ADHD, and GAD--who also tested above 130 in his verbal skills--therapy and meds have been AMAZING. He's maturing into a well-adjusted, bright, funny young man. He isn't embarrassed about his dx or that he takes meds. In fact, he has told the psychiatrist several times that he finally feels "like himself."

Being the parent of a child with some extra needs (well, really just being a parent) mean we have to set aside some of our expectations and be open to a variety of options. From what the experts are telling you, this isn't just a little issue that's part of a typically developing child. Being the youngest doesn't help, but the behaviors are still not within the norm. I honestly can't imagine why you would just pull him from all therapy and not talk to the therapist first and find the purpose of their therapy together.

I'm sorry if this post comes across as a little harsh, but from what I've read, it seems like what you want the issues to be and what they really are, are two different things. Just because a child is super smart, or outperforming peers in kindergarten, does not mean that they will ALWAYS outperform or that intelligence is the only indicator worth valuing.

[dogmom]

Zoloft is a fairly safe medication that is easy to adjust dosages up. My DD is on it for anxiety since 7, almost 8. She has been on a small dose for two years now and fairly stable for a year. My experience is some small GI complaints when we started that disappeared after a month. Can get a headache if we forget a dose. That's it.

What it does for her is just modulate her anxiety and depression so she has less outbursts. Now that she is older she has been in a stable place for a while and can start really learning and using coping skills. There a lot of coping skills someone can use, but they aren't easy to learn or implement. Adults have problems with them. I can see before high school that my daughter could stop medications. I feel like this is a bridge for her. So I would encourage you to think about meds as a temporizing measure. You can always stop them. But my general belief is with medications that have been well trialed and around for a long time it's worth a try when other interventions haven't produced the result you are looking for.

[gatorsmom]

Ugh, I'm sorry the results came as a surprise to you. That is never fun. I've talked about our ds3 and our struggles with him here for years. Still the ADHD and anxiety diagnosis were a surprise. He does have moments of aggression too, at school and at home, but they come and go. This spring we would see an episode every other day for 3 weeks. Then nothing for months. Or even years. It's hard walking on egg shells.

Dont be afraid of the medications. When people outside our family ask me if I've tried other solutions ( I've heard every suggestions under the sun), I just point out that 1- would you ask a nearsighted person to try other solutions before getting them glasses? And 2- studies are starting to show that a large percentage of children who don't receive the tools they need to cope with ADHD as children, turn to self-medicating (drugs and alcohol) when they are older to cope with their racing brain. It's worth trying the medications now.

After 6 months of trying different meds and with the wise counsel of the mamas here, we have settled on Concerta as the ADHD med that helped ds3 best with the fewest side effects. A couple of the meds we tried caused some serious emotional outbursts (vyvanse and focalin) but Concerta didn't cause the awful outbursts. It does cause low appetite and OCD or exasperates what he already has (I think we have some OCD in the family), and it causes him anxiety so we put him on Prozac. It had worked for members of our family in the past and is working very, very well for him. It takes a lot for him to have an outburst now.

We also started behavioral therapy which has been very helpful for him and our family.

Dont get discouraged! Getting our diagnoses was hard to swallow at first but has been fantastic for our DS3 as well as our entire family. We have been able to enjoy activities that we couldn't for the last 8 years because it would be too hard for him. And he is excited to try them!

I agree with holding off on the Zoloft until you have the ADHD med sorted out. See how he does with the ADHD medication before trying an antidepressant. Zoloft wasn't the best choice for our DS3. His aunt had a difficult time with that medication. But she had great success with Prozac and so did MIL. Apparently because of family brain similarities, some antidepressants can have similar effects on family members. Just something to keep in mind when considering the antidepressant.

[Kindra178]

Could you hold him back now? Have him repeat kindergarten? There is a huge correlation between ADHD diagnoses and having your birthday within a month of the cut off. If you can manage the ADHD symptoms, things all around might be better. I would not worry about him being challenged in school if he repeats. There are numerous areas for differentiation in school. This should be your first step.

I would not shy away from medications. Untreated ADHD makes it hard for kids to manage friendships, even in grades 1-2. I am not sure your school is a good fit - is your town/school district known for special ed? IF not, you should move to a town that is known for that. Still baffled as to why they moved him out of a general ed classroom - that's usually a last resort. What about the school social worker? He should see her every week and that should be added into his IEP.

ETA: Have you started OT yet? It's a great way to get kids to regulate emotions and employ strategies so not to have emotional outbursts in school. Find an OT that does the Superflex program. NorthShore Pediatric Therapy may be by you and their OTs have access to the program.