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

[tabegle]

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.

I don't know if we will have a separate Rx for ADHD. When we initially saw the pediatric neurologist, he didn't suspect IED, but did suspect ADHD and Anxiety. At that time he put the bug in our ear about Zoloft being an eventual tool, but no other medications and suggested a therapy switch.

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.

I pretty much walked out of the meeting assuming meds would be the next step. It was a lot to take it, especially since so much of it was unexpected. I need to get over my mental block for it and, well, wait until the next appointment to get the script. It's hard, mentally/emotionally for me.

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.

Not harsh, and I appreciate the input. I am only one parent (plus the DH), and these pediatric specialists have their recommendations with all kinds of schooling and hands-on experience that I am definitely going with so I can help my son. I am not at all pulling my son from therapy, though I have researched other therapy options since I haven't seen any improvements in 6 months where he is at. Ds is the second child of 3, and soon to be 4. I guess I'm venting a little bit because, you're right, the dx and recommendations were not what I expected. I just need to adjust my expectations and I'm reaching out for help and advice because this is not a traveled road for me.

Again, thank you all for your input and experience.

[jse107]

Hang in there--it's a journey and you're at the beginning. Educate yourself as much as you can and ask lots of questions. Try not to be afraid of letting it all hang out so that everyone can work together and be on the same page.


Sent from my iPhone using Tapatalk

[StantonHyde]

My DS has ADD, Dyslexia, and Anxiety. We medicated for anxiety starting when he was 7--which is when he was evaluated. We use Zoloft and have for 7 years. We added in Concerta 3 or 4 years later when it became a big issue for school. There is a significant difference in DS on Zoloft and not. DH did not want to medicate because it would reshape DS's brain forever. The doctors pointed out that NOT having the meds definitely reshapes the brain and wires kids to self medicate, wires for anxiety pathways etc. I have anxiety. I can tell you that Zoloft is a life saver for me. DS also got therapy for tools to soothe the anxiety. I can tell you that I spent years in therapy before I got to the point I needed meds. It was life changing. I no longer spent gobs of time and energy calming myself. I freed up all this mental energy and creativity etc etc and I really liked who I became.

As for expectations. Whoo boy. yep. BTDT. Take everything you held dear and chuck it out the window. Look at your child. Make the decision based on what is there in front of you, not what it "could have, should have, would have" been. Yes, you can process this underneath for a long time. But decisions must be made quickly and you have to let go. No it's fun explaining to family or to yourself--but it was interesting. i found out later that people admired me for facing these issues head on and moving forward in DS's best interests. As for the road not traveled--it was a truly humbling experience that first year. I was facing something I knew NOTHING about, had no experience with, I was overwhelmed and felt like I was moving through mud most of the time. It is HARD. And then you get a number of specialists who each want you to work 30 minutes a day on their recommendation--when is the child supposed to breathe? We consulted a great deal with our child psychologist on what to prioritize. We basically didn't do a darned thing with handwriting because we knew he could type--his handwriting at 13 is atrocious. He will have to get to the point that he can fill out a form but otherwise I am ok with letting that go.

As for the intelligence--I do mean this gently, I promise. Please do not become one of those parents who only focuses on how smart their child is and poo poos all the behavior pieces. It is amazing to watch this and I see it a lot. Because the bottom line is that a kid can be smart as all get out but he can't access the teaching if he so anxious he can't concentrate or he is so explosive he won't follow directions. And guess what is actually going to get you ahead in life--social skills. I am not talking about being a Miss Manners diplomat, just a kid who can function in a classroom. I have a friend with a daughter who is smart as a whip but her anxiety is so bad that she gets Cs because she can't cope in the class room (and she has lots of accommodations and is medicated and in therapy etc--they are truly doing everything for her, poor kid).

Good luck with this. I do hope you have a child psychiatrist managing the meds--that really is the best way to go. You can start with a pediatrician but you will want to get in with a child psychiatrist. Breathe--a lot. It is a challenge to push yourself way out of your comfort zone while taking time to be gentle on yourself. I probably could have used some therapy to deal with that first year to tell you the truth! I really leaned on the psychologist--I credit her with all of our sanity!

[tabegle]

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.

I'm not keen on holding him back. Academically, he's awesome. Physically, he's bigger than kids in his older sister's class. I know those aren't good reasons to not hold him back, but they are pretty big sticking points to me. Then again, I apparently have many mental hurdles to overcome.

I agree with you on the school not being a good fit. Overall, I've been displeased on behalf of both my school-aged children and have broached the subject of moving to DH. DS was in weekly sessions with the school social worker, whom I believe is still pretty wet behind the ears. She did introduce the "unthinkables" along with superflex and rock brain. The outside behavior therapist was also working with those. But the school never stuck with one plan for very long to even see if it would work. Now in the special ed class, there is an on-site social worker/therapist (I'm not sure what her title is exactly) . At this point though, I personally am having a lot of trust issues with "is the school doing what's best for my kid, or what's easiest for them and maintaining each classroom".

[tabegle]

My DS has ADD, Dyslexia, and Anxiety. We medicated for anxiety starting when he was 7--which is when he was evaluated. We use Zoloft and have for 7 years. We added in Concerta 3 or 4 years later when it became a big issue for school. There is a significant difference in DS on Zoloft and not. DH did not want to medicate because it would reshape DS's brain forever. The doctors pointed out that NOT having the meds definitely reshapes the brain and wires kids to self medicate, wires for anxiety pathways etc. I have anxiety. I can tell you that Zoloft is a life saver for me. DS also got therapy for tools to soothe the anxiety. I can tell you that I spent years in therapy before I got to the point I needed meds. It was life changing. I no longer spent gobs of time and energy calming myself. I freed up all this mental energy and creativity etc etc and I really liked who I became.

As for expectations. Whoo boy. yep. BTDT. Take everything you held dear and chuck it out the window. Look at your child. Make the decision based on what is there in front of you, not what it "could have, should have, would have" been. Yes, you can process this underneath for a long time. But decisions must be made quickly and you have to let go. No it's fun explaining to family or to yourself--but it was interesting. i found out later that people admired me for facing these issues head on and moving forward in DS's best interests. As for the road not traveled--it was a truly humbling experience that first year. I was facing something I knew NOTHING about, had no experience with, I was overwhelmed and felt like I was moving through mud most of the time. It is HARD. And then you get a number of specialists who each want you to work 30 minutes a day on their recommendation--when is the child supposed to breathe? We consulted a great deal with our child psychologist on what to prioritize. We basically didn't do a darned thing with handwriting because we knew he could type--his handwriting at 13 is atrocious. He will have to get to the point that he can fill out a form but otherwise I am ok with letting that go.

As for the intelligence--I do mean this gently, I promise. Please do not become one of those parents who only focuses on how smart their child is and poo poos all the behavior pieces. It is amazing to watch this and I see it a lot. Because the bottom line is that a kid can be smart as all get out but he can't access the teaching if he so anxious he can't concentrate or he is so explosive he won't follow directions. And guess what is actually going to get you ahead in life--social skills. I am not talking about being a Miss Manners diplomat, just a kid who can function in a classroom. I have a friend with a daughter who is smart as a whip but her anxiety is so bad that she gets Cs because she can't cope in the class room (and she has lots of accommodations and is medicated and in therapy etc--they are truly doing everything for her, poor kid).

Good luck with this. I do hope you have a child psychiatrist managing the meds--that really is the best way to go. You can start with a pediatrician but you will want to get in with a child psychiatrist. Breathe--a lot. It is a challenge to push yourself way out of your comfort zone while taking time to be gentle on yourself. I probably could have used some therapy to deal with that first year to tell you the truth! I really leaned on the psychologist--I credit her with all of our sanity!

I certainly hope that I do not become one of those parents that disregards behavior in light of academics. I've just been very shocked at how lax (or rather lacking ENTIRLEY) the recommended academic portion in his IEP was before DH and I had input. The neuro psych eval also mentioned how "light" it was and said she was adding more to her recommendations. I also come from a different view point. My brother was in special ed all his life. I don't know why, but he started at very young age/grade. And to this day, I don't think my parents knew any better than to question or challenge the recommendations. When I was in HS, I was a student aide in his classroom and they didn't really challenge the kids at all. It was all busy work. With my new knowledge coming into this as a parent, it really makes me question what my brother's potential really could have been. And that saddens and scares me.

I want my kid to be challenged and mainstreamed. Hell, if it is all behavior/AHDH/Anxiety/IED, I'm happy to set him up in the special ed classroom until we find a nice balance with therapy/meds/solutions, but please continue to encourage his passion for math, his love for science, wet his appetite. Don't stick him in a classroom with a "bunch of worksheets other kids his age are doing". Encourage him to his capacity, not to the "state mandated acceptable level". And if he continues to outperform, get his social emotional skills ready for the next grade and put him in there.

[niccig]

And if he continues to outperform, get his social emotional skills ready for the next grade and put him in there.

You also have responsibility for this, whether it's combination of therapies, counseling or medications. It's not all on the school.

I work with children who are enrolled in Autism special education classes and we do work on social emotional skills. I have one child that always invades other children's space and growls like a monster, he thinks it's funny. They don't like it and push him away, he can then push back and someone can get hurt. We're working on him not doing it (also working on other children not pushing back) but the behavior continues at home (he does it to his siblings according to his parents), so we're battling to extinguish the behavior at school. Monday's are worse days for him as he's had 2 days of being out of school routine and expectations. We really need the family to be also working on his behaviors as we can't be there at home.

Check if your state regional center offers any therapies or ABA, if he qualifies (each state has different criteria). Many of my students get interventions after school and it's really made a difference to have the families get help at home as well as interventions at school. I communicate with the outside therapists when parents give permission so we're all on the same page.

Also look to see if the school district has other placement options. Go tour more classrooms. My 2 special education Autism classrooms follow the general education curriculum, there are other classrooms at different schools that follow an alternative curriculum (not general education curriculum). Teachers are also very different. So ask to see different placement options. The school should also provide transportation if class placement is at a different school.

I also wouldn't ignore the ADHD piece, participating in a classroom is very difficult if you can't attend for very long, especially as class numbers get higher and give more distractions. As he gets older, there will be more emphasis on independent work too. I do have students that aren't functioning in general Ed classroom, who don't get help with their ADHD and I have to wonder if they would function better if the ADHD was better controlled.

[Cam&Clay]

DS2 has anxiety and ADHD. Prior to medication, he was explosive, both here and at home. Once he went on Lexapro, the explosions became infrequent. He was explosive BECAUSE of the anxiety. Where someone like me would cry when anxious, he blew up and threw chairs and hit people. Currently we are not medicating for the ADHD but will if we need to.

If the medication helps with the explosiveness, would they move him back to the regular classroom?

I'm a little confused about the IEP situation, though. DS2 has an IEP for an emotional disability and it contains goals that are only for his behavior and ability to cope. Academically, he is doing very well and will be in a self-contained gifted class starting next year, but none of this is specifically stated on his IEP. It mentions in the write-up that he benefits from being academically challenged, but his goals are not academic based because he doesn't have a learning disability. Maybe it differs by state?

I hope that all of this works out for your DS. You are doing the right thing!

[PZMommy]

. At age 5 I kind of ignore the ADHD dx.

I strongly disagree with this. I've been teaching 5 year olds for 12 years now, and I can easily spot the difference between an active 5 yr old boy, and a 5 yr old with ADHD. There is a huge difference with how they are able to attend to simple tasks, pay attention to stories, follow classroom procedures, interact with peers on the playground, etc. You will do the child no favors if you ignore the seriousness of ADHD behaviors and how they impact a child in the classroom.

[hillview]

I strongly disagree with this. I've been teaching 5 year olds for 12 years now, and I can easily spot the difference between an active 5 yr old boy, and a 5 yr old with ADHD. There is a huge difference with how they are able to attend to simple tasks, pay attention to stories, follow classroom procedures, interact with peers on the playground, etc. You will do the child no favors if you ignore the seriousness of ADHD behaviors and how they impact a child in the classroom.

I appreciate that and so I think we have to agree to disagree. When my DS1 was dx via a neuropsych with ADHD it was not a correct dx and he later got a different dx. I personally feel 5 is too young.

[elephantmeg]

I strongly disagree with this. I've been teaching 5 year olds for 12 years now, and I can easily spot the difference between an active 5 yr old boy, and a 5 yr old with ADHD. There is a huge difference with how they are able to attend to simple tasks, pay attention to stories, follow classroom procedures, interact with peers on the playground, etc. You will do the child no favors if you ignore the seriousness of ADHD behaviors and how they impact a child in the classroom.

With DS, he was at the end of 2nd grade before he got a diagnosis. He was SO far behind socially, and academically. DD was diagnosed the summer between K and 1st and started meds the first week of 1st grade. She has excelled and had a much easier time then DS. Now, I do believe he had a more severe case and anxiety that goes a long with it but I do wish we had been able to start meds earlier with him. Our pedi is willing to prescribe meds with the report from the pscyh. So that may be an option. We see the psych monthly for counseling and see the pedi every 3 months for a med check up-it was more often at the beginning.