Another diagnosis

[Malika]

A few months back, a psychiatrist diagnosed J as ADHD in a letter to the other psychiatrist we see. I saw the second psychiatrist this morning with J and asked her whether she also confirmed ADHD. She said yes, she supposed so, but it was a very mild degree of ADHD. She said there were 8 points difference between my Connors questionnaire and that of the teacher (don't know what that means) and that that was a lot - though we agreed that the previous teacher's cynicism about the existence of ADHD might have played a role.

J while in her office wasn't clambering all over the place but mainly playing quietly with the toys, and also her stethoscope, listening to his heart beat, which she didn't seem to mind... She says she would not think of prescribing any medications at this time but that we should see how things evolve for J in future. I think of the first time he went to see this psychiatrist in her office... he was manic, rushing everywhere, touching everything, playing with the blinds, jumping off a high step... I presume the difference is anxiety. When a situation is new, he gets anxious and becomes hyper hyperactive?

So the psychiatrist's assessment seems to fit in with my own for the moment. J is a very challenging child who displays hyperactivity and impulsivity but we do not feel the degree to which he cannot function in life justifies the taking of stimulants with their side effects. She said that in any case medications would not take away his oppositionality and I would still have to struggle with that.

I guess there is something helpful in people just knowing about J and how he is even if nothing specific is going to happen for the moment in terms of treatment... She stressed that if ever there is any problem at school or the teacher, I should ring her and she will speak to the teacher.

 

[InsaneCdn]

Oppositionality is often a side-effect of anxiety - an attempt to maintain some level of control.
Perhaps it is the anxiety that needs to be "watched"... ?

 

[Malika]

Thank you, IC. Yes, in fact recently I have begun to feel this myself... that J needs to control everything all the time because he does not feel safe enough to let go, safe enough to trust me or anything in his environment. It is partly why in some ways he seems SO much older than his years, so street smart, as it were.
This makes me sad that things have evolved this way. How best might I help him relax and feel less anxious, I wonder?

 

[SuZir]

This makes me sad that things have evolved this way. How best might I help him relax and feel less anxious, I wonder?

Sorry to say, but; structure, predictability, routine, discipline.

When he knows what is going to happen, when, how and how he is supposed to do things, anxiety may lessen. Unknown and unpredictable cause nervousness, especially when J is certainly smart enough to know that his choices and solutions on the new situations are not always getting a wide approval around him.

 

[DDD]

Ditto. DDD

 

[Malika]

Hmmm, well our lives are already pretty low-key, routine and dull as it is Don't know that there's a great deal further that I can go in that direction...

 

[BusynMember]

in my opinion if it's his inner makeup, it is hard for us to change. He can try hard to change it in therapy when he is older, if he wants to.

When my daughter was born, although she was adopted, I got to see her birth and then go to the baby nursery. It was my second time looking at babies in a nursery. From birth, they were all different. Some slept. Some cried. Some were awake, just looking around (they aren't supposed to be able to see well, but who knows? Jumper was doing this). Some are hyper. Some seem mellow. We are not born a blank slate. Our temperament is inborn and rather hard to change, especially as children

 

[lovelyboy]

My little one, turning 5 today......is also on the go....but it is more about SI issues! He is sensory seeking and avoiding!
He had a highly critical teacher....She filled in the Conners questionaire....but according to that he didnt have ADHD!!! But she has always been on hiscase for not sitting still, bothering the other kids exct! Dr( Neuro) wanted to start low dose Ritalin....even without fully meeting criteria. medications that could be used to " smooth the edges of oppositional" is Risperdal! It changed our lives to the good with my oldest son! Regardless all the negative stuff you read on google! This is part of the reason we are shifting schools! To get little one in a smaller more tolerant friendly and less critical environment, with ST and Occupational Therapist (OT) and then reassess! So they didnt suspect any Autism Spectrum Disorders (ASD) with your son....didnt you thought in that direction? Or am I confused?

 

[Malika]

Hi lovelyboy. My psychiatrist is not prepared to give J any medications and I'm afraid I wouldn't be open to him having Risperdal anyway, about which I have heard a lot of negative things. Obviously it works and helps in some cases and I'm very glad it does in yours. J for sure has a lot of undiagnosed sensory things going on and is sensory seeking but he clearly isn't Autism Spectrum Disorders (ASD) - unless you follow the thinking of some people that ADHD is in a sense on the autism spectrum.

 

[InsaneCdn]

Malika... Don't think of the "spectrum" as being a line with varying degrees of severity. It's a differently-wired brain. And yes, ADHD people (like me) think more like Aspies than like Neurotypicals. We don't have as many negative impacts as Aspies (and Autism Spectrum Disorders (ASD) is usually more complex yet) - but we don't have all the advantages either. Many highly-talented movers and shakers in this world are ADHD or Aspie.

Not because of any connection to J, but just for your own interest... have you ever read Look Me In The Eye (by John Elder Robinson)? It's an interesting look into how an Aspie thinks, works, survives... and a whale of a tale in it's own right.

 

[Malika]

Sure, IC. However, I think I may take issue with you a little While some people with ADHD may also have Asperger's (and I believe this is quite common), I think that ADHD and Asperger's present quite differently. Asperger's is clearly on the autism spectrum while ADHD debatably is, but in a way this is jostling words around...
Both ADHD and Asperger's people have social problems. But in ADHD (with hyperactivity), these will be due to impulsivity and hyperactivity - unable to wait turns, interrupting, difficulty sharing, over-bossy, probably over-physical - while people with Asperger's have quite other difficulties in social situations.
Does it matter? Well, just in terms of understanding and relating to what's going on, I think. I would actually prefer to say that J is hyperactive and impulsive since these are observably and undeniably true whereas the jury is out on whether he is ADHD or not since he seems to concentrate when he needs to, or at least enough to get by... and I don't think hyperactivity and impulsivity are really autistic traits, as such. I've watched J a fair bit with other kids - he's just a regular boy, like any other, relating to his peers like any other except... he has this need to climb, twirl, twist and touch. I don't think this has much to do with Asperger's, really.

 

[SuZir]

Hmmm, well our lives are already pretty low-key, routine and dull as it is Don't know that there's a great deal further that I can go in that direction...

Yes, but you have already done a lot to help with it. And you are learning new things all the time. If I remember correctly you recently posted how oppositional he was when you had not told him beforehand how long he can watch tv. Eliminating that kind of things and keeping daily routine, especially when it comes to sleep and food quite same and clear are the things that can help. And yes, it takes some spontaneity out of life and can be dull. But then again J is likely to be able top handle more change when he comes older so it will not be the rest of your life. And when you do or go something/where new and different talking about it, telling what will happen, telling him how he should behave etc. could help. And on the other hand if done too much/starting too early can make him build up anxiety. So you just have to find the ways that work with him.

Other than that I have few ideas,I would try if I had a young kid with anxiety issues. No idea if they make any sense or would work, but I do think they could not cause any harm either. They are something that have come up as 'shoulda coulda woulda's when thinking my difficult child's younger years and hearing what kind of things he is now doing with his mental coach. Some of it I even did try when he was young at times it did help.

There will be times, when you simply can't keep J's life that routine and same. And times when he gets anxious over something external. That is life. But maybe you could create small routines to ease his anxiety also during those times. They should be created when he is not anxious, when you are at home, with no hurry and everything is pleasant and you are both in the good mood. Use transitional objects and create new ones. There really isn't any good reason why bigger kids could not have them. They may not be teddy bears or security blankets any more but the same emotional content can be directed to something else. A toy, a gadget (think something sensory) he can carry with him. It can also be a story you read for him or something you do together. Something to provide him safety and relaxation. You could have many of different things you could choose from when needed. And think them as batteries, they need to be charged with calm and relaxing energy before they can be used in 'real situation' and between using them.

Things you could try could be example a story time, choose just few different stories that he likes and that are not too stimulating, have him nestled on your lap and take your time to read the story. Just slow, lazy, relaxing way when he is in the mood. After you have 'charged' enough of that content to that routine, you can try to use it when you have a break on your routine (trip, visitors or something) and see if that would help him gain that same emotional state he has, when you are at your home with comfortable routine. Other things like that could be rubbing his shoulders or feet, playing some calm game (for example memory game) you could keep with you and play with him when things get likely to cause him anxiety. Just make easily portable routines in calm times that you can use during more challenging times with him. If you can, adding smells can be very efficient. Smells are strong triggers for memories and moods and adding for example certain scented candle or other object to those routines (lotion for feet rub for example) can be very useful trigger for the mood you are looking for.

Okay, I'm not sure if i made any sense, but these have been things I would have been thinking lately and difficult child's mental coach (who by the way is totally awesome) is using something similar (of course more adult versions) with difficult child to help him handle his anxiety.

 

[BusynMember]

Actually, anxiety, hyperactivity and impulsivity are classic autism signs. And they do the same things to ostracize other kids that you mentioned. In both cases, the k ids do not understand how to socialize.

I have a little boy on my bus who is labeled ADHD...so far. And I see why. He talks a lot, can't sit still, babbles a lot, is very difficult and obstinate. I have to sit next to him or he will get out of his seat belt and try to walk around while the bus is moving, which is very dangerous.

At the same time, I have a spectrum child and my bus driver has a spectrum grandson and both of us think he'll end up with a spectrum diagnosis., in spite of his being friendly. I do not know J, but this little boy constantly gets the other kids in the bus irritated if it's because he screams on the bus then laughs or kicks the seat in front of him or shoves other kids. My opinion (layperson) is he is somewhere inbetween ADHD and autistic spectrum. He does have to go a half a day to our school and a half a day to a regular school to be with a teacher who works with kids who have special needs. If he just has ADHD, he is quite extreme and, unless he calms down, will have trouble in life. He is on medication, but nobody thinks it really helps him.

I think the diagnosis. of ADHD is close to the diagnosis. of Aspergers. Everyone who meets my son thinks he has ADHD and they always did. It's very confuzzalating...hehe

 

[Malika]

Well, I agree it's confusing MWM and I am by no means an expert. However, I have known some Asperger's people...
Doubtless the dividing line is not so clear. However, I am sure that each case, each child, is unique and this is also what makes blanket diagnoses difficult. In the case you mention, for example, of a school trip on a bus or coach, J would NOT be screaming or trying to run around while the bus is moving. In that setting, he is basically obedient, basically like the other kids, though he will be scolded more than some others for talking too loudly or whatever. I know this because I used to accompany his school to the swimming pool, involving a half hour bus ride each way, occasionally. No way would he be behaving like your little boy - this is because in France children are very disciplined and severely reprimanded if they step out of line. Left to his own devices, he may well be doing all of what your chap is doing... Which does rather beg the question of how much is the "syndrome". how much is the setting, etc, etc.
Are you saying that you don't think some kids are just ADHD?? I'm a bit confused about this.
It really doesn't matter but I just don't think J has either Asperger's or is autistic. If he did, I would say so, honest What I am trying to describe is that he DOES know how to socialise with other kids - I've seen it a lot. He looks interested in what the other is saying, has good eye contact, shares a joke, asks questions, seems quite empathetic, etc. It just goes alongside all the hyperactive and impulsive stuff which sort of runs in the other direction to that, if that makes sense...
I do know he's very difficult and demanding at times... whatever label one puts on it.
SuZir, thanks for your helpful suggestions. There are some good things to think about there. Actually, J would do very well with a behaviour coach, I am sure.

 

[lovelyboy]

Malika....I hear what you say about your son and I understand how you feel he doesnt meet Autism Spectrum Disorders (ASD) criteria......
I just wanted to add that hightend anxiety is almost the key symptom with AS.....and even with Pervasive Developmental Disorder (PDD) not otherwise specified......And also their Obsessive Compulsive Disorder (OCD) traids....The Obsessive Compulsive Disorder (OCD) traids can be seen in the repetitive thoughts, behaviour, questions( getting stuck on one idea, like wanting to rent a dvd), following rules by the dot....
AS people DO HAVE empathy, they just dont always show the behaviour, like giving warm hugs......
AS people CAN have " good" eye contact, it only gets harder in overstimulated or new environments, or sometimes its the quality thats poor......
AS people LOVE jokes and "playing around" with funny words.....
For kids to be diagnosed with AS there is 2 main criteria: Struggles with socialization....and this doesnt imply NOT being able to socialize! It can present with often wanting other kids to follow THEIR rules, being bossy, often thinking others are bullying them( because they misread the cues), often getting into power struggles, exct.
And repetitive behaviour...And again not the "rain man" type! But like wanting to have Mc Donalds on Wednesdays because they had it last week.....Wanting to play their faviourite ps3 game, not understanding other kids might not
enjoy it.....
I truely think your son is maybe to young to see clearly whats up....We are seing the little leave coming out of the ground, not knowing if its going to become a lemon or apple tree! As social expectations and pressure in school increases all might become clear!
Why we need to know what kind of tree he is.....because the wrong medications might worsen the situation and the right ones will improve it....You dont like medications? Believe me, there might come a day when your live becomes so out of control that you will do ANYTHING to help your child and keep your sanity! Hope this will not be the case for you!
Just my thoughts

 

[Malika]

Lol, lovelyboy, well you don't give up, I'll give you that That's exactly it - J doesn't have Obsessive Compulsive Disorder (OCD) traits or get fixated on rules. He likes routine and structure, which is rather different. He fairly clearly isn't Autism Spectrum Disorders (ASD). Having anxiety doesn't equate by itself to Autism Spectrum Disorders (ASD). I don't know what else to say to you.
This other stuff though, about sensory integration disorder, I really don't know... When I read about it, I think in many ways "yes, that's J". Seems there is also something else they've categorized called Self-Regulation Disorder which certainly seems to fit him. It would also explain why he doesn't really have bad attention problems or sleep problems. Reason I don't pursue that is because there would be nowhere to go with it here, it wouldn't be recognised as a diagnosis or have any treatment options. If I were in Paris, perhaps...

 

[SuZir]

Malika, I think J is one of those kids that you simply can't know in this point what, if anything diagnosable, he does have. He is still so young that there are only some clear cut things you can say for sure he doesn't have. He doesn't have classic autism, he doesn't have mental retardation and so on. It seems that he does have something different but because they all look so much the same at that age and kids change so quickly it is impossible to tell what it is.

In some places they would throw him several diagnoses and then look what would stick in later age. Other way to do it is not give anything and look what it turns out to be. Or give describing 'diagnose' of his current issues (for example hyperactive or sensory seeking or something.) What they do depends on local practises and what is needed to get services a kid needs.

In this point of time one can probably safely say that J is a little bit different child. When he grows older and environment begins to put more press on him it may become more clear what it exactly is. Or he may even grow out of it. Or he may end up like my difficult child with whom the 'not quite neurotypical' in my sig is still the best way to describe it. Just now you can really only wait and see and try things that could help with his current challenges.

I can't say my kid would be a success story; the 'PTSD' in my sig bothers the heck out of me, it shouldn't had happened. But then again I still don't know what I could had done to make it any better.

I can't remember have you tried to pursue occupational therapy for J? And would that be possible. At least with my difficult child it did help a lot with him when he was around J's age even though there was no diagnose, just descriptions of his difficulties. His Occupational Therapist (OT) was able to address those difficulties without knowing what diagnose, if any, was behind them.

 

[TerryJ2]

I agree: structure, predictability, routine, discipline.
Easier said than done.
The psychiatrist sounds nice. I'd keep her number handy!

 

[lovelyboy]

Double lol Malika.....we warior moms dont give up!