Teacher called me

[Elise N. T.]

Joseph is 9yo and has ADHD. He's on 50mg vyvanse in the morning and .2mg clonidine at night.

His teacher called me this morning to set up a meeting between us, the school counselor, and who knows who else. She is very concerned over his behavior. He has been hitting his head on things when he is upset/angry. He has been doing some Obsessive Compulsive Disorder (OCD) things in class like repeatedly getting up to write more things on papers he has already turned in. He is withdrawing and not talking to anyone. He is not getting any work done. He has had two head injuries at school in the past week - one from falling in the bathroom and one from falling into the fence outside. She is not sure the stories he is telling are true and thinks he might have hurt himself because he was angry.

Joseph has always been calm at school but very hyper, aggressive, and destructive at home. His teachers usually don't believe me that he is hyperactive unless they see him without medications. I have been asked in the past to up his medication dosage because he is inattentive, and later asked to lower it because he isn't interacting. So far we haven't been able to find a good balance.

He's tried ritalin, concerta, focalin, daytrana, and adderall. He was on daytrana at the end of last year but it was giving him tics and he was having wild aggressive mood swings so he was switched to adderall. In november his teacher said she was concerned because he wasn't talking at all at school and was very withdrawn. His doctor switched him to 30mg vyvanse. I tried that for two weeks and his teacher said he was talking more. However, I noticed it was wearing off by 4pm. He couldn't do his homework or eat dinner and was constantly in trouble. So we raised the dosage and it does last longer. He's been at this dosage for six weeks now. I just refilled his medications yesterday, too, so I don't think insurance will cover it if he needs to switch medications this month. I don't really know what else they would try with him.

I don't notice him being a zombie on weekends. He does tend to play by himself and gets very wrapped up in what he's doing. He never gets quiet with me like he does at school. I have noticed he has more of an attitude lately, like he really just doesn't like me. I thought that was probably a preteen thing?

I'm partially afraid this is my fault - I just had a baby four weeks ago so his schedule has been disrupted. I've been having the usual postpartum mood swings and I've lost it with him a few times when he was out of control.

Does anyone have any ideas or know what I should say at the meeting tomorrow? I know they'll want me to decrease or change his medications but honestly he's had this problem with every medicine he's been on. Either it makes him a zombie at school or a monster at home.

 

[witzend]

I'm no expert on this, but I'm sure that there will be others who can give you some very good advice as to how to make the most out of this proposed meeting. I know that I dreaded the phone calls from school regarding M, but in hindsight I probably could have utilized opportunities if I had only known what was available to us.

You might want to post this on the Special Education 101 forum. Those gals are true Warrior Moms and won't let you down. They're the best.

 

[busywend]

I would just tell them exactly what you are telling us. The different reactions are common and difficult to determine when it is necessary to change medications or increase or decrease.
Bring a list and the reactions difficult child has experienced with each. Make it clear you have been listening and reacting to their concerns.

 

[LittleDudesMom]

Hi Elise!

First of all, the school cannot "make" you change, stop, or start medications. If the meeting is just his teacher and the school councelor neither of them are qualified or educated to recommend medications for your son. Please don't let them "bully" you, especially at this time when your emotions are running high (understandably :smiles.

I beleive you should approach this meeting as an information gathering. Find out if there are certain times of the day when your son seems to have more issues. See if there are any triggers that that teachers have noticed. Find out of there is a particular subject that seems to raise his frustration or a particular student that he does not get along with. Find out how he does socially at lunch and at recess. Does he misbehave in he classroom and not at gym or music class? I would do my best to narrow down his behaviors as much as possible.

I believe you should let them know that you are open to the idea of having your son reevaluated. If you can afford or your insurance will cover, I would suggest a multidisciplinary evaluation or an evaluation by a pediatric neuropdoc. Given that your son has been on so many "traditional" adhd medications wihtout success, could mean that there is more to the boy than adhd. He could be on the totally wrong line of medications.

Take a deep breath and let the school know that you are just as, and more so, concerned about his behaviors as they are. That you will be looking into continueing his evaluation process, but you welcome any ideas and suggestions they may have in the meantime. I'm sure your little boy is not the first to cross their paths with behavior issues. Listen to their ideas, but follow your gut.

And, congrats on the birth of your new baby . I'm sure your older son is feeling some emotions that he cannot exactly put words to. He may be feeling a little second fiddle. How about just some mommy and him time this weekend when someone can look after the little one for a couple hours?

I hope the meeting goes well. Pop in and give us an update tomorrow.

Sharon

 

[BusynMember]

Ok, first of all schools can't force medication. Secondly, who diagnosed your child with ADHD? Is that all you feel he has? Did he have any problems with early development? Any psychiatric, neurological or substance abuse issues on the family tree? I always recommend a neuropsychologist evaluation as they are really thorough compared to what other types of professionals give. My son had twelve hours of testing and finally got it right.
Welcome!

 

[smallworld]

Elise, congrats on the new baby!

Are you working with a child psychiatrist on Joseph's medications? If not, I'd strongly recommend finding one to help you figure out the best medication combo for Joseph.

Any stimulant like Vyvanse can cause side effects of anxiety, Obsessive Compulsive Disorder (OCD) and withdrawal, particularly if the dose is too high. I'm wondering why Joseph's doctor upped the Vyvanse if it was wearing off at 4 pm. It is general practice not to up the dose but rather to add a short-acting booster dose at 4 pm to allow the child to do homework and other activities at home. From what you describe, I'm guessing his Vyvanse dose is too high.

With Joseph's history of aggression and destructiveness, I agree with the need for a re-evaluation. You might be looking at more than ADHD. As LDM suggested, you should consider a multidisciplinary team or neuropsychologist, generally found at children's or university teaching hospitals.

In terms of tomorrow's meeting, you can simply tell the teacher and counselor that you're there to listen and bring their concerns back to Joseph's doctor so he can make appropriate treatment decisions. You can describe what you're seeing at home, but you don't need to get defensive, confrontational or commit to any new treatment. Does Joseph have an IEP by any chance? Maybe it's time to consider one if it's not already in place.

Good luck tomorrow.

 

[Calista]

Who prescribes your son's medications? A pediatrician or a psychiatrist? My difficult child has many of the same reactions to stress and life in general when he is taking a stimulant. I think that a full evaluation is an excellent idea to address the mood changes exacerbated by the stims. It sounds like there is more than ADHD going on. You can always request that the school do and evaluation but, it won't cover much in the area of nuerological or psychiatric needs. It is a good place to start. Also, are they accommodating him in anyway to help him follow rules and meet ecpectations. Accommodations definitely need to be addressed. You can request an IEP under OHI or 504 to get things rolling. They cannot bully you into drugging your child into compliance. They are part of his team and need to act as such by offering accommodations, evaluations, etc...

 

[Elise N. T.]

Thanks for all the replies!

He was diagnosed by his pediatrician on my request while he was in kindergarten. His teacher, my husband, and I all filled out questionnaires. His teacher's showed ADD and ours showed ADHD. We've never seen a psychiatrist for him and it's never been suggested.

He has been seeing a physician's assistant at his pediatrician's office for the last three years, and he's the one that's been prescribing the medications. He does take a lot of time to listen and seems to really care. Their office advertises itself as specializing in kids with ADHD and behavioral issues so they see a lot of these kids.

I did ask to have an evening booster with the vyvanse but the PA said he's never seen a kid who needed a booster with it and he upped the dosage instead.

I have questioned before if he could have bipolar or depression but it's been quickly dismissed. He has weeks when everything is fine and then weeks where he's off the wall, all on the same medication. He has the clonidine because in the past there have been times when he didn't sleep for 2-3 days and was still hyper.

He has an IEP. He was in special services to help with speech therapy, and when he tested out of that I had him requalify for medical reasons (ADHD).

Would I get a referral from his doctor for a psychiatrist? My son is on the WA children's medicaid program.

Family history: there's depression on my side, and my husband's aunt has bipolar and schizophrenia

 

[tryinghard]

Hi Elise,

I am new to the site but felt compelled to drop you a quick note.

First of all, hang in there and try your best to enjoy each day with your children. I know it sounds corny, but sometimes things seem so hard and I am so tired, I forget that this is a journey and you need to try and sit back and enjoy it as much as possible.

I too had a meeting at school this morning and had to hear about all the negative things my son does. In addition, at the end of the conference, I was told the teachers felt I was enabling him not supporting him. I have heard this over and over for many years. The problem is they do not understand because they do not have children with the same needs as ours. I am hear to tell you that I understand I am know you are a good mother who is trying everything to help her child.

I believe that most teachers mean well. They just do not understand that what works with most children does not work with ours. Hang in there and stay positive. What you teach them may help the next parent\child they deal with in the future. My sister in law once told me that our job is to educate people so they can better understand our children. It is so true.

There is hope....my nephew was the worst child I had ever seen in my life. So many issues. With love, patience and many tears....he is now a lovely well mannered 18 year old. You would never believe he is the same child!!!

I wish you peace and patience. Hang in there and take care of yourself.

 

[wakeupcall]

SO true. The teachers have no idea what it's like to live with children like ours. My difficult child has an IEP and I have to remain vigilant about them adhering to it. It's a constant watch for me. Another thing......our children NEED a soft place in their lives. They seldom get that soft place at school. It's extremely difficult, but I try to make the soft place home. difficult child is disobedient, hateful, smart-alec, nasty and eveything else you can think of.....but he's my little boy and I love him, just as you do yours. I don't like to look at the school as the enemy, but sometimes that's how it feels. I believe our difficult children really do try to hold it together as much as they can at school, then let their hair down when at home, because they know we love them unconditionally. Educating the school is an ongoing process. Be strong, be his advocate.

 

[susiestar]

Congratulations on the new baby. Be sure to watch your son very very carefully around the baby, to be sure he doesn't' direct behaviors toward the baby. I had to deal with this and it was totally horrible.

As for the school, gather info on his behaviors, tell them you want an IEP, and write a letter (see the Special Education 101 forum) asking for a full and complete evaluation for an IEP. That puts certain protections into place for your son, and the letter MUST be sent certified, even if the school people are "nice" to you.

I really think you need a psychiatrist to evaluate your son, and a neurologist to run an EEG (sleep deprived), to rule out neurological problems - the falls and the head banging make me think this is needed. And you probably do need your pediatrician to do a referral, but the state children's insurance should cover it all. I know it did for us.

Hugs,

Susie

 

[BusynMember]

Sweetie (I'm an old fart so I can call ya that, I hope ) I would not trust his psychiataric/neurological diagnosis to even the most understanding pediatrician. You have a complicated gene pool and he has odd symptoms that may be more than ADHD. I would take him to a neuropsychologist and/or a Psychiatrist (with the MD). This pediatrician may know a lot about ADHD, but he does he know how to test for Autism Spectrum Disorders (ASD), bipolar, etc? I just wouldn't trust that his diagnosis. is the big picture. Up to you, of course, but they didn't have all the extra years of psychology/psychiatry/neurology that the other guys do, and I like to start at the top. Especially since your son isn't better, I'd go further. Lots of kids with disorders have good/bad weeks. It's part of it. Just when we think they're A-ok, they flounder again. medications or the right interventions can really change things a lot for the better.
Congrats on the new baby!

 

[Calista]

You can get a referal for a psychiatrist from his Primary doctor. I would definitely not wait to do a more indepth evaluation. He's clearly not recieving all the help he needs. You can also request a Functional Behavior Assessment at school to be followed by a Behavior Intervention Plan so theat he can have supports that allow/help him to follow the rules and regs of the school.

 

[Elise N. T.]

The meeting went well. They were trying to say (without actually saying it) that he might have autism/aspergers/Obsessive Compulsive Disorder (OCD) and should be evaluated further. They're especially worried about the lack of social interaction and how he gets obsessive about interests.

They are going to call his doctor and explain their concerns. I made an appointment for Friday morning to talk to his doctor myself, and I'm going to ask for an evaluation.

The counselor said there is a new place she just heard about that does full testing but she thinks they only take private insurance. She's going to check and let me know. There was also some suggestion of the local children's hospital which does a five week inpatient program. They said it's usually for kids with behavior issues though (which they don't see and I do). I'm torn about that idea. I really can't see myself taking him somewhere like that - he would be scared! - but on the other hand it would be nice to get his medications straightened out and find out what's going on with him.

There was some suggestion when he was in preschool that he could have high-functioning autism. However, when I pushed his teacher on it to talk to his doctor she decided he was doing better and wasn't really having problems anymore.

 

[LittleDudesMom]

Elise, I would not let the personnel at school speak with your son's doctor. Why can't you express their concerns? I'm sorry, I may be jaded, but I would wonder at their enthusiasm to speak with the doctor. I don't believe there is the need for them to have contact with his doctor at this point.

As to the children's hospital, it is a great place to start the evaluation process! There is no need for your son to be an inpatient for him to begin the multidisciplinary evaluation process. Speak to your son's doctor about a referral to a pediatric neuropdoc or speak to the children's hospital about an evaulation. Another option is a local teaching university. At this point, you are not talking about a child that is completely "melting down", you are talking about needing some further evaulations which could result in a differnt or added diagnosis's as well as eventual medication changes.

Glad you have scheduled an apointment with his doctor on Friday. Keep us posted.

Sharon

 

[Calista]

The word Autism scares a SD because they know that once there is an Autism Spectrum Disorders (ASD) diagnosis then they have to open doors of support and accommodation. That may be why the first teacher backed off after you mentioned it. A stimulant can definitely have bad side effects for spectrum kids, they do for mine. I will tell you that having a correct diagnosis and know which path to take, no matter what it is, is a relief. Push hard for the evaluation. Get it done anyway you can. I knew when my difficult child was 4 that he had Asperger's. We had been going to a children's hospital for years with no improvement and many many continued problems. They would not diagnose the Asperger's. The SD is the one that finally made the official Asperger's diagnosis. We went through HELL for a while and ended up placing difficult child in a short-term (4 week) placement where they found medications that work. We now have a new PDdoc, from the placement center, who is treating the Asperger's. It hasn't been a walk on the beach but, at least we know what were dealing with, everyone is on board, and difficult child is TONS better with everyone treating the same, CORRECT, diagnosis.

God Bless and Good Luck with the evaluations.

 

[looking4hope]

Elise:

Welcome! You've come to the right place. First of all, I know what you're going through. My difficult child had similar behaviors, and being a teacher, I can tell you that your son's has his best interests in mind. Given that, here's my two cents:

My son did many of the same behaviors on stimulants. Ask about switching to Strattera, which is not a stimulant but is effective with ADHD. I found that when my son came off the stimulants in the evenings, not only did he get hyper, but he got aggressive as well.

Second, definitely have a second evaluation done by a psychiatrist or neuropsychologist. It does sound like there may be something else going on, but it could also be the stress of a new baby in the house. It's hard to tell, but don't try to evaluate this on your own.

Lastly, when you meet with the teachers, etc., bring a written letter asking that your son be tested for learning disabilities along with a full psychological profile. The school has 30 days to schedule the testing, but they will NOT do it unless the request is in writing. The reason for this is that if you son has a gap between his ability to learn what he is learning, he is eligible for an IEP. This document gives you and your son a lot more protection, and it will give him services that can help him to do better at school. Most kids on an IEP are very intelligent, but they need some accomodations to help them realize their potential. Your son sounds like the latter. My son is extremely intelligent, but he doesn't do well in large classes. His current placement has him doing above grade level work, but in a class with only ten students (and the school pays for the placement!!).

Anyway, hang in there and keep us posted. Let us all know how the meeting turned out!

 

[Elise N. T.]

We had our doctor's appointment today. I had Joseph stay in the waiting room after his weight / blood pressure checks because I didn't want him paranoid that his teachers think he's weird or something. His NP told me that the teachers had talked to him. He's not sure if Joseph's behavior is from the medication or something else. He's worried about Joseph being so quiet and withdrawn in class so he's going back down to 30mg vyvanse. That should be fun, since before it was wearing off by 4pm. He said some things the teachers said were new to him and concerned him. He hasn't seen signs of autism spectrum behaviors but the teachers know Joseph better than he does. He wrote us a referall for testing at a neuropsychologist place. Normally his insurance doesn't cover testing because it's three to five thousand dollars, but lately they'v e been putting approvals through. Hopefully we can get the testing done before they change their minds.

 

[smallworld]

Elise, great news about the evaluation referral. Hope you are able to get the evaluation completed.

If 30 mg Vyvanse is wearing off at 4 pm, you might want to check with the doctor about adding a low dose of a short-acting booster stimulant in the afternoon that will tide him over until bedtime.