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Two Steps Forward, One Step Back?
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<blockquote data-quote="soapbox" data-source="post: 487018" data-attributes="member: 13003"><p>Well, lets see.</p><p>A boy. 5 years old, just getting going in school.</p><p>At least one parent with ADD.</p><p>And some behaviour issues...</p><p></p><p>Am I right so far?</p><p></p><p>So, psychiatrist probably assumes that for a minimum, he will be ADD or ADHD.</p><p>Might be a reasonable assumption. Hard at age 5 - not always enough data to go on yet.</p><p>But it would explain the trial of Concerta - very common rx for ADHD.</p><p></p><p>Is there more going on? probably.</p><p>But not necessarily something big - like mental illness, or Autism Spectrum Disorders (ASD).</p><p></p><p>One big red flag, to me, is the fine motor skills stuff.</p><p>Doesn't like art.</p><p>Doesn't like writing because he can't get it perfect. (really? or is that an excuse, because he really can't quite get his hands to do what his brain is saying?)</p><p></p><p>Given that 50% of kids with ADHD also have Developmental Coordination Disorder (DCD)... there's a fair chance that he has motor skills issues.</p><p>Best way to handle this - at least initially - is with an Occupational Therapist (OT) evaluation for motor skills.</p><p>While you're at it, have the Occupational Therapist (OT) evaluate for sensory issues, too.</p><p>Occupational Therapist (OT) doesn't give any dxes... but does run evaluations, generates reports that others (including other medical, and schools) use. AND has therapies to help. Early intervention helps.</p><p></p><p>(Developmental Coordination Disorder (DCD) diagnosis seems to be hard to get - everywhere. Doesn't make it less real. But getting help is more important than getting the diagnosis.)</p><p></p><p>Next... trouble with transitions. Can be an executive functions issue - no medications for THAT, but there are things that help. Have you seen the book "the explosive child" (Green)?</p><p></p><p>FWIW... I don't see these as contra-indications for Concerta.</p><p>Instead... by peeling back part of ONE layer, you can see other issues that were not so obvious before.</p><p>This is NOT unusual.... and especially in the younger child.</p></blockquote><p></p>
[QUOTE="soapbox, post: 487018, member: 13003"] Well, lets see. A boy. 5 years old, just getting going in school. At least one parent with ADD. And some behaviour issues... Am I right so far? So, psychiatrist probably assumes that for a minimum, he will be ADD or ADHD. Might be a reasonable assumption. Hard at age 5 - not always enough data to go on yet. But it would explain the trial of Concerta - very common rx for ADHD. Is there more going on? probably. But not necessarily something big - like mental illness, or Autism Spectrum Disorders (ASD). One big red flag, to me, is the fine motor skills stuff. Doesn't like art. Doesn't like writing because he can't get it perfect. (really? or is that an excuse, because he really can't quite get his hands to do what his brain is saying?) Given that 50% of kids with ADHD also have Developmental Coordination Disorder (DCD)... there's a fair chance that he has motor skills issues. Best way to handle this - at least initially - is with an Occupational Therapist (OT) evaluation for motor skills. While you're at it, have the Occupational Therapist (OT) evaluate for sensory issues, too. Occupational Therapist (OT) doesn't give any dxes... but does run evaluations, generates reports that others (including other medical, and schools) use. AND has therapies to help. Early intervention helps. (Developmental Coordination Disorder (DCD) diagnosis seems to be hard to get - everywhere. Doesn't make it less real. But getting help is more important than getting the diagnosis.) Next... trouble with transitions. Can be an executive functions issue - no medications for THAT, but there are things that help. Have you seen the book "the explosive child" (Green)? FWIW... I don't see these as contra-indications for Concerta. Instead... by peeling back part of ONE layer, you can see other issues that were not so obvious before. This is NOT unusual.... and especially in the younger child. [/QUOTE]
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