Questioning Diagnosis - VERY long

[TeDo]

My difficult child was diagnosed at 3 yrs old with ADHD. They put him on Adderall since he was very small for his age and that was the only thing that came in a small enough dose. It was VERY scary watching my 3 yr old "tripping". He acted like he was on a drug high! At 5 yrs old, he was finally big enough to try other things and Strattera has been a Godsend. I don't question the ADHD diagnosis at all.

I really am beginning to question the ODD. I'll give you some of his history. At 3 1/2 yrs old, I discovered that both my boys were being sexually abused by my babysitter. difficult child had classic symptoms of PTSD: night terrors, incontinence, didn't allow touch from anyone except me, anger outbursts, anxiety, etc. With some therapy, that eventually got better. He also developed other sensory issues and received Occupational Therapist (OT) for a while. That also helped for the most part.

He has had 3 Big Brothers in the past 5 years who have all moved out of state literally without a word after 2-6 months. difficult child loves doing male things with other males. He has also had his favorite aunt, who lived 3 blocks away from us, walk out on her husband and kids as well as our entire family 2 years ago. Also, his cousin whom he adores has "outgrown" difficult child and doesn't do anything with him anymore. Talk about sever abandonment issues!

School has been tough all along because of his trust and boundary issues. His reaction to everything was anger with physical acting out so people would get away from him.

He has many friends but all of them are 1-3 years younger than he is. Most of his peers don't want to be friends because of the way he behaves in school.

This year, things have gotten so much worse at school. He "hates" all his teachers. He refuses to write but will use a voice activated program for dictating or have someone scribe for him. In class, he plays with anything he can find; eraser pieces, rubber bands, paper, string, etc. He is allowed to chew gum in school but he is supposed to be discreet. That isn't happening because he is chewing it so hard. He talks back and yells at teachers, throws things, tips chairs, walks away. When the SpEd teacher, who he likes and looks up to, tries to talk to him, he walks away.

I think he is on sensory overload. My suspicions at this point are a return of the PTSD? Asperger's? Sensory Integration Disorder (SID)? Auditory Processing Disorders (APD)? Abandonment issues? I really don't think ODD is the correct diagnosis.

I don't know what to do anymore? We had a neuropsychologist done 5 years ago which was a waste of time. I can't even find a different one now. He has his IEP on the 1st and want to make sure everything meets his needs appropriately. Everything has been to meet the ADHD and ODD but they don't seem to be working anymore.

Any advice or suggestions or just thoughts? I really need some help here. I really feel for the little guy.

 

[gcvmom]

What does his psychiatrist say about his behavior? I am surprised to see him on the Depakote/Strattera combo. Whenever I see Depakote and there's no seizure disorder, it makes me think bipolar because that is what it's rx'd for so often. It's possible that he really has a mood disorder towards the depressive end of the spectrum. Maybe he would do better with something like Lamictal, which tends to help with depressive symptoms. But I'm not a doctor and I don't know your difficult child. I would call the psychiatrist and be a squeaky wheel until you get some answers. When I see anger and extreme irritability in people, I tend to think depression.

 

[Marguerite]

You can often get depression as a result of not fitting in or of not being able to cope for all sorts of reasons. I know my kids were depressed, badly, as a result of problems at school and problems with friendships. We had difficult child 1 on suicide watch for two years.

The irritability can be sensory overload, or it can be frustration, or all sorts of other things. The ODD-like behaviours (yelling back at school staff; walking away etc) can often be his response to how other people treat him. I found with easy child 2/difficult child 2 and difficult child 3 especially, that they treated other people in the same way those people treated them. So I would often hear myself coming back at me from their mouths. Imagine a two year old girl, hands on hips, telling you off for failing to provide her with the drink of choice she requested (and which I chose to not give her, since it would have been her third straight glass of it and it was time to have plain water for a change).

A Pervasive Developmental Disorder (PDD) kid, also even a kid with just ADHD, can feel that they have no control over what happens to them. They try to assert control and often will fight hard for it. When we try to manage their behaviours by asserting control over them, it can trigger a stronger fight from them for control and the problem can escalate. That's where a switch to Ross Greene's methods can break the negative cycle and begin to get positive results.

These kids don't want to be bad. They want to please us. But often they feel backed into a corner and lash out the only way they know how.

Your son has a whole lot of issues possibly tangled up in there. It is possible to have a combination of problems. The PTSD should not be discounted, but good therapy can do a lot to help there. For the possible Asperger's, have a look at the Pervasive Developmental Disorder (PDD) questionnaire on www.childbrain.com and see what it indicates. Print it out and take a copy to the next psychiatrist your son sees, even if he scores normal. It can still show the sort of things that are concerning you.

Develop your own working hypothesis, and use this to get through until you get more professional, certain information. But even when you do feel more confident in a diagnosis, never expect some health professional to be able to step in, take over and take away your workload in helping your son. The best help and therapy your child can ever get, will come from you and what you instinctively put in place for your child. You do what you can, you think outside the square and if something helps, do it more. if something doesn't help, drop it. That is how, over time, you develop the best therapy possible, by yourself. Any professionals tat come along and can help - use them. But in the long run, it is down to you and down to your child. All the others are assists, tools, adjuncts. Nothing more.

Marg

 

[DaisyFace]

He refuses to write but will use a voice activated program for dictating or have someone scribe for him. In class, he plays with anything he can find; eraser pieces, rubber bands, paper, string, etc.

To me - these are classic ADHD symptoms. Handwriting is hard for these kids because their brain speed and their hand speed are running at two different MPH.

And the fidgeting! - eraser pieces, rubber bands, paperclips, paper bits, strings, straws, plastic wrap, marbles....constantly "playing" with little objects

Chewing - gum (best option)...but I've seen these kids chew their clothes, their hair, their fingers/fingernails.

These are ADHD, in my opinion.

The anger and outbursts may be frustration - but it may be something else, too. Reaction to medications, PTSD...??? This is the part that definitely needs looking into...

 

[smallworld]

Refusing to write is not necessarily classic ADHD. My son doesn't have ADHD (proven several times on neuropsychologist testing), but he has a disorder of written expression that makes it difficult for him to organize his thoughts and get them out on paper. He also has poor handwriting. Fidgeting can be related to anxiety or sensory issues; it, too, does not necessarily have to be related to ADHD.

ODD is not a helpful diagnosis at all. A good diagnostician won't even give it. It describes a set of behaviors for which there is an underlying cause. When the underlying cause is identified and treated, the oppositional behaviors subside.

I would recommend that your difficult child have a full neuropsychologist workup, but with someone who has expertise with mood issues. That may be the only way you get at the bottom of what's really going on.

Good luck.

 

[Marguerite]

In our family, the handwriting issues are due to hypermobile joints. In my observation (of my kids plus other High-Functioning Autism (HFA) kids we have met - an increasingly large number) this seems to be connected to High-Functioning Autism (HFA) and Asperger's so some degree. I don't know why. But it means their hands hurt when they try to write. So we found they will expend the vast bulk of their mental efforts on calculating how to compose an answer with the fewest pen strokes, rather than actually giving the answer they should. So you get the kid answering a question like "Can you tell me why dogs chase cats?" with "no".

ADHD does sometimes go hand in hand with Asperger's and High-Functioning Autism (HFA), so it is still possible to see a similar correlation with hypermobile joints and ADHD. Correlation does not equal causality. It is merely the observation of a higher frequency of co-morbid presentation. Hey it happens sometimes, we don't know why, sort of thing. We deal with it by encouraging the kid to use a keyboard or other method of non-handwritten communication. Tat way they can go back to focussing on properly answering the question - "dogs chase cats because dogs are predators and programmed to chase something moving, especially something running away. Cats are smart and will run to avoid a larger animal chasing them. This encourages dogs to chase after the cats even more, as long as the cut is running away." It's a lot easier to type such an answer, than to hand-write it.

Marg

 

[BusynMember]

My son is on the autism spectrum and to this day he can't write. He is seventeen and he has to print. It's not exclusive to ADHD. Fortunately, he is good on the keyboard. My son used a special pencil with an adapter when he was younger. He also constantly fidgets, even today. When he was in choir, hub and I used to laugh because he would pick at his nice, white button shirt the entire time as he sang. Sometimes he'd stand on the sides of his feet, look at the lights, look down at the floor...all this while the other teenage kids were just staring at the choral director. My son wants to touch everything...I think it's a sensory thing.

I agree that it's a good idea to look into (and lealrn about) Pervasive Developmental Disorder (PDD). It is often right there with ADHD. I know that the diagnostic process is different in Canada than in the US, but I'd just like to share, for what it's worth, that no pediatrician ever caught onto the fact that my son was on the spectrum. We had to take him to more specialized professionals. Pediatricians tend to not know much beyond ADHD/Odd and that's what my son's first diagnosis was, but it was not correct.
Good luck!