Should I be worried??

[JKF]

So I just got an email from easy child/difficult child's behavioral therapist at school. She asked if it was ok if she sent home a release for me to sign so she can talk to his therapist and psychiatrist. I said sure, send it. Then I asked if something particular happened today and she said no it's the same old stuff with some of his old behaviors resurfacing.

She wrote "He has issues letting social things go, and then he will bug that child even if the child is doing nothing to him. Also, the attitude and speaking in a disrespectful tone is coming back a bit. It was much better at the beginning of the school year, not sure if it that the work is getting harder, the holidays?? Difficult to tell." I explained to her that he's starting Intuniv in addition to his Vyvanse over Christmas break and the psychiatrist feels that should help him "even out" a bit. She then replied to me "Could you please tell the psychiatrist about him not letting things go. I think that is an important piece of information."

I've told the psychiatrist that before. Sometimes he has a hard time letting things go. She didn't seem overly concerned about it but should she be?? I'm worried now!

 

[TeDo]

To be perfectly honest, that should give the psychiatrist a clue that something other than or in addition to ADHD is going on. That's more of a spectrum trait. They are rule-bound and in most cases, that includes their OWN unwritten "rules": the way they think things should be/happen/etc. Both of my kids are like that. It's one of the reasons difficult child 1 had a hard time in regular school. THAT is something that needs to be addressed through social skills training of some sort.

 

[JKF]

To be perfectly honest, that should give the psychiatrist a clue that something other than or in addition to ADHD is going on. That's more of a spectrum trait. They are rule-bound and in most cases, that includes their OWN unwritten "rules": the way they think things should be/happen/etc. Both of my kids are like that. It's one of the reasons difficult child 1 had a hard time in regular school. THAT is something that needs to be addressed through social skills training of some sort.

I'll have to address it again. Both the psychiatrist and therapist are new. therapist since September, psychiatrist since November. We have another appointment on Dec 31st with the psychiatrist. therapist is tomorrow - we go every week.

He definitely has his own unwritten "rules". I can see that. He has a much easier time at home than at school or in social situations but we try to keep him socially active as much as possible. There are a couple of other kids in his grade who go with him to the behaviorist weekly for social skills and last year they even had an after school social skills program but that's gone this year.

 

[JKF]

I mean he's a really social kid. He seeks out other kids and adults to socialize with. He doesn't feel uncomfortable speaking to people. In fact, he talks A LOT. He's not focused on any one subject. He talks about everything equally. It could be anything and he's got an answer.

It's just the constant talking and thinking he knows everything about everything. That's one of his biggest problems with socializing. I think his "know it all" attitude gets on the other kids nerves. And if someone tells him he's wrong he will try to convince that person to no end that he's not.

 

[TeDo]

I can see why the behaviorist wants you to mention it to the psychiatrist. It IS an important piece of information. Has he had a thorough evaluation by a neuropsychologist or anything or was it just you and a teacher filling out ADHD questionaires? I really think there is something else going on and adding another ADHD medication isn't going to help with that. In fact, if he is even Pervasive Developmental Disorder (PDD), ADHD medications won't help any more than they are right now, without the Intuniv. The behaviorist is saying this behavior is not ADHD but without an accurate diagnosis to explain it, it is seen as an intentional behavior. They are politely telling you there is something else going on. Jump on it before it causes huge problems at school and he ends up getting in trouble all the time (been there done that). If it's getting worse, it will continue to get worse. Puberty is when difficult child 2's minor "quirks" started to grow and have become HUGE problems at times.

Added: you're second post just now just described my difficult child 1 ..... to a T.

 

[JKF]

He's had 3 thorough evaluations in the last 3 years by a neuropsychologist. The neuropsychologist is one of the best in our area. He recently started seeing this new psychiatrist due to our new insurance not covering the neuropsychologist. He's been on the Vyvanse for 2 years now. The neuropsychologist is the one who started him on it.

I have to add too - these behaviors come and go. He does amazing in the beginning of school, declines around the holidays and then gets back on track and does well from February on. It's so strange. It's almost like a "cycle".

I have always worked very hard with the school and doctors regarding easy child/difficult child. I will be calling the psychiatrist this afternoon. Thanks TeDo! I appreciate your input and suggestions!

 

[soapbox]

Have you ever considered that he may have a "minor" disability? The kind that don't show up even on neuropsychologist testing?

The reason I'm asking that is because the whole "cycle" thing is VERY familiar.
My difficult child was worse on Friday than on Monday, a LOT worse before Christmas break, and so on.
The reason was... fatigue.

Has your son ever been evaluated for the complete suite of APDs? including things like auditory figure ground and auditory discrimination? These do not affect language development - but DO make learning in a classroom much more challenging. There are accommodations and interventions that make a huge difference.

And... has he ever been evaluated by an Occupational Therapist (OT) for sensory and motor skills issues? If your son has developed "reasonable" self-accommodations, the issues may not be obvious, but again, can cause significant fatigue to accumulate.

 

[JKF]

Have you ever considered that he may have a "minor" disability? The kind that don't show up even on neuropsychologist testing?

The reason I'm asking that is because the whole "cycle" thing is VERY familiar.
My difficult child was worse on Friday than on Monday, a LOT worse before Christmas break, and so on.
The reason was... fatigue.

Has your son ever been evaluated for the complete suite of APDs? including things like auditory figure ground and auditory discrimination? These do not affect language development - but DO make learning in a classroom much more challenging. There are accommodations and interventions that make a huge difference.

And... has he ever been evaluated by an Occupational Therapist (OT) for sensory and motor skills issues? If your son has developed "reasonable" self-accommodations, the issues may not be obvious, but again, can cause significant fatigue to accumulate.

That makes a lot of sense. Fatigue. He was seeing the Occupational Therapist (OT) in 3rd grade but they felt he didn't need to see him after that. Perhaps "they" were wrong. Something is defnitely going on and I need to get to the bottom of it! Thanks for the suggestions soapbox!

 

[InsaneCdn]

It may not even be that he needs more Occupational Therapist (OT) therapy... he may need accommodations, though, like if writing is a challenge (he can do it but it tires him out), he may need access to a computer for written work. Not everything can be "fixed" but accommodations make a big difference. Same for APDs - things like soundfield or personal FM systems make a huge difference, by making the teachers voice louder than the background noise.

 

[confuzzled]

i think maybe the teeny red flag is not that he isnt social, but the appropriateness of that social interaction.

which certainly can look like a spectrum issue. but can also look like a lot of other things...namely, anxiety. with the (i assume, disregard if it doesnt fit) holidays coming, school break, unorganized school days with parties, assemblies and weird assignments like "what do i think the holidays mean" or "what am i going to do over the break", and unscheduled, well meaning teachers whipping out candy canes as a treat....it can kick into high gear, even if undiagnosed.

but with the exception of life threating behavioral changes, i wouldnt necessarily put too much stock in any minor ramp-ups this time of year. typical kids are a whirlwind of chatter, anxiety and inappropriateness before a major holiday.

i would watch carefully to see if this is a noteable change well into january (give him time to setting back INTO the normal routine) and then decide if its cause for concern. i'm not saying he gets a free pass, and certainly should be redirected if he can be, but i do think everyone needs to consider all of the contributing events and stress that come with them.

 

[susiestar]

I would certainly mention it to the psychiatrist, but I would NOT give them a release to talk to the therapist and psychiatrist. Ask the behavior therapist to give you any questions/issues in writing via email or letter and you will ask the psychiatrist/therapist/whomever and give her the response. She has zero need to talk to these people with-o you. Signing that release means that she can get ANY info and often this leads to big problems. Many parents here have had this happen. It lets the behav therapist and the psychiatrist/therapist to discuss things and make decisions with-o you being in the picture, and this could create all sorts of problems. If you know the issues, you can judge what seh needs to know and this helps preserve your and difficult child's privacy and security. Also schools tend to be less than rigorous about privacy and information sharing and it would be very easy for her to leave something on a desk about your difficult child and for a student, parent, teacher or staff member to gossip about this with people who have no right to the info. Sadly our kids can be gossip fodder very easily and so can we, and this can permanently damage both your and difficult child's ability to trust. It just isn't worth it. It also lets the behav ther and psychiatrist/therapist to not have all info that you ahve when making decisions.

If you have signed the releases, send each party a letter revoking it and asking that all questions/issues run through you because you are the person coordinating all aspects of difficult child's care and life. Make sure your parent report states this clearly so there are no future issues over this.

I do NOT mean to bash or speak badly of schools/teachers/docs of all kinds. I just know that often in a school info is very easy to access and it can cause big problems. It is easy to forget that what you are discussing might be overheard by a student, teacher, parent or other person at the school simply because there are so many people at the school at any time.

 

[DammitJanet]

I am with Susie on this one after I read my son's Special Education file years ago. I wasnt smart enough not to allow full disclosure between all agencies back then and when my son's HS had me hand carry his Special Education binder from one school to another...well I took advantage of the time to have a sit down lunch and really read through it. I was astounded by some of the things I found in it.

There were things in there that had absolutely nothing to do with his education. There were mental health records from when he was 4 years old and he was in a Children's Day Treatment program and one of the psychiatric assistants made a note in his file that said "child sometimes comes to center in mismatched clothing and has shoes untied." Uhh, sorry. He picked out his own clothes sometimes and stepped on his shoe laces at times. I did have 3 boys. "Mother isnt always as consistent as we would like. Child doesnt seem to improve with behavior charts as we hoped." Oh really. And that was my fault? LOL. Sure maybe I could have done better, I wont lie. And my all time favorite was "Child wearing his oldest brothers clothing over a body cast." He was in a full upper body case and Billy's pullover shirts were the only things that would fit him because it was so bulky. He did wear sweat pants that fit him on his lower half.

Needless to say I sat there at lunch and did my own editing of that folder. What I didnt want in it got pulled and sent to the trash can. The school didnt need to know those things.