Treat add child with- drugs or o/t therapy?

[kayla'smom0501]

I need advice and am thoroughly confused as what to do. difficult child is Kindergartener who has just been diagnosed ADD (with- possible ODD) by neurologist who examined her as prompted by CST at her school. Behavior has been a problem since day one. husband and I started seeing therapist over two years ago. Tried to implement recommendations (i.e., Magic 123 book and the like). Nothing worked. Began integrated therapy at home with- therapist and partner (not covered by insurance - still appealing). Therapy had little effect. Observation by therapists, as well as by teacher, it was discovered difficult child was "severely behind in her fine motor skills." School felt to reason to get involved, as she was very "clever." Therapists referred us to O/T who performed evaluation in 12/06. Demanded action from school. Met with- CST beginning of the year. They all performed their evaluations and agreed to give o/t at school. Continue to go to o/t by the private o/t to make sure she is getting enough. Behavior at home greatly improved initially, but has since regressed. Neurologist tells me yesterday difficult child should be on medication and that extra therapy is a waste. O/T thinks difficult child's behavior will continue to improve with- therapy (neuro said don't let o/t bully me into more therapy). I see difference in difficult child and am reluctant to medicate. Should I continue o/t and hope for the best or just agree to medicate? Do I trust the more learned, experienced doctor? I can't just discount o/t altogether -- after all, it is offered in the schools and the like. I'm thinking I should try to get a 2nd opinion from another neuro. Also, neuro didn't see need for mri or other tests. O/T thought she should have. . . I know its alot of info to read, but I would just like some feedback from some parents who think difficult child's behavior could be modified with- just o/t therapy alone or I'm fighting a losing battle and should just succumb to the medication? Appreciate anyone's thoughts!

 

[DDD]

Does the decision have to be one or the other? I should think
that a combination of medications and therapy would be the best way to
go for your child....the ongoing therapy can't hurt and if you are lucky the medications will make it possible for your child to function normally. Few of us have been eager to medicate but most of us have found that the medication has allowed our children to become part of their peer group. Good luck. DDD

 

[Sunlight]

I have been away from ADHD issues for many years because my son is almost 24. when he was diagnosis adhd in kindergarten, he was also tested and found to have high IQ.
given the opportunity to have a do over I would have tried him in a smaller school setting. perhaps montessori.

I would say try anything and everything. combos of medications and therapy seem to help most. God bless you, you tired momma!

 

[oceans]

Was it a neurologist or a neuropsychologist? Was high functioning autism ruled out? If you are seeing progress with the therapy, keep doing it! Sometimes difficult child's do need both therapy and medications. It depends on the difficult child, and if it is an accurate diagnoses. It would not hurt to get a second opinion. If you do decide to try stimulants, you would know fairly quickly if they are helping or not. Stimulants can always be stopped if they are not working. It sounds like you would be more comfortable getting another diagnostic opinion. You can always decide after that if you want to try the medication or not.

 

[smallworld]

Welcome! I'm glad you found us.

I agree that most kids written about on this site benefit from an integrated approach that can include both medications and therapeutic interventions. Having said that, you need to know what specifically you are treating. I'm suspicious that Occupational Therapist (OT) would solve a behavior problem caused by ADHD so I'm wondering if you really are looking at ADHD. Sorry for all the questions, but your answers will help us point you in the right direction:

What behaviors do you find troubling?
How does your difficult child do in school, both academically and with peers?
Did your difficult child have any speech or developmental delays (in addition to the fine motor challenges)?
Any sensory issues (bothered by clothing tags, loud noises, certain foods, for example)?
Any psychiatric issues or substance abuse in the family tree?

Again, welcome.

 

[BusynMember]

Was your child diagnosed by a Psychiatrist (the one with the MD?)

 

[slsh]

I wonder if possibly you're caught in that horrible gray area where the two issues overlap (alot of us have been there). I don't really see this as an either/or choice.

Personally, I would not stop Occupational Therapist (OT) for a kiddo who was "severely behind" in fine motor skills unless and until a new evaluation shows that she's caught up *and* doesn't need continued Occupational Therapist (OT) to stay caught up. It makes sense to me in a lay sense that if a child has motor delays, at least part of the behaviors could be related to frustration and as her skills have improved, her frustration related to the motor issues has decreased.

Has she been evaluated for speech and gross motor skills? Is she pretty much on target developmentally otherwise?

However, if you're still seeing similar behavioral issues, you could also be dealing with- ADHD or something else that will not necessarily be helped by Occupational Therapist (OT). Not that you necessarily want to jump to medication (I get the sense you don't), but perhaps further investigation to figure out what is going on. An MRI and/or EEG certainly seem like reasonable tests at this point.

The professionals in our kids' lives can only give us their best guesses. Some folks will be right on, some will be incredibly off base. There's a lot of art involved here and my best advice to you is to follow your gut. You may not have degrees to back you up, but you *are* the expert on your child. Equal footing with- the professionals in my opinion. A second opinion sounds like it might be your best option, especially re: the need for further testing, especially since she's so young - getting a hard and fast diagnosis at that age can be a challenge.

I'd probably lean towards a developmental pediatrian - I think they can be found at most major Children's Hospitals and university (teaching) hospitals. You've already got what sounds like a pretty firm diagosis of a fine motor delay - a development pediatrician might be more tuned into other subtle delays *or* might be able to reassure you in terms of moving foward with- addressing the ADHD.

If there are continuing behavioral issues, I would be very surprised if Occupational Therapist (OT) alone, without some other intervention (behavior mod, tweaking parenting style, continued therapy, medications, or a combination), ultimately solves the problem.

 

[kris]

<span style='font-size: 14pt'> <span style='font-family: Georgia'> <span style="color: #000099"> neurologist isn't saying no Occupational Therapist (OT), is he? maybe thinks that what the school is providing is suffien?

i think most kids get the best results from the integrated approach as well. i understand the hesitancy to medicate, but often it makes a world of difference for kids with-add & can actually lead to your daughter catching up on her fine motor delays as she should be able to concentrate better. you may have to try more than one ADD medication as each child reacts differently. did the neuro recommend one over the other....ritalin, adderall.

by the way, ADD is a neurological disorder so a diagnosis from a neurologist ~~~ who is an M.D. ~~~ is just as valid as one given by a psychiatrist.

kris </span> </span> </span>

 

[Samantha36]

Hi

I have an 11yr old son who was diagnosed with ADHD/ODD three years ago. I too was concerned about allowing him to be px medication and I spent two years fighting the school and my son's father to use just a CBT approach. After some time I realised that in fact the only reason I wouldnt medicate Lew was down to my own guilt and belief that this condition may have been down to my failings as a mum. I missed out on the reality of the situation and as a result Lewis became more and more isolated from his peers and began to suffer both academically and emotionally. I finally agreed to try medication and the change was amazing; he began to enjoy school again, began to build up his peergroup again and until the medication wears off is a child that you would not even realise had ADHD...when it wears off thats when I remember how life was for all concerned pre medication days! Good luck, Samantha.

 

[timer lady]

Hi & welcome to our little corner of the cyber world.

Medications were a huge component in the treatment plan for my difficult children. Until the right medications were prescribed & they were "stable", no other intervention was of any use.

Our treatment plan is a milieu of medications, therapy, speech & Occupational Therapist (OT) therapy, along with behaviorial interventions & redirection.

Exhausting yet we're finally seeing some light at the end of the tunnel.

I've never ever ruled out a viable treatment option - I keep all doors open for my difficult children.

Keep us updated on your decision. At the very least, we're hear to listen & support.

 

[momof3boys]

My son was also diagnosed with ADHD/ODD a little over a year ago. He's now 5yo. We were also very reluctant to try medication. We ttied all sorts of behavioral therapy, which helped abit, but not enough. After a particularly bad weekend (I'll spare you the details), we decided to give it a try. His psychiatrist explained to us that Adderall is similar to caffeine in the way that it starts to work quickly, and is out of your system within several hours. So, if we were unhappy with the way the medication affected him, we could just take him off it - no long term consequences. To us, it was worth a try.

We started with 2.5 mg of Adderall in the morning. What a wonderful difference! I felt like he was finally able to be himself. He was still the bright, funny, creative kid he's alway been, but able to control his impulses. His teachers noticed the difference immediately (I didn't tell them that he was starting to take medication, but the first day he went to school on the adderall, they told me that they noticed a huge difference in his behavior that day and that "whatever I told him worked!").

He takes his adderall twice a day, and its made a huge difference in our entire family. We are all so much happier, and have so much less stress. He no longer show defiant behavior, he's still more impulsive than your average kid when he's on his medication, but its MUCH better than when he's not on the adderall.

Medication is a very difficult and personal decision, I just thought I'd share our story with you. Good luck.

 

[kayla'smom0501]

Wow! I am so grateful for all of your responses. This is so comforting and very helpful, but it appears you all might need some more information, so here it goes: The o/t is primarily working on difficult child's fine motor skill problem; gross motor skills are in tact. O/T has just informed she thinks there is a speech delay, even though the school CST did not find same. Am considering another independent evaluation by speech therapist. O/T feels that continued o/t and then speech therapy will address difficult child's behavioral issues, i.e., if she was able to verbalize a response other than yelling, etc., the "bad behavior" would not exist. Sounds very plausible to me, but what do I know? ADD with- possible ODD (not ADHD) diagnosis came from experienced neurologist who works with- several school districts and is head of local hospital department. I believe her suggested medication was Ritalin and then something with an F (I can't recall). Family history - husband was ADD/ADHD as a child on Ritalin. Also, when difficult child started O/T earlier this year, her behavior improved tremendously, she was really an ANGEL, but then she regressed (teacher and I agree it may be due to her awareness of being different - peers question certain modifications in classroom). So, if she could essentially be a well-behaved child for nearly two months, then its possible that she can! difficult child had a really good week, but I don't know if that's because she was off school or the new eyeglasses (after exam by behavioral optometrist) -- only wearing them for 1 1/2 weeks so far (o/t sees 50-60% improvement in her visual skills already). difficult child does well in school - very clever. School thinks maybe retention due to fms delay. First grade is alot of writing. She does have sensory issues. mother in law (expert?) was convinced it was aspergers -- that has definitely been ruled out. O/T does brushing with- her and that has seemed to really help, and the very short haircut! mother in law also shoving autism down throat and I want to slap her! She watches one stinking episode of Oprah and that qualifies her to make a diagnois. All experts say no to autism. difficult child plays well with peers. Lots of substance abuse on both sides of family -- husband's father; my brother and loads of uncles and cousins -- typical Irish (although bro is sober 2 years and doing wonderful!) I think I've answered most of the questions and appreciate all of your very warm welcomes and sound advice. Who knew? I wish I found this site years ago, but better late than never. I sent a detailed e-mail to our therapists (who have been working with- us throughout) and am awaiting a response. I'll keep you posted and, again, thank you so much!

 

[tiredmommy]

I'd like to see you post a query on the Special Education forum about possible modifications that could be afforded to your difficult child so that she's not retained for only fms. There are some very knowledgeable people there that will steer you you in the right direction about difficult child's IEP.

 

[smallworld]

We honestly can't diagnose over the internet, but in your shoes, I'd want my difficult child to have either a multidisciplinary evaluation, a neuropsychological evaluation or an evaluation with a developmental pediatrician (all can be found at university and children's hospitals). The fact of the matter is she has red flags -- inattention, sensory issues, fine motor challenges and a speech delay -- for an autism spectrum disorder (and it is a spectrum from mild to severe) that should be checked out. Unfortunately, neurologists sometimes miss Autism Spectrum Disorders (ASD). Furthermore, Autism Spectrum Disorders (ASD) is sometimes missed until the child is older and the differences more apparent. I'm not saying she has it or doesn't, but I'd certainly recommend having a thorough evaluation to rule it in or out.

Good luck.

 

[BusynMember]

I read all the responses, and, with a speech delay involved, plus the ADHD diagnosis, I'd want a neuropsychologist evaluation or MDE. This kid COULD be on the high end of the autism spectrum, and, if not, a neuropsychologist does such intensive testing that you can come closer to the actual problem (likely the diagnosis will change with time). My son's first diagnosis was ADHD/ODD, but he is on the autism spectrum and is doing great with the right interventions (he's not on medications after a trial of about ten medications that he didn't need--there are no medications for Autism Spectrum Disorders (ASD)). At almost fourteen he no longer has any behavioral problems and is almost completely mainstreamed at school and is a real blessing. But he was 11, and two diagnosis too late, before we got the right diagnosis. If you're "iffy" about medicating, I think you're smart. My son was on every ADHD medication that exists plus heavy drugs like Lithium and Risperdal because his ADHD/ODD diagnosis. was then switched to bipolar--both wrong. In hindsight, I wish I'd held off and gotten the interventions without adding the stimulants (which made him aggressive) or agreeing to put him on bipolar medications (bad reactions plus a fifty pound weight gain--three years later he is still overweight even NOT on medications). We learned that professionals can be wrong, yet they tend to be very insistent that they are RIGHT. If you have any doubts about the diagnosis. get an MDE or neuropsychologist report(not a Neurologist--they don't do the right kind of testing). A neuropsychologist or an MDE evalu can also be wrong, but it will guide you closer to the real problem and maybe you can get some interventions that will improve the life of your child. Be sure to get all interventions. It will be harder to get them if you only have an ADHD diagnosis. After another complete evaluation you'll have a better idea of his issues and can then decide to medicate. I wish I had not jumped on the stimulants just because a psycologist said ADHD. Good luck :smile:

 

[kayla'smom0501]

Again,
Thank you for all your sound advice. I still have not heard from therapists - their response e-mail yesterday was that they were reviewing my e-mail and would get back to me with their thoughts. I guess I'll have to wait till Monday. I think perhaps we should consider a dev pediatrician, neurosyphc. or multidisc. evaluation as suggested. I seem to recall discussing a possible evaluation by the specialized hospital in our area before the integrated therapy, but we held off because of the wait (well over 6 months as I recall) and decided to pursue other avenues. I will suggest this to therapists as well. Thank you all so much and I'll keep you posted. Will try to hop over to Special Education forum as well. Thanks!