Question: When are fidgeting, spacing-out, silliness, lack of focus, inattention to detail, emotional overreaction to 'change' and hyperactivity "normal" in a child?
Answer: Apparently, it depends on if those things are causing said child to struggle at school, with friends or at home.
Question: If you find it necessary to attempt to address (i.e., "fix") those aforementioned behaviors, and following an in-depth conversation with an "expert", the first thing said expert(s) identify is ADHD, followed by a suggestion of medication, what should you do?
Answer: I. Don't. Know.
This is sensitive, because I'm not really seeking advice, per se, and my wife straight-up told me that she really doesn't want to tell our family about this (though my mother already has some knowledge of it). However, I know we have lots of parents here, with a pretty wide variety of experiences - both professional and personal - who might be willing to talk about what they know, think they know, or otherwise have an opinion on.
I have a child with a lot of intelligence, curiosity and quality interpersonal skills. Great kid - caring, empathetic and friendly. Also, this kid cannot sit still in class, stay on task, pay attention to things that aren't of interest, etc., etc., etc... to the point that two-years worth of teachers have spoken to us about her inability to complete tasks on time, without continuous prompting and repeated reminders. No surprise there, because tasks like getting ready for dinner, bedtime, breakfast, school, play, bath .... all take much longer than they should, and frequent prompting typically results in tears and overreaction (on my/our part as well).
We want to help, and want help, so we sought out expert advice. I trust experts - attorneys, physicians, accountants, mechanics, etc. I look for the 'best' and trust what they tell me. That initial meeting went well, confirming (but not formally diagnosing) what we'd already considered. However, when the inevitable discussion of options to address the concerns led to information about medications, I immediately felt a panic - "No! Not my child! I've seen/heard too many horror stories about [insert whatever 'brand name' stimulant or anti-depressant(!) comes to mind] to be giving that to my child!" That's all the farther we've gone; still working on a formal diagnosis, but I'm feeling conflicted about what comes next.
What do ya got for me?
I mean, c'mon, even the label warns to "Keep Out of Reach of Children" !!!
I put myself through a pretty extended period – about ten years – where I was not dealing with things that I should’ve been addressing. I did this well into adulthood, fully aware that what I was trying to cope with was not something I was capable of handling well on my own. It took a number of people – my spouse, my mentor, a social worker friend who’d known me for twenty years, my parents – working me over before I eventually started working on things. Even then, it was mostly a move out of desperation.
I say all that because, in theory, I was cognizant of my troubles and old enough to do something about it. Thinking about what I would do if my child were dealing with a challenge I could only perceive from the outside makes my own experience seem like a walk in the park. The potential for second guessing any decision you make in that situation likely seems enormous & frightening. Not having arrived at that position yet, I can only speculate based on my experience on the other end of things – what to do for a parent who can’t do for themselves anymore.
When Pops entered hospice care at home we had a frank conversation with his nurse about medications, particularly for pain & discomfort. She was phenomenal, and I trusted her because she seemed like she had his best interest at heart, knew what she was talking about, and because, well, what choice did I have? Early on I decided that I wanted my stepmom to be able to have as much time with Pops as she could, not in a caretaker role, but simply to be together with him. My younger brother was a college freshman at the time and helped shoulder the caretaker burden; we handled things together so his mom & our younger siblings could be free of those worries. As Pops gradually drifted from us, the burden of guessing what he needed, and when, and how much, became progressively more difficult. My brother & I did our best for him in the moment. We haven’t talked since then about how we handled things, so I don’t know how he feels about it. But I know that I am vulnerable to the creeping doubts about what I could have done better, or differently, or shouldn’t have done. Those doubts started settling in during the first hours after he was gone, while I was destroying the medications he wouldn’t be using anymore. The more I learn about opioids, the more that doubt creeps over me. I’ll never know whether how I cared for him was truly right or not.
I say this because you may never get to live outside the shadow of doubt, either. No matter what you & your wife decide, you’re going to have to live with it, and there’s no way of knowing what “living with it” means right now. You may find the right combination of things that support your child the first time you try something, or you might not. You might find out a good ways down the road that something you tried was counterproductive. You’ll probably beat yourself up for that, because you clearly care about your kid and doing what’s best for her. Just don’t forget that you already are doing your best for her, based on expert advice, the most complete information available to you, and your knowledge of your child’s personality & personhood. The always-incomplete knowledge of what she’s experiencing inside her own existence is a perpetual invitation for the doubts to creep in, and the best defense I’ve found against it is to try to remind myself that I listened to everything available to me, listened to what my head & heart knew about Pops, and watched him for signs of things I could do better. In the end, that’s all I’ve got to lean on. Some days it’s enough, and some days it’s not. But everything I did came from a place of love.
I can't be of much help with something like this yet. Our daughters are pretty much the same age (1st grade, right?), but the trinket has had no issues adjusting to school life. We have 4K in WI, so this is her third year in the school system and all three teachers have raved about her behavior in class, her willingness to share and help, and her leadership, and all this despite being the youngest kid in class (she made the birthday cutoff by two days).
Now, I say all that not to gloat, but to then segue to my son. He.... does not exhibit any of that positive stuff. He started 4K this year and the initial transition from daycare/pre-school to that was difficult, and, according to his teachers, those difficulties are fairly persistent. He had to go sit outside of the classroom for disruptive behavior fairly often, he doesn't listen to his teachers and/or argues with them (and us! ZOMG that kid!) and generally has a hard time sitting still/not goofing off as demonstrated directly to us during their holiday sing last week. His first report card showed he was generally doing quite well in cognitive and physical development, but was less so in social skills. We haven't taken him to see anyone yet, because we're (well, me, my wife just thinks he's bored in class) not sure if its something diagnose-able or if its just because he's a 4-year-old boy (and also pretty much the youngest kid in class). I'm hoping to see how he does next year in kindergarten, which is full day. I'm also going to be paying attention to the conversation here.
I can say that there is a time and place for medication to
fiximprove things, and deciding on that route and finding that right medication/dosage can have satisfying results. I personally prefer not to make chemicals the first solution, but I'm not averse to it.What Rhu said. If the first thing the "professional" suggests is medication, I would seek a second opinion. But it might be the right thing.
Lots of boys in particular struggle with attention/focus. Simple things like sit/stand desks have been demonstrated to make a big difference. Finding a good therapist to assess and perhaps do some counseling would be worth exploring.
While I never had an attention issue (that I know of), I tended to get projects done early/quickly and had a lot of free time on my hand in classes. I found a good channel was reading, and always had a good book on hand to read during classroom lulls.
Gosh, tough subject. So much gray area in this field. My son has many of the issues above. He is 18 now and is in a better place. However, it all peaked in the 3-5th grade years. He is brilliant, and I am not trying to brag. Off the charts smart like his mother. We never did seek professional advice other than school behavioral counselors. He is so easily distracted and trying to get him to focus is nearly impossible. I have had so many employees in the 18-22 range who are on various medications for depression, anxiety, ADHD, etc. I know nothing about these medications, but it sure seems like (at times) they struggle with the meds just as much as the issues the meds are supposed to help. The common denominator of these kids seems to be rough parents who weren't too supportive of the kid in emotional ways. These kids all were into other vices like alcohol, partying and recreational drugs.
As a result, we stayed away from medications and decided we would do everything we could to address it in our household. He is much better, but still can be a handful at times. We have had to learn as parents that he might take longer to come to the dinner table, go to bed, etc than most kids including his sister. Oh, the patience we had to acquire (something neither of us is really strong at). It would be silly for me to give advice not knowing all the details, but one thing I would do is ask the experts where your child fits in the spectrum of kids with similar issues. I think that might help guide you to a decision your are comfortable with. If he is high on the spectrum, you probably don't want to take the chance of managing without meds?? If he is really low on the spectrum, it might make you more comfortable with looking for alternative ways to manage his issues.
Either way, in my opinion, you are on the right track by informing yourselves first and gathering knowledge. I know personally, how agonizing this can all be, but most importantly, know that you and your wife can only do your best. Show as much love, patience and understanding that you can. Raising kids is tough. I often compare it to gambling. You can do a ton to increase the odds of your kid having a great life. However, there is so much out of our control. Both myself and my wife grew up in decent households, but we both have siblings that are just bat-shit crazy. I don't think it was our parents fault on either sibling. All we can do is be the best we can be. We make mistakes and must forgive ourselves and learn from them. I truly wish you the best as you go down this road.
Thank you all for the responses. I hadn’t intended to drop the post and then miss the conversation, but I am grateful for your shared insights and experiences. Driving to The Range this a.m. for family X-Mas stuff and may not get back here for a bit, but I do plan to comment on these thoughts as I’m able to.
I take medication for this condition, having been officially diagnosed about 8 years ago, after having a nagging suspicion for a few years prior to that.
Being untreated was hampering my productivity at work to the point where it became career-threatening (or at least career-stalling).
I have more thoughts on medication options I'll share later, but because I've taken my medication today, I can leave them unsaid and actually get to work.
My son is 10. He has severe ADHD and is in a level III special ed classroom for this because, despite not having an actual learning disorder (and tested to have a pretty high functional IQ), the ADHD made it nearly impossible to learn without modifications. And especially impossible without medications. He's been on them since he was six. Without medications, he would probably be dead by this point, but that's due to his mood disorder (disruptive mood dysregulation disorder -- which is basically kid bipolar, but they don't like diagnosing kids with bipolar for obvious reasons) more than the ADHD. Nonetheless, the stimulant is a life saver. Yes, we had to go through a couple different versions of stimulants due to unwanted side effects, but once we found the right one, it was amazing. My son is a more extreme case, though, than probably the average ADHD kid. Keeping that in mind, he personally identifies medications as extremely helpful to life and school. I know many grown ups who had ADHD as kids, too, some who were on meds and some who weren't. Those who were on meds rarely wish they hadn't been. Those who weren't on meds generally regretted not having more help. That's a broad generalization, but maybe it'll inform things.
Hopefully linking is allowed, but I actually blog about raising a child with these issues at HealthyPlace and Psychology Today. I don't know if I know you in real life "Can of Corn", but feel free to message me personally if you have more questions.
Yeah. I didn't struggle with college, but did most of my work in flurries right before they were due. I wonder how much more smoothly things would have gone if I had these back then.
I needed medication because my "cram/marathon" methods didn't work as I got older and when I had family obligations (like coming home from the office in the evenings).
Frustration with my ADD and my inability to picture improvements in my situation triggered some depression, which I've only barely tasted since finding treatment.
This is a big part! So many grownups with ADHD (not all) who didn’t get treated in childhood or adolescence suffer from depression and/or anxiety because they didn’t get to tackle the ADHD as a kid and it led to not doing things they wanted, or being told they weren’t good enough, or watching their friends handle “easy” things when they themselved had to struggle more , etc etc. My hubby has panic attacks because he’s always afraid he’s forgetting something important. He’s one of those that’s pretty annoyed his pediatric nurse father never thought of getting his kid diagnosed and medicated for ADHD early on.
My thoughts on meds: stimulants are fast-in, fast-out (especially with the Immediate-release versions, which are way cheaper). I know they work differently with young brains, but you should be able to see how s/he reacts within a few hours. And if it's too much, you can stop giving them and see a quick return to the old normal. I take IRs in the morning on the bus and I need a second dose around noon. IRs have nice score lines and if I sleep in late on the weekend, I can adapt my dose a bit to the situation and
sell the excess on the streetsave some for when one month's supply runs out so I don't have to live my life about getting to the pharmacy TODAY.That's not the best for kids at school/daycare but I'd assume the IR and XR versions of the same drugs have similar reactions, so that'd be an easier way to test.
I believe Antidepressants take a long time to start working and need to be weaned off of. I'd think it'd be hard to tell how well they're even working with kids (as kids are pretty variable and have "developmental changes" as they age).
I'd think of them
Caveats:
I am not a doctor. My experiences are not necessarily generalizable. Speak to your child's doctor.
Anxiety meds also take a while to determine proper dosage and success, and can take a few weeks to get a good read on them.
Anti-depressants also act differently on kid brains. They’re more likely to trigger suicidal thoughts early in Treatment with young’uns. You always have to weigh risks vs benefits, of course, but for a kid whose primary concern is ADHD, I’d personally rather start with stimulants than anti-depressants for many of the reasons AMR pointed out. My son started with anti-depressants along with stimulants because he was already suicidal and they thought it was major depression. Turned out it was the DMDD, so the anti-depressants didn’t help. Mood stabilizer did. But that’s not ADHD related.