Monday, July 18, 2011

Update: Rethinking my Thinking

A few weeks ago, I posted (see Rethinking my Thinking) about my youngest daughter. After much deliberation and discussion, I decided to take her to a psychotherapist for an evaluation. I wanted to see what this professional's opinion would be. After all, when you homeschool it can be hard to tell what is "normal" (even if it seems different ) and what needs attention. I went in with an open mind, and also no sense that anything would be resolved whatsoever. This series of meeting was for evaluation purposes only and wanted to get an outside opinion. I've had many opinions given to me for free - from my parents, my siblings, my in-laws, other homeschoolers, wonderful and supportive folks over at Secular Homeschool, the pediatrician.... but not someone from the mental health and wellness world. So I decided to give it a fair try.

The therapist is a young, pretty woman (which only matters because my daughter responds better to young, pretty women than to "scary" older men) who was very nice, but all business. Which suited me fine because, after all, I'm paying her by the hour. I asked her her opinion on medicating children, and she told me that in most cases it is, in her opinion, a last resort. Over the course of the meetings, it became clear that she is a huge supporter of homeschooling, which makes things easier in general. The evaluation took place over several meetings, involving oral interview with me, thousands of forms and questionnaires, meeting with my daughter and asking questions while playing games, observations, and a perusal of medical records.  In the end, she met with me one last time to go over the results and come up with a game plan. That meeting was on Friday.

The results were not all-together shocking, but I felt somewhat surprised nonetheless. The bottom line is that she believes my daughter has the combined type of AD/HD. She also indicated that there may be some sensory processing issues at play, but that because the AD/HD is so strong, and because both AD/HD and sensory processing involve the same part of the brain and brain function, the treatment remains the same. She told me that in her opinion, behavioral therapy would be extremely beneficial to a child like my daughter, but that she doesn't feel it would be helpful to her at all unless she is on medication because the AD/HD is so severe. Basically, she told me that if you were to line up 100 seven-year girls with AD/HD in order from most severe to least severe, my daughter would be second in line. Therefore, she told me that she really isn't willing to start behavioral therapy until my daughter is on a stimulant AD/HD medication and the dosage is worked out because it would be like pouring water through a sieve.

She also added that she does not always feel that medication should be the first line of attack, but that with my daughter it would be virtually impossible for her to learn to modify her behavior because her brain is not developed in that area to allow her filter through her actions, impulses and emotions. She is not making a choice, she simply is. In the therapist's opinion, a stimulant medication would allow my daughter to have that filter in place so that she can learn to make choices and think about consequences.

I asked a lot of questions, we talked for an hour, and I left feeling exhausted. I'm probably leaving out a lot of the meeting, but the key thing that stuck with me is that (1) this therapist believes that my daughter's behavior is in fact quite severe; and (2) she is recommending stimulant medication.

My husband and I decided that, as we almost always do, it's worth getting a second opinion.  And I'm definitely not inclined to go forward with medication at this point. Beyond that, I have to accept that her behavior really is that "wild" and I'm going to have to figure out how to deal with it one way or the other.....

9 comments:

  1. Here is my completely personal (ie not in the least informed or professional) opinion. Two thoughts. You should get the transcript or profile that the therapist wrote up on your daughter and take that to others to get their opinions prior to taking her through the whole testing process. As you know, the testing is exhausting and hard and probably expensive. One of the things that you've paid for are the tests. You might be able to get a 2nd opinion based on the test results (as a first step).

    I would ask the therapist some more tough questions such as:
    - Whats the likely developmental path for someone like my daughter. I know there are a number of speech issues which most kids just outgrow. Yes, they are behind in the meantime but one option with them is to just go at their pace. I have no insight into the developmental impact of ad/hd kids but I'd ask about it.
    - I'd also ask about other interventions other than drugs. I've heard of some kids who get "treatment" in the form of intense sports activity. I'm not sure if that's for ADHD or other issues and I'm not sure if its in addition to medication.

    Good luck. PS. I clicked through from:
    http://www.secularhomeschool.com/entries/836-Update-Rethinking-my-Thinking

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  2. That's a lot to process for you :( No advice, just good luck with your decision making - and well done mama for seeking information to help your daughter.

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  3. Wow. I'm always suspicious of the sort of medical establishment in this sort of regard. They say medication is a last resort, but then their actions don't reflect that. Back when I was teaching, we did on a couple of occasions request that parents strongly consider medication as recommended by a doctor, but always after knowing a kid day in, day out for months and trying all kinds of things - not after observing a kid for an hour. So I'm not against meds - I've seen kids get huge help from them. I just don't know how one can say it's a last resort if it's a first suggestion. In any case, good luck with whatever you decide.

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  4. Thank you all so much!

    @BBatSo - great advice on getting the documents. Didn't even think of that, though in hindsight I feel like a big dummy for missing it. And you raise some really good questions. I did ask about the developmental path, and her frontal lobe will develop, though she may not necessarily outgrow having ADHD. It will likely change in it's appearance as she matures. And if she learns techniques for dealing with it, she can improve as she ages. It's funny b/c I have read about vigorous exercise and ADHD, had listened to a podcast on ADHD and that was a huge part, and then the therapist mentioned that she needs it. Basically, she told me to think of a child with diabetes - diet is extremely important, it's important that the child exercise, but at the end of the day that kid's body is not going to produce insulin. She likened the lack of my daughter's frontal lobe "filter" to that - we can do all the right things, and we should, but at the end of the day that area of her brain is still lacking stimulation. I definitely agree with the exercise - actually, I think ALL humans could and should do it! - and I think I'm going to try all that before jumping into anything else.

    @Farrar - I know. I felt the same way - the first thing I asked was how she handled medication and she said last resort. Then it appears to be a first line of attack here. Very confusing. In my heart of hearts, I'm afraid that my daughter is as severe as the therapist says. It feels that way to me on a daily basis. But at the same time, I have nothing to compare it to other than my other three girls. I've been feeling like maybe I'm this terrible parent, unable to handle things, maybe I'm a big whiner. At least I'm leaving this therapist having had an outsider recognize that yes, this girl is something else! At the same time, you're right - it WAS only a few hours. Is that really enough time to determine that she needs medication that affects the brain? I worry about her losing herself and I don't want that. Some of the things that make her difficult also make her great.

    Sigh. Parenting is so much harder than they tell you about.

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  5. I'd like to give you some advice from the perspective of someone who suffered from ADHD for years. I suffered without medication for years. I managed with medication for years. And now I've managed without medication for years.

    My parents did not put me on medication. I put myself on medication. I would likely have left school without it. I might never have gotten my PhD, never have gotten a good job, never have gotten married or had kids. From an interior perspective, the medication (first Ritalin, then Concerta) didn't change me, didn't fog me, didn't slow me. It quieted something. It's as if there were TVs on in my head at full volume, and the Rit shut them off. The silence allowed me to deal with things better, allowed me to learn and develop better responses to stress and conflict, allowed me to learn more about myself and my responses so that I could eventually manage without it, happily.

    The biggest problem with impulsive and destructive behavior, such as you describe, is not in the moment. It's what happens after. These actions affect one long after the day is over. One suffers from disapprobation, from rejection, from anger, and one may be _incapable_ of fixing the problems that lead to these responses. One's behavior can spiral out of control into pathology. The emotional affect on one can take decades to resolve, if ever. This secondary problem can be worse than the first.

    One of the questions you might ask yourself is whether you can be sure, without the use of medicine, that you and your family won't fall into a pattern where your youngest girl is "the bad girl," a pattern which will repeat itself again and again, and create a social perpetuation to a cognitive problem. Being "the bad girl" can be worse than being impulsive in itself.

    My experience with Rit is that the effect was nigh-immediate (about 30 minutes) and very clear. Even to a seven year old, if the medication is effective, it should be obvious. Perhaps seven is not too young to develop self-knowledge and awareness of the problem of impulsive behavior. The medication can be a _tool_ for developing this awareness, rather than a _barrier_ to it. Perhaps seven is too young to be put on psychoactive medication by your mom. But perhaps seven is young enough to avoid years of impenetrable, incomprehensible, and painful social problems resulting from cognitive peculiarities that are not your choice.

    And one more comment... your font is terribly hard to read. I find your blog interesting, but read it less than I would because it's such hard work to slog through the font. It's like a sharp stick in the eye.

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  6. @nthanonymouse - Thank you so much for sharing your story (and, btw, I agree about the font - I've been changing it around almost every day; I can't stand the standard font, but that last one was super annoying in anything longer than one word).

    She IS already feeling like the bad girl, which I brought up to the therapist. And she does suffer in the aftermath of her impulsiveness.

    I have a lot to think about and research. I appreciate your story very much!

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  7. That is a hard decision to make. I'm sorry.

    I didn't want my son on medication for asthma because I have taken meds for asthma my whole life, and some of it had terrible side effects. At first, I did a lot of alternative medicine and breathing exercises with him, but it wasn't enough, and I finally realized that I wasn't doing him any favors by allowing the asthma to take control and get out of hand.

    I think we vilify modern medicine because too often it is used with indiscretion and without any supporting therapy, but sometimes it has an actual benefit. We have to weigh the good with the bad. I empathize with what you are feeling right now. It's a difficult choice. Perhaps it would help to remember that you always have an option. Deciding to do it now doesn't mean you can never change your mind and she will be on medication for life. You have tried other things. You are seeking second opinions. I'm sure you will learn all you can about ADHD and always consider doing what is best for your child. Good luck!

    Peace and Laughter,
    Cristina

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  8. Hi, I clicked through from SHS.com and wanted to just say that you are doing the right thing! Getting a second opinion is a must before putting any child on meds. I don't know anything about diagnosing AD/HD but I do know a little about being a parent! So go with your gut and you will do fine.

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  9. Good luck in your decision! We tried just about EVERYTHING for my son before resorting to medication! After having several meetings with the school he attended at the time to create various "strategies" to help my son back in elementary school, they called just to tell me he's really "turned a corner in the last few weeks" and that they hadn't even employed all the strategies. Yes, it was exactly when we started medication. My son is really bright (now between 6-10 grade levels advanced!) but couldn't concentrate enough in school to complete classwork and was sent home with most of his classwork to complete as well as homework and never got to play at recess since he had to finish his work... so home was a mess at the time as well as school for the poor guy (and us!)

    I have ADHD (diagnosed as Hyperactivity Disorder back in the fourth grade- I'm old and ADHD didn't exist at that point!) I've tried medication and I can say it is like putting on a pair of glasses- all of a sudden everything is just clear! You know what you need to do when you are unmedicated, but you CAN DO IT when you are medicated. (BTW, We liked Concerta, but found Adderall to have a terrible crash at the end of the day. NOT worth the benefit IMHO!) I actually hate NOT medicating my son now because he's so regretful at his impulses after the fact- it tears away at his self esteem. He's 14 now (and is finally homeschooled since March!) and I have halved his medication dosage, but it's still somewhat "necessary." I let him decide if he wants to take it.

    The BEST book I've read is Right-Brained Child in a Left-Brained World (with ADHD in the subtitle.) It fit my son very well and offered real advice to help with kids that dance to the beat of a different drummer. As challenging (and rewarding!) as it is to raise these kids, THEY are the ones whose energy and creativity will be rewarded in the jobs of the future! We don't need worker cogs that institutional school was meant to produce! Enjoy the differences and gifts of ADHD!!! :-)

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