A few Tuesday nights ago, the kids had swimming lessons and we went as a family to Fuzzy's afterward for dinner. Daniel wasn't on his best behavior at the restaurant. He fidgeted almost nonstop, didn't listen when we asked him to do things, played with his food before finally eating it, and needed constant redirection. It wasn't a fun time for him or us. We've experienced that scene many times before, but lately, we can see it through a different perspective.
Daniel isn't deliberately acting out when he behaves like that.
He is a child with ADHD.
Attention deficit/hyperactive disorder, aka ADHD, is a neurological condition that affects a person's ability to stay on task, focus, and inhibit inappropriate behaviors. It's believed to be genetically passed down, and while Kevin doesn't have it, we believe his dad, while never diagnosed, probably did. In summary, in a person with ADHD, the parts of the brain which control executive function don't do their jobs. Signals get lost in the static, such that a child with ADHD can hear the instruction to put on his shoes but fail to process it and convert it into action.
So how did we arrive at this diagnosis?
For as long as I can remember, I've suspected Daniel might have ADHD. One of the first incidents that stood out to me was shortly after Rebecca was born. He was 2 1/2 and I was home on maternity leave and had plans to meet up with 2 friends and their kids at the aquarium. One family was running behind, so my kids and I waited with my friend and her kids. Her son, just a few months older than Daniel, stood patiently at his mother's side as we waited and I don't recall her once having to redirect him. Daniel, on the other hand, was constantly fidgeting and darting away from me into the crowd and I had to physically hold his hand to keep him by me.
The incident worried me, but when it's your firstborn, it's hard to know what's typical toddler behavior and what's not. Plus, with a newborn in the house, it seemed reasonable that the acting out might just be a bid for attention. Still, it made me nervous to take them both out by myself to crowded places.
His first year of preschool went pretty well and the reports we got home from the teacher were generally good with only a few behavior issues. The second year he was still a happy kid and made progress but his teacher expressed frustration several times that he could learn and accomplish so much more if only he had better focus and concentration. She also mentioned some annoying and disruptive behaviors he had developed including playing with spit in his mouth, fidgeting constantly, and making noises, among others. We had a lot of talks with him about this and we would generally see improvement for a day or so, but then we'd revert back to the same.
This past school year though, the wheels came off. The inattention continued and so did the disruptive and annoying behavior, which at times became defiant. His teacher, a seasoned pro, tried a lot of things with him and kept in touch with us, often sending home detailed notes about the behavior issues and how they were preventing him from learning. The notes were difficult and frustrating for us to read but what she described mirrored what we were seeing at home. It wasn't just an issue at school or with this teacher.
A few weeks ago we had some particularly challenging moments. First, I took him with me to Dick's Sporting Goods while I handled a quick exchange. He ran away from me in the store not once but twice and rather than come when I called him, he'd laugh and run away through the store out of my sight (alas, Mommy's a runner so I caught up pretty quickly). While this happened in an enclosed space, I was truly afraid of what could happen if he did this somewhere else. What if he ran away at a crowded public place? Or near a busy street? And what if I'd had Rebecca with me too and couldn't easily chase after him?
A few days later I took both kids to Walgreen's to take their passport photos. There was a 5 minute wait for our pictures to be finished and it was among the longest 5 minutes of my life as each kid squirmed away and tried to grab everything in sight. I felt like a broken record constantly repeating "put those up," "come back," "hold my hand," "hold each other's hands." It reminded me why I never run errands with both kids with me if I don't have to.
Between the reports from school and our own experiences it was clear the problems were escalating. I didn't want to let him or us go through years of frustration if there were solutions available. It was time to take action.
In late January we scheduled a meeting with the kids' pediatrician to discuss our concerns. She referred us to a child psychologist for evaluation and behavior modification suggestions. Kevin and I each filled out an evaluation and so did Daniel's teacher. As expected, the tests confirmed that he had ADHD. Specifically, his results were consistent with the combined type of ADHD, meaning he has at least 6 of the characteristics of both the inattentive type and the hyperactive-impulsive type- a combo package, if you will, where the sum is definitely more than the parts. Along with that, he also displayed some characteristics of oppositional defiance disorder, a condition which commonly coexists with ADHD in children his age. She then referred us back to the pediatrician for follow-up.
One of the reasons we like the pediatrician is her conservative approach of not medicating unless necessary. She doesn't routinely prescribe antibiotics for ear infections and when we first met with her about ADHD, she said that while medication is the gold standard for treatment, she doesn't generally prescribe it for children who aren't yet in grade school. So when we met with her again after visiting the psychologist and she felt that Daniel's symptoms were severe and negative enough to warrant medicating at his age, the recommendation carried a lot of weight for us. Between that and our own research on it, we agreed to start him off with a low dose of a stimulant medication then go from there.
For the past month Daniel took a dose of Adderal XR every morning. It's certainly not a magic wand but I can see that it helped him. When he's "on," he listens and follows directions better and isn't as fidgety. And even though it has worn off (or, as he puts it "run out of energy") by the time I pick him up from extended care in the afternoon, he can describe his school day in far more detail than he could previously. I suspect this is because his brain is "capturing" the memories better during the day when the meds are reducing the static in his brain. His teacher noted that the fidgety behavior had greatly improved but the inattention persisted.
As with many medications though, it comes with side effects, namely appetite suppression and difficulty falling asleep. Daniel eats breakfast before taking his pill and still seems to be eating his lunch pretty well at school but his dinner appetite is noticeably lighter most nights. Also, even though we put the kids to bed around 8 it's not unusual for him to still be awake till well after 10 some nights which understandably leaves him tired the next morning.
After our appointment this past Friday, we have a new medicine for him now, Focalin, and will see if that addresses the inattention better and may wear off more easily so he can sleep better. Finding the right dosage and formulation of the right drug is a trial and error process, so it may be awhile before we determine the magic combination. But at least we're on the right track.
Starting medication isn't the only big change for him lately. In light of the issues he was having in the primary (pre-K) classroom this year, the director made the decision to move him back to the pre-primary class he had been in the past school year. While we knew a change may be in order, it's not the change we were expecting. We thought he'd go to the other primary class but once the director explained it, the move made a lot of sense.
First, we've long noticed that in extended care, when all the ages are together, he seemed to gravitate more toward the kids a year younger than him, so now during the whole day he's with his emotional peer group and in his comfort zone. Also, that classroom has an assistant, so there's a 5:1 student/teacher ratio, meaning more help and closer supervision than in the older classes, when the kids are expected to be more self-directing. And while this was a step back to a younger class, the individualized nature of Montessori classes is such that we knew he could still be appropriately challenged academically. His current teacher picks 2 of the 3 works he does every day to challenge him and if he does those well, he gets to pick whatever he wants for the 3rd. He has always enjoyed the practical life works so he always chooses one of those as his "reward."
Daniel tells us every day he's happy to be in this "new" classroom and that he likes his medicine because it helps him to listen, and his teacher reports that he is doing better and learning. We're hopeful that between the two changes, the rest of the school year will go well.
The diagnosis brought many feelings for me. Worry for Daniel and the extra challenges he'll face throughout his life in school, work, and personal settings. Guilt at blaming him for behavior that wasn't his fault. Realization that throughout his school career, I'll have to advocate for him to ensure he's given the chance and tools to succeed. Determination to learn all I can about ADHD so I can be the best mom. Humbled by the task in front of him and us. Grateful for the vast resource of other ADHD parents who, like me, find themselves members of a club they hadn't planned to join, but are determined to rise to the challenge membership entails. Resolve to help him harness the power of his turbo-charged brain and find ways to use this difference as a strength as so many successful people with ADHD have done.
Odd as it may sound, though, another feeling was relief. Because frustrating as Daniel's behavior was, now we understood why he was doing it. He wasn't ignoring or disobeying us because he was a bad kid. In fact, it was probably as frustrating for him as it was for us when we had hard days. He really wants to please us and I'm sure it was frustrating to him when he couldn't.
I'm grateful to the teachers who shared their concerns. It would have been easy to just set him in the corner and let him lose chances to learn but they cared enough to let us know what was going on. I'm glad we took their concerns seriously and followed up.
ADHD also meant that the challenges I was having with him weren't because I was a bad parent. I couldn't help but notice that other kids his age seemed to listen to their parents better, and that tasks like taking both kids to the grocery store or solo parenting while Kevin was out of town seemed a lot harder for me than for other parents I knew. If not for the feedback from the teachers, I'd have thought maybe it was just me.
Now, armed with this knowledge and some behavior management techniques the psychologist shared with us, we can address his challenges more effectively. And help him develop his strengths. I'm as Type-A, left-brain logical as they come, so while we'll have plenty of misunderstandings I'm fascinated to see what I can learn from him. What connections will he see with his non-linear thought processes that the rest of us miss? What gift will his hyperfocus enable him to develop and hone?
Michael Phelps's ADHD enabled him to spend hours upon hours in the pool. It may be that he is the success story he is today not in spite of his ADHD but because of it. I've read ADHD described as having a racecar engine with bicycle brakes. But if we can help him, through medication and coping mechanisms, to apply the brakes and control the steering, imagine where that turbo engine can take him. I'm excited to find out.
For the record, I don't see this diagnosis as anything to be embarrassed about or pitied for, for him or for us. It's a medical condition, not a reflection of his character or intelligence. Being smart and having ADHD aren't mutually exclusive, he just needs a little help unlocking his brain's capacity and directing its power. ADHD doesn't put a ceiling on his potential. And frankly, even if it did, as children's health problems go, I know plenty of parents and would-be parents who would trade situations in a heartbeat.
Fortunately ADHD is also a condition that the medical community has learned a fair bit about and the medications available, while not perfect, offer significant benefit to most individuals with ADHD. It may be that someday he doesn't need medication, or can reduce his dosage, but for now, it gives him the best chance to unlock his potential and be his best self. I'm thankful it's an option.
It's a long journey and we're only at the start of it. But I'm glad we know more and have options. Most importantly, Daniel was a sweet, smart, thoughtful, funny boy before his diagnosis and he's a sweet, smart, thoughtful, funny boy now. He's the same great kid we've loved from day one, but now we know more and have better tools to help him grow into the boy and young man he'll become.
