If its not ADHD, then what is it?
October 20, 2010 10:14 PM Subscribe
What effect would you expect to see if a child (a pre-teen boy) who does NOT have ADHD is treated with ADHD meds (Ritalin, Adderall, or similar)?
I have a dear friend who has been battling the school system for several years over her son's behavioral/learning issues. He is just entering third grade. To make a very long story short, she has been pressing since prior to Kindergarten to have him assessed for learning disabilities. The school system has basically concluded he has ADHD. Her pediatrician referred her to a child psychologist who also concluded that he presented with "some signs" of ADHD. The mom (I'll call her Kay) disputes the diagnosis, but was willing to have her son begin behavior therapy which helped (and is helping) somewhat. She did not want to start him on medication right away due to a number of factors, including her firm belief that he has a non-ADHD learning disability and his history of a heart murmur (which resolved on its own) as an infant.
Although his behavior -- specifically, his in-classroom behavior -- improved somewhat due to the therapy, his teachers continued to press for her to "explore other alternatives" (ie: medication). His home behavior is not as 'extreme' as what his teachers report, possibly because his parents live on a farm and he works along side his dad doing active farm things. His grades, and his ability to learn and retain material, continue to be very poor, although he's terrific at anything math related. In particular, his reading is far below grade level, although its anyone's guess if the issue is that he can't read well or simply can't concentrate on what he's reading. He does talk a mile a minute, but his vocabulary is somewhat limited for a child his age. He tends to speak in whole phrases he's heard elsewhere - from movies, from things that have been read to him, from his parents and teachers - sometimes correctly in context, sometimes not - but its pretty clear to anyone who spends any time around him that he's aurally processing language in some wild and unusual ways.
Over the summer he turned 8, and, in preparation for third grade and under pressure from the school, Kay agreed to start him on medication, under the supervision of the child psychologist. In August they started Ritalin, and it was a total disaster. He became much more impulsive and aggressive, and (working with her doc) he was taken off Ritalin after a very short time and switched to Adderall. The Adderall was just as bad - an increase in impulsive, almost manic behaviors with a side dose of insominia. He was also taken off Adderall after a matter of weeks.
Kay is pressing the school - hard - to do a comprehensive assessment for learning disabilities, but her school district is small and rural and has been ... reluctant ... to do more than a cursory assessment without direction from the Ch.Psych. The Ch.Psych is standing by his diagnosis of "probably" ADHD and wants to start a third medication, but at this time Kay is unwilling to put her son through another month or so of what she views as "drug experiments", given how badly the first two trials turned out. She is seeking a new doctor but her choices are limited because she lives in such a remote, rural area. (Driving two hours each way for weekly appointments would be a real hardship, but a one time, or semi-yearly evaluation in Bangor, Portland, or Boston would probably be doable.)
So, finally, our questions:
+ Can you point her to a study showing how kids who do NOT have ADHD react when given Ritalin/Adderall or similar? (She feels strongly that his reactions to the meds are a clue to the real issues, but the Ch.Psych's response is "some kids just can't tolerate the meds". She'd love to present him with some kind of formal study of the effect of ADHD meds on non ADHD kids, but we've dug through Google Scholar with little success.)
+ Can you point her to resources in Maine that can help in persuading the school district to do its duty and provide him with the more comprehensive evaluation he needs? (Note: its possible that the district simply doesn't have the professional staff available to handle a child with a significant and/or hard to diagnose LD issue, but its our impression that they are required by state law to pay for it to be performed elsewhere if they can't provide it.)
+ Can you suggest a good, open-minded, Child Psychologist (or similar) in Maine, NH, or Boston who might be willing to see her son for a second opinion? Bonus points for someone in the region between Bangor and Houlton, Maine. (Feel free to MeMail me on this last point.)
A couple of other things: Autism spectrum disorders don't seem to be on the table here. That's pretty much the only thing everyone - the school, his parents, the Ch.Psych - agree on. His parents are profitably running a fifth-generation family farm, so leaving their rural location and moving to a larger school district isn't really an option, and his parents are reluctant to homeschool because neither of them are well educated (his father did not finish HS, his mother has only a HS diploma) and because there isn't a significant non-religious homeschooling community in their area to provide support. Private school is not a realistic option. He's been on a gluten-free diet twice, and it doesn't seem to have changed or improved much of anything. Ditto with removing dyes, etc. He's an only child. As I mentioned above, his behavior is significantly different (worse) in the school environment than what his parents (and others, including me) see at home.
Thanks for any assistance or pointers you can provide.
I have a dear friend who has been battling the school system for several years over her son's behavioral/learning issues. He is just entering third grade. To make a very long story short, she has been pressing since prior to Kindergarten to have him assessed for learning disabilities. The school system has basically concluded he has ADHD. Her pediatrician referred her to a child psychologist who also concluded that he presented with "some signs" of ADHD. The mom (I'll call her Kay) disputes the diagnosis, but was willing to have her son begin behavior therapy which helped (and is helping) somewhat. She did not want to start him on medication right away due to a number of factors, including her firm belief that he has a non-ADHD learning disability and his history of a heart murmur (which resolved on its own) as an infant.
Although his behavior -- specifically, his in-classroom behavior -- improved somewhat due to the therapy, his teachers continued to press for her to "explore other alternatives" (ie: medication). His home behavior is not as 'extreme' as what his teachers report, possibly because his parents live on a farm and he works along side his dad doing active farm things. His grades, and his ability to learn and retain material, continue to be very poor, although he's terrific at anything math related. In particular, his reading is far below grade level, although its anyone's guess if the issue is that he can't read well or simply can't concentrate on what he's reading. He does talk a mile a minute, but his vocabulary is somewhat limited for a child his age. He tends to speak in whole phrases he's heard elsewhere - from movies, from things that have been read to him, from his parents and teachers - sometimes correctly in context, sometimes not - but its pretty clear to anyone who spends any time around him that he's aurally processing language in some wild and unusual ways.
Over the summer he turned 8, and, in preparation for third grade and under pressure from the school, Kay agreed to start him on medication, under the supervision of the child psychologist. In August they started Ritalin, and it was a total disaster. He became much more impulsive and aggressive, and (working with her doc) he was taken off Ritalin after a very short time and switched to Adderall. The Adderall was just as bad - an increase in impulsive, almost manic behaviors with a side dose of insominia. He was also taken off Adderall after a matter of weeks.
Kay is pressing the school - hard - to do a comprehensive assessment for learning disabilities, but her school district is small and rural and has been ... reluctant ... to do more than a cursory assessment without direction from the Ch.Psych. The Ch.Psych is standing by his diagnosis of "probably" ADHD and wants to start a third medication, but at this time Kay is unwilling to put her son through another month or so of what she views as "drug experiments", given how badly the first two trials turned out. She is seeking a new doctor but her choices are limited because she lives in such a remote, rural area. (Driving two hours each way for weekly appointments would be a real hardship, but a one time, or semi-yearly evaluation in Bangor, Portland, or Boston would probably be doable.)
So, finally, our questions:
+ Can you point her to a study showing how kids who do NOT have ADHD react when given Ritalin/Adderall or similar? (She feels strongly that his reactions to the meds are a clue to the real issues, but the Ch.Psych's response is "some kids just can't tolerate the meds". She'd love to present him with some kind of formal study of the effect of ADHD meds on non ADHD kids, but we've dug through Google Scholar with little success.)
+ Can you point her to resources in Maine that can help in persuading the school district to do its duty and provide him with the more comprehensive evaluation he needs? (Note: its possible that the district simply doesn't have the professional staff available to handle a child with a significant and/or hard to diagnose LD issue, but its our impression that they are required by state law to pay for it to be performed elsewhere if they can't provide it.)
+ Can you suggest a good, open-minded, Child Psychologist (or similar) in Maine, NH, or Boston who might be willing to see her son for a second opinion? Bonus points for someone in the region between Bangor and Houlton, Maine. (Feel free to MeMail me on this last point.)
A couple of other things: Autism spectrum disorders don't seem to be on the table here. That's pretty much the only thing everyone - the school, his parents, the Ch.Psych - agree on. His parents are profitably running a fifth-generation family farm, so leaving their rural location and moving to a larger school district isn't really an option, and his parents are reluctant to homeschool because neither of them are well educated (his father did not finish HS, his mother has only a HS diploma) and because there isn't a significant non-religious homeschooling community in their area to provide support. Private school is not a realistic option. He's been on a gluten-free diet twice, and it doesn't seem to have changed or improved much of anything. Ditto with removing dyes, etc. He's an only child. As I mentioned above, his behavior is significantly different (worse) in the school environment than what his parents (and others, including me) see at home.
Thanks for any assistance or pointers you can provide.
Response by poster: I've seen a study that said that if you put a "normal" (ie, neurotypical) person on ADHD meds, they'll improve academically as well. My experience as an undergrad seeing my friends casually using adderall bears this out.
That was our impression as well. After all, these are drugs that lots of people take illegally specifically for the "sharper" or "euphoric" feeling. He wasn't on a high dose at any time - they started his Ritalin at one 5 mg dose and brought him up to 10 before they ended the trial, so we're not talking huge/overdoses here. As I said above, Kay feels very strongly that his reaction to both these meds is a clue, but the Ch.Psych sort of pooh-pooh's her. Any help you can provide would be terrific.
posted by anastasiav at 10:38 PM on October 20, 2010
That was our impression as well. After all, these are drugs that lots of people take illegally specifically for the "sharper" or "euphoric" feeling. He wasn't on a high dose at any time - they started his Ritalin at one 5 mg dose and brought him up to 10 before they ended the trial, so we're not talking huge/overdoses here. As I said above, Kay feels very strongly that his reaction to both these meds is a clue, but the Ch.Psych sort of pooh-pooh's her. Any help you can provide would be terrific.
posted by anastasiav at 10:38 PM on October 20, 2010
2nding the suggestion of legal guidance. I've worked for various school districts and in many situations an official statement of "we're not messing around, and we are going to get this child's needs met" is met with action. School districts would much rather pay for services than for legal fees in the event of a lawsuit.
posted by corey flood at 10:47 PM on October 20, 2010
posted by corey flood at 10:47 PM on October 20, 2010
Each medication is different. As someone who benefited from these types of medications, I would urge Kay not to discount the whole class of medications based on two bad experiences.
I tried one with awful side effects, another that didn't seem to do anything, then a third that was really helpful. There is no blood test that will tell you which ADHD med is the right one and what dose to prescribe. It's a lot about trial and error.
posted by colgate at 10:59 PM on October 20, 2010
I tried one with awful side effects, another that didn't seem to do anything, then a third that was really helpful. There is no blood test that will tell you which ADHD med is the right one and what dose to prescribe. It's a lot about trial and error.
posted by colgate at 10:59 PM on October 20, 2010
I'm not a doctor or any sort of specialist on this topic, but increased aggression seems to be a known possible side-effect of Ritalin, and mania seems to be a known possible side-effect of Adderall. So I don't see how that's diagnostic. The symptoms sound vaguely in the ballpark for pragmatic language impairment / semantic-pragmatic disorder, which has a relationship to autism, but it's unclear enough that a mild case might not make you think so. That is, I think it's conceivable you could get a PLI/SPD diagnosis without exhibiting other hallmarks of autism. But down that path lies a whole lot of guesswork and confirmation bias, when the important thing is just to get the school system to give this kid attention. To that end, the legal route seems appropriate.
posted by Monsieur Caution at 11:24 PM on October 20, 2010 [1 favorite]
posted by Monsieur Caution at 11:24 PM on October 20, 2010 [1 favorite]
+ Can you point her to resources in Maine that can help in persuading the school district to do its duty and provide him with the more comprehensive evaluation he needs? (Note: its possible that the district simply doesn't have the professional staff available to handle a child with a significant and/or hard to diagnose LD issue, but its our impression that they are required by state law to pay for it to be performed elsewhere if they can't provide it.)
I have a friend who dealt with this exact issue - I've contacted her and will post back or memail you if/when I get relevant info.
posted by hapax_legomenon at 12:08 AM on October 21, 2010
I have a friend who dealt with this exact issue - I've contacted her and will post back or memail you if/when I get relevant info.
posted by hapax_legomenon at 12:08 AM on October 21, 2010
Special education teacher and parent of kid with ADD here.
I can't find anything quotable, but...I've NEVER seen or heard anything to support that those reactions to meds are indicative of another disability. With ADD, medication is unfortunately imprecise and usually, parents have to try a few until one works. If after 3 or 4 variations nothing is working, then the kid probably doesn't have ADD. My own kid became aggressive on Ritalin but is absolutely 100% focused and acting like himself on Adderall.
Unless a kid is displaying extreme behavior (especially a 3rd grader), diagnosing ADD isn't a precise science. The diagnosis comes from a behavioral scale (and then med trials).
Using the Conners Diagnostic Screener (which is how ADD is assessed) many, MANY third grade boys are "somewhat" ADD.
Your friend can memail me, but here's what I think she should do:
* contact her state department of education and talk to someone who can explain her rights and the process. If her son's been diagnosed with a health disability (ADD), then legally he needs to be put on an IEP or a 504 plan. If they're not doing that then the school is out of compliance, is violating his civil rights, and needs to be reported. Sometimes the school is acting out of ignorance, not malice. In either case, a letter from their department of education should set them straight very quickly.
* because it's entirely possible that there's more than one thing going on (I work with a lot of boys who had the same issues as your friend's son, and it often turns out that a kid has a reading disability/math disability, etc. as well as ADD), she absolutely should go to Children's Hospital in Boston and have a full neuropsychiatric workup. And the school district should pay. They're required to assess her son.
posted by dzaz at 3:18 AM on October 21, 2010 [3 favorites]
I can't find anything quotable, but...I've NEVER seen or heard anything to support that those reactions to meds are indicative of another disability. With ADD, medication is unfortunately imprecise and usually, parents have to try a few until one works. If after 3 or 4 variations nothing is working, then the kid probably doesn't have ADD. My own kid became aggressive on Ritalin but is absolutely 100% focused and acting like himself on Adderall.
Unless a kid is displaying extreme behavior (especially a 3rd grader), diagnosing ADD isn't a precise science. The diagnosis comes from a behavioral scale (and then med trials).
Using the Conners Diagnostic Screener (which is how ADD is assessed) many, MANY third grade boys are "somewhat" ADD.
Your friend can memail me, but here's what I think she should do:
* contact her state department of education and talk to someone who can explain her rights and the process. If her son's been diagnosed with a health disability (ADD), then legally he needs to be put on an IEP or a 504 plan. If they're not doing that then the school is out of compliance, is violating his civil rights, and needs to be reported. Sometimes the school is acting out of ignorance, not malice. In either case, a letter from their department of education should set them straight very quickly.
* because it's entirely possible that there's more than one thing going on (I work with a lot of boys who had the same issues as your friend's son, and it often turns out that a kid has a reading disability/math disability, etc. as well as ADD), she absolutely should go to Children's Hospital in Boston and have a full neuropsychiatric workup. And the school district should pay. They're required to assess her son.
posted by dzaz at 3:18 AM on October 21, 2010 [3 favorites]
A very simplistic answer is they will typically become more hyperactive with an increased heart rate.
posted by WhiteWhale at 4:45 AM on October 21, 2010
posted by WhiteWhale at 4:45 AM on October 21, 2010
Adderall is an amphetamine. They will act like they are on speed. Increased concentration, more talkative, euphoria, teeth grinding, etc. This is, btw, the same way that people with ADHD react to it.
posted by empath at 4:54 AM on October 21, 2010
posted by empath at 4:54 AM on October 21, 2010
Most of the meds used to treat ADD and ADHD are actually stimulants. Students regularly and actively trade them for help in studying. This isn't just undergrads, it's law students too, and I'd be surprised if med students didn't get in on the action as well.
posted by valkyryn at 5:30 AM on October 21, 2010
posted by valkyryn at 5:30 AM on October 21, 2010
Adderall is an amphetamine. They will act like they are on speed. Increased concentration, more talkative, euphoria, teeth grinding, etc. This is, btw, the same way that people with ADHD react to it....but the exception is if the kid has ADD. In that case, they calm down and can focus. The speed goes to the part of their brain that craves stimulation, fills it up, and allows them to hold it together.
posted by dzaz at 5:46 AM on October 21, 2010 [5 favorites]
posted by dzaz at 5:46 AM on October 21, 2010 [5 favorites]
He wasn't on a high dose at any time - they started his Ritalin at one 5 mg dose and brought him up to 10 before they ended the trial, so we're not talking huge/overdoses here.
Don't let the low numbers fool you--Ritalin and Adderall are very powerful stimulants. These are schedule II drugs for a reason. I'm almost 30 years old, and I started on 10 mg of Focalin (a Ritalin variant) for ADD treatment a few months ago. I felt like I was on a coke binge for the first two days I took it. Imagine what an 8 year old would feel like on the same dose. This kind of reaction to a "low dose" is not unusual and would not be indicitave that your child does not have ADHD. All it may indicate is that stimulants might not be the proper treatment for your son.
I wish him the best of luck. If he does indeed have ADHD, he has a tough life ahead of him. Please, for his sake, be supportive, and try not to blame him for it like my parents did.
posted by TrialByMedia at 5:51 AM on October 21, 2010
Don't let the low numbers fool you--Ritalin and Adderall are very powerful stimulants. These are schedule II drugs for a reason. I'm almost 30 years old, and I started on 10 mg of Focalin (a Ritalin variant) for ADD treatment a few months ago. I felt like I was on a coke binge for the first two days I took it. Imagine what an 8 year old would feel like on the same dose. This kind of reaction to a "low dose" is not unusual and would not be indicitave that your child does not have ADHD. All it may indicate is that stimulants might not be the proper treatment for your son.
I wish him the best of luck. If he does indeed have ADHD, he has a tough life ahead of him. Please, for his sake, be supportive, and try not to blame him for it like my parents did.
posted by TrialByMedia at 5:51 AM on October 21, 2010
In that case, they calm down and can focus. The speed goes to the part of their brain that craves stimulation, fills it up, and allows them to hold it together.
I'm afraid it's not quite that simple, and it's not true in every case.
posted by TrialByMedia at 5:54 AM on October 21, 2010
I'm afraid it's not quite that simple, and it's not true in every case.
posted by TrialByMedia at 5:54 AM on October 21, 2010
I'm afraid it's not quite that simple, and it's not true in every case.
That's true; it's not. But generally, that's how it works. If a kid has genuine ADD and they go on a stimulant that's working as it should, then they don't get more speedy; they calm down.
posted by dzaz at 5:56 AM on October 21, 2010 [2 favorites]
That's true; it's not. But generally, that's how it works. If a kid has genuine ADD and they go on a stimulant that's working as it should, then they don't get more speedy; they calm down.
posted by dzaz at 5:56 AM on October 21, 2010 [2 favorites]
If he does indeed have ADHD, he has a tough life ahead of him.
I don't think that's true across the board at all.
posted by dzaz at 5:57 AM on October 21, 2010
I don't think that's true across the board at all.
posted by dzaz at 5:57 AM on October 21, 2010
Has she tried modifying his diet? I don't have any study to cite, but I have my own experience.
My daughter has Celiac Disease (I'm not saying your friend's boy does too) but before she was diagnosed her teacher thought she had ADD, she wasn't doing well in school and wasn't doing well socially. Her symptoms looked similar to ADD but didn't quite fit.
Six weeks after going on the gluten free diet she was a new kid. It's been four years and she's still having issues that we're trying to address, but the diet has been really effective. When she does accidentally get gluten there's a huge difference in her behavior.
I'm not saying that a gluten free diet is for everyone, but it could be another avenue for your friend to explore.
posted by TooFewShoes at 6:09 AM on October 21, 2010
My daughter has Celiac Disease (I'm not saying your friend's boy does too) but before she was diagnosed her teacher thought she had ADD, she wasn't doing well in school and wasn't doing well socially. Her symptoms looked similar to ADD but didn't quite fit.
Six weeks after going on the gluten free diet she was a new kid. It's been four years and she's still having issues that we're trying to address, but the diet has been really effective. When she does accidentally get gluten there's a huge difference in her behavior.
I'm not saying that a gluten free diet is for everyone, but it could be another avenue for your friend to explore.
posted by TooFewShoes at 6:09 AM on October 21, 2010
but the exception is if the kid has ADD. In that case, they calm down and can focus. The speed goes to the part of their brain that craves stimulation, fills it up, and allows them to hold it together.
Low doses of ritalin or adderall help everyone focus, even people without ADD. "Calming down" is not an accurate description of what it does to anyone, though.
posted by empath at 6:15 AM on October 21, 2010
Low doses of ritalin or adderall help everyone focus, even people without ADD. "Calming down" is not an accurate description of what it does to anyone, though.
posted by empath at 6:15 AM on October 21, 2010
Low doses of ritalin or adderall help everyone focus, even people without ADD
The difference being that people with ADHD are unable to function to their natural potential without some kind of treatment. Normal people, on the other hand, take it to go beyond their natural potential. Use versus abuse.
"Calming down" is not an accurate description of what it does to anyone, though.
Except the people with ADHD.
Stimulants will have the same physiological effects on everyone, more or less, but they DO NOT have the same psychological ones. Nobody knows the actual biochemical causes for ADHD, but it basically comes down to a sort of deficiency in the adrenelin/noradrenelin areas. Since their brains are craving that base level stimulation that everyone else just inherently has, *EVERYTHING* stimulates their brains, such that they cannot distinguish between what they are supposed to be doing with that shiny [whatever]. It is easy to joke, but imagine you are driving down the road terrified that anything shiny on the side of the road will make you forget you are driving and crash. That's what ADHD is like.
So, the drugs amp up the psychological stimulation of ADHD patients ONLY TO THE LEVELS OF NORMAL PEOPLE.
Please stop spreading FUD.
posted by gjc at 6:34 AM on October 21, 2010 [8 favorites]
The difference being that people with ADHD are unable to function to their natural potential without some kind of treatment. Normal people, on the other hand, take it to go beyond their natural potential. Use versus abuse.
"Calming down" is not an accurate description of what it does to anyone, though.
Except the people with ADHD.
Stimulants will have the same physiological effects on everyone, more or less, but they DO NOT have the same psychological ones. Nobody knows the actual biochemical causes for ADHD, but it basically comes down to a sort of deficiency in the adrenelin/noradrenelin areas. Since their brains are craving that base level stimulation that everyone else just inherently has, *EVERYTHING* stimulates their brains, such that they cannot distinguish between what they are supposed to be doing with that shiny [whatever]. It is easy to joke, but imagine you are driving down the road terrified that anything shiny on the side of the road will make you forget you are driving and crash. That's what ADHD is like.
So, the drugs amp up the psychological stimulation of ADHD patients ONLY TO THE LEVELS OF NORMAL PEOPLE.
Please stop spreading FUD.
posted by gjc at 6:34 AM on October 21, 2010 [8 favorites]
Sorry, forgot part of my point. People with ADHD, lacking that base level stimulation, are in constant need of some kind of stimulation. Sometimes this manifests as physical hyperactivity. When the base levels of stimulation are restored, they calm down.
Another tortured analogy. People with ADHD are like cars that can't idle. They always have to find things to goose the accelerator to keep the engine running. Their engines are constantly revving and dying. Stimulants bring their idle back up to 500.
Normal people, however, take the same dose and their idle goes to 1000, and they eventually spaz out because they aren't meant to idle that high.
posted by gjc at 6:40 AM on October 21, 2010 [4 favorites]
Another tortured analogy. People with ADHD are like cars that can't idle. They always have to find things to goose the accelerator to keep the engine running. Their engines are constantly revving and dying. Stimulants bring their idle back up to 500.
Normal people, however, take the same dose and their idle goes to 1000, and they eventually spaz out because they aren't meant to idle that high.
posted by gjc at 6:40 AM on October 21, 2010 [4 favorites]
Empath, I have to strongly disagree with what you've said. My son takes Ritalin and does not react to it the way you suggest. I'm not saying every single person with ADHD reacts the same way to a medication, but it seems you are, and that's not helpful to the OP. Also, (and again, anecdotal) I accidentally took one of his Ritalin once and it totally messed with me. It did not help me focus. It made me feel jumped-up and scatter-brained and I talked about a miles a minute and could not get my thoughts focused. And then I crashed and slept for three hours. Just as people will react differently to medications for allergies, people will react differently to stimulants and other medications for ADHD. To suggest otherwise simplifies the process a great deal.
Finding the right medication for ADHD can be a huge pain, anastasiav. Then again, your friend's son might not even have ADHD. I think your friend ought to get him an appointment at a children's hospital, one that is equipped with a developmental disabilities clinic. She also ought to get a lawyer involved with the school. She is under absolutely no requirement to put her child on voluntary medications for ADHD and the school should know that.
posted by cooker girl at 6:44 AM on October 21, 2010 [2 favorites]
Finding the right medication for ADHD can be a huge pain, anastasiav. Then again, your friend's son might not even have ADHD. I think your friend ought to get him an appointment at a children's hospital, one that is equipped with a developmental disabilities clinic. She also ought to get a lawyer involved with the school. She is under absolutely no requirement to put her child on voluntary medications for ADHD and the school should know that.
posted by cooker girl at 6:44 AM on October 21, 2010 [2 favorites]
Hi, I've been diagnosed with ADHD and have been prescribed stimulants and I used them to add 2 points to my GPA when I was in college. I'm pretty sure I know how they effect me. It doesn't calm me down, it energizes me. But it at least lets me focus on one thing at a time. Being calm has nothing to do with it.
Talking about people's 'natural potential' is bullshit. My natural potential is just what I am when I wake up in the morning. If I'm taking ritalin, I'm exceeding my natural potential in the same way that any other person taking ritalin does.
This is a derail, though. She asks how it affects people. I answered the only way I know how, as someone who has ADHD who has taken it (and also, as someone who knows a lot of other people who take adderall who both have ADHD and don't have it). I have been unable to tell the difference from their behavior, personally. And everyone I know who has taken it describes it exactly the same way.
posted by empath at 6:48 AM on October 21, 2010
Talking about people's 'natural potential' is bullshit. My natural potential is just what I am when I wake up in the morning. If I'm taking ritalin, I'm exceeding my natural potential in the same way that any other person taking ritalin does.
This is a derail, though. She asks how it affects people. I answered the only way I know how, as someone who has ADHD who has taken it (and also, as someone who knows a lot of other people who take adderall who both have ADHD and don't have it). I have been unable to tell the difference from their behavior, personally. And everyone I know who has taken it describes it exactly the same way.
posted by empath at 6:48 AM on October 21, 2010
I think the use of the phrase "calm down" is what's causing the problem here. "Able to focus on and complete tasks" is a very different feeling for me than "calming down.". Other people may observe me quietly reading while on medication and describe me as "calmed down," but it's not the word I would use.
posted by TrialByMedia at 7:20 AM on October 21, 2010
posted by TrialByMedia at 7:20 AM on October 21, 2010
I forgot to add that if Kay doesn't want her son on medication, she isn't required to put him on medication, no matter what the school wants. They can suggest all they want to, but ultimately she's the parent and they can't force her to do anything.
Also, I have ADD and Adderall calms me down to the point where, if I take too much, I'll fall asleep wherever I sit down. Not everyone reacts this way.
posted by corey flood at 7:34 AM on October 21, 2010
Also, I have ADD and Adderall calms me down to the point where, if I take too much, I'll fall asleep wherever I sit down. Not everyone reacts this way.
posted by corey flood at 7:34 AM on October 21, 2010
The type of reaction they saw with the ADHD medication is pretty typical of what happens if you give an already energetic but not ADHD child ADHD medication. I try to explain ADHD medications' effects to parents as being like a strong espresso--some people would drink it and get wild and jittery, while others might drink it and be able to sit down and read a good book. If you try it and see more of the former than the latter, it's a very good sign that ADHD may not be the proper diagnosis. This is really a simplification (everyone has there own threshhold at which drinking coffee turns from "reading the morning MeFi" to "I can feel my teeth vibrating!"), but it's an okay basic indicator.
I'm not familiar with the Special Ed policies in your state, but your friend should probably request an IEP meeting with a formal letter to the school. Google around for a form letter, fill it in, and send it certified mail to the school; they typically have 10 business days from receipt of the letter to schedule a meeting. Try to get the behavioral therapist and any other people involved in for the meeting and state that the child has a diagnosis (leave at the disputed diagnosis part for now) and that you wish to have a full psychological and intellectual assessment done by a school psychologist; this is typically enough to force the issue. Regardless of what they say, request a copy of all notes from the meeting; if they do not attempt to meet your needs be prepared to get an educational advocate involved. The more that you show them that you're documenting all of the meetings and interactions you have with the school, the more lawsuit-adverse they'll become and they're much more likely to take your issues seriously.
posted by Benjy at 7:46 AM on October 21, 2010
I'm not familiar with the Special Ed policies in your state, but your friend should probably request an IEP meeting with a formal letter to the school. Google around for a form letter, fill it in, and send it certified mail to the school; they typically have 10 business days from receipt of the letter to schedule a meeting. Try to get the behavioral therapist and any other people involved in for the meeting and state that the child has a diagnosis (leave at the disputed diagnosis part for now) and that you wish to have a full psychological and intellectual assessment done by a school psychologist; this is typically enough to force the issue. Regardless of what they say, request a copy of all notes from the meeting; if they do not attempt to meet your needs be prepared to get an educational advocate involved. The more that you show them that you're documenting all of the meetings and interactions you have with the school, the more lawsuit-adverse they'll become and they're much more likely to take your issues seriously.
posted by Benjy at 7:46 AM on October 21, 2010
+ Can you point her to a study showing how kids who do NOT have ADHD react when given Ritalin/Adderall or similar? (She feels strongly that his reactions to the meds are a clue to the real issues, but the Ch.Psych's response is "some kids just can't tolerate the meds". She'd love to present him with some kind of formal study of the effect of ADHD meds on non ADHD kids, but we've dug through Google Scholar with little success.)
It took 6-9 months to get my son's medication dialed in. Once we did, it was a miracle. But yeah, that was a really trying time.
Then he would grow and we'd have to adjust dosages and whatever to find that sweet spot again.
If the child has ADHD, the drugs work. They are imprecise, though. Ritalin alone comes in several different forms with several different suspensions that have several different release rates in several different kids. Too much makes my son wacky. Too little makes him wacky. Just right, and you'd never know he has ADHD. We must have tried 20 different formulations of ritalin alone.
He takes Concerta, which has proven to work really well with his metabolism. The generics were too inconsistent and the other brands just didn't last that long. I was fortunate to have a good doctor who had some good intuition about my son and his treatment - and even at that, I was very,very frustrated at times. It took a lot of experimentation and observation to get to that point - but it made a world of difference to him.
In talking with other parents of ADHD kids, my experience isn't atypical. Very few got the right medication on the first few tries.
posted by Pogo_Fuzzybutt at 7:51 AM on October 21, 2010 [1 favorite]
It took 6-9 months to get my son's medication dialed in. Once we did, it was a miracle. But yeah, that was a really trying time.
Then he would grow and we'd have to adjust dosages and whatever to find that sweet spot again.
If the child has ADHD, the drugs work. They are imprecise, though. Ritalin alone comes in several different forms with several different suspensions that have several different release rates in several different kids. Too much makes my son wacky. Too little makes him wacky. Just right, and you'd never know he has ADHD. We must have tried 20 different formulations of ritalin alone.
He takes Concerta, which has proven to work really well with his metabolism. The generics were too inconsistent and the other brands just didn't last that long. I was fortunate to have a good doctor who had some good intuition about my son and his treatment - and even at that, I was very,very frustrated at times. It took a lot of experimentation and observation to get to that point - but it made a world of difference to him.
In talking with other parents of ADHD kids, my experience isn't atypical. Very few got the right medication on the first few tries.
posted by Pogo_Fuzzybutt at 7:51 AM on October 21, 2010 [1 favorite]
Lots of information about IEPs and reluctant schools at the Wrightslaw website.
www.wrightslaw.com
posted by southeastyetagain at 8:17 AM on October 21, 2010
www.wrightslaw.com
posted by southeastyetagain at 8:17 AM on October 21, 2010
As an adult somewhat recently diagnosed with ADHD, my very first drug was Ritalin SR and it worked/works well for me. Because I have to take it 3x/day, we tried me out on both Biphentin and Concerta to see if I could take a 1x/day pill instead - both turned me into a bad caricature of an ADHD person, and I think that if I had tried either of them (or both of them) before the Ritalin, I would have been really distressed. I know it sucks, but it's like anti-depressants (or any brain drug, it seems) - there's still a fair degree of uncertainty about exactly why many of these drugs "work", so there's a lot of trial-and-error involved in dosing.
posted by purlgurly at 8:32 AM on October 21, 2010
posted by purlgurly at 8:32 AM on October 21, 2010
The first time I took Adderall I fell asleep. If I'm tired, it makes me more alert, if I'm distractable, it makes me more focused. I've never tried to take more than my prescribed dosage because I'm a hypochondriac, but if I have too much caffeine or nicotine AND take my Adderall I'm completely spun.
Medication, especially in kids, takes a lot of fine tuning. Please don't give up. Adderall has changed my life. I wish I could have taken it while I was in school.
posted by elsietheeel at 8:40 AM on October 21, 2010
Medication, especially in kids, takes a lot of fine tuning. Please don't give up. Adderall has changed my life. I wish I could have taken it while I was in school.
posted by elsietheeel at 8:40 AM on October 21, 2010
His adverse response to the medication isn't anything more than simply being a response, it doesn't say anything about whether they and them are right, or what might actually be wrong. In this instance it's exceedingly problematic to use a reaction to a substance as conclusive proof that its not Y but something else entirely. When it comes to psychiatric illnesses and, medication it's a lot like a game of whack the mole to find the one that works.
More than anything this sounds more like the school et al are being sticks in the mud. I don't think using a study or two to try and disprove ADHD is going to be helpful. I have no clue how to go about it, but think she needs to find a way to apply pressure outside the system that's ignoring her which will make them sit up and, take notice. An independent second opinion and/or an advocate or, lawyer perhaps?
but it seems you are, and that's not helpful to the OP.
Well not really. Drugs have side effects and, even people with ADHD might respond to them in a way that non-ADHD people would. I have ADHD I don't respond to Ritalin that way, but that doesn't mean someone else with ADHD might.
posted by squeak at 8:47 AM on October 21, 2010 [1 favorite]
More than anything this sounds more like the school et al are being sticks in the mud. I don't think using a study or two to try and disprove ADHD is going to be helpful. I have no clue how to go about it, but think she needs to find a way to apply pressure outside the system that's ignoring her which will make them sit up and, take notice. An independent second opinion and/or an advocate or, lawyer perhaps?
but it seems you are, and that's not helpful to the OP.
Well not really. Drugs have side effects and, even people with ADHD might respond to them in a way that non-ADHD people would. I have ADHD I don't respond to Ritalin that way, but that doesn't mean someone else with ADHD might.
posted by squeak at 8:47 AM on October 21, 2010 [1 favorite]
I really, really wish I'd gotten a lawyer or some other professional advocacy for my son during his school years. Everything took forever, and he ended up getting a terrible education, and feeling terrible about himself. The Portland, Maine school department was wretched to deal with.
Coffee is a reasonable substitute for Ritalin, for mild ADHD.
They have a farm. I'd look into chemicals used on the farm. Many chemicals, even natural or organic ones, have neurological effects. They may already have considered this, but I'd look again.
posted by theora55 at 9:12 AM on October 21, 2010 [1 favorite]
Coffee is a reasonable substitute for Ritalin, for mild ADHD.
They have a farm. I'd look into chemicals used on the farm. Many chemicals, even natural or organic ones, have neurological effects. They may already have considered this, but I'd look again.
posted by theora55 at 9:12 AM on October 21, 2010 [1 favorite]
That was our impression as well. After all, these are drugs that lots of people take illegally specifically for the "sharper" or "euphoric" feeling. He wasn't on a high dose at any time - they started his Ritalin at one 5 mg dose and brought him up to 10 before they ended the trial, so we're not talking huge/overdoses here. As I said above, Kay feels very strongly that his reaction to both these meds is a clue, but the Ch.Psych sort of pooh-pooh's her. Any help you can provide would be terrific.
She quit far too soon, IMO. Most doctors like to start at the bottom and work thier way up so as to find the minimum effective dose. My son in 3rd grade was on 40-50 mgs IIRC - but he was pretty tall and skinny for his age with a high metabolism. I suspect a more typical kid would be in the 25-30 mg range, give or take.
Once you get close to the correct dosage, it takes a week or two to sort out issues with sleep and other outside stressors. And then it takes some time to figure out if the suspension is working well - giving a nice even dose all day. Then the medication will have to be adjusted as the child grows and matures.
It's not a place you go to and stay. It's a process you have to continuously revisit.
The meds do not work right unless the dosage is correct. Experimentation is the only way to find the correct dosage. I know every parent frets, and it can be harrowing. But really, of the things that might harm a kid, this isn't it - and the quality of life improvement is immense. It's a risk well worth taking, IMO.
posted by Pogo_Fuzzybutt at 9:28 AM on October 21, 2010
She quit far too soon, IMO. Most doctors like to start at the bottom and work thier way up so as to find the minimum effective dose. My son in 3rd grade was on 40-50 mgs IIRC - but he was pretty tall and skinny for his age with a high metabolism. I suspect a more typical kid would be in the 25-30 mg range, give or take.
Once you get close to the correct dosage, it takes a week or two to sort out issues with sleep and other outside stressors. And then it takes some time to figure out if the suspension is working well - giving a nice even dose all day. Then the medication will have to be adjusted as the child grows and matures.
It's not a place you go to and stay. It's a process you have to continuously revisit.
The meds do not work right unless the dosage is correct. Experimentation is the only way to find the correct dosage. I know every parent frets, and it can be harrowing. But really, of the things that might harm a kid, this isn't it - and the quality of life improvement is immense. It's a risk well worth taking, IMO.
posted by Pogo_Fuzzybutt at 9:28 AM on October 21, 2010
empath is mostly correct, even if the way he is phrasing it is guaranteed to rile people up. Giving amphetamines to almost anyone will have pretty much the same effects... it's just that the dosages will be different. Low doses will make almost anyone more able to focus, more able to complete tasks, and so on. It's just that people with what we call ADHD are less able to do those things than typical people, so the theory is that it is bringing them up to what most people can already do. In my experience this is only true for some of the people prescribed it; a lot of people are clearly taking more than that amount and are riding a bit of a speed bump for an hour or two.
But that and most of the discussion above is basically irrelevant to the actual question.
OP: Some people have indeed given you the correct answer but I'll reiterate it for emphasis. The boys negative reaction to adderall and ritalin does not provide good evidence as to whether or not he has ADD, ADHD, or whatever. I understand this isn't the answer you're wanting to hear but it's the case. Please don't reject it because your friend wants the opposite to be true.
Note that it obviously provides no evidence that he does have ADHD. I have no idea if he does or not. I'm just saying that having a bad reaction to Adderall does not indicate that he doesn't, if you see what I mean.
posted by Justinian at 9:41 AM on October 21, 2010
But that and most of the discussion above is basically irrelevant to the actual question.
OP: Some people have indeed given you the correct answer but I'll reiterate it for emphasis. The boys negative reaction to adderall and ritalin does not provide good evidence as to whether or not he has ADD, ADHD, or whatever. I understand this isn't the answer you're wanting to hear but it's the case. Please don't reject it because your friend wants the opposite to be true.
Note that it obviously provides no evidence that he does have ADHD. I have no idea if he does or not. I'm just saying that having a bad reaction to Adderall does not indicate that he doesn't, if you see what I mean.
posted by Justinian at 9:41 AM on October 21, 2010
Nthing everyone who said the side effects of the medication are just that - side effects - and do not indicate one way or the other whether the kid has ADHD. I do not have ADHD but take Ritalin daily for narcolepsy. It's a stimulant that keeps me awake. I have no other side effects, despite not having ADD or ADHD. Everyone reacts differently to different drugs, whether or not they have the underlying condition that the drugs normally treat.
posted by thejanna at 6:11 AM on October 22, 2010
posted by thejanna at 6:11 AM on October 22, 2010
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