I need help to decide what to do next with my 10 year old son. He's the sweetest most charming kid you've ever met, but he has language processing and attention issues (
more inside), and I feel like we're at a pivotal point. But I don't know what the next step should be or even what my options are.
Prepare for incoming brain dump. I'm not sure how better to express my concerns and my picture of the situation; your patience in reading this is appreciated immensely and I'm grateful for any feedback.
My son is 10 years old and in the fourth grade at a public school in a suburb of the DFW area in Texas. His mother and I (he and his older sister spend a week with me then a week with her and so on) are generally pleased with the school, and he's been lucky in his life to have teachers and specialists that work with and accommodate his special needs, but I feel like he's slipping further and further behind despite the fact that he seems to be "getting it" now more than ever before.
I must say, I've felt some of that for a long time. "Second grade... that's a lot tougher than first, I hope he can keep up!" ... but he's always passed (with grades generally in the B-C range). At the same time, though, he's had lots of accommodation; and it's hard for me to tell how much that affects any assessment of how much he's really
learning. Also, my concern is not just with how much he has learned in terms of facts but in terms of reading/study skills - tonight we've been working on one of the first reports he's ever written, and without me nearly writing it for him (attempting to involve him at every. painful. step.), he wouldn't have a chance. There's going to be far, far more of this sort of work in the coming years, and I can't imagine him succeeding at it with his current capability.
Some background: my son was delayed in starting to speak and in fine motor skills from early on. He received services from an early age in Texas' Early Childhood Intervention program and started school at 4 in the Preschool Programs for Children with Disabilities program. He's been variously described as exhibiting sensory integration disorder, issues with language integration/processing and fine motor skills, speech delays, ADHD, maybe others. These terms seem to me to come and go depending on who's working with him; this is an item in particular that I'd like some advice on: what should his pediatrician be doing to help diagnose and treat him? I don't feel like she's as pro-active as I might like, though I don't really know what my expectations should be, either. Obviously just slapping a descriptive label on his issues doesn't do anything by itself to help the problem, but I also have never really had a sense of knowing exactly what's wrong
. Maybe there's not a name for it.
About three years ago, we'd tried a couple of medicines including Focalin. It seemed to provide a modicum of help, but also came with side-effects, including near-constant picking at his fingers, etc. He also was a bit of a zombie on it sometimes. The benefit wasn't sufficient to continue with it.
Then, in early 2010, I took him back to his pediatrician and pushed for some suggestion. She referred us to a therapist at a well-respected program at a nearby university. I only ever spoke with this therapist on the phone, but after I faxed her his school assessments and she heard my description of him, her opinion was that his core problem is with taking in, processing, and understanding language which is greatly exacerbated by attention problems. Her recommendation was to give him a medication for his attention problems, hoping that would help him in his acquisition of language skills. After consulting with his pediatrician, I started him on Strattera at 18 mg daily.
The difference has been dramatic. Both his mother and I noticed significant change in his play patterns - now he actually occasionally sits and plays with one thing for several minutes at a time. Other side effects have all been positive, too: he had near-daily toilet accidents before; almost immediately after starting Strattera, those dropped to essentially zero. At the first ARD (meeting with his school teachers and therapists) after we started the medicine, everyone in the room commented on what improvement they'd seen. We've really seen no negative side-effects, either: even his mood is better.
So this is one of my biggest questions: I believe the most common dosage for a child in his age/weight range is 25mg, with some going up to 40. If we've seen such success with 18mg, should we try 25? And if we try 25 and find further improvement, how do we know if we should try even higher?
Another of the foremost questions I struggle with: is 4th grade the right place for him? My intuitive sense is that he'd be better off right now in 3rd, and, honestly, I think he'd take in even more if he were in 2nd right now.
Of course, that comes with its own difficulties of "fitting in". (On the plus side, he's an early August birthday so he's one of the youngest in his class; he's also fairly small for his age.) Also, I don't know what my options are with the school system and with the fact that we're about a quarter of the way into the school year. Obviously I need to talk to them, but I wanted to get some advice first. In meetings with his teachers, I've occasionally floated the idea that it seems like he might be better off in a lower grade and I don't seem to get any buy-in at all. Not that there's a negative reaction, but it just doesn't seem to be something they're interested in exploring; I, regretfully, have never pushed the issue in the least, being as unsure as I am of whether that's the right course. And I suppose they have incentives to keep promoting kids and not holding them back? So how much resistance will I meet if I wanted to move him to a lower grade? Might such a move affect his eligibility for services? Is such a move even done
in the midst of a school year? I don't expect it would affect him socially in a bad way: in fact I'd expect he'd end up making a lot of friends that are closer to "his level". He's certainly not the type to angst on his own over being moved back, but of course he might if his peers made him feel that way. And of course it might cause problems later on down the road (when he is
at a stage where he'd be concerned by such things) if his age difference was noticeable and remarked upon.
For a while now I've kept a file of notes on issues or differences contra other kids that I notice with my son. I'm going to paste it below; I know this is even more brain-dumpy than the rest of my post and it doesn't even really have a specific question behind it - this is just a call for comment and advice, but I don't know a better way to paint a picture of him. Also, I don't mean to imply that I consider all these items as being problems or even necessarily non-normative, but my intent is just to describe these aspects of him and to give a sense of what's "different" about him from his peers.
- His only understanding of humor is slapstick. Not that most 10 year old boys are appreciating Nabokov, but wordplay and abstract concepts essentially never make him laugh. He doesn't "get" jokes in general. Not that he doesn't do a good job of laughing along (un-self-consciously, I might add).
- He exhibits little capability for abstract thought - one example: several times over the last few years I've shown him the image here; every time, his answer is "in the box". Each time I've attempted to explain why she would look in the basket. He acts like he understands, but I've never really felt like he's "gotten" it.
- Attention problems - even with the improvement from his medication, he has a lot of trouble staying on task and isn't self-directed at all. It's rare that he can be given even a small handful of problems and work through them one-by-one without being kept on track by reminders of what he needs to be doing. Occasionally he'll get into a repetitive task (answering multiplication problems by looking answers up on a chart, for example) and have some success alone, but I've never seen him do a few of one type of problem and then go right into a set of problems of a different type.
- He can be clingy and have issues with personal space. He's famous among his cousins for getting up-close and touchy in a way they don't like. He's very sweet and loves to hug, but sometimes it can be too much.
- Problems playing games with other kids - when it's his turn to be "it", he'll just quit. Despite this, he is popular. Neighborhood kids come here and play more often than at nearly any other neighborhood house.
- He seems to prefer younger children as playmates. His best friend is six years old. (But he spends lots of time with kids his age too.) He loves playing with little girls... I think perhaps because they're not intimidating. This isn't to say that he doesn't like to play rough and tumble: he certainly does. I don't feel like, though, that he generally plays "too rough"... he doesn't take particularly out-of-line risks or hurt his friends during play more often than would be expected from little boys.
- He can be "babyish" for lack of a better word at times. Also, lethargic and very resistant to trying new things. This has been helped some by his medication, though not radically.
- He has a strong "acting" ability - sometimes the border between make-believe and real life isn't particularly clear, I think.
- He continues to have trouble with coordination and fine motor skills. Catching a ball is difficult, though not impossible. His handwriting is poor. He has no trouble, though, with wrestling, climbing trees, etc.
- Perhaps related to the above: he sits far more often than his peers with his legs splayed (in a "M").
- Scrapes and injuries provoke a far greater reaction than one would expect from most kids. He can be feeling fine and become aware of a scratch on his arm from earlier in the day and start to whimper. A bonk on the head is a traumatic injury until his attention can be redirected to something else: a little tickle can make him laugh and forget about the thing that you thought he seemed like he was going to die from 5 seconds earlier. In general, the best way I can say it is that his experience of the world seems far more intense than most people's.
- He continues to have trouble with "ask" vs. "tell". He sometimes mixes up "looks like" and "sounds like". The distinction between lunch and dinner is vague for him. Distinguishing between how/why/when/etc can be quite problematic. At least the latter issue seems in my mind to be related to his issues with abstract concepts: he seems to have trouble with anything he can't see. At 10, most of his peers have some understanding of roughly how long an inch is versus a mile. He doesn't. He also doesn't have any concept of what time it is, what it means when he's told it's 6:30, or how long five minutes is versus an hour. "Next month" has essentially no more meaning to him than "next year". He gets that it's Saturday today and that he won't have school tomorrow since it'll be Sunday, but even on that he'll ask hesitantly to make sure he's got it (and often will be wrong).
- Likewise, he has trouble with ontological hierarchies. The fact that a jet is also a plane seems to be a really difficult thing for him. The fact that we're in Texas which is part of the USA which is a part of North America - I don't get a sense that any of that is in any way meaningful to him.
- He mixes up "d" and "b" very often. He reads only the first few characters of a word and jumps to a conclusion of what it is. Likewise, he very often leaves off the endings of words in his reading.
- He really doesn't like to write - it almost seems "painful" sometimes.
- He carries one or more toys with him much of the time, often to his detriment - things can be frustratingly difficult for him because he's trying to do them with an action figure in his hand that he never thinks to put down.
- He really likes to wear costumes. He lives much of his life in a cape and has since he was tiny. I don't get a feeling that he's trying to cover up or hide from the world: he's not bashful or shy. In fact, he strikes up conversations with people in "inappropriate" ways - it's not problematic, I don't mean, but the fact that in our society we don't generally talk to the guy behind us in line or show him our superhero toys we have in our hand isn't something he "gets".
Anything I can do to help this precious boy live the most enjoyable life possible, I'd love to know, so any feedback is very much appreciated. Thank you.