"I want to do my schoolwork, mom. Oooh, look at the kitty!"
March 18, 2013 1:17 PM   Subscribe

My gifted daughter is displaying all the classic signs of ADD/ADHD. She is does not have an IEP, but does have an incredibly supportive teacher/principal who want to help, but don't know how. What should I be asking them to do? What can I do at home to support her? (And if you have ADD/ADHD, did anything help you as a kid?)

I know there have been several AskMes on this topic, but the problem is slightly different: I don't have to fight uphill against a callous school system, given that she is attending private, not public school. The private school is really great - she has a fourth grade class with only 16 other kids, and her teacher and the principal are both very involved in figuring out what's going on with the kids and helping them. But they - and I - don't know what they should be doing. The teacher hasn't been going out of her way to figure it out, because she figures Child will do fine anyway (due to the giftedness) but I know all too well where that path leads.

She has never been tested for ADD/ADHD, and thus does not have an IEP - but I have some form of it and recognize all the signs of my own childhood. She is very inattentive, doesn't like doing things if she can't do it well right away, and has impulse control issues. I haven't gotten her tested for it primarily because I'm concerned about the effects of stimulants on children. (But if you know better, feel free to cite!)

I developed some minor self-coping skills, but none of them seem to be useful for her. Any idea what to do - and how her teacher can help her learn discipline given her special situation? And is there such a thing as a "professional friend-interaction teacher" or anything like that?

Money is not an issue, unless your suggestion is to buy her an elephant or something extreme like that. We do have fairly good healthcare, etc and can afford a good professional.
posted by corb to Human Relations (34 answers total) 8 users marked this as a favorite
IANAD, but what is your resistance to having your child diagnosed so that she can get an IEP?
posted by roomthreeseventeen at 1:21 PM on March 18, 2013 [2 favorites]

My son was diagnosed in 3rd grade, but I fought it for a year. Not a wise move. I took him to a neurologist, he got the diagnosis, a bunch of helpful and not so helpful books, and an Rx. I didn't love the idea of medication, but it made a huge difference in his attention span and his ability to complete his work, which meant he was no longer feeling like a doofus and I was no longer on his case. I'm medicated myself. My son, my daughter and I all went through a clinical study at UCLA's genetics program, and I'm glad we did. You may not opt for medication, but ADD/ADHD is brain chemistry and while coping skills are immensely valuable, you can't train it away.
posted by Ideefixe at 1:23 PM on March 18, 2013 [4 favorites]

Even if your daughter is diagnosed with ADD/ADHD, you do NOT automatically have to start her on medication. But, I think a specific diagnosis would help with knowing exactly what the problem is. Also, a good psychologist can likely help provide resources for coping skills, suggestions for the teacher, etc. Maybe call some offices/ask friends for recommendations for people who do not jump to medication immediately.
posted by rainbowbrite at 1:27 PM on March 18, 2013 [2 favorites]

Get the diagnosis first. Then get the IEP. The IEP will have specific things that will assist your daughter, ability to write on the test, more time to take the test, etc. A diagnosis won't always lead to medication, but it will help identify what's going on and some strategies to deal with it (and medication is a GODSEND if it's needed.)

One thing that really helps the ADD/ADHD kid is dissipating all of that kinetic energy, so get your daughter moving. Games at recess, breaks during homework time where you go outdoors and run around, Tag, is great for this. One on one in the driveway, a game of HORSE (put the hoop over the garage.)

Be open-minded.
posted by Ruthless Bunny at 1:28 PM on March 18, 2013 [2 favorites]

And is there such a thing as a "professional friend-interaction teacher" or anything like that?

Yes, behavioral therapists can work with your daughter on social skills and social interactions. You can also check out the book "It's So Much Work to Be Your Friend" which is about social relationships for children with learning differences. There are many universities and educational therapy practices that provide social skills groups for children with learning differences as well.

An evaluation by a qualified educational psychologist or a school psychologist is a very good place to start.
posted by Snarl Furillo at 1:29 PM on March 18, 2013

ADD/ADHD doesn't always result in an IEP, often the accommodations are facilitated through a 504 plan. Although I believe meds are often overused, there ARE times when they can be pretty helpful.

I would encourage you to get a formal diagnosis to determine that you're correct in your assumptions, work with a physician to determine if meds might be helpful, and at least have a conversation with an advocate.

It's great that your child is in a supportive private school, but when services start to cost the school money, the support fades quickly.
posted by HuronBob at 1:29 PM on March 18, 2013 [1 favorite]

Yes, definitely get the diagnosis and proceed from there. And don't discount meds; they turned my mostly F son into a straight A student (seriously).

But two things: first, as parents it's all too easy to transfer our own experiences on to our kids. I see it all the time in parent meetings when they say that science or whatever was always hard for them and that's why their kid is doing poorly. Except their kid is doing poorly because they're always napping or talking to their friends and not taking notes. So make sure you're not doing the apple/tree thing with your kid.

Also, bear in mind that private schools do not have to accept kids who are on IEPs, so if you have any inkling that your current school will not give your kid the accommodations they need, be prepared that you may be looking at a new school.
posted by kinetic at 1:36 PM on March 18, 2013 [1 favorite]

My son has been diagnosed with ADD combined, the school is fully aware of it and working with him and with us to help him succeed in school, and because the efforts across the board are generally paying off, it hasn't had to reach the IEP step. Having the diagnosis, and passing this knowledge to the teaching and support staff, has paid significant dividends in figuring out solutions that do genuine good (and in getting the school to understand that these are struggles he's having, rather than the willfully bad behavior they were previously treating it as.) YMMV of course.
posted by davejay at 1:37 PM on March 18, 2013

I wasn't diagnosed until I was in my mid-30s, but your daughter sounds like me. What I think would have helped me:

-- my parents getting on my back about homework and papers, and laying down rules as to when and how to do them.

-- the same about practice on musical instruments.

-- getting me into some sort of team sport early on, where I could learn to deal with others and get a lot of physical exercise. The team bit is essential: I took dance classes for 2 years, and cheerleading for a few weeks, but those didn't involve me having to work with others, and my parents kept forgetting to take me to class anyway (er, we suspect that Mom is ADHD as well!).

-- teaching me study skills early on. I'm in my 40s and still don't know how to study, and lack the ability to apply myself, no matter what the subject is. I skated through school, up to & including 2 graduate degrees (one is in library science, which is not the most demanding of disciplines and relies on writing and researching more than tests), because I have a fairly quick mind at making connections, and I can pick up enough from classes to get by. But ask me to do math problems, or study a language, and I fail utterly and completely because I have no idea how to make myself sit down and do it, no idea what to do if I do manage to sit down for longer than ten minutes, and no ability to work a problem over and over until I get it right, or to do anything other than read a paragraph over and over and hope something sticks.

(Also, it may be too early for her right now, but Mom didn't tell me her coping mechanism for studying for tests until my very last semester of my first time through grad school, which annoys me because I could have used it from highschool onward: she typed all her class notes. I did that for my study guide in the final class I took there, and wow...I aced the test with very little effort. So I recommend seeing if that works!)
posted by telophase at 1:37 PM on March 18, 2013 [5 favorites]

postscript: he's doing so well in and out of school now, without meds, that his sister is now really jealous that he's getting so many accolades.
posted by davejay at 1:38 PM on March 18, 2013

There is a term for your daughter (and my son, who is 6). "Twice Exceptional" Also, if you google around a bit, you'll find lots of articles on the intersection between the two things.

The evaluation services my son got through public school are as follows:
- Evaluation by a pediatric psychologist.
- Evaluation by a pediatric occupational therapist (to help develop strategies to channel excess energy)
- Evaluation by a pediatric physical therapist
- Evaluation by the school social worker (seperate from the psychologist).
- (We also had an evaluation by a speech langauge pathologist, but you probably won't need that.)

There is a standard test (WISC-IV) that serves as a starting point for an evaluation by a psychologist. There were other evaluations as well (checklists to be filled out by us (his parents), his teacher, and the psychologist).

All this got us a "functional" diagnosis. To get a "medical" diagnsis, we'll probably have to submit all our documentation to a pediatric neurologist or other MD. But the functional diagnosis was sufficiant to trigger the IEP process.

To date, zero people have suggested medication for my son, despite him being extremely disruptive in the classroom and in general a bundle of issues. He gets OT once a week and also works with a special education specialist (ABA certified) to create accomodations in the classroom (a visual schedule, motor breaks, a special seat he uses at circle to help him keep his body in his own space). ADHD management is much, much more than just medication. Changes in diet (particularly the elimination of certain dyes, including Yellow 5 - there are non-woo studies that show a link) have helped a great deal.

So, to sum up, you'll need, at a minimum, an evaluation by a pediatric psychologist, preferably one that specializes in ADHD. An evaluation by an occupational therapist will also be very helpful. Since your child is in private school, I'd recommend you try calling around to some of your local public schools and seeing if there is a private psychologist that they recommend.

is there such a thing as a "professional friend-interaction teacher" or anything like that?

This is actually why the social worker is involved in my son's IEP. There is also a curriculum called Social Thinking that was developed for kids on the spectrum but is also very helpful for kids with ADHD and other diagnosis where they are having friend-based issues.

Feel free to MeMail me if you want more details about the process.
posted by anastasiav at 1:39 PM on March 18, 2013

I've been diagnosed later in life, and consequently keep reading academic articles on the issues. Something I learned yesterday (I forgot the things before that), was the people with ADHD will sometimes have reduced symptoms if they experience foreign environments (so doing her homework in different places might be helpful, the library one week, a coffee shop the next), and increased attention from adults (if you are there with you, not answering, but being interested). Increased symptoms can occur from noisy classrooms (distracts without providing the stimulus of interest).
posted by b33j at 1:41 PM on March 18, 2013 [1 favorite]

but what is your resistance to having your child diagnosed so that she can get an IEP

For clarification: It is my understanding (and please correct me if I'm wrong) that IEPs are things you must disclose or that get automatically passed on when looking into schools. We initially had a really hard time in public school, and the difference between it and private school is like night and day. I'd like to keep her in private schools, and I'm concerned that an IEP might lower her chances of admission in future.
posted by corb at 1:54 PM on March 18, 2013

I can't remember where, but I once heard a story on the radio about physical activity--especially physical activity that involves a lot of focused, coordinated movements like gymnastics or martial arts--being very helpful for children with ADHD. I was in gymnastics as a child and the year I quit coincides directly with the year I started losing focus and performing poorly in school. I still go to open gym at gymnastic centers sometimes it has the most incredible effect on me. I'm suddenly snapped into a zone where I'm completely in the moment and feeling the rush of physical exertion.
posted by hannahelastic at 2:03 PM on March 18, 2013 [2 favorites]

Chiming in to agree that a diagnosis doesn't necessarily mean meds. Also, meds doesn't mean "meds forever".

Having a routine will do wonders. For other aspects of your lives besides just homework. Examples: homework gets done right away. She may want you to sit with her for company--often there's an element of performance in completing tasks. Make a bedtime routine of checking the calendar for tasks the next day, lay clothes out to wear, put tomorrow's stuff/book bag at a "landing station" ready for tomorrow so nothings forgotten. It doesn't all have to be routine, but getting routines done first gives you time to play, read for fun, etc. five minutes picking up your room, each day, means it never gets overwhelmingly messy. But it helps if you follow your routines too! It's not punishment or even ADHD -- these are life skills for everybody, but will work to her advantage.
posted by vitabellosi at 2:07 PM on March 18, 2013

The teacher hasn't been going out of her way to figure it out, because she figures Child will do fine anyway (due to the giftedness) but I know all too well where that path leads.

Can I point out this isn't the school being 'really great'? This is them dropping the ball.
posted by hoyland at 2:29 PM on March 18, 2013 [2 favorites]

I haven't gotten her tested for it primarily because I'm concerned about the effects of stimulants on children.

This is like saying "I haven't gotten that suspicious mole on my back looked at primarily because I'm concerned about the effects of chemotherapy."

Asking a doctor for help finding a diagnosis using medically indicated evaluation and testing just means getting a sense of what's happening in your child's body and mind. It doesn't obligate you to any particular course of treatment or way of dealing with the diagnosis. You could find out that your kid is just a little flighty. You could get a diagnosis of something, serious or not, that has nothing to do with ADHD. You could get an ADHD diagnosis and then choose to pursue non-drug treatments. You could get an ADHD diagnosis and choose to try non-stimulant drugs. You can disclose the diagnosis to the school to try to get an IEP for your child, or you can choose not to do so and deal with the issue privately, outside of school.

A diagnosis is just information--information that you as her parent get to decide what to do with. Right now, you have no information other than the fact that your child is having a hard time. Please seek help from medical professionals who can help you figure out what's causing that, and then work with them to determine what to do next. Don't let your (possibly unfounded) fears about one specific outcome prevent you from seeking the information you can use to figure out how to help your kid.
posted by decathecting at 2:34 PM on March 18, 2013 [4 favorites]

I'd like to keep her in private schools, and I'm concerned that an IEP might lower her chances of admission in future.

It most certainly can keep her from being accepted into a private school. Not fair but it happens.
posted by kinetic at 2:48 PM on March 18, 2013

I'd like to keep her in private schools, and I'm concerned that an IEP might lower her chances of admission in future.

Let me chime in on this as well. If the private schools you are considering would not want her because she needs additional services, is that really where you want her to go?

The advantage of an IEP, of course, is that, under the law, the school needs to provide the necessary services, and it gives you the leverage to demand that they do so.
posted by HuronBob at 2:58 PM on March 18, 2013 [1 favorite]

I think it depends on where you are. My kids were in private schools in the LA area, and no one ever blinked twice at the ADD. I think my daughter wrote her admissions essay for her high school about it.
posted by Ideefixe at 3:01 PM on March 18, 2013

An awful lot of bright kids are easily distractable due to boredom. Think how raptly you would pay attention if you were in kindergarten or second grade and expected to hang on every word the teacher said even though you are bored to tears and learning nothing new. Some kids improve dramatically just by getting them adequate intellectual challenge. Even if she is ADHD, boredom can be compounding the problem.
posted by Michele in California at 4:00 PM on March 18, 2013

If you don't think she needs specialized instruction and alternate assessment standards and think reasonable accommodations would meet her needs, ask about doing a 504 Plan instead of an IEP.
posted by Dr. Zira at 4:16 PM on March 18, 2013 [1 favorite]

What helped me was stimulant medication. It's the standard treatment for ADHD. Makes it like I don't even have it. I am known at work for being highly organized and detail-oriented. I'm not sure what your concerns are about stimulant medication, which, depending on the specific medication, has been in use for many years and has been studied for quite a long time in children. There are risks to it as well as side-effects, just like with any medication, but there are also notable and provable benefits.

Perhaps you could tell us some specific concerns you have?

She doesn't necessarily need an IEP, but she does need evaluation by a professional, who can also answer your questions about accommodations. You can then decide about stimulant medication with the advice and understanding that a professional can bring to the situation. Going to a professional won't require that she have an IEP and take meds.

I firmly believe that letting a child have untreated and unacknowledged ADHD is really bad for their self-esteem, their feelings towards school, and their development of healthy social relationships with their teachers and peers.
posted by the young rope-rider at 4:30 PM on March 18, 2013 [1 favorite]

Also, consider that private school admissions often require recommendations or forms to be filled out by prior teachers, guidance counselors, and/or principals. If those have "bright but doesn't pay attention" or "interrupts frequently" or "social skills below grade level" then that will be a problem for her admissions as well.
posted by the young rope-rider at 4:33 PM on March 18, 2013

I agree with the diagnosis first. Be aware of other things too - some kids exhibit signs of ADHD from artificial coloring. This runs like wildfire in my wife's family and eliminating Red 40, Yellow 5, and the Blues from her diet might make a strong difference. Data point: my niece at age 7 announced that when she ate a piece of candy (with red) that it made her feel like she couldn't control her body.

Also, some of the things you describe also sound like the category of Strong Willed Child. This has been an eye opener with my son who falls into the category of "if it's easy, it's contemptible but if it's challenging, it's not worth the effort if I can't succeed right away" especially when he doesn't buy into the task. For example, he was being asked to skate backwards in drills in hockey and he declared that it was impossible and cheated as much as he could. In talking with him, I mentioned that pro hockey players skate backwards almost half the game. He didn't believe me. We took him to a game and pointed out players coming back on defense, skating backwards like rockets. Sure enough, his next game he was skating backwards with intent.

I strongly recommend "You Can't Make Me (But I can Be Persuaded)" At least look over the checklist of traits and see if there's a match.
posted by plinth at 4:37 PM on March 18, 2013

Perhaps you could tell us some specific concerns you have?

Sure! Most of them are around the fact that she's a kid - I actually /do/ think stimulant medication for adults isn't a bad idea, but I'm concerned that some things that adults can control might be dangerous for kids.

Concerns are:
1) stimulants will affect normal growth, possibly by affecting appetite, etc.
2) Stimulants tend to increase anger, and she already has a bit of a temper. (Nothing crazy, but enough that I'm concerned about increasing it.)
3) Stimulants will increase hormonal action - oversexed pre-teen is also scary.
4) If I or the doctor is wrong, stimulants will really mess her up in longterm ways.
5) Doctor will be beholden to Big Pharma, and will overprescribe with my having no way to judge.
posted by corb at 4:40 PM on March 18, 2013

As a sufferer myself, a parent and the husband of an educator, my greatest frustration has been that ADHD is often treated, by everyone except very specialized pros, as a behavioral problem.

Eventually the reality of the condition and the perception that it's a correctable behavior are going to butt heads and by then it's too late and the kid is always the one left feeling damaged and holding the bag.

Investigate, learn, plan and implement right now. See a psychologist and neurologist. Get the testing done. When you have full understanding, then think about a 504 plan or an IEP.

FWIW, my parents tried really hard to take care of me. They took me to specialists and tried to get me set up. But back then, as is now, ADD was still seen as a behavioral issue in the classroom. The situation eventually became a cycle of increasingly "bad" behavior, shame, guilt and punitive measures that resulted in my just plain hating education and schools.

We can do much better than that these days. Don't worry about IEP stigma either...let her increased performance speak for itself. Don't leave any stone unturned.

Best of luck and I hope this helps!
posted by snsranch at 4:46 PM on March 18, 2013

My kids are of normal height and weight and have been taking stimulant meds for years. My son is in business school in Hungary and plays semi-pro rugby. Eating is not an issue.
The anger issue usually happens when the meds start to wear off and the kid needs a snack, pronto.
My MD hasn't increased my daughter's dosage since 6th grade and she graduates from undergrad this spring. I'm more in the clutches of Big Pharms due to my thryoid meds. I can't really fathom our neurologist trying to sell a higher dose--what's the payoff for him?

stimulant meds and hormones? is there actual data about this? I'd be more worried about alcohol.
posted by Ideefixe at 6:24 PM on March 18, 2013

You don't have to fill prescriptions and there are lots of doctors in the world. If you decide not to medicate - I decided against it myself when my 9 year old was diagnosed with ADD; 12 years later I think that was a mistake; however, we all survived - big pharma is not going to show up with guns and make you dose your kid. However, you can't start exploring all the other possible options without a clear diagnosis. I can't emphasize this enough. Without a diagnosis, you have no idea whether your kid actually has ADD or food allergies or learning disabilities or is completely neurotypical and having an off year. You need to get your child tested. It cannot possibly hurt and it may help a tremendous amount.

For the diagnosis, you're going to need an appointment with a child psychiatrist and you can get that from your pediatrician. Call the pediatrician, say you're concerned about your child's behavior & etc and you'd like to have testing done, who would they recommend? Or, you might want to start with an appointment with her pediatrician to rule out purely physical stuff, like any brain issues or glandular stuff or, I don't know, the aforementioned food allergies. Anyway, once that kind of thing is ruled out, then the doctor's office will help you make the appointment with the psychologist / psychiatrist - and you will probably start, actually, with a psychologist and eventually maybe see a psychiatrist - for you. Then the tests will take a couple of visits, probably and remember they are not going to be just testing her for ADD.

They'll test her for a whole variety of stuff - you will learn all kinds of new stuff about your kid in the process, which is actually pretty cool. For example, my son's visual perception disorder means that he cannot copy simple drawings down accurately - they come out sort of upside down and inside out. I would never have known this without the tests. And there really doesn't need to be stigma or any freak out or anything much attached to this if you go at it from that perspective, like, "Hey! Let's do this cool thing with these cool doctors and learn more about how people's brains work!"

Once you get the diagnosis, then there is plenty of time to discuss various treatment options. Treatment can be all kinds of stuff from occupational therapy to play therapy to regular old psycho therapy and medication is really just one part of it - and you can say no to any and all of it. If you do all of this without the school's involvement, too, then you can choose whether to go for an IEP or whether just to keep it a bit on the down low, it will be up to you.
posted by mygothlaundry at 6:53 PM on March 18, 2013

I've been reading a bit lately about the benefits of exercise for kids and adults with ADHD, and I also know of a little boy who has done incredibly well with horseback riding as ADHD therapy. Here's the abstract of a study on this. What's especially interesting is that they saw measurable improvement in all five kids after 8 weeks of riding twice/week.

So, yeah, there are alternative therapies out there. I'm sure there's more information on this out there.
posted by bluedaisy at 7:55 PM on March 18, 2013 [1 favorite]

Excercise (specifically gymnastics) has been immensely helpful for my ADHD/dyslexic/dysgraphic boys.

I would recommend getting a full psycho-educational evaluation. Very often ADHD co-exists with other learning disabilities in twice-exceptional kids. Those other learning disabilities exacerbate the ADHD (because they increase frustration).
Learning disabilities can also manifest themselves with ADHD-like behavior. My copy of this book is dogeard and frequently loaned out:

When my kids were younger, I had to homeschool them. They would, literally, climb on top of the table while trying to do math without being aware that they were moving! I had to sit next to my son and tap the page every few seconds to re-focus his attention. We worked a LOT on attention and now he is back in public school and doing quite well. This book was great:
How to Get Your Kids off the Refrigerator was an incredibly helpful book for me.
posted by LittleMy at 4:37 AM on March 19, 2013

Adding to my comment up above: I was on Strattera for my ADHD for quite a while, and it's a non-stimulant medication. So you do have non-stimulant options! (Also, my coworker's son has been on it for years, and as far as I can tell, has had no bad effects from it.)
posted by telophase at 9:15 AM on March 19, 2013

I have another article to recommend on exercise and benefits for folks with ADHD, from Bicycling Magazine. This article was written about young man who is a collegiate athlete in bicycle racing, though it touches on ADHD more widely. The athlete was diagnosed in first grade, so it seems relevant to your daughter.
Riding Is my Ritalin

In 1978, two years before the National Institute of Mental Health (NIMH) recognized ADHD as a condition, W. Mark Shipman, MD, conducted a simple test. Shipman was medical director of the San Diego Center for Children, an institute for psychologically troubled children. Back then, kids at the center were among the few in the United States taking psychostimulants such as Ritalin to calm what was then called hyperactivity. Kids can be naturally impulsive, inattentive and overactive, but those with ADHD are more so, all the time. (ADHD is an umbrella term that also includes ADD, attention deficit disorder.)

Shipman sent a group of hyperactive kids running for as much as 45 minutes a day, four days a week. An amazing thing happened: The running kids started acting as if they were getting extra doses of medication. After a while, the doctors who monitored the behavior of each child began lowering drug doses for most of the runners. Very few nonrunning participants had their doses reduced. The doctors who were administering the doses didn't know which students were running; the changes in behavior were that clear.

The athlete in the article is male, and I think it's a bit easier for us, culturally, to see exercise as a benefit for boys who have too much energy. My anecdote: I'm a woman and was diagnosed with ADHD a few years ago. I've been on stimulants. However, I've also become much more physically active in the past few years, and now I can recognize how much more focused I am when I've had more frequent and vigorous exercise. When my mind is a stew, sometimes a long run or bike ride is what gets me back on track (even if I can't see that's what I need at the time).

I hope this isn't too far off-track. A diagnosis can be helpful, because then you'll know if what's your actually dealing with. And maybe it isn't! Then you'll have another set of options to explore.

Also please note that it seems some sports/activities are better than others.

Good luck.
posted by bluedaisy at 11:06 AM on March 19, 2013

I'd request testing. It took my child's school over a year to do the testing, so get started. You don't have to give your kid drugs, but an an IEP can help your child get better assistance when/if she needs it. I was the one who recognized that my son has ADHD, and just knowing it helped me help him deal with school.
posted by theora55 at 9:49 AM on April 10, 2013

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