Sunday, June 24, 2012

Overdiagnose this!

So The Atlantic had an interesting article out the other day titled "Are You Listening? Your Child May Not Actually Have ADHD." First of all, ha ha ha, laugh riot of a headline. What do they title an article about blindness -- "Hey, Look At This"?

The point of the article is that, per the FDA, prescriptions for ADHD medications jumped 43 percent from 2002 to 2010, but a recent Penn State study of 1,473 ADHD, autistic and neurotypical kids found that the kids scored roughly the same on a diagnostic test as kids from 1983. Ergo ipso facto etc., the number of kids with ADHD is the same as in 1983 (their baseline info), so the soaring meds rate must be because ADHD is overdiagnosed. The end.

OK, really, one study? One study that didn't even just focus on ADHD kids? That used precisely one diagnostic test as the basis for its conclusion?

Hey, I'm perfectly willing to believe that there were just as many ADHD kids in 1983 as now. Except back then they were called troublemakers, problem kids, bad seeds or stupid, and were either kicked out of school or just failed out. I went through the public school system, and believe me, if you're at all different or quirky, if you have trouble learning the slightest thing in the standard pre-approved way, you get trashed for it, or you get ignored, or you fail. And for the record, I was a "gifted" kid in honors classes.

I didn't know any kids with ADHD growing up. But I did know kids who were smart and creative but struggled anyway, who were great in all classes but one, or who did the homework and learned the material but froze at test time and failed. And if anyone with an ounce of expertise had bothered to really look at these kids, maybe they would have seen something that explained the problem, and could have helped improve things. But hey, easier to write the kids off as stupid, right?

The article also says: "For one thing, it's become one of the world's most overdiagnosed diseases, increasing by an average 5.5 percent a year in the United States. There's no comprehensive clinical test for ADD and ADHD -- usually, doctors simply assess the disorder by intuition and rules of thumb."

Uh, no?  We went through a whole series of tests the first time we brought kiddo to the hospital, observing his motor skills, his problem-solving skills, his ability to transition, checking his reflexes and his hearing and his ability to make eye contact, in addition to the questionnaires his teachers and we had to fill out about specific behaviors. And then we did the questionnaires again the next year when his behaviors had gotten worse. I don't think the neurologist was diagnosing him by "intuition."

The writer's basis for that comment is an Atlantic article from April, titled "Study: Why Attention Deficit Disorder Is Over-Diagnosed." (Oh, and nice stock photo of a stoned-looking kid they used to illustrate it.) Seems a university study of 473 psychotherapists/psychiatrists in Germany determined that they were making ADHD diagnoses even though most of the "case vignettes" they were given didn't meet the diagnostic criteria. Says the article, "Many mental health practitioners seem to proceed heuristically and base their decisions on unclear rules of thumb."

So if I'm reading this correctly ... these doctors were given a piece of paper describing a mythical child's alleged symptoms, told to make a diagnosis, then knocked for diagnosing something that wasn't there?

Come on, my pediatrician won't even diagnose my kid with a cold unless I physically bring him in.
I'm sorry, but I don't buy this. These studies don't seem comprehensive to me. Not enough people participating, not enough variables taken into account. Way too skimpy to make sweeping conclusions like "ADHD is overdiagnosed!"

And I wouldn't get so worked up about it except I've heard "ADHD is overdiagnosed!" from a few people myself, usually in the context of "The teachers don't know how to discipline anymore and they just want the kids on meds to shut them up!" And I feel like the corollary to that is "The parents don't know how to discipline anymore and they're throwing a pill at the problem!"

Yeah? Here's the thing. My son has ADHD and he isn't on meds. Maybe he'll need them in the future, in which case we'll deal with it then. But clearly the automatic assumption with people is, ADHD = drugs. And then the next assumption is, ADHD drugs = zombie  children. And because I know some kids who are on meds, I know that isn't true either. The meds are supposed to focus them, not brainwash them.

I never like it when people make assumptions about things based on their own biases. I especially don't like it when it involves my son.

Sunday, June 17, 2012

Good news, and maybe good news

Week 1 of Operation Nanny was a success. She's a sweetheart and she keeps him incredibly active -- they're basically living on the playground. She tired him out so much on the first day, in fact, that his OT ended the session early, on account of he was too wiped to do the exercises properly. We're a little in awe, because we can't remember the last time anyone tired him out (or outlasted him, for that matter).

So this does seem to have been the right move. He even still seems excited about kindergarten in the fall.

The bad part is that kiddette has figured out what's going on and appears to be jealous of her brother, because man is she acting up at school. She's pinching people. She's disobedient. She's giving teachers the Look of Death.

I'll explain: All of the women in my family can do the Look of Death (as DH calls it). It is a seethingly baleful glare that says, "Don't mess with me or I will destroy you." It is an especially intimidating look and I have occasionally found it useful. (No, not on DH. I wouldn't, and he's immune.) I expected kiddette to develop the look at some point, it being part of her heritage and all. I don't quite think I was expecting her to develop it at age 2. Umm ... hooray, she's a fast learner?

Admittedly, that look coming from a toddler is actually a little funny.

Anyway, her teachers find the look off-putting. One of them decided to give her a look right back. There was a stare-down. I kind of wish someone had taken video of this. I keep picturing it like a showdown at the OK Corral, with some Ennio Morricone whistle-twang music in the background. Fortunately, perhaps, for all of us, kiddette quit first and looked away.

I just can't wait until that child is 14. Oh, the slammed doors and the stomping feet and the teenage Look of Death, which will not be nearly as cute as the toddler version.

Aside from that, we got the test results back from the Brigance screening the district did a few weeks ago. Nothing incredibly detailed -- just the final score. The letter notes that they assessed for "reporting and printing personal data, gross and visual motor skills, counting, number readiness and uppercase letter identification," as well as checking for "handedness, pencil grasps, hearing and speaking." The categories were Partially Proficient, Proficient and Advanced Proficient. Advanced Proficient was a score of 80 and up for his age group; kiddo got an 85.5.

Well, OK. We knew he was smart. Because even if we hadn't figured that one out for ourselves, every single doctor or therapist he's ever been to has made a point of telling us that. It's nice to see that the testing reflected as much ...

Except that sometimes, per my research, districts will say to parents of an ADHD child, "But your child is smart. He doesn't need any special services." Completely overlooking the fact that ADHD kids tend to be very smart and creative. Their problems lie elsewhere.

Also, no breakdown by individual score means I don't know if he was doing well across the board, or if he was great during some parts of the assessment and entirely blew it on others. The highs and the lows could have averaged out to a good score, hiding the fact that there were any lows. Meaning there could be something he's not good at that he doesn't get help for, because hey, the final score was good, right? No problems here.  (This is also per my research.)

So I will probably call the school and ask if they have the full breakdown, and they will probably think I am crazy for complaining about a good score. C'est la vie.

In closing, I'd like to wish DH a Happy Father's Day, even though I think he's afraid to read this blog, because he's a wonderful husband and daddy and he's willing to do the grilling today when Grandma and Grandpa come up to visit. (His grill; I don't touch it.) I hope he has a lovely day.

Sunday, June 10, 2012

Leaving school

At least temporarily. Kiddo's last day for the summer was Friday. Tomorrow a nanny will start. She's getting her degree in occupational therapy, she's interned at his OT facility, she's home for the summer and she seems good with kids. Kiddette even took right to her, and kiddette takes right to nobody. Normally she studies unknown people, poker-faced, until she's decided the person meets with her approval, but this time she was practically climbing into the girl's lap.

The nanny said she could work with kiddo on physical things and suggested she could check in with her sister (a teacher) on classwork to use. But mainly what I want is for kiddo to get a break. Because I'm sick of this scene:

ME: OK, kiddo, time to get up.

KIDDO: Where are we going?

ME: School.

KIDDO: Nooooooooo! I don't want to!!!! Can we go somewhere else first? Can I stay home?

It's a nice enough school, where he's been going. If kiddo were, as they say, "neurotypical," I think things would be fine. (Kiddette, in fact, is doing perfectly well there and will keep attending.) But he's not. And they just flat out don't know what to do with him. And when I make suggestions, they either don't have the staff to do it, need approval from corporate or don't do it consistently, across the board, and then it doesn't work.

For instance, the star chart, which someone there threw out after a week because they didn't think it was working. And never told us (or the director, apparently). So we spent most of the next week reminding kiddo to get more stars on his chart, and he kept telling us it had been thrown in the garbage, and we didn't believe him.

Eventually, we brought in our own dry-erase chart for him. But even still I don't know that it was being used properly, or consistently. What makes me think that? A couple weeks ago, kiddo was being spoken to about the chart, and he went up to it and erased the whole thing.

We started giving him an extra blankie to bring to school as sort of a comfort item, so he could have it when he needed to calm down. After he had some sort of spectacular meltdown at school one day, he explained to us that he'd asked the teacher for his blankie and the teacher said no. Could he have made that up? Sure. But we'd also been sending small toys and books in his backpack to use if he got enough stars that day; it's plausible that someone might have mistaken the blankie for just another prize, instead of something he could have whenever he wanted.

He was hitting teachers. Pulling their hair. Kicking them. Running around the classroom, not listening. Refusing to do classwork. All this while we were seeing improved behavior at home, in public, around relatives -- basically everywhere else except school.

And here's the bottom line: As I say, it's a nice school. They really made the extra effort to teach him to write, and he more or less can now, and I appreciate that. But what we really need for him is day care. Because we both work. I'd almost rather blow off the "school" portion and just focus on the day care. Otherwise, he's going to enter kindergarten in September already hating school and hating classwork and refusing to do things and hitting people, and we can't have that. I've read online other parents' accounts of their ADHD kids having school troubles, and a lot of what they describe seems eerily similar to what we've been dealing with, and these other kids are way older than 5.

 What everyone involved needs is a break. Before kiddo actually becomes the bad kid he's probably being seen as.

We did reserve his spot there for September, because kindergarten is half-day, and they do aftercare. I'm hoping by then we'll have made some sort of progress, and the break will have made a difference.

Because he shouldn't be flipping out this much about going to school when he's 5. Just no.

Sunday, June 3, 2012

Kindergarten: The preview

So our district does something called Countdown to Kindergarten, in which the kiddies get an hourlong tour of the school and the classrooms, get to ride a school bus (the first week) and get to have a peanut-free snack with the kindergarten kids (the second week). This seemed like a good thing, so I signed kiddo up.

Incidentally: I am totally in favor of kids with peanut allergies not dying, but planning lunches and snacks around said allergies can be frustrating. In that kiddo is supposed to be getting more protein, and nuts and peanut butter are among the few types of protein he'll willingly eat. If I could get the kid to like a turkey and Swiss on whole wheat, it would be less of a pain. Also (said the school nurse at orientation) you can't bring cupcakes or cookies or whatever to the school unless you can vouch for every single ingredient in them, and you're supposed to call ahead 48 hours before you're planning on bringing in the whatever so that they can pull the allergy records for the class and see what you need to watch for. Lemon ice is always fine, apparently.

If it seems like parents are more neurotic than they were a generation ago, it's because most parents a generation ago could give their kids PBnJs for lunch -- or bring in cupcakes for the kid's birthday -- without worrying about accidentally killing another kid. Just saying.

The night before Countdown, I lay awake and worried. Because of the school bus. Kiddo has had a tendency to run in front of vehicles lately. I imagined him getting away from the coordinator, running circles around the bus, the driver not noticing ...

He was of course thrilled to be going to the big school, and while we were waiting in the office with his usual security-blanket Matchbox car, another little boy came in with his mom, and while the other mom (nice) and I chatted, the two of them instantly bonded over the car, rolling back and forth to each other across the floor (until they started to throw it to each other and then I had to step in).

The coordinator turned out to be a PTA member who's been doing this program for years. I quietly explained to her that I knew parents weren't supposed to stick around, but that my son has ADHD and is liable to run, especially around buses. She said no problem, we'll keep an eye on him. And then promptly made him the line leader, so he would stay right in front and they'd know exactly where he was. Smart. He was delighted to be line leader, even if he didn't know what it meant.

They all trooped off, I ran errands for an hour, I came back, he was fine. The coordinator explained to me that her teenage son has it too, so she knew how to handle it. The more I talk to people, the more ADHD kids I find. Just never kiddo's age, I guess.

Week #2 was less dramatic. I packed an apple and a yogurt smoothie and sent him off. He was line leader again, and he had a good time. 

So at least we know he can handle kindergarten for an hour at a time, right?

They also did kindergarten screenings last week -- apparently this is new. They use the Brigance program to see if kids are gifted or have learning disabilities, or anything else they should worry about, and then the results help them determine the makeup of the classes as well as whether any kids are going to need extra help in anything in September. It seems like a good idea to me, but then we already know our kid needs help (and I remind every school official I meet that he's already approved for a 504. Because I am that mom). I'm genuinely curious to see what the test comes up with. The parents had to wait in the lobby while the kids were tested, so I can't say what they were doing, but the survey we were asked to fill out had questions like, "Does your child know his first and last name? Can he stand on one foot? Can he count to 10? 20? 30? Can he play well with other children?" That sort of thing. Basic knowledge, basic social skills. They'll send us the results. The official running the testing did say he'd done well, and seemed to find him quite charming, as many adults do.

Of course, he's always charming when he's meeting new people or something interesting is going on. Less so when he's bored, upset or being asked to do schoolwork.

I think the next thing we're supposed to worry about is buying all the supplies on the checklist, but I am so waiting until August on that one.