Monday, April 29, 2013

Professional help, round 3

Kiddo's pediatrician thinks we should be pursuing further behavioral training, so that he learns proper social skills. This is probably a valid point. Since he seems to be back to having semi-regular incidents at school. (For instance, hitting a classmate with a book today.) Said incidents may or may not be why so few classmates came to his birthday party.

The pediatrician recommended someone who deals in ABA therapy, or applied behavior analysis. Its goals, according to (the therapy is frequently used with kids on the autism spectrum, though can also be used in other circumstances), are:

1. Managing the consequences of behavior by rewarding positive behavior, withholding positive consequences, or – in some cases - using punishment (e.g., scolding) to deter behavior
2. Re-arranging antecedents to promote positive behavior and minimize the likelihood of problem behavior (e.g., clarifying expectations, simplifying tasks, providing choices)
3. Teaching skills that allow individuals to be more successful and less reliant on problem behavior to meet their needs

We do some of this already, obviously, but could probably use the assist.

And speaking of professional help, our former OT facility could use an accountant. Currently DH is serving as one, to find out why they insist they're still owed $700 even though our insurer says they paid the claims. As far as he can tell,  none of the paperwork matches up. The owner has been taking a snippy attitude with us ever since I told off her billing person for expecting me to know more about insurance codes than she did. (I do not regret this, on account of the big hissy fit the owner threw about not getting paid in the first place, even though she didn't bother to tell us about it for months, until the amount owed was huge.)

And as all the adults get mired in arguments about money, kiddo still asks when he's going back to the gym doctor, because he liked it there so much. Even though he hasn't been there since September. Sigh.

Sunday, April 21, 2013

Good news generally

We had another meeting with the school in which they said how much improved kiddo's behavior was and how well he's doing academically -- apparently he's jumped a few reading levels and is now slightly ahead of where he needs to be. The takeaway was, basically, "Keep doing what you're doing." His OT also sees some improvement but plans to continue working with him on motor skills and such.

I am a little concerned that his daily check mark quota on the behavior chart has gone down of late, from eight or nine to four or five. That might partially be the new-and-improved chart structure, which more closely tracks the specific times of day on his behaviors. It might be a more or less attentive substitute teacher, since his teacher gets a sub for conference days. What I'm afraid of, of course, is the medication suddenly not working anymore, because sometimes that happens.

Friday seemed to bear that out a bit; he got two checks. And was hitting kids and pushing them again. This literally a day after hearing the school officials rave about him.

Saturday, I took him to Trader Joe's. He likes these trips, because there are always free samples of food, and because if he finds the giant stuffed lobster hidden somewhere in the store, he gets to take a cereal bar from the prize box. And everything went great. I mean shockingly so. No running in the aisles. No hiding behind displays. No tantrums about wanting to ride in the cart even though he's grown way past the cart-riding stage. No throwing himself to the floor because he wasn't getting his way. I always knew where he was, and when I told him to go somewhere, he went. I almost wanted to pinch myself.

Saturday afternoon, the kids and I went for a walk, he on the tricycle he really shouldn't be riding anymore because his knees stick out at the sides (but he refuses to switch up to the bike). Things were fine until he and kiddette decided it would be fun to race ahead of me, and then kiddo thwacked the toy monkey right out of her hand and kept riding. And kept riding, even though I was yelling at him to stop. I caught up to him, confiscated the trike and made him walk right home.

Definitely he and kiddette egg each other on in a bad way, which might be what happened here. Occasionally if I want one of them to do something, I'll kick the other one out of the room, just to squash that tendency.

Today was the Spring Shiai for kiddo's karate studio (and a couple other studios/dojos as well). I hadn't originally signed him up for it, because we were going to be out of town this weekend, but change of plans (boo strep throat). But since we suddenly had no plans, well. A shiai is a combination exhibition and sparring competition, plus the announcement of any students who are being promoted to a higher belt. Before today, I did not know this. 

Kiddo only just started, so he wasn't ready for sparring (plus we haven't actually dropped the $65 on the padded gear yet). He sat out that part, then rejoined the students for the demonstration, sitting on the floor with the other white belts until it was his turn, following along as best he could, then sitting back down. All this took several hours. And he was a total champ about it. He didn't freak that we weren't down there with him. He did the moves. He sat. No defiance, no refusal, no running. A little goofing around. At one point, when they were supposed to be standing still, he appeared to be doing his own version of the chicken dance. But really that was it. He didn't even get upset about no trophy or no new belt.  He followed directions and behaved. This is better than any trophy.

It did occur to me, sitting in the bleachers with an increasingly bored kiddette, that we were now doing the official parent thing -- sitting through your kid's athletic meet. On the plus side, better this than football. On the minus side, everything I know about karate I learned in "The Karate Kid," so I kept thinking "sand the floor" and "wax on, wax off" and "Do the crane, Daniel!"

So the good really outweighed the bad this weekend. Hoping to say the same about the coming week.

Monday, April 15, 2013

The Times is concerned

about the jump in ADHD cases and the corresponding rise in medications. Because obviously the real problem is crappy parents medicating their kids into submission, I assume. Anyway, from the article:

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.
“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.” 

Or, possibly, there are a lot of kids out there who should've been diagnosed in the first place but weren't because people think ADHD isn't real? Sorry, just speculating wildly.

The article says:

While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school. Pills that are shared with or sold to classmates — diversion long tolerated in college settings and gaining traction in high-achieving high schools — are particularly dangerous, doctors say, because of their health risks when abused.

Yeah, and when I was in college it was Red Bull, and/or NoDoz. (Or in my case, coffee.) Sharing pills with classmates is essentially becoming a drug supplier to drug abusers and should be treated accordingly. But it's a misperception that the drugs are designed to give kids better grades. They're designed to help the kids focus long enough to get their own good grades. Because ADHD kids tend to be smart and creative thinkers whose easily distracted brains go wonky when they're loaded down with busywork and test-by-memorization.

Kiddo isn't on medication for his grades. He's in kindergarten. Do they even get grades in kindergarten? Is it smiley faces or something? He's on medication because occupational therapy, behavioral therapy, behavior charts and a social skills group weren't enough to help him keep his hands to himself or prevent meltdowns over things he didn't like or couldn't control. Emotionally, he isn't 6; he's more like 3 or 4. That's part of the disorder. (Believe me, at home it's like we have two 3-year-olds, not a 3-year-old and a 6-year-old.) I'm hopeful, long-term, that he'll catch up emotionally and the medication won't be a permanent thing. But it's working right now and right now is good enough.

The Times also said this:

A.D.H.D. has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.

Funny, I don't remember the "subjective process" being skipped. I remember a two-month wait to see a pediatric neurologist at the county hospital. I also remember her conducting actual tests, of reflexes and motor skills (ADHDers tend to have issues with fine motor skills), in addition to going over the surveys.

Also, "historically"? This generation of kids growing up now is probably the first to even have access to medical and educational experts who knew anything about ADHD or what to look for. So what historically are we talking about? Because historically, what I remember from my own school days is that kids who couldn't do the work were written off as lazy or stupid, not as potentially having cognitive or behavioral issues that might be getting in the way. When you're talking about a disorder that right up until 1980 was still known as "minimal brain dysfunction," of all things, there is no historically. There's now and in the future.

So what's the result of all this hand-wringing by the Times? Comments like this.

As a school psychologist I have watched the rise in ADHD being diagnosed in children for the last thirty-four years. The diagnostic criteria for ADHD could be well termed: “Things that children do that annoy adults.”

And this.

Helicopter parenting and all that it entails, is one of the greatest factors in the ruination of their children. I have seen parents wanting their children to be labeled, to have a personal ed plan, so their children can have more time on tests, both classroom and standardized. Medicating the kids so that they can get better grades certainly makes these parents preen.

And this.

The problem is self created, we don't provide quality time to our kids, and that's what they are all craving for. 

Because it's always the parents' fault, right? And stories like this just confirm people's preconceived notions.

The Times, of course, was not done. They offered an editorial on the matter a day or two later, concluding thus:

The increase in reported cases, experts say, has been fueled by awareness of the disorder, drug company advertising, and parental pressure on doctors to prescribe drugs to help children focus. With the growing concern that many young people may be sharing or abusing these drugs, it is crucial that parents and doctors are vigilant about overmedication. 

 And by "experts" do we mean all two of the ones you interviewed for the last article?

Look, I agree that there likely is some overdiagnosing, and some unnecessary medicating, going on. I honestly don't think general-ed practitioners or pediatricians should be doing the diagnosing, unless they have significant experience in ADHD and other mental disorders. There's so clearly a general lack of knowledge and understanding in the general population that I'd only want to (and did) deal with a specialist. But I don't think any of that should take away from the many legitimate diagnoses out there, the many kids and adults who benefit from finding out exactly how their mind works and how to properly deal with it. 

Just once, I'd like the Times to interview someone who has ADHD, or the parent of an ADHDer. (Some non-celebrity, that is. They have, tangentially, interviewed Andres Torres and Michael Phelps about it.) Not to sound the alarm about drug abuse. Not to declare that all these kids can't possibly have this disorder. Just so they can tell their readers what it's really like to deal with ADHD. Because that alone would convey the idea that the Times says ADHD is real. That would be a powerful thing.

And then maybe I wouldn't feel like the most powerful paper in the country is taking potshots at my parenting decisions.

Saturday, April 6, 2013

And kiddo is 6

He's not up yet, because I got home from work late last night and we had dinner late and baths and I made him do another "book report" -- he's supposed to write down the name of the book and author, draw a picture about the book and write a sentence about it -- because I misunderstood the directions on the whole reading-program thing and he's supposed to have done 19 of these things already, 25 for the school year. So he's doing one nearly every day to catch up. Fortunately he doesn't mind because it means I read a book to him first. Anyway, with all that he got to bed late. No hurry to wake him up, since his party starts at 11.

We're actually doing two parties this weekend, one for school friends and one for family and close friends of ours, most of whom also have kids anyway, all of whom live at least an hour away from us so we'd rather not make them drive out for a two-hour party at a restaurant. So basically, we'll be recovering from the first party and then cleaning the house for the second one. Because clearly we're gluttons for punishment.

I'm hoping he likes the present I made for him -- a Shutterfly book of his Lego creations. He's really pretty good with them, and just for fun I started taking pictures of his strange and fantastic vehicles. Like this one, for instance.

Things have been going well at school. His teacher reports he transitioned back from spring break very well. He has the occasional meltdown with us, because he's tired or hungry generally, but we know to stay calm and wait it out and then he calms down. He's even better about turning off the TV for dinner. So things are ... good? I think? Assuming all goes well at the parties.

And I believe he's up, since I hear him talking to Grandpa. Quiet moment over.