Sunday, November 24, 2013

He's a contradictory sort

Not that kiddo means to be contradictory. In fact being inconsistent is one of the consistent things about ADHD, because rote, routine things hurt his brain. Sometimes it's entertaining, though.

His anxiety, for instance. He doesn't like to be in a room (or a bathroom) by himself. Doesn't like scary stories or loud dogs. Will practically run the other way if someone's Halloween decorations are too frightening. ("But you're Superman!" I protested while we were trick or treating. "You're not afraid of anything!" Meantime his sister the strawberry was already at the door, getting candy.)

And then we met another family for hibachi last weekend. Now, we've done this sort of thing before, with cousin H. and family down South. And it went fine. But I don't recall there being quite the same reaction last time. By which I mean kiddo practically standing up in his seat yelling "More fire! More fire!"

"Don't you think he sounds like Beavis?" I said to DH.

Wow, did he love the fire. I think maybe the chef this time around had cranked up the flames on the table a little more than the last one. But still. Kiddo seemed to think this was his own private fireworks show and he did not want it to end. (In a complete reversal of the usual, kiddette was hiding behind me. "I don't like the fire," she said. Though she did like the food.)

The chef seemed to find our little pyro hilarious, playing little games with him, pretending to give him rice and then dropping it on someone else's plate instead. Kiddo was a pretty good sport about it, especially when the chef finally dumped a ton of rice on his plate.

As we were leaving the restaurant, DH encouraged kiddo to go thank the chef for the meal. Kiddo walked up to him and said, "Thank you for the fire!"

Can't wait to see what he does when we light the Hanukkah candles Wednesday.

Another contradiction: girls. He got in trouble last week for smacking himself in the face, spinning around and throwing himself on the ground. I heard this from the guidance counselor and I thought, Is this a tic of some sort? Is it related to the medication? Should I call the doctor? Yeah. Turns out he and another boy had been "trying to make the girls smile."

Seriously. He's 6. Aren't boys supposed to be totally clueless about girls until high school or later? Why is he trying to make girls smile? And couldn't he just tell them a knock-knock joke or something?

Also, lately he and kiddette have been making marriage plans. Kiddette is going to marry one of her little friends from school. Kiddo is going to marry a girl from the neighborhood. This is actually a step up from before, when they were going to marry each other. (I explained that that was not possible.) Kiddette's friend was not happy about the suggestion. I don't think kiddo has informed his intended yet.

And yet despite all this, when kiddo and I were reading the latest "Wimpy Kid" book and it mentioned a Valentine's Day dance, kiddo said "Ewwwwwwww!"

I couldn't help calling him out on that. "What do you mean Ewwwwww? You just got in trouble for trying to make the girls smile." He had no answer. I suspect the other boys at school told him dances were yucky. Maybe the next time he talks about marrying someone, I'm going to tell him that getting married involves a lot of dancing, and see if that puts an end to the talk.

Finally, of course, I would be remiss if I didn't mention the latest news: according to the Centers for Disease Control and Prevention, more than 1 in 10 children in the U.S. has been diagnosed with ADHD, per their 2011 survey of 95,000-plus parents. They say diagnoses have been rising since at least 1997, which may be because of greater awareness on the part of doctors and parents. Per the data (says the Associated Press), that's about 6 and a half million kids, half of whom are diagnosed by age 6. The CDC site also says this:

Although investigation of ADHD has been quite extensive over the past 30 years, the scientific process has been significantly slowed by the lack of a single, consistent, and standard research protocol for case identification. Variable and disparate findings have been noted throughout the literature even on basic issues such as prevalence. As a consequence, speculation regarding possible increases in ADHD prevalence cannot currently be evaluated.

So, they know there's more of it, but they don't really know why.

They also say:

CDC acknowledges the need for further research in ADHD. Specifically, key public health questions yet to be answered include:
  • What are the causes and risk factors of ADHD? What is the prevalence of ADHD? Is the prevalence increasing?
  • What social and economic impacts does ADHD have on families; schools; the workforce; and judicial and health systems?
  • Are ADHD and its comorbidities being appropriately diagnosed and treated? Are people with ADHD able to access appropriate and timely treatment?
  • How effective are current interventions? What are the long-term effects of drug treatments?

This all seems like they really don't want to say anything definitive on the topic, which makes me wonder why the 1-in-10 thing was a story in the first place. Dear medical science folks, we need something definitive on the topic. That's the only way people are going to stop thinking ADHD is made up. Get on that, would you?

Sunday, November 17, 2013

Deciding I'm OK with the Wimpy Kid

Because I was not OK with him before. I'd never read these books, being that I had already well aged out of the target audience by the time they came out. (In fact, the first book was published the year kiddo was born.) So I came to this whole phenomenon -- more than 115 million copies sold worldwide, per the Los Angeles Times, not to mention the three movies -- a bit innocently, when my mother bought a signed copy of the latest "Diary of a Wimpy Kid" book, and just to start us off properly, the first book too. (That's right, Mom. I'm blaming you.)

Kiddo was beyond thrilled when he saw the books, because clearly some of his buds are reading them too. He chattered about them all night -- "Haha, 'Diary of a Wimpy Kid,' I can't wait to read 'Diary of a Wimpy Kid,' when can we read 'Diary of a Wimpy Kid'" -- and when we finally did start reading one, thought it was the funniest book ever ever in the history of anything and couldn't wait to hear the next part.

The problem is, this Wimpy Kid dude is kind of a jerk.

He bonks the star of the school play on the head with an apple in the middle of the play. (He was a tree.) He terrorizes a bunch of kindergartners when he's supposed to be escorting them home, then lets his friend take the blame. He devises a game in which he tries to knock that friend off a Big Wheel while he's riding it downhill. That sort of thing.

OK, they're in middle school. Kids generally are jerks in middle school. And he generally gets his comeuppance by the end of the book. And this stuff is more silly than outright horrible. DH and I even think the book is kind of funny. It's just that it's clearly a book meant for kids, not adults, in the sense that the kids can laugh at it when the adults are not around, in that subversive way. So it's a little bit of cognitive dissonance for DH and I to be using it as kiddo's bedtime story. I feel like as the authority figures, it's our job to disapprove, or something. Eat your vegetables! Do your homework! Don't laugh when the Wimpy Kid bonks that girl with an apple!

On the other hand, I've always had these two warring impulses in me: the desire to do all my homework and get good grades and be liked by the teacher, and also the desire to sit back and giggle at the kids throwing spitballs in the back of the room. I'm a well-behaved smartass. So I can understand the appeal here.

And frankly, after reading him the original "Peter Pan," in which the pirates and the Lost Boys are doing the logical thing with all those swords and actually killing each other, and "The Secret Garden," in which Mary's parents and a gazillion other people die of cholera by about page 5, I probably don't have any right to complain.

Also, there's this one interesting fact about the author, per the Sydney Morning Herald:

Jeff Kinney, author of the Wimpy Kid series, has attention deficit disorder; he is sure of it. This explains why writing the opening pages of a new book is as excruciating as doing a tax return and also why he drifts away at the most inopportune of times.

Like last week at the Sydney Writers' Festival when he was giving a talk at the Opera House and found his mind wandering off to compose a plot for his new novel; it's as if his body, he says, is physically trapped in a space but his head is somewhere else completely - roaming the creative playground of infinity looking for the next mishap, gag or twist.

The ADD has never been formally diagnosed and he isn't interested in getting treatment; the condition has served him well - people who have it are often very creative, he thinks.

In fact, this is what he tells kids at a school assembly, per the LA Times article:

"I have ADD," he told the crowd. "Does anybody here have ADD? You do? Congratulations. You're going to go far."

How about that!

I am always on the lookout for authors/artists/athletes/actors/other fascinating people to add to my list of successful people with ADHD (thought I saw something about Jimmy Fallon recently too but can't find the article), because it's interesting, and a bit reassuring, to see people who have the disorder but have succeeded spectacularly in spite of it. Or because of it? Either way.

So consider me on the Wimpy Kid bandwagon. We've already started the other book, and I expect will eventually move on to the movies. Not to mention the rest of the books. And kiddo is back to pleading for one more entry every night at book time.

"Hey kiddo," I said the other day at breakfast, "the man who wrote these books has ADHD like you do."

"Cool!" he said.

Yeah, it is.

Monday, November 11, 2013

... And here we go again

"Perhaps parents of children with ADHD shouldn't have sinned so much in their youth. Western medicine can't solve your problems now, only the lord can."

That enlightening statement was provided in the comments section of a recent Washington Post article (not the Times, C! Don't yell yet!) describing one mother's struggle with her son's possible ADHD, and putting it in the larger context of how it can be difficult to diagnose -- and how people can still so blithely choose to disparage the diagnosis. Like, say, the above commenter. 

For the record, I wouldn't have described myself as a "sinner" per se. I pay my taxes. I serve jury duty. I give blood. I have a thing for cheesesteaks, but that really just makes me a bad Jew.

The article itself is fine enough, though maybe sketchy on some details:

[ADHD] is far more prevalent in boys than in girls. Among those given the diagnosis, a small minority suffers extreme symptoms, and in those cases, diagnosis is fairly straightforward. Children with extreme cases tend to have trouble staying engaged in tasks, even those that they enjoy, for any length of time and find it impossible to stay still, particularly in classroom settings.
Really, if that were kiddo's only problem that would be lovely. This leaves out the sensory issues that frequently accompany ADHD, not to mention the issues with social skills, inability to recognize personal space/facial cues, developmental delays that make it near-impossible for kiddo to process emotions sometimes, delayed motor skills that make writing anything a struggle for him (though he's getting better at it). Not to mention the almost physical pain he seems to be in when asked to do a routine task that doesn't interest him (like, say, picking up his toys. Yes, that's fun to deal with). And he's lucky, in that his brain actually shuts off so that he can sleep; other ADHDers have to resort to medication just to get sleep. Also, other disorders frequently co-occur with ADHD -- Tourette's, dyslexia, dyspraxia, Asperger's, etc. So yeah, the sitting still in class? Kind of just the tip of the iceberg. 

“There is no line” that defines who does and does not have ADHD, says Lawrence Diller, a behavioral developmental pediatrician and an assistant clinical professor at the University of California at San Francisco. Except in the extreme, diagnosing ADHD is a “judgment call based on subjective opinion,” he says.

Well, maybe for you it is. I watched the pediatric neurologist run tests on my son -- physical and cognitive. That plus the questionnaires from his teacher and from us, which happened to match up pretty closely. Didn't strike me as a subjective judgment call.

Many doctors and some schools rely on the Vanderbilt Assessment Scale, a questionnaire meant to flag symptoms of ADHD and identify other underlying conditions. It includes general statements — such as “Is distracted by extraneous stimuli” and “Is forgetful in daily activities” — and asks the person completing the form to rank how often each applies to the child throughout the day.
But the test does not provide the necessary insights into a child’s home life — discipline patterns, inadequate learning environments, familial difficulties — Diller says. “If the behavior crosses the threshold on these forms, the parent is likely to be told the child has ADHD, even though there can be a host of other reasons why the kid is acting that way.” The child may also have other problems that have little to do with attention but result in ADHD-type behaviors.

Um, actually we were questioned about our home life too. And the questions on symptoms we answered were more precise than those above. So, different questionnaire then?

The one thing this Diller guy says that I agree with is using the book "123 Magic," which has come in handy for us. Even now, when we don't rely on the technique regularly, if I want to get the kids' attention I'll say, "That's 1." Generally it works.

The article does touch on recent studies showing that low dopamine levels in the brain might be associated with ADHD symptoms, and that stimulant medications increase levels of dopamine. So there's that.

The writer concludes that her son seems to be doing fine in school, so they'll take a wait-and-see approach with diagnosing. Which is totally fine. Great, in fact. But I do kind of wish the writer had put more information into the article. Because I know there have been studies other than the ones she's citing, I know brain imaging as a way of diagnosing ADHD is slowly gaining credence, and if all you read was this article you'd think there were scores of neurotic parents wringing their hands over giving Johnny meds just because he wiggles around in his seat at school. Incompetent teachers! Bad parents! Blah blah blah ad nauseum.

Why do I get so exasperated by these articles? These comments on said articles.

"These newly-invented alphabet-soup "disorders" serve one purpose, and that is to sell expensive and debilitating proprietary medications. Maybe kids would pay attention more, and generally behave better, if they were allowed to bring peanut butter and jelly sandwiches for their school lunch. Meanwhile, school administrators are incapable of making normal, common-sense decisions without first looking up the "correct" (i.e., absolutely inane) response in their little red rule books."
Soooo, the real solution here is that my kid should endanger his classmate's life by sneaking peanut butter into school? Hey thanks, man, you totally nailed it.
(Why is it that kids are so completely cool with the idea of no peanut butter because it's dangerous, and adults get so ranty about it? You want a PBnJ, you make one. Cut the crusts off and everything. Have a blast.)
Also, according to the National Institutes of Health, the earliest known reference to an ADHD-like disorder was by a physician named Sir Alexander Crichton in 1798. Yes, I said 1798. That only counts as "newly invented" if the commenter grew up during the Roman Empire.

"I taught for many years in an elite NYC private school.
Many of my students were taking Ritalin or some other drug if they were not getting A grades.
The parents would not accept that their child was not an Einstein.
That the child was not an A student in every course must [since the child was obviously a genius] be because the student had ADHD. ...

There is a reason in the lower grades boys are more often misdiagnosed with ADHD than girls.
Elementary school teachers are not hired because of their knowledge of the subject matter.
It is not hard for a boy to know more arithmetic than his [usually female] teacher. ..."

So you're 1. male, 2. kind of a misogynist, 3. extrapolating your elite New York experience to the rest of the planet? Because I feel pretty confident in saying that New York is not like anywhere else on the planet. 

Also, I can't emphasize this enough: The medications are not designed to give the kids easy A's. They're designed to help the kids feel comfortable and not overstimulated in a group setting, or improve their executive function skills, or help them build in that "pause" so they can stop and think before taking a potentially harmful action. 

I'm perfectly willing to believe that ADHD is overdiagnosed. But if all you read is articles suggesting (or saying outright) that ADHD is overdiagnosed, then you doubt all diagnoses. That's the part I don't appreciate. Don't make my job harder. Don't make me  wonder what kind of reception kiddo is going to get in a world that seems to largely believe his disorder is a great big lie.

Sunday, November 3, 2013

Halloween: A Postmortem

Superman and the strawberry had a fine time. They each got parades and parties at their respective schools, and then came back here and dragged me halfway around the neighborhood, and then had pumpkin macaroni and cheese for dinner (sounds odd but is good), and eventually we were able to get them to bed.

I took a half-day from work to catch kiddo's parade and to handle trick or treat duties. (There was no way I could make both parades unless I skipped work altogether, but skipping work altogether seemed like a bit much. DH and MIL attended kiddette's parade.) I'm always kind of fascinated by what the neighborhood is like during the day, when I'm not there. It's like a glimpse into the stay-at-home moms' world. Although actually there were quite a few dads at the parade too; either they all work two minutes away from the school, or they skipped work.

At any rate there was a crowd of adults lining either side of the sidewalk outside the school along with MIL and me, and then "Monster Mash" blasted out from the speakers and out came the kids. ("Monster Mash" continued to repeat, scratchily, for the entire parade. If there's one song you shouldn't listen to 10 times in a row, this is probably the one.) Kindergarten first, then the first-graders, and as I was frantically fumbling with the camera to capture Super-kiddo I heard a happy shout: "Mommy!" And hearing that made the whole half-day worth it.

Trick or treating went ... well, pretty much as I should've expected. Kiddo refused to go up to one house at all because there was a fake dead guy in the driveway. He was nearly scared off a couple other places because of dogs. (We are clearly never getting a dog. Okay by me, since I'm more of a cat person.) He insisted I walk him up to all houses after that, holding his hand. The irony of a kid in a Superman costume acting less than brave was not lost on me. I pointed this out to him, but it didn't help. I guess dogs and scary decorations are his kryptonite.

One of our neighbors was giving out whistles instead of candy. I'm sure she thought she was helping break the candy cycle, or something. I'm also sure her house was soundproofed. Because throughout the neighborhood, you could tell which kids had been to her house by the piercing sounds echoing through the streets. Kiddo, adorably, thought they were all sending messages to each other via the whistles. Sure, and the message was: "All I got was this lousy whistle so I'm going to break some eardrums!"

Really the kids around here are pretty nice, though. They all say thank you when taking candy and they ask before taking extra (I always let them). At one point when kiddette was coming down the steps of one house, she slipped (it had been raining) and fell. One of the older boys passing us stopped to ask if she was okay, and helped pick up her dropped loot. Very sweet.

(Incidentally, I was totally kidding about parents driving the kids from house to house in the rain, but I swear some parents were doing just that. It wasn't even raining that hard. Wusses. Work for your candy.)

I managed to more or less keep the kids together until we visited a family we're friends with, and then fell in with the son and all his buds as they went back out. Bunch of boys together, running ahead of their parents, and you can guess what happened next: Kiddo ran off with them, kiddette and I were three houses behind, it was getting dark and I started to panic because I couldn't see him. There was a point where I was in the middle of the street, kiddette at the house behind me, kiddo at the house across the street in front of me, and I wasn't sure which one to go after. That was when I finally hauled him out of the group, and we headed back shortly after.

We were home and he was already out of his costume when we noticed the fire truck lights outside. No fire, just the firefighters roaming around the neighborhood, giving out thick glow necklaces to the kids. (Cute, I know.) Kiddo ran back outside. I was in the middle of making a salad, but I ran out after him, minus my coat. The truck drove off and kiddo nearly had a massive meltdown, but I pointed out that it was going to stop again up the street. We were on the sidewalk and I thought it might be safe enough, so I let him run. Man, he is fast. I'm thinking we sign him up for track as soon as he's old enough. Unfortunately the truck made a bit of a rolling stop and kept going, and kiddo kept running after it, and at this point I couldn't see him and realized there was no way I could catch up to him, ever. But then the truck did stop, and he scored a necklace and came bounding back to me, like the world's most fright-inducing boomerang. I even got him to get a second necklace for kiddette, who unlike her brother had come back to the house when called. So everyone was happy, and it could've been worse, I suppose.

And my next source of worry will be the parent-teacher conference next week, because while kiddo is doing just fine academically, behaviorally, not so much. At least one incident of lying on the floor and refusing to do something or other. I suspect there have been meltdowns, since he's been having them at home. Not sure yet what we do about it.

But at least we had Halloween without any major incidents. Oh, and that salad? The kids ate it. I figure that sort of offset the candy.