Monday, February 24, 2014

I never thought I'd say this

but I liked a story about ADHD in the Times.

Heavens! Down is up! Up is down! Dogs and cats living together! Mass hysteria! (OK, sorry, couldn't help it. Harold Ramis, RIP.)

The Times, forgoing its usual "clueless parents and incompetent doctors have been brainwashed by drug ads into overmedicating children" meme, chronicles instead how child psychiatrists are teaching pediatricians and general practitioners how to properly diagnose -- not overdiagnose -- ADHD, and to not rush to medicate.

The story confirms what I suspected:

Because the disorder became a widespread national health concern only in the past few decades, many current pediatricians received little formal instruction on it, sometimes only several hours, during their seven years of medical school and residency. 

In other words, pediatricians right now don't have the background or experience to be making diagnoses. Which is what I've said about 50 million times here.

Various medical experts quoted in the story admitted they didn't have very in-depth knowledge:

Harriet Hellman, a certified pediatric nurse practitioner in Southampton, N.Y., who is licensed to make mental-health diagnoses, said that there were times she would identify the disorder through mere instinct, a “hair-on-the-back-of-your-neck feeling.”

So I'm glad that this seminar exists and I wish there were lots of others like it. Because the biggest problem with ADHD is the lack of information -- not just among doctors, but among the general population, who still think that the disorder is a made-up thing to justify lousy parenting. 

And just when I'm sort of OK with the Times comes this op-ed arguing that universal pre-K might lead to an epidemic of ADHD diagnoses. To quote:

Introducing millions of 3- to 5-year-olds to classrooms and preacademic demands means that many more distracted kids will undoubtedly catch the attention of their teachers. Sure, many children this age are already in preschool, but making the movement universal and embedding transitional-K programs in public schools is bound to increase the pressure. We’re all for high standards, but danger lurks.
Right, fellas, the key is "many children this age are already in preschool." Except it's probably private preschool, it costs parents lots of money and if there is a problem -- as was the case with my son, who got in trouble basically every day for a year at two different preschools before he was diagnosed -- there are no experts on staff and no resources available to assist. We yanked him out of day care entirely the summer before kindergarten and kept him home with a nanny because the school setting was so difficult for him -- and that was after he was diagnosed. But the school wasn't equipped to deal with him, period. (This was all pre-medication. Something else the writers rail against.)

My point? Sure, it's possible overdiagnoses might result. It's also possible that legitimate cases of ADHD will be caught earlier and treatment plans, behavioral or otherwise, begun earlier, thus preventing a lot of anger, angst and heartache for those families.

So I'm a little dubious about this op-ed, and annoyed at the Times all over again. It was nice while it lasted, right?

Monday, February 17, 2014

And there it is ...

The moment, the exact moment, when it is blindingly obvious that you are not dealing with a neurotypical kid, no matter what people say about blah blah blah ADHD is fake etc. The moment was at the snack table.

Our church has a snack table for post-service munching and chatting. Generally the offerings are cakes and crackers and cheese and fruit. I try to discourage the kids from attacking the snack table, because there isn't a ton of food there, and because generally we go out for lunch afterward anyway, so I can get some sort of protein into them and so I can get the Sunday paper and more or less read it in peace while they split the comics. Such is my strategy.

Kiddo, however, will not be denied the snack table. He'll swoop back onto it again and again, like a carb-craving vulture, even though his RE class just had a separate snack, even though he knows we're about to go out for lunch, even though I have told him not to. I do occasionally worry how this looks to the other folks there, some of whom might not know what he has, and might just think he's a greedy little brat. Invisible disabilities are fun, right?

So I told him flat out: You may take one snack, and then you're done, because we're going to go to the restaurant. He agreed and took one snack. And two minutes later was begging for another one. I said no, and two minutes after that I saw him dart to the other side of the room and I went and dragged his protesting little body away from the snack table. Reminded him again that he was done, and that we would be leaving shortly. He said OK.

Kiddette was finishing up the craft she had made in class, and while we waited for her, I saw him dart across the room again and grab something. Not like he'd forgotten. Not like he was deliberately disobeying (though yeah, he was). Like he wanted the snack so badly it was all he could think about and his entire body vibrated with the need and he had to grab it even though he'd get in trouble because it was not physically possible for him to stop himself. As though he had absolutely no choice in the matter and it just had to be done. Boom.

Classic ADHD moment. Impulse! Action! Consequences? Oh shoot, there are consequences?

The consequence was that we did not go out for lunch after all, but instead went straight home. That's generally the consequence if they act up at church. Unfair to kiddette? Sure. Unfair to me, missing out on my paper? Um, yes. But we can't let him get in the habit of ignoring us. We have to remind him, constantly, of the natural order of things: Action-consequence. Over and over again. We have to be the structure for him, until and unless he's capable of building that structure for himself. He needs to get to the point where he can, maybe, pause and think about an action beforehand, and then, maybe, make a different choice.

It's so unbelievably frustrating sometimes. I hope the work pays off in the end.

Monday, February 10, 2014

The winter of everyone's discontent

There cannot be more snow coming. Seriously. I am in denial because our patio set is caked in white and my poor garden gnome is buried up to the top of his hat and there is no more room for snow in these parts, so it's just going to have to go somewhere else because I said so. The kids had two snow days and a delayed opening last week. At this rate the school year will be extended until Aug. 30.

The best part about driving home from work in the snow? I mean, aside from the 5-mile-per-hour rate of speed. Definitely how you can't even see the lanes anymore and you keep behind whoever's in front of you because you figure they must be in a proper lane, and if they're not, there's two of you doing it so it's a lane now, right?

Punxsutawney Phil, you are not beloved in New Jersey this year. A certain restaurant in the area is jokingly advertising fried groundhog on their billboard. At least I think they're joking.

Spring will be a nice change of pace. Sunshine. Flowers. T-ball. Um.

Yes, we signed kiddo up for T-ball. I have expressed my reservations, though not in front of kiddo. Team sports are not recommended for ADHD kids -- they're likely to get sensory overload and shut down, or forget whatever it is they're supposed to be doing, or miss social cues from their teammates as well as signals from their coach, or overly freak out when they screw up, or any number of other things that would make them less than stellar team players. Every other family in our informal moms group has said they tried signing their son up for a team sport, and it was a disaster.

Individual sports, in which the child is basically competing against himself, is a better bet. Hence why kiddo takes karate. One of the other kids in our group fences. Swimming is also good (just ask Michael Phelps) and I would think track would be too (because running comes quite naturally to these kids).

Still. Our friend M. points out that this is the year to get kiddo started in baseball, if we're going to do it at all. And T-ball is very low-key. And DH, who knows something about baseball, would love to have some father-son bonding over pitches and catches.

So we signed kiddo up and maybe I'm wrong. Maybe he'll do great. DH says he has a nice even swing, and that's something that can't be taught. Maybe I'm just being Mommy Chicken Little here.

If he hates it, he can drop it. He'll have an out. And by extension, so will we.

Tuesday, February 4, 2014

Existential crises and other weekend activities

So I bought kiddette a book about Emma Lazarus. This seemed like a good idea at the time. She's fascinated with the Statue of Liberty, which I expect we'll be visiting at some point when the weather warms up (HAHAHA that's a good one, clearly we are going to be having winter forever and I will be driving to work in the snow every day from now on), and this lovely children's book explains all about Emma and how she wanted to advocate for immigrants and so she wrote the poem that's engraved on the base. You know the poem. Don't make me weep for the future of literacy in America. Just say you know the poem.

Kiddette loved the book and we were reading it when, toward the end, she wanted to know where Emma was. Here's the thing: Emma died young, before the poem was added to the base. The book gently phrases it as "she lived a short time after" or something like that, so kiddette missed the nuance. So I explained to her that Emma -- who I'd already said was a real person, who lived a long time ago -- had died.

Now I've had endless conversations about death with kiddo, but in this interested abstract sort of sense. Most notably, during the opening chapter of "The Secret Garden," but I had that coming because everyone Mary knows dies of cholera by page 12 or so.

Kiddo: Do people die of cholera?

Me: No, that was a long time ago, no one dies of cholera now.

Kiddo: Daddy's sick. Will he die of cholera?

Also, he was fairly gleeful about the evil aunts getting squished by the peach in "James and the Giant Peach," but in his defense, they are pretty evil.

So I've gotten used to the idea that death is an endlessly fascinating topic but not an upsetting one.

Kiddette, apparently, begs to differ. As soon as I told her Emma Lazarus was dead, she dissolved into tears and was inconsolable for several minutes. Then she started asking whether various family members were going to die. Then she asked whether she was going to die.

Sweetheart. Seriously. You are 4.

I'm not going to lie to her -- obviously, otherwise I would've said Emma Lazarus is totally fine and lives right around the block -- but I'd like to be diplomatic about these things whenever possible. So I said that everyone dies eventually, but that she was going to live a long long time and grow up and do wonderful things, and she seemed fine with that. I have no idea if that's what you're supposed to say. I never looked it up, because I didn't expect to be having this conversation with a 4-year-old. Next she's going to ask me where babies come from.

Kiddo meanwhile is -- well, it's hard to say. He's had a couple of good-enough days at school. He hasn't complained about the vest -- to us, anyway. He got a good report card (as expected, just fine academically, less so behaviorally). But he's been a hair-trigger away from a meltdown on pretty much a constant basis. On Saturday, he utterly flipped because he didn't have time to watch TV before karate class, to the point where I nearly didn't bring him to class. On Sunday, he utterly flipped because the guests for our impromptu Super Bowl party were running late and he wanted them to come play with him. Today, he utterly flipped because he would not be woken from his nap and thus missed out on playing in the snow during his 197876879732877684th snow day of the year. I wonder what he'll utterly flip about tomorrow?

He's got no coping skills, emotionally. Something that would be a minor annoyance to another kid is a major crisis to him, and he can't process it. I don't know if it's the ADHD or the OCD talking, or if they're just sort of ganging up on him and it's a team effort. I can't lie -- it's exasperating, even knowing he's not doing it on purpose. I'm not always sure what to do about it.

Today was kind of a freebie with the snow day, but we'll see how he does the rest of the week. If the modified class accommodations keep helping, great. If not ... hmm.