Slightly better?

So far so good, anyway. I'm not sure kiddo is any different, but the setting is different, and I think that's what he needed most -- to be in a room where there's always someone to help him, and he isn't automatically the bad kid, and the other kids are more or less like him anyway. Arguably he needed that at least a year ago. But he's got it now, and he's had some good days -- and he's actually doing his homework instead of, say, hiding it under a floor mat at school and then coming home and telling us he didn't have any.

We had one awful day last week, where he switched into some other, meaner kid and was kicking and punching so he wouldn't have to do homework, but we're hoping that was him transitioning into the new situation; we haven't seen the other kid since, at least not to that level.

We spent the entire week alternately meeting with and yelling at various school officials over the way we thought the whole situation had been handled, and to everyone's credit, they were helpful and did not yell back. So we will try not to dwell.

Everyone we speak to has a different theory, a different concern about kiddo. He's OCD. He's not OCD. He's got social communication disorder. Well, now we're not sure about that. He's got pieces of autism. Hmm, sort of. He needs speech-language pathology testing. Nope, no disability there.

Let him indulge in the baby talk. No, tell him to stop. Use a behavior chart. Don't use a chart. Use THIS chart. Get him into Boy Scouts. He might not do well in Boy Scouts.

Is your head spinning yet? Imagine mine.

So he's got ADHD, and some form of Who Knows What Else.

The one thing every single doctor, therapist, educator and otherwise observant adult is happy to agree on is that kiddo is smart. Which is great. But we jump off from there into a minefield of "This-No-This-No-This-No-Try-This."

There is something that stuck with me, from the school's OT, who wanted to pass on her observations about him: She said that because kiddo doesn't understand emotional communication, he just doesn't speak that language, he spent most of school in this "fight or flight" state, not understanding what was happening around him, not sure what to do about anything, and thus constantly trying to protect himself by lashing out, acting silly or running off. She thinks some of his behaviors, sometimes aggressive, seemingly out of nowhere, were defense mechanisms. It makes sense to me. (It may also describe some other people I know.)

I'm not sure yet what to do with that insight. I'm not sure what to do about a lot of things. But it's nice not to be getting calls from the school every day -- seriously, I was starting to cringe every time the phone rang -- and it's nice to see his daily chart saying positive things. I'm hoping it can continue.

He came home today and, after some protest, did his homework. Then he sat next to me on the couch and waited for me to finish something so he could use my computer. Then he fell asleep on my shoulder. I finished my work that way, with him sleeping on me, and it was such a peaceful little moment. We don't always get those, so I'm glad I got that one.

In which she reappears

Wherever did I go? Well, first I took a month to work on a novel. And then it was the holidays. And then I left my job. So, how have you been?

I had a few reasons for the move. One was to focus on getting published finally. Another was to actually be around to parent my children once in a while. Have dinner before 7:30. Be awake enough to handle my special-needs kid. Things like that. Because parenting neurotypical kids is difficult enough when you work full-time. Parenting a kid with ADHD, who is physically incapable of brushing his teeth without getting distracted about a thousand times? It takes so much more patience. I'm barely capable of that as it is, let alone when I'm exhausted from working.

So after much strain on the family, I finally made the decision that any number of loved ones had been suggesting I make for, oh, I hate to even tell you how long. I kept delaying because I had visions of singlehandedly bankrupting the family and getting thrown out on the street. I'm a worst-case-scenario kind of thinker. But actually we should be all right financially. And already kiddette is over the moon that I'm picking her up at night and we're making dinner together. She insisted on helping with the chicken pot pie last night, and the salad, and on eating whatever slivers of avocado didn't make it into the salad.

Kiddo? It's hard to say. He's having major issues with transitions again. He's refusing to do things at school. He doesn't get dressed in the morning unless I repeatedly walk into his room to nag him about it. He's defiant when he's upset. "I don't have to listen to you!" That sort of thing.

It's possible my being home has upset his routine, and he doesn't know how to process it. Or just going back to school after a lovely, gift-filled holiday is too much to bear. I'm not sure.

We did finally get our insurer to reimburse for a social skills group, so he's started that this week. He's doing well with his behavioral therapist. Something has to work, right?

The important thing is, whatever happens, I'm here to deal with things. And that should make a difference in the long term, for all of us.

And another diagnosis

Which comes courtesy of the psychiatrist who evaluated kiddo as part of the IEP evaluation process. Kiddo currently has a 504 plan, which would be fine if the accommodations got him to the point where he could perform well academically, but his grades were starting to slip. Hiding under your desk instead of doing your math classwork will do that. The hope here is that he'll get approved for the IEP and an in-class aide, because I'm not sure how he'll stay on task otherwise -- and the work is only going to get harder. 

The school suggested another evaluation just to make sure we had the right diagnosis, and that we hadn't missed anything. So kiddo and I hauled out to the psychiatrist's office, where I spent the next three hours filling out forms. No, sorry, it just felt that way. Actually it was just over an hour. So much better, right?

Those social history forms depress me. "Does the child live with his/her biological parents? Are there any custody disputes? Has DYFS gotten involved? Is there a history of drug or alcohol abuse in the family?" Etc. You get the feeling that a lot of kids who go through these evaluations have bigger issues to deal with. 

The psychiatrist was nice enough, though she had that dripping-with-sympathy look on her face that I've gotten from other medical types. Like she was waiting for me to freak out when she said "social communication disorder." No time for freak-outs, lady. I've been through this whole diagnosis thing before. He's a lovely kid, yeah yeah I know. Now what is it he has again, and what do I do about it?

What he has -- well, that's seemingly a debatable point. This particular diagnosis is new to the latest edition of the DSM, aka the Diagnostic and Statistical Manual of Mental Disorders. If this were a few years ago, he might have gotten an Asperger's diagnosis, or else PDD-NOS, aka "pervasive developmental disorder not otherwise specified." Since it is not a few years ago, we get to be a bit of a diagnostic guinea pig, I suppose. The basic point being, he shows some signs of autism, such as the inability to maintain eye contact, but not all of them, such as the hand flapping or spinning in circles.

Social skills are definitely an issue for him. Reading facial expressions. Getting too hyped up and thus overreacting to things. Respecting personal space. This just puts a name to it, I guess? I mean aside from the ADHD, which he most definitely has, in case there were any doubts. 

Among the recommended treatments -- and this does not appear to be set in stone, because the diagnosis is so new -- is behavioral therapy, which coincidentally we were looking for anyway, so that sort of worked out. We haven't gone to a behavioral therapist since the last one quit taking our insurance, and then we spent a year fighting with the occupational therapy facility about their inability to file insurance invoices properly, so we never found a new practitioner. We have an appointment set with a new one in a couple weeks, so we'll see what happens. 

In the meantime, we're hoping to get kiddo through day care all summer with a minimum of meltdowns and/or other incidents. More information on this whole SCD thing as soon as I have some.

Put the tablets away.

Restaurant dining is more or less a minefield for an ADHD parent. You have to be mindful: Will he stay in his seat? Get bored and act up waiting for his entree? Will he be too cold or will the noise around him be too loud? Will he settle for hiding in his hoodie or will he hide under the table? Will something cause a meltdown and will you have to haul him out of the restaurant until he calms down?

Will you get to eat a single bite of your meal in relative peace?

I never of course considered the tablet factor. Which is because I would never dream of letting my kids play with a tablet in the middle of a restaurant. They're out at dinner, it's a special occasion, they should have actual conversations with the other people at their table. At most, I'll give the kids pens and let them draw on the placemats until dinner arrives, presuming the placemats are paper.

But let's just say the parents at the next table were working from a different playbook (one that's battery-operated, clearly), because their kid was on his tablet the whole meal. Even though it was a semi-expensive place generally used for special occasions. Even though, judging from the large group at the table and the presents and such, they were there for granddad's birthday. Nope, the whole meal. I know this because kiddo's eyes were glued to the screen for our entire meal.

He's not capable of looking away from a screen when one is available. He kept kneeling on his seat, craning his neck to watch the other kid ignore his loved ones and play Minecraft. Then he snuck over to the other table to watch from behind the kid. Over and over again, no matter how many times we shooed him away.

Vastly irritating, made more so by two factors: 1. There were 10 of us and no way to easily move to another table and 2. Every single other table around us also featured a kid on a tablet so there was no escaping it.

Seriously, if you're just going to hand the kid an electronic babysitter so he shuts up, why are you bothering to shell out the cash for nice food? Get the kid a real babysitter, send out for some pizza and leave. That way no one has to pretend to enjoy the others' company.

One of kiddo's relatives, who was trying to be helpful, pulled out her own tablet so he would leave the other kid alone. Except that this was what we were trying to avoid in the first place. Why? Because when the cake and the candle showed up, kiddo was too busy playing Plants vs. Zombies to notice that we were singing Happy Birthday to Daddy, and when I tried pulling the tablet away so he'd join us, he freaked out.

For the remainder of the meal, kiddo either obsessed about wanting the tablet back (no way) or hung around behind the other kid and watched him play. One lady from the other table, clearly thinking she was being nice, walked by and assured me it was no problem if kiddo watched the gameplay. What I did not say was, "Actually it would be really helpful if you took that stupid tablet and tossed it in the nearest Dumpster so that my son would calm down for five minutes and I could salvage some part of this meal." Because, you know, probably not nice.

To be clear, I don't object to the general use of tablets and phones. I use my phone a lot. I love my phone. But I don't bring it to the dinner table. And I'm perfectly OK with kids using a device until the appetizer shows up, or until the entrees show up, as long as that's their cue to quit their game and start making eye contact with people.

I am most definitely not OK with other parents making my job harder. Especially since my kid -- the one having the freakout -- was the one who looked like a bad kid, not the other kids sitting silently at their tables, obliviously using their tablets.

We're unlikely to have 10 people to dinner again anytime soon, though, so next time this issue comes up -- and I have no doubt there will be a next time -- I'm going to ask the waiter to switch our table. I'll request a no-tablet zone.

On being the LCD

Meaning, lowest common denominator. See, I remember some stuff from math class. I just justified my education. Now if I could figure out how to calculate the tip on a restaurant bill, I'd be absolute genius level.

DH and I are the LCD. And so are you, if you're a special-needs parent. You're the one who knows everything there is to know about your child and your child's diagnosis, and what's worked in the past and what hasn't, and which medication your child is or isn't on and whether that's the second or third medication you've tried. You know the names of all his doctors and his OT and his teacher. You know her favorite book and her favorite color and what she's thinking about when she melts down. You know how he does in karate class or how she does in ballet. Everyone else knows a piece, a part, one thing. You know everything. You are the lowest common denominator in this equation.

I was reminded of that fact when kiddo had a bad time last week and got himself suspended from the bus for a day. He likes to be first off the bus. Several times he's pushed other kids to get in front of them. The driver was worried a kid would fall down the steps. I get it -- it's dangerous. Kiddo shouldn't be doing that. At the same time, I get kiddo -- he's not trying to hurt anyone. He genuinely didn't realize he could hurt anyone. He just wanted to be first. When his mind is locked on a thing, it's difficult to get him unlocked.

Fortunately the 504 coordinator gets that too, but it didn't prevent the suspension. Kiddo was also more defiant all week, talking back to us, more sullen, refusing to do things when asked, and more hyperactive than usual. Which is why I yanked him right off medication #3 and he's back on #1, which seems to have calmed things somewhat. It's not a perfect fix -- he's still hiding under his desk instead of doing his classwork -- but his usual sweet personality seems to have more or less emerged.

DH and I were displeased about the suspension. Sure kiddo should be punished if he does something wrong. But kicking a kid off the bus for a day is a bit more like punishing the parents, who then have to rearrange their work schedules to account for it. Also we would've been less aggravated if it hadn't taken 10 days to find out about the first infraction. What are we supposed to do at that point?

US: "Hey, kiddo, remember 10 days ago when you pushed a kid on the bus?"
KIDDO: "Huh?"

I mean he's lucky if he remembers what he had for lunch that day.

Anyway. DH and I requested a meeting with the school, to complain about the lack of communication and the lack of info we were getting about how he was doing. It's a good thing we did. One of the assembled officials had no idea we'd been trying a new medication. Another one was unaware that kiddo's social skills group had ended for the year. A third had revised his behavior chart but never sent along a finished version, so he was working without one. (Apparently kiddo has been doing fine without a chart, so we're leaving that one alone.) The assumption had been that we didn't want daily updates on kiddo's behavior, when actually we very much do. It seemed like everyone had a piece of information about kiddo, or about his accommodations, but DH and I were the ones who knew the most. And if we hadn't requested the meeting, possibly the officials would never have shared their information with each other (or us). 

We are the LCD. We make sure everyone is aware of everything. Because teachers and doctors, despite the best of intentions, are not going to be able to help kiddo unless they know everything they need to know. Ultimately, always, it's up to us to make things happen.

Kiddo really does seem improved this week, so here's hoping he keeps at it.

In memoriam

I met Tanji Dewberry at the Happy Mama Conference -- that is, the conference for mothers of special-needs kids -- last year. I was struck by several things: She was incredibly nice; she'd turned herself into a strong advocate for her son, a little older than my son, who also had ADHD; and man, did she wear amazing shoes.

She was one of the few other New Jerseyans I came across that weekend, and she'd self-published a children's book, "Oh Fiddlesticks!" designed to teach kids how to handle their anger. I was nosy, so I quizzed her on how she'd gotten the book done, how much it had cost, that sort of thing; she readily answered every question. She signed a copy for my son.

On Sunday night, she and her son died in a house fire.

The cause is unclear, though possibly an electrical malfunction. I keep being horrified by this story all over again. She was doing right by her son and trying her best to achieve her dreams, and it is just not right that the two of them are not here anymore.

Over on the Happy Mama Facebook page, there is talk of creating a conference scholarship in her honor. I think that's a nice idea, and should one happen, I'll post any pertinent links. I keep looking for an obituary, for someplace to send a memorial contribution or a card or, I don't know, something. I feel like attention should be paid.

I can't say I knew her well. But she seemed very much worth knowing. And I think this is a tremendous loss.

Incidentally, her book? My kids like it. In fact kiddette asked me to read it to her tonight.

I'm glad I bought it when I had the chance.

Dear Abby, think again.

I mean, I guess it's progress of sorts when ADHD makes it into a nationally syndicated advice column. Even if you don't totally agree with the advice given.

A high school student (I'm assuming high school, no age given) wrote to say that their ADHD medication was suppressing their appetite, and so they didn't eat any lunch, and well-meaning teachers and friends have been pushing them to eat, not knowing the situation. The student didn't want to tell anyone, because some of those friends make fun of people with ADHD.

Abby (okay, "Abby") says to inform the teachers about the medication, but added this:

"It's a shame they would tease someone who has ADHD because it's a condition that so many students and adults share. However, because you feel it would make you a target, you're wise to say nothing."

No, no, no.

I wouldn't call it "wise" to hide a significant part of yourself away in hopes that no one will laugh at you for it. That suggests that people are right to laugh at it, and no they are not.

Also, frankly, if you're different, people pick up on it, and if they're so inclined, they'll make fun of you for it even if you pretend that difference doesn't exist.

Really. Just ask every kid in grade school who made Jew jokes about me.

You have to turn it around. Why is it on you to convince people not to pick on you? Why isn't it on them to try harder not to be jerks?

You should never be ashamed of who you are, and anyone who would try to make you ashamed is not someone who deserves the privilege of sitting next to you in the cafeteria.

At no point have I hidden kiddo's diagnosis from anyone. His family knows. His teacher knows. The other moms know. His karate sensei knows. Because I am not ashamed of him, and because figuring out what works and doesn't work with him is sometimes a group effort. It takes a village to tackle ADHD.

And because of that openness, other people are open with me; they talk to me about their special-needs child, or ask where to go for an evaluation. It's good to know other parents deal with the same issues.

Even if I wanted to, I'm not a good enough liar to pretend I have some sort of Stepford-perfect son. I'd rather be honest, with other people, with kiddo and with myself. I don't want kiddo to grow up thinking he needs to hide his ADHD from people. I want him to be proud of who he is -- all that he is.

Just my two cents, Abby. Carry on.

Part one: Exasperation

I'm breaking this up into two posts because I've been short on time this week. Just catching up.

Kiddo has the occasional off day, when his hypersensitivity is extra-sensitive or he can't stay in place for more than a nanosecond or he stomps around in an evil mood because his understimulated brain craves the drama. So that might have been his problem this past weekend. Or he was acting out because DH was out of town for work. Or the 6 p.m. birthday party he went to threw off his sleep schedule (though he did have a blast at it). Or who knows. But he spent most of Sunday being thoroughly whiny and unpleasant and having those tantrums in which he collapses to the floor and wails. Something you'd expect from a 3-year-old, maybe not an almost 7-year-old, but ADHDers tend to be behind their peers emotionally and behaviorally. I can handle two or three of those fits, but when it's more like seven or eight within two hours, yeah, I'm done. Especially when one is in the middle of church.

Actually one was in the parking lot outside church, because I wouldn't let him bring his noise-making Angry Bird toy inside, on the grounds that it might make noise. It got to the point where I walked kiddette back to the car and started strapping her back in, because I didn't think he would make it inside. After that was the tantrum inside church, when he darted off toward the snack table again, I darted after him and grabbed him away (the kids had literally just had their own snack) and he collapsed on the floor. In front of everyone. It's probably just my imagination that we instantly became the center of attention. Right? It is not my imagination, however, that one of the adults announced jokingly, "It's the RE eater!" Oh good, thanks for the nickname. Appreciate that.

Some of the other adults -- as in, the ones who have kids -- tried to help, telling kiddo he needed to listen to me and such. But I still ended up dragging him to the other side of the room to start getting the kids ready to go. At which point one of the other kids, clearly sent over by a parent, brought him an apple slice. Which was nice. Really. But also entirely defeating the purpose of my dragging him away from the snack table in the first place.

I'm feeling like maybe we need to reconsider this church thing.

That wasn't the end of the tantrums, of course, because he threw a few more during the post-church playdate, about sharing toys and cleaning up, at which point I hauled them both home and quit attempting the model-parent act, being thoroughly angry and growly, and made them both take naps. Kiddo was out like a light, proving that what I really should've done was skipped church entirely and sent them to bed for half the afternoon, but the other mom and I have been trying to schedule a playdate for a month-plus. I want kiddo to have a social life, but what if he keeps getting in his own way?

And why does kiddette keep having to suffer indirectly from her brother's wrath? I honestly don't know what to do about that.

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.”

Argh.

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?

No vest for the weary

Kiddo wears a weighted vest at school. Not all day, but at timed intervals; X minutes on, X minutes off, that sort of thing. It's supposed to help with his sensory issues, since he doesn't feel grounded, doesn't "know where his body is in space," as the therapists say; to ground himself, he might otherwise "seek input" by crashing into things and/or people. (Or my hip. That's been going on for years. A hug from kiddo is more like a full-body assault. I'm used to it, and will brace myself when I hear him coming so I don't topple over.) Also, carrying the extra weight around -- aka "heavy work" -- helps burn off some of the extra energy. At least in theory.

In practice, he's been complaining at school about it, wanting to take the thing off as soon as he gets there. He's never said anything to us about it, but maybe he thinks we won't listen. Or maybe getting out of the house is such a monumentally herculean task every single weekday, requiring the extensive use of timers and repeated instructions and occasional threats ("OK, you can skip breakfast today if you don't want to get dressed. I'm going downstairs, bye." Obviously a threat we've never carried out. But still), that he's just doing what he's asked so he can be done more quickly. Because doing any routine sort of anything hurts his brain.

This came up during our meeting with the school last week, set up because he's also been shutting down approximately after lunch, lying on the floor, refusing to do his work, basically hiding in the sensory corner. We were trying to figure out how to settle him so he could focus on the work, which his teacher (and I) are positive he can do, because he's smart.

By the way? I love that his teacher set up a sensory corner in the classroom, even if kiddo would rather spend all day in it than do his work.

I'm not sure what to think about the vest. He's never had an issue wearing it before. But possibly, he's finally noticed that the other kids don't wear one.

"Hypersensitivity" is another part of the whole ADHD puzzle. It means ADHDers are very, very aware of what the people around them are doing or saying, like having antennae permanently at work, and are liable to think they're being criticized or laughed at when they're not.

One time a year-plus ago, kiddo and I were walking through a parking lot, and maybe 20 feet away were a couple of teenage girls, laughing to each other. Kiddo was utterly convinced that the girls were laughing at him, because he'd just lost his toy car. I explained to him that 1. they were total strangers, 2. they were twice as old as he was, 3. they were too far away to hear or be heard and 4. why would they care about his car anyway? And yet I couldn't shake him on it. That's the sort of thing we occasionally deal with.

So, is he being hypersensitive about his vest? Has it outlived its usefulness? His teacher is going to switch him over to a weighted lap blanket for parts of the day to see if that makes a difference.

The other possibility is, well, he's just tired. It is, as every other adult on the planet is fond of pointing out to me, a long day. (Gosh, and I do appreciate the daycare guilt. Thanks.) He'll still take a nap if you let him. How do I know? It's 5 p.m. on Sunday and he's napping right now. And has been since about 2. (I suspect he's going to be annoyed when he wakes up to discover it's too dark to play in the snow. Sorry, kid.)

So if he's just too tired, what do I do, start sending him to school with mocha lattes? Slip a Red Bull in his backpack? Because while he can lie down at the nurse's office for a few minutes as needed, they don't do naptime in first grade.


At the school meeting, we agreed that they would adjust his behavioral chart, add in more little breaks throughout the day and give him extra chances to move around, in addition to using the blanket. Maybe it'll help, maybe not. If he really is too tired to function, does he need a 6 p.m. bedtime? And in what universe would that be logistically possible?

Tell you the truth, I don't blame him. One of the more disappointing things about adulthood is the lack of naps. Or maybe it's no summers off. Yeah, it's that.

New year, old rants

But first, Happy New Year plus five days! The kids had a lovely time with Grandma and Grandpa and we had a lovely time without the kids. Although I don't know how much longer we'll be doing these yearly shindigs, since this time next year, all the couples involved will have kids. I guess we could just let the kids have the world's longest playdate while we make fun of Ryan Seacrest in the next room. (Seriously, would that guy's hair move in a hurricane?)

The schools were open precisely one day last week because the weatherfolks were predicting Snowpocalypse Part II and school officials statewide panicked. (Spoiler alert: It was not Snowpocalypse Part II.) So this week will be one massive transition back to regular school life, unless the freezing temps/ice storm prompt yet another closure, and let's hope not.

How well are we transitioning so far? You mean aside from kiddo being an utter basket case by dinnertime and inconsolable by bedtime? Oh, fine. Just fine. He got the necessary number of checks on his behavior chart at school, so at least he kept it together long enough to come home and dump his lopsided emotional equilibrium on us. Because we only let him watch one TV show. And because we actually expected him to eat his dinner. And because having correctly judged his emotional state, we refused to let him work on his book report tonight, since it wasn't due yet. That's right. He flipped out because we told him *not* to do homework.

I mention all this because there's a wonderfully helpful neurologist coming out with a book called "ADHD Does Not Exist: The Truth About Attention Deficit and Hyperactivity Disorder.” Isn't that nice? I must've imagined the whole scene tonight. Or all the other moms I know whose kids have ADHD must also be imagining their kids' behavior, which -- funny thing -- strongly resembles my son's behavior. What a strange thing to be delusional about. I'd much rather be delusional about the idea that ice cream has no calories.

Anyway the NY Post, displaying the subtlety it's known for, writes:


Patients show up at the clinic with their own ADHD diagnoses these days, simply because ADHD is in the air all around us — and because they want to score some delightful drugs like Adderall or Ritalin, or because their parents want an easy way to get them to sit down and shut up.


*sigh* Yeah. Number one: It's not "in the air all around us." What you're thinking of might be cold germs. Number two: There are actually a number of medications available to treat/manage ADHD, many of which aren't stimulants. And none of these medications is meant to be "delightful" -- just "functional." Number three: If all my kid did was run around a lot and talk a lot, do you really think I'd be taking him to a pediatric psychiatrist?

I have a tendency on thishere blog to focus on the meltdowns and the personal-space issues and the sensory issues and the frustration over being asked to do any sort of rote, routine anything, but the thing is, kiddo is a total sweetheart. He's utterly charming, he's friendly to everyone, he plays peekaboo with babies in the checkout line at the supermarket. He tells me he loves me constantly, gives me hugs and plays with my "squiggly" hair. He's smart and funny and he loves books. I wouldn't trade this kid for anything. No, he's not easy to raise. If I wanted something easy to raise, I'd have gotten a goldfish.

Richard Saul, the neurologist in question, says:


“ADHD makes a great excuse,” Saul notes. “The diagnosis can be an easy-to-reach-for crutch. Moreover, there’s an attractive element to an ADHD diagnosis, especially in adults — it can be exciting to think of oneself as involved in many things at once, rather than stuck in a boring rut.”


 I don't think people find it exciting to think they might have a mental disorder. I think maybe they're relieved to finally discover what's wrong with them, why they can't hold down a job or keep a relationship or manage their money. I think the person I briefly emailed with via the ADDitude boards, the one who hoped my moms group might help him, wasn't excited about his "easy-to-reach-for crutch." More like, his life was in ruins and he didn't have anywhere else to turn. (I never did hear back from him. I hope he's all right.)

Frankly nearly every debunked case cited in the article is an adult patient -- not a kid. I fully believe that there are a lot of misinformed adults out there who might jump to a conclusion about a diagnosis without ruling out all physical possibilities (sleep deprivation, too much caffeine, as the article cites) first. Because this is a country of jumping to conclusions. Fiber is good for you? Put it in everything. Omega 3's are good for you? Put that in everything. Eggs will kill you instantly! Eggs will save your life! Etc.

But none of that explains the kids. The ones almost physically unable to join in the group. The ones who are so clearly trying to listen to everything around them at once that they don't hear anything. The ones who are so unable to comprehend personal space that they repeatedly get in other kids' faces until the other kids bite them, just to make them stop. (Kiddo, in preschool.) The ones who blatantly stand out from the other kids, no matter how hard they try to fit in. Explain that. Help that. Or would that not help book sales?

Moving on ... to, shockingly, a story in the Times. Aren't you shocked? The Times tried to prematurely ruin my New Year's with this article, saying that some authors of a NIMH study 20 years ago now think the study oversold the benefits of drugs and discouraged other treatments, such as behavioral therapy. And then the big bad pharmaceutical companies used the study to direct-sell their drugs to parents and doctors. Because apparently parents and doctors don't know how to do research. Or else they would have read about that NIMH study, as I did when I was first researching kiddo's diagnosis, in "ADHD: What Every Parent Needs to Know" from the American Academy of Pediatrics:

"[The study] found that stimulants used as the sole form of treatment led to significantly better results for the core symptoms of ADHD than behavior therapy used alone. A combination of the two approaches, however, has been shown to lead to the best overall improvement in several aspects of ADHD. ... Parents in the MTA study whose children used this combined approach were often significantly more satisfied with the treatment plan than those whose children received medication alone."  (2nd edition, p. 50, if you're interested.)

So, if I was able to read this book and find this passage, and know all along that medication was a last-resort possibility even as I hunted down a behavioral therapist and an occupational therapist for kiddo, then, really, no one else for 20 years has been capable of doing that? Or does the whole notion of doing your own research not fit with the theme of the Times' stories?

All I want for 2014 is to read one story about ADHD that acknowledges what it's like to live with the disorder, instead of taking potshots at the mere existence of medication. And my birthday is coming up. Hint hint.

My continued annoyance

I'm still irked at the last Times story. (I know, C. I know.) Just once I'd like a major news outlet to report some aspect of ADHD other than, it's overdiagnosed and kids are drugged-out zombies. It amazes me that the Times is only capable of finding 1. now-grown kids who say they were wrongly diagnosed or 2. parents of now-grown kids who say they were wrongly diagnosed, as opposed to, say, someone who was correctly diagnosed, benefited from the diagnosis and even benefited from the medication. But that wouldn't fit the reporter's predetermined narrative, I think.

I would also like to think that the whole process of diagnosing and treating kids has changed in the last 20-30 years or so -- being that there's more potential for physical evidence of it (hence the federal approval of this brain wave test), and more awareness of the disorder generally (in that no one is calling it minimal brain dysfunction anymore). So why the Times is insisting on solely reporting about cases 20-30 years ago is beyond me. Kids and adults are dealing with it now. Maybe the Times would like to pay attention to that? Or is that too much of a ... distraction?

I love my son, but I don't always love the cascading series of meltdowns over being asked to get dressed, brush his teeth, put his shoes on, put his coat on, get his backpack, walk in the direction of the door, every day, when the idea of doing any sort of routine thing ever clearly hurts his brain so much he'd rather hide under the couch cushions. I could probably do without his being the only kid in the entire restaurant to wear his cloth napkin on his head. (OK, admittedly a little funny.) And I'd kind of like it if he could get through one lunch period at school without getting too overstimulated and goofy, and getting in other kids' faces and roughhousing too much, because a crowded, noisy, unstructured cafeteria is going to ping his hyperactivity/sensory issues/social skills issues. And yet kiddo's story isn't anywhere to be found in the Times, and I think if the Times is going to continue to rant about ADHD that they should make sure to tell all the stories.

Incidentally, since I was mainly doing a little flamethrowing last week (admittedly something I enjoy), here are two other responses to the Times article that are better than mine: One from ADDitude magazine and the other from the Child Mind Institute.

And now I swear to quit snarking on the Times until after Christmas. That's only three days, you say. It still counts, I say.

Kiddo has been pretty consistently demanding a "bomb gun," i.e. a gun that shoots some sort of harmless ball things, which he's wanted ever since seeing one at a friend's house on a play date. So, serves me right for giving him a social life. I'm not wild about toy guns. I don't feel like guns should be used for play. And if you think I'm overthinking it ... well, you must not watch the news much.

But. being still new to this Santa business, I felt I was in a conundrum. Does Santa ever say no? Does he ever not bring a kid the specific thing the kid asked for, on moral grounds? And if kiddette gets the thing she asked for (a purple cat, in case you were wondering, and I'm not sure why she thinks the entire world should come in purple, but at least it's not pink), how is kiddo supposed to feel if he doesn't?

I finally told him that Santa and I talked about it, and that if Santa were to bring him one, he would have to promise never to point it at any person, ever, or he would lose it. I don't know if that's the right solution. I do know I'm holding him to that promise.  And I hope that that's good enough.

Man this Santa thing is complicated. It's like another layer of bureaucracy to think about.

At any rate, Merry Everything, and may your holidays be lovely and may you continue to be full of wonder at the world around you, like kiddette, who today discovered that she really, really likes carrot cake.

The Times reports

that the overbearing direct marketing of ADHD medications to neurotic parents and clueless doctors is the reason for the jump in ADHD diagnoses over the past 20 years. The Times also seems to think that ADHD drugmakers are the only ones guilty of such a thing, and no other drugs for any other malady, disorder or issue have ever been over-aggressively marketed to the public. Also, the Times thinks that the only parents or kids worth asking about the subject are the ones who disagreed with the diagnosis and hated the drugs in the first place.

But really, the Times says, it's a real disorder. Really, we believe that, we swear. Sort of.

The article I'm talking about is of course this one, from Sunday. I quote:

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge. 

But even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data. 

Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension. 

I can't really speak to the advertising, because I tend to ignore advertisements, except when I'm mocking them out of sheer exasperation (I'm looking at you, giant-bow-wearing Lexus one-percenter car ads). I didn't seek treatment for my kid because an ad told me he would get better grades. I sought treatment because it was the only way he was ever going to function in a group setting. Or possibly in any setting.

It's entirely possible ADHD is overdiagnosed. I guess it's possible some people would rather get their medical info from a magazine ad than from a doctor. It's also possible that certain doctors are diagnosing without the proper medical experience or knowledge and are using the medications as the first treatment option, not the last resort. Just saying. 

Believe me, I am in no way defending the drug companies and their massive marketing budgets. I don't much like that either. I also don't like all the other medication ads I see on a regular basis, in magazines or on TV. Judging from the ads during football games, football fans all have erectile dysfunction; judging from the ads in the magazines I read, all women interested in entertainment news are severely depressed. Also, all watchers of WE tv and Lifetime have weight issues, and all watchers of, well, anything have insomnia. 

I would be perfectly in favor of all drug ads going away; for one thing, they're insulting. For another, they're inaccurate. Of course they're inaccurate. They're selling something. Even cereal ads make misleading or false claims to make the sale. Medication, naturally, being of greater concern than Frosted Mini Wheats.

The Times again:

 

Companies even try to speak to youngsters directly. Shire — the longtime market leader, with several A.D.H.D. medications including Adderall — recently subsidized 50,000 copies of a comic book that tries to demystify the disorder and uses superheroes to tell children, “Medicines may make it easier to pay attention and control your behavior!”

Profits for the A.D.H.D. drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health. 

Yeah, I've got a bunch of books that try to "demystify the disorder." "Shelley the Hyperactive Turtle." "Cory Stories." "Eddie Enough." Pretty good books. In all of them, the main character, at some point, begins taking medication. I don't love that, if only because people can and do manage without it. But all the kids I know with ADHD take something or other, because they needed to, or because their parents tried every other option first and decided this had to be the next step. Like us. So honestly, if that's in the books, so be it. Those books don't appear to have been subsidized by any drug companies, dear Times -- is that all right by you?

Believe me, if a kid has ADHD, they know they're different. They know they have trouble with things their friends can do with no problem. If the best way to explain to that kid what's going on is to use a book, or a comic book, is that really so objectionable?

When federal guidelines were loosened in the late 1990s to allow the marketing of controlled substances like stimulants directly to the public, pharmaceutical companies began targeting perhaps the most impressionable consumers of all: parents, specifically mothers.

Says you.

A.D.H.D. patient advocates often say that many parents resist having their child evaluated because of the stigma of mental illness and the perceived risks of medication. To combat this, groups have published lists of “Famous People With A.D.H.D.” to reassure parents of the good company their children could join with a diagnosis. One, in circulation since the mid-1990s and now posted on the psychcentral.com information portal beside two ads for Strattera, includes Thomas Edison, Abraham Lincoln, Galileo and Socrates.

The idea of unleashing children’s potential is attractive to teachers and school administrators, who can be lured by A.D.H.D. drugs’ ability to subdue some of their most rambunctious and underachieving students. Some have provided parents with pamphlets to explain the disorder and the promise of stimulants. 

(OK, seriously, Psychcentral, you can't diagnose someone a century or two after they're dead. You couldn't just go with Michael Phelps or Ty Pennington or Jeff Kinney? People who are still living?)

Also, teachers and school administrators should not be advising medication, because that is out of their area of expertise, and they could be courting legal trouble. It just figures the only parents the Times could find to talk to for this article are parents whose school officials acted inappropriately.

Insurance plans, increasingly reluctant to pay for specialists like psychiatrists, are leaving many A.D.H.D. evaluations to primary-care physicians with little to no training in the disorder. If those doctors choose to learn about the diagnostic process, they can turn to web-based continuing-education courses, programs often subsidized by drug companies. 

Soooo, maybe the answer is that insurance plans should provide coverage for psychiatrist visits? Oh wait, that doesn't come up again, because the point of the article is to rail against the drug companies. 

Look, I'm not necessarily saying the article is bad. It's just, if the only time you're going to write about ADHD is because college kids are abusing the drugs and dying, or because the drug companies have played hardball in selling their products, you're still implying the disorder isn't real. Especially if you don't talk to a single parent of an ADHDer, or adult ADHDer, who has good things to say about medication.

I'm all for enforcing truth in advertising, but can't we also have some actual truth?

The week in ADHD news

Well, apparently there is hand-wringing about baseball players on Adderall. The Los Angeles Times says Major League Baseball players received 119 exemptions for ADD medications last season (incidentally, dear L.A. Times, the preferred term these days is ADHD. You might want to make a note of that), which is apparently a record number. Also, seven players were disciplined for unauthorized use of Adderall; the exemptions became necessary as of the 2006 season, when MLB banned amphetamines. The number of exemptions has risen every year.

The Times says that according to the MLB's numbers, one in 10 players has been diagnosed with ADHD (not ADD), which it calls "at least double the incidence of ADD in the general population." Uh, for real? Because literally just last week, the CDC said more than 1 in 10 U.S. kids has been diagnosed with ADHD, per a 2011 survey. That's just kids, not adults -- and plenty of adults have been getting diagnosed for the first time in the past generation or so, after spending their whole lives wondering what was wrong with them. (Don't believe me? You go read the posts on the ADDitude boards.) I'm no statistician or math whiz or even remotely comfortable around numbers of any sort, but if the CDC is correct, then how in the world is the MLB number double the general population?

I think what the Times is getting at is that players are scoring legal methamphetamines so that they can, well, score. And field the ball, presumably. Except here's the thing. It's not unrealistic for an athlete to have ADHD, any more than it is for a singer/actor/writer/artist. Exhibit A: Michael Phelps. Exhibits B and C: Shane Victorino and Andres Torres. ADHDers tend to have ridiculous amounts of energy and a need to burn it off. They tend not to do well in very rigid surroundings. They'd much rather be moving about than, say, filling out TPS reports.

As always, don't take my word for it. Per ADDitude magazine:


Many experts say a connection between ADHD and athletics makes sense. "Having ADD can actually be an advantage in certain sports for ADHD children," says Mike Stabeno, author of The AD/HD Affected Athlete. "While some activities require intense concentration, that's not always the case with athletics. Everything happens instantaneously. You're in there for 10 minutes, you've got five people trying to take your head off, three referees, four teammates. You need to take in everything that's going on all at once. That's how people with ADD go through life. So it makes sense that they thrive in this field." 

So 119 out of 1,200 baseball players having ADHD doesn't sound unrealistic to me.

Sure it's possible some of those diagnoses are specious, or made on a snap-judgment basis, or made for the access to medications. Of course it's possible. Is it possible that every single diagnosis is bogus? Again, not a statistician, but I don't think so. I think the real issue, again, is this assumption that ADHD itself is bogus and people just get diagnosed so they can get the meds. And that assumption will never stop irritating me. We've spent the past year and a half doing occupational therapy, behavioral therapy, social skills classes, pediatric psychiatry and classroom accommodations, not to mention the money we've dropped on a weighted vest, compression shirts, triangular pencils, etc. You think we're doing all this for a bogus diagnosis? I assure you: No.

In slightly less exasperating news, there's this article about a startup company that's launching a game next year that's supposed to improve kids' focus using a brain-to-computer interface. It's currently in testing.


The distinction of the Atentiv system, according to Atentiv founder and Chief Executive Eric Gordon, is the precision with which its technology calibrates each individual's mental circuitry and then zeroes in on electrical activity related to attention, as opposed to memory, for instance, or critical thinking. A numerical indicator on the screen gives a real-time reading of the child's attention level, the numbers fluctuating from zero to 100.

The goal of the game is to get a bird to move along a winding road and perform certain tasks that require tapping keys. But the bird speeds along, or slows down and stops, depending solely on the degree to which the user stays focused.

It's not an easy task, as this reporter found when he tried on the headband [which contains sensors to monitor brain activity]. Willing oneself to "pay attention" can bring the bird figure to a stop. The user must ignore all distractions—including the mind saying, "Focus! Focus!" 


There are a few other companies offering similar "games" -- Cogmed and Lumosity among them -- but as the article notes, there have been studies debunking the usefulness of those companies' products. Still, assuming testing goes well, it could be promising ... mainly because I think all this effort put into helping kids improve their focus has got to result in something useful, at some point. And then families have a tool in addition to, or in place of, medication -- and then maybe ADHD loses some of the stigma. So I'll be curious to see how the Atentiv testing plays out.

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?

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.

... 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.

So far so good

On the weather, I mean. No signs of any superstorms. Or snowpacalypses. There is a pretty good chance of rain this week, but do you think for a second that kids are going to let a little rain stop them? Oh no. They'll trick or treat under umbrellas. They'll wear rain galoshes over their superhero boots. They'll talk their parents into driving them from house to house. (Note: We would never do this.) We are 0 for 2 on actually getting to celebrate Halloween on Halloween, instead of sitting in the dark/sitting in a storm shelter/sitting on an hour-long gas line/sitting in a hotel room because we can't stay in our house. We will not be denied. We will have costume parades and trick or treating and ritual viewings of "It's the Great Pumpkin, Charlie Brown." Because we are Jersey Strong and we want candy.

I mean, unless the locusts show up.

Anyway there had better be trick or treating this year or I will end up eating all the peanut butter cups stashed in our pantry. Which, technically speaking, I probably should not do.

I am hoping that kiddo remembers to stay with his adult guide instead of seeing a group of kids going house to house and running off to join them.  I am also hoping he doesn't become so candy-crazed that he starts running across the street without looking first.

I'm hoping a lot of things with kiddo. I'm hoping he quits having meltdowns, because they seem to have reentered his regular emotional rotation. I'm hoping he quits blurting things out in class. I'm hoping he stops picking bedtime to be the time he hyperfocuses on his Legos and can't be budged for any reason whatsoever.

There have been some frustrating moments the past couple weeks, let's say.

But whatever. It's Halloween. Since we have the option, apparently, for the first time in three years, I want the kids to have fun on Halloween. Parades and candy and everything.
And we're guaranteed to not even get through a third of the candy because DH and I are pretty strict on treats, but the point is the acquisition, isn't it?

So, Happy Halloween to you, and may there be no snowstorms or superstorms or locusts. And kiddo ... well, he'll do the best he can do. Whatever his best happens to be. 

Arguing the hypothesis

Kiddo was supposed to be getting moving yesterday, and getting ready for karate class. Instead he was hunting down his plastic sword so he could have swordfights with, I dunno, the air? and intently trying to build a truck out of Legos. (He has a book showing different Lego creations you can make, and he seems to regard it the way I do a recipe book -- as useful source material.) He didn't want to put his uniform on, he didn't want to pick out a change of clothes for after class, and the more DH and I nagged and warned him, the more stubborn and upset he got, until he went into full-on screamy meltdown mode and refused to even sit in the chair for time out. I had to take him by the shoulders and sit him down.

He calmed down after that, and after time out was done, he and I hugged and apologized to each other and he was able to get his shoes on and go. And he was giggling and goofing around like the whole thing had never happened. Typical. (Not neurotypical. But typical.)

He hasn't had a meltdown like that in a long time. Seeing one all over again reminded me that it has been a long time, and he's been better able to hold it together when asked to complete tasks. It also reminded me how horrible those meltdowns are, and how stressful to deal with, and how almost exasperating it can be to watch him having totally forgotten about it two minutes later. I almost expect scenes like that to have some sort of emotional aftereffect. Like a meltdown hangover, if you will. But no.

This morning at church (UU fellowship but "church" is fewer syllables), kiddo only kicked his legs against the pew a few extra times before I glared him into stopping. So that was fine. Generally the problem is after services, when I go downstairs to collect the kids from RE class and they're jumping around the room and stealing extra snacks from the snack table. This time, some of the other boys were goofing around on bongos (yes, bongos. Just go with it) and cracking silly jokes, and kiddo found this all so hilarious that he went into extra-hyper overdrive, giggling madly, bouncing around, trying to join in. Generally when he gets like that, it's Code Red for "get him out of the room before he really goes too far and hurts himself/hurts someone else/damages property." He was so wound up I practically dragged him out of the room, after several unsuccessful attempts to get him to voluntarily walk out. And then of course a well-meaning elderly lady stopped me to tell me about how when her kids -- or grandkids, I didn't really hear her -- were being just like little jumping beans, she would make them do somersaults, or something like that. I didn't really hear her because in the time it took her to stop me and tell me all about jumping beans, my kids had already run upstairs and were heading right for the parking lot. Hey thanks for the advice. You know what would've been more useful? Staying out of my way so I could more effectively keep the kids away from moving cars. Just a thought.

I mention all this as a leadup to this article in the Times, which I notice is being namechecked all over the Twitters today so people can trash ADHD as being trumped-up and fake and a big conspiracy by Big Pharma and incompetent bureaucratic schools etc. First of all, you think ADHD is fake? You take my kids to church. Second of all, that's not exactly what the article is saying.

The writer's point -- and she acknowledges up front that she has ADHD herself, which alone is some sort of breakthrough here, because generally Times stories about ADHD only talk about how college kids are OD'ing on stimulants -- is that the rise in diagnoses might be related to sociological factors as much as medical need. First of all, she notes:

Most children are given the diagnosis on the basis of a short visit with their pediatrician. In fact, the diagnosis can be as simple as prescribing Ritalin to a child and telling the parents to see if it helps improve their school performance.

Right, I agree, that's no way to diagnose. I keep harping on the fact that general practitioners shouldn't be making these calls. That's why we went to a pediatric neurologist.

The sociologists she quotes say that the policy shift making ADHD kids eligible for academic accommodations -- extra time on tests, etc. -- made the diagnosis more appealing, and linking school funds to students' test scores coincided with a jump in ADHD diagnoses in some states. 

Well, my kids are going to have to take standardized tests no matter what I think of them, so I won't go into that now. I can only speak for myself here: I didn't push to have kiddo evaluated so he would get better grades. I pushed because he couldn't function at school and he couldn't function at home. I pushed because the screamy fit he had yesterday used to be an everyday occurrence, and just being around him was mentally exhausting. Stick that on your standardized test.

A psychiatry professor she quotes offers this:

Schools used to punish kids who wouldn’t sit still. Today we tend to see those kids as needing therapy and medicine. When people don’t fit in, we react by giving their behavior a label, either medicalizing it, criminalizing it or moralizing it ...

Oh, if only kiddo's entire problem had been sitting still in class.

The problem with this article -- and don't get me wrong, I think it's generally a well-written, well-researched article -- is that it operates on several assumptions. One, that all kids diagnosed with ADHD automatically get fed stimulants. There are, in fact, no hard numbers in the article about how many of those kids actually do take stimulants. Some families can and do operate without them. Two, that the only ways ADHD shows up are in academic underachievement and fidgeting in the classroom. This completely leaves out issues like 1. inability to read social cues, 2. no understanding of "personal space" (really a subset of 1), 3. lack of "executive function" skills, 4. delayed behavioral/emotional development, 5. delayed motor skills, 6. hyperfocus (granted hyperfocus can be a bit of a plus sometimes). And none of this touches on frequently co-occurring (or "comorbid") disorders like Asperger's, Tourette's, dyslexia/dyspraxia or OCD/anxiety disorders.  

Are there not-incredibly-educated authority figures out there looking for a quick-fix solution, or a way to game a funding system? Let's say it wouldn't surprise me. But I don't think that should take away from the fact that ADHD is real and there is genetic evidence to support that (as the writer says, early on). Unfortunately, all that the commenters on this article seem to have gotten out of the article is that kids today watch too much TV and eat too much sugar and never ever play outside, and that's the whole goshdarn problem.

Oh yeah? Kiddo gets restricted screen time and loves playing outside every chance he gets. (Like today, when we were on the playground for an hour.) As for the diet ...

Me: "Hey, sweetie, we're going to have chef salad for dinner this week."

Kiddo: "Yay!"

And yet he still has ADHD. How about that.

The down and the up

So for a while I was posting on ADDitude's message boards, seeking other moms/kids/etc. dealing with ADHD, looking for the same answers we were, maybe looking for fellowship and a place to vent. And it worked -- that's how I and the other ADHD moms in our little informal group found each other. They're awesome women and all our respective kids are doing pretty well in school right now.

The thread I was posting on is still up there, and that's how another poster found me, an adult with ADHD. They asked about our group, I explained that we're all moms of ADHD kids, but that certainly we're available for anyone to vent or commiserate. The person wrote back explaining that what they really needed was a support group, because their professional and personal lives were in shambles, and they didn't know what to do anymore. (Note I'm leaving most details out, to respect the person's privacy.) I felt awful. Advise a fellow mom about the benefits of a 504 plan? That I can do. Help an adult who's got way more hand-on experience with ADHD than I will ever have? There I'm out of my depth. The person wasn't really interested in talking further, but I offered the name of my old therapist, who deals with a lot of ADHD adults, and I wished them luck. Which I think was about the limit of my usefulness.

My therapist had always said that adults with ADHD, the more severe cases, can't handle money, can't hold down a job, can't maintain relationships. What are they supposed to do? Who helps them? And what if that's my son in 30 years?

On the other hand, I was poking around the Interwebs and I found this, written by a TV documentary filmmaker in the U.K. He realized late in life that he probably had ADHD, but decided it was a gift, not a curse, because it gave him endless energy and the ability to mega-multitask.

He says:

By the age of 26, I had directed 26 plays, two operas and two TV dramas.
Then I switched to being a documentary film-maker and have made more than 130 films and studio dramas as director, producer, series producer and now executive producer.
Last year I executive-produced 13 films, and am responsible for nine so far this year.
In my 50s, I also became a writer - three books and hundreds of articles so far.


(I'm tired just reading that.)

He adds:

So I hope the parents and teachers of children with these problems, and those who have suffered from ADHD, will see beyond its drawbacks to a future of excitement and creativity if sufferers are given the chance to learn how to use their energy positively.

Well, thank you, Mr. Graef. I hope you're right. I hope we figure out how to channel kiddo's energy and hyperfocus in the right way. I hope we all don't fail this generation of ADHD kids. And I hope my ADDitude correspondent finds whatever they need to get through.