Mutterings Of A Mindless Mommy

When an individual has Asperger’s Syndrome and is also gifted, s/he falls into the category of twice exceptional(2E).  The same would be of a child with ADHD and Giftedness or a whole bevy of other conditions.  A child could even have a reading learning disability but be gifted in math and thus, twice exceptional.  Twice exceptional students present an interesting challenge to teachers - whether the child is homeschooled or in a traditional classroom.  One benefit of homeschooling a 2E child is that the parent can tailor the education specifically for the child.

My son is twice exceptional having officially been declared gifted in the verbal arena and nearly gifted in mathematics (95th percentile).  However, his anxiety crept up when the school did a giftedness assessment on him at the end of Kindergarten (per the teacher’s recommendation).  He actually scored in the at-risk range verbally (20th percentile).  When he had one-on-one testing with the neuropsychologist he scored in the 98th percentile. 

So now it is the end of 1st grade, a few weeks ago Alexander’s teacher informed me that she would like to recommend Alexander for the ALP (Advanced Learning Program - also called GATE) testing.  She said he has strengths that are commonly seen among the gifted and knows of his scoring with the neuropsych.  I talked to Alex about it and he said sure, that one of his closest friends was going to do them this year and he wanted to as well.  So I signed off on it and testing started yesterday and will continue through tomorrow.

The school uses the CogAT (Cognivite Abilities Test) which is administered to a group of children.  Alexander told me yesterday that there were 3 plus 3 plus 3 plus 1 students in the room, all first graders.  He said his ears were working well, his nerves stayed behind and it was fun.  I don’t care what the results are, I’m just glad that it isn’t an anxiety-riddled event for him.  Group-given tests like this aren’t really a strongpoint of a child with attention and auditory issues but hey, ya never know, right?

I don’t know how many times a month I hear someone tell me, not knowing my family’s makeup, that ADHD is not real.  Usually the comment is followed by a statement placing the blame on bad parents who can’t, or don’t want to, control their kids so they simply medicate them into a zombie state.  Our local news station even had a special report with a local counselor who swore up and down that ADHD is simply not a real condition.  As she sat there spewing her nonsensities, my son was jumping up and down incessantly trying to form a thought.  This was around dinner time and obviously his medication had worn off.  He never did get that sentence out.

I do agree with those that state that ADHD is overdiagnosed and overmedicated.  I do think that some children are placed on ADHD medication for the benefit of the teacher(s) and/or the parent(s).  Some children who are medicated are also like little zombies, I have seen it myself.  My son, however, is not one of these.  He is medicated because *he* notices the difference and likes the way he feels and act.  I’ve mentioned it before, he even calls it his “control medicine.” Pretty insightful comment from a five year-old.  Read my entry The Controversy Behind ADHD.

Parentingguides.org has an article up entitled “I Don’t Believe in ADHD” - it is more than worth the two minutes or so it takes to read it.

In my Google alert for ADHD there was a post by a mom detailing her experience trying to find a pediatrician for her daughter who was recently diagnosed with ADHD.  Reading her post leaves me wondering if the black box warning label on most (if not all) ADHD medication has caused pediatricians to steer away from accepting these children as clients. 

Read crazymamasusan’s post on her blog:  Doctors Refuse to Accept ADHD Patients.

 I’d love to hear what others think of this.  I’m going to spend some time this evening and see if I can dig anything up on the topic.

I have previously discussed tantrums - if you’d like to read up on my post check it out here:  The Dreaded Autism Tantrum.  Today I am going to revisit that topic but the subject is my son, not my daughter.  My son will be six in a few weeks and has comorbid diagnoses of ADHD and Asperger’s Syndrome.  On Friday night we went for an evening/night hike with my dad, sister, and nephews.  My dad is a member of the search and rescue team for the mountains we went into so we were in good hands.  We had a lot of fun - got rained on, played with millipedes and frogs (well me, not Alexander hehe), and got a great workout.

When we get back to my parent’s house and get in our car to go home (we live 3.5 miles away) my son quickly asserts “I am not getting a shower.”  I kindly let him know that he is getting a shower and explain to him that we were rained on, we were sweaty (100% humidity), we were dirty, and we both absolutely needed a shower.  He reiterated that he was not getting a shower.  I didn’t bother arguing with him as it was a moot point.  The battle began when we drove into the garage.  Alexander refused to exit from the vehicle.  I closed the garage door and then went into the laundry room (right off of the garage).  I laid the door against the door frame but did not click it close so I could listen to Alexander.  When the garage light went off he screamed so I quickly went out there and he decided to get into the car.  Holy heck the tantrum of all tantrums began.

 He immediately started screaming - not words, just noises.  I asked him to not scream because daddy and his sister were asleep.  He responded with a louder scream, again not words just noises.  This woke up my husband who came out and helped me undress Alexander.  Alexander is a wee little guy, tipping the scales at a whopping 36lbs (he’s 46″ tall) but wow did he have some power in him.  He was kicking, punching, screaming and then suddenly he said his first words “I’m going to kick your butt.”  My husband looked at me and we both tried to stifle a giggle - I don’t think either of us have ever seen Alexander this mad.  He was in total meltdown mode. 

We finally got his clothes off and I started walking with him down the hallway and then he started in on me - punching me, slapping me, kicking me, etc.  I ignored it and made sure the water temperature in the shower was appropriate.  So I put Alexander in the shower and he yells “I’ll do it myself!” and then closes the curtain and starts punching me through the curtain.  I step around the corner and not 20 seconds later he starts to get out.  I was OK with that because he at least got a rinse off but he had tons of shampoo in his hair.  I told him that but he was not going to let me rinse it out.  I told him he could just lean his head over the tub and I’d pour water on it with our cup to get it out - nope, not gonna happen.  Well I managed to get him in position, turn the water on, and fill up the cup before he turned the water off.  I poured it over his head and got the shampoo out which evidently made Alexander even more mad.

At this point Alexander decides to attack the shower.  He grabs the handle and yells “I’m going to break this” and proceeds to tug at it to try to break it.  I took his hands up and picked him up and my husband stepped in with the towel.  Alexander demanded to go to bed wet and I said that was fine so we let him go.  He runs into his room, gets on his undies, and then wants us to tuck him in.  BAM - tantrum is instantly over.  It was like he flipped a switch.

I feel bad about making him take the shower but it was something that really needed to be done in my opinion.  We were so sweaty it was disgusting - our clothes and hair were completely soaked.  Alexander seems to have moved on from the moment, now I need to do the same.

Last month I discussed autism and sleep issues; my daughter’s sleep issues continue despite having purchased a weighted blanket.  Autism isn’t the only thing in my house associated with sleep issues, we also have the ADHD/sleep connection to look at with regards to my son.  My son is five and since he was three he has been one of those kids who gets very little sleep, whether he needs it or not.  Regardless of the time he goes to sleep he is almost always up between 5:30 and 6:00 am.  This doesn’t count the numerous times he’s up during the night.  It is not unusual to wake up at 2 am and find my son sitting in the playroom watching late-night cartoons.  Thankfully we have thought ahead and not only do we have a house alarm but we have childproof doorknob covers on every exiting door in our house.  If either child gets out during their night wakings we’ll at least know about it relatively quickly.

 Now on to the question of why people with ADHD can often-times have sleep issues.  There are numerous reasons including, but not limited to, the following:

• Sensory issues (overstimulation to sounds, textures, etc)
• Difficulty relaxing and falling asleep
• Night wakings (difficulty staying asleep)
• Snoring
• Sleep Apnea

The list could go on and on.  My son has issues both falling asleep and staying asleep.  On a recommendation from our pediatrician we give my son .5 mg of melatonin a few nights a week to help him fall asleep.  We don’t do this every night but on certain nights it is clear that he needs that extra boost to fall asleep.  This doesn’t keep him asleep through the night but at least it gets him off to a good start.  We don’t have any idea how to prevent the night wakings.  He’ll wake up and be up for an hour or two then go back to sleep.  The odd thing is since he started taking a stimulant to control his ADHD symptoms he sleeps better.  That’s a conundrum; give him a stimulant and he sleeps better. 

I am at the point now where I consider an interrupted night of sleep a normal night of sleep for me.  My husband and I try to take turns giving each other a break a few nights a week.  Its amazing what one uninterrupted night of sleep does for me.  I wake up feeling 19 again and ready to tackle my day. 

The April issue of Alcoholism: Clinical & Experimental Research has published two stories confirming what has long been suspected; children with ADHD are at an increased risk for alcohol and other substance-abuse problems as they get older.

“Children with ADHD are believed to be at risk for alcoholism because of their impulsivity and distractibility, as well as other problems that often accompany ADHD such as school failure and behavior problems,” explained Brooke Molina, author for both studies.

The first study was on “Age Specificity” and found that drinking problems usually begin around age 15. “42 percent of those children with ADHD who also had serious, persistent behavior problems [later] had alcohol abuse or dependence by the age of 18 to 25.” Molina also says.

The second study was on “Life Stress”. “One of the reasons that children with ADHD might be at risk for alcohol problems is that alcoholism and ADHD tend to run together in families,” said Molina. “We found that parental alcoholism predicted heavy problem drinking among the teenagers, that the association was partly explained by higher rates of stress in these families, and these connections were stronger when the adolescent had ADHD in childhood. So, the bottom line is that when the child has ADHD and the parent has suffered from alcoholism, either currently or in the past, the child will have an increased risk for alcohol problems himself or herself.”

Very interesting studies, but they actually don’t have me worried. Neither my husband and I are alcoholics and no one that my son knows is an alcoholic. It isn’t being modeled for him so between the lack of alcoholics and the fact that good parenting will make a difference (yes I consider myself a good parent) I think that my son won’t fall into this statistical category.

Dictionary.com defines comorbid as:

pertaining to two diseases which occur together, such as ADHD and depression

and also as:

existing simultaneously with and usually independently of another medical condition

ADHD isn’t always seen alone, very often there are comorbid conditions present - from sensory processing disorder to autism spectrum disorders to anxiety. In my son’s case he presents with ADHD (primarily hyperactive/impulsive type), sensory processing disorder, and childhood anxiety. According to an article “ADHD with Comorbid Anxiety” by David Beck Schatz and Anthony L. Rostain “ADHD is often comorbid with anxiety disorders, with rates approaching 25% in many samples.” That means that as many as 1 in 4 people afflicted with ADHD also suffer from anxiety, that’s quite a high rate.

Now let’s pursue other conditions which are often found alongside ADHD. In my reading I saw mention that somewhere between 50% and 90% of people diagnosed with ADHD will be treated for a second condition at one point in their life. The more commonly diagnosed comorbid disorders are depression, bipolar disorder, anxiety, learning disabilities, and oppositional defiant disorder. This makes me wonder what it is in these individual’s brain wiring or genetics that leaves them open to additional diagnoses above and beyond the initial diagnosis of ADHD. This also makes me wonder if my son has a more arduous road ahead of him then I initially thought.

As I mentioned previously there seems to be a lot of controversy surrounding ADHD these days; from the levels at which it is being diagnosed to the amount of children being medicated for it. I have heard all of the controversy and I do agree with a lot of it.

Let’s start off with a little bit about ADHD. It was once referred to as ADD (Attention Deficit Disorder) but since then the DSM has been revised and it is known officially known as Attention Deficit Hyperactivity Disorder (ADHD); it now has three subtypes - inattentive, hyperactive-impulsive, and combination type. Inattentive is what ADD would be classified as, the dreamy kid who’s mind wanders and can’t seem to focus on schoolwork, tasks, etc. Hyperactive-impulsive is the child who seems like they are bouncing off the walls, they can’t sit still, they blurt out answers, talk incessantly, etc. This is my son, a very severe case of hyperactive-impulsive per his diagnostician. The final type is the combination type which is pretty self-explanatory, the child exhibits symptoms of both inattentiveness as well as hyperactive/impulsive behaviors.

So where does the controversy lie. Let’s look at the first bit I mentioned, the diagnosis rate. While I can’t find exact statistics right now (lost my bookmarks in a computer move) the diagnosis rate for ADHD has gone up over the past two decades. Children who were once considered spirited or high-needs are now being labelled and sometimes incorrectly. You may ask why I say incorrectly when I don’t have a medical degree; the reason I say incorrectly is that later in their childhood years many children are often rediagnosed with a different disorder. This new diagnosis can range from something like Central Auditory Processing Disorder to Childhood Bipolar Disorder and the list goes on. In addition there is also a theory that schools and teachers are forcing a diagnosis on their harder to handle kids. I have first-hand experience with that; of course in this case the diagnose appears to be rather accurate.

The other controversy surrounding ADHD is with the increased rate of diagnosis we now have an increased rate of children being medicated for ADHD. It is not unusual to see a three year-old on a stimulant to control their symptoms. Even though we have chosen to add medicine to our list of things we do to combat my son’s symptoms I don’t think medicine should be a first option. Dietary change and behavior modification are two things that I think every parent of a child with ADHD should consider prior to starting medicine. Medication may end up being the ultimate choice but with the new “black box warning” being placed on the medicine it is wise to exhaust your other choices prior to introducing medicine.

Now while I do agree with some of the controversy surrounding ADHD these days I am also the mother of a child who takes a stimulant for his ADHD symptoms. I have had parents confront me who believe ADHD is a myth and I’m doing my child harm by choosing a pharmacological route to managing his symptoms. To those parents I merely say that until you have walked a day in my shoes your opinion, and your judgment, mean nothing to me. It is not easy and the more support you have, the better.