Inattention , behavior mod, and other options...

I just want to throw in my 2 cents…I know we all have ‘potentials’ and those of us who don’t work up to them…can find life pretty difficult. Having been one of ‘those kids’, I tend to see this from the POV of the kids, not the moms — so just take my 2 cents for a couple of pennies dropped into your pool, OK?

My first reaction to those scores, in a kid with reported anxiety, is this: STOP TIMING HIM…I know that doesn’t really give you ideas of ‘how to get him to perform to his potential’ but maybe that simply isn’t possible right now…and maybe that is going to be his major challenge — learning to control his anxiety, in order to perform to his potential. He HAS the high IQ, but that is not a guarantee of academic performance — he needs help with the anxiety. (and personally, if he was my kid, I don’t think he needs MEDS — he needs coaching, therapy, and self-knowledge PLUS maturity — but just my opinion — he’s not my kid!)

Is he managing acceptable grades at present? If anxiety is ONLY in the learning situation, your doc may not vote for anti-anxiety meds — and those meds, like any, come with side-effects that are not always desirable. (I’m talking from experience with adults here — don’t know any kids taking anti-anxiety meds, so perhaps my opinion is not valid.)

Maybe the approach to take is to remove the pressure to perform wherever possible — including expectations, similar to how we do with accomodations for a kid whose reading is not up to grade level — but, like a dyslexic would then get intensive reading instruction outside of school, give him coaching and therapy plus unpressured TIME to reduce his anxiety…

Just to be clear, he’s in a special school and he’s not timed, (or graded on spelling thank goodness.) The school does extensive testing each year to place the kids in appropriate language arts and math groups and they do note the results as timed vs. untimed. I don’t know how significant the comparison really is. The principal seems to think the size of the discrepancy is significant for him.

We will probably do an updated neuropsych evaluation to try to tease out how much is attention, how much is anxiety etc. We are not rushing to medicate, but I also don’t want to withhold something that could change his life either.

If it come down to just really really slow processing speed I don’t think that is an easy thing to address

Karen,

Why do you think that the differences between timed and untimed scores reflect either attention deficits or anxiety? It is very common for LD children to basically process slower. I have seen studies that show that LD children benefit from extended time on SAT/ACT college entrance exams while the extra time does not significantly impact other students’ scores.

I know my son even after much remediation is slower at both math calculations and reading than the average child. The good news is, like your child, he can perform at grade level with more time. For example, he brought home his Monday folder this week and he had a math quiz with 40% and a math test with 90%. Turns out that he was rushing with the math quiz because he didn’t want to be the last one done (as he usually is) and took his time on the math test.

In my experience, LD can cause inattentiveness. Unlike your son, mine was actually diagnosed with ADD-inattentive. We decided to try to remediate the LD and see what inattentiveness remained—partly because our Neuronet therapist was not convinced of the diagnosis. It has been hard to separate out—I mean even one on one in reading therapy his attention wondered as recently as last December (PG intensive). But last summer during the SS intensive, his attention was not an issue. Perhaps you will find the same thing as you continue to remediate his underlying deficits.

Beth

I don’t know actually! I think that’s why an updated neuropsych. might help us determine if its processing speed, anxiety or whatever. Although isn’t slow processing a component of inattentive ADD? It s confusing.

I think my son has some anxiety, some attentional issues and for sure is a slow processor. Its a soup of issues. Whether its appropriate to medically treat any of them has been an ongoing question. The threshhold has always been “is he learning” and right now the school thinks the answer is “yes, but…” Also I know my son is aware of his focus problem and that makes him anxious! maybe breaking the cycle would allow him to develop some self monitoring ability.

Also, he is in a very protected environment - a reading group of 7, a social studies group of 10— with 2 special ed teachers! If they feel his zoning out is impacting learning can you imagine what will happen when he mainstreams? Sooner or later we have to find a solution.
I’m not anti-meds, and had he not developed tics I would have done a trial by now.

Our plan is taking shape. A neuropsych eval . done by a dr. in the same practice as our neurologist. THis practice is very famliar with the school and knows how to “read” the feedback from the school. And then we’ll see…..

The difficulty with timed tests could impact him down teh road with SATs and ACTs. I would certainly keep careful records of all his ‘issues’ because this is truly a kid who could benefit from teh available time extensions for LD kids

But if that is his only problem? Its not impacting him yet-its more a warning for the furture

Its a tough call because things could improve with age and experience by the time hs rolls around. OTOH, you dont want to be in high school saying “I should have…..”

Good luck with the decision; hopefully the neuropsych will have some insight

It sounds like you are doing as much as you can do.

I read an interesting lecture by Dr. Barkley (spelling?) who is an expert on ADHD. (I think it is on the Schwab site). He said that ADD-inattentive and ADHD are really two different beasts. He also said we know a whole lot more about ADHD and medication is much more effective with ADHD (in terms of percentage of kids helped). You are right the processing issues do seem to come along with ADD-inattentive. Dr. Barkely seemed to characterize ADD-inattentive as more of a sort of learning disability—it is more of input problem while ADHD is more of an output control problem.

If your son is aware of his inability to focus and it bothers him, I think that is important information. My son has learned that physical exercise helps him focus and will often go ride his bike before tackling something difficult. He def. fits the lethargic ADD-inattentive profile but has learned to manage it, at least for now. And frankly I think he enjoys some of the distractions his mind brings him! He’d much rather think what he wants to think than do his homework. But I have noticed that now he will say—if I do this x, can I ask you/tell you something now.

And you are right—your son is in an optimal learning situation. If you tried meds and you did have anxiety kinds of reactions, does the reaction go away if you stop the meds? In other words, are there any long term risks in terms of anxiety/tics associated with trying stimulants on a kid like him?

The only thing I can think of that might help, based on my son, is to try to get some exercise first thing in the morning. My son used to like to ride his bike to school or walk from the car (as opposed to being dropped off). He says it woke up his brain.

Beth

How recently has your child been evaluated for ADHD? It can be really hard to tease out what is attention and what is LD and sometimes the best you can do is to come up with a realistic hypothesis as as to the cause of the inattention. If the last eval was a while ago, it really might be worthwhile to get him looked at again, and it ought to be by somebody who knows something about gt/ld/adhd issues. In deciding who you might want to do an evaluation, I would advise placing your greatest emphasis on the gt component. I have a gt/ld/adhd child, a gt/adhd child and a gt/ld child, so I can relate to your situation. It was very hard to identify the adhd in both children who have it . The first eval of each said no adhd. The second eval said borderline but the doctor who did the eval recommended a meds trial anyway. For my kids, that turned out to be a blessing as both showed huge academic improvement and experienced vastly reduced stress and anxiety. My gt/ld/adhd child did have motor tics but the advice we received was that recent research suggested that stimulants could be safely used in children with tics even though there were earlier studies that suggested the contrary. My kid’s tics actually got better after meds, though it could have just been that he outgrew them.

Guest,
If you don’t mind my asking, how old was your child when he developed tics, and how old when he was on meds. My son is 10 1/2 and didn’t develop tics until he was 9 1/2. I’ve been told tics often peak at 10-12, and often diminish after puberty. So we also are thinking that certain meds might be less risky if we can hold off a year or so . (puberty is right around the corner!!)

Our expert opinions have been delivered over the last 3 years. The neuropsych eval is 2.5 years old and we are going to do a new one. (should be very interesting given the amount of remediation we’ve done since then!). The neurologists dx of anxiety (and not ADD) was just this past summer.

thanks!

Another broad based eval is probably a good idea, as it sounds like you and the special school are doing everything that can be done to maximize learning and reduce anxiety; is the anxiety only with difficult school subjects? My LD 8th grade son still gets anxious in the most difficult subjects for him now(Algebra and Spanish), but has learned to reduce it by taking his time and going for after school help. Of concern in a boy your son’s age would be continued difficulty with social situations(immature behavior), eye contact, pragmatic language(does he “get” irony, jokes, etc?)…along with anxiety and difficulty with attention; this may point to a different dx or cause of the inattention, like NVLD or Asperger’s Syndrome. If these are not a concern, I would ask someone else to re-eval for ADD…get another opinion.

My son looked at more NLDish a few years ago. (never enough for a diagnosis of course - that is the story of our life!)

I have concluded that his most NLDish behvior (poor eye contact primarily) is really social anxiety. His eye contact and other social skills vary greatly based on his comfort level. Although he is a fairly literal kid, he gets irony and sarcasm and seems to be developing an age appropriate abilitiy to come up with a snappy comeback. He can read social cues - he just doesn’t always respond in a timely manner. I’m coming to believe its more anxiety and slow processing than an inability to read the cues - if that makes sense. When I compare notes with parents of true NLD children its clear that my son’s deficits are very mild. His biggest issue is decoding/fluency/spelling. He excels in math .

He had a significant VIQ>PIQ gap, mostly due to an unbelievalbe “1” in coding. New testing should be interesting, and I’m sort of excited to get some new data to analyze.

[quote:c8ea97498d=”KarenN”]Guest,
If you don’t mind my asking, how old was your child when he developed tics, and how old when he was on meds. My son is 10 1/2 and didn’t develop tics until he was 9 1/2. I’ve been told tics often peak at 10-12, and often diminish after puberty. So we also are thinking that certain meds might be less risky if we can hold off a year or so . (puberty is right around the corner!!)

thanks![/quote]

My son developed tics at 6 years old. His LD was diagnosed that same year. ADHD was not diagnosed until he was 9 and he began meds then. He was stilll ticcing at the time he started meds. They disappeared within about a year after that. He is 15 now and has no tics. He still takes medication.

My son developed tics at 6 years old. His LD was diagnosed that same year. ADHD was not diagnosed until he was 9 and he began meds then. He was stilll ticcing at the time he started meds. They disappeared within about a year after that. He is 15 now and has no tics. He still takes medication.[/quote]

That is encouraging. I know every child is different but your story jibes with what I have learned thus far. If my son’s tics never get any worse I will be very happy. I hope if we need to medicate that they don’t exacerbate the tics. Is your son on stimulants or something else?

I think it is very telling that your son is aware of his inattention - does it bother him? Does he feel like it is ‘out of his control’? I ask because one of the most helpful posts I ever read when I first came to this site was from Patti M, who described her daughter’s reaction once meds took hold — something like ‘so THIS is what you mean when you say focus!’.

I have heard a similar comment reported by the mom of one of my cubs, whose child is add and uses meds for school only — one of those who did not begin to learn until he had meds, then came along quickly. Since he IS what the school thought my son ‘WAS’, I have followed his progress very carefully — as you know, even when you feel ‘sure’ you are constantly reviewing your own decisions to make sure new knowledge doesn’t make you wish ‘hindsight were foresight’!

In opposition to that is my son — he CAN focus but is not academically motivated — and is a child, and an artistic, daydreamy type — but NOT ADD. He KNOWS when he wanders — only time he can’t ‘stop it’ is if the material is beyond his skill/understanding level — that is quite different, IMO.

I think you will find the new neuro workup very interesting — and hopefully very informative. This is probably preaching to the choir but get all the data re tests used, standard scores etc. not just the ‘opinion’ part, so you can be sure you agree with his analysis…they’re not perfect, as you know.

BTW ALSO…lots of kids with Tourettes Syndrome have ADHD co-morbid…I know personally of one, and he is on stimulant meds (which he NEEDS, much as the side effects of lack of appetite and PM rebound in his case are a pain and a worry to his parents!) as well as meds for the tics — so it may not be so black and white in your case — you may find the whole business needs more research. TS is also a spectrum disorder — my family is definitely on the spectrum, but no-one requires medication and none would qualify for a DSM-IV dx. I don’t think the tics mean NO stims could/should be used — it may be you need a doc with more experience in both, and the new evaluation will hopefully point you in the best direction.

And even though my decision was that meds were not appropriate in our case…I will NEVER stop ‘re-evaluating’ the meds question constantly, it just happens that (so far!) I keep getting the same decision re-affirmed…that is not the case for everyone. In the case of the child I mentioned above, his parents were LOATHE to try them — but after a bit, she could see that her son was NOT being helped by the one-on-one as my son had been — and that, to me is one of the biggest ‘dividing lines’ on the ‘LD vs ADD’ conundrum…in other words, if your son continues to IMPROVE…that tells you one thing — If he starts to slip — I think it tells you another…

Hi elizabeth - thanks for chiming in.

My son is aware of his “zoning out” as he calls it and he says he cannot control it all the time. And it makes him anxious when he realizes he missed something in school. So that is cause for concern.

Hopefully if it all works out his evaluation will be done by a psychologist in the same practice as our neurologist. They all are ina practice dedicated to kids with learning, attentional and tic issues. And they are well known to our school and visa versa. SO I am actually feeling somewhat optimistic that this experience will be enlightening. Its hard to imagine that they’ll find something we haven’t already considered.

Overall we are very pleased with his progress academically and socially. I feel we’ve been given a reprieve by placing him in a small specialized enviroment. But he will have to mainstream by high school , if not before, so now is the time to put the other pieces together. He absolutely could not function in a mainstream classroom today.

I’m very glad to hear about TS kids who can take stimulants successfully. My son is not dx with TS (no vocal tics) but that doesn’t matter. Tics are tics regardless of the name, and I am the most fearful about making them worse.

More for you to ponder…..

my 7th grader is my ADD inattentive, LD, medicated since age 9 kid but I have two others

I think I have mentionned the now 19 yr old before. I somewhat suspected ADHD when he was in third grade but it was brief because I knew so little. After all, he was an excellent student and no teacher had suggested the disorder. He was in gifted programming all through school

When I had ds3 evaluated, he met some, but not all of the criterion yet….wow-this description was ds1 exactly

We did start an evaluation his senior year but wed moved states-i didnt know the best resources-we didnt follow through. He was accepted to a top notch college-dropped out after 3 months. Currently attending junior college but leaving at end of semester

Says he would rather work and insists it is physically painful for him to be in school. He cannot tolerate the inactivity

Hes 19 and KNOWS EVERYTHING and will not seek help;hes too old to carry in and even if I could, how would I see that he took his meds?

This came across my email yesterday:

http://www.campusblues.com/adhd/adhd_Screener.asp

The opening page of the email it was contained in stated that only 5% of people with ADHD receive a college degree compared to 35-40% of the general population

I deeply regret not following through his hs senior year if not sooner. Maybe things would be exactly the same-who knows? Maybe its just his personality or maturity level.

But I have regrets now…wish it wasnt so.

marycas,

Why do you think college is more difficult for him than gifted programming through high school? I would actually think there would be more opportunities to move around—have to get to those classes, you know. Or is that just a cover for what ever the real reasons are?

And remember, we all do the best we can, so don’t beat yourself up over what you wish you had done in retrospect.

Beth

Hi Karen,
I recently moved and haven’t visited here in awhile. I think updated testing sounds like a good idea. Hopefully you’ll learn more useful information and get a better of idea of what may be the best direction. My son’s processing speed is very low and this is a hinderance. He may be “good” at math (understanding math concepts), but because he’s quite slow he is usually placed in the lower level math classes.

Regarding tics and meds… My son has a good friend who is quite ADHD (gifted and with tics). He is also 10 and taking meds. (He has to because he can’t function in a classroom without them). Although I’m not necessarily recommending meds, I do know of at least one child with tics who takes them. I think the difficulty is finding the right med at the right amount to avoid increasing tics.

Laura in CA

Hi Laura, Hope your move went well. That is so stressful!

How do you find your son’s processing speed on medication? That is one question I have that I dont’ have a crisp answer for. Some people talk about processing speed and meds, as if speed were part of the ADD. Others refer to it as a separate problem altogether.

[quote:5e4c587267=”KarenN”]. Is your son on stimulants or something else?[/quote]
\

He takes adderall xr. He started on regular adderall because his doctor told us that it had a smoother onset than some of the other stimulants and therefore was a better choice for a child with tics. FYI, our pediatric neuro told us that Tourette’s is a diagnosis best made in retrospect. The basic criteria are, as you know, vocal plus motor tics. We were told that transient tic disorder of childhood is quite common and is more often seen in children with LD and ADHD. My child’s tics were made much worse by stress and we could use them as a barometer of his emotional health. There is not a trace of a tic left now.

Good info. thanks. I don’t think my son’s tics are transient, its been a year now, I suppose he has a chronic motor tic disorder. not TS. Also very much an indicator of stress now that they’ve leveled off . If I raise my voice he tics!

While we haven’t had the same problem with persistant anxiety my son has had some bouts with anxiety during some of the tough times. He had a teacher that just didn’t get him and he was at the nurses office with stomach problems ever few days. Also, adjusting to a new teacher with new demands brought out similar symptoms.

He also has had a problem with slow processing.

After a hiatus from vision therapy we went back and the doctor asked what are the problems he still struggles with. I told him about the fact that things just take longer for him and his teacher had noticed this.

He told me that it is a problem that he can fix. He has been pretty open about things he can and can’t fix through vision therapy.

In order to address this he worked on fully automating some of the skills that we had worked on in the past. He seemed to think my son had developed binocular vision but that it was not automatic. So we worked on further improving the overall flexibility of his eye movements and I will say that it has had an impact. He is still a bit slower than the rest of the class though, but I don’t think the flexibility in his eyes is all the way there. He will STILL get nauseous when I hold a pen close to his eyes and ask him to make it one (rather than seeing double.)

I honestly believe some of his anxiety was related to the fact that without these very basic skills the world was a confusing and difficult to organize place. (Does that make any sense????)

As deficits have improved I have seen an equal improvement in the level of anxiety and an improvement in is ability to handle the ever increasing work load and academic demands.

So, as always, I say, figure out what the deficits are at the most specific level possible then address them.

Your post makes perfect sense. We were hoping that by placing DS in a safe, appropriate school setting the performance anxiety and confusion he was feeling would ease, and he’s be more attentive. But we are finding that even in a very small classroom he zones out. We see less of a problem at home though.

Hence the new neuropsych. Hopefully it will reveal what deficits remain, how much is anxiety (which I think he’s hard wired for to a certain extent) and how much is true attention.

Hi Karen,
I’m sorry I haven’t had a chance to write respond sooner, but I’m still busy unpacking (I have a garage full of boxes), have been busy working (only part-time, but it feels like more!) and spending my internet time researching temporal lobe seizures (or partial seizures) and the LD’s associated with them…

I do think Adderall helps my son with processing (and processing is the main reason I decided to try meds - not attention), although since we only use it on school days I can’t fully describe the differences. But his teacher does feel it makes a difference. She thinks he participates more in class and seems more “aware.” One kind of interesting thing. I signed him up for some chess classes on Monday after school. He used to play chess when he was younger and was extremely good at it. But over time he became disenchanted and didn’t play as well.

For the first two weeks of chess he didn’t get medication on those Mondays. On those days he didn’t seem particularly interested, maybe won one game and then lost all the other games. Then this last Monday I gave him Adderall in the morning. Later at chess class he won every single game he played and even won the instructor (who never loses).

By the way, I asked my friend about tics and her son does take a medication to specfically reduce them. I didn’t get the name, but if you’re interested I can ask her for more information. I know for his ADHD he takes Strattera.

Interesting.

I bet your friend’s son takes straterra because it isn’t a stimulant ,and therefore isn’t considered as risky for kids with tics. My son’s tics are so mild and infrequent we don’t need to medicate for them, but we want to avoid anything that makes them worse.

We happened to see DS’s psychiatrist yesterday (we check in a few times a year) and then I met alone with him. So I asked him if ADD-inattentive and slow processing were the same thing. He said current thought is that they are distinct, although many ADD kids are slow processors. THen I asked if you can medicate for slow processing. He said “we don’t think so…”

That could be the crux of our decision making, if the neuropsych. evaluation reveals that slow processing is the primary issue for my son.
Stay tuned!

After your testing some questions to ask are: does my son have a slow, deliberate thinking style(our 13yo LD son does esp. in tasks involving reading and algebra, and regularly asks for extra time on math tests) which I think is not influenced by attention, but is slowed even more by anxiety….or is the cluster of poor attention, below average social skills, delayed academic performance and slow performance something else? I would ask more about the dx of anxiety…is it generalized anxiety, social anxiety, test anxiety, and see if there is a treatment that would help here.

Interestingly, my son has had A LOT of testing over the years and no doctor, psychiatrist or neuropsych has ever diagnosed ADD or ADD-inattentiveness. It has been considered, but no one has ever felt he has it. I did read one study on RAN (although I think the participants were adults and they may have had ADD or ADHD) and I believe the stimulants made a difference.

I don’t like medication, I don’t feel great about my son being on it and I wouldn’t recommend them (except maybe when all other possibilities have been exhausted and you’ve hit a level of desperation).

For us, it was a desperation issue. We decided on a med “trial.” I feel we’re still in the midst of a trial and depending upon how things continue, that will determine if we continue or discontinue it.

One thing I will say, it’s fascinating. For example, my son’s handwriting has been improving over the years, but I think the meds helped improve it even more. I even think my son visually processes better on meds. It’s really weird.