Banner has kept me on my toes. He's kept me challenged and worried for most of his life. When he was in PreK, his teachers praised his skills and abilities to learn quickly and remember so many details of the stories and things they talked about in class. The only two weaknesses they focused on were completing work and accepting disappointments and no for an answer. When we asked these teachers if they thought Banner demonstrated ADHD-like characteristics, they adamantly said no. My mind was put at ease that he was seemingly doing well at school, and we could work on the struggles he was having while at home - which we agreed needed our attention and consistency. I also felt that since he could focus on things he enjoyed - almost to a fault - then surely there was nothing "wrong." He could focus on building with Legos or K'nex for hours at a time; he could be on the iPad for hours and tune everything else out. I've come to know, though, especially after sitting in meeting after meeting with my own students and the LSSPs in our school district, that hyper-focusing is a part of ADHD. It's as if there are doors that open and close based on what a child needs to attend to, and his doors don't close or open as they should, so when I'm calling his name again and again, he doesn't attend; he's too zoned in to his game or his video or his construction. He cannot close the iPad door and open the Mommy door.
Then came Kindergarten, and Banner was doing great. He was a reader in PreK, so he was able to come in to "big school" with letters, sounds, sight words, and knowing how to decode well under his belt. He knew his numbers, knew how to count and put numbers together and take them apart. He made friends easily, and he seemed to really like his teacher. He was admitted to the GT program, and he loved his newest teacher who would challenge him and give him that extra attention he liked. He did not enjoy the homework, but then again, neither did I. It was much too simple, extremely monotonous, and tedious - math workbook pages and getting in nightly math and reading minutes. It was such a pain to make him do when I didn't really believe it was accelerating him at all. His teacher didn't give us much insight into what Banner was like at school as a student, but he sure was getting "practice academy" (walking laps at recess) quite often without any communication home about the reasons why. With every doctor's appointment Knox or Quinn had, I would touch base with our pediatrician about Banner's inability to follow basic routines and directions at home. He insisted that if Banner only struggled at home and not at school, we simply needed to put some more strategies in place to help him at home, and certainly this wasn't really ADHD - at least it was too early to tell.
I was getting frustrated with the lack of communication from school and at our doctor's insistence that this was just behavioral issues at home. The way I saw it, Banner's lack of attention, inability to focus, inability to remember simple requests or tasks, quick temper, inability to get to sleep easily or stay asleep all night, constant up and downs at the dinner table, impulsivity at lashing out at his brothers or at us and his grandparents was so problematic that it was hard to believe there wasn't something bigger going on. Without examples of his struggles at school and reasons why he was having those damn "practice academies" despite my numerous requests to his teacher - and later even the principal, I was at a loss of how to proceed.
At the very end of his Kindergarten year, Banner started saying some pretty eye-opening, concerning remarks near bedtime. Of those comments, the most notable ones were: "Mommy, something is wrong with my brain," "God made me wrong," "Nobody likes me; you don't love me," and "You have to ask me to do things over and over again, but you only have to ask Quinn once." Even scarier was, "I'm listening to the ghost that tells me not to listen to you and daddy." When I'd ask Banner to tell me more, we finally realized he was talking about his conscience, that he was struggling with doing what he wanted vs. doing what was asked of him. We talked about the "devil" and the "angel" on his shoulder, and to try to follow what he knows will keep him out of trouble. He was just so insightful, verbal, and articulate. I was proud of him for being able to tell me that something was going on inside him. I told him we would talk to Dr. B about it in a couple weeks at his well-check. When that time seemed to take too long to Banner, he would get frustrated: "You keep saying that, but we never go to him!" I told him I promised there was already an appointment set; we just had to wait. He grew impatient and really wanted to know if Dr. B could give him medicine to help him.
Finally, his well-check came, and when it was time for Banner to open up to Dr. B, he seemed to get shy about the topic. Dr. B was great and said, "Whatever it is, Banner, you can tell me. You can tell me anything." Banner opened up about the "ghost" and how he felt inside. Dr. B agreed he was hearing an inner struggle to do the right thing and stop listening to the pull to not obey when he'd rather not. He suggested we let Banner have the summer to just mature and grow, get through the beginning of first grade, and then reconvene to see how he's doing.
Well, I had a hard time waiting for that when my son was asking for more. So, we made an appointment to have him evaluated at the end of July. By mid-August, we had our meeting with the psychologist who assessed him, along with he director of the behavior center. Our suspicions were right on; Banner was diagnosed with ADHD-combined type. The report was so insightful. Bottom line: Banner's cognitive testing confirmed what a smarty-pants the kid is. His IQ is in the superior range, but his processing speed was significantly lower, which is why he may be feeling like something is off. While it's in the average range, that processing speed doesn't seem to keep up with the other abilities he has. Our ratings AND his Kindergarten teacher's ratings (after all my probing and trying to get information about what she was seeing in class!) both showed inattention and impulsivity issues. The psychologist also mentioned that Banner was fidgety and moved around in his chair quite a bit during the evaluation. He said Banner was easily distracted by items in the room - even the very blank walls and boring decor: "Hey, what's in those cabinets?" while he was supposed to be naming as many animals as he could in one minute. This didn't surprise me in the least!
With the evaluation in hand, we went to an appointment with a psychiatrist to discuss medication options. I don't necessarily feel that we HAVE to medicate, but with Banner's requests to get help with medication coupled with my feeling that if ADHD is a true medical diagnosis, why wouldn't we medicate? If you have a child with diabetes, you give her insulin when she needs it. If you have a child who has asthma, you give him his inhaler when he needs it. If my son has ADHD, I'm going to give him the medicine he needs to help him be his best him and not feel badly about himself because he truly cannot focus or listen or attend or sit still. ADHD is one of those invisible disorders, and it's been hard to know if my child truly wasn't capable or if he was choosing not to. That's another big reason we went forward with the testing to begin with... how do proceed when we don't know? Was he being a jerk or could he truly not attend/focus/listen/remember/think before acting? Should we punish his transgressions or should we give even more accommodations than we were already giving? Even before a diagnosis, we were already doing what we knew to help: make eye contact, get on his level (or lower), use positive rewards/incentives through a behavior plan, make him repeat our requests, touch him on the shoulder to ensure attention, say his name, take away distractions... and we still weren't seeing consistent improvement. So, a visit to the psychiatrist it was.
Banner really enjoyed talking with the psychiatrist. Dr. A said Banner was such a great kid and quiet gifted given how articulate he was about his feelings and insights into himself. He agreed to medicate Banner if we so chose, but he would want us to be seen by a neurologist before putting him on any stimulants mostly because Banner has had a facial tic since April, and while we hope it is transient and will resolve itself, we don't want to put him on a medication that could exacerbate the tic. In addition, we have concerns about his sleep issues. (As an aside: while at Quinn's appointment, I asked the ENT about sleep apnea if a child does NOT snore/gasp for air, and the ENT looked at Banner's tonsils and said they look smaller than Quinn's, but with bedwetting being a nightly occurrence for Banner still at age 6, he believed seeing the neurologist was a great idea. Furthermore, we spoke to Banner's allergist, and sleep apnea can actually be the cause of unresolved allergy issues even with daily care for them, which Banner has through taking Zyrtec and Nasocort each day. I should also mention we saw the eye doctor to make sure the "tics" weren't related to dry eye or vision issues, and while she saw a little bit of dry eye, she believed tics were the most likely reason for the wide eye-opening movements he was making. We have been trying lubricating drops to see if that helps, but I haven't seen much improvement.)
So, after consulting with the pediatrician, the psychologist, the psychiatrist, the ophthalmologist, the allergist, and the ENT, we headed to the neurologist! Whew. At that appointment, we learned that our responses to a detailed questionnaire once again supported an ADHD profile. However, we talked about other issues that could be at hand, namely sleep problems. The neurologist recommended we partake in a sleep study to see what feedback we can gain from his sleep patterns: how often is he moving in his sleep, is he having abnormal sleep patterns, is he breathing properly while sleeping, etc. The neurologist suggested that more than likely Banner does not have sleep problems, as he is missing the most common symptoms of it: snoring, turning blue in sleep, gasping for air. Yet, he also said that studies have shown that not all children demonstrate these characteristics and they STILL have sleep issues. So, it's worth looking into before we start medication, especially medication that could worsen his motor tics. This doctor also told us that if teachers are not complaining about Banner's inattention AND he's making scholastic progress, we should not medicate and instead do some therapy to help him and us. My rebuttal to this suggestion was my concern with Banner's self-report. Dr. M applauded our taking Banner's comments seriously and not ignoring them; he also commented that most kids don't say such insightful things and speculated that Banner must have a high EQ (emotional quotient) and sensitivity to his own feelings. He went on, however, to say that they only person who doesn't have a say in a diagnosis is the patients themselves. Parents, teachers, and psychologists/physicians are involved in the data collection, but never the patient. The reason for that, according to Dr. M, is that children are unreliable resources. He says in studies where treatment is given, kids don't consistently acknowledge improvement or change when everyone else in their lives might. So, while he agrees we should keep an eye on this, he doesn't believe it should be the reason we medicate.
As you can see, the many people who help make these diagnoses might just have made my head spin circles on knowing the right thing to do. Banner has requested medication; he's telling us he's struggling. We could get therapy, of course. I'm a school counselor, and while I'm utilizing all my knowledge and skills to aid him at home and teach him strategies to cope, talking to another professional - someone who isn't his mom - would be ideal. I'm just not convinced that medicine isn't our best option. If ADHD is truly a disability, a disorder, a medical diagnosis that picks up on deficits in the brain, why wouldn't I offer medication? A child who has seizures is not told to just go to therapy and see if that helps; medication is offered in addition to learning how to avoid triggers. If there were a medicine for treating aphasia, we would offer patients that, not just rely on speech-language therapy to help with recovery. And I know from my professional background that if we don't do SOMETHING to help this boy, he will try to find his own way of dealing - and it might not be pretty. I'm already terrified about what risk-taking behaviors we will see in his teenage years. The last thing this precocious boy needs is an excuse to self-medicate.
I am not excited about this road we are about to continue on, but I sure am glad we can start trying to figure out what will work to help Banner. It's not easy to watch your baby feel so low or so bad about himself. It's unnerving to hear him say awful, hurtful things to the ones he loves most and how care so deeply for him simply because he is too impulsive to screen his reactions to frustration. My expectations of Banner have always been high; my mother would probably say too high. But, the way I see Banner is that he is well capable of doing what is asked of him. He is a sweet, tender, sensitive boy who has a big heart and a brilliant mind. Like most parents, I want to see that part of him unveiled to its highest potential and not masked by inattention, impulsivity, impatience, irritability, or any feelings of inferiority frustration. I see Banner. I see that newborn, that toddler, that preschooler who is curious and inquisitive and in his own little world of wonder. I see he wants to be the best he can be. I see him struggling to be that sometimes. I know my boy will do amazing things. I just have to keep him on the right path; and this road to ADHD help will hopefully point us in the right direction.
As you can see, the many people who help make these diagnoses might just have made my head spin circles on knowing the right thing to do. Banner has requested medication; he's telling us he's struggling. We could get therapy, of course. I'm a school counselor, and while I'm utilizing all my knowledge and skills to aid him at home and teach him strategies to cope, talking to another professional - someone who isn't his mom - would be ideal. I'm just not convinced that medicine isn't our best option. If ADHD is truly a disability, a disorder, a medical diagnosis that picks up on deficits in the brain, why wouldn't I offer medication? A child who has seizures is not told to just go to therapy and see if that helps; medication is offered in addition to learning how to avoid triggers. If there were a medicine for treating aphasia, we would offer patients that, not just rely on speech-language therapy to help with recovery. And I know from my professional background that if we don't do SOMETHING to help this boy, he will try to find his own way of dealing - and it might not be pretty. I'm already terrified about what risk-taking behaviors we will see in his teenage years. The last thing this precocious boy needs is an excuse to self-medicate.
I am not excited about this road we are about to continue on, but I sure am glad we can start trying to figure out what will work to help Banner. It's not easy to watch your baby feel so low or so bad about himself. It's unnerving to hear him say awful, hurtful things to the ones he loves most and how care so deeply for him simply because he is too impulsive to screen his reactions to frustration. My expectations of Banner have always been high; my mother would probably say too high. But, the way I see Banner is that he is well capable of doing what is asked of him. He is a sweet, tender, sensitive boy who has a big heart and a brilliant mind. Like most parents, I want to see that part of him unveiled to its highest potential and not masked by inattention, impulsivity, impatience, irritability, or any feelings of inferiority frustration. I see Banner. I see that newborn, that toddler, that preschooler who is curious and inquisitive and in his own little world of wonder. I see he wants to be the best he can be. I see him struggling to be that sometimes. I know my boy will do amazing things. I just have to keep him on the right path; and this road to ADHD help will hopefully point us in the right direction.
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