A Diagnosis

I've been hesitant post this for several reasons, but I just need to put it in words and get it off my chest.

Justin's propensity to initiate trouble, his boundless supply of energy, and his ability to look through you when you're trying to talk to him have long been sources of concern for his father and me. At his 5 year well visit, 10 days before kindergarten started, Justin was in rare form, seemingly bouncing off walls in the examining room and making it nearly impossible for the doctor to take a good look at him or for she and I to have any type of dialogue. She mentioned at that visit, "I won't be surprised if you are back here for help after school starts." We had hoped that a change of scenery -- from preschool to kindergarten -- would help and that he'd slow down a little as he grew older, but that obviously proved not to be the case. The entire month of October was an endless stream of red on the behavior chart at school, and nothing we tried got through to him. We tried taking away toys, privileges, etc., but he just honestly didn't seem to care what the consequences were and continued on a path that looked like it could only get worse. We felt like we needed to address it and rein it in now, so that he doesn't struggle more than necessary in school in the future.

I love Justin's pediatrician and while we had mentioned our concerns about his behavior for a few years prior to this, she had been resistant to do anything with respect to testing for learning disorders or behavior problems before he was school age. The rationale from care providers, among other reasons, is that it's difficult to tell the difference between normal toddler/preschooler behavior and what's not normal in a child so young. I can appreciate this, but when you're a parent seeking some guidance, it's tough to be told "we need to wait a few years" before doing anything. My biggest struggle was knowing in my gut that we had a problem, and not wanting to wait until Justin had been in school for a few years before doing anything about it. Why have your child needlessly suffer trouble if you know you need help?

Fortunately, the school setting afforded us the opportunity to test for ADHD (attention deficit hyperactivity disorder), which I had long felt was the root cause of Justin's behavior. The pediatrician's office uses the Vanderbilt Assessment Scale to evaluate behaviors for an ADHD diagnosis. Forms are completed by both parents and teachers that interact with the child on a regular basis, and then they are scored. Justin's scores showed a definitive conclusion that he does indeed have ADHD, specifically the combined inattentive/hyperactive type.

After the doctor's office scored the forms, my husband and I had a conference with his physician. It was really honestly such a relief to finally know what we are dealing with, but it's very overwhelming. Although there are many options for treatment, it's tough to realize that the school years will be an uphill road for your child. Choosing medication as a form of treatment isn't as easy as it sounds......there are side effects to be considered, some of which aren't known, and there is constant monitoring and evaluating taking place because the entire time a child is taking medicine, they are growing and changing and nothing stays the "same" like it would in an adult. Behavior therapy -- for both the parents and the kid -- is always recommended in conjunction with any decision to medicate. Some families are successful in treating the disorder with behavior therapy alone, but in children with the type of ADHD that Justin has, its success rate is low. It's really hard to decide what to do. The diagnosis itself has a stigma attached to it (at least in my opinion), and the decision on how a family chooses to manage it is very personal.

Justin's doctor recommended the combination approach of medication and behavioral therapy. We started him on his medicine during the Thanksgiving break from school, since it afforded us several days to observe his behavior and any adverse reactions that he might have. for the first few days, he honestly was a completely different child. I would almost use the word "subdued" to describe him, and believe me when I say that's never been in my vocabulary when describing my oldest son. It definitely affected his appetite -- he wasn't and isn't the least bit interested in eating anything. It's a struggle to get food in him at all. After 4 or 5 days, he seemed to be getting used to being on the medication, and was more like himself, but a calmer version. It's kind of hard to describe the differences.

Unfortunately, we started all of this during the holiday season so we have not been able to sign up for behavioral therapy sessions yet. There are a couple of series through Children's Hospital that were recommended for us to attend, but the last session for 2012 ended at the end of November and they don't start up again till early March 2013. Hopefully, once we get started on that, we will have more tools in our arsenal that will help us handle things at home.

The best news, though, is that he's made a remarkable change for the better in school. After being on mostly yellow and red for the first 3 months of school, he was on blue for nearly the entire month of December. (For reference, every student starts out on green for the day. They have opportunities to move up to purple or blue, or down to yellow or red, based on behavior choices.) It was wonderful. We visited the doctor the first week in January to make sure there weren't any concerning physical side effects. Justin lost two pounds since his visit in August, and grew an inch. I honestly thought he'd have lost more weight, although I wish he hadn't lost any. We made the decision to keep him on the medicine at the same dosage and follow up in the summer unless something changed.

In the last 3 weeks, the behavior reports coming home from school have not been good. It's more of the same type of stuff we experienced at the beginning of the year. After 2.5 weeks of the reversal in behavior, I called the doctor. She is a great listener and she asked me several questions. She recommended that we tweak the dosage of his medication to see if it will help. I didn't honestly believe we'd be doing that only two months into his treatment, but he is growing fast so it's entirely likely that he needs a different dosage. I'm still so conflicted about the medication, though. The whole situation is so utterly frustrating and to be honest, we feel really helpless. No amount of talking to Justin and asking him why he doesn't listen, why he doesn't follow directions, etc., yields any useful information. It makes me sigh heavily, and sometimes I just want to bury my head in the sand and imagine that we won't have years of this struggle. It makes me sad for Justin, because he's just so darn smart and ornery, but he can't focus and I'm worried that he won't be able to achieve his full potential.

Justin's teacher has been very supportive and helpful as we've gone through this process. She has worked really hard with him this year, and I think that's really to her credit. He can be positively unlovable some days when he is at his most energetic and, for lack of a better term, hyper. She's handled him extremely well and has found creative ways to help him get his work done. I'm really happy about that aspect of it, because we wouldn't be successful in trying to treat him if we couldn't partner with his teachers.

So that's it -- the diagnosis. I don't talk to people about it much, because I'm a little embarrassed, I guess. I know that this is nothing that we, as parents, have caused or could have avoided -- but the way he acts sometimes garners some stares from people who don't know us, from people who see me frustrated and chastising him for the 117th time in a restaurant or store, etc. I just really hope that as Justin gets older, he will naturally calm down a little bit (after all, he is only 5) and start listening. I'm worried about first grade, where they sit in desks and are required to be even more quiet and attentive than in kindergarten. Lord grant me strength to be the advocate and support that he really needs.