New

[InsaneCdn]

Hopefully, the report will include recommendations for Speech evaluation and Occupational Therapist (OT) evaluation, not just therapy - these evaluations may add more details to the picture (auditory issues, sensory issues, coordination issues, etc.) - which would be useful.

Even if not specified in the report... these are not overly expensive, if you are able to get them privately. If you're going this way, you'll want to specifically ask about Central Auditory Processing Disorder (CAPD)/Auditory Processing Disorders (APD)/misc. auditory issues for the Speech Language Pathologist (SLP) evaluation, and about both sensory and motor coordination/control for the Occupational Therapist (OT).

 

[DS3]

That is about how our first psychiatrist appointment went. Are you sure it was a neuropsychologist? I have never heard of such a short appointment for them.

It was at the center for neuro-psychological studies, and it says he's a neuro psychiatric... So I'm fairly certain. I hadn't heard about such a short appointment either. Perhaps that's where the 50 pages of history/questions I had to fill out come into play. Anyone else have that much paperwork?

 

[DS3]

Hopefully, the report will include recommendations for Speech evaluation and Occupational Therapist (OT) evaluation, not just therapy - these evaluations may add more details to the picture (auditory issues, sensory issues, coordination issues, etc.) - which would be useful.

Even if not specified in the report... these are not overly expensive, if you are able to get them privately. If you're going this way, you'll want to specifically ask about Central Auditory Processing Disorder (CAPD)/Auditory Processing Disorders (APD)/misc. auditory issues for the Speech Language Pathologist (SLP) evaluation, and about both sensory and motor coordination/control for the Occupational Therapist (OT).

I'll have to double check that when the report comes in. Thanks for giving me the heads up. It's not too hard to get a referral, so no concerns there.

 

[InsaneCdn]

Paperwork? We've been snowed under with forms and questionaires with EVERY round of testing. So that part is normal. The shorter appointment isn't quite as "normal" - at least, if its going to be done in a single appointment (last round, we had 3 or 4 of 1.5 to 2 hours each - so about an "all day" thing either way, the one before that was 2x2.5h)

 

[DS3]

(Try: Driven to Distraction, a book about ADHD that's really well done)

I want to read this book, but the current version is from 1994. For people who don't know, there's a revised edition due out next month. So I'm pre-ordering that one.

 

[DS3]

So we went back to the psychiatrist today. They're upping his adderall to 10 mg 2x daily. This is mainly because he is starting school and he doesn't believe the 5 mg to be working effectively. He also mentioned that if I didn't see a change in the next week, we would have to try another medication.

As for the PTSD, it was ruled out at our initial appointment, but for some reason carried over on the paperwork, so they are going to change that.

We get the results of the neuropsychologist within the next day or two! I'm excited and nervous at the same time.

Oh, and his psychiatrist said that my difficult child is off the charts with his ADHD, so I am curious as to what else may be going on. Hopefully the neuropsychologist caught it.

 

[TeDo]

Glad you got that PTSD cleared up. I am waiting to hear what the neuropsychologist tells you. Share the info as soon as you get it. I hope it is as helpful as I have heard they tend to be.

 

[InsaneCdn]

Oh, and his psychiatrist said that my difficult child is off the charts with his ADHD, so I am curious as to what else may be going on. Hopefully the neuropsychologist caught it.

Usually, that means "executive function problems".
Like, all the hard-to-manage challenging stuff.
Inhibit (i.e. no self control)
Shift (moving from one activity to another)
Plan, organize, execute,
etc.

Sound familiar?

medications don't touch this, for the most part. Its mostly maturity (give him about 20 years), and a whole raft or repetitive teaching. Slowly, they learn.

If there's more going on than "just" ADHD, there can be overlap in symptoms - executive function problems are not exclusive to ADHD. And medications for other problems sometimes have positive side-effects.

 

[DS3]

That's good to know. I'm waiting anxiously for the results.... a phone call, something so that I can either go get them, or know that they are in the mail.

On a positive note, my difficult child had his very first day of school today. He did well the teacher said. She also asked if I could give him his medications earlier since he was a little distracted at the beginning of class. He's growing up so fast...

 

[DS3]

Well the results came today in the mail. I don't know if I want them...

The evaluation indicates that the following are present (a)"a mental diagnosis" with (b) "substantial limitations related to the diagnosis"; and (c) "the affected activities are central to daily life".


Officially diagnosis's: Extreme ADHD, Phonological Disorder; Parent-Child relational problem, Sibling relational problem

Recommendations:

For difficult child: Speech therapy, Occupational Therapy, Psychiatrist for medication, a sport or activity, possible 504 needed for school, or special education classes, re-testing in the future to ensure that there are not other learning disabilities present, behavior management and skills development services, no unsupervised contact with deviant peers, opportunities to be around pro-social peers, keyboarding skills and/or speech recognition software to help with writing.

For mom (and dad when he's home): Books to read, parenting classes, Social Worker, Respite Care, and possibility of financial support. (I've already taken the parenting classes, and I'm in the midst of reading some books, but he gave some suggestions for more)


More information:

The test scores in the report are consistently low, but being that there is a high margin of error since he wasn't medicated at the time, they suggest that the report be interpreted very cautiously. He ranked low in the motor output, attention, memory, visual-motor coordination, executive functioning, naming, auditory-verbal comprehension, speech articulation, listening comprehension, and reading.

Being that he was a preemie, known long term problems may exist (such as lower IQ, language problems, visual-motor problems, behavioral and learning difficulties, respiratory problems, and visual processing problems).

His home environment 'is worthy of clinical attention' (have no idea what that means).

They were unable to get a good sense of difficult child's underlying neuro-psychological functioning base caused by poor effort, and he should be diagnosis'd later in life to make the correct diagnosis.

Future testing will help to rule in or out: Adjustment disorder, developmental coordination disorder, oppositional defiant disorder, mood disorder, and borderline intellectual functioning.

GAF: > 61 (psychiatric impairment)
SOFAS: > 40 (cognitive impairment)

Ok, I really have no idea what the GAF or SOFAS mean. I also don't know what all the numbers on his test result mean. If someone could explain, it would be greatly appreciated.

Also, I need a hug. After reading the report, it makes me feel like a bad mother. Hubby says I'm doing everything that I can, and that I should be proud of everything that I have accomplished. But the recommendation for parenting classes, a social worker, and the suggested readings seem to be putting a damper on it. Not too mention that there is a lot to still work on and I'm afraid to even try to process it at the moment for fear of breakdown. I see my therapist tomorrow, and I'm thankful for that.

Thanks in advance.

 

[Ktllc]

Try not to blame yourself. Remember that the doctor has to be scientific, have a clinical analysis of things.
To say that you need classes or book reading would be good or even that your "home is worthy of clinical attention" is not necessarly shading bad light on you.
From the outside looking in, here is what I think it means:
* you difficult child is not a typical child and no parent is ever prepared for that. You have to learn about his issues, how to handel them and someone will teach you. Help is on its way!! That is wonderful, you will not be battling alone anymore.
* your husband, his Dad is deployed. That is terribly hard on a family. You should be proud of what your husband does for all of us, but in the mean time it might create a lot of extra stress on you and your kids. The home is under a lot of added stress and some professional might be able to help you cope with it. Once again, help is on its way!
The GAF score is a subjective measure on how an individual function in society (has nothing to do with intellect). If you look on wikipedia, you will have the whole scale. It goes from 0 to 100. I had to look that up as well recently. My difficult child's GAF score is only 51... I have to remind myself not to give too much importance to numbers! The whole picture is what matters.
There is a lot to process and it will not happen over night. Try to give yourself a break, take sometime to breath.
You have embarqued on a long journey, now you have a map of what you are dealing with. Learn how to read it, how to use it. This report is not here to scare or blame anyone. It is just here to help you put the best plan of action possible.
BIG HUGS!!!

 

[InsaneCdn]

I know its all overwhelming. But there is GOOD news buried in there. And lots of "no news" in there too.
This is NOT the end of the story, its just one more chapter.

For mom (and dad when he's home): Books to read, parenting classes, Social Worker, Respite Care, and possibility of financial support. (I've already taken the parenting classes, and I'm in the midst of reading some books, but he gave some suggestions for more)

Not sure about the "parenting classes" - but if you've got an official recommendation for Respite Care - Wow! The Social Worker recommendation is probably to give you some support in figuring out what works, etc. - if you can get a good one, its worth it.
I read this as a statement that the psychiatrist takes the problems seriously, and is willing to help push the system to take it seriously also.

"for difficult child". Well - some of that list is "standard psychiatrist talk". "Every" kid needs a sport or an activity. At least in theory.
Neither you nor difficult child will be able to tackle all the items on this list initially. Read it carefully. Pick the items YOU see as the most important right now. Probably...
- speech therapy
- Occupational Therapist (OT)
- psychiatrist
- 504 for school

The rest of it will have to wait. Its been flagged. As things develop, the report can support all sorts of other interventions. But difficult child can't take 25 interventions at once.

Ignore the test scores stuff. In spite of what they say, the tests are NOT set up to handle every combination of special needs. So, some kids do not test well. Take the results as a flag of "possible" issues, be prepared to re-test from multiple angles on a periodic basis. But don't believe everything they say.

He ranked low in the motor output, attention, memory, visual-motor coordination, executive functioning, naming, auditory-verbal comprehension, speech articulation, listening comprehension, and reading. /QUOTE]
Motor output and visual-motor coordination are Occupational Therapist (OT) issues... recommended? check. Bring up the "possible developmental coordination disorder" point with the Occupational Therapist (OT). There are specific tests that OTs can do, that would help support or rule out that diagnosis. They can't do the diagnosis... but their testing is an important part of the background.

Auditory-verbal comprehension, speech articulation, and listening comprehension are Speech Language Pathologist (SLP) issues... recommended? check. Might end up with Central Auditory Processing Disorder (CAPD), Auditory Processing Disorders (APD) or other auditory processing issues. PUSH for these evaluations sooner rather than later. Auditory discrimination testing is relatively new - INSIST on it.

Executive functioning... well, that's a tougher one. Read "the explosive child" - probably comes closer than anything else I've seen on the issue.

There. Sit down with a nice cuppa, put on some soft music, and do some slow-breathing exercises.
The world did not just end. Your child tomorrow is the same as your child yesterday - only now, you should have access to more resources.

{{hugs}}

 

[Liahona]

These reports are overwhelming. You can read it and re-read it. It doesn't have to be understood all at once.

You are not a bad mom. You are on-line looking up information trying to get your kid some help. All of us can use parenting classes and reading and re-reading books. These kids keep us on our toes.

lots of {{hugs}}

 

[DS3]

Thanks for the support. I got the speech evaluation started through school. Looking into getting the rest of it done. I am going to sign him up for soccer which starts next month. That should cover the exercise and socializing for now. Looking into the Occupational Therapist (OT) and the behavioral management stuff. Wish me luck. Any advice as to where to look for these things is also appreciated.

 

[DS3]

So difficult child decided that staying up until 130am was fun. I think he forgot that he had to be up at 530 to get ready for school. I had been trying to get him to go to bed since 8pm. I took away the tv, the toys, and what not. And still he was up. When taking everything away, he went downstairs and proceeded to go through the cabinets (I dozed off for a little bit). So we had a pancake mix mess, as well as coffee creamer, juice, and water. So I cleaned up and sent him to his room and figured he's have to deal with the natural consequence of being tired at school today. I'll warn his teacher when I drop him off.

I've noticed that he has been staying up later and later since the doctor upped his adderall to twice a day. Could it possibly be the afternoon dose that is causing him to stay up so late? I give it to him around noon.

On a different note, he was very chatty last nite. He pointed to a couple of things that had his name on it, and told me what it said! I was so proud of him. Not even a week in school and he has learned to read his name!

The funny side: I asked him how school was going, and his response was that the teacher is always telling him 'no', 'stay in your seat' and 'don't touch that'. LOL. Well it's not the best of news, it was the first time I got him to talk about it. And I just think it's funny.

 

[Free Kittens]

Hi DS3

WHEW! that is a report! Here's some tips from the inside (I used to be a socialworker have my masters)

GAF Global Assessment of Functioning. Can you beleive I was on a work group that helped make this awful thing? It is just a measurement of how badly a diagnosis impacts a person's life, well that was the intent anyway. It ends up being used as a measure to get services funded. Anyone with over 60 will not have services covered by insurance or publically funded.

As for the multiple DXes, Good testing will list all DXes that are possible. The 'relational' disorders simply means that there is stress in the family, well no duh.

Personally, I think it is a sign of a good professional to consider the whole family. And, personally I think it is not right to simply send you the report in obvious psychiatric lingo and not have you in to interpret the results.

You get a BIG HUG
Free Kittens

 

[DS3]

Thanks FreeKittens. I could really use a hug today. It's been a day from hell and not because of difficult child either. Granted I did have to carry him to his class kicking and screaming, but that wasn't the worst of it. And I did get difficult child signed up for soccer which starts in two weeks. That's the good news. One thing accomplished. Yes!

My friend borrowed my hubby's car since he's away and wasn't using it. Today she rolled it and it's completely totaled. After that (right as the towing company is dropping off the wreck it is now), my mom calls. Dad had a biopsy today on his other lung (he's a survivor of lung cancer which was on the other side), and it's positive for cancer. The kids didn't want to nap, so I'm dead tired tonight, and difficult child is still running around. Hopefully I'll be able to get him down soon.

Things I'm thankful for: My friend and her two small children were alright. Actually the kids walked away unscathed, as I put their car-seats in the car and made sure it was done correctly (I'll put that feather in my hat as a positive). They were more shaken then anything. My friend has some whiplash (no cuts what so ever), but the car landed on its wheels, and that's something to be thankful for. The airbags didn't deploy since it was a side impact and not a front impact. I think it would have caused more damage if it had. No other vehicles were hit. Two witnesses stopped and the car that had pushed her off the road stopped. Even though my husband was having a very bad day, he took the news very well (that his car would be no longer). A different friend came over to chat for a bit, and helped to keep my mind off of things. The school held difficult child for me since I had to be on scene for the car and wait for the towing company. They even fed him lunch and got his little brother some lunch too once we showed up.

Both boys have had a relatively good afternoon without too much havoc. Some squabbles over toys, but nothing like throwing chairs.

So overall, I may have had the day from hell, but it's a day that I am very thankful for since in the end, everyone was alright. Sometimes it takes looking at the what 'could'ves' that really put things into perspective.

For example, if my friend had been driving her mini cooper instead of my husbands SUV, there would be a lot more damage to not only the car, but her and the kids as well. Since the jack wasn't secured correctly, it came flying up and landed in between the driver and passenger seats. It missed the girls head by a couple of inches. If the fence hadn't have caught her (and blown the tires), she would've ended up in a utility thing of sorts. If I hadn't have done a wonderful job installing those car seats, the girls could have gone flying. If my friend hadn't put her seat-belt on, she would have gone through the windshield. Even though she landed on the fence, the gasoline tank was not punctured. So no fire. Since the car landed upright (and facing the road coincidentally), there was no need for the 'jaws of life'. Since the company that made the car made it well, the frame only bent, and didn't give-way when the accident occurred.

There are a lot of different scenerios that run through your head with these things. And cars can be replaced. The people in them cannot. This is an important reminder when things seem to be going wrong. It could always be worse.

And while my friend does feel bad for wrecking the car. The important thing is that they are still here with us today, and they are safe. Thank you Mercury for making the SUV as sturdy and reliable as it was. She will be missed. And thank you to whomever was watching over my friend and her children today. It was definitely a miracle.

 

[TeDo]

DS3, {{{{(((HUG)))}}}} from me to. You sure are dealing with a lot right now but I admire the way you have (again) found the silver lining. That is awesome (and a sanity saver).

Absolutely, adding a second dose of the adderall could be causing the insomnia/hyperactivity. I would definitely bring it up to the psychiatrist SOON. go too long without adequate sleep and difficult child's problems can drastically increase. It may also be that adderall isn't the right medication for him. Just my opinion but it might be worth looking into.

More {{{{(((HUGS)))}}}}

 

[DS3]

DS3, {{{{(((HUG)))}}}} from me to. You sure are dealing with a lot right now but I admire the way you have (again) found the silver lining. That is awesome (and a sanity saver).

I figure there's two ways to look at this. I could have gotten upset, angry, et cetera, but not only would that have been shallow and uncaring -it wouldn't have changed anything. So why bother.

And it's like I said the car can be replaced. The important thing is that the people who cannot be replaced are alright. (Since I'm not uncaring, shallow nor angry).

On another positive note (in my mind) Car shopping will be a nice break from doctors appointments for myself and difficult child. I may even talk my hubby into that van I've been wanting.

Absolutely, adding a second dose of the adderall could be causing the insomnia/hyperactivity. I would definitely bring it up to the psychiatrist SOON. go too long without adequate sleep and difficult child's problems can drastically increase. It may also be that adderall isn't the right medication for him. Just my opinion but it might be worth looking into.

More {{{{(((HUGS)))}}}}

We go back to his psychiatric doctor tomorrow. Yesterday, despite having only 4 hours of sleep in him, difficult child did not take a nap and stayed up until almost 11 at night. So definately something to talk about with his doctor.

*Hugs*

And thanks for reading my super long story on yesterday. Today should be better.

 

[InsaneCdn]

Ditto on the medications - if the dose is too high, there's no way he could nap - or, if he is napping at all, its because of accumulated exhaustion that overrides the stimulant effect - and residual effects can last into the late evening hours...
Or its the wrong medication.
Or he needs something else with it - but I wouldn't do that without also reducing the dose...

As they get older, the effect of stims on sleep cycles is not as pronounced.