Ritalin and impulse control

[pepperidge]

Malika,

At therisk of seriously annoying you I am going to suggest a different way of thinking based on ten plus years of two difficult children and five or so years of reading on this board. I think the abilityy of even very good psychiatrists to diagnose kids correctly or usefully is limited by the state of knowlege of what causes difficult children behavior (how many of us have been to multiple psychiatrists and gotten slightly different diagnosis) and how psychotroppic drugs work. My child is bit hyperactive and impulsive probably a result of some fetal alcohol exposure. Everything you describe about your son fits my sone to a T. I often feel you are describing my son better than I could.

Does that mean your child might have some form of Fetal Alcohol Syndrome (FAS)? Who knows. My first few years of coming to terms with my children's difficult child-ness was spent on exhaustive internet research. was it bi\polar, depression, Fetal Alcohol Syndrome (FAS) ADHD? Ultimately I decided with the help of a wise psychiatrist that it didn't really make a rat's ass of a difference. The question was what were we going to do about the symptoms that were comprising his ability to lead a happy normal childhood to the extent such was possible.

difficult children are what they are. Now sometimes have a diagnosis to guide intervention is a useful thing, but it is a guide as to what might or might not work. A diagnosis is ticket into the mental health system and educational accommodations.

It seems to me that the really important work you are doing is not figuring out what his diagnosis is. It is really observing his behavior, triggers etc and trying to ascertain whether he is out there on the bell curve for whatever reason. You are doing a great thing by putting your energies there. If he is really not typical and he is suffering, then you have to figure out whether there is any intervention, medication, therapy etc that might help and whether you are willing to go that direction.

If getting him an ADHD diagnosis will get him some intervention that you think will be useful then go for it, realizing that the 20 psychiatrists are probably going to give you 20 different answers. It is frustrating and ultimately one needs to do what is best. I spent just about every night for a year researching different medications and ultimately went to the psychiatrist and convinced her that my son needed to try Lamictal. it made a big difference in his life. Does he have any of the standare diagnosis's for it? No, but who cares, it works.

We would all like to know what is 'wrong" with our kids so we can fix it. The ultimate irony or cruelty is that we would do all that we could if only we knew what to do. But unfortunately about 50 or 75% of the time it seems that these kids are complex.

 

[Malika]

Hi pepperidge. No, you haven't seriously annoyed me! Have to try harder Seriously, though, I do think it is normal and natural to want to know what is going on - what is the cause, what is the manifestation? I particularly have a mind like that, I don't know. But of course it is in a sense a luxury and the vital thing, as you say, is to get to know how to handle the behaviour, etc.
The problem here, as elsewhere, is that without a diagnosis people just see the child as "naughty", badly brought up, wild, etc. And then, in France at least, even with a diagnosis people's expectation and behaviour doesn't change; on this forum for parents of ADHD kids, there is a depressing litany of testimonies of how teachers constantly punish and scapegoat the ADHD child, even after the diagnosis and repeated attempts of the parents to make the teachers understand and take the condition into consideration. Just doesn't happen... but somwhere, sometime, with some people it presumably does? And then the medications - I am curious to see what a stimulant would do to/for J because of his hyperactivity that serves him ill socially.
It is interesting that J sounds just like your son. Does/did your son also have the good stuff? I have seen J get increasingly co-operative, less rude and defiant (not saying that has disappeared, just lessened in frequency and intensity), he is reasonably often to be mistaken for a easy child - helpful, polite, tractable and so on. And then his impulses will be set off at some trigger and... all the wild cats fly out of the bag. If your son also presented this uneven picture, did it mean people sometimes told you nothing was wrong? Did/does he concentrate well at school and get good results? I am interested to know more!

 

[pepperidge]

Hi malika,

My son's best features are his sociability, his 'coachability" and his willingness to try new experiences. As for the sociabiilty, it is a bit of a mixed blessing because he wants to be around kids all the time but he doesn't really have good friends. He is not shunned, but it is like no one really wants him. He has general social skills but I think it is the impulsivity that gets in the way. When he was in first and second grade he would often get in trouble during unstructured time--couldn't keep his hands to himself when he was in line kind of things. Eventually other kids get tired of that sort of thing, and the ones who don't are not really the ones you want to have as friends. He was physcial during play--not mean or aggressive. But he had these show off kind of tendencies rather than cooperative play so I think he scared kids (and their mothers!). Ever since we moved (when he was in first grade) he lost his one friend that he played with alot and I think he has been lonely. As he has gotten to be a teenager, there is this competivitive boy culture (not very supportive) and I sense that he has not really been able to find his place socially in school. He has gotten more agumentative and irritable (maybe is typical teen, I wouldn't know lol) which doesn't help on the friend front. The downside of the sociability is that he will do just about anything to try to fit in with friends so he has become a bit of the class clown.

He is very coachable. He loves hanging around with male figures who encourage him and provide a little bit of the male rough and tumble type stuff. His coaches have all praised him as him wanting to listen and try to take on board advice. We have gone out of our way to surround him with good role models. he has had a twenty something really terrific athetic trainer, a counselor at schoo, a couple of sports coaches. Sometimes parents have trouble taking the really positive attitude. But my son just eats up that kind positive support--right now he is really into identifying with men so that's what we are going for.

He also has a kind of joie de vivre, willingness to try new things. My other son will say no to everything but my youngest is willing to try new things, go to camp where he doesn't know the kids etc..

Unfortunately the happy go lucky kind of kid he was when he was young is slowly being eroded by the constant negative messaging of some of the teachers he has had, his parents frustration when he was younger of the stupid things he would do etc. We are really trying to work on that.

As far as intellectually his neuropsychologist testing showed that he has a pretty average IQ. He did better in school when he was younger, as the material gets more complex and abstract it gets harder. He can focus on school work pretty well and wasn't off the charts in terms of hyperactivity. But he is a physical kid. A lot of whether he focuses depends on his mental state etc. I think one of the points about ADHD is that kids can focus but that it requires a whole lot of effort. We don't have much luck with getting him to do a lot of homework after school as he has used up his mental energy for the day. In general he wants to do well in school and will do his work, but as things get harder he seems to be having more trouble remaining on task.

We did see some results with Abilify. We tried a form of Ritalin when he was younger but it seemed to increase his tendency to perseverate which wasn't helpful. He tried Concerta when he was in 7th grade and getting into minor trouble all the time at school and it was helpful. We just discontinued it because we weren't really sure it was helping anymore.

WE are in the process of looking for other educational options for him--one that understands the needs of boys to really affiliate with good adult role models and with a substantial physical component to the schooling, and one that tries to focus on the positives of a kid like my son.

I would be a little leery of Waldorf, my impression of the one I knew something about was that it was more gentle arts type of kids. I just don't think it would have appealed to my son. He wants to be out in the woods learning survival skillls.

I feel for you dealing with the French system--my impression have worked with a number of French people is that they have very clear ideas of what is right and wrong and I don't know how they deal with kids that don't fit the mold.

I understand your frustration--it would be so useful to have a clear idea of what's wrong and how you can fix it. I am very glad that I took a lot of time to research different medications etc--it meant I could have intelligent talks with the psychiatrists and was better placed to recognize negative side effects (which docs tend to poo poo). As time as gone on, i spend less time loooking at dxes and more time trying to find people and educational options that will interact positively with my kids. That's where I think we will see the biggest returns.

 

[InsaneCdn]

Unfortunately the happy go lucky kind of kid he was when he was young is slowly being eroded by the constant negative messaging of some of the teachers he has had, his parents frustration when he was younger of the stupid things he would do etc. We are really trying to work on that

Pepperridge... we've been there done that.
You mention ADHD - ever had him tested for Auditory Processing Disorders (APD)? it's not uncommon as a co-morbid diagnosis...
Plus... is this difficult child 2? heading into HS? Can you get him into a full comprehensive HS with all the shop classes? That was a total gift to our difficult child... made a huge difference even in his attitude toward school. There was "something" HE could really shine in... and does.

 

[Malika]

Thanks for sharing that portrait of your son, pepperidge (by the way, your name makes me think of delicious pepperidge farm little biscuits from time I spent in Bermuda and the States when I was 18 - don't know if they still exist? )
Yes, I kind of get the picture with your boy. It is so sad that he has been marginalised in this way (I understand only too well of course) and think it would be great if you could get him into the right school for him. I've looked at all that with schools, been round the houses with it and in the end decided to stay here for the time being because I see that stability suits J so much (having had very little of it up to age 3).
As for Ritalin... well, tonight I took J to see one of the two psychiatrists he occasionally sees. This one clearly has a psycho-analytical background and has this whole thesis about why J is hyperactive, to do with moving between cultures, trying to find an identity, etc. Lot of moonshine, really, if you ask me but I'm sure the things he points to has some influence. Anyway, in the course of our conversation of about half an hour he seemed to change views twice about whether or not J had ADHD - yes he does, no he doesn't. And the same with taking Ritalin. No, he shouldn't, yes he should. Thanks very much for clearing things up for me Anyway, he has written a letter to J's general medical doctor and to the other psychiatrist saying that I am now open to use of stimulants and these could possibly be tried in future. And now of course I'm absolutely terrified of them and want to say, no, no, let's put that off until there's absolutely no choice! Anyway, gently, gently does it... J still isn't even six yet, the age of minimum prescription (except in extreme cases) here.
I think J does sound like your son, pepperidge. He also sounds different... the uniqueness of each child. The physicality and the showing off are just the same. Best social experience I've seen with J is when he goes to a small play centre here during the holidays - relaxed, fun atmosphere, just play activities, friendly staff. J always seems to be in the thick of things, having great fun. Because he's not being punished all the time and so other kids don't look at him as if there's anything wrong. Thanks to this dear school teacher and her methods, the kids in his school see him as a troublemaker who is always in trouble... So very not good, as you say.