Wednesday, February 27, 2013

ADHD?

About 6 weeks ago, I went to Harry's class to volunteer like I always do and his teacher greeted me with a list of behaviors she found questionable that Harry had been performing.  I read the list-- making animal noises during silent work time, going to the bathroom every 10 minutes during work alone time, spitting, puling up his shirt, not respecting others' space bubbles-- and asked her if this was all from the current week.

"This," she told me, "All happened before 10:00 this morning."

At first, Ben and I were annoyed that the teacher waited to tell us until things got out of hand.  At our conference just 2 months earlier, she said Harry sometimes has trouble sitting still and focusing but that he was meeting or exceeding all of his grade level expectations and had great relationships with his friends.  6 weeks later, though, he was having a hard time meeting grade level expectations for writers workshop, and she noticed that other kids were censoring his behavior more and more.  She said the behavior had been building-- at first she thought he was excited about winter break and the holiday season.  Then she thought maybe he was tweaking out about his sister's arrival.  Finally, she decided to talk to us.  I think she was hesitant because we are both so involved in the classroom, and she didn't want us to get defensive and stop coming-- which, of course, we considered.

It is important to note that Harry was never in trouble at school-- no trips to the office or anything like that.  But he did sit next to the kid with a full time aid so he could chatter away to another adult, and he did spend some of his "silent" work time sitting at the teacher's desk.

Ben and I called our pediatrician's office, and we decided to have his teacher and his specials teachers fill out a Vanderbilt's questionnaire so we could discuss possible ADHD.  This is not the first time a teacher has mentioned his inability to focus.  At our bullshit billion dollar Reggio preschool, we (I) got really angry at the "teacher" who suggested we go to the doctor for a diagnosis because A.  Reggio is bullshit, B. She has no degree in anything that I know of, let alone a medical one, and C. The kid was 4.  In kindergarten, his teacher praised his energy and reading and math skills and said we should keep an eye on the focus issue, which he may or may not outgrow.  She also said that while having friends was really important to Harry, he didn't always know how to act to maintain those relationships.  Based on these reports and his first grade teacher's concern with his writing, we wanted to be proactive before he fell behind socially or academically.

Ben had his mind made up that Harry was textbook ADHD and should have meds ASAP.  I was anti-meds and hopeful that our hippie doctor who doesn't even prescribe a damn antibiotic would back me up.

During our appointment, Harry bounced on the exam table and shredded the paper cover like he was a cat.

The doctor said Harry might in fact have ADHD.  Or he might grow out of his attention/behavior issues. He also said it is not his practice to medicate a smart, happy kid so he can perform in the classroom.  BUT, he also said that if we wanted a prescription, he would write it anytime, but he suggested we try behavioral interventions first. (This guy has known Harry since he was a few hours old-- we really do trust his judgement.)

So, that's what we have been doing.

Here's what we've changed:

Ourselves: 
  • We have tried not be be such assholes, and we have tried to only say no when we mean it, not just when saying no is easier for us.  
  • We have also stopped getting emotionally involved in tantrums-- we give him clear choices with consequences and let him decide and ignore ignore ignore hysteria.

School: 
  • During silent reading time, he reads to himself for 3 minutes and to the teacher for 2 minutes, instead of 5 minutes to himself-- this has been so helpful! 
  •  We have talked about the importance of being in class instead of in the bathroom, and he has regular break times!
  • He was getting distracted by drawing pictures in his writers workshop books and not finishing the stories.  Now, he writes the story on a plain piece of lined paper and draws a picture if he has time.  At night, he spends a few minutes editing his work and copying his story into a book which he also illustrates.  At the suggestion of a friend who is also a first grade teacher, we found a bunch of graphic organizers on the internet and downloaded them.  Every night, he fills one in for the next day's story, jotting down the main point and enough details for 5-7 sentences which he turns into a small moment story with a beginning, middle, and end during writers workshop.  At first, he was taking the full 30 minutes in class to come up with barely 5 sentences.  Now he has time to write his story, draw a picture, do a little editing, and talk to his friends.  Sometimes, he even gets to make the actual book during his 30 minute writers workshop.  (And it takes many kids in the class 2 workshop sessions to come up with 5-7 sentences, so he is not behind anymore as far as we can tell-- he always produces a complete story and edits it everyday between school time and home time).  At night, he was taking 30 more minutes to do his book and the next day's map, but now, he can do the whole task in 15 minutes, and he is better at staying focused-- we don't have to sit right next to him and coach him the whole time, but he does need reminders to stay on track and add punctuation.
  • His teacher keeps a sticker chart everyday.  At first, it was just for doing his work, which he did EVERYDAY from the time she instituted the chart!  And we bought him a toy for every 5 perfect charts in a row.  Now, we have upped the ante, and she is also including categories for cleaning up, being good at snack, behaving appropriately at lunch, modeling good behavior during rug time, putting away his things efficiently in his locker.  He has yet to get 5 in a row, but if he does, he'll get a new DS game.  On days he misses a sticker (and he has only missed for acting like a jerk at lunch, being disruptive on the rug, etc-- never for work), he can't play with his DS after school.
Routine:
  • Homework right after school no matter what.  He sort of hates this a little, but he is doing such a good job with the work! Also, I hate that a 6 y/o has homework, but I think we are moving toward him getting it done at school.  I have also been on a baking binge lately, so hot and fresh snacks from the oven make homework time more fun.
  • No more nagging him to eat breakfast.  Instead, I give him half a peanut butter sandwich and a cup of whole milk before we leave for school, and I don't care how much he eats at his first breakfast-- much more pleasant w/o all the nagging and complaining.
  • 30 minutes of exercise every morning before school.  Bounce house in the basement.  Dance party in the kitchen.  Walk.  Skateboard in the snow.  Play in the backyard.  This has been fun for everyone, and it has cut morning fighting (kid v kid and kid v adult) by 95%.
  • When we get to school, we help him be primed for success.  We talk about how much fun we had in the morning.  We tell him how excited we are to read his story and ask him to remind us of the details.  We make sure his gloves are inside his hat, his shoes are in the front mesh pocket of his backpack, and he is wearing his lunchbox like a messenger bag, so he can easily put his things in his locker and change out of his boots.  These little steps have meant the most change, I think, especially the overall focus on harmony and physical exercise in the morning.
Things are definitely improving, but both Ben and I wonder if prescription meds for ADHD are in our future.  They might be. We do not want Harry to fall behind academically or socially, and we are trying to be hyper vigilant.  I think we both have a tendency to romanticize the meds, too-- to think that every annoying or high maintenance behavior will go away, leaving THE PERFECT CHILD instead, and we know this isn't how it works.

I think he is a normal, rowdy six year-old boy, and I have to tell you that his sticker chart has been raising my mam bear hackles, especially since I go into that classroom every week and see all the other  loud pain in the ass kids-- Harry is far from the only one blurting answers, getting out of his seat, and talking to his friends.  Sometimes it seems like the reasons he didn't get a sticker are kind of silly--- like yesterday, he was talking too much and making noises during exercise time (they do exercises mid-afternoon because his teacher is too cold to take the class out for second recess.  Um.).  I kind of don't give a shit about that, you now?  I don't want him to be so frustrated that he can't get a sticker in every category that he backslides on the work-- because, really, getting his work done in class is the most important thing.

I have also been concerned about this classroom from the beginning of the year because there is SO MUCH GOING ON-- one kid with a full time aid for learning disability, one kid with a full time aid for behavior problems, and at least 3 other kids who have aids and other classroom-based interventions throughout the day.  On the one hand, this is great because there is an extremely low teacher:student ratio.  On the other hand it is very distracting under the best of circumstances for the least distractable kid. His teacher is really great, though-- extremely skilled at adapting what she is doing to a variety of learning styles/levels, and she does this naturally and spontaneously, reacting really well and really quickly to feedback from students.  Harry is also no longer sitting next to another adult all day (and he was never by himself or anything like that, but his table cluster included one of the kids with an aid I think in part because Harry needed another adult to give him direction), and he's not even the closest table cluster to the teacher's desk anymore, signs that he is making progress

There's no real ending to this post because we're still in the middle of everything, but I'll keep you posted.  Get it-- posted?

4 comments:

sarah said...

You know my story; so many similarities. Like you, we're not opposed to the medications in the future, I felt like the school we were at was incredibly out of line pushing us to medicate before they gave us any guidance on behavior modification, and strategies to create more structure for Ethan at home and at school.

Home work right after school (and with a smiley-face chart to go along w/ it) has really helped, and just the change in structure in his class room has made a huge difference. I look at his old classrooms (single room that could be opened up to the 2nd grade, and then a Multipurpose room that was used simultaneously by 3-4 grades at a time) and can't fathom how anyone could expect a high energy 6 year old to function in that environment.

And I'm sorry, but that teacher who won't take the kids out for recess? That's bullshit. 15 minutes of running around is a HUGE deal for a kid w/ ADHD attributes. Ethan has joined the lunch time "running club" at school and his teacher said it has been great for him.

Since we stopped the testing and moved his school, we've noticed a huge jump in his academic confidence and achievement. I'm still not sure if he'll be considered "on grade level" in all areas, but in just the past month, with the added structure and new environment, good things seem to be happening and he's feeling better about himself, which really, is the most important thing.

Oh, also--you know this already but we cut out red dye. Makes a huge difference.

Becca said...

Oh, this kind of thing can be so stressful. I am sorry you are going through it. I love the idea of him planning his stories the night before. Not everyone writes in the same way or at the same pace and this seems like a great way to set him up for success at school.

We've noticed huge benefits to morning exercise with Charlie (he rides his bike to school 1.2 miles, which is just far enough but not too far, IMO). I've been reading a lot that says six year old boys (in particular) are wired for physical activity and it can make school really challenging. You know about all the struggles we had at the beginning of the year. It was such a hard time for our family. I know you guys will help him through this--and sounds like you're already on the right track.

Chiconky said...

I have come to believe that traditional classrooms are just not the best fit for six-year-old boys. Everything about them directly contradicts normal, appropriate behavior for this age. With that being said, I want to commend you for being so willing to try behavioral strategies first. I think a lot of people have this romanticized idea about the meds, and are hesitant to make other changes first. If you're still struggling, it may be worth talking to a child psychologist or the school psychologist.
It does sound like there's a lot going on in the classroom, so the teacher may be "primed" to identify issues (aka there may be an availability bias). And the recess thing would be problematic for me, and may warrant a conversation.
All that to say, it sounds like you guys are doing everything you can, and Harry's a good, smart kid. Meds or no meds, he's going to do amazing things. Hang in there.

Anonymous said...

See I like your approach better than Sara's
I had commented on her blog too but I never ever get a response ..whatever..

You are practical in your realisation that yes you may needs meds /or not ..you acknowledge he may have adhd ..and not ju ast blaming the school ..have n't many boys had the same school system and gone on to become drs/engineers etc ?
My daughter was born at 27 wks and my bedrest was 180 degrees with emergent cerclage and I looked upto sara's blog ..
for inspiration