Generalized Anxiety NOS/ ADHD (combined)

shopgirl78

I'm just looking for some thoughts on how to handle DS1's dx.  Questions below....Background: DS1 has been in school since Prek3.   He had a rough year in PreK3, a good year in Prek4 and it all fell apart in KG partly because he had FOUR teachers.  The first teacher, he was removed because there were too many "hard" kids in the class and they thought DS would do better in a calmer class and he did but the second teacher got ill and left.  Third "teacher" was just out of student teaching and DS's behavior (defiant) got him suspended.  BTWN that and his decline in academics, I pulled him from his school to mine (I'm a teacher) and he did a 180 but at the teacher's request we did a psychological eval and he saw a behavior specialist.  Honestly, we were looking for an ODD dx but he received the dx above.  Since starting with the 4th teacher, we saw huge improvements in behavior and academics.  She pinpointed at the point in the day where the behavior began (ELA, the only subject where he is behind) and made an informal BIP that processed the behavior and pretty much the behavior went away....However, it left us still behind in ELA and I face the following decisions:

Despite being the second oldest in the class, hold him back a year to catch up in ELA...teacher suggested it, pyschologist said he was against it.  I don't think he's THAT low across the district but in this school, he is.  Compared to friends kids, he's middle of the road... I'm working with DS this summer to see if I can pull him up....he's fine in math and reading comp.  However, I am so not a KG or ELA teacher and its harder with your own kid.  We have been running 2 houses (bills), second one just sold so a tutor wasn't in the cards.  How do you feel about retention? 

Medication:   To medicate or not?  Surely, we will see improvement in focus; however, at what cost when he CAN manage classroom behavior but he's got to be with an awesome teacher willing to work with him....plus anyone deal with DH being against medication?!?  Also, none of the teachers thought ADHD.  It was always discussed but 3 teachers said there is no hyperactivity.  That dx was a bit of a shock. 

504:  This one I am sure I am going to do.  It will leave him with some protection with his behavior from suspension and he can also have frequent breaks if needed.  The AP was all for it and they seem really willing to work with him.  However, I teach at a top school in town and at anytime I fear they can drop him (or me) from the campus.  To get an IEP, he'd have to go through the whole tier/SPED testing process.  He is currently tier 2 reading and sees the reading specialist (for ELA) also he hasn't been in that long enough to qualify for testing.  Furthermore, we don't have a strong SPED program.  Any reason not to get the 504?  DD is on one for dyslexia.  

Any thoughts?!?

shopgirl78

-auntie- said:

shopgirl78 said:

I'm just looking for some thoughts on how to handle DS1's dx.  

Hi. Welcome.

Thanks.  I was hoping you'd reply.  

Questions below....Background: DS1 has been in school since Prek3.   He had a rough year in PreK3, a good year in Prek4 and it all fell apart in KG partly because he had FOUR teachers.  The first teacher, he was removed because there were too many "hard" kids in the class and they thought DS would do better in a calmer class and he did but the second teacher got ill and left.  Third "teacher" was just out of student teaching and DS's behavior (defiant) got him suspended. 

Not a huge fan of the ironic use of quotes. Was she a garden variety newbie teacher or was she truly incompetent? It sounds like he's had challenging behavior on and off since 3. Also not a proponent of teachers and their children in the same building. BTDT, it sucks. For a parent of kid with special education or behavior needs, being in the same school can adversely impact your ability to be an effective advocate.

I think the teacher was just new and didn't have a lot of experience under her belt. Teacher was in quotes because she hadn't finished her certificate despite being close (graduating this summer).   Honestly, I have found the opposite to be true.  It's easier to advocate for him in my building.   

Is this a public school?  Yes, although we are considered transfers.  We are not in this school's neighborhood.  

BTWN that and his decline in academics, I pulled him from his school to mine (I'm a teacher) and he did a 180 but at the teacher's request we did a psychological eval and he saw a behavior specialist.  Honestly, we were looking for an ODD dx but he received the dx above. 

That's an interesting dx for a six. While there are kids with GAD as a stand alone, IME, anxiety is usually part of some other issue that the eval missed or that hasn't fully revealed itself. 

Was this eval done privately or via your local school district? What scales were used? Did they R/O ASD and learning differences? Both of these can look and feel like ADHD or ODD.  Private eval.  They used clinical interviews, behavioral observation, WISC-IV (intelligence, his was low average), WIAT-III (achievement), RCMAS-2 (anxiety), BSAV-2 (behavior), CPT-II (performance) and Roberts 2 (apprecption).  It confirmed he was low in memory, processing, spelling..High math, numerical, comprehension and oral expression.  It basically said the same thing the school said.  

FTR, I have a son with Aspergers, ADHD, GAD and Specific LD (primarily dyslexia)- a lot of what you write sounds very like a kid with LD issues. They seem to take the "better to be seen as bad rather than dumb" approach to self regulation. 

Since starting with the 4th teacher, we saw huge improvements in behavior and academics.  She pinpointed at the point in the day where the behavior began (ELA, the only subject where he is behind) and made an informal BIP that processed the behavior and pretty much the behavior went away....However, it left us still behind in ELA and I face the following decisions:

Despite being the second oldest in the class, hold him back a year to catch up in ELA...teacher suggested it, pyschologist said he was against it.

Here's the thing. This is age appropriate material he's struggling with. Giving him another year of more of the same probably won't "fix" this. If something's not working, more of it doesn't work better.  He may need differentiated instruction in the form of a multisensory reading curriculum like Orton Gillingham or Lindamood Bell. I am not certain DS would ever have learned to read if we hadn't pulled the trigger on a specialized reading school. 

What if my hunch is right, but he revisits kindie/first (not sure which) as the oldest kid there who still doesn't get it. He'll have taken the hit to his self esteem for no good reason. KG, and that's what I said.  

I'm on Team Psychologist.

  I don't think he's THAT low across the district but in this school, he is. 

The reality is that 1) he's comparing himself to the pool in which he swims. If you're in a high achieving district/school that's his reality. True.  His end of the year reading level is B.  C is end of the year KG. (Fontus Pinelle-spelling error, I'm sure) And 2) the standards include all kids- even those with special needs, who are living with the challenges of poverty and who are being taught in sub-par schools- a middle class kid with a teacher for a mom should be thriving.

I felt this way initially since DS bridged to public reading on grade level. Little did I know that in my district, the average kids were 2-3 grades ahead.

 Compared to friends kids, he's middle of the road... I'm working with DS this summer to see if I can pull him up....he's fine in math and reading comp.  However, I am so not a KG or ELA teacher and its harder with your own kid.  We have been running 2 houses (bills), second one just sold so a tutor wasn't in the cards. 

Can you get a school based reading program? Can you get a teacher friend to make suggestions and start a program for you to follow? In a perfect world, I say see if you can do a summer Orton or LB program. Certainly it's something to consider for next year.  I got it from the KG teacher.  We are more than half way through the first book of three.  

 How do you feel about retention? 

I don't think it's an appropriate choice in this situation. I think you need to figure out why he's not learning as well as he should be and fix that. 

Medication:   To medicate or not?  Surely, we will see improvement in focus; however, at what cost when he CAN manage classroom behavior but he's got to be with an awesome teacher willing to work with him....plus anyone deal with DH being against medication?!?  Also, none of the teachers thought ADHD.  It was always discussed but 3 teachers said there is no hyperactivity.  That dx was a bit of a shock. 

If nobody thinks it's ADHD either he has an atypical presentation or he doesn't have it. How was this dx arrived at? IDK Did they just do a Conner's Scales or did the psychologist observe him in school? It took me a long time to get on board the ADHD bandwagon with DS- I could totally see the AS and the LD, but it wasn't until he was in 4th that I saw the executive function deficits that I could wrap my mind around it. I think the one thing that helped me keep an open mind around this was that DS's clinical psych, his dev pedi and the school psych all saw it. DS's presentation is almost a girl-like dreamy presentation at times. Maybe a second opinion would make sense.

504:  This one I am sure I am going to do.  It will leave him with some protection with his behavior from suspension and he can also have frequent breaks if needed. 

I wouldn't bother with a Section 504- it has no teeth and doesn't offer the same level behavioral safeguards an IEP does. I know an IEP can prohibit a district from more than 10 days of suspension for a manifestation of a disability- but I don't think a 504 offers that. It's pretty unlikely your 6 year old is going to commit the sort of infraction that would give him a 10-Day suspension. He got a three day one in March (before the move) for defiance.   Nothing else.  

 The AP was all for it and they seem really willing to work with him.  However, I teach at a top school in town and at anytime I fear they can drop him (or me) from the campus.

It's the nature of your job that you can be reassigned unless your contract says otherwise. How do they get to turf your kid? This is a public school, no?  It's not our neighborhood school, same district/different school.  I have to apply for them to come.  

  To get an IEP, he'd have to go through the whole tier/SPED testing process. 

Which might help you understand why he isn't doing well. It might offer an IEP with differentiated instruction.

He is currently tier 2 reading and sees the reading specialist (for ELA) also he hasn't been in that long enough to qualify for testing. 

So they are doing RTI? You have to hit tier 3 before testing which takes one full school year at tier 2 and generally failing state tests.  Not a fan, but I guess this is something you need to do before they'll take the next step. Is there any way you could have educational testing done privately?  In the future, maybe.  It was $500 for the first round and like I said have been running two households and bills.   DS was seen by a developmental/educational neurologist for a fill educational workup- it was very useful for educational planning.

 Furthermore, we don't have a strong SPED program.

And this is supposed to be a good school.  Due to the nature of the cliental, its a small program and personally, I'm not a fan of that teacher either.  Furthermore, because our state test scores are so high and its an upper middle class school, there is NO extra funding.  

  Any reason not to get the 504?  DD is on one for dyslexia.  

What sort of services is your DD getting? Oral delivery of test, extra time and small group instruction.   Most of the 504 help with state testing which she will need this year for the writing exam.  She's horrible at creative writing.  Not with ideas, but execution.  For DS1, I'd have it read extra time and frequent breaks. That's all that I think will help him at this time.   Do you think perhaps they both have dyslexia and that's why he's not quite where you expected in ELA?  It's been brought up but I am not sure that he can be tested yet.  I'll have to check on that.  He may also start receiving speech as he confuses the "T" and "C" sounds.  For example, he says "Tookie" instead of "Cookie."   It can run in families. My one BIL's 3 kids (with 2 different moms) all have dyslexia. Oldest boy was identified later and didn't do as well as his sisters. They're both college grads, he squeaked through college. They have a teacher and a college professor as parents.

Any thoughts?!?

shopgirl78

DC2London said:

I'm assuming that your school is not your neighborhood school, but you've been granted special permission as a staffmember to bring him from outside of boundaries.  Nailed it.  

I think it would take a pretty sadistic admin to reassign an otherwise good teacher bc her child is a challenging pupil.  I've also never heard of revocation of special permission due to a child having special needs, behavioral or otherwise.   I hope so.  Seriously, it is one of my fears.  It's only my second year at this school.  

For an anxious child (with or without clinical anxiety), bouncing around between classrooms is going to be traumatic and negatively impact his learning. It was and I think he got the idea that he was a "bad" kid.  I daresay that any kindergarten student forced to switch classrooms thrice is going to react negatively.  I'm glad that he was able to thrive in the fourth classroom, but I would assume that all of the change and disruption in the first quarter or half of the year affected his learning throughout kindergarten.  It sounds like the fourth teacher is a real gem and took a deep interest in helping your son succeed.  She was amazing!  And really helped his self esteem.      But, at that point, he may well have already been behind.

Would you be able to do something like Sylvan, which would provide tutoring at perhaps a lower cost than private tutors?  Any chance an elementary ed major from a local college would work with him at a reasonable rate?  The college idea is good.  

I have to agree with auntie and the psych that retention doesn't sound like a wise move. This school banks on their state scores and I seriously think that's their reasoning behind it (although, test don't start til 3rd).    

shopgirl78

-auntie- said:

shopgirl78 said:

-auntie- said:

shopgirl78 said:

I'm just looking for some thoughts on how to handle DS1's dx.  

Hi. Welcome.

Thanks.  I was hoping you'd reply.  

Questions below....Background: DS1 has been in school since Prek3.   He had a rough year in PreK3, a good year in Prek4 and it all fell apart in KG partly because he had FOUR teachers.  The first teacher, he was removed because there were too many "hard" kids in the class and they thought DS would do better in a calmer class and he did but the second teacher got ill and left.  Third "teacher" was just out of student teaching and DS's behavior (defiant) got him suspended. 

Not a huge fan of the ironic use of quotes. Was she a garden variety newbie teacher or was she truly incompetent? It sounds like he's had challenging behavior on and off since 3. Also not a proponent of teachers and their children in the same building. BTDT, it sucks. For a parent of kid with special education or behavior needs, being in the same school can adversely impact your ability to be an effective advocate.

I think the teacher was just new and didn't have a lot of experience under her belt. Teacher was in quotes because she hadn't finished her certificate despite being close (graduating this summer).   Honestly, I have found the opposite to be true.  It's easier to advocate for him in my building. 

Wow. An uncertified teacher would never fly in my district. I live in an award winning district that has the highest paid teachers in the state- they tend to bring new teachers in as long term subs (secondary) or paras (elementary) for a year or two as part of the unofficial application process.   The district they were in was smaller and less resources.  It was a good school for DD but very bad for DS1.  

The bolded is the first I've ever heard a parent/teacher express this. Maybe because a lot of my peeps are dealing with ASD, or because your kids are getting more free accommodations than actual interventions but it's a different spin on things than what I usually hear.

  

Is this a public school?  Yes, although we are considered transfers.  We are not in this school's neighborhood.  

BTWN that and his decline in academics, I pulled him from his school to mine (I'm a teacher) and he did a 180 but at the teacher's request we did a psychological eval and he saw a behavior specialist.  Honestly, we were looking for an ODD dx but he received the dx above. 

That's an interesting dx for a six. While there are kids with GAD as a stand alone, IME, anxiety is usually part of some other issue that the eval missed or that hasn't fully revealed itself. 

Was this eval done privately or via your local school district? What scales were used? Did they R/O ASD and learning differences? Both of these can look and feel like ADHD or ODD.  Private eval.  They used clinical interviews, behavioral observation, WISC-IV (intelligence, his was low average), WIAT-III (achievement), RCMAS-2 (anxiety), BSAV-2 (behavior), CPT-II (performance) and Roberts 2 (apprecption).  It confirmed he was low in memory, processing, spelling..High math, numerical, comprehension and oral expression.  It basically said the same thing the school said.  

Some of this is standard stuff, some I'm not familiar with. The WISC and WIAT are good options. CPT is a computerized Conners (as opposed to the old school paper reports filled out by parent and teachers). I know of the anxiety one, but most docs I know use something like BASC-2 and/or Vineland to tease out emotional issues like anxiety and how they manifest. Have no idea what BSAV is; I googled it and got a link to this thread.   I copied straight from the report hopefully no typos.  

FTR, I have a son with Aspergers, ADHD, GAD and Specific LD (primarily dyslexia)- a lot of what you write sounds very like a kid with LD issues. They seem to take the "better to be seen as bad rather than dumb" approach to self regulation. 

Since starting with the 4th teacher, we saw huge improvements in behavior and academics.  She pinpointed at the point in the day where the behavior began (ELA, the only subject where he is behind) and made an informal BIP that processed the behavior and pretty much the behavior went away....However, it left us still behind in ELA and I face the following decisions:

Despite being the second oldest in the class, hold him back a year to catch up in ELA...teacher suggested it, pyschologist said he was against it.

Here's the thing. This is age appropriate material he's struggling with. Giving him another year of more of the same probably won't "fix" this. If something's not working, more of it doesn't work better.  He may need differentiated instruction in the form of a multisensory reading curriculum like Orton Gillingham or Lindamood Bell. I am not certain DS would ever have learned to read if we hadn't pulled the trigger on a specialized reading school. 

What if my hunch is right, but he revisits kindie/first (not sure which) as the oldest kid there who still doesn't get it. He'll have taken the hit to his self esteem for no good reason. KG, and that's what I said.  

In reading, I wasn't sure if you were talking the year that is wrapping up in some places or the one before. Given your son's age and the range of cut-off dates around the country I didn't want to assume. Sorry, I meant "that's what I said" to go long with the retention stuff.  

I'm on Team Psychologist.

  I don't think he's THAT low across the district but in this school, he is. 

The reality is that 1) he's comparing himself to the pool in which he swims. If you're in a high achieving district/school that's his reality. True.  His end of the year reading level is B.  C is end of the year KG. (Fontus Pinelle-spelling error, I'm sure) And 2) the standards include all kids- even those with special needs, who are living with the challenges of poverty and who are being taught in sub-par schools- a middle class kid with a teacher for a mom should be thriving.

I felt this way initially since DS bridged to public reading on grade level. Little did I know that in my district, the average kids were 2-3 grades ahead.

 Compared to friends kids, he's middle of the road... I'm working with DS this summer to see if I can pull him up....he's fine in math and reading comp.  However, I am so not a KG or ELA teacher and its harder with your own kid.  We have been running 2 houses (bills), second one just sold so a tutor wasn't in the cards. 

Can you get a school based reading program? Can you get a teacher friend to make suggestions and start a program for you to follow? In a perfect world, I say see if you can do a summer Orton or LB program. Certainly it's something to consider for next year.  I got it from the KG teacher.  We are more than half way through the first book of three.  

Is it the same materials he used in class? Is he doing better with your 1:1 attention or is it still a lot of work for him?  Yes, same materials in class however since he came in March.  He never got to them.  He gets harder the harder the stories get and I think there are so many distractions (fun) around here that I generally have to bribe him.  "We can swim but we have to read our stories first."  He went to VBS this week which is a lot more arts and crafts but some (hidden) academics and he did fine.  However, his stories in this afternoon was a pill (BUT he feel asleep shortly after completing one and throwing a fit).  I don't know where he is better.  The last teacher said she had some luck with grouping him with high boys and him following their lead.  

For DS, all the individual attention in the world would help him learn to read in a whole language setting. He needed a robust multisensory approach. 

 How do you feel about retention? 

I don't think it's an appropriate choice in this situation. I think you need to figure out why he's not learning as well as he should be and fix that. 

Medication:   To medicate or not?  Surely, we will see improvement in focus; however, at what cost when he CAN manage classroom behavior but he's got to be with an awesome teacher willing to work with him....plus anyone deal with DH being against medication?!?  Also, none of the teachers thought ADHD.  It was always discussed but 3 teachers said there is no hyperactivity.  That dx was a bit of a shock. 

If nobody thinks it's ADHD either he has an atypical presentation or he doesn't have it. How was this dx arrived at? IDK Did they just do a Conner's Scales or did the psychologist observe him in school? It took me a long time to get on board the ADHD bandwagon with DS- I could totally see the AS and the LD, but it wasn't until he was in 4th that I saw the executive function deficits that I could wrap my mind around it. I think the one thing that helped me keep an open mind around this was that DS's clinical psych, his dev pedi and the school psych all saw it. DS's presentation is almost a girl-like dreamy presentation at times. Maybe a second opinion would make sense.

504:  This one I am sure I am going to do.  It will leave him with some protection with his behavior from suspension and he can also have frequent breaks if needed. 

I wouldn't bother with a Section 504- it has no teeth and doesn't offer the same level behavioral safeguards an IEP does. I know an IEP can prohibit a district from more than 10 days of suspension for a manifestation of a disability- but I don't think a 504 offers that. It's pretty unlikely your 6 year old is going to commit the sort of infraction that would give him a 10-Day suspension. He got a three day one in March (before the move) for defiance.   Nothing else. 

I seriously side-eye a school that would discipline a kindie kid with a 3 day suspension for anything short of rape or murder.   Which is one of many reasons I yanked him out of that school...in another example, they took away the Valentines Day party (with my permission) but the admin renigged and he got to participate.  I think it came to heads where there were no more consequences.  They were bribing him with an Ipad.  Neither school has aides in KG.  Its very hard on the teachers I know too.  

At the last school (mine), they took the opposite approach.  He didn't go to the office for being "bad."  He went when he was good and got to go to the P's treasure box.  He had to complete so many activities (the number went up over time).  This worked for him! 

 The AP was all for it and they seem really willing to work with him.  However, I teach at a top school in town and at anytime I fear they can drop him (or me) from the campus.

It's the nature of your job that you can be reassigned unless your contract says otherwise. How do they get to turf your kid? This is a public school, no?  It's not our neighborhood school, same district/different school.  I have to apply for them to come. 

Can they turf the kids? Our district doesn't allow kids outside of IEPs to attend a school that isn't in their catchment area. (There are a bunch of math wiz kids who are bused "up" to middle school from elementary, middle to high and high to a local college; and there are high school kids who visit the other campus for some AP courses. We have one very small and desirable elementary the turfs kids with IEPs on the grounds that the school doesn't have the resources to service the IEP- i.e. the SLP is only in house one morning a week and the kid needs two 30 minute sessions. I'm not sure what turf means.  I have never heard it.  

  To get an IEP, he'd have to go through the whole tier/SPED testing process. 

Which might help you understand why he isn't doing well. It might offer an IEP with differentiated instruction.

He is currently tier 2 reading and sees the reading specialist (for ELA) also he hasn't been in that long enough to qualify for testing. 

So they are doing RTI? You have to hit tier 3 before testing which takes one full school year at tier 2 and generally failing state tests.  Not a fan, but I guess this is something you need to do before they'll take the next step. Is there any way you could have educational testing done privately?  In the future, maybe.  It was $500 for the first round and like I said have been running two households and bills. 

This kind of testing can be outrageous. The eval we had done on DS in first now costs just about $6K. DH's insurance picked up about 80% when we did it.

  DS was seen by a developmental/educational neurologist for a fill educational workup- it was very useful for educational planning.

 Furthermore, we don't have a strong SPED program.

And this is supposed to be a good school.  Due to the nature of the cliental, its a small program and personally, I'm not a fan of that teacher either.  Furthermore, because our state test scores are so high and its an upper middle class school, there is NO extra funding.  

So it's the families feeding in that are high achieving, not the school. It's pretty much the same here. DS's middle school is always in the top 5 statewide for NCLB testing- and they opt out only 2-3 kids per grade. The high school gets placed in many "Top Schools" polls.  Pretty much.  The school doesn't generally get the hard, poverty, diverse population...

  Any reason not to get the 504?  DD is on one for dyslexia.  

What sort of services is your DD getting? Oral delivery of test, extra time and small group instruction.   Most of the 504 help with state testing which she will need this year for the writing exam.  She's horrible at creative writing.  Not with ideas, but execution.  For DS1, I'd have it read extra time and frequent breaks. That's all that I think will help him at this time.  

Those are mostly accommodations rather than interventions. TBH, they're the sort of "helps" that will benefit the school at least as much as the student when they do the state testing. DS had most of those in his IEP, as he got older he found them to be stigmatizing and fought them. We did keep resource classes because he got differentiated instruction there.

No differentiated instruction? She goes to a dyslexia class 30 mins a day outside of regular class (though the accommodations are suppose to happen in class too).  They do a book set.  I can't remember the name but I think it was one of the big ones in dyslexia.  Not even a little Wilson Reading or Scholastic Read 180? Perhaps some scaffolding as part of her writing prompts? DS struggled early on with written expression. Early on we did prompts. Some kids do really well with Kidspiration/Inspiration  software. Our district teaches reading into 8th grade and does a lot of writing. We added additional speech to help with expressive language and writing. It worked pretty well- DH aced both hhis required college comp courses.

 Do you think perhaps they both have dyslexia and that's why he's not quite where you expected in ELA?  It's been brought up but I am not sure that he can be tested yet.  I'll have to check on that.  He may also start receiving speech as he confuses the "T" and "C" sounds.  For example, he says "Tookie" instead of "Cookie."

After a year exposed to a reading program, they should be able to test. At least privately. Does he have trouble making the "C" sound? Or could it be that he's not hearing it as it's spoken? Maybe an issue with phonemic awareness or even auditory processing.  THinking about this a little more, with the current (private) testing in place/just handed off.   He will not qualify.  If his IQ is low as well as his ability, he is function at the rate he is suppose to.  That's not dyslexia.  Dyslexia is the difference between IQ and ability.  DD had a gifted IQ but functioned at an average rate...there has to be that lag.  I'm a math teacher.  

Honestly, I always thought "Tookie" was cute and never corrected him.  He has gotten better over time.  

  It can run in families. My one BIL's 3 kids (with 2 different moms) all have dyslexia. Oldest boy was identified later and didn't do as well as his sisters. They're both college grads, he squeaked through college. They have a teacher and a college professor as parents.

Any thoughts?!?