2 ADHD Questions - meds & school

Re: 2 ADHD Questions - meds & school

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  Starr57 member

  January 2014

  -auntie- said:

  Some questions-

  
  

  1. What behavior mods are included in his IEP to deal with out of seat behaviors? How did they work without the meds?

  We haven't gotten to do an IEP yet. We have an appointment for IEP/504 in 2 weeks. At the moment, he has a small fidget toy and velcro on his seat. Honestly, they don't do much at all as far as keeping him focused or in his seat (unmedicated, anyway).
  

  2. Who is prescribing his psychoactive meds?

  He sees a developmental pedi who specializes in attention disorders. She is part of one of the only clinics in our area that treats for autism, ADD/ADHD, social disorders, etc. Her preference would be a stimulant med as well, but we have to take his father's opinions/preferences in mind (see question 4).
  

  3. What was the reasoning between taking Intuniv and Focalin? What was Intuniv supposed to bring to the party? 

  He was on a lower dose of Focalin and was doing well, probably about 6 on a 1-10 scale. He was still experiencing impulse control issues and we wanted to see if the Intuniv would help alleviate that. It just turned out to not be a good fit for him.
  

  4. Why Straterra and not one of the other stimulants? A lot of families report that Straterra isn't as effective at symptoms relief as a stimulant. Intuniv seems a little worse according to those I know who've trialed it. Two other common glitches with Straterra are significant GI upset and that it becomes less effective over time (about 18 months for most who report this)

  His father is very anti-med. Our custody agreement provides for joint custody and decision making, so we agreed as a compromise to try Strattera for approximately 6 months and reassess at that time. From our conversations with the dr, stimulants can cause a sort of rollercoaster effect and Strattera (once it builds in your system) is more steady. That alone seemed to be more comfortable for XH.
  

  5. Emotional lability is a pretty common side effect with any of the stimulants, but most often a person who doesn't do well on one can do really well on one of the other two families of this medication. DS doesn't do well on the Ritalin/Concerta active ingredient, but is great with Adderall/Dexedrine.

  He was not very irritable (in my opinion) with the Focalin until we added the Intuniv. It seemed the combination didn't work for him. If I was making the decision alone, I would go back to the Focalin (or another stimulant) before trying a non-stimulant route.
  

  6. One downside to the Straterra is that it needs to be taken daily. If a goal is to eventually wean off meds, the stimulants can be preferable because they can be taken as needed. 

  This has both positives and negatives. Weaning is difficult, but the level of meds in his system stays more consistent than stimulants. If we forget (or he doesn't take) a dose of the stimulant before school, he has an absolute nightmare of a day. Not to say that we are not consistent with the medication, but accidents happen and it's had pretty drastic consequences in the past.
  

  As for schooling, a lot of kids with ADHD do really well in schools designed for kids who learn differently. DS attended a reading lab school for bright kids with ADHD and LD issues- every part of the school was tweaked to be a best possible fit for the kids. It was awesome when he was your son's age. Unfortunately are very expensive; I think DS's old school is up to $28K/year. But every aspect of the school was tweaked for kids to be successful- rooms were stripped down to avoid visual distractions, academics were before lunch/specials after, classes were assigned by level and learning style, classes were small, the days were shorter, but they attended year round.

  
  

  Is your son learning well in this traditional class? Is he wandering because he's completed his work and needs something more to challenge him? (a common gifted MO) Or is he struggling and wandering to avoid doing work that is too hard for him to do easily? Is he a self directed learner who is willing to take on all kinds of material or does he hyperfocus on specific subjects to exclusion of others?

  Right now he is in a traditional class. He is above grade level in most subjects, but he does not complete work. He wanders simply because he is not interested in completing his work. He's never been in a learning environment that is more self-directed so it may be an option. He does seem to be hyperfocused on things that interest him and for example, will draw or read for hours on end if left to his own devices. A lot of the work in his class is worksheet based and I think it just doesn't hold his attention. I personally sympathize with that... I often find myself easily distracted at work when I am given a task that does not interest me.
  

  Montessori can be a good fit for a bright self directed kid who is an experiential learner and will apply themselves even at subjects that aren't their preference. It's not ideal for a kid who requires constant redirection to complete their lessons.

  
  

  Do you have a Montessori program that would be willing to accept him at age 7? To what grade do your local schools enroll? One of ours ends at 2nd or 3rd grade, another runs through 6th.

  There is a local Montessori program that is a charter school and there is also a magnet program at a public school. Both run through 5th or 6th grade and I'm looking into that. It is also something I plan to discuss with the behaviorist. Either way, it's not likely that we would change in the middle of the school year. The teacher he currently has was also his teacher last year (she moved up to 1st and got him again in her class) so she has been with us through all the med trials.
  

  
  

  
  

  

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  Princess_Lily member

  January 2014

  For DS structured settings work better than a montessori, our pedi doc says, "...traditional schools usually tend to work better for children with ADHD, because they are led by structured time, and they know what is expected over time."
  
  That being said, I would wait for an IEP review as a possibility for your child.
  After all plans are exhausted in the public school, we personally would seek out a school which is designed for children who have ADHD...but your then looking at $$$.

   
  

    

   
  

  
  

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  Starr57 member

  January 2014

  I will definitely hold off on making any decisions about school until after we have the IEP/504 talk and see the behavior therapist. Just trying to think outside the box and explore some options.

  The nice thing is that the two Montessori options I'm looking at are either a magnet program at a public school or a charter school (which means no cost!). I don't know what the acceptance rate is like or anything, but I think it's at the very least worth learning about.

  

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  Starr57 member

  January 2014

  Great responses, auntie & fred. I appreciate the insight and will focus on the IEP for now. We will discuss possible changes of school environments as we go.

  As far as getting around his dad, we may have to do that in the future. Our current parenting time arrangement has DS switching houses every week (so this week he is with me, then he will go back to his dad's house on Friday for a week), and I think that is really doing him a disservice with the inconsistency. His dad and I have admittedly different styles and while we've had some success with trying to even it out, we are just such different people that it often falls short. In my state, however, I would have to prove that there would be benefit in changing our arrangement and that would be difficult without recommendation from other professionals. Yet another thing on my ultimate goal list...

  

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