Is the pediatrician right about my daughter? Re ADHD

amother

Sun, Oct 24 2021, 4:18 am

My daughter is very bright but has always had problems organizing her things, doing boring tasks like brushing teeth or cleaning up, sleeping (since she was a newborn), and is in generally very emotionally volatile at home (fighting with siblings often, lots of drama).

She's a great student in the sense that she loves to read (she would read all day if we let her), has no problem sitting quietly in class (she's shy to act up there even when she wants to), and last year in particular she loved her teacher and loved exceeding expectations in every scholastic area. When I see her with her friends, I see that she is peaceful and quiet--really not the same screaming, crying, hitting, flailing kid we often see at home. She's ten years old. The only negative feedback we ever got from the teacher was that she doesn't really participate in davening, just seems to be spacing out. That's exactly the kind of boring repetitive thing she just has a really hard time doing.

I am pretty sure she can qualify for an ADHD diagnosis because I see so clearly that she is impulsive and struggling to manage herself, and even says that (for example) she doesn't want to hit her siblings but can't stop herself. She wants to clean up, but can't seem to make herself. Etc.

We went to the pediatrician not because we want meds for her but really just as a first step for any other treatments that might be available for her, and I feel it would also help her understand herself better because she feels really bad about her inability to manage herself.

As part of the evaluation, we needed to bring a questionnaire filled out by her teacher--we started jumping through these hoops last year, so the questionnaire we brought was filled out by her last year's teacher.

The pediatrician said that he never saw such a good report from a teacher. And if she had ADHD, it would manifest in every environment, not just at home. So she doesn't have ADHD. He said she may have problems with emotional regulation, and for that he will send us to get parenting advice.

So my question is:

1) Is it true that ADHD needs to manifest in every environment?

2) Is emotional dysregulation not in an of itself part of ADHD? Like, can't you have ADHD but just focus really well on your school work, because you find it just the right amount of challenging and you want to please your teacher? (To be clear, she stressed about her schoolwork plenty at home, but her teacher didn't see that part...)

Thanks for any insight! I'll take advice too, on what to actually do Smile

Thanks!

amother

Maroon

Sun, Oct 24 2021, 4:36 am

I had a similar experience with one of my kids. I went to a neurologist for an ADHD eval for the child. She was a MONSTER at home, and calm and collected at school. He said the issues are most likely emotional if she's only acting out at home. He staid a diagnosis is not a helpful thing in this scenario, whether she has ADHD or not. He's a doctor who prescribes medicine. Medicine works in the morning and wears off in the afternoon. It can actually make your child's behavior more unbearable in the afternoon hours. It's also to help for scholastic difficulties, which your daughter seems to be managing well right now. Medicine does not help for organizational issues. So you need to ask yourself what you hope to accomplish with a diagnosis. Perhaps in her situation, it's better to put the diagnosis aside and just treat the symptoms?

I understand you might want therapy and OT for her, those things might be helpful. The doctors don't like to give out diagnosis of ADHD without school difficulty, and the insurance funds where I live don't like to cover OT just for emotional issues alone. They say it's outdated. Are you in Israel? Maybe we saw the same Neurologist. Very Happy

amother

Honeysuckle

Sun, Oct 24 2021, 4:48 am

It's true that ADHD needs to manifest in every environment.

But it's also true that ADHD can be 'hidden' in some environments, depending on circumstances.

If your dd was capable of choosing to focus on schoolwork, hours a day every day for an entire year, I'd say that's a pretty strong indicator that the issue isn't ADHD. Even the schoolwork being an appropriate level and the kid wanting to do well in school would usually only help for 2-3 months. It wouldn't be a long term solution, because ADHD is an internal problem.

But if she did struggle to pay attention in class, and the teacher just never noticed because she wasn't bothering anyone and was smart enough to follow the material anyway - in that situation you could get a glowing teacher's report, but ADHD is still very much a possibility.

I wouldn't accept the pediatrician's response. First I would go back and ask her teacher specifically about the kinds of problems ADHD might cause. It's easy to just think of her as a good student because she learned the material and didn't bother the class, but was she actively participating in class? Did she pay attention to detail? Were her school materials organized? Was her work consistent?

And then back to the pediatrician, to insist on an ADHD eval. Because it's a lot more likely that the teacher missed something - very normal with well-behaved girls with ADHD - than that emotion regulation problems are what's making her struggle with staying organized, sleeping, or doing boring tasks. It might not be ADHD but at least let an expert be the one to make that call.

amother

Honeysuckle

Sun, Oct 24 2021, 4:58 am

One of my kids has classic, no questions about it ADHD. Very very little impulse control at home or at school. Behavioral issues. Can't stop moving. Can't focus on anything that's boring, and almost everything is boring. Will fail a test because she only filled out half the answers (and got all of the ones she did fill out right).

But you know what? She can still sit and read a book for hours, and she's still fully at grade level with her schoolwork.

Kids' books are designed to be interesting. Just because a kid can maintain interest in a book with tons of action and plot twists doesn't mean they don't have attention issues.

And kids with ADHD can often keep up with schoolwork by working in stops and starts. Eg my dd ignored history class for a month, completely, but she also spent a month fascinated with the Roman empire and now knows more about it than most adults. She misbehaved in reading classes but learned 13 new letters with me one afternoon while our bus was stuck in traffic.

So I wouldn't put much weight on those two things.

I do agree that a kid who is behaving well in school and keeping up probably shouldn't be on meds, because the meds will only help during school hours anyway. But it's still worth getting a diagnosis just so they can understand what is going on with their brain and learn skills like organizing and impulse control in an ADHD-friendly way. Also, a lot of kids with ADHD who do fine in elementary school start to struggle later on when the material gets harder and you can't just catch up on a month of classes in a single weekend. So it's good to be ready for that.

amother

Sun, Oct 24 2021, 5:09 am

amother [ Maroon ] wrote:

Yes, I'm in Israel. But I just saw the pediatrician, not a neurologist. What did you end up doing for your daughter?

I don't want to give her medication anyway. Just more to understand and yes maybe something like OT if they'd give it.

amother

Sun, Oct 24 2021, 5:14 am

amother [ Honeysuckle ] wrote:

I don't think she's focusing that well all day. And her notebooks etc. are a mess. But she's very smart and can cover for things that she missed (doesn't know the times tables because she never did the drills, but calculates it again each time), and she doesn't misbehave. Also, we made Aliyah two years ago and switched her to a new school just last year so being in a new country, new school, new language provided lots of challenge for her! In America she did sometimes cry in class or things like that (lose her cool) but here she is just quiet and seemingly composed. According to the pediatrician, her emotional regulation problems may be CAUSED by the moves... But she was this way in America (not sleeping, lots of tantrums and fighting at home...) and is actually happier here, so I don't think that is the case.

Thanks, I will ask or an ADHD eval. He said if I want he can send us for something called a... moxo test? Can't remember what it's called.

amother

Sun, Oct 24 2021, 5:16 am

amother [ Honeysuckle ] wrote:

Right!!! I don't think the fact that she can read for hours means she doesn't have ADHD... if anything, the opposite! She can read for hours and meanwhile forget to eat breakfast and lunch (and then explode because she's so hungry).

Right I don't want meds for her but for her to learn those organizing and impulse control skills... How do I do that??

imasinger

Sun, Oct 24 2021, 6:40 am

Not every pediatrician is properly aware of the nuances in ADHD or other neurodiverse conditions. If you see an issue, keep detailed notes of what's going on, and consider a second opinion. Also, maybe look to get reports from afternoon teachers instead of morning teachers, if they are different.

As to what you can do besides medication, there is a lot.

- Include regular exercise daily

- Have visual checklists and charts detailing steps, jobs, etc. Make sure home life is well structured.

- Use timers and 5 minute warnings to aid transitions.

- look into diet changes (avoiding food dyes, Feingold diet) and essential oils -- never helped us, but some folks say it changed everything)

- Record in writing anything that precedes meltdowns -- 20-30 minutes prior, 10 minutes prior, 3 minutes prior. Record details of meltdown, and what happened afterwards ("ABC chart"). Look for patterns and possible causes. Does she need a snack the second she walks home? Is the environment too loud for her to focus on homework? Etc.

- Offer praise and positive reward for cooperation.

- Social skills classes to help with things she might have missed due to driftiness

- Make sure sleep schedule is good.

Hope this helps!

amother

IndianRed

Sun, Oct 24 2021, 8:23 am

Aaaaand this is why so many adhd diagnoses get missed in girls. This is why so many girls don't get diagnosed until they have kids of their own and find themselves drowning in managing it all. Find a new doctor, one who understands that adhd manifests differently in boys and girls. Even if she doesn't need meds (and it sounds like for now she doesn't, though that may change as she grows older and responsibilities become greater and more complex) she can get therapies that can help.

FranticFrummie

Sun, Oct 24 2021, 8:32 am

amother [ OP ] wrote:

Wow, you are describing my DD completely. She didn't really "grow out of it." She has emotional regulation problems, and probably BPD. She's on Zoloft now, and she's in therapy to learn coping techniques to help her self soothe so she won't have meltdowns.

Kids can feel very inhibited in school or among friends, but when they are home they know that you love them unconditionally. They feel safe to finally let go of all the frustration they've been holding in all day, and they just explode.

Other kids feel very inhibited at home, especially if they are getting hit or yelled at a lot for the tiniest thing. They may be quiet as a mouse, but when they get to school they can be real terrors. That's why teachers need to know about problems in the home.

B'H, DD is doing exceptionally well these days. She still gets over emotional, but she can be self aware enough to tell herself that it's just over-feeling, and that she knows what to do to take care of herself.

There is no magic pill for that. Zoloft helps, but its just one part of the puzzle. The right type of therapy (CBT is great for this), time, and maturity all play a big part.

Something you might do to help your DD, is to give her a task at home that she enjoys. Folding laundry, setting the table, helping cooking, whatever appeals to her. The thank her for being so helpful, and doing such a great job (even if she folds the towels wrong.) This will build up her self esteem, and make her less likely to fly off the handle.

amother

Stone

Sun, Oct 24 2021, 11:29 am

I didn't read the entire thread, but it seems like an important piece was not discussed. Most people use the general term ADHD, but there is also a disorder called ADD, without the hyperactivity factor. Those with the ADD profile are much harder to detect. They are not disruptive in school and may appear to be listening, but are actually spacing in and out. High interest subjects are easier for them to maintain focus. They can also be very bright and compensate for the material they missed. I have many years of experience working with school age girls and have a Ds with ADD and one with ADHD. Their symptoms were different, yet they are both on the same meds. Please don't disregard the possibility of ADD just because their are no behavior issue in the classroom.

amother

Molasses

Sun, Oct 24 2021, 12:11 pm

Adhd and really all mental health disorders are on a spectrum. Because they are diagnosed based on symptoms and not based on lab work, clinicians had to draw the line somewhere and so they made strict diagnostic criteria. But just because someone doesn’t fit enough diagnostic criteria to meet an official classic diagnosis, that doesn’t mean they aren’t struggling with some of the same issues people with “true” adhd are.
Honestly, this is why I personally believe we need to move away from clinical labels and look a little deeper at what’s going on underneath, biologically.

amother

Peachpuff

Sun, Oct 24 2021, 12:24 pm

What’s the point of a diagnoses? You seem set on getting her one. Why can’t you get her the help she needs without attaching a label? My daughter has executive function issues (I’m sure she has adhd too) No doubt about that. She definitely does not need or qualify for meds. So I got her an executive function coach. What do I need an adhd diagnoses for? To have insurance cover it? Honestly, I’d rather pay for this than label her. There are definitely downsides to labeling. (Yes, there are pros to having one in some cases, but in other cases it actually gets in the way)

amother

Mon, Oct 25 2021, 6:07 am

Thank you everyone!

And thanks for the validation! The pediatrician was sort of mocking me ("I could tell YOU have ADHD from the minute you walked in cuz you can barely control yourself from interrupting me") so it feels good to read that it is indeed common for ADHD to be missed in girls, as I suspected. (I did great in school and only got myself diagnosed recently as an adult and mentioned it to him to explain why I thought it might apply to her too.)

Any suggestions for who I can contact in Israel for expert help, whether that includes a diagnosis or not? I feel like I need some sort of outside expert. I am already working on many of these avenues (for example, I really try hard to get her to bed onetime and in the right state of mind, including magnesium supplements, bath and wind down time, consistent wake ups, room with good lighting and air...) but I feel like professional advice would really help both me and my daughter just to feel like we're on the right track, and to help us fill in the things I'm missing. (And note I have AHDD myself so I'm not THAT good at routines!)

An executive function coach--how do I get one?