If it looks like a duck and quacks like a duck…

It must be a duck, right? Not necessarily so.
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The mention of ADHD, or attention deficit hyperactivity disorder, with regard to my older son first came up when he was in kindergarten.  About halfway through the school year, his teacher mentioned that where she was seeing the other children improving in certain areas and advancing, my son wasn’t.  He wasn’t staying in his seat, he was interrupting and talking out of turn, he was making rocket ships out of his pencils (complete with sound effects), he just wasn’t learning to “fit” the school routine.  So we each filled out questionnaires, and the counselor there determined that he had ADHD tendencies, but it wasn’t enough to where he’d actually be diagnosed with ADHD.

On to first grade.  A new school was built in our area, and we were zoned for it, so my son was in a new school.  Again, his first grade teacher brought up some issues.  Notes came home every day telling me that he was talking, or up out of his seat, or running in the hall, or leaving the classroom without permission.  One day I got a call from the assistant principal – they’d sent him to the office because he’d taken it upon himself to cut his hair during class.  Homework was a battle royal every night, and his attention span to darned near anything was about as long as the life of your average fruit fly.  Finally, when he was in second grade and still having the same issues, still struggling to keep his conduct grades up, still finding school a lot harder than any kid should find it in my book, we began the process of having him formally evaluated.

First we went to the Child Study Center in Fort Worth.  There he had a thorough evaluation, the end result of which was a diagnosis of ADHD combined type, dysgraphia, and fine motor skill delays.  So we started to treat that.  We tried medication.  Vyvanse made him so anxious he didn’t want to leave our house, not even to go someplace five minutes away.  Focalin made him high – literally.  He was himself to the power of ten, and couldn’t stop talking all.day.long.  Intuniv seemed like it might have helped some, but then it just didn’t.  He may as well have eaten a bag of Skittles for all the good it did.  Then we tried the Daytrana patch.  He was awake for 31 hours straight.  Epic fail.  And then there was Strattera.  Not much help with focus and impulsivity and talking out of turn in class, but it did make him rage-y.  We figured the tiny improvement wasn’t worth putting up with the anger and tendency to throw and hit things when life didn’t go his way.   So, we figured we’d better look elsewhere, that perhaps ADHD really wasn’t the issue.

We went for an occupational therapy evaluation at Our Children’s House at Baylor.  Wonderful people to work with, and the evaluation was the first time we’d ever walked away with some concrete ideas on things to try to help.  The OT found that my son had difficulty tracking objects as he moved them from one hand to the other.  As she tested him, he rocked back in his chair, moved his arms and legs a lot, and couldn’t sit still to save his life.  She got out a wobble cushion, also called a sit disc, and the difference was amazing.  Her report said she observed a 75% reduction in his movements while he was sitting on the cushion.  I didn’t quantify it like that, all I knew was that I’d never before seen him sit that still.  He didn’t rock in his chair.  His arms and legs didn’t disturb the space around him.  She suggested we go in for a pediatric sleep study, given his history of sleep issues – she said that a poor sleep pattern can cause a host of behavioral and attention issues.  We’d also said we were considering a visit to a behavioral optometrist, and she said we should pursue that.  She suggested that we get an MP3 player for him and let him listen to instrumental music, that he talks so much likely because he’s seeking the auditory input (and you can’t get that by talking to yourself in your head!).  She also said that it would be good for him to get out and work up a sweat on a regular basis, that regular physical activity can have a cumulative calming effect over time.  So, things to work with.  Yay!  (She has recommended OT services, but that will have to wait until there’s money in the budget for it.)

And we went ahead with the behavioral optometrist evaluation.  My son went in twice for examination and testing.  It was a bit of a lengthy process, and he got grumpy about it.  And he wasn’t particularly keen on having his eyes examined.  But we made it through, and my husband and I went for the results this past Friday.  Turns out my son has 20/20 sight, but has other vision issues – we learned that sight and vision are not the same thing.  He has a hard time going from distance sight to near sight – he can’t refocus quickly or easily.  His eyes don’t work well together – he has a hard time maintaining single vision, especially for close work.  He scored “significantly” below age level in his ability to fix on information and process it while moving his eyes, like you’d do while reading, and in his ability to stay on a visual task.  The optometrist felt like the impact of the vision issues on my son’s academic performance was fairly profound.

So, the recommendations?  Special glasses, to help him focus.  Several sessions of vision therapy in the office and in-home exercises as well.  A consultation with a nutritionist to see if there are any supplements that could be helpful.  There’s a waiting list to get into the therapy program, and it’s going to take us a bit to get the funds together to pay for all of this, so it will be a while before I’m able to blog about any results. I did want to share this, though, I guess to offer hope and a possibility of things to consider to parents whose kids have been diagnosed with ADHD but who don’t seem to respond well to anything that’s “supposed” to help with ADHD.

I’ll be posting more updates and information as I have them.

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