ADHD. The disorder, the myth, the legend.
Lil' George's behavior was crashing and burning when he hit kindergarten. "We had trouble keeping George in his seat today." "George hit another student and was touching others throughout the day." "George was disruptive in class, interrupting others and constantly out of his seat." "George bit a girl at lunch today." The steady stream of bad news we received from his kindergarten teacher in his take-home notes would make you think the boy has anger issues, perhaps lack of boundaries or discipline at home. From the outside in, I know I would have questioned the parenting of the child myself.
George by nature is sensitive, talks to everyone (everyone, to a fault), hugs almost everyone, and is by all accounts a sweet boy. This isn't parent bias, it really is how he's regarded. It was the saving grace that gave his teachers patience through the erratic bursts of misbehavior.
For me, as a parent of much stricter, "old school" parents (the kind that made use of belts, spatulas and handmade paddles), it was a devastating conundrum. At this stage, with a 6 and a 5 year old who're starting to assert independence and form personalities, discipline at home is put to the test. When I received bad news, George was punished. I would take away toys, ban TV, give him writing drills and sometimes spank him. I still had this terrible idea in my mind passed down from father to father that spanking was the "ultimate discipline". I'd soon realize the hypocrisy of hitting my child to deter him from hitting other children.
No matter what we did at home, the effects were short term at best. George would promise to do better, a day would go by, and the notes home would continue. I would have gone mad had my older daughter not been doing fine in her class. She'd get an occasional note, we'd levy a punishment, talk it through, and she'd adjust her behavior. By contrast, it was magical.
When you know there's a problem
About 2 months into kindergarten, after receiving another note for disrupting class, as we started to talk with George, he broke down and started crying over how bad he is and how he didn't deserve any privileges. Nothing stops you in your tracks like seeing a 5 year old boy in tears, beating himself up for being a "bad person".
Immediately, I found and scheduled time with a child psychologist. At first, he walked us through the fundamentals of measured discipline and calm delivery. It was helpful, though it was mostly reinforcing a lot of what we were already doing at home (just with less yelling – I'm a yeller). We attended weekly sessions for about 5 months, until finally the psychologist basically said, "there's nothing more we can do here. Your next steps are diet and nutrition, and medication."
Medication. I was anxiously waiting for that shoe to drop.
At that time I was no stranger to the idea of ADHD. Anyone old enough to hear news stories in the 90's is familiar with the term and it's ADD predecessor, and likely familiar with the same "wow, being a child is now a disorder" cynical response – with good reason. Ritalin flourished in the 90's, like Seattle grunge and slap bracelets. I never thought much of it, until my nephew Michael was diagnosed with ADHD at three years old, and my mom sent me a copy of a book on the subject to help show support.
A Rose by any other name…
In all of our sessions, the psychologist never fully diagnosed George with ADHD, and perhaps there's a clinical or technical reason for it. It didn't matter to me, I'd already been reading up on the disorder, trying to reconcile where my son was at and what could help. If you read through enough books and sites on ADHD, it's characterized at best as a wide-spectrum of behavioral patterns to varying degrees that generally subside in teen years, and at worst it's considered a myth to shill daily pharmaceuticals.
I didn't care if George's behavior – his nature – had a name from the DSM or a guy down the street. ADHD by nature is a _disorder_, and while I certainly won't argue it's not real, to me the disorder just means it's poorly understood (to prove this point, search for books on ADHD, and you'll find a deluge of all sorts ranging from self-help, to parenting books, to conspiracy books). Instead, my wife and I were looking for effective ways to help our son sit in class quietly, respect the boundaries of others, stay on task, and respond to us when we called his name. So, we took the next step and went to our pediatrician to talk about medication. If that could help George through his early years, we could ween him off an get him adjusted for adolescence.
When you start on the road of medication through a pediatrician, your kid's brain effectively becomes a testing ground. The doc starts with a low dose of something general, sees how it goes, and adjusts. We were really hesitant about the idea – first my wife who had balked at the notion months before, and later myself, as I still struggle with the wisdom of using short term drugs to address something my son will need to adjust for his entire life. I don't recall what he started on – my wife picked up the prescription. What I do recall is George jumping wildly from one emotion to the next, crying occasionally to talk about common things. We hit a road bump, time to change course.
We eventually landed on a stimulant called Quillivant (in no way should you regard this as a promotion). He was wrapping up kindergarten at the time, so we skipped the medication for the summer and started back up in the fall for first grade. His first month was superb, and his teacher even nominated him for a monthly award, understanding his nature and the accomplishment it was to focus in the classroom. Success, right? Buy 4 more crates of this stuff and let's call the case closed, right?
Next month we went right back to the notes. Notes earned "write-outs" (he despised the tedious task of writing sentences repeatedly). Write-outs provoked him to balk at work, which earned more notes. You really couldn't connect every action with a cause, only to say we were right back in the same space as kindergarten. He had fortunately stopped hitting others mostly, but there were some classic notes.
"In gym class, George was running around with his shirt pulled over his head and one shoe in his mouth."
OK, that one made me laugh. I mean, you gotta admit, that takes some effort.
We'd meet with the school – which in all of this had been awesome – and would try to tell them everything we were doing on our end to keep George on the straight and narrow. Then we'd analyze the last few weeks, and Anna would say the medication is working, while I never saw the direct correlation. We kept him on to stay safe, and in time, he'd find a balance of good days and not so good days. With a lot of patience from his teacher and a lot of communication with her on strategies and the latest from both fronts, he was OK in the first grade.
A synopsis from year 3
Lil' George is now in the second grade, completing his second wkidseek of class. He's riding the bus, but in the front seat. He's had some issues in class, but we addressed them and he's responding. He's still on Quillivant, but at best it's giving him a dose of focus that lasts until lunchtime. He's pretty damn smart, so fortunately through all of this his grades and schoolwork were never really a problem (yet again fitting the typical bill sold as an ADHD child – "smart but scattered").
Does George have ADHD? I don't know, but he's certainly on the spectrum. I've met parents that say their children have ADHD, and in some cases their child's behavior never measured up. Or so it seemed – surely others could say that of my own for a 10 minute window. I will tell you George can read a book for hours, but the moment you put him in a room with distractions and tell him to sit down, he's inevitably in trouble. We tried Gymnastics yesterday, and he literally ran around the whole gym and took a dive in to the foam pit. I was mad, but the kid in me knew that was exactly what I'd want to do in his shoes. So no more Gymnastics. We'll stick to rock climbing class and the park for now.
Does the medicine help? Again, no clear answers. My wife thinks so, I have my doubts. Some will tell you – and I can vouch there's truth to it – that stimulants are temporary and tend to prompt exaggerated behavior when they wear off. For now, we've seen no side effects, which is typically loss of appetite. He'll polish off 3 slices of pizza if the mood is right. We may try other formulas or medications, but again my hope is he'll get mature enough to where he responds well enough to discipline and our expectations. For now we're hoping the medication is just the one small thing that tips the balance and helps him make the right decision.
What I can say has worked for us and getting George to focus and stay on task:
- Occasional forcing eye contact and making sure we speak directly to him when giving instructions
- Getting him outdoors and expending that energy whenever we can, because ADHD or not, it can only help
- Coming up with consequences that work, which seem to change as they get older. Right now, his consequence is doing "laps" in our driveway, running from one end to the other for 20-30 times. I get no… OK, I get little pleasure from punishing George like this, but it's kind of a sneaky way give him some exercise and using up his energy while I'm holding him accountable for his actions.
- Encouragement. I'm probably the "heavy" of his two parents, but I know he's hearing negatives a lot and reminded of boundaries constantly. I just make sure he knows none of this reflects on his character or makes him "bad".
And the most obvious one…
- Patience. This one is tough for me, but if you take anything from the materials on ADHD, you'll know more than half of boys grow out of these issues in time, and anecdotally you'll find many parents see their kids getting better toward high school (though still with some struggles along the way).
In the end, my son is a brilliant little fire cracker. He's definitely a little weird, it doesn't help he's on the young end of his class, and he constantly finds new ways to do things that drive me nuts. But ADHD or not, he's just his own personality, and as with every other kid, is a unique set of parenting challenges to keeping him on the right path. I have no doubt, regardless of notes from teachers, he has a pretty good shot at being a happy adult.