So my school has all day preschool, and some of these kid are BARELY 4 years old. A parent came to me yesterday upset because the teacher told her she needed to take her son (turned four barely a month ago) to the doctor because he can't stay on task, sit still,or follow directions in class. WHAT??
I thought pre-school was about getting them ready for school, and teaching them these skills? I think it's absolutely ABSURD to jump to medication for a PK4 child in the second week of school.
The mom said she didn't want to drug her son, I assured her I would help her advocate for her son. I was just completely caught off guard. Is it normal for them to jump so quickly to eval/drugs?
Tell them the teacher was inappropriate. They need to know others recognize that, because accurate or not, it WAS inappropriate.
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Ixchel, I loved and your story and have seen similar versions so often. Something I always try to convey is that we are in no way trying to squelch the wonderful creative, bright child you know and love. The social difficulties and safety issues are so often overlooked when deciding that ADHD is something a child can live with rather than treat with a medication. It sounds like you found the right combination for your child to be safe, successful and happy.
I would however disagree about saying another professional was inappropriate to a parent especially if OP wasn't witness to the conversation, and I'm guessing if they were it would have been addressed at that time. I'm picturing something along these lines
Teacher: "it might be helpful to get an evaluation based on the concerns we have been discussing"
Parent: "Are you saying my child has ADHD?"
Teacher: "I'm not sure but there are some read flags so I would recommend having him seen"
Parent: "And what then? Medicate him? He's only 4yo, he is talented, he is energetic, he is an active boy!"
Later:
Parent to RN: "That teacher told me my child has ADHD and that I need to medicate him".
My suggestion definitely talk to the teacher to clarify but I'd hold off judgement and even if the teacher was inappropriate it sounds like OP did a fine job of supporting and offering assistance to the parents without causing a deeper rift in the parent teacher relationship.
Jules, I hadn't thought that one through. I agree with you completely.
Now let a social worker or teacher come to me with a particular name of a medication they think a kiddo needs and watch my hackles raise. I had one therapist who would leave sticky notes in the chart with things like "Can we try some Adderall for Mr. XYZ's adult onset ADHD?" Note that these patients were almost always court ordered sexoffenders with addictions issues who were unemployed. Thankfully it was sticky notes that I could file in the trash and ignore rather than her actually attempting to discuss this with me and causing my early CVA as I attempted to remain even remotely professional. :)
I really try to remember and truly believe that most people have the best of intentions. At least thats what I tell myself so I don't go around slapping all the nitwits who irritate me on a daily basis, lol.
One of the big concerns that we can discuss with parents is that in my understanding research seems to support that appropriate stimulant treatment as a child does not increase a patient's risk for substance abuse later in life. From what I have read I believe their rate of SUD is comparable to the general population. Here's an oldie but goody:
Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature.
Timothy E. Wilens, Stephen V. Faraone, Joseph Biederman and Samantha Gunawardene
Lifelearningrn, please consider all I am about to say with an open mind, as I am a parent-turned-nurse who has walked down the ADHD path. I have a brilliant boy. He's gifted in so many ways. His teachers have recognized this as well, so that's not just mama bias. As a baby, he was energetically curious about everything, struggled to sleep, and constantly explored. I struggled to take him places because this exploration need he had was borderline scary and dangerous at times. Taking him to a grocery store meant not leaving him in the cart's seat because he might fall out. He was, frankly, wild. We did finger foods on the run, because he couldn't sit to eat. He was terribly skinny, with circles under his eyes. But, he met his milestones (MONTHS early), slept soundly when he did sleep, and was a happy baby.It wasn't until baby #2 was born, and I discovered "play dates" that I realized my boy was different. I'd never been around babies before, so I really didn't know. Babies weren't supposed to be that hard. And, what was most helpful to me was realizing it wasn't my failings as a parent, it was that my baby was simply different. Wild. Smart. Fun. And we could arrange our house and lives around him.I was a crunchy all natural mama who was anti-vax and anti-med. I started my journey to BSN when my kids started their first year of pre-k. Every day, his teacher had struggles with him, and would pull me aside to talk. The teachers at that school were very careful to stay within their boundaries. Not one of them threw around acronyms like ADHD. They all made accommodations to help him, which I was thankful for. We tried so many things, too, but he still struggled. He would be impulsive, hyperactive, and invasive of the spaces of kids around him. Even still, I knew nothing about ADHD, and my boy was still in my mind, simply energetic. Exuberant. Toward his last months at that school, I could tell his teacher was so worn out. I knew it was him. I knew she would never tell me that. I knew she tried everything. I knew something more was happening. I started to feel the weight of responsibility.The following year we were at a new school. It was time for kindergarten. We had a teacher whose boundaries weren't as good. She had no problem telling me that he needed to get evaluated for ADHD. She suggested coffee, tea, but never medication. We developed a system of communication so that she could relay to me his behavior without needing a daily conference with me. I was glad for that. I was tired of her judgments and advice. The nagging wore me down. It offended me. The balance between my personal responsibility and her professional responsibility became blurred. I knew it was spite that caused it. Shouldn't she know how to handle a wild child in her classroom? Academically, he had no struggles. He was brilliant. I decided she wasn't holding his attention. He already knew so much of what they were doing. He started kindergarten already knowing how to read and understanding basic math and science concepts. He was bored. That's all.He started upsetting his friends. Teacher notes coming home started reflecting social consequences more and more. I realized.... This is a problem. This is a really big problem. I had my first conversation with my pediatrician about it. He urged me to start learning about ADHD. He knew. He just knew I wasn't going to be a parent he could say, "your son has ADHD", to without me rejecting the idea outright. I had to come to this conclusion on my own.At the end of kindergarten, we did behavioral questionnaires. I left out that this was the second time we were doing them. The first time, he was younger than the questionnaires usually looked at, so I was told outright, his "borderline" results may be inaccurate because my 4 year old was younger than the questionnaire was designed for. I was also told that due to his results, he most definitely was on his way to an ADHD diagnosis. At that time, the DSM-IV was not supportive of an ADHD diagnosis at that age.But now, he was just about 6. We went to a new person. I was in the worst denial. This new person used more than questionnaires. This new person got to know my boy. And after all that, she agreed with what everyone was saying all along. He had ADHD. This time I was READY to hear it.By this point, I was starting nursing school. I had access to academic journals. I researched. OMG I did so much research. I also decided to make my nursing elective an independent study on pediatric behavioral disorders, and best practice for treatment. Heck - if I was going to put in that much effort, I might as well get credit for it! Research at this time pretty significantly points to medications being first line treatment. ADHD is an imbalance of neurotransmitters just like depression or bipolar. Stimulant medications assist in correction of that imbalance. I also learned that symptoms tend to get worse until 9-11 years old, and for some children, they do "grow out of it". For others, they continue into adulthood.My point in sharing all of this is this..... When his kindergarten teacher started pushing for me to use caffeine, I was furious. When she relentlessly badgered me about getting him checked out for ADHD, she made me reject the diagnosis more, out of spite, but I never would have admitted that. But..... She was right. And I needed her to keep pushing me. She's been teaching for nearly 40 years, and as far as childhood behavior goes, she really is an expert. No, she can't diagnose or recommend treatment. She violated boundaries terribly and was completely out of line. She could have gotten in a lot of trouble for it. But she was right.This family has every right to be upset. Between us professionals here, I doubt this teacher would have stuck her neck out like that unless she felt strongly that this child needed advocating for. I'm sure she understands the consequences of what she said. Also remember you are hearing what the teacher said from the point of view of an upset family. It may very well be that the medication part of the conversation was just a tiny blip in a much longer conversation about behavior issues. The family may have heard the word "medication" and zeroed in on it because the idea of medicating children is truly offensive to mainstream society.Approaching this family, I would be gentle and supportive. Let them know you are available to answer questions and point to resources if they need them. Tell them the teacher was inappropriate. They need to know others recognize that, because accurate or not, it WAS inappropriate. If you do not know the latest research on ADHD and other neurobiological behavioral disorders, I encourage you to learn more. A good review of uptodate and the DSM-V might be helpful so that you're prepared to answer their questions when they are feeling ready to talk.I'll be giving them hugs in my heart. This journey sucks. Once you find adequate treatment, though, a massive door opens to the child. They'll be more socially appropriate to peers, they'll be able to do well in school, and they'll have the ability to maintain control of their body and mind. Imagine constantly being out of control, unable to keep your thoughts still and your body from moving all the time. Some days it literally is painful. Anyway, I hope my story is helpful, and you can get in touch with me anytime you need help/resources.
I have been afraid this might be my son. He will be turning 6 in January and his ability to not sit still, always stimulated and no personal space boundaries has been worrying me. We let him start first grade this year and I am worried sick already since his new teacher has already requested a meeting with us. Sigh. Being that we are now in Canada their system is different from the US and everything happens at a snails pace especially when it comes to specialist appointments. I would rather know if something is wrong, get the appropriate treatment and make sure he is doing well than guessing as to what might be wrong. It doesn't help that his dad, Kindergarten teacher last year don't think he needs an evaluation. We have gone through a lot with my sweet boy. First it was not being able to speak till he was three due to all the ear infections and it wasn't until I changed Drs he got his tubes placed and after some extensive speech therapy he caught up with his peers and doing well. As a mom, I am always scared of just how far I am willing to go in regards to him being medicated. Thanks for sharing your story. Will see how our meeting with the teacher goes and we will go from there.
I have been afraid this might be my son. He will be turning 6 in January and his ability to not sit still, always stimulated and no personal space boundaries has been worrying me. We let him start first grade this year and I am worried sick already since his new teacher has already requested a meeting with us. Sigh. Being that we are now in Canada their system is different from the US and everything happens at a snails pace especially when it comes to specialist appointments. I would rather know if something is wrong, get the appropriate treatment and make sure he is doing well than guessing as to what might be wrong. It doesn't help that his dad, Kindergarten teacher last year don't think he needs an evaluation. We have gone through a lot with my sweet boy. First it was not being able to speak till he was three due to all the ear infections and it wasn't until I changed Drs he got his tubes placed and after some extensive speech therapy he caught up with his peers and doing well. As a mom, I am always scared of just how far I am willing to go in regards to him being medicated. Thanks for sharing your story. Will see how our meeting with the teacher goes and we will go from there.
(((Hugs))) You are doing great by that little guy! Good luck in your meeting with the teacher, and feel free to pm anytime. :)
One of the big concerns that we can discuss with parents is that in my understanding research seems to support that appropriate stimulant treatment as a child does not increase a patient's risk for substance abuse later in life. From what I have read I believe their rate of SUD is comparable to the general population. Here's an oldie but goody:
Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature.
Timothy E. Wilens, Stephen V. Faraone, Joseph Biederman and Samantha Gunawardene
Pediatrics 2003;111;179-185 Pediatrics
DOI: 10.1542/peds.111.1.179
When I first saw that research was pointing this direction, it made me feel so much better. Further research pointed toward why. ADHD children who aren't treated spend their childhood, from infancy through adolescence, being rejected for the behaviors they can't control. They develop depression, anxiety, and sometimes conduct disorder or oppositional defiant disorder from the ongoing and potentially constant feeling of rejection. Their inability to do well at school and socially leads to poor social interactions and higher drop out rates. The rate of "self medication" in those who have mood disorders is huge. Dropping out of school is obviously going to lead to lower socioeconomic status. These higher risk circumstances create the platform for SUDs in adults with ADHD. Divorce rates are higher, incomes are lower, incarceration rates are higher.... NOT seeking adequate treatment has potentially worse outcomes than using stimulant medications. I am so, so thankful for this research as it comes out, and I hope hope hope that it becomes more embraced soon.
Specializes in orthopedic/trauma, Informatics, diabetes.
That is my son. I am a teacher-turned nurse. I have seen kids medicated that were not ADHD/ADD that were miserable and kids that were not medicated and needed it and were miserable. My son is a poster child for medication. He doesn't even like himself off the medication. He had issues before he was 2. He was diagnosed as a T1 diabetic just after turning 2. He has sensory issues. We took him to sensory integration therapy, OT, psychiatrist, psychologist, had him tested privately and at the school. Due to his diabetes, they were reluctant to give him a stimulant (food/appetite issues) but finally, around 6 he started on a stimulant. It took a few tries, but he is doing fabulous on long-acting ritalin. He is 11 now. Made the honor roll for the entire year. I am so proud of him.
If a teacher "suggests" discussing behavior with your pediatrician, don't assume that it is for medication, it can be to rule out issues. Teachers usually know kids behaviors and know if something is not right. As a PP said, it is easy to get defensive if someone suggests that there is something is wrong with our children. No one wants that. But when we are ready to "hear" it. we do. And we grieve the loss of having a child that is not "normal" (whatever that is).
I also want to address the untreated. My husband is an untreated (I guess self-treated) ADHD. He consumes huge amounts of caffeine; coffee, coke. He smokes instead of eating. He doesn't sleep well. It is very frustrating to me that he won't discuss it. My older son and I, I believe, are more ADD. We have an interesting household!! I am not medicated, but my oldest is and is thriving as well. I hate that my children have to be medicated, but I would not hold insulin for the diabetic child to avoid a medication, which would kill him. I feel that giving him the ritalin is giving him better quality of life.
I think from this post you might be able to tell that I jump around and am not good at keeping flow in my writing. LOL
ADHD children who aren't treated spend their childhood, from infancy through adolescence, being rejected for the behaviors they can't control. They develop depression, anxiety, and sometimes conduct disorder or oppositional defiant disorder from the ongoing and potentially constant feeling of rejection. Their inability to do well at school and socially leads to poor social interactions and higher drop out rates. The rate of "self medication" in those who have mood disorders is huge.
THIS. THIS. THIS!!!!
My 15 year old got diagnosed with ADHD last year. She was fidgety as a kid, but never had behavior issues and always did well in school. Then when she hit puberty, her ADHD manifested itself as depression + anxiety + auditory/tactile/visual hallucinations. Through multiple psych hospitalizations, suicidal ideations, multiple anti-depressant/anti-anxiety meds, one of her providers said we need a neuropsych eval. This child was also a preemie born at 26 weeks gestation with a grade III IVH- so maybe we missed something that might be causing this? Neuropsych eval said ADHD with processing issues. We are on a good medication regimen now, and her mental health is so much better (hospital-free x 1 year- WOOT!). We stopped therapy after 2 + years this past spring.
She still has some processing issues. We have a 504 and IEP in place for her, which was quite the challenge because she is a straight-A honors student. Try convincing the financially strapped special ed department that she needs those services... luckily I had a really great guidance counselor and case manager on my side and she qualified for both.
So my point in sharing my story is my daughter went through HELL because her brain was so overstimulated by the time she reached puberty that she ended up in a major depressive/anxiety state. And her anxiety manifested itself auditory/visual/ and tactile hallucination- 3 distinct people who beat on her, told her she was useless, and repeatedly told her to kill herself, which she tried to do multiple times (not anywhere near dying, but the intent was there).
Consider getting treatment/meds for ADHD sooner rather than later if there is at all a chance that you can stop your child from going through what my kid has gone through.
My nephew is severely ADHD. I knew it when he was three. His parents were in denial until he couldn't cope with school. He has some self esteem issues now because he thinks he's a bad kid.
The earlier the intervention, the less long-term psychological damage in the child.
Sounds like the Pre-K teacher is just looking out for the kid.
Besides, if the child was acting normally for their age, the teacher wouldn't have brought anything up. These teachers KNOW the normal for their age groups.
I know it's a knee-jerk defensive reaction to think the best of your friend's child, but try to help the parents keep an open mind.
When I first saw that research was pointing this direction, it made me feel so much better. Further research pointed toward why. ADHD children who aren't treated spend their childhood, from infancy through adolescence, being rejected for the behaviors they can't control. They develop depression, anxiety, and sometimes conduct disorder or oppositional defiant disorder from the ongoing and potentially constant feeling of rejection. Their inability to do well at school and socially leads to poor social interactions and higher drop out rates. The rate of "self medication" in those who have mood disorders is huge. Dropping out of school is obviously going to lead to lower socioeconomic status. These higher risk circumstances create the platform for SUDs in adults with ADHD. Divorce rates are higher, incomes are lower, incarceration rates are higher.... NOT seeking adequate treatment has potentially worse outcomes than using stimulant medications. I am so, so thankful for this research as it comes out, and I hope hope hope that it becomes more embraced soon.
Yeah, me and my two brothers weren't treated and only one of us was diagnosed as a child. We're all pretty socially unacceptable. I'm a hermit and they're jerks.
My one brother is in and out of jail, in and out of jobs, in and out of addiction. My other brother can't keep a relationship and is, well, a flaming a-hole. All of us have problems with self-esteem, anxiety, and depression.
You can't pound a square peg in a round hole without breaking it, but you can round off the corners if you're careful.
Anyway, I hope my story is helpful, and you can get in touch with me anytime you need help/resources.
Jules A, MSN
8,864 Posts
Ixchel, I loved and your story and have seen similar versions so often. Something I always try to convey is that we are in no way trying to squelch the wonderful creative, bright child you know and love. The social difficulties and safety issues are so often overlooked when deciding that ADHD is something a child can live with rather than treat with a medication. It sounds like you found the right combination for your child to be safe, successful and happy.
I would however disagree about saying another professional was inappropriate to a parent especially if OP wasn't witness to the conversation, and I'm guessing if they were it would have been addressed at that time. I'm picturing something along these lines
Teacher: "it might be helpful to get an evaluation based on the concerns we have been discussing"
Parent: "Are you saying my child has ADHD?"
Teacher: "I'm not sure but there are some read flags so I would recommend having him seen"
Parent: "And what then? Medicate him? He's only 4yo, he is talented, he is energetic, he is an active boy!"
Later:
Parent to RN: "That teacher told me my child has ADHD and that I need to medicate him".
My suggestion definitely talk to the teacher to clarify but I'd hold off judgement and even if the teacher was inappropriate it sounds like OP did a fine job of supporting and offering assistance to the parents without causing a deeper rift in the parent teacher relationship.
Great thread!