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Decisions, Decisions

Hopefully I will get a post up about Sophia's birthday party at Chuck E. Cheese on Sunday, but for this post, I'm going to focus on all three kids' follow-up appointments with Dr. A. this afternoon at the Naval hospital.

Rob and I both went, so that he could corral the children in the waiting room when they weren't being seen in the exam room, while I talked to the young doc.

Sophia's blood pressure was again higher than Jack and Chloë's today, when taken with the automated cuff. After three bouts of pre-eclampsia, I don't put a whole lot of stock in those machines and much prefer a manual reading, so I was glad when Dr A chose to do one, and it came out much lower.

So let's talk about Sophia first. She's fine, fine, fine. Even the higher BP readings were on the high side of normal, which is still normal, so that's good. Her urine and blood test results were in, and the frequent drinking and peeing seems to be a behavior issue - which is not to say that it's a problem for us, because it's not - rather than a medical one. There is no physiological cause for her excessive thirst and urine output. Everything is normal. So, yay. One less worry.

On to Jack.

The screenings that both his teacher and I filled out on him were both very positive for ADHD. Not surprisingly, he was strongly positive for both of us on the "inattention" side of things, but to my surprise, the teacher also rated him strongly for the "hyperactivity" set of questions, as well. So it would appear that he is a classic case of ADHD, and treatment is advised.

Also, based on my answers, the doctor said he has ODD, or Oppositional Defiant Disorder, which can sometimes masquerade as ADHD. You can read more about that at the link, but here's how I think he matches up with the symptoms listed there:

  • Frequent temper tantrums  - Semi
  • Excessive arguing with adults - Often
  • Often questioning rules - Always
  • Active defiance and refusal to comply with adult requests and rules - Often
  • Deliberate attempts to annoy or upset people - Often (his sisters esp.)
  • Blaming others for his or her mistakes or misbehavior - Constantly
  • Often being touchy or easily annoyed by others - Always
  • Frequent anger and resentment - Often
  • Mean and hateful talking when upset - Usually
  • Spiteful attitude and revenge seeking - Eh, not sure about that one

Basically, he's not a mean, nasty kid, and I'm not worried him being a socio- or psychopath down the road (although he does frequently wet the bed). I've always just dismissed the above things as being Jack's personality, and we've dealt with it as such. It never occurred to me it might be an actual disorder! Behavioral modification therapy was recommended for this, so I'm going to try to get him in at the same place, if not with the same therapist, where Chloë is going for her "Adjustment Disorder." It will be interesting to see if there is any change in his attitude and behavior.

Which is not to say that he's Oscar the Grouch 100% of the time, either. He can be the sweetest, most loving and affectionate kid out of the three of them, but those moods are few and far between. He can be funny and fun, he can laugh and play, and all of that... but the grouchy grumpies are what I see most of the time. I have always thought of him as our most difficult, challenging child. Hopefully with the appropriate therapies, we can help him become a happier little guy.

Back to the ADHD, which often presents along with ODD and has some of the same symptoms... First, I was very relieved when Dr. A. validated my concerns about medicating him, and also agreed that homeschooling and NOT medicating was a viable, valid option. I am about 98% sure I am going to pull him out of public school and homeschool him for the '10-'11 school year. I haven't looked into it much at ALL yet, so I haven't registered this plan with the city/state/planet or done too much research into what resources we'll use.

It just seems to me that if this is not a medically harmful condition, and that if the medication IS potentially harmful (and I think we can all agree that it is, and there are some scary things out there on the interwebs), then we should consider all available options. It also seems to me that if the reason to medicate is so that he can behave properly in a traditional school environment, then perhaps a traditional school environment is not ideal for my son.

Yes, I am aware that at some point he will need to learn to behave appropriately in a traditional environment. But you know what? He is not out of control, and his behavior is not so 'bad' that we are exasperated parents. The problem, at least with inattentiveness, is at school, much more so than at home. If anything, his ability to sit down and focus on getting his homework done has improved over the months, without medication or any other "treatment" than giving him guided, one-on-one attention. And really, his homework consists entirely of doing worksheets. Honestly, I think in this day and age, we have better educational tools than handing out an endless stack of fecking worksheets. I loathe the worksheets! There has got to be a better way. {End rant.}

This is a child who is frequently taken out to restaurants, and I'm not talking about McDonald's. I'm talking fine dining establishments, occasionally where the other diners and servers are surprised to see a child in attendance. We would not and could not do this if his behaviors (ODD, hyperactivity, etc.) were so severe that I was rushing to the pharmacy for an immediate solution.

I am also aware that ADHD can continue into adulthood. (Exhibit one, his father, who is self-diagnosed as having it.) However, maybe with effective psychotherapy in childhood, he can learn coping skills and mechanisms for getting himself focused and on-track. Maybe not; I don't really know. This is all just one big experiment, isn't it?

However, my number one goal as a parent is to meet my children's needs and do what is best for them. So after reading the above, it may surprise you that I agreed to start him on a trial of Adderall. Originally, the plan was to put him on Concerta, but since he can't swallow pills and Concerta can't be broken open, the doc put him on Adderall instead. Dr. A. described it as the "Coke vs. Pepsi of ADHD medication."

Why did I accept this prescription? I am asking myself that after doing more reading on the 'net. However, he still has to get through the rest of the '09-'10 school year (I am not quite ready to just pull him out and start teaching him TODAY; I feel unprepared at best), and apparently the problem is quite severe. Dr. A was NOT trying to convince me to have him take it; he very much left it up to me to decide. (I told him that I would talk it over with my husband, who was outside in the waiting area with the kids, before filling the prescription. However, Rob didn't question my decision at all, as he often doesn't on these types of matters, and I'm not going to address here whether that fact bothers me at all...)

Hours later, I can't even say for sure what it was that made me say, "Okay, give me the prescription." I was exhausted, for one thing, and for another, I forgot my pen and notebook. I always take notes, but this time I didn't. Couldn't. And yes, I cried. Not really, but the tears definitely welled up in my eyes. I want to do what is best for my child. I want to make the right decisions for him. I want to get him all the help he needs.

Thankfully, there is no reason we could not IMMEDIATELY stop the medication if there were adverse side effects, and those are numerous. Dr. A. said there were no withdrawal symptoms from going off rapidly, although it was not a good idea to go off-and-on, on-and-off, but I have no plans to do so. We will start at the lowest possible dose, and I will email Doc in a week or two to let him know how things are going. We are going to plan the trial for a month and then follow up again with Dr. A.

One side effect almost every child gets is loss of appetite. The plan is to give the kids (plural, since Chloë will be going on it, too, but I'll get to that) a huge breakfast, then give the medicine. I can break up the pill and mix it with applesauce - or ice cream, since they need the fat and calories anyway. We'll plan for a small lunch, and then by the time dinner rolls around, the appetite-supression should have worn off. If not, a small dinner followed by a good snack before bed.

If, after being on the smallest dose, we notice that there are no real side effects, and also it's not doing anything for him/them, we will up the dose to the next level. If at the next dose, the same thing, then we'll go up again. If ever we notice adverse effects, we go back down. If ever there are really bad side effects, and/or the medication just isn't effective, we will stop immediately and be done with it.

I'm VERY nervous about this medication. I can't believe I am about to give psychotropic drugs to my 7- and 8-year-old, teeny-tiny children. If you're the praying sort, maybe you can say one for us. If not, please don't tell me about your second cousin's next-door-neighbor's wife's youngest sister who died after taking one dose. I don't need to hear any more stories like that right now!

On to Chloë.

She is borderline positive for ADHD. Nothing on the hyperactivity side, much more positive on the inattention side. She is a bit of a worrier, a bit anxious, which can also masquerade as ADHD, which brought up the subject of her being in therapy. I apologized to Dr. A. for not bringing it up at her check-up last month, but I'd plum forgotten. After discussing what's going on with her (frequent tantrums and emotionality more suitable to a two-year-old being the salient feature), he agreed that it was appropriate, and he would have referred her for psychotherapy himself. He was glad we took that action.

As for the ADHD, after seeing her scores, he discussed her with the neurodevelopment ADHD specialist on the hospital campus, and Strattera was suggested as the drug of choice. It's less effective, but also less... risky, I guess? It's just LESS, all-around, and is not a stimulant like the other meds. However, since she also cannot take pills and Strattera can't be opened, Doc also suggested the low-dose Adderall. Eek.

I don't know what it is, but I feel somewhat less strongly about NOT medicating Chloë than I do for Jack, even though his problem presents as far more severe. Maybe it's because she's been in school longer, and her teachers (including dance teachers) have been complaining about her lack of ability to focus, etc. since kindergarten, I don't know, but I feel less scared and unsure about the ADD diagnosis and medication where she is concerned. The "what should I do?" conversation with the doc was much shorter than it was concerning Jack, that's for sure. I would have preferred the Strattera, but she just can't swallow the pills yet. So. We will try the Adderall for her, too.

Between the two kids with ADHD, the ODD, and the Adjustment Disorder, I am having another attack of the "where did I go wrong" yucky feelings. Reassurance would be a big help.

And also, between that stuff and the fact that now all three kids need glasses (they're all far-sighted to some degree, like their father, although Chloë's is the most severe. She also has a pretty bad astigmatism thang goin' on), I'm more grateful than ever to have good health insurance. Being in the military isn't SO bad, I guess. ;) I just wish it covered 100% of the braces that all 3 kids will likely need, starting soon with Chloë's orthodontia, too!

Time to hit "publish."